胰腺导管内乳头状黏液性肿瘤的MSCT征象

MSCT features of intraductal papillary mucinous neoplasm in the pancreas

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点。方法回顾性分析27例经病理证实的IPMN的MSCT表现。所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查。结果27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化。分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈"葡萄串"样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化。混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化。7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通。结论 IPMN的MSCT表现具有一定特征。MSCT结合ERCP检查有助于术前准确诊断。

Objective To analyze MSCT features of intraductal papillary mucinous neoplasms（IPMN） of the pancreas.Methods Totally 27patients with IPMN confirmed by pathology were retrospectively analyzed.All patients underwent plain and contrast-enhance CT,7patients underwent ERCP.Results Among the 27cases,11were interpreted as IPMN of the main pancreatic duct（MPD）.Two of these 11MPD were classified as borderline tumors,4were carcinomas,and 5 were adenocarcinoma.The atrophy of pancreas at different degrees and obvious dilation of MPD were demonstrated on CT,with solid mural nodules in the duct were seen in 8cases,while 1case had pancreatic calcification.Nine cases were interpreted as IPMN of the branch-duct type,3were classified as adenomas,3were borderline tumors,1was carcinomas,and 2were adenocarcinoma.Among these 9cases,7IPMN located in the pancreas head,displayed as cystic lesions linking to the main duct which shaped like grape string,with some septum and nodules could be seen within the duct,and 1case had pancreatic calcification,while 2IPMN located in the pancreas tail,shaped like round and did not enhance after injection of contrast medium.Seven cases were interpreted as IPMN of the mixed type with solitary papillary nodules in the duct wall,together with dilation of the main duct and branches,the cystic lesions linking with the main duct were presented on MSCT,3of the 7mixed type were classified as borderline tumors,3were adenocarcinoma,and 1was carcinoma.Cystic lesion linking with the main duct was found in 5of 7patients who underwent endoscopic retrograde cholangiopancreatography（ERCP）.Conclusion IPMN has some characteristic MSCT features.MSCT combined with ERCP is helpful to diagnosing IPMN of the pancreas before operation.