摘要目的 探讨动态增强多层螺旋CT(MSCT)联合2D曲面重建技术对胰腺导管内乳头状黏液性肿瘤(IPMN)良恶性鉴别诊断的价值,并与MRCP进行对比分析.方法 回顾性分析经手术病理证实的50例IPMN患者的MSCT及MRCP影像学资料,根据影像图像出现壁结节、主胰管直径≥10 mm、分隔厚度≥2 mm、病灶内钙化、周围血管侵犯、胰周淋巴结肿大、远处转移灶以及分支胰管型IPMN病灶最大径≥30mm征象鉴别IPMN的良恶性,计算它们的敏感性、特异性和准确性,并绘制影像学征象的受试者工作特征(ROC)曲线,计算曲线下面积(AUC).结果 MSCT和MRCP以出现病灶内壁结节诊断恶性IPMN的敏感性、特异性和准确性分别为77.1％ (27/35)、80.0％ (12/15)、78.0％(39/50)和77.1％(27/35)、86.7％ (13/15)、80.0％ (40/50);以主胰管直径≥10 mm诊断恶性IPMN的敏感性、特异性、准确性分别为96.3％(26/27)、81.8％(9/11)、92.1％(35/38)和96.3％(26/27)、90.9％(10/11)、94.7％(36/38);以肿瘤内分隔厚度≥2 mm诊断恶性的敏感性、特异性和准确性分别为48.6％(17/35)、93.3％(14/15)、62.0％ (31/50)和51.4％ (18/35)、93.3％(14/15)、64.0％(32/50).50例IPMN中MSCT发现6例病灶内有钙化,其中5例病理诊断为恶性,而MRCP未发现钙化灶.MSCT的主胰管直径≥10 mm、壁结节、分隔厚度≥2 mm的AUC分别为0.973(P=0.000)、0.825(P=0.002)、0.704(P =0.051);MRCP的AUC分别为0.976(P =0.000)、0.825(P =0.002)、0.722(P=0.034).MSCT和MRCP诊断恶性IPMN的敏感性、特异性和准确性分别为94.3％(33/35)、73.3％ (11/15)、88.0％(44/50)和94.3％ (33/35)、80.0％(12/15)、90.0％ (45/50).结论 MSCT联合2D曲面重建图像或MRCP图像上出现IPMN病灶内壁结节、主胰管直径≥10 mm及分隔厚度≥2 mm对恶性IPMN有较高的诊断价值.MSCT与MRCP对IPMN良恶性的鉴别诊断价值基本一致,可作为缺乏MR设备的基层医院诊断IPMN的首选检查方法.

abstractsObjective To analyze the value of dynamic enhanced multi-slice spiral computed tomography (MSCT) combined with two-dimensional (2D) curved reconstruction technique in the differentiation of benign and malignant intraductal papillary mucinous neoplasm (IPMN) of pancreas,and compare with magnetic resonance cholangiopancreatography(MRCP).Methods MSCT and MRCP data of a total of 50 patients with IPMNs confirmed by pathology after surgery was retrospectively reviewed.The benign and malignant IPMNs were differentiated based on the presence of mural nodules,main pancreatic duct (MPD) ≥ 10 mm,septum thickness ≥2 mm,calcification,surrounding vascular infiltration,enlarged peripancreatic lymph nodules,distant metastatic lesions and maximal branch duct type IPMN lesions ≥30 mm shown in the images.The sensitivity,specificity and accuracy were calculated and the receiver-operating-characteristics (ROC) analysis were drawn.Area under the curve (AUC) was calculated.Results Mural nodules in MSCT had a sensitivity,specificity,and accuracy of 77.1％ (27/35),80.0％ (12/15) and 78.0％ (39/50) for diagnosing malignant IPMN,respectively;which in MRCP were 77.1％ (27/35),86.7％ (13/15),and 80.0％ (40/50) in comparison.When MPD diameter ≥10 mm was used for diagnose malignancy,MSCT and MRCP had the sensitivity,specificity,and accuracy of 96.3％ (26/27),81.8％ (9/11),92.1％ (35/38),and 96.3％ (26/27),90.9％ (10/11),94.7％ (36/38),respectively.For thick septum ≥2 mm,MSCT and MRCP had the sensitivity,specificity,and accuracy of 4.8.6％ (17/35),93.3％ (14/15),62.0％(31/50),and 51.4％ (18/35),93.3％ (14/15),64.0％ (32/50),respectively.Out of 50 cases,calcifications were detected on MSCT in 6 patients,and 5 of them were pathologically diagnosed as malignant IPMN.MRCP failed to identify calcifications in any of these lesions.For MSCT,the AUC of MPD diameter ≥ 10 mm,mural nodules and thick septum ≥ 2 mm were 0.973 (P =0.000),0.825 (P =0.002) and 0.704(P =0.051),respectively.For MRCP,the AUC of the three factors above were 0.976(P =0.000),0.825(P =0.002),0.722 (P =0.034),respectively.For the predicting of IPMN malignancy,MSCT had an overall sensitivity,specificity,and accuracy of 94.3％ (33/35),73.3％ (11/15) and 88.0％ (44/50),respectively;in comparison,MRCP had values of 94.3％ (33/35),80.0％ (12/15) and 90.0％ (45/50),respectively.Conclusions Presence of mural nodules,MPD ≥10 mm and thick septum ≥2 mm on MSCT combined with 2D curved reconstruction or MRCP have a high value for predicting the malignancy of IPMN.The values of MSCT and MRCP were basically consistent in the differentiation of benign and malignant IPMN.MSCT can be used as the preferred examination for diagnosing IPMN in the primary hospitals without MR equipment.