胰腺囊性肿瘤的CT、MRI诊断

胰腺囊性肿瘤一直是影像学检查的难点，近年来新的成像技术的应用明显改善了胰腺囊性肿瘤的诊断及分期，现就近年来对胰腺的CT、MRI成像技术、常规胰腺。挺性肿瘤的成像方案选择及其影像学表现的研究综述如下。     

胰腺肿瘤的影像学

胰腺肿瘤一直是影像学检查的难点,近年来新的成像技术的应用明显改善了胰腺肿瘤的诊断和分期。简要介绍用于胰腺肿瘤的各种影像技术,并描述常见胰腺肿瘤的成像方案的选择及其表现。     

胰腺肿瘤的影像学

胰腺肿瘤一直是影像学检查的难点,近年来新的成像技术的应用明显改善了胰腺肿瘤的诊断和分期.简要介绍用于胰腺肿瘤的各种影像技术,并描述常见胰腺肿瘤的成像方案的选择及其表现.     

胰腺MRI、MRS和MRCP检查与正常表现

MR检查已成为临床上评价胰腺疾病的常用手段.了解不同MR脉冲序列上正常胰腺的影像表现是合理应用扫描序列和识别病变的前提.介绍了胰腺MRI、磁共振波谱和磁共振胆胰管成像检查技术,描述了正常胰腺影像解剖以及不同脉冲序列上胰腺MRI信号变化情况.     

胰腺CT灌注成像的应用进展

CT灌注成像将疾病的影像学诊断从单一的形态学诊断带入了功能性或形态加功能性诊断的新时代。自1991年起Miles最先提出后,各脏器的CT灌注成像已成为研究的热点。目前,脑部CT灌注已趋于成熟,胰腺的灌注起步较晚,由于技术及脏器本身条件的限制,胰腺的CT灌注仍处于尚待完善阶段。     

3.0T磁共振在胰腺病变中的应用探讨

胰腺是人体重要的消化器官,胰腺疾病特别是胰腺癌严重威胁人类健康,因此早期的准确诊断对治疗和愈后起着重要作用,目前CT是胰腺疾病的主要检查手段,近几年高场磁共振的出现,以其敏感的信号变化及多平面成像,脂肪抑制及快速动态增强成像技术在胰腺病变的检查中体现了独特的优势.本文就3.0T磁共振在胰腺病变的应用及新技术做一初步讨论.     

蛛网膜下腔出血MRI诊断价值与进展

蛛网膜下腔出血(SAH)是临床最常见的危急病之一,准确及时地诊断十分必要.随着现代医学影像技术的飞速发展,尤其是MRI新技术的临床应用,其对SAH诊断的敏感性不断增加,但对蛛网膜下腔少量出血的早期确诊仍是影像学检查的一个挑战.简述CT与MRI各序列的成像原理,对比了CT和MRI对急性、亚急性、慢性SAH诊断的敏感性,并总结SAH在CT和MRI影像表现上的各种假阳性情况.旨在提高本病的诊断率,为临床确定治疗方案提供依据,探讨最合适的影像学检查方法.     

CT肾脏灌注成像的临床应用

CT肾脏灌注成像是通过增强前后不同时相CT图像的动态变化来观察组织血流动力学改变。近年来，随着影像技术的发展，CT灌注成像的应用研究日渐增多，其中大多应用于颅脑，部分用于胸部、肝脏、胰腺和脾脏等，用于肾脏的临床研究有少量报道。笔者对肾脏灌注成像的影像学方法作一回顾，并对CT肾脏灌注成像的应用现状作一综述。     

胰腺疾病的MRI诊断

随着MBI成像技术的迅速发展和MBI的广泛应用，利用MBI诊断胰腺疾病正引起人们的普遍关注。现代MRI技术包括屏气T1加权成像及其脂肪抑制、T2加权成像及其脂肪抑制、MBI动态增强扫描、MR胰胆管成像和MR血管成像。这些脉冲序列各自有不同的组织对比机制，而且是互相补充的，它们的综合应用，可以较全面地评价胰腺及胰腺病变，从而明显改善了MBI对胰腺疾病的检测和诊断。本文着重介绍胰腺的MR成像技术，正常解剖、先天性异常和常见疾病的NR诊断价值。     

