醫(yī)學(xué)影像學(xué)教學(xué)課件：肝膽胰影像 Hepatocholangiopancreatic Radiology

HepatobiliaryPancreaticRadiology

肝膽胰影像LearningobjectivesUnderstandtheconceptofcontrastmediaandcontrast-enhancedCTUnderstandthenormalanatomyoftheliver,bilesystem,andpancreasonCTBeabletoidentifytheimagefindingsofhepatocellularcarcinoma,pancreatitis,pancreaticheadcancer,andbiliarystonesOutlineIntroductionofcontrastmediaandcontrast-enhancedmultiphaseCTstudyNormalanatomyofliver,bilesystem,pancreasonCTLiverSimplecystCavernoushemangiomaHepatocellularcarcinomaBilesystemGallstoneIntroductionofMRCPPancreasPancreatitisPancreaticheadcancerCTvalues(HounsfildUnit,HU)ContrastmediaSubstanceusedtoenhancethecontrastofstructureswithinthebodyinmedicalimagingCommoncontrastmedia:Positive:barium(GI/BE),iodinebased(CT),gadolinium(MR)Negative:airNeutral:waterIodine-basedcontrastmediaInjector造影劑高壓注射器InjectionofcontrastmediacontrastmediaMultiphasecontrast-enhancedCTAnatomyofliverIdentifythediaphragm,Liver,spleen,stomach,kidney,adrenalgland,gallbladder,pancreas,aorta,portalvein,IVCSimplecyst肝囊腫Round,oval,well-definedwaterdensitywithoutcontrastenhancementPolycysticliverdisease多囊肝DiffusivehepaticcystswithvarioussizesHemangiomamostcommonbenigntumoroftheliverImagefindingsNodularC+attheperipheryinthearterialphase,centripetalfill-in(向心性填充)progressingtocompletefill-inthereafterRapid-fillinghenamgioma:completeenhancingnoduleinthearterialphaseNodularC+atperipheryGradualcentripetalC+NodularC+atperipheryGradualcentripetalC+completeC+noduleatart.phasepersistenceC+atequ.phaseRapid-fillinghenamgiomaHemangiomaHepatocellularcarcinomaHistoryofcirrhosisorfindingofcirrhosisonCTArterialhypervascularityANDlate(portalvenous,equlibirumordelay)phasewashout–

快進(jìn)快出EnhancementofthepseudocapsuleinlatephaseHCC(Hepatocellularcarcinoma)HCC:typicalCTfindingsArterialenhancement(hypervascularity)withlatephasewashoutandenhancementofpsedocapsuleNotethenodularcontouroftheliver,indicatingcirrhosisNon-contrastArterialphasePortalvenousphaseEqulibirumphaseRupturedHCCNECTshowsthehyperattenuatedhematoma.PortalphaseCTscanshowsahypoattenuatingmasswithperipheral,subtlerimenhancementandamarginaldiscontinuityintheleftlobeofliver.NotearterialenhancementandlatephasewashoutofthetumorAnatomyofbilesytemGallstoneDensitydependedoncholesterol()andcalciumcontent()MRCP-MRcholangiopancreatographyWater-sensitivesequence:waterisbrightonMRCPimagesContrastmediaisNOTrequiredAnatomyofpancreasAcutepancreatitisLeadingcausesofacutepancreatitis:biliarystones>alcoholabuse>Post-ERCPImagefindings:1.Enlargement/swellingofthepancreas2.Inflammationofthefat(“dirtyfat”)3.Fluidcollection4.Necrosis(requirecontrastenhancementstudy)AcutepancreatitisEnlargementofthepancreaseInflammationofthefatFluidcollectionAcutepancreatitisEnlargementofthepancreaseInflammationofthefatFluidcollectionnecrosis**PancreaticcancerIrregular,hetrogeneous,poorly-enhancingmasswithabruptobstructionofpancreaticand/orcommonbileduct(“doubleductsign”)Location:Head(60%),body(20%),diffuse(15%),tail(5%)Localtumorextensionintosplenichilum&portahepatis,andvascularinvasionarecommonAtpresent65%patients:advancedlocaldisease/metastases21%:localizeddiseasewithspreadtoregionallymphnodes14%:tumorconfinedtopancreasPancreatic