医学影像5.doc

医学影像学Medical Imageology一、课程简介医学影像学是指应用一定的条件，如设备、材料和技术等，使人体的正常解剖结构和病变形成图像，再运用这些图像资料进行疾病诊断和治疗的一门新兴的发展迅速的临床医学学科。随着科技的日新月异，医学影像学的范畴不断扩大，在传统的X线诊断技术、超声学和核医学的基础上，又相继出现CT、MRI、DSA等新的影像技术。与此同时，医学影像学突破以往只限于诊断的局面，开辟了以介入放射学为代表的影像治疗新领域，使医学影像学发展成为集诊断和治疗为一体的独立的临床医学学科。本教学大纲适用于七年制临床医疗专业，系考试课。因此，本学科的教学将以X线、CT、MRI等影像学技术的基本原理、基本知识、基本技能为主，着重于各系统基本病变的影像学表现和常见疾病的影像征象分析和诊断，并注意培养学生的临床实践和创新思维的能力。本学科目前采用第1版医学影像学（张雪林主编，人民卫生出版社）作为教材。共65学时，理论与实习基本按3：1分配。为3学分。二、教学(实验)内容与要求第一章 总 论要求与内容第一节 X线成像1熟悉X线产生的原理以及X线成像的基本原理。2掌握X线的特性：穿透作用、荧光作用、感光作用、电离作用、生物效应。3全面了解各种X线检查技术的应用原理、优缺点、适应症和注意事项。4熟悉造影检查的方法以及造影剂的分类、应用。5了解X线防护的措施及其具体内容。6熟悉X线诊断的新进展CR、DR的基本原理、优势以及临床应用。第二节 数字减影血管造影（DSA）了解DSA的基本设备、基本原理和成像方式；熟悉DSA的优点、各钟造影方法的选择原则以及在介入放射学中的应用。第三节 计算机体层摄影（CT）1熟悉CT成像的基本概念、成像原理和CT机的基本结构。2了解CT机的分代，熟悉CT设备和技术的进展，尤其是螺旋CT的优势，并熟悉各种CT图像后处理技术的临床应用。3熟悉CT检查方法以及其临床应用。第四节 磁共振成像（MRI）1熟悉MRI基本结构、成像原理以及各种序列脉冲的优势与应用。2了解MRI新技术（MRA、MRS、DWI、PWI、fMRI）及其临床应用。3了解MRI对比剂的机制、分类和临床应用。第五节 超声检查1 熟悉超声仪器及图像的基本概念，了解各型超声仪的工作原理。2 了解各型超声仪的临床应用价值。第六节 图像存档和传输系统与信息放射学了解PACS的定义、基本原理、组成部分和临床应用。第七节 影像诊断原则与诊断步骤掌握解诊断的原则与步骤，熟悉影像阅片的方法及程序。Chapter One OverviewTeaching contents and requirementsSection One X-ray imaging1. acquaint with principles of X-ray production and image formation2. grasp of X-ray characters :penetration effect, fluorescence effect, sensitization effect, ionization effect, biological effect.3. understand all kinds of X-ray technology, including application principles,advantages and disadvantages,indications and announcements4. acquaint with opacification process,as well as contrast mediums classifications and applications5. understand X-ray protection measures and its details6. acquaint with new diagnostic progress, such as CR&DR and its corresponding basic principles , superiority and clinical applications Section Two Digital substraction angiography (DSA)Comprehend of its foundmental equipments,basic principles and imaging methods; familiar with its dominance and selecting principles of various contrast medium, as well as its applications in the intervention radiography.Section Three Computed tomography (CT)1. familiar with its basic concept, imaging principal and elementary structure of CT units.2. comprehend with generations of CT units ; familiar with the developments of CT sets and technology, especially the dominance of Spiral CT, and acquaint with all kinds of the clinical applications of CT images post-processing techniques3. familiar with CT examination methods and its corresponding