胰腺囊性病变的影像诊断
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• Uncommon cystic neoplasms:
– SPEN (solid pseudopapillary epithelial neoplasm) – Tumors with cystic degeneration: – adenocarcinoma - neuroendocrine tumor
– Solid Pseudopapillary Neoplasm – Neuroendocrine tumor with cystic degeneration
Classification
• Pancreatic cysts can be categorized into the following groups:
• The left CT-image is of a patient with a history of pancreatitis. • There are two unilocular or simple cysts. • Notice also the retroperitoneal fat-stranding on the right. • The most likely diagnosis is pseudocysts. • The CT on the right shows a cyst in the pancreatic tail in a 36 year old woman,
which was found incidentally with US. • The cyst has a thick irregular rim and contains solid 'non-dependent'
– and the lesion is unilocular or contains nonenhancing dependent debris.
• Cystic neoplasm- Think of the possibility of a cystic neoplasm,
– when there is no history of pancreatitis or trauma,
• Age and gender
– Serous cystic neoplasm – Mucinous Cystic Neoplasma – Intraductal Papillary Mucinous Neoplasm
• Main-duct IPMN • Branch-duct IPMN
• Uncommon Neoplasms with specific findings
• Pseudocysts • Common cystic neoplasms:
– IPMN - intraductal papillary mucinous neoplasm – SCN - Serous cystic neoplasm – MCN - Mucinous cystic neoplasm
• 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.
– This tumor can look like a SCN, but has no scar or calcifications.
– MRCP or Fra Baidu bibliotekeavily weigted T2WI may show the connection to the pancreatic duct, which is highly specific.
– The typical appearance makes a specific diagnosis possible, which is important, because SCN is the only tumor that is not premalignant.
• Branch-duct IPMN –
• 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
– 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.
• Introduction
– Classification – Systematic Approach – MRI versus CT
• Small pancreatic cysts
– How to report – Management
• Pseudocyst • Cystic Neoplasms
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.
– SPEN (solid pseudopapillary epithelial neoplasm) – Tumors with cystic degeneration: – adenocarcinoma - neuroendocrine tumor
– Solid Pseudopapillary Neoplasm – Neuroendocrine tumor with cystic degeneration
Classification
• Pancreatic cysts can be categorized into the following groups:
• The left CT-image is of a patient with a history of pancreatitis. • There are two unilocular or simple cysts. • Notice also the retroperitoneal fat-stranding on the right. • The most likely diagnosis is pseudocysts. • The CT on the right shows a cyst in the pancreatic tail in a 36 year old woman,
which was found incidentally with US. • The cyst has a thick irregular rim and contains solid 'non-dependent'
– and the lesion is unilocular or contains nonenhancing dependent debris.
• Cystic neoplasm- Think of the possibility of a cystic neoplasm,
– when there is no history of pancreatitis or trauma,
• Age and gender
– Serous cystic neoplasm – Mucinous Cystic Neoplasma – Intraductal Papillary Mucinous Neoplasm
• Main-duct IPMN • Branch-duct IPMN
• Uncommon Neoplasms with specific findings
• Pseudocysts • Common cystic neoplasms:
– IPMN - intraductal papillary mucinous neoplasm – SCN - Serous cystic neoplasm – MCN - Mucinous cystic neoplasm
• 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.
– This tumor can look like a SCN, but has no scar or calcifications.
– MRCP or Fra Baidu bibliotekeavily weigted T2WI may show the connection to the pancreatic duct, which is highly specific.
– The typical appearance makes a specific diagnosis possible, which is important, because SCN is the only tumor that is not premalignant.
• Branch-duct IPMN –
• 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
– 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.
• Introduction
– Classification – Systematic Approach – MRI versus CT
• Small pancreatic cysts
– How to report – Management
• Pseudocyst • Cystic Neoplasms
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.