肾细胞癌患者中，通过CT或MRI鉴别肾细胞癌转移至胰腺与胰腺神经内分泌肿瘤。

Differentiation between renal cell carcinoma metastases to the pancreas and pancreatic neuroendocrine tumors in patients with renal cell carcinoma on CT or MRI.

作者信息

Nduwimana Marie-Joy, Colak Ceylan, Bilgin Cem, Kassmeyer Blake A, Bolan Candice M, Menias Christine O, Venkatesh Sudhakar K

机构信息

Mayo Clinic Rochester, Rochester, MN, USA.

Mayo Clinic Jacksonville, Jacksonville, FL, USA.

出版信息

Abdom Radiol (NY). 2025 Jan 7. doi: 10.1007/s00261-024-04787-7.

DOI:10.1007/s00261-024-04787-7

PMID:39775027

Abstract

PURPOSE

To determine whether renal cell carcinoma metastases (RCC-Mets) to the pancreas can be differentiated from pancreatic neuroendocrine tumors (PNETs) in patients with RCC on CT or MRI at presentation.

METHODS

This retrospective study included patients with biopsy-proven RCC-Mets (n = 102) or PNETs (n = 32) at diagnosis or after nephrectomy for RCC. Inter-observer agreement (Cohen kappa) was assessed in 95 patients with independent reads by two radiologists, with discrepancies resolved by consensus for final analysis. The remaining 39 cases underwent consensus reads by two different radiologists for final analysis. The CT/MRI images were reviewed for number, size, regional distribution, parenchymal location (exophytic or intrapancreatic), contrast-enhancement, and enhancement pattern of pancreatic lesions in the available phases. Statistical tests were conducted using two sample t-tests and Pearson's chi-squared test for numeric and categorical variables respectively.

RESULTS

The study group comprised of 134 patients (90 males) with 265 lesions (229 RCC-Mets and 36 PNETs). Patients with PNETs were significantly younger (62 ± 12 years vs. 67 ± 9 years, p = 0.013). Inter-observer agreement for CT/MRI features was excellent across multiple imaging variables (k = 0.86-1.00). Most PNETs were single lesions (88 vs. 63%, p = 0.008), smaller in size (14 mm vs. 23 mm, p = 0.042), more common in the body and tail (81 vs. 57%, p = 0.01), showed homogeneous contrast enhancement (64-79% vs. 39-49%, p < 0.01-0.03), less T1-hypointense (80 vs. 99%, p = 0.002) and more DWI hyperintense (71 vs. 58%, p < 0.001) compared to RCC-Mets.

CONCLUSION

PNETs are typically single, occur in distal pancreas, and enhance homogeneously compared to RCC-Mets which are often multiple, occur in the proximal pancreas, and enhance heterogeneously.

摘要

目的

确定在肾癌患者初诊时，通过CT或MRI检查能否将肾细胞癌转移至胰腺（RCC-Mets）与胰腺神经内分泌肿瘤（PNETs）区分开来。

方法

这项回顾性研究纳入了经活检证实为RCC-Mets（n = 102）或PNETs（n = 32）的患者，这些患者在诊断时或肾癌肾切除术后确诊。由两名放射科医生对95例患者进行独立阅片，评估观察者间一致性（Cohen κ值），分歧通过达成共识解决以进行最终分析。其余39例病例由两名不同的放射科医生进行共识阅片以进行最终分析。回顾CT/MRI图像，观察胰腺病变在各可用期的数量、大小、区域分布、实质位置（外生性或胰腺内）、对比增强及增强模式。分别使用两样本t检验和Pearson卡方检验对数值变量和分类变量进行统计分析。

结果

研究组包括134例患者（90例男性），共265个病灶（229个RCC-Mets和36个PNETs）。PNETs患者明显更年轻（62±12岁 vs. 67±9岁，p = 0.013）。在多个影像变量方面，观察者间对CT/MRI特征的一致性极佳（κ = 0.86 - 1.00）。与RCC-Mets相比，大多数PNETs为单个病灶（88% vs. 63%，p = 0.008），尺寸较小（14mm vs. 23mm，p = 0.042），更常见于胰体和胰尾（81% vs. 57%，p = 0.01），表现为均匀对比增强（64 - 79% vs. 39 - 49%，p < 0.01 - 0.03），T1低信号较少（80% vs. 99%，p = 0.002），扩散加权成像（DWI）高信号较多（71% vs. 58%，p < 0.001）。