胰腺结核的 MSCT 表现及误诊分析

摘要

Objective To investigate the multi‐slice spiral CT (MSCT) features of pancreatic tuberculosis and to study its differential diagnosis .Methods Imaging features of MSCTwere retrospectively reviewed on 3 cases with pancreatic tuber‐culosis that were confirmed by pathology ,including location ,boundary ,density ,enhancement features ,the relationships between the lesion and bile/pancreatic duct ,peripheral vessels .Results 1 case of pancreatic cancer ,1 case of pancreatic cancer with retroperitoneal lymph node metastasis ,and 1 case of lymphoma were diagnosed by MSCT ,whereas ,all the le‐sions were diagnosed as pancreatic tuberculosis pathologically ,the misdiagnosis rate was 100% .Pancreatic tuberculosis often presented as local low density mass ,with slightly or moderate ring‐like or honeycomb enhancement after contrast in‐jection .The retroperitoneal and adjacent lymph nodes were always enlarged with ring‐like enhancement ;peripheral vessels were also compressed ;the enlargement of the pancreatic or bile duct wasn’t obvious .Conclusion Ring‐like or honeycomb enhanced pancreatic lesion masses with ring‐like enhanced lymph nodes without(with) slightly enlargement of pancreatic or bile duct are characteristic MSCT features of pancreatic tuberculosis .%目的：探讨胰腺结核（pancreatic tuberculosis ，PT）的多层螺旋CT（MSCT）表现，并行误诊原因分析。方法回顾性收集3例行 MSCT 检查并经病理证实的 PT 患者，分析 PT 的 MSCT 表现，分析其位置、边缘、密度、增强特征及与胆管、胰管、周边血管的关系。结果 MSCT 诊断为胰腺癌1例，胰腺癌伴后腹膜淋巴结转移1例，淋巴瘤1例，经病理证实3例均为 PT ，误诊率达100％。 MSCT 多表现为胰腺内局灶性略低密度肿块，轻中度环形强化或蜂房状强化，常伴有后腹膜及邻近淋巴结肿大，且肿大淋巴结呈环形强化，胰管及胆管扩张程度轻，周边血管为受压改变。结论胰腺内局灶性环形或蜂房状强化的肿块及伴有环形强化的胰周淋巴结肿大，胰管及胆管扩张程度轻或不扩张，为 PT 相对特征性的 MSCT 表现。