消化系统-医学影像学.ppt

Fig. 13.15a–d. Poorly differentiated hepatocellular carcinoma. The lesion appears hypointense on T1-weighted images (a) and hyperintense on T2-weighted images (b), showing a clear-cut enhancement in the arterial phase (c) and wash-out in the portal venous phase (d) on dynamic study Fig. a–d. Well-differentiated hepatocellular carcinoma. The lesion appears hyperintense on T1-weighted images (a), slightly hypointense on T2-weighted images (b), does not show a clear-cut enhancement in the arterial phase (c) and appears isointense in the portal venous phase (d) on dynamic study 发病率仅次于HCC；中国：占原发肝癌的5%，国外：20-30% 多为原发，少数继发于胆管变异或炎症，癌前病变复杂 根据肿块生长方式（分型2）: 外生型（壁外型） exophytic (mass-forming) 浸润型（围管型） infiltrative (periductal), 息肉型（腔内型） polypoid (intraductal) 混合型 the combined type 胆管 细 胞 癌 cholangiocarcinomas Drawings illustrate the four growth patterns of cholangiocarcinoma. exophytic infiltrative polypoid combined Exophytic peripheral cholangiocarcinoma: thick, bandlike contrast enhancement around the tumor at the arterial phase and concentric filling of contrast material at the equilibrium phase Figure 4. Infiltrative hilar cholangiocarcinoma in a 59-year-old woman with progressive jaundice. (a) Arterialphase CT scan shows a well-enhancing, thickened bile duct wall (arrows) at the hepatic hilar level. (b) Cholangiogram shows complete obstruction at the hepatic hilar level and severe strictures (arrows) that involve both hepatic ducts. Figure 8: Mucin-hypersecreting intraductal papillary cholangiocarcinoma in a 48-year-old woman with indigestion Hemangioma、FNH、HCC、CCC磁共振T2WI信号比较 Hemangioma、FNH、HCC、CCC 磁共振增强信号比较 Pancreatic carcinoma 90%为导管细胞腺癌，病理为致密的纤维性硬化性病变 70%发生于胰头部，其次为头、体、尾或者全胰 40～60岁男性多见 生物学特性：围管型浸润、嗜神经生长、乏血供肿瘤、向后方生长 围管型浸润——胰管和胆管梗阻，导致远侧管道扩张、胰腺萎缩或者胰腺炎；包绕腹腔干和肠系膜上动脉 乏血供肿瘤——早期不强化，延迟充填式强化 嗜神经、向后——肿瘤倾向于向后侧生长，包绕腹膜后血管等 转移征象：淋巴结转移、肝脾转移 胰头癌 Pancreatic carcinoma Functioning islet cell tumors 急性坏死性胰腺炎 Acute necrosistc pancreatitis 呈局灶性或弥漫性出血坏死 胰腺体积大 密度低，坏死区密度更低，出血