自身免疫性胰腺炎的CT和MRI影像学征象

目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的CT及MRI影像学表现特征.方法 回顾性分析14例经组织学和(或)类固醇激素治疗证实的AIP患者的CT及MRI资料.10例行CT检查,7例行MRI检查(其中3例同时做CT和MRI检查).结果 11例AIP表现为胰腺弥漫性肿大,3例为胰腺局限性肿大.10例CT平扫见胰腺病变区密度均降低,5例显示节段性胰管,5例见胆总管胰头段狭窄;7例在胰腺病变区周围可见环绕包膜样结构;动态增强后出现延迟均匀强化.7例MRI的抑脂T1WI显示胰腺病变后信号均匀降低(3例)或不均匀降低(4例),抑脂T2WI信号均匀增高(3例)或不均匀增高(4例);4例MRI显示胰管,MRCP见1例胰头部胰管局限性狭窄,2例胰管节段性狭窄;5例MRI见胆总管胰头段狭窄,MRCP见3例胆总管胰头段呈鸟嘴样狭窄;6例见胰腺病变区周围环绕包膜样结构.14例AIP均未见胰腺实质钙化,胰管均未见明显扩张(＞3 mm).结论 AIP的CT、MRI表现具有特征性,主要为胰腺呈腊肠样改变,胰周出现包膜样结构,胰管弥漫性或局限性狭窄,胆总管胰头段炎性狭窄.     

IgG4相关硬化性胆管炎并自身免疫性胰腺炎8例临床分析

目的总结Ig G4相关硬化性胆管炎(Ig G4-SC)并自身免疫性胰腺炎(AIP)的临床特征、实验室检查及影像学检查结果,以提高本病的诊断水平。方法对8例Ig G4-SC并AIP患者的临床资料进行回顾性分析。结果 8例患者均以梗阻性黄疸为主要表现,上腹痛或腹部不适5例,腹泻2例,淋巴结肿大2例,体质量下降3例。合并糖尿病4例,合并自身免疫性肝病1例。直接胆红素增高8例,血清淀粉酶增高4例,γ球蛋白增高6例,CA19-9增高8例,抗核抗体阳性3例,血沉增高2例,类风湿因子增高3例,抗中性粒细胞胞浆抗体阳性3例,抗线粒体阳性2例。CT表现为胰腺弥漫性肿大6例,局限性肿大2例;胆胰管水成像表现为胆总管下段局限性狭窄(1型)6例,肝门区胆管及胆总管下段狭窄(3型)2例。8例患者使用激素治疗均有效。随诊6~24个月均未再复发。结论 Ig G4-SC并AIP患者多以阻塞性黄疸及腹部不适为主要表现,伴有肝功酶学改变及自身免疫性抗体异常;CT表现为胰腺肿大;胆胰管水成像主要表现为胆总管下段局限性狭窄(1型)。     

自身免疫性胰腺炎的影像特征及其诊断价值

目的 探讨自身免疫性胰腺炎(AIP)的影像特征及其在AIP诊断中的价值.方法 回顾性分析13例AIP患者的影像和临床资料.结果 11例AIP表现为胰腺弥漫性肿大,2例胰头局限性肿大.CT平扫病变密度均均匀.4例在MR T1WI上信号降低、T2WI上信号轻度升高,增强后动脉期病变轻度强化,门脉期及延迟期进一步强化.9例胰腺周围有包膜样结构.横轴位图像上肝内外胆管扩张、胆总管胰腺段狭窄或闭塞10例,胰管未显影11例.6例行MRCP者有4例显示胆总管胰腺段较大范围狭窄或闭塞,胰管节段性狭窄.7例ERCP显示胰管弥漫性、不规则狭窄.胰周静脉受累8例,肾脏多发低密度灶6例,腹膜后纤维化2例,肝门部胆管狭窄1例,肺间质病变1例,强直性脊柱炎1例.结论 AIP的影像学征象具有一定特征性,影像检查在AIP诊断中起重要作用.识别胰腺外脏器受累对正确诊断AIP有帮助.     

