タグ別アーカイブ: Pancreas

Pancreas 症例5　回答に文献、CT, MRI静止画像を追加 2012/3/11

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key words: 漿液性嚢胞腺腫、漿液性嚢胞腺癌、膵囊胞性病変

Serous cystadenoma,　SCA, 　SCAs, 　cystic lesions of the pancreas

 

漿液性嚢胞腺腫の文献とURL表示


・SCA の病理と対比したMDCTの診断

Shah AA, Sainani NI, Kambadakone AR, et al.

Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma: radiologic-pathologic correlation.

World J Gastroenterol. 2009 Jun 14;15(22):2739-47.
http://www.ncbi.nlm.nih.gov/pubmed?term=Predictive%20value%20of%20MDCT%20for%20accurate%20diagnosis%20of%20serous
直接PDF(Free)
http://www.wjgnet.com/1007-9327/pdf/v15/i22/2739.pdf

・典型、非典型の漿液性嚢胞腺腫
Choi JY, Kim MJ, Lee JY, et al.

Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation.

AJR Am J Roentgenol. 2009 Jul;193(1):136-42.
http://www.ncbi.nlm.nih.gov/pubmed/19542405
Free

・漿液性嚢胞腺腫：serous oligocystic adenma とMCTやIPMNとの鑑別の論文
Kim SY, Lee JM, Kim SH, Shin KS, Kim YJ, An SK, Han CJ, Han JK, Choi BI.

Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor.

AJR Am J Roentgenol. 2006 Nov;187(5):1192-8.

http://www.ncbi.nlm.nih.gov/pubmed/17056905

Free


・膵嚢胞性病変のまとめ論文

Kalb B, Sarmiento JM, Kooby DA, et al.
MR imaging of cystic lesions of the pancreas.
Radiographics. 2009 Oct;29(6):1749-65.

http://www.ncbi.nlm.nih.gov/pubmed/19959519

2012年3月3日現在Free


・膵充実と囊胞性病変の拡散強調像論文まとめ

Wang Y, Miller FH, Chen ZE, et al.
Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas.
Radiographics. 2011 May-Jun;31(3):E47-64. Review.

http://www.ncbi.nlm.nih.gov/pubmed/21721197

Not Free


・SCN　の臨床的特徴の論文

Fukasawa M, Maguchi H, Takahashi K, et al.
Clinical features and natural history of serous cystic neoplasm of the pancreas.
Pancreatology. 2010;10(6):695-701. Epub 2011 Jan 18.

http://www.ncbi.nlm.nih.gov/pubmed/21242709

Free


・PK と　SCN, MCT, 偽嚢胞との鑑別

Lv P, Mahyoub R, Lin X, et al.
Differentiating pancreatic ductal adenocarcinoma from pancreatic serous cystadenoma, mucinous cystadenoma, and a pseudocyst with detailed analysis of cystic features on CT scans: a preliminary study.
Korean J Radiol. 2011 Mar-Apr;12(2):187-95. Epub 2011 Mar 3.
http://www.ncbi.nlm.nih.gov/pubmed/21430935
Free

・大腸と脾臓に浸潤した悪性SCCs の症例
Cho W, Cho YB, Jang KT, et al.
Pancreatic serous cystadenocarcinoma with invasive growth into the colon and spleen.
J Korean Surg Soc. 2011 Sep;81(3):221-4. Epub 2011 Sep 26.
http://thesurgery.or.kr/DOIx.php?id=10.4174/jkss.2011.81.3.221
Free

Bano S, Upreti L, Puri SK, Chaudhary V, Sakuja P.
Imaging of pancreatic serous cystadenocarcinoma.
Jpn J Radiol. 2011 Dec;29(10):730-4. Epub 2011 Oct 19.
http://www.ncbi.nlm.nih.gov/pubmed?term=Bano%20S%2C%20Upreti%20L%2C%20Puri%20SK%2C%20Chaudhary%20V%2C%20Sakuja%20P.%20Imaging%20of%20pancreatic%20serous%20cystadenocarcinoma.

