不同MR快扫序列对胰腺肿瘤的诊断价值

目的明确各种MR快扫序列对胰腺肿瘤的诊断价值,确定最佳扫描序列组合.方法对40名临床怀疑胰腺占位患者行MR检查,扫描序列包括:FS FLASH T1WI、TSE T2WI、True-FISPT2WI、MRCP及多时相动态增强3-D FLASH T1WI.测量正常胰腺与病灶的信号强度,计算胰腺-肿瘤的CNR,对各序列图像质量进行评分.最后,将各序列MRI的诊断和评价结果与手术病理相对照.结果胰腺-肿瘤的CNR:多时相动态增强3-D FLASH T1WI中,以胰腺实质期的胰腺-肿瘤CNR最高(9.7),其同期所获得的图像质量也最好(3.54±0.64),均优于平扫各序列(P＜0.05).对胰腺肿瘤的评价:动态增强3-D FLASH T1WI在检出胰腺癌及评价癌肿胰周血管受累、邻近器官受侵及转移灶方面均为最优(P＜0.05);MRCP对胰腺癌导致的胰胆管受侵最敏感,其次是True-FISP T2WI.综合各扫描序列的敏感性和准确性均优于任何单一的平扫、水成像或动态增强扫描序列.结论胰腺肿瘤的MR检查,多种扫描序列各有优缺点,联合应用能发挥最大潜力.理想的检查组合应包括:平扫屏气FS-FLASH T1WI、TSE T2WI、高分辨力的厚层及薄层MRCP、屏气的三维梯度回波序列多时相动态增强扫描.     

超声内镜诊断胰腺内分泌肿瘤的价值

目的探讨超声内镜诊断胰腺内分泌肿瘤的价值．方法胰腺内分泌肿瘤患者１０例,进行了超声内镜、血管造影、ＭＲＩ,ＣＴ及超声波检查．结果超声内镜对胰腺内分泌肿瘤的诊断率为９２３％,其中肿瘤直径在２ｃｍ以下的诊断率为８７５％,肿瘤轮廓清晰,边缘整,内部回声呈强回声、低回声、等回声和混合性回声;超声波的诊断率为４６２％;ＣＴ平扫和增强扫描的诊断率分别为３０７％和４６２％;ＭＲＩＴ１呈低信号、Ｔ２呈高信号,诊断率为７２７％;血管造影的诊断率为８４６％．结论超声内镜对胰腺内分泌肿瘤的定位诊断和定性诊断优于其他影像学检查,特别是对胰腺小肿瘤的诊断,更显示出它的价值．     

多层螺旋CT对胰腺囊性肿瘤的诊断价值

目的探讨多层螺旋CT对胰腺囊性肿瘤的表现和诊断价值,以提高对该类疾病的认识。方法回顾性分析谷城县人民医院2010年1月-2013年1月18例经手术或穿刺活检标本病理证实的胰腺囊性肿瘤患者的CT资料。结果浆液性囊腺瘤8例,7例小囊型,1例大囊型,小囊型病灶较小,囊内有分隔,强化是呈海绵状,1例可见中央星状瘢痕伴钙化,大囊型病灶呈薄壁大囊,无囊壁结节及分隔,增强扫描囊壁轻度强化;黏液性腺瘤6例,2例表现为单房囊性病灶,4例表现为多房分隔囊性病灶,增强后壁有强化;黏液性囊腺癌2例,1例伴有肝转移;实性假乳头状瘤2例,均为囊实混合型。结论多层螺旋CT对胰腺囊性肿瘤具有高度敏感性,不同病变有其特征表现,对术前诊断有一定价值。     

内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

CT和MRI在胰腺疾病的诊断价值及进展

随着ＣＴ和ＭＲＩ的发展，特别是成像速度的加快，胰腺疾病的诊断准确率在不断提高。ＣＴ是目前胰腺疾病诊断的最重要的影像检查方法，超声包括腔内超声和ＭＲＩ成像在胰腺疾病诊断上的价值进一步提高。１ＣＴ和ＭＲＩ对胰腺疾病诊断价值ＣＴ能清楚显示胰腺正常或异常的形...     

