胰腺导管内乳头状黏液性肿瘤的CT和MRI特征及诊断价值研究

Characteristics and clinical diagnostic value of CT and MRI for intraductal papillary mucinous neoplasms

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMNs)的CT、MRI表现特征及诊断价值。方法选取2012年3月至2016年6月自贡市第四人民医院收治的20例经病理诊断为IPMNs的患者作为研究对象。观察CT及MRI图像特点、诊断结果,并与术后病理结果比较。结果分支胰管型IPMNs 12例,CT及MRI表现为葡萄串样或分叶状囊性变,内部伴壁结节和分隔,且主胰管轻中度扩张,MR胰胆管成像(MRCP)扫描发现主胰管与病灶相通。主胰管型IPMNs 4例,表现为主胰管节段性或弥漫性扩张,伴乳头状、扁平状突起,增强后突起处强化程度不同。混合型4例,表现为主胰管、分支胰管均扩张,内部可见囊性病变,其中3例内壁结节大于10 mm。CT及MRI检查共提示恶变11例,术后病理显示恶性病变12例,CT联合MRI诊断恶性IPMNs的准确率为95%,与病理结果基本一致。结论 CT联合MRI能够有效鉴别IPMNs类型,诊断IPMNs恶变的准确率高,对临床诊断IPMNs具有重要意义。

Objective To evaluate the image features and diagnostic value of CT and MRI of intraductal papillary nmcinous neoplasms （IPMNs）. Methods Results of CT or MRI of twenty patients with IPMNs were observed and compared with postopera- tive pathological results. Results CT and MRI showed 12 cases of branched pancreatic type IPMNs with grape - like or lobular cystic degeneration, internal esophageal nodules and separation, and the main pancreatic duet mild to moderate expansion. MRCP scan found that the main pancreatic duct and lesions were connected. There were 4 cases of primary pancreatic duct type IPMNs on CT and MRI, with the segmentation or diffuse dilatation of the main pancreatic duct, papillary and flattened processes. The enhancement degree of the enhancement after the protrusion was different. CT and MRI showed 4 cases of mixed type, the performance of the main pancreatic duct, branch pancreatic duct were expanded with internal visible cystic lesions. 3 cases of mixed type showed wall nodules more than 10 ram. CT and MRI showed a total of 11 cases of malignant transformation, and post- operative pathology showed 12 cases of malignant transformation. The accuracy rate of CT combined with MRI was 95%. Conclusion CT combined with MRI can effectively identify the type of IPMNs, and provide accurately diagnosis of IPMNs ma- lignant transformation.