胰胆管扩张的MRCP表现对胰腺癌和慢性胰腺炎的诊断意义

目的研究胰胆管扩张对胰腺癌和慢性胰腺炎的诊断价值.方法回顾性分析45例胰腺癌和41例慢性胰腺炎的MRCP资料.结果胰腺癌组的MRCP主要特征包括:(1)胰管扩张多呈管腔光滑,明显扩张,并多在胰头肿块处截断(26例,占74.3%);(2)扩张的胆总管多呈突然截断(26例,占89.7%);(3)双管征(28例,占62.2%).慢性胰腺炎组的MRCP主要特征:(1)胰管扩张多呈粗细不均的不规则型,并贯通病变(18例,占60.0%),部分可见胰管结石(6例,占14.6%);(2)扩张的胆总管由上至下逐渐变细(18例,占90.0%).结论胰胆管MRCP表现的形态特征对胰腺癌和慢性胰腺炎的诊断有鉴别意义.     

磁共振胰胆管成像(MRCP)对胆道梗阻性疾病的诊断价值

目的:分析磁共振胰胆管成像(MRCP)检查方案在胆道肠梗阻患者临床诊断的价值.方法:选用2020年4月-2021年3月期间接受临床检查的胆道梗阻性疾病患者共100例作为研究对象,按照检查方案的不同将患者分为A组与B组,B组实施CT检查方案,A组实施MRCP检查方案,比较两组患者胆管扩张程度与诊出率.结果:A组患者严重胆...     

影像学检查在诊断慢性胰腺炎中的意义

目的　分析评价多种影像学检查在慢性胰腺炎诊断中的作用 ,有助于慢性胰腺炎的诊断。方法　回顾性总结北京协和医院 1991～ 2 0 0 0年间确诊的慢性胰腺炎患者 12 9例 ,分析体外超声 (US)、计算机X线断层摄影 (CT)、内镜逆行胰胆管造影 (ERCP)、超声内镜 (EUS)及磁共振胰胆管显影 (MR CP)在诊断慢性胰腺炎中的作用。结果　①EUS和MRCP诊断慢性胰腺炎的敏感性高 ,与ERCP的一致性较好。②ERCP的敏感性显著高于US与CT(P <0 .0 5 )。③US对胰管扩张检出的敏感性与特异性为 5 9.4 %与 93.8% ,CT分别为 6 0 .0 %与 95 .7%。④胰管病变重度组ERCP与BT PABA的一致率(87.5 % )较轻 中度组 (6 6 .7% )高。⑤慢性胰腺炎并发症越多 ,胰管病变程度越重。结论　在传统检查中 ,ERCP诊断慢性胰腺炎的敏感性最高 ;新近开展的EUS和MRCP敏感性高 ,且与ERCP有较好的一致性 ,是很有前途的检查方法     

慢性胰腺炎与胰腺癌的诊断

慢性胰腺炎（chronic pancreatitis，CP）与胰腺癌的诊断、治疗和基础研究一直存在很多难题，很少有患者得到早期诊断及有效治疗，且CP与胰腺癌的因果关系一直存有争议，缺乏有效的鉴别诊断方法。因此，对胰腺疾病的诊断研究多年来已成为全球性的热点。     

胰腺癌和慢性胰腺炎的影像诊断与鉴别诊断

慢性胰腺炎（chronic pancreatitis．CP）是由多种原因造成的胰腺局部、节段或弥漫性炎症。胰腺癌则是一种恶性程度高、易转移、预后差的消化道肿瘤。甲期发现较困难，因此多数患暂丧失了手术机会。CP和胰腺癌之间存在着较为复杂的火系，CP可能发展为胰腺癌，特别是好发于胰头部的肿块型胰腺炎，影像学及临床表现均难以与胰头癌鉴别。但CP病例并不是一旦确诊就需根治于术，规范的内科保守治疗不但可以缓解临床症状，还可以减慢疾病的自然进程。如何准确地鉴别胰腺癌和CP，避免不必要的开腹手术，并指导临床制定合理的治疗方案，影像诊断起着不可替代的重要作用，方法也不断更新。     

慢性胰腺炎影像学诊断进展

慢性胰腺炎的发病率有不断增高趋势，随着影像学检查技术，尤其是ERCP、集MRI、MRCP和MRA于一体的磁共振成像、三维CT重建以及PET等手段的不断改进和涌一同，慢性胰腺炎的诊断准确率有了显提高。本扼要综述慢性胰腺炎影像学诊断的有关进展。     