Lahat G, Lubezky N, Haim MB, et al.
Cystic tumors of the pancreas: high malignant potential.
Isr Med Assoc J 2011 May;13(5):284-9.
http://www.ima.org.il/imaj/dynamic/web/ArtFromPubmed.asp?year=2011&month=05&page=284

King JC, Ng TT, White SC, Cortina G, Reber HA, Hines OJ.
Pancreatic serous cystadenocarcinoma: a case report and review of the literature.
J Gastrointest Surg. 2009 Oct;13(10):1864-8. Epub 2009 May 21. Review.
http://www.ncbi.nlm.nih.gov/pubmed/19459016

・腫瘍の大きさと部位と臨床所見との関連性
Khashab MA, Shin EJ, Amateau S, et al.

Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms.

Am J Gastroenterol. 2011 Aug;106(8):1521-6. doi: 10.1038/ajg.2011.117. Epub 2011 Apr 5.

http://www.nature.com/ajg/journal/v106/n8/full/ajg2011117a.html

キー画像

膵頭部から鈎部に分葉状の低吸収域腫瘤を認める

膵実質相では強く濃染する充実様に見える部分と囊胞性部分が混在

充実部分にみえ、よく濃染していた部位はwash out されている

 

DWI では高信号信号を示す

腫瘤はかなり強い高信号を示す。ADC値=2.84×10-3mm2/s

MRCP 2D multislce 多数の小嚢胞から構成される

MRCP: Single thick slub  多数の小嚢胞で構成されているT2WI axial 　蜂巣状の囊胞性病変

 

 

Emergency radiology 第１回　 解答

投稿日: 作成者:


文献： 
急性膵炎診療ガイドライン 2010年
http://www.suizou.org/etc.htm　　よりダウンロードを。

一般情報：難病情報セン ター　ホームページへのリンク
http://www.nanbyou.or.jp/entry/271

Balthazal EJ.
Acute Pancreatitis: assessment of severity with clinical and CT evaluation.
Radiology 2002; 223:603-613

のp 608 より引用抜粋改変

CT Enhancement Values and Pitfalls
With helical or multidetector scanning with rapid acquisition of sequential images and　collimation of less than 5 mm, images can be obtained in the early portal venous phase (60.70 seconds after intravenous administration of 150 mL of iodinated contrast material at a rate of 3 mL/sec). We still use a monophasic protocol, starting at the top of the diaphragm and covering the entire abdomen and pelvis. Since unenhanced images are　not obtained, the detection of parenchymal injury is based solely on the degree and homogeneity of pancreatic enhancement. Basic pancreatic CT numbers of 40 .50 HU seen on unenhanced CT images are expected to increase to 100–150 HU throughout the entire normal gland during contrast material administration, depending on the size of the bolus, the speed of the injection, and the time of image acquisition (Fig 3). Lack of contrast enhancement or minimal contrast enhancement of less than 30 HU of a portion of the pancreas or of the entire pancreas indicates decreased blood perfusion (ischemia) and correlates with the development of necrosis (Figs 1, 4, 6). In this regard, however, several factors and potential pitfalls should be kept in mind.

 

この論文の中で壊死と浮腫をしっかり分けている。かなり具体的：p608-609 CT enhancement value
MDCT 5mm slice 厚、60-70s 3ml/s 150ml 総量
単純CT上膵実質は40-50HUを示す。上記相では、100-150HUまで上昇する
門脈相(60-70s 後)30HU未満では虚血、壊死を示唆する
しかし、いくつかの要因やピットフォールもある。例えば、元もと脂肪変性強い膵の場合、浮腫の強い場合、正常でも そう言う場合がある
もう一つ時間的要素
膵壊死は、臨床症状発症から24-48時間後に生じる。もし、CTが12時間以内に撮影される とよくわからない。はっきりと壊死として濃染しない状態と成るには2－3日かかる。従って、72時間後 の方が壊死の正診率は高まる。48-72時間後がいい

上記もととなったと考えられる膵壊死と病理の対比論文
Larvin M, Chalmers AG, McMahon MJ.
Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis.
BMJ 1990 Jun 2;300(6737):1425-8.

最近の膵壊死のない急性膵炎の予後についての論文
Lenhart DK, Balthazar EJ.
MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections.
AJR Am J Roentgenol. 2008 Mar;190(3):643-9.