Dachman A H, Newmark G M, Thistlethwaite J R, Oto A, Bruce D S, Newell K A
Department of Radiology, The University of Chicago, IL 60637, USA.
AJR Am J Roentgenol. 1998 Jul;171(1):157-63. doi: 10.2214/ajr.171.1.9648780.
We describe the normal radiologic appearance of pancreatic allografts transplanted using portal venous drainage with enteric drainage of exocrine secretions. We also describe the radiologic appearance of postsurgical complications.
Of 56 patients who received pancreatic transplants using the portal-enteric technique, 24 patients subsequently required radiologic examination for suspected complications involving the pancreatic allograft. Twenty-three patients underwent CT scanning; a total of 58 CT scans were obtained. Nine abdominal sonograms were obtained in five patients, and one patient underwent angiography. The radiologic appearance of each transplant and the complications were analyzed retrospectively and correlated with the clinical course.
The most common indications for CT scanning were fever, elevated levels of serum amylase, and evaluation or follow-up of fluid collections. CT showed the normal and abnormal anatomy of the allograft. Abnormal findings seen in the 58 CT scans included fat stranding (30 scans), ascites (21 scans), peripancreatic fluid or pseudocyst (13 scans), and heterogeneity of the allograft (five scans). One patient had pancreatic infarction with pneumatosis and pneumoperitoneum. The allograft was obscured by bowel gas on three sonograms. Four sonograms showed no abnormalities (one Doppler sonogram showed the arterial supply and venous drainage), and one sonogram showed a pseudocyst. In the one patient who underwent angiography, imaging showed no arterial blood flow to the transplant.
Pancreatic transplantation with portal venous drainage and enteric drainage of exocrine secretions and the complications of such transplantation were revealed with CT, sonography, and angiography. Knowledge of normal anatomic configuration will allow proper interpretation of normal and abnormal findings.
我们描述了采用门静脉引流及外分泌液肠内引流方式移植的胰腺同种异体移植物的正常放射学表现。我们还描述了术后并发症的放射学表现。
在56例采用门静脉 - 肠内技术进行胰腺移植的患者中，24例随后因怀疑胰腺同种异体移植物出现并发症而需要进行放射学检查。23例患者接受了CT扫描；共获得58次CT扫描结果。5例患者进行了9次腹部超声检查，1例患者接受了血管造影。对每个移植物的放射学表现及并发症进行回顾性分析，并与临床病程相关联。
CT扫描最常见的指征是发热、血清淀粉酶水平升高以及对液体积聚的评估或随访。CT显示了移植物的正常和异常解剖结构。在58次CT扫描中发现的异常表现包括脂肪浸润（30次扫描）、腹水（21次扫描）、胰周液体积聚或假性囊肿（13次扫描）以及移植物不均匀性（5次扫描）。1例患者出现胰腺梗死伴积气和腹腔积气。3次超声检查中移植物被肠气遮挡。4次超声检查未发现异常（1次多普勒超声检查显示了动脉供血和静脉引流），1次超声检查显示有一个假性囊肿。在接受血管造影的1例患者中，影像学检查显示移植物无动脉血流。
CT、超声和血管造影显示了采用门静脉引流及外分泌液肠内引流方式的胰腺移植及其并发症。了解正常解剖结构有助于正确解读正常和异常表现。
