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肝脏疾病影像表现课件

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肝脏 疾病 影像 表现 课件
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新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 133 概论 肝海绵状血管瘤 原发性肝癌 转移性肝瘤 肝囊肿 肝硬化 肝 脏 P229 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 133 肝脏教学目标 v掌握肝脏CT检查技术 熟悉MRI检查技术 v掌握肝脏正常X线和CT表现 v掌握肝海绵状血管瘤 原发性肝癌 转移性肝 癌的影像学表现 v了解肝囊肿的影像学表现 v熟悉肝硬化的影像学表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 133 普通X线检查 血管造影检查 USG检查 CT检查 MRI检查 肝脏影像学检查技术 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 133 肝脏X线检查 v透视和平片 价值有限 临床应用较少 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 133 肝动脉造影检查 v采用Seldinger技术 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 6 133 肝脏CT检查技术 vCT平扫 扫描前常规口服1 2 泛影葡胺500ml 800ml 层厚10mm 层间隔10mm 必要采用薄层 扫描 螺旋扫描层厚10mm 螺距为1 0 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 7 133 肝脏CT检查技术 vCT增强 对比剂 离子型或非离子型100ml 静脉注射 流量2ml s 3ml s 压力注射器 肝动脉期 20s 25s 门静脉期 50s 60s 平 衡 期 110s 120s 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 8 133 肝脏CT检查技术 vCT增强的目的 增加病变与正常组织之间的密度差 显示 平扫不能显示或可疑的病灶 帮助鉴别病灶的性质 显示肝内血管情况 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 9 133 肝脏MRI检查技术 vMRI平扫 SE T1WI T2WI 横断 冠状及失状面 T1WI显示解剖结构 T2WI观察病理变化 脂肪抑制技术 vMRI增强 Gd DTPA v动态增强MR血管造影 DCE MRA 显示肝动脉 肝静脉和门静脉全貌 判断肝癌对血管的侵犯情况 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 10 133 肝脏影像观察与分析 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 11 133 肝脏正常平片表现 v大致了解肝脏的轮 廓 大小 钙化和 积气 不能了解肝 脏的内部结构 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 12 133 肝脏正常血管造影表现 v肝动脉造影 动脉期 肝动脉分支呈树枝状 分布均匀 走行自然 毛细血管期 动脉影消失 细小毛细血管影出现 肝实质期 肝实质密度均匀增高 门静脉显影 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 13 133 正常肝动脉造影 DSA 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 14 133 肝脏正常CT表现 vCT平扫 肝实质呈均匀的软组织密度 高于脾 胰 肾等 肝脏轮廓光整 其形态随扫描层面而异 肝内门静脉 肝静脉密度低于肝实质 vCT增强 动脉期 门静脉期 实质期 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 15 133 肝脏正常CT平扫 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 16 133 肝脏正常CT增强 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 17 133 肝脏正常MRI表现 vMRI平扫 肝实质 T1WI呈均匀中等信号 稍高于脾 T2WI明显低于脾 胆管 点状或条状长T1低信号长T2高信号 血管 流空低信号 vMRI增强 肝实质均匀强化 肝血管明显强化 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 18 133 肝脏正常MRI 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 19 133 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 20 133 肝海绵状血管瘤 cavernous hemangioma of the liver v常见的肝脏良性肿瘤 多无症状 瘤体大小不 一 可单发或多发 v病理上瘤体由大小不等的血窦组成 血窦间可 有发自中心的放射状间隔 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 21 133 肝海绵状血管瘤X线表 现 v肝动脉造影 供血动脉增粗 周围血管 抱球征 早期动脉相 肿瘤边缘出现 树上挂果征 静脉期表现肿瘤显影渐向中央扩散 肿瘤染色持续到肝实质后期不退 表现为 早出晚归 征象 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 22 133 肝海绵状血管瘤X线表 现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 23 133 肝海绵状血管瘤CT表现 v平扫 圆形 类圆形或分叶状低密度区 病灶边缘清楚 密度均匀 较大病灶内可 有更低密度区 v增强 早期肿瘤边缘出现结节状强化 延时扫描强化范围渐向中心扩展 密度逐 渐降低 直至肿瘤与肝实质强化密度相同 其特点是对比剂在瘤内 快进慢出 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 24 133 肝海绵状血管瘤CT表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 25 133 肝海绵状血管瘤CT表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 26 133 肝海绵状血管瘤MRI表现 vMRI平扫 呈T1WI低信号 T2WI高信号 且随回波时 间延长信号递增 在重T2WI 上信号更高 称之为 灯泡征 vMRI增强 病变增强特点同CT 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 27 133 SE T1WI SE T2WI 