10.胰腺病变的MRI信号分析与诊断思路

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1、2016/4/23胰腺肿瘤的分类ExocrineneoplasmsSerouscysticneoplasmsMicrocystic/MacrocysticVHL-associatedserouscysticneoplasmSerouscystadenocarcinoma外分泌腺肿瘤内分泌腺肿瘤上皮样肿瘤1-2%PANCREATICNEOPLASMMucinouscysticneoplasmslow-gradetocarcinoma•粘液性囊腺瘤•良性•胰腺母细胞1-2%Intraductalpapillarymu

2、cinousneoplasms-癌•潜在恶性瘤3-5%Ductaldladenocarc•浆液性囊腺iinoma•低度恶性•实性假乳头85%DIAGOSGNOSEDBYMRICarcinosarcoma瘤-癌•高度恶性状瘤•胰腺导管内Acinarcellneoplasms1-2%乳头状瘤Endocrineneoplasms1-2%北京大学人民医院放射科•导管腺癌Epithelialneoplasmswithmultipledirectionsofdifferentiation<1%•腺泡样肿瘤王屹Epitheli

3、alneoplasmsofuncertaindirectionofdifferentiation1-2%Miscellaneousepithelialneoplasms神经内分泌胰腺肿瘤的分类实淋巴瘤IgG4相关疾病肿瘤肿块型胰腺炎NeoplasticlesionsSolidlesions转移瘤Ductaladenocarcinoma85%导管腺癌Endocrineneoplasm实性肿瘤囊性肿瘤肿瘤样病变1-2%Acinarcellcarcinoma1-2%Pancreatoblastoma•粘液性囊腺瘤<1%

4、Solid-pseudopapillaryneoplasm•导管腺癌•慢性胰腺炎1-2%IPMNCysticlesions•内分泌肿瘤•浆液性囊腺瘤假性囊肿形恶恶良浆/粘液性实性假乳头状假性囊肿良Mucinouscysticneoplasm•腺泡细胞癌•胰腺导管内乳成1-2%囊腺癌肿瘤Serouscystadenoma•胰腺母细胞瘤头状瘤•粘液性非肿1-2%Intraductalpapillarymucinousneoplasm•实性假乳头状瘤样囊肿3-5%Non-Neoplasticlesions肿瘤交界性IP

5、MNIPMNPancreatitis浆/粘液性浆/粘液性囊Mucinousnon-neoplasticcyst囊腺瘤囊腺瘤MRI检查方法PancreaticDuctualAdenocarcinoma•FSET2WI+Fatsuppression20–25sT2稍高信号•FSPRET1WI+Fatsaturation20-25sT1低信号•DWIb=50,1000;b=0,800强化程度低•LAVA3Ddynamiccontrast-enhancedimages4-6s于周围胰腺•MRCP2s强化程度低于周围胰腺1

6、2016/4/23PancreaticDuctualAdenocarcinomaPancreaticDuctualAdenocarcinoma•间接征象：阻塞胰管、胆管T2稍高信号•胰腺萎缩，胰管扩张，可合并炎症、假囊肿•胆总管梗阻，近端扩张T1低信号•脂肪间隙消失、包绕血管、血管变细、血管阻塞、癌栓强化程度低于周围胰腺强化程度低于周围胰腺PancreaticDuctualAdenocarcinomaDWI：PancreaticDuctalAdenocarcinomaSen%Spe%T2稍高信号MRI75-100

7、81-92T1低信号•MRI影像诊断PC的准确性可以达到98%；•得益于成像方法的强化程度低进步于周围胰腺•诊断难点：•体积小，不易发现强化程度低于周围胰腺神经内分泌实淋巴瘤IgG4相关疾病肿瘤肿块型胰腺炎PancreaticDuctualAdenocarcinoma转移瘤Sen%Spe%导管腺癌T2稍高信号MRI75-10081-92T1低信号•MRI影像诊断PC的准确性可以达到98%；恶恶良良•得益于成像方法的进步强化程度低于周围胰腺•鉴别点：•体积小•肿块型胰腺炎囊强化程度低•IgG4相关疾病于周围胰腺22

8、016/4/23PancreaticDuctualAdenocarcinomaIgG4相关肿块型胰腺炎&胰腺癌Desmoplasticresponse促纤维化反应胰腺癌低密度/信号肿块或结节强化程度始终低于周围胰腺实质肿块型胰腺炎ADC值高于肿块型胰腺炎IgG4相关疾病的诊断Sirrhous硬化Hypovascular乏血供Mass-formingPancreatitis