IgG4相关疾病的影像特征及疗效监测

目的：探讨IgG4相关疾病的影像学特征及激素治疗后疗效的评估。方法收集13例经病理证实的IgG4相关疾病的影像资料,均行CT检查,其中5例同时行MR检查,6例患者有治疗前及治疗后3~6月的完整影像资料。分析病灶的形态、分布、影像特征以及治疗后影像变化。结果13例中1例病灶位于泪腺,1例位于颌下腺,1例位于胆道,3例位于胰腺,4例位于肾脏,2例位于腹膜后,1例位于肺。其中2例病变累及多部位,包括腹膜后、胰腺及肾脏等。所有受累脏器呈弥漫性肿胀或局部软组织肿块,CT平扫呈低密度,T2WI上呈低信号,增强后轻度均匀性强化。6例患者经激素治疗后病灶缩小,T2WI信号有增高表现。结论受累脏器肿胀,CT平扫低密度以及T2WI低信号,轻度均匀强化是IgG4相关疾病的影像学特征,CT及MR在疾病的诊断及激素治疗后疗效的评估方面具有重要的临床应用价值。     

Multidetector CT of the pancreas

CT is the primary imaging modality of the pancreas. This article reviews the multidector CT technique and its current status in the diagnosis of various pancreatic diseases. Special emphasis is given to the impact of multidetector CT and postprocessing imaging techniques on the staging of pancreatic adenocarcinoma.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

MR imaging in the diagnosis of pancreatic disease

MR imaging examinations of 20 patients with normal pancreas and of 38 patients with suspected pancreatic disease were analyzed retrospectively to evaluate the ability of MR imaging to depict the normal and abnormal pancreas, establish MR criteria for various pancreatic diseases, determine if MR imaging can distinguish among various pancreatic diseases, and compare the usefulness of MR imaging with CT. In all 20 patients with normal pancreas and in 34 of the 38 patients with suspected pancreatic disease excellent or good evaluation of the pancreas was achieved. A 0.35-T magnet (Diasonics MT/S) was used, and both T1- and T2-weighted images were needed. T1 and T2 relaxation times and MR signal intensities showed no specific pattern to allow consistent differentiation between normal and diseased pancreatic tissue or to distinguish between tumor and inflammation. In the 29 patients in whom MR and CT images could be compared, MR imaging and CT provided equivalent information in 20 (69%). In 4 patients (14%), MR imaging added information, and in 5 patients (17%) of cases, MR imaging yielded less information than CT. MR imaging of the pancreas was found to be superior to CT in selected instances, such as in the staging of pancreatic neoplasms (n = 4) and in the evaluation of pancreatic disease after surgery (n = 3). We conclude that, at present, MR imaging should not be used as the screening method for pancreatic disease but should be reserved as an adjunct when the information provided by CT is insufficient.     

胰腺癌的螺旋CT诊断与术前评估

胰腺癌临床表现隐慝，临床诊断困难。随着ＣＴ、多层螺旋CT的运用，多期扫描，血管重建等功能的实现，使CT成为胰腺癌诊断及评价的重要手段之一，本文着重介绍螺旋CT在胰腺癌的诊断及鉴别诊断，术前分期及其手术切除的可能性评价的重要作用，对胰腺癌的发病机制、临床特征和病理及CT扫描技术等方面也作了简介。     

64-detector row computed tomography: an improved tool for evaluating the biliary and pancreatic ducts?

The imaging evaluation of patients with suspected pancreaticobiliary abnormality includes noninvasive imaging modalities such as sonography and MRI. The use of computed tomography (CT) has typically been limited to the evaluation and staging of malignancy affecting the pancreas and biliary tree. With the increasing use of CT in abdominal imaging for patients with a wide variety of indications, biliary and pancreatic abnormalities are being initially identified with increasing frequency on CT. The evolution of CT technology to multi-detector channel row (MDCT) scanners, currently culminating in use of 64-detector-row MDCT scanners, has provided unprecedented image quality. We have recently installed three 64-MDCT scanners in our institution and, in this article, we describe our experience in their application to imaging of the pancreatic and biliary ducts. Our current protocols for imaging the biliary tree and pancreatic duct using this technology are discussed. Additionally, the advantages of novel interpretation techniques including multi-planar and minimum intensity projection reformations are detailed. Various diseases affecting the pancreaticobiliary tree are briefly discussed along with their typical imaging evaluation. The application of 64-MDCT technology to these abnormalities is described along with expected imaging findings on CT. The imaging findings of various pancreaticobiliary abnormalities using 64-MDCT scanner technology encountered at our institution are illustrated. In summary, 64-MDCT technology offers several technical advances which may increase utilization of CT in the evaluation and diagnosis of pancreaticobiliary abnormalities.     

