论文部分内容阅读
目的：探讨MRI在较小胰腺癌（大小<3cm）的临床诊断价值。资料与方法回顾性分析本院2002年1月至2012年12月间行胰腺MRI检查的病例，经手术病理证实为胰腺癌且癌肿长径<3c m者，共计9例（男7例、女2例）患者纳入研究，年龄48-80岁（平均69.2岁）。由2名放射学医师盲法阅片，观察肿块/结节灶的部位、大小、边缘、是否突出胰腺轮廓外、增强特征、肿块远端胰腺情况、主胰管及分支胰管改变、肝内外胆管改变、胰腺及胰周是否伴发囊肿、是否出现淋巴结和远处脏器转移灶。结果肿块/结节灶位于胰头占5/9、胰体占3/9、胰体尾部交界处占1/9。结节大小为2.2×0.6cm (1.3-2.7cm)。病灶未突破胰腺轮廓占5/9。肿块/结节远端出现慢性胰腺炎改变占7/9，主胰管扩张占7/9。肿块/结节灶与远侧主胰管改变共同构成两种表现：“蛇形征”和“蝌蚪征”。1例患者首诊以胰体尾前方巨大囊肿入院，行“胰腺假性囊肿-空肠吻合术”，术后3月余复查MRI发现较大胰体结节影。结论 MRI和MRCP能很好地评价较小胰腺癌本身、癌肿远侧胰腺改变、胰胆管改变等。“蛇形征”和“蝌蚪征”系未突破胰腺轮廓的较小胰腺癌的两种征象。“,”Objective To study the MRI clinical diagnostic value in smal er pancreatic carcinoma with lesion size <3cm. Materials and methods A total of 9 cases (male 7 cases, female 2 cases; age 48-80 years old, average 69.2 years) were included in the retrospective study in our hospital from January, 2002 to December, 2012. Al patients had pancreatic MRI examination and the cases were confirmed by operation and pathology of pancreatic cancer with the tumor diameter <3cm. MRI images were readed blindly by two radiologists. It included:the mass/ nodule location, size, edge, the pancreas contour, enhanced features, pancreatic duct and branch duct change, intrahepatic and extrahepatic bile duct, pancreatic and peripancreatic concomitant cyst change, and findings of lymph node and distant organ metastasis. Results The masses or nodules were located in pancreatic head (5/9), body (3/9), and the junction of body and tail of pancreas (1/9), respectively. The nodule size is 2.2±0.6cm (1.3-2.7cm). Lesions which did not break through pancreatic contour accounted for 5/9. Masses or nodules with chronic pancreatitis and the expansion of main pancreatic duct accounted for 7/9. The pancreatic nodules and distal pancreatic duct change constituted two performances: “snake-like sign” and “tadpole-like sign”. Conclusion MRI and MRCP can wel evaluate smal er pancreatic cancer including cancer of pancreas itself and pancreatic duct change and so on. “snake-like sign” and “tadpole-like sign” refer to two signs of smal er pancreatic cancer without breaking through pancreatic contour on MRI.