導語(yu)：如何(he)才能寫(xie)好(hao)一篇專科醫(yi)學影像技術前(qian)景(jing)，這就需要(yao)搜(sou)集整理更多的(de)資料和文獻，歡迎(ying)閱讀由公務員之家(jia)整理的(de)十(shi)篇范(fan)文，供你借(jie)鑒(jian)。

篇1

[中(zhong)圖分類號] R576 [文獻標識碼]A[文章(zhang)編號]1673-7210（2007）06（a）-016-03

胰(yi)(yi)(yi)腺(xian)(xian)(xian)疾(ji)病是臨(lin)床(chuang)上常(chang)見(jian)的(de)(de)腹部病癥(zheng)(zheng)，它包(bao)括急性胰(yi)(yi)(yi)腺(xian)(xian)(xian)炎、慢(man)性胰(yi)(yi)(yi)腺(xian)(xian)(xian)炎、胰(yi)(yi)(yi)腺(xian)(xian)(xian)癌、胰(yi)(yi)(yi)腺(xian)(xian)(xian)實性――假狀瘤，胰(yi)(yi)(yi)腺(xian)(xian)(xian)囊實性狀上皮性腫瘤，胰(yi)(yi)(yi)腺(xian)(xian)(xian)囊內新(xin)生物，腹腔內胰(yi)(yi)(yi)源等疾(ji)病。近年來(lai)，隨著(zhu)生活節奏(zou)的(de)(de)加(jia)快，我國(guo)老齡化人(ren)口的(de)(de)增多(duo)，其發病率有逐年增高的(de)(de)趨勢，胰(yi)(yi)(yi)腺(xian)(xian)(xian)疾(ji)病十分兇(xiong)險，并發癥(zheng)(zheng)多(duo)，因此早(zao)期(qi)診(zhen)斷、早(zao)期(qi)治療至關(guan)重(zhong)要。CT、MRI、B超(chao)、介入檢(jian)(jian)查成為診(zhen)斷胰(yi)(yi)(yi)腺(xian)(xian)(xian)疾(ji)病的(de)(de)重(zhong)要手段。本(ben)文將胰(yi)(yi)(yi)腺(xian)(xian)(xian)病變(bian)的(de)(de)影像(xiang)學特點、新(xin)發現、檢(jian)(jian)查方法、診(zhen)斷方面(mian)的(de)(de)研究進(jin)展情況進(jin)行綜述，以提(ti)高對胰(yi)(yi)(yi)腺(xian)(xian)(xian)疾(ji)病的(de)(de)認(ren)識和診(zhen)斷水平。

1胰腺炎的影像學診(zhen)斷

1.1 急性胰(yi)腺炎的CT表現

急(ji)性(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)（acute pancreatitis，AP）是臨(lin)床(chuang)(chuang)上常見的(de)急(ji)腹癥(zheng)，是胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)及(ji)其(qi)周圍組織(zhi)被胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)分(fen)泌的(de)消化(hua)酶自身消化(hua)的(de)化(hua)學(xue)性(xing)(xing)炎(yan)癥(zheng)，依據病理變化(hua)分(fen)為(wei)急(ji)性(xing)(xing)水腫型(xing)(xing)和出血(xue)壞死(si)(si)(si)型(xing)(xing)兩種，其(qi)中后(hou)者易并發休克、呼吸衰(shuai)竭和腹膜炎(yan)等，死(si)(si)(si)亡率(lv)高(gao)達25%~40%[1]。急(ji)性(xing)(xing)壞死(si)(si)(si)性(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)在CT上表(biao)現(xian)(xian)為(wei)彌漫(man)或局限性(xing)(xing)腫大，壞死(si)(si)(si)范圍表(biao)現(xian)(xian)為(wei)低(di)密度灶，胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)周圍脂肪消失(shi)，腎周包膜增厚，CT不僅可以(yi)了解胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)的(de)壞死(si)(si)(si)程度，還可以(yi)觀察(cha)胰(yi)(yi)(yi)(yi)外侵犯的(de)范圍，以(yi)及(ji)有(you)無合(he)并癥(zheng)。CT不但能(neng)在手術前明(ming)確胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)的(de)診(zhen)(zhen)斷(duan)類型(xing)(xing)，而且能(neng)為(wei)臨(lin)床(chuang)(chuang)提供合(he)理的(de)治療方(fang)案(an)及(ji)作出預后(hou)的(de)判(pan)(pan)斷(duan)。CT增強掃描對(dui)診(zhen)(zhen)斷(duan)急(ji)性(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)有(you)重要意義，它可以(yi)分(fen)辨(bian)急(ji)性(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)因炎(yan)癥(zheng)水腫引起(qi)胰(yi)(yi)(yi)(yi)實質密度降低(di)還是胰(yi)(yi)(yi)(yi)組織(zhi)壞死(si)(si)(si)引起(qi)低(di)密度變化(hua)，這對(dui)于我們診(zhen)(zhen)斷(duan)急(ji)性(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)時明(ming)確類型(xing)(xing)，判(pan)(pan)斷(duan)預后(hou)，制定治療方(fang)案(an)具有(you)指導性(xing)(xing)作用。急(ji)性(xing)(xing)水腫型(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎(yan)由(you)于血(xue)管(guan)擴(kuo)張，血(xue)流量增多以(yi)及(ji)血(xue)管(guan)通(tong)透性(xing)(xing)增加(jia)，CT增強掃描時胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)顯示強化(hua)，表(biao)現(xian)(xian)為(wei)增強掃描區低(di)密度[2]。

1.2 急性胰腺炎的MRI表現

急性胰腺炎的診斷最常見的是對血、尿淀粉酶的測定[3]。影像學檢查以往一直認為CT是檢查胰腺炎比較理想的方法，近年來，隨著MRI快速成像序列的發展以及脂肪抑制技術的(de)(de)(de)(de)(de)出(chu)(chu)(chu)現(xian)，使得MRI檢(jian)(jian)(jian)查大(da)量應用(yong)于急(ji)性(xing)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎的(de)(de)(de)(de)(de)診斷(duan)(duan)(duan)，MRI對(dui)(dui)(dui)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)周圍(wei)液體滲(shen)出(chu)(chu)(chu)、胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)出(chu)(chu)(chu)血、胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)組(zu)織壞(huai)死(si)(si)顯(xian)(xian)(xian)示(shi)(shi)尤(you)佳。邱德正(zheng)等(deng)[4]報道(dao)：磁共(gong)振(zhen)對(dui)(dui)(dui)急(ji)性(xing)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎的(de)(de)(de)(de)(de)診斷(duan)(duan)(duan)分(fen)型有著十分(fen)重要的(de)(de)(de)(de)(de)意義(yi)，可提供病(bing)變(bian)的(de)(de)(de)(de)(de)范圍(wei)、程度(du)及(ji)(ji)并發癥(zheng)信(xin)息(xi)。研究組(zu)全部病(bing)例(li)進行(xing)MRI檢(jian)(jian)(jian)查時(shi)均(jun)以橫斷(duan)(duan)(duan)面檢(jian)(jian)(jian)查為(wei)(wei)主，因為(wei)(wei)橫斷(duan)(duan)(duan)面有利于顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)全貌，T1WI采用(yong)2DFLASH脂(zhi)肪抑(yi)制(zhi)掃(sao)描(miao)(miao)，脂(zhi)肪抑(yi)制(zhi)T1WI能(neng)比較清(qing)楚地顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)輪廓(kuo)、大(da)小及(ji)(ji)形(xing)態(tai)，對(dui)(dui)(dui)于胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)腫大(da)的(de)(de)(de)(de)(de)診斷(duan)(duan)(duan)十分(fen)重要，后(hou)者可以顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)周脂(zhi)肪墊的(de)(de)(de)(de)(de)情況(kuang)。該組(zu)共(gong)4例(li)，顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)周脂(zhi)肪信(xin)號(hao)不(bu)均(jun)勻減低，兩(liang)者對(dui)(dui)(dui)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)壞(huai)死(si)(si)和出(chu)(chu)(chu)血的(de)(de)(de)(de)(de)診斷(duan)(duan)(duan)沒有差別，出(chu)(chu)(chu)血均(jun)顯(xian)(xian)(xian)示(shi)(shi)為(wei)(wei)高信(xin)號(hao)，壞(huai)死(si)(si)顯(xian)(xian)(xian)示(shi)(shi)為(wei)(wei)稍低信(xin)號(hao)或等(deng)信(xin)號(hao)。T2WI采用(yong)TSE序列(lie)加(jia)脂(zhi)肪抑(yi)制(zhi)技術，可以清(qing)楚地顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)周液體、滲(shen)出(chu)(chu)(chu)情況(kuang)。有組(zu)37例(li)研究顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)周有程度(du)不(bu)等(deng)的(de)(de)(de)(de)(de)液體滲(shen)出(chu)(chu)(chu)，其中29例(li)是在(zai)TSE T2WI加(jia)脂(zhi)肪抑(yi)制(zhi)序列(lie)上(shang)得到顯(xian)(xian)(xian)示(shi)(shi)，另(ling)有9例(li)因屏(ping)氣不(bu)好，SE T2WI圖像不(bu)清(qing)而改(gai)做HASTE加(jia)脂(zhi)肪抑(yi)制(zhi)序列(lie)，也能(neng)清(qing)楚顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)周滲(shen)出(chu)(chu)(chu)。增強掃(sao)描(miao)(miao)采用(yong)2DFldsh T1WI加(jia)脂(zhi)肪抑(yi)制(zhi)序列(lie)，注射造影劑后(hou)，首先進行(xing)橫斷(duan)(duan)(duan)位動(dong)態(tai)掃(sao)描(miao)(miao)，動(dong)脈早期強化(hua)不(bu)甚均(jun)勻，實質期有18例(li)顯(xian)(xian)(xian)示(shi)(shi)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)組(zu)織壞(huai)死(si)(si)，表現(xian)不(bu)強化(hua)區(qu)，這些不(bu)強化(hua)區(qu)域在(zai)T1WI上(shang)表現(xian)為(wei)(wei)高信(xin)號(hao)或稍高信(xin)號(hao)。通過本(ben)組(zu)病(bing)例(li)研究發現(xian)，對(dui)(dui)(dui)于急(ji)性(xing)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎的(de)(de)(de)(de)(de)MRI的(de)(de)(de)(de)(de)增強掃(sao)描(miao)(miao)、動(dong)態(tai)掃(sao)描(miao)(miao)沒有明確的(de)(de)(de)(de)(de)意義(yi)，但實際(ji)工作中我們仍然推薦動(dong)態(tai)增強掃(sao)描(miao)(miao)。MRI是急(ji)性(xing)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎的(de)(de)(de)(de)(de)一種(zhong)有效的(de)(de)(de)(de)(de)檢(jian)(jian)(jian)查方法(fa)，它不(bu)但可以了(le)解(jie)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)的(de)(de)(de)(de)(de)形(xing)態(tai)、大(da)小及(ji)(ji)輪廓(kuo)的(de)(de)(de)(de)(de)改(gai)變(bian)，對(dui)(dui)(dui)胰(yi)(yi)(yi)周液體滲(shen)出(chu)(chu)(chu)十分(fen)敏感，可以通過胰(yi)(yi)(yi)內(nei)(nei)的(de)(de)(de)(de)(de)信(xin)號(hao)變(bian)化(hua)及(ji)(ji)增強掃(sao)描(miao)(miao)了(le)解(jie)胰(yi)(yi)(yi)內(nei)(nei)有無出(chu)(chu)(chu)血、壞(huai)死(si)(si)及(ji)(ji)其程度(du)，有利于急(ji)性(xing)胰(yi)(yi)(yi)腺(xian)(xian)(xian)(xian)(xian)炎的(de)(de)(de)(de)(de)分(fen)型，使臨床治療更有針對(dui)(dui)(dui)性(xing)，對(dui)(dui)(dui)病(bing)因學的(de)(de)(de)(de)(de)診斷(duan)(duan)(duan)有一定的(de)(de)(de)(de)(de)幫助。

