胰腺导管内乳头状黏液性肿瘤恶变的影像表现

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)恶变的影像表现和诊断价值。方法回顾分析经手术或超声内镜下活检病理证实的60例IPMN,探讨IPMN恶变的CT及MRI影像表现和诊断价值,并进行统计学分析。结果60例患者共发现良性IPMN 34例,恶性26例。良性IPMNs的特征性表现为胰腺内囊性病灶,和主胰管相通,IPMNs恶变的特征有:增粗的胰管内出现明显强化的壁结节(17/26),结节直径>10 mm(13/26);主胰管直径>10 mm(10/26);或IPMN随访过程中出现胰腺明显肿块,胰管、胆管逐渐增粗、扩张加重。MRCP对IPMN与胰管相通的显示率高达91.7%(55/60),明显高于CT(76.7%,46/60)(χ^2=5.065,P<0.05)。恶性IPMN中胆总管扩张有14例,而良性IPMN胆总管扩张仅2例。根据MRCP胆总管扩张情况诊断IPMN恶变的诊断敏感性及特异性分别为53.8%及94.1%,阳性预测值为87.5%。恶性IPMN DWI受限达21例(80.8%),良性IPMN DWI轻度受限5例(14.7%)。恶性IPMN的ADC值[(2.04±0.38)×10^-3mm^2/s]显著低于良性IPMN[(2.83±0.29)×10^-3mm^2/s],统计学有差异(P<0.05)。ROC曲线下面积为0.9383,以2.34×10^-3mm^2/s为阈值,敏感性和特异性分别达到80.8%和94.1%,95%可信区间值80.32%~99.28%。对IPMN恶变的诊断敏感性MRI及CT分别为88.5%(23/26)、80.8%(21/26),诊断特异性分别为88.2%(30/34)、79.4%(27/34),统计学无差异(P>0.05)。结论胰腺导管内乳头状黏液性肿瘤恶变的影像表现具有一定特征性,在IPMN随访过程中应注意并提早判断,有助于改善临床治疗方案及提高患者预后及生存。     

胰腺导管内乳头状黏液性肿瘤良恶性的CT鉴别诊断

目的 探讨CT检查对良、恶性胰腺导管内乳头状黏液性肿瘤(IPMN)的鉴别诊断价值.方法 收集20例经手术病理证实的IPMN患者,其中良性者8例,恶性者12例,恶性中包括胰腺导管内乳头状黏液性交界性肿瘤5例和胰腺导管内乳头状黏液性腺癌(IPMC)7例.回顾性分析其CT表现,分析肿瘤发生部位、肿瘤大小、主胰管宽度、病灶内实性成分及病变内囊的数目等与良恶性的关系.结果 (1)肿瘤发生部位分型与肿瘤性质之间的关系:主胰管型与混合型恶性者有9例,而分支胰管型仅3例为恶性,病变影像表现为主胰管型及混合型者恶性可能性较大(P<0.05).(2)病变的大小:恶性组病变最大 直径较良性组大(P<0.01),且当病变范围＞30 mm时,恶性可能性较大(P<0.05).(3)主胰管(MPD)的宽度:恶性组病变MPD最大宽度明显大于良性组(P<0.05),且当MPD宽度＞9 mm时,病变恶性的可能性较大(P<0.05).(4)囊内有无合并结节或肿块:恶性组病变合并壁结节或肿块者有8例,良性组病变仅1例见壁结节,两者之间差异显著(P<0.05).(5)病变内囊的数目:囊的数目＞3个或者囊内合并不规则隔膜者恶性可能性更大(P<0.05).结论 恶性与良性IPMN的CT表现具有差异性,正确的分析能做出鉴别诊断.     

2型糖尿病患者中胰腺导管内乳头状黏液性肿瘤影像学分析

目的分析2型糖尿病患者中胰腺导管内乳头状黏液性肿瘤(IPMN)的影像学良恶性表现,提高影像学诊断水平。方法选取我院经手术病理证实的2型糖尿病患者伴胰腺IPMN患者20例。记录肿瘤分型、部位、大小、囊壁结节、胰管扩张等影像学表现。结果 20例IPMN中,头颈部9例,体尾部11例;混合型8例,多表现为主胰管不同程度扩张并周围分支胰管扩张,分支型6例,表现为单发单囊或多房囊性病灶;肿瘤平均直径约25.2 mm,主胰管型6例,表现为全程主胰管不同程度扩张,平均直径约15.9 mm;良性17例,恶性3例(2例为主胰管型均伴壁结节,1例混合型)。结论糖尿病患者的胰腺IPMN具有较为特征的影像学良性及恶性表现,临床上应严格把握手术和随访指征,结合患者的其他临床资料评估决定。     

