增强CT及MR DWI序列对自身免疫性胰腺炎与胰腺癌的鉴别诊断价值

摘要

目的 探讨增强CT及MR扩散加权成像(DWI)对鉴别自身免疫性胰腺炎(AIP)与胰腺癌(PC)的诊断价值.方法 12例AIP患者、15例PC患者均行增强CT及DWI扫描,观察AIP和PC病灶形态及胰胆管形态,测量胰腺病灶的CT值和表观扩散系数(ADC)值,对2组病灶CT征象出现的频数及所测CT值、ADC值进行统计学分析.结果 AIP多表现为弥漫性肿胀、腊肠样外观、胰周包壳、胰管贯穿,受累胆管壁增厚,这些征象对于鉴别AIP与PC有统计学意义(P＜0.05).AIP组与PC组比较,增强CT各期病灶CT值、胰腺病灶CT值/肝脏CT值的差异有统计学意义(P＜0.05).AIP组病灶ADC值显著低于PC组病灶(P＜0.05).结论 胰腺的形态学改变、胰胆管情况对于鉴别AIP与PC具有一定帮助;病灶增强后的CT值及MR上的ADC值对于鉴别AIP和PC具有一定价值.%Objective To investigate the diagnostic value of contrast-enhanced CT and MR diffusion-weighted imaging (DWI) in differentiating autoimmune pancreatitis (AIP) from pancreatic carcinoma (PC).Methods Twelve patients with AIP (AIP groups) and 15 patients with PC (PC groups) were included in this study.Contrast-enhanced CT and DWI were performed in all patients.The manifestations of the pancreatic lesions,pancreatic duct and bile duct were observed.The CT attenuation values and the apparent diffusion coefficient (ADC) values of the lesions were calculated.Frequencies of the CT manifestations,and the mean CT attenuation values,and the ADC values were compared between the two groups.Results Most of the AIP showed diffuse enlargement,sausage shape,peripancreatic capsule,penetrating sign of pancreatic duct and thickness of the bile duct.The frequencies of the findings mentioned above were significantly different between AIP and PC (P＜0.05).The CT attenuation values of the lesions,and the rate of lesions' CT attenuation values to livers' in 3 phases of contrast enhanced CT were significantly different between AIP and PC (P＜0.05).The ADC values of AIP were significantly lower than that of PC (P＜0.05).Conclusion The changes of morphology of pancreas,pancreatic and bile duct may facilitate in differentiating AIP from PC.Quantitative analysis of CT attenuation values and ADC values measured on MR images may be helpful in differentiating AIP from PC.