胰腺富血供肿瘤的影像学特征

Imaging features of pancreatic hypervascular tumors

目的探讨胰腺富血供肿瘤的CT及磁共振成像检查特征。方法采用回顾性描述性研究方法。收集2007年3月至2021年2月2家医学中心收治的53例(宁波大学医学院附属医院32例、海军军医大学第一附属医院21例)胰腺富血供肿瘤病人的临床病理资料;男21例,女32例;年龄为(48±23)岁。53例病人[胰腺神经内分泌肿瘤(PNET)19例、肾透明细胞癌胰腺转移瘤(PRCC)9例、实性假乳头状瘤(SPTP)8例、胰腺异位副脾(IPAS)7例、浆液性囊腺瘤(SCP)6例、动脉瘤4例]行CT和MRI检查。观察指标:(1)PNET的影像学检查表现。(2)PRCC的影像学检查表现。(3)SPTP的影像学检查表现。(4)IPAS的影像学检查表现。(5)SCP的影像学检查表现。(6)动脉瘤的影像学检查表现。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示,计量资料以绝对数表示。结果(1)PNET的影像学检查表现:19例PNET病人中,1例Von Hippel-Lindau病,8例多发内分泌肿瘤1型,10例神经内分泌肿瘤。19例病人中,16例为单个肿瘤,3例为2个肿瘤;肿瘤位于胰头部9例,胰体尾部10例;肿瘤多为圆形或椭圆形,部分可见浅分叶,边界清楚;4例肿瘤中央有簇样钙化,15例未见钙化;肿瘤长径为(26.7±10.3)mm。19例病人中,1例胰腺萎缩、主胰管节段性扩张,18例未见萎缩,主胰管无明显扩张;2例胆管扩张,17例无胆管扩张。PNET影像学检查强化模式为“快进快出”型。(2)PRCC的影像学检查表现:9例PRCC病人中,2例为单个肿瘤,分别位于胰颈部和胰体部,7例为多个肿瘤,在胰头、颈、体尾部均可见;肿瘤为圆形或类圆形,边界清楚;单个肿瘤长径为(18.0±5.0)mm,多个肿瘤长径为2.0~50.0 mm。9例病人中,2例胰管可见扩张,7例胰管未见扩张。PRCC影像学检查强化模式为“快进快出”型。(3)SPTP的影像学检查表现:8例SPTP病人均为单个肿瘤,肿瘤位于胰头部4例,胰体尾部4例;肿瘤大部分可见分叶,边界清楚;2例肿瘤未见钙化,6例肿瘤内可见钙化;2例肿瘤未见囊变坏死,6例肿瘤内见囊变坏死;3例肿瘤内未见出血,5例肿瘤内见出血;肿瘤长径为(51.6±11.8)mm。8例病人胰管均未见扩张,邻近脏器受压推移。SPTP影像学检查强化模式为“渐进”型。(4)IPAS的影像学检查表现:7例IPAS病人均为单个肿瘤,位于胰尾部;肿瘤为圆形或类圆形,边界清楚;1例肿瘤为囊实性,密度不均,为胰尾部副脾合并表皮样囊肿,6例肿瘤为实性,密度均匀;肿瘤长径为(25.5±8.5)mm。7例病人胰管均未见扩张,周围结构清晰。IPAS影像学检查强化模式为“渐进”型。(5)SCP的影像学检查表现:6例SCP病人均为单个肿瘤,位于胰颈部1例,位于胰体尾部5例;肿瘤为圆形或类圆形,边界清楚;2例肿瘤为囊性,4例肿瘤为实性;肿瘤长径为(35.5±15.4)mm。6例病人中,2例胰管扩张,4例胰管未见扩张。SCP影像学检查强化模式为“快进快出”型。(6)动脉瘤的影像学检查表现:4例动脉瘤病人均为单个肿瘤,位于胰体部1例,为十二指肠上动脉瘤,位于胰尾部3例,为脾动脉瘤;肿瘤呈圆形,边界清楚;1例肿瘤未见钙化,3例肿瘤边缘钙化;肿瘤长径为(11.3±2.5)mm。4例病人胰管未见扩张。动脉瘤影像学检查强化模式为“快进快出”型。结论胰腺富血供肿瘤CT和磁共振成像检查表现多样,PNET、PRCC、SCP及动脉瘤强化模式为“快进快出”型,SPTP、IPAS强化模式为“渐进”型。

