胰腺实性假乳头状瘤与无功能神经内分泌肿瘤的MSCT鉴别诊断-Differential diagnosis of solid psuedopapillary tumor and non functional neuroendocrine tumor of pancreas with MSCT

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【摘要】目的：探讨MSCT对胰腺实性假乳头状瘤与无功能神经内分泌肿瘤的鉴别诊断价值。方法：回顾性分析2008年-2013年经病理证实的16例胰腺实性假乳头状瘤和16例胰腺无功能神经内分泌肿瘤的病例资料，所有患者均行CT平扫及动态增强扫描，对病变位置、密度、边界、钙化、强化峰值、导管扩张、远处转移进行分析。结果：16例实性假乳头状瘤中，病灶位于胰头8例、胰腺体部4例、胰腺尾部4例；病变呈实性6例、囊实性9例、囊性1例；出现钙化9例；边界清晰13例，无边界或边界模糊3例；导管扩张3例；强化峰值均在门脉期；无远处转移。16例无功能神经内分泌肿瘤中，病灶位于胰腺头部9例、胰体3例、胰尾4例；病变呈实性7例、囊实性8例、囊性1例；出现钙化4例；边界清晰11例、边界不清5例；导管扩张6例；强化峰值在动脉期9例、门脉期7例；远处转移3例。两种肿瘤强化峰值差异有统计学意义（P＜0.05），两种肿瘤的位置、密度、有无钙化、边界是否清晰、有无导管扩张、有无远处转移间差异均无统计学意义（P＞0.05）。结论：胰腺动态增强扫描有助于鉴别实性假乳头状瘤与无功能神经内分泌肿瘤，强化峰值在动脉期有助于胰腺无功能神经内分泌肿瘤的诊断，而胰腺实性假乳头状瘤均在门脉期强化；出现远处转移倾向于无功能性神经内分泌肿瘤的诊断。;【Abstract】Objective:To study the value of MSCT in the differential diagnosis of solid-psuedopapillary tumor and non-functional neuroendocrine tumor of pancreas.Methods:A retrospective analysis of pathology proved solid-psuedopapillary tumor and neuroendocrine tumor (16 patients for each) in the period of 2008-2013 was performed.All had CT plain scan and dual phase (arterial and portal venous) contrast enhancement.The location,density,boundary,calcification,peak of enhancement,ductal dilatation of tumor and existence of distant metastasis were analyzed.Results:Of the 16 solid psuedopapillary tumors,the location of tumor were head (8 cases),body (4 cases) and tail (4 cases) of pancreas respectively;6 cases were solid lesions,9 cases were cystic solid,1 case was cystic;9 cases had calcification;13 cases had clear boundary,3 cases without or had blurred boundary;3 cases had ductal dilatation.The peak of enhancement were showed at portal venous phase,no distant metastasis was found.Of the 16 non functional neuroendocrine tumors,the location were head (9 cases),body (3 cases) and tail (4 cases) of pancreas respectively;7 cases showed solid lesion,8 cases were cystic solid,one case was cystic;4 cases had calcification;11 cases had clear boundary,5 cases had ill defined boundary;6 cases had ductal dilatation.The peak of enhancement was showed at arterial phases in 9 cases,portal venous phase in 7 cases;3 cases had distant metastasis.The peak of enhancement showed significant statistical difference between these two types of tumor （P＜0.05）.No statistical difference could be assessed in tumor location,density,presence of calcification,boundary,ductal dilatation and presence of distant metastasis between these two tumors (P>0.05).Conclusion:Dynamic enhanced CT of pancreas is helpful in the differential diagnosis of solid psuedopapillary tumor and non-functional neuroendocrine tumor.The peak of enhancement in arterial phase was helpful in the diagnosis of non-functional neuroendocrine tumor,however,in solid psuedopapillary tumor,the enhancement peak was all in portal venous phase.Presence of distant metastasis tends to be helpful in the diagnosis of non functional neuroendocrine tumor.