探究双层光谱探测器CT在鉴别可切除胰腺导管腺癌与肿块型慢性胰腺炎方面的价值

doi:10.19401/j.cnki.1007-3639.2024.01.003

中国癌症杂志 ›› 2024, Vol. 34 ›› Issue (1): 67-73.doi: 10.19401/j.cnki.1007-3639.2024.01.003

探究双层光谱探测器CT在鉴别可切除胰腺导管腺癌与肿块型慢性胰腺炎方面的价值

刘伟¹(), 解添淞¹, 陈雷², 张泽华², 周正荣¹^,²()

1.复旦大学附属肿瘤医院放射诊断科，复旦大学上海医学院肿瘤学系，上海 200032
2.复旦大学附属肿瘤医院闵行分院放射诊断科，上海 201100

收稿日期:2023-08-28 修回日期:2023-12-15 出版日期:2024-01-30 发布日期:2024-02-05
通信作者: 周正荣（ORCID: 0000-0002-9922-1000），博士，主任医师，复旦大学附属肿瘤医院闵行分院执行院长。
作者简介:刘伟（ORCID: 0000-0003-3789-8953），博士在读，主治医师。
基金资助:
上海市“科技创新行动计划”港澳台科技合作项目(22490760800);上海市闵行区医学特色专科建设项目(2020MWFC05)

Investigating the value of dual-layer spectral detector CT in distinguishing resectable pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis

LIU Wei¹(), XIE Tiansong¹, CHEN Lei², ZHANG Zehua², ZHOU Zhengrong¹^,²()

1. Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2. Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China

Received:2023-08-28 Revised:2023-12-15 Published:2024-01-30 Online:2024-02-05
Contact: ZHOU Zhengrong.

摘要/Abstract

摘要：

背景与目的：胰腺导管腺癌（pancreatic ductal adenocarcinoma，PDAC）与肿块型慢性胰腺炎（mass-forming chronic pancreatitis，MFCP）的准确鉴别具有较大的临床意义。双层光谱探测器计算机体层成像（dual-layer spectral detector computed tomography，DLCT）在胰腺方面的应用已有一定的探索。本研究旨在探究DLCT在鉴别可切除PDAC与MFCP方面的价值。方法：回顾性分析2021年9月1日—2023年5月31日复旦大学附属肿瘤医院收治的33例可切除PDAC和19例MFCP患者的临床影像学资料，术前行DLCT增强扫描，扫描期相包括动脉期（arterial phase，AP）、实质期（parenchymal phase，PP）和静脉期（venous phase，VP）。计算DLCT定量指标，包括衰变强化分数（attenuation enhancement fraction，AEF）、病灶胰腺实质比（lesion to parenchyma ratio，LPR）、碘强化分数（iodine enhancement fraction，IEF）。采用独立样本t检验或χ²检验进行统计学分析，采用二元逻辑回归进行单因素及多因素分析，采用受试者工作特征（receiver operator characteristic，ROC）曲线进行效能评价。P<0.05为差异有统计学意义。结果：在PDAC与MFCP之间，AEF_AP/PP、LPR₄₀_VP、IEF_PP/VP、糖类抗原19-9（carbohydrate antigen 19-9，CA19-9）及双管征的差异有统计学意义（P<0.05）。LPR₄₀_VP与IEF_PP/VP构成的融合模型具有最佳的鉴别效能，优于CA19-9、双管征及AEF_AP/PP（P<0.05），其曲线下面积（area under curve，AUC）为0.841，灵敏度为90%，特异度为73%，准确度为79%。结论：DLCT在鉴别可切除PDAC与MFCP方面具有一定潜能，光谱定量参数可以弥补CA19-9、常规CT在鉴别可切除PDAC与MFCP方面的不足。

关键词: 胰腺导管腺癌, 肿块型慢性胰腺炎, 双层光谱探测器计算机体层成像, 常规计算机体层成像

Abstract:

Background and Purpose: Accurate differentiation of pancreatic ductal adenocarcinoma (PDAC) from mass-forming chronic pancreatitis (MFCP) is clinically significant. The application of dual-layer spectral detector CT (DLCT) in pancreas has been explored. This study aimed to investigate the value of DLCT in distinguishing resectable PDAC from MFCP. Methods: We retrospectively collected data of 33 patients with resectable PDAC and 19 patients with MFCP admitted to Fudan University Shanghai Cancer Center from September 1, 2021 to May 31, 2023. Prior to surgery, patients underwent enhanced DLCT scans, including arterial phase (AP), parenchymal phase (PP) and venous phase (VP). DLCT quantitative parameters, including attenuation enhancement fraction (AEF), lesion-to-parenchyma ratio (LPR) and iodine enhancement fraction (IEF) were calculated. Difference analysis was conducted using independent sample t-test or chi-square test. Univariate and multivariate analyses were performed using binary logistic regression. Receiver operating characteristic (ROC) curves were used for performance evaluation. P<0.05 was considered statistically significant. Results: Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP, LPR₄₀_VP, IEF_PP/VP, carbohydrate antigen 19-9 (CA19-9) and double-duct sign (all P<0.05). The spectral combined model composed of LPR₄₀_VP and IEF_PP/VP exhibited the best discriminatory efficacy, surpassing CA19-9, double-duct sign and AEF_AP/PP (all P<0.05). The combined model demonstrated an area under curve (AUC) of 0.841, sensitivity of 90%, specificity of 73%, and accuracy of 79%. Conclusion: DLCT has certain potential in differentiating resectable PDAC from MFCP. Spectral quantitative parameters can complement CA19-9 and outcome shortcomings of conventional CT in distinguishing resectable PDAC from MFCP.

Key words: Pancreatic ductal adenocarcinoma, Mass-forming chronic pancreatitis, Dual-layer spectral detector computed tomography, Conventional computed tomography

中图分类号:

R735.9

刘伟, 解添淞, 陈雷, 张泽华, 周正荣. 探究双层光谱探测器CT在鉴别可切除胰腺导管腺癌与肿块型慢性胰腺炎方面的价值[J]. 中国癌症杂志, 2024, 34(1): 67-73.

LIU Wei, XIE Tiansong, CHEN Lei, ZHANG Zehua, ZHOU Zhengrong. Investigating the value of dual-layer spectral detector CT in distinguishing resectable pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis[J]. China Oncology, 2024, 34(1): 67-73.

