胰腺实性假乳头状瘤17例影像学分析

目的 探讨胰腺实性假乳头状瘤（SPTP）影像学特点。方法 收集2005年1月至2011年4月于我院经手术及病理证实的SPTP 17例，回顾性分析其影像学特征、手术方式及预后情况。结果 肿物位于胰头、胰颈部7例，胰体尾部10例，直径1.5～9.0 cm，平均4.8 cm。超声显示肿物多为低回声光团，内呈混杂回声，有明显包膜。CT平扫多为囊实混杂密度，动脉期实性部分呈现轻中度强化，静脉期及平衡期实性部分及壁结构强化逐渐增强，囊性部分无强化。MRI扫描T1WI、T2WI上呈高、低混杂信号，实性部分在T1WI呈稍低信号，T2WI呈等或稍高信号；囊性部分T1WI呈低信号，T2WI呈高信号。其中伴钙化5例，界限不清3例，胰胆管扩张2例。术前准确诊断15例，误诊为胰腺癌1例，误诊为胰腺假性囊肿1例。均行手术治疗，其中行肿物切除10例，行胰头十二指肠切除术2例，行胰体尾切除3例，行胰尾联合脾切除2例。10例得到随访9～36个月，均未复发及转移。结论 影像学对SPTP的诊断及恶性程度的评估均有一定意义，结合临床特点，多可达到准确的术前诊断及并指导治疗。

Imaging analysis of 17 cases of solid-pseudopapillary tumor of pancreas

Objective To investigate the imaging features and their significances for diagnosis and clinical evaluation of solid pseudopapillary tumor of pancreas (SPTP). Methods Imaging character, surgical style and prognosis of 17 cases with pathologically proven SPTP in the pancreas admitted between Jan 2005 and April 2011 in our hospital were reviewed retrospectively. Results Seven cases occurred in the head and the neck, and 10 in the body and tail. The size of SPTP ranged from 1.5 to 9.0 cm (mean 4.8 cm). On ultrasonography, most of the tumors appeared homogeneous hypochoic and heterogeneous, the tumors were defined and encapsulated. On CT scans, the tumors were cystic and soild mixed density, the solid portion demonstrated slight enhancement in the arterial phase and marked enhancement in the portal venous phase on post contrast CT scan. The cystic portions appeared hypo-attenuation on both pre-and post-contrast. On MRI scans, all masses were mixed hypo-and hyper intense on T1WI and T2WI, and soild portions of mass showed slightly hypointense on T1WI, and iso-or slightly hyperintense on T2WI; and cystic portions of mass showed hypo intense on T1WI, and hyper intense on T2WI. Five cases showed calcification, three cases showed unclear margins, two cases showed slight dilatation of the common bile duct or pancreatic duct, three cases showed pathologically high degree level malignancy. Fifteen cases were correctly diagnosed, 1 case was misdiagnosed as pancreatic cancer, and 1 case as pancreatic pseudocyst before operations. All of these cases were treated by surgical methods. Among them, 10 cases were undergone local pathological tissues resection, 2 cases received pancreatoduodenectomy, 3 cases received distal pancreatic resection, and 2 cases received distal pancreatic resection with spleen removed. Ten cases were followed up for 9 to 36 months without no metastasis or recurrence. Conclusion There are some characteristics on imaging of SPTP, and they are important to the diagnosis and evaluation of malignancy degree. correct preoperative diagnosis and clinical evaluation are possible based on clinical characterstics and imaging findings.