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 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 胰胆管开口方式 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 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 大体病理与MRI对照 ReijiSugita AkemiFuruta KeiIto etal PeriampullaryTumors High Spatial ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns Radiology2004 231 767 774 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 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 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 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 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 TNM分期 图示T分期 ReijiSugita AkemiFuruta KeiIto etal PeriampullaryTumors High Spatial ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns Radiology2004 231 767 774 壶腹癌T分期 AmpullarycancerT1indicatestumorlimitedtoOddimuscleT2 tumorwithinvasionofduodenalwallT3 tumorwithinvasionofpancreas 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 ReijiSugita AkemiFuruta KeiIto etal PeriampullaryTumors High Spatial ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns Radiology2004 231 767 774 ExtrahepaticbileductcancerT1indicatestumorconfinedtobileductT2 tumorwithinvasionbeyondwallofbileductT3 tumorwithinvasionofpancreasT4 tumorwithinvasionofduodenumoradjacentorgans 肝外胆管癌T分期 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 ReijiSugita AkemiFuruta KeiIto etal PeriampullaryTumors High Spatial ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns Radiology2004 231 767 774 DuodenalcancerT1indicatestumorwithinvasionoflaminapropriaorsubmucosaT2 tumorwithinvasionofmuscularispropriaT3 tumorwithinvasionthroughmuscularispropriaintosubserosaT4 tumorwithdirectinvasionofotherorgansorstructures 十二指肠癌T分期 MRI表现 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 十二指肠癌 病例1179363 F 43上腹胀痛 黄疸 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 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 胰头癌男 61岁 200333钩突增大 边缘隆起肿瘤T1WI信号减低肿瘤DW