【作者】 时高峰； 彰俊杰； 许茜； 李如迅； 王琦； 杜煜； 王亚宁；

【Author】 Shi Gao-Feng Zhang Jun-Jie Xu Qian Li Ru-Xun Wang Qi Du Yu Wang Ya-Ning Department of CT, The fourth hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院CT室；

【摘要】 目的:分析胰岛细胞瘤多层螺旋CT多期扫描的表现,评价多层螺旋CT双期增强扫描对胰腺功能性胰岛细胞瘤和无功能性胰岛细胞瘤的诊断价值。方法:2000年5月～ 2004年4月在我院作CT检查并经手术与病理证实的胰岛细胞瘤13例,其中男6例,女3例,年龄16岁-70岁,平均34． 5岁(其中胰岛素瘤5例,无功能性胰岛细胞瘤8例)。所有患者均经手术和病理证实。所有患者术前均采用多层螺旋CT 机进行CT检查,检查前需做胃肠道准备,患者空腹,检查前5min口服清水约500ml以进一步充盈胃和十二指肠。先进行常规CT扫描,然后用高压注射器将100ml碘海醇(含碘 300mg／ml),以3ml／s的速度经肘静脉注人,注入造影剂后 30～70s各扫描一次,分别得到动脉期及门脉期图像。扫描参数:120kV,250mA,层厚3mm,准直2．5mm螺距1mm,重建间隔1．5mm。结果:13例胰岛细胞瘤全部经手术和病理证实。5例功能性胰岛细胞瘤全部是胰岛素瘤,肿块位于胰体1 例,胰尾3例,胰头1例。肿瘤直径0．6～2cm,平均1．1cm。 CT平扫均为等密度,1例肿瘤呈现胰体局部隆起约5mm。增强CT示5例瘤灶在动脉期明显强化,门脉期则与邻近胰腺实质密度差减小、不易分辨。8例无功能性胰岛细胞瘤,肿块位于胰头及胰尾各3例,胰体2例,肿瘤直径5～12cm,平均 6．3cm;根据肿块的密度分三种类型,均匀密度实体瘤3例, 混合密度肿块2例,囊性肿块3例。增强扫描,均匀密度实体瘤在动脉相均明显强化,门脉期和延迟期出现进行性强化。3 例囊性肿块在各期均呈边缘环样中度强化。混合密度者,肿瘤实质成分多数在动脉相出现明显强化,中等程度强化。2例胰尾病变胰周血管均见包绕,3例侵犯脾静脉。2例胰岛细胞瘤可见轻度胆管、胰管扩张。1例术后2个月出现肝脏转移, 为富血供转移灶。结论:胰腺功能性肿瘤(常见胰岛素瘤)直径大小常不超过2cm,平扫常呈等密度,胰腺轮廓一般改变不明显。增强扫描动脉期,肿瘤呈明显均匀强化。无功能性胰岛细胞瘤由一般有完整包膜,多为向外突出生长,CT平扫表现、边界清楚、边缘光滑较大肿块,囊变坏死多见,内可见分隔及壁结节,增强扫描时肿瘤实质或囊壁明显强化或呈中度以上强化或仅包膜强化,无胆系梗阻征象。螺旋CT双期增强扫描对胰岛细胞瘤具有诊断价值。更多还原

【Abstract】 Objective: To analyze multislice spiral CT (MSCT ) feature of the islet cell tumor and to evaluate the diagnosis value between the functioning islet cell tumor and nonfunctioning islet cell tumor( NIT )in MSCT enhanced scan. Methodd: 13 cases were scanned by MSCT in our hospital from May, 2000 to Apr,2004 and they were surgery operated and pathologically proved. 6 cases were males and 3 cases were females. They were between 16 and 70 years .The average age was 34.5 years (5cases were insulinoma and 8 cases were non-functioning islet cell tumor). All cases were scanned by SIEENS VOLUME ZOOM MSCT .Scanning parameter: 120kV, 250mA, layer deep 3mm, collimation 2.5mm ,spiral distance 1mm, restoration interval 1.5mm. Results: 13 cases were all surgery operated and pathologically proved. 5 cases of functioning islet cell tumor were all insulinoma. On plain CT scans, the tumors showed heterogeneous lumps with iso-density. 1 case located in pancreatic body. 3 cases located in pancreatic trail and 1 case located in the pancreatic head. The tumor diameter was 0.6 to 2 cm and the average was 1.1 cm. On plain CT scanning, the tumors all showed iso-density and 1 case was upheaval 5 mm in pancreatic body .On enhanced CT scanning, 5 cases were marked enhancement in artery-phase but could not be distinguished easily in the portal- phase. In the 8 cases of non- functional islet cell tumor, 3 cases located in the pancreatic head and trail ,lcase located in pancreatic body . The tumor diameter were 5 to 12 cm and the average was 6.3 cm. According to the density of the tumor, they were divided to three types.3 tumor were equality density. 2 tumor were mixed density and 3 tumor were cystic. On enhanced CT scanning, 3 cases of equality density were obviously enhanced in artery-phase and processing enhancement in the vein and postponing phases.3 fringe of cystic tumor were ringed middling enhancement in every phase. 2 cases of pancreatic around vein were encircled in pathological changes of pancreatic trail .3 cases infringed spleen veins. 2 islet cell tumors were lightly bile duct and pancreatic duct after the operation. 1 cases appeared liver transferring and were rich in blood supplying. Conclusion: Functional islet cell tumor ( NIT) diameter was not beyond 2 cm. On plain CT scanning, the tumors all showed iso-density. the center of pancreas did not changed obviously .On enhanced CT scanning, the tumor were marked enhancement equably .The nonfunctional islet cell tumor were full envelop with predominating exophytic growth , well-defined marge, cystic changes and necrosis , within compartmentation and well-nodes. On enhanced CT scanning, the essential or cystic wall was marked enhancement or mid-enhanced or only envelop enhanced. Dual-phase SCT enhancement scanning was valuable in diagnosis of islet cell tumor of the pancreatic.更多还原