新自身免疫性胰腺炎的影像诊断进展资料.ppt

自身免疫性胰腺炎的影像学表现;概 况;诊断标准进展;AIP有两个类型;;I-AIP;I-AIP病理学特征;Ⅱ一AIP;临床表现;主要内容;AIP病变形态、累及部位、范围;弥漫性;累及胰腺体尾部;累及胰腺尾部;多发病灶，累及胰腺颈部及尾部;多发病灶;;;;AIP信号;;;动态增强;;;;DWI;男，43岁，上腹部疼痛入院;男，43岁，上腹部疼痛入院;DWI （ b= 600× 10 ? 3 mm 2 / s） 示弥漫性高信号，与胰腺长轴一致;弥漫性AIP;;MRCP显示病变区胰管节段性变细、狭窄（细箭）。胆总管胰腺段狭窄（弯箭），其以上胆总管及肝内胆管轻度扩张;;Figure 2 A 53-year-old man with f-AIP at the pancreatic tail;;多发病灶MRCP 节段性狭窄;多发病灶MRCP 节段性狭窄;假包膜征象;;刘才根，男，77岁 AIP,胰腺尾部假包膜;胰腺外器官受累的表现;;AIP激素治疗前后MRI表现的比较;AIP与胰腺癌鉴别;;;;;;穆增翠，女，54岁; 图4 胰体部腺癌DWI（Siemens 1.5T Avanto磁共振仪）。A、为b=100× 10 ? 3 mm 2 / s的DWI，胰腺癌呈局限性高信号（弯箭），胰腺尾部萎缩，信号轻度增高（箭），低于胰腺癌，在b值为600× 10 ? 3 mm 2 / s的DWI（B），两者信号差别更显著。C为ADC图。; 弥漫性AIP 的DWI（GE 3.0T HDXT磁共振仪）。A、为b=100× 10 ? 3 mm 2 / s时的DWI，受累的胰腺稍高信号（箭）；B、高b值（600× 10 ? 3 mm 2 / s）DWI，AIP病变区呈弥漫性高信号，与胰腺长轴一致（箭）。C为ADC图。 ;;;; 图4 胰体部腺癌DWI（Siemens 1.5T Avanto磁共振仪）。A、为b=100× 10 ? 3 mm 2 / s的DWI，胰腺癌呈局限性高信号（弯箭），胰腺尾部萎缩，信号轻度增高（箭），低于胰腺癌，在b值为600× 10 ? 3 mm 2 / s的DWI（B），两者信号差别更显著。C为ADC图。;;ROC表明，AIP与胰腺癌鉴别的最佳ADC值的界值为1.068× 10?3 s/mm2，诊断的敏感性和特异性均为83.3%，曲线下面积为0.896;局限性AIP;Figure 4. A 58-year-old man with f-AIP at the pancreatic body and tail. A-C: CE CT images obtained during the atery phase showing that the spleen atery was surrounded by the enlarged pancreatic body and tail but without any signs of being invaded.;局限性AIP与血管关系;Figure 1. A 59-year-old man with f-AIP at the pancreatic tail. A: pre-contrast axial computered tomography image shows the “sausage-like” -swollen pancreatic tail. B: Aixal contrast-enhanced computed tomograpy (CE CT) image obtained during the atery phase showing the heterogeneous good-enhanced of the “sausage-like” pancreatic tail, a hypeoattenuating capusule-like rim can be observed around the pancreatic tail, which manifested delayed enhancement during the delayed phases (C, D). ;Figure 2. A 53-year-old man with f-AIP at the pancreatic tail. A-D: The lesion showed heterogenous T1WI hypointensity and heterogenous T2WI hyperintensity, which was delayed enhanced. The capsule-like rim appearing as a T1WI iso- or slight hyperin