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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (06) : 367 -375. doi: 10.3877/cma.j.issn.2095-3232.2016.06.007

所属专题： 文献；

临床研究

胰腺囊性肿瘤影像学诊断价值
陈璐1, 余日胜1,†()   
  1. 1. 310009　杭州，浙江大学医学院附属第二医院放射科
  • 收稿日期:2016-09-01 出版日期:2016-12-10
  • 通信作者: 余日胜
  • 基金资助:
    浙江省重点学科创新团队(2013TD06); 浙江省重点研发计划项目(2015C03G2010148)

Diagnostic value of imaging examinations in pancreatic cystic neoplasm

Lu Chen1, Risheng Yu1,†()   

  1. 1. Department of Radiology, the Second Affiliated Hospital, College of Medical Sciences, Zhejiang University, Hangzhou 310009, China
  • Received:2016-09-01 Published:2016-12-10
  • Corresponding author: Risheng Yu
  • About author:
    Corresponding author: Yu Risheng, Email:
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陈璐, 余日胜. 胰腺囊性肿瘤影像学诊断价值[J]. 中华肝脏外科手术学电子杂志, 2016, 05(06): 367-375.

Lu Chen, Risheng Yu. Diagnostic value of imaging examinations in pancreatic cystic neoplasm[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(06): 367-375.

目的

探讨胰腺囊性肿瘤的影像学表现及其诊断价值。

方法

回顾性分析2014年1月至2015年12月浙江大学医学院第二附属医院收治的95例胰腺囊性肿瘤患者临床资料。其中 男37例，女58例；年龄10～80岁，中位年龄54岁。浆液性囊性肿瘤（SCN）16例，黏液性囊性肿瘤（MCN）11例，导管内乳头状黏液肿瘤（IPMN）21例，实性假乳头状瘤（SPN）囊变12例，胰腺神经内分泌肿瘤（PNEN）囊变24例，胰腺癌囊变11例。患者均签署知情同意书，符合医学伦理学规定。分析胰腺囊性肿瘤患者的CT、MRI表现及计算其诊断准确率。

结果

SCN以多发细小囊为特征。MCN以边界清晰的厚壁单腔病灶为特征，好发于胰体尾部。IPMN以病灶与主胰管相通为特征，主胰管和分支胰管均有不同程度扩张。SPN囊变以渐进性强化为特征，但强化程度低于胰腺实质。PNEN囊变以动脉期明显强化为特征。胰腺癌囊变以缺乏血供并周围组织侵犯或远处转移为特征。SCN的CT及MRI诊断准确率最低，分别为29%和14%；PNEN囊变CT及MRI诊断准确率最高，分别为89%和100%。

结论

胰腺囊性肿瘤临床症状不典型，影像学检查仍为主要诊断手段，对大多数胰腺囊性肿瘤的诊断以及良恶性的鉴别具有较高价值。

关键词: 胰腺囊肿, 肿瘤，囊性，粘液性和浆液性, 诊断，鉴别
Objective

To investigate the manifestations and diagnostic value of imaging examinations in pancreatic cystic neoplasm.

Methods

Clinical data of 95 patients with pancreatic cystic neoplasm who were admitted to the Second Affiliated Hospital, College of Medical Sciences, Zhejiang University between January 2014 and December 2015 were retrospectively analyzed. Among the patients, 37 were males and 58 were females, aged 10-80 years old with a median age of 54 years old. Sixteen cases were diagnosed with serous cystic neoplasm (SCN), 11 with mutinous cystic neoplasm (MCN), 21 with intraductal papillary mucinous neoplasm (IPMN), 12 with cystic solid pseudopapillary neoplasm (SPN), 24 with cystic pancreatic neuroendocrine neoplasm (PNEN) and 11 with cystic pancreatic adenocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of the patients with pancreatic cystic neoplasm were analyzed, and the diagnostic accuracy was calculated.

Results

SCN was characterized with multiple small cysts. MCN was characterized with a clear border, single lumen and thick wall lesion, mainly occurred in the pancreatic body and tail. IPMN was characterized with lesions connected to the main pancreatic duct. Dilation of varying degrees in the main and branch pancreatic duct dilation were observed. Cystic SPN was characterized with gradual enhancement, but the enhancement intensity was lower than that of pancreatic parenchyma. Cystic PNEN was characterized with evident enhancement in arterial phase. Cystic pancreatic adenocarcinoma was characterized with insufficient blood supply complicated with surrounding tissue invasiveness or distal metastasis. The diagnostic accuracy of CT and MRI was the lowest for SCN (29% for CT and 14% for MRI), and highest for cystic PNEN (89% for CT and 100% for MRI).

Conclusions

Due to the nonspecific clinical manifestations of pancreatic cystic neoplasm, imaging examination remains the main method for the diagnosis. It has high value for the diagnosis of most pancreatic cystic neoplasms and the differential diagnosis between benign and malignant tumors.

Key words: Pancreatic cyst, Neoplasms, cystic, mucinous, and serous, Diagnosis, differential
表1 胰腺囊性肿瘤患者的一般情况
胰腺囊肿类型 例数 性别(例) 年龄[岁，M（QR）] 症状（例） 最大直径[cm，M（QR）] 部位（例）
男 女 无 有 头颈 体尾
SCN 16 5 11 53（24～75） 9 7 2.8（1.1～7.8） 9 7
MCN 11 0 11 45（23～79） 8 3 4.8（2.3～7.6） 3 8
IPMN 21 11 10 63（42～80） 12 9 2.8（1.3～4.5） 7 2
SPN囊变 12 3 9 34（10～50） 9 3 4.9（3.2～8.0） 5 7
PNEN囊变 24 11 13 52（34～79） 10 14 3.2（1.4～16.0） 11 13
胰腺癌囊变 11 7 4 66（58～73） 4 7 4.0（1.9～10.0） 6 5
图2 一例恶性浆液性囊腺癌患者的CT图像。2a为CT平扫示胰尾肿瘤边缘可见等高密度不规则实性成分，边界不清；2b为CT平扫示病灶内钙化灶；2c为CT增强扫描示病灶内少许分隔影，囊壁较厚，实性成分及囊壁中度强化；2d示轻中度强化的壁结节（箭头所示）
图3 一例黏液性囊腺瘤患者的MRI扫描图像
图5 一例分支胰管型导管内乳头状黏液瘤患者MRI扫描图像。5a为T1加权成像，胰体部肿瘤呈低信号；5b为T2加权成像，可见肿瘤呈不规则高信号，内见多发细小低信号分隔；5c可见主胰管从病灶内穿行；5d为增强扫描，分隔可见轻度强化，囊性区无强化（箭头所示）
图6 一例导管内乳头状黏液性癌患者的CT扫描图像
图8 一例胰腺神经内分泌肿瘤囊变（G1期）患者的CT扫描图像。8a为CT平扫，胰头部见类圆形稍低密度影，边缘欠清；8b、8c、8d为CT增强扫描，病灶明显渐进性强化，动脉期明显环形强化，延迟期可见病灶与周围胰腺组织基本呈等信号 （箭头所示）
图9 一例胰腺神经内分泌癌囊变患者的MRI扫描图像
表2 胰腺囊性肿瘤的CT和MRI诊断准确率（%）
胰腺囊肿类型 例数 CT MRI
IPMN 21 76 80
SCN 16 29 14
MCN 11 50 67
SPN囊变 12 80 65
PNEN囊变 24 89 100
胰腺癌囊变 11 75 67
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