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| 胰腺导管腺癌影像学误诊因素分析 |
| 王志锋1,陈雀芦2,马小龙3*,袁渊3,王铁功3,张雪凤3,杨盼盼3 |
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(1. 宁波市中医院放射科, 宁波 315010;
2. 温州市中心医院放射影像科, 温州 325000;
3. 第二军医大学长海医院影像医学科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 总结胰腺导管腺癌(ductal adenocarcinoma of pancreas, DACP)影像学误诊经验,探讨误诊原因,提高其影像学诊断水平。 方法 51例误诊患者中男13例,女38例,年龄37~79岁,中位年龄54岁;所有患者均接受CT和MRI平扫加增强检查,并经术后病理确诊为DACP。回顾对比分析影像学资料与病理结果,总结误诊原因。 结果 20例低分化DACP完全无囊性成分,因增强后无明显强化被误诊为"胰腺囊性肿瘤"或"胰腺囊肿";16例DACP伴发假性囊肿因肿瘤被囊肿掩盖而被误诊为"胰腺炎伴假性囊肿";15例DACP伴发阻塞性胰腺炎因肿瘤体积小且被炎症表现掩盖而被误诊为"局灶性胰腺炎"。所有病例(100%)均有边缘不清晰的无强化或轻度强化肿块,43例(84%)出现上游主胰管扩张并至肿瘤处"截断"征象,胆总管扩张至胰腺段"截断"征象在肿瘤位于胰头的病例中占100%。 结论 熟练掌握胰腺局部解剖及DACP病理组织学特点并了解其常见继发性改变的影像特征有助于避免其影像学误诊。 |
| 关键词: 胰腺导管腺癌 误诊 X线计算机体层摄影术 磁共振成像 |
| DOI：10.3724/SP.J.1008.2015.1259 |
| 投稿时间：2015-03-21修订日期：2015-07-29 |
| 基金项目:第二军医大学长海医院"1255计划"学科特色提升项目(CH125520804). |
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| Analysis of imaging misdiagnosis of patients with ductal adenocarcinoma of pancreas |
| WANG Zhi-feng1,CHEN Que-lu2,MA Xiao-long3*,YUAN Yuan3,WANG Tie-gong3,ZHANG Xue-feng3,YANG Pan-pan3 |
(1. Department of Radiology, Ningbo Municipal Hospital of Chinese Traditional Medicine, Ningbo 315010, Zhejiang, China;
2. Department of Radiology, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China;
3. Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To summarize the experience of imaging misdiagnosis in patients with ductal adenocarcinoma of pancreas (DACP), to investigate the reasons of misdiagnosis and improve the imaging diagnosis of DACP. Methods The 51 patients who were misdiagnosed by imaging in this study included 13 men and 38 women, with ages ranging from 37-79 years old and the median being 54 years old. All patients underwent CT and MRI examination before they were confirmed as DACP by pathological examination after surgery. The imaging data and pathological results were reviewed and the reasons of misdiagnosis were analyzed. Results Twenty poorly differentiated DACP without cysts were misdiagnosed as "cystic tumor of pancreas" or "pancreatic cyst" due to no obvious enhancement in images; 16 cases of DACP associated with pseudocysts were misdiagnosed as "pancreatitis associated with pseudocyst" due to that the tumors were masked by pseudocysts; and 15 cases of DACP associated with obstructive pancreatitis were misdiagnosed as "focal pancreatitis" due to the tumors' small volume and pancreatitis mask. Indefinite-edge masses which documented no or slight enhancement were seen in all cases (100%); 43 cases (84%) documented the dilated main pancreatic duct were "interrupted"; and 100% of bile ducts were blocked by masses located in the pancreatic head. Conclusion Knowing the local anatomy of pancreas and histopathological features of DACP and understanding imaging characteristics of the secondary changes of DACP can help to avoid imaging misdiagnosis. |
| Key words: pancreatic ductal adenocarcinoma diagnostic errors X-ray computed tomography magnetic resonance imaging |
