CT、MRI对胰腺导管内乳头状黏液性肿瘤的诊断价值

目的：分析胰腺导管内乳头状黏液性肿瘤的CT、MRI表现,提高对该病的诊断水平。方法：回顾性分析18例经手术证实的胰腺导管内乳头状黏液性肿瘤的CT及MRI资料,并与手术病理结果对比分析。结果：CT、MRI诊断为主胰管型IPMNs 3例,分支胰管型IPMNs 10例,混合型5例。主胰管型CT及MRI表现为主胰管弥漫性或节段性扩张,常伴有扁平状、乳头状突起,增强后突起处有不同程度强化;分支胰管型CT及MRI为病变呈葡萄串样或分叶状囊性变,内部常伴有分隔和壁结节,伴有主胰管轻中度扩张,MR胰胆管成像（MRCP）显示病灶与主胰管交通;混合型5例,主、分支胰管扩张,内可见囊性病变,其中3例内壁结节>10mm。病理分型与CT、MRI分型一致,根据CT及MRI提示恶变的标准,诊断恶变10例,手术病理证实恶变11例,两者基本一致。结论：CT及MRI对IPMNs的诊断、分型和恶变的判断具有重要的诊断价值。     

胰腺导管内乳头状黏液癌：动态增强CT、MR表现及其病理基础

目的：探讨胰腺导管内乳头状黏液性癌（IPMC）的MSCT、MR表现及诊断价值。材料和方法：经手术病理证实的IPMC 9例,术前均经多排螺旋CT平扫和增强扫描,5例行MR平扫和增强扫描,复习扫描结果并和手术病理作回顾性对照分析。结果：9例患者中主胰管型5例,表现为主胰管明显扩张,多数见管壁结节,CT呈稍高密度,MRI为稍长T1长T2信号,不均匀,胰管内呈长T1长T2信号;分支胰管型3例,表现为分叶状单发囊性或多发囊性病变,腔内见分隔及结节样突起或肿块,CT呈稍高密度,MRI为稍长T1长T2信号,2例CT MPR图像及MRCP显示病灶与主胰管相通;混合型1例,表现为囊状病灶,内有附壁结节,合并主胰管扩张,囊内为长T1长T2信号。6例病灶主胰管不同程度扩张（4～45mm）,6例胰腺不同程度萎缩,3例显示十二指肠乳头膨大,2例见不规则点状钙化。增强扫描分隔强化较明显,附壁结节强化稍弱且不均匀。结论：MSCT薄层扫描及MRI对IPMC诊断价值较大,结合MPR、CPR、MRCP能够显示胰腺IPMC的病理特征,有利于显示较小结节及胰管改变,结合其临床特征,多数病例可与胰腺导管内良性乳头状黏液性肿瘤鉴别。     

胰腺导管内乳头状黏液性肿瘤的MSCT征象

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点。方法回顾性分析27例经病理证实的IPMN的MSCT表现。所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查。结果27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化。分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈"葡萄串"样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化。混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化。7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通。结论 IPMN的MSCT表现具有一定特征。MSCT结合ERCP检查有助于术前准确诊断。     

MSCT和MRI诊断胰腺导管内乳头状黏液瘤的比较

目的：比较MSCT和MRI在诊断胰腺导管内乳头状黏液瘤（IPMN）的价值。材料和方法：回顾性分析12例病理证实的IPMN患者的临床和影像学资料。结果：MSCT和MRI均可显示主胰管和囊性病灶。囊性病灶与主胰管的交通在MSCT、MRI和MRCP分别显示10（83.3%）、10（83.3%）和11（91.7%）例。壁结节在CT和MRI上分别显示5（41.7%）例和4（33.3%）例。囊性病灶内的分隔在CT和MRI上分别显示9（75.0%）例和7（58.3%）例。结论：MSCT所提供的IPMN的诊断信息与MRCP相当,两者都可作为有效的诊断技术。     

胰腺导管内乳头状黏液性肿瘤的MSCT和MRCP诊断

目的 探讨胰腺导管内乳头状黏液性肿瘤 （IPMN）的MSCT和MRCP影像学表现.方法 对26例经内镜或手术病理证实的IPMT患者的CT和MRCP表现进行回顾性分析.结果 分支胰管型IPMN12 例,表现为单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;主胰管型 IPMN 5 例,表现为主胰管扩张伴管壁结节样突起;混合型IPMN 9例,表现为主胰管扩张和囊性病变合并存在.9例手术病理结果为腺瘤1例,交界性肿瘤2例,腺癌6例.结论 MSCT和MRCP对发现和诊断胰腺 IPMN具有较高价值.     