中老年人自身免疫性胰腺炎的磁共振表现

目的 探讨中老年人自身免疫性胰腺炎(AIP)的磁共振(MRI)特征. 方法 17例经组织学或类固醇激素治疗证实的中老年AIP患者,均接受MRI检查,对患者的临床和MRI资料进行回顾性分析. 结果 17例中老年AIP中,13例AIP表现为胰腺弥漫性肿大,4例为局限性肿大或局限性信号异常.病变T_1WI上呈明显低信号,在T_2WI上呈轻度高信号,动脉期强化减弱但呈现明显的延时强化.13例在胰腺病变周围环绕包膜样结构.15例AIP伴有胰腺段胆总管的狭窄,5例胰胆管磁共振显示胰管不规则狭窄.11例AIP的平均表观扩散系数值为1.64×10~3mm~2/s. 结论 AIP好发于中老年人;其MRI特征包括胰腺呈香肠样或香蕉样肿大、病变胰腺周围延迟强化的包膜样影、胰管弥漫不规则狭窄等,MRI既可用于诊断AIP,也是评价其疗效的重要手段.     

老年人自身免疫性胰腺炎超声表现及临床分析

目的探讨自身免疫性胰腺炎（AIP）的超声声像图表现并结合有关文献分析其临床特点,以加深对该病的认识。方法回顾性分析经超声检查及临床随访最终证实的6例AIP患者临床资料,并结合有关文献分析其临床表现。结果 6例AIP患者超声表现为胰腺体积弥漫性或局限性肿大,形态多不规则,实质回声显著或稍减低。2例胰头部肿大明显,略呈分叶状,内回声欠均匀,彩色多普勒示胰头区周边见少许点、条状血流信号;2例表现为胰体尾部局限性增大。6例均有不同程度的弥漫性肝损害声像图表现,肝内胆管、胆总管轻度扩张;2例胆总管中上段壁增厚;4例胆总管中下段略呈鸟嘴样狭窄;1例患者出现颌下腺、腮腺及多处淋巴结肿大。5例AIP患者经激素治疗后,胰腺功能和形态基本恢复正常,复发1例。结论 AIP超声声像图具有一定特征,作为首选的影像学检查方法,超声有助于AIP的早期正确诊断,对临床治疗具有指导意义。     

自身免疫性胰腺炎激素治疗的疗效及预后研究

目的 探讨自身免疫性胰腺炎(AIP)激素治疗的远期疗效、预后及激素治疗的给药方法.方法 分析2004年8月至2008年8月北京协和医院确诊并随访的13例AIP患者临床资料.结果 13例AIP患者中男12例、女1例,平均年龄58.7岁,平均随访30个月.合并胆管病变11例,其中9例放置胆管支架且均已取出.11例患者接受激素治疗,平均起始剂量为每日0.6 mg/kg.10例患者临床治愈,已停用激素,平均激素治疗时间为9.2个月,其中6例联合胆管支架置入者平均激素治疗时间为7.9个月,4例单纯激素治疗者则为13.4个月,差异有统计学意义(P=0.023).激素治疗后患者各血清学指标于5.3～8.8周内恢复正常.经激素治疗后第1次影像学复查时(1.0～11.3周)患者胰腺肿大均获改善,9例患者平均经16.6周激素治疗后胰腺大小恢复正常.随访期间所有患者无影像学胰腺炎复发表现.8例合并新发糖尿病的患者经激素治疗后4例血糖恢复正常.2例合并自身免疫性肝病患者随访结束时出现早期肝硬化表现.1例患者在停用激素6个月时颌下腺肿大复发.结论 AIP患者对激素治疗反应良好,放置胆管支架可缩短激素治疗时间,合并胆管病变及新发糖尿病者在激素治疗后部分可获缓解,但合并自身免疫性肝病者预后相对较差.     

