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.     

Chronic pancreatitis: reassessment with current CT

A retrospective analysis was performed of contrast material-enhanced current-generation computed tomographic (CT) examinations in 56 patients with documented chronic pancreatitis. Dilatation of the main pancreatic duct was seen in 68% of cases, parenchymal atrophy in 54%, pancreatic calcifications in 50%, fluid collections in 30%, focal pancreatic enlargement in 30%, biliary ductal dilatation in 29%, and alterations in peripancreatic fat or fascia in 16%. The relatively small proportion of examinations in which no abnormalities were observed, 7%, differs from that in early reports, as does the absence of generalized pancreatic enlargement. Pancreatic ductal dilatation and parenchymal atrophy were notably more prevalent than reported previously. Nine of the 17 patients with focal pancreatic enlargement had calculi within the mass, which suggested benign disease; of the eight other patients, two of whom had coexistent carcinoma, this finding was absent and the masses were considered indeterminate at CT.     

MRI features of groove pancreatitis

OBJECTIVE: The purpose of this article is to discuss and illustrate the most relevant and unique MRI features of groove pancreatitis. CONCLUSION: Groove pancreatitis in an uncommon type of focal chronic pancreatitis. Its appearance may resemble pancreatic adenocarcinoma. Although distinction between these two entities remains challenging, knowledge of MRI findings is important in suggesting the correct diagnosis and programming therapeutic decisions.     

自身免疫性胰腺炎MRI表现

目的 探讨自身免疫性胰腺炎(AIP)的MRI表现.方法 回顾性分析经组织学和(或)类固醇激素治疗证实的11例AIP患者的MRI资料.结果 9例AIP表现为胰腺弥漫性肿大,2例为胰腺局限性肿大.11例病变区压脂T1WI信号明显减低,压脂T2 WI信号略增高,DWI病变区信号增高,动态增强后呈延迟强化;MRCP 8例显示胆总管胰头段呈鸟嘴样狭窄,6例胰管节段性狭窄,1例胰头部胰管局限性狭窄;5例胰腺病变区周围见包膜样结构,1例胰周间隙水肿;1例胰头周围淋巴结肿大及双肾多发结节.结论 AIP的MRI表现具有特征性.掌握AIP胰腺外病变的影像表现,有利于该病的诊断与鉴别诊断.     

Chronic focal fibrosing pancreatitis: detection by MRI.

The study of a 70-year-old woman with fibrosing pancreatitis, an uncommon variety of chronic pancreatitis, presenting as a discrete solid mass in the head of the pancreas, is reported. CT and US were non-diagnostic while ERCP and MR detected a focal anomaly. This case report stresses the sensitivity of MR in some pancreatic pathologies.     

胰腺炎并发假性动脉瘤的CT表现

目的探讨胰腺炎并发假性动脉瘤的CT征象及CT在诊断中的价值。方法回顾性分析经手术及DSA证实的6例胰腺炎并发假性动脉瘤患者的CT资料，分析假性动脉瘤的部位、大小、CT表现等。结果6例假性动脉瘤患者中，2例并发于急性胰腺炎，4例并发于慢性胰腺炎。发生于脾动脉2例，位于腺体尾部脾动脉走行区；胃十二指肠动脉及胰十二指上肠动脉分别为2例和1例，位于胰头区域；肠系膜上动脉1例，位于肠系膜上动脉走行区域；瘤体直径3．2～7．0cm，平均5．8cm。假性动脉瘤平扫时呈圆形或类圆形低密度病灶，中心密度均匀或不均匀，增强后病灶部分明显强化，与同层面主动脉CT值接近，病灶周边存在无强化区域。结论增强CT扫描在胰腺炎并发假性动脉瘤的诊断中有重要价值。     

局限性自身免疫性胰腺炎的CT影像学特征分析

目的探讨局限性自身免疫性胰腺炎(focal autoimmune pancreatitis,f-AIP)的CT影像学表现特点,以期提高其影像学鉴别诊断水平。方法回顾性分析13例经组织学、IgG4检验或类固醇激素治疗证实的局限性自身免疫性胰腺炎患者的CT影像学资料,从胰腺形态表现、病变区密度及强化方式、胆胰管改变和假包膜结构显示等情况进行分析。结果本研究13例局限性自身免疫性胰腺炎患者中,13例均有局部胰腺肿大(胰头部3例,胰体尾部5例,胰尾部5例),与正常胰腺比较,CT平扫提示病变区密度降低(4例)或降低不明显(9例),增强扫描动脉期均见病变区强化程度较正常胰腺减低,门脉期及延迟期均提示病变区逐渐均匀强化,与正常胰腺强化程度相仿。7例显示病变区有假包膜结构,4例胆管扩张,胰管不规则硬化狭窄显示7例。结论局限性自身免疫性胰腺炎CT影像学表现具有一定的特征性,正确掌握这些特征有助于提高诊断准确率,从而避免不必要的手术治疗。     

Gray scale features of hematomas: an ultrasonic spectrum.

