胰腺囊性病变的影像诊断教材教学课件.pptx

CYSTIC LEISIONS OF PANCREASPHD. MD. ZHENSHEN MATHE IMAGING DEPARTMENT OF SHANDONG PROVENCE QIANFOSHAN HOSPITAL IntroductionClassification Systematic ApproachMRI versus CT Small pancreatic cystsHow to reportManagement Pseudocyst Cystic Neoplasms Age and gender Serous cystic neoplasm Mucinous Cystic Neoplasma Intraductal Papillary Mucinous Neoplasm Main-duct IPMN Branch-duct IPMN Uncommon Neoplasms with specific findings Solid Pseudopapillary Neoplasm Neuroendocrine tumor with cystic degenerationClassificationPancreatic cysts can be categorized into the following groups:PseudocystsCommon cystic neoplasms:IPMN - intraductal papillary mucinous neoplasmSCN - Serous cystic neoplasmMCN - Mucinous cystic neoplasmUncommon cystic neoplasms:SPEN (solid pseudopapillary epithelial neoplasm)Tumors with cystic degeneration: adenocarcinoma - neuroendocrine tumorSystematic ApproachWhen a cystic pancreatic lesion is detected, the first step is to decide whether the lesion is most likely a pseudocyst or a cystic neoplasm.This scheme is a simplified roadmap for the differentiation of pancreatic cysts.Pseudocyst – Think pseudocyst when there is a history of pancreatitis, alcohol abuse, stone disease or abdominal trauma and the lesion is unilocular or contains non-enhancing dependent debris.Cystic neoplasm- Think of the possibility of a cystic neoplasm, when there is no history of pancreatitis or trauma, or when the cyst has internal septa, a solid component, central scar or wall calcification.Mucinous cystic neoplasm - This is usually a unilocular cyst filled with mucin sometimes with wall calcification, exclusively seen in women.SCN with central scar seen on MRIMRI versus CTCT will depict most pancreatic lesions, but is sometimes unable to depict the cystic component. MR with heavily weighted T2WI and MRCP will better demonstrate the cystic nature and the internal structure of the cyst and has the advantage of demonstrating the relationship of the cyst to the pancreatic duct as is see