醫(yī)學影像學教學課件：RADIOLOGY

RADIOLOGY

(MedicalImaging)OverviewandPrinciplesofDiagnosticImagingMedicalImagingDiagnosticImagingInterventionalRadiologyDiagnosticRadiologyUltrasonographyNuclearImagingDiagnosisTherapyMagneticResonance

Theaimofourcourseismainlytostudythebasicknowledgeaboutdiagnosticradiology:howtousex-rays,whatcanx-raysdofordiagnosisofdiseases,thevariousexaminationmodalities,andwhataretheadvantagesandlimitationsoftheseexaminationmodalities.Althoughabriefintroductionofmagneticresonance(MR)isincludedinourcourse,ultrasound(US)andnuclearimagingwillbetaughtinadditionalcourses.DiagnosticImagingMethodsDiagnosticimagingisadynamicspecialtythathasundergonerapidchangewithcontinuingadvancementsintechnology.Notonlyhasthenumberofimagingmethodsincreasedbuteachonecontinuestoundergoimprovementandrefinementofitsuseinmedicaldiagnosis.RadiographicTechniquesTheprincipleofselectionSafeAccurateConvenientEconomicPrinciplesofx-rayThex-raybeamisproducedbybombardingatungstentargetwithanelectronbeamwithinanx-raytube.Asx-raypassthroughthehumanbodytheyareattenuatedbyinteractionwithbodytissues(absorptionandscatter),resultinginanimagepatternrecognizableashumananatomy.naturalcontrast

artificialcontrastRadiographicTechniquesX-rayfilmFluoroscopySoftbeamradiographyforbreastContrastadministrationexaminationRadiographicTechniquesContrastadministrationexaminationcontrastmediumHigherdensitycontrast：barium，iodineLowerdensitycontrast：gasagentsThewayofcontrastadministrationdirect：takeorally、enema、injectintothevesselsindirect：injectintotheveins，physiologicalexcretionDigitalRadiographyDRComputedRadiographyCR，(imagingplateIP)DigitalFluorography，DF(影像增強電視系統(tǒng)，IITV)DigitalRadiography,DR(flatpaneldetectors)PrincipleofCRPrincipleofDRPACSPictureArchivingandCommunicatingSystemRISRadiologicalInformationSystem

RIS＋PACS＋WebPACS示意圖

DigitalSubtractionAngiography(DSA)PrincipleofDSAImagingAmethodforshowingcontrast-filledvesselswithoutanyinterferingbackground.“Mask”image,justbeforethecontrastmediumisinjected,ontowhichtheimageswithcontrastmediumwereoverlaidtocoincide,producingasubtractionimageonlydisplayingthecontrast-filledvessels.angiographyComputedTomographyIntroduction

Sinceitsintroductioninthe1970s,CThasbeenshowntohavewideapplicationswithinalltheradiologicalsubspecialities.Ithasbecomeaprimaryimagingtechniqueintheclinic.WhatisCTCTimagesasectionorsliceofthepatientTwo-dimensionalimageofthesliceReconstructedimage(arrayofquantizedgrayscalevaluesorpixels)Pixelvalues(CTnumber)arerelatedtothelinearattenuationofthecorrespondingvolumeelementoftheslice(voxel)BasicComponentsofaCT

GantryTableGeneratorConsoleComputerFromtheoutside...TableGantryGeneratorInsideascannerTubeDetectorDASTubecollimatorHowdoesaCTwork

ImageProcessingDatadetection&acquisitionX-raysourceCTvalue圖像質(zhì)量的進展...二維橫斷面到三維圖像重建

EquipmentConventionalCTSpiral(helical)CTMultisliceCT(MSCT)ElectronbeamCT(EBCT)DualsourceCT(DSCT)MultisliceCT（MSCT）MultisliceCT,alsoknownasmultidetectorCT(MDCT)ormultidetectorrow,isthelatestbreakthroughinCTtechnology.Ithastrans-formedCTfromatransaxialcross-sectionaltechniqueintoatruethree-dimensionalimagingmodality.Majorattributesthatareimprovedarethez-axiscoveragespeedandthelongitudinalresolution(isotropicarrays).Multi-Slicevs.SingleSliceTechnologyKeybenefitsofmulti-sliceCToversingleslicescannersincreasedcoverageinasinglebreathholdbetterimagequalitydecreasedacquisitiontimethinnerslicesimproved3DpostprocessingtechniquesClinicalBenefitsofMultisliceCTShorterScanTime0.37sLargerVolumeClinicalApplicationIsotropicResolution0.4mm多層CT發(fā)展迅猛

