1、胰胆管十二指肠连接区肿瘤MRI诊断,胰胆管十二指肠连接区(Pancreaticobiliary Ductal and Duodenal Union, PDDU)又称壶腹部(ampulla region)，发生于该区域的肿瘤称壶腹周围肿瘤(Periampullary tumor)系十二指肠乳头区2cm 左右区域，包括胆总管下段、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，鉴别诊断困难,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2CM范围内的肿瘤胰头癌（pancreatic head cancer）胆总管下
2、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,大体病理与MRI对照,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopat
3、hologic Findings in Ampullary Region Specimns. Radiology 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.,壶腹区正常结构:病理-影像对照,duodenal wall with
4、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 2004; 231:767-774.,Ampullary tumor with inva
5、sion of pancreasOblique high-spatial resolutionT1- (500/20) and T2-weighted (4,000/85) MR imagesshow tumor (white arrowheads) with invasion ofduodenal 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,Rei
6、ji 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.,Pancreatic cancer with invasion into ampullary regionOblique high-spatial-resolution T2-weightedMR images (4,000/8
7、5). Pancreatic tumor (P) extends across muscularis propria (arrowheads and broken line) and infiltraes ampullary region (arrow) and surrounding duodenal wallTumor (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. Peri
8、ampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings 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 (arrowhe
9、ads)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 2004; 231:767-774.,Periampullary duodenal cancer without invasion into ampullary regionObl
10、ique 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 R
11、egion Specimns. Radiology 2004; 231:767-774.,壶腹癌T分期,Ampullary cancerT1 indicates tumor limited to Oddi muscle T2, tumor with invasion of duodenal wallT3, 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: 肿瘤侵犯胰腺不超过2cmT4: 肿瘤侵犯胰腺超过2cm, 或侵犯邻近其它器官,Reiji Sugita, Akemi Furuta, Kei Ito, e
12、t al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,Extrahepatic bile duct cancerT1 indicates tumor confined to bile ductT2, tumor with invasion beyond wall of bile ductT3, tumor with invasion of pancr
13、easT4, 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 2004; 231:767-774.,Pancreatic cancerT1 indicates tumor (2 cm in
14、 greatest dimension) limited 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 Imaging and Histopathologic Findings in Ampullary Region Spec
15、imns. Radiology 2004; 231:767-774.,Duodenal cancerT1 indicates tumor with invasion of lamina propria or submucosaT2, tumor with invasion of muscularis propriaT3, tumor with invasion through muscularis propria into subserosaT4, tumor with direct invasion of other organs or structures,十二指肠癌T分期,MRI表现,壶
16、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,200333钩突增大,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,后者强化显著主胰管未扩张,谢谢！,