1.3 急性重(zhong)癥胰腺炎的(de)CT表現(xian)

岳輝等[5]報(bao)道(dao)53例(li)急性(xing)(xing)(xing)重(zhong)癥胰(yi)(yi)(yi)腺(xian)(xian)炎的(de)表(biao)(biao)現：胰(yi)(yi)(yi)腺(xian)(xian)彌(mi)漫腫大，胰(yi)(yi)(yi)頭寬(kuan)(kuan)徑3~6 cm，平(ping)均(jun)(jun)(jun)4.3 cm,胰(yi)(yi)(yi)體寬(kuan)(kuan)3~5 cm，平(ping)均(jun)(jun)(jun)3.5 cm，胰(yi)(yi)(yi)尾寬(kuan)(kuan)2.5~3.5 cm，平(ping)均(jun)(jun)(jun)3 cm。胰(yi)(yi)(yi)腺(xian)(xian)密度減低，測試CT值(zhi)為15.9~38.9 Hu，平(ping)均(jun)(jun)(jun)33.5 Hu。增強(qiang)后(hou)胰(yi)(yi)(yi)腺(xian)(xian)不均(jun)(jun)(jun)勻增強(qiang)，CT值(zhi)為38.6~57.1 Hu，平(ping)均(jun)(jun)(jun)50.8 Hu，突出胰(yi)(yi)(yi)腺(xian)(xian)表(biao)(biao)面的(de)類(lei)圓形或不規則形囊性(xing)(xing)(xing)低密度的(de)假性(xing)(xing)(xing)囊腫，呈單腔或分(fen)隔成多(duo)腔，囊壁厚薄較均(jun)(jun)(jun)勻，最小囊腫為1.5 cm×1.5 cm×1.5 cm,最大囊腫隨胰(yi)(yi)(yi)腺(xian)(xian)表(biao)(biao)面。CT對(dui)于急性(xing)(xing)(xing)重(zhong)癥性(xing)(xing)(xing)胰(yi)(yi)(yi)腺(xian)(xian)炎的(de)診斷及臨床病理分(fen)型較準確，可(ke)作為本病的(de)重(zhong)要檢查方(fang)法。

2 胰腺癌的影像(xiang)學診(zhen)斷

2.1 胰腺癌的表(biao)現

胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)的(de)(de)發(fa)病(bing)率(lv)及(ji)死(si)亡率(lv)逐年升高(gao)，已成(cheng)為(wei)(wei)癌(ai)(ai)(ai)(ai)癥(zheng)致(zhi)死(si)的(de)(de)第(di)4位(wei)病(bing)因。為(wei)(wei)提(ti)高(gao)早期(qi)小(xiao)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)的(de)(de)檢出(chu)率(lv)，彭勇等(deng)[6]對(dui)(dui)21位(wei)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)患者進行高(gao)壓(ya)注射造(zao)影劑后動脈期(qi)和(he)實質期(qi)快速螺旋CT增(zeng)強掃(sao)描。胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)平掃(sao)：21例(li)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)腫(zhong)瘤大(da)(da)小(xiao)范圍為(wei)(wei)1.1 cm×1.2 cm~2.0 cm×2.0 cm,其中(zhong)5例(li)位(wei)于鉤(gou)突部(bu)，胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)輪(lun)廓完整，血(xue)管(guan)(guan)(guan)(guan)(guan)及(ji)周圍臟器無受累，伴有(you)不(bu)(bu)(bu)同(tong)程度膽(dan)管(guan)(guan)(guan)(guan)(guan)、胰(yi)(yi)(yi)(yi)管(guan)(guan)(guan)(guan)(guan)擴張。有(you)6例(li)侵(qin)及(ji)腸(chang)系(xi)膜上靜(jing)脈，1例(li)累及(ji)12指腸(chang)。王西昌等(deng)[7]研究總結(jie)認(ren)為(wei)(wei)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)有(you)如下幾點可以作為(wei)(wei)定性診(zhen)(zhen)斷(duan)的(de)(de)主要(yao)依據：①胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)出(chu)現(xian)局(ju)限性腫(zhong)塊或(huo)全部(bu)腫(zhong)大(da)(da)，主要(yao)為(wei)(wei)癌(ai)(ai)(ai)(ai)腫(zhong)的(de)(de)腫(zhong)大(da)(da)，破(po)壞了正常胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)的(de)(de)比例(li)關系(xi)；②胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)可直(zhi)接侵(qin)犯或(huo)包埋鄰近血(xue)管(guan)(guan)(guan)(guan)(guan),CT表現(xian)血(xue)管(guan)(guan)(guan)(guan)(guan)的(de)(de)改變、血(xue)管(guan)(guan)(guan)(guan)(guan)增(zeng)粗，有(you)邊界不(bu)(bu)(bu)清或(huo)包埋后血(xue)管(guan)(guan)(guan)(guan)(guan)腔受壓(ya)、變窄，一般多以門(men)靜(jing)脈及(ji)下腔靜(jing)脈受累為(wei)(wei)甚；③“雙管(guan)(guan)(guan)(guan)(guan)征(zheng)”，主要(yao)胰(yi)(yi)(yi)(yi)頭(tou)堵塞(sai)或(huo)壓(ya)迫膽(dan)總管(guan)(guan)(guan)(guan)(guan)，造(zao)成(cheng)膽(dan)管(guan)(guan)(guan)(guan)(guan)下段擴張，癌(ai)(ai)(ai)(ai)腫(zhong)的(de)(de)增(zeng)大(da)(da)使(shi)正常胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)縮小(xiao)，造(zao)成(cheng)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)分泌障礙(ai)，使(shi)胰(yi)(yi)(yi)(yi)管(guan)(guan)(guan)(guan)(guan)出(chu)現(xian)囊珠樣擴張，亦(yi)可引起黃(huang)疸等(deng)癥(zheng)狀(zhuang)；④胰(yi)(yi)(yi)(yi)周脂(zhi)肪(fang)間隙(xi)消失，表示(shi)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)已侵(qin)及(ji)胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)附近，但亦(yi)可表示(shi)侵(qin)及(ji)胰(yi)(yi)(yi)(yi)周血(xue)管(guan)(guan)(guan)(guan)(guan)。總之(zhi)，對(dui)(dui)于胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)癌(ai)(ai)(ai)(ai)體積較大(da)(da)者CT診(zhen)(zhen)斷(duan)不(bu)(bu)(bu)難，對(dui)(dui)于癌(ai)(ai)(ai)(ai)腫(zhong)較小(xiao)，胰(yi)(yi)(yi)(yi)腺(xian)(xian)(xian)體積及(ji)血(xue)管(guan)(guan)(guan)(guan)(guan)、胰(yi)(yi)(yi)(yi)管(guan)(guan)(guan)(guan)(guan)改變不(bu)(bu)(bu)明顯(xian)時(shi)，多采用CT掃(sao)描即有(you)很大(da)(da)的(de)(de)診(zhen)(zhen)斷(duan)價值(zhi)，可以幫助對(dui)(dui)血(xue)管(guan)(guan)(guan)(guan)(guan)位(wei)置(zhi)的(de)(de)判斷(duan)。

