肿块型胰腺炎的CT诊断

目的：探讨肿块型胰腺炎的CT征象特征。方法：回顾性分析经病理证实的25例肿块型胰腺炎的CT资料，采用PQ5000V螺旋CT，平扫及增强，层厚及层距均为10mm。结果：25例中23例肿块位于胰头部，2例位于胰体部。16例肿块密度均匀，增强一致。5例可见钙化；胰管扩张15例，14例轻度，10例不规则扩张，6例穿过肿块；12例合并胆总管炎，5例胆总管内可见结石；肝外胆管扩张18例，15例轻度，12例下端逐渐变细；肾前筋膜增厚10例；胰前脂肪层模糊6例。结论：肿块型胰腺炎具有较可靠的CT征象，CT能对大多数的肿块型胰腺炎作出较准确诊断。     

36例急性胰腺炎的CT诊断分析

目的 评价多层螺旋CT平扫和增强扫描对急性胰腺炎的诊断价值.方法 回顾性分析经手术及临床证实的36例急性胰腺炎患者的CT扫描资料,重点评价CT在急性胰腺炎诊断中的价值.探讨CT表现和预后的关系.结果 本组36例急性胰腺炎患者除1例胰腺实质表现正常外,其余35例胰腺均呈局限或普遍性肿胀,以体尾为著.17例在胰腺实质内可见点状或小片状低密度区,3例可见高密度出血灶,增强扫描低密度的坏死病灶与增强的正常胰腺组织形成明显的对比.胰腺包膜增厚7例,包膜不清5例.结论 CT作为无创性检查技术,对急性胰腺炎有明确的诊断价值.     

CT诊断急性胰腺炎60例分析

目的探讨CT对急性胰腺炎的诊断价值。方法对60例经手术病理证实和CT复查确诊的急性胰腺炎病例进行回顾性分析,52例平扫 增强扫描,8例患者为急诊病人只做平扫。结果60例急性胰腺炎中:水肿型48例、坏死型12例。其中8例合并感染。结论CT检查对急性胰腺炎有较高的诊断价值,不仅能明确诊断,而且有助于临床定量分析,可发现并发症和判断预后。     

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.     

螺旋CT对重症急性胰腺炎的诊断价值

目的探讨螺旋CT对急性胰腺炎患者的临床诊断价值。方法回顾性分析45例经临床证实并行螺旋CT平扫及增强检查的急性胰腺炎的表现。结果急性水肿性胰腺炎31例(68.9%),2例胰腺无明显异常,1例胰头增,2例胰体增大,1例胰尾增大,25例弥漫性增大;急性出血坏死性胰腺炎14例(31.1%),表现胰腺密度不均、胰周积液8例,胰周脓肿2例,假性囊肿形成6例。结论 CT检查有助于急性胰腺炎的诊断,并能明确有无并发症。     

胰头部肿块型胰腺炎的临床特征及K-ras基因突变

目的分析胰头部肿块型胰腺炎临床特征及K-ras基因突变以明确其与胰腺癌关系.方法回顾性分析临床及随访资料并应用聚合酶链反应-单链构象多态性分析(PCR-SSCP)方法分别检测胰头部肿块型胰腺炎、胰腺癌、癌旁导管增生、手术切缘正常组织、石蜡包埋组织的K-ras突变.结果胰头部肿块型胰腺炎和胰头癌血清总胆红素、CA19-9、ERCP检查结果的差异有助于两者的鉴别诊断;肿块型胰腺炎增生导管K-ras突变率为40%(6/15),与癌周增生导管31.2%(10/32)的突变率相近,但显著低于胰头癌83.3%(15/18)的突变率,且胰腺炎手术后患者随访至2000年12月均健在且未发现胰头癌的临床表现.结论良性胰腺疾病导管增生存在K-ras突变并不一定向恶性发展.     

