Zamboni Giulia A, Ambrosetti Maria Chiara, Zivelonghi Caterina, Lombardo Fabio, Butturini Giovanni, Cingarlini Sara, Capelli Paola, Pozzi Mucelli Roberto
Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, Verona, Italy.
Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, Verona, Italy.
HPB (Oxford). 2017 Nov;19(11):986-991. doi: 10.1016/j.hpb.2017.06.013. Epub 2017 Aug 4.
Since prognosis and treatment of pancreatic endocrine tumors (pNET) are based on tumor grade, contrast-enhanced multidetector computed tomography (MDCT) features of solid non-functioning pNETs were studied and correlated with pathology tumor grading.
MDCTs of diagnosed pNETs were reviewed retrospectively. Each tumor was analyzed for location, size, homogeneity, margins, arterial and venous phase enhancement, main pancreatic duct diameter, calcifications, vascular invasion, lymph-nodes enlargement, and liver metastases.
Of 154 pNETs presenting between January 2000 and May 2016 with available histology from resected specimen or biopsy, there were 65 G1, 72 G2 and 17 G3 pNETs. Tumor diameter varied significantly between the three groups. Tumors >20 mm were more frequently malignant and non-homogeneous than smaller tumors. G1 tumors were more commonly hypervascular and G3 tumors more often non-hypervascular in the arterial phase. Arterial phase non-hyperdensity and tumor non-homogeneity had a higher rate of metastatic lesions. Vascular invasion correlated with presence of metastases and histological grade. G3 tumors were all >20 mm (p = 0.007), more often non-hypervascular in the arterial phase (p = 0.0025), and non-hyperdense in the venous phase (p = 0.009), and showed more often vascular invasion (p = 0.0198).
CT correlated with tumor grade; differentiating low-grade and high-grade pNETs through routine CT imaging might improve patient management.
由于胰腺内分泌肿瘤（pNET）的预后和治疗基于肿瘤分级，因此对实性无功能pNET的多排螺旋CT（MDCT）增强特征进行了研究，并与病理肿瘤分级进行关联。
对已确诊pNET的MDCT进行回顾性分析。分析每个肿瘤的位置、大小、均匀性、边界、动脉期和静脉期强化、主胰管直径、钙化、血管侵犯、淋巴结肿大及肝转移情况。
在2000年1月至2016年5月间出现的154例pNET中，有来自切除标本或活检的可用组织学检查结果，其中G1级pNET 65例，G2级72例，G3级17例。三组间肿瘤直径差异显著。直径>20 mm的肿瘤比小肿瘤更易为恶性且不均匀。G1级肿瘤在动脉期更常见为富血供，G3级肿瘤则更常为非富血供。动脉期非高密度及肿瘤不均匀性的转移病变发生率更高。血管侵犯与转移及组织学分级相关。G3级肿瘤均>20 mm（p = 0.007），在动脉期更常为非富血供（p = 0.0025），在静脉期为非高密度（p = 0.009），且更常出现血管侵犯（p = 0.0198）。
CT与肿瘤分级相关；通过常规CT成像区分低级别和高级别pNET可能改善患者管理。
