Oxford University Hospitals NHS Trust, Headington, Oxford, UK.
Clin Radiol. 2012 Dec;67(12):1187-92. doi: 10.1016/j.crad.2011.11.021. Epub 2012 Jul 4.
To describe the frequency of normal variation in contour of the head and uncinate process of the pancreas in patients with intestinal malrotation, some of which can mimic neoplasm, and their relationship with mesenteric vascular inversion.
A retrospective analysis of 25 cases of intestinal malrotation on cross-sectional imaging [24 computed tomography (CT) examinations, one magnetic resonance imaging (MRI) examination], was performed by two specialist gastrointestinal radiologists. The presence and type of intestinal malrotation, variations in pancreatic contour, and the location of the superior mesenteric vessels were analysed.
Twenty-five cases of malrotation (21 complete, four partial) with a median age of 50 years (range 17-91 years) were reviewed. Eighty-six percent (18/21) of complete malrotation cases demonstrated an unusual pancreatic contour. There was hypoplasia or aplasia of the uncinate process in 86% (18/21) of cases. Both uncinate process and pancreatic head contour anomalies were demonstrated in 57% (12/21) of cases, which included 24% (5/21) with a globular-shaped enlargement of the head of pancreas. Mesenteric vascular inversion was seen in 90% (19/21) of cases. One hundred percent (4/4) of partial malrotation cases had normal pancreatic and vascular anatomy.
Pancreatic contour variations are common in malrotation and the enlargement of the pancreatic head in some cases can mimic a neoplasm. The embryological cause may be due to anomalous fusion of the ventral bud of the pancreas with the dorsal bud, explaining the common finding of a small uncinate process with a large pancreatic head.
描述肠旋转不良患者胰头钩突轮廓的正常变异频率，其中一些变异可能类似于肿瘤，并探讨其与肠系膜血管反转的关系。
对 25 例肠旋转不良的横断面影像学检查（24 例 CT 检查，1 例 MRI 检查）进行回顾性分析，由两位胃肠放射学专家进行。分析肠旋转不良的存在和类型、胰轮廓的变化以及肠系膜上血管的位置。
共回顾了 25 例旋转不良（21 例完全性，4 例部分性），中位年龄为 50 岁（范围 17-91 岁）。86%（18/21）的完全性旋转不良病例显示胰轮廓异常。86%（18/21）的病例钩突发育不良或缺如。57%（12/21）的病例同时存在钩突和胰头轮廓异常，其中 24%（5/21）的病例胰头呈球形增大。90%（19/21）的病例可见肠系膜血管反转。4 例（4/4）部分性旋转不良病例的胰血管解剖均正常。
胰轮廓变异在旋转不良中很常见，某些情况下胰头增大可能类似于肿瘤。胚胎发育异常可能是由于胰头腹侧芽与背侧芽异常融合所致，这可以解释常见的小钩突和大胰头的发现。
