自身免疫性胰腺炎合并腹部其它组织器官受累的影像学表现【摘要.doc

自身免疫性胰腺炎腹部其它组织器官受累的影像学表现 【摘要】目的 研究自身免疫性胰腺炎（autoimmune pancreatitis，AIP）腹部其它组织器官受累的影像学表现。方法 回顾性研究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患者临床资料，发现腹部其它组织器官受累者17例，14例进行了CT检查，9例进行了MRI检查，6例同时行CT及MRI检查。结果 16例见胆道系统受累，其中12例见胆总管下段为主的管壁规则增厚，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，未见胆管壁增厚及异常强化。4例见肾脏受累，2例为右侧肾脏单发病灶，2例为两侧肾脏多发病灶，病变位于肾脏皮质，CT平扫病灶均为等或等高密度，MRI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，病灶可出现延迟强化。4例见腹膜后纤维化，2例伴腹主动脉下段管壁增厚，1例双侧输尿管上段受累肾脏积水动态增强扫描病灶渐进性延迟强化。1例肝门区见2枚肿大淋巴结结论 AIP患者腹部其它组织器官受累具有特征性的CT和MRI影像表现，对于明确AIP诊断具有重要的临床意义。 【关键词】胰腺炎；体层摄影术，X线计算机；磁共振成像 Abdominal extrapancreatic lesions associated with autoimmune pancreatitis: CT and MRI findings 【Abstract】Objective To investigate the imaging characteristics of bdominal extrapancreatic lesions associated with autoimmune pancreatitis. Methods Twenty-three patients with AIP proved histopathologically or clinically were investigated retrospectively, abdominal extrapancreatic lesions occurred in 17 of them. CT was performed in 14 patients and MR imaging in 9 patients (including both of CT and MRI in 6 patients). Results 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 hyperattenuating with plain CT, hypointense with T2WI, decreased enhancement lesions in the renal cortex. One mass-like lesion in the right renal showed gradually delayed enhancement. Retroperitoneal fibrosis was seen in 4 patients, which involved abdominal aorta wall (in 2 patients) and ureters (in 1 patient) as well. Gradually delayed enhancement of retroperitoneal fibrosis was seen during dynamic contrast-enhancement. Abdominal lymphadenopathy at hepatic portal was observe