隐匿性小胰腺癌并急性胰腺炎与单纯性急性胰腺炎的CT对比分析  

Comparative Analysis of CT between Occult Small Pancreatic Caner Complicated with Acute Pancreatitis and Simple Acute Pancreatitis

作　　者：游红莲 闫明艳 褚千琨 王芳芳 陈文晶 于根建 王静 YOU Honglian;YAN Mingyan;CHU Qiankun;WANG Fangfang;CHEN Wenjing;YU Genjian;WANG Jing(Department of Radiology,Qianhai Shekou Free Trade Zone Hospital,Shenzhen,Guangdong 518000,China;Department of Radiology,Union Hospital of Huazhong University of Science and Technology,Shenzhen Hospital/Nanshan Hospital,Shenzhen,Guangdong 518000,China;Department of Radiology,Nanfang University of Science and Technology Hospital,Shenzhen,Guangdong 518000,China)

机构地区：[1]深圳市前海蛇口自贸区医院放射科,广东深圳518000 [2]华中科技大学协和深圳医院(南山医院)放射科,广东深圳518000 [3]深圳市南方科技大学医院放射科,广东深圳518000

出　　处：《临床误诊误治》2024年第17期63-68,共6页Clinical Misdiagnosis & Mistherapy

基　　金：深圳市南山区卫生科技项目(NS2022104);深圳市南山区卫生科技重点项目(NS2022020)。

摘　　要：目的对比分析以急性胰腺炎为首发症状的隐匿性小胰腺癌并急性胰腺炎(SPC-AP)与单纯性急性胰腺炎(S-AP)的CT特征。方法收集2014年1月至2023年8月收治的以急性胰腺炎为首发症状,经病理检查证实为SPC-AP患者34例,并随机抽取随访1年以上诊断为S-AP患者68例,均在初诊时行胰腺CT增强三期扫描。对比分析2组患者临床资料及CT特征的差异。结果SPC-AP组年龄大于S-AP组(P<0.05)。SPC-AP组CT胰腺实质动脉期截断强化、局限性低强化区、主胰管扩张及截断发生比例较S-AP组高(P<0.01);SPC-AP组周围血管累及、侧支循环形成、结构清晰发生比例较S-AP组高,胰腺形态增大、胰周局部液体聚集发生比例较S-AP组低(P<0.01);2组肾前筋膜增厚位置及胆总管直径比较差异有统计学意义(P<0.05,P<0.01);胆总管扩张、肾前筋膜增厚与胰腺周围淋巴结显示率2组间比较差异无统计学意义(P>0.05)。结论成人发生不明原因轻度胰腺炎并左肾前筋膜增厚,多期CT增强扫描出现胰腺实质动脉期截断强化、局限性低强化、主胰管扩张及截断征象,需警惕隐匿性SPC-AP。Objective To compare and analyze the CT features of occult small pancreatic cancer with acute pancreatitis(SPC-AP)with acute pancreatitis as the initial symptom and simple acute pancreatitis(S-AP).Methods A total of 34 patients with acute pancreatitis as the initial symptom and confirmed as SPC-AP by pathological examination were collected from January 2014 to August 2023,and 68 patients diagnosed with S-AP after more than 1 year of follow-up were randomly selected,all of whom underwent phaseⅢCT enhanced scanning of pancreas at the time of initial diagnosis.The differences of clinical data and CT features between the two groups were compared and analyzed.Results The age of SPC-AP group was higher than that of S-AP group(P<0.05).The incidence of CT truncation artifacts in arterial phase enhancement of pancreatic parenchyma,localized low enhancement area,main pancreatic duct dilation and truncation in SPC-AP group were higher than those in S-AP group(P<0.01).The incidence of peripheral vascular involvement,collateral circulation formation and clear structure in SPC-AP group was higher than that in S-AP group,while the incidence of pancreatic enlargement and local fluid accumulation around the pancreas was lower than that in the S-AP group(P<0.01).There was a significant difference in the location of the prerenal fascia thickening and the diameter of the common bile duct between the two groups(P<0.05,P<0.01).There was no significant difference in the display rates of common bile duct dilation,prerenal fascia thickening and peripancreatic lymph nodes between the two groups(P>0.05).Conclusion In adults with unexplained mild pancreatitis and left prerenal fascia thickening,when multi-phase CT enhanced scan shows signs of truncation artifacts in arterial phase enhancement of pancreatic parenchyma,localized low enhancement,main pancreatic duct dilation and truncation,occult SPC-AP should be suspected.

关 键 词：胰腺肿瘤 急性胰腺炎 CT检查 增强扫描 影像特征 

分 类 号：R735.9[医药卫生—肿瘤]