胰腺导管内乳头状黏液癌：动态增强CT、MR表现及其病理基础

目的：探讨胰腺导管内乳头状黏液性癌（IPMC）的MSCT、MR表现及诊断价值。材料和方法：经手术病理证实的IPMC 9例，术前均经多排螺旋CT平扫和增强扫描，5例行MR平扫和增强扫描，复习扫描结果并和手术病理作回顾性对照分析。结果：9例患者中主胰管型5例，表现为主胰管明显扩张，多数见管壁结节，CT呈稍高密度，MRI为稍长T1长T2信号，不均匀，胰管内呈长T1长T2信号；分支胰管型3例，表现为分叶状单发囊性或多发囊性病变，腔内见分隔及结节样突起或肿块，CT呈稍高密度，MRI为稍长T1长T2信号，2例CT MPR图像及MRCP显示病灶与主胰管相通；混合型1例，表现为囊状病灶，内有附壁结节，合并主胰管扩张，囊内为长T1长T2信号。6例病灶主胰管不同程度扩张（4～45mm），6例胰腺不同程度萎缩，3例显示十二指肠乳头膨大，2例见不规则点状钙化。增强扫描分隔强化较明显，附壁结节强化稍弱且不均匀。结论：MSCT薄层扫描及MRI对IPMC诊断价值较大，结合MPR、CPR、MRCP能够显示胰腺IPMC的病理特征，有利于显示较小结节及胰管改变，结合其临床特征，多数病例可与胰腺导管内良性乳头状黏液性肿瘤鉴别。

Dynamic CT and MR in the diagnosing intraductal papillary mucinous carcinoma of the pancreas and correlation with pathology

Objective： To explore the clinical value of MSCT and MRI findings in the diagnosing intraductal papillary mucinous carcinoma of the pancreas. Materials and Methods： Nine cases of intraductal papillary mucinous carcinoma of the pancreas underwent plain and contrast MSCT and among these 5 cases had plain and contrast MRI scanning. All cases were confirmed by surgical and pathology. The CT and MRI data were reviewed and analysed retrospectively and correlated with surgical and pathologic results. Results： Among the 9 cases, 5 cases were of the main duct type, showed obvious dilation of the main duct of the pancreas, most cases with mural nodules in the duct, which showed high density on CT and inhomogeneous long T1 nad long T2 signal on MRI, the main duct showed long T1 and long T2 signal. Three cases were of the branch-duct type, showed solitary or multiple cystic lesions with septum or nodules within the duct, CT showed high density, MRI showed long T1 long T2 signal. Two cases showed the lesion linked with the main duct. One case belonged to the mixed type showed solitary cystic lesion with nodules in the duct, together with dilation of the main duct, the lesion showed long T1 and long T2 signal. Six cases showed dilation of the main duct （4～45mm）. Six cases showed atrophy of the pancreas, 3 cases with dilation of the duodenal papilla, 2 cases with irregular calcifications. After injection of contrast medium the intracystic septum was markedly enhanced and the mural nodules within the duct were mildly enhanced. Conclusion： Dynamic thin slice MSCT with MPR, CPR and MRI with MRCP have important value in diagnosing intraductal papillary mucinous carcinoma of the pancreas, small nodules can be showed clearly, and correlated well with pathologic findings. Connected with clinical signs, most cases can be distinguished from benign intraductal papillary mucinous neoplasms of the pancreas.