胰腺囊性肿瘤影像学诊断价值

Diagnostic value of imaging examinations in pancreatic cystic neoplasm

目的探讨胰腺囊性肿瘤的影像学表现及其诊断价值。方法回顾性分析2014年1月至2015年12月浙江大学医学院第二附属医院收治的95例胰腺囊性肿瘤患者临床资料。其中男37例，女58例；年龄10～80岁，中位年龄54岁。浆液性囊性肿瘤（SCN）16例，黏液性囊性肿瘤（MCN）11例，导管内乳头状黏液肿瘤（IPMN）21例，实性假乳头状瘤（SPN）囊变12例，胰腺神经内分泌肿瘤（PNEN）囊变24例，胰腺癌囊变11例。患者均签署知情同意书，符合医学伦理学规定。分析胰腺囊性肿瘤患者的CT、MRI表现及计算其诊断准确率。结果SCN以多发细小囊为特征。MCN以边界清晰的厚壁单腔病灶为特征，好发于胰体尾部。IPMN以病灶与主胰管相通为特征，主胰管和分支胰管均有不同程度扩张。SPN囊变以渐进性强化为特征，但强化程度低于胰腺实质。PNEN囊变以动脉期明显强化为特征。胰腺癌囊变以缺乏血供并周围组织侵犯或远处转移为特征。SCN的CT及MRI诊断准确率最低，分别为29％和14％；PNEN囊变CT及MRI诊断准确率最高，分别为89％和100％。结论胰腺囊性肿瘤临床症状不典型，影像学检查仍为主要诊断手段，对大多数胰腺囊性肿瘤的诊断以及良恶性的鉴别具有较高价值。

Objective To investigate the manifestations and diagnostic value of imaging examinations in pancreatic cystic neoplasm. Methods Clinical data of 95 patients with pancreatic cystic neoplasm who were admitted to the Second Affiliated Hospital, College of Medical Sciences, Zhejiang University between January 2014 and December 2015 were retrospectively analyzed. Among the patients, 37 were males and 58 were females, aged 10-80 years old with a median age of 54 years old. Sixteen cases were diagnosed with serous cystic neoplasm （SCN）, 11 with mutinous cystic neoplasm （MCN）, 21 with intraductal papillary mucinous neoplasm （IPMN）, 12 with cystic solid pseudopapillary neoplasm （SPN）, 24 with cystic pancreatic neuroendocrine neoplasm （PNEN） and 11 with cystic pancreatic adenocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Computed tomography （CT） and magnetic resonance imaging （MRI） manifestations of the patients with pancreatic cystic neoplasm were analyzed, and the diagnostic accuracy was calculated. Results SCN was characterized with multiple small cysts. MCN was characterized with a clear border, single lumen and thick wall lesion, mainly occurred in the pancreatic body and tail. IPMN was characterized with lesions connected to the main pancreatic duct. Dilation of varying degrees in the main and branch pancreatic duct dilation were observed. Cystic SPN was characterized with gradual enhancement, but the enhancement intensity was lower than that of pancreatic parenchyma. Cystic PNEN was characterized with evident enhancement in arterial phase. Cystic pancreatic adenocarcinoma was characterized with insufficient blood supply complicated with surrounding tissue invasiveness or distal metastasis. The diagnostic accuracy of CT and MRI was the lowest for SCN （29% for CT and 14% for MRI）, and highest for cystic PNEN （89% for CT and 100% for MRI）. Conclusions Due to the nonspecific clinical manifestations of pancreatic cystic neoplasm, imaging examination remains the main method for the diagnosis. It has high value for the diagnosis of most pancreatic cystic neoplasms and the differential diagnosis between benign and malignant tumors.