联合应用CT、MRI增强扫描鉴别诊断胰腺癌与慢性胰腺炎

目的探讨联合应用MSCT和MRI增强扫描在胰腺癌与慢性胰腺炎鉴别诊断价值。方法选择经手术病理证实或临床随访证实的胰腺癌及慢性胰腺炎患者56例。所有患者在手术或随访前均同时行MSCT及MRI增强扫描。由高年资医生观察胰腺MSCT及MRI影像，对其影像学特征进行分析。总结胰腺癌及慢性胰腺炎的影像学特征，统计其在胰腺癌组与慢性胰腺炎组的统计学差异；统计MSCT、MRI及二者组合在胰腺癌和慢性胰腺炎的鉴别诊断上的统计学差异。结果胰腺体积增大、胰腺周围组织及大血管的侵犯、胰腺周围淋巴结肿大、动脉期强化不明显、胰胆管不规则扩张等多见于胰腺癌；病变内及病变周围囊肿、病变钙化、胰胆管平滑状扩张多见于慢性胰腺炎。以上征象在胰腺癌组与慢性胰腺炎组间均存在明显统计学差异（P〈0．05）。应用各种MSCT和MRI影像学方法综合鉴别诊断胰腺癌和慢性胰腺炎，其诊断准确度均优于任何以上单一影像学技术（P〈0．05）；而MSCT增强扫描和MRI增强扫描在胰腺癌和慢性胰腺炎的鉴别诊断上，诊断准确度未见明显差异（P〉0．05）。结论MSCT和MRI增强扫描联合应用在胰腺癌与慢性胰腺炎的鉴别诊断上，具有突出的临床应用价值。

Differential diagnosis between pancreatic cancer and chronic pancreatitis by enhanced scanning of both CT and MRI

Objective： To evaluate the value of combined application of enhanced scanning of both MSCT and MRI in differential diagnosis between pancreatic cancer and chronic pancreatitis. Materials and Methods： Enhanced scanning images of both MSCT and MR/of pancreatic cancer in 31 cases and chronic pancreatitis in 25 cases were analyzed retrospectively. The image features of both pancreatic cancer and chronic pancreatitis were sumerized, and the differences of image features between pancreatic cancer and chronic pancreatitis were stated. The differences in differential diagnosis between Pancreatic Cancer and Chronic Pancreatitis by MSCT, MRI respectively, or both MSCT and MRI were also stated. Results： Volume of tumor, infiltration into blood vessel or tissue nearby, intumescent lymph node, scarcely-enhanced mode of tumor and irregular distention of chol-pancreatic duct were relative to pancreatic cancer. Cyst in tumor or nearby, calcification in tumor and smooth distention of chol-pancreatic duct were relative to chronic pancreatitis. There were significant differences in the signals above between pancreatic cancer and chronic pancreatitis （P〈0.05）. The accuracy in distinguishing pancreatic cancer from chronic pancreatitis by both MSCT and MRI was higher than that by MSCT or MRI respectively （P〈0.05）. There were not differnces in diagnosing pancreatic cancer from chronic pancreatitis either by MSCT or by MRI （P〉0.05）. Conclusion： It was useful to distinguish pancreatic cancer from chronic pancreatitis by combined application of enhanced scanning of both MSCT and MRI.