《腹部超声》PPT课件.ppt

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1、AbdominalSonography腹部超声腹部超声2 2Also known as-Abdominal ultrasound(US)scanning-Abdominal US imaging-Abdominal ultrasonography-Abdominal ultrasound 3 3Aboutthecourse4 4WhatisAbdominalSonography?WhatisanAbdominalSonogram?Whataresomecommonusesoftheprocedure?Howwouldpatientsprepare?Howdoestheprocedurework

2、?Whatdoestheequipmentlooklike?Whointerpretstheresults?Whatarethebenefitsvs.risks?WhatarethelimitationsofAbdominalUSG?UltrasonographyInfo5 5What is Abdominal Sonography?Abdominalsonographyisamethodofobtainingimagesofinternalorgansbysendinghigh-frequencysoundwavesintothebody.Thereflectedsoundwavesarer

3、eturnedasechoes.Theechoesarethenrecordedanddisplayedasareal-timevisualimage.Sinceultrasoundimagesarecapturedinreal-timetheyhavetheabilitytoshowmovementofinternaltissues,liverfunction,andbloodflow.6 6Ultrasonographyisanoninvasivemedicaltestthathelpsphysiciansdiagnoseandtreatmedicalconditions.Anabdomi

4、nalultrasonographyproducesapictureoftheorgansandotherstructuresintheupperabdomen.What is Abdominal Sonography?7 7ADopplerultrasoundstudymaybepartofanabdominalultrasoundexamination.Dopplerultrasoundisaspecialultrasoundtechniquethatevaluatesbloodasitflowsthroughabloodvessel,includingthebodysmajorarter

5、iesandveinsintheabdomen,arms,legsandneck.What is Abdominal Sonography?8 8What is an Abdominal Sonogram?Anabdominalsonogramcanhelptodiagnoseavarietyofconditionsandtoassessdamagecausedbyillness.Liver,gallbladder,spleen,pancreas,andkidneyswillbeevaluatedduringanabdominalsonogram.Variousreasonsare:abdom

6、inalpain,abnormallabresults,andenlargedabdominalorgans.9 9What is an Abdominal Sonogram?Anabdominalsonographerwillberequiredtoimagesmallbodypartsaswell.Thesepartsinclude:thyroidgland,testicles,breast,andvarioussofttissueofbodyparts.Doctorscanalsouseabdominalsonographytoguidethemastheyperformneedlebi

7、opsiesonabdominalorgans.1010Whataresomecommonusesoftheprocedure?-Kidneys-Liver-Gallbladder-Pancreas-Spleen-AbdominalaortaandotherbloodvesselsAbdominalultrasoundimagingisperformedtoevaluatethe:1111Whataresomecommonusesoftheprocedure?AbdominalpainsAbnormalliverfunctionEnlargedabdominalorganAbnormaliti

8、esintheabdomen:gallstones,livercirrhosis,cyst,tumor,etc.Ananeurysmintheaorta 1212Whataresomecommonusesoftheprocedure?Dopplerultrasoundimagescanhelpthephysiciantoseeandevaluate:Blockagestobloodflow(blood clots/atherosclerotic plaque)Narrowingofvessels(whichmaybecausedbyplaque)Tumorsandcongenitalmalfo

9、rmation血凝块血凝块/动脉粥样硬化斑块动脉粥样硬化斑块1313Whataresomecommonusesoftheprocedure?Guideinvasiveproceduressuchasneedlebiopsyandwithdrawaloffluid1414How would patients prepare?（）wearcomfortable,loose-fittingclothing（）bariumenemaorupperGI(gastrointestinal)tests钡餐灌肠钡餐灌肠 上消化道检查上消化道检查1515Forastudyoftheliver,gallbladd

10、er,spleen,andpancreas,patientmaybeaskedtoeatafat-freemealontheeveningbeforethetestandthentoavoideatingfor8to12hoursbeforethetest.Forultrasoundofthekidneys,maybeaskedtodrink4to6glassesofwateraboutanhourbeforethetesttofillyourbladder.maybeaskedtoavoideatingforeightto12hoursbeforethetesttoavoidgasbuild

11、upintheintestines.Forultrasoundoftheaorta,youmayneedtoavoideatingforeightto12hoursbeforethetest.How would patients prepare?1616Incaseofanemergency,examscanbedonewithoutspecialpreparations.Tellthesonographer,sonologist,orphysicianconductingtheexaminationaboutpain,bleeding,oranyothersymptoms.Tellingth

12、eexamineraboutpastultrasoundsandsurgeriesishelpful,andsometimesprovidescrucialinformation.（重要信息）（重要信息）How would patients prepare?1717Howdoestheprocedurework?Youwillbepositionedonanexaminationtableandmadetoliedownonyourbackandlayyourhandsaboveyourhead.Itmaybecomenecessarytochangepositionsduringtheexa

