壁结节的影像学表现对鉴别胰腺导管内乳头状黏液瘤良恶性的价值

目的 探讨壁结节的影像学表现在鉴别胰腺导管内乳头状黏液瘤(IPMN)良恶性中的价值.方法 回顾性分析2012年1月至2016年6月于长海医院诊治的112例IPMN患者的病理和影像学资料.患者术前均行CT和MRI检查,由2位主治医师观察病灶壁结节的影像学表现,比较并分析良、恶性IPMN的壁结节大小、位置、个数、边界和强化程度.绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价壁结节大小、个数、边界在鉴别IPMN良恶性中的作用,并确定壁结节大小的最佳诊断界值和敏感度、特异度及准确度.结果 纳入经手术病理证实且在影像学检查中明确观察到壁结节的IPMN患者61例,病理检查结果示良性36例、恶性25例;主胰管型15例、分支型为13例、混合型33例,良、恶性患者IPMN分型差异有统计学意义(P=0.01).壁结节大小对判断IPMN良恶性有临床意义(P＜0.01),其鉴别良、恶性的最佳诊断界值为1.35 cm,AUC为74.7％,敏感度56.0％、特异度91.7％、准确度77.5％.良、恶性患者的壁结节个数(P=0.02)、边界(P＜0.01)差异均有统计学意义,其鉴别良、恶性的AUC分别为64.2％、72.1％.所有患者壁结节强化程度均为渐进性强化,良、恶性患者的强化程度差异无统计学意义.结论 壁结节影像学表现对IPMN良恶性的鉴别具有敏感性,对术前评估和随访具有一定的临床价值.

Distinguishing benign from malignant intraductal papillary mucinous neoplasms of the pancreas by imaging features of mural nodules

Objective To explore the diagnostic value of the imaging features of mural nodules in differentiating benign from malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Methods In this retrospective study, we analyzed the pathology and imaging data of 112 patients with IPMNs in Changhai Hospital from Jan. 2012 to Jun. 2016. All patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), and the mural nodule imaging features were observed and recorded by two resident physicians. The size, location, amount, margin and enhancement of the mural nodules were compared and analyzed in benign and malignant IPMNs. Finally, a receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was calculated to evaluate the diagnostic value of the size, amount and margin of the mural nodules observed by imaging in differentiation of malignant and benign IPMNs, and to determine the best cut-off value, sensitivity, specificity and accuracy of the size. Results Sixty-one patients with definite mural nodules confirmed by pathology after surgery and imaging examination were included in this study; pathological analysis showed 36 patients having benign IPMNs and 25 having malignant, with main duct in 15 patients, branch duct in 13, and mixed type in 33. The malignant IPMNs mainly occurred in main duct and mixed type (P=0.01). The size of the mural nodules could be used to distinguish benign from malignant IPMNs (P<0.01), and the best cut-off value was 1.35 cm; the AUC was 74.7%, and the sensitivity, specificity and accuracy were 56.0%, 91.7% and 77.5%, respectively. Multiple mural nodules (P=0.02) and ill-defined margins (P<0.01) could be an imaging features for distinguishing benign from malignant IPMNs, and the AUC was 64.2% and 72.1%, respectively. The mural nodules of all patietns showed a progressive enhancement, which was not useful for differentiation. Conclusion The imaging features of the mural nodules are valuable for differentiation between benign from malignant IPMNs of the pancreas, and it is of clinical value for pre-operative evaluation and follow-up.