CT在自身免疫性胰腺炎和胰腺癌鉴别诊断中的应用价值

Value of CT in the differential diagnosis of autoimmune pancreatitis and pancreatic cancer

目的探讨CT在自身免疫性胰腺炎(AIP)与胰腺癌(PC)鉴别诊断中的应用价值。方法选取周口市中心医院于2018年1月至2019年12月收治的80例疑似自身免疫性胰腺炎或胰腺癌的患者作为研究对象,按照就诊时疑似病情分为A、B两组。A组为疑似自身免疫性胰腺炎患者(n=21)、B组为疑似胰腺癌患者(n=59)。两组均接受CT检查,记录两组CT检查结果,并将结果与穿刺/手术病理检查结果进行对比。结果 CT对自身免疫性胰腺炎的诊断敏感性为94.44%,特异性为100.00%;CT对胰腺癌的诊断敏感性为96.15%,特异性为85.71%。经CT检查可见,A组局灶性密度减低、淋巴结增大、胰管截断、胰腺肿胀/弥漫性强度减低、被膜样边缘、血管受侵犯、腊肠样外观、肾脏受累、胆总管壁增厚所占比例与B组比较差异有统计学意义(P<0.05);两组钙化、假囊肿形成、胰管不规则扩张/狭窄所占比例比较差异未见统计学意义(P>0.05)。A组胰腺病变平扫、动脉期、静脉期、延迟期CT值均高于B组(P<0.05)。结论自身免疫性胰腺炎与胰腺癌的CT征象具有显著差异,CT作为鉴别诊断二者的辅助检查方法,具有一定临床价值。

Objective To investigate the value of computed tomography(CT)in differential diagnosis of autoimmune pancreatitis(AIP)and pancreatic cancer(PC).Methods A total of 80 patients with suspected autoimmune pancreatitis or pancreatic cancer who were admitted to Zhoukou Central Hospital from January 2018 to December 2019 were selected as the subjects.All the patients were divided into group A and group B according to the suspected condition.Group A was suspected of autoimmune pancreatitis(n=21),group B was suspected of pancreatic cancer(n=59).Both groups received CT examination,the CT examination results of the two groups were recorded,and the data were compared with the results of puncture/operation pathology.Results The sensitivity of CT in the diagnosis of AIP was 94.44%,and the specificity was 100.00%;the sensitivity of CT in the diagnosis of PC was 96.15%,and the specificity was 85.71%.CT examination showed that the proportions of focal density decreasing,lymph node enlargement,pancreatic duct truncation,pancreatic swelling/diffuse intensity reduction,capsule like edge,vascular invasion,sausage like appearance,kidney involvement and common bile duct wall thickening in group A were different from those in group B(P<0.05);and there was no significant difference in the proportions of calcification,pseudocyst formation and irregular dilatation/stenosis of pancreatic duct between the two groups(P>0.05).The CT values of pancreatic lesions in group A were higher than those in group B on plain scan,arterial phase,venous phase and delayed phase(P<0.05).Conclusions The CT signs of AIP and PC are significantly different.As an assistant examination method for differential diagnosis of AIP and PC,CT has certain clinical value.