MRCP和DWI鉴别自身免疫性胰腺炎和胰腺导管腺癌  

Differential diagnosis of autoimmune pancreatitis and pancreatic ductal cancer by MRCP and DWI

作　　者：裴新龙[1] 谢敬霞[1] 刘剑羽[1] 苏静[2] 

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学第三医院病理科,北京100191

出　　处：《影像诊断与介入放射学》2015年第4期299-304,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨磁共振胰胆管成像(MRCP)和扩散加权成像(DWI)对鉴别自身免疫性胰腺炎(AIP)和胰腺导管腺癌(PDAC)的价值。方法 21例经证实的AIP患者回顾性分析其治疗前MRCP检查,其中11例行DWI检查,同时回顾性分析30例经证实的PDAC患者MRCP和DWI检查,以及30例无胰腺疾病患者上腹部DWI检查。观察AIP和PDAC病灶形态以及胰管、胆管形态,比较AIP、PDAC、对照组DWI表现,计算各组表观扩散系数(ADC)值并进行对照。结果 AIP多表现为弥漫性或混合多病灶、腊肠样肿胀、胰周包壳、病变段胰管多表现为渐进性或多节段狭窄,胰管多数贯通病变,病变远端胰管多无扩张或轻度扩张小于5 mm,胰腺段胆管多呈渐进性或胆管多发狭窄。30例PDACA病灶均表现为结节状,病变段胰管多狭窄闭塞,狭窄远端胰管扩张大于5 mm,常伴有胰腺实质萎缩,累及胆总管多呈截断狭窄。AIP病灶ADC值显著低于PDAC病灶(P<0.01)。结论 MRCP和DWI对于AIP和PDAC具有较高的鉴别诊断价值。Objective To investigate the differentiating features, if any, between autoimmune pancreatitis（AIP） and pancreatic ductal cancer （PDAC） on magnetic resonance cholangiopancreatography （MRCP） and diffusion-weighted MR imaging （DWI）. Methods MRCP （21） and DWI （11 ） of 21 patients with confirmed AIP as well as MRCP （30, 30） and DWI （30, 30） of 30 patients with PDAC and 30 normal subjects were retrospectively analyzed. The appearance of the pancreatic lesions, involvement of the pancreatic duct and bile duct were compared between AIP and PDAC. ADC values of AIP, PDAC and normal subjects were also compared. Results Features of AIP included diffuse or multiple lesions, sausage-like pancreatic swelling, peripancreatic capsule, progressive or skipped stricturing of pancreatic and biliary ducts, no or less than 5 mm dilatation of the proximal pancreatic ducts. In PDAC, the lesions were nodular with pancreatic and biliary duct strictures, proximal pancreatic duct dilatation greater than 5 mm, and pancreatic atrophy. ADC values of AIP were significantly lower that of PDAC （P〈0.01）. Conclusion There are distinguishing MRCP and DWI features between AIP and PDAC.

关 键 词：自身免疫性胰腺炎 磁共振胰胆管成像 扩散加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R576[医药卫生—诊断学] R735.9[医药卫生—临床医学]