磁共振在自身免疫性胰腺炎诊断及鉴别诊断中的应用价值

Application magnetic resonance imaging in the diagnosis and differential diagnosis of autoimmune pancreatitis

目的分析自身免疫性胰腺炎的MR检查特点,探讨MR各序列在自身免疫性胰腺炎诊断及鉴别诊断中的应用价值。方法回顾性分析2012年9月—2014年12月哈尔滨医科大学附属第二医院经临床确诊的10例自身免疫性胰腺炎的MR表现,均行MR常规平扫、磁共振胰胆管成像(MRCP)、弥散加权成像(DWI)和动态增强扫描。结果胰腺弥漫性受累者7例,胰头局限性受累者2例,胰体尾部受累者1例。MR平扫:T1WI呈等或稍低信号,T2WI呈稍高信号;MRCP:9例胆总管胰腺段狭窄,8例见胰管弥漫性或局限性狭窄;DWI:呈高信号,ADC呈低信号;动态增强扫描:动脉期强化不明显,静脉期及延迟期呈均匀或不均匀延迟强化。其中6例患者经激素治疗后复查MR,提示病变体积明显减小,信号基本恢复正常。结论自身免疫性胰腺炎在MR各序列上具有特征性表现,MR有助于正确诊断自身免疫性胰腺炎并与其他胰腺疾病进行鉴别诊断。

Objective To analyze the characteristics of MR examination in autoimmune pancreatitis,and to investigate the application value of MR in diagnosis and differential diagnosis of autoimmune pancreatitis.Methods Retrospectively analyzed the MR of 10 cases of autoimmune pancreatitis,all patients were underwent MR conventional plain scan,magnetic resonance cholangiopancreatography（MRCP）,diffusion weighted imaging（DWI） and dynamic enhanced scanning.Results7 cases of diffuse pancreatic involvement,2 cases of pancreatic head limitations involvement,1 case involved the body and tail of the pancreas.MR scan：T1WI showed equal or slightly low signal,T2 WI showed slightly higher signal;MRCP：9 patients with common bile duct stenosis,8 cases of pancreatic duct diffuse or localized stenosis;DWI showed high signal,ADC showed low signal;dynamic enhanced scanning：lesions were not obviously enhanced in the arterial phase,venous phase and delayed phase revealed a homogeneous or heterogeneous delayed enhancement.6 patients with hormone therapy were followed up with MR,which indicates that the lesion volume was significantly reduced,the signal returned to normal.Conclusion Autoimmune pancreatitis has character in each sequence of the MR,and MR is helpful for diagnosis of autoimmune pancreatitis and differentia]diagnosis with other pancreatic diseases.