病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
A. 腹部CT扫描门静脉相，显示胰尾部看见：卵圆形的，增强的结节（箭头示）。病灶密度为高密度高于胰腺与脾类似。
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病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
B,横断面灰阶超声影像显示低回声、均质的结节（大箭头示），位于胰尾部，清晰的高回声边界，后方回声增强（双箭头示）。病灶的的回声与胰腺（短箭头示）和脾脏（Ｓ）相似。
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病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
C,注射超声造影剂６秒获得的动脉相影像，血管蒂（小箭头示）进入脾内（大箭头示）。增强的程度和模式与脾相似（此图未显示）。ＬK左肾。
（缩略图，点击图片链接看原图）
病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
D,系列超声造影图(ADI software, Siemens Medical Solutions)，注射超声造影剂后，34秒（左上图），101秒（右上图），4分（下图），显示胰腺内一个均匀增强的结节（箭头示）。S-脾、LK左肾。
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病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
E,99mTc同位素SPECT检查，显示在脾门附近放射性核素积聚（箭头示）。
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病例2 女，70岁，胰尾部结节。
A,灰阶超声显示胰尾圆形结节（单箭头示），直径1.1cm，周边高回声晕，后方回声增强（双箭头示）。病灶回声低于胰腺（三角箭头示）。
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病例2 女，70岁，胰尾部结节。
B,彩色多普勒超声，血管门（空箭头示）围绕病灶（实箭头示）。
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病例2 女，70岁，胰尾部结节。
C,超声造影：脾动脉显影9秒，清楚显示供血蒂（空箭头示）。
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病例2 女，70岁，胰尾部结节。
D,系列超声造影图(ADI software, Siemens Medical Solutions)：注射超声造影剂后23″、37″、84″和4分。S-脾。
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病例2 女，70岁，胰尾部结节。
E、未增强MR影像，T1为低信号。
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病例2 女，70岁，胰尾部结节。
F, 未增强MR影像，T2为高信号。
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病例2 女，70岁，胰尾部结节。
G, 超顺磁性氧化铁(SPIO)增强，注射SPIO10分钟后T2加权影像显示边界（箭头示）。S-脾。
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请大家积极发言。
病变单发，位于胰尾与脾门之间，椭圆形，边界清晰，与脾脏密度、回声、信号一致，并且同步强化。首先考虑副脾。
其它还要考虑淋巴结肿大、胰腺肿瘤。
临床资料：
病例1：男、45岁，小肠粘膜下层肿瘤体检时偶然发现一个结节。
影像表现：
1、超声所见：胰尾部低回声结节、均质，边界较清晰，边缘回声强，后方回声增强。超声造影，例一是6秒获得的动脉相影像－血管蒂－进入脾内。增强的程度和模式与脾相似。34秒、101秒、4分结节明显强化，持续均匀增强。例二，脾动脉显影9秒，清楚显示供血蒂，23″、37″、84″和4分结节强化特点同上。
2、CT扫描：门静脉相，显示胰尾部高密度结节。没有平扫片，楼主介绍为强化的结节，密度为高于胰腺与脾类似。
3、E,99mTc同位素SPECT检查，显示在脾门附近放射性核素积。
4、例2，MR影像，T1为低信号, ，T2为高信号。 超顺磁性氧化铁(SPIO)增强，注射SPIO10分钟后T2加权影像显示边界清楚，内部为低信号。
分析：
胰岛细胞瘤是胰腺常见肿瘤，多发生于体尾部。不管是良性还是恶性胰岛细胞瘤，多血管性及血供丰富是典型胰岛细胞瘤病理血特征。其CT主要表现在动脉早期－即肝动脉期明显强化。
这两例从以上影像都表现胰腺尾部结节血供丰富。尽管例2的MR影像超顺磁性氧化铁(SPIO)增强，注射SPIO10分钟后T2加权影像显示结节内部为低信号，我认为可能时间长造影剂已经廓清。
需要鉴别：
1、胰腺Ca：胰腺形态失常，周围有肿大淋巴结。楼主没有提供相关情况，估计不是重点考虑。
2、胰腺假性动脉瘤：常发生于急性胰腺炎患者。此例与病理资料不符。
3、异位副脾：没见过，果真要是，那就即饱了眼福又长了学问，谢了楼主还要谢老杏。
本想给楼主投一票，可是我今天已经投了4票，投票权被限制，有权后一定补上。
首先支持老否老师丰富的临床实践经验。
病变位于胰腺与脾门之间，单发，卵圆形，边界清，与脾等回声，造影增强的程度和模式与脾相似。首先考虑副脾，其次是淋巴结肿大。
期待xiaoyuchen战友公布结果！
病变位于胰尾与脾门之间，呈类圆形，边界清，内回声尚均，通过CT、CDFI、声学造影及同位素检查均可见其与脾脏的密度、回声、信号一致，考虑为副脾。但位置与常见的副脾有异，本人在临床中见到的副脾均距脾门甚近。
期待谜底揭晓 (^ o ^)
Contrast-Enhanced Sonography of Intrapancreatic Accessory Spleen in Six Patients
超声造影胰腺内副脾6例
Se Hyung Kim1 Jeong Min Lee1,2 Jae Young Lee1 Joon Koo Han1,2 Byung Ihn Choi1,2
AJR 2007; 188:422–428 American Roentgen Ray Society
OBJECTIVE. The purpose of this article is to describe the characteristic findings of intrapancreatic accessory spleen over time on contrast-enhanced sonography.
