定量分析钙化和囊变鉴别肿块型慢性胰腺炎与胰腺导管腺癌
Quantitative analysis of calcification and cystic degeneration in differentiating mass-forming chronic pancreatitis from pancreatic ductal adenocarcinoma
夏小梅 1阮志兵 2陈慧淋 1文凤 1陈坤 1石士晗1
作者信息
- 1. 贵州医科大学医学影像学院 贵州 贵阳 550004
- 2. 贵州医科大学附属医院放射科 贵州 贵阳 550004
- 折叠
摘要
目的 定量分析肿块内钙化和囊变,探讨量化指标钙化体积与主观评估钙化及囊变CT征象在鉴别肿块型慢性胰腺炎(MFCP)与胰腺导管腺癌(PDAC)中的价值及其诊断效能的差异.方法 选取 103 例MFCP患者(MFCP组)与188 例PDAC患者(PDAC组)的临床及CT资料,重点分析肿块内钙化及囊变CT征象,并基于软件定量分析技术提取肿块内钙化体积及测量最大囊直径,对两组数据进行统计学分析,ROC曲线评估钙化发生率、囊变发生率及钙化体积在鉴别MFCP与PDAC的诊断效能.结果 1)肿块钙化:MFCP组与PDAC组钙化发生率分别为 54.4%与 10.1%,差异有统计学意义(P<0.001);MFCP组以混合型钙化、多发且弥漫分布为主,PDAC组以少许斑点状、结节状钙化且中心分布为主;两者钙化体积(cm3)Median(IQR)分别为 1.16(0.55,2.54)与 0.12(0.06,0.24),差异有统计学意义(P<0.001);2)肿块囊性灶:MFCP组与PDAC组囊变发生率分别为 77.7%与 48.9%,差异有统计学意义(P<0.001),其中蜂窝状囊性灶仅见于MFCP组,发生率为 16.5%,MFCP组囊性灶多饱满有张力,18 例囊壁钙化;PDAC组囊性灶表现形式多样(囊实性24 例、单纯囊性灶 5 例),1 例囊壁钙化;两组在多发囊发生率、最大囊直径比较差异无统计学意义(P>0.05);3)ROC评价:两组在钙化发生率、囊变发生率及钙化体积的AUC值分别为 0.726、0.664、0.876,钙化体积最佳截断值为 0.32cm3,当钙化体积>0.32 cm3 时提示为MFCP.结论 钙化与囊变CT征象有助于MFCP与PDAC鉴别,定量指标钙化体积具有更好鉴别诊断效能,多发、弥漫分布混合型钙化与饱满具有张力的蜂窝状囊性灶有助于诊断MFCP,钙化体积>0.32cm3时提示为MFCP.
Abstract
Objective To quantitatively analyze the calcification and cystic changes in the mass,and to explore the value of quantitative index calcification volume and subjective evaluation of calcification and cystic CT signs in the differential diagnosis of mass-forming chronic pancreatitis(MFCP)and pancreatic ductal adenocarcinoma(PDAC)and the difference in diagnostic efficacy.Methods The clinical and CT data of 103 patients with MFCP and 188 patients with PDAC were collected,and the CT signs of calcification and cystic degeneration in the mass were analyzed.Based on the software quantitative analysis technol-ogy,the calcification volume in the mass was extracted and the maximum cyst diameter was measured.The data of the two groups were statistically analyzed.The ROC curve was used to evaluate the diagnostic efficacy of the incidence of calcification,the inci-dence of cystic degeneration and the volume of calcification in differentiating MFCP from PDAC.Results 1)Mass calcifica-tion:The incidence of calcification in the MFCP group and the PDAC group was 54.4％and 10.1％,respectively,and the dif-ference was statistically significant(P＜0.001).The MFCP group was dominated by mixed calcification,multiple and diffuse distribution,and the PDAC group was dominated by a few spotted,nodular calcification and central distribution.The calcifica-tion volume(cm3)Median(IQR)was 1.16(0.55,2.54)and 0.12(0.06,0.24),respectively,and the difference was statisti-cally significant(P<0.001).2)Cystic lesions:The incidence of cystic lesions in MFCP group and PDAC group was 77.7％and 48.9％,respectively,and the difference was statistically significant(P<0.001).Among them,honeycomb cysts were only found in the MFCP group,with an incidence of 16.5％.The cystic lesions in the MFCP group were full of tension,and 18 cases of cys-tic wall calcification.The cystic lesions in the PDAC group showed various forms(24 cases of cystic solid and 5 cases of simple cystic lesions),and 1 case of cystic wall calcification.There was no significant difference in the incidence of multiple cysts and the maximum cyst diameter between the two groups(P＞0.05).3)ROC evaluation:The AUC values of calcification incidence,cystic degeneration incidence and calcification volume in the two groups were 0.726,0.664 and 0.876,respectively.The optimal cutoff value of calcification volume was 0.32cm3.When the calcification volume was＞0.32cm3,it was suggested to be MFCP.Conclusion The CT signs of calcification and cystic degeneration are helpful for the differential diagnosis of MFCP and PDAC.The quantitative index calcification volume has better differential diagnosis efficiency.Multiple,diffusely distributed mixed calci-fication and full honeycomb cystic lesions with tension are helpful for the diagnosis of MFCP.MFCP is indicated when the calcifi-cation volume＞0.32 cm3.
关键词
肿块型慢性胰腺炎/胰腺导管腺癌/钙化/囊变/体层摄影技术,X线计算机Key words
Mass-forming chronic pancreatitis/Pancreatic ductal adenocarcinoma/Calcification/Cystic degeneration/To-mography,X-ray computed引用本文复制引用
出版年
2024
NETL
NSTL
万方数据