胰腺囊性肿瘤的多层螺旋CT表现与病理对照

Imaging features of cystic tumors of the pancreas with multi-slice CT:compared with pathology

目的:探讨胰腺囊性肿瘤的多层螺旋CT(MSCT)表现和诊断价值。方法:回顾性分析21例经手术病理确诊的胰腺囊性肿瘤MSCT表现,其中浆液性囊腺瘤5例,黏液性囊腺肿瘤10例,导管内乳头状黏液瘤3例,实性假乳头状瘤3例。男5例,女16例,年龄14～78岁,平均52岁。使用4层和16层螺旋CT,平扫21例,同时增强20例。结果:①浆液性囊腺瘤多表现为多房囊性肿块,囊壁及分隔厚薄均匀,无壁结节。②黏液性囊腺肿瘤表现为多房或单房、边界清楚、无壁结节或壁结节小;而黏液性囊腺癌浸润周围组织、边界不清、壁结节较大。③导管内乳头状黏液瘤为多房或葡萄串样囊性肿块,与扩张的胰管相通。④实性假乳头状瘤边界清,可有较厚包膜,囊性成分与实性成分构成比例不一,实性部分逐步强化。结论:MSCT可以展示胰腺囊性肿瘤的病理特征,对诊断与鉴别诊断有较高的价值。

Objective： To explore the imaging features and diagnostic value of cystic tumors of the pancreas with multislice CT （MSCT）. Methods： Twenty-one patients confirmed by surgery and pathology were studied retrospectively, including serous cystadenoma（n=5）, mucinous cystic neoplasm（n=10, mucinous cystadenoma 5 cases, mucinous cystadenocarcinoma 5 cases）, intraductal papillary mucinous tumor （n=3）, solid and pseudopapillary tumor （n=3）. They all underwent the pre- and postenhanced multi-phase CT examination with Siemens sensation 4- or 16-slice scanner. Results： ①Five cases of serous cystadenoma all occured in women, of which 4 tumors located in the head of the pancreas and manifested as a muhilocular sponge-like mass. Central calcification was seen in 1 case. ②In 10 patients with mucinous cystic neoplasm, 7 cases were female, 8 cases involved the body and tail： of the pancreas. Tumors were muhilocular or unilocutar. Benign cystic neoplasm（cystadenoma） showed a well-defined border with no or small intramural nodule, whereas malignant cystic neoplasm（cystadenocarcinoma） displayed a ill-defined border with larger intramural nodule and peripancreatic infiltration. The dilation of the bile duct and pancreatic duct or distal metastasis could be seen. ③In 3 cases with intraductal papillary mucinous tumor, 2 were women, and in 2 cases the lesion located at the head of the pancreas. Cystic tumors had the grape-like locular appearance and communicated with the dilated pancreatic duct. ④In 3 cases of solid and pseudopapillary tumor, 2 were women which all located in the body and tail of the pancreas. They were young or middle aged. The tumors were well circumscribed, and may be enclosed by thick fibrous capsule. The proportion of the solid part to cystic part of the tumor was changeable. Solid part was heterogeneously enhanced during the arterial phase with progressive fill-in to the lesion during the late phases. Conclusion： MSCT can reveal the pathologic characteristics of cystic tumors of the pancreas and play an important role in diagnosis and differential diagnosis.