复复复复复复复复复复 Zhongshan Hospital Fudan Un Solid Pseudopapillary Tumor Solid Pseudopapillary Tumor of the Pancreas: Diagnosis of the Pancreas: Diagnosis with CT and MRI with CT and MRI Mengsu Zeng, Xiuzhong Yao Mengsu Zeng, Xiuzhong Yao 曾曾曾 曾曾曾 曾曾曾 曾曾曾 Department of Radiology, Zhongshan Hosp Department of Radiology, Zhongshan Hosp ital of Fudan University and Department ital of Fudan University and Department of Medical Image, Shanghai Medical Coll of Medical Image, Shanghai Medical Coll ege of Fudan university, Shanghai, Chin ege of Fudan university, Shanghai, Chin a a
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Solid Pseudopapillary Tumor of the Pancreas: Diagnosis with CT and MRI
Solid Pseudopapillary Tumor of the Pancreas: Diagnosis with CT and MRI. Mengsu Zeng, Xiuzhong Yao 曾蒙苏 姚秀忠 Department of Radiology, Zhongshan Hospital of Fudan University and Department of Medical Image, Shanghai Medical College of Fudan university, Shanghai, China. Background. - PowerPoint PPT Presentation
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复旦大学附属中山医院 Zhongshan Hospital Fudan University
Solid Pseudopapillary Tumor of the PancSolid Pseudopapillary Tumor of the Pancreas: Diagnosis with CT and MRIreas: Diagnosis with CT and MRI
Department of Radiology, Zhongshan Hospital oDepartment of Radiology, Zhongshan Hospital of Fudan University and Department of Medical If Fudan University and Department of Medical I
mage, Shanghai Medical College of Fudan univermage, Shanghai Medical College of Fudan university, Shanghai, Chinasity, Shanghai, China
BackgroundBackground With the increasing radiological reports of Solid pseudopapilWith the increasing radiological reports of Solid pseudopapil
lary tumor of the pancreas, its typical imaging features have lary tumor of the pancreas, its typical imaging features have been well known to radiologists. been well known to radiologists.
However, with the improvement in the imaging modalities aHowever, with the improvement in the imaging modalities and widespread use of CT and MRI, those atypical neoplasmnd widespread use of CT and MRI, those atypical neoplasms have been becoming more and more commons have been becoming more and more common. .
肿瘤实质和囊性成分肿瘤实质和囊性成分 年轻女性 年轻女性 (35(35 岁岁 ) 85% ) 85% 边缘包膜清晰,境界规则边缘包膜清晰,境界规则 周缘或中心可见钙化( 周缘或中心可见钙化( 29% of 56 pts29% of 56 pts )) --------------Buetow, et al. Radiology 1996; 199:707Buetow, et al. Radiology 1996; 199:707 肿瘤位于胰腺体尾部较多见肿瘤位于胰腺体尾部较多见 手术切除预后好手术切除预后好(恶性程度与肿瘤大小、年龄正比)(恶性程度与肿瘤大小、年龄正比)
李卉 曾蒙苏 等 中华放射学 2006 , 8 : 846
史讯 曾蒙苏 等 放射学实践 2007 , 11 : 356
史讯 曾蒙苏 等 中国医学计算机成像 2007 , 13 ; 370
姚秀忠 曾蒙苏等 中国肿瘤影像学杂志 2010 , 5 ; 458
中山医院
门诊大楼
The purpose of this study was to The purpose of this study was to
investigate the accuracy of CT investigate the accuracy of CT
and MRI for diagnosis of solid and MRI for diagnosis of solid
pseudopapillary tumor of the pancrepseudopapillary tumor of the pancreas as
(SPTP).(SPTP).
Material and Material and MethodsMethods
39 patients with SPTP proven by histopathology 39 patients with SPTP proven by histopathology were divided into the were divided into the correct diagnosiscorrect diagnosis and and misdiagnosismisdiagnosis group based on the preoperative group based on the preoperative imaging and histopathologic results. imaging and histopathologic results.
All CT and MR imaging signs, including gender, All CT and MR imaging signs, including gender, age, tumor size, modalities (CT or MRI), location, age, tumor size, modalities (CT or MRI), location, shape, capsule, cystic degeneration, hemorrhage, shape, capsule, cystic degeneration, hemorrhage, calcification and enhancement type, were calcification and enhancement type, were retrospectively evaluated with a correlation to their retrospectively evaluated with a correlation to their pathologic findings and statistically analyzed.pathologic findings and statistically analyzed.