目的：这篇文章的目的是描述胰腺内副脾超声造影特征。
CONCLUSION. On contrast-enhanced sonography, intrapancreatic accessory spleens showed a characteristic inhomogeneous enhancement on the early vascular phase, enhancement similar to the main spleen during the postvascular phases, and prolonged enhancement on the delayed hepatosplenic phase.
结论：胰腺内副脾超声造影表现是：早期血管相为不均匀增强，血管后相增强类似于主脾，肝脾延迟相增强延长。
An accessory spleen is a congenital anomaly consisting of ectopic splenic tissue separated from the main body of the spleen; it occurs in approximately 10–30% of the population [1]. The most common site of an accessory spleen is the splenic hilum, with the pancreatic tail the second most common site [1].
副脾是一种先天性异常，即存在主脾外异位的脾组织，发生率约10-30%[1]。最常见的位置在脾门处，其次在胰腺的尾部。
Although an accessory spleen usually appears as an isolated asymptomatic abnormality, it may have clinical significance in some situations. In particular, when the accessory spleen is located in the pancreas, it may mimic a well-enhancing solid pancreatic tumor. There have been sporadic reports regarding imaging findings of intrapancreatic accessory spleen in which the tentative preoperative diagnosis included islet cell tumor, solid pseudopapillary neoplasm, and metastatic renal cell carcinoma [2–4]. Given that an accessory spleen does not usually require treatment, accurate preoperative diagnosis will obviate surgery.
虽然副脾通常是孤立且无症状的，在一些情况下可有临床意义。特别是副脾位于胰腺内，造成胰腺内实性肿瘤的假象。偶有胰腺内副脾影像发现的报道，术前诊断为胰岛细胞瘤、实质性假性乳头状新生物、转移性肾癌[2-4]。副脾通常不需要治疗，因此，准确的术前诊断以避免外科手术。
Radionuclide splenic scanning using 99mTc heat-damaged RBCs (HDRBC) has been regarded as a highly specific test for differentiating splenic tissue from other tissue based on showing functioning splenic tissue by means of the phagocytic activity of the reticuloendothelial system (RES) cells. However, 99mTc HDRBC scintigraphy offers far inferior anatomic resolution compared with sonography, CT, and MRI, which may limit detection of small splenic tissue.
99mTc放射性核素脾热损害红细胞扫描(HDRBC)，在鉴别脾组织上是具有高特异性的检查，主要是显示脾组织功能――网状内皮系统(RES)细胞的吞噬性活动。然而99mTc HDRBC闪烁照相术与超声、CT、MRI相比，解剖分辩率较低，限制其对较少脾组织的探查。
Recently, superparamagnetic iron oxide (SPIO)-enhanced MRI has been proposed as an alternative diagnostic tool for imaging of the intrapancreatic accessory spleen because of its higher spatial resolution compared with scintigraphy [5]. Because the specific diagnosis of intrapancreatic accessory spleen is based on RES function on both scintigraphy and SPIO-enhanced MRI, we assume that contrast-enhanced sonography using galactose and palmic acid (Levovist [SH U 508A], Schering), which is known to be exclusively accumulated by the hepatic and splenic parenchyma due to RES activity on the delayed phase, can provide valuable information for the diagnosis of intrapancreatic accessory spleen [6]. Until now, there has been only one case report describing the contrast-enhanced Doppler findings of intrapancreatic accessory spleen [7]; however, to our knowledge there has been no report addressing the enhancing patterns over time on contrast-enhanced sonography. Therefore, the aim of this study is to describe the findings of intrapancreatic accessory spleen on baseline and contrast-enhanced sonography and to determine the role of contrast-enhanced sonography for the diagnosis of intrapancreatic accessory spleen.
