胰腺导管内乳头状黏液瘤的影像分析

Imaging analysis on intraductal papillary mucinous tumors of the pancreas

目的分析胰腺导管内乳头状黏液瘤的影像特征,以鉴别其良恶性。方法经手术和病理证实的5例胰腺导管内乳头状黏液瘤患者(男性3例,女性2例)均经CT平扫及增强扫描,4例经MRCP检查。对所有患者的影像表现进行回顾性分析。结果 5例中,主胰管型2例,分支型2例及混合型1例。肿瘤病灶位于胰头或钩突部2例,胰体尾部2例,胰尾部1例,在CT及MR像上表现为胰管扩张呈圆桶状的囊性或囊实性肿块,囊壁可见结节状突起,增强扫描壁结节呈轻中度强化或呈多囊状葡萄串样低密度影,MRCP清晰显示了扩张的胰管及分支的形态,胰管分支与主胰管相通。结论胰腺导管内乳头状黏液瘤有明确的影像特征,有助于良恶性鉴别,指导临床治疗及预后评估。

Objective To analyze the imaging featureas of intraductal papillary mucinous tumors of the pancreas（IPMTs） so as to differentiate benign from malignant lesions.Methods Five patients（3 men,2 women） with surgically and pathologically proved IPMT underwent preoperatively precontrast and postcontrast 16-slice spiral CT（MSCT） scans of the abdomen,4 patients underwent additional magnetic resonance cholangiopancreatography（MRCP）.The imaging findings acquired from the both techniques were retrospectively analyzed in all patients.Results Among 5 cases with IPMT,the main pancreatic duct type was found in 2,the branch duct type in 2,and the mixed type in 1;IPMT lesions located in pancreatic head or uncinate process were found in 2,pancreatic body and tail in 2,and pancreatic tail in 1.On CT and MR images,IPMT lesions appeared as cystic or cystic-solid masses with barrel-like dilatation of pancreatic ducts and protrusion of the mural nodules.Contrast-enhanced CT scans showed slight or moderate enhancement of the mural nodules or polycystic-mimicking a brunch of grapes shadows with hypodensity.MRCP clearly showed the shape of dilated pancreatic ducts and the patency between main pancreatic ducts and branches.Conclusion IPMTs have definite imaging features which are helpful to differentiate the benign from malignant lesions,to guide the clinical therapy,and to evaluate the prognosis.