胰腺巨囊型浆液性囊腺瘤的MSCT表现及其诊断

目的：探讨胰腺巨囊型浆液性囊腺瘤的MSCT特点,提高诊断准确性。方法：13例经手术病理证实为胰腺巨囊型浆液性囊腺瘤的患者,术前行上腹部MSCT平扫及双期增强扫描。结果：13个病灶均为类圆形囊性灶,呈均匀薄壁,轮廓清、欠规则,大部分未见壁结节(12例),其中2例呈外生性生长,最大径2.0～6.5 cm,平均3.3 cm。...     

多层螺旋CT对胰腺囊腺瘤与囊腺癌的诊断价值

目的：探讨胰腺囊腺瘤和囊腺癌的多层螺旋CT表现及其诊断价值。方法：回顾性分析21例经手术病理证实的胰腺囊腺瘤和囊腺癌的多层螺旋CT表现。所有患者均行CT平扫及增强扫描,并采用多平面重组（MPR）和最大密度投影（MIP）等方法对图像进行后处理。结果：21例中胰腺浆液性囊腺瘤7例,其特征性的CT表现有蜂窝样囊性病灶（6例）且单个小囊最大直径≤2cm、分叶状（4例）、囊壁及囊内间隔增强后呈轻度强化（7例）、囊壁光整（7例）。黏液性囊腺瘤4例,主要CT表现为多房囊性病灶（4／4）、绝大多数小囊的最大直径〉2cm、囊壁较厚且厚薄不均（4例）、2例可见壁结节,增强扫描示囊壁、分隔及壁结节有轻度一中度强化。胰腺囊腺癌10例,CT平扫示肿瘤呈囊状低密度影,有壁结节及分隔;增强扫描示囊壁、壁结节及分隔呈中度一明显强化。结论：胰腺黏液性和浆液性囊腺瘤及囊腺癌的MSCT表现有一定特征性,MSCT对本病的诊断及鉴别诊断具有重要的临床价值。     

Macrocystic serous adenoma of the pancreas: radiologic-pathologic correlation

OBJECTIVE: Macrocystic serous adenoma is a rare benign pancreatic neoplasm, recently described in the pathology literature. We describe the CT and MR imaging features in a series of five consecutive pathologically proven cases. MATERIALS AND METHODS: Of seven cases fulfilling the pathology criteria for macrocystic serous adenoma over an 11-year period, five patients underwent preoperative CT and MR imaging at our institution. In addition to the clinical presentation and pathologic features of the tumor, the following CT and MR imaging features were reviewed: size and location; wall thickness; internal septations; and presence of mural nodules, papillary projections, or calcifications. RESULTS: All patients but one were women (age range, 36-78 years; mean age, 48.6 years). The sizes of the tumors ranged from 1.5 to 5.0 cm (mean, 3.1 cm). Three (60%) of five tumors were located in the pancreatic head. The wall measured less than 2 mm in four lesions and 4 mm in one. No mural nodules, papillary projections, or calcifications were present. Lesions were unilocular (n = 3) or bilocular (n = 2). Excellent correlation of imaging features with gross pathology was observed. CONCLUSION: On CT and MR imaging, the macrocystic variant of serous adenoma typically appears as a small (< 5 cm), uni- or bilocular cyst with a thin (< 2 mm) wall that lacks mural nodules or calcifications. The imaging appearance of macrocystic serous adenoma is distinctly different from that of microcystic serous cystadenoma, but the imaging appearance of macrocystic serous adenoma is indistinguishable from mucinous cystadenoma and cystadenocarcinoma of the pancreas.     

胰腺囊性病变的CT诊断价值

目的 探讨CT对胰腺囊性病变的诊断价值。资料与方法 分析54例胰腺囊性病变的CT表现，其中假性囊肿41例，真性囊肿2例，浆液性囊腺瘤3例，黏液性囊腺瘤2例，囊腺癌3例，无功能性胰岛细胞瘤3例。结果 41例假性囊肿CT共检出44个囊性病灶，其中41个病灶为单房囊肿，3个病灶囊内见分隔。40个病灶为低密度，4个病灶为略高密度，增强后均无强化。另见。肾前筋膜增厚(32例)、胰周脂肪层模糊(14例)和胰管扩张(6例)。真性囊肿表现为单发或多发无强化囊性病灶，确诊主要依赖特殊临床资料和组织病理学检查。5例囊腺瘤表现为多房分隔囊性肿块，3例浆液囊腺瘤中2例中央见星芒状钙化，增强后分隔有强化。3例囊腺癌表现为多房分隔囊性病灶，其中2例有肝内多发转移。3例无功能胰岛细胞瘤，2例表现为单房囊性病灶，1例表现为多房分隔及囊内出血。结合病变本身及胰腺和胰周改变(包括肝脏)，CT对假性囊肿诊断的准确性为98．1％，对囊性病变诊断的准确性为90．7％。结论 CT能显示病变本身和胰腺及胰周(包括肝脏)形态学改变，有助于胰腺囊性病变的诊断与鉴别诊断。     

Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

Objective

To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst.

