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目的探讨CT鉴别诊断胃肠胰神经内分泌瘤(NETs)肝转移与伴神经内分泌分化腺癌[NED(+)ADCs]肝转移的价值。方法收集经手术或活检病理证实的胃肠胰NETs肝转移患者23例(NETs组)及NED(+)ADCs肝转移患者17例[NED(+)ADCs组]。对两组CT征象(肝转移灶数目、大小、分布、形态、肝动脉期强化范围、肝动脉期强化程度、增强类型、腹腔积液及淋巴结肿大)的差异进行分析。采用Logistic回归分析确定鉴别诊断的独立影响因素,并计算其敏感度、特异度、阳性预测值、阴性预测值和准确率。结果NETs组肝转移整体强化比例高于NED(+)ADCs组[56.52%(13/23)vs 5.88%(1/17),χ~2=11.02,P<0.01]。NETs组肝转移伴淋巴结肿大比例低于NED(+)ADCs组[30.43%(7/23)vs 64.71%(11/17),χ~2=4.64,P=0.03]。Logistic回归分析结果显示,肝动脉期强化范围是具有鉴别价值的征象(P=0.01),其诊断敏感度、特异度、阳性预测值、阴性预测值和准确率分别为94.12%(16/17)、56.52%(13/23)、61.54%(16/26)、92.86%(13/14)、72.50%(29/40)。结论增强CT可为NETs与NED(+)ADCs肝转移的鉴别诊断提供有价值的参考信息。
Objective To investigate the value of CT differential diagnosis of hepatic metastasis of gastrointestinal pancreatic neuroendocrine neoplasms (NETs) and hepatic metastases with neuroendocrine differentiation adenocarcinoma [NED (+) ADCs]. Methods Twenty-three patients (NETs group) and 17 patients with NAD (+) ADCs liver metastasis [NED (+) ADCs group) were enrolled in this study. The differences of CT features (number, size, distribution, shape of liver metastasis, enhancement range of hepatic arterial phase, degree of hepatic arterial enhancement, type of enhancement, ascites and lymphadenopathy) were analyzed. Logistic regression analysis was used to determine the independent influencing factors of differential diagnosis, and its sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results The overall enhancement rate of liver metastasis in NETs group was significantly higher than that in NED (+) ADCs group [56.52% (13/23) vs 5.88% (1/17), χ ~ 2 = 11.02, P <0.01]. The proportion of hepatic metastasis with lymph nodes in NETs group was lower than that in NED (+) ADCs group [30.43% (7/23) vs 64.71% (11/17), χ ~ 2 = 4.64, P = 0.03]. Logistic regression analysis showed that the enhancement range of hepatic arterial phase was a sign of discrimination (P = 0.01). The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 94.12% (16/17) , 56.52% (13/23), 61.54% (16/26), 92.86% (13/14) and 72.50% (29/40) respectively. Conclusion Enhanced CT can provide valuable information for the differential diagnosis of liver metastases between NETs and NED (+) ADCs.