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肝脏常见疾病诊断课件

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肝脏 常见 疾病诊断 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏影像诊断 嘉峪关市第一人民医院CT室 宋 涛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏的影像诊断 检查技术 CT检查 1 CT平扫 1 扫描前口服水或1 2 泛影葡胺500 800ML 2 层厚及层隔 5MM 重建0 625mm 3 范围 肝顶至肝下缘 2 增强扫描 1 目的 增加正常组织与病灶间的密度差 显示等 密度或可疑病灶 帮助鉴别病灶性质 显示肝内血管 解剖 2 方法 静脉快速注射对比剂后扫描叫增强扫描 肝动脉期 门静脉期 肝实质期 2 3分钟 延迟期 5 7分钟 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏的影像诊断 检查技术 MRI检查 1 MRI平扫 SE序列 横断面T1WI T2WI 冠状面T1WI T2WI 2 MRI增强扫描 与CT同 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏的CT影像诊断 n正常CT表现 1 肝实质呈均匀一致的软组织密度 CT值 50 70HU 2 肝动脉 门静脉 胆管进出肝门其密度 低于肝质 3 增强扫描 A 门脉期门静脉肝静脉明显 强化 肝实质开始强化B 肝实质期肝实 质强化达峰值 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏的MRI影像诊断 n正常肝脏的MRI表现 v肝实质 1 信号均匀 2 T1WI像肝为中等信号略高于脾 T2WI像肝 的信号明显低于脾 v门静脉主支及肝静脉主干因流空效应而呈低信 号 v肝动脉不显示 v肝裂因含有脂肪T1WI像 T2WI像呈高信号 n增强扫描肝实质均匀增强 肝血管增强明显 肝内胆管无增强 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝脓肿 q临床与病理 分细菌性和阿米巴性两种 单发或多发 临床主 要为发热 肝大和肝区痛 qCT表现 1 平扫 1 圆形低密度 密度稍高于水 CT值20 40HU 少 数可见气体影 2 脓肿壁密度高于脓腔而低于肝脏 2 增强扫描 1 脓肿壁呈环状强化 环厚薄均匀 内外壁光整 2 脓腔无强化 脓肿壁外周有低密度水肿带 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝脓肿 nMRI表现 1 形态及边缘 圆形 椭圆形边缘锐利 2 信号 T1WI像 低信号 但不均匀 脓肿壁信号略高于脓腔 而低于肝实质 厚薄均匀 外侧可见低信号水肿带 T2WI像 大片状高信号 中心信号最高 部分脓肿为 多房 腔内可见信号分隔 3 增强扫描 A 脓肿壁轻 中度增强 内壁光整可有分隔 强化信 号略高 B 脓肿周围肝实质因充血可有高灌注异常 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝血管瘤 概述 肝血管瘤是肝脏最常见的良性肿瘤 一 般无临床症状 个别有发热 贫血 腹 痛等症状 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝血管瘤 病理 1 大体病理 外观呈紫红色 质软无包膜 切面为囊筛状似海绵而得名 2 镜下 由无数的大小不等的血管腔组成 根据瘤壁的厚薄分为 薄壁型 壁薄腔大 厚壁型 壁厚腔小 个别呈裂隙状或完全闭塞 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝血管瘤 CT表现 A 平扫 1 境界清楚的低密度 CT值30Hu 2 较大的血管瘤中央有裂隙状 星状或不规则形的 更低密度 瘤内血栓形成 机化 纤维化 坏死 囊变 陈旧性出血等所致 B 增强扫描 特征为早出晚归 1 早期病变边缘呈高密度强化 块状或棉絮状 2 增强区域进行性向心性扩展 3 延迟扫描呈高或等密度充填时间 一般大于3分钟 通常7 15分钟 最高达20 60分 钟 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 平扫平扫 门脉期门脉期 动脉期动脉期 延迟延迟 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CTCT平扫平扫 CTCT强化强化 延迟扫描延迟扫描 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝血管瘤 nMRI表现 是最好的检查方法 1 形态及边缘 类圆形 边缘清晰 2 信号 T1WI呈略低信号 T2WI呈高信号 信号强度随TE时间延长 120ms 而 增高 称为灯泡征 一般瘤灶信号均匀 大的病灶因血栓或纤维瘢痕而信号不均 n3 增强扫描 周边结节样或棉絮样强化 逐渐向中 心扩展 延迟为高信号或等信号充填 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n发生于脂肪肝背景的血管瘤 a 平扫肝脏多发高密度 b 动脉期病变与肝脏等密度 c 门静脉病变仍强化 