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目的探讨动态增强CT征象在鉴别胃肠胰神经内分泌癌(GEP-NECs)与伴神经内分泌分化(NED)腺癌(GEP-ADCs)肝转移的可行性。方法回顾性分析经手术或活检病理证实的GEP-NECs肝转移患者49例及NED(+)的GEP-ADCs肝转移患者17例。对比肝转移灶动态增强CT影像学征象。结果 GEP-NECs与NED(+)的GEP-ADCs肝转移两组比较,病灶分布、数量、大小、形态、动态增强类型、肝动脉期强化范围、伴发腹腔积液及淋巴结肿大出现比例两组差异无统计学意义(P值均>0.05)。在GEP-NECs中肝动脉期瘤周灌注增高出现比例高于NED(+)的GEP-ADCs组(34.7%比11.8%),虽然两组比较未达到统计学意义(P=0.137),但Logistic回归分析显示其是判断GEP-ADCs的独立预测因素(P=0.048),ROC分析其判断GEP-ADCs的曲线下面积为0.705。结论GEP-NECs与NED(+)GEP-ADCs的CT征象中,肝动脉期瘤周灌注增高具有潜在鉴别诊断价值。
Objective To investigate the feasibility of dynamic contrast-enhanced CT in differentiating hepatic metastases from gastrointestinal pancreatic neuroendocrine carcinoma (GEP-NECs) and neuroendocrine differentiation (NEP) adenocarcinoma (GEP-ADCs). Methods A total of 49 patients with GEP-NECs liver metastasis and 17 patients with NEP (+) GEP-ADCs liver metastasis confirmed by surgery or biopsy were retrospectively analyzed. Contrasting liver metastases dynamic enhanced CT imaging signs. Results The distribution, number, size, shape, dynamic enhancement type of GEP-NECs and hepatic metastasis of GEP-ADCs in NED (+) group were significantly different There was no significant difference between the two groups (P> 0.05). In the GEP-NECs, the rate of peri-perfusion in hepatic artery was higher than that in NEP (+) GEP-ADCs group (34.7% vs. 11.8%). Although the two groups did not reach statistical significance (P = 0.137) Regression analysis showed that it was an independent predictor of GEP-ADCs (P = 0.048). The ROC analysis showed that the area under the curve of GEP-ADCs was 0.705. Conclusion Among the CT signs of GEP-NECs and NED (+) GEP-ADCs, there is a potential differential diagnostic value in the peritumoral perfusion of hepatic artery.