Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu Province, China.
Department of Pathology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu Province, China.
Abdom Radiol (NY). 2019 Mar;44(3):867-876. doi: 10.1007/s00261-018-1803-x.
To determine useful contrast-enhanced computed tomography (CE-CT) features in differentiating duodenal gastrointestinal stromal tumors (duodenal GISTs) from hypervascular pancreatic neuroendocrine tumors in the pancreatic head (pancreatic head NETs).
Seventeen patients with pathologically confirmed duodenal GISTs and 25 with pancreatic NETs underwent preoperative CE-CT. CT image analysis included tumor size, morphology, and contrast enhancement. Receiver operating characteristic curves were performed, and cutoff values were calculated to determine CT findings with high sensitivity and specificity.
CT imaging showed duodenal GISTs with higher frequencies of tumor central location close to the duodenum and a predominantly solid tumor type when compared with pancreatic head NETs (p < 0.05 for both). Duodenal GISTs were larger than pancreatic head NETs (3.3 ± 0.9 cm vs. 2.5 ± 1.1 cm, p = 0.03). Duodenal GISTs had significantly lower CT attenuation values (112.9 ± 17.9HU vs. 137.4 ± 32.1HU, p < 0.01) at the arterial phase and higher CT attenuation values at the delayed phase (94.3 ± 7.9HU vs. 84.9 ± 10.4HU, p < 0.01) when compared with pancreatic head NETs. A CT attenuation value of ≤ 135 HU at the arterial phase (30 s) was 76% sensitive, 94.1% specific, and 83.3% accurate for the diagnosis of duodenal GISTs, while a CT attenuation value of ≥ 89.5 HU at the delayed phase (120 s) was 93.3% sensitive, 81.8% specific, and 76.2% accurate for the diagnosis of duodenal GISTs.
Tumor central location, size, texture, and contrast enhancement are valuable characteristics for the differentiation between duodenal GISTs and hypervascular pancreatic head NETs during preoperative examination.
确定有助于鉴别十二指肠胃肠道间质瘤（duodenal GISTs）与胰头部富血供胰腺神经内分泌肿瘤（pancreatic head NETs）的增强 CT（CE-CT）特征。
17 例经病理证实的十二指肠 GIST 患者和 25 例胰腺 NET 患者接受了术前 CE-CT 检查。CT 图像分析包括肿瘤大小、形态和对比增强。绘制了受试者工作特征曲线，并计算了截断值，以确定具有高灵敏度和特异性的 CT 发现。
与胰腺头部 NETs 相比，CT 影像学显示十二指肠 GISTs 肿瘤中央位置更靠近十二指肠，且以实体瘤型为主（均为 p＜0.05）。十二指肠 GISTs 比胰腺头部 NETs 更大（3.3±0.9 cm 比 2.5±1.1 cm，p=0.03）。动脉期，十二指肠 GISTs 的 CT 衰减值明显较低（112.9±17.9 HU 比 137.4±32.1 HU，p＜0.01），而延迟期的 CT 衰减值较高（94.3±7.9 HU 比 84.9±10.4 HU，p＜0.01）。动脉期（30 s）CT 衰减值≤135 HU 的诊断十二指肠 GISTs 的灵敏度为 76%、特异度为 94.1%、准确度为 83.3%，而延迟期（120 s）CT 衰减值≥89.5 HU 的诊断十二指肠 GISTs 的灵敏度为 93.3%、特异度为 81.8%、准确度为 76.2%。
在术前检查中，肿瘤中央位置、大小、质地和对比增强是鉴别十二指肠 GISTs 和胰头部富血供胰腺 NETs 的有价值特征。
