CAJ | 학술논문

胰腺导管内乳头状黏液性肿瘤的CT表现与病理对照分析
이선도관내유두상점액성종류적CT표현여병리대조분석
CT and pathological manifestations of intraductal papillary mucinous neoplasm of pancreas: a comparative study

万方数据

中华医学杂志中華醫學雜誌 중화의학잡지
National Medical Journal of China
2008年 14期 943-947 ,共5页

张静%王培军%袁小东%邵成伟%赵小虎%徐卫国%董宁欣%王国良%邵志宏%黄宗良%张炜

장정%왕배군%원소동%소성위%조소호%서위국%동저흔%왕국량%소지굉%황종량%장위

胰腺肿瘤%癌,乳头状%体层摄影术,X线计算机%病理学胰腺腫瘤%癌,乳頭狀%體層攝影術,X線計算機%病理學
이선종류%암,유두상%체층섭영술,X선계산궤%병이학
Pancreatic neoplasms%Carcinoma,papillary%Tomography,X-ray computed%Pathology

目的分析胰腺导管内乳头状黏液性肿瘤(IPMN)的CT表现特征并与病理结果进行对照,探讨CT在胰腺IPMN诊断和鉴别诊断的价值.方法分析39例临床资料齐全、手术病理证实为IPMN病例资料,将本组病例的CT表现分为3型:(1)单纯主胰管扩张型;(2)主胰管扩张伴胰腺囊性灶型;(3)单纯胰腺囊性灶型.分析CT分型与Takada病理分型(主胰管型、分支型、混合型)的对应关系;按病理结果将IPMN分为良性组和恶性/交界组,对病变的CT特征(有无壁结节、有无分隔、病灶大小、主胰管及胆总管扩张程度)进行统计学分析.结果单纯主胰管扩张型对应于主胰管型,主胰管扩张伴胰腺囊性灶型主要对应于分支型和混合型,单纯囊性灶型对应于分支型(P＜0.001).病灶内无壁结节时病理为良性的概率为92%,病灶内有壁结节时病理为良性的概率为42%,两者差异有统计学意义(P=0.003),病灶内是否出现分隔与肿瘤的良恶性无关(P=0.793),恶性/交界性病灶的最大径大于良性病灶,P=0.016,主胰管管径、胆总管管径在良性和恶性/交界两组间差异均无统计学意义,但在不考虑病理分组的情况下,全部病例主胰管管径大于胆总管管径(P=0.02).结论 IPMN CT表现的三种分型与病理分型有较好的对应关系,有利于IPMN CT征象的分析及提高诊断的准确性.IPMN的主胰管扩张程度常超过胆总管亦具有一定的特征,结合其他典型征象能够对IPMN做出较准确的诊断.
목적 분석이선도관내유두상점액성종류(IPMN)적CT표현특정병여병리결과진행대조,탐토CT재이선IPMN진단화감별진단적개치.방법 분석39례림상자료제전、수술병리증실위IPMN병례자료,장본조병례적CT표현분위3형:(1)단순주이관확장형;(2)주이관확장반이선낭성조형;(3)단순이선낭성조형.분석CT분형여Takada병리분형(주이관형、분지형、혼합형)적대응관계;안병리결과장IPMN분위량성조화악성/교계조,대병변적CT특정(유무벽결절、유무분격、병조대소、주이관급담총관확장정도)진행통계학분석.결과 단순주이관확장형대응우주이관형,주이관확장반이선낭성조형주요대응우분지형화혼합형,단순낭성조형대응우분지형(P＜0.001).병조내무벽결절시병리위량성적개솔위92%,병조내유벽결절시병리위량성적개솔위42%,량자차이유통계학의의(P=0.003),병조내시부출현분격여종류적량악성무관(P=0.793),악성/교계성병조적최대경대우량성병조,P=0.016,주이관관경、담총관관경재량성화악성/교계량조간차이균무통계학의의,단재불고필병리분조적정황하,전부병례주이관관경대우담총관관경(P=0.02).결론 IPMN CT표현적삼충분형여병리분형유교호적대응관계,유리우IPMN CT정상적분석급제고진단적준학성.IPMN적주이관확장정도상초과담총관역구유일정적특정,결합기타전형정상능구대IPMN주출교준학적진단.
Objective To evaluate the diagnostic value of CT in pancreas intraductal papillary mucinous neoplasm(IPMN) by analyzing its CT feature and pathological findings. Methods The clinical and CT data was analyzed among 39 patients with IPMN whose diagnosis was confirmed by pathology. The CT manifestations were classified into 3 types: simple main pancreatic duct enlargement; main pancreatic duct enlargement combined with pancreatic cystic lesion; and simple pancreatic cystic lesion. The correlation between the CT types and Takada pathological types(main duct type, branch type, and mixed type)was analyzed. All the cases were pathologically classified into benign and malignant/boundary groups. Statistical tests of the difference of CT features(mural nodule, septa, size, caliber of main pancreatic duct and common bile duct)between the 2 groups were performed. Results The CT type Ⅰ matched the main duct type, the CT type Ⅱ mainly matched the branch type and mixed type, and the CT type Ⅲ matched the branch type(P＜0. 001). The probability of benign lesion was 92% with no mural nodule in the lesion, while the probability of benign lesion was only 42% with mural nodule presented(P=0. 003). In terms of the septa, there was no significant difference between benign and malignant lesions(P=0. 793). The size of malignant/boundary lesions exceeded that of benign lesions(P=0. 016). There were no significant difference in calibers of main pancreatic duct and common bile duct between the benign and malignant/boundary groups. Without considering pathological grouping the caliber of main pancreatic duct exceeded that of the common bile duct in all the cases(P=0. 02). Conclusion CT typing of IPMN well matches the pathological typing which benefits the CT diagnosis of IPMN. The caliber of main pancreatic duct usually exceeds that of common bile duct in IPMN. This feature contributes to its diagnosis.