| Objective:SPNP is a rare low grade malignant tumor,which is mainly found in young female,There is no typical manifestation,about 10%-20% tumors is aggressive.preoperative CT examination is preferred diagnostic method.However,if the tumor is found in male or older,they do not have special image performance,so it is easily to misdiagnosis as other pancreatic tumor.surgery is the main treatment,The tumor with aggressive is easy to metastasis or reoccur,so it is of great significance to distinguish the nature of the tumor for the choice of operation methods and prognosis.The purpose of this study is to improve the clinical diagnosis rate through analyzing the CT finding of SPNP,which mainly focus on the different sex and age.By relying on the pathological diagnosis for the gold standard,we will analysis the CT imaging manifestation of the SPNP between the aggressive and nonaggressive of the SPNP,then explore the predictive value of preoperative CT signs for the tumor invasive and hope to help clinical doctor to choose the operation methods and improve prognosis.Method:We retrospectively analyzed 55 SPNP patients in the Department of hepatobiliary,the first hospital of Jilin University from January 2018 to December2020.According to the postoperative pathological results,they were divided into two groups:the aggressive group and nonaggressive group.All patients were examined by MSCT(non-enhancement and enhancement).We recorded the general information of patients including age,gender,clinical symptoms,diagnosis of preoperative and imaging findings.The CT imaging findings include tumor location,size,shape,texture,boundary,envelope,hemorrhage,calcification,the expansion of pancreatic duct and bile duct,CT value(plain scan,arterial phase,venous phase,delayed phase)and the degree of enhancement of each phase.All the results were analyzed by two experienced radiologist.All data were analyzed by using spss25.0 statistical software.If the Measurement data conform to the normal distribution,it is expressed by average value ± standard deviation,if not,it was expressed by median with quartile.Measurement data were measured by two independent sample t test or rank sum test.Chi square test was used for comparison about enumeration data.P<0.05 means there is statistical significance.Results:A total of 55 patients with SPNP were included in this study,all with single lesions,which included 8 males(14.5%)and 47 females(85.5%).The mean age of male and female was 34.25±15.43 or 29.09±13.37 years old.Among the 8 male patients,5 patients(62.5%)were more than 40 years old.while among 47 patients,10patients(21.3%)were more than 40 years old.The difference was statistically significant(P=0.047).The mean maximum tumor diameters in male and female patients were 5.38±2.62 and 7.14±3.22 cm respectively,There was no statistically significant difference(p>0.05).Male patients were older,and the tumor components were mostly solid(75%)and calcification(87.5%),the difference was statistically significant compared with female patents(p=0.048,0.037).there was no statistically significant difference in the clinical manifestation,preoperative diagnosis,the location of the tumor,maximum diameter,shape,boundary,coated,hemorrhage,expansion of the pancreatic duct and bile duct,the pancreatic atrophy,plain Scan+ enhanced CT value and degree of enhancement in each stage between male and female(p>0.05).Compared with patients with age less than 40 years old,the male patients with age more than years old were more common(3.3VS37.5),more prone to preoperative misdiagnosis(40%vs7.5%),smaller mean maximum dame(7.61vs5.09cm)and calcification(80%vs35%).The difference between two groups was significant difference(p=0.047,0.021,0.006,0.003).There was no statistically significant difference in The clinical manifestation,preoperative diagnosis,the location of the tumor,maximum diameter,shape,boundary,coated,hemorrhage,expansion of the pancreatic duct and bile duct,the pancreatic atrophy,plain Scan+enhanced CT value and degree of enhancement in each stage between male and female(p>0.05).11 patients with aggressive group(20%)include 8 cases of women(72.73%)and 3patients of men.44 patients(80%)with nonaggressive include 39 females(88.64%)and 5 males(11,36%),there was no statistically significant difference in the sex.In the nonaggressive group,12 patents(27.27%)were more than 40 years old,32 patients were less than 40 years old,the age difference between two group was statistically significant(p=0.014).Compared with the nonaggressive group,the tumor in the group of aggressiveness were prone to irregular morphology(81.2%),and boundary(81.82%)and incomplete capsule(90.91%),the two group was different in tumor morphology,boundary,capsule integrity.there was statistically significance(p=0.008.0.022,0.007),The arterial CT value of the patients in the aggressive group was higher than that in the nonaggressive group,and the enhancement was more obvious,the difference was statistically significant(p=0.021,0.009),There was no statistical significance in tumor gender,clinical manifestations,preoperative diagnosis,tumor location,hemorrhage,calcification,texture,pancreatic bile duct dilatation and pancreatic atrophy,CT value of plain scan+venous phase and delayed phase,enhancement degree of venous phase and delayed phase between the two groups(P>0.05).Conclusion:(1).The CT findings of SPNP have certain characteristics,which mainly located in the pancreatic body and tail,mainly showed solid-cystic masses,some of which have pseudocapsule,calcification and hemorrhage,and mild to moderate progressive enhancement.Compared with patients more than fourty years old,patients with less than fourty years old are more likely to be female,with larger tumor and higher preoperative diagnosis rate.SPNP should be considered when older male patents present solid components and calcification.(2).The age of the SPNP with aggressive group is greater than the nonaggressive group,and the tumor morphology is irregular,the boundary is fuzzy,the capsule is incomplete,and the enhancement in the arterial phase is obvious,which all suggest that the aggressive of tumor.Irregular morphology is independent risk factor for predicting the invasion of SPNP. |
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