Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan.
Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan.
Abdom Radiol (NY). 2018 Dec;43(12):3374-3380. doi: 10.1007/s00261-018-1645-6.
To reveal the prevalence of small (≤ 20 mm) pancreatic ductal carcinomas with enhanced rims on triple-phase contrast-enhanced CT and correlate the CT images with the pathologic findings.
Between April 2005 and April 2016, 45 patients underwent preoperative triple-phase contrast-enhanced CT and were pathologically diagnosed with small pancreatic ductal carcinoma. CT images were independently reviewed by two radiologists. The attenuation values of the enhanced rims, internal areas of the tumors, and surrounding pancreatic parenchyma were compared using Mann-Whitney U test. These areas were also correlated with the pathologic findings. Tumor invasiveness was compared between the tumors with and without enhanced rims using Fisher's exact test.
Enhanced rims were identified in 18 tumors (40%) by consensus between the two reviewers. The enhanced rims showed significantly higher mean attenuation values compared with the internal areas of the tumors (p < 0.001) and surrounding pancreatic parenchyma (p < 0.0086), and were most clearly visualized on equilibrium phase. The enhanced rims pathologically reflected the abundant fibrotic stroma with cancer cells in all tumors. There was no statistically significant difference in tumor invasiveness between the tumors with and without enhanced rims (anterior peripancreatic invasion, p = 0.137; posterior peripancreatic invasion, p = 0.758; portal vein invasion, p = 0.639; and lymph node metastases, p = 0.359).
Enhanced rims were detected at a rate of 40% in small pancreatic ductal carcinomas and could be an important finding for diagnosis on CT images, but did not suggest a less aggressive nature.
揭示在三期增强 CT 上具有增强边缘的小（≤20mm）胰腺导管腺癌的患病率，并将 CT 图像与病理发现相关联。
在 2005 年 4 月至 2016 年 4 月期间，45 名患者接受了术前三期增强 CT 检查，并经病理诊断为小胰腺导管腺癌。由两位放射科医生独立对 CT 图像进行了回顾性分析。采用 Mann-Whitney U 检验比较增强边缘、肿瘤内部区域和周围胰腺实质的衰减值。这些区域也与病理发现相关联。采用 Fisher 确切检验比较有增强边缘和无增强边缘的肿瘤的侵袭性。
两位阅片者达成共识，在 18 个肿瘤（40%）中发现了增强边缘。增强边缘的平均衰减值明显高于肿瘤内部区域（p<0.001）和周围胰腺实质（p<0.0086），在平衡期显示最为清晰。所有肿瘤的增强边缘在病理上均反映了富含纤维性基质的大量癌细胞。有增强边缘和无增强边缘的肿瘤在侵袭性方面无统计学差异（前胰腺周侵犯，p=0.137；后胰腺周侵犯，p=0.758；门静脉侵犯，p=0.639；淋巴结转移，p=0.359）。
在小胰腺导管腺癌中，增强边缘的检出率为 40%，这可能是 CT 图像诊断的一个重要发现，但并不提示肿瘤侵袭性较低。