自身免疫性胰腺炎胆管损害的临床影像分析

目的总结并探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)胆管损害的临床影像学特点,提高对AIP的认识。方法回顾性分析中日友好医院2008年5月-2012年9月资料完整的AIP患者16例,总结临床及影像学改变,并将治疗前后相关资料进行对照分析。重点分析与胆管损害相关的临床、影像改变。结果 AIP患者以男性为主,年龄48~78岁,平均年龄(63.4±5.7)岁。13例(81.3%)患者以梗阻性黄疸就诊,伴有ALP、GGT、CA199升高。影像学检查发现13例(81.3%)胰腺弥漫性肿大,呈"腊肠样"外观,3例(18.8%)胰头局灶性肿大;所有患者均有胆总管及肝内胆管扩张,14例(87.5%)仅为胆总管下段(胰腺段)1处狭窄,2例(12.5%)为肝外胆管2处狭窄。在使用糖皮质激素治疗的14例患者中,经治疗3~6个月,所有患者胰腺大小均恢复正常,但是12例(85.7%)仍有胆总管下段均匀性或不均匀性狭窄。2例(12.5%)未使用糖皮质激素治疗的患者,随访1年后胰腺及胆管均恢复正常。结论 AIP多伴有胆管病变,并且以胆总管下段受累为主。AIP中的胆管损害和胰腺炎症可能是相互独立的病变,均为IgG4相关疾病一部分。     

自身免疫性胰腺炎的CT和MRI特征分析

自身免疫性胰腺炎（AIP）是一种自身免疫介导的胰腺慢性炎症,是慢性胰腺炎的特殊类型。以胰腺肿大和胰管不规则狭窄为影像特征性表现。本文回顾性分析4例经影像学检查、实验室检查及激素治疗有效的AIP患者,旨在提高对本病的认识。     

185例自身免疫性胰腺炎的荟萃分析

目的总结自身免疫性胰腺炎临床特征与诊治经验。方法以“自身免疫性胰腺炎”为关键词,通过中国医院知识数据库、万方数据、维普数据库,检索2011年1月以前发表的文献,并进行汇总分析。结果符合Kim标准的自身免疫性胰腺炎（auto-immunepancreatitis,AIP）患者共185例,临床表现主要为间歇性或进行性黄疸、轻度腹痛、体质量减轻等。影像学特点包括胰腺肿大,尤以胰头明显,主胰管狭窄及胆总管胰腺段狭窄合并近端胆管扩张。病理检查可见胰腺组织内淋巴细胞、浆细胞浸润和实质纤维化。AIP诊断主要依赖临床表现、影像学和病理学特征。临床误诊为胰胆恶性肿瘤93例,其中85例实施手术,185例患者中127例使用糖皮质激素治疗后临床症状明显缓解。结论AIP是一种特殊类型的慢性胰腺炎,易误诊为胰腺癌而采取手术治疗。临床医师需提高对该类疾病的认识和临床诊疗水平。     

1型自身免疫性胰腺炎13例临床分析

目的总结1型自身免疫性胰腺炎(AIP)的临床特征,进一步认识该病,减少误诊率,加深人们对该病的认识。方法回顾性分析2012年1月-2016年12月吉林大学第一医院收治的13例1型AIP患者的临床资料,包括一般情况、临床表现、实验室血清学检查、影像学、组织病理学、治疗及预后等。结果 13例患者中男9例,女4例,平均(60.08±9.47)岁。主要临床表现为黄疸(69.2%)、腹痛(61.5%)、体质量减轻(61.5%);最常见合并累及器官为胆管受累(46.2%)、硬化性胆管炎(30.8%);23.1%患者合并糖尿病;血清学指标中92.30%患者Ig G4升高2倍以上,7.69%升高1~2倍,53.85%患者CA19-9升高,69.23%患者TBil升高,三分之二以上患者转氨酶或GGT升高;影像学表现上53.8%患者CT示胰腺弥漫性肿大,46.2%为局灶性肿大,46.2%胰腺病变区低密度包囊样边缘影;病理检查显示胰腺导管周围纤维结缔组织增生,伴大量淋巴细胞、浆细胞浸润。所有患者均接受正规的糖皮质激素治疗(起始剂量泼尼松30~40 mg/d),激素治疗缓解率100%。随访时间12个月,1例患者病程中多次复发。结论1型AIP是Ig G4相关性疾病在胰腺的局部表现,好发于中老年男性,常伴有胰腺外病变,激素治疗有效,预后良好,在不规范或不能长期激素治疗的情况下常有复发。     