clinical applicationsSection Four Magnetic resonance imaging (MRI)1. familiar with its elementary structures, imaging principles, dominances and applications of various kinds of sequence and square pulse2. understand new MRI techniques (MRA,MRS,DWI,PWI,FMRI) and its clinical applications3. understand MRI contrast mediums mechanism, classification, and its clinical applicationsSection Five Ultrasound imaging1. familiar with the basic conceptions of ultrasound equipments and images; understand working principles of all types of ultrasound device2. understand clinical values of various types of ultrasound deviceSection Six Picture archiving and communication system (PACS) Understand its definitions, rudiments, ingredients and its clinical applicationsSection Seven Principles and procedures of Imaging Diagnostics Handle principles and procedures of imaging diagnostics; familiar with methods and procedures of reading films第二章 中枢神经系统目的与要求1. 了解颅脑和脊髓的检查方法。2. 熟悉颅脑和脊髓的X线、CT和MRI正常解剖。3. 掌握颅脑和脊髓的基本病变的影像学表现，尤其CT、MRI表现。4. 掌握常见颅内肿瘤、脑血管疾病、外伤、常见感染性疾病的影像学表现。5. 熟悉脊髓疾病的影像学表现。教学内容第一节 检查方法1. 颅脑 （1）X线检查：平片、血管造影。（2）CT检查：平扫、增强、CTA以及CT灌注扫描。（3）MRI检查：侧重常规序列的讲解，简单介绍功能成像。2. 脊髓 （1）X线平片：常规正侧位。（2）脊髓造影：了解适应症。（3）CT检查：平扫、增强以及脊髓造影CT（CTM）。（4）MRI检查：侧重常规序列的讲解，简单介绍MR脊髓成像（MRM）。第二节 正常影像解剖1. 头颅平片的正常表现和变异，侧重讲述颅缝、囟门、颅壁压迹、蝶鞍的表现。2. 颅脑CT、MRI横断面正常表现。3. 脊髓CT、MRI正常表现。第三节 基本病变的影像学表现1. 颅脑 （1）平片：侧重讲解颅内压增高、颅内肿瘤定位征象。（2）CT和MRI：分别讲解颅内病变的病灶显示、强化表现、脑水肿、占位效应、脑积水和脑萎缩的表现。2. 椎管内肿瘤 简单介绍X线平片和脊髓造影的表现。第四节 颅内肿瘤1. 神经胶质瘤：熟悉星形细胞瘤、少突胶质细胞瘤和髓母细胞瘤的临床和病理表现，掌握其CT和MRI征象。2. 脑膜瘤：熟悉其临床和病理表现，掌握CT和MRI征象。3. 垂体腺瘤：了解其分类和临床表现，掌握微腺瘤和大腺瘤的CT和MRI特点。4. 颅咽管瘤：熟悉其好发部位、病理特点以及CT、MRI诊断依据。5. 生殖细胞瘤：熟悉其好发部位、病理特点以及CT、MRI诊断依据。6. 听神经瘤：熟悉其病理改变，掌握CT和MRI表现，了解桥小脑角占位的鉴别诊断。7. 血管母细胞瘤：了解其病理特点，熟悉CT和MRI表现。8. 脑转移瘤：熟悉其临床和病理表现，掌握CT和MRI特点。第五节 脑血管疾病1. 脑梗死：结合动脉性脑梗死后的病理生理改变，重点掌握常规CT和MRI表现；熟悉腔隙性脑梗死和出血性脑梗死的CT和MRI诊断要点。2. 脑出血：结合脑出血不同时期的病理改变，着重讲述常规CT和MRI表现。3. 结合病例，熟悉蛛网膜下腔出血、动静脉畸形、动脉瘤的CT、MRI、DSA的表现。第六节 颅脑外伤1. 硬膜外血肿：了解本病的发生机理、病理改变，掌握其CT和MRI表现。2. 硬膜下血肿：了解本病的发生机理、病理改变，掌握其CT和MRI表现。3. 脑挫裂伤：了解本病的发生机理、病理改变，掌握其CT和MRI表现。4. 弥漫性轴索损伤：自学。第七节 颅内感染性疾病1. 化脓性脑脓肿：了解发病机制、病理表现，掌握其CT、MRI典型表现。2. 颅内结核：熟悉CT、MRI表现。3. 病毒性脑炎：自学内容。4. 脑囊虫病：自学内容。第八节 脱髓鞘疾病 本节简单介绍多发性硬化的影像学表现。第九节 颅脑先天性畸形及发育障碍 本节为自学内容。第十节 脊髓疾病 结合病例，介绍常见的脊髓内肿瘤（室管膜瘤、星形细胞瘤）、髓外硬膜下肿瘤（神经鞘瘤、神经纤维瘤、脊膜瘤）的CT和MRI表现。脊髓损伤、脊髓空洞症为自学内容。实验内容与要求通过示教片了解中枢神经系统的平片、造影检查、CT和MRI检查方法。通过示教片熟悉颅脑和脊髓平片、CT和MRI正常影像；熟悉颅脑和脊髓异常表现。通过示教片掌握神经胶质瘤、脑膜瘤、垂体腺瘤、听神经瘤、脑转移瘤、脑梗死、脑出血、颅脑外伤、化脓性脑脓肿、脊髓内肿瘤、髓外硬膜下肿瘤的影像学表现。熟悉颅咽管瘤、生殖细胞瘤、血管母细胞瘤、蛛网膜下隙出血、动静脉畸形、动脉瘤、颅内结核、脊髓空洞症的影像学表现。