腹部超声知识讲座培训课件

腹部超声知识讲座2 2Also known as-Abdominal ultrasound(US)scanning-Abdominal US imaging-Abdominal ultrasonography-Abdominal ultrasound 腹部超声知识讲座腹部超声知识讲座3 3Aboutthecourse腹部超声知识讲座腹部超声知识讲座4 4WhatisAbdominalSonography?WhatisanAbdominalSonogram?Whataresomecommonusesoftheprocedure?Howwouldpatientsprepare?Howdoestheprocedurework?Whatdoestheequipmentlooklike?Whointerpretstheresults?Whatarethebenefitsvs.risks?WhatarethelimitationsofAbdominalUSG?UltrasonographyInfo腹部超声知识讲座腹部超声知识讲座5 5What is Abdominal Sonography?Abdominalsonographyisamethodofobtainingimagesofinternalorgansbysendinghigh-frequencysoundwavesintothebody.Thereflectedsoundwavesarereturnedasechoes.Theechoesarethenrecordedanddisplayedasareal-timevisualimage.Sinceultrasoundimagesarecapturedinreal-timetheyhavetheabilitytoshowmovementofinternaltissues,liverfunction,andbloodflow.腹部超声知识讲座腹部超声知识讲座6 6Ultrasonographyisanoninvasivemedicaltestthathelpsphysiciansdiagnoseandtreatmedicalconditions.Anabdominalultrasonographyproducesapictureoftheorgansandotherstructuresintheupperabdomen.What is Abdominal Sonography?腹部超声知识讲座腹部超声知识讲座7 7ADopplerultrasoundstudymaybepartofanabdominalultrasoundexamination.Dopplerultrasoundisaspecialultrasoundtechniquethatevaluatesbloodasitflowsthroughabloodvessel,includingthebodysmajorarteriesandveinsintheabdomen,arms,legsandneck.What is Abdominal Sonography?腹部超声知识讲座腹部超声知识讲座8 8What is an Abdominal Sonogram?Anabdominalsonogramcanhelptodiagnoseavarietyofconditionsandtoassessdamagecausedbyillness.Liver,gallbladder,spleen,pancreas,andkidneyswillbeevaluatedduringanabdominalsonogram.Variousreasonsare:abdominalpain,abnormallabresults,andenlargedabdominalorgans.腹部超声知识讲座腹部超声知识讲座9 9What is an Abdominal Sonogram?Anabdominalsonographerwillberequiredtoimagesmallbodypartsaswell.Thesepartsinclude:thyroidgland,testicles,breast,andvarioussofttissueofbodyparts.Doctorscanalsouseabdominalsonographytoguidethemastheyperformneedlebiopsiesonabdominalorgans.腹部超声知识讲座腹部超声知识讲座1010Whataresomecommonusesoftheprocedure?-Kidneys-Liver-Gallbladder-Pancreas-Spleen-AbdominalaortaandotherbloodvesselsAbdominalultrasoundimagingisperformedtoevaluatethe:腹部超声知识讲座腹部超声知识讲座1111Whataresomecommonusesoftheprocedure?AbdominalpainsAbnormalliverfunctionEnlargedabdominalorganAbnormalitiesintheabdomen:gallstones,livercirrhosis,cyst,tumor,etc.Ananeurysmintheaorta 腹部超声知识讲座腹部超声知识讲座1212Whataresomecommonusesoftheprocedure?Dopplerultrasoundimagescanhelpthephysiciantoseeandevaluate:Blockagestobloodflow(blood clots/atherosclerotic plaque)Narrowingofvessels(whichmaybecausedbyplaque)Tumorsandcongenitalmalformation血凝块血凝块/动脉粥样硬化斑块动脉粥样硬化斑块腹部超声知识讲座腹部超声知识讲座1313Whataresomecommonusesoftheprocedure?Guideinvasiveproceduressuchasneedlebiopsyandwithdrawaloffluid腹部超声知识讲座腹部超声知识讲座1414How would patients prepare?