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MRI、CT及超声在诊断胰岛素瘤中应用研究

作者:蔡 俊1 沈钧康2

所属单位:1.江苏省太仓市第一人民医院影像 科 (江苏 太仓 215400) 2.苏州大学附属第二医院影像科 (江苏 苏州 215004)

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摘要

目的 分析MRI(磁共振成像)、CT 及超声3种不同影像学检查方法在诊断胰 岛素瘤的应用价值。方法 选取我院收治 且进行手术治疗的胰岛素瘤患者72例,术 前均行MRI、CT 及腹部超声检查,将检查 结果与手术结果比较,分析病灶部位、 大小,并比较三种影像学成像结果。结 果 经MRI、CT、超声依次检测有58例、46 例、44例病灶,检出率依次为80.5%、 63.9%、61.1%,胰岛素瘤分布、大小均 无显著差异(P>0.05),MRI检出率最高, 差异显著(P<0.05);MRI平扫抑脂序列 T1WI、T2WI及DWI上呈现明显异常信号, 且动态增强期均明显强化,CT显示32例为 后动脉期,均高于门静脉期,12例显示为 增强后动脉期及门静脉轻度强化;超声显 示边界清楚,可见瘤体与血管部位。结论 MRI、CT及超声进行胰岛素瘤诊断中,三 者均有较高的检出率,其中MRI检测率最 高,但价格昂贵,CT与超声检测率相近, 但超声易受胃肠气体干扰,影响结果,应 根据患者实际病情选择最佳诊断方法。

Objective To analyze the application value of MRI (magnetic resonance imaging), CT and ultrasound in the diagnosis of insulinoma. Methods Seventy-two patients with insulinoma who underwent surgical treatment in our hospital were enrolled in the study. All subjects underwent MRI, CT and abdominal ultrasonography, and the results were compared with the operation results to analyze the site and size of lesions. The imaging findings were also compared. Results MRI, CT and ultrasound respectively detected 58 cases, 46 cases and 44 cases of lesions, and the incidence rates were 80.5%, 63.9% and 61.1%, respectively. The site and size of insulinoma showed no significant difference (P>0.05). The detection rate of MRI was the highest (P<0.05). MRI scan showed abnormal signal on T1WI, T2WI and DWI, obvious enhancement in dynamic enhancement phase. CT showed 32 cases in arterial phase, more than those in portal vein phase, and 12 cases showed slight enhancement in arterial phase and portal vein phase;Ultrasound showed clear boundaries, visible tumor and vascular site. Conclusion The detection rate of MRI is the highest but expensive. The detection rate of CT is similar to that of ultrasound but the ultrasound is easy to be interfered by gastrointestinal gas, affecting the results. Therefore, the best diagnostic method should be chosen according to the actual condition.

【关键词】磁共振;超声检查;CT;胰岛 素瘤

【中图分类号】R458+.5

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.07.031

前言

胰岛素瘤是起源于体内胰岛B细胞的神经内分泌肿瘤,属于功能性 胰岛细胞瘤一种[1]。患者因胰岛B细胞功能异常引起胰岛素分泌过多, 易出现低血糖症状且胰岛素水平不受血糖控制,其中Whipple三联征 (低血糖、交感神经兴奋、中枢神经障碍)是其典型的临床表现[2]。胰 岛素瘤大多属于单发性肿瘤,约90%为良性肿瘤,发展为恶性病变概 率较低,患者一旦确诊为胰岛素瘤,手术是目前唯一可治愈的方法, 但胰岛素瘤一般非常小,术前定位较为困难[3]。临床常用超声、CT、 MRI、血管造影、动脉内钙离子激发试验等影像学方法,但血管造影、 动脉内钙离子激发试验均属于有创性检查,故本文采取MRI、腹部超声 及CT三种影像学对胰岛素瘤进行诊断治疗,分析此三种检查方法的诊 断价值,现报告如下。