胰腺囊性病变的影像诊断课件.ppt

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1、CYSTICLEISIONSOFPANCREASPHD.MD.ZHENSHENMATHEIMAGINGDEPARTMENTOFSHANDONGPROVENCEQIANFOSHANHOSPITALIntroductionClassificationSystematicApproachMRIversusCTSmallpancreaticcystsHowtoreportManagementPseudocystCysticNeoplasmsAgeandgenderSerouscysticneoplasmMucinousCysticNeoplasmaIntraductalPapilla

2、ryMucinousNeoplasmMain-ductIPMNBranch-ductIPMNUncommonNeoplasmswithspecificfindingsSolidPseudopapillaryNeoplasmNeuroendocrinetumorwithcysticdegenerationClassificationPancreaticcystscanbecategorizedintothefollowinggroups:PseudocystsCommoncysticneoplasms:IPMN-intraductalpapillarymucinousneopl

3、asmSCN-SerouscysticneoplasmMCN-MucinouscysticneoplasmUncommoncysticneoplasms:SPEN(solidpseudopapillaryepithelialneoplasm)Tumorswithcysticdegeneration:adenocarcinoma-neuroendocrinetumorSystematicApproachWhenacysticpancreaticlesionisdetected,thefirststepistodecidewhetherthelesionismostlikelya

4、pseudocystoracysticneoplasm.Thisschemeisasimplifiedroadmapforthedifferentiationofpancreaticcysts.Pseudocyst–Thinkpseudocystwhenthereisahistoryofpancreatitis,alcoholabuse,stonediseaseorabdominaltraumaandthelesionisunilocularorcontainsnon-enhancingdependentdebris.Cysticneoplasm-Thinkoftheposs

5、ibilityofacysticneoplasm,whenthereisnohistoryofpancreatitisortrauma,orwhenthecysthasinternalsepta,asolidcomponent,centralscarorwallcalcification.Mucinouscysticneoplasm-Thisisusuallyaunilocularcystfilledwithmucinsometimeswithwallcalcification,exclusivelyseeninwomen.Serouscysticneoplasm-Thisi

6、samicrocysticlesion,thatconaintsserousfluidwithsometimesacharacteristicscarwhichmaycalcify.Itcanlooklikeabranch-ductIPMN,butSCNhasnocommunicationwiththepancreaticduct.Thetypicalappearancemakesaspecificdiagnosispossible,whichisimportant,becauseSCNistheonlytumorthatisnotpremalignant.Branch-du

7、ctIPMN–ThistumorcanlooklikeaSCN,buthasnoscarorcalcifications.MRCPorheavilyweigtedT2WImayshowtheconnectiontothepancreaticduct,whichishighlyspecific.TheleftCT-imageisofapatientwithahistoryofpancreatitis.Therearetwounilocularorsimplecysts.Noticealsotheretro