肿块型自身免疫性胰腺炎与胰腺导管腺癌的超声及超声造影表现分析  

Ultrasound findings and contrast-enhanced ultrasound findings of mass-type autoimmune pancreatitis versus pan-creatic ductal adenocarcinoma

作　　者：欧阳向柳 韩云霞 郑立春[2] 赵英春 申新宇 张文军[2] 王艳滨 OUYANG Xiangliu;HAN Yunxia;ZHENG Lichun;ZHAO Yingchun;SHEN Xinyu;ZHANG Wenjun;WANG Yanbin(Department of Ul-trasound,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China;Department of Nuclear Medicine,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China;Department of Nutrition,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市工人医院超声科,河北唐山063000 [2]唐山市工人医院核医学科,河北唐山063000 [3]唐山市工人医院营养科,河北唐山063000

出　　处：《临床肝胆病杂志》2022年第6期1351-1355,共5页Journal of Clinical Hepatology

基　　金：唐山市科学技术研究与发展计划(19150220E)。

摘　　要：目的探讨超声及超声造影对肿块型自身免疫性胰腺炎(AIP)与胰腺导管腺癌(PDAC)的鉴别诊断价值。方法回顾性分析2015年1月—2020年12月唐山市工人医院确诊的11例肿块型AIP患者的临床资料及常规超声、超声造影资料,分析其特征性表现,并与23例PDAC患者的资料进行对比,计数资料两组间比较采用χ^(2)检验。结果11例肿块型AIP超声造影的诊断准确性为63.64%,均为单发病灶,且均低回声,在边界清晰、形态规则、胰管扩张或截断、血流信号方面所占比例分别为54.55%、63.64%、18.18%、36.36%,而PDCA组分别为30.43%、34.78%、78.26%、21.74%,两组间是否伴胰管扩张或截断方面存在统计学差异(χ^(2)=11.089,P<0.05),其余指标均无明显统计学差异(P值均>0.05)。超声造影中7例(63.64%)肿块型AIP动脉期呈高增强,4例(36.36%)呈等增强,静脉期5例(45.45%)呈高增强、6例(54.55%)呈等增强;23例PDAC中22例(95.65%)病灶在动脉期及静脉期均呈低增强,两者动、静脉期强化方式差异均有统计学意义(χ^(2)值分别为30.345、30.084,P值均<0.05)。结论超声造影检查增强模式及是否伴胰管扩张或截断方面在肿块型AIP与PDCA的鉴别诊断中具有较高的价值。Objective To investigate the value of ultrasound and contrast-enhanced ultrasound(CEUS)in the differential diagnosis of mass-type autoimmune pancreatitis(AIP)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was per-formed for the clinical data,ultrasound findings,and CEUS findings of 11 patients with mass-type AIP who were diagnosed in Tangshan Workers’Hospital from January 2015 to December 2020,and their characteristic manifestations were analyzed and compared with the data of 23 patients with PDCA.The chi-square test was used for comparison of categorical data between two groups.Results For the 11 patients with mass-type AIP,CEUS had a diagnostic accuracy of 63.64%,and all of these patients had hypoechoic single lesions;the patients with clear boundaries,regular morphology,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 54.55%,63.64%,18.18%,and 36.36%,respectively,while in the PDCA group,such patients accounted for 30.43%,34.78%,78.26%,and 21.74%,respectively,and there was a significant difference in the presence or absence of pancreatic duct dilatation or cutoff between the two groups(χ^(2)=11.089,P<0.05),with no significant differences in the other indices(all P>0.05).For the 11 patients with mass-type AIP,CEUS showed that 7 patients(63.64%)had hyperenhancement and 4(36.36%)had iso-enhancement in the arterial phase,and 5 patients(45.45%)had hyperenhancement in the arterial phase and 6(54.55%)had iso-enhancement in the venous phase;for the 23 patients with PDCA,22(95.65%)had hypoenhancement of lesions in both arterial and venous phases,and there were significant differences in the enhancement pattern in arterial and venous phases between the two groups(χ^(2)=30.345 and 30.084,both P<0.05).Conclusion The enhancement pattern of CEUS and the presence or absence of pancreatic duct dilatation or cutoff have a relatively high val-ue in the differential diagnosis of mass-type AIP and PDCA.

关 键 词：超声检查 超声造影 胰腺炎 胰腺肿瘤 诊断 鉴别 

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