肝脏疾病的超声诊断PPT课件

.,1,肝脏疾病超声诊断DiagnosisofLiverDiseasewithUltrasoundSonography,.,2,肝脏疾病超声诊断,肝脏弥漫性疾病DiffuseLiverDisease,肝脏占位性疾病FocalAbnormalies,.,3,正常肝脏声像图,大小、形态、包膜、边界sizeshapecapsuleboundary肝实质回声liverparenchymaechopattern:isoechoichomogeneous肝內管道系统hepaticarteryportalveinhepaticveinsintrahepaticbiliary肝质地,.,4,leftlobesagittalsection,.,5,rightlobesagittalobliqueview,.,6,rightlobesagittalobliqueview,.,7,.,8,.,9,.,10,.,11,.,12,.,13,.,14,肝脏弥漫性疾病,肝炎hepatitisvialinfection急性肝炎acutehepatitis慢性肝炎chronichepatitis肝硬化cirrhosis慢性血吸虫性肝病schistosomiasis淤血性肝病liverincardiacdisease脂肪肝fattyliver(hepaticsteatosis),.,15,急性肝炎AcuteHepatitis,大小、形态、包膜、边缘大饱满平整钝肝实质回声低于正常明显低于正常（黑色肝脏）分布均匀肝内血管无明显异常肝脏质地中等,.,16,慢性肝炎ChronicHepatitis,大小、形态、包膜、边缘肝实质回声正常增粗coarseechopattern明显增粗均匀homogeneous不均匀inhomogeneous肝内血管肝静脉（正常变细）门静脉（正常增宽）肝脏质地尚软中等偏硬,.,17,肝硬化Cirrhosis,大小、形态、包膜、边缘小异常不平diffusenodularity鋭肝实质回声增粗增强increasedechogenicity分布不均匀肝内血管肝静脉变细、迂曲attenuation门静脉：肝外增宽肝內变细肝脏质地硬hard,.,18,.,19,.,20,.,21,.,22,.,23,门高压Portalhypertention,侧枝循环建立portosystemicvenouscollaterals(paraumbilicalvein;coronaryvein;gastroesophagealvein;splenorenal-gastrorenalvein)脾肿大splenomegaly腹水ascites,.,24,.,25,.,26,.,27,.,28,.,29,.,30,慢性血吸虫性肝病schistosomiasis,大小、形态、包膜、边缘肝实质回声斑块状网络状地图样分布不均匀肝内血管肝脏质地中等,.,31,.,32,.,33,淤血性肝病LiverinCardiacDisease,大小、形态、包膜、边缘大饱满平整钝肝实质回声无明显变化肝内血管肝静脉明显增宽肝静脉搏动下腔静脉增宽门静脉无明显变化肝脏质地中等,.,34,.,35,.,36,脂肪肝FattyLiver,大小、形态、包膜、边缘肝实质回声近程回声细小、致密，远程衰减肝内血管显示欠清晰（因衰减）肝脏质地中等,.,37,.,38,.,39,.,40,.,41,肝脏弥漫性疾病,肝硬化慢性血吸虫性肝病淤血性肝病脂肪肝,.,42,肝脏占位性疾病,肝脏液性占位病变肝囊肿肝包囊虫病肝脓肿肝脏混合性占位病变肝包囊虫病肝脓肿肝癌肝脏实质性占位病变肝血管瘤肝癌肝腺瘤,.,43,肝脏的分叶分段,Couinaud8段法尾状叶()左外叶上段()左外叶下段()左内叶()右前叶下段()右后叶下段()右后叶上段()右前叶上段(),.,44,.,45,.,46,.,47,肝囊肿hepaticcyst,声像图特征形态圆形/橢圆形roundoroval-shaped內部回声无回声anechoic壁薄thinwell后方回声后方呈增强回声distalacousticenhencement其他侧壁回声失落內部出现回声混响效应部分容积效应囊肿合并感染,.,48,.,49,肝脓肿,声像图特征形态圆形橢圆形类圆形壁厚內壁不光滑（虫蛀形）thickwall內部回声带细光点液性暗区hypoechoicappearancewithfinehomogeneousechoes重力转移试验（+）肝脓肿声像图演变实质肿块混合性肿块液性肿块,.,50,肝血管瘤Hemangioma,毛细血管瘤海绵状血管瘤capillaryHemangiomacavernousHemangioma大小小大形态圆形/橢圆形多样內部回声高回声网络状低回声边缘不整齐（花边状）回声增强彩色血流无无/少血流,.,51,.,52,.,53,.,54,肝癌LiverCarcinoma,原发性肝癌PrimarylivercarcinomaHepatocellularcarcinoma继发性肝癌secondarylivercarcinomalivermetastases,.,55,原发性肝癌,肿块形态圆形（多数）不规则形內部回声低回声等回声高回声回声特征结节状回声结节周围有声晕肿块质地硬彩色血流多血流少血流肿瘤周围/结节周围抱球样血流,.,56,.,57,.,58,.,59,.,60,原发性肝癌几种特殊情况,弥漫性肝癌肝脏明显增大多伴肝硬化肝癌伴出血坏死混合性回声肝癌伴局部转移肿瘤周围有小肿瘤（卫星灶）肝癌治疗后表现混合性回声强回声等门静脉癌栓门静脉內低