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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (08) : 788 -794. doi: 10.3877/cma.j.issn.1672-6448.2021.08.014

腹部超声影像学

常规超声联合超声造影对胰腺浆液性囊腺瘤与黏液性囊性肿瘤的鉴别诊断
刘阳1, 朱丽1, 陈伟男1, 李建春1, 王力1, 王立刚1, 范小明1, 彭成忠1,()   
  1. 1. 310014 杭州,浙江省人民医院 杭州医学院附属人民医院超声医学科
  • 收稿日期:2021-03-09 出版日期:2021-08-01
  • 通信作者: 彭成忠
  • 基金资助:
    浙江省卫生健康科技计划(2020KY419,2021PY036); 浙江省中医药科技计划(2021ZB018); 浙江省人民医院优秀科研启动基金(ZRY2020B009)

Value of conventional ultrasound combined with contrast-enhanced ultrasound in differential diagnosis of serous cystic adenoma and mucinous cystic neoplasm of the pancreas

Yang Liu1, Li Zhu1, Weinan Chen1, Jianchun Li1, Li Wang1, Ligang Wang1, Xiaoming Fan1, Chengzhong Peng1,()   

  1. 1. Department of Ultrasonography, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310014, China
  • Received:2021-03-09 Published:2021-08-01
  • Corresponding author: Chengzhong Peng
引用本文:

刘阳, 朱丽, 陈伟男, 李建春, 王力, 王立刚, 范小明, 彭成忠. 常规超声联合超声造影对胰腺浆液性囊腺瘤与黏液性囊性肿瘤的鉴别诊断[J/OL]. 中华医学超声杂志(电子版), 2021, 18(08): 788-794.

Yang Liu, Li Zhu, Weinan Chen, Jianchun Li, Li Wang, Ligang Wang, Xiaoming Fan, Chengzhong Peng. Value of conventional ultrasound combined with contrast-enhanced ultrasound in differential diagnosis of serous cystic adenoma and mucinous cystic neoplasm of the pancreas[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(08): 788-794.

目的

探讨常规超声及超声造影(CEUS)对胰腺浆液性囊腺瘤(serous cystic adenoma,SCA)和黏液性囊性肿瘤(mucinous cystic neoplasm,MCN)的鉴别诊断价值。

方法

回顾性分析浙江省人民医院2016年6月至2020年12月经手术病理证实的86例胰腺SCA和MCN的一般临床资料及常规超声和CEUS影像资料,对其进行单因素及多因素Logistic回归分析,并建立Logistic回归模型,绘制回归模型鉴别SCA与MCN的ROC曲线,评价常规超声及CEUS特征对SCA与MCN的鉴别诊断价值。

结果

86例胰腺囊性肿瘤病例中SCA共58例,MCN共28例。单因素分析结果显示:SCA与MCN的性别、肿瘤生长部位、生长形态、临床症状、CEUS动脉期增强强度及强化模式比较,差异均无统计学意义(P均>0.05);2组的发病年龄、瘤体最大径、病灶内部囊腔是否≥6个、有无钙化及钙化在病灶内的分布情况、单个囊腔的最大径是否≥20 mm、囊壁厚度及均匀性、囊壁结节的有无及CEUS静脉期增强强度比较,差异均有统计学意义(P均<0.05)。Logistic多因素回归分析结果显示:囊腔个数≥6个(OR=0.163,95%CI:0.047~0.561)、囊壁增厚或厚度不均(OR=9.388,95%CI:2.663~33.094)及单囊腔直径≥20 mm(OR=3.254,95%CI:1.037~10.213)是诊断MCN的独立危险因素,建立Logistic回归模型为:Logit(P)=-2.792-1.815X3(囊腔个数)+2.239X5(囊壁特征)+1.180X6(单囊腔直径),ROC曲线显示该回归模型鉴别SCA与MCN的曲线下面积为0.823(95%CI:0.734~0.913)。

结论

胰腺SCA和MCN具有各自的超声影像学特征,应用常规超声及CEUS可以较好地对二者进行鉴别,为临床进一步治疗提供依据。

Objective

To investigate the routine ultrasound and contrast enhanced ultrasound (CEUS) manifestations of serous cystic adenoma (SCA) and mucinous cystic neoplasm (MCN) of the pancreas, in order to improve their diagnostic accuracy.

Methods

The clinical data and conventional ultrasound and CEUS imaging data of 86 cases of SCA and MCN confirmed by surgery and pathology at Zhejiang Provincial People's Hospital from June 2016 to December 2020 were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to evaluate the diagnostic value of clinical data as well as conventional ultrasound and CEUS characteristics in SCA and MCN.

Results

There were 58 cases of SCA and 28 cases of MCN. Univariate analysis showed that there were no significant differences between SCA and MCN in gender, tumor site, tumor morphology, clinical symptoms, and enhancement intensity and mode of CEUS in the arterial phase (P>0.05). There were statistically significant differences between the two groups in age of onset, the largest diameter of the tumor, the presence of more than six cysts in the lesion or not, the presence of calcification or not and the distribution of calcification in the lesion, the largest diameter of a single cyst more than or equal to 20 mm or not, the uniformity of the thickness of the cyst wall, the presence of cyst wall nodules or not, and the intensity of enhancement in the middle venous phase of CEUS (P<0.05). Multivariate analysis showed that the number of cysts ≥6, non-uniform cyst wall, and the diameter of single cyst ≥20 mm were independent risk factors for the diagnosis of MCN, with odds ratio values of 0.163 (95% confidence interval [CI]: 0.047-0.561), 9.388 (95%CI: 2.663-33.094), and 3.254 (95%CI: 1.037-10.213), respectively. The Logistic regression model was as follows: Logit (P) = -2.792-1.815X3 (number of cystic cavities) + 2.239X5 (characteristics of cystic walls) + 1.180X6 (diameter of single cystic cavities). ROC curve analysis showed that the area under the curve of this regression model for identifying SCA and MCN was 0.823 (95%CI: 0.734-0.913).

Conclusion

Pancreatic SCA and MCN have appreciated imaging characteristics, and ultrasound examination allows for a better differential diagnosis of the two, thus providing a basis for clinical treatment.

图1 患者,女,47岁,胰腺浆液性微囊腺瘤超声及超声造影图像。图a为常规超声示胰腺头颈部囊实性病灶;图b为超声造影动脉期示病灶实性部分明显强化,囊性部分无强化;图c为超声造影静脉期示实性部分仍呈高增强
图2 患者,女,50岁,胰腺浆液性巨囊腺瘤超声及超声造影图像。图a为常规超声示胰腺头颈部多囊性病灶,单囊直径大于20 mm;图b为超声造影动脉期示病灶实性部分明显强化,囊性部分无强化;图c为超声造影静脉期示病灶实性部分明显强化,囊性部分无强化
图3 患者,男,58岁,胰腺黏液性囊腺癌超声及超声造影图像。图a为常规超声示胰腺体尾部囊实性占位,囊壁厚薄不均;图b为超声造影动脉期示病灶实性部分轻度强化,囊性部分无强化;图c为超声造影静脉期示病灶实性部分强化减退,囊性部分无强化
表1 SCA与MCN一般资料比较
表2 SCA与MCN常规超声特征比较(例)
表3 SCA与MCN的CEUS特征比较[例(%)]
表4 鉴别SCA与MCN的各因素赋值表
表5 鉴别SCA与MCN的二元多因素Logistic回归分析
图4 Logistic回归模型鉴别诊断浆液性囊腺瘤与黏液性囊性肿瘤的ROC曲线
表6 不同病理类型MCN的CEUS特征比较(例)
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