胰腺导管内乳头状黏液性肿瘤的MRI表现

目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MRI特征.资料与方法 6例经病理或逆行性胆胰管造影(EBCP)证实的胰腺IPMN患者.MR扫描包括T_1WI、T_2WI、MRCP和动态增强.分析胰腺IPMN的MRI征象,并与临床及病理对照.结果 主胰管型、分支胰管型及混合型各2例,病灶主要位于胰头颈部,最大径(27.4±14.5)mm,呈分叶状,边缘清晰,T_1WI上呈低信号,T_2WI上呈高信号,增强后无强化或线状强化.2例病灶远端胰腺萎缩.2例分支胰管型主胰管最大径2.9 mm和2.2 mm,其余4例最大径(5.9 ±1.6)mm.结论 MRI对发现和正确诊断胰腺IPMN有较高价值.     

胰腺导管内乳头状粘液性肿瘤的影像分析

目的探讨胰腺导管内乳头状粘液性肿瘤(intraductal papillary mucinous neoplasm, IPMN)的CT及MRI表现和诊断价值。方法回顾分析经手术或超声内镜下活检病理证实的48例IPMN,探讨CT及MRI的影像表现和诊断价值。结果 IPMN的特征性表现为胰腺囊性病灶与主胰管相通,可分3型;1)主胰管型4例(2例恶性),表现为主胰管弥漫性或节段性扩张;2)分支胰管型23例(8例恶性),表现为胰腺分支胰管扩张,多位于胰头钩突部,可呈单囊或多囊形,和主胰管相通,恶性者可见分隔、壁结节;3)混合型21例(12例恶性),该型同时具有分支胰管、主胰管扩张的特点。IPMN诊断敏感性MRI及CT分别为90.9%(20/22)、77.3%(17/22),诊断特异性分别为88.5%(23/26)、76.9%(20/26),统计学无差异(P0.05)。MRCP对IPMN与胰管相通的显示率高达93.7%(45/48),明显高于CT(79.2%,38/48),统计学有差异(P0.05)。参考2012年新版IPMN诊治共识指南中的高危特征,良、恶性IPMN出现强化的实性成分分别为3/26 vs 13/22,其中1例良性IPMN壁结节及10例恶性IPMN壁结节大于10mm;主胰管直径大于10mm分别为2/26 vs 8/22,统计学有差异(P0.05)。结论胰腺导管内乳头状粘液样瘤的影像表现有一定特征性,影像学诊断对其良恶性判断、临床治疗方案制定及随访具有重要价值。     

动态增强MRI评估胰腺导管内乳头状黏液性肿瘤恶性潜能的价值

【摘要】目的：探讨采用动态增强MRI评估胰腺导管内乳头状黏液性肿瘤（IPMNs）恶性潜能的价值。方法：回顾性分析经手术病理证实115例IPMNs患者的动态增强MRI的影像学表现、临床及病理资料。男75例,女40例;年龄41~83岁,平均（63.8±7.9）岁。将患者分为轻度~中度不典型增生组、重度不典型增生组和IPMN伴浸润性癌三组。分析三组IPMNs在DCE-MRI动态增强MRI上的影像学表现,包括病灶位置、壁结节、主胰管管径、胰腺周围组织及血管侵犯情况等。参照2016年修订版福冈共识对IPMNs进行影像学分类。结果：三组间可强化壁结节≥5mm、主胰管≥10mm、主胰管改变伴远端实质萎缩这3个征象出现率的差异有统计学意义（P＜0.05）。肿瘤指标CA19-9升高在低度~中度不典型增生与浸润性癌组间差异有统计学意义（P＜0.017）。结论：DCE-MRI动态增强MRI对评估IPMNs恶性潜能有一定价值。     

CT征象联合肿瘤标志物对孤立性肺结节良恶性的鉴别诊断分析

目的 探讨CT征象联合肿瘤标志物对孤立性肺结节良恶性的鉴别诊断价值.方法 选取70例孤立性肺结节患者,行高分辨率CT、肿瘤标志物检查及病理检查.以病理组织学检查结果分为恶性结节组39例,良性结节组31例,对比两组CT征象和肿瘤标志物水平差异,运用受试者工作特征曲线(ROC)分析CT联合肿瘤标志物检测鉴别孤立性肺结节良恶...     

