胰腺钩突癌的MRI表现及其分析  

MRI Appearances and Analysis of Pancreatic Uncinate Carcinoma

作　　者：殷允娟[1,2] 曾蒙苏[1,2] 陈财忠[1,2] 沈继章[1,2] 施伟斌[1,2] 李卉[1,2] 

机构地区：[1]复旦大学附属中山医院放射科,上海市影像医学研究所 [2]无锡市第三人民医院放射科

出　　处：《放射学实践》2005年第6期486-488,共3页Radiologic Practice

摘　　要：目的:通过分析14例胰腺钩突癌的MRI表现,进一步提高对该病的认识和诊断水平。方法:搜集14例经手术病理或随访证实的胰腺钩突癌,其中14例行SET1WI、FSET2WI,其中13例行DCEFMPSPGR序列扫描,8例同时行SET1WI+FS序列扫描,5例行MRCP检查。结果:13例行动态增强检查病例,术前诊断符合率为100%。本组病例中当胰胆管累及时,依其扩张程度分为4型。Ⅰ型:“双管征”改变,即胆胰管均扩张,本组4例;Ⅱ型:胆总管不扩张,胰管扩张,本组3例;Ⅲ型:胆总管扩张,胰管不扩张,本组2例;Ⅳ型:胆胰管均不扩张,本组共5例。胰周血管侵犯情况:肠系膜上动脉、静脉均受累6例,门静脉受累3例,左肾静脉、主动脉、腹腔干及肝总动脉受累各1例。3例发生肝转移,2例发生腹膜后淋巴结转移,1例合并腹腔积液。结论:胰腺钩突癌的MRI表现:①胰腺钩突部乏血供病灶;②可伴有较明显的胰周血管侵犯;③可仅表现为胆总管或主胰管扩张,或两者均不扩张。动态增强动脉期扫描表现为乏血供病灶是MRI诊断胰腺钩突癌的关键。Objective:To improve the diagnostic accuracy by means of analyzing MRI appearances of 14 cases of pancreatic uncinate carcinomas.Methods:Fourteen cases of pancreatic uncinate carcinomas confirmed by histopathology were analyzed,in which MRI sequences such as SE T_1WI,T_2WI and dynamic contrast enhanced GRE triphase scans were performed in 13 cases.Among them,in eight cases SE T_1WI+FS sequences were added and five cases were performed MRCP techniques.One case was only done by SE T_1WI and T_2WI sequences.Results:Preoperative diagnostic accuracy was 100% for 13 cases that were performed DCE FMPSPGR sequence.According to the degree of dilatation of common bile duct and/or main pancreatic duct caused by tumor the appearances could be classified into four types:Ⅰ,'double duct sign',both the common bile ducts and main pancreatic ducts dilatated,four cases; Ⅱ,common bile ducts were normal while the main pancreatic ducts dilatated,three cases;Ⅲ,common bile ducts dilatated while the main pancreatic ducts were normal,two cases;Ⅳ,neither of the two ducts dilatated,five cases.Peripancreatic vessels invasion was as follows:both the superior mesenteric vein and artery were invaded in six cases,portal vein was invaded in three cases,the left renal vein,aorta,celiac trunk and hepatic artery were involved in one case respectively.Meanwhile hepatic metastases were found in three cases,retroperitoneal lymphatic metastases in two cases and ascites in one case.Conclusion:MRI appearances of pancreatic uncinate carcinomas are as following:the carcinoma showed mild enhancement during arterial phase,accompanied with dilatation of common bile ducts and/or main pancreatic ducts or not,and markedly invasion of surrounding vessels.The key point for MRI diagnosis of pancreatic uncinate carcinoma is the finding of lack of blood supply appeared in the arterial phase of dynamic contrast enhancement.

关 键 词：胰腺肿瘤 磁共振成像 扫描序列 

分 类 号：R735.9[医药卫生—肿瘤]