Materials and Methods

This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher''s exact test was used to analyze the results.

Results

A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different.

Conclusion

The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.     

腹膜假性黏液瘤CT诊断(附21例报告)

目的:探讨腹膜假性黏液瘤的CT表现,提高对本病的认识.方法:搜集经手术、病理证实的腹膜假性黏液瘤21例,回顾性分析其CT表现.结果:21例中原发瘤恶性8例,其中卵巢黏液囊腺癌3例,阑尾黏液囊腺癌4例,结肠黏液腺癌1例;良性13例,其中阑尾黏液囊腺瘤4例,阑尾黏液囊肿2例,卵巢黏液囊腺瘤6例,胰腺黏液囊腺瘤1例.CT平扫见肝脾等实质脏器边缘扇贝样或结节状压迹,腹腔不规则囊实性肿块,CT值19.9～25.8 HU;脏器周围、网膜间隙、腹腔、盆腔见大量黏液性腹水,CT值10～15 HU;腹膜增厚,厚度1.0～2.0 cm;增强扫描显示囊实性病变仅见囊壁、网膜、腹膜轻度强化,囊内病灶无明显强化.结论:腹膜假性黏液瘤CT表现具有一定的特征,是诊断腹膜假性黏液瘤的重要方法.     

卵巢囊腺瘤与囊腺癌的CT诊断

目的探讨CT对卵巢囊腺瘤与囊腺癌的诊断价值。方法对32例经手术病理证实的卵巢良恶性肿瘤患者包括良性卵巢囊腺瘤10例,交界性卵巢囊腺瘤4例以及恶性卵巢囊腺癌18例均经腹部CT扫描,对所有患者的CT表现进行回顾性分析。结果10例11个卵巢囊腺瘤中浆液性囊腺瘤7个,其中,单房5个,密度均匀;黏液性囊腺瘤4个,多房为主,密度不均,内见大小不等的子囊。交界性（4个）和恶性（28个）卵巢肿瘤32个,囊壁及分隔厚薄不均,不同程度强化,多有壁结节或肿块成分。结论卵巢囊腺瘤常表现为I型,囊腺癌以Ⅱ型常见。CT能很好显示卵巢肿瘤的形态特征,在鉴别卵巢囊腺肿瘤良恶性方面有一定价值。     

"Ductectatic" mucinous cystadenoma and cystadenocarcinoma of the pancreas

Five cases of localized cystic dilatation of a side branch of the main pancreatic duct due to a new entity ("ductectatic" mucinous cystadenoma and cystadenocarcinoma) are reported. The dilated duct was widely covered by epithelium indistinguishable from that of mucinous cystadenoma (n = 4) or cystadenocarcinoma (n = 1) of the pancreas. All lesions were located in the uncinate process and were about 3 cm in size. On computed tomographic scans and sonograms, lesions were difficult to distinguish from simple cyst of the pancreas unless lobulated or irregular margins were demonstrated. Endoscopic retrograde pancreatography (ERP) or operative pancreatography clearly demonstrated characteristic findings: localized, prominent cystic dilatation of a side branch of the main pancreatic duct with grape-like clusters or pear-shaped pools of contrast material associated with filling defects of various sizes. When a cystic lesion is noted in the uncinate process of the pancreas, ERP is mandatory to confirm or rule out this potentially or overtly malignant disease.     

Macrocystic pancreatic lesions: differentiation of benign from premalignant and malignant cysts by CT

Objective

To assess useful CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions.

Methods

Seventy-four patients with pathologically proven macrocystic pancreatic lesions were enrolled: 17 benign cysts (macrocystic serous cystadenoma, n = 12; congenital cyst; n = 5) and 57 premalignant and malignant cysts (mucinous cystic neoplasm, n = 28; intraductal papillary mucinous neoplasm of branch duct type, n = 20; tumor with cystic change, n = 9). Size, location, shape (lobulated, round or oval, or complex cystic with tubular cyst), wall thickness (thin, ≤1 mm; thick, >1 mm), internal surface (smooth or irregular), and other findings were analyzed with multiphasic CT with thin-section (2.5-3 mm) images. CT features between two groups were compared using univariate and multivariate stepwise logistic regression analyses.