超顺磁性氧化铁(SPIO)增强MRI是另一种胰腺内副脾的影像诊断方法，较闪烁照相术有较高的分辩率[5]。胰腺内副脾的特殊诊断技术，闪烁照相术和超顺磁性氧化铁(SPIO)增强MRI是基于RES的功能，我们设想使用半乳糖棕榈酸(Levovist [SH U 508A], Schering)进行超声造影，由于RES的作用，Levovist在肝脾延迟相中特有积聚，可对胰腺内副脾的诊断提供有价值的信息[6]。目前，仅有1例多普勒增强超声胰腺内副脾的报道[7]；然而，据我们所知尚无超声造影增强模式的报道。因此，本研究的目的是描述胰腺内副脾的基波超声和超声造影特征，以确定超声造影在胰腺内副脾诊断中的作用。
Materials and Methods
Patients
During the 12-month period from June 2004 to June 2005, we encountered six patients (four men and two women; mean age, 53 years; age range, 32–70 years) whose routine CT examinations revealed solid pancreatic lesions suspected of being intrapancreatic accessory spleens. These patients underwent baseline and contrastenhanced sonography examinations using Levovist for characterization of the pancreatic lesion. The final diagnosis was established by 99mTc HDRBC scintigraphy in three patients and by SPIO-enhanced MRI in the other three patients. This study was approved by our hospital’s institutional review board. Before undergoing sonography, all subjects gave their informed consent to allow their data to be used for research purposes.
Sonography Acquisition
All baseline and contrast-enhanced sonography examinations were performed by one abdominal radiologist with 8 years of experience using a Sequoia 512 scanner (Acuson) equipped with a convex 3–5 MHz transducer and agent detection imaging software (ADI, Siemens Medical Solutions). Before receiving the contrast agent, all patients underwent baseline examinations including gray-scale and color or power Doppler sonography examinations.
超声设备Sequoia 512(ADI, Siemens Medical Solutions)，造影软件(ADI, Siemens Medical Solutions)。
Levovist, which consists of galactose microparticles (99.9%) and palmitic acid (0.1%), was injected through a brachial vein as a bolus (within 10 seconds) at 300 mg/mL followed by a 10-mL flush of 0.9% saline solution. After engaging the ADI function, machine settings, such as the region-ofinterest box covering the lesion, depth, focus, and time–gain compensation, were readjusted. The default settings of the other machine parameters for ADI were as follows: maximum mechanical index, 1.9; a low level of line density; and frame rate, 9 Hz with no frame averaging (persistence). We used a similar scanning protocol as that used during our previous studies regarding focal hepatic lesions [8].
造影剂Levovist。
Even though Levovist is one of the most widely available sonographic contrast agents, it is known to have a weak harmonic response when insonated with an ultrasound beam at a low mechanical index. Therefore, destruction of the bubble is required for its detection. Broadband harmonic imaging, such as phase-inversion harmonic imaging, can effectively show the nonlinear echoes produced from disruption of microbubbles by the incidental ultrasound beam [9]. However, with phase-inversion harmonic imaging, which uses two alternately phased pulses and adds echoes from both pulses together, the fundamental tissue echoes are summed to zero and are not detected, but the tissue harmonics and contrast agent responses are detected together; therefore, the technique is not literally contrast-specific. On the contrary, with ADI, using two pulses with the same polarity and subtracting the signals from the two pulses, only fundamental and harmonic contrast agent signals remain; therefore, ADI may be referred to as contrast-only imaging. As a result, ADI may depict signals from microbubbles better than phaseinversion harmonic imaging, and the use of an intermittent imaging strategy (interval delay) with ADI may effectively reveal the vascularity of focal lesions and also may help in lesion characterization. Four rapid serial sweeps were obtained—that is,vascular phase (real-time scanning during the 7 seconds after the first arrival of contrast material),postvascular phases (arterial and portal phases: 30 and 90 seconds after contrast injection, respectively), and a delayed hepatosplenic parenchymal phase (3–5 minutes after contrast injection). All baseline and contrast-enhanced sweeps were obtained as cine loops and transferred to a PACS.
