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Imaging Features of Computed Tomography of Non-benign Intraductal Papillary Mucinous Neoplasm of Pancreas
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摘要:
目的 探讨非良性胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm, IPMN)计算机断层摄影(computed tomography, CT)典型影像学表现, 分析IPMN影像与病理表现的一致性。 方法 回顾性分析2008年5月至2011年2月本院收治的12例经手术病理证实为交界性胰腺IPMN或胰腺导管内乳头状黏液癌(intraducted papillary mucinous carcinoma, IPMC)患者的术前CT影像(腹平扫+增强+三维重建), 并与其术后病理结果进行对照。 结果 术后病理证实的12例非良性胰腺IPMN患者中4例为交界性IPMN, 2例为非浸润性IPMC, 6例为浸润性IPMC。IPMN患者临床表现腹痛无特异性, 而体重减轻、黄疸和糖尿病主要见于浸润性IPMC。恶性IPMN的CT分型多为主胰管型(3例)或混合型(4例), 分支胰管型较少(1例)。IPMN患者常见CT表现包括胰腺内囊性病变形成、胰管扩张、胰腺钙化、实质萎缩等, 其中囊内密度增高和壁结节等在交界性病变和恶性病变中均存在, 胰管扩张程度与病变恶性程度呈正相关, 而壁结节直径与病变恶性程度无明显相关性。恶性病变囊内容物的CT值一般高于交界性病变, 且多表现为不均匀高密度。浸润性IPMC患者中50%有周围组织受累, 其CT表现和病理结果完全吻合。CT显示胆总管明显增宽的病变仅见于浸润性IPMC患者。 结论 多排螺旋CT对非良性胰腺IPMN的术前诊断价值较高, 与病理结果的相关性较好, 对于IPMN病变恶性程度预测及周围组织受累判断的准确度较高, 可为临床诊断和手术方式选择提供良好的支持。 -
关键词:
- 非良性，胰腺导管内乳头状黏液瘤 /
- 断层摄影术，X线计算机
Abstract:Objective To evaluate the imaging features of computed tomography (CT) of non-benign intraductal papillary mucinous neoplasm (IPMN) of pancreas, and to explore the correlation between radiological and pathological finding. Methods CT images of 12 patients who were pathologically diagnosed as non-benign IPMN of pancreas between May, 2008 and February, 2011 in Peking Union Medical College Hospital were retrospectively evaluated. Their pre-surgery CT images were reviewed by 2 experienced radiologists, and the radiopathological results were compared to evaluate the diagnostic value of CT techniques. Results Of these 12 patients, 4 were pathologically proved as borderline IPMN, 2 as non-invasive intraductal papillary mucinous carci-noma (IPMC), and 6 as invasive IPMC. The clinical manifestations including weight loss, jaundice and diabetes suggested malignancy, while abdominal discomfort or pain has no specificity. IPMN were divided into 3 types according to CT classification, namely main pancreatic duct type, branch pancreatic duct type and mixed type. The branch duct type were rarely seen in malignant IPMN cases. The common radiological features of IPMN included pancreatic duct dilation or large cysts formation (with septa or focal nodules inside), pancreatic parenchymal calcification and atropy, which were seen in both borderline IPMN and IPMC. However, for malignant cases, the pancreatic duct dilation were much severer; CT values in the dilated pancreatic ducts were higher, and showed a heterogeneity within the duct. Common bile duct dilation were seen in invasive IPMC only. Conclusions Multi-slice spiral CT is valuable in the pre-surgery diagnosis of non-benign IPMN, and shows a good agreements with pathological results. The CT features of IPMN lesions can predict the degree of malignancy and the involvement of surrounding tissues at a favorable accuracy, and therefore provides useful information for clinical diagnosis and decision for surgery. -
图 1 浸润性IPMC典型镜下表现:上皮重度不典型增生，呈复层结构，有乳头结构形成(粗箭头)，上皮细胞极性紊乱，异型性明显，细胞核大、色深染、核仁突出，核分裂相易见; 间质内可见巢样肿瘤上皮(细箭头); 间质纤维化，大量炎性细胞浸润
IPMC:同表 1
图 3 67岁，男性，腹部不适、体重减轻4个月，发现胰头占位1个月，病理诊断为浸润性IPMC
CT分型为混合型; CT曲面重建图像示: A.胰头葡萄串样多房囊性病变(粗箭头)，囊壁厚，分隔可见强化(细箭头); B.主胰管明显扩张(箭头); C. “满天星”样散在细小钙化(箭头)
IPMC:同表 1
图 4 53岁，男性，左中腹隐痛3个月，病理诊断为交界性IPMN
CT分型为分支胰管型; CT曲面重建示: A.胰头葡萄串样多囊性病变，部分区域囊壁较厚; B.横断面平扫期图像可见囊壁上微小钙化点
IPMN:同表 1
图 5 66岁，女性，口渴、多饮、多尿、血糖升高5个月，发现胰腺占位3周，病理诊断为浸润性IPMC
CT分型为主胰管型; CT曲面重建示: A.胰头部大浸润性肿块，密度不均，与十二指肠肠壁融合; 十二指肠乳头明显增大(白箭头); 胰头部位正常胰腺组织已不可见，肿物后方主胰管全程扩张; B.胆总管下端狭窄，狭窄以上胆总管及肝内胆管扩张，胆囊增大，张力高; 可见鸟嘴样狭窄的胆总管下段，其远端明显扩张，伴肝内胆管扩张(黑箭头)
IPMC:同表 1
图 6 55岁，男性，病理诊断为浸润性IPMC
CT分型为混合型; CT曲面重建图像可见钩突部位分支胰管高度扩张迂曲，横断面CT类似多房囊性病变; 主胰管增宽，病变部位胰腺实质强化减低; 扩张的胰管和十二指肠乳头相通，但乳头形态尚可(白箭头)
IPMN:同表 1
图 7 67岁，男性，病理诊断为浸润性IPMC
CT分型为混合型:横断面CT示胰头葡萄串样多房囊性病变，囊壁厚，主胰管扩张，CT重建图像则更好地显示细节，可以看出“囊样病变”是胰头及钩突部位主胰管迂曲扩张形成(右上箭头)，以及数条扩张的分支胰管呈蟹爪样(左下箭头)
IPMN:同表 1表 1 12例胰腺导管内乳头状黏液瘤患者的临床资料及病理诊断
患者编号 性别/年龄 病理诊断 临床表现 病变部位 CT分型 无症状查体发现 腹痛 黄疸 体重减轻 糖尿病 胰腺炎 1 F/57 交界性IPMN - + - + - + 胰体 混合型 2 M/54 交界性IPMN + - - - - - 胰体 主胰管型 3 M/53 交界性IPMN - + - - - - 钩突 分支胰管型 4 M/57 浸润性IPMC - + + + + + 胰头 主胰管型 5 F/72 浸润性IPMC - + - + - + 胰体尾 混合型 6 M/55 浸润性IPMC - + - - + - 钩突 混合型 7 M/63 非浸润性IPMC - + - - - + 胰体尾 混合型 8 M/58 非浸润性IPMC - - - - - - 胰头颈 分支胰管型 9 F/66 浸润性IPMC + - - + + + 胰头 主胰管型 10 M/39 交界性IPMN - + - - - - 胰头 分支胰管型 11 M/66 浸润性IPMC - - + + + + 胰头 主胰管型 12 M/67 浸润性IPMC - - - + - + 胰头 混合型 IPMN:导管内乳头状黏液瘤; IPMC:导管内乳头状黏液癌 
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