Results

On univariate analysis, the differences for the shape (p = 0.007), wall thickness (p = 0.011), and internal surface (p = 0.012) between benign and premalignant and malignant cysts were significant. A lobulated shape, a thin wall and a smooth internal surface were more frequent in benign cysts, whereas a round or oval shape or a complex cystic shape with tubular cyst, a thick wall and an irregular internal surface were more frequent in premalignant and malignant cysts. On multivariate analysis, the shape (p = 0.002) and wall thickness (p = 0.025) were significant CT features for differentiating benign from premalignant and malignant cysts.

Conclusion

Shape and wall thickness are the main CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions.     

腹部巨大囊性病变CT诊断

目的：探讨腹部巨大囊性病变的ＣＴ诊断和鉴别诊断要点。方法：腹部巨大囊性病变３０例,均经手术病理证实,分析其病变中心点、边界、囊壁、分隔、钙化、液平征、强化等要素。结果：中下腹包块１４便,有１５个包块。其中：卵巢浆液性囊腺瘤４例,５个包块。粘液性囊腺瘤３例,卵巢囊肿１例,卵巢－输卵管炎性囊肿１例,巨大膀胱憩室１例,成熟性囊性畸胎瘤４例;中上腹包块１３例,其中：囊性淋巴管瘤５例,和重复畸形囊肿２例,小     

胰腺黏液性囊腺肿瘤的CT表现

目的 探讨胰腺黏液性囊腺肿瘤的CT表现,以提高对该肿瘤的鉴别诊断水平.方法 回顾性分析20例经病理证实的胰腺黏液性囊腺肿瘤患者的CT资料,分别由2名医师采用盲法对肿瘤囊的数量、大小、位置、边界、壁厚度、分隔、肿瘤内钙化、壁结节和强化情况进行评价.所有患者均行CT平扫及增强扫描,比较良恶性病变患者上述征象的差异.采用Fisher检验进行统计学分析.结果 良性胰腺黏液性囊腺肿瘤(黏液性囊腺瘤)12例,恶性胰腺黏液性囊腺肿瘤8例(其中包括3例交界性黏液性囊腺瘤和5例黏液性囊腺癌).16例(16/20)病灶位于胰腺体尾部.12例良性黏液性囊腺瘤中出现厚壁4例,肿瘤内钙化和壁结节各2例;而8例恶性胰腺黏液性囊腺肿瘤中出现厚壁7例,肿瘤内钙化和壁结节各5例,厚壁、肿瘤内钙化和壁结节在良恶性肿瘤间差异有统计学意义(P<0.05).结论 胰腺黏液性囊腺肿瘤的CT表现形式多样,具有一定特征性,其征象有助于胰腺黏液性囊腺肿瘤的良恶性鉴别.     

卵巢囊腺瘤的CT诊断

目的　分析卵巢囊腺瘤的CT表现 ,提高CT诊断的正确性。方法　收集经手术和病理证实的 5 7例 62个卵巢囊腺瘤 ,对其CT表现作回顾性分析。结果　 62个卵巢囊腺瘤中 ,浆液性 2 6例 3 1个肿瘤 ,黏液性 3 1例。 3 1个浆液性瘤中单房囊 19个、多房囊12个 ,分别占 61.3 %和 3 8.7% ;良性 2 2个 ,占 71.0 % ,交界性和 /或恶性变 9个 ,占 2 9.0 %。3 1例黏液性囊腺瘤中单房囊 3例、多房囊 2 8例 ,分别占 9.7%和 90 .3 % ;良性 2 3例 ,占 74.2 % ,交界性和 /或恶性变 8例 ,占 2 5 .8%。良性表现为光滑圆形或卵圆形薄壁囊 ,囊内分隔薄而规则 ;交界性或恶性变表现为厚而不规则的囊壁及囊内分隔 ,常见囊壁结节。浆液性和黏液性肿瘤的术前CT诊断准确率分别为 48.4%和 77.4%。结论　多房囊腺瘤具较典型CT表现 ,诊断不难 ;单房囊腺瘤缺乏特异表现 ,易与其他囊性病变混淆 ,CT明确诊断有一定限度     

