自身免疫性胰腺炎的影像诊断

目的探讨自身免疫性胰腺炎(AIP)的动态增强CT及内镜逆行胰胆管造影(ERCP)影像学表现。方法收集并分析经组织病理学证实的7例AIP患者,治疗前的动态对比增强CT、ERCP检查资料及相关临床资料。结果 7例患者中,2例为弥漫型,5例为局限型AIP。治疗前增强CT检查显示受累胰腺早期强化程度弱于正常胰腺,呈延迟期轻中度强化;1例弥漫型AIP伴有肾脏低密度结节状病变。ERCP示各例AIP示主胰管弥漫或节段性狭窄,1例弥漫型和2例局限型AIP伴有胆管狭窄。类固醇激素治疗半年后CT复查显示,各例AIP胰腺炎症明显减轻,胰胆管狭窄改善。结论 AIP的影像表现具有一定特征性,类固醇治疗前影像学检查及治疗后随访有助于其明确诊断。     

自身免疫性胰腺炎的CT和MRI诊断

_目的：探讨 CT 及 MRI 对自身免疫性胰腺炎（AIP）的诊断价值。方法：回顾性分析经实验室检查、穿刺活检、手术或临床激素治疗有效确诊的28例 AIP 患者的临床及影像学资料。21例行 CT 检查,其中17例行 CT 增强扫描;18例行 MRI 检查,其中11例行 MRI 增强扫描,12例行 MRCP 扫描;15例同时行 CT 及 MRI 扫描。结果：CT 与 MRI 可清楚显示胰腺实质及胰腺外脏器的形态、密度或信号改变。胰腺实质表现：胰腺弥漫性增大呈＂腊肠＂样改变,边缘呈＂香蕉皮＂样改变;局限性病变病灶呈＂假肿瘤＂样改变,增强扫描延迟期与正常胰腺实质密度、信号一致。胰腺外脏器表现：胆系改变表现为胆总管及肝内胆管扩张,管壁增厚,增强扫描呈明显强化;肾脏改变表现为 CT 增强扫描动脉期呈斑片状低密度,MRI 呈稍长 T1、稍长 T2信号,延迟期病灶与周围肾实质密度、信号一致;肺内改变表现为肺门区软组织肿块影。结论：自身免疫性胰腺炎 CT 及 MR 表现具有一定特征性,对于该病的诊断及治疗前后疗效的评估具有重要价值。     

The MRI diagnosis of autoimmune pancreatitis

目的:探讨自身免疫性胰腺炎(ALP)的MRI诊断价值.方法:搜集12例临床证实的AIP患者资料,12例均行MRI平扫、增强扫描及磁共振胰胆管水成像(MRCP),分析总结AIP的MRI表现特点.结果:12例AIP中7例表现为弥漫性胰腺体积增大,1例表现为胰腺体尾部肿大,MRI平扫胰腺信号欠均匀,T1 WI呈高低混杂信号,T2 WI信号普遍增高,另4例以胰头肿大为主,MRI示胰头区类似软组织信号肿块影,与周围胰腺组织信号一致;病灶增强扫描动脉期强化不明显,门脉期逐渐强化;MRCP示胆总管胰腺段变细,伴肝内外胆管不同程度扩张,胰腺管弥漫性狭窄.结论:AIP的MRI表现具有一定特异性,对AIP的临床诊断及治疗有一定指导意义.     

自身免疫性胰腺炎的MRI诊断

目的:探讨自身免疫性胰腺炎(AIP)的MRI诊断价值。方法:搜集12例临床证实的AIP患者资料,12例均行MRI平扫、增强扫描及磁共振胰胆管水成像(MRCP),分析总结AIP的MRI表现特点。结果:12例AIP中7例表现为弥漫性胰腺体积增大,1例表现为胰腺体尾部肿大,MRI平扫胰腺信号欠均匀,T1WI呈高低混杂信号,T2WI信号普遍增高,另4例以胰头肿大为主,MRI示胰头区类似软组织信号肿块影,与周围胰腺组织信号一致;病灶增强扫描动脉期强化不明显,门脉期逐渐强化;MRCP示胆总管胰腺段变细,伴肝内外胆管不同程度扩张,胰腺管弥漫性狭窄。结论:AIP的MRI表现具有一定特异性,对AIP的临床诊断及治疗有一定指导意义。     