13、m,andliedownonyoursideorsitup.Alubricatinggel（甘油凝胶（甘油凝胶/耦合剂）耦合剂）isappliedtothepatientsabdominalarea.1818Howdoestheprocedurework?Anapparatusknownasatransducerisplacedontheabdominalareaandmovedaroundtogetrealtimeimages.Sometimesyouwillhavetobreatheinandholdyourbreathaccordingtothetechnologist,sonologi

14、st,orphysiciansinstructions.Examinationsusuallytake10-30minutes.1919n nSmall structure-higher-frequency linear arrayn nAbdomen-curved/linear/arrayn nEchocardiography-sectorn nObstetric&gynecologic-curved arrayInstrumentation2020Whointerpretstheresults?A radiologist,or sonogist2121Whatarethebenefitsv

15、s.risks?Benefitsnoninvasive(noneedlesorinjections)andisusuallypainless.widelyavailable,easy-to-useandlessexpensivethanotherimagingmethods.usesnoionizingradiation.givesaclearpictureofsofttissuesthatdonotshowupwellonx-rayimages.causesnohealthproblemsandmayberepeatedasoftenasisnecessary.providesreal-ti

16、meimaging,makingitagoodtoolforguidingminimallyinvasiveproceduressuchasinjections,needlebiopsiesandneedleaspirationoffluid2222Whatarethebenefitsvs.risks?RisksForstandarddiagnosticultrasoundtherearenoknownharmfuleffectsonhumans.Pregnantwomenandfetusescanbesafelyexamined.2323WhatarethelimitationsofAbdo

17、minalUSG?Ultrasoundwavesaredisruptedbyairorgas;thereforeultrasoundisnotanidealimagingtechniqueforthebowelororgansobscuredbythebowel.Inmostcases,bariumexams,CTscanning,andMRIarethemethodsofchoiceinthissetting.2424WhatarethelimitationsofAbdominalUSG?Ultrasoundwavesdonotpassthroughair;thereforeanevalua

18、tionofthestomach,smallintestineandlargeintestinemaybelimited.Intestinalgasmayalsopreventvisualizationofdeeperstructuressuchasthepancreasandaorta.Largepatientsaremoredifficulttoimagebecausetissueattenuates(weakens)thesoundwavesastheypassdeeperintothebody2525Gallstonesandcholecystitis胆结石，胆管炎胆结石，胆管炎Hep

19、atitis/livercirrhosis肝炎肝炎/肝硬化肝硬化Kidney/Bladderstones肾肾/胆囊结石胆囊结石Hydronephrosis肾积水肾积水Tumors肿瘤肿瘤Cancersoftheliver,kidneys,pancreas,gallbladder,biliarytree癌癌Lymphoma淋巴瘤淋巴瘤Metastasis转移灶转移灶Cysts囊肿囊肿Infections感染感染CommonconditionsrevealedbyAbdominalsonography2626Abscesses脓肿脓肿Appendicitis阑尾炎阑尾炎Enlargedliver,

20、spleen,kidneys,lymphnodes增大增大Pancreatitis胰腺炎胰腺炎Congenitalmalformation先天畸形先天畸形Injury-hematoma,tear,rupture创伤（血肿、撕创伤（血肿、撕裂、破裂）裂、破裂）Hemorrhageoftheadrenalgland肾上腺出血肾上腺出血Abdominalaorticaneurysm腹主动脉瘤腹主动脉瘤Ascites腹水腹水Peritonitis腹膜炎腹膜炎Bowelobstruction肠梗阻肠梗阻Hernia疝气疝气FOUNDATIONS2828SonographicTerminologyDesc

21、riptive terminologyHyperechoic-Hypoechoic(高回声低回声高回声低回声高回声低回声高回声低回声)Isoechoic（等回声）（等回声）Anechoicorsonolucent（无回声）（无回声）Enhancement（回声增强）（回声增强）Heterogeneous-Homogeneous（非均质（非均质（非均质（非均质/均质）均质）均质）均质）Shadowing（声影）（声影）2929HyperechoicHyperechoicshadowingshadowingHypoechoicHypoechoicHyperechoicHyperechoicHypo

22、echoicHypoechoicshadowingshadowing3030HeterogeneousHeterogeneousHomogenousHomogenousAnechoicAnechoicSonolucentSonolucentEnhancementEnhancementIsoechoicIsoechoic3131Sonographic EvaluationThesizeTheechoandattenuationoftheorganParenchyma实质实质Thetexture质地质地Thepresenceofvascularstructures,ligaments,andfis

23、sures裂隙裂隙Abnormality异常异常andmass占位占位3232Thenormalorabnormalimagesofabdominalorgans3333The LiverUltrasoundisoftenthefirstlineofinvestigationforsuspectedliverpathologyandthedecisiontoproceedtosecondaryinvestigativeprocedures,suchasfurtherradiologyorhistology.Ultrasoundisusedinthediagnosis,stagingandmon

