胰腺结核和胰周淋巴结结核的影像学表现

Imaging Manifestations of Pancreatic and Peripancreatic Lymphoid Tuberculosis

目的探讨胰腺结核及胰周淋巴结结核的影像学表现及诊断要点,评价影像学检查对其的诊断价值。方法选取胰腺结核和胰周淋巴结结核患者5例,2例为手术病理学证实,3例为经抗结核治疗追踪临床证实;其中2例为胰头部结核伴胰周淋巴结结核,3例为胰头周围淋巴结结核(伴脾脏结核1例)。5例均行多层螺旋CT(MSCT)平扫+三期动态增强扫描,其中1例行MRI平扫,1例行MRI平扫+三期动态增强扫描。回顾性分析患者的MSCT和MRI表现。结果 2例胰头部结核伴胰周淋巴结核,1例伴钙化,CT表现为多发结节状混杂密度灶,轻度-中度蜂窝样强化,并伴有胰周淋巴结肿大,部分融合,呈环形强化。3例胰头周围淋巴结结核CT表现为淋巴结肿大,向上延伸至肝门部,部分融合,1例合并脾脏粟粒样结核灶,增强扫描显示肿大淋巴结呈环状强化。2例胰头周围淋巴结结核MRI表现T1WI为等或略低信号,T2WI为稍高信号,扩散加权成像(DWI)呈高信号,增强扫描显示边缘环形强化。结论胰腺结核和胰周淋巴结结核的CT表现为胰腺局灶蜂窝状轻中度强化,肿块及胰周淋巴结肿大伴边缘环状强化,可合并脾脏等腹腔结核灶,影像学表现有一定的特异性。

Objective To explore the CT manifestations and diagnostic points of pancreatic and peripancreatic lymphoid tuberculosis and to evaluate the diagnostic values of imageology.Methods Five cases of pancreatic and peripancreatic lymphoid tuberculosis patients were enrolled in this study,2 of them with pancreatic tuberculosis in the head of the pancreas and the peripancreatic lymphoid while the other 3 with peripancreatic lymphoid tuberculosis（one of them complicated with spleen tuberculosis）.Two of these cases were verified pathologically after operation and the other three were verified by clinical TB treatment.MSCT scan with multi-period enhancement was performed in all cases,with one case underwent MRI plain scan and another case underwent MRI plain scan with multi-period dynamic enhancement MSCT and MRI manifestations were retrospectively analyzed.Results Of the 2 cases of pancreatic tuberculosis in the head of pancreas with peripancreatic lymphoid tuberculosis,one was with calcinosis.Multiple nodular mixed densities,mild-moderate honeycomb-like strengthening,and enlarged peripancreatic multiple fusional lymph nodes with annular enhancement were seen in these cases.Of the 3 cases of peripancreatic lymphoid tuberculosis.CT scan showed enlarged peripancreatic lymph nodes partially fused and with marginal annular enhancement up to the hepatic portal.Mild edge enhancement was found in one case with multiple foxtail millet of nodules in the spleen.MRI manifestations of the 2 cases of pancreatic tuberculosis in the head displayed equal or slightly lower T1WI signals,slightly higher T2WI signals,and high DWI signals with marginal enhancement.Conclusion Pancreatic tuberculosis and peripancreatic lymphoid tuberculosis display local pancreatic low density mass and honeycomb-like mild or moderate strengthening.Spleen tuberculosis is seen in some cases.These manifestations are specific to some extent.