胰胆管扩张的MRCP表现对胰腺癌和慢性胰腺炎的诊断意义

目的 研究胰胆管扩张对胰腺癌和慢性胰腺炎的诊断价值。方法 回顾性分析45例胰腺癌和41例慢性胰腺炎的MRCP资料。结果 胰腺癌组的MRCP主要特征包括：(1)胰管扩张多呈管腔光滑，明显扩张，并多在胰头肿块处截断(26例，占74．3％)；(2)扩张的胆总管多呈突然截断(26例，占89．7％)；(3)双管征(28例，占62．2％)。慢性胰腺炎组的MRCP主要特征：(1)胰管扩张多呈粗细不均的不规则型，并贯通病变(18例，占60．0％)，部分可见胰管结石(6例，占14．6％)；(2)扩张的胆总管由上至下逐渐变细(18例，占90．0％)。结论 胰胆管MRCP表现的形态特征对胰腺癌和慢性胰腺炎的诊断有鉴别意义。     

胰腺癌的MRI表现

目的总结胰腺癌的MRI征象，并比较不同序列对胰腺癌诊断的价值．方法70例经临床与手术证实的胰腺癌患者均采用1．5T超导MR机扫描，除常规的T1WI，T2WI序列外，还采用RT1WI、造影增强后FMPSPGR和延迟T1WI及MRCP扫描．对各序列的图象进行质和量分析．结果FT1WI对肿块的显示最明显，72．22％为明显的低信号，尤其对无明显轮廓改变的小胰腺癌显示更敏感；胰、胆管扩张以造影增强后T1WI及FMPSPGR显示最可靠；胰周血管包绕、浸润以造影后FMPSPGR显示最清楚；腹膜后淋巴结转移以T1WI显示最好；肝脏转移灶以T2WI序列最敏感．MRCP形成类似ERCP的影像，对胆管的梗阻部位和形态的显示有很大的帮助。结论MRI多种扫描序列的应用对胰腺癌的诊断是很有价值的．     

以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎（AP）为首发表现的胰腺癌的诊断和治疗。方法 对从1996-2006年问部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析。结果 21例患者人院时均有典型AP的症状、体征和实验室检查，CA19—9正常或升高，CT、ERCP等均提示胰腺肿大，部分患者伴胰管扩张及胆囊结石和胆管扩张．人院时均诊断为AP，外院19例诊断为胰腺癌时已错过根治性手术时机，本院1例及时修正诊断后行根治性手术，预后良好，另一例术中明确诊断后已失去根冶机会。结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌，才能对此类特殊病例及时诊断、果断手术以取得满意疗效。     

胰腺导管腺癌和肿块型慢性胰腺炎的化学位移法胰腺水脂比例分析

目的 探讨胰腺导管腺癌(PDAC)和肿块型慢性胰腺炎(MFP)胰腺水脂比例,为临床诊疗工作提供参考.方法 运用GE3.0T MR扫描仪对13例PDAC患者、8例MFP患者以及20名健康志愿者进行胰腺三点法水脂分离技术(IDEAL)序列扫描,对所得图像进行信号强度测量,利用水脂比例(WF1)=水相信号强度(SW)/脂相信号强度(SF)及水脂比例(WF2)=[同相位信号强度(SIP)+反相位信号强度(SOP)]/(SIP- SOP)两种公式进行水脂比例分析.结果 运用WF1公式,正常胰腺水脂比例为7.97±0.95,PDAC为9.94±1.19,MFP为5.08±0.49;运用WF2公式,正常胰腺水脂比例为11.51±1.62,PDAC为13.87±1.84,MFP为5.73±0.65.同一公式下,正常胰腺、PDAC和MFP的胰腺水脂比例差异有统计学意义(P＜0.05).PDAC组WF2值＞WF1值,并且差异有统计学意义.结论 正常胰腺及PDAC与MFP的胰腺水脂比例不同,PDAC的比值最高,其次是正常胰腺,MFP的比值最低.     

