动态增强MSCT对胰腺导管内乳头状黏液癌的诊断分析

Diagnostic analysis of dynamic enhanced MSCT for intraductal papillary mucinous carcinoma

目的分析胰腺导管内乳头状黏液癌(IPMC)的多层螺旋CT(MSCT)表现,以提高其诊断水平。方法对经手术病理证实的12例IPMC的MSCT资料进行回顾性分析。结果 12例患者中主胰管型7例,表现为主胰管不规则明显扩张,胰管内呈较均匀低密度,多数可见管壁小结节,CT呈稍高密度;分支胰管型4例,表现为分叶状单发或多发囊性低密度病变,腔内见分隔及结节样突起或肿块,呈稍高密度,2例CT的MPR图像显示病灶与主胰管相通;混合型1例,表现为胰头部囊状病灶,内有附壁结节,合并主胰管轻度扩张,内呈较均匀低密度。8例病灶主胰管不同程度扩张(4～68 mm),7例胰腺不同程度萎缩,4例显示十二指肠乳头膨大,2例见不规则点状钙化。增强扫描囊内分隔强化较明显,附壁结节强化稍弱且不均匀,以胰腺期较明显。结论 MSCT薄层扫描对IPMC诊断价值较大,结合MPR、CPR图像能够较清晰显示胰腺IPMC的病理特征,有利于显示胰管壁小结节及胰管扩张、十二指肠乳头改变,多数可与胰腺导管内良性乳头状黏液性肿瘤鉴别。

Objective To analyze the multi-slice spiral CT（MSCT） appearances of intraductal papillary mucinous carcinoma to raise its diagnostic level.Methods Twelve cases with intraductal papillary mucinous carcinoma confirmed by surgical pathology undergone MSCT plain scanning and enhancement scanning before operation,the CT data were reviewed and analyzed retrospectively.Results Among 12 cases,7 cases belonged to main-duct type,showed obvious dilation of main duct of pancreas with low density,most cases with mural nodules in duct of pancreas,CT showed high density;4 cases belonged to branch-duct type showed solitary or multiple cystic lesion with compartmentations or nodules in the duct,CT showed high density;2 cases showed the lession was linked with main duct;1 cases belonged to mixed type,showed solitary cystic lesion with nodules in the duct,together with the dilation of main duct of pancreas;8 cases showed dilation of main duct of pancreas（4～68 mm）,7 cases showed atrophy of pancreas,4 cases with dilation of duodenum papill,2 cases with irregular spotted calcification.The compartmentations were enhanced,notable and mural nodules in duct of pancreas were enhanced in middle extent in contrast-enhancement.Conclusion MSCT with thinnest scan showed important value for the diagnosis of intraductal papillary mucinous carcinoma,small nodules can showed clearly,combined with MPR and CPR,showed the pathologic symptoms clearly,most intraductal papillary mucinous carcinomaes can be distinguished from benign intraductal papillary mucinous neoplasms.