Yamada Yasunari, Mori Hiromu, Hijiya Naoki, Matsumoto Shunro, Takaji Ryo, Ohta Masayuki, Kitano Seigo, Moriyama Masatsugu
Department of Radiology, Oita University Faculty of Medicine, Hasama-machi, Yufu, Japan.
Abdom Imaging. 2012 Feb;37(1):100-9. doi: 10.1007/s00261-011-9723-z.
To correlate the CT and MR images with pathologic findings on intraductal papillary mucinous neoplasms (IPMNs) complicated with intraductal hemorrhage, perforation, and fistula.
We retrospectively evaluated the CT (n = 5), MR imaging (n = 4), and pathological features of five IPMN patients complicated with intraductal hemorrhage (n = 5), perforation (n = 1), and fistula into the duodenum and jejunum (n = 1).
Intraductal hemorrhage could be detected as high attenuation on non-contrast CT in two of the five cases, and as high signal intensity on fat-suppressed T1-weighted MR images in all four of the cases. Perforation and fistula could be recognized on CT images. In all IPMNs, denuded epitheliums were observed pathologically. Dissolution of the duct wall and extension of mucinous materials were seen at the area of denuded epithelium. Perforations and fistula, without evidence of cancer invasion, were recognized in the dissolved duct wall. Pathogenesis of the perforations and fistula formations appeared to be related to excessive pressure in the dilated ducts and autodigestion of enzyme-rich fluids.
Complications with IPMN could be recognized on CT and fat-suppressed T1-weighted MR images. Intraductal hemorrhage might be predictive sign of perforation and fistula formation.
将导管内乳头状黏液性肿瘤（IPMNs）合并导管内出血、穿孔及瘘管的CT和MR图像与病理结果进行对比。
我们回顾性评估了5例IPMN患者的CT（n = 5）、MR成像（n = 4）以及病理特征，这些患者分别合并导管内出血（n = 5）、穿孔（n = 1）以及十二指肠和空肠瘘管形成（n = 1）。
5例中有2例在非增强CT上可检测到导管内出血呈高密度影，4例在脂肪抑制T1加权MR图像上呈高信号强度。穿孔和瘘管可在CT图像上识别。在所有IPMN中，病理检查均观察到上皮剥脱。在剥脱上皮区域可见导管壁溶解和黏液物质延伸。在溶解的导管壁中可识别出无癌浸润证据的穿孔和瘘管。穿孔和瘘管形成的发病机制似乎与扩张导管内的压力过高以及富含酶的液体的自身消化有关。
IPMN的并发症可在CT和脂肪抑制T1加权MR图像上识别。导管内出血可能是穿孔和瘘管形成的预测征象。
