Intraductal Papillary Mucinous Tumor of the Pancreas: Computerized Tomography and Magnetic Resonance Imaging Features

胰管內粘液性乳突腫瘤之電腦斷層與磁振造影表現

洪敦玫(Tun-Mei Hong) ； 李潤川(Rheun-Chuan Lee) ； 姜仁惠(Jen-Huey Chiang) ； 張政彥(Cheng-Yen Chang)

《The Kaohsiung Journal of Medical Sciences》 19卷2期 (2003/02) Pp. 55-61

https://doi.org/10.6452/KJMS.200302.0055

摘要

本文分析八位具有病理証實胰管內粘液性乳突腫瘤（一例良性乳突狀增生，七例腺癌）患者之胰管內乳突狀粘液性腫瘤的電腦斷層與磁振造影影像學表現。研究方法是以回溯性資料分析及影像學檢查（六個電腦斷層，七個磁振迼影和磁振膽胰管造影），此腫瘤之影像學表現再與其手術、病理以及內視鏡逆行性膽胰攝影的發現作一比照探討。唯一一例良性胰管內乳突狀粘液性腫瘤在電腦斷層影像上以－胰臟體部單房性囊泡表現，並無明顯囊壁上結節亦無合併總胰管擴張。所有七例惡性胰管內乳突狀粘液性癌均呈現多房性囊泡在胰臟頭部以及（或）鉤狀突，同時合併有瀰漫性或節段性總胰管擴張。囊泡壁上乳突狀增生以及囊泡和總胰管相交通均可見。其中一例在胰臟體部的側支胰管同時可見管壁上結節，五例可見鼓出但暢通之十二指腸乳突，一例腫瘤生明顯腫塊效應和胰實體侵犯，導致總膽管阻塞；另外一例在作完超音波導引抽吸後發生囊泡破裂，黏液流至右側前腎旁區的情形。結論：大部份腫瘤是以具乳突狀增生的多房性囊泡在胰臟頭部和鉤狀突表現。雖然電腦斷層與磁振造影無法區分是黏液還是胰液成份，但囊泡和擴張的總胰管相交通，以及出現鼓出但暢通的十二指腸乳突是胰管內乳突狀粘液性腫瘤的特徵。

關鍵字

胰管內乳突狀粘液性腫瘤 ； 胰臟腫瘤 ； 電腦斷層 ； 磁振造影

並列摘要

The aim of this study was to analyze the computerized tomography (CT) and magnetic resonance imaging (MRI) features of intraductal papillary mucinous tumor (IPMT) of the pancreas. The cases of eight patients with pathologically proven IPMT (1 papillary hyperplasia, 7 adenocarcinoma) of the pancreas were retrospectively reviewed. There were five men and three women with ages ranging ham 42 to 82 years. Imaging studies included six thin-section dynamic CT scans, seven MRI scans, one MR cholangiopancreatography scan, and two endoscopic retrograde cholangiopancreatography scans. There was only one benign PMT, which presented as a unilocular cyst in the pancreatic body with no mural nodules and no dilatation of the main pancreatic duct (MPD). All seven patients with malignant IPMT process accompanied by dilated MPD (5 diffuse, 2 segmental). Communication between the Cystic lesions and the MPD were evident in all seven patients. One patient had small mural nodules in the branch ducts of the pancreatic body and five had a bulging papilla with a One patient had a ruptured cyst with mucin leakage into the right anterior pararenal space following sono-guided aspiration .In conclusion, the main imaging feature of IPMT in our patients was multilocular cyst with papillary projections located in the pancreatic head and uncinate process. Although CT and MRI cannot differentiate mucin content from pancreatic juice, communication between the cystic lesion and the dilated MPD and bulging papilla with a patulous orifice are characteristics of IPMT.

並列關鍵字

intraductal papillary mucinous tumor ； pancreas neoplasms ； computerized tomography ； magnetic resonance imaging