自身免疫性胰腺炎的MRI表现及临床分析

目的探讨自身免疫性胰腺炎（AIP）的MRI表现及临床特点。资料与方法搜集3例AIP患者的MRI资料,3例均行MRI平扫、增强扫描及磁共振胰胆管水成像（MRCP）。结果3例AIPMRI平扫均表现胰腺体积弥漫性增大,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及其以上胆管扩张,胰管不规则狭窄。3例经激素治疗有效。结论MRI在AIP的诊断中作用显著,对临床诊断及治疗有重要指导意义。     

自身免疫性胰腺炎的临床进展及影像学评价

自身免疫性胰腺炎(AIP)是慢性胰腺炎中的一种特殊类型,是与IgG4相关的系统硬化性疾病,其主要影像学检查手段包括B超检查、超声内镜、CT、MRI、磁共振胆胰管成像、经内镜逆行胰胆管造影等。AIP在影像学上表现为胰腺弥漫性或局灶性肿大,伴不同程度胰管或胆管的狭窄,但经超声引导下的细针穿刺活检诊断的敏感性与特异性均不高,正确的诊断对其治疗方案的选择和预后具有重要意义,现就AIP的临床进展及影像学表现予以综述。     

急性胆源性胰腺炎的诊断与治疗现状

急性胆源性胰腺炎 (ABP)的诊断除典型症状外 ,主要依靠B超、CT、内镜逆行胰胆管造影 (ERCP)、磁共振胰胆管造影 (MRCP)及实验室检查。B超简便 ,但敏感性低 ,MRCP诊断准确率达 95 2 %,ERCP与MRCP相近 ,实验室检查主要为ALT和TBIL。外科手术治疗经历了由主张早期手术到延期手术 ,到“个体化治疗”的三个阶段。手术原则为解除梗阻 ,通畅引流 ,一并处理胰腺病变。目前 ,内镜介入治疗已渐成为处理ABP的主要措施之一。     

自身免疫性胰腺炎的临床进展及影像学评价

自身免疫性胰腺炎（AIP）是慢性胰腺炎中的一种特殊类型,是与IgG4相关的系统硬化性疾病,其主要影像学检查手段包括B超检查、超声内镜、CT、MRI、磁共振胆胰管成像、经内镜逆行胰胆管造影等。AIP在影像学上表现为胰腺弥漫性或局灶性肿大,伴不同程度胰管或胆管的狭窄,但经超声引导下的细针穿刺活检诊断的敏感性与特异性均不高,正确的诊断对其治疗方案的选择和预后具有重要意义,现就AIP的临床进展及影像学表现予以综述。     

胰腺分裂二例报告及文献复习

目的 探讨胰腺分裂形成过程及诊疗水平、策略和方法.方法 回顾分析2012年8月至10月我院收治的2例胰腺分裂,总结其发生过程、影像学表现及目前治疗方法.结果 2例胰腺分裂均伴有胰头囊肿.磁共振胰胆管成像(MRCP)能清晰显示胆总管、背、腹胰管与及十二指肠的关系.2例中,1例给予胃肠减压,对症、支持治疗,腹痛症状消失;另1例给予内镜逆行性胰胆管造影(ERCP)并十二指肠主乳头切开减压,症状缓解,建议隔期复查.结论 胰腺分裂影像学表现具有明显特征性;MRCP对胰腺分裂诊断具有明显优势;胰腺分裂治疗需综合评价病例特点选择最佳治疗方法.     

十二指肠乳头癌的影像学研究进展

从十二指肠低张X线造影、超声检查、经内窥镜逆行胆胰管造影检查（ERCP）、CT、MRI和磁共振胆胰管成像（MRCP）五个方面对十二指肠乳头癌的影像学进展进行了概述,分析上述检查方法在诊断十二指肠乳头癌方面的优势及不足。提出在传统方法的基础上,更好地利用常规超声、MRI、CT、ERCP及超声内镜（EUS）等多种影像学方法来对十二指肠乳头癌进行综合诊断,可明显提高诊断的准确率。     

