自身免疫性胰腺炎患者的腹部影像学改变  

Imaging characteristics of abdominal organs in autoimmune pancreatitis

作　　者：梁亮[1,2] 陆秀良[1,2] 顾君英[1,2] 陈刚[1,2] 饶圣祥[1,2] 纪元[3] 曾蒙苏[1,2] 

机构地区：[1]复旦大学附属中山医院放射诊断科 [2]复旦大学上海医学院影像医学系上海市影像医学研究所,上海200032 [3]复旦大学附属中山医院病理科,上海200032

出　　处：《临床肝胆病杂志》2012年第8期579-583,共5页Journal of Clinical Hepatology

摘　　要：目的研究自身免疫性胰腺炎(AIP)患者腹部的影像学改变。方法回顾性研究25例经病理证实或肾上腺皮质激素规范治疗后随访证实的AIP患者临床资料,21例行CT检查,14例行MRI检查,其中10例同时行CT及MRI检查。结果胰腺弥漫肿大者16例(64.0%),局限肿块型7例(28.0%),混合型2例(8.0%)。CT平扫病变呈等密度13例(61.9%),稍低密度8例(39.1%),1例胰腺内及周边见多个囊性低密度灶,MRI检查病变T1WI序列信号均匀或稍不均匀降低,T2WI序列信号不同程度均匀或稍不均匀升高,23例(92.0%)DWI序列信号升高。动态增强扫描时,胰腺病变处呈"雪花状"不均匀渐进性延迟强化。18例(72.0%)病变周围见包壳样结构。7例(28.0%)胰管形态不规则,5例(20.0%)胰管轻度扩张。17例(68.0%)胆道系统受累;4例(16.0%)肾脏受累;4例(16.0%)见腹膜后纤维化。1例(4.0%)肝门区见肿大淋巴结。结论 AIP患者胰腺及其他腹部器官具有特征性的影像学改变,对其诊断和鉴别诊断具有重要意义。Objective To investigate the imaging characteristics of abdominal organs in autoimmune pancreatitis （AIP）. Methods Twen- ty- five patients with AIP that had been diagnosed by histopathological or clinical findings were studied retrospectively. Computed tomo- graphy （CT） was performed for 21 patients and magnetic resonance imaging （MRI） for 14 patients, with 10 patients undergoing both CT and MRI. Results Imaging findings revealed that all 25 patients had enlarged pancreas, including diffuse （ n = 16, 64. 0% ）, focal （ n = 7, 28.0% ） , or mixed （n = 2, 8.0% ） types. Lesions showed isodensity （n = 13, 61.9% ） or mild hypodensity （ n = 8, 39.1% ）. One case showed several small cystic lesions within and around the pancreas. Imaging of the pancreatic lesions revealed that most cases were isointense or mildly hypointense on T1WI and mildly hyperintense on T2WI. All but two of the displayed lesions were detected as high - signal intensity areas on DWI. Dynamic contrast enhanced imaging of the lesions demonstrated ＂snow -like＂ heterogeneous and delayed gradual enhance- ment. A ＂capsule -like＂ rim was present around the lesions in 18 cases （72. 0% ）. The main pancreatic duct was irregular in seven pa- tients （28.0%） and slightly dilated in five patients （20. 0% ）. Bile duct involvement was observed in 17 patients （68.0%）. Renal in- volvement was observed in four patients （ 16.0% ）. Retroperitoneal fibrosis was found in four patients （ 16.0% ）. Abdominal lymphadenopa- thy involving the hepatic portal was observed in one patient （4.0%）. Conclusion Patients with AIP have characteristic imaging findings for the pancreas and other abdominal organs. CT and MRI modalities play a very important role in the diagnosis of AIP.

关 键 词：自身免疫性胰腺炎 体层摄影术 X线计算机 磁共振成像 

分 类 号：R576[医药卫生—消化系统] R816.5[医药卫生—内科学]