Insulinoma Detection With MDCT: Is There a Role for Whole-Pancreas Perfusion?
Insulinoma Detection With MDCT: Is There a Role for Whole-Pancreas Perfusion?
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MDCT 胰岛素瘤检测：全胰腺灌注有作用吗？
DOI：
10.2214/ajr.16.16351
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发表时间：
2017-02-01
影响因子：
5
通讯作者：
Zhao, Yupei
中科院分区：
文献类型：
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作者：
Zhu, Liang;Xue, Huadan;Zhao, Yupei
客观的。本研究的目的是探讨全胰腺灌注在使用 MDCT 检测胰岛素瘤中的作用。材料和方法。回顾性分析2011年1月至2011年12月期间连续70例因疑似胰岛素瘤而接受双相增强CT和全胰腺CT灌注的患者（男性33例，女性37例；平均年龄46岁；范围17-73岁）。对患者进行至少 3 年的监测。两名对临床和手术数据不知情的放射科医生独立评估了图像，首先仅评估双相增强 CT 图像以检测肿瘤并以 5 分制评估诊断置信度。接下来，评估灌注参数图并测量胰腺灌注参数，并结合双相 CT 和灌注图像集重新识别肿瘤的存在。生成 ROC 曲线来比较两个图像集的诊断准确性。结果。胰岛素瘤和胰岛素瘤所在区域的平均血流量 (BF) 值均显着高于无肿瘤胰腺实质的 BF 值（两者均 p < 0.01）。对于胰岛素瘤的检测，双相CT的敏感性为88.1%，特异性为85.7%，阳性预测值为91.1%，阴性预测值为81.4%，而双相CT联合灌注的敏感性为94.6%，特异性为94.7%，阳性预测值为96.7%，阴性预测值为91.5%。 ROC 曲线下的平均面积从双相 CT 的 0.939 增加到添加灌注后的 0.999。双相 CT 检测结果呈阴性 (n = 2) 或不确定 (n = 7) 的 46 个肿瘤中有 9 个 (19.6%) 通过添加灌注得到了正确诊断。结论。在双相增强 CT 中添加胰腺灌注可能会提高胰岛素瘤的检出率。
OBJECTIVE. The purpose of this study is to investigate the role of whole-pancreas perfusion in detecting insulinomas with the use of MDCT.MATERIALS AND METHODS. From January 2011 to December 2011, a total of 70 consecutive patients (33 men and 37 women; mean age, 46 years; range, 17-73 years) who underwent biphasic contrast-enhanced CT and whole-pancreas CT perfusion for suspected insulinomas were identified retrospectively. Patients were monitored for at least 3 years. Two radiologists who were blinded to the clinical and surgical data independently evaluated the images, first assessing only the biphasic contrast-enhanced CT images to detect tumor and assess diagnostic confidence on a 5-point scale. Next, perfusion parametric maps were evaluated and pancreatic perfusion parameters measured, and the presence of tumor was reidentified using a combination of the biphasic CT and perfusion image sets. A ROC curve was generated to compare the diagnostic accuracy of the two image sets.RESULTS. The mean blood flow (BF) values of both the insulinomas and the insulinoma-harboring regions were statistically significantly higher (p < 0.01, for both) than the BF value of tumor-free pancreatic parenchyma. For the detection of insulinoma, biphasic CT had a sensitivity of 88.1%, a specificity of 85.7%, a positive predictive value of 91.1%, and a negative predictive value of 81.4%, whereas combined biphasic CT and perfusion had a sensitivity of 94.6%, a specificity of 94.7%, a positive predictive value of 96.7%, and a negative predictive value of 91.5%. The mean area under the ROC curve increased from 0.939 with biphasic CT to 0.999 with the addition of perfusion. Nine of 46 tumors (19.6%) for which findings were negative (n = 2) or indeterminate (n = 7) on biphasic CT were correctly diagnosed with the addition of perfusion.CONCLUSION. The addition of pancreatic perfusion to biphasic contrast-enhanced CT may improve the detection of insulinomas.