胰腺导管内乳头状黏液性肿瘤的CT诊断价值

目的:探讨胰腺导管内乳头状黏液性肿瘤的螺旋CT诊断价值.方法:回顾性分析50例经手术切除和病理学证实的胰腺导管内乳头状黏液性肿瘤的临床、CT等影像学资料,其中男34例,女16例,年龄32～87岁,平均61岁.结果:50例IPMN患者多发于老年人,年龄大于60岁28例(56%),临床主要表现为腹痛和(或)胰腺炎.CT诊断主胰管型20例(35.7%),分支胰管型21例(25%),混合型9例(39.3%);术后病理示胰腺导管内乳头状黏液性瘤28例,胰腺交界性导管内乳头状黏液瘤5例,胰腺导管内乳头状黏液性癌9例,胰腺浸润性导管内乳头状黏液癌8例.22例胰腺导管内乳头状黏液性癌中,其中3例胰腺钙化,3例伴有淋巴结转移,5例侵犯血管,2例肝脏转移.恶性的IPMN常发生在混合型和主胰管型中(n=14),而分支型多为良性肿瘤(n=18).结论:胰腺导管内乳头状黏液性肿瘤有相对特征性的影像学表现,CT对IPMN的诊断、分型和恶变预测具有重要的临床应用价值.

Diagnostic Value of CT for Intraductal Papillary Mucinous Neoplasm of the Pancreas

Purpose: To evaluate the role of spiral CT in diagnosis of intraductal papillary mucinous neoplasm(IPMN) of pancreas.Methods: A total of 50 patients (age range, 32 - 87 years, mean age, 61 years) with histopathologically proved IPMN were enrolled in the study, including 34 men and 16 wom-en. The clinical manifestation and the CT apperances of them were analyzed. Results:Among the total 50 patients with IPMN, most(n = 28,5696)were elderly(> 60 years). The primary symptoms were abdominal pain with or without pancreatitis.As the results of CT exam, 20(35.79%) cases were interpretated as IPMN of the main pancreatic duct(MPD);21(25%)as IPMN of the side branches; and 9(39.3%) as IPMN of the both the MPD and the side branches(mixed type). As the results of histopathologic examination of the surgical specimen, 28 of the 50 IPMN were classified as adenomas, 5 were classified as borderline tumors, 9 were classified as carcinomas, and 8 were classified as carcinomas with invasion. Of the 22 malignant(borderline and carcinomas) IPMN, 3 had pancreatic calcification, 3 had lymph metastasis, 5 had capillary invasion, and 2 had liver metastasis. The malignant IPMN mainly occured in MPD or mixed type(n = 14), whereas side branch IPMN were mostly benign (n = 18). Conclusion: CT is of great value in diagnosing, classifying and predicting malignancy of IPMN.