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  • 宋涛,刘敬禹,马超,陈录广,陆建平,邢朋毅.胰腺实性假乳头状瘤的影像学表现及生长特点研究[J].第二军医大学学报,2019,40(12):1292-1297    [点击复制]
  • SONG Tao,LIU Jing-yu,MA Chao,CHEN Lu-guang,LU Jian-ping,XING Peng-yi.Imaging features and growth characteristics of solid pseudopapillary tumor of pancreas[J].Acad J Sec Mil Med Univ,2019,40(12):1292-1297   [点击复制]
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胰腺实性假乳头状瘤的影像学表现及生长特点研究
宋涛1,刘敬禹2,马超1,陈录广1,陆建平1*,邢朋毅1
0
(1. 海军军医大学(第二军医大学)长海医院影像医学科, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院介入诊疗科, 上海 200433
*通信作者)
摘要:
目的 分析胰腺实性假乳头状瘤(SPTP)的计算机断层扫描(CT)及磁共振成像(MRI)特征,研究其生长特点,以提高对SPTP的认识及诊断水平。方法 回顾性分析2012年5月至2018年11月于我院行手术切除且术后病理证实为SPTP的103例患者的临床资料及CT、MRI资料。分析患者的性别、年龄、肿瘤最大径、肿瘤部位、肿瘤形状、是否有假包膜、是否有囊性退变、是否有瘤内出血及钙化等资料,并根据性别、年龄、肿瘤最大径、肿瘤部位进行分层分析。结果 共纳入103例SPTP患者104枚病灶,其中男25例(24.3%)25枚肿瘤,女78例(75.7%)79枚肿瘤。男性、女性患者平均年龄分别为(40.4±11.3)岁和(32.9±12.0)岁,差异有统计学意义(P=0.004)。男性、女性患者肿瘤平均最大径分别为(36.8±25.3)mm和(50.0±31.2)mm,差异有统计学意义(P=0.046)。分层分析结果显示,女性患者肿瘤更容易出现假包膜(62枚)、囊性退变(41枚)及瘤内出血(37枚),与男性患者(分别为13枚、3枚、6枚)相比差异均有统计学意义(P均<0.05);年龄≤40岁SPTP患者更容易出现肿瘤囊性退变(37枚)及瘤内出血(37枚),与年龄>40岁患者(分别为7枚、6枚)相比差异均有统计学意义(P均<0.01);最大径>3 cm的肿瘤主要分布在胰尾(33枚),且更容易形成假包膜(59枚)及发生囊性退变(40枚)、瘤内钙化(26枚),与最大径≤3 cm肿瘤(分别为14枚、16枚、4枚、5枚)比较差异均有统计学意义(P均<0.01);胰尾肿瘤更容易形成假包膜(40枚)及囊性退变(25枚),其次为胰头肿瘤(分别为26枚、17枚),差异均有统计学意义(P均<0.01)。结论 SPTP的发生、发展可能是一个经完全实性、囊实性、囊性变化的动态过程,在此过程的不同阶段,影像学表现随着肿瘤内部成分的不同而不同。女性患者、≤40岁患者、胰尾肿瘤、最大径>3 cm的肿瘤更容易形成假包膜,以及发生囊性退变、瘤内出血及钙化。
关键词:  实性假乳头状瘤  胰腺肿瘤  X 线计算机体层摄影术  磁共振成像  囊性退变
DOI:10.16781/j.0258-879x.2019.12.1292
投稿时间:2019-09-19修订日期:2019-11-18
基金项目:国家自然科学基金(81601468,81871352),上海市科学技术委员会科研计划项目(17411952200),国家临床重点专科军队建设项目(总后卫生部).
Imaging features and growth characteristics of solid pseudopapillary tumor of pancreas
SONG Tao1,LIU Jing-yu2,MA Chao1,CHEN Lu-guang1,LU Jian-ping1*,XING Peng-yi1
(1. Department of Radiology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Interventional Radiology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of solid pseudopapillary tumor of pancreas (SPTP) and to study the growth characteristics, so as to improve the understanding and diagnosis of SPTP. Methods The clinical data, and CT and MRI data of 103 patients with SPTP confirmed by postoperative pathology, who underwent surgical resection in our hospital between May 2012 and Nov. 2018, were analyzed retrospectively. The gender, age, tumor maximum diameter, tumor location, tumor shape, pseudocapsule, cystic degeneration, intratumoral hemorrhage and calcification were analyzed, and the stratified analysis was carried out according to gender, age, tumor maximum diameter and tumor location. Results A total of 104 lesions (25 lesions in males and 79 in females) of 103 SPTP patients (25[24.3%] males and 78[75.7%] females) were included. The average ages of the males and females were (40.4±11.3) years old and (32.9±12.0) years old, respectively, and the difference was significant (P=0.004). The mean tumor maximum diameters of the males and females were (36.8±25.3) mm and (50.0±31.2) mm, respectively, and the difference was significant (P=0.046). The results of stratified analysis showed that the females were more likely to have pseudocapsule (62 cases), cystic degeneration (41 cases) and intratumoral hemorrhage (37 cases) compared with the males (13 cases, 3 cases and 6 cases, respectively), and the differences were significant (all P<0.05). The patients aged ≤ 40 years old were more likely to have tumor cystic degeneration (37 cases) and intratumoral hemorrhage (37 cases) compared with the patients aged > 40 years old (7 cases and 6 cases, respectively), and the differences were significant (both P<0.01). The tumors with maximum diameter > 3 cm were mainly distributed in the tail of the pancreas (33 cases), and were more likely to have pseudocapsule (59 cases), cystic degeneration (40 cases) and intratumoral calcification (26 cases) compared with the tumors with maximum diameter ≤ 3 cm (14 cases, 16 cases, 4 cases and 5 cases, respectively), and the differences were significant (all P<0.01). The tumors in the tail of the pancreas were more likely to have pseudocapsule (40 cases) and cystic degeneration (25 cases), followed by the tumors in the head of the pancreas (26 cases and 17 cases, respectively), and the differences were significant (both P<0.01). Conclusion The development and progression of SPTP may be a dynamic process of complete solid, cystic solid and cystic changes. At different stages of this process, the imaging manifestations vary with the internal components of the tumors. The tumors in females, in patients aged ≤ 40 years old, in the tail of the pancreas or with the maximum diameter > 3 cm are more likely to have pseudocapsule, cystic degeneration, hemorrhage and calcification.
Key words:  solid pseudopapillary tumor  pancreatic neoplasms  X-ray computed tomography  magnetic resonance imaging  cystic degeneration