教学时数分配理论课学时分配章节理论课内容学 时第二章第一节第二节检查方法颅脑正常影像表现脊髓正常影像表现1第二章第三节颅脑基本病变的影像学表现椎管内肿瘤的基本影像学表现1第二章第四节颅内肿瘤：侧重讲解神经胶质瘤、脑膜瘤、垂体腺瘤、听神经瘤、脑转移瘤；简单介绍颅咽管瘤、生殖细胞瘤、血管母细胞瘤11第二章第五节脑血管疾病：重点讲解脑梗死、脑出血；简单介绍蛛网膜下隙出血、动静脉畸形、动脉瘤11第二章第六节颅脑外伤：重点讲解硬膜外血肿、硬膜下血肿和脑挫裂伤1第二章第七节颅内感染性疾病：重点讲授化脓性脑脓肿，简单介绍颅内结核、病毒性脑炎1第二章第八节第十节脱髓鞘疾病：简单介绍分类和多发性硬化脊髓疾病：重点讲解椎管内肿瘤1总学时9实验课学时分配序号实习课内容实验类型学时1读片内容：颅脑、脊髓正常表现：基本病变；颅内肿瘤的影像学表现演示性22读片内容：脑血管疾病、脑外伤、脑感染性疾病以及脱髓鞘疾病；椎管内肿瘤演示性2总学时4思考题1颅内压增高的X线诊断？2星形细胞瘤的组织学分级和CT、MRI表现？3脑膜瘤的CT和MRI诊断要点？4垂体大腺瘤的MRI表现？5常见的桥小脑角区肿瘤的CT和MRI鉴别诊断？6缺血性脑梗死的CT和MRI表现？7不同时期脑出血的MRI信号特点？8硬膜外血肿和硬膜下血肿的CT鉴别诊断？Chapter 2 Central nervous systemRequirement1.Comprehend examination methods for brain and spinal cord.2.Conversant with normal anatomy appearance of brain and spinal cord in x-ray, CT and MRI. 3.Master image appearance of basic disease in brain and spinal cord, especially CT and MRI ones.4.Master image appearance of common intracranial tumors, cerebrovascular disease, trauma and common infective disease.5.Conversant with image appearance of spinal disease.Teaching ContentSection 1 Examination method1.Brain 1）x-ray: plain film and angiography(comprehend) 2）CT: all examination technique (comprehend) 3）MRI: emphasize on conventional sequence and simply present functional MRI2. Spine 1）X-ray plain film：posterior-anterior and lateral position is routine. 2）Spinal myelography 3）CT：plain scan, contrast scan and CT myelography(CTM)；4）MRI：emphasize on conventional sequence and simply present MR myelography.Section 2 Normal imaging anatomy1. Normal appearance and variance in skull plain film ,emphasis on cranial suture, fontanelles, impression of cranial bone and sella turcica 2. CT and MRI sectional anatomy of brain 3. Normal appearance of spinal cord in CT and MRISection 3 Image appearance of basic disease1. Brain 1）Plain film: location symptom of increased intracranial pressure and brain tumors. 2）CT and MRI：displaying lesions, enhancement appearance, cranial edema, common mass effect, hydrocephalus and brain atrophy.2. Intraspinal tumors Comprehend image appearance of x-ray film and myelography. Section 4 Intracranial tumors1.Gliomas：Master main manifestation of astrocytoma, oligodendroglioma and medulloblastoma in CT and MRI after be familiar with their clinic and pathologic findings. 2.Meningioma：Master main sign in CT and MRI after be familiar with their clinic and pathologic findings. 