胰腺囊性良恶性病变的CT诊断

目的分析胰腺囊性病变的CT表现, 提高胰腺病变的CT诊断准确率。方法 回顾分析经手术、病理证实的22例胰腺囊性病变的CT表现。螺旋CT机为TOSHIBA Aquilion 16多层螺旋CT机, 采用平扫和双期(动脉期, 门静脉期)增强扫描, 层厚7.0mm, 螺距1.0, 非离子型碘对比剂总量100mL, 注射流率3mL/s, 动脉、门脉期扫描分别为30s和70s。结果 胰腺假性囊肿12例, 平扫为囊状水样密度影, 增强扫描囊壁轻度强化, 内无分隔。胰腺脓肿4例, 平扫为类圆形液性密度, CT值为24Hu左右, 内见小气泡影, 增强扫描囊壁呈环形明显强化。胰腺囊腺瘤4例, 平扫为类圆形的水样或肌肉样密度影, 增强扫描囊壁分隔及壁结节呈不规则强化, 囊壁厚度＜2mm。胰腺囊腺癌2例, 平扫呈囊状水样密度及壁结节, 其内有分隔, 增强扫描囊壁、壁结节及分隔可见不规则明显强化, 囊壁厚度＞2mm, 1例伴有肝内转移及腹膜后淋巴结转移。结论 胰腺囊性病变有各自的CT特征, 但相似之处较多, 结合临床病史、必要时密切随访加以鉴别, 可提高胰腺病变的CT诊断准确率。

CT diagnosis of cystic benign and malignant lesions of pancreas

To analyze the CT findings of cystic lesions of pancreas. Methods CT findings of 22 patients with pathologically - proved pancreatic cystic lesions were analyzed retrospectively. Results In 12 cases with pseudocyst which showed watery density in plain CT scanning and mild enhancement in capsule wall and without septa in the cysts. Four pancreatic abscess demonstrated round - like shape and hyperattenuation in density and marked ring - form enhancement after contrast injection. Other sign including little bubbles in some lesions. Four cases were cystadenoma of pancreas manifested round - like in shape with watery or muscle density and irregular nodular or capsule wall enhancement after contrast injection,the thickness of capsule wall less than 2 mm. Two cystadenocarcinomas manifested cyst with wall nodule, internal septa and watery density in plain scans ,the wall nodule and septa enhanced irregularly in the postcontrast images and the wail of cyst larger than 2 mm, one case of which metastased in liver and retroperitoneal lymph node. Conclusion Pancreatic cystic lesions have its individual features in CT scans but with similar manifests sometimes, combining patients＇ medical history and follow up CT scanning are helpful in improving CT diagnostic accuracy.