《腹部超声》PPT课件.ppt

Abdominal Sonography,腹部超声,2,Also known as-Abdominal ultrasound(US)scanning-Abdominal US imaging-Abdominal ultrasonography-Abdominal ultrasound,3,About the course,4,What is Abdominal Sonography?What is an Abdominal Sonogram?What are some common uses of the procedure?How would patients prepare?How does the procedure work?What does the equipment look like?Who interprets the results?What are the benefits vs.risks?What are the limitations of Abdominal USG?,Ultrasonography Info,5,What is Abdominal Sonography?,Abdominal sonography is a method of obtaining images of internal organs by sending high-frequency sound waves into the body.The reflected sound waves are returned as echoes.The echoes are then recorded and displayed as a real-time visual image.Since ultrasound images are captured in real-time they have the ability to show movement of internal tissues,liver function,and blood flow.,6,Ultrasonography is a noninvasive medical test that helps physicians diagnose and treat medical conditions.An abdominal ultrasonography produces a picture of the organs and other structures in the upper abdomen.,What is Abdominal Sonography?,7,A Doppler ultrasound study may be part of an abdominal ultrasound examination.Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel,including the bodys major arteries and veins in the abdomen,arms,legs and neck.,What is Abdominal Sonography?,8,What is an Abdominal Sonogram?,An abdominal sonogram can help to diagnose a variety of conditions and to assess damage caused by illness.Liver,gallbladder,spleen,pancreas,and kidneys will be evaluated during an abdominal sonogram.Various reasons are:abdominal pain,abnormal lab results,and enlarged abdominal organs.,9,What is an Abdominal Sonogram?,An abdominal sonographer will be required to image small body parts as well.These parts include:thyroid gland,testicles,breast,and various soft tissue of body parts.Doctors can also use abdominal sonography to guide them as they perform needle biopsies on abdominal organs.,10,What are some common uses of the procedure?,-Kidneys-Liver-Gallbladder-Pancreas-Spleen-Abdominal aorta and other blood vessels,Abdominal ultrasound imaging is performed to evaluate the:,11,What are some common uses of the procedure?,Abdominal pains Abnormal liver function Enlarged abdominal organ Abnormalities in the abdomen:gallstones,liver cirrhosis,cyst,tumor,etc.An aneurysm in the aorta,12,What are some common uses of the procedure?,Doppler ultrasound images can help the physician to see and evaluate:,Blockages to blood flow(blood clots/atherosclerotic plaque)Narrowing of vessels(which may be caused by plaque)Tumors and congenital malformation,血凝块/动脉粥样硬化斑块,13,What are some common uses of the procedure?,Guide invasive procedures such as needle biopsy and withdrawal of fluid,14,How would patients prepare?,（）wear comfortable,loose-fitting clothing（）barium enema or upper GI(gastrointestinal)tests,钡餐灌肠 上消化道检查,15,For a study of the liver,gallbladder,spleen,and pancreas,patient may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for 8 to 12 hours before the test.For ultrasound of the kidneys,may be asked to drink 4 to 6 glasses of water about an hour before the test to fill your bladder.may be asked to avoid eating for eight to 12 hours before the test to avoid gas buildup in the intestines.For ultrasound of the aorta,you may need to avoid eating for eight to 12 hours before the test.,How would patients prepare?,16,In case of an emergency,exams can be done without special preparations.Tell the sonographer,sonologist,or physician conducting the examination about pain,bleeding,or any other symptoms.Telling the examiner about past ultrasounds and surgeries is helpful,and sometimes provides crucial information.（重要信息）,How would patients prepare?,17,How does the procedure work?,You will be positioned on an examination table and made to lie down on your back and lay your hands above your head.It may become necessary to change positions during the exam,and lie down on your side or sit up.A lubricating gel（甘油凝胶/耦合剂）is applied to the patients abdominal area.,18,How does the procedure work?,An apparatus known as a transducer is placed on the abdominal area and moved around to get real time images.Sometimes you will have to breathe in and hold your breath according to the technologist,sonologist,or physicians instructions.Examinations usually take 10-30 minutes.,19,Small structure-higher-frequency linear arrayAbdomen-curved/linear/arrayEchocardiography-sectorObstetric&gynecologic-curved array,Instrumentation,20,Who interprets the results?,A radiologist,or sonogist,21,What are the benefits vs.risks?,Benefits,noninvasive(no needles or injections)and is usually painless.widely available,easy-to-use and less expensive than other imaging methods.uses no ionizing radiation.gives a clear picture of soft tissues that do not show up well on x-ray images.causes no health problems and may be repeated as often as is necessary.provides real-time imaging,making it a good tool for guiding minimally invasive procedures such as injections,needle biopsies and needle aspiration of fluid,22,What are the benefits vs.risks?,Risks,For standard diagnostic ultrasound there are no known harmful effects on humans.Pregnant women and fetuses can be safely examined.,23,What are