胰腺导管内乳头状黏液性肿瘤胶样癌恶变的影像学特征及其与导管腺癌恶变鉴别  

Colloid carcinoma arising from intraductal papillary mucinous neoplasm of pancreas:imaging features and differentiation from ductal adenocarcinoma

作　　者：方旭 边云 蒋慧 李晶 刘芳 邵成伟 王莉 陆建平 Fang Xu;Bian Yun;Jiang Hui;Li Jing;Liu Fang;Shao Chengwei;Wang Li;Lu Jianping(Department of Radiology,Changhai Hospital,Navy Medical University,Shanghai 200433,China;Department of Pathology,Changhai Hospital,Navy Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院(上海长海医院)影像医学科,200433 [2]海军军医大学第一附属医院(上海长海医院)病理科,200433

出　　处：《中华放射学杂志》2021年第7期758-763,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81871352);上海申康医院发展中心重大临床研究项目(SHDC2020CR4073);234学科攀峰计划平台学科夯基项目(2019YPT001)。

摘　　要：目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)胶样癌恶变的影像学特征及其与导管腺癌恶变鉴别,并与病理对照分析。方法回顾性分析2013年11月至2020年1月海军军医大学第一附属医院24例经手术病理确诊为IPMN恶变成分为胶样癌的患者临床、影像学和病理资料。同时收集同时期经手术病理确诊为IPMN恶变成分为导管腺癌患者30例。分析患者术前CT和MRI影像学表现,包括病灶的部位、IPMN形态类型、最长径、成分、密度及信号、钙化、胰管扩张及胰管内径、胰腺实质萎缩、与周围器官形成瘘管等。两组影像学表现特征比较采用χ^(2)检验或Fisher确切概率法。结果IPMN胶样癌发生于胰头部16例、胰体尾部7例、全胰腺1例。22例有肿块形成,最长径54.5(29)mm。囊实性19例、囊性4例、实性1例,囊壁和内部分隔增厚,增强后轻度强化。5例T_(1)WI有高信号。肿块内有钙化13例、气体2例。胰管扩张内径(13±5)mm。胰腺实质萎缩21例。8例与周围器官形成瘘管。IPMN胶样癌肿块最长径大于IPMN导管腺癌[31(16),Z=-3.758,P<0.001]。IPMN胶样癌以囊实性为主,IPMN导管腺癌以实性为主(P<0.001)。IPMN胶样癌钙化、与周围器官形成瘘管、T_(1)WI点状高信号多于IPMN导管腺癌(P=0.001、0.031、0.034)。结论与IPMN导管腺癌相比,IPMN胶样癌更倾向于囊实性肿块、伴有钙化、与周围器官形成瘘管、T_(1)WI呈点状高信号。Objective To investigate the imaging features of colloid carcinoma arising from intraductal papillary mucinous neoplasm(IPMN)of pancreas and the differentiation features from ductal adenocarcinoma arising from IPMN,using the pathological findings as the reference.Methods Twenty-four patients with pathologically confirmed colloid carcinoma from November 2013 to January 2020 in Changhai Hospital,Navy Medical University were included in this study.The clinical manifestations,imaging features and pathological data were retrospective reviewed.Thirty patients of ductal adenocarcinoma arising from IPMN confirmed by pathology were selected as the control group.CT and MRI features of two groups were blindly analyzed by two radiologists,including the lesions location,type of IPMN,size,components,density or signal,calcification,dilation and size of the main pancreatic duct(MPD),pancreatic parenchymal atrophy,fistula formation.The χ^(2)test or Fisher exact probability was used to compare the imaging features between the two groups.Results As for IPMN with colloid carcinoma,16 cases were located in the head of the pancreas,7 cases in the body and tail of the pancreas,and 1 case showed diffused changes of the pancreas.Mass was found in twenty-two cases,with the size of 54.5(29)mm.Nineteen cases were solid-cystic,4 were cystic and 1 was solid.Thick wall and internal separation with mild enhancement were displayed.Five cases were found with high signal on T_(1)WI.Thirteen cases had calcification and 2 cases had gas in the tumor.The size of MPD was(13±5)mm.Pancreatic parenchymal atrophy was found in 21 cases and fistula formation was found in 8 cases.The mass size of IPMN with colloid carcinoma was significantly greater than that of IPMN with ductal adenocarcinoma[31(16)mm,Z=-3.758,P<0.001].Solid-cystic mass was more found in IPMN with colloid carcinoma and solid mass was more found in IPMN with ductal adenocarcinoma(P<0.001).Calcification(P=0.001),fistula formation(P=0.031),and high signal on T_(1)WI(P=0.034)were more found in

关 键 词：胰腺肿瘤 体层摄影术 X线计算机 磁共振成像 胶样癌 导管内乳头状黏液性肿瘤 

分 类 号：R735.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44