胰腺实性假乳头状瘤CT征象探析  

Exploration and analysis of CT signs of pancreatic solid pseudopapillary neoplasms

作　　者：石士奎[1] 梁啸寒 陈宏志[1] 蔡兆根[2] 李国平[1] SHI Shi-kui(Department of radiology,first affiliated hospital of Bengbu Medical College,Bengbu,Anhui,233004, China)

机构地区：[1]蚌埠医学院第一附属医院放射科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院病理科,安徽蚌埠233004

出　　处：《齐齐哈尔医学院学报》2019年第3期319-322,共4页Journal of Qiqihar Medical University

摘　　要：目的探析胰腺实性假乳头状瘤(solid pesudopapillary neoplasms,SPNs)的CT征象,提高胰腺SPNs的CT诊断及鉴别能力。方法搜集2014年3月—2018年1月本院13例胰腺SPNs患者的CT检查资料进行回顾性研究,女12例,男1例,年龄16～52岁,平均30岁。11例行CT平扫及增强,2例行CT平扫。增强扫描中,10例行动脉期及门脉期双期扫描,1例行动脉期、门脉期、延迟期三期扫描。所有病例均经手术病理证实。结果本组13例SPNs均为单发,圆形、卵圆形为主,少数呈分叶状,未见明显胰管扩张征象。9例SPNs包膜完整,边缘清晰,4例局部包膜不完整,边缘欠清。肿瘤大小4.0 cm×3.5 cm～9.5 cm×7.2 cm。肿瘤位于胰头部、体尾部、尾部及体部分别为4例、4例、4例及1例。胰头部肿块与胰体尾部形成"蝌蚪"征。体尾部肿块完全位于胰腺内形成"吞物"征,向腹腔内突出形成"龟背"征,向腹膜后突出形成"抱物"征。胰尾从周围包绕尾部肿块形成"喇叭"征;肿块完全向胰尾外生长形成"托球"征。肿块密度不均,内见散在不规则低密度区及中央坏死囊变区。坏死囊变范围较大者,分布于周边的实性部分形成"破冰"征、"大陆架"征。11例增强扫描病例中,SPNs实性部分强化程度低于胰腺,肿块门脉期强化程度高于动脉期,差异有统计学意义(t=-3.395,P=0.007);部分不规则低密度区稍显强化,坏死囊变区强化不明显。结论胰腺SPNs的CT征象具有一定特征性,是其病理改变的必然反映。Objective To explore and analyze CT signs of pancreatic solid pesudopapillary neoplasms( SPNs),and to improve CT diagnosis and differential diagnosis ability of SPNs. Methods CT findings of 13 cases of pancreatic SPNs confirmed by postsurgical pathology in our hospital from March 2014 to January 2018 were retrospectively analyzed.There were 12 females and 1 male,aged from 16 to 52 years old,with an average of30 years old. Plain and enhancement CT scan were performed in 11 cases and plain CT scan in 2 cases.In contrast-enhanced scan,10 cases were scanned in arterial phase and portal phase,and 1 case was scanned in arterial phase,portal phase and delayed phase.Results All 13 cases of SPNs were solitary,mainly round and oval,few of them were lobulated,no obvious signs of pancreatic duct dilatation.In 9 cases,the SPNs capsule was integral,the margin being clear.4 cases had localized incomplete capsule,the margin not being clear.The size of neoplasms was4.0×3.5 cm to 9.5×7.2 cm.There were 4 cases,4 cases,4 cases and 1 case of neoplasms located in the head,body-tail,tail and body of pancreas respectively.A"tadpole"sign formed by pancreatic head mass and pancreatic body and tail was found.A"swallowing"sign could be seen when the mass was completely within the pancreas.A"turtle back"sign was formed when the mass was protruded to the abdominal cavity from the pancreas.An"arm"sign was found when the mass was protruded to the retroperitoneum. The pancreatic tail surrounding the tail mass forms a"trumpet"sign.When the mass grows completely out of the pancreatic tail,it forms a"supporting ball"sign.The density of the lumps was uneven,the irregular low density area and central cystic degeneration and necrosis scattered in the mass. The solid components distributed in the periphery form the"ice breaking "sign and"continental shelf"sign in case of larger area of cystic degeneration and necrosis. In 11 cases of enhanced scan,the enhancement amplitude of solid components was lower than that of pancreas.The amplitude of enhanceme

关 键 词：实性假乳头状瘤 胰腺 体层摄影术 X线计算机 诊断 征象 

分 类 号：R814[医药卫生—影像医学与核医学]