2.2 胰頭癌(ai)的MRCP特異征象

MRCP檢查是一種(zhong)簡(jian)便無痛苦的有(you)(you)效診斷(duan)(duan)手段(duan)(duan)，其對(dui)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)診斷(duan)(duan)有(you)(you)特異征(zheng)(zheng)象，包括了(le)分子影(ying)像學(xue)和分子病(bing)理學(xue)的內容。鵬等[8]報道(dao)：35例胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)在MRCP上(shang)(shang)全(quan)部侵襲了(le)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)內的膽(dan)(dan)總(zong)管(guan)(guan)(guan)和主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)，可(ke)見(jian)(jian)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)這一病(bing)理改變的普遍(bian)性，這是我們(men)的新發現(xian)(xian)，既往(wang)中(zhong)(zhong)外(wai)文獻未見(jian)(jian)報道(dao)。胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)瘤(liu)體MRI上(shang)(shang)多數表(biao)(biao)現(xian)(xian)為等T1和等T2并(bing)略帶混雜信號，少(shao)數低分化癌(ai)(ai)呈等T1長T2之表(biao)(biao)現(xian)(xian)。在中(zhong)(zhong)外(wai)文獻的胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)MRCP的特異征(zheng)(zheng)象，在MRI上(shang)(shang)不(bu)(bu)(bu)能(neng)直(zhi)觀看到膽(dan)(dan)總(zong)管(guan)(guan)(guan)樹(shu)和主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan),因此單憑(ping)MRI影(ying)像胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)往(wang)往(wang)難以(yi)確(que)(que)診。而(er)MRCP可(ke)以(yi)清楚地顯示膽(dan)(dan)管(guan)(guan)(guan)樹(shu)和主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)，因此它可(ke)以(yi)準確(que)(que)診斷(duan)(duan)各種(zhong)膽(dan)(dan)、胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)的疾病(bing)，尤其是胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)。MRCP胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)的特異征(zheng)(zheng)象為：膽(dan)(dan)總(zong)管(guan)(guan)(guan)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)段(duan)(duan)及主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)段(duan)(duan)或整個主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)被癌(ai)(ai)瘤(liu)組織破壞中(zhong)(zhong)斷(duan)(duan)，二者(zhe)之殘留近段(duan)(duan)多數有(you)(you)擴(kuo)張(zhang)并(bing)有(you)(you)信號增高(gao)，二者(zhe)在正(zheng)常情況下應與(yu)壺腹部相(xiang)(xiang)交(jiao)，而(er)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)則不(bu)(bu)(bu)能(neng)相(xiang)(xiang)交(jiao)，我們(men)稱這種(zhong)特異征(zheng)(zheng)象為膽(dan)(dan)總(zong)管(guan)(guan)(guan)與(yu)主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)段(duan)(duan)破壞，膽(dan)(dan)總(zong)管(guan)(guan)(guan)殘留段(duan)(duan)明顯擴(kuo)張(zhang)，主胰(yi)(yi)(yi)(yi)(yi)管(guan)(guan)(guan)殘留段(duan)(duan)多數擴(kuo)張(zhang)信號增高(gao)不(bu)(bu)(bu)相(xiang)(xiang)交(jiao)征(zheng)(zheng)，簡(jian)稱為“不(bu)(bu)(bu)相(xiang)(xiang)交(jiao)征(zheng)(zheng)”。只要MRCP上(shang)(shang)出現(xian)(xian)“不(bu)(bu)(bu)相(xiang)(xiang)交(jiao)征(zheng)(zheng)”，就可(ke)以(yi)確(que)(que)診為胰(yi)(yi)(yi)(yi)(yi)頭(tou)(tou)(tou)(tou)(tou)(tou)癌(ai)(ai)。

