自身免疫性胰腺炎MRI表現及隨訪分析

張斌斌靳二虎陳光勇張潔張澍田鄭新楊正漢馬大慶

自身免疫性胰腺炎MRI表現及隨訪分析

張斌斌1，4靳二虎1陳光勇2張潔1張澍田3鄭新4楊正漢1馬大慶1

目的探討自身免疫性胰腺炎（AIP）的MRI表現以及隨訪過程中影像動態變化。方法分析11例AIP病人的臨床及MRI資料，觀察AIP在類固醇治療前、后不同時期的MRI表現。采用配對樣本t檢驗，分別對初診與自然病程下及初診與類固醇治療后的胰腺大小測量值進行比較。結果初診時9例胰腺彌漫性腫大，1例胰頭局限性腫大，1例胰體見局限性腫塊；受累胰腺在T1WI低信號11例，T2WI高信號10例、等信號1例；4例顯示胰周低信號帶；胰腺病變區7例胰管不可見，2例間斷顯示，1例呈串珠狀改變，1例胰體部胰管受壓、移位；9例胰腺段膽管壁增厚。自然病程下隨訪，5例胰腺腫大程度及MRI信號異常與初診病變相似，4例膽管壁病變范圍較初診病變加重。類固醇治療后，6例胰腺腫大、MRI信號異常以及膽管壁增厚趨于正常，胰周低信號帶消失。有效治療后3例胰腺病變復發，復發性AIP的MRI表現與初診病變相似，其中1例胰體尾前方出現假性囊腫。初診與自然病程下胰腺大小差異無統計學意義（P＞0.05），初診與類固醇治療后胰腺大小差異有統計學意義（P＜0.05）。結論AIP的MRI表現有一定特征，MRI可用于診斷AIP，評估類固醇療效，長期隨訪以及了解有無病變復發。

自身免疫性胰腺炎；磁共振成像；隨訪

DOI：10.19300/j.2016.L3365

【Abstract】ObjebtiveTo explore MRI features of autoimmune pancreatitis（AIP）at initial diagnosis and follow-up periods.MethodsClinical and MRI appearances in 11 patients with AIP were observed，and MRI features before and after steroid treatment in different periods were retrospectively analyzed.The difference in pancreatic size between initial and follow-up exam was tested with paired samples t test，comparison was done also for measures at initial and after steroid treatment.ResultsOn initial MRI，pancreatic parenchyma showed diffuse enlargement in 9 patients，focal enlargement at the pancreatic head in 1，and focal mass at the body in 1.The involved pancreas appeared as hypo-intense on T1-weighted images in all patients，hyper-intense on T2-weighted images in 10，and iso-intense in 1.Hypo-intense rim around the pancreas was seen in 4 patients.Pancreatic duct was not visible in 7 patients，intermittent display in 2，beading change in 1，and displacement at the body in 1.Thickening of intra-pancreatic bile duct wall was seen in 9 patients.Follow-up in natural process，pancreatic enlargement and MRI signal change were similar to the initial lesions in 5 patients，progression of bile duct involvement was noted in 4.Following steroid treatment，the pancreas swelling，signal abnormalities，thickening of bile duct wall became normal in 6 patients，hypo-intense rim around the pancreas disappeared in 4 patients.Pancreatic lesions recurred in 3 patients.The lesion features in recurrence were similar to those in the original.In addition，a pseudocyst occurring in front of pancreatic body and tail was found in 1 patient.There was no significant difference in pancreatic size between initial and followup exams in the patients with natural process，and there was statistical significance before and after steroid treatment.ConclusionMRI features of AIP were characteristic，and MRI can be used in diagnosis，evaluation of steroid effect，long-term follow-up and identifying recurrence.

【Key words】Autoimmune pancreatitis；Magnetic resonance imaging；Follow-up Int J Med Radiol，2016，39（2）：111-115

作者單位：首都醫科大學附屬北京友誼醫院1放射科，2病理科，3消化科，北京100050；4首都醫科大學附屬北……