胰腺导管内乳头状黏液性肿瘤的CT表现与病理对照分析

CT and pathological manifestations of intraductal papillary mucinous neoplasm of pancreas： a comparative study

目的分析胰腺导管内乳头状黏液性肿瘤（IPMN）的CT表现特征并与病理结果进行对照，探讨CT在胰腺IPMN诊断和鉴别诊断的价值。方法分析39例临床资料齐全、手术病理证实为IPMN病例资料，将本组病例的CT表现分为3型：（1）单纯主胰管扩张型；（2）主胰管扩张伴胰腺囊性灶型；（3）单纯胰腺囊性灶型。分析CT分型与Takada病理分型（主胰管型、分支型、混合型）的对应关系；按病理结果将IPMN分为良性组和恶性／交界组，对病变的CT特征（有无壁结节、有无分隔、病灶大小、主胰管及胆总管扩张程度）进行统计学分析。结果单纯主胰管扩张型对应于主胰管型，主胰管扩张伴胰腺囊性灶型主要对应于分支型和混合型，单纯囊性灶型对应于分支型（P〈0．001）。病灶内无壁结节时病理为良性的概率为92％，病灶内有壁结节时病理为良性的概率为42％，两者差异有统计学意义（P=0．003），病灶内是否出现分隔与肿瘤的良恶性无关（P=0．793），恶性／交界性病灶的最大径大于良性病灶，P=0．016，主胰管管径、胆总管管径在良性和恶性／交界两组间差异均无统计学意义，但在不考虑病理分组的情况下，全部病例主胰管管径大于胆总管管径（P=0．02）。结论IPMNCT表现的三种分型与病理分型有较好的对应关系，有利于IPMNCT征象的分析及提高诊断的准确性。IPMN的主胰管扩张程度常超过胆总管亦具有一定的特征，结合其他典型征象能够对IPMN做出较准确的诊断。

Objective To evaluate the diagnostic value of CT in pancreas intraductal papillary mucinous neoplasm （IPMN） by analyzing its CT feature and pathological findings. Methods The clinical and CT data was analyzed among 39 patients with IPMN whose diagnosis was confirmed by pathology. The CT manifestations were classified into 3 types： simple main pancreatic duct enlargement; main pancreatic duct enlargement combined with pancreatic cystic lesion; and simple pancreatic cystic lesion. The correlation between the CT types and Takada pathological types （ main duct type, branch type, and mixed type） was analyzed. All the cases were pathologically classified into benign and malignant/boundary groups. Statistical tests of the difference of CT features （mural nodule, septa, size, caliber of main pancreatic duct and common bile duct） between the 2 groups were performed. Results The CT type I matched the main duct type, the CT type Ⅱ mainly matched the branch type and mixed type, and the CT type Ⅲ matched the branch type （ P 〈 0. 001 ）. The probability of benign lesion was 92% with no mural nodule in the lesion, while the probability of benign lesion was only 42% with mural nodule presented （ P = 0.003 ）. In terms of the septa, there was no significant difference between benign and malignant lesions （ P = 0. 793 ）. The size of malignant/boundary lesions exceeded that of benign lesions （ P = 0. 016 ）. There were no significant difference in calibers of main pancreatic duct and common bile duct between the benign and malignant/ boundary groups. Without considering pathological grouping the caliber of main pancreatic duct exceeded that of the common bile duct in all the cases （ P = 0.02）. Conclusion CT typing of IPMN well matches the pathological typing which benefits the CT diagnosis of IPMN. The caliber of main pancreatic duct usually exceeds that of common bile duct in IPMN. This feature contributes to its diagnosis.