（）wearcomfortable,loose-fittingclothing（）bariumenemaorupperGI(gastrointestinal)tests钡餐灌肠钡餐灌肠 上消化道检查上消化道检查腹部超声知识讲座腹部超声知识讲座1515Forastudyoftheliver,gallbladder,spleen,andpancreas,patientmaybeaskedtoeatafat-freemealontheeveningbeforethetestandthentoavoideatingfor8to12hoursbeforethetest.Forultrasoundofthekidneys,maybeaskedtodrink4to6glassesofwateraboutanhourbeforethetesttofillyourbladder.maybeaskedtoavoideatingforeightto12hoursbeforethetesttoavoidgasbuildupintheintestines.Forultrasoundoftheaorta,youmayneedtoavoideatingforeightto12hoursbeforethetest.How would patients prepare?腹部超声知识讲座腹部超声知识讲座1616Incaseofanemergency,examscanbedonewithoutspecialpreparations.Tellthesonographer,sonologist,orphysicianconductingtheexaminationaboutpain,bleeding,oranyothersymptoms.Tellingtheexamineraboutpastultrasoundsandsurgeriesishelpful,andsometimesprovidescrucialinformation.（重要信息）（重要信息）How would patients prepare?腹部超声知识讲座腹部超声知识讲座1717Howdoestheprocedurework?Youwillbepositionedonanexaminationtableandmadetoliedownonyourbackandlayyourhandsaboveyourhead.Itmaybecomenecessarytochangepositionsduringtheexam,andliedownonyoursideorsitup.Alubricatinggel（甘油凝胶（甘油凝胶/耦合剂）耦合剂）isappliedtothepatientsabdominalarea.腹部超声知识讲座腹部超声知识讲座1818Howdoestheprocedurework?Anapparatusknownasatransducerisplacedontheabdominalareaandmovedaroundtogetrealtimeimages.Sometimesyouwillhavetobreatheinandholdyourbreathaccordingtothetechnologist,sonologist,orphysiciansinstructions.Examinationsusuallytake10-30minutes.腹部超声知识讲座腹部超声知识讲座1919n nSmall structure-higher-frequency linear arrayn nAbdomen-curved/linear/arrayn nEchocardiography-sectorn nObstetric&gynecologic-curved arrayInstrumentation腹部超声知识讲座腹部超声知识讲座2020Whointerpretstheresults?A radiologist,or sonogist腹部超声知识讲座腹部超声知识讲座2121Whatarethebenefitsvs.risks?Benefitsnoninvasive(noneedlesorinjections)andisusuallypainless.widelyavailable,easy-to-useandlessexpensivethanotherimagingmethods.usesnoionizingradiation.givesaclearpictureofsofttissuesthatdonotshowupwellonx-rayimages.causesnohealthproblemsandmayberepeatedasoftenasisnecessary.providesreal-timeimaging,makingitagoodtoolforguidingminimallyinvasiveproceduressuchasinjections,needlebiopsiesandneedleaspirationoffluid腹部超声知识讲座腹部超声知识讲座2222Whatarethebenefitsvs.risks?RisksForstandarddiagnosticultrasoundtherearenoknownharmfuleffectsonhumans.Pregnantwomenandfetusescanbesafelyexamined.腹部超声知识讲座腹部超声知识讲座2323WhatarethelimitationsofAbdominalUSG?Ultrasoundwavesaredisruptedbyairorgas;thereforeultrasoundisnotanidealimagingtechniqueforthebowelororgansobscuredbythebowel.Inmostcases,bariumexams,CTscanning,andMRIarethemethodsofchoiceinthissetting.