| 摘要: |
| 目的 分析伴有胰管梗阻的胰腺神经内分泌肿瘤（pNEN）的影像学特征及误诊原因。方法 回顾性分析2012年6月至2018年10月在我院接受手术治疗并经病理检查证实的25例伴有胰管梗阻的pNEN患者资料，由2名高年资影像诊断医师统计资料并总结其影像学表现及误诊原因。结果 25例患者共26枚病灶纳入研究，包括G1级病灶6枚、G2级19枚、G3级1枚，病灶大小为（2.5±1.7）cm（0.4～9.1 cm）。26枚病灶中，主胰管轻度扩张12枚（46.2%），中度扩张8枚（30.8%），显著扩张6枚（23.1%）。17枚（65.4%）病灶上游胰腺实质重度萎缩，6枚（23.1%）上游胰腺实质中度萎缩，1枚（3.8%）上游胰腺实质轻度萎缩，2枚（7.7%）未见上游胰腺实质萎缩。术前14枚（53.8%）病灶正确诊断为pNEN，8枚（30.8%）误诊为胰腺癌，2枚（7.7%）误诊为胰腺实性假乳头状瘤，1枚（3.8%）误诊为胰腺浆液性囊腺瘤，1枚（3.8%）误诊为胰腺导管内乳头状黏液瘤。误诊原因主要为病灶表现不典型、对疾病的不典型表现认识不足、影像细节观察不到位、未完整结合患者临床资料进行判断等。结论 伴有胰管梗阻的pNEN有时与其他胰腺肿瘤的鉴别诊断存在难度，熟悉该病的不典型表现、细心观察影像细节，同时密切结合临床资料有助于减少误诊，提高该病的诊断准确率。 |
| 关键词: 胰腺肿瘤 神经内分泌瘤 X线计算机体层摄影术 磁共振成像 |
| DOI：10.16781/j.0258-879x.2020.10.1096 |
| 投稿时间：2020-03-09修订日期：2020-06-05 |
| 基金项目: |
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| Imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm with pancreatic duct obstruction |
| ZHANG Qian-wen,SONG Tao,HAO Qiang,MA Qing,ZHOU Zhen,LU Jian-ping* |
(Department of Radiology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the imaging feature and misdiagnosis reason of pancreatic neuroendocrine neoplasm (pNEN) with pancreatic duct obstruction. Methods The data of 25 patients with pNEN accompanied by pancreatic duct obstruction who underwent surgical treatment in our hospital from Jun. 2012 to Oct. 2018 were retrospectively analyzed. The imaging findings and misdiagnosis reason of pNEN were summarized by two senior radiologists. Results A total of 26 lesions in 25 patients were included, including six G1 tumors, 19 G2 tumors and one G3 tumor. The average size of the lesions was (2.5±1.7) cm (range, 0.4-9.1 cm). Of the 26 lesions, the main pancreatic duct was mildly dilated in 12 cases (46.2%), moderately dilated in eight cases (30.8%), and severely dilated in six cases (23.1%). Seventeen (65.4%) lesions were accompanied by severe atrophy of the upstream pancreatic parenchyma, six (23.1%) by moderate atrophy, one (3.8%) by mild atrophy, and two (7.7%) with no atrophy. Before operation, 14 (53.8%) lesions were correctly diagnosed as pNEN; and eight (30.8%) lesions were misdiagnosed as pancreatic cancer, two (7.7%) as solid pseudopapillar tumor, one (3.8%) as intraductal papillary mucinous neoplasm and one (3.8%) as serous cystadenoma. The main reasons of misdiagnosis included atypical lesion manifestations, insufficient understanding of atypical manifestations of the disease, inadequate observation of image details, less consideration of clinical data of the patients, etc. Conclusion It is difficult to differentiate pNEN with pancreatic duct obstruction from other pancreatic tumors. Being familiar with the atypical manifestations of the lesion, observing the image details carefully and understanding clinical data with imaging findings can help to reduce misdiagnosis and improve the accuracy of diagnosis. |
| Key words: pancreatic neoplasms neuroendocrine tumors X-ray computed tomography magnetic resonance imaging |
