胰腺囊性病变影像诊断.pptVIP

CYSTIC LEISIONS OF PANCREAS PHD. MD. ZHENSHEN MA THE IMAGING DEPARTMENT OF SHANDONG PROVENCE QIANFOSHAN HOSPITAL Introduction Classification Systematic Approach MRI versus CT Small pancreatic cysts How to report Management 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 degeneration Classification Pancreatic cysts can be categorized into the following groups: Pseudocysts Common cystic neoplasms: IPMN - intraductal papillary mucinous neoplasm SCN - Serous cystic neoplasm MCN - Mucinous cystic neoplasm Uncommon cystic neoplasms: SPEN (solid pseudopapillary epithelial neoplasm) Tumors with cystic degeneration: adenocarcinoma - neuroendocrine tumor Systematic Approach When 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. Serous cystic neoplasm - This is a microcystic lesion, that conaints serous fluid with sometimes a characteristic scar which may calcify. It can look like a branch-duct IPMN, but SCN has no communication with the pancreatic duct. The typical appearance makes a specific diagnosis possible, which is important, be