自身免疫性胰腺炎CT诊断

目的应用螺旋CT双期增强扫描,探讨自身免疫性胰腺炎CT征象。方法CT增强扫描25例自身免疫性胰腺炎患者,评价自身免疫性胰腺炎胶囊样环,胰周线征,胰腺钙化,胰腺假囊肿,胆管壁增强,肾脏损害,胰管扩张与突然截断出现频率,确定在自身免疫性胰腺炎中诊断价值。结果自身免疫性胰腺炎CT增强后胰腺呈弥漫性低密度17例（68％）,胰腺局限性肿块且增强后呈低密度10例（40％）,胶囊样环16例（64％）,胰周线征15例（60％）,胰周血管受累11例（44％）,胰腺病灶钙化8例（32％）,胰腺假囊肿3例（12％）,胰管扩张5例（20％）,胰管截断4例（16％）,胆管扩张14例（56％）,胆管壁增强19例（76％）,腹膜后纤维化4例（16％）,肾脏损害12例（48％）。结论自身免疫性胰腺炎CT增强呈现弥漫性肿大且呈低密度,胶囊样环,胆管壁增强,肾脏损害是诊断自身免疫性胰腺炎重要CT征象。     

自身免疫性胰腺炎的影像学表现和临床特点

目的 探讨自身免疫性胰腺炎（AIP）的影像学表现及临床特点。方法收集3例AIP患者的影像学资料，3例中2例行CT扫描，1例行MRI平扫、增强扫描及磁共振胰胆管水成像（MRCP）。结果3例AIP影像学均表现胰腺体积弥漫性增大，密度或信号不均匀，胰周少量积液。增强扫描呈延迟强化。MRCP示胆总管胰腺段狭窄，其以上胆管扩张，主胰管节段或弥漫性狭窄。3例经激素治疗均有效。结论影像诊断在AIP的诊断中有一定作用，对临床诊断及治疗有重要指导意义。     

MRI与CT诊断自身免疫性胰腺炎的价值

目的比较CT与MRI诊断自身免疫性胰腺炎（AIP）的临床价值。方法以2008年AIP诊断的亚洲标准中影像学改变为标准，分析18例AIP患者的MRI及CT资料，比较两者对AIP影像特征的诊断能力。结果本组18例AlP患者中，CT发现肿大者16例，MR均发现胰腺肿大者17例，两者差异无统计学意义；CT显示4例有假包膜，MRI显示有12例有假包膜。CT未能发现胰管的狭窄，MRI通过MRCP显示6例主胰管的狭窄，CT显示8例胰腺段胆管狭窄，而MRCP显示14胆管狭窄；两者差异均有统计学意义。结论在显示胰腺实质性改变上两者无明显差别，在显示胰胆管改变上MR要优于CT。     

自身免疫性胰腺炎的影像学诊断

目的 探讨自身免疫性胰腺炎影像学诊断的价值、特征以及临床特点。方法 收集30例临床、手术或病理证明的自身免疫性胰腺炎患者,患者30例均接受了超声检查,其中14例接受了CT及MR平扫及增强检查,11例接受了单一CT平扫或增强检查,5例接受了单一MR平扫或增强检查。回顾性分析弥漫性胰腺肿大26例,局限性胰腺肿大4例的临床特点和影像学表现。结果 弥漫性胰腺肿大,边缘锯齿状结构消失,呈腊肠样外观26例,节段性肿大4例,其中胰腺尾部肿大2例,胰腺头部及钩突2例。有假包膜11例,假包膜多出现在胰腺腹侧(腹侧9、背侧2),形态为条索样、短线样;胆管扩张12例,胆总管下段狭窄5例;胰管扩张13例;胰腺管狭窄7例;有周围侵犯的4例,其中累及左侧肾前筋膜1例,脾静脉1例,腹膜后纤维化1例,围绕腹主动脉和下腔静脉的软组织肿块1例。2例高度怀疑胰腺癌患者手术,术中见胰腺和周围组织粘连,略僵硬,病理未找到癌细胞,病理诊断与自身免疫有关的慢性胰腺炎。所有患者均接受皮质激素治疗,给予泼尼松规律治疗后,复查肝功能、IgG、CA 199、肝功能,均有不同程度改善或恢复正常。结论 正确诊断自身免疫性胰腺炎对临床选择治疗方案非常重要,它是一类可逆性胰腺炎,对指导临床治疗意义重大。     

