CLINICAL SIGNIFICANCE OF UNEVEN FATTY REPLACEMENT OF THE PANCREAS

我们假设在CT上胰腺脂肪替代不均匀可分为四种类型。为明确胰腺不均匀脂肪替代与动脉因素的关系，对14例胰腺肿瘤患者行选择性胰腺血管CT扫描。胰头前部与胰头十二指肠前动脉与胰背动脉吻合支的CT范围相对应，多数患者的CT表现为严重的脂肪替代。此外，避免剧烈脂肪置换的头部后方和胰腺钩突与胰腺-十二指肠后动脉的CT范围相对应。这些结果表明，吻合支的CT区域可能发生缺血性改变，从而导致脂肪沉积到其受损的胰腺实质中。动脉硬化可能是胰腺不均匀脂肪置换的临床因素之一。此外，我们在6名患者中使用三维重建图像对胰腺不均匀脂肪置换进行了进一步的CT评估。提示CT对胰腺不均匀脂肪置换，尤其是胰体尾部脂肪置换进行详细分型的可能性。

We have postulated that uneven fatty replacement of the pancreas at CT would be classified into four types. In order to clarify the relationship between uneven fatty replacement of the pancreas and arterial factor, we performed selective pancreatic angio-CT in 14 patients who had pancreatic tumor but were normal in pancreas head region. The anterior aspect of the head of the pancreas, which showed severe fatty replacement on CT in most patients, corresponded with the CT territory of the anastomotic branch between anterior pancreatico-duodenal artery and dorsal pancreatic artery. Furthermore, the posterior aspect of the head and uncinate process of the pancreas, which were spared from intense fatty replacement, corresponded with the CT territory of the posterior pancreatico-duodenal artery. These results suggest that the CT territory of the anastomotic branch may tend to suffer from ischemic change and, consequently, induce fat deposition into its damaged pancreatic parenchyma. Arteriosclerosis could be one of the clinical factors of uneven fatty replacement of the pancreas.In addition, we performed further evaluation of uneven fatty replacement of the pancreas at CT using 3-dimensional reconstruction images in six patients. The result indicated the possibility of detailed CT classification of uneven fatty replacement of the pancreas, especially at the body and tail of the pancreas.