胰腺囊腺瘤的多层螺旋CT表现特征及诊断准确性

目的探讨多层螺旋CT诊断胰腺浆液性囊腺瘤、粘液性囊腺瘤与粘液性囊腺癌的准确率及有鉴别诊断意义的CT征象。方法单盲法回顾性分析30例经病理证实的胰腺囊腺瘤病例（浆液性囊腺瘤12例、粘液性囊腺瘤14例、粘液性囊腺癌4例）的CT图像,记录肿瘤位置、分房情况、钙化情况、囊壁特征、囊壁乳头及最大囊直径等CT征象,并做出胰腺浆液性囊腺瘤或粘液性囊腺瘤/癌的判断。所得数据进行统计学分析。结果胰腺浆液性囊腺瘤的CT诊断准确率为75.0%,粘液性囊腺瘤/癌的诊断准确率为88.9%。3例浆液性囊腺瘤误诊为粘液性囊腺瘤,2例粘液性囊腺瘤/癌误诊为浆液性囊腺瘤。浆液性囊腺瘤位于胰头颈部者占75.0%,粘液性囊腺瘤/癌位于胰体尾部者占66.7%,两者比较差异具有显著性（P〈0.05）。肿瘤钙化灶,尤其是中心钙化与浆液性囊腺瘤有相关性（P〈0.05）。最大囊直径大于2cm与粘液性囊腺瘤/癌有相关性（P〈0.05）。结论胰腺浆液性囊腺瘤与粘液性囊腺瘤/癌的CT表现明显不同。螺旋CT具有较高的诊断准确率,但对于不典型表现的诊断存在困难。

Characterization and diagnostic accuracy of serous cystadenomas and mucinous neoplasms of the pancreas with multi-slice helical computed tomography

Objective To evaluate the feasibility of using multi-slice helical computed tomography(MS-CT)to accurately distinguish serous cystadenomas from mucinous cystadenomas or cystadenocarcinomas of the pancreas and to determine their radiographic appearances that can be applied for differentiative diagnosis.Methods We performed a single-blind retrospective analysis of CT images of 30 patients with pathologically proven primary cystic pancreatic neoplasms(12 cases of serous cystadenomas,14 cases of mucinous cystadenomas,and 4 cases of mucinous cystadenocarcinomas)to reach a diagnosis of either serous cystadenoma or muci-nous cystic tumor.CT features such as tumor location,septations,presence of calcification,features of cystic wall,papillary excrescences,and size of the largest cyst were recorded.Statistical analysis was performed to eva-luate the efficacy of certain CT findings in the differentiation of serous cystadenomas and mucinous neoplasms.Results Totally 9(75.0%)serous cystadenomas and 16(88.9%)mucinous tumors were correctly diagnosed.Three serous cystadenomas were misdiagnosed as mucinous cystadenomas,while 2 mucinous neoplasms were misdiagnosed as serous cystadenomas.And 9(75.0%)serous cystadenomas were located at the pancreatic head and neck areas,while 12(66.7%)mucinous neoplasms were located at the pancreatic body and tail areas(P<0.05).The presence of calcification,especially central calcification,had statistical significance in differentiating serous cystadenoma from mucinous neoplasms(P<0.05).The size of the largest cyst over 2 cm was positive associated with mucinous neoplasms(P<0.05).Conclusion CT characteristics between serous cystadenomas and mucinous neoplasms of the pancreas have distinct difference,which validates the values of CT in differentiating these tumors.However,atypical CT appearances may compromise its diagnostic accuracy.