肠型与胰胆管型壶腹部浸润性腺癌的影像学特征  

Imaging features of intestinal-type and pancreaticobiliary-type invasive adenocarcinoma of the ampullary region

作　　者：柴瑾[1] 王玉涛[3] 颉克蓉[2] 陈强[2] 丁前江 邓生德[3] 

机构地区：[1]兰州大学第二医院健康管理中心,730030 [2]兰州大学第二医院放射科,730030 [3]宁波大学医学院附属医院影像科,315020

出　　处：《中华消化外科杂志》2016年第4期395-400,共6页Chinese Journal of Digestive Surgery

基　　金：浙江省医药卫生科技计划项目，宁波市自然科学基金，Science and Technology Development Program for Health & Medicine of Zhejiang Province，Natural Science Foundation of Ningbo City

摘　　要：目的分析肠型与胰胆管型壶腹部浸润性腺癌（IAAR）的CT、MRI影像学检查特征，探讨其诊断及鉴别诊断的要点。方法采用回顾性横断面研究方法。收集2013年9月至2015年8月兰州大学第二医院（20例）和宁波大学医学院附属医院（13例）收治的33例IAAR患者的临床病理资料。患者行CT或MRI平扫及增强扫描检查。（1）观察肿瘤的大小、形态、生长方式、边界、内部结构、密度和（或）信号、强化模式和（或）程度、胆管和（或）胰管改变、侵犯和转移情况。（2）比较肠型IAAR和胰胆管型IAAR临床和影像学特征。（3）完善术前相关检查后行手术治疗，术后行病理学检查和免疫组织化学染色检测。正态分布的计量资料以-x±s表示，组间比较采用独立样本t检验；计数资料比较采用x2检验。结果（1）33例IAAR患者，19例行CT平扫，其中17例同时行增强扫描；14例患者行MRI平扫（9例包括DWI序列），其中12例同时行增强扫描。33例患者肿瘤的最大直径为（2．8±1．4）cm。14例患者肿瘤呈圆形或卵圆形，19例形态不规则。24例患者肿瘤呈腔内型，6例呈腔外型，3例呈混合型。17例患者肿瘤边界清晰，16例边界模糊。5例患者瘤体内出现坏死和（或）囊变，33例均未见出血或钙化。18例患者肿瘤密度和信号均匀，15例不均匀。29例行CT或MRI增强扫描患者中强化模式：14例肿瘤呈均匀强化，15例呈不均匀强化；强化程度：15例肿瘤呈轻度强化，14例呈中等强化，没有明显强化患者。9例患者肿瘤在DWI上呈略高或高信号。30例患者继发胆管扩张（轻度3例、中度6例、重度21例），3例胆管未见改变。26例患者继发胰管扩张，7例胰管未见改变。16例患者肿瘤侵犯胰腺组织；7例患者发生淋巴结转移。（2）33例IAAR患者中，肠型1AAR19例（男8例、女11例），胰胆管型IAAR14例（男11例、女3例）。�Objective To analyze the computed tomography （CT） and magnetic resonance imaging （MRI） features of intestinal-type and pancreaticobiliary-type invasive adenocarcinomas of the ampullary region （IAARs） and investigate the value of the differential diagnosis. Methods The retrospective cross-sectional study was adopted. The clinicopathological data of 33 patients with IAAR who were admitted to the Lanzhou University Second Hospital （20 patients） and Affiliated Hospital of Ningbo University （13 patients） between September 2013 and August 2015 were collected. The patients underwent plain and enhanced scans of CT and MRI. （1） Observation indictors included tumor size, shape, growth pattern, boundary, internal structure, density and/or signal, style and/or degree of contrast enhancement, changes of bile and/or pancreatic duct, invasion and metastasis. （2） The clinical and imaging features of intestinal-type and pancreatieobiliary-type IAARs were compared. （3） Operation was performed after preoperative examinations, and patients received the postoperative pathological examination and immunohistochemistry. Measurement data with normal distribution were presented as x ＋ s. Comparison between groups was evaluated with an independent sample t test, and count data were analyzed using the chi-square test. Results （ 1 ） Of 33 patients with IAAR, 19 received plain scan of CT, including 17 receiving simultaneous enhanced scan of CT. Fourteen patients [ 9 receiving diffussion-weighted imaging （DWI） sequence of MRI ] received plain scan of MRI, including 12 receiving simuhaneous enhanced scan of MRI. The maximum diameter of IAAR in 33 patients was （2.8 ± 1.4） cm. Fourteen tumors were round-like or oval shape and 19 tumors were irregular shape. The intracavity type, extracavity type and mixed type of tumors were detected in 24, 6 and 3 patients, respectively. There were clear boundary of tumors in 17 patients and fuzzy boundary of tumors in 16 patients. Tumors of 5 patients had appeared

关 键 词：壶腹部肿瘤 浸润性腺癌 体层摄影术 X线计算机 磁共振成像 

分 类 号：R735.0[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2