CAJ | 학술논문

目的探讨自身免疫性胰腺炎(AIP)胰腺外病变的CT、MRI及18F-脱氧葡萄糖(FDG)PET-CT表现.方法回顾性分析2004年5月至2012年6月,符合2008年亚洲AIP诊断标准的44例患者的影像资料.检查包括增强CT扫描29例,MR扫描38例,18F-FDG PET-CT扫描6例,观察分析胰腺外病变的影像特征.结果 (1)胆管受累32例,表现为胆管狭窄及管壁增厚强化,其中胆总管胰腺段狭窄,受累节段胆管壁增厚强化16例；肝门区胆管管壁增厚1例；胰腺段胆总管及其上游胆管均受累15例.(2)胆囊受累19例,表现为胆囊增大,壁增厚延迟强化；(3)肾脏受累10例,为双肾多发低灌注灶,T2WI上呈低信号；(4)血管受累16例,包括脾动(静)脉、肠系膜上动(静)脉和门静脉被包埋及静脉管径变细；(5)淋巴结改变35例,可见腹腔及腹膜后单组或多组淋巴结,其中多组15例,以腹腔淋巴结组最常见；(6)消化道受累2例,表现为胃及近段小肠浆膜面延迟强化；(7)腹膜后纤维化3例；(8)肝脏受累2例,表现为局灶性结节及肝内胆管周围片状异常强化；(9)颌下腺受累5例,PET-CT表现为颌下腺增大,放射性摄取增高.结论多器官受累是AIP的重要特征,了解其胰腺外病变表现有助于AIP的诊断.
목적 탐토자신면역성이선염(AIP)이선외병변적CT、MRI급18F-탈양포도당(FDG)PET-CT표현.방법 회고성분석2004년5월지2012년6월,부합2008년아주AIP진단표준적44례환자적영상자료.검사포괄증강CT소묘29례,MR소묘38례,18F-FDG PET-CT소묘6례,관찰분석이선외병변적영상특정.결과 (1)담관수루32례,표현위담관협착급관벽증후강화,기중담총관이선단협착,수루절단담관벽증후강화16례；간문구담관관벽증후1례；이선단담총관급기상유담관균수루15례.(2)담낭수루19례,표현위담낭증대,벽증후연지강화；(3)신장수루10례,위쌍신다발저관주조,T2WI상정저신호；(4)혈관수루16례,포괄비동(정)맥、장계막상동(정)맥화문정맥피포매급정맥관경변세；(5)림파결개변35례,가견복강급복막후단조혹다조림파결,기중다조15례,이복강림파결조최상견；(6)소화도수루2례,표현위위급근단소장장막면연지강화；(7)복막후섬유화3례；(8)간장수루2례,표현위국조성결절급간내담관주위편상이상강화；(9)합하선수루5례,PET-CT표현위합하선증대,방사성섭취증고.결론 다기관수루시AIP적중요특정,료해기이선외병변표현유조우AIP적진단.
Objective To describe the imaging findings of extrapancreatic lesions of autoimmune pancreatitis (AIP).Methods From May,2004 to June,2012,44 patients were diagnosed of AIP according to Asia criteria of AIP made in 2008.All the imaging data,including contrast-enhanced CT (in 29 patients)or/and MR (in 38 patients),and 18F-FDG PET-CT (in 6 patients),were retrospectively reviewed.All the extrapancreatic lesions was described involved in bile duct,gallbladder,kidneys,vessels,lymph nodes,liver,digestive tract,retroperitoneum,and salivary glands,etc.Results IgG4-related sclerosing cholangitis was revealed in 32 patients,presented biliary strictures and thickened wall of bile ducts.Among those,biliary lesions involved intrapancreatic segment of common bile duct (CBD) in 16 patients,hilar bile duct in 1 patient,both intrapancreatic and extrapancreatic segment of CBD in 15 patients,separately.Nineteen patients with AIP presented dilated gallbladder,with delayed enhancement of the thickened wall.Renal involvement was observed in 10,patients appeared as multiple round or wedge-shaped low-enhanced foci in bilateral renal parenchyma,which were hypo-intense on T2-weighted images with mild enhancement.Blood vessel involvement was observed in 16 patients,appeared as embedded vessels with or without stenosis.Furthermore,abdominal lymphadenopathy was observed in 35 patients,in which celiac lymph node group was commonly found in addition to the involvement of multiple lymph node groups for 15 patients.Two patients presented delayed enhancement of serosa of stomach and proximal intestine.Three patients were diagnosed to have retroperitoneal fibrosis surrounding the aorta,inferior mesentary artery and superior mesentary artery.Focal nodular and abnormal enhancement of patchy lesion around intrahepatic bile duct implied of liver involvements in 2 patients.Five among six patients who took 18 F-FDG PET-CT were observed salivary involvements with pathologic uptake of 18F-FDG.Conclusion As multiple organs involvement was the critical characterization of AIP,sufficient understanding of relevant extrapancreatic diseases would be helpful to the diagnosis of this disease.