胰腺实性假乳头状瘤的CT表现及鉴别诊断

目的 探讨胰腺实性假乳头状瘤（SPTP）的CT表现,提高对该病的诊断水平.方法 回顾性分析11例经手术和病理证实SPTP患者的临床资料及CT表现.结果 11例患者中,9例CT诊断结果与术后病理结果相符,术前诊断准确率82％;肿瘤均为单发灶,胰头5例、胰腺体尾部5例,胰颈部1例;平扫呈囊实性肿块,伴多发钙化灶4例;增强扫描动脉期肿块实性部分轻度强化,门静脉期、平衡期强化程度逐渐明显,但其强化程度均低于正常胰腺组织,肿块囊实性交界部分呈片状相间分布,呈“浮云”征.11例边界清晰,5例可见包膜.瘤体相邻的正常胰腺组织增大伴“杯口征”改变10例,胆总管轻度扩张2例,胰管轻度扩张1例.结论胰腺实性假乳头状瘤相邻的正常胰腺组织增大伴“杯口征”,出现此征象可准确判断肿瘤组织起源于胰腺,结合 SPTP好发于年轻女性及其影像学特征,术前CT检查可做出正确定性诊断与术前准确评估,为临床治疗方案提供重要资料依据.

CT manifestiation and differential diagnosis of solid-pseudopapillary tumor of pancreas

Objective To discuss the CT manifestiation of solid-pseudopapillary tumors of pancreas （SPTP） and to improve the CT diagnostic level of SPTP.Methods Clinical data and CT manifestiation of 11 patients with SPTP proved by surgery and pathology were retrospectively analyzed.Results The CT results of 9 cases were consistent with postoperative pathologic results in all of the patients,the accuracy rate was 82％.Tumors were single,with 5 cases of pancreatic head,5 cases of pancreatic body and tail,1 case of pancreatic neck,cystic solid mass was found with CT scan,4 cases with multiple calcification; mild enhancement was found in the solid parts mass with enhanced scan during arterial period,degree of enhancement became clear during portal venous period and equilibrium period,which was slightly lower than normal pancreatic tissue.Flaky distribution was found with ＂clouds＂ sign in the junction of cystic and solid parts.There were boundaries clear in 11 cases,5 cases with complete envelopes.Nommal pancreatic tissues adjacent to the tumor enlarge with ＂cup mouth＂ sign in 10 cases,2 cases of common bile duct and 1 case of pancreatic duct dilated mildly.Conclusion Normal pancreatic tissues adjacent to solid-pseudopapillary tumor of pancreas are enlarged with ＂cup mouth＂ sign,which can determine accurately the tumors from the pancreas.Preoperative CT examination can provide correct qualitative diagnosis and can provid accurate estimation for clinical treatment.