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; 解添淞; 陈雷; 张泽华; 周正荣

doi:10.19401/j.cnki.1007-3639.2024.01.003

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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

论著 | 更新时间：2025-12-31

- 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
- 中国癌症杂志 2024年34卷第1期页码：67-73
- 作者机构：
  
  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
- 作者简介：
  
  [ "刘伟（ORCID: 0000-0003-3789-8953），博士在读，主治医师。" ]
  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。
- 基金信息：
  
  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)
- DOI：10.19401/j.cnki.1007-3639.2024.01.003
  中图分类号： R735.9
- 收稿：2023-08-28，
  
  修回：2023-12-15，
  
  纸质出版：2024-01-30
- 稿件说明：
移动端阅览
刘伟, 解添淞, 陈雷, 等. 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.

Wei LIU, Tiansong XIE, Lei CHEN, et al. 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.
刘伟, 解添淞, 陈雷, 等. 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. DOI： 10.19401/j.cnki.1007-3639.2024.01.003.

Wei LIU, Tiansong XIE, Lei CHEN, et al. 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. DOI： 10.19401/j.cnki.1007-3639.2024.01.003.

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

检验或

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。

0.05为差异有统计学意义。

结果：

在PDAC与MFCP之间，AEF_AP/PP、LPR

_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（

0.05）。LPR

_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（

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。

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

-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.

0.05 was considered statistically significant.

Results:

Statistically significant differences were observed between PDAC and MFCP in AEF_AP/PP

LPR

_VP

IEF_PP/VP

carbohydrate antigen 19-9 (CA19-9) and double-duct sign (all

0.05). The spectral combined model composed of LPR

_VP and IEF_PP/VP exhibited the best discriminatory efficacy

surpassing CA19-9

double-duct sign and AEF_AP/PP (all

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.

关键词

Keywords

references

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