IgG4-unrelated type 1 autoimmune pancreatitis

A 50-year-old male was referred to our hospital for the evaluation of hyperproteinemia.Fluorodeoxyglucose positron emission tomography revealed high fluorodeoxyglucose uptake in the pancreas,bilateral lacrimal glands,submandibular glands,parotid glands,bilateral pulmonary hilar lymph nodes,and kidneys.Laboratory data showed an elevation of hepatobiliary enzymes,renal dysfunction,and remarkably high immunoglobulin(Ig) G levels,without elevated serum IgG4.Abdominal computed tomography revealed swelling of the pancreatic head and bilateral kidneys.Endoscopic retrograde cholangiopancreatography showed an irregular narrowing of the main pancreatic duct in the pancreatic head and stricture of the lower common bile duct.Histological examination by endoscopic ultrasonography-guided fine-needle aspiration revealed findings of lymphoplasmacytic sclerosing pancreatitis without IgG4-positive plasma cells.Abnormal laboratory values and the swelling of several organs were improved by the treatment with steroids.The patient was diagnosed as having type 1 autoimmune pancreatitis(AIP) based on the International Consensus Diagnostic Criteria.Therefore,we encountered a case of compatible type 1 AIP without elevated levels of serum IgG4 or IgG4-positive plasma cells.This case suggests that AIP phenotypes are not always associated with IgG4.     

Endoscopic therapy for benign bile duct strictures

Endoscopic therapy was attempted in 25 patients with benign strictures of the bile duct. In 23 patients, treatment involved endoscopic balloon dilation of the stricture zone or balloon dilation plus endoprosthesis placement. In 22 of 25 patients (88%), there was benefit from the endoscopic treatment. In 20 of 23 patients, there was significant radiographic improvement (p less than 0.001) in the diameter of their stricture following endoscopic therapy. All patients with elevated liver enzymes demonstrated rapid improvement following treatment. There was no significant morbidity or mortality associated with endoscopic treatment of benign biliary tract strictures. Follow-up study (mean, 4 +/- 0.3 years) discloses no recurrence of symptoms or elevated enzymes indicative of recurrent strictures. The treatment of benign bile duct strictures by a combination therapy of balloon dilation and stent placement provides a safe and effective treatment modality and an alternative to operative intervention.     

Autoimmune pancreatitis associated with a large pancreatic pseudocyst that disappeared after corticosteroid therapy: a case report and literature review

A 51-year-old woman was admitted to our department because of upper abdominal pain. The serum IgG4 concentration was elevated, and abdominal computed tomography revealed diffuse enlargement of the pancreas associated with a large cyst, measuring 8 cm in diameter. Endoscopic retrograde cholangiopancreatography revealed narrowing of the main pancreatic duct (from the body to the tail), narrowing of the intrapancreatic bile duct, and dilatation of the bile ducts. The patient was given a diagnosis of autoimmune pancreatitis (AIP) associated with a pancreatic pseudocyst and intrapancreatic bile duct stenosis. Oral steroid therapy resulted in reduced pancreatic swelling, complete disappearance of the pancreatic cyst, and an improvement in biliary stenosis. AIP is rarely associated with pancreatic cyst, and only 13 cases, including ours, have been reported to date. In our patient, intense inflammation apparently led to cyst formation in association with AIP, which responded remarkably to corticosteroid therapy. Correct diagnosis of AIP associated with a pancreatic pseudocyst might save patients from undergoing unnecessary endoscopic and surgical procedures.     

MRCP and MRI findings in 9 patients with autoimmune pancreatitis

AIM: To evaluate magnetic resonance cholangiopancre-atography (MRCP) findings in conjunction with magnetic resonance (MR) images in autoimmune pancreatitis (AIP) patients. METHODS: Nine patients with AIP underwent MRI, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography, and ultrasonography. The MRCP and MR images taken before and after steroid therapy were reviewed and compared with other imaging modalities. The MRCP findings of the AIP cases were compared to those of 10 cases with carcinoma of the head of the pancreas. RESULTS: On MRCP, the narrowed portion of the main pancreatic duct noted on ERCP was not visualized, while the non-involved segments of the main pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder than that seen in cases of pancreatic carcinoma. Stenosis or obstruction of the lower bile duct was detected in 8 patients. MR images showed enlargement of the pancreas with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images, and, in 3 patients, a hypointense capsule-like rim. After steroid therapy, the previously not visualized portion of the main pancreatic duct was seen, along with improvement of the bile duct stenosis. Pancreatic enlargement decreased, and the abnormal signal intensity on both T1- and T2-weighted MR images became isointense. CONCLUSION: MRCP cannot differentiate irregular narrowing of the main pancreatic duct seen with AIP from stenosis of the main pancreatic duct seen with pancreatic carcinoma. However, MRCP findings in conjunction with MR imaging of pancreatic enlargement that shows abnormal signal intensity on T1- and T2-weighted MR images are useful in supporting a diagnosis of AIP.     

