胰腺囊性肿瘤的MSCT表现及鉴别诊断

MSCT Manifestation and Differential Diagnosis Of Cystic Pancreatic Neoplasm

目的总结胰腺囊性肿瘤的MSCT表现并复习相关文献,提高对该类疾病的认识。方法回顾性分析27例经病理证实为胰腺囊性肿瘤的MSCT资料,其中浆液性囊腺瘤8例、粘液性囊腺瘤6例、粘液性囊腺癌4例、导管内乳头状粘液性肿瘤4例、胰腺实性假乳头状瘤3例、胰腺转移瘤2例。所有患者均行上腹部MSCT平扫及增强扫描。结果 8例浆液性囊腺瘤中,6例表现为"微囊型",具有典型影像学表现,病灶边界清楚,由数个直径约1mm～2cm的小囊组成,中心有星状纤维瘢痕;2例表现为"大囊型",病灶由单个薄壁大囊构成,中心无星状瘢痕;6例粘液性囊腺瘤均表现为多房大囊性病变(直径>2cm),类圆形或形态不规则;4例粘液性囊腺癌表现多房大囊性病变,囊壁厚并见壁结节,局部形成软组织肿块;4例胰腺导管内乳头状粘液性肿瘤表现为多发类圆形囊状低密度影,伴胰管节段性扩张;3例胰腺实性假乳头状瘤表现为肿瘤内大范围囊变、坏死低密度区,囊壁厚薄不均匀,囊内见软组织密度样突起;2例胰腺转移瘤原发病均为肺癌,胰腺病灶表现为类圆形低密度影。结论胰腺囊性肿瘤较为少见,掌握胰腺囊性肿瘤的不同MSCT征象,有助于我们对其做出正确的诊断。

Objective MSCT manifestations of cystic pancreatic neoplasms were summarized and in order to further acknowledge these diseases.Methods MSCT data of 27 pathologically confirmed cystic pancreatic neoplasm were retrospectively analyzed（including 8 cases of serous cystadenomas,6 cases of mucinous cystadenomas,4 cases of mucus cystadenocarcinomas,4 cases of intraductal mucinous papillary tumors,3 cases of solid pseudopapillary neoplasm,and 2 cases of pancreatic metastases.All patients were underwent abdominal CT and enhanced CT scan.Results Eight cases of serous cystadenomas,＂microcystic type＂ was shown in 6 cases,with typical image manifestations which are composed of grape-like collections of predominantly small（1mm-2mm）,with center scar;2 cases showed ＂macrocystic type＂ with large thin-walled single cystic lesions and without center scar.6 cases of mucinous cystadenomas manifested multi-cells with large cystic lesions（diameter of cyst was more than 2cm）.4 cases of mucinouadenocarcinomas were displayed large capsule multi-cells with thick capsule and mural nodules,and showed soft tissue mass.4 cases of pancreatic intraductal mucinous papillary tumors showed multiple lesions with thick and rough septa and dilatation of the pancreatic duct.3 cases of solid pseudopapillary neoplasms displayed wide range of necrosis,uneven wall and capsule-like protrusions.2 cases of pancreatic metastases manifested round-like low density.Conclusion Though cystic pancreatic neoplasms were rare,mastering different CT manifestations of these diseases will help us make correct diagnosis.