2.3影像學對胰腺癌(ai)可切(qie)除評價

迄今為止，手術切除是治療胰腺癌的主要方法。目前SCT對胰腺癌的可切除評價的準確性可達95%~100%，而評價可切除性的陽性預測值僅67%~80%，在不可切除的原因中，血管受侵包埋是最重要的指標，有些病例血管的受侵包埋甚至較胰腺內發現更早、更顯著[9]，因而血管受侵犯的范圍及程度決定能否手術切除。嚴志漢等[10]研究：螺旋CT采用雙期增強掃描，是目前最理想的檢查方法。多排螺旋CT（multi-sliee spiral CT,MSCT）在一次屏氣內能獲得較大范圍內的薄層高分辨圖像，大大提高了Z軸方向上的空間分辨率，利于胰腺供血動脈的顯示，在觀察胰腺動脈解剖方面具有廣泛的應用前景。胰(yi)(yi)腺(xian)(xian)供(gong)血(xue)動(dong)脈CT表(biao)現評價采(cai)用上述掃描(miao)方法(fa)，對(dui)胰(yi)(yi)腺(xian)(xian)直接供(gong)血(xue)動(dong)脈的(de)(de)(de)顯示(shi)率總(zong)體上高于(yu)以往的(de)(de)(de)研究。胰(yi)(yi)腺(xian)(xian)的(de)(de)(de)供(gong)血(xue)動(dong)脈由(you)多個(ge)相互(hu)連(lian)接、吻合(he)的(de)(de)(de)動(dong)脈網構(gou)成，熟悉(xi)動(dong)脈解(jie)剖，對(dui)于(yu)胰(yi)(yi)腺(xian)(xian)及腎周(zhou)外科手(shou)術治療非常重要(yao)，另外胰(yi)(yi)腺(xian)(xian)癌易侵(qin)犯(fan)周(zhou)圍(wei)的(de)(de)(de)動(dong)脈，對(dui)侵(qin)犯(fan)程(cheng)度(du)的(de)(de)(de)判斷有利(li)于(yu)胰(yi)(yi)腺(xian)(xian)手(shou)術前(qian)分期和可切除(chu)(chu)評價[11]。龍建新[12]報(bao)道，目(mu)前(qian)一般(ban)認為胰(yi)(yi)腺(xian)(xian)腫(zhong)瘤(liu)具(ju)(ju)有以下(xia)一個(ge)或多個(ge)征象即無法(fa)切除(chu)(chu)：①腫(zhong)瘤(liu)直徑≥5 cm,但不重要(yao)，更(geng)為重要(yao)的(de)(de)(de)是胰(yi)(yi)周(zhou)侵(qin)犯(fan)；②胰(yi)(yi)腺(xian)(xian)主(zhu)要(yao)血(xue)管狹窄、包埋(mai)和瘤(liu)栓形成；③腫(zhong)瘤(liu)侵(qin)犯(fan)鄰(lin)近組織或血(xue)管，如肝(gan)門(men)和胃部浸(jin)潤，但單純十(shi)二(er)指腸(chang)受(shou)損除(chu)(chu)外；④出現遠(yuan)處(chu)或腹膜癌變征象，如肝(gan)轉(zhuan)移或腹水形成；⑤區域性或遠(yuan)處(chu)淋巴轉(zhuan)移。排除(chu)(chu)上述征象時方可認為腫(zhong)瘤(liu)具(ju)(ju)有可切除(chu)(chu)的(de)(de)(de)可能性。

3 胰腺腫(zhong)瘤與胰源囊腫(zhong)的影像(xiang)學表現

3.1 胰腺實性(xing)――假狀瘤(liu)