慢性胰腺炎的猫模型制作及磁共振影像表现

目的 制备猫慢性胰腺炎(CP)模型,观察其MRI与MRCP的影像学表现.方法 32只猫按数字表法随机分为对照组及制模后3、5、7周组.采用胰管不全结扎法制备CP模型,术后3、5、7周行MRI平扫及MRCP检查,观察胰腺形态,测量胰管直径及感兴趣区(ROI)的T1信号强度值(Tls),计算同层胰腺及肝脏Tls比值.结果 制模的24只猫中存活19只,其中15只形成CP,病理证实轻、中、重度CP分别为7、5、3只,制模成功率为62.5％.在MRI上,猫的正常胰腺显示清晰,T1加权像信号强度高于肝脏,T2加权像信号强度低于肝脏;在MRCP图像上,4只正常猫显示主胰管,胰管最大径(0.79±0.18)mm,并可见胰管及胆总管共同开口于十二指肠降部.正常胰腺及轻、中、重度CP感兴趣区的rTls值分别为1.03±0.06、0.95±0.08、0.90±0.10、0.80±0.11,各CP组与正常对照组间差异均有统计学意义(t=2.18,P＜0.05;t =2.89,P＜0.05;t =4.63,P＜0.01);胰管最大径分别为(0.79±0.18)、(0.95±0.24)、(1.26±0.31)、(2.67±0.71)mm,中、重度CP组与正常对照组间差异均有统计学意义(P＜0.05或＜0.01).结论 胰管不全结扎可制备猫的CP模型.猫的胰腺解剖形态、CP的MRI及MRCP表现与人类相似.     

慢性胰腺炎与胰腺癌

慢性胰腺炎与胰腺癌虽分属良、恶性两种疾病，但可有相似的临床表现及影像学检查结果，有时鉴别诊断非常困难。这两种疾病有时可能互为因果，增加对它们各自特征及相互关系的认识，有助于恰当地诊治这两种疾病。 一、慢性胰腺炎与胰腺癌的病理 胰腺癌病灶与周围正常胰腺组织分界不很清楚，常深埋于胰腺实质中，切面呈黄白或灰白色；慢性胰腺炎可有广泛的纤雏化及不规则结节样硬化。在一组接受手术的慢性胰腺炎患者中，约３０％有胰腺炎性肿块，与胰腺癌在肉眼上难以鉴别，故术中常需冰冻切片，通过组织学检查确定病理诊断。慢性胰腺炎与胰腺…     

内镜下胰胆管造影对慢性胰腺炎的诊断价值

内镜下逆行胰胆管造影术(ERCP)可以清楚显示胰胆管影像，对慢性胰腺炎的诊断与组织学对比敏感性80％～87％，特异性56％～88％。而作为一项创伤性检查，ERCP有一定风险性，其中并发症发生率7％(操作后胰腺炎、败血症、出血、穿孔)，死亡率1％以及3％～99／5的插管不成功，且由于慢性胰腺炎     

以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎（AP）为首发表现的胰腺癌的诊断和治疗。方法 对从1996-2006年问部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析。结果 21例患者人院时均有典型AP的症状、体征和实验室检查，CA19—9正常或升高，CT、ERCP等均提示胰腺肿大，部分患者伴胰管扩张及胆囊结石和胆管扩张．人院时均诊断为AP，外院19例诊断为胰腺癌时已错过根治性手术时机，本院1例及时修正诊断后行根治性手术，预后良好，另一例术中明确诊断后已失去根冶机会。结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌，才能对此类特殊病例及时诊断、果断手术以取得满意疗效。     

内镜下抽线式金属支架取出胰管结石——附3例报告

目的设计抽线式胰管金属支架,以利于取出胰管结石。方法收集3例确诊胰管结石并胰管远端狭窄,且ERCP取石失败者,应用十二指肠镜在主胰管置入抽线式金属支架,24～48h后再次ERCP取石。结果3例患者主胰管结石直径1～1.5cm,造影显示胰管远端狭窄。先置入抽线式胰管金属支架,24～48h后金属支架完全膨胀,插入气囊顺利取出全部结石,再将金属支架抽成丝样经活检孔取出。术后无出血、嵌顿、胰腺炎等并发症发生。结论内镜下胰管内置入抽线式金属支架取石,安全、有效,费用低廉,增加了胰管取石的成功率。     