肝海绵状血管瘤MRI表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 28 133 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 29 133 原发性肝癌 v组织学上肝细胞癌 hepatocellular carcinoma 占90 以上 发病与乙肝和肝硬化有关 v临床症状出现于中晚期 表现为肝区疼痛 消瘦乏力 腹部包块 60 90 AFP阳性 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 30 133 原发性肝癌病理改变 v病理学分三型 巨块型 癌瘤直径 5cm 结节型 癌结节 5cm 弥漫型 癌结节 1cm 弥漫分布 小肝癌 单发结节直径 3cm或2个结节直 径之和不超过3cm 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 31 133 原发性肝癌病理改变 v主要由肝动脉供血 且90 为富血供肿瘤 v容易侵犯门静脉和肝静脉引起血管内癌栓或肝 内血行转移 v侵犯胆道引起阻塞性黄疸 v肝门及腹主动脉旁等处淋巴结转移 v晚期可发生肺 骨 肾上腺和肾等转移 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 32 133 原发性肝癌X线表现 v肝动脉造影 供血动脉增粗 出现肿瘤血管 占位征象 肿瘤染色 静脉早显 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 33 133 原发性肝癌CT表现 vCT平扫 常见肝硬化表现 多为边缘不规则低密度灶 单发或多发 vCT增强 不均匀强化 界限清楚 坏死区不强化 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 34 133 原发性肝癌CT表现 vSCT双期增强 动脉期明显强化 门静脉期密度明显下降 时间 密度曲线呈 速升速降 的特点 伴发改变 如压迫周围结构 门脉癌栓 肝硬化 腹水等 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 35 133 巨块型肝癌 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 36 133 弥漫型肝癌 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 37 133 肝癌并腔静脉癌栓 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 38 133 肝癌平扫 双期增强扫 描 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 39 133 原发性肝癌MRI表现 vT1WI 肿瘤呈稍低信号或等信号 边界不清 有时难易分辨 肿瘤出血或脂肪变性呈高 信号 坏死 囊变呈低信号 假包膜呈环形 低信号 vT2WI 肿瘤呈稍高信号 巨块型肝癌信号可 不均匀 v增强 同CT 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 40 133 原发性肝癌MRI表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 41 133 原发性肝癌MRI表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 42 133 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 43 133 转移性肝癌 secondary tumor of the liver v全身的恶性肿瘤约有30 50 可转移到肝脏 形成转移性肝癌 以消化道和胰腺肿瘤多 见 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 44 133 转移性肝癌 v转移途径 邻近器官直接侵犯 肝门部淋巴 结转移 门静脉转移 肝动脉转移 v肿瘤易发生坏死 囊变 出血和钙化 vAFP多阴性 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 45 133 转移性肝癌CT表现 v平扫 多发大小不等的圆或类圆形低密度灶 v增强 典型表现 病灶边缘环状强化 中心为 低密度 最外缘有一低密度环 即 牛 眼征 增强后病灶边缘更加清楚 少数多血供 肿瘤在动脉期呈显著强化 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 46 133 转移性肝癌CT表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 47 133 转移性肝癌MRI表现 vT1WI呈稍低信号 T2WI呈稍高信号 v 牛眼征 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 48 133 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 49 133 肝囊肿 liver eyst v胆管发育异常形成的小胆管丛 逐渐扩大融合 形成的囊形病变 v囊肿的大小从数毫米到数厘米 薄壁 内充澄 清液体 v临床上多无症状或症状轻微 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 50 133 肝囊肿CT表现 v平扫 肝实质内圆形低密度区 边缘锐利 境界清楚 囊内密度均匀 CT值为0 20HU v增强 囊内无强化 囊肿境界更加清楚 囊壁菲薄一般不能显示 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 51 133 肝囊肿 单发 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 52 133 肝囊肿 多发 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 53 133 肝硬化 cirrhosis of liver v常见病因 病毒性肝炎 酒精中毒 胆道梗阻 等 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 54 133 肝硬化病理改变 v肝细胞变性 坏死 纤维组织增生和肝细胞结 节再生等 v早期肝脏体积增大 晚期缩小 v肝脏质地变硬 表面呈结节状 v可伴有门静脉高压 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 55 133 肝硬化X线表现 v钡餐造影 食管 胃底静脉曲张 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 56 133 肝硬化CT MRI表现 v肝体积缩小 v肝表面不光滑呈结节状改变 v肝叶比例失调 v肝门及肝裂增宽 v脾大 腹水 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 57 133 肝硬化CT表现 新乡医学院第一临床学院影像诊断学教研室 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 58 133 肝硬化CT表现
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