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目的总结胰腺导管腺癌(ductal adenocarcinoma of pancreas,DACP)影像学误诊经验,探讨误诊原因,提高其影像学诊断水平。方法 51例误诊患者中男13例,女38例,年龄37~79岁,中位年龄54岁;所有患者均接受CT和MRI平扫加增强检查,并经术后病理确诊为DACP。回顾对比分析影像学资料与病理结果,总结误诊原因。结果 20例低分化DACP完全无囊性成分,因增强后无明显强化被误诊为“胰腺囊性肿瘤”或“胰腺囊肿”;16例DACP伴发假性囊肿因肿瘤被囊肿掩盖而被误诊为“胰腺炎伴假性囊肿”;15例DACP伴发阻塞性胰腺炎因肿瘤体积小且被炎症表现掩盖而被误诊为“局灶性胰腺炎”。所有病例(100%)均有边缘不清晰的无强化或轻度强化肿块,43例(84%)出现上游主胰管扩张并至肿瘤处“截断”征象,胆总管扩张至胰腺段“截断”征象在肿瘤位于胰头的病例中占100%。结论熟练掌握胰腺局部解剖及DACP病理组织学特点并了解其常见继发性改变的影像特征有助于避免其影像学误诊。
Objective To summarize the misdiagnosis experience of ductal adenocarcinoma of pancreas (DACP) and to explore the causes of misdiagnosis and to improve its imaging diagnosis. Methods 51 cases of misdiagnosed patients, 13 males and 38 females, aged 37 to 79 years old, the median age of 54 years; all patients underwent CT and MRI plain and enhanced examination, and postoperative pathology diagnosed as DACP. Review comparative analysis of imaging data and pathological findings, summarizes the causes of misdiagnosis. Results Twenty cases of poorly differentiated DACP had no cystic components and were misdiagnosed as “pancreatic cystic tumors” or “pancreatic cysts” due to enhanced enhancement. 16 cases of DACP accompanied by pseudocysts were covered by cysts And was misdiagnosed as “pancreatitis with pseudocyst”. Fifteen patients with obstructive pancreatitis complicated with DACP were misdiagnosed as “focal pancreatitis” because of their small size and their masking of inflammation. In all cases (100%), there were no enhanced or mildly enhanced lumps with unclear margins. In 43 (84%) cases, the dilatation of the upper main pancreatic duct and the “truncation” sign of the tumor appeared. The common bile duct was expanded to the pancreas segment “Truncated” signs account for 100% of the cases where the tumor is located in the head of the pancreas. Conclusion Proficiency in the local anatomy of the pancreas and the histopathological features of DACP and understanding of the imaging features of common secondary changes help to avoid misdiagnosis of the imaging.