Abstract：Objective: To analyze the clinical characteristics and CT findings of heterotopic pancreas in duodenum. Methods: The clinical and imaging data of 10 patients with heterotopic pancreas in duodenum were reviewed retrospectively,which were confirmed by pathology but misdiagnosed by imaging. Clinical manifestations, morphological characteristics, the ratio range between longitudinal diameter(LD) and short diameter(SD) and the differences in CT values between normal pancreas and the lesions were analyzed. Results: Main clinical manifestations in these patients were as follows: recurrent abdominal pain and distension in 5 cases, melena in 3 cases and jaundice in 2 cases. In terms of imaging findings, two lesions were not shown on CT which were located in duodenal papilla or Vater ampulla, and eight cases showed nodular lesions which were all above Vater ampulla. Six cases were Yamada type Ⅱ, seven cases were intracavitary, five cases showed clear margin and homogeneous density. The LD/SD values in eight cases were from 1.14 to 1.92, which was 1.52±0.24 in an average, LD/SD were above 1.4 in 5 cases. In the plain phase and the portal vein phase, CT values of the lesions were slightly lower than normal pancreas(t=-3.41, -1.00, P＜0.05), the mean differences were only (6.38±2.45) HU and (5.25±3.33) HU respectively, which were indistinguishable to naked eyes. In the aspect of misdiagnoses, four cases were misdiagnosed as leiomyomas or inflammatory polyps, four cases as gastrointestinal stromal tumors(GIST), two cases as periampullary carcinomas. Conclusion: The imaging findings of heterotopic pancreas in duodenum are nodules with broad base, intracavitary distribution, clear margin, homogeneous density and the similar characteristics of enhancement to normal pancreas. However, atypical imaging findings may lead to misdiagnosis. Further understanding of the disease as well as fully combining with clinical features are of vital importance for diagnosis.
夏振元，李伟雄，何 华，董 鑫. 十二指肠异位胰腺的临床特点及影像学误诊分析[J]. 中国临床医学影像杂志, 2017, 28(7): 500-503.
XIA Zhen-yuan, LI Wei-xiong, HE Hua, DONG Xin. Clinical characteristics and imaging misdiagnosis analysis of duodenal heterotopic pancreas. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(7): 500-503.
[1]赵苏苏，余泽前，王剑蓉，等. 异位胰腺的临床特点及病理特征：附36例报告[J]. 中国普通外科杂志，2013，22（3）：871-872.
[2]路利军，李鹏，雷小艳. 胃部异位胰腺1例[J]. 中国临床医学影像杂志，2008，19（7）：497.
[3]张伶，蒋新华，关键，等. 多层螺旋CT联合超声内镜对十二指肠异位胰腺的诊断[J]. 中外妇儿健康，2011，19（6）：62-63.
[4]屠霖，徐佳，曹晖. 异位胰腺误诊为胃肠道间质瘤的临床分析[J]. 中华胃肠外科杂志，2014，17（4）：348-351.
[5]续文婷，杨桢，吕农华. 异位胰腺的罕见临床特征及其诊治策略[J]. 中国实用内科杂志，2013，33（10）：824-827.
[6]沈杰，李智，肖玉良，等. 上消化道异位胰腺35例临床分析[J]. 重庆医学，2013，42（27）：3244-3245；3248.
[7]Wang D, Wei XE, Yan L, et al. Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas[J]. World J Gastroenterol, 2011, 17(33): 3850-3855.
[8]陈秀珍，黄文薮，陈建宁，等. 消化道异位胰腺的MDCT表现分析[J]. 中国CT和MR杂志，2015，13（7）：60-63.
[9]Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma[J]. Radiology, 2009, 252(1): 92-100.
[10]Lee SW, Yun SP, Seo HI. Heterotopic pancreas of the gallbladder associated with segmental adenomyomatosis of the gallbladder[J]. Kor Surg Soc, 2013, 84(5): 309-311.
[11]王倩，杨学华，高剑波，等. 异位胰腺的CT表现与病理联系[J]. 实用放射学杂志，2014，30（5）：815-817.
[12]Wei R, Wang QB, Chen QH, et al. Upper gastrointestinal tract heterotopic pancreas: findings from CT and endoscopic imaging with histopathologic correlation[J]. Clin Imaging, 2011, 35(5): 353-359.
[13]马得贝，初建国，杨婷婷，等. CT和X线钡餐造影诊断胃肠道异位胰腺[J]. 中国医学影像技术，2016，32（5）：757-760.
[14]许建兴，郑建刚，龚波，等. 64层螺旋CT增强扫描对较小壶腹周围癌的诊断价值探讨[J]. 中国临床医学影像杂志，2014，25（2）：133-135.
[15]Attwell A, Sams S, Fukami N. Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration[J]. World J Gastroenterol, 2015, 21(8): 2367-2373.
