肝脏原发性和转移性神经内分泌肿瘤的超声造影表现对比

摘要/Abstract

摘要： 目的比较肝脏原发性神经内分泌肿瘤(PHNEN)、转移性神经内分泌肿瘤(MHNEN)超声造影表现。方法回顾性分析2008年1月至2019年7月间菏泽市中医医院收治的肝脏神经内分泌肿瘤患者26例。其中MHNEN患者22例,男性12例,女性10例,年龄(50.6±9.4)岁;PHNEN患者4例,男性2例,女性2例,年龄(53.1±14.2)岁。计量资料以±s表示,用t检验比较;计数资料以百分比表示,用卡方检验比较。结果 22例MHNEN患者肿瘤原发部位包括胰腺(9例)、胃(4例)、胆囊(4例)、小肠(2例)、结直肠(2例)及肺(1例),病灶共发现28个,病灶直径1.5～12.8 cm,平均(4.2±3.6)cm。16个病灶表现为高或稍高回声,12个病灶表现为稍低或低回声;11个病灶边界清楚,14个病灶边界欠清,3个病灶边界不清楚;15个病灶可见血流信号。4例PHNEN患者病灶共发现7个,病灶直径1.8～17.4 cm,平均(7.2±5.5)cm。5个病灶表现为高或稍高回声,2个病灶表现为稍低或低回声;4个病灶边界清楚,2个病灶边界欠清,1个病灶边界不清楚;2个病灶可见血流信号。MHNEN、PHNEN患者病灶直径存在显著差异(P<0.05)。MHNEN、PHNEN患者开始增强时间、开始消退时间、增强持续时间、增强速度、消退速度、增强形式及增强形态差异均无统计学意义(P>0.05)。结论 MHNEN、PHNEN超声及超声造影表现具有特征性,以整体增强、“快进快退”模式为主,对神经内分泌瘤的诊断具有临床价值,但需要今后进一步比较MHNEN、PHNEN的超声表现差异。

关键词: 肝肿瘤, 神经内分泌肿瘤, 超声造影

Abstract: Objective The contrast-enhanced ultrasonographic findings of primary hepatic neuroendocrine neoplasm (PHNEN) and metastatic neuroendocrine neoplasm (MHNEN) were compared.Methods A retrospective analysis was made of 26 patients with hepatic neuroendocrine neoplasm treated in our hospital from January 2008 to July 2019, including 26 patients with contrast-enhanced ultrasonography. There were 22 patients with MHNEN, 12 males and 10 females, aged (50.6±9.4) years, and 4 patients with PHNEN, including 2 males and 2 females, aged (53.1±14.2) years. The measurement data are expressed as (±s), compared by t-test, the counting data are expressed as percentages, and compared by chi-square test. Results The primary sites of tumors in 22 patients with MHNEN included pancreas (n=9), stomach (n=4), gallbladder (n=4), small intestine (n=2), colon and rectum (n=2) and lung (n=1). A total of 28 lesions were found with a diameter of 1.5×12.8 cm. The average value was (4. 2±3. 6) cm. 16 lesions showed high or slightly high echo, 12 lesions showed slightly low or low echo, 11 lesions had clear boundary, 14 lesions had unclear boundary, 3 lesions had unclear boundary, and 15 lesions had blood flow signal. A total of 7 lesions were found in 4 patients with PHNEN, with a diameter of 1.8 to 17.4 cm, with an average of (7.2±5.5) cm. 5 lesions showed high or slightly high echo, 2 lesions showed slightly low or low echo, 4 lesions had clear boundary, 2 lesions had unclear boundary, 1 lesion had unclear boundary, and 2 lesions had blood flow signal. There was significant difference in lesion diameter between MHNEN and PHNEN patients (P<0.05). There was no significant difference in the beginning enhancement time, the beginning regression time, the enhancement duration, the enhancement speed, the regression speed, the enhancement form and the enhancement shape between MHNEN and PHNEN patients (P>0.05).Conclusion MHNEN and PHNEN are characteristic in ultrasonography and contrast-enhanced ultrasonography, mainly in the mode of overall enhancement and 'fast forward and fast retrogression'. They are of clinical value in the diagnosis of neuroendocrine neoplasm, but it is necessary to further compare the differences of ultrasonographic findings between MHNEN and PHNEN in the future.

Key words: Liver neoplasms, Neuroendocrine neoplasm, Contrast-enhanced ultrasonographic

王文清. 肝脏原发性和转移性神经内分泌肿瘤的超声造影表现对比[J]. 肝脏, 2020, 25(5): 498-500.

WANG Wen-qing. Comparison of contrast-enhanced ultrasonography between primary and metastatic neuroendocrine tumors of the liver[J]. Chinese Hepatolgy, 2020, 25(5): 498-500.

参考文献

[1] Ricci C, Casadei R, Taffurelli G, et al. Sporadic small (≤20 mm) nonfunctioning pancreatic neuroendocrine neoplasm: Is the risk of malignancy negligible when adopting a more conservative strategy? A systematic review and meta-analysis. Ann Surg Oncol, 2017, 24: 2603-2610.
[2] Kim JY, Hong SM, Ro JY. Recent updates on grading and classification of neuroendocrine tumors. Ann Diagn Pathol,2017,29:11-16.
[3] 李梦霞, 李启勇, 肖慜, 等. 原发性肝脏神经内分泌肿瘤的诊断和治疗进展. 临床医学进展, 2019,9:225-234.
[4] 梁霄, 蔡经纬. 肝脏原发性神经内分泌肿瘤的诊治进展.中华普通外科杂志,2019,34:816-818.
[5] 张力夫,姚小晓,王禹,等. 原发性肝脏神经内分泌肿瘤的诊断与治疗. 中华消化外科杂志,2019,18:698-700.
[6] Dörffel Y, Wermke W. Neuroendocrine tumors:characterization with contrast-enhanced ultrasonography. Ultraschall Med, 2008,29(5):506-514.
[7] 李攀, 杨晓鸥, 钱家鸣. 神经内分泌肿瘤肝转移的临床特征与诊治. 中华内科杂志, 2012, 51:289-293.
[8] 严华. 超声造影在诊断肝脏转移性神经内分泌肿瘤中的价值. 临床与基础研究,2019,24:902-904.
[9] Mörk H, Ignee A, Schuessler G, et al. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography. Scand J Gastroenterol, 2007, 42:652-662.
[10] 林晓娜, 陈洁, 谢晓燕, 等. 肝脏神经内分泌肿瘤的超声表现. 中华超声影像学杂志, 2018, 27:698-703.
[11] 高伟华,向晓星. 原发性肝脏神经内分泌肿瘤最新研究.胃肠病学和肝病学杂志,2019,28:121-125.
[12] 唐永强,石磊,舒俊,等. 原发性肝脏神经内分泌肿瘤影像学表现. 医疗卫生装备,2018,39:57-61.
[13] 冯秋霞,刘娜娜,张海龙,等. 原发性肝脏神经内分泌肿瘤的影像学表现. 医学影像学杂志,2019,29:598-602.
[14] 汪瀚韬, 王文平, 张小龙, 等.肝脏转移性神经内分泌肿瘤的超声造影诊断研究.中华超声影像学杂志, 2017, 26:872-876.
[15] 尹珊珊, 姜彬彬, 崔秋丽, 等.神经内分泌肿瘤肝转移超声造影表现与分化程度的关系初探. 中华超声影像学杂志, 2019, 28:109-114.