胰腺导管内乳头状黏液性肿瘤的声像图分析

目的 分析胰腺导管内乳头状黏液性肿瘤的临床及声像图特点,探讨经腹超声对本病的应用价值.方法 回顾性分析12例经手术病理证实的胰腺导管内乳头状黏液性肿瘤的病例资料,其中黏液腺瘤4例,黏液腺癌8例.依据病灶发生部位将其分为三种类型:主胰管型、分支胰管型和混合型,对照组织病理学结果总结其临床及声像图表现.结果 恶性者中临床症状较重,5例伴有糖尿病,2例有脂肪泻表现,4例伴有CA19-9升高,而良性者仅表现为上腹不适、腹痛等.超声显示病灶呈囊性或囊实性,良性病灶平均(1.4±0.8)cm,主胰管平均直径(1.0±0.8)cm,其中分支导管型3例(75%),主胰管型1例(25%);2例可见附壁结节,未见明确血流信号.恶性病灶平均(6.3±6.0)cm,主胰管平均直径(1.6±1.0)cm主胰管型5例(62.5%),混合型3例(37.5%),未见分支导管型;7例(7/8,87.5%)可见附壁结节,5例结节内测及较丰富的血流信号.结论 经腹超声可显示胰腺导管内乳头状黏液性肿瘤的病变特点,即囊性或囊实性病灶及扩张的胰管,结合患者的临床症状及超声所显示的病灶大小、结构及血流信号等可进一步提示其良恶性.     

13例胰腺导管内乳头状黏液性肿瘤影像分析

目的:探讨胰腺导管乳头状黏液性肿瘤(IPMN)影像诊断及鉴别诊断。方法:回顾性分析经手术病理证实的13例IPMN影像所见。结果:13例病例中,病变位于主胰管的4例,其中3例位于胰头颈部,1例位于胰腺体部,2例可见乳头状壁结节;病变位于分支胰管的4例,2例位于胰头,1例位于胰颈部,1例位于胰腺体尾部,2例可见乳头状壁结节;病变既位于主胰管又位于分支胰管的5例,3例位于胰腺头部,2例位于胰腺体尾部,3例可见乳头状壁结节。IPMN较少发生钙化,本组13例中,仅1例发生钙化。结论:MSCT、MRI、MRCP提供的影像信息有一定特征性,相互补充能为IPMN的确诊及分型提供依据。     

胰腺导管内乳头状黏液性肿瘤的影像学分析

目的:探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)的CT和磁共振成像(mag-netic resonance imaging,MRI)影像学表现。方法:回顾性分析经手术病理证实的18例胰腺导管内乳头状黏液性肿瘤的影像资料与病理诊断。结果:主胰管型IPMN 3例,表现为主胰管扩张;分支胰管型IPMN 5例,表现为分叶状单发囊性病变或葡萄串样多发囊性病变伴腔内分隔;混合型IPMN 10例,表现为囊性病变伴主胰管扩张。结论:CT和MRI对胰腺IPMN的诊断具有重要价值。     

胰腺导管内乳头状黏液性肿瘤的影像学诊断进展

胰腺导管内乳头状黏液性肿瘤是一种位于扩张的主胰管和(或)分支胰管内、伴大量黏液分泌的肿瘤,易与慢性胰腺炎或胰腺囊腺瘤混淆而延误诊断.本文就国内外近年来关于胰腺导管内乳头状黏液性肿瘤的临床病理学及影像学研究进展进行综述,评价不同影像技术(US、CT、MRCP、ERCP)在胰腺导管内乳头状黏液性肿瘤诊断中的作用.     

内镜下胰胆管逆行造影术在胆胰管导管内乳头状黏液性瘤中的应用价值

目的探讨内镜下胰胆管逆行造影术(ERCP)对胆胰管导管内乳头状黏液瘤(IPMN)的诊治作用。方法回顾性分析经ERCP诊治的9例IPMN,分析临床表现、实验室检查、影像学表现等方面特点,经ERCP结合超声内镜作出初步诊断,采用超细内镜进入囊腔活检,以求术后病理确诊,后根据具体病情予相应内镜处理。结果 5例胆管导管内乳头状黏液瘤(IPMNs-B),4例胰管导管内乳头状黏液瘤(IPMNs-P),均无特异性的临床表现和实验室检查;超声、CT、MRI主要表现为胆胰管扩张,仅1例IPMNs-P胰头部见囊实性团块、壁结节及主胰管明显扩张(5.5 cm);ERCP均显示乳头开口扩张,胶冻样黏液流出,胰胆管不同程度扩张。9例行ERCP抽吸黏液后,1例IPMNs-B同时置入胆管及胰管支架,3例IPMNs-P置入胰管支架,1例放置胆道金属支架;术后1例出现轻症胰腺炎(11.1%,1/9),3例出现淀粉酶升高而无症状(33.3%,3/9),无出血或穿孔等并发症发生。结论ERCP是一种安全可靠的诊断方法选择,对IPMN的诊治具有重要作用。结合病理诊断,可为外科术前提供明确的诊断和可靠的证据。     

