胰管内乳头状黏液性肿瘤的CT表现与临床、病理对照

CT features of intraductal papillary mucinous tumors of the pancreas: comparison with clinical and pathological findings

目的探讨胰管内乳头状黏液性肿瘤的CT特点,并与临床、病理对照,提高该病的诊断正确率.方法回顾性分析经手术病理证实的8例胰管内乳头状黏液性肿瘤的CT表现,其中男6例,女2例,平均54岁.术前8例均行CT平扫及增强检查,5例行内镜逆行胰胆管造影(ERCP)检查,8例患者亦进行了B超检查,1例行MR检查.结果 CT检查发现胰头部囊实性混合肿块6例,胰头颈体部低密度肿块1例,胰腺体积增大1例,肿块最大径5.6～9.5 cm不等,增强后表现为不均匀强化,6例肿块边界尚清晰,1例病灶与胃后壁紧密粘连.8例均有不同程度的胰管扩张,无一例出现远处转移.5例ERCP检查,发现十二指肠乳头增大和黏液溢出者3例,胰头体部胰管中断1例,4例全程胰管扩张.结论胰腺导管内乳头状黏液性肿瘤的CT表现有一定的特点;CT结合ERCP有助于该病的诊断和指导治疗.

Objective To evaluate the CT features of intraductal papillary mucinous tumors of the pancreas （IPMT）, and to compare with the clinical and pathological findings in order to improve the diagnostic accuracy. Methods The CT appearances were analyzed retrospectively in eight patients with pathologically proven IPMT. There were 6 men and 2 women, with the mean age of 54 years. Plain CT and contrast CT were performed in all 8 cases, ERCP was undertaken in 5, B-ultrasound scan was performed in all 8 patients, and MRI was obtained in 1 case. Results CT demonstrated the cystic and solid lesions in the head of pancreas in 6 cases and low density mass in the neck and body of pancreas in 1 case, and pancreas volume expanded in 1 case. The largest diameter arranged from 5.6 cm to 9. 5 cm. Inhomogeneous enhancement was revealed in contrasted CT scan. Clear tumor margins were seen in 6 cases and the lesion adhered to the back wall of stomach in 1 case. Different extent dilatation of the main pancreatic duct was demonstrated in all 8 cases and no metastasis were seen. Abnormal protruding papilla of Vater with expulsion of mucus was seen in 3 of the 5 cases undertaken ERCP. The main pancreatic duct discontinued in 1 case and dilated in 4 cases. Conclusion Certain CT features may suggest the diagnosis of IPMT of the pancreas. CT combined with ERCP is helpful to the diagnosis and treatment planning.