IgG4相关自身免疫性胰腺炎的超声表现及特征分析

Ultrasound manifestations and characteristics analysis of IgG4-related autoimmune pancreatitis

目的总结IgG4相关自身免疫性胰腺炎(IgG4-AIP)的超声表现及特征。方法回顾性分析2014年12月至2019年4月首都医科大学附属北京友谊医院收治的40例IgG4-AIP患者的临床及影像学资料,观察胰腺大小、形态、回声,有无肿物及肿物的大小、形态、回声及血流情况,同时观察主胰管、肝内外胆管有无狭窄或扩张,胆管壁有无增厚,腮腺、颌下腺有无肿大或肿物,其中3例行超声造影检查,观察胰腺病灶的增强-消退过程。结果本组患者男女比例为5.7︰1,50~79岁者占90%。临床表现以黄疸、腹痛为主。胰腺超声表现分为3型:节段型8例(20.0%),胰腺大小、形态正常,局部回声不均匀,以回声减低为主;弥漫型17例(42.5%),胰腺弥漫性肿大,回声不均匀减低;肿块型15例(37.5%),胰腺局限性肿大,回声与周围胰腺类似或减低,“肿块”位于胰头10例,胰尾5例。3例肿块型病变行超声造影检查,2例动脉期呈高或等增强,延迟期呈等增强,1例动脉期及延迟期均呈低增强。本组合并IgG4相关胆管炎29例(72.5%),其中超声确诊胆管炎10例,表现为肝内和(或)肝外胆管管壁不均匀增厚;合并IgG4相关涎腺炎6例(15.0%),表现为腮腺和(或)颌下腺回声弥漫不均匀,伴或不伴有纤维条索样高回声。结论IgG4-AIP超声表现以弥漫型及肿块型为主,超声检查在发现胰腺病变的同时,联合胆管、涎腺等多器官扫查可为临床提供更有价值的信息。

Objective To summarize the ultrasound manifestations and characteristics of IgG4-related pancreatitis(IgG4-AIP).Methods The clinical and imaging data of 40 patients with IgG4-AIP admitted to Beijing Friendship Hospital from December 2014 to April 2019 were retrospectively analyzed.The size,shape,echo and blood flow of pancreas and the mass were observed.At the same time,the stenosis or dilation of main pancreatic duct,intrahepatic and extrahepatic bile ducts and bile duct wall were observed,enlargement or mass of parotid and submandibular glands were observed.Contrast-enhanced ultrasonography was performed in 3 cases to observe the enhancement-resolution process of pancreatic lesions.Results The ratio of male to female in this group is 5.7:1 and 90%of patients aged 50-79 years old.The main clinical manifestations were jaundice and abdominal pain.The ultrasonographic manifestations of pancreas were divided into three types:segmental type in 8 cases(20.0%),with normal size and shape of pancreas,non-uniform local echo,mainly hypoechoic;diffuse type in 17 cases(42.5%),diffuse enlargement of pancreas,with inhomogeneous reduction of echo;mass type in 15 cases(37.5%)with localized enlargement of pancreas,echo similar to or hypoecho of surrounding pancreas,"mass"were located in the head of pancreas in 10 cases,and in the tail of pancreas in 5 cases.Contrast-enhanced ultrasonography was performed in 3 cases of mass lesions,2 cases showed high or equal enhancement in arterial phase and equal enhancement in delayed phase.1 case showed all hypoenhancement from arterial phase to delayed phase.Twenty-nine cases(72.5%)with IgG4-related cholangitis in this group,of this 10 cases were diagnosed by ultrasound,with intrahepatic and/or extrahepatic bile duct wall uneven thickening.Six cases(15.0%)with IgG4-related sialoadenitis were characterized by diffuse and uneven echoes of parotid and/or submandibular glands with or without fibrous cord-like hyperechoes.Conclusion Ultrasound images are mainly diffuse and mass type in IgG4-AIP,combined biliary,salivary gland and other organs scan will provide more valuable information for clinical practice.