Page 95 - 南京医科大学学报自然科学版

第43卷第9期 南京医科大学学报（自然科学版）
2023年9月 Journal of Nanjing Medical University（Natural Sciences） ·1273 ·

·影像医学研究·

双能CT细胞外容积分数在鉴别胰腺导管内乳头状黏液性肿瘤

良恶性中的应用价值

武凌宇，白潇涵，余 静，史红媛，徐 青 *
南京医科大学第一附属医院放射科，江苏 南京 210029

［摘 要］ 目的：探讨双能CT（dual⁃energy computed tomography，DECT）细胞外容积分数（extracellular volume fraction，ECV）在
鉴别胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm，IPMN）良恶性中的应用价值。方法：回顾性收集
2018年6月—2021年12月外科手术病理证实为IPMN，且术前1个月内行DECT检查的患者57例（良性组28例，恶性组29例）。测
量平衡期病灶周围1 cm范围内的胰腺实质碘浓度（iodine concentration，IC）及同一层面腹主动脉IC，依据（IC 胰腺/IC 腹主动脉 ）×（1-
红细胞比容）的公式计算DECT⁃ECV。对两组患者的临床及影像资料进行单因素及多因素Logistic回归分析，确定独立危险因
素并分别构建影像模型、临床模型及影像联合临床模型。采用受试者工作特征曲线评估其诊断效能，并使用Delong检验进行
比较。结果：多因素 Logistic 回归分析提示，DECT⁃ECV、糖类抗原（carbohydrate antigen，CA）19⁃9 升高、有急性胰腺炎（acute
pancreatitis，AP）病史是恶性IPMN的独立危险因素。影像模型（DECT⁃ECV）、临床模型（CA19⁃9升高及有AP病史）、影像联合
临床模型（DECT⁃ECV、CA19⁃9升高及有AP病史）诊断恶性IPMN的曲线下面积分别为0.808、0.759、0.884。影像联合临床模型
的诊断效能显著高于临床模型（P=0.007）。结论：病灶周围胰腺实质的 DECT⁃ECV 参数可以提高良恶性 IPMN 的鉴别诊断效
能，为临床诊疗提供参考依据。
［关键词］ 双能CT；细胞外容积分数；胰腺导管内乳头状黏液性肿瘤；鉴别诊断
［中图分类号］ R736.7 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）09⁃1273⁃06
doi：10.7655/NYDXBNS20230914

The value of the extracellular volume fraction measured by dual ⁃ energy computed
tomography in differentiating benign and malignant intraductal papillary mucinous
neoplasms

WU Lingyu，BAI Xiaohan，YU Jing，SHI Hongyuan，XU Qing *
Department of Radiology，the First Affiliated hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To explore the value of extracellular volume fraction（ECV）measured by dual⁃energy computed tomography
（DECT）in differentiating benign and malignant intraductal papillary mucinous neoplasms（IPMN）. Methods：A total of 57 patients
with IPMN confirmed by surgical pathology and underwent DECT examination within one month before the operation were
retrospectively collected between June 2018 and December 2021. According to pathological results，the patients were divided into
benign group（28 cases）and malignant group（29 cases），and the iodine concentration（IC）of pancreatic parenchyma within 1 cm
around the lesions and abdominal aorta on the same picture in the delayed⁃phase were measured respectively，and the value of DECT⁃
ECV was calculated according to the formula：（ICpancreas/ICabdominal aorta ）×（1-Hematocrit）. The clinical and imaging data of the two groups
were analyzed by univariate analysis and multivariate logistic regression analysis to determine the independent risk factors，and the
imaging model，clinical model and imaging combined clinical model were constructed respectively. The performance of each model was
evaluated according to the area under curve（AUC）under the receiver operating characteristic（ROC）curve，and the diagnostic
efficency of each model was compared by Delong test. Results：Multivariate analysis showed that the DECT⁃ECV，the elevated level of
carbohydrate antigen（CA）19⁃9，and the history of acute pancreatitis（AP）were independent risk factors for differentiating benign and

［基金项目］ 国家自然科学基金（81701760）
∗
通信作者（Corresponding author），E⁃mail：13776683209@163.com