图/表 6

图1

图2

表1

表2

图3

表3

参考文献 26

[1]	WHITCOMB D C, FRULLONI L, GARG P, et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition[J]. Pancreatology, 2016, 16(2): 218-224. doi: 10.1016/j.pan.2016.02.001 pmid: 26924663
[2]	SINGH V K, YADAV D, GARG P K. Diagnosis and management of chronic pancreatitis: a review[J]. JAMA, 2019, 322(24): 2422-2434. doi: 10.1001/jama.2019.19411 pmid: 31860051
[3]	LIAO Q, ZHAO Y P, WU W W, et al. Diagnosis and treatment of chronic pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2003, 2(3): 445-448.
[4]	KIM T, MURAKAMI T, TAKAMURA M, et al. Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings[J]. AJR Am J Roentgenol, 2001, 177(2): 367-371. doi: 10.2214/ajr.177.2.1770367
[5]	KIRKEGÅRD J, MORTENSEN F V, CRONIN-FENTON D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis[J]. Am J Gastroenterol, 2017, 112(9): 1366-1372. doi: 10.1038/ajg.2017.218 pmid: 28762376
[6]	LUETMER P H, STEPHENS D H, WARD E M. Chronic pancreatitis: reassessment with current CT[J]. Radiology, 1989, 171(2): 353-357. doi: 10.1148/radiology.171.2.2704799 pmid: 2704799
[7]	WOLSKE K M, PONNATAPURA J, KOLOKYTHAS O, et al. Chronic pancreatitis or pancreatic tumor? A problem-solving approach[J]. Radiographics, 2019, 39(7): 1965-1982. doi: 10.1148/rg.2019190011 pmid: 31584860
[8]	GANDHI S, DE LA FUENTE J, MURAD M H, et al. Chronic pancreatitis is a risk factor for pancreatic cancer, and incidence increases with duration of disease: a systematic review and meta-analysis[J]. Clin Transl Gastroenterol, 2022, 13(3): e00463. doi: 10.14309/ctg.0000000000000463
[9]	国家卫生健康委办公厅. 胰腺癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(5): 1006-1030.
	General Office of National Health Commission. Standard for diagnosis and treatment of pancreatic cancer (2022 edition)[J]. J Clin Hepatol, 2022, 38(5): 1006-1030.
[10]	ASLAN S, NURAL M S, CAMLIDAG I, et al. Efficacy of perfusion CT in differentiating of pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis and characterization of isoattenuating pancreatic lesions[J]. Abdom Radiol, 2019, 44(2): 593-603. doi: 10.1007/s00261-018-1776-9
[11]	SANDRASEGARAN K, NUTAKKI K, TAHIR B, et al. Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer[J]. AJR Am J Roentgenol, 2013, 201(5): 1002-1008. doi: 10.2214/AJR.12.10170
[12]	ELSHERIF S B, VIRARKAR M, JAVADI S, et al. Pancreatitis and PDAC: association and differentiation[J]. Abdom Radiol (NY), 2020, 45(5): 1324-1337. doi: 10.1007/s00261-019-02292-w pmid: 31705251
[13]	SEICEAN A, BADEA R, MOLDOVAN-POP A, et al. Harmonic contrast-enhanced endoscopic ultrasonography forthe guidance of fine-needle aspiration in solid pancreatic masses[J]. Ultraschall Med, 2017, 38(2): 174-182. doi: 10.1055/s-0035-1553496
[14]	FACCIORUSSO A, MARTINA M, BUCCINO R V, et al. Diagnostic accuracy of fine-needle aspiration of solid pancreatic lesions guided by endoscopic ultrasound elastography[J]. Ann Gastroenterol, 2018, 31(4): 513-518.
[15]	FRITSCHER-RAVENS A, BRAND L, KNÖFEL W T, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis[J]. Am J Gastroenterol, 2002, 97(11): 2768-2775. doi: 10.1111/j.1572-0241.2002.07020.x
[16]	BEER L, TOEPKER M, BA-SSALAMAH A, et al. Objective and subjective comparison of virtual monoenergetic vs polychromatic images in patients with pancreatic ductal adenocarcinoma[J]. Eur Radiol, 2019, 29(7): 3617-3625. doi: 10.1007/s00330-019-06116-9
[17]	SHI H Y, LU Z P, LI M N, et al. Dual-energy CT iodine concentration to evaluate postoperative pancreatic fistula after pancreatoduodenectomy[J]. Radiology, 2022, 304(1): 65-72. doi: 10.1148/radiol.212173
[18]	YIN Q H, ZOU X N, ZAI X D, et al. Pancreatic ductal adenocarcinoma and chronic mass-forming pancreatitis: differentiation with dual-energy MDCT in spectral imaging mode[J]. Eur J Radiol, 2015, 84(12): 2470-2476. doi: 10.1016/j.ejrad.2015.09.023 pmid: 26481480
[19]	GROßE HOKAMP N, MAINTZ D, SHAPIRA N, et al. Technical background of a novel detector-based approach to dual-energy computed tomography[J]. Diagn Interv Radiol, 2020, 26(1): 68-71. doi: 10.5152/dir.2019.19136 pmid: 31904573
[20]	ZHANG H, MENG Y H, LI Q, et al. Two nomograms for differentiating mass-forming chronic pancreatitis from pancreatic ductal adenocarcinoma in patients with chronic pancreatitis[J]. Eur Radiol, 2022, 32(9): 6336-6347. doi: 10.1007/s00330-022-08698-3 pmid: 35394185
[21]	YEH B M, SHEPHERD J A, WANG Z J, et al. Dual-energy and low-kVp CT in the abdomen[J]. AJR Am J Roentgenol, 2009, 193(1): 47-54. doi: 10.2214/AJR.09.2592
[22]	GHASEMI SHAYAN R, OLADGHAFFARI M, SAJJADIAN F, et al. Image quality and dose comparison of single-energy CT (SECT) and dual-energy CT (DECT)[J]. Radiol Res Pract, 2020, 2020: 1403957.
[23]	SAKABE D, FUNAMA Y, TAGUCHI K, et al. Image quality characteristics for virtual monoenergetic images using dual-layer spectral detector CT: comparison with conventional tube-voltage images[J]. Phys Med, 2018, 49: 5-10. doi: S1120-1797(18)30447-2 pmid: 29866343
[24]	REN S, ZHANG J J, CHEN J Y, et al. Evaluation of texture analysis for the differential diagnosis of mass-forming pancreatitis from pancreatic ductal adenocarcinoma on contrast-enhanced CT images[J]. Front Oncol, 2019, 9: 1171. doi: 10.3389/fonc.2019.01171 pmid: 31750254
[25]	SU S B, QIN S Y, CHEN W, et al. Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis[J]. World J Gastroenterol, 2015, 21(14): 4323-4333. doi: 10.3748/wjg.v21.i14.4323
[26]	SINGH S, TANG S J, SREENARASIMHAIAH J, et al. The clinical utility and limitations of serum carbohydrate antigen (CA19-9) as a diagnostic tool for pancreatic cancer and cholangiocarcinoma[J]. Dig Dis Sci, 2011, 56(8): 2491-2496. doi: 10.1007/s10620-011-1709-8