Autoimmune pancreatitis: imaging features

PURPOSE: To retrospectively determine imaging findings in patients with autoimmune pancreatitis. MATERIALS AND METHODS: Twenty-nine patients (25 male and four female; mean age, 56 years; range, 15-82 years) with histopathologic diagnosis of autoimmune pancreatitis were examined. Data were reviewed by two radiologists in consensus. Imaging findings for review included those from helical computed tomography (CT), 25 patients; magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP), four patients; endoscopic ultrasonography (US), 21 patients; endoscopic retrograde cholangiopancreatography (ERCP), 19 patients; and percutaneous transhepatic cholangiography, one patient. Images were analyzed for appearances of pancreas, biliary and pancreatic ducts, and other findings, such as peripancreatic inflammation, encasement of vessels, mass effect, pancreatic calcification, peripancreatic nodes, and peripancreatic fluid collection. Follow-up images were available in nine patients. Serologic markers such as serum immunoglobulin G (IgG) and antinuclear antibody levels were available in 12 patients. RESULTS: CT showed diffuse (n = 14) and focal (n = 7) enlargement of pancreas. Seven patients had minimal peripancreatic stranding, with lack of vascular encasement, calcification, or peripancreatic fluid collection. Nine patients had enlarged peripancreatic lymph nodes. MR imaging showed focal (n = 2) and diffuse (n = 2) enlargement with rimlike enhancement in one. MRCP revealed pancreatic duct strictures in two and sclerosing cholangitis-like appearance in one. Endoscopic US showed diffuse enlargement of pancreas with altered echotexture in 13 patients and focal mass in the head in six. ERCP showed stricture of distal common bile duct in 12 patients, irregular narrowing of intrahepatic ducts in six, diffuse irregular narrowing of pancreatic duct in nine, and focal stricture of proximal pancreatic duct in six. Serologic markers showed increased IgG and antinuclear antibody levels in seven of 12 patients. At follow-up, CT abnormalities and common bile duct strictures resolved after steroid therapy in three patients. CONCLUSION: Features that suggest autoimmune pancreatitis include focal or diffuse pancreatic enlargement, with minimal peripancreatic inflammation and absence of vascular encasement or calcification at CT and endoscopic US, and diffuse irregular narrowing of main pancreatic duct, with associated multiple biliary strictures at ERCP.     

MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP

The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. Received: 20 May 1998; Revision received: 26 November 1998; Accepted: 7 January 1999     

磁共振胰胆管成像技术及临床应用价值

目的 :探讨磁共振胰胆管成像 (MRCP)技术的临床价值。方法 :对 49例胰胆管病变的病人采用快速自旋回波之重 T2 加权技术进行 MRCP检查 ,经最大信号强度投影 (MIP)取得图像。2 0例有手术病理结果。结果 :MRCP图像与 ERCP、PTC图像相似 ,能较好地显示胰胆管疾病的病变部位、梗阻程度、狭窄和充盈缺损 ,准确性较高。结论 :MRCP作为一种安全非创伤性影像学诊断技术 ,不使用造影剂 ,能较好地显示胰胆管的解剖和病理变化 ,从而提高胰胆管疾病的诊断水平。     

Malignant obstructive jaundice: comparison of MRCP and ERCP in the evaluation of distal lesions

PURPOSE: To compare the diagnostic accuracy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of malignant stenosis of the distal common bile duct. MATERIALS AND METHODS: Twenty-one patients (12 males and 9 females, mean age 62 years) with a clinical suspicion of malignancy of the distal biliary tract and pancreatic head underwent tomographic RM evaluation and diagnostic MRCP, followed by diagnostic and, where possible, therapeutic ERCP. The images obtained with ERCP and MRCP were reviewed blind by two experts who evaluated the presence, site, signal features and locoregional extension of the tumours. Histology performed by brushing or biopsy during ERCP and after surgical resection provided the standard of reference for all 21 patients. RESULTS: CPRM correctly identified the presence and site of the distal biliary stenosis in 21/21 (100%) cases, as well as allowing evaluation of the upper abdomen by associating it with conventional MRI. ERCP, instead, allowed detection of the presence and site of biliary stenosis in 20/21 (95%) cases. DISCUSSION AND CONCLUSIONS: ERCP may have some limitations as regards identification of distal bile duct stenosis in cases of critical stenosis. The non-invasive nature and panoramic capabilities of MRCP and the fact that no contrast material is needed make MRCP the examination of reference in the diagnosis of malignant stenosis of the distal bile duct, also thanks to its ability to visualise the entire biliary tree in the presence of critical strictures of the common bile duct. The rationale for the use of ERCP lies in the possibility of taking histological samples and performing minimally invasive surgical interventions.     

Pancreas. Congenital changes, acute and chronic pancreatitis

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.     