胰腺导管内乳头状黏液瘤的影像诊断观察

目的:研究分析胰腺导管内乳头状黏液瘤的影像临床特征及诊断。方法:选择2013.04-2014.04期间在我院接受手术及病理检验证实的15例胰腺导管内乳头状黏液瘤患者,均进行CT平扫、增强扫描,其中12例患者给予MRCP检查。结果:本组15例患者中,主胰管型者6例,分支型者6例,混合型者3例。肿瘤病变部位在钩突部或胰头者6例,胰体尾部者6例,胰尾部者3例。在CT、MR检查中显示胰管扩张成圆桶状的囊实性或囊性肿块,囊壁显示结节状突起;增强扫描后壁结节表现多囊状葡萄样或轻中度强化低密度影;MRCP检查可清晰观察到扩张的胰管、分支的形态,主胰管与胰管分支相通。结论:胰腺导管内乳头状黏液瘤存在典型的影像特征,以利于良恶性的鉴别诊断,可正确指导临床治疗、预后评估。     

探讨磁共振检查方法在胰腺炎临床诊断中的作用

目的探讨胰腺炎在磁共振（MRI）成像中的影像特征和对胰腺炎的临床诊断价值。方法挑选临床疑似胰腺炎的患者85例,其中住院患者62例,门诊患者23例;85例患者全部做磁共振胰腺扫描,其中47例患者增加MRCP扫描,29例患者增加增强扫描。结果采用不同的胰腺扫描序列,有52例患者胰腺腺体显示异常（不均匀）信号,采用MRCP扫描,35例患者胰管显示扩张。结论应用磁共振对软组织、腺体及水成像扫描的固有特性,结合胰腺磁共振增强扫描,对胰腺炎的临床诊断有非常重要的价值。     

胰腺MR检查序列应用探讨

目的分析97例胰腺MRI检查中不同序列图像,探讨胰腺MR扫描序列优化方案。方法胰腺检查患者97例,其中,正常36例、囊肿2例、胰腺炎42例、胰腺肿瘤17例。平扫序列横轴位T2WIFSE、T2WI FS-FSE、T1WI SPGR In phase和Out of phase,T1WI FS-SPGR;冠状位FIESTA,T1WISPGR,动态增强检查序列为LAVA。重点分析胰腺疾病征象在各序列中的显示情况。结果胰腺病变总显示率96.7%,其信号改变以T1WI FS-SPGR显示最优(91.8%);胰周、肾前筋膜改变T2WIFS-FSE序列显示率分别为70.5%、62.3%,二者均具有显著性优势P<0.05;FIESTA对胰管及胰周改变显示率与T2WI FS-FSE相比没有显著性优势P>0.05;MRCP胰管显示率100%,LAVA对各项观察指标显示率并不优于所有平扫序列,对肿瘤病变显示率为94.1%,高于胰腺炎显示率52.4%,但没有统计学意义(P>0.05)。结论 T1WI FS-SPGR序列,可作为胰腺MR平扫的基本序列,T2WI首选T2WI FS-FSE序列,二者结合能很好显示胰腺及周围病变,配合冠状位T1WI SPGR和3D MRCP,显示胰周脂肪结构及胰管情况,部分病变能初步定性,如怀疑胰腺肿瘤,LAVA序列必不可少,可确定病变范围及周围血管、腹膜后受累情况。     

局限性自身免疫性胰腺炎的影像学诊断特征

目的分析局限性自身免疫性胰腺炎（ AIP）的影像学诊断特征。方法7例局限性自身免疫性胰腺炎患者均经肾上腺皮质激素治疗后随访证实或手术病理证实。行CT检查,均进行CT平扫和增强扫描,进行定期随访。结果 AIP 影像学变现：2例局限型肿块;5例胰腺弥漫肿大。 CT 扫描病变：5例呈等密度;1例呈稍低密度;1例呈低密度。 CT平扫及增强扫描：胰腺病变区呈“雪花状”不均匀强化,病变渐进性延迟强化,强化程度由不均匀逐渐变为均匀。1例胰管出现轻度扩张;5例胰腺周围出现“包鞘样”结构;5例出现胰管狭窄或不规则形态;7例胰腺炎累及胆道系统。结论局限性自身免疫性胰腺炎（ AIP）作为一种特殊的慢性胰腺炎,它的影像学表现具有特征性,为其进行正确的诊断和治疗提供了有利依据。     

急性胰腺炎的CT诊断及疗效观察

目的：探讨CT在急性胰腺炎中的表现及CT诊断价值。方法：对临床拟诊的32例急性胰腺炎病人进行CT常规扫描，观察胰腺大小、形态、胰周肾旁筋膜、间隙、胸腹腔情况。结果：患者中，30例表现胰腺弥漫性肿大或局限性肿大，并可伴有胰腺实质改变、胰周改变及（或）出现胸腹腔积液。并经CT诊断和临床治疗证实。结论：急性胰腺炎的CT表现特征具有重要诊断价值，动态观察CT改变，对疗效及预后评定意义重大。     

