Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Radiology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Jiading, Shanghai, China.
Acad Radiol. 2021 Feb;28(2):208-216. doi: 10.1016/j.acra.2020.01.033. Epub 2020 Feb 26.
The purpose of this study was to define the CT spectral imaging characteristics of pancreatic neuroendocrine neoplasms (PNENs) and evaluate their potential for differential diagnosis of nonlow grade (non-LG) PNENs from low grade (LG) PNENs.
CT spectral imaging data of 54 pathologically proven PNENs were retrospectively reviewed. Patients were divided into two groups: 40 cases with grade 1 in LG PNENs group and 14 cases with grade 2 and grade 3 in non-LG PNENs group.
Gender, calcification, inhomogeneity, invasiveness, PD dilatation, lymph node enlargement, size, normalized iodine (water) concentration in arterial phase (AP) (Iodine (ap)), normalized effective-Z (Z), slope of normalized CT spectral curves in both AP, and portal venous phase were found to be significant variables for differentiating non-LG PNENs from LG PNENs (p < 0.05). Non-LG PNENs had larger size and lower Z and Iodine (ap) than LG PNENs. The tumor size, Z and Iodine (ap) had fair to good diagnostic performance with the area under receiver-operating-characteristic curve (AUC) 0.843, 0.733, and 0.728, respectively. Multivariate analysis with logistic regression had higher AUC (p<0.05) than all the single parameters except for size.
There were significant differences in CT spectral imaging parameters between non-LG and LG PNENs. Tumor size was the most promising independent parameter and the combination of quantitative parameters with qualitative parameters is the best predictor in differentiating of non-LG PNENs from LG PNENs. CT spectral imaging can help determine the malignancy of PNENs, which can better assist in surgical planning.
本研究旨在确定胰腺神经内分泌肿瘤（PNENs）的 CT 能谱成像特征，并评估其在鉴别非低级别（non-LG）PNENs 与低级别（LG）PNENs 方面的应用价值。
回顾性分析了 54 例经病理证实的 PNENs 的 CT 能谱成像资料。患者分为两组：LG PNENs 组 40 例，grade 1；non-LG PNENs 组 14 例，grade 2 和 grade 3。
性别、钙化、不均匀性、侵袭性、胰管扩张、淋巴结肿大、肿瘤大小、动脉期（AP）标准化碘（水）浓度（Iodine（ap））、有效 Z 值（Z）、AP 和门静脉期标准化 CT 能谱曲线斜率在鉴别 non-LG PNENs 与 LG PNENs 方面差异有统计学意义（p<0.05）。non-LG PNENs 的肿瘤大小、Z 值和 Iodine（ap）均低于 LG PNENs。肿瘤大小、Z 值和 Iodine（ap）的诊断效能具有中等至良好，曲线下面积（AUC）分别为 0.843、0.733 和 0.728。多因素分析显示，与所有单参数相比，logistic 回归的 AUC 更高（p<0.05），但不包括肿瘤大小。
non-LG 和 LG PNENs 的 CT 能谱成像参数存在显著差异。肿瘤大小是最有前途的独立参数，定量参数与定性参数的联合是鉴别 non-LG PNENs 与 LG PNENs 的最佳预测指标。CT 能谱成像有助于确定 PNENs 的恶性程度，从而更好地辅助手术规划。
