ステロイド治療効果判定にMRI拡散強調画像が有用であった自己免疫性膵炎の1例  [in Japanese] Utility of diffusion-weighted MRI for assessment of response to therapy in a case of autoimmune pancreatitis  [in Japanese]

Access this Article

Author(s)

Abstract

症例は40歳代の男性.心窩部の違和感にて当院を受診し,血液検査で炎症反応と膵酵素の上昇を認めた.CTでは,膵尾部に限局した腫大を認め,平衡相で淡い造影効果を認めた.EUSで同病変は43×27mm大の低エコー腫瘤として描出され,MRIではT1強調画像で低信号,T2強調画像で高信号,拡散強調画像(DWI)で著明な高信号を呈した.ERCPでは膵尾部主膵管に約20mmの狭細像を認めた.EUS-FNAでは悪性所見は認めず,慢性炎症細胞浸潤を認めた.また,血清IgG4は432mg/d<i>l</i>と上昇を認めた.以上より膵尾部に限局した自己免疫性膵炎と診断しPSL 40mg/日より開始した.治療開始7日目のDWIでは膵尾部の高信号域の縮小および信号低下を認め,ADC値は1.05×10<sup>-3</sup>mm<sup>2</sup>/sから1.25×10<sup>-3</sup>mm<sup>2</sup>/sと改善を示した.治療開始2週間後には膵尾部の腫大,膵管の狭細像の改善を認めた.<br>

A male in his 40's was admitted to our hospital due to upper abdominal discomfort for 1 week. Blood chemistry suggested inflammation and slightly elevated levels of pancreatic enzymes. CT revealed a focal tumor in the pancreatic tail and a slight contrast enhancement in the late phase. EUS showed a low echoic tumor 43mm×27mm in size. MRI revealed the tumor to have low intensity in T1WI, high intensity in T2WI, and higher imaging in DWI. ERCP showed main pancreatic ductal narrowing over 20mm in the pancreatic tail. EUS-FNA revealed no malignancy or chronic inflammation. Serum IgG4 was elevated (432mg/d<i>l</i>). The final diagnosis was autoimmune pancreatitis with focal enlargement of the pancreatic tail, and steroid therapy was initiated. After one week, diffusion-weighted MRI revealed that the high-density area in the pancreatic tail was smaller and lower in intensity. The apparent diffusion coefficiency (ADC) was reduced from 1.25×10<sup>-3</sup>mm<sup>2</sup>/s to 1.05×10<sup>-3</sup>mm<sup>2</sup>/s. After 2 weeks, pancreatic tail swelling and main pancreatic duct narrowing were improved.<br>

Journal

  • Suizo

    Suizo 27(4), 608-616, 2012

    Japan Pancreas Society

Codes

  • NII Article ID (NAID)
    130004495998
  • Text Lang
    JPN
  • ISSN
    0913-0071
  • Data Source
    J-STAGE 
Page Top