肝脏解剖与常见病影像诊断ppt课件

TheHepaticLesion RadiologicAssessmentTheAffiliatredhospitalofNBUWangJIANHUAwoxingw 2014 12 29 CASE Objectives NormalliveranatomyImagingtechniquesCommondiseasesimagingdiagnosisDiffusediseasesFocaldiseases Anatomyoftheliversegments Twodifferentaspects morphologicalanatomyandfunctionalanatomy C Couinaud 1957 dividedtheliverintoeightfunctionallyindepedentsegments Thisclassificationwillbepresentedherewithseveralillustrations Couinaudclassification Dividestheliverintoeightfunctionallyindepedentsegments Eachsegmenthasitsownvascularinflow outflowandbiliarydrainage Inthecentreofeachsegmentthereisabranchoftheportalvein hepaticarteryandbileduct Intheperipheryofeachsegmentthereisvascularoutflowthroughthehepaticveins Righthepaticveindividestherightlobeintoanteriorandposteriorsegments Crosstransverse Portalveindividestheliverintoupperandlowersegments Middlehepaticveindividestheliverintorightandleftlobes orrightandlefthemiliver Thisplanerunsfromtheinferiorvenacavatothegallbladderfossa Lefthepaticveindividestheleftlobeintoamedialandlateralpart Theimageonthefarleftisattheleveloftherightportalvein Atthisleveltherightportalveindividestherightlobeoftheliverintosuperiorsegments 7and8 andtheinferiorsegments 5and6 Theleveloftherightportalveinisinferiortotheleveloftheleftportalvein Atthelevelofthesplenicvein whichisbelowtheleveloftherightportalvein onlytheinferiorsegmentsareseen rightimage Counterclockwise 1Caudatelobe Segment1 2Leftlateraluppersagment 8Rightanterioruppersagment 4Leftmedialsagment 7Rightposterioruppersagment Leftlateraluppersagment Leftlaterallowsegment Leftmedialsegment Rightposterioruppersegment Rightanteriorupperdegment Rightanteriorlowdegment Rightposteriorlowsegment Liveranatomy Imagingtechniques US firstchoice screening difficulttocharacterizethelesions CT importanttechniqueMRI problemresolvingtechnique Goodmethodsofdecidingpositionandpredictingthenatureofthemass CTtechniques CTenhancedtechniques Theliverhasadualbloodsupplyfromthehepaticarteryandportalvein Hepaticartery 1 3Portalvein 2 3 3minutes Whydoweneedmultiple phaseenhancdment Increasethecontrastbetweennormalparenchymaandthelesionsothatincreasethedetectionrate Understandingthecharacteristicsofbloodsupplyandspeculatingthepathologicalchangesforthequalitativediagnosis CASE Multiple phaseenhancement MRIadvantages MRIisoftenusedasaproblem solveingtechniquetogiveadditionalinformationtoUSandCTExcellenttechniquefoedemonstratingtumoursImagescanbeobtainedincoronalandsagittalplanesIntravenuouscontrastisusedtoimprovevisualizationandhelpcharccterizelesions Newliver specificagents Sometakenbythehepatocytessomebythereticuloendothelialcell MRI MRCP Multiple phaseEnhancement Arterialphase Equilibriumphase Delayedphase90min Multihanceliver specificagents specificallytakenbythehepatocytes Portalveinphase Hepatocarcinomacan ttaketheagent multihance Commonliverdiseasesimaging Diffusediseases fattyliver cirrhosisFocaldiseases Benign Livercyst absecess hemangiomaFocalnodulehyperplasia FNH adenomaMalignant heptocellularcarcinomacholangiocarcinomametastasistumors Fattyliver RelativelyfrequentfindingHypercholesterolaemiaobesityordiabetes alcoholaddictandpatientsonchemotherapyorhormonotherapyDiffuseorlocalFattyinfiltrationleadstoareductionintheattenuationoftheaffectedparenchymacausinglowdensityonCTscans 局灶性脂肪肝 Fattyliver Cirrhosis Pathology Livercelldegenerationandnecrosis extensivefibrosisnodularregeneration liverstructureandbloodcirculationsystemreconstructionImagingFeatures Xray esophagus thebottomofthestomachvarices CT MRIfindings 1 Shapemorphology hepatomegaly atrophic liverloberatiochange outerconcavecontour parenchymalnodularregeneration2 Density Inhomogeneousattenuation3 ContrastEnhancement CE inhomogeneousdegreeofenhancement intrahepaticarterioportalfistulas4 Extrahepaticfindings varices scites splenomegaly 5 Thedifferentialdiagnosis Hepatocellularcarcinoma HepaticCyst CT MRIFeaturesRoundandquasi circularSharpdemarcatationNonenhancingUniformdensityorsignalCT lowdensity waterdensity0 15HU T1WI verylowsignalintensityT2WI veryhighsignalintensity HepaticCyst HepaticAbscess BacterialandamebicliverabscessPathology Pus Necrosis Fibertissue InflammatorycellsinfiltrationEdemaImagingFeaturesSingleormultiplelowdensitylesionRoundorovalCircumferential s k mf ren l wall enhancementfluildorgas fluidlevelMRI T1WI hypo intensityT2WI hyper intensity Targetsign Targetsign Aftertreatment Hemangioma Pathology BenignlesionCavernoushemangioma mostly capillary hemangioendotheliomaAtypeofbloodvesselmalformation hemangioma thathasrelativelylargeblood filledspaces cavities Nocontaintissueoftheorganinwhichtheyaresituated ImagingFeatures Singleormultiplelowdensitylesion CTvalue 30 40HU Roundoroval Sharpmargin nocapsuleContrast earlyperipheralnodularenhancement graduallyfillinginovertimeMRI T1WI hypo intensityT2WI hyper intensity Hemangioma Hemangioma FNH影像特征 平扫密度信号与肝实质接近强化明显内部瘢痕假包膜少见 肝腺瘤Hepatocelluaradenoma 女 18岁 增强 强化明显 男 22岁 易出血 女性 23岁 MRI扫描 征象 包膜 脂肪 肝细胞癌 我国最常见的恶性肿瘤之一发病率居恶性肿瘤的第2或第3位恶性程度高 5年生存率低于5 肝细胞癌 中国85 左右的HCC与病毒性肝炎肝硬化有关10 的中国人感染乙型肝炎病毒日本70 左右的HCC与丙型肝炎有关美国30 50 左右的HCC与丙型肝炎有关 肝细胞癌 大体病理分型块状型直径大于5厘米 大于10厘米为巨块型结节型癌结节直径小于5厘米 单发或多发弥漫型癌结节小 弥漫分布小肝癌单发结节小于3厘米 或2个病灶直径之和小于3厘米 肝细胞癌 临床表现右上腹痛消瘦乏力 进行性加重腹胀 腹泻 恶性 纳差黄疸发热AFP升高 400ug L 持续4周以上 除外妊娠 活动性肝炎或生殖细胞肿瘤 肝细胞癌 肝细胞癌 肝细