Data	PDAC (n=33)	MFCP (n=19)	P value
Clinical variables
Age/year x±s	62.75±10.45	63.95±11.76	0.707^*
Gender male/female	16/17	11/8	0.513^#
CA19-9 ≤37 U/mL/>37 U/mL	6/27	10/9	0.010^#
CA12-5 ≤35 U/mL/>35 U/mL	32/1	19/0	1.000^#
CEA ≤5.2 ng/mL/>5.2 ng/mL	30/3	18/1	1.000^#
Size/cm x±s	2.50±0.83	2.67±0.66	0.429^*
Location head/body and tail	26/7	13/6	0.618^#
Imaging morphological variables
Duct-penetrating sign yes/no	0/33	1/18	0.365^#
Collateral duct dilatation yes/no	0/33	0/19
Duct-to-parenchyma ratio≤0.34 yes/no	23/10	15/4	0.469^#
Displaced calcification yes/no	0/33	0/19
Double duct sign yes/no	14/19	2/17	0.016^#
SMA-to-SMV ratio>1 yes/no	0/33	0/19
Vessel encasement or deformity yes/no	1/32	0/19	1.000^#

Variable	Univariate analysis		VIF	Multivariable analysis
Variable	OR (95% CI)	P value	VIF	OR (95% CI)	P value
LPR₄₀_PP/%	1.046 (1.010-1.084)	0.012	3.165		0.111
LPR₄₀_VP/%	1.054 (1.022-1.087)	0.001	2.253	1.050 (1.015-1.086)	0.004
IEF_PP/VP/%	1.057 (1.016-1.099)	0.006	1.716	1.051 (1.002-1.102)	0.039

Variable	AUC (95%CI)	Cutoff value	Sensitivity/%	Specificity/%	Accuracy/%	Youden index
CA19-9	0.672 (0.539-0.806)		53	82	71	0.35
Double duct sign	0.675 (0.563-0.786)		90	46	60	0.36
AEF_AP/PP	0.703 (0.562-0.845)	79%	95	49	65	0.44
LPR₄₀_VP	0.825 (0.712-0.937)	91%	90	67	75	0.57
IEF_PP/VP	0.777 (0.648-0.905)	91%	79	70	73	0.49
Combined model	0.841 (0.736-0.945)	0.34	90	73	79	0.63

