Ⅰ型自身免疫性胰腺炎的MRI表现特征
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摘要
目的探讨Ⅰ型自身免疫性胰腺炎(AIP)的MRI表现特点。方法回顾性分析18例I型AIP患者的MRI资料,包括T_1加权成像、T_2加权成像、磁共振胰胆管成像(MRCP)、扩散加权成像(DWI)和动态增强扫描。观察病变累及部位、范围、信号及动态强化方式。结果 18例中胰腺弥漫性肿大呈"腊肠状"14例,局限性肿大4例。胰腺病变区T_2WI均呈稍高信号,T_1WI呈稍低信号,T_1WI抑脂序列呈低信号。病变区周围环绕增厚的包膜样结构15例,T_2WI均为低信号,T_1WI呈略低信号9例、等信号6例。MRCP示胆总管胰头段呈"鸟嘴样"11例。18例增强扫描病变区动脉期均轻度强化,门静脉期及延时期呈均匀强化。包膜样结构动脉期均无强化,平衡期及延时期强化。18例激素治疗后复查MRI示胰腺外形、信号异常明显好转,胆管狭窄、扩张程度明显减轻。结论Ⅰ型AIP的MRI表现以胰腺弥漫性肿大呈"腊肠状",病变周围环绕增厚的包膜样结构,病变区T_2WI呈稍高信号,T_1WI呈稍低信号,增强呈渐进性延迟强化为特征。其特征对临床诊断及疗效判断有指导意义。
Objective To investigate the MRI characteristics of type Ⅰ autoimmune pancreatitis(AIP-I). Methods The MRI imaging data of 18 cases of AIP-I were analyzed retrospectively. Including T_1 weighted imaging, T_2 weighted imaging, magnetic resonance cholangiopancreatography(MRCP), diffusion-weighted imaging(DWI), and dynamic enhanced scan. We observed the lesion area, range, signal and dynamic strengthening method. Results 18 cases appeared pancreas enlargement, including that 14 cases showed diffusely enlargement, and 4 cases showed segmental enlargement. The lesion area showed a slightly high signal on T_2WI, a slightly low signal on T_1WI, and a low signal on the T_1WI fat-suppression sequence. The capsule-like structure around pancreas were seen in 15 cases, which showed low signal on T_2WI, 9 cases with slightly low signal and 6 cases with equal signal on T_1WI. MRCP showed the pancreatic segment of common bile duct displayed the appearance of "beak like" stenosis in 11 cases. All cases appeared slightly enhanced on the arterial phase and evenly enhanced on the portal vein and delayed phase. The capsule-like structure showed no enhanced on the arterial phase and enhanced on the delayed phase. After hormone therapy, all the cases showed the lesions of the pancreas were improved. Conclusion AIP-I has certain characteristic MRI imaging features,such as the "sausage-shaped" enlargement in the lesion of the pancreas and the capsule-like structure around pancreas, the lesions showed slightly high signal on T_2WI, slightly low signal on T_1WI and enhanced with progressive delayed enhancement. This is helpful for the diagnosis and the curative effect judgment.
Objective To investigate the MRI characteristics of type Ⅰ autoimmune pancreatitis(AIP-I). Methods The MRI imaging data of 18 cases of AIP-I were analyzed retrospectively. Including T_1 weighted imaging, T_2 weighted imaging, magnetic resonance cholangiopancreatography(MRCP), diffusion-weighted imaging(DWI), and dynamic enhanced scan. We observed the lesion area, range, signal and dynamic strengthening method. Results 18 cases appeared pancreas enlargement, including that 14 cases showed diffusely enlargement, and 4 cases showed segmental enlargement. The lesion area showed a slightly high signal on T_2WI, a slightly low signal on T_1WI, and a low signal on the T_1WI fat-suppression sequence. The capsule-like structure around pancreas were seen in 15 cases, which showed low signal on T_2WI, 9 cases with slightly low signal and 6 cases with equal signal on T_1WI. MRCP showed the pancreatic segment of common bile duct displayed the appearance of "beak like" stenosis in 11 cases. All cases appeared slightly enhanced on the arterial phase and evenly enhanced on the portal vein and delayed phase. The capsule-like structure showed no enhanced on the arterial phase and enhanced on the delayed phase. After hormone therapy, all the cases showed the lesions of the pancreas were improved. Conclusion AIP-I has certain characteristic MRI imaging features,such as the "sausage-shaped" enlargement in the lesion of the pancreas and the capsule-like structure around pancreas, the lesions showed slightly high signal on T_2WI, slightly low signal on T_1WI and enhanced with progressive delayed enhancement. This is helpful for the diagnosis and the curative effect judgment.
引文
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[13] 张晶,付旷,沈丹丹,等.磁共振在自身免疫性胰腺炎诊断及鉴别诊断中的应用价值[J].疑难病杂志,2016,15(2):169-171.
[14] 杨盼盼,弓静,王莉,等.自身免疫性胰腺炎胰腺内外病变的影像学特征[J].中华胰腺病杂志,2015,15(4):261-265.
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[16] 裴新龙,谢敬霞,刘剑羽,等.MRCP和DWI鉴别自身免疫性胰腺炎和胰腺导管腺癌[J].影像诊断与介入放射学,2015,24(4):299-304.
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[19] 梁亮,曾蒙苏,姚秀忠,等.自身免疫性胰腺炎的影像学研究[J].中华普通外科杂志,2012,27(9):721-725.
[20] 汪建华,王玉涛,马小龙,等.磁共振成像在自身免疫性胰腺炎诊断与鉴别诊断中的价值[J].中华消化杂志,2014,34(4):260-265.
