胰尾富血供结节的CT诊断及鉴别

CT differentiation of hypervascular nodules in pancreatic tail

目的:探讨胰尾内富血供结节的CT诊断及鉴别诊断价值。方法:回顾性分析28例胰尾内富血供结节患者的临床及影像资料,其中21例经手术病理证实,7例副脾中1例手术证实,6例随访证实。结果:28例患者(胰尾富血供结节35个)中神经内分泌肿瘤16例(20个结节),其中2例为多发内分泌肿瘤1型(MEN1)综合征,CT平扫8个结节伴囊变和/或钙化,16个结节双期(动脉期和静脉期)强化与脾脏不一致。胰内副脾7例,均为单发,平扫密度均匀,6例双期强化与脾脏一致,4例见脾动脉分支供血。肾脏透明细胞转移癌4例(7个结节),平扫6个结节伴囊变或钙化,增强扫描动脉期强化程度均高于脾脏。慢性炎症1例,病灶形态不规则,双期强化程度均高于脾脏,结节周边及内部见增粗小血管。结论:CT平扫加双期增强扫描有助于胰尾内富血供结节的诊断及鉴别,结合患者临床资料可协助制定合适的诊疗方案。

Objective:To explore the value of CT for differentiation of hypervascular nodules in the pancreatic tail.Methods:The clinical and imaging data of 28 patients with 35 hypervascular nodules in the pancreatic tail were retrospectively analyzed.22 cases were confirmed by surgery and pathology,and the remaining 6 were confirmed by follow-up imaging.35 hypervascular nodules included 20 neuroendocrine tumors,7 intrapancreatic accessory spleen,7 metastasis from renal clear cell carcinoma,and 1 chronic inflammation.Results:For neuroendocrine tumors,2 patients had MEN-1 syndrome,8 nodules had cystic degeneration and/or calcification,and 16 nodules had enhancement pattern inconsistent with spleen on dynamic images.Intrapancreatic accessory spleen all was solitary and uniform density on plain scan.6 cases showed enhancement characteristics consistent with spleen at dynamic contrast-enhanced CT;4 cases had blood supply from spleen artery branch.metastasis from renal clear cell carcinoma showed cystic degeneration or calcification(6/7)and increased enhancement compared to spleen(7/7).1 case of chronic inflammation showed irregular shape,increased enhancement compared to spleen,dilated small vessels within the nodule and at periphery.Conclusion:CT is helpful for differentiation of hypervascular nodules in the pancreatic tail.