胰腺脂肪增多症的CT表现及临床分析

目的 探讨胰腺脂肪增多症的CT表现及临床意义。方法 回顾性分析12例胰腺脂肪增多症的CT表现,重点观察胰腺的形态及大小、脂肪替代的部位及范围、腺小叶及小叶间隔、主胰管的显示情况,结合临床资料及其超声、MR及相关检验结果,分析其临床意义。结果 胰腺形态正常或稍饱满者8例。胰腺各部弥漫性密度降低者5例,CT表现为腺体大部分被脂肪密度代替,显示低密度,CT值为-85.0～-95.0HU,边缘呈分叶状、颗粒状、沟深,腺小叶间隔增大,主胰管无扩张;以胰头为主局限性密度降低者7例,CT表现为胰头形态饱满,局部向外略凸4例,显示局限性低密度,CT值为-75.0～-85.0HU。胰腺体积缩小者4例,均为高龄患者,继发性胰管轻度扩张。反复腹泻半年以上10例,合并糖尿病6例,胆管结石3例,十二指肠憩室炎并轻度黄疸1例。本组病例经抗炎及对症治疗后症状减轻者8例,但腹泻反复者3例,治疗无效者4例。结论 由于脂肪组织的CT值为负值,胰腺脂肪增多症的CT表现具有较高的特征性,在临床上常表现为胰腺外分泌功能不足,结合相关检查可对该病做出定性诊断。

CT manifestation and clinical analysis of pancreatic lipomatosis

Objective To investigate the CT manifestation and clinical significance of pancreatic lipomatosis. Methods A retrospective analysis of CT manifestation of pancreatic lipomatosis in 12 patients was performed, which focused on the changes of the shape and size of the pancreas, fat alternative location and range, the display of gland lobule, interlobular septa and main pancreatic duct, and comparative analysis of the results with ultrasound. MR and related tests were also performed. Results The shape of pancreas was normal or slightly plump in 8 cases. The density of pancreas was entirely decreased in 5 cases, and glands were mostly replaced by fat-like low density shadow, with CT value-85.0~-95.0 HU. The gland was lobulated in leaf edges, granular, with deep groove and increased gland septa, but without expansion of the main pancreatic duct; density locally decreased mainly in pancreatic head in 7 cases~ Pancreatic head was slightly expanded locally in 4 cases which showed local low density, with CT value-75.0~-85.0 HU. The pancreatic size was reduced in 4 cases, with slightly secondary pancreatic duct expansion, who were all old patients. Repeated diarrhea more than six months was found in 10 cases, 6 cases were accompanied by diabetes, three cases with gallstones, and one case with duodenal diverticulitis and slight obstructive jaundice. Eight cases got better after treatment with antibiotics and other drugs, but 3 cases got repeated diarrhea, and 4 cases with invalid treatment. Conclusion CT findings of pancreatic lipomatosis are high specific because the CT value of fat is negative, and the clinical manifestation is insufficiency of pancreatic endocrine function. So together with relevant examination, CT manifestation could provide support for the confirmed diagnosis for pancreatic lipomatosis.