卵巢囊腺瘤的CT诊断

目的:提高对卵巢囊腺瘤CT诊断及鉴别诊断能力。方法:回顾性分析手术病理证实的27例卵巢囊腺瘤的CT表现。结果:浆液性囊腺瘤5例,单房4例,多房1例,密度均匀,囊壁可薄可厚或厚薄不均。粘液性囊腺瘤9例,单房3例,密度均匀,囊壁厚,多房6例,密度不均匀,内见多发大小不等子囊。交界性(6例)和恶性变(7例)13例,其中浆液性3例,粘液性10例,12例为多房改变,囊壁及分隔增厚且边缘模糊,部分呈囊实性及壁结节改变,2例恶性变者伴有大量腹水。结论:单房浆液性囊腺瘤及多房粘液性囊腺瘤具有较典型CT表现,CT易于诊断及鉴别诊断,当病变呈囊实性改变,出现壁结节,或囊壁分隔不规则增厚模糊时,提示交界性或恶性变。     

Solid Pancreatic Tumors with Unilocular Cyst-Like Appearance on CT: Differentiation from Unilocular Cystic Tumors Using CT

Objective

To describe the computed tomography (CT) features of neuroendocrine tumors (NETs) and solid pseudopapillary tumors (SPTs) with unilocular cyst-like appearance, and to compare them with those of unilocular cystic tumors of the pancreas.

Materials and Methods

This retrospective study was approved by our Institutional Review Board, and informed consent was waived. We included 112 pancreatic tumors with unilocular cyst-like appearance on CT (16 solid tumors [nine NETs and seven SPTs] and 96 cystic tumors [45 serous cystadenomas, 30 mucinous cystic neoplasms, and 21 branch-duct intraductal papillary mucinous neoplasms]). Two radiologists reviewed the CT images in consensus to determine tumor location, long diameter, morphological features, wall thicknesses, ratio of wall thickness to tumor size, wall enhancement patterns, intratumoral contents, and accompanying findings. Fisher''s exact test was used to analyze the results.

Results

All 16 solid tumors had perceptible walls (mean thickness, 2.7 mm; mean ratio of wall thickness to tumor size, 7.7%) with variable enhancement. Four NETs and seven SPTs had hemorrhage, calcifications, and/or mural nodules. Six CT findings were specific for solid tumors with unilocular cyst-like appearance: a thick (> 2 mm) wall, uneven thickness of the wall, high ratio of wall thickness to tumor size, hyper- or hypo-attenuation of the wall in the arterial and portal phase, and heterogeneous internal contents. When three or more of the above criteria were used, 100% specificity and 87.5-92% accuracy were obtained for solid tumors with unilocular cyst-like appearance.

Conclusion

A combination of CT features was useful for distinguishing solid tumors with unilocular cyst-like appearance from unilocular cystic tumors of the pancreas.     

胰腺囊腺瘤与囊腺癌的CT诊断价值

目的：探讨胰腺浆液性囊腺瘤、黏液性囊腺瘤或囊腺癌具有鉴别诊断意义的CT征象。方法：回顾性分析经手术及病理证实的17例胰腺浆液性囊腺瘤、黏液性囊腺瘤或囊腺癌的CT表现,总结其特征性表现。结果：17例中浆液性囊腺瘤7例,黏液性囊腺瘤8例,黏液性囊腺癌2例。浆液性囊腺瘤呈分叶状轮廓者占85.7%（6/7）,均为多囊状结构,其中最大囊直径小于2cm者占71.4%（5/7）,出现病灶中心钙化者1例;黏液性囊腺瘤或囊腺癌位于胰体尾部者占90%（9/10）,无分叶状轮廓,单囊者占80%（8/10）,最大囊直径大于2cm者占90%（9/10）。囊内乳头状突起,囊壁厚薄不均,病灶内实性成分增多,多提示恶性。结论：胰腺浆液性囊腺瘤与黏液性囊腺瘤或囊腺癌的CT表现明显不同,多可做出诊断与鉴别诊断,但对于不典型表现的诊断存在困难。     

Diagnostic value of cyst fluid analysis in cystic lesions of the pancreas: current data, limitations, and perspectives