Cystic pancreatic neoplasms evaluation by CT and magnetic resonance cholangiopancreatography

CT provides limited assistance in the differentiation between serous and mucinous neoplasms. Because of the variability in the radiographic appearance of serous cystadenomas and overlap in CT characteristics with mucinous neoplasms, most serous neoplasms still require ancillary testing such as biopsy to reach a definitive diagnosis. MRCP is useful in differentiating benign and malignant mucinous tumors including IPMT of the pancreas. The presence of mural nodules is suggestive of malignancy; however, the absence of mural nodules does not indicate that the tumor is benign. A maximum main pancreatic duct diameter of greater than 15 mm and diffuse dilatation of the main pancreatic duct are suggestive of malignancy in main duct-type tumors. Among branch duct-type tumors, malignant tumors tend to be larger than benign tumors; however, this finding is variable. The presence of main pancreatic duct dilatation may be helpful in determining malignancy of branch duct-type tumors.     

Management of branch duct-type intraductal papillary mucinous tumor of the pancreas based on magnetic resonance imaging

Background: We assessed the usefulness of magnetic resonance imaging (MRI) in identifying nonmalignant intraductal papillary mucinous tumors (IPMTs) of the pancreas.Methods: Thirty-three patients with branch duct-type IPMT diagnosed by endoscopic retrograde cholangiopancreatography were prospectively examined with magnetic resonance cholangiopancreatography followed by dynamic gadolinium-enhanced MRI examinations, and patients with no findings suggestive of malignancy, including a solid mass, mural nodules, a main pancreatic duct wider than 5 mm in diameter, and stenosis of the main pancreatic duct, were prospectively followed up with sequential MRI examinations once or twice a year.Results: Twenty-six (79%) patients showed no findings suggestive of malignancy in the initial MRI examination. The diameter (mean ± standard error) of the main pancreatic duct was 3.9 ± 0.7 mm and that of the ectatic branch pancreatic duct was 36.0 ± 9.1 mm. Twenty-three patients were prospectively followed for more than 36 months and 22 of them showed no findings suggestive of malignancy during follow-up periods ranging from 39 to 77 months (mean = 55 months).Conclusion: MRI was useful to identify nonmalignant IPMTs of the branch duct type, and close follow-up observation with serial MRI examinations may be appropriate in the management of such patients.     

Mucinous cystadenomas and intraductal papillary mucinous tumors of the pancreas in magnetic resonance cholangiopancreatography

BACKGROUND AND STUDY AIMS: In mucin-producing tumors of the pancreas, diagnosis using endoscopic retrograde cholangiopancreatography (ERCP) is limited to cystic formations that communicate with the main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) is a new, sophisticated method which is currently under evaluation. The authors describe the usefulness of MRCP in diagnosis of mucin-producing tumors. PATIENTS AND METHODS: Six patients with mucin-producing tumors were investigated using MRCP and ERCP. Imaging was compared with surgery and histopathological examinations. RESULTS: Three patients were found to have mucinous cystadenomas (MC), two patients had intraductal papillary mucinous tumors (IPMT) and one patient had a cystadenocarcinoma. MRCP demonstrated the cystic formations in all patients. Magnetic resonance imaging (MRI) showed contrast-mediated enhancement of the cystic wall in patients with MC, and visualized the pancreatic ducts completely in patients with IPMT. ERCP failed to visualize the cystic lesion in one patient with MC of the pancreatic tail. Furthermore, ERCP showed evidence of IPMT in dilated main ducts with multiple filling defects but did not visualize the ducts completely. CONCLUSIONS: MRCP provides visualization of pancreatic ducts, extraductal variations, and cystic formations more completely than ERCP does. It avoids complications seen in ERCP. MRCP may replace ERCP in the evaluation of mucin-producing tumors of the pancreas.     

