自身免疫性胰腺炎与胰腺癌的CT增强表现  

Differential Diagnosis of Autoimmune Pancreatitis and Pancreatic Cancer by CT Enhancement

作　　者：裴新龙[1] 刘剑羽[1] 谢敬霞[1] 苏静[2] 

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

出　　处：《临床放射学杂志》2016年第1期71-76,共6页Journal of Clinical Radiology

摘　　要：目的探讨自身免疫性胰腺炎(AIP)与胰腺导管腺癌(PDAC)的CT增强表现。方法将23例经手术(6例)、组织学活检(9例)和激素治疗后随访(8例)证实的AIP患者纳入研究组,将36例手术证实的PDAC患者作为对照组,比较两组患者的CT平扫及动态增强图像,主要记录病变及胰腺形态、受累胰管和胆管形态,测量病灶各期CT值。结果 23例AIP包括6例局灶型、14例弥漫型及3例混合型,20例呈腊肠样肿胀,13例出现胰周包壳,均无胰腺萎缩,17例病灶出现延迟强化,仅4例病变远端胰管扩张且<0.5 cm;19例胰腺段胆管狭窄,多为渐进性(14例),伴有上方胆管扩张(7例伴有狭窄)。而36例PDAC均呈结节状,均未出现腊肠样肿胀及胰周包壳,27例出现胰腺萎缩,仅4例出现延迟强化;33例病变远端胰管扩张,其中27例≥0.5 cm;17例胰腺段胆管受侵狭窄,多为截断样(11例),15例伴有上方胆管扩张。结论腊肠样肿胀、胰周包壳、病灶延迟强化、胰管无扩张或轻度扩张(<0.5 cm)、胰腺段胆管渐进性狭窄、胰腺段以上胆管狭窄更多见于AIP患者,而胰腺萎缩、胰管扩张≥0.5cm、胰腺段胆管截断样狭窄更多见于PDAC患者。CT增强检查有助于两者的鉴别。Objective To discuss imaging features on contrast - enhanced computed tomography （CT） that help differ- entiate autoimmune pancreatitis （AIP） from pancreatic duct adenocarcinoma（PDAC）. Methods Research group includ- ed 23 AIP patients confirmed by surgery （6 cases）, biopsy （9 cases） and hormone therapy effect （8 cases）. Control group included 36 PDAC patients confirmed by surgery. The CT unenhaneed and dynamic enhancement images of the two groups were retrospectively analyzed, including pancreatic changes and location, morphology and scope of pancreatic lesion, in- volvement of the pancreatic duct and bile duct,changes of adjacent artery and vein, and other organ lesions. CT values of the pancreatic lesion in unenhanced and enhanced images were measured. The AlP and PDAC groups were compared. Re- suits Diffuse swelling, peri - pancreatic halo, delayed homogenous enhancement, the absence of main pancreatic duct dilatation or less than 5 mm, pancreatieobiliary progressive stenosis and bile duct stenosis above pancreas were found to have high specificity for AlP. On the other hand, pancreatic atrophy, main pancreatic duct dilatation greater than 5 ram, and pancreaticobiliary cutting stenosis, more often occurred in PDAC patients （P ≤ 0. 001 ）. There were no obvious differences in vascular involvement that were demonstrated. Conclusion AIP and PDAC had prominent imaging characteris- tics, and CT enhancement helped to differentiate the two lesions.

关 键 词：自身免疫性胰腺炎 胰腺导管腺癌 体层摄影术 X线计算机 

分 类 号：R735.9[医药卫生—肿瘤] R576[医药卫生—临床医学] R730.44