1992：2層1998：4層2001：16層2003：64層

2005：雙源2006:256層2007:320層單源CT雙源CTSOMATOMDefinition－世界首臺雙源CT

任意心率條件下的時間分辨率83ms=83msRotationTime4TemporalResolution=CTTechniquesplainscanningcontrastenhancementothercontrastexaminationHRCT(highresolutioncomputedtomography)HRCTCTTechniquesReconstructionSurfaceShadedDisplay(SSD）MaximumIntensityProjection(MIP）VolumeRendering(VR）MultiplanarReconstruction(MPR）CurvedMultiplanarReconstruction(CMPR）VirtualEndoscopy(VE）齒狀突骨折伴環(huán)枕、環(huán)樞關(guān)節(jié)脫位Fractureoftheodontoidprocesswithdislocationoftheatlanto-occipitalandatlanto-axialjointsHeadlinestenosisCourtesyofUniversityofErlangen,DepartmentofRadiologyandInstituteofMedicalPhysicsSOMATOMSensation646secfor350mm64x0.6mm(2x32)Resolution0.4mmRotation0.37sec120kV/150mAs缺乏造影劑？掃描比造影劑跑得快！AneurysmandDissection

CTAoflivingdonortransplantationCTTechniquesFunctionandothertechniques

Perfusion

QuantitativeCT(QCT)CTcoronaryarteryangiography

Function

常規(guī)CTTimetoPeakCBF隨訪

顱內(nèi)動脈栓塞

隨訪CT顯示液化灶embolismofintracranialarteries,follow-upCTimageshowstheinfarctionmale,56,150minaftertheonset左前降支狹窄LeftanteriordescendingbranchstenosisCTcoronaryarteryVESpeed4D-CardiacImagingwith0.37sRotation

ImprovedDiagnosticConfidenceforPlaqueAnalysisCourtesyofThoraxCenterRotterdam,theNetherlands掃描層厚、空間分辨率和冠脈成像SOMATOMSensationCardiacCardiacMorphology

AdditionalClinicalInformationreceivedfromECG-gatedscan

CalcifiedThrombusAorticValveECG-GatedScan16-SliceCardiacFunctionAnalysis

syngoArgus,CT4DandLV-FunctionCourtesyofGrosshadernClinicEFEDVESVMassWallThickeningMovieCompatibletoMRIandCTDataHeadlineSpeed4D-CardiacImagingwith0.37sRotation

ImprovedDiagnosticConfidenceforPlaqueAnalysis6monthsfollowupofstentpatency,

noin-stentre-stenosis,67bpm

16x0.75mm,185ms,

12cmin16s,

only80mlcontrastCourtesyofThoraxCenterRotterdam,theNetherlands直接的雙能量肌骨成像顯示肌腱DynamicVolumeScanningCourtesyofDrRogalla,ChariteDynamicOrthopedicAdvantageandDisadvantageofCTAdvantage：TomographicalimageHighdensityresolutionContrastenhancementhavewideapplicationsDisadvantage：ExpensiveX-rayMagneticResonanceImaging(MRI）Imagingmethodusingastrongmagneticfieldandgradientfieldtolocalizeburstofradiofrequencysignalscomingfromasystemofspinsconsistingofreorientinghydrogen(H)1nuclei(protons)aftertheyhavebeendisturbedbyradiofrequencypulses.RecentprogressintheartofMRIMagneticresonanceimaging(MRI)isanoninvasivemethodofmappingtheinternalstructureofthebodywhichcompletelyavoidstheuseofionizingradiationandappearstobewithouthazard.MRIhasnowrapidlyprogressedfrombeingatechniquewithgreatpotentialtoonewhichhasbecometheprimary,andoftentheonly,diagnosticmethodrequiredformanyclinicalproblems.RecentprogressintheartofMRIThephenomenonofMRwasdescribedindependentlybutalmostsimultaneouslybyBlochandPurcellin1946andfortheirdiscoverytheywerejointlyawardedtheNobelPrizeforPhysicsin1952.BecausetheuseofMRforimagingrequiredamethodforspatiallocalization,LauterburandMansfieldwerejointlyawardedtheNobelPrizeformedicinein2003.MRhastheabilitytodisplaystructuresinatransverseoraxialfashion,similarlytoCT.However,MRhastheadditionaladvantageofbeingabletoproduceimagesinvirtuallyanyorientation.Thecommondisplayorientationsusedaresagittalandcoronalaswellasaxialplanes.Ingeneral,duringanMRexaminationthreeformsofMRimagecanbeproduced:T1weightedimage(T1WI),T2weightedimage(T2WI),andprotondensityweightedimage(PDWI).TissuesorsubstanceswithshortT1relaxationtimes(shortT1)havehighsignalintensityandappearbrightonT1WI,whereastissuesorsubstanceswithlongT1relaxationtimes(longT1)havelowsignalintensityandappearblackonT1WI.TissuesorsubstanceswithshortT2relaxationtimes(shortT2)havelowsignalintensityandappearblackonT2WI,whereastissuesorsubstanceswithlongT2relaxationtimes(longT2)havehighsignalintensityandappearbrightonT2WI.WaterappearsblackonT1WIandbrightonT2WIbecauseithaslongT1andlongT2relaxationtimes.FatappearsbrightonT1WIandmediumsignalintensityonT2WIbecauseithasshortT1relaxationtimesandmediumT2relaxationtimes.MuscleappearsmediumsignalintensityonbothT1WIandT2WIbecauseithasmediumT1andmediumT2relaxationtimes.Corticalbones,calcium,andlungtissuesappearlowsignalintensity(black)onPDWIaswellasT1WIandT2WIbecausetheyhaveverylitterhydrogen(proton).Imagingpulsesequencespinecho(SE)sequenceinversionrecovery(IR)sequenceavarietyofacronymicgradientecho(GRorGRE)sequencetechniques(e.g.STIR,FISP,andFLASH,etc.)ThefastestsequenceofMRIusedtodayisechoplanarimaging(EPI)MRIcharacteristicsmultiplesequencesprovideimagesinanyanatomicplaneflowingeffectscontrastenhancement膝關(guān)節(jié)外傷，脛骨骨折ApplicationofMRIEnhancementtumorblood-brainbarriermoresensitiveMRAMRIcontrastmediumGd-DTPAparamagneticcontrastmediumAMI-25superparamagneticcontrastmediumMRIEquipmentLowfieldMR，opensystemMRRecentprogressinMRIunitPolarizationofmagneticfieldSpecialMRUnitFasterandstrongermagneticresonancegradientsRFcoilRFCoilsAdvancedImagingTechniquesWholebodyMRscreening

