男性生殖系统

男性生殖系统,CT检查方法,肠道准备：检查前3小时分次口服2%泛影葡胺8001000ml；清洁灌肠和保留灌肠膀胱准备：憋尿充分充盈膀胱；或静注造影剂后扫描，使膀胱内充满高密度造影剂扫描范围：耻骨联合下缘至髂嵴层距/层厚：510mm；必要时用23mm薄层增强扫描：鉴别盆腔内髂血管影与增大淋巴结,正常CT表现,精囊与前列腺周围由低密度脂肪包绕精囊位于膀胱后方，呈八字状对称软组织密度影，边缘常呈小的分叶。两侧精囊于中线部汇合，精囊前缘与膀胱后壁之间为三角形低密度脂肪间隙，称为精囊角前列腺紧邻膀胱下缘，横断面上呈椭圆形软组织，随年龄而增大。前列腺：上下前后左右径 30岁以内 323 cm60岁以上 545 cm,正常男性盆腔,正常男性盆腔,正常男性盆腔,正常男性盆腔,正常膀胱和精囊腺,正常前列腺,MRI检查方法,检查前准备：膀胱适量充盈尿液，去除体内外一切金属异物扫描切面：横断 /矢状 /冠状扫描技术：序列：TSE/FLASH/IR，成像：T1WI/T2WI/FS，特殊检查：直肠内线圈增强扫描：不作为常规,正常MRI表现,前列腺：T1WI呈均匀偏低信号，信号强度类似肌肉信号，前列腺周围是高信号的脂肪组织，其中可见蜿蜒状无信号的静脉丛T2WI自内向外前列腺各区因组织结构和含水量差异可分辨：移行区和中央呈低信号，周围区呈较高信号，周边可见低信号包膜精囊腺：T1WI呈低信号，T2WI高信号,正常男性盆腔矢状T1WI,正常男性盆腔横断T2WI,正常男性盆腔横断,MR Imaging Appearance of Normal Prostate Anatomy,On T1WI, the normal prostate gland demonstrates homogeneous intermediate-to-low signal intensity. As with computed tomography (CT), T1WI has insufficient soft-tissue contrast resolution for visualizing the intraprostatic anatomy or abnormality. The zonal anatomy of the prostate gland is best depicted on high-resolution T2WI,Normal prostate zonal anatomy,A 60-year-old manT2WI at the level of the seminal vesiclesat the base of the prostateB = urinary bladderC = central zone,Normal prostate zonal anatomy,A 60-year-old manT2WI at the level of the mid-gland FS = anterior fibromuscular stromaP = peripheral zoneT = transition zone,Normal prostate zonal anatomy,A 60-year-old manT2WI at the level of the apex at the level of the membranous urethraU = urethra,Normal prostate zonal anatomy,Normal prostate zonal anatomy in a 60-year-old manT2WI corona, midsagittal, and parasagittal MR imagesThe letters in g correspond to the anatomic levels used for images a-f The vertical line in g indicates the membranous urethral length. B = urinary bladder, C = central zone, P = peripheral zone, SV = seminal vesicles, U = urethra.,On T2WI, the normal peripheral zone demonstrates a high signal inten-sity. The peripheral zone is surrounded by a thin rim of low signal intensity, which represents the anatomic or true capsule. Low-signal-intensity foci posterolateral to the capsule are indicative of neurovascular bundles. The signal intensities in the central and transition zones are lower than those in the peripheral zone. The central and transition zones have similar signal intensities and are best differentiated by their respective anatomic locations. The anterior fibromuscular stroma has low signal intensity. The proximal urethra is rarely identifiable unless a Foley catheter is present or a transurethral resection has been performed. The distal prostatic urethra can be seen as a low-signal-intensity ring in the lower prostate. The vas deferens and seminal vesicles demonstrate high signal intensity. On contrast-enhanced MR images, the peripheral zone enhances more than the transition or central zone. The contrast resolution is similar to that seen on