淋巴系统及淋巴结成像技术PPT

right lymphatic duct
vein
heart
thoracic duct
“venous angle”
Lymphatic Drainage Areas
lymphoid organs
Lymphatic drainage pathways
Lymph
lymphatic capillaries
Lymph Node Imaging(DWI)
a 67-year-old female with grade I follicular lymphoma and cervical lymph node involvement
Impeded diffusivity
Lymph Node Imaging(MRI)
Lymph Node Imaging(ultrasound)
ShearWave Elastography (SWE)
SWE mode (top) and B mode (bottom) ultrasound imaging of a lymph node with a long axis of 19 mm.This node was considered normal on the basis of the B mode ultrasound image, but showed high stiffness values as demonstrated by the Q-Box measurements. Histological analysis found a 5 mm metastatic lesion
Consequently,will it cause limitation of the water diffusion?
hyperintensity on DWI?How to distinguish from metastatic LN?
Lymph Node Imaging
important role： ① provide accurate pretreatment staging of the tumor for planning medical, surgical, and radiation interventions ② monitor response to therapy and provide surveillance after curative treatment Morphology measurements are still the most frequently used method for discriminating malignant from non-malignant lymph nodes, but are insufficiently accurate.
Lymph Node Imaging(CT/MRI)
Axial contrast-enhanced CT and T2WI image of lower abdomen show a 9-mm aortocaval node(arrow) with central fatty hilum.
Lymph Node Imaging(CT/MRI)
The purple portion within nodes indicates normal nodal tissue, and the pink portion indicates metastatic tissue.
Lymph Node Imaging(ultrasound)
normal lymph node. Image shows flattened hypoechoic cigar-shaped structure (arrow).
Lymph Node Imaging
more rounded shape Increased size（short-axis diameter >1.0cm） Malignant tendency long-to-short axis ratio decrease(L/S<1.6) Increased cortical thickness(>3mm) central fatty hilum disappear
③ to absorb lipids from the intestine
Organization of The lymphatic system
lymphatic capillaries lymphatic vessels the conducting system lymphtic trunk lymphtic duct Thymus primary lymphoid organs Bone marrow the lymphoid organs secondary lymphoid organs lymph nodes tonsils spleen adenoids Appendix
respond to antigens and generate antibodies——Clear harmful substances，“Filter”
lymph node
fibrous capsules trabeculae
lymphoid lobule （basic anatomical and functional unit）
pathology
cortex (arrowhead) and medulla (arrow)
cells in the medullary sinuses macrophages and plasma cells
pathology
secondary lymphoid follicles B lymphocytes activated plasma cells differentiate (secret immunoglobulin)
Plasma leaks out of the capillaries
tissue cell exchange interstitial fluid
10% lymph 90% of this fluid returns to the venous circulation through the venules and continues as venous blood.
The lymphatic system
董龙春 2013.719
the lymphatic system
Definition:The lymphatic system is a network of channels, lymph nodes, and organs Function: ① to collect and return interstitial fluid, and thus help maintain fluid balance ② to defend the body against disease by producing lymphocytes
Numerous macrophages
question need to be considered seriously
What's the different changes between the manlignant LN and the benign reactive hypertrophy LN? Once out-antigen stimulated the germinal center development,the extracelluar become more crowd.
paired
Subclavian trunk
Jugular trunk
Unpaired
Intestinal trunk
two lymphtic ducts
Right Bronchomediastinal trunk Right Subclavian trunk Right Jugular trunk Left Bronchomediastinal trunk Left Subclavian trunk Left Jugular trunk Lumbar trunks Intestinal trunk
Lymph Node Imaging
Current research trends from conventional anatomic modalities to molecular techniques in functional and physiologic assessment PET/CT and MRI with nanoparticles provide both anatomic and functional information
Global organization
cortex
paracortex
medulla
multiple afferent lymphatics a single efferent lymphatic vessel hilum artery
Bean-shaped,cortex and medulla,filter
afferent lymph vessels Lymph nodes efferent lymph vessels
Lymphatic trunks lymphtic ducts
ቤተ መጻሕፍቲ ባይዱ
Elephantiasis leg
parasite/bacteria infection flow of lymph blockage
malignant lymph node. Image shows enlarged round lymph node with mixed cystic and solid components