MRCP对胰头癌与胰头部肿块型慢性胰腺炎的鉴别诊断价值

目的探讨磁共振胰胆管成像（MRCP）对胰头癌与胰头部肿块型慢性胰腺炎的诊断与鉴别诊断价值。方法分析30例胰头癌与30例胰头部肿块型慢性胰腺炎患者的MRCP表现。结果胰头癌组的MRCP征象包括不相交征（83.3%）、双管征（46.7%）、四管征（36.7%）、软藤征（36.7%）、胰管贯通征（13.3%）。胰头部肿块型慢性胰腺炎的MRCP特征包括双管征（20%）、枯树枝征（36.7%）、胰管贯通征（86.7%）。结论双管征和软藤征是胰头癌的重要征象,四管征与不相交征是胰头癌的特异性征象;枯树枝征是胰头部肿块型慢性胰腺炎的重要征象,胰管穿通征是肿块型胰腺炎的特异性征象。     

自身免疫性胰腺炎与小胰腺癌的CT、MRCP征象分析

目的 分析自身免疫性胰腺炎(AIP)与小胰腺癌的CT、MRCP影像学征象的差异,提高对AIP的认识及诊断的准确率.方法 回顾性分析符合2008年AIP亚洲诊断标准的24例AIP及病理证实的25例小胰腺癌(≤2 cm)的影像学资料,从胰腺的形态改变、密度及强化方式、胰管及胰周、胰外表现等方面进行比较,采用×2检验或确切概率法行统计学处理.结果 在AIP和小胰腺癌组间,肿块部位、远端胰腺萎缩、肿块持续强化、胰管“截断征”、“鞘膜征”及肾脏受累征象差异具有统计学意义(x2 =9.010、10.506、15.288、8.688、6.292和4.966,P＜0.05),但是只有远端胰腺萎缩和肿块持续强化征象在局限性AIP与小胰腺癌组间差异具有统计学意义(P＜0.05).结论 弥漫性AIP的影像学改变具有特异性,与小胰腺癌容易鉴别诊断,但局灶性AIP与小胰腺癌鉴别诊断价值有限.     

自身免疫性胰腺炎与胰腺癌的鉴别诊断

自身免疫性胰腺炎（AIP）是慢性胰腺炎的一种特殊类型。尽管关于 AIP 的各种临床指南相继推行,但在临床上,AIP 与胰腺癌的鉴别仍十分困难。参考 AIP 的指南及最新的相关文献,总结了关于 AIP 与胰腺癌的临床表现、血清学改变、影像学改变及激素反应四个方面的鉴别诊断要点。通过综合分析上述鉴别要点,胰腺占位患者的正确诊断可以得以明确,一些 AIP 患者也可以避免不必要的开腹手术。     

胰腺癌和慢性胰腺炎的影像诊断与鉴别诊断

慢性胰腺炎（chronic pancreatitis．CP）是由多种原因造成的胰腺局部、节段或弥漫性炎症。胰腺癌则是一种恶性程度高、易转移、预后差的消化道肿瘤。甲期发现较困难，因此多数患暂丧失了手术机会。CP和胰腺癌之间存在着较为复杂的火系，CP可能发展为胰腺癌，特别是好发于胰头部的肿块型胰腺炎，影像学及临床表现均难以与胰头癌鉴别。但CP病例并不是一旦确诊就需根治于术，规范的内科保守治疗不但可以缓解临床症状，还可以减慢疾病的自然进程。如何准确地鉴别胰腺癌和CP，避免不必要的开腹手术，并指导临床制定合理的治疗方案，影像诊断起着不可替代的重要作用，方法也不断更新。     

MRI联合MRA和MRCP对胰腺癌的诊断及术前分期

胰腺癌的早期诊断极为困难,约50%患者确诊时已有远处转移,35%患者肿瘤呈局部浸润性改变[1].外科手术为目前唯一可能治愈胰腺癌的治疗手段.     

