自身免疫性胰腺炎CT表现及随访分析

目的:观察自身免疫性胰腺炎(AIP)CT表现及动态变化特征。方法:回顾性分析6例AIP患者的临床及CT资料,通过随访患者分析类固醇治疗前、后不同时期AIP的CT表现及转归。结果:类固醇治疗前,5例AIP患者CT见胰腺弥漫性肿大,1例胰头局限性肿大;CT增强扫描显示受累胰腺渐进性强化;2例CT见胰周低密度带;6例受累胰腺区胰管不可见;6例CT见胰腺段胆管壁增厚、管腔狭窄。类固醇治疗后,6例复查和4例远期随访患者CT显示胰腺进行性缩小,其中2例萎缩的胰腺实质呈渐进性强化;2例胰周低密度带消失;6例胆管恢复至正常管径。3例胰腺病变复发,其中2例胰腺弥漫性肿大,1例胰头局限性肿大伴胰体尾萎缩;3例受累胰腺区胰管不可见;1例胰体尾前方出现假性囊肿。结论:类固醇治疗前与病变复发时AIP的CT表现相似,主要包括胰腺弥漫性、局限性肿大以及受累胰腺区胰管不可见,治疗后CT复查及随访可见胰腺进行性缩小或胰腺萎缩。 

CT Features and Follow-up Analysis of Autoimmune Pancreatitis

Objective: To explore CT features of autoimmune pancreatitis(AIP) at initial diagnosis and during follow-up period. Materials and Methods: Clinical and CT features were retrospectively analyzed in 6 patients with AIP, and the abdominal CT examinations included CT before and after steriod treatment, CT in the periods of disease recurrence, and CT in the routine follow-up. Results: At initial diagnosis, pancreatic parenchyma showed diffuse enlargement in 5 patients and focal enlargement in 1 patient, and gradual enhancement in the involved pancreatic parenchyma was seen. Hypo-attenuation rim was seen in 2 patients, pancreatic duct within the diseased pancreas was not visible in 6 patients, and intra-pancreatic bile duct wall thickening was seen in 6 patients. On the abdominal CT after steroid treatment, the size of the diseased pancreas decreased gradually in 6 patients with recheck and 4 patients with routine follow-up CT, the atrophy of the pancreatic parenchyma and progressive enhancement were seen in 2 patients. The hypo-attenuation rim around the pancreas disappeared in 2 patients. The diameter of the narrowed bile duct returned to normal in 6 patients. The pancreatic lesions recurred in 3 patients, diffuse enlargement of the pancreas, and focal enlargement in the pancreatic head was shown in 1 patient accompanying the atrophy of the pancreatic body and tail. The pancreatic duct was not visible in 3 patients. A pseudocyst in the front of pancreas was found in 1 patient. Conclusion: CT features of AIP were similar at initial diagnosis and disease recurrence, the main findings included diffuse or focal enlargement of the pancreas and invisible pancreatic duct; the pancreatic parenchyma decreased gradually, even atrophied, may be seen during follow-up after steroid treatment.