胰腺实性假乳头状瘤的CT诊断

目的：分析胰腺实性假乳头状瘤（SPTP）的CT表现，探讨CT对SPTP的诊断价值。方法：回顾性分析经手术病理证实的18例SPTP的影像资料。18例患者均为女性，年龄12～48岁，平均27岁。由两名放射科医生分析影像资料，分析内容包括：肿瘤发生位置、形态、大小、密度、囊实性比例、强化方式、是否合并出血、是否存在钙化、包膜、是否合并胆管或胰管扩张、胰腺是否萎缩、是否有浸润转移。结果：18例SPTP均为单发，位于胰头部8例，胰体5例，胰尾部5例。肿瘤圆形3例，卵圆形11例，分叶状4例。最大肿瘤长径10．3cm，最小肿瘤长径2．1cm，平均长径5．4cm。其中肿瘤长径〉3cm的SPTP14例，≤3cm的SPTP4例。肿瘤以囊性为主6例，囊性和实性比例相仿4例，实性成分为主8例。肿瘤实性部分呈渐进性强化，强化程度等于或略低于正常胰腺；囊性成分不强化。3例肿瘤坏死区合并出血。10例肿瘤合并钙化。11例有边界清楚的完整包膜，7例未见完整包膜。所有病例均无胆管扩张，1例合并胰管轻度扩张和胰腺的轻度萎缩。1例发生周围组织结构浸润并淋巴结及肝脏转移。结论：SPTP常发生于年轻女性，直径〉3cm的SPTP的CT表现有一定特征：较大的囊实性肿块，清楚的边缘，实性部分渐进性强化，可以合并出血和钙化。而≤3cm的SPTP的CT表现缺乏特征，在临床工作中应多加总结。SPTP的CT表现对其术前诊断具有重要的参考价值。

CT diagnosis of solid-psuedopapillary tumors of pancreas

Objective：The aim of our study was to study the CT manifestations of solid pseudopapillary tumor of the pancreas （SPTP） so as to improve the imaging diagnostic abilities. Methods：The CT materials of 18 cases with surgery and pathology proved SPTP were retrospectively analyzed,all of the patients were female,their age ranged from 12 to 48 years （average 27.2 years）. Two radiologists in consensus analyzed the CT findings for the location, shape, diameter, density, ratio of solid-to-cystic components, enhancement pattern, hemorrhage, as well as the presence of calcification, dilatation of the bile or pancreatic duct, parenehymal atrophy, and surrounding infiltration or metastasis of tumor. Results： All of the 18 cases presented solitary mass. They were located at the head （n=8）, tail （n=5）, and body （n=5） of the pancreas. Their shapes were round （n=3）, oval （n = 11 ）, and lobular （n = 4）. The long-axis diameter ranged from 2. 1 - 10. 3cm （mean 5.4cm） ,of the 18 SPTPS,there were 4 small SPTP （≤3cm in diameter） and 14 large SPTP （〉3cm in diameter）. Most of neoplasms consisted of solid and cystic components. Mostly cystic components in 6 cases, nearly the same proportion of solid and cystic part in 4 cases,and mostly solid components in 8 cases （purely solid in 2）. After dynamic contrast-enhanced scan-ning,the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhance ment. 3 cases showed obvious signs of hemorrhage. Calcification was noted in 10 cases. 11 cases were completely encapsula- ted, 7 cases had incomplete capsules, No patient showed bile duct dilatation, Pancreatic duct dilatation and parenchymal atro phy was noted in one case. Only one case had surrounding infiltration, enlargement of the intra-abdominal lymph nodes and distant organ metastasis. Conclusion：SPTP occurs mainly in young women,large SPTP has comparatively characteristic CT imaging features：a large solid and cystic tumor of pancreas, sharp edges, the solid parts of the lesion showed progressive en-hancement,a few with hemorrhage and calcification （peripheral rim or eggshell）. But, small SPTP is lack of certain charac-teristic,we should pay more attention to it and summarize in our daily work.