CAJ | 학술논문

目的研究自身免疫性胰腺炎(AIP)合并腹部其他组织器官受累的影像表现.方法回顾性分析23例经病理证实或肾上腺皮质激素规范治疗后随访证实的AIP患者临床及影像资料,发现腹部除胰腺外其他组织器官受累者17例,其中14例进行了CT检查,9例进行了MR检查,6例同时行CT及MR检查,分析其影像表现特征.结果 23例患者胰腺呈弥漫性(14例)、局限性(7例)及混合性(2例)肿大,均伴不均匀渐进性延迟强化,16例伴包壳样结构显示.16例胆道系统受累,其中12例见胆总管下段为主的管壁规则增厚,伴增厚处明显强化及胆总管下段“鸟嘴样”移行性狭窄,2例仅见胆总管下段管壁局限性环形强化,2例仅见肝内外胆管扩张.4例肾脏受累,2例为右肾单发病灶,2例为双肾多发病灶,病变主要位于肾脏皮质,CT平扫病灶均为等或等高密度,MR平扫病灶T1WI均为等信号,T2WI均为稍低信号,动态增强扫描各期病灶强化程度均低于正常肾实质,较大病灶可出现延迟强化.4例腹膜后纤维化,其中2例伴腹主动脉下段管壁增厚,1例双侧输尿管上段受累伴肾脏积水,动态增强扫描病灶呈渐进性延迟强化.1例肝门区见2枚肿大淋巴结.结论 AIP患者腹部其他组织器官受累具有特征性的CT和MRI影像表现,有助于明确AIP诊断.
목적 연구자신면역성이선염(AIP)합병복부기타조직기관수루적영상표현.방법 회고성분석23례경병리증실혹신상선피질격소규범치료후수방증실적AIP환자림상급영상자료,발현복부제이선외기타조직기관수루자17례,기중14례진행료CT검사,9례진행료MR검사,6례동시행CT급MR검사,분석기영상표현특정.결과 23례환자이선정미만성(14례)、국한성(7례)급혼합성(2례)종대,균반불균균점진성연지강화,16례반포각양결구현시.16례담도계통수루,기중12례견담총관하단위주적관벽규칙증후,반증후처명현강화급담총관하단“조취양”이행성협착,2례부견담총관하단관벽국한성배형강화,2례부견간내외담관확장.4례신장수루,2례위우신단발병조,2례위쌍신다발병조,병변주요위우신장피질,CT평소병조균위등혹등고밀도,MR평소병조T1WI균위등신호,T2WI균위초저신호,동태증강소묘각기병조강화정도균저우정상신실질,교대병조가출현연지강화.4례복막후섬유화,기중2례반복주동맥하단관벽증후,1례쌍측수뇨관상단수루반신장적수,동태증강소묘병조정점진성연지강화.1례간문구견2매종대림파결.결론 AIP환자복부기타조직기관수루구유특정성적CT화MRI영상표현,유조우명학AIP진단.
Objective To investigate the imaging characteristics of abdominal extra pancreatic lesions associated with autoimmune pancreatitis (AIP).Methods Twenty-three patients with AIP proved through histo-pathological or clinical diagnosis were investigated retrospectively.Abdominal extra pancreatic lesions occurred in 17 of them.CT scans were performed in 14 patients and MR imaging in 9 patients (including both of CT and MRI in 6 patients).Results All 23 patients showed enlargement of the pancreas,with diffuse (n =14),focal (n =7) or mixed (n =2) type,with heterogeneously decreased enhancement and gradually delayed enhancement.A "capsule-like" rim was present around the lesions in 16 cases.Bile duct involvement was observed in 16 patients,including bile duct dilatation with lower common bile duct wall thickening and enhancement in 12 patients,as well as bile duct dilatation without wall thickening and bile duct wall enhancement without bile duct dilatation seen in 2 patients respectively.Renal involvement was observed in 4 patients.CT and MR imaging revealed single (in 2 patients) or multiple (in 2 patients),iso or hyper-attenuating.With plain CT,it revealed hypo-intense with T2WI,decreased enhancement lesions in the renal cortex.One mass-like lesion in the right renal showed gradually delayed enhancement Retro-peritoneal fibrosis was seen in 4 patients,which involved abdominal aorta wall (in 2 patients) and ureters (in 1 patient) as well.Gradual delayed enhancement of retro-peritoneal fibrosis was seen during dynamic contrast-enhancement.Abdominal lymphadenopathy at hepatic portal was observed in 1 patient.Conclusions Abdominal extra pancreatic lesions associated with AIP show characteristic imaging findings.CT and MRI modalities may be helpful in the diagnosis of AIP.