目的 探讨超声在老年自身免疫性胰腺炎(AIP)早期诊断及鉴别诊断中的应用价值.方法 分析经影像学检查及临床随访最终证实的7例老年AIP患者影像学资料,并结合临床表现分析其声像图特征.结果 7例AIP患者超声检查后,4例行CT平扫+增强,3例行MRI扫描.超声、CT、MRI示AIP均表现为胰腺体积弥漫性或局限性肿大.超声检查AIP形态多不规则,实质回声显著或稍减低.其中2例胰体头部肿大明显,略呈分叶状,内回声欠均匀,彩色多普勒示胰头区周边见少许点、条状血流信号,血流不丰富；2例表现为胰体尾部局限性增大；3例表现为胰腺弥漫性肿大.7例均有不同程度的弥漫性肝损伤声像图表现,肝内胆管和胆总管轻度扩张.2例胆总管中上段壁增厚,4例胆总管中下段略呈“鸟嘴样”狭窄,1例患者出现颌下腺、腮腺及多处淋巴结肿大(双侧颌下区、锁骨上窝、双侧腋窝、腹股沟处及腹腔腹膜后).6例AIP患者经治疗后,胰腺功能和形态基本恢复正常,复发1例.另1例患者高度怀疑肿瘤,但术中未见癌细胞,后对症治疗.结论 AIP超声图像具有一定特征,超声作为首选的影像学检查方法有助于AIP的早期准确诊断,对临床治疗有指导意义.%Objective To investigate the application value of ultrasonography in the early and differential diagnosis of age-related autoimmune pancreatitis (AIP). Methods The imaging data of seven patients with AIP,who were confirmed by imaging and clinical follow-up, were retrospectively reviewed;the ultrasound features were analyzed with the combination of their clinical manifestations. Results Of the seven cases, after ultrasonography, plain and enhanced CT were carried out in four cases; MRI was carried out in three cases. The results of ultrasonography, CT and MRI revealed that pancreas was diffusely or locally swollen in AIP. In the ultrasonography, pancreas had an irregular shape and the internal echo was reduced significantly or slightly. In two of them, pancreas head swelled significantly with a leafy shape and uneven internal echo. Color Doppler imaging revealed that there was a little point-strip bloodstream signals around pancreas head. In two cases, pancreas body and tail swelled locally. Different degrees of diffuse hepatic damage, slightly dilated intrahepatic and common bile duct were shown in all of the seven cases by ultrasonography. The mid-upper common bile duct wall was thickened in two cases and mid-lower common bile duct was beak-likely narrow in four cases. Lymph nodes were swollen in submaxillary and parotid gland and multiple areas including bilateral submaxillary region, supraclavicular region, bilateral fossa axillaris, groin and retroperitoneal region. After corticosteroid therapy, the pancreas function and morphology returned to normal in six cases but AIP relapsed in one case. Conclusion AIP had certain ultrasonography characteristics. Ultrasonography can be used a preferred imaging method for the early diagnosis of AIP and provides guidance for the clinical treatment of AIP.
展开▼
