1、胰膽管十二指腸連接區(qū)腫瘤MRI診斷,胰膽管十二指腸連接區(qū)(Pancreaticobiliary Ductal and Duodenal Union, PDDU)又稱壺腹部(ampulla region)，發(fā)生于該區(qū)域的腫瘤稱壺腹周圍腫瘤(Periampullary tumor) 系十二指腸乳頭區(qū)2cm 左右區(qū)域，包括膽總管下段、肝胰壺腹、胰頭部、十二指腸乳頭區(qū)等 解剖結(jié)構(gòu)細(xì)微、毗鄰關(guān)系復(fù)雜，病變癥狀缺乏特征性，鑒別診斷困難,胰膽管開口方式,壺腹周圍腫瘤（Periampullary tumor） 發(fā)生于十二指腸乳頭及其周圍2CM范圍內(nèi)的腫瘤 胰頭癌（pancreatic head cancer）

2、 膽總管下段癌（lower common bile duct cancer） 壺腹癌（ampullary cancer） 壺腹周圍十二指腸癌（periampullary duodenal cancer） 壺腹周圍癌發(fā)病率位列胃腸道腫瘤第三，僅次于胃癌和結(jié)直腸癌,壺腹周圍腫瘤: 按發(fā)生部位分類,壺腹周圍腫瘤: 按發(fā)生部位分類,胰頭癌,壺腹癌,膽總管下段癌,十二指腸癌,大體病理與MRI對(duì)照,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and

3、Histopathologic 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.,壺腹區(qū)正常結(jié)構(gòu):病理-影像對(duì)照,duodenal wa

4、ll 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 2004; 231:767-774.,Ampullary tumor

5、 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),壺腹癌侵犯

6、胰腺:病理-影像對(duì)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.,Pancreatic cancer with invasion into ampullary region Oblique high-spatial-resolution T2-weighted MR

7、 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,胰腺癌侵犯壺腹區(qū):病理-影像對(duì)照,Reiji Sugita, Akemi Furuta, Kei

8、 Ito, et al. Periampullary 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 region Oblique high-spatial-resolution T2- weighted MR image (4,000/85) shows tumo

9、r invasion (arrowheads) of pancreas (P),膽總管下段癌侵犯壺腹區(qū):病理-影像對(duì)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

10、 ampullary region Oblique high-spatial-resolution T2- weighted MR image (4,000/85) shows tumor (arrowheads) Arrow shows marker for location of tumor,壺腹周圍十二指腸癌:病理-影像對(duì)照,TNM分期:圖示T分期,Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic

11、Findings in Ampullary Region Specimns. Radiology 2004; 231:767-774.,壺腹癌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,壺腹癌T分期,T1: 腫瘤局限于壺腹內(nèi) T2: 腫瘤蔓延至十二指腸壁 T3: 腫瘤侵犯胰腺不超過2cm T4: 腫瘤侵犯胰腺超過2cm, 或侵犯鄰近其它器官,Reiji Sugi

12、ta, 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.,Extrahepatic bile duct cancer T1 indicates tumor confined to bile duct T2, tumor with invasion beyond wall of bile duct T

13、3, tumor with invasion of pancreas T4, tumor with invasion of duodenum or adjacent organs,肝外膽管癌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 c

14、ancer 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 Histopathologi

15、c Findings in Ampullary Region Specimns. Radiology 2004; 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,十二指腸癌T分期,MRI表現(xiàn),壺腹癌 男,57歲,188408 膽道低位梗阻 膽總管下端壁增厚、強(qiáng)化,壺腹癌,十二指腸癌: 病例1 179363,F,43 上腹脹痛,黃疸,十二指腸癌 男,54歲,192802 十二指腸乳頭區(qū)腫塊呈半球形,表面見糜爛區(qū) 膽總管擴(kuò)張,十二指腸癌: 病例2,擴(kuò)張膽總管,胰頭癌 男,70歲,197096 胰頭腫瘤T1WI呈低信號(hào) 膽總管、主胰管擴(kuò)張 膽總管下段狹窄,胰頭癌: 病例1,胰頭癌 男,61歲,200333 鉤突增大,邊緣隆起 腫