胰腺导管内乳头状黏液性肿瘤的CT诊断价值

Diagnostic Value of CT for Intraductal Papillary Mucinous Neoplasm of the Pancreas

目的:探讨胰腺导管内乳头状黏液性肿瘤的螺旋CT诊断价值。方法:回顾性分析50例经手术切除和病理学证实的胰腺导管内乳头状黏液性肿瘤的临床、CT等影像学资料,其中男34例,女16例,年龄32～87岁,平均61岁。结果:50例IPMN患者多发于老年人,年龄大于60岁28例(56%),临床主要表现为腹痛和(或)胰腺炎。CT诊断主胰管型20例(35.7%),分支胰管型21例(25%),混合型9例(39.3%);术后病理示胰腺导管内乳头状黏液性瘤28例,胰腺交界性导管内乳头状黏液瘤5例,胰腺导管内乳头状黏液性癌9例,胰腺浸润性导管内乳头状黏液癌8例。22例胰腺导管内乳头状黏液性癌中,其中3例胰腺钙化,3例伴有淋巴结转移,5例侵犯血管,2例肝脏转移。恶性的IPMN常发生在混合型和主胰管型中(n=14),而分支型多为良性肿瘤(n=18)。结论:胰腺导管内乳头状黏液性肿瘤有相对特征性的影像学表现,CT对IPMN的诊断、分型和恶变预测具有重要的临床应用价值。

Purpose：To evaluate the role of spiral CT in diagnosis of intraductal papillary mucinous neoplasm（IPMN）of pancreas.Methods：A total of 50 patients （age range,32～87 years,mean age,61 years） with histopathologically proved IPMN were enrolled in the study,including 34 men and 16 women.The clinical manifestation and the CT apperances of them were analyzed.Results：Among the total 50 patients with IPMN,most（n=28,56%）were elderly（60 years）.The primary symptoms were abdominal pain with or without pancreatitis.As the results of CT exam,20（35.7%）cases were interpretated as IPMN of the main pancreatic duct（MPD）;21（25%）as IPMN of the side branches; and 9（39.3%） as IPMN of the both the MPD and the side branches（mixed type）. As the results of histopathologic examination of the surgical specimen,28 of the 50 IPMN were classified as adenomas,5 were classified as borderline tumors,9 were classified as carcinomas,and 8 were classified as carcinomas with invasion. Of the 22 malignant（borderline and carcinomas） IPMN,3 had pancreatic calcification,3 had lymph metastasis,5 had capillary invasion,and 2 had liver metastasis. The malignant IPMN mainly occured in MPD or mixed type（n=14）,whereas side branch IPMN were mostly benign （n=18）. Conclusion：CT is of great value in diagnosing,classifying and predicting malignancy of IPMN.