自身免疫性胰腺炎假包膜的CT及MRI特征分析  

CT and MRI feature analysis of pseudocapsule in autoimmune pancreatitis

作　　者：张斌斌[1,2] 戴娜[1] 杨迎[1] 侯新萌[2] 陈羽琦[2] 靳二虎[2] ZHANG Binbin;DAI Na;YANG Ying;HOU Xinmeng;CHEN Yuqi;JIN Erhu(Department of Radiology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Radiology,Beijing Friendship Hospital,Capital Medical University)

机构地区：[1]首都医科大学附属北京中医医院放射科,北京100010 [2]首都医科大学附属北京友谊医院放射科

出　　处：《国际医学放射学杂志》2023年第5期537-542,共6页International Journal of Medical Radiology

摘　　要：目的探讨自身免疫性胰腺炎(AIP)假包膜的CT和MRI特征及转归,并分析假包膜与脾静脉受累的相关性。方法回顾性收集101例AIP病人的临床和影像资料,根据初诊时是否出现假包膜将其分为2组,假包膜组52例(51.5%),无假包膜组49例(48.5%)。观察初诊及治疗随访的CT和MRI影像,分析假包膜的CT及MRI特征。采用卡方检验或Mann-WhitneyU检验比较2组间临床和影像指标的差异;采用McNemar检验或Fisher确切概率检验比较CT平扫、CT动脉期、MRI平扫、MRI动脉期对假包膜的检出率,以及2组间随访复发时假包膜发生率的差异;对假包膜与脾静脉受累的相关性进行Spearman相关分析。结果2组病人的临床和影像学资料间差异均无统计学意义(均P>0.05)。当胰腺呈弥漫型肿大时,假包膜位于胰腺周围及体尾部,而胰腺呈局灶型肿大时,假包膜位于肿大部位周围。假包膜组中,42例假包膜呈环状分布于胰腺周围,8例分布于胰腺腹侧,2例分布于胰腺背侧;37例假包膜紧邻胰腺实质,15例假包膜与胰腺病变间存在线状低密度/信号带;18例行全部4种检查(即CT和MRI平扫及增强),CT平扫对假包膜的检出率(27.8%)分别低于CT动脉期(94.4%)、MRI平扫(94.4%)、MRI动脉期(100%)检查(均P<0.05)。假包膜组中,17例接受短期(<6个月)随访,有14例假包膜消失,其余3例假包膜厚度变薄;25例接受长期(>12个月)随访,有16例假包膜消失,另外9例胰腺病变复发,复发伴假包膜者6例。无假包膜组中,有20例进行长期随访,其中5例复发,伴假包膜者1例。2组间长期随访显示复发伴假包膜发生率的差异无统计学意义(P>0.05)。101例AIP病人中,30例脾静脉受累,假包膜与脾静脉受累呈正相关(r=0.332,P=0.001)。结论AIP病人假包膜的CT及MRI表现有一定特征性,出现假包膜时应警惕脾静脉受累的可能。类固醇治疗后假包膜可伴随胰腺炎症的消散而变薄或消失。Objective To investigate the CT and MRI features and outcomes of pseudocapsule in autoimmune pancreatitis(AIP)and analyze the correlation between pseudocapsule and splenic vein involvement.Methods We retrospectively collected clinical and imaging data from 101 patients with AIP.They were divided into two groups based on the presence of a pseudocapsule at the initial diagnosis:52 cases(51.5%)in the pseudocapsule group and 49 cases(48.5%)in the non-pseudocapsule group.CT and MRI images at the initial diagnosis and follow-up were observed,and the CT and MRI features of the pseudocapsule were analyzed.Chi-square test or Mann-Whitney U test were used to compare the differences in clinical and imaging indicators between the two groups.McNemar’s test or Fisher’s exact test was used to compare the differences in the detection rate of pseudocapsule between CT plain scans,CT arterial phases,MRI plain scans,and MRI arterial phases,as well as the difference in the incidence of pseudocapsule between the two groups during recurrence.Spearman correlation analysis was used to analyze the correlation between pseudocapsule and splenic vein involvement.Results There was no statistically significant difference in clinical and imaging data between the two groups(all P>0.05).When the pancreas presented with diffuse enlargement,the pseudocapsules were located around the pancreas and at the body and tail of the pancreas.When the pancreas presented with focal enlargement,the pseudocapsules were located around the enlarged pancreas.The pseudocapsules were distributed around the pancreas in 42 cases,ventrally to the pancreas in 8 cases,and dorsally to the pancreas in 2 cases.In 37 of the cases,the pseudocapsules were adjacent to pancreatic parenchyma,while in 15 of the cases,the pseudocapsules had a linear low-density(signal)band between the pseudocapsule and the diseased pancreas.Eighteen cases underwent four types of examinations(CT and MRI plain and enhancement scans),and the detection rate of pseudocapsule on CT plain scans(27.8%)w

关 键 词：自身免疫性胰腺炎 假包膜 脾静脉受累 体层摄影术 X线计算机 磁共振成像 

分 类 号：R725.7[医药卫生—儿科] R814.42[医药卫生—临床医学] R816.92