胰腺导管内乳头状黏液瘤的MRI表现与病理对照

Imaging features of intraductal papillary mucmoas neoplasm of pancreas with MRI:compared with pathology

目的探讨胰腺导管内乳头状黏液瘤(IPMN)的MRI表现和诊断价值。方法回顾性分析11例经超声内镜引导下细针穿刺(EUS-FNA)或手术病理证实的胰腺导管内乳头状黏液瘤的MRI表现。MRI扫描包括常规平扫、动态增强以及磁共振胰胆管成像(MRCP)和扩散加权成像(DWI)。测量每个病灶的表观扩散系数(ADC)值,比较高异型性/侵袭性与低异型性IPMN的ADC值。结果主胰管型3例,主胰管弥漫性或节段性扩张,可见附壁结节;分支胰管型5例,呈分叶状或葡萄状扩张;混合型3例,主胰管和分支胰管均有不同程度扩张。高异型性/侵袭性IPMN的ADC值明显低于低异型性IPMN(P=0.03)。结论 MRI可以展示胰腺导管内乳头状黏液瘤的病理特征,测量ADC值有助于评估其良恶性。

Objective To evaluate the MR imaging features and Diagnostic value of pancreas intraduetal papillary mucinous neoplasm （IPMN）. Methods MRI findings of a retrospective analysis of 11 cases by endoscopic ultrasound- guided fine-needle aspiration （EUS-FNA） or pathologically confirmed pancreatic intraductal papillary mucinous neoplasm. MRI scan including conventional unenhanced,dynamic contrast-enhanced, magnetic resonance eholaugiopanereatography （MRCP） and diffusion-weighted imaging （DWI）. The apparent diffusion coefficient （ADC） values were measured for each lesion, relatively the ADC values of high-grade or invasive IPMN and low-grade IPMN. Results 3 cases of main duct type, the main pancreatic duct diffuse or segmental dilation, can be seen mural nodules. 5 cases of branch duct type, lobulated or grape-like expansion. 3 cases of mixed type, the main pancreatic duct and branch ducts have different levels of dilation. The ADC values for high-grade or invasive 1PMN were significantly lower than those for low-grade IPMN （P = 0.03）. Conclusion MRI can show pathological features of intraductal papillary mueinous neoplasm and measurements ADC values can help assess it＇ s benign or malignant.