双层光谱CT术前预测胰腺导管腺癌神经周围侵犯
该回顾性研究纳入100例病理证实的胰腺导管腺癌患者，评估双层光谱CT参数对神经周围侵犯（PNI）的预测价值。多因素分析显示胰腺实质期归一化碘浓度（nDIa）是唯一独立预测因子，其诊断效能优于常规CT参数， cutoff值0.16，AUC达0.86。
要点
- 胰腺实质期nDIa是PNI的独立预测因子，cutoff值0.16，AUC 0.86。
- nDIa诊断敏感度71.8%、特异度89.7%，优于常规CT强化参数。
- 肿瘤直径及常规/40keV归一化CT衰减与PNI相关，但非独立。
关键影像表现/征象
- PNI阳性71例，阴性29例；PNI相关因素包括肿瘤直径、常规CT胰腺实质期归一化CT衰减值（nCTa）、DLCT 40keV胰腺实质期归一化CT衰减值及胰腺实质期归一化碘浓度（nDIa）。
诊断标准与关键数值
- nDIa为唯一独立预测因子（p<0.001；校正OR 1.41，95%CI 1.19-1.68），cutoff值0.16，AUC 0.86。
- nDIa诊断敏感度71.8%、特异度89.7%、准确率77.0%、F1评分0.90；常规CT参数nCTa敏感度36.6%、特异度89.7%、准确率52.0%、AUC 0.68。
- nDIa与nCTa的AUC比较（ROC：0.86 vs 0.68，PR：0.93 vs 0.84）均p<0.001；准确率比较p=0.048，敏感度比较p=0.03，特异度比较p=0.13。
临床应用与阅片要点
- 阅片时测量胰腺实质期nDIa有助于术前评估PNI风险，cutoff值0.16可作为参考阈值。
- nDIa诊断特异度高（89.7%），阳性提示PNI可能性大，可辅助手术范围规划。
- nDIa敏感度（71.8%）优于常规CT参数（36.6%），但仍存在假阴性可能，需结合其他征象综合判断。
局限性
- 回顾性单中心研究，样本量100例，可能存在选择偏倚。
- PNI阳性与阴性组例数不均衡（71 vs 29）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: Perineural invasion (PNI) is an independent predictive factor for pancreatic ductal adenocarcinoma (PDAC); however, preoperative prediction is difficult. This study aimed to evaluate the value of dual-layer spectral CT (DLCT) parameters in PNI in PDAC.
MATERIALS AND METHODS: This retrospective study included patients with pathologically confirmed PDAC who underwent DLCT between August 2019 and March 2024. Risk factors were identified using univariable and least absolute shrinkage and selection operator (LASSO) regression. Receiver operating characteristic (ROC), precision-recall (PR) curves, calibration curves and decision curve analysis (DCA) accessed diagnostic performance.
RESULTS: We included 100 patients (mean age: 60.88 ± 11.39 years old, 59 males). There were 71 patients with PNI and 29 without PNI. Relevant factors for PNI included tumour diameter, normalised CT attenuation during the pancreatic parenchymal phase in conventional CT (nCTa), normalised CT attenuation during the pancreatic parenchymal phase in DLCT at 40 keV, and normalised iodine concentration during the pancreatic parenchymal phase (nDIa) (odds ratio [OR], 1.34; 95% confidence interval [CI]: 1.19, 1.51; p < 0.001). Of these, nDIa was the only independent predictor (p < 0.001; adjusted OR, 1.41; 95% CI: 1.19, 1.68) and demonstrated superior diagnostic performance compared to nCTa, with a cutoff value of 0.16, higher area under the curve (ROC: 0.86 vs. 0.68, PR: 0.93 vs. 0.84; both p < 0.001), higher accuracy (77.0% vs. 52.0%, p = 0.048), an F1 score of 0.90, higher sensitivity (71.8% vs. 36.6%, p = 0.03), and the same specificity of 89.7% (p = 0.13). The calibration plot illustrated satisfactory agreement of nDla and DCA confirmed its promising clinical application value.
CONCLUSION: The DLCT parameter nDIa allows for non-invasive prediction of PNI in PDAC with superior diagnostic efficacy compared to conventional CT parameters.
引用
- Liu J, Wei L, Luo J, et al. Preoperative prediction of perineural invasion in pancreatic ductal adenocarcinoma using dual-layer spectral CT. Abdom Radiol (NY). 2026. PMID: 42033644. doi:10.1007/s00261-026-05529-7
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。