ResultsResults Among 39 imaging cases, Among 39 imaging cases, 15 (38.5%) misdiagnosed (mean age 41.07 years old)15 (38.5%) misdiagnosed (mean age 41.07 years old) 24(61.5%) diagnosed. (mean age 26.75 years old, p=0.000). 24(61.5%) diagnosed. (mean age 26.75 years old, p=0.000). Tumor size tended to be smaller in the elder group and had a negative linear correlation with the patient agTumor size tended to be smaller in the elder group and had a negative linear correlation with the patient ag
e (r=-0.408, p=0.025). e (r=-0.408, p=0.025). cause of higher misdiagnosis: cause of higher misdiagnosis: correctly diagnosis : correctly diagnosis : the older patients (p=0.007), gender, the older patients (p=0.007), gender, small tumors (p=0.037), location, small tumors (p=0.037), location, CT (p=0.049) shape, CT (p=0.049) shape, non-hemorrhage (p=0.000) capsule, non-hemorrhage (p=0.000) capsule, cystic degeneration, cystic degeneration, calcification calcification type of enhancement . type of enhancement . Macroscopically, large SPTPs were more likely to appear the capsule (p=0.002), Macroscopically, large SPTPs were more likely to appear the capsule (p=0.002), cystic degeneration (p=0.003) cystic degeneration (p=0.003) and hemorrhage (p=0.029) than small tumors. and hemorrhage (p=0.029) than small tumors.
ResultsResultsTable 1 Comparison of tumor size and age between two groups
(a) Photograph of gross surgical specimen demonstrates the fibrous capsule, hemorrhagic areas and cystic degeneration.
Fig. 1.—23-year-old woman with a typical solid pseudopapillary tumor of pancreas
Fig. 1b Fig. 1cFig. 1.—23-year-old woman with a typical solid pseudopapillary tumor of pancreas(b, c) T2 weighted image and T1 weighted image with fat suppression showed the typical imaging features: the capsule, cystic degeneration and hemorrhagic areas.
Fig. 1d Fig. 1e
Fig. 1f
(d, e,f) Dynamic contrast-enhanced MR scans revealed the early peripheral enhancement with progressively fill in and delayed enhancement of the capsule.
(a) Photograph of gross surgical specimen demonstrated the septations among chamberlets with cystic degeneration and the incomplete pseudocapsule.
Fig. 2.—19-year-old woman with a solid pseudopapillary tumor of pancreas misdiagnosed as mucinous cystic adenocarcinoma.
Fig. 2a
Fig. 2bFig. 2c
Fig. 2d
(b, c,d) Dynamic contrast-enhanced CT scans demonstrated the pseudoseptate type enhancement and contrast medium was progressively filled in from the septation and margin to the centre of tumors.
Fig. 3 —51-year-old man with a small solid pseudopapillary tumor of pancreas.
(a) Photograph of gross surgical specimen demonstrated a small solid tumor with the thick and irregular rim.
Fig. 3a
Fig. 3bFig. 3c
Fig. 3d
(b) Axial T1-weighted image reveals the tumor’s rim with hyperintense and the solid portions with homogeneous hypointense.
(c, d) The small tumor appeared imperceptible in the contrast-enhanced T1-weighted and CT images on the delayed phase.
Fig. 4a
Fig. 4—49-year-old woman with a solid pseudopapillary tumor of pancreas misdiagnosed as an inflammatory mass.
(a) Photograph of gross surgical specimen demonstrated a relatively large solid tumor without pseudocapsule and hemorrhagic areas.
Fig. 4b Fig. 4c
Fig. 4d
(b) Axial unenhanced CT showed the swelling pancreatic head with isodensity. (c, d), Dynamic contrast-enhanced CT scans displayed a large tumor with markedly early and delayed enhancement in the pancreatic head.
ConclusionConclusion To avoid misdiagnosis, it should be very To avoid misdiagnosis, it should be very
careful to evaluate some characteristic icareful to evaluate some characteristic imaging signs in small tumors and those maging signs in small tumors and those occurred to the aged. Compared to CT, occurred to the aged. Compared to CT, MR was much superior to avoid misdiagMR was much superior to avoid misdiagnosis of SPTP. nosis of SPTP.