Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan.
World J Gastroenterol. 2011 May 14;17(18):2332-7. doi: 10.3748/wjg.v17.i18.2332.
To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP).
ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients.
The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%.
Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP.
确定内镜逆行胰胆管造影（ERCP）和磁共振胰胆管造影（MRCP）上的胰影像学表现，以帮助区分自身免疫性胰腺炎（AIP）和胰腺癌（PC）。
比较了 48 例 AIP 和 143 例 PC 患者的 ERCP 结果。在 30 例 AIP 患者中比较了 ERCP 和 MRCP 对 AIP 的诊断准确性。
以下 ERCP 结果提示 AIP 而非 PC 的诊断。主胰管（MPD）阻塞在 PC 中更常见（P < 0.001）。仅在 AIP 中检测到跳过的 MPD 病变（P < 0.001）。从狭窄的 MPD 分支出来的侧支更常见于 AIP（P < 0.001）。AIP 中狭窄的 MPD 更长（P < 0.001），且狭窄的 MPD 长于 3 cm 更常见于 AIP（P < 0.001）。AIP 中上游 MPD 的最大直径较小（P < 0.001），MPD 上游扩张小于 5mm 更常见于 AIP（P < 0.001）。87%的 AIP 患者的下胆管狭窄呈平滑状，而 65%的 PC 患者呈不规则状（P < 0.001）。肝内或肝门胆管狭窄仅在 AIP 中检测到（P = 0.001）。在 MRCP 上，ERCP 上弥漫性狭窄的 MPD 在 50%的病例中表现为跳过的未见病变，在 19%的病例中表现为微弱可见，而 MPD 的节段性狭窄仅在 14%的病例中表现为微弱可见。
一些 ERCP 结果有助于区分 AIP 和 PC。尽管 MRCP 不能替代 ERCP 用于 AIP 的诊断评估，但一些 MRCP 结果支持 AIP 的诊断。
