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目的探讨自身免疫性胰腺炎(AIP)与胰腺导管腺癌(PDAC)的CT增强表现。方法将23例经手术(6例)、组织学活检(9例)和激素治疗后随访(8例)证实的AIP患者纳入研究组,将36例手术证实的PDAC患者作为对照组,比较两组患者的CT平扫及动态增强图像,主要记录病变及胰腺形态、受累胰管和胆管形态,测量病灶各期CT值。结果 23例AIP包括6例局灶型、14例弥漫型及3例混合型,20例呈腊肠样肿胀,13例出现胰周包壳,均无胰腺萎缩,17例病灶出现延迟强化,仅4例病变远端胰管扩张且<0.5 cm;19例胰腺段胆管狭窄,多为渐进性(14例),伴有上方胆管扩张(7例伴有狭窄)。而36例PDAC均呈结节状,均未出现腊肠样肿胀及胰周包壳,27例出现胰腺萎缩,仅4例出现延迟强化;33例病变远端胰管扩张,其中27例≥0.5 cm;17例胰腺段胆管受侵狭窄,多为截断样(11例),15例伴有上方胆管扩张。结论腊肠样肿胀、胰周包壳、病灶延迟强化、胰管无扩张或轻度扩张(<0.5 cm)、胰腺段胆管渐进性狭窄、胰腺段以上胆管狭窄更多见于AIP患者,而胰腺萎缩、胰管扩张≥0.5cm、胰腺段胆管截断样狭窄更多见于PDAC患者。CT增强检查有助于两者的鉴别。
Objective To investigate the CT manifestations of autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC). Methods Twenty-three AIP patients confirmed by operation (6 cases), histological biopsy (9 cases) and post-hormone treatment follow-up (8 cases) were enrolled in the study group. Thirty-six patients with PDAC confirmed by surgery were selected as control group, CT scan and dynamic enhancement of the patient’s image, the main lesion and pancreas morphology, pancreatic duct involvement and bile duct morphology, CT value of the lesion were measured. Results 23 cases of AIP included 6 cases of focal type, 14 cases of diffuse type and 3 cases of mixed type, 20 cases of sausage-like swollen, pancreatic peripancreatic envelope in 13 cases, no pancreatic atrophy, delayed enhancement of 17 cases, only 4 Cases of distal pancreatic duct dilatation and <0.5 cm; 19 cases of bile duct stenosis, mostly progressive (14 cases), accompanied by the upper bile duct dilatation (7 cases with stenosis). While 36 cases of PDAC were nodular, no sausage-like swelling and pancreas peripancapsulation, 27 cases of pancreatic atrophy, delayed enhancement in only 4 cases; 33 cases of distal pancreatic duct dilatation, of which 27 cases ≥ 0.5 cm 17 cases of bile duct invasion of the narrow stenosis, mostly truncated (11 cases), 15 cases associated with the upper bile duct dilatation. Conclusions The sausage-like swelling, peripancapsulation, delayed enhancement of the lesion, no or slight dilatation of the pancreatic duct (<0.5 cm), progressive narrowing of the bile duct in the pancreatic segment and more common bile duct stenosis in the pancreatic segment are more common in patients with AIP. However, pancreatic atrophy, Pancreatic duct dilatation ≥ 0.5cm, pancreatic segmental biliary duct stenosis more common in PDAC patients. CT enhanced examination will help identify the two.