急性胰腺炎的螺旋CT诊断分析

目的探讨急性胰腺炎的螺旋CT影像表现及价值。方法回顾性分析笔者所在医院51例急性胰腺炎病例的螺旋CT资料，观察其CT影像特征。结果急性水肿性（轻型）胰腺炎大部分表现为胰腺弥漫性或局限性肿大，境界不清，胰周脂肪间隙内见片絮状密度增高影，部分病例伴有单侧或双侧肾前筋膜增厚。急性重症胰腺炎CT表现为胰腺肿大显著，轮廓外突，胰周大量渗出，增强扫描胰腺实质内可见局限性或弥漫性无强化的低密度坏死区。结论螺旋CT是诊断急性胰腺炎的一种简便、有效的影像学检查方法，对指导临床正确诊断和治疗具有重要价值。     

自身免疫性胰腺炎的影像学表现

目的：研究自身免疫性胰腺炎（AIP）的影像学特征。方法：回顾性分析15例符合2008亚洲诊断标准的AIP患者的CT和MRI影像学资料,总结胰腺及胰腺外的影像学表现。结果：10例AIP表现为胰腺弥漫性增大,5例AIP表现为胰腺局部肿大。病灶区在T1WI上信号明显降低,在T2WI上信号轻度升高,15例均见渐进性延迟强化,3例见“鞘膜征”,9例AIP胆总管胰腺段的狭窄,3例ERCP均示胰管不规则狭窄,2例双肾多发节结影。结论：AIP具有一定特征性影像学表现;影像检查是诊断AIP的必要手段。     

Diagnostic value of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP)

BACKGROUND AND AIMS: To evaluate the value of S-MRCP in patients in whom ERCP performed by experts in a tertiary center were unsuccessful. PATIENTS AND METHODS: From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent pancreatitis (n = 2) or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were postsurgical anatomy (n = 7), duodenum stenosis (n = 3), duodenal diverticulum (n = 2), or technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after the i.v. administration of 0.5 IU/kg secretin. RESULTS: The MRCP images were diagnostic in all but 1 patient. Five patients gave normal MR fadings and required no further intervention. S-MRCP detected abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilatation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepatico-jejunostomy owing to common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy + Kehr drainage because of narrow biliary-enteric anastomosis; choledocho-jejunostomy, gastro-jejunostomy and Wirsungo-gastrostomy in consequence of chronic pancreatitis or choledocho-jejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage; the indications were choledocholithiasis in one patient choledocho-jejunostomy anastomosis, narrow biliary-enteric anastomosis, or cholangiocarcinoma. CONCLUSION: S-MRCP is the method of choice in cases where ERCP is not possible.     

MRCP结合MRI在壶腹癌中的诊断价值

目的：探讨MRCP及MRI联合应用对壶腹癌的诊断和鉴别诊断价值,通过与手术病理对照分析,进一步提高MRI对壶腹癌诊断的准确性。方法：回顾性分析笔者所在医院经手术病理或十二指肠镜活检证实的25例壶腹癌MRCP及MRI影像学资料。结果：25例壶腹癌中,术前有22例经MRI准确诊出。25例中表现为十二指肠乳头区肿块的18例（81.8%）,其中,肝内外胆管软藤样扩张14例,双管征17例,胆囊体积增大14例,胆总管腔截断征12例。余7例中,4例MRCP表现为：胆总管末端呈漏斗征4例,胰管轻度扩张3例,3例十二指肠壁不规则增厚。另有3例术前未能准确诊断。结论：MRCP结合MRI对壶腹癌有较高的诊断价值。     

Autoimmune Pancreatitis in an Asian-dominant American Population

Autoimmune pancreatitis is a rare type of chronic pancreatitis that occurs predominantly in males and was first described in the Asian population. The following study seeks to characterize autoimmune pancreatitis in Hawai‘i''s Asian-dominant population through a retrospective review of 65 pancreaticoduodenectomy cases performed between 2000 and 2010. Three of the 65 pancreaticoduodenectomies were diagnosed with autoimmune pancreatitis, and 3 additional cases were diagnosed prior to surgery. All six patients were males and presented with obstructive jaundice, 5 with weight loss, and 4 with epigastric pain and elevated serum lipase. All six patients showed elevated serum IgG4. Imaging revealed findings typical of pancreatic malignancy: distal bile duct stricture and pancreatic head mass. However, no nodal involvement and vascular invasion were found. In conclusion, autoimmune pancreatitis should be considered in patients presenting with obstructive jaundice. Elevated serum IgG4, normal serum carbohydrate antigen CA19-9, a benign fine needle aspiration/core biopsy, and a therapeutic response to corticosteroid are typical findings of autoimmune pancreatitis. Serum IgG4 measurement is a useful tool to help differentiate autoimmune pancreatitis from most pancreatic cancers. It is important to consider autoimmune pancreatitis as a differential diagnosis of pancreatic malignancy to avoid unnecessary surgery.     