胰胆管疾病的ERCP影像诊断

目的评价内窥镜逆行胰胆管造影(ERCP)对胰胆管疾病的诊断价值。方法回顾性分析了经手术或病理及临床证实胰胆管疾病480例的ERCP表现,并与CT,MRI,MRCP,超声及透皮肝穿刺胆道造影(PTC)等检查方法进行对比。结果正常胰胆管75例,先天性胆管囊肿14例,胆系结石292例,奥狄括约肌狭窄症46例,壶腹癌、胆管癌52例,胰管癌4例,胰腺炎2例,胰管结石3例,胆道蛔虫症9例,肝内胆管发育变异2例,胆囊管异位开口6例,胆道-腹腔漏2例,十二指肠乳头旁憩室9例,十二指肠乳头开口于憩室内2例,肝移植后吻合口狭窄2例,肝移植后吻合口狭窄并胆漏1例,肝移植后肝外胆管条状结石2例。结论ERCP及MRCP检查同为诊断胰胆管疾病的“金标准”,但每种影像学方法均有其优缺点,应根据患者情况选择。ERCP虽有一定的创伤性,但检查同时可行内镜下乳头括约肌切开术(EST)等微创治疗。     

肝移植后MR征象的探讨

目的:探讨原位肝移植术后MR征象形成及临床意义。方法:13例原位肝移植术后患者均用SE序列及FSE序列常规扫T1WI及脂肪抑制T2WI,部分选用磁共振胰胆管成像(MRCP)、钆喷替酸葡甲胺(Gd-DTPA)动态增强3D MRA检查,分析各序列图像特点。结果:13例患者均在脂肪抑制T2WI上出现门静脉周围间隙增宽,并伴有长T1、长T2信号;1例出现肝内胆管的弥漫性囊柱状扩张;10例出现移植肝周围及叶间裂少量积液,部分患者合并胸腔积液;10例MRCP示胆道明显或稍狭窄,其中5例为吻合口狭窄,2例为肝门部淋巴结压迫所致,3例ERCP结果与之相符;5例见可疑胆湖。2例ERCP发现吻合口胆漏而MRCP表现为阴性;4例追踪发现肝内肿瘤复发或出现远处转移灶;1例诊断为局灶性肝坏死。结论:通过对肝移植术后门周间隙增宽,弥漫性胆管扩张及胆汁瘤等征象进行探讨,为临床评价移植物功能,诊断胆漏提供了一定的信息。     

Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis

PURPOSE: To assess the usefulness of magnetic resonance (MR) cholangiopancreatography (MRCP) in the evaluation of disease in patients with acute or chronic pancreatitis. MATERIALS AND METHODS: MR imaging was performed at 1.5 T in 39 patients with chronic (n = 30) or acute (n = 9) pancreatitis. The patients underwent a pancreas MR imaging protocol that included an MRCP sequence. Comparison was made with findings at endoscopic retrograde cholangiopancreatography (ERCP), performed within 30 days. Three blinded readers used a scoring system to evaluate nine segments of the pancreatic and biliary ducts as depicted on the ERCP and MRCP images. MRCP image quality was also evaluated. RESULTS: Of 196 segments analyzed, 17 were not seen at MRCP (sensitivity, 91%). Of the segments visualized at MRCP, 14 were incorrectly characterized (accuracy, 92%). At MRCP, segments not detected or mischaracterized were either normal, slightly dilated, or narrowed. At ERCP, 42 segments in 19 patients were not visualized. MRCP findings were considered useful in all those cases. MRCP image quality was not interpretable in two cases due to artifacts. CONCLUSION: Very good correlation between ERCP and MRCP findings was demonstrated. Both modalities failed to depict pathologic conditions depicted by the alternative method. MRCP may obviate ERCP, particularly in patients who cannot undergo ERCP or in whom ERCP has been unsuccessful.     

MR cholangiopancreatography: evaluation of common pancreatic diseases

In the evaluation of common pancreatic diseases, MRCP is a noninvasive alternative to ERCP. Ductal anatomy can be ascertained without risk of complications. MRCP is valuable in defining common anatomic variants, determining the state of the pancreatic duct in pancreatitis, and characterizing neoplasms, especially combined with other MR imaging sequences. With the advent of MRCP, techniques requiring endoscopy and percutaneous access are largely reserved for histologic diagnosis and treatment, or for cases in which MRCP fails to establish a diagnosis.