胰头癌与胰头慢性胰腺炎的MR诊断与鉴别诊断

目的探讨胰头癌及胰头慢性胰腺炎的MR诊断与鉴别诊断。方法回顾性分析24例胰头癌及3例胰头慢性胰腺炎的MR表现。全部27例病人均行常规及压脂SET1WI序列、常规及压脂FSET2WI序列扫描。8例胰头癌及3例胰头慢性炎症患者行压脂SET1WI序列增强扫描。T2WI序列发现胰管扩张时行MRCP共24例,其中胰头癌23例,慢性胰腺炎1例。结果24例胰头癌于常规SET1WI序列呈低(n=8)或稍低(n=16)信号,于常规FSET2WI序列可表现为高(n=8)、稍高(n=5)、等(n=10)或低(n=1)信号,于压脂FSET2WI序列可表现为高(n=11)、等(n=11)或稍低(n=2)信号,于压脂SET1WI序列均呈低信号。23例胰头癌于MRCP均可见典型的“双管征”、胆总管扩张及远端截断。8例胰头癌无明显强化。3例胰头慢性胰腺炎于常规SET1WI序列呈稍低或等信号,于常规FSET2WI序列均呈高信号。2例于压脂SET1WI及FSET2WI序列分别呈等信号及稍高信号,另1例则分别呈低信号及混杂信号,MRCP可见胆总管轻度扩张伴胰管近端不规则扩张。3例慢性胰炎均呈不同程度强化。结论胰头癌与胰头慢性胰腺炎均于多个序列表现出信号的多样性,均可见异常强化,绝大多数胰头癌及部分胰头慢性胰腺炎有异常的MRCP表现。联合使用多种序列特别是平扫及增强压脂SET1WI序列及MRCP,可能鉴别胰头癌与胰头慢

Pancreatic Head Carcinoma Versus Chronic Pancreatitis of Pancreatic Head: MR Imaging

Objective: To evaluate the manifestation of pancreatic head carcinoma and chronic pancreatitis of pancreatic head on magnetic resonance (MR) imaging and to determine whether MR imaging can distinguish the two diseases. Methods: A retrospective review of MR findings was performed for 24 patients with pancreatic head carcinoma and 3 patients with chronic pancreatitis of pancreatic head. SE T1WI and FSE T2WI sequences with and without fat suppression were performed on all 27 cases. Enhanced SE T1WI with fat suppression was performed on 8 patients with carcinomas and 3 patients with pancreatitis, respectively. When dilatation of the pancreatic and/or biliary ducts was noted on T2WI sequence, MRCP were performed on 23 patients with carcinoma and 1 patient with pancreatitis, respectively. Results: Cases of carcinoma presented hypointensity (n=8) or mild hypointensity (n=16) on conventional SE T1WI, hyperintensity (n=8), mild hyperintensity (n=5), isointensity (n=10) or hypointensity (n=1) on conventional FSE T2WI, hyperintensity (n=11), isointensity (n=11) or mild hypointensity (n=2) on FSE T2WI with fat suppression, and hypointensity (n=24) on fat-suppressed SE T1WI. MRCP demonstrated typical double duct sign and abrupt interruption at distal segment of dilated common bile duct. All 8 patients with carcinoma showed little enhancement. All 3 patients with chronic pancreatitis showed mild hypointensity or iosintensity on conventional SE T1WI and hyperintensity on conventional FSE T2WI sequences, respectively. Two patients showed isointensity and mild hyperintensity on fat-suppressed SE T1WI and FSE T2WI sequences, respectively. The remaining patient showed hypointensity and heterogeneous intensity on fat-suppressed SE T1WI and FSE T2WI sequences respectively and a mild dilated common biliary duct with irregularly dilated proximal pancreatic duct on MRCP. All 3 patients with chronic pancreatitis showed various enhancements. Conclusion: Both pancreatic head carcinoma and chronic pancreatitis show various signals on various sequences and abnormal pancreatic enhancement pattern and most cases of pancreatic head carcinoma and some cases of chronic pancreatitis show abnormal MRCP appearances. With the combined use of multiple sequences, especially precontrast and postcontrast SE T1WI FS and MRCP, pancreatic head carcinoma and chronic pancreatitis of pancreatic head may be distinguished from each other.