对比增强计算机断层扫描在鉴别慢性钙化性胰腺炎胰腺导管腺癌与炎性肿块中的应用

Thara Pratap, Dhanya Jacob, Sudhakar K. Venkatesh, Muhammed Jasim Abdul Jalal, Vishnu K.
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Quantitative parameters included duct-to-body ratio, common bile duct (CBD) diameter, main pancreatic duct (MPD) diameter, and carcinoembryonic antigen 19-9 (CA19-9). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for prediction of PDAC. A receiver operating characteristic (ROC) curve analysis was performed and the area under ROC curve (AUROC) was calculated to determine diagnostic accuracy to assess the optimal cutoff. Results PDAC was confirmed in 48 patients and MFCP in 53 patients. A duct-to-body ratio greater than 0.48 had 95.5% sensitivity, 83.3% specificity, 80.8% PPV, 96.2% NPV, and 88.5% accuracy for predicting PDAC. A CBD diameter cutoff ≥9.5 mm had an accuracy of 75% (p < 0.019) and an MPD cutoff ≥6.25 mm had an accuracy of 67.8% (p = 0.008) for predicting PDAC. On binary logistic regression, the duct-to-body ratio was found to be the significant independent factor associated with malignancy. 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引用次数: 0

摘要

摘要目的本研究的目的是鉴别慢性钙化性胰腺炎(CCP)中胰腺导管腺癌(PDAC)与肿块形成性慢性胰腺炎(MFCP)最有用的对比增强计算机断层扫描(CECT)特征。方法将101例CCP合并局灶性胰腺肿块患者作为研究对象。分析了16个定性参数和4个定量参数。定性参数包括大小、部位、边缘、病灶内低密度、侧支管征象、胰管突发性切断、胰管上游扩张、远端胰腺萎缩、双管征象、增强模式、对比减弱、胰周炎症、血管受累、局部淋巴结和转移。定量参数包括管体比、胆总管(CBD)直径、主胰管(MPD)直径、癌胚抗原19-9 (CA19-9)。计算预测PDAC的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性。进行受试者工作特征(ROC)曲线分析,并计算ROC曲线下面积(AUROC)来确定诊断准确性,以评估最佳截止。结果48例确诊为PDAC, 53例确诊为MFCP。导管与体比大于0.48预测PDAC的敏感性为95.5%,特异性为83.3%,PPV为80.8%,NPV为96.2%,准确率为88.5%。CBD直径切断≥9.5 mm的准确度为75% (p <0.019), MPD临界值≥6.25 mm预测PDAC的准确率为67.8% (p = 0.008)。在二元逻辑回归中,发现导管与体比是与恶性肿瘤相关的重要独立因素。结论导管与体比大于0.48、病灶内低密度、导管突然切断是鉴别PDAC与MFCP的最有效CT征象。二元logistic回归分析发现,管道与体比是一个显著的独立因素。弥散的正常实质是MFCP的一个非常特殊的征象。实质内低密度具有高特异性,但需要进一步验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Utility of Contrast-Enhanced Computed Tomography for Differentiating Pancreatic Ductal Adenocarcinoma from Inflammatory Mass in Chronic Calcific Pancreatitis
Abstract Objective The aim of this study was to identify the most useful contrast-enhanced computed tomography (CECT) features for differentiating pancreatic ductal adenocarcinoma (PDAC) from mass-forming chronic pancreatitis (MFCP) in chronic calcific pancreatitis (CCP). Methods In total, 101 patients with CCP and focal pancreatic mass formed the study group. Sixteen qualitative and four quantitative parameters were analyzed. Qualitative parameters included size, site, margin, intralesional hypodensity, collateral duct sign, abrupt pancreatic duct (PD) cutoff, upstream PD dilatation, distal pancreatic atrophy, double duct sign, enhancement pattern, contrast attenuation, peripancreatic inflammation, vascular involvement, regional nodes, and metastasis. Quantitative parameters included duct-to-body ratio, common bile duct (CBD) diameter, main pancreatic duct (MPD) diameter, and carcinoembryonic antigen 19-9 (CA19-9). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for prediction of PDAC. A receiver operating characteristic (ROC) curve analysis was performed and the area under ROC curve (AUROC) was calculated to determine diagnostic accuracy to assess the optimal cutoff. Results PDAC was confirmed in 48 patients and MFCP in 53 patients. A duct-to-body ratio greater than 0.48 had 95.5% sensitivity, 83.3% specificity, 80.8% PPV, 96.2% NPV, and 88.5% accuracy for predicting PDAC. A CBD diameter cutoff ≥9.5 mm had an accuracy of 75% (p < 0.019) and an MPD cutoff ≥6.25 mm had an accuracy of 67.8% (p = 0.008) for predicting PDAC. On binary logistic regression, the duct-to-body ratio was found to be the significant independent factor associated with malignancy. Conclusion A duct-to-body ratio greater than 0.48, intralesional hypodensity, and abrupt duct cutoff are the most helpful computed tomography (CT) features for distinguishing PDAC from MFCP in CCP. On binary logistic regression, the duct-to-body ratio was found to be a significant independent factor. Interspersed normal parenchyma was observed as a very specific sign of MFCP. Intraparenchymal hypodensity has high specificity, but further validation is needed.
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