胰腺囊性病变的MRI诊断

Value of MRI in diagnosis of cystic lesions of pancreas

目的探讨胰腺囊性病变的MRI诊断。方法回顾性分析我院近5年经手术病理证实的31例(33个病灶)胰腺囊性病变患者的临床资料,均行MRI平扫、MRCP和多期增强扫描,分析其MRI表现。结果 31例患者中,单纯性囊肿1例,囊壁薄且均匀,囊内呈均匀的长T1长T_2信号。潴留性囊肿2例,均与胰管相通,其中1例伴发胰头囊腺癌。假性囊肿2例、坏死性包裹4例,均有胰腺炎病史,2例假性囊肿囊壁均匀,囊内为均匀长T1长T_2信号;4例坏死性包裹囊壁厚薄不一,囊内信号不均。浆液性囊腺瘤5例,囊壁及间隔纤细,各囊腔之间信号相同,3例呈蜂窝状。黏液性囊腺瘤5例,2例可见壁结节,3例患者各囊腔间信号一致;黏液性囊腺癌5例,均可见壁结节,各囊腔间信号不一。导管内乳头状黏液性肿瘤4例,呈与主胰管相通的"葡萄串"状囊性病灶。实性假乳头状瘤5例,3例为囊实性,2例以囊性成分为主,增强后实性部分呈渐进性强化。结论 MRI在胰腺囊性病变的诊断和鉴别诊断中具有重要价值。

Objective To explore MR feature of cystic lesions of the pancreas. Methods Thirty - one patients（33 lesions） with pathologically proven cystic lesions of the pancreas were performed with conventional MR imaging, MRCP and mutiphasic contrast enhance-ment. The data of clinic and imaging appearance were retrospectively analyzed. Results Among 31 patients, there was only one case with congenital cyst, which was low intensity on T x WI and high intensity on T2 WI with thin and smooth cyst wall. Two cases were retention cysts which connected to the pancreatic duct, and mucinous cystadenocarcinoma of head of pancreas was accompanied in one case. Two cases were pancreatic pseudocysts, which showed homogeneous long T1 and long T2 signal intensity with smooth wall; four cases were walled off necrosis, the wall of which was irregular with heterogeneous signal intensity in it; all six patients had history of pancreatitis. Five caseshad serous cystic neoplasm, whose wall and septa were thin and the signal was the same among cavities, of themthree cases were honeycomb in shape. Five ca-ses were mucinous cystadenoma, and of them two cases had wall nodule, and three cases had homogeneous signal among cavities. Five cases were mucinous cystadenocarcinoma, all of which had wall nodule and the signal of cavities was heterogeneous. Four cases were intraductal pa-pillary mucinous neoplasm, which appeared as botryoidal cystic lesionsconnected to the main pancreatic duct. Five cases showed solid pseud-opapillary neoplasm, of which two cases were cystic and three cases were cystic and solid, with progressive enhancement in solid components. Conclusion MRI is valuable for the diagnosis and differentiated diagnosis of cystic pancreatic diseases.