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自身免疫性胰腺炎合并腹部其他组织器官受累的影像表现

Imaging findings of abdominal extra pancreatic lesions associated with autoimmune pancreatitis: CT and MRI findings

摘要:

目的 研究自身免疫性胰腺炎(AIP)合并腹部其他组织器官受累的影像表现.方法 回顾性分析23例经病理证实或肾上腺皮质激素规范治疗后随访证实的AIP患者临床及影像资料,发现腹部除胰腺外其他组织器官受累者17例,其中14例进行了CT检查,9例进行了MR检查,6例同时行CT及MR检查,分析其影像表现特征.结果 23例患者胰腺呈弥漫性(14例)、局限性(7例)及混合性(2例)肿大,均伴不均匀渐进性延迟强化,16例伴包壳样结构显示.16例胆道系统受累,其中12例见胆总管下段为主的管壁规则增厚,伴增厚处明显强化及胆总管下段“鸟嘴样”移行性狭窄,2例仅见胆总管下段管壁局限性环形强化,2例仅见肝内外胆管扩张.4例肾脏受累,2例为右肾单发病灶,2例为双肾多发病灶,病变主要位于肾脏皮质,CT平扫病灶均为等或等高密度,MR平扫病灶T1WI均为等信号,T2WI均为稍低信号,动态增强扫描各期病灶强化程度均低于正常肾实质,较大病灶可出现延迟强化.4例腹膜后纤维化,其中2例伴腹主动脉下段管壁增厚,1例双侧输尿管上段受累伴肾脏积水,动态增强扫描病灶呈渐进性延迟强化.1例肝门区见2枚肿大淋巴结.结论 AIP患者腹部其他组织器官受累具有特征性的CT和MRI影像表现,有助于明确AIP诊断.

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Objective To investigate the imaging characteristics of abdominal extra pancreatic lesions associated with autoimmune pancreatitis (AIP).Methods Twenty-three patients with AIP proved through histo-pathological or clinical diagnosis were investigated retrospectively.Abdominal extra pancreatic lesions occurred in 17 of them.CT scans were performed in 14 patients and MR imaging in 9 patients (including both of CT and MRI in 6 patients).Results All 23 patients showed enlargement of the pancreas,with diffuse (n =14),focal (n =7) or mixed (n =2) type,with heterogeneously decreased enhancement and gradually delayed enhancement.A "capsule-like" rim was present around the lesions in 16 cases.Bile duct involvement was observed in 16 patients,including bile duct dilatation with lower common bile duct wall thickening and enhancement in 12 patients,as well as bile duct dilatation without wall thickening and bile duct wall enhancement without bile duct dilatation seen in 2 patients respectively.Renal involvement was observed in 4 patients.CT and MR imaging revealed single (in 2 patients) or multiple (in 2 patients),iso or hyper-attenuating.With plain CT,it revealed hypo-intense with T2WI,decreased enhancement lesions in the renal cortex.One mass-like lesion in the right renal showed gradually delayed enhancement Retro-peritoneal fibrosis was seen in 4 patients,which involved abdominal aorta wall (in 2 patients) and ureters (in 1 patient) as well.Gradual delayed enhancement of retro-peritoneal fibrosis was seen during dynamic contrast-enhancement.Abdominal lymphadenopathy at hepatic portal was observed in 1 patient.Conclusions Abdominal extra pancreatic lesions associated with AIP show characteristic imaging findings.CT and MRI modalities may be helpful in the diagnosis of AIP.

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