淋巴系统及淋巴结成像技术课件.ppt

1、The lymphatic system董龙春董龙春2013.719the lymphatic system Definition:The lymphatic system is a network of channels,lymph nodes,and organs Function:to collect and return interstitial fluid,and thus help maintain fluid balanceto defend the body against disease by producing lymphocytes to absorb lipids fr

2、om the intestine Organization of The lymphatic systemtheconductingsystemthelymphoidorganslymphaticcapillarieslymphaticvesselslymphtictrunklymphticductprimarylymphoidorganssecondarylymphoidorgansThymusBonemarrowlymphnodestonsilsspleenadenoidsAppendixPlasmaleaksoutofthecapillarieslymph10%90%ofthisflui

3、dreturnstothevenouscirculationthroughthevenulesandcontinuesasvenousblood.tissuecellinterstitialfluidexchange lymph transparent,usually slightly yellow,often opalescentples()nt liquid about 95 percent waterthe remainder:plasma proteins,other chemical substances cellular component:lymphocytes lined by

4、 endothelial cells a thin layer of smooth musclesone-way valves to prevent any backward flowLymphatic vesselslymphtictrunkLumbartrunkBronchomediastinaltrunkSubclaviantrunkJugulartrunkIntestinaltrunkUnpairedpairedtwolymphticductsRightBronchomediastinaltrunkLeftBronchomediastinaltrunkRightSubclaviantr

5、unkLeftSubclaviantrunkRightJugulartrunkLeftJugulartrunkIntestinaltrunkLumbartrunksright lymphatic duct thoracic ductveinheartLymphatic Drainage Areas“venous angle”lymphoidorgansLymphlymphaticcapillariesafferentlymphvesselsLymphnodesefferentlymphvesselsLymphatic drainage pathwaysLymphatictrunkslympht

6、icductsElephantiasis legparasite/bacteriainfectionflowoflymphblockagelymphedemaFibrosis,fatsclerosis,fasciathickenedlymph node 400-450 Round/oval/bean shaped Different size,usually 1.0cm）long-to-shortaxisratiodecrease(L/S3mm)Lymph Node Imaging(CT/MRI)Axialcontrast-enhancedCTandT2WIimageoflowerabdome

7、nshowa9-mmaortocavalnode(arrow)withcentralfattyhilum.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)normallymphnode.Imageshowsflattenedhypoechoiccigar-shapedstructure(arrow).malign

8、antlymphnode.ImageshowsenlargedroundlymphnodewithmixedcysticandsolidcomponentsLymph Node Imaging(ultrasound)Abnormallymphnodefrompapillarythyroidcarcinomametastasis.AbsenceoftheechogenichilusabnormalperipheralflowLymph Node Imaging(ultrasound)SWEmode(top)andBmode(bottom)ultrasoundimagingofalymphnode

9、withalongaxisof19mm.ThisnodewasconsiderednormalonthebasisoftheBmodeultrasoundimage,butshowedhighstiffnessvaluesasdemonstratedbytheQ-Boxmeasurements.Histologicalanalysisfounda5mmmetastaticlesionShearWaveElastography(SWE)Lymph Node ImagingCurrent research trendsfrom conventional anatomic modalities to

10、 molecular techniques in functional and physiologic assessment PET/CT and MRI with nanoparticles provide both anatomic and functional information Lymph Node Imaging(DWI)a67-year-oldfemalewithgradeIfollicularlymphomaandcervicallymphnodeinvolvementImpededdiffusivityLymph Node Imaging(MRI)MRlymphograph

11、y(USPIO)30nm,half-periodlong(AC)Normallymphnodeinleftiliacregion(D-F)Nonenlargediliaclymphnodecompletelyreplacedbytumor(GI)MicrometasasesinretroperitonealnodeMRlymphography(USPIO）Systemically injected long circulating particles gain access to interstitium and are drained through lymphatic vessels.Ly

12、mph flow disturbances or disturbances of nodal architecture by metastases lead to abnormal accumulation patterns,detectable by MRIPET/CT for LN imaging Imaging mechanism:the glucose analog 18F-FDG,could be avidly taken up by cells with increased rates of glycolysis.Weak point:the image resolution of

13、 PET is relatively low.The implementation of PET and CT fusion either by dual PET/CT or computer registration has evolved to overcome this obstacle.PET/CT for LN imagingA 57-y-old woman with chest pain after lobectomy for lung cancerPET/CT for LN imaging62-y-old man with pancreatic cancerWhats the d

14、ifferent changes between the manlignant LN and the benign reactive hypertrophy LN?lymph channel and vasculature reorganization overexpression of vascular endothelial growth factor-C in tumors can induce hyperplasia of vessels and lymphaticsproliferation rate increasedmore hypercellularity the lumina of the lymph sinuses become dilated(relatively few lymphocytes)Thank you for Ur attention!