CT在胰腺结核诊断中的价值

Evaluation of CT in the Diagnosis of Pancreatic Tuberculosis

目的 探讨胰腺结核的CT征象及其诊断价值。资料与方法 回顾性分析 1 4例胰腺结核的CT表现及临床资料。结果 胰腺结核表现为 3型 :(1 )局灶型 :9例 ,多位于胰头 ,表现为低密度肿块伴有周边或蜂房状强化 ;(2 )多结节型 :4例 ,胰腺内多发低密度病变 ,无强化或轻度强化 ,胰头病变明显 ,呈蜂房状强化 ;(3)弥漫型 :1例 ,表现为胰腺弥漫性肿大 ,边缘模糊。胰腺结核常伴有胰外结核。胰周淋巴结肿大 9例 ,7例增强 ,呈花环状或环形强化 ;肝脏受累 3例 ,脾脏受累 4例 ,表现为肝、脾实质内低密度无强化病灶 ;胆管梗阻、结核性腹膜炎各 3例。结论 胰腺结核CT表现多样 ,包括胰腺局灶性低密度肿块、多发低密度结节或弥漫性胰腺肿大 ,但最常见的表现是胰腺内局灶性蜂房状强化的肿块。

Objective To study CT features of pancreatic tuberculosis.Materials and Methods The clinical data and CT findings in 14 cases with pancreatic tuberculosis were retrospectively analyzed.Results On CT scan, three types of pancreatic tuberculosis were seen. (1) Localized type (n=9): the lesion was located mainly at the head of the pancreas and displayed on CT as a low density mass with marginal or honeycomb enhancement. (2) Multiple nodular type (n=4): which was manifested as multiple low density lesions without or only with slight enhancement. (3) Diffuse type (n=1): the pancreas was diffusely enlarged with ill defined borders. Extra pancreatic tuberculosis was a common finding in the patients. Peripancreatic lymphadenopathy was seen in 8 cases, of which ring like enhancement was seen in 7. Hepatic involvement (n=3) and splenic involvement (n=4) displayed as low density lesions within the liver and spleen, which showed no enhancement. Bile duct obstruction and tubercular peritonitis were also found in 3 cases each.Conclusion Pancreatic tuberculosis has a variety of CT findings, including localized low density mass, multiple low density nodules and diffusely enlargement of the pancreas. The most common finding is a localized mass with honeycomb enhancement. Enlarged low density peripancreatic and periportal lymph nodes which show ring like enhancement on enhanced CT scanning, and the presence of extra pancereatic tuberculosis are important supportive signs for the diagnosis of pancreatic tuberculosis.