醫(yī)學(xué)影像學(xué)課件：腹部一eng

1、ABDOMEN（） Diagnostic imaging of esophagus and gastrointestinal tract lack of natural contrast rely on contrast examinations Barium examinations remains the main diagnostic imaging up to now Barium meal examination Attention items prior to contrast examination: for barium meal examination: patients s

2、hould be fast 6 hours at least, high-density medicine should be prohibited from 3 days ahead of the examination; for barium enema examination: aperient should be administrated at the night before the examination, cleaning enema should be done prior to the examination; contraindication :gastric-intes

3、tinal perforation (absolute), hemorrhea, acute bowel obstruction Attention items during contrast examination of gastrointestinal tract : both mucosal images and barium pool images be obtained and viewed; fluoroscopy be combined with spot film; both morphologic and functional changes of the organs be

4、 concerned; observe in different directions and at different aspects; compression method be appropriately applied; observe dynamically Normal anatomy Normal anatomy three impressions Esophagus Esophagus CT appearance Stomach varies and depends upon the gastric tone and body built. Steer hornJ-shaped

5、CascadeFish-hook Iliac crest barium pool images AB Mucosal view Stomach Stomach Coronal reconstructionAxial image duodenum cap descending horizontal ascending (1)Shape, distribution, division (2) mucosal fold (3)peristalsis 1. No obvious boundary 2. Mucosal fold: plicae circularis 3. peristalsis and

6、 empty Jejunum ileum Ileocecal Junction Jejunum and ileum Barium pool imageMucosal image (1) anatomical position, name of each portion (2) feature of colons contour (3) cavity width (4) mucosal fold (5)Peristalsis colon and recta basic x-ray appearance in disease of gastric-intestinal tract outline

7、change Lumen change mucosal change Function change en face on profile Niche Outline the unchanging collection of barium will project outside the confine of the stomach Filling Defect caused by a space occupying mass producing defect on the barium pool images (mass lesion). Outline Diverticulum A ben

8、ign outpouching of the gastro-intestinal tract at the point of weakness in the wall(pulsion type) or when the wall becomes abherent to an adjacent inflammatory process(traction type). Diverticulum is covered by all layers of the bowel. 食道與胃腸道的基本病變食道與胃腸道的基本病變 lumen stricture dilation mucosal interrup

9、ti on 粘膜平坦 mucosal ulceration mucosal folds radiate (ulceration chronic stage) function alterations： secrete increased； irritation； peristalsis increased or weakened； empty delayed: gastric4h, small intestinal 9h。 spasm incisure spasm incisure o A. o B. Chronic Peptic ulcer o C. Gastric carcinomas o

10、 D. Tuberculosis of Intestine Radiology of Common Diseases of Gastrointestinal Tract Case 1 Male，50 years old，hepatitis B for 20 years， 1、What kind of lesion？ 2、What s the diagnosis and the diagnosis basis? pathogenesis：most commonly due to cirrhosis of the liver, represent collateral venous channel

11、s that open up when blood flow from the bowel to the liver via portal veins is impeded Clinical symptom：haematemesis and hematochezia Earthworm-like X-ray appearance： (1)mucosal fold： spread gradually from lower esophageal to the upper， appeared as widening or distorting of mucosal foldsbead-like or

12、 earthworm-like filling defects (2)wall：the wall is soft, the lumen is unobstructed, no stenosis is presented。 Case 2 Female，48 years old， epigastic pain for 2 year， 1、What kind of lesion？ 2、What s the diagnosis and the diagnosis basis? Gastric and duodenal ulcer 2050 years old，epigastric pain Lesio

13、n affected mucosa and submucosa, often arrived muscular layers X-ray identify lesion location, numbers, size and development Predilection site：lesser curvature、anterior and posterior wall near lesser curvature、posterior wall of duodenal bulb X-ray features (1)direct sign; en face (looking directly f

14、acing the ulcer): crater on profile (looking from the side): Niche (2)indirect sign: acute stage：Hamptons line、collar sign、narrow neck sign chronic phase：mucosal folds radiate to crater edge (3) organ deformation : distortion (4) functional alteration 直接征象直接征象 Mucosa radiationMucosa radiation A B A

15、niche B collar sign Direct sign incisure Narrow collar I NicheNiche I DistortionDistortion I IrritationIrritation Duodenal ulcer 直接征象直接征象 Duodenal ulcer Case 3 male，60 years old， epigastic pain for 2 years， haematemesis and melena for 6 months 1、What kind of lesion？ 2、What s the diagnosis and the di

16、agnosis basis? Gastric carcinomas CLINICAL PRESENTATION 40-60 years old patients. Weight loss, abdominal pain are the most frequent initial symptoms. PATHOLOGY(gross features) Fungating tumors , Infiltrating tumors, Superficial spreading carcinoma outline change Lumen obstrucion mucosal interruption

17、 Function change Gastric carcinomas x-ray appearance Early gastric carcinoma： definition, types disorder or vanish of the mucosa of gastric area; small niches; granular small round filling defects of early carcinomas Early gastric carcinoma manifestation of advanced stage carcinomas intraluminal fil

18、ling defect; intraluminal crater; mucosa destroy; contour alteration; lumen alteration Infiltrating gastric carcinoma Mushroom gastric carcinoma Filling defect 龕影（半月綜合龕影（半月綜合 征）征） 指壓征指壓征 裂隙征裂隙征 Ulcerated gastric carcinoma niche Radiological differential features between a benign gastric ulcer and ul

19、cerating malignancy: ulcer carcinomas Summary: general x-ray appearance of gastro carcinomas irregularity of luminal contour, rigidity of the wall, narrowing of the lumen; irregular intraluminal filling defect; local mucosa destruction, interruption or vanishing; peristalsis weakened or vanished; ul

20、ceration may be presented intestinal tuberculosis clinical, pathologic, predilection site(ileocecal ) types: ulcerative type (caseous necrosis) proliferative type (tuberculous granulomas ) 1. Stierlin sign There is a lack of barium retention in a diseased segment of ileum and caecum but with a colum

21、n of barium remains on either side of the affected area. This phenomenon mey result from spasm, organic contracture of a combination of both. 2. String sign A radiological sign shows persistent narrow stream of barium in distal portion of the small bowel due to increased irritability or organic sten

22、osis 3. Distorted ileocecal region, 4. Intestinal Obstruction, 5. Distorted or destroyed mucosal folds proliferative type ulcerative type Stierlin sign Acute abdomen 1. Examination methods X- ray examination: (1) Plain film and fluoroscopy: The preferred method (2)Contrast examination: barium meal,

23、barium /atmosphere enema, water-soluble iodine contrast CT DSA: selective / super-selective angiography Simple small-intestine obstruction plicae circularis haustrum Perforation of gastrointestinal tract Cause of disease Clinical manifestations Examination methods (1) fluoroscopy, abdominal plain film: upright, side- lying cross-table position (2) water-soluble iodine contrast examination (3) CT X-ray manifestation (1)