钙化与囊性CT征象在胰头部肿块型慢性胰腺炎与胰头癌鉴别诊断中的价值  

The value of calcification and cystic lesion of CT findings in differentiating pancreatic head ductal carcinoma from mass-forming chronic pancreatitis of the pancreatic head

作　　者：阮志兵 焦俊 瞿金环 闵定玉 范光明 RUAN Zhibing;JIAO Jun;QU Jinhuan;MIN Dingyu;FANG Guangming(Department of Imaging, the Affiliated Hospital of Guizhou Medical University ,Guiyang 550004, China;Department of Medical Records and Statistics ,Guizhou Provincial People＇ s Hospital ,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院影像科,贵州贵阳550004 [2]贵州省人民医院病案统计科,贵州贵阳550004

出　　处：《实用放射学杂志》2018年第6期897-900,共4页Journal of Practical Radiology

基　　金：贵州医科大学-贵阳市科技局联合基金项目（GY2015-32）.

摘　　要：目的 探讨钙化与囊性CT征象在胰头部肿块型慢性胰腺炎（MFCP）与胰头癌鉴别诊断中的价值。方法 回顾性分析经临床手术病理证实的24例胰头部MFCP与30例胰头癌患者的临床及CT资料，2位腹部放射医学高级职称医师在飞利浦影像工作站双盲法评价图像。采用两独立样本t检验或χ2检验对数据进行统计学分析。结果 （1）肿块钙化：MFCP（n=24）与胰头癌（n=30）钙化出现率分别为58.33％（n=14）与10％（n=3），差异有明显统计学意义（P〈0.001），其中两者斑片状钙化、结节状钙化及混合型钙化出现率分别为28.57%（n=4）、14.29%（n=2）、57.14％（n=8）与0%（n=0）、66.67%（n=2）及33.33%（n=1），MFCP以混合型钙化为主，分布呈弥漫型且于病灶边缘分布为著，胰头癌钙化少见或以病灶中心区分布的少许结节状钙化为主；（2）囊性灶：MFCP与胰头癌坏死、囊变出现率分别为29.17％（n=7）与60％（n=18），有统计学差异（P〈0.05），胰头癌囊变、坏死区多单发、囊较小，囊壁厚薄明显不均；2组假性囊肿出现率分别为58.33％（n=14）与10％（n=3），存在明显差异（P〈0.001），MFCP囊性灶多饱满，具有张力，囊壁可见钙化，囊内壁光整但不连续，较大、多发，具有张力的蜂窝状囊仅见于MFCP。另外，11例（45.83%）MFCP病灶内可见残存的正常胰腺组织。结论 混合型钙化与具有张力的蜂窝状囊征象对胰头部MFCP与胰头癌有重要的鉴别诊断价值。Objective To investigate the diagnostic value of calcification and cystic lesion of CT findings in differentiating pancreatic head ductal carcinoma （PHDA） from mass-forming chronic pancreatitis （MFCP） of the pancreatic head.Methods The clinic data and CT findings of 30 cases with PHDA and 24 cases with MFCP of the pancreatic head, which were confirmed by surgery and pathology were analyzed retrospectively.The images were reviewed independently by two expert radiologists with a double-blind method. An independent sample t test and chi-square test were used to compare the data of imaging findings between two groups. Results ① Calcification was found in 14 cases （58.33%） with MFCP and in 3 cases （10% ） with PHDA （P〈0.001）. The percentage of patchy,punctate and mixed calcification were 28.57% （n=4）,14.29% （n=2） and 57.14% （n=8） in MFCP,0% （n=0）,66.67% （n=2） and 33.33% （n=1） in PHDA, respectively. ② Necrotic cyst was founded in 7 cases （29.17%） with MFCP and 18 cases （60%） with PHDA（P〈0.05）. Pseudocysts were demonstrated in 14 cases （58.33%） with MFCP and in 3 cases （10%） with PHDA （P〈0.001）. Honeycombed change with tension within or around the lesion were demonstrated only in patients with MFCP. In addition, normal tissue of the pancreas was found within the lesion in 11 cases （45.83%） of MFCP and none in PHDA, which showed significant difference between two groups.Conclusion Mixed calcification and honeycomb with tension of CT findings are of significant value in differentiating PHDA from MFCP of the pancreatic head.

关 键 词：胰头部肿块 肿块型慢性胰腺炎 胰头癌 计算机体层成像 

分 类 号：R576[医药卫生—消化系统] R735.9[医药卫生—内科学]