Ultrasonographic evaluation in patients with autoimmune-related pancreatitis

Background The concept of autoimmune-related pancreatitis (AIP) has recently been described. It is important to exclude pancreaticobiliary malignancy in patients with AIP who develop distal bile duct strictures. The aim of this study was to evaluate distal common bile duct strictures in AIP patients by endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and contrast-enhanced EUS (ceEUS).Methods Five patients with AIP, encountered from January 2000 through December 2001, underwent EUS, IDUS, and ceEUS, using Levovist as a contrast medium. EUS and ceEUS were used to follow changes in distal bile duct strictures in three of these five patients following a trial of steroid therapy.Results Of the five patients, four had cholestatic biochemical profiles, three were positive for autoantibodies, and three had elevated serum immunoglobulin G (IgG) or IgG4. A diffusely enlarged pancreas, narrowing of the main pancreatic duct (MPD), and strictured common bile duct in the pancreatic head were features common to all patients. Pretherapy EUS or IDUS imaging showed concentric wall thickening of the distal common bile duct causing bile duct stenosis. ceEUS showed diffuse strong enhancement of the thickened bile duct wall, possibly due to inflammation. After the steroid therapy, the stenotic lesions in both the MPD and distal common bile duct were rapidly attenuated, with a decline in biochemical cholestatic enzymes and serum IgG or IgG4 levels.Conclusions On EUS and IDUS imaging, concentric bile duct wall thickening and its strong enhancement by Levovist was characteristic in AIP patients.     

内镜在胰胆管合流异常诊疗中的作用探讨

目的探讨ERCP在胰胆管合流异常中的诊断价值,评估内镜治疗的效果。方法16例胰胆管合流异常（PBM）患者,通过ERCP造影进行PBM分型,结合临床症状,分析引起相关疾病的机制、影像特点,根据合并的其它胰胆疾病,选择适当的内镜取石、扩张或引流等治疗,观察治疗效果。结果16例胰胆管合流异常患者多伴有腹痛、呕吐、黄疸等症状,及转氨酶和／或淀粉酶水平的升高。其中,Ⅰ型（B—P型）7例,Ⅱ型（P—B型）5例,Ⅲ型（复杂型）4例;合并胆总管囊肿扩张10例,无扩张者5例,胆管癌并狭窄1例;伴有胆管结石11例（4例为蛋白栓）、胰管结石2例（1例不伴胆管结石）。9例予内镜下胆管取石,2例胰管取石,术中置入胆道支架引流7例,行鼻胆管引流3例,胰管支架置入5例,胆道金属支架置人1例。术后临床症状均明显缓解。结论ERCP是一种可靠的诊断手段,其分型与PBM相关疾病表现有明显相关,选择性、暂时性的内镜治疗在外科术前是有效的、必要的。     

自身免疫性胰腺炎11例临床分析

目的 回顾性分析自身免疫性胰腺炎(AIP)的实验室、病理学及影像学表现,以便早期诊断AIP并进行治疗.方法 选取2007年6月至2009年6月我院收治、诊断明确及资料完整的AIP患者11例.所有患者均检测血常规、肿瘤指标、血淀粉酶、自身抗体等指标,并行腹部CT和B超检查.结果 实验室检查:血淀粉酶和肝酶增高5例,高胆红素血症4例,高球蛋白血症3例;肿瘤指标:6例患者CA199升高,平均值为78.4 U/ml;影像学检查:11例患者均有胰腺肿大.4例患者给予药物治疗,3个月后复查胰腺体积恢复正常,胰管及胆管未见狭窄或扩张;7例患者术后病理证实胰腺内大量纤维组织增生,淋巴细胞、浆细胞浸润,并见淋巴滤泡形成,其中2例术后6～12个月确诊为干燥综合征和类风湿关节炎,予糖皮质激素及免疫抑制剂治疗后症状消失.结论 AIP是一种特殊类型的慢性胰腺炎,具有特征性的实验室、影像学及组织学特点.如诊断明确,糖皮质激素及免疫抑制剂治疗有效.