帕金森病伴抑郁症患者的CT与临床分析

探讨帕金林病（ＰＤ）伴抑郁症患者ＣＴ和临床表现有无特异性。方法采用汉密顿抑郁量表（ＨＲＳＤ）为抑郁症评定工具对３１例ＰＤ伴抑郁症患者的ＣＴ和临床表现进行分析比较。结果３１例ＰＤ患者中轻度抑郁１６例。中度８例,重度７例。ＰＤ患者抑郁程度与年龄,性别,病程及病情分期无关。而与临床分型有关。以强直为主的ＰＤ患者抑郁程度明显重于以震颤为主的患者。ＣＴ检查异常率达７４％。其中中－重度抑郁患者第Ⅲ脑室扩大和脑     

肺部炎性肿块的CT诊断

肺部炎性肿块为胸部ＣＴ检查中常见病变,表现为肺内球形病灶,其表现与肺癌相似,鉴别困难。为进一步提高对这类病变ＣＴ征象的认识,现报告我院２０例肺部失性肿块患者的ＣＴ资料,结合有关文献探讨其ＣＴ表现及诊断价值。 临床资料：２０例患者中,男１４例,女６例,年龄２８～７１岁,平均５３岁。主要临床表现为轻咳、白痰、低热和胸痛,少数患者只有乏力感。 ２０例患者分别用 ＳＯＭＡＴＯＭ ＣＲ和 ＳＯ－ＭＡＴＯＭ ＰＬＵＳ ４ＣＴ机,自胸锁关节平面ＬＺ ８～１０ｍｍ层厚连续扫描至肋膈角, １３例做了平扫并增强 ＣＴ扫描。 …     

B超和CT对老年急性胰腺炎的诊断价值

目的　 探讨B超和CT检查对老年急性胰腺炎 (AP)的早期诊断价值。　 方法 　回顾性分析我院1993～ 1999年间住院的老年急性胰腺炎患者发病后的第 1次B超和CT检查资料 ,统计其检查的阳性率和影像学表现。　 结果　 10 7例次老年AP患者中轻型 80例次、重型 2 7例次 ,有 86例次和 62例次患者分别进行了B超和CT检查 ,诊断阳性率分别为 60 5 %和 72 6%。轻型患者B超和CT检查阳性诊断率分别为 5 2 5 % (3 2 /61)和64 3 % (2 7/4 2 ) ;重型患者B超和CT检查阳性诊断率分别为 80 % (2 0 /2 5 )和 90 % (18/2 0 ) ;72h内B超和CT检查阳性诊断率分别为 66 7% (4 8/72 )和 79 6% (3 9/4 9) ;72h后B超和CT检查阳性诊断率分别为 2 8 6% (4 /14 )和46 2 % (6/13 )。CT严重程度指数和临床分型具有良好的一致性。　 结论 　发病后及时进行B超和CT检查 ,对老年急性胰腺炎的诊断和病情判断具有良好辅助价值 ,尤其对那些临床表现不典型的患者 ,两者还可互为补充。     

多排螺旋CT在鉴别老年患者肿块型胰腺炎与胰腺导管腺癌中的应用价值

目的 探讨多排螺旋CT在鉴别老年人肿块型胰腺炎(MFP)和胰腺导管腺癌(PDAC)的价值。方法 回顾性分析复旦大学附属华东医院2011年1月—2021年12月经临床手术/穿刺病理证实的24例肿块型胰腺炎与52例胰腺导管腺癌老年患者的临床及多排螺旋CT征象,采用独立样本t检验或χ²检验对数据进行统计学分析,探究具有鉴别价值的临床及影像特征。结果 2组疾病的价值的CT征象包括：直接征象：MFP与PDAC患者病灶密度均匀者分别为18例(75%)和15例(28.85%),差异具有统计学意义(2=14.328,P<0.001);病灶CT值方面：在增强扫描后,MFP组病灶的强化程度总体高于PDAC组,MFP组与PDAC组病灶动脉期CT值分别为(59.4±10.5)HU和(53.8±11.5)HU,静脉期CT值分别为(85.8±13.8)HU和(78.9±14.0)HU,差异均有统计学意义(t=2.024/2.011,P=0.047/0.048);间接征象：PDAC更容易出现胰周血管侵犯(36.54%)、胰尾部萎缩(53.85%)和远处转移征象(17.31%),比例均高于...     