Standard of Reference Examinations
标准的相关检查
99mTc HDRBC SPECT—In three patients, 99mTc
3例进行99mTc HDRBC SPECT检查
HDRBC SPECT of the spleen was performed according to the following protocol. Ten milligrams of sodium pyrophosphate in 3 mL of isotonic saline was injected IV. Thirty minutes later, 10 mL of blood was withdrawn from a vein into a heparinized syringe. Next, 20 mCi (740 MBq) of freshly eluted 99mTc pertechnetate was added to the blood, and the mixture was heated in a water bath at 49.5°C for 30 minutes. The damaged cells were then cooled to room temperature and reinjected into the patient. Abdominal SPECT scintigraphy was performed using a dualhead gamma camera with low-energy, high-resolution collimators in a 128 × 128 matrix. One experienced nuclear physician reviewed the scintigraphic images. The diagnostic criterion used for intrapancreatic accessory spleen was the presence of a marked increase in uptake of 99mTc HDRBC exceeding the cardiac blood pool at the site of the suspected intrapancreatic accessory spleen [10].
SPIO-enhanced MRI—In three patients, SPIOenhanced MRI was used as a confirmatory tool to diagnose the intrapancreatic accessory spleen [5]. A 1.5-T scanner (Sonata, Siemens Medical Solutions) with a body phased-array coil was used. Before injection of SPIO (ferucarbotran [Resovist, Schering]), fat-saturated T2-weighted turbo spinecho (TSE); T2*-weighted gradient-refocused echo (GRE); and T1-weighted dual-echo GRE images were obtained. Imaging parameters for T2- weighted TSE sequences were as follows: TR/TE, 1,700/100; echo-train length, 13; signal acquisitions, 3; slice thickness, 7 mm with interslice gap of 25%; and matrix, 320 × 280. T2*-weighted images were obtained using the following parameters: 130/10; 1 signal acquisition; slice thickness, 9 mm with interslice gap of 25%; and matrix, 256 × 125. The parameters for T1-weighted GRE sequences were 110/5.1 for in-phase and 110/2.4 for opposedphase; 1 signal acquisition; slice thickness, 7 mm with interslice gap of 25%; and matrix, 320 × 224. Ten minutes after SPIO administration, T2- and T2*-weighted images using the same parameters as the unenhanced images were obtained. The dose of ferucarbotran ranged between 8.0 and 12.0 μmol Fe/kg. The diagnostic criterion used for intrapancreatic accessory spleen was a loss of signal intensity of the lesion similar to normal spleen on SPIOenhanced T2- and T2*-weighted images [5].
3例进行超顺磁性氧化铁(SPIO)增强MRI检查。
Image Analysis
Sonography images were evaluated by consensus by two additional radiologists who were not blinded to the diagnosis of intrapancreatic accessory spleen. The reviewers determined the location, size, shape, echogenicity, and homogeneity of the lesion on baseline gray-scale sonography images. The echogenicity of the lesion was compared with those of the pancreas and main spleen as one of the three echotextures: low, isotexture, or high. In addition, the presence of a hyperechoic rim and posterior acoustic enhancement were also recorded. The presence of vascular hilum within the lesion, which is known to be a characteristic feature of an accessory spleen, was also determined on color or power Doppler sonography images [11].
For contrast-enhanced sonography images, the echo enhancement of the lesion relative to that of the pancreas and spleen was evaluated on all four sonography phases. The echogenicity was assigned one of three characteristics—isoechoic, low, or high—compared with those of the reference organs. Reviewers also determined whether lesion enhancement on each phase was inhomogeneous or homogeneous. In addition, the presence of the vascular hilum entering into the lesion was also determined on the real-time vascular phase.
Results
结果
Clinical Findings
临床表现
The pancreatic abnormalities were detected incidentally in all patients. The indications for the initial CT were the staging of small-bowel tumor and colon cancer, nonspecific abdominal discomfort, liver abscess, confirmation of the residual stone after open cholecystectomy and choledocholithotomy, and common bile duct stone and liver abscess. The mean duration between the CT revealing the pancreatic abnormality and the diagnosis was 14.3 months (range, 1–53 months).