MR imaging of the pancreas: a practical approach

This article reviews the current practical MRI techniques in assessment of the pancreas. With the comprehensive "one-stop-shopping" approach, the great majority of pancreatic diseases can be detected and characterized by the use of a combination of T1, T2-weighted, MRCP, and fat-suppressed T1-weighted dynamic post-gadolinium SGE sequences. This approach may provide the clinician with information regarding the site, nature, and staging of pancreatic tumor in a single setting. In many institutions worldwide, however, including our own, CT remains the main imaging method for the assessment of acute pancreatic diseases, due largely to its wide availability. MR imaging is reserved for the indications listed above, most importantly, the detection of small and non-organ-deforming pancreatic ductal adenocarcinoma, islet cell tumors, choledocholithiasis and pancreatic duct calculi, cholangiocarcinomas, and in cases of pancreatic head enlargement with no mass discernable on CT.     

胰腺癌:MRI检查技术和诊断

胰腺癌的患病率呈上升趋势。更重要的是胰腺癌早期没有症状，恶性程度高，发展快，侵及范围广，病死率高。外科手术切除是胰腺癌治疗的有效手段，胰腺癌的检测和分期是MRI的重要课题。近年来，MRI技术的发展可以较全面地评价胰腺及胰腺病变，这些技术包括屏气T1加权成像及其脂肪抑制，T2加以成像及其抑制、Gd-DTPA,动态增强、MRCP和MRA，这些脉冲序列各自有其不同的组织对比机制，而且是相互补充的。其中Gd-DTPA动态增强MRI是检测胰腺癌最可靠，应用最广的技术，它们的联合应用，在检测胰腺癌，特别是局限于胰腺内的小部肿，优于螺旋CT；在胰腺癌的分期中，动态增强MRI在确定肿瘤的局部侵犯和肝转移上优于螺旋CT，对血管的侵犯的判断两者相似。     

Current status of imaging in pancreatic diseases

Recent technological developments in multidetector CT allow pancreatic imaging in a single breath-hold, which is especially valuable in obtaining isotropic three-dimensional reformations that improve our ability to provide accurate preoperative vascular mapping. Advanced MR technology allows faster imaging of pancreas, thus facilitating MR cholangiopancreatography. Use of tissue-specific MR contrast agents, endoscopic ultrasound, and positron emission tomography (PET) in pancreatic imaging has evolved considerably. This review article discusses the roles of CT, MR, endoscopic ultrasound, and PET imaging in the pancreas.     

胰腺内分泌肿瘤影像学检查

胰腺内分泌肿瘤是相对少见的一类胰腺肿瘤。本文系统阐述了胰腺内分泌肿瘤的病理组织学发生，影像学检查方法以及常见的功能性胰腺内分泌肿瘤和无功能性胰腺分泌肿瘤的临床及影像学表现。功能性胰腺内分泌肿瘤包括胰岛素瘤，胃泌素瘤，胰高血糖素瘤，生长抑制素瘤，血管活性肠肽瘤，胰多肽瘤等。用于胰腺内内分泌肿瘤检测的影像学检查主要包括超声，腔内超声，CT、MR、血管造影，经皮肝穿门静脉学样，动脉内钙离子激发试验及肝静脉内采样检查等。     

Duktales Adenokarzinom und ungewöhnliche Differenzialdiagnosen

Ductal pancreatic adenocarcinoma is by far the most common solid tumor of the pancreas. It has a very poor prognosis, especially in the more advanced stages which are no longer locally confined. Due to mostly unspecific symptoms, imaging is key in the diagnostic process. Because of the widespread use of imaging techniques, incidental findings are to a greater extent discovered in the pancreas, which subsequently entail further work-up. Ductal pancreatic adenocarcinoma can be mimicked by a large number of different lesions, such as anatomical variants, peripancreatic structures and tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Additionally, a number of precursor lesions can be differentiated. The correct classification is thus important as an early diagnosis of ductal pancreatic adenocarcinoma is relevant for the prognosis and because the possibly avoidable treatment is very invasive. All major imaging techniques are principally suitable for pancreatic imaging. In addition to sonography of the abdomen, usually the baseline diagnostic tool, computed tomography (CT) with its superior spatial resolution, magnetic resonance imaging (MRI) with its good soft tissue differentiation capabilities, possibly in combination with MR cholangiopancreatography (MRCP), endosonography with its extraordinary spatial resolution, conceivably with additional endoscopic retrograde CP or the option of direct biopsy and finally positron emission tomography CT (PET-CT) as a molecular imaging tool are all particularly useful modalities. The various techniques all have its advantages and disadvantages; depending on the individual situation they may need to be combined.