MRI对胰腺囊性肿瘤的诊断价值

目的探讨MRI对胰腺囊性肿瘤的诊断价值。方法回顾分析23例经手术病理证实的胰腺囊性肿瘤资料,总结其影像表现。结果黏液性囊性肿瘤10例,囊性肿块较大,肿块平均直径超过10 cm,由较厚的纤维壁分隔成多房囊肿,外壁光滑,边界清楚。浆液性囊腺瘤6例,病灶较小,囊内有分隔而呈放射状排列,中心瘢痕为其特征性表现。胰腺囊性转移瘤3例,均有肿瘤病史,表现不典型,需结合肿瘤病史定性。胰胚细胞瘤2例,幼儿发病,肿块巨大,肿瘤坏死囊变,形成假-假性囊肿。胰腺乳头状囊实性肿瘤1例,表现为边界清楚的囊实性肿块,囊壁上有壁结节。胰腺毛细血管瘤1例,表现与浆液性囊腺瘤相似,难以术前诊断。结论MRI对胰腺囊性肿瘤具有高度敏感性,不同病变有一定的特征性表现, 对术前定性极有价值。     

MRI对胰腺囊性肿瘤的诊断价值

目的探讨MRI对胰腺囊性肿瘤的诊断价值.方法回顾分析23例经手术病理证实的胰腺囊性肿瘤资料,总结其影像表现.结果黏液性囊性肿瘤10例,囊性肿块较大,肿块平均直径超过10 cm,由较厚的纤维壁分隔成多房囊肿,外壁光滑,边界清楚.浆液性囊腺瘤6例,病灶较小,囊内有分隔而呈放射状排列,中心瘢痕为其特征性表现.胰腺囊性转移瘤3例,均有肿瘤病史,表现不典型,需结合肿瘤病史定性.胰胚细胞瘤2例,幼儿发病,肿块巨大,肿瘤坏死囊变,形成假-假性囊肿.胰腺乳头状囊实性肿瘤1例,表现为边界清楚的囊实性肿块,囊壁上有壁结节.胰腺毛细血管瘤1例,表现与浆液性囊腺瘤相似,难以术前诊断.结论 MRI对胰腺囊性肿瘤具有高度敏感性,不同病变有一定的特征性表现,对术前定性极有价值.     

胰腺肿块伴黄疸对肿瘤标志物诊断的影响分析

目的 评价有无黄疸在肿瘤标志物对胰腺良恶性占位中的意义.方法 对60例胰腺恶性肿瘤及19例良性占位患者,利用美国雅培公司化学发光分析仪器及配套试剂进行测定血CA199、CA125和CEA含量,分析比较其单项及联合诊断的敏感度和特异度、ROC曲线分析及组间比较分析.结果 (1)单项指标检测以CA199诊断价值最大,敏感度和特异度分别为66.7%、78.9%,误诊率22.1%,漏诊率33.3%(约登指数＝0.456);两者联合中,CA199+CEA组敏感度和特异度分别为73.3%、73.7%,误诊率26.7%,漏诊率26.3%,联合诊断价值最高(约登指数＝0.470);优于CA199等单项指标组,差异具有统计学意义(P<0.05);而三者联合诊断并不优于CA199或CA199+CEA联合诊断.(2)胰腺良性占位组中,CA199等在黄疸或不伴黄疸组表达无统计学差异(P>0.05);而在胰腺恶性肿块患者中,黄疸组与无黄疸组相比,非参数检验结果为CA199(Z=1.063,P=0.020)、CA125(Z=0.067,P=0.947)、CEA(Z=0.502,P=0.616),黄疸对CA199水平影响差异有统计学意义(P<0.05),而对CA125、CEA等影响,统计分析显示均无统计学差异(P>0.05).结论 对于胰腺肿瘤的诊断,CA199+CEA联合诊断价值最高,优于CA199等单项指标组及三者联合组.CA199在对伴有黄疸的胰腺良恶性疾病的鉴别,除考虑其肿瘤标志物外还要考虑黄疸的影响作用,将来通过ROC曲线等研究CA199调定点的不同,有望达到更优的诊断效能.另外胰腺癌伴有胆红素异常患者是否为胰腺癌一个独特亚型,有待进一步临床证实.     