Forty-eight B-scan ultrasound examinations were performed on 25 patients with hematomas. Hematomas are usually spherical or ovoid within the abdomen, and lentiform within the pleural space or abdominal wall. They generally decrease in size with time, and usually have irregular walls. Hematomas contain a variable amount of internal echoes during the first month, and then gradually become anechoic. The sonographic appearance is not specific; an abscess may have a similar appearance. An old, anechoic hematoma may contain a gelatinous material which cannot be aspirated.     

Chronic pancreatitis and inflammatory bowel disease.

A consecutive series of 59 patients with abnormal pancreatograms indicative of chronic pancreatitis included five patients who also had inflammatory bowel disease. This is greater number than would be expected by chance. The cases are presented, and possible explanations are discussed.     

Gray-scale ultrasonic features of ovarian teratomas.

Forty patients with pelvic masses were examined with ultrasound; surgical exploration subsequently revealed an ovarian teratoma. The echographic appearance of the lesions was extremely variable. Although a number of characteristic features of teratomas have been described (axial location, solid mural component, acoustic shadow, and "hair/fluid level"), these occurred only in a minority (17/40) of patients. When the clinical setting suggests an ovarian teratoma, the ultrasonographer should consider it regardless of the internal architecture and consistency of the mass.     

急性轻、重型胰腺炎的MRI表现与评价

目的:探讨急性轻、重型胰腺炎的MRI表现与价值.方法:对114例采用腹部屏气磁共振序列进行扫描的急性胰腺炎MRI进行回顾性分析.结果:98例诊断为急性轻型胰腺炎,表现为胰腺肿大,花边样轮廓消失.T1 WI胰腺信号降低,可低于肝脏信号,而与脾脏信号强度无明显差异;T2WI呈高或稍高信号.16例诊断为急性重型胰腺炎,T1WI可呈斑片状高信号,T2WI可出现低信号环.结论:MRI对于急性胰腺炎的诊断具有重要价值.     

Lymphoplasmacytic sclerosing pancreatitis with obstructive jaundice: CT and pathology features

OBJECTIVE: The clinical presentation of lymphoplasmacytic sclerosing pancreatitis (LPSP) can be very similar to that of pancreatic cancer, with no statistically significant differences in the rates of abdominal pain, weight loss, jaundice, or levels of carcinoembryonic agent or cancer antigen 19-9. The purpose of this study is to describe and illustrate the CT features of LPSP presenting with obstructive jaundice and to correlate CT and pathology findings. MATERIALS AND METHODS: Five patients with LPSP were evaluated. Morphologic features of the pancreas on CT scans, including the size of the pancreas, presence or absence of a mass, segmental difference of contrast enhancement, pancreatic duct, major pancreatic vasculature, and biliary tract, were retrospectively evaluated and correlated with histopathology. The degree of contrast enhancement of the pancreas was compared in 10 patients without LPSP, who were scanned with the same protocol. RESULTS: CT scans showed diffuse (n = 2) or focal (n = 3) enlargement of the pancreatic head. The normal lobular appearance of the pancreas was effaced, and the gland appeared featureless in the involved region. Enlarged areas showed an enhancement pattern similar to that of the rest of the pancreas, and no segmental difference of contrast enhancement was identified. Pancreatic duct dilatation was not seen in any patient. Thickening and contrast enhancement of the common bile duct wall (n = 4) and gallbladder wall (n = 3) were observed and were pathologically correlated with inflammatory infiltrate and fibrosis of the common bile duct (n = 3) and gallbladder (n = 1). CONCLUSION: When these findings are encountered, further evaluation with serologic tests or biopsy may aid in the diagnosis of LPSP.     

