Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
Department of Diagnostic Imaging, The Ottawa Hospital- Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
Abdom Radiol (NY). 2019 Mar;44(3):992-999. doi: 10.1007/s00261-018-01889-x.
To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases.
This IRB-approved multi-center retrospective case-control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative enhanced CT identified consecutively between 2003 and 2017. Two blinded radiologists (R1/R2) independently assessed tumor location, attenuation (relative to pancreas), composition (solid/cystic/mixed), homogeneity (homogeneous/heterogeneous), calcification, multiplicity, and for main pancreatic duct (MPD) dilation. Tumors were segmented for quantitative texture analysis. Data were analyzed with Chi square, logistic regression, and receiver operating characteristic (ROC). Inter-observer agreement was assessed (Cohen's kappa).
There was no difference in age, gender, location, attenuation, or composition (P > 0.05) between groups. PNETs were larger than RCC metastases (37 ± 23 mm vs. 26 ± 21 mm, P = 0.038), more frequently solitary (P < 0.001), subjectively more heterogeneous (P = 0.033/0.144, R1/R2), and associated with calcification (P = 0.002/0.004) and MPD dilation (P = 0.025/0.006). Agreement for subjective features was moderate-to-almost perfect (K = 0.4879-0.9481). Quantitative texture analysis showed higher entropy in PNETs (6.32 ± 0.49 versus 5.96 ± 0.53; P = 0.004) with no difference in other features studied (P > 0.05). Entropy had ROC area under the curve for diagnosis of PNET of 0.77 ± 0.06, with optimal sensitivity/specificity of 71.4/79.1%.
Compared to pancreatic RCC metastases, PNETs are larger, more frequently solitary, contain calcification, show MPD dilation, and are subjectively and quantitatively more heterogeneous tumors.
评估增强 CT 的定性和定量成像特征，以区分胰腺神经内分泌肿瘤（PNET）与胰腺肾细胞癌（RCC）转移。
这项经过机构审查委员会批准的多中心回顾性病例对照研究比较了 2003 年至 2017 年间连续切除的 43 例 PNET 和 28 例 RCC 转移瘤，术前均行增强 CT 检查。两名盲法放射科医生（R1/R2）独立评估肿瘤位置、衰减（相对于胰腺）、成分（实性/囊性/混合性）、均匀性（均匀/不均匀）、钙化、多发性和主胰管（MPD）扩张。对肿瘤进行定量纹理分析。采用卡方检验、逻辑回归和受试者工作特征（ROC）分析数据。评估了观察者间的一致性（Cohen's kappa）。
两组间在年龄、性别、位置、衰减或成分方面无差异（P＞0.05）。PNET 比 RCC 转移瘤大（37±23mm 比 26±21mm，P=0.038），更常为单发（P＜0.001），主观上更不均匀（P=0.033/0.144，R1/R2），与钙化（P=0.002/0.004）和 MPD 扩张（P=0.025/0.006）相关。主观特征的一致性为中至高（K=0.4879-0.9481）。定量纹理分析显示 PNET 中熵值较高（6.32±0.49 比 5.96±0.53；P=0.004），而其他研究特征无差异（P＞0.05）。熵值对 PNET 诊断的 ROC 曲线下面积为 0.77±0.06，最佳敏感性/特异性为 71.4/79.1%。
与胰腺 RCC 转移瘤相比，PNET 体积较大，更常为单发，含有钙化，显示 MPD 扩张，且主观和定量上更不均匀。