腹部超声知识讲座腹部超声知识讲座2424WhatarethelimitationsofAbdominalUSG?Ultrasoundwavesdonotpassthroughair;thereforeanevaluationofthestomach,smallintestineandlargeintestinemaybelimited.Intestinalgasmayalsopreventvisualizationofdeeperstructuressuchasthepancreasandaorta.Largepatientsaremoredifficulttoimagebecausetissueattenuates(weakens)thesoundwavesastheypassdeeperintothebody腹部超声知识讲座腹部超声知识讲座2525Gallstonesandcholecystitis胆结石，胆管炎胆结石，胆管炎Hepatitis/livercirrhosis肝炎肝炎/肝硬化肝硬化Kidney/Bladderstones肾肾/胆囊结石胆囊结石Hydronephrosis肾积水肾积水Tumors肿瘤肿瘤Cancersoftheliver,kidneys,pancreas,gallbladder,biliarytree癌癌Lymphoma淋巴瘤淋巴瘤Metastasis转移灶转移灶Cysts囊肿囊肿Infections感染感染CommonconditionsrevealedbyAbdominalsonography腹部超声知识讲座腹部超声知识讲座2626Abscesses脓肿脓肿Appendicitis阑尾炎阑尾炎Enlargedliver,spleen,kidneys,lymphnodes增大增大Pancreatitis胰腺炎胰腺炎Congenitalmalformation先天畸形先天畸形Injury-hematoma,tear,rupture创伤（血肿、撕创伤（血肿、撕裂、破裂）裂、破裂）Hemorrhageoftheadrenalgland肾上腺出血肾上腺出血Abdominalaorticaneurysm腹主动脉瘤腹主动脉瘤Ascites腹水腹水Peritonitis腹膜炎腹膜炎Bowelobstruction肠梗阻肠梗阻Hernia疝气疝气腹部超声知识讲座腹部超声知识讲座FOUNDATIONS2727腹部超声知识讲座腹部超声知识讲座2828SonographicTerminologyDescriptive terminologyHyperechoic-Hypoechoic(高回声低回声高回声低回声高回声低回声高回声低回声)Isoechoic（等回声）（等回声）Anechoicorsonolucent（无回声）（无回声）Enhancement（回声增强）（回声增强）Heterogeneous-Homogeneous（非均质（非均质（非均质（非均质/均质）均质）均质）均质）Shadowing（声影）（声影）腹部超声知识讲座腹部超声知识讲座2929HyperechoicHyperechoicshadowingshadowingHypoechoicHypoechoicHyperechoicHyperechoicHypoechoicHypoechoicshadowingshadowing腹部超声知识讲座腹部超声知识讲座3030HeterogeneousHeterogeneousHomogenousHomogenousAnechoicAnechoicSonolucentSonolucentEnhancementEnhancementIsoechoicIsoechoic腹部超声知识讲座腹部超声知识讲座3131Sonographic EvaluationThesizeTheechoandattenuationoftheorganParenchyma实质实质Thetexture质地质地Thepresenceofvascularstructures,ligaments,andfissures裂隙裂隙Abnormality异常异常andmass占位占位腹部超声知识讲座腹部超声知识讲座3232Thenormalorabnormalimagesofabdominalorgans腹部超声知识讲座腹部超声知识讲座3333The LiverUltrasoundisoftenthefirstlineofinvestigationforsuspectedliverpathologyandthedecisiontoproceedtosecondaryinvestigativeprocedures,suchasfurtherradiologyorhistology.Ultrasoundisusedinthediagnosis,stagingandmonitoringofliverdisordersandalsocontributestotheirtreatmentwithultrasound-guidedinvasiveprocedures.Developingtechnologyandtechniquesnowresultinimproveddiagnosticaccuracyandareincreasinglyobviatingtheneedforfurtherradiology.Intraoperativeandlaparoscopicultrasound,usinghigh-frequency,direct-contacttechniques,setthestandardforliverimaginginmanycases.腹部超声知识讲座腹部超声知识讲座3434腹部超声知识讲座腹部超声知识讲座3535Thesimplecysthasthreeacousticpropertiesanechoichasawell-defined smooth capsuleexhibitsposterior enhancement(increasedthroughtransmissionofsound)肝囊肿肝囊肿肝囊肿肝囊肿hepaticcysthepaticcyst腹部超声知识讲座腹部超声知识讲座3636肝血管瘤肝血管瘤HepatichemangiomaSmallsolitaryormultiplenodularlesionRoundedwell-definedHyperechoicmassUsuallynotvisualizecolourflow腹部超声知识讲座腹部超声知识讲座3737术语TermsThis 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腹部超声知识讲座腹部超声知识讲座3838腹部超声知识讲座腹部超声知识讲座3939Benign hepatic tumorsBenign hepatic tumors hemangiomahemangioma,hepatocellular adenomahepatocellular adenoma,hepatic cystadenomahepatic