非富血供胰腺神经内分泌肿瘤与导管腺癌肝转移MSCT表现

目的 探讨非富血供胰腺神经内分泌肿瘤（PNET）与胰腺导管腺癌（PDAC）肝转移CT影像特征及其在二者鉴别诊断中的价值。方法 回顾性分析21例非富血供PNET伴肝转移及56例PDAC伴肝转移患者的资料，分析其肝转移病灶数目、分布、大小、病灶融合、周围肝组织异常灌注、增强扫描强化程度等CT特征。结果 非富血供PNET与PDAC肝转移病灶的数目、分布、病灶融合之间差异无统计学意义（P均>0.05），非富血供PNET及PDAC肝转移灶的最大径差异有统计学意义（P=0.03），PDAC肝转移灶周围肝组织异常灌注发生率（67.86%）多于非富血供PNET肝转移灶（28.57%），差异有统计学意义（P<0.01），非富血供PNET肝转移动脉期、门静脉期、平衡期强化指数高于PDAC（P<0.01）。Logistic多因素分析显示动脉期强化指数是鉴别非富血供PNET与PDAC肝转移的独立预测因素，鉴别诊断二者的AUC为0.97。结论 非富血供PNET与PDAC肝转移灶的CT影像特征有助于鉴别伴有肝转移的非富血供PNET与PDAC。

MSCT features of hepatic metastases of nonhypervascular pancreatic neuroendocrine tumor and pancreatic ductal adenocarcinoma

Objective To explore MSCT features of hepatic metastases of nonhypervascular pancreatic neuroendocrine tumor(PNET) and pancreatic ductal adenocarcinoma (PDAC), and its value for differential diagnosis. Methods A total of 21 patients with nonhypervascular PNET and 56 patients with PDAC associated with hepatic metastases were analyzed retrospectively. The CT features of hepatic metastases including tumor number, distribution, size, fusion of lesions, abnormal hepatic perfusion and the CT enhancement degree were observed and analyzed. Results There was no significant difference of the tumor number, distribution and lesion fusion of hepatic metastases between nonhypervascular PNET and PDAC (all P>0.05). There was significant difference of the maximum diameter of hepatic metastases between nonhypervascular PNET and PDAC (P=0.03). The incidence of abnormal hepatic perfusion of PDAC was higher than that of nonhypervascular PNET (67.86% vs 28.57%,P<0.01). In arterial phase, portal phase and equilibrium phase, the enhancement index of hepatic metastases of nonhypervascular PNET were all higher than that of PDAC(P<0.01).Logistic regression analysis showed that only the enhancement index in arterial phase was an independent factor for differentiating hepatic metastases between nonhypervascular PNET and PDAC, with AUC of 0.97. Conclusion The imaging features of hepatic metastases on MSCT is helpful for differentiating diagnosis of nonhypervascular PNET and PDAC.