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Radiologische Diagnostik der intraduktalen papillär muzinösen Neoplasie

Radiological evaluation of intraductal papillary mucinous neoplasm

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Zusammenfassung

Die intraduktale papillär muzinöse Neoplasie (IPMN) ist die häufigste zystische Neoplasie des Pankreas, die wegen der zunehmenden Verbreitung hochauflösender Schnittbildverfahren meist zufällig entdeckt wird. Den überwiegenden Anteil machen die Seitenastformen aus, die relativ häufig multifokal imponieren. Das klinische Bild kann einer chronischen Pankreatitis ähneln und auch das morphologische Bild kann eine chronische Pankreatitis vortäuschen. Zunehmend werden auch Schübe einer akuten Pankreatitis gesehen, die zumeist einen milden Verlauf nehmen. Das häufigste diagnostische Verfahren ist die kontrastverstärkte Computertomographie (CT), die in der Regel eine Differenzierung von anderen zystischen Pankreasneoplasien erlaubt und die Zuordnung zu einer Haupt- oder Seitenast-IPMN ermöglicht. Für die Darstellung der Feinarchitektur sind Magnetresonanz(MR)-Tomographie einschließlich MR-Cholangiopankreatographie und die Endosonographie der CT überlegen. Insbesondere zur Frage der malignen Entartung ist eine hochauflösende Bildgebung erforderlich. Während die Hauptgang-IPMN eine Indikation zur Resektion darstellt, wird bei kleinen und asymptomatischen Seitenast-IPMN eine Verlaufskontrolle in 6- bis 12-monatlichen Abständen empfohlen.

Abstract

The intraductal papillary mucinous neoplasm (IPMN) is the most frequent cystic neoplasm of the pancreas. Due to the widespread use of cross-sectional imaging IPMN is being incidentally recognized with increasing frequency. The most common type is branch- duct IPMN which occurs multifocally in about 20–30%. Patients with IPMN may present with symptoms resembling chronic pancreatitis and episodes of acute pancreatitis are increasingly being reported which usually have a mild course. The most important diagnostic technique is contrast-enhanced multidetector computed tomography (MDCT), which most frequently allows the differentiation from other cystic lesions and enables the attribution to branch duct or main duct IPMN. Magnetic resonance imaging (MRI) in combination with magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound are superior in depicting the fine architecture of cystic tumors. Particularly for evaluation of malignant transformation and extent of malignant disease, high resolution imaging is essential. Whereas main duct IPMN is an indication for resection therapy for small and asymptomatic branch duct IPMN periodic surveillance at 6–12 month intervals is recommended.

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  1. Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Steinhövelstr. 9, 89075, Ulm, Deutschland

    H.J. Brambs & M. Juchems

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  1. H.J. Brambs
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  2. M. Juchems
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Correspondence to H.J. Brambs.

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Brambs, H., Juchems, M. Radiologische Diagnostik der intraduktalen papillär muzinösen Neoplasie. Chirurg 83, 116–122 (2012). https://doi.org/10.1007/s00104-011-2182-9

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  • DOI: https://doi.org/10.1007/s00104-011-2182-9

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