胰腺囊性和囊实性病变的影像误诊分析  

Analysis of imaging misdiagnosis in pancreatic cystic and cystic-solid lesions

作　　者：吕蓉[1,2] 张翔[2] 亓俊霞[2] 于长路[2] 

机构地区：[1]天津医科大学总医院放射科,天津300000 [2]天津市第三中心医院放射科

出　　处：《实用放射学杂志》2013年第5期780-782,共3页Journal of Practical Radiology

摘　　要：目的探讨胰腺各种囊性和囊实性病变的影像特征、诊断要点及鉴别诊断，并对部分误诊病例进行分析。方法回顾性分析40例经手术或细针穿刺活检病理证实及临床综合诊断证实的胰腺囊性和囊实性病变患者的影像资料，结合文献总结不同类型病变的影像表现。并对误诊病例原因进行分析。结果40例胰腺囊性和囊实性病变中因影像表现不典型将1例实性假乳头状瘤误诊为胰腺癌，1例假性囊肿误诊为囊腺瘤；因结合临床不够将1例实性假乳头状瘤误诊为囊性病变；因检查方法的局限性将1例导管内乳头状黏液性肿瘤（IPMN）的CT结果误诊为囊腺瘤，1例浆液性囊腺瘤误诊为胰腺恶性病变，1例黏液性囊腺瘤误诊为胰腺囊肿；因细节观察不仔细将1例胰腺癌伴囊变误诊为囊腺癌。共7例误诊，误诊率17．5％。结论充分理解胰腺囊性和囊实性病变的不典型征象，密切结合临床，认真观察影像学细节，正确选择影像检查方法是减少溟诊率的保证。Objective To investigate the imaging findings and differential diagnosis of pancreatic cystic and cystic-solid lesions, and analyze retrospectively some misdiagnostic cases. Methods The imaging findings in 40 patients with pancreatic cystic and cystic- solid lesions confirmed by operation-pathology or fine needle aspiration biopsy and comprehensive clinical manifestations were ana- lyzed retrospectively in the study. The reasons of misdiagnostic cases were analyzed by combining imaging findings of these lesions with related literature. Results Among 40 cases, the misdiagnosis resulted from atypical imaging findings in 2 cases （a solid pseudo- papillary tumor misdiagnosed as pancreatic carcinoma and a pseudocyst as cystadenoma）, lack of enough clinical experience in 1 （the solid pseudopapillary tumor rnisdiagnosed as cystic lesions）, inherent limitations of each imging modality in 3 （an intraductal papillay mucious neoplasms misdiagnosed as cystadenoma by CT, a serous cystadenoma as malignant lesions, and a mucinous cystadenoma as pancreatic cyst）, and from careless observation in 1 （a pancreatic carcinoma with necrosis misdiagnosed as cystadenocarcinoma）. The overall rate of misdiagnosis was 17.5% （7/40）. Conclusion Understanding the acypical images sufficiently, observing detailed imaging findings carefully and selecting correct imaging modalities are necessary to decrease the misdiagnosis of pancreatic cystic and cystic-solid lesions.

关 键 词：胰腺 囊性病变 囊实性病变 误诊 

分 类 号：R576[医药卫生—消化系统] R814.4[医药卫生—内科学]