24、itoringofliverdisordersandalsocontributestotheirtreatmentwithultrasound-guidedinvasiveprocedures.Developingtechnologyandtechniquesnowresultinimproveddiagnosticaccuracyandareincreasinglyobviatingtheneedforfurtherradiology.Intraoperativeandlaparoscopicultrasound,usinghigh-frequency,direct-contacttechn

25、iques,setthestandardforliverimaginginmanycases.34343535Thesimplecysthasthreeacousticpropertiesanechoichasawell-defined smooth capsuleexhibitsposterior enhancement(increasedthroughtransmissionofsound)肝囊肿肝囊肿肝囊肿肝囊肿hepaticcysthepaticcyst3636肝血管瘤肝血管瘤HepatichemangiomaSmallsolitaryormultiplenodularlesionRo

26、undedwell-definedHyperechoicmassUsuallynotvisualizecolourflow3737术语TermsThis term describes the effect of a focal mass,whether benign or malignant,on surrounding structures and is a useful diagnostic tool.It implies the lesions displacing or invasive nature,i.e.the displacement of vessels and/or inv

27、asion or distortion of adjacent structures and tissues as a result of the increasing bulk of a lesion.This effect differentiates a true mass from an infiltrative process占位效应Mass effect38383939Benign hepatic tumorsBenign hepatic tumors hemangiomahemangioma,hepatocellular adenomahepatocellular adenoma

28、,hepatic cystadenomahepatic cystadenoma,FNHFNH(focal nodular focal nodular hyperplasiahyperplasia)etc.)etc.Malignant tumorsMalignant tumors hepatocarcinoma,hepatocholangiocarcinomahepatocarcinoma,hepatocholangiocarcinoma,metastasesmetastases,lymphoma lymphoma etc etc Hepatic tumors4040n nTypes massi

29、ve type nodular type diffusely infiltrating type n nVascularinvasionPathologyPrimary CarcinomaHepatic tumorsHepatic tumors4141EchoicpatternEchoicpatternSonographictypesSonographictypesInvasionInvasionColorDopplerFlowColorDopplerFlowImageImageUSG FeatureUSG FeatureHepatic tumorsHepatic tumors4242hype

30、rechoichypoechoichypoechoicisoechoic434344444545VIDifferentialDiagnosesn nCystn nHemangioman nMetastasesPrimary Carcinoma4646ClinicalFindingsClinicalFindingsUSGFindingsUSGFindingsHemangiomaN/ASolitaryormultipleRoundorovalWell-definedborderHyperechoic（mostparts）ColorflowPrimaryCaPrimaryCa80%HCC80%HCC

31、70%70%HCCAFPHCCAFP AbnormalLFTsAbnormalLFTsSolitaryormultipleInfiltrative,diffuseHypoechoic,isoechoic,hyperechoicPortalveins/hepaticveinsinvadedthrombusMetastasesMetastases转移性肝癌转移性肝癌转移性肝癌转移性肝癌AbnormalLFTsAbnormalLFTsSolitaryormultipleWell-,ill-definedHypoechoicorhyperechoicDiffusedistortionofbullsey

32、epattern4747hemangiomaSimple hepatic cyst48484949hyperechoichypoechoichypoechoicisoechoicHepaticcarcinoma5050Metastatictumor5151USG-Guided Liver Biopsy Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue,which can be examined under a microscope to help identify the c

33、ause or stage of liver disease.5252ThegallbladderUltrasoundisanessentialfirst-lineinvestigationinsuspectedgallbladderandbiliaryductdiseaseItishighlysensitive,accurateandcomparativelycheapGallbladderpathologyiscommonandisasymptomaticinover13%ofthepopulation5353Therearethreeclassicacousticpropertiesas

34、sociatedwithstonesinthegallbladder;theyarehighly reflective,mobile andcastadistal acoustic shadow.Inthemajorityofcases,allthesepropertiesaredemonstrated5454Reflectivity（hyperechoic）ShadowingMobilitySupine viewerect view5555ThepancreasBecausethepancreasliesposteriortothestomachandduodenum（十二指肠）（十二指肠）

35、,avarietyoftechniquesmustusuallybeemployedtoexamineitfully.Althoughultrasoundmaystillbeconsideredthefirstlineofinvestigation,CT,MRIand/orendoscopicretrogradecholangiopancreatography(ERCP内窥镜逆行胰胆管造影内窥镜逆行胰胆管造影)arefrequentlyrequiredtoaugmentandrefinethediagnosis.5656AcutepancreatitisMildacutepancreatitismayhavenodemonstrablefeaturesonultrasound,especiallyifthescanisperformedaftertheacuteepisodehassettled.Inmoreseverecasesthepancreasisenlargedandhypoechoicduetooedema.Themainductmaybedilatedorprominent.5757Necrotictailofpancreassurroundedbyexudatehypoechoicandbulky