胰(yi)(yi)腺(xian)(xian)(xian)實性(xing)(xing)(xing)(xing)(xing)――假狀瘤(liu)(liu)（sptpshi，SPTP）是近幾年臨(lin)床、放射科(ke)、病(bing)(bing)理(li)科(ke)所關注的(de)新的(de)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)實體，因(yin)組織(zhi)發(fa)生(sheng)(sheng)(sheng)(sheng)尚無定(ding)論，病(bing)(bing)例(li)非常罕見，其CT表(biao)現(xian)(xian)(xian)還未被(bei)人們正確認識，SPTP是胰(yi)(yi)腺(xian)(xian)(xian)一種少見的(de)但多為(wei)良性(xing)(xing)(xing)(xing)(xing)和低(di)度(du)惡(e)性(xing)(xing)(xing)(xing)(xing)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)。據統計,截止2001年10月全世(shi)界共(gong)報道(dao)304例(li)，SPTP好(hao)發(fa)于(yu)(yu)(yu)青(qing)年女(nv)性(xing)(xing)(xing)(xing)(xing)，偶發(fa)于(yu)(yu)(yu)老年女(nv)性(xing)(xing)(xing)(xing)(xing)和男性(xing)(xing)(xing)(xing)(xing)，腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)可(ke)(ke)發(fa)生(sheng)(sheng)(sheng)(sheng)于(yu)(yu)(yu)胰(yi)(yi)腺(xian)(xian)(xian)的(de)任何部(bu)位(wei)。SPTP有(you)如下幾點CT表(biao)現(xian)(xian)(xian)可(ke)(ke)作為(wei)定(ding)性(xing)(xing)(xing)(xing)(xing)診斷(duan)的(de)主要依據：①腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)內(nei)有(you)實性(xing)(xing)(xing)(xing)(xing)和囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)結(jie)(jie)構(gou)，CT平掃(sao)結(jie)(jie)構(gou)呈(cheng)低(di)等密度(du)；造影后(hou)(hou)動(dong)脈(mo)呈(cheng)輕(qing)度(du)強(qiang)化(hua)(hua)(hua)(hua)，門(men)靜(jing)(jing)脈(mo)明顯(xian)(xian)強(qiang)化(hua)(hua)(hua)(hua)，囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)在(zai)(zai)增(zeng)強(qiang)后(hou)(hou)掃(sao)描呈(cheng)低(di)密度(du)；②囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)結(jie)(jie)構(gou)為(wei)主或(huo)囊(nang)(nang)(nang)(nang)實結(jie)(jie)構(gou)比例(li)相仿的(de)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)CT表(biao)現(xian)(xian)(xian)為(wei)實質(zhi)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)呈(cheng)附壁(bi)結(jie)(jie)節或(huo)實囊(nang)(nang)(nang)(nang)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)相間分(fen)(fen)(fen)(fen)(fen)(fen)布；③實性(xing)(xing)(xing)(xing)(xing)結(jie)(jie)構(gou)為(wei)主的(de)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)，囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)在(zai)(zai)包(bao)膜下；④腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)絕大(da)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)來(lai)源于(yu)(yu)(yu)胰(yi)(yi)腺(xian)(xian)(xian)，呈(cheng)圓(yuan)形、橢(tuo)圓(yuan)形可(ke)(ke)有(you)分(fen)(fen)(fen)(fen)(fen)(fen)葉；⑤腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)多有(you)完整(zheng)包(bao)膜，厚約2~4 mm,均勻(yun)包(bao)膜內(nei)壁(bi)光滑，增(zeng)強(qiang)后(hou)(hou)強(qiang)化(hua)(hua)(hua)(hua)明顯(xian)(xian)，與(yu)胰(yi)(yi)腺(xian)(xian)(xian)分(fen)(fen)(fen)(fen)(fen)(fen)界清晰(xi)，邊緣(yuan)完整(zheng)；⑥不論腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)瘤(liu)(liu)發(fa)生(sheng)(sheng)(sheng)(sheng)在(zai)(zai)胰(yi)(yi)腺(xian)(xian)(xian)什么部(bu)位(wei)，都(dou)不伴有(you)膽(dan)總管或(huo)胰(yi)(yi)管擴(kuo)張[13]。崔華等[14]報道(dao)：2例(li)均為(wei)囊(nang)(nang)(nang)(nang)實性(xing)(xing)(xing)(xing)(xing)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)塊，以實性(xing)(xing)(xing)(xing)(xing)為(wei)主，呈(cheng)狀，強(qiang)化(hua)(hua)(hua)(hua)明顯(xian)(xian)，囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)呈(cheng)裂隙狀位(wei)于(yu)(yu)(yu)中央或(huo)呈(cheng)類圓(yuan)形位(wei)于(yu)(yu)(yu)病(bing)(bing)灶周圍，且有(you)少許(xu)分(fen)(fen)(fen)(fen)(fen)(fen)離，囊(nang)(nang)(nang)(nang)性(xing)(xing)(xing)(xing)(xing)部(bu)分(fen)(fen)(fen)(fen)(fen)(fen)不強(qiang)化(hua)(hua)(hua)(hua)，分(fen)(fen)(fen)(fen)(fen)(fen)隔(ge)有(you)輕(qing)度(du)強(qiang)化(hua)(hua)(hua)(hua)。包(bao)膜完整(zheng)，內(nei)壁(bi)光整(zheng)，厚度(du)均勻(yun)，強(qiang)化(hua)(hua)(hua)(hua)明顯(xian)(xian)。有(you)1例(li)出(chu)現(xian)(xian)(xian)了胰(yi)(yi)腺(xian)(xian)(xian)受壓(ya)萎縮及胰(yi)(yi)管輕(qing)度(du)擴(kuo)張，門(men)靜(jing)(jing)脈(mo)受侵(qin)后(hou)(hou)，出(chu)現(xian)(xian)(xian)腹(fu)腔靜(jing)(jing)脈(mo)迂曲(qu)擴(kuo)張及脾(pi)臟增(zeng)大(da)，與(yu)繆飛等觀點不同。對于(yu)(yu)(yu)發(fa)生(sheng)(sheng)(sheng)(sheng)于(yu)(yu)(yu)青(qing)年女(nv)性(xing)(xing)(xing)(xing)(xing)，位(wei)于(yu)(yu)(yu)胰(yi)(yi)頭(tou)部(bu)的(de)混雜密度(du)腫(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)塊，邊緣(yuan)清楚，包(bao)膜完整(zheng)，應考慮本病(bing)(bing)，在(zai)(zai)CT或(huo)B超引導(dao)(dao)下穿刺，獲得術(shu)前(qian)病(bing)(bing)理(li)診斷(duan)，對臨(lin)床手術(shu)計劃制定(ding)有(you)一定(ding)指(zhi)導(dao)(dao)意義(yi)。