所有病人均发现胰腺有异常，初始CT检查有小肠肿瘤和结肠癌、非特异性腹部不适、肝脓肿、胆囊切除术和胆总管石切除术后的残余结石、总胆管结石伴肝脓肿。CT发现胰腺异常至做出诊断平均时间约14.3月（范围1－53月）。
Findings at 99mTc HDRBC Scintigraphy and SPIO-Enhanced MRI
In three patients, 99mTc SPECT scans confirmed the diagnosis of intrapancreatic accessory spleen by showing a single focal area of intense radiotracer uptake near the hilum of the normal spleen on 99mTc scintigraphy (Fig. 1). In the other three patients, SPIO-enhanced MR images confirmed the diagnosis of intrapancreatic accessory spleen by showing a significant signal decrease on T2- and T2*-weighted MR images, similar to signal changes of the spleen (Fig. 2).
99mTc HDRBC闪烁照相术和超顺磁性氧化铁(SPIO)增强MRI检查所见
3例病人进行99mTc HDRBC SPECT检查证实胰腺内副脾的诊断，显示为单个局灶性放射性摄取积聚区，位于正常脾门区（图1）3例病人进行超顺磁性氧化铁(SPIO)增强MRI检查，证实胰腺内副脾的诊断。显示为在T2-和T2*加权上显著的信号减低，类似于脾脏的信号变化（图2）。
Findings at Sonography
超声表现
Baseline sonography findings—All lesions were located on the pancreatic tail. The diameter of the intrapancreatic accessory spleen varied between 1.1 and 2.4 cm (mean, 1.6 cm). All intrapancreatic accessory spleens were well marginated and were round in three patients, ovoid in two, and lobulated in one (Figs. 1 and 2). The echogenicity of the intrapancreatic accessory spleen was low compared with the pancreatic parenchyma in five patients (Fig. 2) and isoechoic in one (Fig. 1). In all intrapancreatic accessory spleens, the echogenicity was homogeneous and was identical to that of the main spleen. Five intrapancreatic accessory spleens showed posterior acoustic enhancement and all six had hyperechoic rims (Figs. 1 and 2). On color or power Doppler sonography images, the blood supply to the intrapancreatic accessory spleens from the splenic artery or vein could be shown in two patients and was suspicious in one (Fig. 2).
基波超声所见――所有病灶位于胰腺的尾部。胰腺内副脾的直径1.1-2.4cm（平均1.6cm）所有胰腺内副脾边界清，3例为圆形、3例为卵圆形、1例为分叶状（图1、2）。5例副脾回声低于胰腺实质的回声（图2），1例为等回声（图1）。所有胰腺内副脾回声均匀、与主脾的回声一致。5例胰腺内副脾显示后方回声增强，所有病例均有高回声晕（图1、2）。彩色多普勒或能量多普勒超声显示，胰腺内副脾的血供来自脾动脉，2例显示了静脉，1例可疑（图2）。
Contrast-enhanced sonography findings— The contrast-enhanced sonography features of the six intrapancreatic accessory spleens are presented in Table 1. On the vascular phase, the vascular pedicle was clearly visualized in three patients, including the patient in whom it was suspicious on the color Doppler sonography image (Fig. 2). All six lesions showed an inhomogeneous enhancement, well known as the zebra-striped pattern, of the spleen seen on dynamic CT or MRI [12] (Fig. 1). On the arterial phase, there was inhomogeneous enhancement in three patients (Fig. 2) and homogeneous enhancement in the other three (Fig. 1). In all six patients, the intrapancreatic accessory spleen became homogeneous on the portal phase, showing dense persistent enhancement for as long as 3–5 minutes (Figs. 1 and 2). In comparison with the pancreatic parenchyma, the intrapancreatic accessory spleen appeared to be hyperechoic during all dynamic sonography phases. The echo enhancement of all intrapancreatic accessory spleens, however, was identical to that of the spleen on all phases.