Diagnosis of mucin-producing tumor of the pancreas with an intraductal ultrasonographic system

The purpose of this study is to examine the usefulness of intraductal ultrasonography at a frequency of 20 or 30 MHz in the diagnosis of mucin-producing tumor. The subjects were 66 patients with mucin-producing tumor (10 with main pancreatic duct type tumor and 56 with branch type tumor) who had also undergone endoscopic ultrasonography. In main pancreatic duct type tumors, we could diagnose the extent of the tumor and evaluate the invasion of the tumor into the pancreatic parenchyma in all seven patients who had undergone resection (three invasive tumors, four noninvasive tumors). Sixteen of 32 resected branch type tumors showing mural nodules with intraductal sonography were carcinoma or adenoma. On comparing intraductal and endoscopic ultrasonography in the rate of detecting nodules, in five tumors (one carcinoma and four adenomas), nodules were detected only with intraductal ultrasonography. In conclusion, intraductal ultrasonography is very useful for the diagnosis in the main pancreatic duct type tumor and in the detection of mural nodules in the branch type tumor.     

2D-MR胰胆管造影和平衡梯度回波序列对老年患者胆道结石诊断的联合应用

目的评估2D-MR胰胆管造影（MRCP）和平衡梯度回波（BFFE）序列联合应用对老年胆总管结石的诊断价值。材料与方法搜集2010年1月至2011年12月间进行MRCP检查≥70岁的114例怀疑胆总管结石的患者资料。由2名医师观察2D-MRCP图像,结合BFFE、T2WI评价是否存在胆总管结石。结果所有病例中MRCP能清晰显示胆道系统,114例患者中MR图像提示108例患者合并胆总管结石,6例患者无胆总管结石;手术及ERCP结果显示99例患者合并胆总管结石,15例患者无胆总管结石;对两组结果进行卡方检验差异有统计学意义（χ2=4.281,P=0.031）。结论 2D-MRCP结合BFFE序列能准确获得老年患者胆总管是否存在结石的情况,具有快速、安全的特点,特别适合不合作的患者。     

MRCP诊断肝脏移植术后胆管狭窄

目的：探讨MRCR探查肝脏移植术后胆管狭窄的可行性。方法：19例原位肝脏移植术后3～10月临床怀疑胆管狭窄病人行MRCP检查，其中16例在1周内行ERCP检查确诊，3例经临床和实验室检查随访2月作出最后诊断。MRCP征象与ERCP、临床最终结果对照分析了解MRCP诊断胆管狭窄的价值及局限性。结果：15例病人确诊为胆管狭窄并植入支架，包括1例MRCP正常而ERCP考虑吻合口狭窄，随访半月症状加重也实施支架植入术，其中吻合口狭窄2例，非吻合口狭窄13例。1例供受体胆管不称误诊为吻合口狭窄。3例胆管无狭窄病人诊断为胆管炎。MRCP诊断胆管狭窄敏感性为93%，特异性为75%。本组资料显示碱性磷酸酶和γ-谷氨酰酶升高常提示胆管狭窄。结论：MRCP能够正确诊断肝脏移植术后胆管狭窄，但与ERCP相比由于分辨率较低病变细节不够清晰，往往会夸大狭窄程度，我们认为动态观察碱性磷酸酶和γ-谷氨酰酶、MRCP能够早期作出诊断。     

Biliary cystic intraductal papillary mucinous tumor and cystadenoma/cystadenocarcinoma: differentiation by CT

Purpose To identify differential findings of biliary cystic intraductal papillary mucinous tumor (IPMT) and biliary cystadenoma/cystadenocarcinoma on CT images. Materials and methods Records of 7 patients with biliary cystic IPMT and 17 patients with biliary cystadenoma/cystadenocarcinoma were accessed. A pathologist reviewed gross morphologic and microscopic findings and confirmed the diagnosis. Two radiologists who were blind to the pathologic diagnosis reviewed CT images regarding size of cystic mass, mural nodule, septa, calcification, dilatation of the proximal, and distal bile ducts to the tumor, and the results were analyzed using multivariate analysis. Results Mural nodule and dilatation of the bile ducts distal to the cystic tumor were more commonly seen in patients with cystic IPMT than in patients with biliary cystadenoma/cystadenocarcinoma and these are statistically significant, the P values being 0.029 and 0.016, respectively. Size of the cystic tumor, presence of septa, calcification, and dilatation of the bile duct proximal to the cystic tumor were not statistically different. Conclusion Biliary cystic IPMT could be differentiated from biliary cystadenoma/cystadenocarcinoma on CT images based on the presence of mural nodules and dilatation of the bile ducts distal to the cystic tumor.