医学影像诊断学课件：Abdominal And Superficial Ultrasound

1、Abdominal And Superficial UltrasoundContentsNormal ultrasound images; Abnormal ultrasound indications.Superficial ultrasound:thyroid、breast.Abdominal ultrasound:liver、gall bladder、pancreas、kidney、spleen.Reviewhomogeneous 均匀的heterogeneous 不均匀的microcalcification 微钙化 acoustic attenuation 声衰减acoustic sh

2、adow 声影peripheral halo 晕环anechoic无回声hypoechoic低回声isoechoic等回声hyperechoic高回声Abdominal UltrasoundRoutine physical examinationAcuteabdomendiseaseUltrasound guided puncture Abdominal UltrasoundAbdominal UltrasoundWhich probe is used for abdominal ultrasound examination？ convex array probe: 35 MHzsagitta

3、l planetransverse planeAbdominal Ultrasoundoblique planecoronal planeLiver: parenchyma-homogeneousand isoechoic; membrane-linear hyperechoic. oblique diameter of right lobe:1014cm anteroposterior diameter of right lobe:810cm Normal ultrasound imageThe first hepatic portal: portal vein、common bile du

4、ct、hepatic artery. portal vein: 1012mmcommon bile duct:1/3PW: stationary wave with respiratory fluctuationsNormal ultrasound imageThe second hepatic portal: the junction ofthree hepatic vein and inferior vena cava. left hepatic veinmiddle hepatic veinright hepatic veinNormal ultrasound imagePW: thre

5、e phase waveLobes of liver: interrupted by hepatic veins.right anterior lobe right posterior lobeleft internal lobeleft lateral lobe Normal ultrasound imageSpleen: parenchyma-homogeneous isoechoic; membrane-linear hyperechoic; splenic portal. Length diameter:812cmPachy diameter:34cmSplenic vein:5.0c

6、m )1.diffuse infiltrative type3.nodular type ( 5.0cm ) 1.2.3.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）small carcinoma type （小肝癌）: 肝内出现单个癌结节且直径3cm者，或肝内癌结节不超过2个且直径之和3cm者。Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(1) It appears as single or multiple solid mass

7、es; usually the solid masses show indistinct border-肝内单发或多发实性结节，边界多不清楚.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(2) The echo levels can be different-内部回声可呈低回声、等回声、高回声或混合回声,分布均匀或不均匀.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(3) In some masses, the“Nodule in

8、Nodule” pattern or “Mosaic” pattern are often seen-可出现结中结或马赛克样表现. Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(4) Periphery halo: It is thin hypoechoic strip（2-5mm）around the mass-结节周边可有低回声薄晕环.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(5) In the most masses of

9、 HCC, CDFI can show the blood flow-结节内部及周边多见线状、分支状彩色血流信号.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(6) Contrast enhanced ultrasound: fast enhancement and clearance-超声造影表现为“快进快出”.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(1) Oppressing signs：“hump Sign”-较大或位于

10、肝包膜下的肿块可引起局部肝包膜膨隆; the vessels or bile ducts in liver can be oppressed-肝内管道受压变细或移位.Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(2) Metastatic signs: emboli of carcinoma in portal vein-门静脉癌栓. Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(2) Metastatic signs: embol

11、i of carcinoma in hepatic vein-肝静脉癌栓. Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(2) Metastatic signs: emboli of carcinoma in inferior vena cava-下腔静脉癌栓. Abnormal ultrasound indicationsPrimary hepatic carcinoma（原发性肝癌）(2) Metastatic signs: liver satellite nodules-肝内卫星灶. Abnormal ul

12、trasound indicationsHepatic hemangioma（肝血管瘤）single or multiple solid masses; well-defined lesions; heterogeneous and sieve-like.-肝内单发或多发实性结节，边界清楚，内部回声不均匀，可见低回声、等回声、高回声，呈筛网状。Abnormal ultrasound indicationsHepatic hemangioma（肝血管瘤）CDFI/PW: avascular on ultrasound-结节内部不易探及彩色血流信号，周边可探及点状、线状彩色血流信号.Abnorma

13、l ultrasound indicationsHepatic cyst（肝囊肿）anechoic-无回声;with thin, smooth wall-壁薄、光滑;posterior acoustic enhancement-后方回声增强.absent blood flow signal-无血流信号.Gall bladder: divided into the neck, the body and the fundus; cavity-anechoic;wall-hyperechoic. Normal ultrasound imagelong axisshort axisAbnormal u

14、ltrasound indicationsCholecystolithiasis（胆囊结石）According to the different chemical components, it is divided into three types: cholesterol stone, pigment stone, and mixed stones. Abnormal ultrasound indicationsCholecystolithiasis（胆囊结石）Typical gallstone :the mass of strong echo-团状强回声; posterior acoust

15、ic shadow-后方伴有声影. Abnormal ultrasound indicationsCholecystolithiasis（胆囊结石）Typical gallstone:move with changing of body position-随体位改变而移动. Abnormal ultrasound indicationsCholecystolithiasis（胆囊结石）Atypical gallstone:gallbladder full of stones（充满型胆囊结石）: “WES” sign-即囊壁结石声影三联征，前方为增厚胆囊壁的弱回声包绕中间结石的强回声，后方伴声影

