时间衰减曲线用于区分胰腺腺泡细胞癌和胰腺导管腺癌的价值  

The value of time attenuation curve in differential diagnosis between acinar cell carcinoma and ductal adenocarcinoma of pancreas

作　　者：贾惠惠 林光武 李仕红 彭玉 JIA Huihui;LIN Guangzvu;LI Shihong;PENG Yu(Department of Radiology,Huadong Hospital,Fudan University,Shanghai 200040,Chin)

机构地区：[1]复旦大学附属华东医院放射科,上海200040

出　　处：《实用放射学杂志》2018年第8期1206-1209,共4页Journal of Practical Radiology

摘　　要：目的探讨胰腺腺泡细胞癌（PA（℃）的影像学表现，以提高对该病的准确认识。方法回顾性分析经手术病理证实的PACC5例、胰腺导管腺癌（PDAC）43例，所有受检者均行CT平扫及增强扫描，比较2组患者的CT图像特征。结果5例PACC中，3例位于胰头颈部，2例位于胰腺体尾部，肿瘤平均最大径为31．6mm。1例形态不规则，呈浸润性生长，4例呈圆形或卵圆形。5例PACC中，3例呈部分或完全外生性生长。2例伴胰管扩张，其中1例伴低位胆管梗阻。5例PACC肿瘤均以实性成分为主，其中3例可见强化包膜，均未见出血或钙化。43例PDAC中，时间衰减曲线（TAC）呈渐进性延迟强化，其中31例延迟期达到峰值强化。PACC最多见强化方式为肿瘤动脉期呈轻度强化，门静脉期持续强化，并达到峰值强化。5例PACC中，门静脉期达到峰值强化4例，动脉期达到峰值强化1例，无1例在延迟期达到峰值强化。PACC与PDAC的强化方式差异有统计学意义（P〈0.05）。在延迟期，PACC与PDAC的CT值差异有统计学意义（P〈0．05）。结论PACC的影像学表现具有特征性，肿块体积较大，为外生性、类圆形、边界清、乏血供肿瘤。典型小病灶呈实性，肿块较大时可出现坏死、囊变。TAC有助于区分PAcc和PDAc。Objective To investigate imaging manifestations of pancreatic acinar cell carcinoma （PACC） to improve the accuracy of imaging diagnosis.Methods Both plain and contrast enhanced CT images of 5 patients with PACC and 43 patients with pancreatic ductal adenocarcinoma （PDAC） proved by surgery and pathology were reviewed retrospectively.The CT imaging features of the two groups were compared.Results 5 PACC masses in 5 patients were found,with a median maximal diameter of 31.6 mm,including 3 masses located at the pancreatic head-neck and the other two at the pancreatic body-taiL.A mass in shape was irregular with an infiltrative margin,and the other four were round or ovoid.Among the 5 masses,3 masses were partially or completely exophytic.Dilated pancreatic duct was seen in 2 cases, 1 of which was with low level biliary obstruction.Main solid component was found in the 5 masses, with enhanced encapsulation in 3 cases.No intratumoral haemorrhage or calcification was found.The time attenuation curve （TAC） of dynamic contrast CT showed delayed enhancement in 43 PDACs,31 of which showed the peak enhancement in delayed phase. However, the most common enhancement pattern of PACC was slight enhancement in arterial phase and persistent enhancement with enhanced peak in portal vein phase. The TAC of PACC showed peak enhancement during portal venous phase in 4 cases and during arterial phase in 1 case.The enhancement pattern was different between PACC and PDAC （P〈0.05）. In delayed phase, a significant difference in the CT attenuation values was found between PACC and PDAC （P〈0.05）.Conclusion PACC has some characteristic imaging manifestations which are bulky, exophytic, oval or round,well marginated,and hypovascular mass.The TAC pattern is useful in differential diagnosis of PACC from PDAC.

关 键 词：胰腺肿瘤 腺泡细胞癌 时间衰减曲线 计算机体层成像 

分 类 号：R735.9[医药卫生—肿瘤] R814.42[医药卫生—临床医学]