胰胆管十指肠连接区肿瘤MRI诊疗

胰胆管十二指肠连接区肿瘤MRI诊疗胰胆管十指肠连接区肿瘤MRI诊疗第1页胰胆管十二指肠连接区(PancreaticobiliaryDuctalandDuodenalUnion,PDDU)又称壶腹部(ampullaregion)，发生于该区域肿瘤称壶腹周围肿瘤(Periampullarytumor)系十二指肠乳头区2cm左右区域，包含胆总管下段、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，判别诊疗困难胰胆管十指肠连接区肿瘤MRI诊疗第2页胰胆管十指肠连接区肿瘤MRI诊疗第3页胰胆管开口方式胰胆管十指肠连接区肿瘤MRI诊疗第4页壶腹周围肿瘤（Periampullarytumor）发生于十二指肠乳头及其周围2CM范围内肿瘤胰头癌（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:按发生部位分类胰胆管十指肠连接区肿瘤MRI诊疗第5页壶腹周围肿瘤:按发生部位分类胰头癌壶腹癌胆总管下段癌十二指肠癌胰胆管十指肠连接区肿瘤MRI诊疗第6页大致病理与MRI对照胰胆管十指肠连接区肿瘤MRI诊疗第7页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.胰胆管十指肠连接区肿瘤MRI诊疗第8页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;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)胰胆管十指肠连接区肿瘤MRI诊疗第9页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;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-影像对照胰胆管十指肠连接区肿瘤MRI诊疗第10页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;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-影像对照胰胆管十指肠连接区肿瘤MRI诊疗第11页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;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-影像对照胰胆管十指肠连接区肿瘤MRI诊疗第12页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.PeriampullaryduodenalcancerwithoutinvasionintoampullaryregionObliquehigh-spatial-resolutionT2-weightedMRimage(4,000/85)showstumor(arrowheads)Arrowshowsmarkerforlocationoftumor壶腹周围十二指肠癌:病理-影像对照胰胆管十指肠连接区肿瘤MRI诊疗第13页TNM分期:图示T分期胰胆管十指肠连接区肿瘤MRI诊疗第14页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.壶腹癌T分期AmpullarycancerT1indicatestumorlimitedtoOddimuscleT2,tumorwithinvasionofduodenalwallT3,tumorwithinvasionofpancreas胰胆管十指肠连接区肿瘤MRI诊疗第15页壶腹癌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2cmT4:肿瘤侵犯胰腺超出2cm,或侵犯邻近其它器官胰胆管十指肠连接区肿瘤MRI诊疗第16页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.ExtrahepaticbileductcancerT1indicatestumorconfinedtobileductT2,tumorwithinvasionbeyondwallofbileductT3,tumorwithinvasionofpancreasT4,tumorwithinvasionofduodenumoradjacentorgans肝外胆管癌T分期胰胆管十指肠连接区肿瘤MRI诊疗第17页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.PancreaticcancerT1indicatestumor(≤2cmingreatestdimension)limitedtopancreasT2,tumor(＞2cmingreatestdimension)limitedtopancreasT3,tumorwithextensionbeyondpancreas胰腺癌T分期胰胆管十指肠连接区肿瘤MRI诊疗第18页ReijiSugita,AkemiFuruta,KeiIto,etal.PeriampullaryTumors:High-Spatial-ResolutionMRImagingandHistopathologicFindingsinAmpullaryRegionSpecimns.Radiology;231:767-774.DuodenalcancerT1indicatestumorwithinvasionoflaminapropriaorsubmucosaT2,tumorwithinvasionofmuscularispropriaT3,tumorwithinvasionthroughmuscularispropriaintosubserosaT4,tumorwithdirectinvasionofotherorgansorstructures十二指肠癌T分期胰胆管十指肠连接区肿瘤MRI诊疗第19页MRI表现胰胆管十指肠连接区肿瘤MRI诊疗第20页壶腹癌男,57岁,188408胆道低位梗阻胆总管下端壁增厚、强化壶腹癌胰胆管十指肠连接区肿瘤MRI诊疗第21页十二指肠癌:

病例1

179363,F,43上腹胀痛,黄疸胰胆管十指肠连接区肿瘤MRI诊疗第22页十二指肠癌男,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扩张胆总管胰胆管十指肠连接区肿瘤MRI诊疗第23页胰头癌男,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胰胆管十指肠连接区肿瘤MRI诊疗第24页胰头癌男,61岁,33钩突增大,边缘隆起肿瘤T1WI信号减低肿瘤DWI信号增高胰头癌:

病例2胰胆管十指肠连接区肿瘤MRI诊疗第25页胰头癌:

病例3178964,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胰胆管十指肠连接区肿瘤MRI诊疗第26页胆总管下段癌男,57岁,188408胆总管扩张,