3.Pituitary adenoma：First comprehend its class and clinic findings and then master main characteristics in CT and MRI. 4.Craniopharynioma：Be familiar with its common position, pathologic characteristics and diagnosis points in CT and MRI. 5.Germinoma：Be familiar with its common position, pathologic character and diagnosis points in CT and MRI. 6.Acoustic neurinoma：Be familiar with its pathologic characteristics,master CT and MRI manifestation, and then comprehend differentiating diagnosis of tumors in cerebral-pontinal angle area. 7.Hemangioblastoma：Comprehend its pathologic character and know well CT and MRI findings. 8.Metastatic tumors：Be familiar with its clinic and pathologic findings and master its CT and MRI character. Section 5 Cerebrovascular disease1.Cerebral infarction: Combining physiologic pathology of cerebral ischemia resulting from thrombosis of cerebral artery, emphase on conventional image appearance, and then know well diagnostic points of lacunar infarction and hemorrhagic infarction in CT and MRI scans. 2.Cerebral hemorrhage: Combining pathological variation in different periods, emphase on image appearance of CT and MRI. 3.Combining cases, introduce characteristics about subarachnoid space hemorrhage, arteriovenous malformation and intracranial aneurysm in CT MRI and DSA. Section 6 Injury of skull and brainCombining pathogenisis with pathology, introduce image appearance especially the CT scans of epidural hematoma, subdural hematoma and contusion and laceration of brain.Section 7 Intracranial infective disease1Cerebral abscess：Master typical image appearance of in CT and MRI 2Cranial tuberculosis： Be familiar with CT and MRI manifestation.Section 8 Demyelinating diseaseIntroduce simply the imaging appearance of multiple sclerosis. Section 9 Cranial congenital malformationSelf-culture.Section 10 Spinal cord diseaseCombining cases, introduce characteristics about ependymatoma, astrocytoma, neurinoma, neurofibroma and meningioma in CT and MRI. Experiment Content and RequirementUnderstanding imaging methods by reading film.Understanding the normal manifestations and basic abnormal findings of brain and spine in plain film, CT and MRI by reading film.Mastering the imaging findings of glioma, meningioma, pituitary adenoma, acoustic neurinoma, metastatic tumors, infarction, hemorrhage, trauma, abscess, intraspinal tumors and subedrual tumors by reading film. Being familiar with craniopharynioma, germinoma, hemangioblastoma, sudarachnoid hemorrhage, aterio-venous malformation, aneurysm, tuberculosis