Yamada Yasunari, Mori Hiromu, Matsumoto Shunro
Department of Diagnostic and Interventional Radiology, Oita University Faculty of Medicine, Hasama-machi, Yufu-city, 879-5593, Japan.
Abdom Imaging. 2008 Jul-Aug;33(4):474-81. doi: 10.1007/s00261-007-9289-y.
We assessed the imaging features of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas paying special attention to underlying pancreatic fibrosis on three-phase helical computed tomography (CT) and dynamic magnetic resonance (MR) imaging.
Sixteen patients with histopathologically proven IPMNs underwent three-phase helical CT and dynamic MR imaging.
IPMNs were seen as a cluster of cyst-like structures in branch duct (n = 5) and combined types (n = 10), and as a fusiform appearance in the main duct type (n = 1). IPMN shape was most easily visualized at the portal venous dominant phase or delayed phase owing to rim-like enhancement of the dilated ducts. Pathologically mild to severe fibrosis was seen on this enhanced rim replacing the surrounding pancreatic parenchyma. Communication between the dilated branch ducts and main pancreatic duct was identified in 15 patients on helical CT and 14 patients on dynamic MR imaging. In patients with fibrosis of pancreatic parenchyma surrounding this, communication was most easily visualized at the later phase on CT and MR imaging. Adenocarcinomas were depicted as papillary projections in eight of nine patients on CT and MR imaging. Invasion of the pancreatic parenchyma was seen in five of six patients as a solid mass in the pancreatic parenchyma. These masses were most easily visualized at the arterial dominant phase on both CT and MR imaging.
Three-phase helical CT and dynamic MR imaging were useful in the diagnosis of IPMN of the pancreas.
我们评估了胰腺导管内乳头状黏液性肿瘤（IPMN）的影像学特征，特别关注其在三期螺旋计算机断层扫描（CT）和动态磁共振（MR）成像上潜在的胰腺纤维化情况。
16例经组织病理学证实为IPMN的患者接受了三期螺旋CT和动态MR成像检查。
IPMN在分支导管型（n = 5）和混合型（n = 10）中表现为一簇囊样结构，在主胰管型（n = 1）中表现为梭形外观。由于扩张导管的边缘样强化，IPMN的形态在门静脉期或延迟期最易观察到。在该强化边缘可见病理上轻至重度的纤维化，取代了周围的胰腺实质。15例患者在螺旋CT上以及14例患者在动态MR成像上发现扩张的分支导管与主胰管之间存在相通。在其周围胰腺实质有纤维化的患者中，这种相通在CT和MR成像的后期最易观察到。在9例患者中的8例，CT和MR成像显示腺癌为乳头状突起。6例患者中的5例可见胰腺实质受侵，表现为胰腺实质内的实性肿块。这些肿块在CT和MR成像的动脉期最易观察到。
三期螺旋CT和动态MR成像对胰腺IPMN的诊断很有帮助。