The ultrasonic features of an unusual cholesterol gallstone

We describe a cholesterol gallstone with an unusual macroscopic appearance and only mild acoustic shadowing on ultrasonography with a 3.5 MHz transducer used in vivo; there was greater shadowing using 5.0 and 7.5 Mhz transducters in vitro.     

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。     

Wilms tumor: ultrasonic features, pathologic correlation, and diagnostic pitfalls

The gray-scale ultrasonic features of Wilms tumor are reported with pathologic comparison. The most consistent ultrasonic features are large size, sharp margination, and echogenic heterogeneity. The frequently observed anechoic areas correlated with hemorrhage and necrosis. A rare case of mesoblastic nephroma is included for comparison. Pitfalls in diagnosis are discussed.     

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。     

自身免疫性胰腺炎MRI表现及随访分析

目的探讨自身免疫性胰腺炎(AIP)的MRI表现以及随访过程中影像动态变化。方法分析11例AIP病人的临床及MRI资料,观察AIP在类固醇治疗前、后不同时期的MRI表现。采用配对样本t检验,分别对初诊与自然病程下及初诊与类固醇治疗后的胰腺大小测量值进行比较。结果初诊时9例胰腺弥漫性肿大,1例胰头局限性肿大,1例胰体见局限性肿块;受累胰腺在T1WI低信号11例,T2WI高信号10例、等信号1例;4例显示胰周低信号带;胰腺病变区7例胰管不可见,2例间断显示,1例呈串珠状改变,1例胰体部胰管受压、移位;9例胰腺段胆管壁增厚。自然病程下随访,5例胰腺肿大程度及MRI信号异常与初诊病变相似,4例胆管壁病变范围较初诊病变加重。类固醇治疗后,6例胰腺肿大、MRI信号异常以及胆管壁增厚趋于正常,胰周低信号带消失。有效治疗后3例胰腺病变复发,复发性AIP的MRI表现与初诊病变相似,其中1例胰体尾前方出现假性囊肿。初诊与自然病程下胰腺大小差异无统计学意义(P0.05),初诊与类固醇治疗后胰腺大小差异有统计学意义(P0.05)。结论 AIP的MRI表现有一定特征,MRI可用于诊断AIP,评估类固醇疗效,长期随访以及了解有无病变复发。     

沟槽区胰腺炎多层螺旋CT征象分析

目的:探讨沟槽区胰腺炎的MSCT征象,提高对该病的影像学诊断水平.方法:回顾性分析53例GP患者的临床及CT影像学资料,所有病例经手术病理或ERCP活检病理证实.观察沟槽区肿块或囊状病变的强化特点和分型,以及邻近结构的影像学改变.结果:53例的主要CT表现:①均可见沟槽区软组织增厚改变,CT平扫呈等或混杂稍低密度,动脉期呈轻度强化或无强化,实质期呈渐进性不均匀延迟强化;②57％(30/53)伴有副胰管开口邻近十二指肠降部肠壁或胰头实质的囊性变(长径10～48 mm);③十二指肠降部肠壁增厚45例(85％),其中40例为弥漫性水肿,5例为局部性水肿;④胰管扩张占19％(10/53),胆总管扩张占15％(8/53);⑤其它:沟槽区积液占89％(47/53),淋巴结炎(短径8～17 mm)占23％(12/53).结论:沟槽区胰腺炎的MSCT征象具有一定特征性,双期增强扫描对本病的诊断具有重要价值.     

Chronic erosive gastritis--clinical and radiological features

Chronic erosive gastritis has been regarded as an unusual, ill-defined condition of unknown etiology. We report a retrospective study of 40 patients in whom this diagnosis was made relating radiologic findings to patients' age, symptomatology and possible etiologic factors. The condition is more common than previously suspected and requires careful technique combining double contrast and graded compression to demonstrate fine mucosal abnormalities. The radiologic appearance is of mucosal mounds measuring 3-11 mm in diameter with central barium collections and numbering from 3-27 per examination. Antral involvement occurred in 90% of patients, with diffuse involvement of both antrum and body in 58%. Several linear erosions measuring up to 15 mm in length were also demonstrated. Chronic erosive gastritis is most severe and symptomatic between 40 and 60 years, becoming sub-clinical in the elderly. Symptoms mimic those of a peptic ulcer or gastric neoplasm and are more severe the more extensive the disease. Gastric irritants, virus infection and Crohn's disease were possible etiologic factors in some patients in this study.