多层螺旋CT对胰腺导管内乳头状黏液性肿瘤的诊断价值

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的多层螺旋CT诊断价值。方法分析12例经手术病理证实的IPMN的临床资料及CT图像表现,包括胰管扩张的程度、范围,病灶的大小、形态、密度、边缘和强化方式等。采用曲面重建技术显示扩张的主胰管和分支胰管。结果12例IPMN中,男性8例,女性4例,年龄48~85岁。肿瘤位于钩突部7例,胰腺体部3例,胰腺头部和尾部各1例。分支胰管宽度>5 mm者10例,主胰管宽度>5 mm者4例,其中2例表现为胰腺弥漫性肿胀和胰腺实质内肿块。分支胰管型8例,主胰管型3例,混合型1例。病理结果显示腺瘤4例,交界性肿瘤5例,腺癌3例。结论多层螺旋CT对IPMN的诊断、分型具有重要的临床应用价值。     

多层螺旋CT与磁共振成像对胰腺导管内乳头状黏液性肿瘤的诊断价值比较

目的探讨和比较多层螺旋CT(MSCT)与磁共振成像（MRI）对胰腺导管内乳头状黏液性肿瘤（IPMN）的诊断价值。方法 回顾分析我院2017年2月至2022年6月间收治并经病理诊断为IPMN的43例患者资料，均行MSCT和MRI检查，参考病理诊断，比较两种检查结果。结果 MSCT、MRI对IPMN的病理诊断准确率均达到100%，两种检查结果对IPMN良恶性诊断、IPMN分型、病变部位、病变大小及有无壁结节等方面诊断一致性比例均相同。MSCT、MRI影像学检查结果显恶性肿瘤患者的病变最大直径>30 mm所占比例和有壁结节所占比例均明显高于良性肿瘤患者（P<0.05）;MSCT检查时间明显低于MRI检查时间（P<0.05）。结论MSCT、MRI对IPMN的诊断及良恶性鉴别的准确率较高，且二者诊断准确率差异无统计学意义，但MSCT的检查时间更短。临床应根据患者的具体情况选择适宜的影像学检查方法。     

MR表观扩散系数不同测量方法对乳腺良恶性病变的鉴别诊断价值

目的：探讨不同表观扩散系数(ADC)值测量方法对乳腺良恶性病变的鉴别诊断价值。方法收集248例经病理证实的乳腺病变,采用4种 ADC值测量方法获得4组 ADC值,即局部测量 ADC均值(ADCmean )、局部测量 ADC最小值(ADCmin )、整体测量ADC均值(ADCW-mean )和整体测量 ADC最小值(ADCW-min ),运用 ROC曲线确定4组 ADC值对乳腺恶性病变的诊断临界值并分析其诊断效能。结果诊断乳腺恶性肿瘤效能最高的 ADCmean、ADCmin、ADCW-mean和 ADCW-min临界值分别为1.315×10-3 mm2/s、1.111×10-3 mm2/s、1.223×10-3 mm2/s、0.897×10-3 mm2/s,其鉴别乳腺良恶性病变的 ROC 曲线下面积(AUC)分别为0.919、0.928、0.940、0.969;ADCW-min与ADCW-mean、ADCW-min与ADCmin、ADCW-min与ADCmean、ADCW-mean与ADCmean间的AUC差异具有统计学意义。结论不同 ADC值测量方法对乳腺良恶性病变的鉴别诊断效能存在差异;ADCW-min对乳腺良恶性病变的鉴别诊断价值最大。     

MR cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas

OBJECTIVE: The purpose of this study was to establish MR cholangiopancreatographic criteria for discriminating benign from malignant intraductal mucin-producing tumors of the pancreas. MATERIALS AND METHODS: Thirty-one patients with 34 intraductal mucin-producing tumors underwent MR cholangiopancreatography. Tumors were classified as either main duct type (n = 10) or branch duct type (n = 24). In patients with the main duct type, the maximum diameter and the location of the main pancreatic duct, the extent of main pancreatic duct dilatation, and the presence of a filling defect were evaluated. For branch duct type, the location and maximum diameter of the cystic lesion, the presence of a filling defect, and the presence of associated main pancreatic duct dilatation were evaluated. RESULTS: In patients with the main duct type, the main pancreatic duct was significantly narrower when associated with benign rather than malignant tumors. All malignant tumors showed diffuse main pancreatic duct dilatation, whereas all benign tumors showed segmental dilatation. Among patients with branch duct type, the cyst was smaller when it was a benign rather than malignant tumor. All but one malignant tumor showed mild associated main pancreatic duct dilatation, whereas benign tumors were not associated with main pancreatic duct dilatation. Filling defects suggested malignancy, although half of the malignant tumors had no filling defects. CONCLUSION: In patients with intraductal mucin-producing tumors of the pancreas, filling defects are indicative of malignancy. Diffuse main pancreatic duct dilatation greater than 15 mm (main duct type), or any main pancreatic duct dilatation (branch duct type), is strongly associated with malignancy.     