[21] Ishigami K,Tajima T,Nishie A,et al.MRI findings of pancreatie lymphoma and autoimmune pancreatitis:a comparative study [J].European Journal of Radiology,2010,74(3):22-28.
[22] Hur BY,Lee JM,Lee JE,et al.Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis:comparison with pancreatic adenocareinoma [J].J Magn Reson Imaging,2012,36(3):188-197.
[23] 谭哗,方金洲,杨正汉,等.自身免疫性胰腺炎影像特征的显示:MRI与CT对照[J].中华放射学杂志,2009,43(8):835-839.
[24] 王天龙,张齐,吴刚,等.自身免疫性胰腺炎的诊断与治疗[J].中华消化外科杂志,2016,15(6):584-590.
[25] Raina A,Yadav D,Krasinskas AM,et al.Evaluation and management of autoimmune pancreatitis:experience at a large US center [J].Am J Gastroenterol,2009,104(9):2295-2306.
[2] Dede K,Salamon F,Taller A,et al.Autoimmune pancreatitis mimicking pancreatic tumor [J].Magy Seb,2014,67(1):18-23.
[3] 王泽锋,王海军,张俊晶,等.自身免疫性胰腺炎CT及MRI影像学特征与诊断[J].中华消化外科杂志,2017,16(1):95-101.
[4] 马晓璇,时惠平,郭薇,等.CT灌注成像在局限型自身免疫性胰腺炎诊断中的应用价值研究[J/CD].中华临床医师杂志:电子版,2012,6(14):3899-3903.
[5] Shimosegawa T,Chart ST,Frulloni L,et al.International consen-sos diagnostic criteria for autoimmune pancreatitis:guidelines of the international association of pancreatology [J].Pancreas,2011,40(3):352-358.
[6] Chart ST,Kloeppel G,Zhang L,el al.Histopathologic and clinical subtypes of autoimmune panereatitis:the Honolulu couseflsus document [J].Pancreas,2010,39(5):549-554.
[7] Huggett MT,Culver EL,Kumar M,et al.Type l autoimmune pancreatitis and IgG4-related sclemsing eholangitis is associated with extrapancreatic organ failure,malignancy,and mortality in a prospective UK cohort [J].Am J Gastreenterol,2014,109(10):1675-1683.
[8] Hart PA,Kamisawa T,Brugge WR,et al.Long-term outcomes of autoimmune pancreatitis:a multicentre,international analysis [J].Gut,2013,62(12):1771-1776.
[9] Dong F,Chen QQ,Zhuang ZH,et al.Muhiple gene mutations in patients with type 2 autoimmune panereatitis and its clinical features [J].Cent Eur J Immunol,2014,39(1):77-82.
[10] 黄勤,郑金榆,于成功.自身免疫性胰腺炎的临床与病理学特征[J].中华消化內镜杂志,2006,23(5):372-375.
[11] Rehnitz C,Klauss M,Singer R,et al.Morphologic patterns of autoimmune pancreatitis in CT and MRI [J].Pancreatology,2011,11(2):240-251.
[12] Buscarini E,Frulloni L,Delisi S,et al.Autoimmune pancreatitis:a challenging aiagnostic puzzle for ciinicians [J].Digestive and Liver Disease,2010,42(2):92-98.
[13] 张晶,付旷,沈丹丹,等.磁共振在自身免疫性胰腺炎诊断及鉴别诊断中的应用价值[J].疑难病杂志,2016,15(2):169-171.
[14] 杨盼盼,弓静,王莉,等.自身免疫性胰腺炎胰腺内外病变的影像学特征[J].中华胰腺病杂志,2015,15(4):261-265.
[15] 卢明智,祖茂衡,邵成伟,等.自身免疫性胰腺炎的CT和MRI影像学征象[J].中华胰腺病杂志,2010,10(6):401-403.
[16] 裴新龙,谢敬霞,刘剑羽,等.MRCP和DWI鉴别自身免疫性胰腺炎和胰腺导管腺癌[J].影像诊断与介入放射学,2015,24(4):299-304.
[17] 张斌斌,靳二虎,陈光勇,等.自身免疫性胰腺炎MRI 表现及随访分析[J].国际医学放射学杂志,2016,39(2):111-115.
[18] 朱捷,方金洲,杨正汉.自身免疫性胰腺炎胰腺外病变的影像表现[J].中华放射学杂志,2013,47(6):517-521.
[19] 梁亮,曾蒙苏,姚秀忠,等.自身免疫性胰腺炎的影像学研究[J].中华普通外科杂志,2012,27(9):721-725.
[20] 汪建华,王玉涛,马小龙,等.磁共振成像在自身免疫性胰腺炎诊断与鉴别诊断中的价值[J].中华消化杂志,2014,34(4):260-265.
[21] Ishigami K,Tajima T,Nishie A,et al.MRI findings of pancreatie lymphoma and autoimmune pancreatitis:a comparative study [J].European Journal of Radiology,2010,74(3):22-28.
[22] Hur BY,Lee JM,Lee JE,et al.Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis:comparison with pancreatic adenocareinoma [J].J Magn Reson Imaging,2012,36(3):188-197.
[23] 谭哗,方金洲,杨正汉,等.自身免疫性胰腺炎影像特征的显示:MRI与CT对照[J].中华放射学杂志,2009,43(8):835-839.
[24] 王天龙,张齐,吴刚,等.自身免疫性胰腺炎的诊断与治疗[J].中华消化外科杂志,2016,15(6):584-590.
[25] Raina A,Yadav D,Krasinskas AM,et al.Evaluation and management of autoimmune pancreatitis:experience at a large US center [J].Am J Gastroenterol,2009,104(9):2295-2306.