胰腺转移癌:CT表现及临床分析

Pancreatic cancer metastases: CT features and clinical analysis

目的 分析胰腺转移癌（PM）的CT影像学表现及临床特点,提高诊断水平.方法 回顾性分析21例经病理学证实PM的CT表现及临床资料.结果 21例PM临床主要表现为腹痛而无其他特殊症状.CT共发现27个病灶,呈圆形或类圆形22个,不规则分叶状5个;位于胰头部16个,胰体、颈部7个,胰尾部4个;26个肿瘤中心点位于胰腺内,1个突出胰腺外.肿瘤直径约7～63 mm,平均35 mm.平扫多呈相对较低密度,不均匀囊实性而边界欠清.增强扫描强化类似于原发肿瘤,多呈不均匀环状强化,明显强化9例,中度强化8例,轻度强化4例;边界逐渐清晰,与正常胰腺间分界清晰、边缘锐利13例,8例边缘较毛糙;伴胆总管轻度扩张3例,伴近端主胰管轻度扩张1例,侵犯胰外血管2例,合并胰腺外转移16例.结论 PM以胰腺单发结节或肿块多见,临床多无特殊症状,CT平扫呈不均匀较低密度而边界欠清,增强强化与原发肿瘤相似;肿瘤中心点多位于胰腺内而突出胰腺外少见;多数合并其他转移但胆、胰管梗阻及胰腺外局部侵犯较少见,腹膜后结构相对较清晰,CT有助于PM的诊断及鉴别.

Objective To analyze the CT findings and clinical feature of pancreatic cancer metastases and to improve diagnostic level.Methods The CT findings and clinical feature in 21 cases were reviewed which were proved by pathology.Results The main clinical symptom of 21 cases were bellyache and without specific expression.Twenty-seven foci were detected on CT,22 were regular round or oval,5 were irregular masses with lobes.Sixteen foci located in pancreatic head,7 in the neck or body of pancreas and 4 in pancreatic tail.The central part of twenty-six foci located in pancreas and one focus located outside of pancreas.The maximum diameter was 7 ～63 mm （average 35 mm）.Most cases showed heterogeneous low density with relatively unclear edge on plain CT and were mixed focus of cystic and solid component.On enhanced CT,most PM showed heterogeneous cricoid enhancement and were similar to the primary tumor and showed clear edge.The interface between 13 foci and normal pancreas were sharp and the other 8 cases were not.Three cases were accomponied with the mild enlargement of common bile duct and 1 case was accomponied with mild enlargement at the proximal extremity of the main pancreatic duct,2 cases showed the invasion of blood vessel out of pancreas,metastases accompied with pancreas occurred in 16 cases.Couclusion The clinical features of PM is untypical,most cases show single node or mass with heterogeneous low density on plain CT scan and the enhancement of PM is similar to the primary tumor.The central part of most PM locates in pancreas and outside of pancreas is seldom.The metastases out of pancreas are commonly,but the obstruction of common bile duct or main pancreatic duct and the invasion out of pancreas are seldom,and the retroperitoneal structure is clear relatively.CT is useful for the diagnosis and identification of PM.