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目的分析自身免疫性胰腺炎(AIP)胰腺自身及胰腺外器官受累的CT表现特点,提高对AIP的诊断水平。方法选择经临床诊断为AIP的9例患者,其中男性6例,女性3例;年龄52~63岁,平均年龄56.5岁。CT检查包括平扫、三期(动脉期、门静脉期、延迟期)增强扫描;在CT图像上观察胰腺的形态、大小、强化程度、胰管、胰腺周缘情况;胰腺外受累情况,主要观察胰周血管、肠系膜血管、胆道、肾脏、腹膜后间隙等情况,并结合文献复习,探讨AIP胰腺内外的CT表现。结果 9例均表现为胰腺增大,呈“香肠样”外观,其中6例弥漫性增大,3例局限性增大;病变胰腺强化特点为动脉期强化减弱,门静脉期、延迟期表现为渐进性强化且强化匀匀;4例可见包膜样环。胰腺外表现主要为胆管壁增厚并狭窄3例,脾血管包埋变细3例,肾脏受累3例,腹膜后淋巴结肿大6例,肠系膜血管周围纤维化1例。经类固醇激素治疗后首次CT复查显示胰腺内外病变均有不同程度好转。结论 AIP患者胰腺内、外CT表现均具有一定特征。其CT表现结合类固醇激素治疗有效,可做出正确诊断,避免患者不必要的手术治疗。
Objective To analyze the CT features of pancreatic adenocarcinoma and extrapancreatic organ of autoimmune pancreatitis (AIP) and to improve the diagnostic value of AIP. Methods Nine patients who were clinically diagnosed as AIP were selected, including 6 males and 3 females. The average age was 56.5 years. The CT examination included plain scan and phase III (arterial phase, portal vein phase and delayed phase) enhanced scanning. The morphology, size, degree of enhancement, pancreatic duct and peripancreatic conditions of pancreas were observed on CT images. Peripheral blood vessels, mesenteric vessels, biliary tract, kidneys, retroperitoneal space and so on. Combined with the literature review, CT findings of AIP pancreas both inside and outside were explored. Results All of the 9 cases showed pancreatic enlargement and appearance of “sausage-like” appearance, of which 6 cases were diffusely enlarged and 3 cases were limited. The enhancement of lesion was characterized by weakening of the arterial phase, portal vein phase and delayed phase For the gradual strengthening and strengthening uniform; 4 cases can be seen coated ring. Pancreatic outside the performance of the main bile duct wall thickening and stenosis in 3 cases, 3 cases of splenic blood vessel embolization and thinning, kidney involvement in 3 cases, retroperitoneal lymph node enlargement in 6 cases, 1 case of mesenteric perivascular fibrosis. After the first steroid hormone therapy CT review showed that the internal and external pancreatic lesions have varying degrees of improvement. Conclusion Both intra-and extra-pancreatic CT findings in AIP patients have certain features. Its CT performance combined with steroid treatment is effective, can make the correct diagnosis, to avoid unnecessary surgical treatment of patients.