局限性自身免疫性胰腺炎的多层螺旋CT三期扫描特征分析  

Analysis of 3-phase multi-slice spiral CT characteristics of focal autoimmune pancreatitis

作　　者：孙高峰[1] 左长京[1] 邵成伟[2] 汪建华[3] 张建[1] 程超[1] 

机构地区：[1]第二军医大学长海医院核医学科 [2]第二军医大学长海医院放射科 [3]浙江宁波大学医学院附属医院影像科

出　　处：《放射学实践》2013年第10期1027-1031,共5页Radiologic Practice

基　　金：国家自然科学基金(30970801);国家自然科学基金(81170435);上海市科委基金(10410708800);中国博士后科学基金(20100480545);上海领军人才队伍建设专项资金(2011-036)

摘　　要：目的:探讨局限性自身免疫性胰腺炎(f-AIP)的多层螺旋CT 3期扫描影像学特征,并与正常胰腺和胰腺癌三期扫描增强特征进行比较研究。方法:对79例患者(f-AIP 19例,胰腺癌30例,正常胰腺30例)的多层螺旋CT 3期(动脉期、门脉期及肝脏期)增强扫描影像资料进行分析,分别测定f-AIP病灶、胰腺癌病灶、f-AIP和胰腺癌组中未被累及的正常胰腺实质的平均CT值。分别对f-AIP和胰腺癌病灶增强后各期的CT值、f-AIP组和胰腺癌患者未被累及的正常胰腺实质及正常胰腺组的胰腺实质各期CT值进行比较。绘制ROC曲线,探讨最佳延迟强化值(CT值肝脏期-动脉期)对胰腺癌和f-AIP的鉴别诊断价值。结果:平扫期f-AIP与胰腺癌病灶CT值无统计学差异(P=0.306),增强后f-AIP病灶各期平均CT值均大于胰腺癌组(P<0.05);动脉期及门脉期f-AIP和胰腺癌病灶CT值均小于正常胰腺实质(P<0.05);肝脏期f-AIP病灶CT值与正常胰腺无显著统计学差异,而胰腺癌病灶CT值小于正常胰腺。在平扫期和增强各期各组胰腺实质CT值无显著统计学差异(P=0.245,0.204,0.112,0.112);延迟强化值的ROC曲线下面积(AUC)为0.974,延迟强化界值为28HU时对f-AIP诊断的灵敏度和特异度分别为85.7%和100%。结论:f-AIP的动脉期、门脉期及肝脏期3期扫描增强特征不同于胰腺癌和正常胰腺,当延迟强化值≥28HU时,诊断为f-AIP的特异度为100%。Objective：To study the 3-phase multi-slice spiral CT （MSCT） characteristics of focal autoimmune pancreatitis （f-AIP） and to compare with that of paenreatie carcinoma （P Ca） and nomal pancreas. Methods： 3-phase enhanced MSCT materials （arterial, portal and hepato-parenchyma phase） of 79 paitents （f-AIP, 19 cases ; P Ca, 30 cases ; normal panereas,30 cases） were analyzed. The mean CT attenuation of LAIP lesion,P Ca lesion as well as the normal pancreatic paren ehyma in f-AIP P Ca and normal subjects in different phases were measured and compared. Receiver operating characteristic （ROC） curves were drawn,the most optimal delayed enhanced value （CT valuehopato parenchyma ph iai phase ） for the differential diagnosis of P Ca and f-AIP was studied. Results：The mean CT value of f-AIP and P Ca lesions showed no statistic difference on plain CT scan （P=0. 306）. After enhancement,the CT values of all phases in f-AIP lesions were significantly higher than that of P Ca（P〈0.05）. On arterial and portal phase,the CT values of f-AIP and P Ca lesions were all lower than that of normal pancreatic parenchyma （P〈0.05）. The CT values of f-AIP lesions on hepato-parenehyma phase showed no significant difference with that of normal parenchyma,yet the CT values of PCA lesions were less than that of the normal parenchyma. On plain CT and every enhanced phases, there were no significant statistic differences of the CT value of pancreatic parenchyma in each group （P = 0. 245,0. 204,0. 112,0. 112）. ROC of delayed enhancement, the area under ROC curve was 0. 974. Taken the cut-off value as 28HU,the sensitivity and specificity for the diagnosis of f-AIP was 87.5 % and 100 % respectively. Conclusion：The enhancement pattern of the f-AIP lesions on arterial phase, portal phase and hepato-parenchyma were different from those of pancreatic carcinoma and normal pancreas, when delay-enhanced value ≥28HU,the specificity of diagnosis of f-AIP is 100%.

关 键 词：自身免疫性疾病 胰腺炎 胰腺肿瘤 体层摄影术 X线计算机 

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