自身免疫性胰腺炎的影像学研究  

A study on the imaging characteristics of autoimmune pancreatitis

作　　者：梁亮[1] 曾蒙苏[1] 姚秀忠[1] 饶圣祥[1] 程伟中[1] 纪元 楼文晖 刘厚钰 靳大勇 

机构地区：[1]复旦大学附属中山医院放射诊断科,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 [2]中山医院病理科 [3]中山医院普外科 [4]中山医院消化科

出　　处：《中华普通外科杂志》2012年第9期721-725,共5页Chinese Journal of General Surgery

摘　　要：目的研究自身免疫性胰腺炎（autoimmune pancreatifis，AIP）的影像学表现及其临床价值。方法回顾性研究14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，男13例，女1例，平均58．3岁。12例行CT检查，8例行MRI检查，其中6例同时行CT及MRI检查。结果胰腺弥漫肿大者7例，局限肿块型5例，混合型2例。CT平扫病变呈等密度（5例）或稍低密度（7例），1例胰腺内及周边见多个囊性低密度灶，MRI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，DWI序列信号均升高。动态增强扫描，动脉期病变强化降低呈不均匀“雪花状”，后渐进性延迟强化。9例病变周围见“胶囊样”包壳。4例胰管形态不规则，5例胰管轻度扩张；9例胆总管下段管壁规则增厚伴明显强化及“鸟嘴样”管腔狭窄。4例病变周围血管受累，1例肝门区见2枚肿大淋巴结。2例增强后肾脏内见异常低密度灶。经肾上腺皮质激素规范治疗的10例患者随访影像学检查病变胰腺均有明显的好转及恢复。结论AIP具有特征性的CT和MRI影像表现，对于AIP的诊断和鉴别诊断具有重要意义。Objective To investigate the CT and MRI imaging characteristics of autoimmune pancreatitis and its clinical value. Methods Fourteen patients （13 males, 1 female, mean age 58. 3 years） with autoimmune pancreatitis proved histopathologically or clinically were enrolled in the study. Clinical data was studied retrospectively. Among those patients, CT was performed on 12 cases and MR imaging was performed on 8 patients, 6 patients underwent both CT and MR imaging. Results All 14 patients had enlargement of the pancreas, which could he divided into three types including diffuse type （ n = 7 ）, focal type （ n = 5 ） and mixed type （ n = 2 ）. On plain CT the pancreas was of isodensity （ n = 5 ） or mild hypodensity （ n = 7 ）. In one ease there was several small hypodensity cystic lesions within and around the pancreas that was rarely seen in other autoimmune panereatitis eases. Pancreatic lesions as shown by MRI were all mildly hypointense on T1WI and mildly hyperintense on T2WI, all displayed lesions were detected as high-signal intensity areas on DWI. By medium contrast, autoimmune pancreatitis lesions demonstrated ＂ snow-like＂ heterogeneously decreased enhancement on artery phase of dynamic contrast enhanced imaging and then showed gradually delayed enhancement on portal venous phase and later phases. ＂Capsule-like＂ rim was present around the autoimmune panereatitis lesions in 9 cases. Main pancreatic duct was irregular in shape in 4 cases and slightly dilated in 5 patients. Strictures of lower common bile duct and upper bile duct dilatation as well as thickening and enhancement of the bile duct wall were found in 9 cases. Peripheral vascular involvement was seen in 4 cases. Abdominal lymphadenopathy at hepatic portal was observed in 1 patient. Two cases showed tiny decreased enhancement lesions in the kidneys. Steroid therapy was given in 10 eases, all panereatitis lesions ameliorated as showed by follow-up imaging examinations. Conclusions AIP specific CT and MRI imaging findings are c

关 键 词：胰腺炎 体层摄影术 X线计算机 磁共振成像 

分 类 号：R657.51[医药卫生—外科学] R445.2[医药卫生—临床医学]