课件：自身免疫性胰腺炎的影像诊断进展.ppt

Figure 4. A 58-year-old man with f-AIP at the pancreatic body and tail. A-C: CE CT images obtained during the atery phase showing that the spleen atery was surrounded by the enlarged pancreatic body and tail but without any signs of being invaded. A B C 局限性AIP，与血管关系 局限性AIP与血管关系 Figure 1. A 59-year-old man with f-AIP at the pancreatic tail. A: pre-contrast axial computered tomography image shows the “sausage-like” -swollen pancreatic tail. B: Aixal contrast-enhanced computed tomograpy (CE CT) image obtained during the atery phase showing the heterogeneous good-enhanced of the “sausage-like” pancreatic tail, a hypeoattenuating capusule-like rim can be observed around the pancreatic tail, which manifested delayed enhancement during the delayed phases (C, D). A D C B Figure 2. A 53-year-old man with f-AIP at the pancreatic tail. A-D: The lesion showed heterogenous T1WI hypointensity and heterogenous T2WI hyperintensity, which was delayed enhanced. The capsule-like rim appearing as a T1WI iso- or slight hyperintensity and T2WI hypointensity area surrounding the pancreas (white arrow), and were delayed and moderate enhanced. E: MRCP image shows the irregular narrowing MPD in the pancreatic tail ( white arrow ). A D C B E Figure 3. A 55-year-old woman with f-AIP at the pancreatic head. A-B: Aixal contrast-enhanced computed tomograpy (CE CT) image obtained during the delayed phases showing the enhanced thickening CBD wall (black arrow, A) and the narrowing MPD and distal CBD (black arrow, B). C: Bile duct dilation and irregular narrowing MPD of the pancreatic head can be observed on MRCP image. C A B 鉴别诊断要点 病变区局限或弥漫性胰腺肿大、其长轴与胰腺长轴一致，边缘平直 动态增强：平扫密度（信号）降低或降低不明显，但在动脉期和胰腺实质期病变强化程度低于正常胰腺，延迟期强化 假包膜征象：常见 胰胆管改变:病变区胰管呈局限或节段性不规则狭窄，胆管壁增厚、狭窄，狭窄段以上胆管扩张，但未见突然截断征象；可有胰管穿透征 周围情况：未见血管及周围结构侵犯征象，少数可有淋巴结反应性肿大 胰腺外器官受累：肾脏、唾液腺 血清IgG4阳性 病变区胰腺局限性肿大，边缘隆起，分叶状改变 动态增强：平扫病变区胰腺实质密度（信号）降低明显，低水平渐进性强化，延迟期强化程度仍较低 假包膜征象：无 胰胆管改变:病变区胰、胆管突然截断征象，双管征，病变远侧胰管明显扩张、胰腺萎缩，无胰管穿透征 周围情况：常见胰腺周围血管及等组织结构侵犯征象，常有淋巴结肿大 远处脏