磁共振成像下的胰腺神经内分泌肿瘤：3级与1/2级肿瘤的比较
Pancreatic neuroendocrine neoplasms at magnetic resonance imaging: comparison between grade 3 and grade 1/2 tumors.
作者信息
Guo Chuangen, Chen Xiao, Xiao Wenbo, Wang Qidong, Sun Ke, Wang Zhongqiu
机构信息
Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou.
Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing.
出版信息
Onco Targets Ther. 2017 Mar 7;10:1465-1474. doi: 10.2147/OTT.S127803. eCollection 2017.
BACKGROUND
The grading of pancreatic neuroendocrine neoplasms (PanNENs) is associated with the choice of treatment strategy. The aim of this study is to identify the magnetic resonance imaging (MRI) features in differentiating pancreatic neuroendocrine tumors (PanNETs) grade 1/2 (G1/G2) and pancreatic neuroendocrine carcinoma grade 3 (PanNEC G3).
PATIENTS AND METHODS
A total of 59 patients with histologically proven PanNENs and who underwent pretreatment MRI were retrospectively analyzed. Tumor location, size, boundary, cystic or solid appearance, enhancement degree, pancreatic duct dilatation, metastases and MRI signal were evaluated. Apparent diffusion coefficients (ADCs) were measured on ADC maps. Receiver operating characteristic curve was used to determine the cut off values and the sensitivity and specificity of prediction. Spearman correlation and logistic regression analysis were adopted to identify the association between MRI features and pathological parameters.
RESULTS
A total of 47 lesions were PanNETs G1/G2 and 12 lesions were PanNEC G3. G1/G2 tumors were more common with well-circumscribed border compared with PanNEC G3. Ill- defined boundary, big size, necrosis, low-moderate enhancement, pancreatic duct dilatation, metastases and high diffusion-weighted imaging (DWI) intensity were more common in PanNEC G3 than in PanNETs G1/G2. The ADC values of PanNEC G3 were also significantly lower compared with the PanNETs G1/G2 and normal pancreatic parenchyma. The cut off value of ADC was 0.95×10 mm/s for differentiating PanNEC G3 from PanNETs G1/G2 with 72.3% sensitivity and 91.6% specificity, respectively. Ki-67 index and mitosis count positively correlated with tumor size, pancreatic duct dilatation and metastases (<0.05) and negatively correlated with ADC values (<0.01), respectively. Regression analysis further showed that metastases and ADC value were associated with PanNENs grade.
CONCLUSION
Metastases and ADC value may have potential for differentiating PanNEC G3 from PanNETs G1/G2.
背景
胰腺神经内分泌肿瘤（PanNENs）的分级与治疗策略的选择相关。本研究的目的是确定在鉴别1/2级胰腺神经内分泌肿瘤（PanNETs G1/G2）和3级胰腺神经内分泌癌（PanNEC G3）时的磁共振成像（MRI）特征。
患者与方法
回顾性分析了59例经组织学证实为PanNENs且术前行MRI检查的患者。评估肿瘤的位置、大小、边界、囊实性表现、强化程度、胰管扩张、转移情况及MRI信号。在ADC图上测量表观扩散系数（ADC）值。采用受试者操作特征曲线确定截断值以及预测的敏感性和特异性。采用Spearman相关性分析和逻辑回归分析来确定MRI特征与病理参数之间的关联。
结果
共有47个病灶为PanNETs G1/G2，12个病灶为PanNEC G3。与PanNEC G3相比，G1/G2肿瘤边界清晰更为常见。边界不清、体积大、坏死、低-中度强化、胰管扩张、转移及扩散加权成像（DWI）高信号在PanNEC G3中比在PanNETs G1/G2中更为常见。PanNEC G3的ADC值也显著低于PanNETs G1/G2及正常胰腺实质。ADC的截断值为0.95×10⁻³mm²/s，用于鉴别PanNEC G3与PanNETs G1/G2时，敏感性和特异性分别为72.3%和91.6%。Ki-67指数和有丝分裂计数分别与肿瘤大小、胰管扩张及转移呈正相关（P<0.05），与ADC值呈负相关（P<0.01）。回归分析进一步表明转移和ADC值与PanNENs分级相关。
结论
转移和ADC值可能有助于鉴别PanNEC G3与PanNETs G1/G2。
Zotero 插件