具有囊性改变的胰腺导管腺癌的CT及MRI表现

CT and MRI manifestations of pancreatic ductal adenocarcinoma with cystic features

目的:探讨具有囊性改变的胰腺导管腺癌(PDAC)的CT及MRI表现。方法:回顾性分析经手术病理证实的、CT/MRI上表现为囊性改变的15例PDAC患者的影像资料,观察内容包括病变的位置、形态、囊性/囊实性,肿瘤最大径、囊性成分的最大径、囊内容物特征、囊壁特征、主胰管是否扩张等征象。结果:15例PDAC中,低分化者4例,中分化者5例,高分化者5例,介于中、高分化之间者1例。病灶表现为纯囊性肿块2例;囊实性肿块13例,其中7例表现为实性肿块中心出现不规则囊性区。15例PDAC中,2例囊内容物信号/密度不均匀(2/15),且T1WI上呈高信号;5例出现分隔(5/15),4例出现壁结节(4/15)。15例肿块的最大径为(4.56±1.52)cm;肿块内囊变的最大径为(2.80±1.90)cm。主胰管及胆总管均扩张4例,仅病变处主胰管扩张2例,仅病变后方主胰管扩张1例。结论:具有囊性改变的PDAC并不多见,纯囊性表现者更为少见,临床上极易误诊为单纯囊肿或假性囊肿;囊实性表现者与胰腺囊实性肿瘤鉴别困难,临床需要加强认识,提高诊断准确性。

Objective： To study the CT and MRI findings of pancreatic ductal adenocarcinoma （PDAC） with cystic features. Methods：The imaging data of 15 PDAC patients with cystic changes on CT and MRI confirmed by surgery and pathology were retrospectively analyzed. The observation in- cluded the tumor location, shape, cystic or cystic/solid lesion, the maximum diameter of the neoplasm, the maximum diameter of the cystic structures, the contents of cysts, cystic wall, the main pancreatic duct and other signs of pancreatic and peripancreatic involvement. Results：In 15 cases of PDAC, 4 cases were poorly differentiated, 5 cases moderately differentiated, 5 cases highly differentiated, and 1 case between moderately and highly differentiated. Lesions showed pure cystic mass in 2 cases,cystic-solid mass in 13 cases,of which 7 cases showed irregular cystic area in the center of solid mass. In 15 cases of PDAC,the signal/density of 2 cases with high signal on TlWI was uneven （2/15）,5 cases showed segmentation （5/15） and 4 cases showed mural nodules （4/15）. The mean of maximum diameter of le- sion in the 15 patients was （4. 56±1.52）cm while the mean of maximum diameter of the cystic struc- ture was （2. 80±1.90）cm. The dilatation of main pancreatic duct and common bile duct was shown in 4 cases,only the dilatation of main pancreatic duct in the lesion was shown in 2 cases,and only the dilatation of main pancreatic duct behind the lesion was shown in one case. Conclusion：PDAC with cystic features were not common,and cystic PDAC was rare. Cystic PDAC was easily misdiagnosed as cysts or pseudocyst. Cystic PDAC with solid component was difficult to be differentiated from other cystic and solid tumors. So it is important to reinforce the knowledge of PDAC with cystic features, and it will be helpful for improving diagnostic accuracy.