Intraductal papillary mucinous neoplasms of the pancreas: Correlation of helical CT features with pathologic findings

Objective

To evaluate the CT features of intraductal papillary mucinous neoplasms of the pancreas (IPMNs), and to compare with pathological findings in order to identify CT features that can be helpful in differentiating benign IPMNs from malignant IPMNs.

Materials and methods

The CT findings in 25 patients were reviewed for tumor location, tumor type, dilatation of the main pancreatic duct (MPD), MPD involvement, mural node or solid attenuating component, tumor size in branch duct or mixed duct type, dilatation of common bile duct (CBD) and invasion of surrounding structures. The data was subjected to Chi-Square Tests or Fisher's Exact Test using SPSS13.0 software with p value < 0.05 indicating significant statistical difference.

Results

Presence of mural node or solid enhancing component, size of mural node or solid enhancing component ≥7 mm, dilatation of CBD was more common in malignant IPMNs (p < 0.05). None of tumor location, tumor type, dilatation of MPD, MPD involvement, tumor size, and invasion of surrounding structures was statistically significant in differentiating benign from malignant IPMNs.

Conclusions

CT features suggestive of malignant or invasive IPMNs include presence of mural node or solid enhancing component, size of mural node or solid enhancing component ≥7 mm, and dilatation of CBD.     

Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time

Purpose

The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI).

Materials and methods

A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months. Median follow-up was 25.8 months (range, 12–217). Patients with a follow-up period shorter than 12 months (n=33) and those with a diagnosis of multifocal IPMN of the side branches without any follow-up (n=14) were excluded from the study. The final study population thus comprised 108 patients. A double, quantitative and qualitative, analysis was carried out. The quantitative image analysis included: number of dilated side branches in the head-uncinate process and body-tail; maximum diameter of lesions in the head-uncinate process; maximum diameter in the body-tail; maximum diameter of the main pancreatic duct in the head and body-tail. The qualitative image analysis included: presence of malformations or anatomical variants of the pancreatic ductal system; site of the lesions (head-uncinate process, body-tail, ubiquitous, bridge morphology); presence of gravity-dependent intraluminal filling defects; presence of enhancing mural nodules.

Results

At diagnosis, the mean number of cystic lesions of the side branches was 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean diameter of the main pancreatic duct was 3.6 mm. At follow-up, the mean number of cystic lesions was 7.76. The mean diameter of the cystic lesions was 13.9 mm. The mean diameter of the main pancreatic duct was 3.7 mm. Intraluminal filling defects in the side branches were seen in 18/108 patients (16.6%); enhancing mural nodules were seen in 3/108 patients (2.7%).

Conclusions

Multifocal IPMN of the branch ducts shows a very slow growth and evolution over time. In our study, only 3/108 patients showed mural nodules which, however, did not require any surgical procedure, indicating that careful nonoperative management may be safe and effective in asymptomatic patients.     

MRCP 3D FRFSE系列对良恶性胰胆管梗阻的诊断价值

目的探讨三维快速恢复快速回波脉冲系列磁共振胰胆管水成像(MRCP 3D FRFSE)对良恶性胰胆管梗阻的临床应用价值。方法对106例临床疑有胰胆管梗阻患者行MRCP 3D FRFSE系列检查,2位高年资放射科医师前瞻性分析图像,结果与手术病理或临床随访结果比较。结果106例MRCP检查均一次性成功,肝内外胆管显示率为100%,主胰管显示率为93.4%,其中80例良性梗阻包括肝内外胆管结石66例,乳头炎6例,十二指肠降段憩室炎2例,十二指肠腺瘤样增生1例,慢性胰腺炎5例;26例恶性梗阻包括肝外胆管癌9例,壶腹癌5例,胆囊癌4例,胰头癌8例。MRCP对胰胆管梗阻的定位诊断准确率为100%,在区分良恶性梗阻中,敏感性92.3%,特异性96.3%,准确性95.3%。结论3D FRFSE系列的MRCP是区分良恶性胰胆道梗阻病变较为理想的技术,在临床上有较大的应用价值。     

Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP

PURPOSE: To retrospectively compare accuracy of multi-detector row computed tomography (CT), combined with two-dimensional (2D) curved reformations, and that of magnetic resonance (MR) cholangiopancreatography (MRCP) for characterization of intraductal papillary mucinous neoplasm (IPMN) as malignant, with pathologic examination as reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was waived, and study was HIPAA compliant. Twenty-five patients (12 women, 13 men; age range, 44-88 years) with pathologically proved IPMN were examined with dual-phase CT with 1.25-mm-thick sections for pancreatic phase; 2D curved reformations along main pancreatic duct (MPD) were generated. T2-weighted MRCP included thick- and thin-slab single-shot fast spin-echo imaging and transverse fast spin-echo imaging. Two radiologists, blinded to surgical and pathologic findings, evaluated images for lesion location, septa, mural nodules, communication with MPD, extent and diameter of MPD dilatation, calcifications, and vascular encasement. Malignancy was suspected when one of the following was present: MPD diameter larger than 10 mm, mural nodules, vascular encasement, peripancreatic lymphadenopathy, or metastases. Sensitivity and specificity values for prediction of malignancy were calculated for CT and MRCP. Interobserver variability was determined (kappa analysis). RESULTS: Excellent correlation between modalities was observed. Cyst communication was seen in 20 and 21 of 24 branch pancreatic duct (BPD) IPMNs with CT and MRCP, respectively. Sensitivity, specificity, and accuracy for detection of malignancy were 70%, 87%, and 76% (CT) and 70%, 92%, and 80% (MRCP), respectively. Interobserver agreement was good to perfect for both readers in all comparisons (overall, kappa = 0.70-1.00). CONCLUSION: CT combined with 2D curved reformation can provide imaging details of IPMN, including communication of BPD IPMN with MPD, that are almost equivalent to those provided at MRCP. Presence of mural nodules, dilated MPD (>10-mm diameter), or thick septa at CT or MRCP may be used as independent predictors of malignancy.     

A Case of a gastropancreatic fistula in the setting of intraductal papillary mucinous neoplasms

Intraductal papillary mucinous neoplasms (IPMN) are mucin producing tumors which arise from epithelial cells of the main pancreatic duct, pancreatic branch ducts, or both. They are characterized by mucin-producing columnar cells, papillary ductal proliferation, cyst formation, and varying degrees of dysplasia. IPMNs are classified as main duct or branch duct based upon the pancreatic duct anatomy which the IPMN is arising from. Additionally, they can be classified based on their histologic subtypes, which carry varying associations with dysplasia and/or malignancy. Many patients have incidentally identified IPMNs, which are asymptomatic. However, patients may also present with pancreatitis, elevation of liver enzymes, dilation of the pancreatic duct or bile duct as well as distention of the ampullary pancreatic orifice(s), due to impaction and obstruction with mucus. This is known as an endoscopically visualized “fish eye” sign. Patients may also develop exocrine and endocrine pancreatic insufficiency and maldigestion. Some studies also suggest that patients with IPMNs may also be at increased risk for gastric, colorectal, biliary, renal cell, and thyroid malignancies. Rarely, IPMNs can be complicated by fistulation between the main pancreatic duct and neighboring organs. Herein, we present an unusual case of simultaneous fistulation to both the gastric body and the duodenum.     

磁共振成像技术对胰腺导管内乳头状黏液瘤的诊断价值

目的探讨胰腺导管内乳头状黏液瘤的MRI影像学特点,以提高该病的诊断准确率。方法搜集12例经手术证实的胰腺导管内乳头状黏液瘤患者的临床及影像学资料,回顾性分析主胰管型和分支胰管型的MRI表现。结果研究证实,12例中有主胰管型3例和分支胰管型9例。主胰管型MRI表现为主胰管节段性或弥漫性扩张,可伴有胰腺实质的萎缩;分支胰管型MRI表现为单房或多房型囊性病变,并与主胰管相通。结论 MRI对胰腺导管内乳头状黏液瘤是一种无创、有效的诊断方法,有助于提高该病的诊断准确率。