and syringomyelia by reading film.Course planTheory lessonChapterContentsTimeTwo -One- TwoImaging methodsNormal imaging anatomy of brain and spine1Two Two-ThreeBasal abnormal appearance of brain and spine1Two- FourCranial tumors: glioma, meningioma, pituitary adenoma, acoustic neurinoma, metastatic tumors 2Two - Fivecerebrovascular diseases: cerebral infarction, hemorrhage2Two - SixBrain trauma: epidural hematoma, subdural hematoma, laceration and contusion of brain1Two - SevenCranial infective diseases: brain abscess 1Two - Eight - TenDemyelinating diseases: Multiple sclerosisSpinal diseases1All together9Experiment lessonNumberContentsCategoryTime1Reading films contents: Normal imaging anatomy and basal abnormal appearance of brain and spine, cranial tumorsDemonstrating22Reading films contents: cerebrovascular diseases, brain trauma, Cranial infective diseases, Demyelinating diseases and Spinal diseasesDemonstrating2All together4Questions1 What is the location symptom of increased intracranial pressure in X-ray plain film?2 What is the histological classification and CT and MRI appearance of astrocytoma? 3What is the diagnostic point of meningioma in CT and MRI?4What is the MRI findings if pituitary adenoma?5What is the differentiating diagnosis of common tumors in cerebral-pontinal angle area?6What is the typical manifestation of ischemia infarction in CT and MRI?7Combining pathological variation in different periods, present MRI intensity characteristics? 8Differentiating diagnosis between epidural and subdural hematoma in CT?第三章 头颈部目的与要求1. 了解眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部的常规检查技术。2. 了解眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部的正常解剖。3. 熟悉眼、鼻与鼻窦、咽部、喉部、耳、口腔颌面部以及颈部常见疾病的影像学表现，如眼眶异物、鼻窦炎、鼻咽癌、喉癌、中耳乳突炎、颈淋巴结肿大、甲状腺肿瘤。教学内容此章节的讲授可根据课时实际安排灵活掌握，以了解和自学为主，不做硬性统一安排。Chapter 3 Head and neckRequirement1）Comprehend conventional examination technique of eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck; 2）Comprehend normal anatomy of eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck; 3）Familiar with image appearance of common disease in eyes, nose, nasal sinus, pharynx, larynx, ear, oromaxillary part and neck, such as ocular foreign body, nasal sinusitis, nasopharyngeal carcinoma, laryngeal cancer, otomastoiditis, enlargement of cervical lymph nodes and thyroid tumors.ContentNo compulsory arrangement for this chapter, flexible schedule is allowable according to active teaching.