胰腺腺泡细胞癌的CT及MRI表现

目的 分析胰腺腺泡细胞癌（PACC）的CT及MRI影像表现旨在提高术前诊断水平。 方法 回顾性收集经病理确诊的11例PACC病人的CT（5例）或MRI（6例）影像资料,分析其特征性表现。 结果 实验室检查3例甲胎蛋白（AFP）升高,4例糖类抗原19-9（CA19-9）升高。CT和MRI影像上,11例均为单发,8例为实性,3例为囊实性;6例病灶位于胰头部,5例位于胰体尾;病灶平均最大径为（5.69±3.53） cm。增强扫描后,病灶多呈不均匀渐进式强化（CT 4例,MRI 5例）,少数表现为延迟期强化程度略减低（CT和MRI各1例）。10例病灶与正常胰腺组织进行了比较,动脉期强化程度均低于胰腺组织,延迟期强化程度可降低（CT 上3例,MRI 上1例）或升高（CT上 1例,MRI上 5例）。PACC病灶外常见包膜（8/11例）;病灶内多见囊变坏死（8/11例）,少数可见钙化（1/11例）。病灶可伴有胆管、胰管同时扩张,或仅见胰管扩张,也可伴胰腺实质萎缩;可侵犯肠系膜上动静脉、脾动静脉,少数可累及十二指肠、邻近胃壁及肾上腺。部分病人伴有淋巴结或远处转移。 结论 PACC的实验室检查及影像表现具有一定特征性,CT及MRI对该病的术前诊断具有一定价值。

CT and MRI features of pancreatic acinar cell carcinoma

Objective To analyze the CT and MRI features of pancreatic acinar cell carcinoma(PACC) and to improve the preoperative diagnosis. Methods The CT (n=5) or MRI (n=6) data of 11 patients with pathologically confirmed pancreatic acinar cell carcinoma were retrospectively reviewed. The characteristic radiological manifestations were summarized and analyzed. Results Laboratory tests showed AFP was increased in 3 cases and CA19-9 was increased in 4 cases. CT and MR images showed single lesion in all 11 cases, 8 lesions were solid, and 3 were cystic solid; 6 located in the head of the pancreas, and 5 in the body or tail. The maximum diameter was 5.69±3.53 cm. After the injection of contrast agent, most of the lesions showed a progressively inhomogeneous enhancement (4 cases on CT, 5 cases on MRI), and the enhancement of the remaining lesions were slightly decreased in the delayed phase (1 case each on CT and MRI). Comparing with normal pancreatic parenchyma, the enhancement of 10 lesions was less than that of pancreatic parenchyma in the arterial phase, and could be decreased (3 cases on CT, 1 case on MRI) or increased (1 case on CT, 5 cases on MRI) in the delayed phase. Capsule (8/11) and cystic necrosis (8/11) were commonly seen, and calcification was occasionally seen (1/11 cases). Dilatation of bile duct and/or pancreatic duct, atrophy of pancreatic parenchyma, involvements of the superior mesenteric artery and vein, splenic artery and vein, duodenum, adjacent gastric wall, and adrenal gland, lymph node metastasis or distant metastasis could be presented in some patients. Conclusion The laboratory examination and imaging findings of PACC are characteristic. CT and MRI examination are valuable in the accurate diagnosis.