超声造影所见――6例胰腺内副脾的超声造影特征见表1。在血管相，3例清晰可见血管蒂，包括彩色多普勒疑似的病例（图2）。在做增强CT或MRI时，所有6例病灶显示为不均匀增强，为斑马条模式[12](图1)。在动脉相，3例为不均匀增强，另3例为均匀增强（图1）。在所有6例，在门静脉相均为均匀增强，持续增强3-5分钟（图1、2）。在超声造影所有时相中，与胰腺实质相比，胰腺内副脾显示为高回声；所有胰腺内副脾增强回声与脾脏一致。
Fig. 1—45-year-old man with intrapancreatic accessory spleen detected incidentally during workup for small-bowel submucosal tumor (patient 1).
图1：男、45岁，小肠粘膜下层肿瘤体检时偶然胰腺内副脾（病例1）。
A, Axial CT image obtained in portal venous phase shows ovoid, well-enhanced nodule (arrow) in pancreatic tail. Attenuation of this lesion is hyperattenuated to pancreas and similar to that of spleen (S).
A. 腹部CT扫描门静脉相，显示胰尾部可见：卵圆形的，增强的结节（箭头示）。病灶密度为高密度高于胰腺与脾类似。
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B, Transverse gray-scale sonography image shows homogeneous and isoechoic nodule (large arrows) with subtle hyperechoic rim and posterior acoustic enhancement (double arrows) in tail of pancreas (arrowheads). Echogenicity of this lesion is similar to that of pancreas (arrowheads) and spleen (S).
B,横断面灰阶超声影像显示低回声、均质的结节（大箭头示），位于胰尾部，清晰的高回声边界，后方回声增强（双箭头示）。病灶的回声与胰腺（短箭头示）和脾脏（Ｓ）相似。
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C, On vascular phase contrast-enhanced sonogram obtained 6 seconds after arrival of contrast material, feeding pedicle (arrowhead) enters into intrapancreatic accessory spleen (arrow). Degree and pattern of enhancement of this lesion were similar to those of main spleen (not shown). LK = left kidney.
C,注射超声造影剂６秒获得的动脉相影像，血管蒂（小箭头示）进入胰内的副脾（大箭头示）。增强的程度和模式与主脾相似（此图未显示）。ＬK左肾。
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D, Serial contrast-enhanced agent detection imaging (ADI software, Siemens Medical Solutions) sonograms, obtained 34 seconds (upper left), 101 seconds (upper right), and 4 minutes (lower images) after contrast injection, show homogeneous enhancement of intrapancreatic accessory spleen (arrows) on postvascular phases (upper images) and delayed prolonged enhancement (arrow) on hepatosplenic parenchymal phase (lower left). Degree of enhancement of intrapancreatic accessory spleen (arrow, lower left) on hepatosplenic parenchymal phase is similar to that of main spleen (S). LK = left kidney.
D,系列超声造影图(ADI software, Siemens Medical Solutions)，注射超声造影剂后，34秒（左上图），101秒（右上图），4分（下图），在血管后相显示胰腺内均匀增强的副脾（箭头示）（上图）和在肝脾实质相延迟相增强延长（箭头示）与主脾类似。S-脾、LK左肾。
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E, Axial 99mTc heat-damaged RBC SPECT image shows clear accumulation of radionuclide (arrow) near splenic hilum and confirms diagnosis of intrapancreatic accessory spleen. L = liver, S = spleen.
E,99mTc同位素SPECT检查，显示在脾门附近放射性核素积聚（箭头示），证实胰腺内副脾是诊断。L-肝，S-脾。
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Fig. 2—70-year-old woman with intrapancreatic accessory spleen (patient 4).
病例2 女，70岁，胰腺内副脾（病例4）。
A, Baseline gray-scale sonography shows round nodule (single arrow) 1.1 cm in diameter in pancreatic tail. This lesion has lower echotexture than pancreas (arrowheads) and similar echotexture to that of spleen (S). Note peripheral high-echoic rim surrounding lesion and acoustic enhancement (double arrows) posterior to lesion.
A,灰阶超声显示胰尾圆形结节（单箭头示），直径1.1cm，周边高回声晕，病灶后方回声增强（双箭头示）。病灶回声低于胰腺（三角箭头示）与脾（S）类似。
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B, On color Doppler sonography, vascular hilum (open arrow) around lesion (solid arrow) is suspected but is not definite.
B,彩色多普勒超声，血管门（空箭头示）围绕病灶（实箭头示）（不完全确定）。
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