第四章 呼吸系统目的与要求1了解呼吸系统的各种影像检查方法。2熟悉胸部正常的X线、CT和MRI表现以及正常变异。3掌握呼吸系统各种基本病变的X线表现和CT表现。4掌握支气管扩张、肺部炎症、肺脓肿、肺结核和原发性肺癌的X线和CT表现。5熟悉常见的纵隔原发肿瘤的影像学表现。教学内容第一节 检查方法1X线检查：平片、透视、体层摄影、支气管造影。2CT检查：CT平扫、高分辨CT、螺旋CT、CT增强扫描。3MRI检查：应用于呼吸系统的检查序列。第二节 正常影像解剖一、正常X线表现 1. 胸廓的影像表现：软组织与骨骼。2. 气管和支气管：左右支气管的分支名称及不同点。3. 肺：肺野概念及划分，肺叶和肺段。4. 肺门：构成及正侧位表现，胸膜及叶间裂。5. 纵隔与横膈：位置、分区及正常表现。二、正常CT表现 胸壁、胸膜、支气管、肺动静脉、肺门及膈肌，重点纵隔各层面的表现。三、正常MRI表现第三节 基本病变的影像表现一、 X线表现 1支气管阻塞改变：阻塞性肺气肿（局限性和广泛性）、阻塞性肺不张。2肺部病变：渗出性病变、增殖性病变、纤维化、钙化、空洞性病变、空腔、结节和肿块。3肺门的改变：肺门增大或缩小，肺门移位。4胸膜病变：胸腔积液（游离性、限局性），气胸与液气胸，胸膜肥厚、粘连及钙化，胸膜肿瘤。5纵隔的改变：形态的改变（注意纵隔肿瘤），位置的改变（纵隔摆动）。6膈的改变：形态、位置与运动的改变（矛盾运动）。二、CT表现 1. 气管和支气管病变：管腔内肿物、管腔狭窄和梗阻、管壁增厚和管腔增宽。2. 肺部病变：结节及肿块，空洞和空腔病变，肺叶、肺段病变（肺实变及肺不张），弥漫性肺间质纤维化，弥漫性肺泡病变，多发性小结节及粟粒病变、肺气肿，肺门肿块，胸膜病变及膈病变。第四节 支气管疾病一、支气管扩张症 介绍病理、分型及临床表现，重点为X线和CT表现。二、气管、支气管异物 气管、支气管异物引起的病理改变及X线、CT表现。第五节 肺部疾病一、肺部炎症 1. 大叶性肺炎：病理分期、临床表现，各期的X线与CT表现（含气支气管影）。2. 支气管肺炎：病理改变、临床表现，重点为X线表现。3. 病毒性肺炎：病因、病理及临床表现，主要的X表现。4. 支原体肺炎：病理及临床，X线表现及诊断要点。5. 过敏性肺炎：病因及临床特点，X线与CT表现特点。6. 肺脓肿：感染途径、病理改变及临床表现，X线与CT表现（空洞特点与鉴别）。二、肺结核 肺结核的基本病理改变与转归、临床表现，肺结核的分期，肺结核新旧分类法的区别；着重讲述原发型肺结核、血行播散型肺结核、浸润型肺结核、慢性纤维空洞型肺结核以及结核性胸膜炎的X线、CT表现；并强调对结核球与周围性肺癌、结核性空洞与癌性空洞的鉴别诊断与分析。三、肺部肿瘤 1. 良性肿瘤：重点讲述肺错构瘤的概念、病理、分型，以及其X线和CT表现。2. 支气管肺癌：病理组织学类型、大体病理形态的分型及其生长方式特点，早期肺癌的标准，肺癌的临床表现。着重中心型肺癌和周围型肺癌的X线与CT表现及鉴别；适当介绍MRI表现及弥漫型肺癌影像表现。3. 肺转移瘤：发生途径与机理，X线与CT表现特点。四、支气管及肺部外伤 1气管及支气管外伤。2肺部外伤：肺挫伤、肺撕裂伤和肺血肿。第六节 胸膜病变一、胸膜肿瘤 胸膜间皮瘤的分型、病理改变及X线与CT表现。二、胸膜损伤第七节 纵隔疾病一、纵隔气肿与血肿二、纵隔肿瘤、囊肿和肿瘤样病变 1. 胸内甲状腺肿：X线与CT表现特点。2. 胸腺瘤：病理分型及X线与CT表现，注意鉴别诊断。3. 畸胎类肿瘤：囊性和实性畸胎瘤的X线与CT表现特点。4. 淋巴瘤：中纵隔最常见恶性肿瘤，分两种类型，其X线与CT表现及鉴别。5. 神经源性肿瘤：后纵隔最常见肿瘤，其X线与CT表现，MRI检查的价值。6. 纵隔囊肿：淋巴管囊肿、支气管囊肿、心包囊肿等主要特点及影像学表现。实验内容与要求1通过典型X线和CT示教片及必要的解剖模型辨认和熟悉胸廓的软组织与骨骼，支气管与肺野，肺门与纵隔等的X线与CT正常的表现。2通过示教展示和讲解大量典型的肺部X线与CT教学片，并适当配合CAI课件，着重学习和掌握：支气管阻塞的改变（阻塞性肺气肿、肺不张）；肺部的基本病变（渗出性病变、增殖性病变、纤维化、钙化、空洞性病变、空腔、结节和肿块、弥漫性肺间质纤维化）、胸膜病变（胸腔积液、气胸与液气胸，胸膜肥厚、粘连及钙化，胸膜肿瘤）等的基本征象，并要求懂得其征象的病理基础。3通过X线和CT教学片学习支气管扩张症、大叶性肺炎、支气管肺炎、过敏性肺炎、肺脓肿和各种肺结核病的影像学表现与诊断，注重培养同学独立认征和分析诊断的能力，适当以一些典型病例组织讨论和讲评；注意结核球与周围性肺癌，结核性空洞、肺脓肿与癌性空洞等的鉴别诊断。4以各种类型丰富的教学片介绍肺良性肿瘤中肺错构瘤和肺恶性肿瘤支气管肺癌的X线和胸膜间皮瘤的CT表现，要求熟练掌握其影像诊断与鉴别，并对弥漫型肺癌、肺转移瘤和的X线与CT表现有所了解。5通过教学片（CT为主、X线为辅）学习和掌握常见的纵隔肿瘤如胸腺瘤、畸胎类肿瘤、淋巴瘤、神经源性肿瘤以及淋巴管囊肿和支气管囊肿、心包囊肿的影像学表现。教学时数分配（一）理论课学时分配章节理论课内容学时第四章 第一节检查方法：介绍常规X线、CT及MRI检查技术与应用0.5第四章 第二节胸部主要结构的X线表现、CT表现，适当介绍MRI表现1.5第四章第三节重点讲解支气管、肺脏和胸膜基本病变的X线、CT表现，适当介绍MRI表现。2第四章第四五节适当介绍支气管扩张影像学表现，重点介绍主要肺部炎症、肺结核及肺良、恶性肿瘤的影像学表现（以X线、CT为主）3第四章第六七节适当介绍胸膜的病变影像学表现，重点讲解纵隔内常见肿瘤的影像学表现与诊断。