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肝脏疾病ct诊断课件

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肝脏 疾病 ct 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 肝脏疾病CT诊断 南华附属第一医院 周飞 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 检查技术 n 平扫 常规扫描 n增强扫描 动脉期 门静脉期 延迟期 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肝中静脉将肝脏分为肝右叶 肝左叶 n肝左静脉将肝左叶分为内侧段 外侧段 n门静脉将肝脏分为上下段 左右门脉分别发出上 下两支 进入各段段中心 n肝右静脉将肝右叶分为右前段 右后段 肝脏解剖 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 肝弥漫性病变 单击此处编辑母版标 题样式 单击此处编辑母版副标题样式 6 脂肪肝 病理 过量脂肪尤其是甘油三脂在肝细胞内过度沉积 又名 肝脏脂肪浸润 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 肝脏体积正常或增大 肝实质密度弥 漫性 弥漫性脂肪肝 或局灶性减低 局 灶性脂肪肝 低于脾脏密度 高于脾脏5 10HU n增强 增强特征与正常肝脏一致 但仍保持 相对低密度 肝脏强化血管特别清楚 血 管分布走形正常 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n肝岛 常见于弥漫性脂肪肝肝内残留的正常肝组 织 边界清楚 呈圆形 条形或不规则形 通常 位于胆囊附近 叶间裂附近或包膜下 以肝左叶 内侧段最常见 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 n病理 肝细胞弥漫性变性 坏死 纤维组织增生 肝裂增宽 肝门区扩大 肝细胞结节再生 肝表面凹凸不平 肝小叶结构和血液循环途径改建 肝形态改变 门静脉高压 肝功能受损 n病因 肝炎 酒精 药物中毒 胆汁淤积 肝脏淤血 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n肝脏大小形态改变 肝脏表面凹凸不平 呈波浪状 肝体积缩小 肝叶比例失调 表现为肝右 叶缩小 尾状叶及左叶增大 肝裂增宽 n肝实质密度不均匀 n脾大 腹腔积液 门静脉高压 门静脉增 宽 13mm n侧枝循环开放 脾静脉增粗扭曲 胃底静 脉曲张 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 原发性肝癌 n分型 巨块型 直径 5cm 结节型 直径 5cm 弥漫型 小肝癌 小于3cm的单发结节或两个结 节直径之和小于3cm Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 肝内圆形 卵圆形 不规则稍低密度灶 可有 分叶 大小不等 密度不均匀 境界清楚或不清 楚 单发或多发 常同时 合并肝硬化 平扫很难 显示 1cm病灶 n增强 动脉期迅速不均匀强化 高于正常肝实质 门静脉期强化迅速下降 密度低于正常肝实质 延迟其呈低密度 呈现 快进快出 速升速降 n假包膜 晕圈征 生长方式 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肝癌转移以血行性最常见 其次是淋巴途 径 种植性 侵犯血窦 门静脉和肝静脉癌 栓形成 n可向肝内和肝外转移 肺 肾上腺 骨 肾 脑 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转移 门静脉 下腔静脉 肝静脉癌栓 形成 表现为静脉管腔扩张 增强后 管腔内见充盈缺损 淋巴结转移 肝门区域 腹膜后淋 巴结肿大 肝内 外胆管扩张 常为梗阻性梗 阻 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胆管细胞癌 n胆管细胞癌起源于肝内胆管的上皮细胞 肝脏原发恶性肿瘤中占第二位 常无乙型 肝炎和肝硬化病史 血液AFP场未阴性 临 床意上腹不适和肿块来就诊 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平扫 呈轮廓欠清的低密度实质性病变 密 度不均匀 部分内可见钙化 n增强 不均匀强化 动脉期强化程度低于 肝实质 门静脉期病灶持续强化 增强后 可见周围卫星灶 n常伴有病灶远侧肝内胆管扩张 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n其他恶性肿瘤 胆管细胞囊腺癌 起源同胆管细胞癌一样 但具有分泌粘液功能 育胆管囊腺瘤相 对应 肝脏肉瘤 血管 脂肪 纤维 平滑肌肉 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 n经门静脉途径转移 消化道脏器 胃癌 胰 腺癌 n经肝动脉途径转移 乳腺癌 肺癌 转移性肝癌 转移癌大小 数目 形态多变 组织学特征 与原发癌相似 可发生坏死 囊变 出血 钙化等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 