胰腺癌的非典型增强计算机断层扫描征象及其与自身免疫性胰腺炎的鉴别诊断。

Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis.

作者信息

Zhao Yong, Li Fei, An Ning, Peng Zehua

机构信息

Department of Emergency, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (East Hospital), Chengdu, China.

Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (East Hospital), Chengdu, China.

出版信息

Gland Surg. 2021 Jan;10(1):347-354. doi: 10.21037/gs-20-821.

DOI:10.21037/gs-20-821

PMID:33633991

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7882330/

Abstract

BACKGROUND

To analyze the atypical enhanced computed tomography (CT) signs of pancreatic cancer (PC) and compare them with those of autoimmune pancreatitis (AIP) to explore the differential diagnosis value of CT.

METHODS

The clinical data of 36 AIP (AIP group) and 38 PC patients (PC group), who were admitted to our hospital from January 2013 to June 2020 and confirmed by surgical biopsy or hormone therapy, were retrospectively analyzed. Participants in both groups were examined by CT, the imaging signs of the 2 groups were analyzed, and the results of CT examination were compared.

RESULTS

In the PC group, the density of the lesions on the CT scan was mostly reduced, the pancreas was not swollen, and the kidneys were not involved. The bile duct wall was thickened with a sausage-like appearance, enveloped edges were rare, blood vessels were invaded, lymph nodes were enlarged, and the pancreatic duct was truncated. The findings of the AIP group were the opposite. The difference in the proportion of participants with the above-mentioned CT features between the 2 groups was statistically significant (P<0.05). The shape of the lesions in the AIP group was mainly elongated, of uneven density, and the density of enhanced scanning was medium to high. The predominant shape of the lesions in PC participants was spherical, and the density was uniform. The enhanced scan was mainly low-density. The difference in shape and density between the 2 groups was also statistically significant (P<0.05). The CT values of the plain scan, intravenous phase, and delayed phase in the AIP group were significantly higher than those in the PC group (P<0.05).

CONCLUSIONS

The imaging signs of AIP and PC overlap. Examination with CT is of great value in the differential diagnosis between AIP and PC. Familiarity with and mastery of the CT signs of AIP and PC can help to improve the accuracy of clinical diagnosis and provide a reliable basis for patients' follow-up treatment.

摘要

背景

分析胰腺癌（PC）的非典型增强计算机断层扫描（CT）征象，并与自身免疫性胰腺炎（AIP）的征象进行比较，以探讨CT的鉴别诊断价值。

方法

回顾性分析2013年1月至2020年6月我院收治的36例AIP患者（AIP组）和38例PC患者（PC组）的临床资料，所有患者均经手术活检或激素治疗确诊。两组患者均行CT检查，分析两组的影像学征象，并比较CT检查结果。

结果

PC组CT扫描示病灶密度多减低，胰腺无肿大，未累及肾脏。胆管壁增厚呈腊肠样，包绕边缘少见，血管受侵，淋巴结肿大，胰管截断。AIP组表现则相反。两组具有上述CT特征的患者比例差异有统计学意义（P<0.05）。AIP组病灶形态以长条状为主，密度不均匀，增强扫描密度为中至高。PC组患者病灶主要形态为球形，密度均匀。增强扫描主要为低密度。两组在形态和密度上的差异也有统计学意义（P<0.05）。AIP组平扫、静脉期及延迟期的CT值均显著高于PC组（P<0.05）。