胰胆管十指肠连接区肿瘤MRI诊疗

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,胰胆管十二指肠连接区肿瘤,MRI,诊疗,胰胆管十二指肠连接区,(,Pancreaticobiliary Ductal and Duodenal Union,PDDU,),又称,壶腹部,(,ampulla region)，,发生于该区域旳肿瘤称,壶腹周围肿瘤,(,Periampullary tumor,),系十二指肠乳头区,2,cm,左右区域，涉及胆总管下段、肝胰壶腹、胰头部、十二指肠乳头区等,解剖构造细微、毗邻关系复杂，病变症状缺乏特征性，鉴别诊疗困难,胰胆管开口方式,壶腹周围肿瘤（,Periampullary tumor,）,发生于十二指肠乳头及其周围,2,CM,范围内旳肿瘤,胰头癌（,pancreatic head cancer,）,胆总管下段癌（,lower common bile duct cancer,）,壶腹癌（,ampullary cancer,）,壶腹周围十二指肠癌（,periampullary duodenal cancer,）,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,大致病理与,MRI,对照,Reiji Sugita,Akemi Furuta,Kei Ito,et al.Periampullary Tumors:High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;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 2023;231:767-774.,壶腹区正常构造:病理-影像对照,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 and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Ampullary tumor with invasion of pancreas,Oblique high-spatial resolution,T1-(500/20)and T2-weighted(4,000/85)MR images,show tumor(white arrowheads)with invasion of,duodenal muscularis propria and pancreas.Tumor interrupts duodenal muscularis propria(black arrowhead)and infiltrates pancreas(arrows),壶腹癌侵犯胰腺:病理-影像对照,Reiji Sugita,Akemi Furuta,Kei Ito,et al.Periampullary Tumors:High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Pancreatic cancer with invasion into ampullary region,Oblique high-spatial-resolution T2-weighted,MR images(4,000/85).Pancreatic tumor,(P),extends across muscularis propria(arrowheads and broken line)and infiltraes ampullary region(arrow)and surrounding duodenal wall,Tumor(arrows)largely involves pancreas and compresses duodenal wall outward,胰腺癌侵犯壶腹区:病理-影像对照,Reiji Sugita,Akemi Furuta,Kei Ito,et al.Periampullary Tumors:High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Distal common bile duct cancer with invasion into ampullary region,Oblique high-spatial-resolution T2-,weighted MR image(4,000/85)shows tumor invasion(arrowheads),of pancreas,(P),胆总管下段癌侵犯壶腹区:病理-影像对照,Reiji Sugita,Akemi Furuta,Kei Ito,et al.Periampullary Tumors:High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Periampullary duodenal cancer without invasion into ampullary region,Oblique high-spatial-resolution T2-,weighted MR image(4,000/85)shows tumor(arrowheads),Arrow shows marker for location of tumor,壶腹周围十二指肠癌:病理-影像对照,TNM,分期:图示,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 2023;231:767-774.,壶腹癌,T,分期,Ampullary cancer,T1 indicates tumor limited to Oddi muscle,T2,tumor with invasion of duodenal wall,T3,tumor with invasion of pancreas,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,:,肿瘤侵犯胰腺不超出,2,cm,T4:,肿瘤侵犯胰腺超出,2,cm,或侵犯邻近其他器官,Reiji Sugita,Akemi Furuta,Kei Ito,et al.Periampullary Tumors:High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Extrahepatic bile duct cancer,T1 indicates tumor confined to bile duct,T2,tumor with invasion beyond wall of bile duct,T3,tumor with invasion of pancreas,T4,tumor with invasion of duodenum or adjacent organs,肝外胆管癌,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 2023;231:767-774.,Pancreatic cancer,T1 indicates tumor(,2 cm in greatest dimension)limited to pancreas,T2,tumor(,2 cm in greatest dimension)limited to pancreas,T3,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 Imaging and Histopathologic Findings in Ampullary Region Specimns.Radiology 2023;231:767-774.,Duodenal cancer,T1 indicates tumor with invasion of lamina propria or submucosa,T2,tumor with invasion of muscularis propria,T3,tumor with invasion through muscularis propria into subserosa,T4,tumor with direct invasion of other organs or structures,十二指肠癌,T,分期,MRI,体现,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1,179363,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,202333,钩突增大,边沿隆起,肿瘤,T1WI,信号减低,肿瘤,DWI,信号增高,胰头癌,:,病例2,胰头癌,:,病例3,178964,F,54,胆道低位重度梗阻,胰头近十二指肠区肿块相对乏血供,胆总管下段癌,男,57岁,188408,胆总管扩张,下段壁增厚、强化,胆总管下段癌,:病例1,胆总管下段癌:病例2,F,38,胆总管囊肿,胆总管下段癌:病例2,F,38,胆总管囊肿,胆总管下段癌:病例2,F,38,胆总管囊肿,胆总管下段癌:病例3,306510,M,62,胆道低位重度梗阻,胆总管下段充填软组织肿块,后者强化明显,主胰管未扩张,