胰腺囊性病变的影像诊断.pptx

胰腺囊性病变的影像诊断第1页/共70页 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 degeneration第2页/共70页 ClassificationPancreatic 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 tumor第3页/共70页 第4页/共70页 Systematic 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.第5页/共70页 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.第6页/共70页 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.第7页/共70页 Mucinous cystic neoplasm - This is usually a unilocular cyst filled with mucin sometimes with wall calcification, exclusively seen in women.第8页/共70页 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, because SCN is the only tumor that is not premalignant.第9页/共70页 Branch-duct IPM