探究双层光谱探测器CT在鉴别可切除胰腺导管腺癌与肿块型慢性胰腺炎方面的价值

Investigating the value of dual-layer spectral detector CT in distinguishing resectable pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 26

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李天骄, 叶龙云, 金凯舟, 吴伟顶, 虞先濬. 2023年度胰腺癌研究及诊疗新进展[J]. 中国癌症杂志, 2024, 34(1): 1-12.
[2]	岳铭, 王理伟, 崔玖洁. 胰腺癌器官特异性肺转移机制的研究进展[J]. 中国癌症杂志, 2023, 33(11): 1026-1031.
[3]	高鹤丽, 徐近, 陈洁, 虞先濬. 胰腺神经内分泌瘤的精准诊疗进展[J]. 中国癌症杂志, 2023, 33(11): 993-1001.
[4]	贾聿明, 叶增, 邓艳丽, 李胜超, 张志磊, 王超, 徐晓武, 秦毅, 彭利. FBW7基因通过GSDME介导的焦亡增强紫杉醇对胰腺癌的抗肿瘤作用研究[J]. 中国癌症杂志, 2023, 33(10): 889-897.
[5]	曾铖, 张剑. 2022年度ADC在胰腺癌领域的研究新进展及展望[J]. 中国癌症杂志, 2023, 33(3): 235-240.
[6]	符庆胜, 金雷, 张旭东, 徐荧晨, 朱春富, 秦锡虎, 吴宝强. tRF-Pro-CGG对小鼠胰腺癌细胞生物学行为的影响及其分子机制[J]. 中国癌症杂志, 2023, 33(3): 241-249.
[7]	王旭, 程合, 刘辰, 虞先濬. 2022年度胰腺癌研究及诊疗新进展[J]. 中国癌症杂志, 2023, 33(1): 1-13.
[8]	庄晗, 凌池芳, 王佳舟, 韩序, 姜睿, 胡伟刚. 局部晚期胰腺癌75 Gy同步加量放射治疗的剂量可行性研究[J]. 中国癌症杂志, 2023, 33(1): 54-60.
[9]	罗国培, 虞先濬. 胰腺癌精准治疗：从小众走向主流[J]. 中国癌症杂志, 2022, 32(10): 960-970.
[10]	刘文生, 吉顺荣, 卓奇峰, 高鹤丽, 史逸华, 许文彦, 刘梦奇, 李征, 虞先濬, 陈洁, 徐晓武. 机器人与腹腔镜微创手术治疗分化良好的胰腺神经内分泌瘤的临床研究[J]. 中国癌症杂志, 2022, 32(9): 786-793.
[11]	高鹤丽, 徐近, 虞先濬. 2021年胰腺神经内分泌肿瘤诊治的新进展[J]. 中国癌症杂志, 2022, 32(9): 772-778.
[12]	王先泽, 吴文铭. 胰腺神经内分泌肿瘤外科治疗理念的四种转变[J]. 中国癌症杂志, 2022, 32(9): 765-771.
[13]	李语婕, 陈颢. 靶向TROP2在胰腺癌治疗中的潜力[J]. 中国癌症杂志, 2022, 32(3): 268-273.
[14]	吴梦吟, 吴春晓, 庞怡, 王春芳, 顾凯, 龚杨明, 鲍萍萍, 施亮, 窦剑明, 向詠梅, 施燕. 2016年上海市胰腺癌发病和死亡情况与2002—2016年流行趋势分析[J]. 中国癌症杂志, 2022, 32(2): 97-105.
[15]	朱鑫哲, 李浩, 徐华祥, 罗国培, 虞先濬. 2021年胰腺癌研究及诊疗新进展[J]. 中国癌症杂志, 2022, 32(1): 1-12.