胰腺结核九例的MDCT特征和误诊分析  

Pancreatic tuberculosis： MDCT features and differential diagnosis

作　　者：梁宗辉[1] 窦娅芳[2] 唐颖[2] 汤伟军[2] 冯晓源[2] 

机构地区：[1]复旦大学附属华山医院放射科 上海市静安区中心医院放射科,上海200040 [2]复旦大学附属华山医院放射科,上海200040

出　　处：《中华胰腺病杂志》2011年第2期110-112,共3页Chinese Journal of Pancreatology

摘　　要：目的 分析胰腺结核（pancreatic tuberculoses,PT）的多层螺旋CT（MDCT）征象,以期提高对该病的认识和诊断正确率.方法 收集2003年至2009年行MDCT检查并最终确诊为PT的9例患者,其中2例行MDCT血管成像.分析PT的MDCT特征性表现,并与手术及病理结果进行比较.结果 MDCT诊断为胰腺癌1例、囊腺癌1例、囊腺瘤2例、假性囊肿1例、胰腺癌伴后腹膜淋巴结转移2例、淋巴瘤2例.通过病理证实,9例均为PT,误诊率达100%.PT常表现为胰头肿块,亦可累及体尾部或整个胰腺.MDCT呈现等或略低密度的囊实性肿块,偶见钙化,增强后轻度至中度环形强化.通常不伴有胰管扩张,但常伴有后腹膜或邻近淋巴结肿大,且肿大淋巴结亦呈环形强化.有时伴有腹部其他脏器结核.结论 环形强化的肿块不伴有胰管扩张,同时伴有环形强化的肿大淋巴结为PT特征性的MDCT表现.Objective To study the multi-detector spiral CT （MDCT） features of pancreatic tuberculosis to improve the awareness and correct diagnosis. Methods Imaging features of MDCT were retrospectively reviewed on 9 cases with pancreatic tuberculosis that were diagnosed from 2003 to 2009, among them two patients underwent MDCT angiography, the features were compared with those of operative and pathological findings. Results One case of pancreatic cancer, 2 cases of cystadenocarcinoma and 1 case of pseudocyst, 2 cases of pancreatic cancer with retroperitoneal lymph node metastasis, 2 cases of lymphoma were diagnosed by MDCT, and all the lesions were diagnosed as pancreatic tuberculosis pathologically, and the misdiagnosis rate was 100%. Pancreatic tuberculosis often presented as pancreatic head mass, sometimes pancreatic body and tail were involved. MDCT showed isopycnic or low density solid-cyst mass, occasionally calcification was present, with slightly or moderate ring-like enhancement after contrast injection. There was no enlargement of the pancreatic duct. The retroperitoneal and adjacent lymph nodes were always enlarged with ring-like enhancement. Sometimes there was evidence of tuberculosis of other abdominal organs. Conclusions Ring-like enhanced lesions with ring-like enhanced lymph nodes without enlargement of pancreatic duct are characteristic MDCT features of pancreatic tuberculosis.

关 键 词：胰腺 结核 体层摄影术 螺旋计算机 诊断 

分 类 号：R525[医药卫生—内科学]