T2WI,前列腺增生,老年人常见病变，60岁以上发生率高达75%临床表现尿频、尿急、夜尿及排尿困难增生主要发生在移行区，病理表现为腺体组织和基质有不同程度增生并形成结节前列腺均匀对称性增大，径线超过正常值，边缘清楚CT检查，增大前列腺的上缘超过耻骨联合上方2cm，常突入膀胱底部，密度均匀，内可有钙化灶MRI检查，T1WI为均匀低信号， T2WI周围区仍为高信号，并显示受压变薄，移行区和中央区为高低相间混杂信号，分别代表增生的腺体与基质组织,前列腺增生,前列腺增生,前列腺增生,前列腺增生,前列腺增生,前列腺癌,99%为腺癌，肿瘤主要发生在前列腺的周围区，可侵犯相邻区，并可突破前列腺被膜，进而侵犯周围脂肪、精囊，还可发生淋巴转移和血行转移，以骨转移多见且常为成骨转移早期表现排尿困难，晚期出现膀胱和会阴部疼痛和转移体征肛门指诊可触及前列腺硬结，表面不规则化验显示前列腺特异抗原（PSA）升高,前列腺癌,前列腺癌发生于前列腺泡或导管上皮，70%位于前列腺的外周带 ，少数位于中央区常多灶性生长，肿瘤很少直接侵犯直肠，最常见的侵犯部位为精囊腺，造成膀胱精囊角变钝，消失，两侧明显不对称，继之侵犯膀胱颈及两侧盆壁前列腺癌极易发生远处转移，常见有成骨性转移，腹股沟淋巴结转移，肝转移，肺转移,前列腺癌CT表现,前列腺变形，局限性向外隆起，或外形呈分叶状局部见一个或数个不规则形低密度灶，边界不清膀胱精囊角变钝或消失，两侧明显不对称增强扫描肿块无明显强化，显示低密度灶更明显盆腔内可见异常肿大的淋巴结远处转移（成骨性转移，肺，肝）,前列腺癌,前列腺癌,前列腺癌-右侧膀胱精囊角变钝,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌,前列腺癌复发,前列腺癌转移,Prostate cancer,MRI对发现癌和确定其大小、范围有较高价值T1WI癌与前列腺组织均为一致性较低信号，难以识别T2WI前列腺癌典型表现为正常较高信号的周围区内出现较低信号结节影，肿瘤与周围区正常前列腺组织有显著差异，易于发现早期肿瘤5以上前列腺癌的发现率为60%限度是不能发现起于移行区的早期前列腺癌，因其信号强度类似于周围组织，除非肿瘤侵犯了周围区而在T2WI得以显示,Prostate cancer,MRI检查是确定前列腺癌的最佳检查方法，前列腺被膜有无破坏、突破，对于临床是否采取手术治疗和估价预后非常重要正常前列腺被膜应是光滑连续的，一旦被膜连续性中断或局部病变组织外突均指示被膜破坏病变延伸至被膜外的其他表现有指肠前列腺间隙显示，前列腺周围脂肪内出现低信号影，前列腺周围的神经血管丛发生移位且信号发生改变精囊受累时， 受累精囊增大并T2WI信号减低还可发现转移所致的盆腔淋巴结及其它部位的淋巴结增大，易于发现其他器官和骨转移,前列腺癌MRI表现,前列腺变形，局限性向外隆起，或外形呈分叶状T2WI在高信号的外周带内见一低信号缺损区；T1WI上信号变化不明显 精囊受侵征象：膀胱精囊角变钝或消失，两侧明显不对称；T2WI上信号降低在T1WI上见前列腺周围高信号脂肪影内出现低信号区，则提示为癌肿向周围侵犯盆腔内可见异常肿大的淋巴结,MR Appearance of Prostate Cancer,On T2WI, prostate cancer usually demonstrates low signal intensity in contrast to the high signal intensity of the normal peripheral zone. Low signal intensity in the peripheral zone, however, can also be seen in several benign conditions, such as hemorrhage, prostatitis, hyperplastic nodules, or posttreatment sequelae (eg, as a result of irradiation or hormonal treatment),Postbiopsy hemorrhage,axial T1WI and T2WI and coronal T2WI demonstrate extensive bilateral postbiopsy hemorrhage in the peripheral zones. The transition zone in the left lobe demonstrates high signal intensity on the T1WI and low signal intensity on the T2WI,Biopsy-proved adenocarcinoma,A 71-year-old man with a PSA level of 5.65 ng/mLT2WI and T2WI show that the dominant tumor (T) within the left peripheral zone extends from the apex to the base. Obliteration of the left rectoprostatic angle is indicative of extracapsular extension. Findings at surgery and histopathologic examination helped confirm a large tumor with extracapsular extension (stage T3a),Prostate cancer,T2-weighted axial MR images show an asymmetric bulge and spiculated marginobliteration of the rectoprostatic angle,Prostate cancer,T2-weighted axial MR images show breach of the capsule with direct tumor extension and envelopment of the neurovascular bundle, and asymmetry of the neurovascular bundles,前列腺癌,横断T2WI见癌灶呈略高信号,前列腺癌,横断T1WI见癌灶呈略低信号,前列腺癌,横断T1WI增强扫描见癌灶呈略轻度强化,前列腺癌,矢状T1WI增强扫描见癌灶呈略轻度强化,前列腺癌-T1WI,前列腺癌-T2WI,前列腺癌-T1WI增强,Biopsy-p