培训课件-慢性胰腺炎及并发症.ppt

Chronic Pancreatitis VS. Pancreatic Carcinoma Differentiating between an inflammatory mass due to chronic pancreatitis and pancreatic carcinoma on the basis of imaging criteria remains difficult. Decreased T1 signal intensity with delayed enhancement after gadolinium administration as well as dilatation and obstruction of the pancreaticobiliary ducts can be seen in both diseases . Irregularity of the pancreatic duct, intraductal or parenchymal calcifications, diffuse pancreatic involvement, and normal or smoothly stenotic pancreatic duct penetrating through the mass “duct penetrating sign” favor the diagnosis of chronic pancreatitis over cancer Fig. 16A, 16B, 16C . In distinction, a smoothly dilated pancreatic duct with an abrupt interruption, dilatation of both biliary and pancreatic ducts “double-duct sign” , and obliteration of the perivascular fat planes favor the diagnosis of cancer. 鉴别慢性胰腺炎引发的炎性包块和胰腺肿瘤，从影像学上尚属困难。两者均可出现延迟强化和胰胆管的阻塞扩张。不规则的胰管，胰管内或实质内钙化，弥漫性胰腺受累，光滑狭窄的胰管从肿块内穿过（“穿透症”）更支持慢性胰腺炎的诊断（图16A，16B ，16C）。相反的，平滑扩张的胰管突然中断，胆管和胰管同时扩张（“双管征”），以及血管周围脂肪间隙消失则支持肿瘤的诊断。 Fig. 16A. —58-year-old woman with breast cancer and chronic pancreatitis related to alcohol abuse. Patient had 50-lb 23-kg weight loss. ERCP image not shown revealed stone in pancreatic duct, which was removed. Fine-needle aspiration was suggestive of adenocarcinoma. Whipple procedure indicated chronic pancreatitis without cancer. Axial T1 fat-suppressed spoiled gradient-echo image shows low-signal-intensity pancreas due to chronic pancreatitis.Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during arterial phase shows diffusely decreased enhancement of pancreas due to chronic pancreatitis. Note dilated pancreatic duct. 图16A。 58岁，女，乳腺癌、酗酒相关的慢性胰腺炎。发病以来体重下降23kg。 ERCP图像（图中未示出）显示胰管石并去除。细针穿刺提示腺癌。胰十二指肠切除术提示慢性胰腺炎无癌变。轴向T1WI显示因慢性胰腺炎而呈低信号的胰腺。 动脉期增强T1WI示胰腺弥漫性强化减低。注意胰管扩张。 Fig. 16A.B. Fig. 16C. Axial T2-weighted HASTE image shows markedly dilated main pancreatic duct arrow penetr