Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas
Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas
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DOI：
10.1007/s00330-019-06588-9
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发表时间：
2020-02-05
影响因子：
5.9
通讯作者：
Han, Joon Koo
中科院分区：
文献类型：
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作者：
Bae, Jae Seok;Kim, Se Hyung;Han, Joon Koo
目的探讨胆囊神经内分泌肿瘤（GB-NETs）与胆囊腺癌（GB-ADCs）的MRI鉴别特征及其预后价值。方法回顾性纳入2008年1月至2018年12月期间接受MRI检查的GB恶性肿瘤患者。两名放射科医生独立评估MRI结果并达成共识。识别了区分GB-NET和GB-ADC的重要MRI特征。进行了考克斯回归分析，以发现MRI特征对总生存率的预后。结果63例患者中，GB-NETs 21例，GB-ADCs 42例。与GB-ADC相比，GB-NET更常表现出以下MRI特征：边界清晰，上覆粘膜完整，厚边缘对比增强和/或扩散限制（ps < 0.001）。肝转移更常见，在GB-NETs中显示厚边缘增强和扩散限制（ps < 0.001）。淋巴结（LN）转移在GB-NET中比在GB-ADC中更常显示厚边缘扩散限制（p = 0.009）。在定量分析中，GB-NET中的GB块和转移性LN的大小大于GB-ADC中的那些（分别为p = 0.002和p = 0.010）。病变和脾脏之间的表观扩散系数值的比值在GB-NETs的GB肿块、肝转移和LN转移中低于GB-ADC（分别为p < 0.001、p = 0.017和p < 0.001）。生存分析显示，大转移性LN（风险比1.737; 95%可信区间1.112-2.712）是唯一的不良预后因素（p = 0.015）。结论多种MRI表现有助于鉴别GB-NETs和GB-ADC。大转移性LN与生存率低相关。
Objectives To identify MRI features that are helpful for the differentiation of gallbladder neuroendocrine tumors (GB-NETs) from gallbladder adenocarcinomas (GB-ADCs) and to evaluate their prognostic values. Methods Between January 2008 and December 2018, we retrospectively enrolled patients who underwent MRI for GB malignancy. Two radiologists independently assessed the MRI findings and reached a consensus. Significant MRI features, which distinguish GB-NETs from GB-ADCs, were identified. Cox regression analyses were performed to find MRI features that were prognostic for overall survival. Results There were 63 patients with GB-NETs (n = 21) and GB-ADCs (n = 42). Compared with GB-ADCs, GB-NETs more frequently demonstrated the following MRI features: well-defined margins, intact overlying mucosa, and thick rim contrast enhancement and/or diffusion restriction (ps < 0.001). Liver metastases were more common and demonstrated thick rim contrast enhancement and diffusion restriction in GB-NETs (ps < 0.001). Lymph node (LN) metastasis showed thick rim diffusion restriction more often in GB-NETs than in GB-ADCs (p = 0.009). On quantitative analysis, the sizes of the GB mass and metastatic LNs in GB-NETs were larger than those in GB-ADCs (p = 0.002 and p = 0.010, respectively). The ratio of apparent diffusion coefficient values between the lesion and the spleen was lower in the GB mass, liver metastases, and LN metastases of GB-NETs than those of GB-ADCs (p < 0.001, p = 0.017, and p < 0.001, respectively). Survival analysis revealed that a large metastatic LN (hazard ratio 1.737; 95% confidence interval, 1.112-2.712) was the only poor prognostic factor (p = 0.015). Conclusion Several MRI features aided in differentiating between GB-NETs and GB-ADCs. A large metastatic LN was associated with poor survival.