超声内镜引导下的细针吸取细胞学检查对胰腺肿瘤诊断的价值

流行病学调查表明，胰腺肿瘤的发病率逐渐上升，建立有效的早期胰腺癌的诊断方法迫不及待。由于超声内镜（EUS）和超声内镜引导下的细针吸取（EUS—FNA）细胞学检查独特的诊断能力，1994年以来，EUS—FNA应用于胰腺疾病诊断的安全性、操作性及准确性的报道相继出现，现已成为胰腺肿块的重要诊断工具，本文将就其对胰腺肿瘤诊断的应用作一综述。[第一段]     

胰腺囊性肿瘤的分类与诊断

胰腺囊性肿瘤是临床上较为少见的一类具有潜在及低度恶性的肿瘤,根据胰腺上皮是否存在及特征分为浆液性囊性肿瘤、黏液性囊性肿瘤、导管内乳头状黏液性肿瘤及实性假乳头状肿瘤。因其病理类型复杂且胰腺位置较深,患者临床症状和体征均缺乏典型性而容易导致误诊或漏诊。介绍了胰腺囊性肿瘤的分类,血清学检查、囊肿穿刺抽液分析以及影像学检查在诊断胰腺囊性肿瘤方面的进展,指出需要多种检查综合分析,方可进一步提高胰腺囊性肿瘤的确诊率。     

Diagnostic dilemmas in patients with cystic neoplasms of the pancreas

Summary Cystic neoplasms of the pancreas (CNP) are rare lesions that can be difficult to diagnose preoperatively. Twenty patients with cystic neoplasms of the pancreas including five microcystic adenomas, six benign mucinous cystic neoplasms, three malignant mucinous cystic neoplasms, two solid and papillary epithelial neoplasms, and four cystic neuroendocrine tumors were treated at a single institution between 1962 and 1987. The average duration of symptoms prior to diagnosis was 10 months. Five patients were asymptomatic. Forty percent of patients presented with an abdominal mass. Plain abdominal x-rays and UGI barium contrast studies were never diagnostic. Ultrasonography, computerized tomography (CT) and visceral angiography aided in the correct diagnosis in 28%, 36%, and 75% of patients studied, respectively. Overall a correct diagnosis was made preoperatively in only 35% of patients. Twelve of 13 patients were correctly diagnosed at laparotomy with intraoperative biopsy. Without biopsy the mass was misdiagnosed at laparotomy in five of six cases. CNP must be suspected inany patients who present with an upper abdominal mass with or without abdominal pain and no history of pancreatitis. CT may be diagnostic in up to one third of cases and should be obtained routinely to demonstrate the proximity of the lesion to other structures. Visceral angiography should also be obtained prior to operation. A generous incisional biopsy should be obtained of all pancreatic cysts that are not to be resected.     

低场强MR对脑动静脉畸形的诊断价值

目的　评价低场强MR对脑动静脉畸形的诊断价值。方法　回顾2 2例经低场强MRI检查,并通过数字减影血管造影(DSA)证实(5例为进一步手术病理证实)的脑动静脉畸形(AVM)病例,分析其MRI表现。结果　低场强MRI检查中,异常的血液流空征象为直接征象,脑内及蛛网膜下腔出血,脑组织萎缩、铁环征等均为间接征象。结论　低场强MRI对AVM有定性定位诊断价值。     

