16例慢性胰腺炎误诊为胰腺癌CT征象分析及文献回顾  

A Retrospective Study of Sixteen Patients with Pancreatic Lesions Misdiagnosed as Carcinoma by Computed Tomography：CT Signs and Literature Review

作　　者：杨勇[1] 徐健[1] 魏梦绮[1] 刘凯[1] 宦怡[1] 

机构地区：[1]第四军医大学西京医院放射科,陕西西安710032

出　　处：《实用放射学杂志》2011年第1期76-79,共4页Journal of Practical Radiology

摘　　要：目的分析慢性胰腺炎CT误诊为胰腺癌的原因。方法收集16例慢性胰腺炎CT误诊为胰腺癌的病例，对胰腺病灶的边界、密度、强化效应，周围淋巴结临床表现以及血、尿淀粉酶水平进行分析并复习文献。所有病例均经病理证实。结果16位患者的胰腺周围及腹膜腔均无明确渗出物，12例病变边缘清楚，其余欠清。7个病灶位于胰腺头部，8个位于胰腺体尾部，1个在胰腺钩突部。3个病灶为囊性，CT值在5～20HU之间，13个为软组织密度，CT值在35HU左右。15例患者行CT增强扫描，病灶主体部分三期均无强化，1例未做增强。8例胰腺病灶可见周边环状延迟强化。5例胰腺周围发现肿大淋巴结（直径〉1cm），2例可见胰管及肝胆管扩张（双管征）。患者的血、尿淀粉酶水平均在正常水平上限以内。结论腹腔无渗出，血、尿淀粉酶水平不高，缺乏典型的CT表现是误诊的主要原因。Objective To study the causes of chronic pancreatitis misdiagnosed as pancreatic carcinoma by CT. Methods 16 patients with chronic pancreatitis misdiagnosed as pancreatic carcinoma by CT were collected. Results The lesions located in the pancreatic uncinate process in one,head in 7, the body and the tail in 8. Twelve lesions had clear boundary and the other not. The prerenal fascia was not thickened and no peritoneal exudates were found in all lesions. 3 lesions appeared as cystic masses with CT value of 5 --20 HU,3 lesions appeared as soft tissue with CT value of 35 HU. 15 cases underwent contrast--enhanced CT scans. The main parts of the lesions were no enhancement in all three phases of contrast--enhanced scan, but the periphery of the lesions was of ring delayed enhancement in 8 cases. There was lymphadenopathy around the pancreas in 5 cases. Double duct sign was seen in 2 cases. Test of blood and urine amylase was normal in all cases. All cases were confirmed by pathology. The margins, density and contrast-- enhanced patterns of the lesions, lymphadenopathy around the lesions, clinicai and experimental test data were retrospectively analysed with literature review. Conclusion The main causes of chronic pancreatitis misdiagnosed as pancreatic carcinoma include no peritoneal exudates,the test of blood and urine amylase to be normal and lack of typical CT findings.

关 键 词：胰腺 慢性胰腺炎 胰腺癌 体层摄影术 X线计算机 

分 类 号：R576[医药卫生—消化系统] R735.9[医药卫生—内科学]