本文選題：胰腺腫瘤 + 導(dǎo)管內(nèi)乳頭狀黏液瘤��； 參考：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2017年05期

【摘要】：目的探討壁結(jié)節(jié)的影像學(xué)表現(xiàn)在鑒別胰腺導(dǎo)管內(nèi)乳頭狀黏液瘤(IPMN)良惡性中的價(jià)值。方法回顧性分析2012年1月至2016年6月于長(zhǎng)海醫(yī)院診治的112例IPMN患者的病理和影像學(xué)資料�；颊咝g(shù)前均行CT和MRI檢查,由2位主治醫(yī)師觀察病灶壁結(jié)節(jié)的影像學(xué)表現(xiàn),比較并分析良、惡性IPMN的壁結(jié)節(jié)大小、位置、個(gè)數(shù)、邊界和強(qiáng)化程度。繪制受試者工作特征(ROC)曲線,計(jì)算曲線下面積(AUC),評(píng)價(jià)壁結(jié)節(jié)大小、個(gè)數(shù)、邊界在鑒別IPMN良惡性中的作用,并確定壁結(jié)節(jié)大小的最佳診斷界值和敏感度、特異度及準(zhǔn)確度。結(jié)果納入經(jīng)手術(shù)病理證實(shí)且在影像學(xué)檢查中明確觀察到壁結(jié)節(jié)的IPMN患者61例,病理檢查結(jié)果示良性36例、惡性25例;主胰管型15例、分支型為13例、混合型33例,良、惡性患者IPMN分型差異有統(tǒng)計(jì)學(xué)意義(P=0.01)。壁結(jié)節(jié)大小對(duì)判斷IPMN良惡性有臨床意義(P0.01),其鑒別良、惡性的最佳診斷界值為1.35 cm,AUC為74.7%,敏感度56.0%、特異度91.7%、準(zhǔn)確度77.5%。良、惡性患者的壁結(jié)節(jié)個(gè)數(shù)(P=0.02)、邊界(P0.01)差異均有統(tǒng)計(jì)學(xué)意義,其鑒別良、惡性的AUC分別為64.2%、72.1%。所有患者壁結(jié)節(jié)強(qiáng)化程度均為漸進(jìn)性強(qiáng)化,良、惡性患者的強(qiáng)化程度差異無統(tǒng)計(jì)學(xué)意義。結(jié)論壁結(jié)節(jié)影像學(xué)表現(xiàn)對(duì)IPMN良惡性的鑒別具有敏感性,對(duì)術(shù)前評(píng)估和隨訪具有一定的臨床價(jià)值。
[Abstract]:Objective to investigate the value of imaging findings of mural nodules in differentiating benign and malignant pancreatic intraductal papillary myxoma (IPMN). Methods the histopathological and imaging data of 112 IPMN patients treated in Changhai Hospital from January 2012 to June 2016 were retrospectively analyzed. Both CT and MRI were performed before operation. The imaging findings of the lesions were observed by two attending physicians, and the size, location, number, boundary and enhancement degree of benign and malignant IPMN were compared and analyzed. The area under the curve was calculated to evaluate the role of the size, number and boundary of the wall nodules in differentiating benign and malignant IPMN, and to determine the best diagnostic threshold and sensitivity, specificity and accuracy of the size of the wall nodules. Results among 61 cases of IPMN confirmed by operation and pathology, 36 cases were benign, 25 cases were malignant, 15 cases were main pancreatic duct type, 13 cases were branching type, 33 cases were mixed type. The difference of IPMN classification in malignant patients was statistically significant (P < 0.01). The size of the wall nodule has clinical significance for the diagnosis of benign and malignant IPMN. The best diagnostic threshold for differentiating benign and malignant is 1.35 cm ~ (-1) IPMN. The sensitivity is 56.0, the specificity is 91.7, and the accuracy is 77.5. There were significant differences in the number of mural nodule between benign and malignant patients (P < 0.02, P 0.01). The AUC of benign and malignant was 64.2 and 72.1, respectively. The enhancement degree of wall nodules in all patients was progressive, but there was no significant difference between benign and malignant patients. Conclusion the imaging findings of mural nodules are sensitive to the differential diagnosis of benign and malignant IPMN, and have certain clinical value for preoperative evaluation and follow-up.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院影像醫(yī)學(xué)科;
【分類號(hào)】：R735.9

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