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中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 233 -238. doi: 10.3877/cma.j.issn.1674-0793.2019.03.014

所属专题: 文献

论著

胰腺实性假乳头状瘤的影像诊断与良恶性预测因素分析
曾玉蓉1, 刘庆余2,(), 周泉波3, 陈汝福3, 申忱4, 林良业4   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院放射科
    2. 510120 广州,中山大学孙逸仙纪念医院放射科;511300 广州市增城区人民医院影像科
    3. 510120 广州,中山大学孙逸仙纪念医院胆胰外科
    4. 511300 广州市增城区人民医院影像科
  • 收稿日期:2018-05-25 出版日期:2019-06-01
  • 通信作者: 刘庆余
  • 基金资助:
    广东省自然科学基金资助项目(S2012010008407); 广东省科技计划项目(2014A020212426); 广州市科技计划项目(1563000399)

Solid-pseudopapillary neoplasms of the pancreas: imaging and predictive value of CT and MRI for benignancy and malignancy

Yurong Zeng1, Qingyu Liu2,(), Quanbo Zhou3, Rufu Chen3, Chen Shen4, Liangye Lin4   

  1. 1. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
    2. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; Department of Radiology, Zengcheng District People’s Hospital, Guangzhou 511300, China
    3. Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
    4. Department of Radiology, Zengcheng District People’s Hospital, Guangzhou 511300, China
  • Received:2018-05-25 Published:2019-06-01
  • Corresponding author: Qingyu Liu
  • About author:
    Corresponding author: Liu Qingyu, Email:
引用本文:

曾玉蓉, 刘庆余, 周泉波, 陈汝福, 申忱, 林良业. 胰腺实性假乳头状瘤的影像诊断与良恶性预测因素分析[J/OL]. 中华普通外科学文献(电子版), 2019, 13(03): 233-238.

Yurong Zeng, Qingyu Liu, Quanbo Zhou, Rufu Chen, Chen Shen, Liangye Lin. Solid-pseudopapillary neoplasms of the pancreas: imaging and predictive value of CT and MRI for benignancy and malignancy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(03): 233-238.

目的

分析胰腺实性假乳头状瘤(SPNP)的影像和临床表现,探讨CT和MRI对SPNP的诊断以及良恶性SPNP的预测价值。

方法

回顾性收集2010年1月至2017年12月中山大学孙逸仙纪念医院经病理证实的SPNP 60例,分析患者的临床表现和影像学特征,采用χ2检验和Logistic回归分析患者临床、影像学特征与良恶性SPNP的相关性。

结果

SPNP好发于年青女性(85.0%,51/60),中位发病年龄34.5岁,33例(55.0%)表现为非特异性症状,54例(90.0%)肿瘤特异性指标阴性。CT及MRI显示包膜缺损的患者并发症发生率(44.1%,15/34)高于包膜完整的患者(19.2%,5/26),经腹腔镜术后并发症发生率(10.5%,2/19)低于经腹术后并发症发生率(43.9%,18/41),差异均有统计学意义(χ2=4.106、5.508,P=0.043、0.011)。SPNP肿瘤好发于胰体尾部(60.0%),形态多规则(61.7%),平均直径达5.7 cm。肿瘤具有包膜,增强扫描明显强化,MRI呈环形低信号;瘤内以囊实性为主(56.7%),密度及信号多不均匀(83.3%),可伴有钙化(21.7%)、出血(30.0%),钙化多呈环形位于边缘,增强扫描瘤内表现为渐进性中度强化(100.0%)。良、恶性SPNP患者的年龄、肿瘤的大小、形态以及包膜是否缺损比较,差异有统计学意义(P=0.047、0.029、0.049、<0.001),Logistic多因素回归分析显示上述因素均不是独立的危险因素。

结论

SPNP好发于年轻女性,无特异性临床表现。SPNP的CT、MRI表现具有特征性,对肿瘤的术前诊断和良恶性的评估具有一定价值。手术是SPNP有效的治疗方法,腹腔镜手术可作为首选手术方式,预后效果好。

Objective

To analyze the imaging and clinical manifestations of solid-pseudopapillary neoplasms of the pancreas (SPNP), and to explore the predictive value of CT and MRI for benign and malignant SPNP.

Methods

From January 2010 to December 2017, sixty patients with pathologically proved SPNP were collected from Sun Yat-sen Memorial Hospital. The patients’ clinical and imaging data were analyzed retrospectively with χ2 test and logistic regression.

Results

Fifty-one cases (85.0%) were young women with an average age of 34.5 years. Thirty-three patients (55.0%) had non-specific clinical symptoms and tumor markers were negative in 54 patients (90.0%). All the 60 patients had underwent surgery for treatment, with the incidence of postoperative complications higher in patients with tumor capsular defect (44.1%) than tumor capsular intact (19.2%) (χ2=4.106, P=0.043), and lower in patients under laparoscopic surgery (10.5%) than laparotomy (43.9%) (χ2=5.508, P=0.011). SPNP always occurred in the tail (60.0%), and most of them (61.7%) had regular shape with an average diameter of 5.7 cm. There were capsules with the tumors, which showed up as ring low signal on MRI and enhanced obviously. Most of the tumors were cystic mass (56.7%) and the density or signal was heterogeneous (83.3%), for peripheral calcification (21.7%) and hemorrhage (30.0%) could be found, and in all the cases, CT and MRI enhanced scans appeared as progressive and inhomogeneous. Clinical and CT imaging features including age, tumor size, shape, and tumor capsular defect in benign and malignant SPNP had statistical significance (P=0.047, 0.029, 0.049, <0.001), while none of the above factors were independent risk factors by multivariate logistic regression.

Conclusions

SPNP is commonly seen in young females with no specific clinical symptoms. CT and MRI demonstrate characteristic features of SPNP, and have great value in differential diagnosis between malignant and benign SPNP. Surgery is effective for SPNP, and laparoscopic surgery can be the first choice for good prognosis.

图1 20岁女性胰头部SPNP MRI检查征象 病灶形态规则,呈圆形;肿瘤以囊性成分为主,实质成分偏于一侧;T2WI(a)、T1WI(b)可见完整环形低信号包膜,瘤内见T2WI及T1WI高信号出血区;增强扫描肿块包膜强化明显,实质成分轻度强化(c);DWI示病灶呈高信号(d)
图2 27岁女性胰尾部SPNP CT检查征象 病灶呈分叶状,实性为主,囊性成分呈斑片状位于边缘;CT平扫示瘤内钙化,主要分布于病灶边缘,呈环形包膜状(a);增强扫描病灶渐进性轻度强化(b-d)
图5 42岁女性胰尾部SPNP伴腹腔种植转移CT检查征象
表1 60例胰腺实性假乳头状瘤良恶性的单因素预后分析
表2 60例胰腺实性假乳头状瘤良恶性的多因素Logistic回归分析
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