d MR T2WI的典型表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial na 平扫第四段 大的 不均质病变 有包膜下血肿 注意另外的一个低密度病变 b T1WI显示低信号病变中高信号区域 出血 c T2WI病变明显高信号 d 切片显示出血的血管瘤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 原发性肝细胞癌是我国常见的恶性 肿瘤之一 在男性占第三位 女性 占第四位 原发性肝细胞癌是最常见的一种细 胞类型 常见病的影像诊断 肝癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 大体病理 巨块型 单个或多个 直径 5cm 结节型 单个或多个 直径 5cm 弥漫型 结节小 弥漫而均匀分布 常见病的影像诊断 肝癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 4 临床表现 n有慢性肝炎和肝硬化病史 n肝区疼痛 上腹肿块 消瘦等 n胎甲球 AFP 增高 400ug L Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 5 CT表现 平扫 形态及边缘 1 形态规则或不规则 2 边缘清晰 有假包膜 膨胀性生长 纤维组织增生 病灶周围肝组织受压 3 边缘模糊 肿瘤浸润性生长 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 5 CT表现 平扫 n密度 1 低密度 n2 等或高密度 少见 n3 混杂密度 囊变 陈旧出血 坏死 钙化 脂肪变性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 低密度低密度 高密度高密度 稍低密度稍低密度 混杂密度混杂密度 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 间隔 宽窄不一 方向不定 间隔征 原来的 包膜由于癌瘤发展而残留在更为扩大的 病灶中 肝表面凹凸不平 常见病的影像诊断 肝癌 5 CT表现 平扫 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 5 CT表现 增强 供血 1 正常肝脏供血 20 30 由肝动脉供血 70 80 由门静脉供血 2 肝癌供血 90 由肝动脉供血 10 由门静脉供血 增强 1 动脉期 增强明显 条状 结节状或片絮 状 乏血管者无增强 2 门静脉期 轻或中度增强 病灶与正常肝 脏对比明显 瘤中坏死出血区无增强 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 5 CT表现 增强 门静脉改变 门静脉主干或主支侵蚀破 坏中断消失或腔内形成充盈缺损 肝门及肝内胆管扩张 癌瘤侵犯或淋巴 结压迫胆管形成梗阻性黄疸 肝门或附近淋巴结转移 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 n三 MRI表现 n信号 1 T1WI像低信号 T2WI像高信号 2 瘤灶中心可有脂肪变性 囊变 坏死 出血等而出现不同的信号 n镶嵌样结构 纤维间隔或坏死灶将有活性的瘤结节分 隔使瘤内信号不均 n重T2像 TE时间的延长而信号逐渐减低 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见病的影像诊断 肝癌 三 MRI表现 n假包膜 纤维组织和受压的肝组织 T1WI像肿瘤周围窄带状低信号 T2WI像显示不清 延迟后强化 n瘤周水肿 T1WI像显示不清 T2WI像高信号 n静脉瘤栓 血管流空信号消失呈T1WI像 高信号 T2WI像低信号 n裂隙状 中央易发生液化坏死 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝硬化X线表现 n1 胃肠道钡餐造影课件胃底 食管静脉 曲张 n2 动脉造影可见肝动脉分支变小变少 扭曲 脾 门静扩张 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝硬化CT表现 n1 肝脏大小的改变 早期肝硬化肝脏正 常或增大 中晚期则肝脏体积缩小 n2 肝内密度改变 肝实质密度不均匀 再生结节呈略高密度 脂肪变性和增生 的纤维组织呈低密度 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n3 肝脏形态轮廓改变 肝脏边缘呈结节 状凹凸不平 肝右叶萎缩 左叶和尾状 叶肥大 导致肝叶比例失调 同时伴有 肝门区扩大和肝裂增宽 n4 门脉高压改变 门静脉增粗 脾脏增 大超过5个肋单元 脾门及腹膜后异常血 管影 可伴有腹水 5 增强扫描肝内密度趋向均匀一致 同 时可显示簇状或条索状异常曲张的静脉 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝硬化MRI表现 n1 肝脏大小及形态与CT相同 n2 肝脏再生结节在T1WI像一般呈等信 号 在T2WI 像呈低信号 当结节有等信 号或高信号时 提示癌变 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial
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