胰腺实性假乳头状瘤的临床病理分析

背景：胰腺实性假乳头状瘤（SPNP）是一种并非罕见的低度恶性胰腺肿瘤,近年报道的例数明显增多。目的：总结SPNP的临床病理特点,探讨其生物学行为。方法：回顾性分析2003年1月～2007年6月上海瑞金医院收治的13例SPNP患者的临床病理资料,并采用免疫组化方法检测肿瘤细胞α1-抗胰蛋白酶（AT）、α1-抗胰凝乳蛋白酶（ACT）、神经元特异性烯醇化酶（NSE）、波形蛋白、CD56、CD10、胰岛素、胰高血糖素、胃泌素、生长抑素等的表达。结果：526例胰腺肿瘤患者中,13例（2.5%）诊断为SPNP,男女比例为1∶5.5,平均年龄31.5岁,瘤体平均直径8.0cm。术前影像学诊断SPNP者6例（46.2%）。组织形态学显示瘤细胞大小一致,排列成实性片状区和假乳头结构。影像学显示4例浸润血管和周围组织,其中1例发生肝转移。免疫组化示α1-AT、α1-ACT、波形蛋白均呈阳性,11例NSE阳性,无胰岛素和胃泌素阳性者。所有患者均行手术完整切除肿瘤,术后平均随访24个月,均无复发或转移。结论：SPNP好发于年轻女性,具有低度恶性潜能,免疫组化检测对其诊断和鉴别诊断具有较重要的价值,手术治疗对SPNP的疗效较好。     

胰腺实性假乳头状瘤293例临床荟萃分析

背景：胰腺实性假乳头状瘤（SPNP）是一种低度恶性的胰腺肿瘤,近年报道的例数明显增多。目的：总结SPNP的临床特征。方法：对以“囊实性肿瘤／胰腺”、“实性假乳头状瘤／胰腺”为关键词,在中国医院知识仓库医学专题全文数据库（CHKD）检索得到的1997年10月～2008年8月发表的32篇文献中293例SPNP患者的临床特征进行分析。结果：人组SPNP患者的男女比例为1：8．2,平均年龄27．3岁,临床表现无特异性。SPNP影像学表现为由不同比例的囊实性成分组成,术前影像学检查的诊断率为41．0％。所有患者均为单发性肿块,平均最大径7．6cm。218例患者的包膜完整,75例不完整。共196例患者接受治疗,根治性手术切除率94．9％。220例患者平均随访33_3个月,6例复发．3例死亡。结论：SPNP是一种并非罕见的低度恶性肿瘤,好发于年轻女性。手术切除对SPNP的疗效较好．患者预后佳。     

CT and MR imaging for detecting neoplastic invasion of esophageal inlet

AIM: Direct neoplastic invasion of esophageal inlet is an uncommon but significant sequela of advanced head and neck carcinomas. The aim of this study was to seek an optimal CT or MRI criterion for determining the neoplastic esophageal inlet involvement in order to help tumor staging and surgical planning. METHODS: CT and MRI of 78 head and neck tumor cases were investigated retrospectively. At the level of the esophageal inlet on axial CT and MRI scans, the distance between the posterior aspect of cricoid cartilage and the anterior aspect of vertebra (d-CV) was measured by two senior radiologists who were unaware of clinical findings. Then, according to pathologie evidence and follow-up findings, these patients were divided into patients group, including 32 cases with neoplastic invasion of esophageal inlet and control group, including 46 cases without neoplastic esophageal inlet involvement. The statistical difference based on d-CV between the two groups was determined. The optimal criterion of d-CV on CT or MRI was assessed and lts accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated respectively. RESULTS: In control group, d-CV at the esophageal inlet level was 0.94±0.15 cm on axial CT and 0.91±0.18 cm on axial MRI, whereas in patient group, d-CV was 1.24±0.32 cm on CT and 1.31±0.36 cm on MRI. There was a statistical significance in d-CV between the two groups on CT and MRI modalities (P<0.01). d-CV greater than 1.0 cm was the typicall feature of neoplastic invasion of the esophageal inlet with 73% sensitivity, 83% specificity, 79% accuracy, 76% PPV, 80% NPV on CT and 84% sensitivity, 77% specificity, 80% accuracy, 70% PPV, 88% NPV on MRI respectively. CONCLUSION: Except for other CT and MR imaging features of neoplastic invasion of esophageal inlet, d-CV greater than 1.0 cm is an optimal adjunct criterion for esophageal inlet invasion by advanced head and neck carcinomas.     

