Department of Imaging, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai 200065, PR China.
Eur J Radiol. 2010 Jan;73(1):96-101. doi: 10.1016/j.ejrad.2008.09.035. Epub 2008 Nov 12.
To examine CT patterns of intraductal papillary mucinous neoplasm (IPMN), analyze their correlation with pathologic classification, and discuss the value of CT in the diagnosis and differential diagnosis of IPMN.
CT patterns of 39 IPMN patients, whose clinical data were complete and whose diagnosis was confirmed by surgery and pathology, were classified into three types: (1) simple main pancreatic duct (MPD) dilation type, (2) MPD dilation with pancreatic cystic lesion type, and (3) simple pancreatic cystic lesion type. Correlations between the three CT types and Takada pathologic classification (MPD type, furcation type and mixture type) were analyzed. The 39 IPMN cases were pathologically classified as the benign group and the malignant/borderline group. CT characteristics including the presence or absence of mural nodules, intrafocal partitions, focal size and the degree of MPD and common bile duct (CBD) dilation were analyzed statistically.
A correlation was found between the CT simple MPD dilation type and the pathological MPD type, between the MPD dilation with pancreatic cystic lesion type and the furcation and mixture types, and between the simple cystic lesion type and the furcation type (p<0.001). The benign rate was 92% in patients without intrafocal mural nodules, and 42% in patients with intrafocal mural nodules. The difference between the two groups was statistically significant (p=0.003). The presence or absence of intrafocal partitions was not correlated with benignancy or malignancy (p=0.793). The maximum diameter of malignant/borderline lesions was bigger than that of benign ones (p=0.016). There was no significant difference in MPD and CBD diameters between the benign and malignant/borderline groups. Regardless of pathological classification, the MPD diameter was larger than the CBD diameter in all cases (p=0.02).
The three CT types of IPMN well correlated with the pathologic classification, which is helpful for analyzing CT manifestations and improving the accuracy of diagnosis. MPD dilation is usually larger than CBD dilation in IPMN patients, which is also helpful in the diagnosis and differential diagnosis of IPMN in the context of other related findings.
探讨胰腺导管内乳头状黏液性肿瘤（IPMN）的 CT 表现，分析其与病理分类的相关性，并探讨 CT 在 IPMN 诊断和鉴别诊断中的价值。
回顾性分析 39 例经手术病理证实的 IPMN 患者的临床资料完整的患者，根据 CT 表现将其分为 3 型：（1）单纯主胰管（MPD）扩张型；（2）MPD 扩张合并胰腺囊性病变型；（3）单纯胰腺囊性病变型。分析 3 种 CT 类型与 Takada 病理分类（MPD 型、分叉型和混合型）的相关性。将 39 例 IPMN 患者分为良性组和恶性/交界性组。对有无壁结节、分房、局灶大小、MPD 和胆总管（CBD）扩张程度等 CT 特征进行统计学分析。
CT 单纯 MPD 扩张型与病理 MPD 型、MPD 扩张合并胰腺囊性病变型与分叉型和混合型、单纯胰腺囊性病变型与分叉型均具有相关性（p<0.001）。无分房壁结节患者的良性率为 92%，有分房壁结节患者的良性率为 42%，两组比较差异有统计学意义（p=0.003）。有无分房与良恶性无关（p=0.793）。恶性/交界性病变的最大直径大于良性病变（p=0.016）。良性和恶性/交界性组 MPD 和 CBD 直径之间无显著差异。无论病理分类如何，所有病例的 MPD 直径均大于 CBD 直径（p=0.02）。
IPMN 的 3 种 CT 类型与病理分类具有良好的相关性，有助于分析 CT 表现，提高诊断准确性。在其他相关发现的背景下，IPMN 患者的 MPD 扩张通常大于 CBD 扩张，这也有助于 IPMN 的诊断和鉴别诊断。
