胰腺浆液性囊性肿瘤伴胰管扩张患者的影像学误诊情况分析  

Medical imaging in misdiagnosing serous cystic neoplasms of the pancreas with pancreatic duct dilatation as other pancreatic lessions

作　　者：王鑫 方旭 边云 王莉 邵成伟 陆建平 Wang Xin;Fang Xu;Bian Yun;Wang Li;Shao Chengwei;Lu Jianping(Department of Radiology,Xinyi People's Hospital,Xinyi 221400,China;Department of Radiology,Changhai Hospital,Naval Medical University,Shanghai 200433,China)

机构地区：[1]新沂市人民医院放射科,新沂221400 [2]海军军医大学第一附属医院(上海长海医院)影像医学科,上海200433

出　　处：《中华肝胆外科杂志》2022年第7期510-514,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(82171915);上海市科技创新行动计划自然科学基金(21Y11910300);上海申康医院发展中心重大临床研究项目(SHDC2020CR4073)。

摘　　要：目的分析胰腺浆液性囊性肿瘤(SCN)伴胰管扩张影像学误诊情况。方法回顾性分析2011年1月至2021年11月海军军医大学第一附属医院(上海长海医院)21例胰腺SCN伴胰管扩张患者资料,其中男性9例,女性12例,年龄范围25~74岁,年龄(57.4±13.4)岁。分析其临床表现、手术方式、影像学特征、误诊情况。结果21例患者临床主诉为腹痛11例、腰胀1例、黄疸1例、消瘦1例、乏力1例,体检发现6例。10例行胰十二指肠切除术,8例行胰体尾切除术,2例行胰腺节段切除术,1例行全胰腺切除术。肿瘤位于胰头11例、胰体尾10例。肿瘤长径23.0~92.0(45.8±17.8)mm。21例患者均为SCN上游胰管扩张,下游胰管不扩张,扩张胰管内径4.0~11.0(7.1±2.0)mm。13例T1加权成像呈低信号,18例T2加权成像呈明显高信号,13例弥散加权成像无受限。11例CT诊断为胰腺导管内乳头状黏液性肿瘤(IPMN)5例、胰腺SCN 3例、胰腺神经内分泌肿瘤1例、胰腺癌1例、胰腺囊肿1例,CT误诊率72.7%(8/11)。18例MRI诊断为IPMN 9例、胰腺黏液性囊性肿瘤3例、胰腺SCN 3例、胰腺癌2例、胰腺实性假乳头状肿瘤1例,MRI误诊率83.3%(15/18)。结论胰腺SCN伴胰管扩张影像学易误诊为IPMN或胰腺实性肿瘤,肿瘤下游胰管不扩张可与IPMN相鉴别,T2加权成像呈明显高信号和弥散加权成像无受限可与胰腺实性肿瘤相鉴别。Objective To analyze the medical imaging in misdiagnosing serous cystic neoplasm(SCN)of the pancreas with pancreatic duct dilatation as other pancreatic lesions.Methods Data of 21 patients with SCN and pancreatic duct dilatation who underwent surgical resection from January 2011 to November 2021 at the First Affiliated Hospital of Naval Medical University were retrospectively analyzed.There were 9 males and 12 females with ages ranging from 25 to 74,mean±s.d.(57.4±13.4)years.The clinical features,surgical treatments,CT and MRI imaging features,and misdiagnosis were analyzed.Results Of 11 patients who presented with abdominal pain,1 patient had backache,1 patient was jaundice,1 patient had weight loss,1 patinet had fatigue and 6 patients were asymptomatic.Ten patients were operated using pancreaticoduodenectomy,8 distal pancreatectomy,2 segmental pancreatectomy and 1 total pancreatectomy.For 11 patients,the lesion was located in the head of pancreas,and for 10 patients in the body and tail of pancreas.The tumor size was 23.0-92.0(45.8±17.8)mm.All 21 patients had upstream pancreatic duct dilatation but no downstream pancreatic duct dilatation.The inner diameter of the pancreatic duct was 4.0-11.0(7.1±2.0)mm.Of 13 patients showed a low signal intensity on T1-weighted imaging,18 patients showed a markedly high signal intensity on T2-weighted imaging,13 patients showed no limitation on diffusion weighted imaging.Among the 11 patients who underwent CT examination,5 patients were diagnosed to have intraductal papillary mucinous neoplesm(IPMN),3 SCN,1 pancreatic neuroendocrine tumor,1 pancreatic cancer and 1 cyst.The misdiagnotic rate of CT was 72.7%(8/11).Among the 18 patients who underwent MRI examination,9 patients were diagnosed to have IPMN,3 mucinous cystic neoplasm,3 SCN,2 pancreatic cancer and 1 solid pseudopapillary tumor.The misdiagnosis rate of MRI was 83.3%(15/18).Conclusion SCN with pancreatic duct dilatation was easily misdiagnosed as IPMN or other pancreatic solid tumors.The difference between SCN with

关 键 词：胰腺肿瘤 肿瘤 囊性 黏液性和浆液性 误诊 胰管扩张 影像学 

分 类 号：R735.9[医药卫生—肿瘤]