CT与MRI增强扫描在原发性胰腺癌诊断中的应用价值

目的对比CT与MRI增强扫描诊断原发性胰腺癌所起的作用以及临床意义。方法选取我院收治的临床表现疑似胰腺癌患者47例,患者行CT和MRI增强扫描,经手术病理和临床证实,对比其特征性影像学。结果其中27例增强CT显示其中20例为胰腺癌患者,其中2例与手术病理,临床随访结果不一致,诊断符合率92.6%。在患者中,其中增强CT上显示癌病灶中1cm的病灶33个,1cm的5个,手术病理证实1cm的病灶35个,1cm的3个,CT诊断5.26%与实际有误。另外20例行MRI增强扫描检查,其中17例诊断为胰腺癌,其中1例与手术病理,临床随访结果不一致,诊断符合率95%。癌病灶中1cm的病灶36个,1cm的2个,手术病理证实1cm的病灶35个,1cm的3个,MR诊断2.63%与实际有误。结论目前影像学手段是诊断胰腺癌非常有效的方式,无论是CT还是MRI都有较高的可信度,但在原发性胰腺癌的诊断中,MRI较CT有优势。     

Mangafodipir trisodium-enhanced magnetic resonance imaging for evaluation of pancreatic mass and mass-like lesions

AIM: To investigate the role of mangafodipir trisodium (MnDPDP) in focal pancreatic masses and mass-like lesions by evaluating contrast uptake features of the lesions and pancreatic parenchyma after contrast medium injection. METHODS: A total of 37 patients with pancreatic mass or mass-like lesions were examined by unenhanced and MnDPDP-enhanced magnetic resonance imaging (MRI). RESULTS: MRI was obtained 20-40 min after infusion of MnDPDP and homogeneous contrast enhancement was observed in normal pancreas parenchyma. In patients with atrophic pancreas there was no enhancement in pancreatic parenchyma on MnDPDP-enhanced MRI. In 37 patients with 41 pancreatic masses and mass-like lesions, contrast enhancement was observed at 5 lesions on MnDPDP enhanced MRI. Three of these 5 lesions were focal pancreatitis and the other 2 were adenocarcinoma. No contrast enhancement was determined in 36 pancreatic masses and mass-like lesions in 32 patients. CONCLUSION: MnDPDP contrast-enhanced MRI, especially in cases with no parenchyma atrophy, can distinguish focal pancreatic lesion margins. Information about the function of pancreatic parenchyma can be obtained out of tumor. MnDPDP facilitates staging of pancreatic tumors by detection of metastatic lesions in the liver. In addition, diminished heteregenous uptake of MnDPDP in patients with pancreatitis may be helpful in differential diagnosis.     

内镜超声引导下穿刺活检术在胰腺囊性病变中的 诊断价值

胰腺囊性病变同时包含良性和恶性,性质不同,预后截然不同。内镜超声引导下细针活检术(endoscopic ultrasound-guided fine needle biopsy,EUS-FNB)因其能够直接获取目标病变的囊液、细胞或组织辅助诊断而倍受青睐。本文对EUS-FNB在胰腺囊性病变诊断中的应用做一综述,大部分研究结果认为EUS-FNB获取病变组织标本进行诊断的能力优于内镜超声引导下细针抽吸术,而新近出现的内镜超声引导下小活检钳活检术亦被证实在病变组织标本及诊断价值方面有其独特的优势。