胰腺实性-假乳头状瘤的非典型影像学表现

陈文芳; 顾君英

doi:10.12025/j.issn.1008-6358.2017.20160594

摘要: 目的：回顾分析胰腺实性-假乳头状瘤的典型和非典型影像学表现。方法：与手术病理检查结果相对照，回顾分析33例胰腺实性假乳头状瘤的多排螺旋CT（MDCT）和MRI表现，包括肿瘤位置、形态、最大直径、包膜、囊变、出血、钙化及增强方式。统计学分析组织病理学表现与患者年龄、性别以及肿瘤大小之间的相关性，并比较MDCT和MRI在显示肿瘤的包膜、囊变、出血、钙化及增强方式时有无差异。结果：33例患者中，年轻（≤40岁）女性共17例（51.5％），老龄（＞40岁）女性共11例（33.3%），男性5例（15.2%）；大肿瘤（直径＞3 cm）共26例（78.8%），小肿瘤（直径≤3 cm）共7例（21.2％）。年轻患者比老龄患者更易发生瘤内囊性退变（P=0.030）。男性患者更多发生小肿瘤（P=0.015），肿瘤假包膜及囊性退变的发生率也明显低于女性患者（P=0.025，P=0.002）。大肿瘤实质内囊变、出血和假包膜的发生率明显高于小肿瘤（P值分别为0.001、0.002和0.029）。MDCT和MRI在显示肿瘤的包膜、囊变及增强模式能力上差异无统计学意义（P＞0.05），但MRI在显示肿瘤内出血上效果明显优于MDCT（P=0.001），而MDCT显示瘤内钙化的能力明显优于MRI（P=0.028）。结论：胰腺实性-假乳头状瘤好发于年轻女性，具有典型的影像学表现；而男性或＞40岁的女性胰腺实性-假乳头状瘤患者的影像学表现多为实性肿瘤及周边到中央的渐进性动态强化模式。

Abstract: Objective：To retrospectively analyze the typical and atypical imaging features of solidpseudopapillary tumor of pancreas (SPTP) in contrast with pathology. Methods：Multidetector CT (MDCT) and MR imaging (MRI) appearances of 33 cases with SPTP proven by histopathology, including tumor location, shape, size, capsule, cystic degeneration, hemorrhage, calcification and enhancement type, were retrospectively investigated and compared with their pathological findings. The correlation of pathologic demonstrations with the age and gender of patients and the tumor size were statistically evaluated. The differences of MDCT and MRI in displaying tumor capsule, cystic degeneration, hemorrhage, calcification, and enhancement type were statistically analyzed. Results：Among 33 cases of SPTP, there were 17 (51.5％) young (≤40 years old) females, 11 (33.3%) elderly (＞40 years old) females and 5 (15.2%) males; there were 26 (78.8%) cases with large tumors (the biggest diameter ＞3.0 cm), and 7 (21.2％) with small tumors (the biggest diameter ≤3.0 cm). Young patients were more likely to develop cystic degeneration of tumors than elderly patients (P=0.030). The incidence rates of small tumors (P=0.015), false capsule (P=0.025), and cystic degeneration (P=0.002) of tumors in male patients were lower than those in female patients. The incidence rates of cystic degeneration (P=0.001), hemorrhage (P=0.002), and false capsule (P=0.029) in large tumors were higher than those in small tumors. There were no statistical differences between MDCT and MRI in demonstrational abilities of capsule, cystic degeneration and enhancement type. MRI was much superior to locate the hemorrhagic areas in tumors than MDCT (P=0.001), while MDCT was much superior to detect calcifications than MRI (P=0.028). Conclusions：Typical imaging demonstrations are often observed in the young female patients with SPTP, while atypical imaging demonstrations which mostly exhibit solid tumors and the progressive dynamic enhancement pattern from the periphery to the center are mostly observed in the male and elderly (＞40 years old) female patients with SPTP.