CAJ | 학술논문

目的探讨胆管导管内乳头状黏液性肿瘤(IPMN-B)的CT、MRI特征及其形态分型.方法回顾性分析经病理证实的IPMN-B患者18例,16例行CT平扫+增强扫描,13例行MR增强扫描,其中11例同时行CT和MR检查.观察分析其影像和病理表现,结合影像及病理表现将IPMN-B分为典型IPMN-B、囊性IPMN-B、无肿块型IPMN-B和侵袭性IPMN-B共4种类型,确定其分型.结果典型IPMN-B 9例,表现为沿胆管壁的肿瘤灶,肿瘤上游、下游胆管均明显且广泛扩张.囊性IPMN-B5例,胆管呈动脉瘤样扩张,内可见单发或多发瘤灶.无肿块型IPMN-B 2例,胆管呈广泛明显扩张,未见明确肿瘤病灶,胆管壁光滑.侵袭性IPMN-B 2例,病灶所在节段胆管扩张,肿瘤突向胆管腔内使胆管壁呈锯齿状,伴随胆管外异常密度或信号灶.18例均有胆管扩张,其中16例可见扩张胆管内肿瘤病灶,2例未见明确瘤体显示,仅表现为胆管扩张.CT扫描可见肿瘤密度低于肝实质,并高于胆汁和胆管内黏液.MR T2WI可见肿瘤信号高于结石,并低于胆汁和黏液.DWI肿瘤均表现为高信号.增强扫描肿瘤呈轻中度强化,三期增强扫描可见肿瘤的密度或信号均低于肝实质.结论 IPMN-B的CT和MRI表现具有一定特征性并有助于分型.
목적 탐토담관도관내유두상점액성종류(IPMN-B)적CT、MRI특정급기형태분형.방법 회고성분석경병리증실적IPMN-B환자18례,16례행CT평소+증강소묘,13례행MR증강소묘,기중11례동시행CT화MR검사.관찰분석기영상화병리표현,결합영상급병리표현장IPMN-B분위전형IPMN-B、낭성IPMN-B、무종괴형IPMN-B화침습성IPMN-B공4충류형,학정기분형.결과 전형IPMN-B 9례,표현위연담관벽적종류조,종류상유、하유담관균명현차엄범확장.낭성IPMN-B5례,담관정동맥류양확장,내가견단발혹다발류조.무종괴형IPMN-B 2례,담관정엄범명현확장,미견명학종류병조,담관벽광활.침습성IPMN-B 2례,병조소재절단담관확장,종류돌향담관강내사담관벽정거치상,반수담관외이상밀도혹신호조.18례균유담관확장,기중16례가견확장담관내종류병조,2례미견명학류체현시,부표현위담관확장.CT소묘가견종류밀도저우간실질,병고우담즙화담관내점액.MR T2WI가견종류신호고우결석,병저우담즙화점액.DWI종류균표현위고신호.증강소묘종류정경중도강화,삼기증강소묘가견종류적밀도혹신호균저우간실질.결론 IPMN-B적CT화MRI표현구유일정특정성병유조우분형.
Objective To investigate the CT and MRI features and morphology classification of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B).Methods A total of 18 patients with IPMN-B proved by pathology were retrospectively analyzed.Out of 18 patients,16 patients underwent enhanced and non-enhanced CT,13 underwent contrast enhanced MR,and 11 out of 13 underwent both CT and MRI.IPMN-B was classified into 4 types:typical IPMN-B,cystic-forming IPMN-B,non-tumor IPMN-B and invasive IPMN-B,according to imaging findings and gross pathological findings.Results Typical IPMN-B (9 cases):tumors were distributed along the bile ducts,both upstream and downstream bile ducts were obviously dilated.Cystic-forming IPMN-B (5 cases):single or multiple tumors were found in aneurysmal dilatation of bile ducts.Non-tumor 1PMN-B (2 cases):no mass was found in the widely dilated bile ducts with smooth bile duct wall.Invasive IPMN-B (2 cases):tumors protruded into the dilated bile ducts causing jagged wall of bile duct,with accompanied abnormal density or signal intensity outside the bile ducts.Bile duct dilatations were shown in all 18 cases,and tumors were shown in 16 cases.In 2 cases no mass was displayed in widely dilated bile ducts.CT density of the tumor was lower than that of liver parenchyma,and higher than that of the bile and intraductal mucin.Signal intensity of the tumor was higher than that of stones,and lower than that of bile and intraductal mucin at MR T2WI.All tumors showed high intensity on DWI.Tumors showed mild to moderate enhancement after injection of contrast agent,CT density or signal intensity of the tumors were lower than that of the liver parenchyma during all three phases of contrast-enhanced CT or MRI.Conclusion IPMN-B has some specific CT and MR imaging features,which are helpful for the diagnosis and classification of IPMN-B.