慢性纤维包块型胰腺炎与胰腺导管腺癌癌旁组织的病理学及免疫组化特征

目的 比较慢性纤维包块型胰腺炎（FMCP）及胰腺导管腺癌（PDAC）癌旁组织基本病理变化特征,试从间质微环境角度探讨FMCP在促进PDAC发生、发展中的可能作用.方法 对48例FMCP及62例PDAC的癌旁组织HE切片进行镜下观察比较,观察内容包括导管上皮内瘤变（PanIN）、导管复合体形成（TC）、纤维结缔组织增生、炎细胞浸润及神经炎等病理变化.免疫组化法检测神经纤维增生和微血管形成状况.结果 FMCP及PDAC癌旁组织中PanlN的发生率分别为97.9％ （47/48）和91.4％ （53/58）,其中PanIN-3在PDAC癌旁组织内发生率为20.8％,显著高于FMCP的4.3％（P=0.031）;TC的发生率分别为58.3％ （28/48）和65.0％ （40/62）,差异无统计学意义（P =0.508）.FMCP促纤维结缔组织增生程度重于PDAC癌旁组织,以中、重度为主（P =0.037）.两种组织的炎细胞浸润程度差异无统计学意义（P=0.754）;神经炎发生率分别为81.3％和66.1％,差异亦无统计学意义（P=0.077）.FMCP及PDAC癌旁组织内细小无髓神经纤维数目明显增加,发生率分别为68.8％ （33/48）和63.3％ （38/60）,200倍视野下计数分别为（12.08±3.72）根和（11.14±4.70）根,差异无统计学意义（P=0.537）;微血管密度（MVD）分别为（39.69±22.88）个和（44.89±16.83）个,差异亦无统计学意义（P=0.605）.结论 FMCP及PDAC癌旁呈现较为相似的病理变化,提示FMCP在PDAC发生、发展过程中提供了可能的微环境,FMCP可能是重要的PDAC癌前病变.     

胰腺导管腺癌、慢性胰腺炎及正常胰腺组织中胰腺上皮内瘤变的比较研究

目的探讨胰腺导管腺癌、慢性胰腺炎和正常胰腺组织中各级别PanIN的发生率以及与临床病理学参数间的关系。方法回顾性研究长海医院2001年1月-2003年12月间外科切除和同期尸检获得的250例胰腺标本中PanIN的发生情况,并联系临床病理指标进行相关分析。结果250例胰腺标本中,有156例存在PanIN病变,发生率62.4％。其中,胰腺导管腺癌、慢性胰腺炎和正常胰腺组织中PanIN的发生率分别为75.6％、46.0％和30.0％,胰腺导管腺癌PanIN发生率明显高于慢性胰腺炎及正常胰腺组织(P<0.01);慢性胰腺炎中高级别PanIN发生率明显高于正常胰腺组织(P<0.05)。PanIN-3仅在胰腺导管腺癌和慢性胰腺炎中见到。胰腺导管腺癌中,有烟酒嗜好和(或)糖尿病者高级别PanIN的发生率53.7％,明显高于对照组29.4％(P<0.01)。PanIN的发生率以61-70岁年龄组为最高。结论胰腺导管腺癌、慢性胰腺炎和正常胰腺组织中PanIN的发生率逐渐增加,程度逐渐加重,支持胰腺癌发生的分子模型。     

Clinical significance of main pancreatic duct dilation on computed tomography： Single and double duct dilation

AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases. METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records. RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer. CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful followup since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.     

超声内镜对胰管扩张性疾病的诊断价值

目的 探讨内镜超声检查术(EUS)在胰管扩张病因及恶性疾病邻近脏器浸润的诊断价值。方法 分析129例EUS检查发现胰管扩张的病因，并与同期接受CT检查(n＝40)与ERCP检查(n＝42)的结果相比较。对其中72例胰腺癌引起的胰管扩张病例，分析EUS对邻近脏器浸润检出率，并与CT、ERCP结果相比较。结果 129例胰管扩张病例中，胰腺癌、壶腹癌、慢性胰腺炎为常见病因。EUS对病因检出率较CT及ERCP高。EUS对胰腺癌邻近血管侵犯及淋巴结转移检出率较CT及ERCP高。结论 EUS对胰管扩张的病因诊断较CT及ERCP有明显的优越性，并能全面评估肿瘤的可切除性，指导制定治疗方案。     

Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis

AIM: To evaluate the utility of carbohydrate antigen19-9(CA19-9) for differential diagnosis of pancreatic carcinoma and chronic pancreatitis.METHODS: We searched the literature for studies reporting the sensitivity, specificity, and other accuracy measures of serum CA19-9 levels for differentiating pancreatic carcinoma and chronic pancreatitis. Pooled analysis was performed using random-effects models, and receiver operating characteristic(ROC) curves were generated. Study quality was assessed using Standards for Reporting Diagnostic Accuracy and Quality Assessment for Studies of Diagnostic Accuracy tools. RESULTS: A total of 34 studies involving 3125 patients with pancreatic carcinoma and 2061 patients with chronic pancreatitis were included. Pooled analysis of the ability of CA19-9 level to differentiate pancreatic carcinoma and chronic pancreatitis showed the following effect estimates: sensitivity, 0.81(95%CI: 0.80-0.83); specificity, 0.81(95%CI: 0.79-0.82); positive likelihood ratio, 4.08(95%CI: 3.39-4.91); negative likelihood ratio, 0.24(95%CI: 0.21-0.28); and diagnostic odds ratio, 19.31(95%CI: 14.40-25.90). The area under the ROC curve was 0.88. No significant publication bias was detected.CONCLUSION: Elevated CA19-9 by itself is insufficient for differentiating pancreatic carcinoma and chronic pancreatitis, however, it increases suspicion of pancreatic carcinoma and may complement other clinical findings to improve diagnostic accuracy.     

肿块型慢性胰腺炎11例的临床及影像学特征

目的 分析肿块型慢性胰腺炎的临床和影像学特点,并与胰腺肿瘤相鉴别.方法 回顾性分析11例肿块型慢性胰腺炎的临床、影像学、实验室和病理特征.结果 肿块型慢性胰腺炎多见于老年人、男性患者,临床主要表现为梗阻性黄疸和腹部不适.血清CA19-9水平可轻度升高,通常＜100U/ml,较胰腺癌低.B超对肿块型CP诊断的准确率仅18.2%,只能作为初筛手段;CT的诊断准确率为45.5%,表现为主胰管及其分支呈球样扩张,可见胰腺假性囊肿和钙化;MRCP和EUS均可见胆总管、胰管不规则扩张,表现与胰腺癌相似;ERCP可清楚显示胰胆管的病变部位、梗阻性质、胰胆管的狭窄及扩张情况等,与CT检查结合,对鉴别肿块型CP与胰头癌有重要意义.根据组织病理检查,少部分肿块型慢性胰腺炎属于自身免疫性胰腺炎.结论肿块型慢性胰腺炎临床和影像学特征与胰腺癌相似,需结合病史、临床表现、实验室及影像学检查、组织病理综合判断.     

Telomerase activity in pancreatic juice differentiates pancreatic cancer from chronic pancreatitis: A meta-analysis

Background/objectiveTo evaluate the usefulness of genetic markers in pancreatic juice (PJ), and the combination of these markers with telomerase activity in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from chronic pancreatitis.MethodsWe conducted a meta-analysis for the diagnostic utility of the four major altered genes in PDAC (KRAS, CDKN2A/p16, TP53, and SMAD4/DPC4), telomerase activity, and a combination assay using PJ samples. A literature search was conducted in MEDLINE, Cochrane Library, and Web of Science. Data were pooled and presented as diagnostic sensitivity and specificity with 95% confidence intervals (CIs).ResultsThirty-nine studies fulfilled the inclusion criteria. Pooled estimates of KRAS analysis were as follows: sensitivity was 0.67 (95% CI, 0.63–0.71) and specificity, 0.82 (95% CI, 0.79–0.85). For telomerase activity analysis, sensitivity was 0.82 (95% CI, 0.76–0.87) and specificity, 0.96 (95% CI, 0.90–0.99). The other three tumor suppressors demonstrated low sensitivity. The data did not suggest any publication bias. A combined analysis of KRAS and telomerase activity showed a higher diagnostic sensitivity (0.94; 95% CI, 0.83–0.99) than KRAS alone. A combined analysis of telomerase activity and cytology revealed more reliable diagnostic accuracy than telomerase activity alone, with high sensitivity (0.88; 95% CI, 0.74–0.96) and specificity (1.00; 95% CI, 0.91–1.00).ConclusionsThe most reliable marker in PJ samples for diagnosis of PDAC was telomerase activity. Telomerase activity can play a central role in diagnostic analysis using PJ samples, and can increase diagnostic accuracy when combined with KRAS mutations or cytological examination.