MRCP结合薄层T_2WI对胆总管胰腺段小结石的诊断价值

目的：探讨MRCP结合轴位T2WI薄层对胆总管胰腺段小结石的诊断价值。方法：回顾性观察87例MRCP考虑胆总管胰腺段微小结石（长径≤5 mm,包含泥沙样结石）的MRI表现,结合轴位T2WI薄层进行分析。结果：23例结合轴位T2WI后排除,64例结合轴位T2WI后考虑小结石,与ERCP或手术结果对照,78例诊断符合,符合率约89.7%,3例漏诊,6例误诊。结论：MRCP结合轴位T2WI薄层对胆总管胰腺段有无小结石具有重要的诊断价值,是准确、无创的方法,增加T2WI薄层前后诊断符合率差异有统计学意义。     

Jaundice and a pancreatic tumour caused by auto-immune pancreatitis

Three male patients aged between 50 and 70 years were referred with jaundice and weight loss. Imaging showed a pancreatic mass and changes in the calibre of the choledochal or pancreatic duct, suggestive of malignancy. Two patients were operated on. One patient was considered to have an unresectable carcinoma but showed remarkable clinical improvement after steroids were given for his poor condition. In the other patient a resection was performed. Histology showed IgG4-positive plasma cell infiltration without signs of malignancy. Eventually these patients were diagnosed with auto-immune pancreatitis (AIP). In the third patient AIP was considered beforehand and this patient was treated with steroids. He responded quickly both clinically and radiologically. CT imaging showed complete remission of the mass. AIP is a benign inflammatory process which can mimic pancreatic carcinoma. In doubtful cases, a short trial of steroids might be considered.     

胰管结石的诊治经验

目的探讨胰管结石的诊断与治疗。方法回顾性分析25例胰管结石患者的临床资料，总结诊治经验。内镜下乳头括约肌切开取石术8例，胰管切开取石、胰肠吻合术10例，十二指肠乳头成形、胰石取出术3例，胰体尾切除术2例，胰十二指肠切除术2例。结果所有患者术后7-26d出院。22例获得随访，随访时间为3个月至10年，3例失访。死亡3例。腹痛完全缓解17例，明显减轻2例，无明显效果3例。结论慢性胰腺炎、酗酒是形成胰管结石的主要原因。超声、CT、内镜逆行胰胆管造影及磁共振胰胆管造影对确定诊断有重要意义。胰管切开取石、胰肠吻合术及内镜下括约肌切开取石术是主要手术方式。     

磁共振胰胆管造影对梗阻性黄疸的诊断价值

目的：评价磁共振胆胰管造影（MRCP）对梗阻性黄疸的诊断价值。方法：对67例梗阻性黄疸进行MRCP检查，并与临床诊断或手术和病理结果对照分析。MRCP采用不屏气快速自旋回波（TSE）序列重度T2W扫描，结合呼吸触发及脂肪抑制技术，原始图像以最大信号强度投影（MIP）法进行三维重建。结果：全部67例MRCP检查均一次成功，MRCP对梗阻性黄疸的定位诊断准确率为100％，定性诊断准确率为83．6％，其中MRCP诊断肝外胆管结石和恶性胆管梗阻的准确率分别为95％和65．4％，结论：MRCP检查成功率高，对梗阻性黄疸的定位诊断准确，结合原始图像和常规MRI扫描，对肝外胆管结石和恶性胆管梗阻的定性诊断也有较高的准确性。     

Autoimmune pancreatitis

Autoimmune pancreatitis is a rare form of chronic pancreatitis. Its clinical relevance, however, cannot be dismissed, as it can be difficult to distinguish autoimmune pancreatitis from malignant pancreatic cancer and in contrast with the majority of chronic pancreatitis forms it can be efficiently treated, even complete remission can be achieved on steroid therapy. The clinical picture of autoimmune pancreatitis is not characteristic, obstructive jaundice, abdominal pain, weight loss are frequently observed. Imaging studies often show diffuse pancreas enlargement and irregular narrowing of the main pancreatic duct. Elevated serum IgG4 immunglobulin concentrations, some autoantibodies and the presence of IgG4 positive immune cells were observed in addition to other histological features. Apart from pancreatic manifestations, other organs may also be affected, thus associations with sclerotising cholangitis, sialoadenitis, retroperitoneal fibrosis, Riedel thyroiditis and inflammatory bowel diseases have been described. Based on these findings, autoimmune pancreatitis should be regarded as a systemic disease, as a manifestation of systemic IgG4-related sclerosing disease.