基于增强CT强化差异判断其与可切除性胰腺导管腺癌病理分级的相关性、预测预后

目的 探讨胰腺肿瘤与周围胰腺实质CT值差预测肿瘤分化及患者预后生存期的价值。方法 回顾性收集经病理证实为胰腺导管腺癌的患者150例，测量增强后肿瘤与周围胰腺实质的CT值差（CT胰腺-肿瘤）及肿瘤强化后与平扫期的CT值差（CT实质期-平扫期及CT门脉期-平扫期），将各CT值差与病理分化作对照分析，采用Cox 比例风险模型获得胰腺导管腺癌患者预后的独立影响因素。结果 胰腺实质期CT胰腺-肿瘤与病理分化具有显著负相关性（r =-0.673，P <0.001），胰腺实质期CT胰腺-肿瘤与肿瘤内纤维间质含量具有显著负相关性（r =-0.513，P<0.001），是胰腺癌预后总生存期的独立危险因素（风险比：1.682， 95%可信区间：1.117，2.534，P =0.013）。结论 胰腺实质期CT胰腺-肿瘤可反映病理分级，CT值差越大，恶性程度越高，其内纤维间质含量少，患者存活的时间越短，预后越差。

Pancreatic Ductal Adenocarcinoma: A visually quantifiable CT imaging feature Evaluates malignancy grade and Predicts Prognosis after Curative Resection

Objective To evaluates malignancy grade and the prognostic value of contrast-enhanced CT imaging features in patients with pancreatic ductal adenocarcinoma (PDAC). Methods The clinical and quantitative CT imaging features of 150 patients with PDAC were retrospectively analyzed. The CT enhancement degree and pathological grade of tumor were comparatively analyzed in pancreatic parenchymal and portal venous phase of enhanced CT. The Cox proportional hazards model was used to obtain the independent prognostic influencing factors of PDAC. Results In pancreatic parenchymal phase of enhanced CT, the results of correlation with difference CT value between tumor and surrounding parenchyma and pathological grades of tumor were r=-0.673(P<0.001);the results of correlation with difference CT value and fibrosis were r=-0.513(P<0.001). The difference CT value between tumor and surrounding parenchyma in pancreatic parenchymal phase was significantly associated with overall survival time (hazard ratio, 1.682; 95% confidence interval: 1.117, 2.534, P =0.013) . Conclusion The difference CT value between tumor and surrounding parenchyma in pancreatic parenchymal phase was significant correlation to pathological grades of tumor; and the high difference CT value was associated with lower overall survival rates after attempted curative resection of PDAC.