自身免疫性胰腺炎患者胰腺内外CT和MRI表现  

CT and MRI findings in patients with autoimmune pancreatitis

作　　者：钟百书[1] 杨根仁[1] 张胜[1] 汪启东[1] 许顺良[1] 阮凌翔[1] 

机构地区：[1]浙江大学医学院附属第一医院放射科,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2014年第1期94-100,共7页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:分析自身免疫性胰腺炎(AIP)患者胰腺和胰外受累组织器官的CT和MRI影像表现。方法:回顾性分析24例AIP患者胰腺和胰外受累组织器官的CT和MRI扫描资料和临床表现。CT检查18例,MRI检查11例,CT和MRI联合检查10例。CT和MRI平扫后均行胰腺期、门脉期和延迟期三期动态增强扫描,扫描时间设定为静脉对比剂注射后35、70、180 s。结果:24例表现为胰腺弥漫性肿大,呈"腊肠样"外观6例(25.0%)、局灶性肿大9例(37.5%)、结合型6例(25.0%)、正常外形3例(12.5%)。CT平扫显示胰腺病灶区密度降低2例;增强后扫描显示受累胰实质区异常强化17例:动脉期低强化9例(50%)、延迟期延迟强化17例(94.4%)。MRI平扫显示胰腺实质信号异常9例:T1WI序列呈低信号变化7例、等信号4例,T2WI序列呈高信号变化7例、等信号2例、低信号2例;增强后扫描显示病变区异常强化11例:动脉期呈低强化9例(81.8%,9/11),延迟期延迟强化11例(100%,11/11)。胰腺周围表现为包膜样环9例(37.5%,9/24),其中CT显示6例,MRI显示7例。病灶区胰管显影消失24例(100%,24/24),病灶远侧胰管扩张8例,平均内径为(3.1±0.47)mm。胰腺段胆总管狭窄14例(58.3%,14/24)。其他:胰周静脉狭窄9例,动脉狭窄1例,胰周少量积液2例,假性囊肿3例,无一例胰实质钙化。胰外组织器官受累14例(58.3%,14/24),包括肝门部胆管狭窄5例、胆囊壁增厚5例、后腹膜纤维化2例、小肠系膜纤维化2例、肝圆韧带纤维化1例、肾受累3例、胰周和腹主动脉周围淋巴结肿大10例,以及溃疡性结肠炎3例。结论:AIP患者胰腺具有"腊肠样"外观、胰周包膜样环、延迟期延迟强化、胰管节段性狭窄而远侧段胰管扩张轻和胰外组织器官受累等一些CT和MRI的特征性征象,临床结合血清学检查和胰腺穿刺活检,常可做出正确诊断。Objective： To evaluate computed tomography （CT） and magnetic resonance imaging （MRI） findings in patients with autoimmune panereatitis （ALP）. Methods： The imaging findings of pancreas and extra-pancreas in 24 patients with AIP were retrospectively reviewed. Among them, CT scan was performed in 18 patients, MRI in 11 ,and both CT and MRI in 10. Results： The pancreas showed diffuse enlargement （25% , 6/24 ） , focal enlargement （ 37. 5% , 9/24 ）, combined enlargement （ 25%, 6/24）, and no enlargement （ 12.5% , 9/24）. Unenhaneed CT showed hypoattenuation in AIP area （ n = 2）. After intravenous injection of contrast medium, 17 patients showed abnormal contrast enhancement in the affected pancreatic parenehyma, including hypoattenuation during the arterial phase （50% ,9/18 ） and hyperattenuation during the delayed phase （94.4% , 17/18 ）. Precontrast MRI showed abnormal signal intense （n = 9 ）, including hypointense on T1 -weight images （T1WI） （ n = 7 ）, hyperintense （ n =7 ） and hypointense （n = 2） on T2-weight images （T2WI）. Enhanced MRI demonstrated abnormal contrast enhancement within lesions （n = 11 ）, including hypoattenuation during the arterial phase （81.8% ,9/11 ） and good enhancement during the delayed phase （100%, 11/11 ）. A capsule-like rim was seen around pancreas （37.5% ,9/24）, among which CT detected in 6 out of 18 patients and MRI found in 7 out of 11 patients. The main pancreatic duct lumen within lesions has no visualization （100% ,24/24） and upstream dilation of the main pancreatic duct （ n = 8 ）, ranging from 2.2 to 4.5 mm （mean 3.1 0.47 mm） in diameter. Narrowing of the common bile duct was shown in 14 patients. Miscellaneous findings were ： infiltration of extrapancreatic vein （ n = 9 ） and artery （ n = 1 ） ; mild fluid collection around pancreas （ n = 2 ） ; pseudocysts （ n = 3 ）. Fourteen patients also presented one or more of the following extrapanereatie imaging findings： narrowin

关 键 词：磁共振成像 体层摄影术 X线计算机 胰腺炎 诊断 自身免疫疾病 诊断 胰腺 胰腺管 缩窄 病理性 胆总管 淋巴结 

分 类 号：R576[医药卫生—消化系统]