六院见习泌尿生殖

1、泌尿、生殖系统影像诊断读 片上海交通大学附属第六人民医院放射科赵 俊 功 主持 正常静脉尿路造影表现Appearance of Normal IVP形态功能压迫带压迫不当 静脉性肾盂造影 (排泻性尿路造影)Intravenous Pyelography (IVP) compression release& fluoroscopic spotStandard Intravenous Urographybladder opacification& Postvoid radiograph Standard Intravenous UrographyContour abnormalities Pare

2、nchymal thickness averages 33.5 cm in the polar regions 22.5 cm in the interpolar regions 异常静脉尿路造影表现Appearance of Anormal IVP左输尿管结石、左肾积水 Fifteen-minute later Right renal artery stenosis 异常静脉尿路造影表现Seven-minute later 肾动脉造影renal arteriographyDSAMRA泌尿系统CT检查不同时相扫描动脉期实质期延迟期动脉早期动脉晚期CT urography （CTU)左输尿管下段

3、肿瘤MRU左输尿管下端结石、左肾及左输尿管积水肾脏基本病变影像学分析 1. 肾脏数目、大小、形态和位置的异常 abnormity of number、size、morphous、 position2. 肾脏肿块 tumour of kindey3. 异常钙化影 abnormal calcification4. 肾盂肾盏和输尿管异常 abnormity of renal pelvis and ureter5. 肾血管异常 abnormal vessel of kidney异位肾ectopic kidney先天性发育异常 肾盂、输尿管重复畸形double pelvis, double ureter

4、又称重复肾, 一个肾脏分为上下两部, 并各有一套肾盂和输尿管先天性发育异常肾旋转不良Malrotation of kidney肾脏先天性发育异常正常肾旋转不良Horseshoe kidney 肾脏先天性发育异常 Staghorn and Related Signs Jack Stone and Other Stone Configurations Soft-Tissue Rim Signhelp to distinguish a stone in the ureter from a phlebolith(静脉石）Comet Sign 左输尿管下端结石尿道结石right flank pain 右

5、输尿管结石左输尿管上段结石肾结核renal tuberculosis右肾上中部肾盏破坏左肾中部肾盏破坏肾结核renal tuberculosis肾脏囊肿renal cyst多囊性肾病 合并多囊肝polycystic kidney disease肾脏血管平滑肌脂肪瘤CT 值: -40 -120Hu肾癌 肾癌renal carcinoma肾癌似见假包膜肾癌肾盂癌carcinoma of renal pelvisVHL（双侧肾癌）移行细胞癌Transitional cell carcinoma膀胱癌膀胱癌carcinoma of bladder1、肾包膜下血肿 (renal subcapsular

6、hematoma) 肾实质边缘相邻的高密度灶,无强化,肾实质受压、变形2 、肾周血肿 (perinephric hematoma) 肾周围并限于肾筋膜囊内, 血肿范围较广, 肾表面不变形, 肾筋膜增厚3、肾实质内血肿(intrarenal hematoma) 肾实质内异常密度灶,无强化,可有对比剂血管外溢4 、肾撕裂伤 (renal laceration) 肾实质不连续和肾表面中断肾外伤renal injuries肾实质撕裂出血正常肾上腺肾上腺增生adrenal hyperplasia结节状增生弥漫性增生肾上腺腺瘤adrenal adenoma最常见的肾上腺肿瘤9%发病率, 糖尿病、高血压者无

7、症状肾上腺等密度占位灶 有强化表现同相位反相位肾上腺腺瘤同相位反相位肾上腺转移瘤肾上腺髓脂瘤 adrenal myelolipomaAdrenal venous sampling肾上腺皮质癌adrenocortical carcinoma单侧, 大( 5cm)局部蔓延, 转移多数腺癌是功能性的CT: 肿块, 密度不均、坏死、钙化不均匀强化库欣综合征cushing syndrome肾上腺增生腺瘤皮质癌影像学检查目的: 确定肾上腺病变性质,增生?腺瘤? 皮质癌?T2WI 肾上腺嗜铬细胞瘤adrenal pheochromocytoma肾上腺嗜铬细胞瘤adrenal pheochromocytoma

8、肾上腺淋巴瘤双侧肾上腺病变转移瘤淋巴瘤嗜铬细胞瘤肾上腺转移瘤adrenal metastasis肺癌转移多单侧或双侧肾上腺功能改变少易出血、坏死CT: 密度均一或有坏死诊断依赖临床肿瘤史肾上腺结核adrenal tuberculosis结核菌血行播散所致造成慢性肾上腺皮质功能低下, Addison病双侧, 结核性肉芽组织、干酪性坏死、钙化乏力、体重皮肤粘膜色素沉着、低血压血糖、血尿皮质醇ACTH输卵管走向不定, 形态柔软,边缘光滑, 有蠕动, 可呈不连贯状 24小时后摄片复查,见输卵管内的造影剂皆已排出，弥散于腹腔内,表现为波浪状或弧线状的阴影。子宫输卵管造影输卵管再通ovarian duct

9、 recanalization输卵管内插入一导管，向管腔内注入造影剂，也可用导管使轻微的狭窄阻塞畅通,具有治疗作用子宫先天畸形双子宫双子宫颈鞍形子宫子宫肌瘤肌壁间黏膜下浆膜下子宫肌瘤myoma of uterus子宫肌瘤myoma of uterusDSABenign serous cystadenoma Benign mucinous cystadenoma 卵巢粘液性囊腺瘤T1-weighted imageT2-weighted imageT1-weighted image with contrastRuptured mucinous cystadenocarcinoma 子宫颈癌carcinoma of uterine cervix子宫颈癌carcinoma of uterine cervix子宫内膜癌(endometrial carcinoma)前列腺增生 prostatic hyperplasia 前列腺增生 prostatic hyperplasia 前