自身免疫性胰腺炎的CT诊断

目的 探讨自身免疫性胰腺炎(ALP)的CT表现.方法 回顾性分析6例AIP患者的临床资料,5例行螺旋CT平扫 增强扫描,其中3例患者行CT延迟扫描,其中的1例患者与另1例患者行PET/CT检查;从胰腺形态、大小、强化形式、胰管、胆总管、胰周及腹膜后间隙分析CT表现.结果 66.7%(4/6例)AIP表现为胰腺弥漫增大,33.3%(2/6例)表现为胰腺局限性增大;66.7%(4/6例)可见"鞘膜"征;100%(5/5例)增强扫描呈门脉期和延迟期均匀强化;100%(6/6例)有主胰管狭窄;33.3%(2/6例)可见胆总管胰头段狭窄致低位胆道梗阻;33.3%(2/6例)伴淋巴结肿大.2例(100%)PET/CT提示病变摄取增高.结论 自身免疫性胰腺炎具有典型的CT表现,能够明确诊断,避免不必要的手术.动脉期、门脉期及延迟期增强CT扫描对其诊断具有重要价值.

CT diagnosis of autoimmune pancreatitis

Objective To investigate the CT imaging findings of autoimmune pancreatitis (AIP). Methods The clinical data of 6 AIP patients were retrospectively reviewed. Plain CT and contrast-enhanced dual phase CT scan were performed for 5 patients. Delayed enhanced CT scan were performed for 3 of the 5 patients. PET-CT scan were performed for 1 of the 5 patients and another patient. All imaging data was reviewed, focusing on the shape, size, parenchyma density and enhancement patterns of the pancreas, as well as the biliary and pancreatic ducts, pancreatic fat, vessels, retroperitoneal spaces, lymph nodes. Results 66.7% (4/6) of the patients showed diffuse swelling of the pancreas on CT and 33.3% (2/6) had focal enlargement of pancreatic body and tail. 66.7% (4/6) of the patients showed capsule-like rim around the pancreatic parenchyma. Swelled pancreas showed homogeneous enhancement on portal venous or delayed phase images in all 5 patients. CT revealed pancreatic duct strictures in all patients and distal common bile duct stricture in 33.3% (2/6) of the patients. Lymphadenopathy was seen in 33.3% (2/6) of the patients. All 2 patients showed intense uptake of swelling pancreas on PET/CT. Conclusion The typical CT imaging features of AIP is helpful for the diagnosis of AIP and can avoid unnecessary operation. Contrast-enhanced CT scan at arterial, portal venous and delayed phases do an important role in diagnosis of AIP.