Schawkat Khoschy, Kühn Wolfgang, Inderbitzin Daniel, Gloor Beat, Heverhagen Johannes T, Runge Val Murray, Christe Andreas
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Bern, Switzerland.
Department of Visceral and Transplantion Surgery, Inselspital, University Hospital Bern, Bern, Switzerland.
PLoS One. 2016 Nov 28;11(11):e0166003. doi: 10.1371/journal.pone.0166003. eCollection 2016.
The aim of this retrospective study was to evaluate the diagnostic value and measure interreader agreement of the pancreaticolienal gap (PLG) in the assessment of imaging features of pancreatic carcinoma (PC) on contrast-enhanced multi-detector computed tomography (CE-MDCT).
CE-MDCT studies in the portal venous phase were retrospectively reviewed for 66 patients with PC. The age- and gender-matched control group comprised 103 healthy individuals. Three radiologists with different levels of experience independently measured the PLG (the minimum distance of the pancreatic tail to the nearest border of the spleen) in the axial plane. The interreader agreement of the PLG and the receiver operating characteristic (ROC) curve was used to calculate the accuracy of the technique.
While the control group (n = 103) showed a median PLG of 3 mm (Range: 0 - 39mm) the PC patients had a significantly larger PLG of 15mm (Range: 0 - 53mm)(p < 0.0001). A ROC curve demonstrated a cutoff-value of >12 mm for PC, with a sensitivity of 58.2% (95% CI = 45.5-70.1), specificity of 84.0% (95% CI = 75.6-90.4) and an area under the ROC curve of 0.714 (95% CI = 0.641 to 0.780). The mean interreader agreement showed correlation coefficient r of 0.9159. The extent of the PLG did not correlate with tumor stage but did correlate with pancreatic density (fatty involution) and age, the density decreased by 4.1 HU and the PLG increased by 0.8 mm within every 10 y.
The significant interreader agreement supports the use of the PLG as a characterizing feature of pancreatic cancer independent of the tumor stage on an axial plane. The increase in the PLG with age may represent physiological atrophy of the pancreatic tail.
本回顾性研究旨在评估胰脾间隙（PLG）在多排螺旋CT增强扫描（CE-MDCT）评估胰腺癌（PC）影像特征中的诊断价值，并测量不同阅片者之间的一致性。
回顾性分析66例胰腺癌患者门静脉期的CE-MDCT图像。年龄和性别匹配的对照组由103名健康个体组成。三位经验水平不同的放射科医生在轴位平面上独立测量PLG（胰尾到脾脏最近边界的最短距离）。采用不同阅片者之间的一致性以及受试者工作特征（ROC）曲线来计算该技术的准确性。
对照组（n = 103）的PLG中位数为3mm（范围：0 - 39mm），而胰腺癌患者的PLG明显更大，为15mm（范围：0 - 53mm）（p < 0.0001）。ROC曲线显示胰腺癌的截断值>12mm，敏感性为58.2%（95%CI = 45.5 - 70.1），特异性为84.0%（95%CI = 75.6 - 90.4），ROC曲线下面积为0.714（95%CI = 0.641至0.780）。不同阅片者之间的平均一致性显示相关系数r为0.9159。PLG的大小与肿瘤分期无关，但与胰腺密度（脂肪浸润）和年龄相关，每10年密度降低4.1HU，PLG增加0.8mm。
不同阅片者之间的高度一致性支持将PLG作为轴位平面上独立于肿瘤分期的胰腺癌特征性表现。PLG随年龄增加可能代表胰尾的生理性萎缩。
