胰胆管十二指肠连接区肿瘤MRI诊断PPT课件.ppt

胰胆管十二指肠连接区肿瘤MRI诊断,1,.,胰胆管十二指肠连接区(PancreaticobiliaryDuctalandDuodenalUnion,PDDU)又称壶腹部(ampullaregion)，发生于该区域的肿瘤称壶腹周围肿瘤(Periampullarytumor)系十二指肠乳头区2cm左右区域，包括胆总管下段、肝胰壶腹、胰头部、十二指肠乳头区等解剖结构细微、毗邻关系复杂，病变症状缺乏特征性，鉴别诊断困难,2,3,胰胆管开口方式,4,壶腹周围肿瘤（Periampullarytumor）发生于十二指肠乳头及其周围2CM范围内的肿瘤胰头癌（pancreaticheadcancer）胆总管下段癌（lowercommonbileductcancer）壶腹癌（ampullarycancer）壶腹周围十二指肠癌（periampullaryduodenalcancer）壶腹周围癌发病率位列胃肠道肿瘤第三，仅次于胃癌和结直肠癌,壶腹周围肿瘤:按发生部位分类,5,壶腹周围肿瘤:按发生部位分类,胰头癌,壶腹癌,胆总管下段癌,十二指肠癌,6,大体病理与MRI对照,7,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,8,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,壶腹区正常结构:病理-影像对照,duodenalwallwithfourlayers:mucosa(m)submucosa(sm)muscularispropria(pm)subserosaorserosa(ss),9,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,AmpullarytumorwithinvasionofpancreasObliquehigh-spatialresolutionT1-(500/20)andT2-weighted(4,000/85)MRimagesshowtumor(whitearrowheads)withinvasionofduodenalmuscularispropriaandpancreas.Tumorinterruptsduodenalmuscularispropria(blackarrowhead)andinfiltratespancreas(arrows),壶腹癌侵犯胰腺:病理-影像对照,10,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,PancreaticcancerwithinvasionintoampullaryregionObliquehigh-spatial-resolutionT2-weightedMRimages(4,000/85).Pancreatictumor(P)extendsacrossmuscularispropria(arrowheadsandbrokenline)andinfiltraesampullaryregion(arrow)andsurroundingduodenalwallTumor(arrows)largelyinvolvespancreasandcompressesduodenalwalloutward,胰腺癌侵犯壶腹区:病理-影像对照,11,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,DistalcommonbileductcancerwithinvasionintoampullaryregionObliquehigh-spatial-resolutionT2-weightedMRimage(4,000/85)showstumorinvasion(arrowheads)ofpancreas(P),胆总管下段癌侵犯壶腹区:病理-影像对照,12,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,PeriampullaryduodenalcancerwithoutinvasionintoampullaryregionObliquehigh-spatial-resolutionT2-weightedMRimage(4,000/85)showstumor(arrowheads)Arrowshowsmarkerforlocationoftumor,壶腹周围十二指肠癌:病理-影像对照,13,TNM分期:图示T分期,14,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,壶腹癌T分期,AmpullarycancerT1indicatestumorlimitedtoOddimuscleT2,tumorwithinvasionofduodenalwallT3,tumorwithinvasionofpancreas,15,壶腹癌T分期,T1:肿瘤局限于壶腹内T2:肿瘤蔓延至十二指肠壁T3:肿瘤侵犯胰腺不超过2cmT4:肿瘤侵犯胰腺超过2cm,或侵犯邻近其它器官,16,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,ExtrahepaticbileductcancerT1indicatestumorconfinedtobileductT2,tumorwithinvasionbeyondwallofbileductT3,tumorwithinvasionofpancreasT4,tumorwithinvasionofduodenumoradjacentorgans,肝外胆管癌T分期,17,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,PancreaticcancerT1indicatestumor(2cmingreatestdimension)limitedtopancreasT2,tumor(2cmingreatestdimension)limitedtopancreasT3,tumorwithextensionbeyondpancreas,胰腺癌T分期,18,ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology2004;231:767-774.,DuodenalcancerT1indicatestumorwithinvasionoflaminapropriaorsubmucosaT2,tumorwithinvasionofmuscularispropriaT3,tumorwithinvasionthroughmuscularispropriaintosubserosaT4,tumorwithdirectinvasionofotherorgansorstructures,十二指肠癌T分期,19,MRI表现,20,壶腹癌男,57岁,188408胆道低位梗阻胆总管下端壁增厚、强化,壶腹癌,21,十二指肠癌:病例1179363,F,43上腹胀痛,黄疸,22,十二指肠癌男,54岁,192802十二指肠乳头区肿块呈半球形,表面见糜烂区胆总管扩张,十二指肠癌:病例2,扩张胆总管,23,胰头癌男,70岁,197096胰头肿瘤T1WI呈低信号胆总管、主胰管扩张胆总管下段狭窄,胰头癌:病例1,24,胰头癌男,61岁,200333钩突增大,边缘隆起肿瘤T1WI信号减低肿瘤DWI信号增高,胰头癌:病例2,25,胰头癌: