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中晚期胰腺癌的CT和MRI诊断

时间:2017-09-11 05:00:02来源:www.xielunwen.net 作者:admin 点击: 12 次
作者:张世科,江海燕,关天明 【关键词】胰腺癌;体层摄影术/X线计算机;磁共振成像 [摘要]目的:探讨中晚期胰腺癌的CT和MRI诊断价值。方法:回顾性分析34例经手术或病理证实的中晚期胰腺癌患者的CT和MRI检查资料。结果:中晚期胰腺癌的影像表现为胰腺肿块,肿块与正常肝实质相比,在T1加权像呈低信号,T2加权像呈高信号,CT平扫呈低密度,MRI信号强度和CT密度不均

                        作者:张世科,江海燕,关天明

【关键词】  胰腺癌;体层摄影术/X线计算机;磁共振成像

  [摘  要] 目的:探讨中晚期胰腺癌的CT和MRI诊断价值。方法:回顾性分析34例经手术或病理证实的中晚期胰腺癌患者的CT和MRI检查资料。结果:中晚期胰腺癌的影像表现为胰腺肿块,肿块与正常肝实质相比,在T1加权像呈低信号,T2加权像呈高信号,CT平扫呈低密度,MRI信号强度和CT密度不均匀,增强扫描轻度强化,可见坏死及囊变,胰、胆管扩张,双管征,邻近血管和脏器受侵,肝脏和腹膜后淋巴结转移。结论:CT和MRI检查对中晚期胰腺癌的诊断及鉴别诊断具有重要意义,可判断手术可切除性和预后。

  [关键词] 胰腺癌;体层摄影术/X线计算机;磁共振成像

  CT and MRI Diagnosis of Late and Midtrimester Pancreatic Cancer

  Abstract:Objective To study the diagnostic value of CT and  MRI on late and midtrimester pancreatic cancer.Methods MRI findings of pancreatic cancer in 34 cases were analyzed retrospectively.Results The imaging feature of late and midtrimester pancreatic cancer was pancreatic mass.The pancreatic caner mass showed slightly low signal on T1WI and slightly high signal on T2WI compared with the liver parenchyma.On plain CT scan,the pancreatic caner mass showed hyperdensity.The MR signal and CT density were nonhomogeneous.There was slightly enhancement when contrast was given.The necrosis and cystic changing,double canal sign and cholangiectasis can be seen.The IVC and the superior mesenteric artery and vein can be invasived.Heptic hilum and retroperitoneal lymph nodes metastases.Conclusion MRI examination had importmant value on the diagnosis and differential diagnosis of late and midtrimester pancreatic cancer,the probability of surgery operation and the prognosis of the patients.

  Key words:Pancreatic cancer;Xray/Computed tomography;Magnetic resonance imaging

  胰腺癌约占胰腺恶性肿瘤的75%~90%,近年来发病率有逐渐增高的趋势。由于胰腺癌位置隐蔽和早期无症状,早期诊断困难。本文回顾分析我院及广州南方医院经手术病理证实的34例胰腺癌病例CT及MRI检查资料,以提高对本病的诊断认识。

  1  资料和方法

  1.1  一般资料  经手术病理证实的34胰腺癌患者,最小年龄46岁,最大年龄86岁,平均年龄62岁,男21例,女13例。临床主要表现:腹痛、体重下降、恶心、纳差、乏力、背痛。胰头癌患者多有无痛性黄疸,胰体尾癌多背痛明显。确诊后自然病程短于1 a。

  1.2  仪器设备和检查方法  CT扫描设备采用Somatom Plus4及Prospeed All全身CT机,34例均做平扫和增强扫描,扫描层厚=层距=5 mm,对比剂为尤维显。MR扫描采用SIEMENS公司Somatom Plus Vision1.5T和Magnetomc 0.35T全身MR扫描仪。34例行平扫,其中24例做GdDTPA增强扫描,扫描层厚8 mm,间隔1 mm,常规作轴位和冠状位扫描,序列为用自旋回波(SE)和快速自旋回波(TSE),分别获得T1加权像和T2加权像及脂肪抑制T2像。

  2  结果

  34例中胰头部肿块23例(见图1),其中20例有明显的肝内外胆管扩张,3例胆道系统正常;胰腺头体部肿块7例(见图2),胰体尾部肿块4例(见图3),均无胆道系统扩张;胰腺肿块最大为11 cm×8 cm×7 cm,最小直径为3 cm。肿块信号强度T1WI表现为略低于肝实质信号,T2WI表现为略高于肝实质信号。扩张的胆管T1WI表现为均匀低信号,T2WI表现为均匀明亮的高信号。22例患者可见下腔静脉、肠系膜上动静脉、脾动静脉受压移位或包绕拉直。CT平扫肿块与胰腺多呈等或低密度。胰腺周围脂肪消失、浸润转移。15例见肝门及腹膜后淋巴结肿大。18例胰管扩张呈串珠状,胰头内胰管与总胆管扩张呈“双管征”(见图4)。继发胰腺假性囊肿7例。肝内转移9例,CT呈不规则低密度。当肿瘤内出血、液化、坏死时,T2WI表现混杂不均匀信号。MRCP观察胆总管、胆囊、胰管扩张及假囊肿较好。图1  患者女,73岁,上腹疼痛向双肩放射8个月入院。a:CT平扫示胰头部肿块;b~c:CT增强扫描示胰头肿块轻度不均匀增强,其内可见更低密度无强化坏死区,肠系膜上动静脉受肿块包绕,手术病理为高分化导管腺癌图2  患者男,46岁,反复上腹饱胀不适一年入院。a.CT平扫示胰腺头体部巨大肿块,密度不均;b~c.CT增强扫描示肿块明显不均匀强化,并可见无强化坏死区,肠系膜上动、静脉,右肾静脉及下腔静脉受侵犯;d.上部层面增强扫描示肝内胆管扩张及肝右后叶转移。手术病理为胰腺小圆细胞肿瘤(高度恶性)。

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