CLINICAL SIGNIFICANCE OF UNEVEN FATTY REPLACEMENT OF THE PANCREAS

我们推测，在CT上不均匀的胰腺脂肪替代可分为四种类型。为探讨胰腺脂肪替代不均匀与动脉因素的关系，我们对14例胰头区正常的胰腺肿瘤患者进行了选择性胰腺血管CT检查。胰头前部与胰十二指肠前动脉与胰背动脉吻合分支的CT范围相对应，多数患者CT上显示为严重的脂肪替代。此外，胰腺头部和钩突的后部与胰十二指肠后动脉的CT区域相对应，这两个部位没有发生强烈的脂肪替代。这些结果表明，CT领域的吻合分支可能会遭受缺血性变化，因此，诱导脂肪沉积到其受损的胰腺实质。此外，我们对6例胰腺脂肪替代不均匀的患者进行了CT三维重建，进一步评价了胰腺脂肪替代不均匀的临床因素之一。结果表明，胰腺脂肪替代不均匀，尤其是胰体尾部脂肪替代不均匀，可进行详细的CT分型。

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.