16、. Abnormal ultrasound indicationsCholecystolithiasis（胆囊结石）Atypical gallstone:(2) sand-like stone（泥沙样胆囊结石）: high-echo dots in gallbladder cavity without shadow.Abnormal ultrasound indicationsCholecystolithiasis（胆囊结石）Atypical gallstone:(3) stone located in neck of gallbladder（胆囊颈部结石）: not move with ch

17、anging of body position.Abnormal ultrasound indicationsAcute cholecystitis（急性胆囊炎）95% of acute cholecystitis are combined with gallstones. The symptoms mainly include acute right upper quadrant pain and Murphy Sign is positive.Abnormal ultrasound indicationsAcute cholecystitis（急性胆囊炎）(1) enlarged gall

18、bladder-胆囊肿大;(2) thick diffusely wall（CDFI-show the blood flow）-胆囊壁弥漫性增厚，可见丰富血流信号;Abnormal ultrasound indicationsAcute cholecystitis（急性胆囊炎）(3) some debris-like echoes-胆囊内透声性差，可见点状、片状或絮状高回声，无声影，可移动;(4) localized echo-free around gallbladder-胆囊周围可见液性暗区;(5) ultrasound Murphy Sign-超声Murphy征阳性.Normal ult

19、rasound imagePancrease:splenic veinpancreaseinferior vena cavaabdominal aortaParenchyma:homogeneous,isoechoic;Pancreatic duct:1.5cm). In mild degree, the kidney is in normal size，and the parenchyma of kidney is normal-轻度肾积水时，肾盂肾盏轻度扩张，肾的大小、形态、实质均无改变.Abnormal ultrasound indicationsHydronephrosis（肾积水）I

20、n moderate degree, the parenchyma of kidney is thin-中度肾积水时，肾盂肾盏扩张呈花朵样，肾的大小、形态正常，实质正常或稍变薄. In severe degree, the kidney is enlarged，and the parenchyma almost disappears-重度肾积水时，肾盂肾盏扩张呈调色板样，肾脏增大，形态失常，实质明显变薄甚至消失. Abnormal ultrasound indicationsRenal carcinoma（肾癌）a large, heterogeneous mass which enlarge

21、s and deforms the shape of the kidney. The mass may contain areas of cystic degeneration and/or calcification. Abnormal ultrasound indicationsRenal carcinoma（肾癌）CDFI usually reveals a disorganized and increased blood flow pattern within the mass.Superficial UltrasoundIt is located in the neck anteri

22、orly. It consists of two lobes. The two lobes are connected by the thin isthmus.Normal ultrasound imagelinear array probe :512 MHzNormal ultrasound imageThyroid Gland: the shape of butterfly;isoechoic; mom carotid arteryinternal jugular veintrachea Abnormal ultrasound indicationsHyperthyroidism ( Gr

23、aves Disease )（甲状腺功能亢进）It is regarded as an autoimmune disorder. The main symptoms include diffusely enlargement of thyroid gland, tachycardia, bulging eyes and skin thickening. Abnormal ultrasound indicationsHyperthyroidism ( Graves Disease )（原发性甲状腺功能亢进）(1) The thyroid gland is enlarged symmetrical

24、ly and diffusely;(2) The internal echoes vary. It may appear as diffuse hypoechoic.Abnormal ultrasound indicationsHyperthyroidism ( Graves Disease )（原发性甲状腺功能亢进）(3) CDFI: The blood flow increase markedly and we often call this “Flames Sea Sign”-火海征. Abnormal ultrasound indicationsHyperthyroidism ( Gr

25、aves Disease )（原发性甲状腺功能亢进）The history, symptoms and laboratory results ( T3,T4 ) are very important to the diagnosis.Abnormal ultrasound indicationsAdenoma of Thyroid Gland（甲状腺腺瘤）(1) usually single, round or oval-一般为单发，呈圆形或椭圆形;(2) hypoechoic or isoechoic-低回声或等回声;(3) If cystic change or hemorrhage oc

26、curs, echo-free can be seen-合并囊性变、出血或坏死时可见不规则无回声区;Abnormal ultrasound indicationsAdenoma of Thyroid Gland（甲状腺腺瘤）(4) the border is well-defined and usually there is thin periphery halo-边界清楚，可见薄晕环;(5) CDFI shows blood flow around and within the mass-周边常见环绕血管，内部多见丰富血流.Abnormal ultrasound indicationsAde

27、noma of Thyroid Gland（甲状腺腺瘤）Contrast enhanced ultrasound: fast enhancement and slow clearance-超声造影表现为“快进慢出”.Abnormal ultrasound indicationsCarcinoma of Thyroid Gland（甲状腺癌）Four types: papillary, follicular, medullary and undifferentiated. The papillary carcinoma is the most common type.Abnormal ultrasound indicationsCarcinoma of Thyroid Gland（甲状腺癌）(1) single; hypoechoic; heterogeneous;(2) the border is indistinct;(3) posterior acoustic attenuation;Abnormal ultrasound indicationsCarcinoma of Thyroid Gland（甲状腺癌）(4) microca