六院見習(xí)泌尿生殖

1、泌尿、生殖系統(tǒng)影像診斷讀 片上海交通大學(xué)附屬第六人民醫(yī)院放射科趙 俊 功 主持 正常靜脈尿路造影表現(xiàn)Appearance of Normal IVP形態(tài)功能壓迫帶壓迫不當(dāng) 靜脈性腎盂造影 (排瀉性尿路造影)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 異常靜脈尿路造影表現(xiàn)Appearance of Anormal IVP左輸尿管結(jié)石、左腎積水 Fifteen-minute later Right renal artery stenosis 異常靜脈尿路造影表現(xiàn)Seven-minute later 腎動(dòng)脈造影renal arteriographyDSAMRA泌尿系統(tǒng)CT檢查不同時(shí)相掃描動(dòng)脈期實(shí)質(zhì)期延遲期動(dòng)脈早期動(dòng)脈晚期CT urography （CTU)左輸尿管下段

3、腫瘤MRU左輸尿管下端結(jié)石、左腎及左輸尿管積水腎臟基本病變影像學(xué)分析 1. 腎臟數(shù)目、大小、形態(tài)和位置的異常 abnormity of number、size、morphous、 position2. 腎臟腫塊 tumour of kindey3. 異常鈣化影 abnormal calcification4. 腎盂腎盞和輸尿管異常 abnormity of renal pelvis and ureter5. 腎血管異常 abnormal vessel of kidney異位腎ectopic kidney先天性發(fā)育異常 腎盂、輸尿管重復(fù)畸形double pelvis, double ureter

4、又稱重復(fù)腎, 一個(gè)腎臟分為上下兩部, 并各有一套腎盂和輸尿管先天性發(fā)育異常腎旋轉(zhuǎn)不良Malrotation of kidney腎臟先天性發(fā)育異常正常腎旋轉(zhuǎn)不良Horseshoe kidney 腎臟先天性發(fā)育異常 Staghorn and Related Signs Jack Stone and Other Stone Configurations Soft-Tissue Rim Signhelp to distinguish a stone in the ureter from a phlebolith(靜脈石）Comet Sign 左輸尿管下端結(jié)石尿道結(jié)石right flank pain 右

5、輸尿管結(jié)石左輸尿管上段結(jié)石腎結(jié)核renal tuberculosis右腎上中部腎盞破壞左腎中部腎盞破壞腎結(jié)核renal tuberculosis腎臟囊腫renal cyst多囊性腎病 合并多囊肝polycystic kidney disease腎臟血管平滑肌脂肪瘤CT 值: -40 -120Hu腎癌 腎癌renal carcinoma腎癌似見假包膜腎癌腎盂癌carcinoma of renal pelvisVHL（雙側(cè)腎癌）移行細(xì)胞癌Transitional cell carcinoma膀胱癌膀胱癌carcinoma of bladder1、腎包膜下血腫 (renal subcapsular

6、hematoma) 腎實(shí)質(zhì)邊緣相鄰的高密度灶,無(wú)強(qiáng)化,腎實(shí)質(zhì)受壓、變形2 、腎周血腫 (perinephric hematoma) 腎周圍并限于腎筋膜囊內(nèi), 血腫范圍較廣, 腎表面不變形, 腎筋膜增厚3、腎實(shí)質(zhì)內(nèi)血腫(intrarenal hematoma) 腎實(shí)質(zhì)內(nèi)異常密度灶,無(wú)強(qiáng)化,可有對(duì)比劑血管外溢4 、腎撕裂傷 (renal laceration) 腎實(shí)質(zhì)不連續(xù)和腎表面中斷腎外傷renal injuries腎實(shí)質(zhì)撕裂出血正常腎上腺腎上腺增生adrenal hyperplasia結(jié)節(jié)狀增生彌漫性增生腎上腺腺瘤adrenal adenoma最常見的腎上腺腫瘤9%發(fā)病率, 糖尿病、高血壓者無(wú)

7、癥狀腎上腺等密度占位灶 有強(qiáng)化表現(xiàn)同相位反相位腎上腺腺瘤同相位反相位腎上腺轉(zhuǎn)移瘤腎上腺髓脂瘤 adrenal myelolipomaAdrenal venous sampling腎上腺皮質(zhì)癌adrenocortical carcinoma單側(cè), 大( 5cm)局部蔓延, 轉(zhuǎn)移多數(shù)腺癌是功能性的CT: 腫塊, 密度不均、壞死、鈣化不均勻強(qiáng)化庫(kù)欣綜合征cushing syndrome腎上腺增生腺瘤皮質(zhì)癌影像學(xué)檢查目的: 確定腎上腺病變性質(zhì),增生?腺瘤? 皮質(zhì)癌?T2WI 腎上腺嗜鉻細(xì)胞瘤adrenal pheochromocytoma腎上腺嗜鉻細(xì)胞瘤adrenal pheochromocytoma

8、腎上腺淋巴瘤雙側(cè)腎上腺病變轉(zhuǎn)移瘤淋巴瘤嗜鉻細(xì)胞瘤腎上腺轉(zhuǎn)移瘤adrenal metastasis肺癌轉(zhuǎn)移多單側(cè)或雙側(cè)腎上腺功能改變少易出血、壞死CT: 密度均一或有壞死診斷依賴臨床腫瘤史腎上腺結(jié)核adrenal tuberculosis結(jié)核菌血行播散所致造成慢性腎上腺皮質(zhì)功能低下, Addison病雙側(cè), 結(jié)核性肉芽組織、干酪性壞死、鈣化乏力、體重皮膚粘膜色素沉著、低血壓血糖、血尿皮質(zhì)醇ACTH輸卵管走向不定, 形態(tài)柔軟,邊緣光滑, 有蠕動(dòng), 可呈不連貫狀 24小時(shí)后攝片復(fù)查,見輸卵管內(nèi)的造影劑皆已排出，彌散于腹腔內(nèi),表現(xiàn)為波浪狀或弧線狀的陰影。子宮輸卵管造影輸卵管再通ovarian duct

9、 recanalization輸卵管內(nèi)插入一導(dǎo)管，向管腔內(nèi)注入造影劑，也可用導(dǎo)管使輕微的狹窄阻塞暢通,具有治療作用子宮先天畸形雙子宮雙子宮頸鞍形子宮子宮肌瘤肌壁間黏膜下漿膜下子宮肌瘤myoma of uterus子宮肌瘤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 子宮頸癌carcinoma of uterine cervix子宮頸癌carcinoma of uterine cervix子宮內(nèi)膜癌(endometrial carcinoma)前列腺增生 prostatic hyperplasia 前列腺增生 prostatic hyperplasia 前