the limitations of Abdominal USG?,Ultrasound waves are disrupted by air or gas;therefore ultrasound is not an ideal imaging technique for the bowel or organs obscured by the bowel.In most cases,barium exams,CT scanning,and MRI are the methods of choice in this setting.,24,What are the limitations of Abdominal USG?,Ultrasound waves do not pass through air;therefore an evaluation of the stomach,small intestine and large intestine may be limited.Intestinal gas may also prevent visualization of deeper structures such as the pancreas and aorta.Large patients are more difficult to image because tissue attenuates(weakens)the sound waves as they pass deeper into the body,25,Gallstones and cholecystitis 胆结石，胆管炎Hepatitis/liver cirrhosis 肝炎/肝硬化Kidney/Bladder stones 肾/胆囊结石Hydronephrosis 肾积水Tumors 肿瘤Cancers of the liver,kidneys,pancreas,gallbladder,biliary tree 癌Lymphoma 淋巴瘤Metastasis 转移灶Cysts 囊肿Infections 感染,Common conditions revealed by Abdominal sonography,26,Abscesses 脓肿Appendicitis 阑尾炎Enlarged liver,spleen,kidneys,lymph nodes 增大Pancreatitis 胰腺炎Congenital malformation 先天畸形Injury-hematoma,tear,rupture 创伤（血肿、撕裂、破裂）Hemorrhage of the adrenal gland 肾上腺出血Abdominal aortic aneurysm 腹主动脉瘤Ascites腹水Peritonitis腹膜炎Bowel obstruction 肠梗阻Hernia 疝气,FOUNDATIONS,28,Sonographic Terminology,Descriptive terminologyHyperechoic-Hypoechoic(高回声低回声)Isoechoic（等回声）Anechoic or sonolucent（无回声）Enhancement（回声增强）Heterogeneous-Homogeneous（非均质/均质）Shadowing（声影）,29,Hyperechoic,shadowing,Hypoechoic,Hyperechoic,Hypoechoic,shadowing,30,Heterogeneous,Homogenous,AnechoicSonolucent,Enhancement,Isoechoic,31,Sonographic Evaluation,The sizeThe echo and attenuation of the organParenchyma实质The texture质地The presence of vascular structures,ligaments,and fissures裂隙Abnormality异常 and mass占位,32,The normal or abnormal images of abdominal organs,33,The Liver,Ultrasound is often the first line of investigation for suspected liver pathology and the decision to proceed to secondary investigative procedures,such as further radiology or histology.Ultrasound is used in the diagnosis,staging and monitoring of liver disorders and also contributes to their treatment with ultrasound-guided invasive procedures.Developing technology and techniques now result in improved diagnostic accuracy and are increasingly obviating the need for further radiology.Intraoperative and laparoscopic ultrasound,using high-frequency,direct-contact techniques,set the standard for liver imaging in many cases.,34,35,The simple cyst has three acoustic properties anechoichas a well-defined smooth capsuleexhibits posterior enhancement(increased through transmission of sound),肝囊肿hepatic cyst,36,肝血管瘤 Hepatic hemangioma,Small solitary or multiple nodular lesionRounded well-definedHyperechoic massUsually not visualize colour flow,37,术语Terms,This term describes the effect of a focal mass,whether benign or malignant,on surrounding structures and is a useful diagnostic tool.It implies the lesions displacing or invasive nature,i.e.the displacement of vessels and/or invasion or distortion of adjacent structures and tissues as a result of the increasing bulk of a lesion.This effect differentiates a true mass from an infiltrative process,占位效应Mass effect,38,39,Benign hepatic tumors hemangioma,hepatocellular adenoma,hepatic cystadenoma,FNH(focal nodular hyperplasia)etc.Malignant tumors hepatocarcinoma,hepatocholangiocarcinoma,metastases,lymphoma etc,Hepatic tumors,40,Types massive type nodular type diffusely infiltrating type Vascular invasion,Pathology,Primary Carcinoma,Hepatic tumors,41,Echoic patternSonographic types InvasionColor Doppler Flow Image,USG Feature,Hepatic tumors,42,hyperechoic,hypoechoic,hypoechoic,isoechoic,43,44,45,VI Differential Diagnoses,CystHemangiomaMetastases,Primary Carcinoma,46,47,hemangioma,Simple hepatic cyst,48,49,hyperechoic,hypoechoic,hypoechoic,isoechoic,Hepatic carcinoma,50,Metastatic tumor,51,USG-Guided Liver Biopsy,Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue,which can be examined under a microscope to help identify the cause or stage of liver disease.,52,The gallbladder,Ultrasound is an essential first-line investigation in suspected gallbladder and biliary duct disease It is highly sensitive,accurate and comparatively cheap Gallbladder pathology is common and is asymptomatic in over 13%of the population,53,There are three classic acoustic properties associated with stones in the gallbladder;they are highly reflective,mobile and cast a distal acoustic shadow.In the majority of cases,all these properties are demonstrated,54,Reflectivity（hyperechoic）ShadowingMobility,Supine view,erect view,55,The pancreas,Because the pancreas lies posterior to the stomach and duodenum（十二指肠）,a variety of techniques must usually be employed to examine it fully.Although ultrasound may still be considered the first line of investigation,CT,MRI and/or endoscopic retrograde cholangiopancreatography(ERCP内窥镜逆行胰胆管造影)are frequently required to augment and refine the diagnosis.,56,Acute pancreatitis,Mild acute pancreatitis may have no demonstrable features on ultrasound,especially if the scan is performed after the acute episode has settled.In more severe cases the pancreas is enlarged and hypoechoic due to oedema.The main duct may be dilated or prominent.,57,Necrotic tail of pancreas surrounded by exudate,hypoechoic and bulky,