急性胰腺炎在螺旋CT诊断中的应用

探讨螺旋CT在急性胰腺炎诊断中的价值。回顾分析2002-2004年经临床和螺旋CT确诊的急性胰腺炎52例,其中男37例,女15例。所有病例均经CT平扫,其中增强扫描7例。根据胰腺坏死程度分轻度、中度和重度。轻度为斑片状坏死,中度为段状坏死,重度为整个胰腺坏死。水肿性胰腺炎34例,出血坏死性胰腺炎18例。按Balthazarf分级:A级3例,B级7例,C级16例,D级14例,E级12例。根据胰腺坏死程度分轻度6例,中度9例, 重度11例。螺旋CT检查对急性胰腺炎具有定性诊断价值。CT分级及胰腺坏死程度对急性出血坏死性胰腺炎病情的判断有很大价值。     

Autoimmune pancreatitis with hepatic inflammatory pseudotumor

We report a case of autoimmune pancreatitis (AIP) with hepatic inflammatory pseudotumor (IP). The patient was clinically diagnosed as having multiple metastatic tumors originated from cholangiocellular carcinoma as well as autoimmune pancreatitis and underwent left lobectomy of the liver. Histological examination showed a diffuse or dense lymphoplasmacytic infiltration with obliterating phlebitis but an absence of neoplastic proliferation both in the liver tumor and in the biopsy specimen of the pancreas. Abundant IgG4-positive plasma cells were seen in the lesions. This is the first case report that shows a simultaneous occurrence of hepatic IP and AIP, suggesting that these lesions appeared on the background of the recently proposed entity of IgG4-related systemic disease.     

Sellar inflammatory mass with inflammatory bowel disease

Inflammatory bowel disease may be associated with different intracranial disorders. An inflammatory sellar mass is very rare but includes a variety of noninfectious causes including lymphocytic hypophysitis, granulomatous inflammation and Wegener’s granulomatosis. A 32-year-old man was diagnosed with an inflammatory sellar mass associated with an extensive colonic inflammatory process clinically characteristic of Crohn’s disease. The concurrent onset of these inflammatory disorders in distinctly separate sites may reflect their common embryological origin or represent an unusual form of metastatic Crohn’s disease. Further studies are needed to determine if less overt or focal sellar inflammatory processes occur in inflammatory bowel disease, particularly in Crohn’s disease because their occurrence may be critically relevant for long-term management.     

Idiopathic pancreatitis associated with inflammatory bowel disease

The list of extraintestinal manifestations of inflammatory bowel diseases does not classically include pancreatitis and pancreatic insufficiency. We report here six cases of unexplained pancreatitis associated with inflammatory bowel disease (five patients with Crohn's disease, one with indeterminate colitis). None of the classical etiologies for pancreatitis was found in our patients; moreover none of them had duodenal localization of Crohn's disease or sclerosing cholangitis, two conditions in which pancreatitis associated with inflammatory bowel disease has been previously described. Pancreatitis was painless (or was associated with moderate and atypical abdominal pain) in four of our six cases; no pancreatic calcification was found in any case; in three patients a total or subtotal exocrine pancreatic insufficiency was evidenced. Endoscopic retrograde pancreatography performed in four subjects showed normal or minimally altered pancreatic ducts even in those with severe pancreatic insufficiency. These cases emphasize the existence of a probably nonfortuitous association of inflammatory bowel disease with pancreatitis. Its recognition could make a significant contribution in the management of inflammatory bowel disease.     

Pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head: preoperative and postoperative functional assessment