3.2胰(yi)腺囊實性狀上皮性腫瘤的影像學表現

胰(yi)(yi)腺囊(nang)實(shi)(shi)性(xing)(xing)狀(zhuang)上皮(pi)性(xing)(xing)腫(zhong)(zhong)(zhong)瘤(solid-cystic papillary epithelial neoplasm，SCPEN)較(jiao)(jiao)為少見(jian)，生長(chang)緩(huan)慢，術(shu)后較(jiao)(jiao)好，手術(shu)切(qie)除往(wang)往(wang)可以達(da)到治愈目的。目前，國內未見(jian)相關文獻報(bao)道(dao)本(ben)病(bing)的影(ying)像(xiang)學表現(xian)，國外文獻報(bao)道(dao)亦多局(ju)限于(yu)CT和超聲(sheng)。不少學者(zhe)認為該(gai)腫(zhong)(zhong)(zhong)瘤具(ju)有(you)(you)某些(xie)特征性(xing)(xing)的影(ying)像(xiang)學表現(xian)，如(ru)胰(yi)(yi)腺囊(nang)實(shi)(shi)性(xing)(xing)腫(zhong)(zhong)(zhong)塊(kuai)，境界清(qing)楚(chu)，腫(zhong)(zhong)(zhong)塊(kuai)一般很大，但(dan)較(jiao)(jiao)少引起膽胰(yi)(yi)管擴張(zhang)，其內密(mi)度(du)(du)不均(jun)，中央可見(jian)出血、壞死和囊(nang)變(bian)(bian)區(qu)密(mi)度(du)(du)高于(yu)水；CT增強囊(nang)壁和實(shi)(shi)性(xing)(xing)部分明(ming)顯增強，而出血壞死區(qu)不強化(hua)。但(dan)亦有(you)(you)學者(zhe)認為即使本(ben)病(bing)具(ju)有(you)(you)某些(xie)特征性(xing)(xing)的影(ying)像(xiang)學表現(xian)亦不足以作出準確的定性(xing)(xing)診斷，而依賴于(yu)穿刺活(huo)檢。本(ben)組(zu) 3 例CT表現(xian)與(yu)文獻報(bao)道(dao)一致，表現(xian)為胰(yi)(yi)頭(tou)部巨大囊(nang)實(shi)(shi)性(xing)(xing)腫(zhong)(zhong)(zhong)塊(kuai)，其直(zhi)徑約在(zai)10 cm左右，邊界清(qing)楚(chu)，有(you)(you)纖維包(bao)膜；其中1例腫(zhong)(zhong)(zhong)塊(kuai)內可見(jian)斑點狀(zhuang)鈣化(hua)，腫(zhong)(zhong)(zhong)塊(kuai)囊(nang)壁及(ji)實(shi)(shi)性(xing)(xing)成份明(ming)顯強化(hua)；3例均(jun)無肝內外膽管擴張(zhang)，僅有(you)(you)1例伴有(you)(you)胰(yi)(yi)管擴張(zhang)，但(dan)擴張(zhang)程(cheng)度(du)(du)較(jiao)(jiao)輕。3例患者(zhe)術(shu)前結(jie)合臨床特點均(jun)作出準確性(xing)(xing)的定性(xing)(xing)診斷。此外，本(ben)組(zu)1例MR檢查的病(bing)例胰(yi)(yi)頭(tou)部腫(zhong)(zhong)(zhong)塊(kuai)在(zai)CT上類似肌肉組(zu)織密(mi)度(du)(du)，未明(ming)確顯示腫(zhong)(zhong)(zhong)塊(kuai)內出血及(ji)囊(nang)變(bian)(bian)區(qu)，但(dan)在(zai)T1WI、T2WI上卻明(ming)顯提示腫(zhong)(zhong)(zhong)塊(kuai)內出血及(ji)囊(nang)變(bian)(bian)區(qu)[15]。

3.3 腹腔內胰(yi)源性(xing)假性(xing)囊(nang)腫(zhong)的影(ying)像學表(biao)現

胰(yi)(yi)(yi)(yi)源性(xing)(xing)(xing)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)多在急性(xing)(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)炎(yan)(yan)發(fa)病(bing)后4~6周(zhou)內(nei)形成(cheng)，由于胰(yi)(yi)(yi)(yi)腺(xian)(xian)組(zu)織(zhi)(zhi)出血、壞死和(he)胰(yi)(yi)(yi)(yi)管(guan)破裂(lie)、胰(yi)(yi)(yi)(yi)液外(wai)滲，使周(zhou)圍組(zu)織(zhi)(zhi)發(fa)生(sheng)炎(yan)(yan)癥(zheng)(zheng)和(he)炎(yan)(yan)癥(zheng)(zheng)滲出物及壞死組(zu)織(zhi)(zhi)形成(cheng)液體(ti)未能及時吸(xi)收，積聚并被纖維組(zu)織(zhi)(zhi)黏連包囊(nang)(nang)而成(cheng)，脾(pi)(pi)(pi)(pi)門及脾(pi)(pi)(pi)(pi)內(nei)胰(yi)(yi)(yi)(yi)源性(xing)(xing)(xing)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)，胰(yi)(yi)(yi)(yi)腺(xian)(xian)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)沿(yan)脾(pi)(pi)(pi)(pi)門直(zhi)接(jie)延伸(shen)到(dao)(dao)脾(pi)(pi)(pi)(pi)臟，侵蝕脾(pi)(pi)(pi)(pi)臟。胃(wei)脾(pi)(pi)(pi)(pi)韌(ren)帶(dai)區胰(yi)(yi)(yi)(yi)源性(xing)(xing)(xing)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)：①胰(yi)(yi)(yi)(yi)腺(xian)(xian)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)沿(yan)脾(pi)(pi)(pi)(pi)門直(zhi)接(jie)延伸(shen)到(dao)(dao)脾(pi)(pi)(pi)(pi)韌(ren)帶(dai)；脾(pi)(pi)(pi)(pi)腎韌(ren)帶(dai)與脾(pi)(pi)(pi)(pi)韌(ren)帶(dai)是直(zhi)接(jie)連續的(de)(de)(de)(de)，胰(yi)(yi)(yi)(yi)腺(xian)(xian)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)可(ke)以(yi)從脾(pi)(pi)(pi)(pi)門延續到(dao)(dao)胃(wei)脾(pi)(pi)(pi)(pi)韌(ren)帶(dai)。②胰(yi)(yi)(yi)(yi)酶對腹(fu)(fu)膜的(de)(de)(de)(de)消化作用，胰(yi)(yi)(yi)(yi)腺(xian)(xian)炎(yan)(yan)并發(fa)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)是胰(yi)(yi)(yi)(yi)腺(xian)(xian)分泌物中的(de)(de)(de)(de)蛋白質溶解酶造成(cheng)的(de)(de)(de)(de)網膜囊(nang)(nang)區胰(yi)(yi)(yi)(yi)源性(xing)(xing)(xing)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)；網膜囊(nang)(nang)為(wei)一潛(qian)在腔(qiang)隙(xi)，與胰(yi)(yi)(yi)(yi)腺(xian)(xian)僅(jin)隔一薄層結(jie)締組(zu)織(zhi)(zhi)和(he)壁(bi)層腹(fu)(fu)膜，急性(xing)(xing)(xing)胰(yi)(yi)(yi)(yi)腺(xian)(xian)炎(yan)(yan)時該處最常(chang)受累。腹(fu)(fu)腔(qiang)內(nei)胰(yi)(yi)(yi)(yi)源性(xing)(xing)(xing)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)常(chang)多發(fa)，多呈圓形或卵圓形，病(bing)變(bian)(bian)早期(qi)密度(du)高，邊界(jie)欠清晰，密度(du)低，與水接(jie)近，CT值在12Hu左右(you)，密度(du)均(jun)勻。CT檢查(cha)可(ke)以(yi)明確顯示胰(yi)(yi)(yi)(yi)腺(xian)(xian)病(bing)變(bian)(bian)的(de)(de)(de)(de)發(fa)展趨勢，觀(guan)察腹(fu)(fu)腔(qiang)內(nei)假性(xing)(xing)(xing)囊(nang)(nang)腫(zhong)的(de)(de)(de)(de)變(bian)(bian)化，使用CT動態隨訪病(bing)人，可(ke)及時發(fa)現上述情況(kuang)，為(wei)臨(lin)床(chuang)醫生(sheng)采取恰當的(de)(de)(de)(de)處理措(cuo)施如(ru)介入手術(shu)治療等，提供可(ke)靠的(de)(de)(de)(de)依據，具有重(zhong)要的(de)(de)(de)(de)臨(lin)床(chuang)價值[16]。

