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复旦大学附属中山医院 Zhongshan Hospital Fudan University Solid Pseudopapillary Tumor of the Pancreas: Diagnosis with CT and MRI Mengsu Zeng, Xiuzhong Yao 曾蒙苏 姚秀忠.

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Presentation on theme: "复旦大学附属中山医院 Zhongshan Hospital Fudan University Solid Pseudopapillary Tumor of the Pancreas: Diagnosis with CT and MRI Mengsu Zeng, Xiuzhong Yao 曾蒙苏 姚秀忠."— Presentation transcript:

1 复旦大学附属中山医院 Zhongshan Hospital Fudan University 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

2 Background With the increasing radiological reports of Solid pseudopapillary tumor of the pancreas, its typical imaging features have been well known to radiologists. With the increasing radiological reports of Solid pseudopapillary tumor of the pancreas, its typical imaging features have been well known to radiologists. However, with the improvement in the imaging modalities and widespread use of CT and MRI, those atypical neoplasms have been becoming more and more common. However, with the improvement in the imaging modalities and widespread use of CT and MRI, those atypical neoplasms have been becoming more and more common.

3 SOLID-PSEUDOPAPILLARY EPITHELIAL NEOPLASM 肿瘤实质和囊性成分 肿瘤实质和囊性成分 年轻女性 (35 岁 ) 85% 年轻女性 (35 岁 ) 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( 29% of 56 pts ) 周缘或中心可见钙化( 29% of 56 pts ) Buetow, et al. Radiology 1996; 199: Buetow, 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) 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

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5 The purpose of this study was to investigate the accuracy of CT and MRI for diagnosis of solid pseudopapillary tumor of the pancreas (SPTP).

6 Material and Methods 39 patients with SPTP proven by histopathology 39 patients with SPTP proven by histopathology were divided into the correct diagnosis and were divided into the correct diagnosis and misdiagnosis group based on the preoperative misdiagnosis 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.

7 Results Among 39 imaging cases, Among 39 imaging cases, 15 (38.5%) misdiagnosed (mean age years old) 15 (38.5%) misdiagnosed (mean age years old) 24(61.5%) diagnosed. (mean age years old, p=0.000). 24(61.5%) diagnosed. (mean age years old, p=0.000). Tumor size tended to be smaller in the elder group and had a negative linear correlation with the patient age (r=-0.408, p=0.025). Tumor size tended to be smaller in the elder group and had a negative linear correlation with the patient age (r=-0.408, p=0.025). cause of higher misdiagnosis: correctly diagnosis : cause of higher misdiagnosis: 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.

8 Results Table 1 Comparison of tumor size and age between two groups N Mean (cm) P value sizemisdiagnosis Correct diagnosis agemisdiagnosis

9 Results Graph 1 Linear regression analysis of tumor size and patient age Note: Bconstant=7.435, p=0.000; Bage=-0.067, p=0.025

10 Table 2 imaging Analysis of SPTP between Two groups Evaluations correct diagnosis misdiagnosis Misdiagnosis Rate P value GenderMale3350.0% Female %0.658 Age * The elder(≥40) % The younger( < 40) %0.007 Size * Large ( > 3.0cm) % Small (≤3.0cm) %0.037 Modalitie s * CT % MRI %0.049 LocationHead7646.2% Body9640.0% Tail832.3%0.631 ShapeRound % Oval8433.3% Lobulated5444.4%0.873 CapsulePresence % Absence4763.6%0.068 Cystic degeneration Presence % Absence7750%0.318 hemorrhage * Presence1118.3% Absence %0.013 calcificationPresence % Absence4450%0.686 gradual enhancement Presence % Absence2133.3%1.000

11 Table 3 Tumors’ demonstrations between CT and MRI FindingsCTMRI P value CapsulePresence1414 Absence Cystic degeneration Presence1213 Absence hemorrhagePresence111 Absence calcificationPresence81 Absence gradual enhancement Presence2112 Absence Results

12 Results Table 4 Histopathological analysis in tumor size and patient age Findings Size Group P value Age Group P value LargeSmall The elder The younger Capsule Presenc e Absence Cystic degeneration Presenc e Absence hemorrhage Absence calcification 8246 Absence

13 Fig. 1a (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

14 Fig. 1bFig. 1c Fig. 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.

15 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.

16 (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

17 Fig. 2b Fig. 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.

18 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

19 Fig. 3b Fig. 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.

20 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.

21 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.

22 Conclusion To avoid misdiagnosis, it should be very careful to evaluate some characteristic imaging signs in small tumors and those occurred to the aged. Compared to CT, MR was much superior to avoid misdiagnosis of SPTP. To avoid misdiagnosis, it should be very careful to evaluate some characteristic imaging signs in small tumors and those occurred to the aged. Compared to CT, MR was much superior to avoid misdiagnosis of SPTP.


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