良恶性胰腺实性假乳头状肿瘤的CT影像诊断特征

An analysis of CT imaging characteristics of the benign and malignant pancreatic solid-pseudopapillary neoplasm

目的探讨良恶性胰腺实性假乳头状肿瘤(SPT与SPC)的CT影像学特征。方法回顾性分析经手术病理证实的15例胰腺实性假乳头状肿瘤患者的16个病灶的影像学资料。13例患者行CT平扫及增强检查,2例为CTA直接增强扫描。结果 14例共15个病灶为胰腺实性假乳头状瘤,其中6个对周围包膜及胰腺组织有浸润,临床考虑为恶性胰腺实性假乳头状瘤;1例为胰腺实性假乳头状癌伴肝转移。良性SPT与SPC CT平扫呈不均匀软组织密度,密度不均匀;增强动脉期后以轻-中度不均匀浮冰状渐进性强化为主,病灶与胰腺分界较平扫清晰,门脉期及延迟扫描仍可呈轻-中度强化,病灶中央常可见囊变坏死之无或弱强化区。SPC显示病灶对周围血管有一定侵犯。1例SPC可见数个点状钙化灶,2例SPT与2例SPC均伴病灶远端胰管扩张。1例可见肝内多发转移灶伴脾门淋巴结转移,其余14例均未见明显转移肿大淋巴结,未发现远处转移。结论胰腺实性假乳头状肿瘤是一种少见的肿瘤,CT有一定的特征性表现,但CT对于判断良性SPT与SPC有一定的限度,最终确切的良恶性需要病理证实。

Objective To discuss the CT Imaging Features on the benign and malignant pancreatic solid-pseudopapillary tumor（SPT and SPC）.Methods Imaging data for 16 lesions in 15 patients with solid pseudopapillary tumor of Pancreas which were confirmed by surgery and pathology were retrospectively analyzed.13 patients were examined by plain CT scan and enhancement scan while CTA direct enhancement scan was underwent in 2 cases.Results 14 patients with 15 lesions had solid pseudopapillary tumor of the pancreas,6 of them were considered as malignant solid-pseudopapillary tumor of pancreas because of the capsule and infiltration on the surrounding pancreatic tissue.1 case was found with liver metastasis.Benign SPT and SPC CT plain scan showed inhomogeneous soft tissue density.After the arterial phase,the lesions were found from mild to moderate progressive enhancement and visible cystic lesions at the central necrotic areas.SPC displayed lesions of peripheral blood vessels at a certain degree.More than 1 case had Intrahepatic metastasis with splenic hilar lymph nodes metastases.There were no significant metastatic lymph nodes and distant metastases which were found in the remaining 14 cases.Conclusion Solid pseudopapillary tumor of pancreas is a rare tumor.Although CT has some characteristic manifestations,but it has a certain limit for benign SPT and SPC.The final diagnosis depended on pathological examination.