以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎(AP)为首发表现的胰腺癌的诊断和治疗.方法 对从1996 ～ 2006年间部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析.结果 21例患者入院时均有典型AP的症状、体征和实验室检查,CA19-9正常或升高, CT、ERCP等均提示胰腺肿大,部分患者伴胰管扩张及胆囊结石和胆管扩张,入院时均诊断为AP,外院19例诊断为胰腺癌时已错过根治性手术时机,本院1例及时修正诊断后行根治性手术,预后良好,另一例术中明确诊断后已失去根治机会.结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌,才能对此类特殊病例及时诊断、果断手术以取得满意疗效.     

Clinical significance of main pancreatic duct dilation on computed tomography： Single and double duct dilation

AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases. METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records. RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer. CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful followup since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.     

Pain in chronic pancreatitis: Managing beyond the pancreatic duct

Chronic pancreatitis(CP)continues to be a clinical challenge.Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care.Unfortunately,in spite of using several treatment approaches in the clinical setting,there is no single specific treatment modality that can be earmarked as a cure for this disease.Traditionally,ductal hypertension has been associated with causation of pain in CP;and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct.Recent studies on humans(clinical and laboratory based)and experimental models have put forward several mechanisms,including neuroimmune alterations,which could be responsible for pain.This might explain the partial or no response to single modality treatment in a significant proportion of patients.The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches(other than ductal decompression)to handle persistent or recurrent pain.We focus primarily on parenchymal and neural components;and discuss the role of antioxidants and the existing controversies,drugs that interfere with neural transmission,pancreatic enzyme supplementation,celiac neurolysis,and pancreatic resection procedures.The review concludes with the treatment approach that we follow at our institute.     

Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP

AIM:To obtain reference values for pancreatic flow output rate(PFR)and peak time(PT)in healthy volunteers and chronic pancreatitis(CP);to correlate quantification of secretin enhanced magnetic resonance cholangiopancreatography(SMRCP)of pancreatic fluid output following secretin with fecal elastase-1(FE-1)tests.METHODS:The present study includes 53 subjects comprised of 17 healthy individuals and 36 patients with CP from April 2011 to January 2013.The 36 patients with CP were divided into three groups of mild CP(n=14),moderate CP(n=19)and advanced CP(n=3)by M-ANNHEIM classification for CP..Fifty-three cases underwent FE-1 test and magnetic resonance imaging using 3.0 T-device(Signa EXCITE,GE Healthcare).Coronal T2-weighted single-shot turbo spin-echo,spiratory triggered,covering the papillae,duodenum and small bowel.MRCP was performed with a heavily T2-weighted fat-suppressed long TE HASTE sequence (thick slab 2D MRCP sequence),repeated every 2 min up to 11 min after 0.1 mL/kg secretin injection(Secrelux,Sanochemia,Germany).FE-1 test used sandwich enzyme-linked immunosorbent assay(ELISA)test(ScheBo.Tech,Germany).RESULTS:A good linear correlation showed between the calculated volume and the actual volume by Phantom experiments.Fifty-three paired Quantification of secretin enhanced magnetic resonance cholangiopancreatography(MRCPQ)and FE-1 data sets were analyzed.The mean FE-1 of 53 cases was 525.41±94.44μg/g for 17 healthy volunteers,464.95±136.13μg/g for mild CP,301.55±181.55μg/g for moderate CP,229.30±146.60μg/g for advanced CP.Also,there was statistically significant difference in FE-1(P=0.0001)between health and CP.The mean values of PFR and PT were 8.18±1.11 mL/min,5.76±1.71 min for normal;7.27±2.04 mL/min,7.71±2.55 min for mild CP;4.98±2.57 mL/min,9.10±3.00 min for moderate CP;4.13±1.83 mL/min,12.33±1.55 min for advanced CP.Further,statistically significant difference in PFR(P=0.0001)and PT(P=0.0001)was observed between health and CP.Besides,there was correlation(r=0.79)and consistency(K=0.6