Objective To investigate the imaging features of pancreatic hypervascular tumors in computed tomography(CT)and magnetic resonance imaging(MRI)examinations.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 53 patients with pancreatic hypervascular tumors who were admitted to two medical centers,including 32 cases in the Affiliated Hospital of Medical School,Ningbo University and 21 cases in the First Affiliated Hospital of Naval Medical University,from March 2007 to February 2021 were collected.There were 21 males and 32 females,aged(48±23)years.Of the 53 patients,there were 19 cases with pancreatic neuroendocrine tumor(PNET),9 cases with pancreatic metastasis from renal cell carcinoma(PRCC),8 cases with solid pseudopapillary tumors of pancreas(SPTP),7 cases with intrapancreatic accessory spleen(IPAS),6 cases with serous cystadenoma of pancreas(SCP)and 4 cases with aneurysms.All the 53 patients underwent CT and MRI.Observation indicators:(1)imaging feature of PNET;(2)imaging feature of PRCC;(3)imaging feature of SPTP;(4)imaging feature of IPAS;(5)imaging feature of SCP;(6)imaging feature of aneurysms.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Imaging feature of PNET:of the 19 cases with PNET,there were 1 case with Von Hippel-Lindau disease(VHLD),8 cases with multiple endocrine neoplasia type 1(MEN1)and 10 cases with neuroendocrine tumor(NET).Of the 19 cases,16 cases had single tumor and 3 cases had 2 tumors,9 cases had tumor located at head of pancreas and 10 cases had tumor located at body and tail of pancreas.Morphology of tumors in the 19 cases were mostly round or elliptical,with some shallow lobes and clear boundary.There were 4 cases with cluster-like calcifications in the center of tumors and 15 cases with no cluster-like calcification in the center of tumors.The tumor diameter of 19 cases was(26.7±10.3)mm.Of the 19 cases,1 case underwent pancreatic atrophy and segmental expansion of the main pancreatic duct and 18 cases underwent no pancreatic atrophy or segmental expansion of the main pancreatic duct,2 cases underwent dilated bile ducts and 17 cases underwent no dilated bile ducts.The enhance-ment mode of imaging examination of PNET was wash in and wash out.(2)Imaging feature of PRCC:Of the 9 cases with PRCC,2 cases had single tumor and 7 cases had multiple tumors.Of the 2 cases with single tumor,1 case had tumor located at neck of pancreas and 1 case had tumor located at body and tail of pancreas.All the 7 cases with multiple tumors had tumor located at head,neck,body and tail of pancreas.Morphology of tumors in the 9 cases were round or quasi-circular,with clear boundary.The tumor diameter were(18.0±5.0)mm of the 2 cases with single tumor and 2.0-50.0 mm of the 7 cases with multiple tumors,respectively.Of the 9 cases,2 cases underwent pancreatic ducts dilatation and 7 cases underwent no pancreatic ducts dilatation.The enhancement mode of imaging examination of PRCC was wash in and wash out.(3)Imaging feature of SPTP:all 8 cases with SPTP had single tumor,including 4 cases with tumor located at head of pancreas and 4 cases with tumor located at body and tail of pancreas.Morphology of tumors in the 8 cases were lobulated with clear boundary.Of the 8 cases,there were 2 cases with no calcifications of tumors and 6 cases with calcification of tumors,2 cases with no cystic necrosis of tumors and 6 cases with cystic necrosis of tumors,3 cases with no bleeding in the tumors and 5 cases with bleeding in the tumors.The tumor diameter of 8 cases was(51.6±11.8)mm.All the 8 cases were negative for pancreatic ducts dilatation,but the adjacent organs were compressed and moved.The enhancement mode of imaging examination of SPTP was asymptotic enhancement.(4)Imaging feature of IPAS:all the 7 cases with IPAS had single tumor located at tail of pancreas.Morphology of tumors in the 7 cases were round or quasi-circular shape with clear boundary.Of the 7 cases,1 case with solid-cystic and uneven density tumor was epidermoid cyst in the accessory spleen of the tail of the pancreas,and 6 cases had solid and uniform density tumors.The tumor diameter of 7 cases was(25.5±8.5)mm.All the 7 cases were negative for pancreatic ducts dilatation and the surrounding structures of pancreatic ducts were clear.The enhancement mode of imaging examination of IPAS was asymptotic enhancement.(5)Imaging feature of SCP:all 6 cases with SCP had single tumor,including 1 case with tumor located at neck of pancreas and 5 cases with tumor located at body and tail of pancreas.Morphology of tumors in the 6 cases were round or quasi-circular,with clear boundary.Of the 6 cases,2 cases had cystic tumors and 4 cases had solid tumors.The tumor diameter of 6 cases was(35.5±15.4)mm.Of the 6 cases,2 cases were positive for pancreatic ducts dilatation and 4 cases were negative for pancreatic ducts dilatation.The enhancement mode of imaging examination of SCP was wash in and wash out.(6)Imaging feature of aneurysms:all the 4 cases with aneurysms had single tumor,including 1 case with tumor located at body of pancreas and 3 cases with tumor located at tail of pancreas.One case with tumor located at body of pancreas was superior duodenal aneurysm and 3 cases with tumor located at tail of pancreas were splenic aneurysms.Morphology of tumors in the 4 cases were round,with clear boundary.Of the 4 cases,1 case was negative for tumor marginal calcification and 3 cases were positive for tumor marginal calcification.The tumor diameter of 4 cases was(11.3±2.5)mm.All the 4 cases were negative for pancreatic ducts dilatation.The enhance-ment mode of imaging examination of aneurysms was wash in and wash out.Conclusions The imaging features of pancreatic hypervascular tumors in CT and MRI examinations show diversity.The enhancement mode of imaging examination of PNET,PRCC,SCP and aneurysms is wash in and wash out.The enhancement mode of imaging examination of SPTP and IPAS is asymptotic enhancement.