Itisanidealmodalityforthepurposesofhealthcarescreeningthathasbothhighsensitivityandspecificitywithoutradiationhazard.ThetruebenefitofwholebodyMRimagingisinthevarietyofdiseasefound.ItsvalueisinitsreliabilityandaccuracyPatientwithPlasmocytoma

TSET1+2w,PAT2Schlemmer,Claussenetal.

UniversityTuebingen(Germany)SHChanghaiHospital全身成像多發(fā)轉(zhuǎn)移3DToFTR/TE35/3.6ms,192x512,

SL0.8mm,108partitionsTA:6:44minHigh-ResolutionToFat3T

ToFMRAoftheHandHigh-resolution3DToF

withwaterexcitation

Nocontrastagent3DFLASHfatsat

SL1mm,256x512,215partitions

TR/TE33/4.9ms,TA:9:00min

高分辨乳腺成像SHChanghaiHospital乳腺動態(tài)掃描SHChanghaiHospital2DPACE自由呼吸腹部成像T2WTSEMatrix3842DPACET2WTSEMatrix3842DPACEwithfatsat北京阜外醫(yī)院OtherMRITechniquesFatsuppressionMRC（Cinema）MRAMRCP,MRUFunctionalMRI（fMRI）MRSDWIPWISubsecond3DMRAofAorticAneurysm

HighResolutionMRAngiography

highresolution512matrixin18secaquisitiontimeSubsecond3DMRAofAorticArchStenosisSubsecondMRAofAorticDissection

3DTrueFISPCoronaryMRAFlexibility:

thechoiceisyoursbreathholdin~20secDarkBloodCoronaryMRAwith3DTSE&NavigatorsSchlemmer,Claussen,Univ.HospitalTuebingen,GermanyMRCPpostcholecystectomyin1.8secondsMultiplelivercystsUretercancerMRUBHTA:4secs

Fl2dt1wfswithcontrast

VIBESL2mmTA:18secswithcontrast

河北省腫瘤醫(yī)院3DTSEIACSL0.5mmMIP北京阜外醫(yī)院哈爾濱醫(yī)科大學第一附屬醫(yī)院IncreasedBOLDEffectsat3.0TBOLDcontrastisintherangeof3.0T=5to10%1.5T=1to2%3.0T1.5TIncreasedBOLDEffectsRRRWhitemattertractacd手動功能區(qū)腫瘤天津環(huán)湖醫(yī)院DWI/PWI-based“RiskMaps”T2ADCMTTCBFCBVHWIInitialLowb+ADC01CourtesyO.Wu,G.Sorensen,MGHFollow-upT2(2Months)CombinedDWI+HWICourtesyofDr.R.White,ClevelandClinic,Cleveland,USASiemenswasthefirsttooffertheseasaproductInfarctEvaluation:Cine&LateEnhancementClinicalProtocolsforInfarctEvaluationCourtesyofNorthwesternUniversityChicago,USATrueFISPcineLateEnhancementGadoliniumContrastEnhancementinMyocardialInfarctionEx-vivocomparisonofTTCandGd-enhancedMRIininfarctedmyocardiumCourtesyofDr.