自身免疫性胰腺炎胰腺内外病变的影像学特征

Pancreatic and extra-pancreatic imaging of autoimmune pancreatitis

目的分析自身免疫性胰腺炎（AIP）胰腺及其他组织器官受累的影像学征象，以提高AIP影像学诊断及鉴别诊断水平。方法回顾性分析2011年至2014年6月长海医院收治的38例AIP患者的影像学检查资料，诊断均符合2010年AIP诊断标准国际共识。36例次行CT增强检查，17例次行MRI增强检查，15例次行MRCP检查，分析其影像学征象。结果38例AIP患者的胰腺呈弥漫型（23例）、局限型（9例）、混合型（6例）肿大，均为渐进性延迟强化。14例主胰管粗细不均匀，呈弥漫不规则狭窄，24例可见假包膜样结构，24例累及胆管系统，4例肾脏受累，20例邻近血管受累，8例合并不同部位淋巴结肿大。结论AIP的胰腺和胰腺外器官具有特征性影像学表现，结合多种影像学检查有助于早期确诊。

Objective To describe the imaging findings of pancreatic and extra-pancreatic lesions of autoimmune pancreatitis （AIP） , to improve the imaging diagnostic accuracy of AIP. Methods From 2011 to June 2014, 38 AIP patients according to 2010 international consensus diagnostic criteria for AIP were included. Thirty-six patients underwent contrast enhanced CT scan, 17 patients underwent contrast enhanced MRI, 15 underwent MRCP, and the imaging data were retrospectively reviewed. Results In the 38 patients, the pancreas showed diffuse enlargement in 23, focal enlargement in 9, mixed enlargement in 6. All the patients demonstrated as progressive enhancement and gradually delayed enhancement. Fourteen cases showed diffusely irregular narrowing of the main pancreatic duct. Pseudo-capsule like structure was presented around the lesions in 24 cases. Extra pancreatic lesions included biliary duct involvement in 24 cases, renal lesions in 4 cases, peri-pancreas vessels involvement in 20 cases, 8 cases with enlargement of lymph nodes. Conclusions AIP presents with characteristic imaging features in pancreas and extra pancreatic organs. Imaging tests are helpful in the early diagnosis of AIP.