形态学成像和 CT 直方图分析在鉴别胰腺神经内分泌瘤 3 级与神经内分泌癌中的应用。
Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma.
机构信息
Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France.
Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon Assistance Publique-Hôpitaux de Paris, 92118 Clichy, France; Université de Paris, Diderot Paris 7, 75010 Paris, France; INSERM U1149, CRI, Paris, France.
出版信息
Diagn Interv Imaging. 2020 Dec;101(12):821-830. doi: 10.1016/j.diii.2020.06.006. Epub 2020 Jul 21.
PURPOSE
To compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC).
MATERIALS AND METHODS
Patients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared.
RESULTS
Thirty-seven patients (21 men, 16 women; mean age, 56±13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60±46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70±51 [SD] mm [range: 18 - 196mm] vs. 42±24 [SD] mm [range: 8 - 94mm], respectively; P=0.039), with more tumor necrosis (75% vs. 33%, respectively; P=0.030) and lower attenuation on precontrast (30±4 [SD] HU [range: 25-39 HU] vs. 37±6 [SD] [range: 25-45 HU], respectively; P=0.002) and on portal venous phase CT images (75±18 [SD] HU [range: 43 - 108 HU] vs. 92±19 [SD] HU [range: 46 - 117 HU], respectively; P=0.014). Hemorrhagic content on MRI was only observed in NEC (P=0.007). The mean ADC value was lower in NEC ([1.1±0.1 (SD)]×10 mm/s [range: (0.91 - 1.3)×10 mm/s] vs. [1.4±0.2 (SD)]×10 mm/s [range: (1.1 - 1.6)×10 mm/s]; P=0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7±0.2 [SD] [range: 4.2-5.1] vs. 4.5±0.4 [SD] [range: 3.7-4.9]; P=0.023).
CONCLUSION
Pancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.
目的
比较 3 级胰腺神经内分泌肿瘤（G3-NET）和神经内分泌癌（NEC）的形态学成像特征和 CT 纹理直方图参数。
材料与方法
回顾性纳入了 2006 年至 2017 年间经病理证实的 G3-NET 和 NEC 患者，按照 2017 年世界卫生组织分类标准。由两名放射科医生对 CT 和 MRI 检查进行审查，并分析肿瘤大小、强化模式、出血内容、肝转移和淋巴结病变。对动脉期和门静脉期 CT 图像进行肿瘤纹理直方图分析。比较 G3-NET 和 NEC 的形态学成像特征和 CT 纹理直方图参数。
结果
共纳入 37 例患者（21 名男性，16 名女性；平均年龄 56±13[SD]岁[范围：28-82 岁]），共 37 个肿瘤（所有患者均行 CT 检查，16/37 例患者行 MRI 检查，占 43%）。23 例患者（23/37；62%）为 NEC，14 例患者（14/37；38%）为 G3-NET。NEC 比 G3-NET 大（平均直径分别为 70±51[SD]mm[范围：18-196mm]和 42±24[SD]mm[范围：8-94mm]，P=0.039），肿瘤坏死更多（75%比 33%，P=0.030），平扫时 CT 值更低（30±4[SD]HU[范围：25-39HU]和 37±6[SD]HU[范围：25-45HU]，P=0.002），门静脉期 CT 值更低（75±18[SD]HU[范围：43-108HU]和 92±19[SD]HU[范围：46-117HU]，P=0.014）。MRI 仅观察到 NEC 有出血（P=0.007）。NEC 的平均 ADC 值较低（[1.1±0.1（SD）]×10mm/s[范围：（0.91-1.3）×10mm/s]和 [1.4±0.2（SD）]×10mm/s[范围：（1.1-1.6）×10mm/s]，P=0.005）。CT 直方图分析显示，门静脉期 NEC 更不均匀（熵-0：4.7±0.2[SD][范围：4.2-5.1]和 4.5±0.4[SD][范围：3.7-4.9]，P=0.023）。
结论
与 G3-NET 相比，胰腺 NEC 在 CT 和 MRI 上更大、更常表现为低衰减、更不均匀，且伴有出血。
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