[參考文獻]

[1]鐘(zhong)守先.胰腺外科(ke)[M].長沙：湖南科(ke)學技術出版社，1998.264-307.

[2]徐光(guang)炎(yan).急性胰腺炎(yan)的(de)CT診斷（附31例報告(gao)）[J].實用放射學雜志，1998,14(3)：159-160.

[3]鄧(deng)少倫(lun).急性(xing)胰腺炎實驗室(shi)診斷指標(biao)的應(ying)用概況[J].廣西醫學，2001,23(4)：852-853.

[4]邱德正，雷益，陳志剛,等.急(ji)性(xing)胰腺炎的MRI診斷[J].使用放射學雜(za)志,2005,21(2)：147-148.

[5]岳輝,陳志安,黃長群(qun).急性重癥胰(yi)腺炎的(de)臨床病理(li)分型及(ji)其預后CT預測評(ping)估[J].中國臨床醫學影像雜志,2002,13(4)：271-273.

[6]彭勇,韓迎春,魏夢綺,等.螺旋CT雙期(qi)增強掃描對(dui)胰腺癌的診斷價值[J].實(shi)用放射學雜志,2006,3(22):278-280.

[7]王西昌,王凱,魏正清,等.多層螺旋CT在(zai)胰腺癌診(zhen)斷中的應(ying)用[J].實(shi)用放(fang)射學(xue)雜志,2005,7(21):768-770.

[8]鵬,席永(yong)昌(chang),姜德福.胰頭癌(ai)的(de)(de)MRCP特寫(xie)征像的(de)(de)臨床意義[J].實用放射學雜(za)志,2006,7(22):810-813.

[9]朱捷,劉榮波,周翔平,等.螺旋CT對胰腺癌侵犯血管的(de)評(ping)價[J].放射學實踐(jian)，2002,17（5）：436-439.

[10]嚴(yan)志(zhi)漢，周翔平,宋斌(bin),等.螺旋CT胰(yi)動脈解剖的初步研究[J].臨床(chuang)放(fang)射(she)學雜志(zhi),2001,20(11)：854-856.

[11]朱捷,周翔平,劉榮波,等.胰(yi)腺動脈螺旋CT解剖的研究――正常表現及臨床意義(yi)[J].實用放(fang)射學(xue)雜志,2003,21(3)：260-264.

[12]龍建新.胰腺腫瘤(liu)可切除性(xing)的螺旋(xuan)CT評(ping)價[J].實用(yong)放射(she)學雜志,2005,21(1)：6-7.

[13]繆飛(fei)，展穎,王曉穎.胰腺(xian)實(shi)性(xing)――假狀(zhuang)瘤的CT診斷和鑒別診斷[J].中華放射雜(za)志，2003,37（5）:417-421.

[14]崔華,姚曉群,楊小軍(jun),等.胰腺實性――假狀瘤CTz診斷[J].實用放射學雜(za)志,2006,12(22):1477-1479.

[15]章士正(zheng),譚華僑(qiao),鄧(deng)麗萍.胰腺囊實(shi)性(xing)狀上皮(pi)腫瘤的CT、MRI診斷(duan)[J].中(zhong)華放射雜志，2003,109(37):935-938.

[16]王濤,李琳,董加萍,等.腹腔內胰源性假性囊腫的CT影像研究[J].臨沂醫學專科學校學報,2005,（2）：135-137.