cystadenoma,FNHFNH(focal nodular focal nodular hyperplasiahyperplasia)etc.)etc.Malignant tumorsMalignant tumors hepatocarcinoma,hepatocholangiocarcinomahepatocarcinoma,hepatocholangiocarcinoma,metastasesmetastases,lymphoma lymphoma etc etc Hepatic tumors腹部超声知识讲座腹部超声知识讲座4040n nTypes massive type nodular type diffusely infiltrating type n nVascularinvasionPathologyPrimary CarcinomaHepatic tumorsHepatic tumors腹部超声知识讲座腹部超声知识讲座4141EchoicpatternEchoicpatternSonographictypesSonographictypesInvasionInvasionColorDopplerFlowColorDopplerFlowImageImageUSG FeatureUSG FeatureHepatic tumorsHepatic tumors腹部超声知识讲座腹部超声知识讲座4242hyperechoichypoechoichypoechoicisoechoic腹部超声知识讲座腹部超声知识讲座4444腹部超声知识讲座腹部超声知识讲座4545VIDifferentialDiagnosesn nCystn nHemangioman nMetastasesPrimary Carcinoma腹部超声知识讲座腹部超声知识讲座4646ClinicalFindingsClinicalFindingsUSGFindingsUSGFindingsHemangiomaN/ASolitaryormultipleRoundorovalWell-definedborderHyperechoic（mostparts）ColorflowPrimaryCaPrimaryCa80%HCC80%HCC70%70%HCCAFPHCCAFP AbnormalLFTsAbnormalLFTsSolitaryormultipleInfiltrative,diffuseHypoechoic,isoechoic,hyperechoicPortalveins/hepaticveinsinvadedthrombusMetastasesMetastases转移性肝癌转移性肝癌转移性肝癌转移性肝癌AbnormalLFTsAbnormalLFTsSolitaryormultipleWell-,ill-definedHypoechoicorhyperechoicDiffusedistortionofbullseyepattern腹部超声知识讲座腹部超声知识讲座4747hemangiomaSimple hepatic cyst腹部超声知识讲座腹部超声知识讲座4848腹部超声知识讲座腹部超声知识讲座4949hyperechoichypoechoichypoechoicisoechoicHepaticcarcinoma腹部超声知识讲座腹部超声知识讲座5050Metastatictumor腹部超声知识讲座腹部超声知识讲座5151USG-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.腹部超声知识讲座腹部超声知识讲座5252ThegallbladderUltrasoundisanessentialfirst-lineinvestigationinsuspectedgallbladderandbiliaryductdiseaseItishighlysensitive,accurateandcomparativelycheapGallbladderpathologyiscommonandisasymptomaticinover13%ofthepopulation腹部超声知识讲座腹部超声知识讲座5353Therearethreeclassicacousticpropertiesassociatedwithstonesinthegallbladder;theyarehighly reflective,mobile andcastadistal acoustic shadow.Inthemajorityofcases,allthesepropertiesaredemonstrated腹部超声知识讲座腹部超声知识讲座5454Reflectivity（hyperechoic）ShadowingMobilitySupine viewerect view腹部超声知识讲座腹部超声知识讲座5555ThepancreasBecausethepancreasliesposteriortothestomachandduodenum（十二指肠）（十二指肠）,avarietyoftechniquesmustusuallybeemployedtoexamineitfully.Althoughultrasoundmaystillbeconsideredthefirstlineofinvestigation,CT,MRIand/orendoscopicretrogradecholangiopancreatography(ERCP内窥镜逆行胰胆管造影内窥镜逆行胰胆管造影)arefrequentlyrequiredtoaugmentandrefinethediagnosis.腹部超声知识讲座腹部超声知识讲座5656AcutepancreatitisMildacutepancreatitismayhavenodemonstrablefeaturesonultrasound,especiallyifthescanisperformedaftertheacuteepisodehassettled.Inmoreseverecasesthepancreasisenlargedandhypoechoicduetooedema.Themainductmaybedilatedorprominent.腹部超声知识讲座腹部超声知识讲座5757Necrotictailofpancreassurroundedbyexudatehypoechoicandbulky腹部超声知识讲座腹部超声知识讲座