良、恶性胰腺导管内乳头状黏液瘤超声表现

Ultrasonic features of benign and malignant intraductalpapillary mucinous neoplasm of pancreas

目的 观察良、恶性胰腺导管内乳头状黏液瘤(IPMN)二维超声及超声造影(CEUS)表现。方法 回顾性分析15例良性IPMN(良性组)、11例恶性IPMN(恶性组)患者临床资料、二维超声及CEUS表现,并与MRI/CT表现进行对比。结果 恶性组患者糖类抗原19-9(CA19-9)水平升高及存在临床症状者占比均高于良性组(P均<0.05),该组超声显示病灶大小及病变存在实性成分占比均高于良性组(P均<0.05),且主胰管略宽。CEUS可清晰显示扩张胰管、准确鉴别黏液栓与肿瘤实性成分,描述病灶血供特征并显示MRI/CT显示欠清的病灶内分隔。MRI/CT则能显示超声显示欠清的附壁强化结节、病灶包绕血管、主胰管增宽及胰管与病灶连通。结论 良、恶性IPMN临床及超声表现均有一定差异。相比良性IPMN,恶性IPMN患者CA19-9水平更高、更易出现临床症状,且病灶更大、更多存在实性成分。

Objective To observe two dimensional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics of benign and malignant intraductal papillary mucinous neoplasm(IPMN)of pancreas.Methods Clinical data,two dimensional ultrasound and CEUS features of 15 patients with benign IPMN(benign group)and 11 patients with malignant IPMN(malignant group)were retrospectively comparatively analyzed and compared with MRI/CT features.Results The proportion of patients with elevated carbohydrate antigen 19-9(CA19-9)level and clinical symptoms in malignant group were both higher than those in benign group(both P<0.05).The size of lesions and the proportion of solid components showed on ultrasound in malignant group were higher than those in benign group(both P<0.05),and the main pancreatic duct slightly enlarged in malignant group.CEUS could clearly display dilated pancreatic duct,accurately distinguish mucus thrombi from solid components of tumor,and describe blood supply characteristics of the lesion and internal partitions of lesions not clearly showed on MRI/CT.MRI/CT were able to display some features not clearly showed on ultrasound,such as mural solid components,tumor-surrounding vessels,dilated pancreatic duct,and duct linked to lesions.Conclusion Clinical and ultrasonic features of benign and malignant IPMN were different on some degree.Compared with benign IPMN,patients with malignant IPMN tended to have higher CA19-9 level and clinical symptoms,with larger lesions and more solid components within lesions.