Diagnostic assessment and therapeutic indications in patients with cystic lesions of the pancreas are often difficult, especially since incidental detection of such lesions is increasing due to improvements in imaging techniques. Some lesions are benign (pseudocyst, serous cystadenoma) requiring conservative management and follow-up, whereas others are premalignant (mucinous cystadenoma, intraductal papillary mucinous tumor.) or frankly malignant (cystadenocarcinoma) and require surgical resection when possible. In about a third of cases, imaging findings are not sufficiently accurate in establishing the diagnosis, especially in cases of unilocular lesions. Fine needle aspiration can be considered as a second line method in uncertain cases. Aspiration should be performed in specialized services as the procedure requires careful consideration in some patients. Complications are usually rare and minor. The most accurate markers in this field are the carcinoembryonic antigen and the Ca 72.4. They allow to distinguish between a pseudocyst or a serous cystadenoma and a mucinous tumor (benign or malignant) with a 60% sensitivity and a specificity of nearly 100%. Cytological or histological analysis can provide valuable information but their accuracy seems to depend on tumor type. Genetic studies (Ki-ras.) may be possible in the future, including lesions with low cellular cyst fluid content. In conclusion, cyst fluid analysis after fine needle aspiration is a useful diagnostic tool but should always be interpreted in combination with clinical data and imaging findings.     

腹部巨大囊性病变的CT分析

目的探讨腹部巨大囊性病变的CT表现及其诊断价值。方法搜集经手术病理证实的腹部巨大囊性病变28例,回顾性分析其CT。结果28例中,卵巢囊肿4例,卵巢浆液性和黏液性囊腺瘤各1例,肾重度积水3例,肾囊肿2例,输尿管囊肿2例,胰腺假性囊肿3例,脾脏囊肿3例,先天性胆总管囊肿2例,肝脏囊肿1例,肠系膜囊肿和肠系膜淋巴管囊肿各1例,脐尿管囊肿1例,腹膜后脂肪肉瘤囊性变1例,腹膜不成熟畸胎瘤1例,囊性转移癌1例。腹部囊性病变92.9%为良性,各种囊性病变有其一定的发病部位和其特征性的CT表现。结论CT是腹部囊性病变定位、定性诊断的重要影像学手段。     

卵巢囊腺瘤和囊腺癌的螺旋CT多期增强扫描及MPR重建诊断价值

目的:探讨螺旋CT多期增强扫描对卵巢囊腺瘤和囊腺癌的诊断价值。方法:对经手术、病理证实的34例卵巢囊腺瘤(癌)的CT表现及三维重建结果进行回顾性分析。结果:34例囊腺肿瘤,浆液性囊腺瘤6例,粘液性囊腺瘤4例,浆液性囊腺癌15例,粘液性囊腺癌9例。CT表现为囊肿型(Ⅰ型)10例,囊实型(Ⅱ型)22例,实质型(Ⅲ型)2例。囊实型(Ⅱ型)又分为以囊性为主型(Ⅱa型)7例,囊实混合型(Ⅱb型)9例,以实性为主型(Ⅱc型)6例。增强后扫描,囊肿型(Ⅰ型),囊壁无强化,囊内局限性增厚分隔静脉期中等度强化;囊实型(Ⅱ型)囊壁结节状增厚、乳头状突起、不规则分隔及实性部分动脉期明显强化;实质型(Ⅲ型)动脉期明显强化。矢状位、冠状位、轴位多层面多角度观察肿瘤与周围脏器的关系。结论:卵巢囊腺瘤以Ⅰ型常见,卵巢囊腺癌以Ⅱ型为主。螺旋CT多期增强扫描能够很好地显示病灶的特点,增强后MPR三维重建可清楚地显示肿瘤与周围脏器的关系,血管重建可清楚显示肿瘤的血管构建形态,对于鉴别卵巢囊腺肿瘤的良恶性和定位诊断具有一定价值。     

阑尾黏液性囊腺瘤的MDCT表现及其病理特征

目的 探讨阑尾黏液性囊腺瘤的MDCT表现特征并与病理进行分析,提高对该病的诊断准确性.方法 选取经病理证实的21例阑尾黏液性囊腺瘤的CT轴位及多平面重组(MPR)后处理的图像特征,与手术病理结果进行对照分析.结果 21例中,CT轴位表现为类圆形或椭圆形13例,长管状3例,空腔形成2例,分叶状1例,不规则形2例;MPR表...     

阑尾黏液性囊腺瘤的CT表现

目的:探讨阑尾黏液性囊腺瘤的CT诊断价值。方法:回顾性分析经手术病理证实的6例阑尾黏液性囊腺瘤CT平扫和增强表现。结果:6例中4例阑尾囊状膨胀,4例密度不均匀,3例有曲线状壁的钙化,2例出现小壁结节,2例壁厚度大于3mm,6例瘤体直径大于15mm,5例出现环形壁强化及2例壁结节强化。结论:阑尾黏液性囊腺瘤CT表现为阑尾囊状扩张,密度不均,曲线状钙化壁,小壁结节,增强后瘤体边缘及壁结节强化。