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目的探讨壁结节的影像学表现在鉴别胰腺导管内乳头状黏液瘤(IPMN)良恶性中的价值。方法回顾性分析2012年1月至2016年6月于长海医院诊治的112例IPMN患者的病理和影像学资料。患者术前均行CT和MRI检查,由2位主治医师观察病灶壁结节的影像学表现,比较并分析良、恶性IPMN的壁结节大小、位置、个数、边界和强化程度。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价壁结节大小、个数、边界在鉴别IPMN良恶性中的作用,并确定壁结节大小的最佳诊断界值和敏感度、特异度及准确度。结果纳入经手术病理证实且在影像学检查中明确观察到壁结节的IPMN患者61例,病理检查结果示良性36例、恶性25例;主胰管型15例、分支型为13例、混合型33例,良、恶性患者IPMN分型差异有统计学意义(P=0.01)。壁结节大小对判断IPMN良恶性有临床意义(P<0.01),其鉴别良、恶性的最佳诊断界值为1.35 cm,AUC为74.7%,敏感度56.0%、特异度91.7%、准确度77.5%。良、恶性患者的壁结节个数(P=0.02)、边界(P<0.01)差异均有统计学意义,其鉴别良、恶性的AUC分别为64.2%、72.1%。所有患者壁结节强化程度均为渐进性强化,良、恶性患者的强化程度差异无统计学意义。结论壁结节影像学表现对IPMN良恶性的鉴别具有敏感性,对术前评估和随访具有一定的临床价值。
Objective To investigate the imaging findings of parietal nodules in the differential diagnosis of pancreatic ductal papillary myxoma (IPMN) in the value of benign and malignant. Methods A retrospective analysis of 112 cases of IPMN patients diagnosed and treated in Changhai Hospital from January 2012 to June 2016 was performed. The patients underwent preoperative CT and MRI examinations. The imaging findings of the lesions were observed by two attending physicians. The size, location, number, boundary and enhancement of the wall nodules were compared and analyzed. The receiver operating characteristic (ROC) curves were plotted, the area under the curve (AUC) was calculated, the size and number of wall nodules were evaluated, and the role of boundary in the identification of benign and malignant IPMNs was evaluated, and the best diagnostic threshold of wall nodule size And sensitivity, specificity and accuracy. Results Sixty-one IPMN patients with confirmed wall nodules were confirmed by operation and pathology. The pathological results showed that there were 36 cases of benign and 25 cases of malignant. The main pancreatic duct type was 15 cases and the branching type was 13 cases. Type 33 cases, benign and malignant patients IPMN type difference was statistically significant (P = 0.01). The wall nodule size was of clinical significance in judging the IPMN benign and malignant (P <0.01). The best diagnostic value of differential benign and malignant was 1.35 cm, AUC was 74.7%, sensitivity was 56.0%, specificity was 91.7%, accuracy 77.5%. The number of parietal nodules (P = 0.02) and borderline (P <0.01) in benign and malignant patients were all statistically significant, and the AUC of benign and malignant benign lesions were 64.2% and 72.1% respectively. All patients with enhanced degree of wall nodules were progressive enhancement, benign and malignant patients with no significant difference in the degree of enhancement. Conclusion The findings of wall nodules are sensitive to the identification of benign and malignant IPMN, and have certain clinical value for preoperative evaluation and follow-up.