Toshima Fumihito, Inoue Dai, Kozaka Kazuto, Komori Takahiro, Takamatsu Atsushi, Katagiri Ayako, Gabata Toshifumi
Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan.
Department of Radiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki-Higashi, Kanazawa, Ishikawa, 920-8530, Japan.
Abdom Radiol (NY). 2023 Mar;48(3):936-951. doi: 10.1007/s00261-023-03814-3. Epub 2023 Jan 28.
To investigate the MR findings of the solid components within pancreatic solid pseudopapillary neoplasms (SPNs) to characterize solid SPN without degeneration.
After case matching, 23 patients with SPNs, 23 with pancreatic neuroendocrine neoplasms (PNENs), and 46 pancreatic ductal adenocarcinomas (PDACs) were included in this retrospective comparative study. The MR findings of the solid components within the pancreatic tumors were assessed qualitatively and semi-quantitatively.
In the qualitative assessment, significant differences were noted in T2-weighted imaging and MR cholangiopancreatography (MRCP). SPNs with a score of 4-5 (iso- to hyper-intense compared with the renal cortex) were observed in 18/19 (94.7%) by reader 1 and 15/19 (78.9%) by reader 2 (score 5, 52.6% and 47.4%) on fast spin-echo (FSE) T2-weighted imaging. On MRCP, the two readers identified 12 (63.2%) and 8 (42.1%) SPNs, respectively. The semi-quantitative signal-intensity ratio (SIR, signal intensity of tumor/signal intensity of the pancreatic parenchyma) of SPNs on FSE T2-weighted imaging was significantly higher (mean, 1.99-2.01) than that of PNENs (1.30-1.31) or PDACs (1.26-1.28). The sensitivity/specificity of 'hyper' on T2-weighted imaging (qualitative score of 4-5, or SIR of ≥ 1.5) were 78.9-100.0%/63.8-79.7%. The sensitivity/specificity of 'remarkably hyper' (score of 5, SIR of ≥ 2.0, or visible on MRCP) or salt-and-pepper pattern were 36.8-68.4%/85.5-98.6%.
T2-weighted imaging may be the key sequence for solid SPN. Solid tumors with hyper-intensity on T2-weighted imaging (especially, more hyper-intense than the renal cortex, more than twice the signal of the pancreatic parenchyma, depicted on MRCP, or salt-and-pepper appearance) may be suspected to be SPNs.
研究胰腺实性假乳头状肿瘤(SPN)内实性成分的磁共振成像(MR)表现,以对未发生退变的实性SPN进行特征性描述。
经过病例匹配后,本回顾性对照研究纳入了23例SPN患者、23例胰腺神经内分泌肿瘤(PNEN)患者和46例胰腺导管腺癌(PDAC)患者。对胰腺肿瘤内实性成分的MR表现进行定性和半定量评估。
在定性评估中,T2加权成像和磁共振胰胆管造影(MRCP)存在显著差异。在快速自旋回波(FSE)T2加权成像上,读者1观察到18/19例(94.7%)、读者2观察到15/19例(78.9%)的SPN评分为4 - 5分(与肾皮质相比等信号至高信号)(5分者分别为52.6%和47.4%)。在MRCP上,两位读者分别识别出12例(63.2%)和8例(42.1%)SPN。SPN在FSE T2加权成像上的半定量信号强度比(SIR,肿瘤信号强度/胰腺实质信号强度)显著高于PNEN(1.30 - 1.31)或PDAC(1.26 - 1.28)(均值分别为1.99 - 2.01)。T2加权成像上“高信号”(定性评分为4 - 5分,或SIR≥1.5)的敏感度/特异度为78.9% - 100.0%/63.8% - 79.7%。“显著高信号”(评分为5分,SIR≥2.0,或在MRCP上可见)或椒盐样表现的敏感度/特异度为36.8% - 68.4%/85.5% - 98.6%。
T2加权成像可能是实性SPN的关键序列。T2加权成像上呈高信号的实性肿瘤(尤其是比肾皮质信号更高、为胰腺实质信号两倍以上、在MRCP上显示或呈椒盐样外观)可能怀疑为SPN。