简单总结2总学时9（二）实验课学时分配序号实习课内容实验类型学时1影像检查方法；胸部主要结构正常X线与CT表现；支气管、肺与胸膜的X线与CT基本征象；支气管扩张及常见肺炎的X线、CT诊断演示性22肺结核、肺肿瘤、胸膜常见病变及常见纵隔肿瘤的X线与CT诊断演示性或设计性2总学时4思考题1各种影像学技术方法在胸部的应用价值。2X线与CT检查在胸部正常结构的显示中的优缺点。3支气管阻塞的后果及病理机制。4肺脏常见的基本病变的病理改变及相应的X线与CT表现特点。5常见肺炎的X线与CT诊断。6各型肺结核的特点及影像学表现。7肺错构瘤与各型肺癌的影像学表现与鉴别诊断。8常见纵隔肿瘤及囊性病变的X线与CT诊断。Chapter 4 Respiratory systemObjective and requirement1. Comprehend the imaging examination methods of respiratory system. 2. Familiar with the normal appearance of thorax and its normal variation in X-ray, CT and MRI. 3. Master the X-ray and CT manifestation of basic pathological changes in respiratory system. 4. Master the X-ray and CT manifestation of bronchiectasis, pneumonia, lung abscess, pulmonary tuberculosis and primary bronchogenic carcinoma. 5. Familiar with the imaging manifestation of common primary mediastinal tumors.Content of coursesSection 1 Examination methods1. X-ray: radiography, fluoroscopy, tomography, bronchography. 2. CT: plain scan, high resolution CT, spiral CT scan, contrast enhancement scan. 3. MRI: sequences applied to respiratory systemSection 2 Normal imaging anatomy1. Normal X-ray manifestationa. thorax: soft tissue and skeleton. b. trachea and bronchus: branches of dexter bronchus and sinister bronchus and their difference. c. lung: concept and division of lung field, lobes and segments of lung. d.hilar shadow: component and appearance in the anterioposterior and lateral film, pleura and fissura. e. mediastinum and diaphragm: location, zonation and normal appearance.2. Normal CT manifestationchest wall, pleura, bronchus, pulmonary artery and vein, hilus and diaphragm, lay stress on the normal appearance of mediastinum in each slice.3. Normal MRI manifestationSection 3 Imaging manifestation of basic pathological changes1. X-ray manifestationa. changes of bronchial obstruction: obstructive emphysema (limited and extensive), obstructive atelectasis. b. pulmonary lesions: exudation, proliferation, fibrosis, calcification, cavity, air containing space, node and mass. c. hilar changes: hilar enlargement and shrinkage, shift of hilus. d. pleural lesions: pleural effusion(localized and free), pneumothorax and hydropneumothorax, pleural thickening, adhesion and calcification, pleural tumor. e. mediastinal changes: shape of mediastinum(pay attention to mediastinal tumor), location of mediastinum (pendular movement of mediastinum). f. diaphragm changes: shape, location and movement(paradoxical movement).2. CT manifestationa. changes of trachea and bronchus: mass in th