CAJ | 학술논문

目的：探讨MRI在较小胰腺癌（大小<3cm）的临床诊断价值。资料与方法回顾性分析本院2002年1月至2012年12月间行胰腺MRI检查的病例，经手术病理证实为胰腺癌且癌肿长径<3c m者，共计9例（男7例、女2例）患者纳入研究，年龄48-80岁（平均69.2岁）。由2名放射学医师盲法阅片，观察肿块/结节灶的部位、大小、边缘、是否突出胰腺轮廓外、增强特征、肿块远端胰腺情况、主胰管及分支胰管改变、肝内外胆管改变、胰腺及胰周是否伴发囊肿、是否出现淋巴结和远处脏器转移灶。结果肿块/结节灶位于胰头占5/9、胰体占3/9、胰体尾部交界处占1/9。结节大小为2.2×0.6cm (1.3-2.7cm)。病灶未突破胰腺轮廓占5/9。肿块/结节远端出现慢性胰腺炎改变占7/9，主胰管扩张占7/9。肿块/结节灶与远侧主胰管改变共同构成两种表现：“蛇形征”和“蝌蚪征”。1例患者首诊以胰体尾前方巨大囊肿入院，行“胰腺假性囊肿-空肠吻合术”，术后3月余复查MRI发现较大胰体结节影。结论 MRI和MRCP能很好地评价较小胰腺癌本身、癌肿远侧胰腺改变、胰胆管改变等。“蛇形征”和“蝌蚪征”系未突破胰腺轮廓的较小胰腺癌的两种征象。
목적：탐토MRI재교소이선암（대소<3cm）적림상진단개치。자료여방법회고성분석본원2002년1월지2012년12월간행이선MRI검사적병례，경수술병리증실위이선암차암종장경<3c m자，공계9례（남7례、녀2례）환자납입연구，년령48-80세（평균69.2세）。유2명방사학의사맹법열편，관찰종괴/결절조적부위、대소、변연、시부돌출이선륜곽외、증강특정、종괴원단이선정황、주이관급분지이관개변、간내외담관개변、이선급이주시부반발낭종、시부출현림파결화원처장기전이조。결과종괴/결절조위우이두점5/9、이체점3/9、이체미부교계처점1/9。결절대소위2.2×0.6cm (1.3-2.7cm)。병조미돌파이선륜곽점5/9。종괴/결절원단출현만성이선염개변점7/9，주이관확장점7/9。종괴/결절조여원측주이관개변공동구성량충표현：“사형정”화“과두정”。1례환자수진이이체미전방거대낭종입원，행“이선가성낭종-공장문합술”，술후3월여복사MRI발현교대이체결절영。결론 MRI화MRCP능흔호지평개교소이선암본신、암종원측이선개변、이담관개변등。“사형정”화“과두정”계미돌파이선륜곽적교소이선암적량충정상。
Objective To study the MRI clinical diagnostic value in smal er pancreatic carcinoma with lesion size <3cm. Materials and methods A total of 9 cases (male 7 cases, female 2 cases; age 48-80 years old, average 69.2 years) were included in the retrospective study in our hospital from January, 2002 to December, 2012. Al patients had pancreatic MRI examination and the cases were confirmed by operation and pathology of pancreatic cancer with the tumor diameter <3cm. MRI images were readed blindly by two radiologists. It included:the mass/ nodule location, size, edge, the pancreas contour, enhanced features, pancreatic duct and branch duct change, intrahepatic and extrahepatic bile duct, pancreatic and peripancreatic concomitant cyst change, and findings of lymph node and distant organ metastasis. Results The masses or nodules were located in pancreatic head (5/9), body (3/9), and the junction of body and tail of pancreas (1/9), respectively. The nodule size is 2.2±0.6cm (1.3-2.7cm). Lesions which did not break through pancreatic contour accounted for 5/9. Masses or nodules with chronic pancreatitis and the expansion of main pancreatic duct accounted for 7/9. The pancreatic nodules and distal pancreatic duct change constituted two performances: "snake-like sign" and "tadpole-like sign". Conclusion MRI and MRCP can wel evaluate smal er pancreatic cancer including cancer of pancreas itself and pancreatic duct change and so on. "snake-like sign" and "tadpole-like sign" refer to two signs of smal er pancreatic cancer without breaking through pancreatic contour on MRI.