CT Features And Prognosis Of Gastric Neuroendocrine Neoplasm

Objective To investigate the value of enhanced CT in the differential diagnosis of gastric neuroendocrine tumor(NET)and gastric neuroendocrine carcinoma(NEC)and prognosis related factors of gastric NEC.Materials and Methods1.Patients information A total of 79 patients with neuroendocrine neoplasm(NEN)confirmed by pathology were retrospectively analyzed,including 58 males and 21 females,with an average age of(61.13±9.55)years.All patients underwent upper abdominal enhanced CT examination.2.CT examination method The Siemens Somatom Sensation 64-slice spiral CT scanner was used,and the patient was fasted and banned for at least 6 hours before the examination..All patients were in the supine position scan.Scanning parameters: 120 k V,250 ~ 300 m A,layer thickness5 mm,pitch 1.4;matrix 256× 256.The enhanced scanning was performed by using a double-tube high-pressure syringe(German Ulrich)to inject a non-ionic contrast agent iohexol(350 mg I/L)from 80 to 100 m L from the anterior elbow vein,and the injection flow rate was 3 to 3.5 m L/s.3.Classification criteria According to the WHO 2010 Digestive System Tumor Classification System,the pathological grades of tumors are classified into G1,G2 and G3 grades;among them, G1 and G2 are also called NET,and G3 is also called NEC.4.Image analysis The imaging data of 79 patients were observed and analyzed.Observations included tumor location,size,shape,density,serosal surface,plain and enhanced CT values,arterial phase enhancement,enhanced pattern,specific type enhancement,and lymph node metastasis.5.Survival analysis Patients who were diagnosed with gastric NEC and underwent surgery were followed up until January 9,2019.Disease-free survival(disease-free survival,DFS)is the time from the end of surgery to the first relapse or death.Recurrence criteria: recurrence of gastric NEC or other site metastasis,confirmed by pathology or imaging at least one test.Patients with metastasis or death were included in the progression group,and the remaining patients were non-progressive group.6.Statistical Analysis Statistical analysis was performed using SPSS23.0 software.The Kolmogorov-Smirnov test was used to measure whether the data conformed to the normal distribution.The data that conforms to the normal distribution is represented by((?)± s),and the non-conformity of the normal distribution is expressed by the median(interquartile range).Quantitative data that conformed to the normal distribution were compared by independent sample t-test.Quantitative data that did not conform to the normal distribution of fabrics were compared by Kruskal-Wallis test.The qualitative data were compared using a chi-square test.Variables with statistical significance for univariate analysis were included in the logistic regression model.For the prognosis of patients,Kaplan-Meier(log-rank test)was used for univariate analysis.Cox regression models were used to test meaningful indicators.P < 0.05 was considered statistically significant.Results:1.There were 9 patients with gastric NET,including 1 male and 8 female,with an average age of(50.52±7.50)years;70 patients with gastric NEC,including 57 males and 13 females,with an average age of(62.81±9.09)years old.There was a statistically significant difference in gender and age between the two.2.There is a difference in the distribution of gastric NET and NEC.NET is mostly located in the gastric corpus,and NEC is mostly located in the gastric antrum.There were differences in the maximum thickness,maximum range,morphology and serosal surface of gastric NET and NEC,and the differences were statistically significant.The lesions of the gastric NEC have a larger maximum thickness,a wider range of involvement,a more irregular shape,a more uneven density,and a more ambiguous serosa.3.There was no significant difference in the CT value of the arterial phase,the CT value of the venous phase,the degree of enhancement of the arterial phase and the linear enhancement of the gastric NET and NEC(P>0.05).There were significant differences in the plain CT values,enhancement methods,and lymph node metastasis between NET and NEC(P<0.05).Among all the above factors,gender and maximum thickness of the lesions were independent factors influencing gastric NET and gastric NEC.4.Of the 53 patients with gastric NEC after surgery,12 patients had metastases,22 patients died,34 patients in the progression group,and 19 patients in the non-progress group.The survival time of patients was 0.5~47.5 months,the average survival time was 29.6 months,and the median survival time was 40.1 months.For patients with gastric NEC,age,lymph node metastasis,and TNM staging had different prognostic effects,and the difference was statistically significant(P < 0.05).Lymph node metastasis is an independent risk factor for prognosis.Conclusion:1.The gender and age of gastric NET and gastric NEC are different.NET is mostly female,NEC is mostly male,and NEC is usually older than NET.2.The dynamic enhanced CT findings of gastric NEN have certain characteristics,the distribution of lesions,the size of the lesions,morphology,serosal surface,CT value of the plain scan,strengthening method and Lymph node metastasis is important for the identification of NET and NEC.3.Gender and maximum thickness of the mass are independent factors influencing gastric NET and gastric NEC.4.For patients with gastric NEC undergoing surgery,age,lymph node metastasis,and TNM staging are factors influencing prognosis.Lymph node metastasis is an independent risk factor for prognosis.