胰膽管十二指腸連接區(qū)腫瘤mri診斷

1、胰膽管十二指腸連接區(qū)腫瘤MRI診斷,胰膽管十二指腸連接區(qū)(Pancreaticobiliary Ductal and Duodenal Union, PDDU)又稱壺腹部(ampulla region)，發(fā)生于該區(qū)域的腫瘤稱壺腹周圍腫瘤(Periampullary tumor)系十二指腸乳頭區(qū)2cm 左右區(qū)域，包括膽總管下段、肝胰壺腹、胰頭部、十二指腸乳頭區(qū)等解剖結(jié)構(gòu)細(xì)微、毗鄰關(guān)系復(fù)雜，病變癥狀缺乏特征性，鑒別診斷困難,胰膽管開(kāi)口方

2、式,壺腹周圍腫瘤（Periampullary tumor）發(fā)生于十二指腸乳頭及其周圍2CM范圍內(nèi)的腫瘤胰頭癌（pancreatic head cancer）膽總管下段癌（lower common bile duct cancer）壺腹癌（ampullary cancer）壺腹周圍十二指腸癌（periampullary duodenal cancer）壺腹周圍癌發(fā)病率位列胃腸道腫瘤第三，僅次于胃癌和結(jié)直腸癌,壺腹周圍腫瘤: 按

3、發(fā)生部位分類,壺腹周圍腫瘤: 按發(fā)生部位分類,胰頭癌,壺腹癌,膽總管下段癌,十二指腸癌,大體病理與MRI對(duì)照,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radio

4、logy 2004; 231:767-774.,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,壺腹區(qū)正常結(jié)構(gòu)

5、:病理-影像對(duì)照,duodenal wall with four layers: mucosa (m)submucosa (sm)muscularis propria (pm) subserosa or serosa (ss),Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging an

6、d Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Ampullary tumor with invasion of pancreasOblique high-spatial resolutionT1- (500/20) and T2-weighted (4,000/85) MR imagesshow tumor

7、 (white arrowheads) with invasion ofduodenal muscularis propria and pancreas. Tumor interrupts duodenal muscularis propria (black arrowhead) and infiltrates pancreas (arrows),壺腹癌侵犯胰腺:病理-影像對(duì)照,Reiji Sugita, Akemi Furuta,

8、Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Pancreatic cancer with invasion into ampullary regionObliq

9、ue high-spatial-resolution T2-weightedMR images (4,000/85). Pancreatic tumor (P) extends across muscularis propria (arrowheads and broken line) and infiltraes ampullary region (arrow) and surrounding duodenal wallTumor

10、 (arrows) largely involves pancreas and compresses duodenal wall outward,胰腺癌侵犯壺腹區(qū):病理-影像對(duì)照,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings

11、in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Distal common bile duct cancer with invasion into ampullary regionOblique high-spatial-resolution T2-weighted MR image (4,000/85) shows tumor invasion (arrowh

12、eads)of pancreas (P),膽總管下段癌侵犯壺腹區(qū):病理-影像對(duì)照,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 23

13、1:767-774.,Periampullary duodenal cancer without invasion into ampullary regionOblique high-spatial-resolution T2-weighted MR image (4,000/85) shows tumor (arrowheads)Arrow shows marker for location of tumor,壺腹周圍十二指腸

14、癌:病理-影像對(duì)照,TNM分期:圖示T分期,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,壺腹癌T分期,Am

15、pullary cancerT1 indicates tumor limited to Oddi muscle T2, tumor with invasion of duodenal wallT3, tumor with invasion of pancreas,壺腹癌T分期,T1: 腫瘤局限于壺腹內(nèi)T2: 腫瘤蔓延至十二指腸壁T3: 腫瘤侵犯胰腺不超過(guò)2cmT4: 腫瘤侵犯胰腺超過(guò)2cm, 或侵犯鄰近其它器官,Reiji

16、Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Extrahepatic bile duct cancerT1 indi

17、cates tumor confined to bile ductT2, tumor with invasion beyond wall of bile ductT3, tumor with invasion of pancreasT4, tumor with invasion of duodenum or adjacent organs,肝外膽管癌T分期,Reiji Sugita, Akemi Furuta, Kei Ito,

18、et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Pancreatic cancerT1 indicates tumor (≤2 cm in greatest dimension) l

19、imited to pancreasT2, tumor (＞2 cm in greatest dimension) limited to pancreasT3, tumor with extension beyond pancreas,胰腺癌T分期,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR

20、Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Duodenal cancerT1 indicates tumor with invasion of lamina propria or submucosaT2, tumor with invasion of muscularis propri

21、aT3, tumor with invasion through muscularis propria into subserosaT4, tumor with direct invasion of other organs or structures,十二指腸癌T分期,MRI表現(xiàn),壺腹癌男,57歲,188408膽道低位梗阻膽總管下端壁增厚、強(qiáng)化,壺腹癌,,,,,十二指腸癌: 病例1

22、 179363,F,43 上腹脹痛,黃疸,十二指腸癌男,54歲,192802十二指腸乳頭區(qū)腫塊呈半球形,表面見(jiàn)糜爛區(qū)膽總管擴(kuò)張,十二指腸癌: 病例2,擴(kuò)張膽總管,胰頭癌男,70歲,197096胰頭腫瘤T1WI呈低信號(hào)膽總管、主胰管擴(kuò)張膽總管下段狹窄,胰頭癌: 病例1,,胰頭癌男,61歲,200333鉤突增大,邊緣隆起腫瘤T1WI信號(hào)減低腫瘤DWI信號(hào)增高,胰頭癌: 病例2,

23、,,,胰頭癌: 病例3,178964,F,54膽道低位重度梗阻胰頭近十二指腸區(qū)腫塊相對(duì)乏血供,,膽總管下段癌男,57歲,188408膽總管擴(kuò)張,下段壁增厚、強(qiáng)化,膽總管下段癌:病例1,,膽總管下段癌:病例2,,F,38 膽總管囊腫,膽總管下段癌:病例2,F,38 膽總管囊腫,膽總管下段癌:病例2,F,38 膽總管囊腫,膽總管下段癌:病例3,306510,M,62膽道低位重度梗阻膽總管下段充填軟組織腫塊,后者強(qiáng)化顯著主胰管未