胰腺实性-假乳头状瘤的CT表现及手术可行性评价

探讨胰腺实性-假乳头状瘤的CT特征，以提高术前诊断准确性并为手术和预后评估提供依据。方法: 回顾性分析经手术病理证实的胰腺实性-假乳头状瘤20例，男2例，女18例，年龄12～73岁，平均年龄（30.3±16.2）岁，所有病例均行CT平扫及多期动态增强检查，分析肿瘤的CT表现，并与术中实际情况进行对照。结果:CT平扫:20例肿物均表现为较大的胰腺肿块，其中13例明显突出于胰腺轮廓外；肿块呈类圆形、椭圆形或分叶状，边缘较清楚；13例为囊实性，3例为囊性，4例为实性；其中9例肿物内可见钙化。14例肿块位于胰头，其中4例胰管轻度扩张，1例明显扩张，均未见胆管扩张。1例伴肝转移。CT增强:3例囊性肿物的囊壁及分隔可见强化；17例实性及囊实性肿物的实性部分平扫为等密度或较低密度，增强后均有强化，动脉期强化程度均较低，平均CT值（51.45±10.63）HU，静脉期和实质期强化程度较动脉期提高，平均CT值分别约（82.05±22.04）HU和（81.83±19.86）HU，并与动脉期差别均有统计学意义（t1=-7.34，P=0.000和t2=-7.36，P=0.000），但静脉期和实质期强化CT值无差别（t3=-0.15，P=0.880）。所有20例肿瘤均已行手术切除，其中包括肝转移灶。结论:结合患者年龄、性别和临床表现特点，CT检查多能对胰腺实性-假乳头状瘤做出正确诊断，鉴于肿瘤多为低度恶性或良性，一般均可行手术切除。 

CT Diagnosis and Surgical FeasibilityAssessment of Solid Pseudopapillary Tumors of the Pancreas

Abstract　Objective: To investigate the computed tomographic ( CT ) appearance and characteristics of solid pseudopapillary tumors of the pancreas (SPTP) to improve the accuracy of preoperative diagnosis and to provide a reference for surgical operation and prognostic evaluation. Methods: Data from 20 pathologically confirmed cases of pancreatic solid pseudopapillary tumors 18 females and 2 males, with an age range of 12-73 years and a mean age of ( 30.3 ± 16.2 ) years ] were retrospectively analyzed. The plain CT scan and multi-phase dynamic CT contrast enhancement were conducted in all cases. The CT appearance of these cases were studied and used for comparative analysis with the surgical operation. Results: Under plain CT, the pancreatic tumors were relatively bigger in the 20 cases, 13 of which showed tumors that overtly extruded from the pancreas. The tumors presented a round, oval, or lobular shape with well- defined edges. Among all cases, 13 presented cystic-solid tumors, 3 were cystic, and 4 were solid tumors. Calcification was found in 9 of the cases. Up to 14 of the total tumors were located in the head of the pancreas, 4 of which showed slight dilatation of the major pancreatic duct, one case manifested expansion and 14 cases did not present any cholangiectasis. Liver metastasis was found in one of these cases. CT contrast enhancement, showed a strengthened imaging of the cystic wall and septa in 3 cystic tumors. The plain CT scan for the solid part of 17 solid and cystic-solid tumors showed isodense or relatively low-density areas. All of them were strengthened after contrast enhancement. The degree of arterial phase enhancement was relatively low, with an average CT value of ( 51.45 ± 10.63 ) HU. The enhancement during the portal venous phase and the parenchymal phase increased significantly compared with the arterial phase, with an average CT value of approximately ( 82.05 ± 22.04 ) HU and ( 81.83 ± 19.86 ) HU, respectively. Statistically significant differences were found in the different figures between the arterial phase and the average CT value ( t1 = -7.34, P = 0.000 and? t2 = -7.36, P = 0.000 ), whereas no difference was observed between the portal venous phase and the parenchymal phase ( t3 = -0.15, P = 0.880 ). All 20 tumor patients, including those with liver metastases, underwent surgical excision. Conclusion: Considering parameters such as age, gender, and other related clinical manifestations, the CT scan can be used as an effective tool for accurately diagnosing SPTP. Given that most of Solid pseudopapillary tumors of the pancreas are of low malignancy or are benign, surgical excision is adoptable for almost all cases.
?Keywords　Solid pseudopapillary tumors of the pancreas; X-ray; CT; Surgery