1型自身免疫性胰腺炎的CT和MRI表现  

CT and MRI findings of type 1 autoimmune pancreatitis

作　　者：余庆华 吴建满[1] 陈少斌[1] 范秋玲 YU Qinghua;WU Jianman;CHEN Shaobin;FAN Qiuling(Department of Radiology,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院/福建省立医院放射科,福建福州350001

出　　处：《中国中西医结合影像学杂志》2021年第3期260-263,270,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：福建省自然科学基金面上项目(2018J01243)。

摘　　要：目的:探讨22例1型免疫性胰腺炎(AIP)的CT及MRI表现。方法:收集确诊的22例1型AIP患者,记录其临床表现及实验室检查结果,重点分析胰腺与胆管的CT及MRI表现,主要观察胰腺形态、平扫密度/信号、强化特点及胰管、胆管形态改变等。结果:①胰腺形态改变,22例中,弥漫性肿大18例(81.8%),局限性肿大4例(18.2%)。②胰腺密度/信号改变,CT平扫胰腺密度降低12例(100.0%,12/12);胰腺T2WI信号升高17例(81.0%,17/21);病变区ADC信号降低16例(76.2%,16/21);动脉期强化减弱、延迟期呈渐进性强化21例(100.0%,21/21);“腊肠征”10例(47.6%,10/21)。③胰管、胆管形态改变:22例中,胰管扩张4例(18.2%);胆总管壁均匀增厚15例(68.2%);肝门区肿块样增厚2例(9.1%);合并胆管狭窄,其中移行性狭窄16例(72.7%),截断性狭窄6例(27.3%)。肝内外胆管大部分为轻度扩张。④22例中,腹膜后淋巴结肿大12例(54.5%)。⑤22例治疗后复查均表现为胰腺形态、T2WI信号接近或恢复正常,胆管壁增厚、胆管扩张较前减轻,淋巴结较前减少、缩小。结论:1型AIP有比较特征性的影像学表现,熟悉这些征象,有利于减少误诊。Objective:To study the CT and MRI findings of type 1 autoimmune pancreatitis(AIP).Methods:Patients with clinically confirmed type 1 AIP were enrolled in this study.The clinical manifestations,laboratory examination results(serum IgG4 and CA19-9 level)of patients were recorded.CT and MRI features,including morphological characteristics of pancreas,on non-contrast-enhanced scan,enhancement features and morphological changes of pancreatic duct and bile duct,were analyzed.Results:①Morphological change of pancreas included diffuse enlargement(18/22,81.8%)and localised enlargement(4/22,18.2%).②Pancreatic density/signal changes included decrease in density of the pancreatic parenchyma on non-contrast-enhanced scan(12/12,100.0%),signal intensity increase in pancreas on T2WI(17/21,81.0%)and ADC value decrease in the area of lesion(16/21,76.2%).Enhancement features included hypoenhancement in the arterial phase and progressive enhancement(21/21,100.0%).The“sausage”sign(10/21,47.6%)was also detected.③Morphological changes of pancreatic duct and bile duct included pancreatic duct dilation in 4 cases(18.2%),bile duct with uniform wall thickness in 15 cases(68.2%),tumor-like thickening of hilar bile duct wall in 2 cases(9.1%).There were 22 cases of bile duct stenosis,including smooth tapering stenosis in 16 cases(72.7%),and abrupt cut-off in 6 cases(27.3%).The mild degree dilation of intrahepatic or extrahepatic bile duct were found in most cases.④Retroperitoneal lymph node enlargement was found in 12 cases(54.5%).⑤Pancreatic morphology and signal close to or return to normal,the degree of bile duct wall thickening and bile duct dilatation was reduced,and the number or size of enlarged lymph nodes was reduced in all the 22 cases after treatment.Conclusion:The imaging findings of pancreatitis are characteristic and being familiar with these imaging features is helpful to reduce the misdiagnosis.

关 键 词：免疫球蛋白G 自身免疫 胰腺炎 体层摄影术 X线计算机 磁共振成像 

分 类 号：R576[医药卫生—消化系统] R445.2[医药卫生—内科学] R816.5[医药卫生—临床医学]