肝内单发或多发圆形或类圆形低密度 灶 大小不等 边界清楚或 不清晰 密度 均匀或不均匀 部分病灶可出现钙化 n增强 病灶边缘强化 均匀强化 牛眼征 病灶中心呈低密度 边缘为 高密度强化 最外层密度又低于肝实质 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝血管瘤 n通常为海绵状血管瘤 最常见的良性肿瘤 n大小不一 无临床症状 常偶然发现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 呈圆形或卵圆形稍低密度灶 边界清 晰 密度均匀或较大病灶内见更低密度区 呈裂隙状 星形或不规则形 n增强 动脉期病变边缘显著强化呈结节状 门静脉期病灶强化友边缘进一步向中 心强化 延迟期呈等密度或稍高密度 呈现 早出晚归 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝腺瘤 n肝细胞腺瘤 n常为单个 圆球形与周围组织分解清楚 有包膜 肿瘤主要右正常肝细胞组成 但 排列紊乱 失去正常小叶结构 n常见于女性 与长期服用避孕药有关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 呈圆形或卵圆形等或略低密度 易漏 诊 边界清晰 可以合并出血 n增强 动脉期病变强化明显 强化迅速 门静脉期病灶强化下降呈等密度 延迟期稍低密度 如病灶合并出血 常表现为低密度不强化区域 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 局灶性结节增生 FNH n FNH 实质部分由正常肝细胞 苦否氏细 胞 血管胆管组成 但无正常肝小叶结构 以星状纤维疤痕组织为核心 向周围呈 辐射状分布的纤维足足分隔 形成分房状 结构 纤维分隔内同样含血管腔和增生的 胆管 与周围肝组织分解清楚 无包膜 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 略低或等密度 密度均匀 中心疤痕 呈低密度 常位于肝的外周 靠近包膜 n增强 早期实质呈明显强化 均匀强化 中 心疤痕组织无强化 呈星芒状低密度 后 期病灶几乎呈等密度 中心疤痕逐渐强化 范围缩小 呈裂隙样 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 其它肿瘤 n肝脏囊腺瘤 起源于胆管 又称胆管性囊腺 瘤 有良 恶性 肿瘤边界清楚 囊实性 包块 内含液体 有纤维基质形成分隔 呈多房性 囊壁由纤维组织和上皮细胞组 成 有壁结节突向囊腔内 与胆道无沟通 nCT表现 显示为巨大囊实性肿块 边界清楚 可见壁结节和纤维分隔 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其它肿瘤 脂肪瘤 血管平滑肌脂肪瘤 间叶性错构 瘤等 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分单纯性囊肿 多囊病性囊肿 n 由小胆管扩张演变而成 囊壁分泌液体的 上皮细胞 肝囊肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CT表现 n平扫 肝内圆形 类圆形低密度灶 边界清 楚 密度均匀 呈水样密度的球形阴影 大小不等 数目不等 n增强 无强化 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肝脓肿分细菌性和阿米巴性 以细菌性多 见 n细菌性肝脓肿 全身各部位化脓性感染 可经过胆道 门静脉 肝动脉等途径感染 n临床以寒战高热 肝区疼痛和叩击痛 肝 肿大 血白细胞计数和中性升高 肝脓肿 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阿米巴性肝脓肿 继发于肠阿米巴病 阿 米巴原虫经门静脉系统进入肝脏 产生溶 组织酶 导致肝组织坏死液化而形成脓肿 脓液有臭味 巧克力样 易穿破累及周 围脏器或腔隙 n有痢疾或腹泻史 血白细胞计数和中性不 高 大便找到阿米巴滋养体 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平扫 肝内类圆形或不规则形低密度灶 密 度均匀或不均匀 边界清楚或不清晰 病灶周围可见不同密度环形带 呈靶征 部分病灶内可见气体 n增强 脓肿壁强化 呈环征 可单环 双环 三环 分别代表 水肿 纤维肉芽组织 炎性坏死组织 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝静脉闭塞 n肝静脉闭塞 Budd Chiari综合征 肝静脉闭 塞引起的症状群 n可合并下腔静脉阻塞和门静脉高压 n病因 血液凝固性过高 妊娠 口服避孕 药 肿瘤等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial nCT表现 肝大 腹腔积液 尾状叶正常或 增大 邻近周围肝实质密度增高 外周肝 组织密度偏低 n增强扫描肝静脉狭窄或消失 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏外伤 n腹部外伤中仅次于脾脏 n肝包膜下血肿 肝包膜下形成梭形低密度 或等密度影伴相应肝实质 受压变平 n肝实质血肿 n肝撕裂伤 增强扫描
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