胰腺原发与继发恶性肿瘤CT表现的比较分析

Analysis on the CT findings of primary and metastatic pancreatic tumors

背景与目的:胰腺继发恶性肿瘤少见,胰腺原发和继发恶性肿瘤能否准确诊断对于治疗方案的选择有很大影响。本文旨在探讨CT在原发与继发胰腺恶性肿瘤鉴别诊断中的价值,提高术前定性诊断准确性。方法:回顾性分析30例胰腺原发性与29例胰腺继发性恶性肿瘤的CT表现和临床病理资料,观察和比较肿瘤发生的部位、数量、大小、肿块的密度、有无胰管扩张、胰周血管侵犯和病灶强化程度,并进行统计学处理。结果:原发胰腺癌有14例发生在胰头,继发性恶性肿瘤有6例发生在胰头,差异有统计学意义(P<0.05);原发胰腺癌有10例伴胰周血管的侵犯,而继发恶性肿瘤未发现肿块对胰周血管的侵犯,差异有统计学意义(P<0.05)。原发胰腺癌增强后呈轻度强化;继发恶性肿瘤增强后13例明显强化,15例轻度强化,1例无强化,差异有统计学意义(P<0.01)。结论:肿瘤的发生部位、是否侵犯胰周血管及病灶强化程度是胰腺原发与继发恶性肿瘤的鉴别点,CT在两者的鉴别诊断中具有一定的价值。

Background and purpose： Pancreatic metastatic tumors are rarely occurrea. An accurate diagnosis between primary and metastatic pancreatic tumors has a great influence on the choice of treatment. To evaluate the roles of computer tomography （CT） in differential diagnosis in primary and metastatic pancreatic neoplasm and to improve the diagnostic accuracy. Methods： The clinical data and CT images of 30 patients with primary adenocarcinoma of pancreas and 29 patients with pancreatic metastases tumor were analyzed retrospectively. The location, number, size, density, enhancement of the tumor and vascular invasion were observed and assessed. Results： Fourteen cases of primary pancreas cancer grew in the head of pancreas but 6 cases of pancreatic metastases （P〈0.05）, 10 patients with pancreas cancer had demonstrable involvement of extrapancreatic arteries and veins but none of pancreatic metastases （P〈0.05）. Slight CT enhancement was demonstrated in 30 patients with pancreas cancer and 15 pancreas metastases, high enhancement in 13 pancreas metastases and no enhancement in 1 pancreas metastases （P〈0.01）. Conclusion： The place, the invasion of peripancreatie vessels, and enhancement pattern are factors for distinguishing primary from pancreas metastases. CT plays an important role in evaluating the difference of them.