自身免疫性胰腺炎：增强 MRI、MRCP 和动态促胰液素增强 MRCP 的影像学表现。
Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP.
机构信息
Department of Radiology, University of Verona, P.le Scuro 10, 37134, Verona, Italy.
出版信息
Radiol Med. 2009 Dec;114(8):1214-31. doi: 10.1007/s11547-009-0452-0. Epub 2009 Sep 30.
PURPOSE
This study retrospectively determined magnetic resonance (MR), MR cholangiopancreatography (MRCP) and secretin-MRCP findings in patients with autoimmune pancreatitis (AIP).
MATERIALS AND METHODS
The MR examinations of 28 patients with histopathologically proven AIP were reviewed. In 14 cases, secretin-enhanced MRCP was performed. The observers evaluated pancreatic parenchymal enlargement, signal intensity abnormalities, enhancement, vascular involvement, bile-duct diameter and main pancreatic duct (MPD) narrowing (diffuse/focal/segmental). After secretin administration, the presence of the "duct-penetrating" sign was evaluated.
RESULTS
MR imaging showed diffuse pancreatic enlargement in 8/28(29%) cases, focal pancreatic enlargement in 16/28 (57%) cases and no enlargement in 4/28 (14%) cases. The alteration of pancreatic signal intensity was diffuse in 8/28 (29%) cases (eight diffuse AIP) and focal in 20/28 (71%) cases (20 focal AIP). Delayed pancreatic enhancement was present in all AIP, with peripheral rim of enhancement in 8/28 (29%) AIP (1/8 diffuse, 7/20 focal); vascular encasement was present in 7/28 (25%) AIP (1/8 diffuse, 6/20 focal); distal common bile duct narrowing was present in 12/28(43%) AIP (5/8 diffuse, 7/20 focal). MRCP showed MPD narrowing in 17/28 (61%) AIP (4/8 diffuse, 15/20 focal), MPD dilation in 8/28(29%) AIP (3/8 diffuse, 5/20 focal) and normal MPD in 1/8 diffuse AIP. Secretin-MRCP showed the duct-penetrating sign in 6/14(43%) AIP (one diffuse AIP with MPD segmental narrowing, five focal AIP with MPD focal narrowing), demonstrating integrity of the MPD.
CONCLUSIONS
Delayed enhancement and MPD stenosis are suggestive for AIP on MR and MRCP imaging. Secretin-enhanced MRCP is a problem-solving tool in the differential diagnosis between focal AIP and ductal adenocarcinoma.
目的
本研究回顾性分析了自身免疫性胰腺炎（AIP）患者的磁共振（MR）、MR 胆胰管成像（MRCP）和促胰液素-MRCP 表现。
材料与方法
对 28 例经组织病理学证实的 AIP 患者的 MR 检查进行了回顾性分析。在 14 例患者中进行了促胰液素增强 MRCP。观察者评估了胰腺实质增大、信号强度异常、增强、血管受累、胆管直径和主胰管（MPD）狭窄（弥漫性/局灶性/节段性）。促胰液素给药后，评估“胆管穿透”征的存在。
结果
MR 成像显示 28 例患者中弥漫性胰腺增大 8 例（29%），局灶性胰腺增大 16 例（57%），无增大 4 例（14%）。28 例患者中胰腺信号强度改变弥漫性 8 例（29%），局灶性 20 例（71%）。所有 AIP 均有延迟性胰腺增强，28 例中 8 例（29%）有外周边缘增强（8 例弥漫性中 1 例，20 例局灶性中 7 例）；血管包绕 28 例中有 7 例（25%）（8 例弥漫性中 1 例，20 例局灶性中 6 例）；12 例（43%）有胆总管下段狭窄（8 例弥漫性中 5 例，20 例局灶性中 7 例）。28 例 MRCP 显示 MPD 狭窄 17 例（61%）（8 例弥漫性中 4 例，20 例局灶性中 13 例），MPD 扩张 8 例（29%）（8 例弥漫性中 3 例，20 例局灶性中 5 例），1 例（3%）弥漫性 AIP 正常。14 例中促胰液素增强 MRCP 显示胆管穿透征 6 例（43%）（1 例 MPD 节段性狭窄，5 例 MPD 局灶性狭窄），显示 MPD 完整。
结论
延迟增强和 MPD 狭窄提示 AIP 的 MR 和 MRCP 成像。促胰液素增强 MRCP 是鉴别局灶性 AIP 和导管腺癌的一种解决问题的工具。
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