BACKGROUND/AIMS: In chronic pancreatitis patients with an inflammatory mass of the pancreatic head receiving pancreatoduodenectomy, postoperative quality of life, including nutritional status, has become important. Pre- and postoperative evaluation of pancreatic function is essential as an effective means of proper nutritional management of patients following pancreatoduodenectomy. METHODOLOGY: Fifteen patients with chronic pancreatitis and inflammatory mass of the pancreatic head who had received standard pancreatoduodenectomy were enrolled in this investigation. All patients had their biliary and pancreatic ducts reconstructed according to Child's arrangement. Furthermore, all patients had smooth postoperative courses and were assessed for the pancreatojejunostomy by magnetic resonance cholangiopancreatography at least a month after the initial operation. Exocrine pancreas functions were clinically assessed with various clinical items and two indirect pancreatic function tests: the fecal elastase test and the Bentiromide test. Endocrine pancreas functions were assessed using serum C-peptide level, HbA1 level and the need for hypoglycemic therapy. RESULTS: The results indicated that the pancreatojejunostomies of all patients are patent magnetic resonance cholangiopancreatography. All patients benefited from the selected symptom relief and various clinical parameters, including medications, dietary restrictions, body mass index and plasma albumin levels, experiencing pain relief and improved exocrine and endocrine functions. CONCLUSIONS: Pancreatic function did not deteriorate after pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head, while quality of life was significantly improved.     

核磁共振及CT检查在急性胰腺炎诊治中的应用进展

简述了近年来核磁共振和CT在急性胰腺炎诊断和治疗中的应用进展,介绍了2008年修订的亚特兰大分类标准影像学部分的变化,其中进一步规范了急性胰腺炎的影像学名词并评价了影像学在诊疗中的作用。认为影像学技术对急性胰腺炎的诊断及指导治疗具有重要的临床意义,影像学术语的规范将有助于急性胰腺炎相关科研和临床工作中的交流。     

多层螺旋CT灌注成像评估急性胰腺炎的价值

目的 探讨CT灌注成像对急性胰腺炎(AP)患者病情严重程度的评估价值.方法 收集2006年8月至2008年1月AP患者82例,入院后2～3 d行多层螺旋CT(MSCT)胰腺灌注成像.另选取30名健康人群行腹部CT检查作对照.采用64层螺旋CT进行动态增强扫描,利用CT自带软件PCT进行处理得到灌注参数,比较血流量(BF)、血容量(BV)、峰值时间(TTP)、表面通透性(PS)变化.结果 AP组平均BF、BV、TTP、PS分别为(110.57±60.04)ml·100 ml-1·min-1、(156.68±65.11)ml/L、(146.58±29.46)0.1 S、(110.73±62.66)0.5 ml·100 ml-1·min-1,与对照组相比BF、BV明显下降(P<0.05),而TTP、PS变化差异无统计学意义(P>0.05).结论 AP患者胰腺血流灌注降低,且与病情严重程度有关,灌注参数BV、BF可用于评估AP病情的严重程度.     

Early inflammatory response in acute pancreatitis is little affected by body mass index

Objective. Obesity is a known risk factor for severe acute pancreatitis (AP), but the mechanism by which it affects the severity of AP is not fully understood. The main objective of this study was to investigate the relationship between obesity and inflammatory markers in AP. Material and methods. Thirty patients with AP who developed organ failure (Group I) and 87 patients with AP who survived without organ failure (Group II) were studied. Patients’ height and weight were measured at admission for calculation of body mass index (BMI). Blood samples were taken at admission for measurement of plasma interleukin (IL)-1β, IL-6, IL-10, IL-1 receptor antagonist, procalcitonin, C-reactive protein (CRP) and monocyte human leucocyte antigen (HLA)-DR expression. Results. Group I patients had higher BMI values (median 26.2 kg/m²) than Group II patients (25.2 kg/m²), p=0.033. Both CRP values and monocyte HLA-DR expression showed a significant correlation with BMI (Spearman's rank correlation r=0.32, p=0.003 and r=?0.33, p=0.002, respectively). The correlation between BMI and monocyte HLA-DR expression was significant in Group II patients (r=?0.34, p=0.002) but not in Group I patients (r=?0.02, p>0.05). There was no correlation between BMI and IL-1β, IL-6, IL-10, IL-1 receptor antagonist or procalcitonin. Conclusions. BMI did not affect either pro-inflammatory or anti-inflammatory cytokine levels in early AP. However, in patients with mild AP, BMI correlated positively with CRP levels and inversely with monocyte HLA-DR expression, which might reflect an amplified inflammatory response in these patients. Taken together, acute inflammatory response in AP, which ultimately determines the severity of AP, was little affected by BMI.