腹部超声

nullAbdominal SonographyAbdominal Sonography腹部超声null*Also known as ---Abdominal ultrasound (US) scanning ---Abdominal US imaging ---Abdominal ultrasonography ---Abdominal ultrasound null*About the coursenull* 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 Infonull*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. null*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? null*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 body's major arteries and veins in the abdomen, arms, legs and neck.What is Abdominal Sonography? null*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. null*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.  null*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:null*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 null*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null*What are some common uses of the procedure? Guide invasive procedures such as needle biopsy and withdrawal of fluid null*How would patients prepare? －（√）wear comfortable, loose-fitting clothing －（Х）barium enema or upper GI (gastrointestinal) tests钡餐灌肠 上消化道检查null* 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? null*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? null*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 patient's abdominal area. null*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 physician's instructions. Examinations usually take 10-30 minutes. null*Small structure---higher-frequency linear array Abdomen---curved/linear/array Echocardiography---sector Obstetric & gynecologic---curved arrayInstrumentationnull*Who interprets the results?A radiologist, or sonogistnull*What are the benefits vs. risks? Benefitsnoninvasive (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 fluidnull*What are the benefits vs. risks? RisksFor standard diagnostic ultrasound there are no known harmful effects on humans. Pregnant women and fetuses can be safely examined. null*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.null*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 bodynull*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 sonographynull*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FOUNDATIONSFOUNDATIONSSonographic Terminology*Sonographic TerminologyDescriptive terminology Hyperechoic---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）null*HyperechoicshadowingHypoechoicHyperechoicHypoechoicshadowingnull*HeterogeneousHomogenousAnechoic SonolucentEnhancementIsoechoicnull*Sonographic EvaluationThe size The echo and attenuation of the organ Parenchyma实质 The texture质地 The presence of vascular structures, ligaments, and fissures裂隙 Abnormality异常 and mass占位null*The normal or abnormal images of abdominal organsnull*The LiverUltrasound 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.null*null*The simple cyst has three acoustic properties －－anechoic －－has a well-defined smooth capsule －－exhibits posterior enhancement (increased through transmission of sound)肝囊肿hepatic cystnull*肝血管瘤 Hepatic hemangiomaSmall solitary or multiple nodular lesion Rounded well-defined Hyperechoic mass Usually not visualize colour flownull*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 lesion’s 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 effectnull*null*Benign hepatic tumors hemangioma, hepatocellular adenoma, hepatic cystadenoma, FNH(focal nodular hyperplasia) etc. Malignant tumors hepatocarcinoma, hepatocholangiocarcinoma, metastases, lymphoma etc Hepatic tumorsPathology*Types massive type nodular type diffusely infiltrating type Vascular invasionPathologyPrimary CarcinomaHepatic tumorsUSG Feature*Echoic pattern Sonographic types Invasion Color Doppler Flow ImageUSG FeatureHepatic tumorsnull*hyperechoichypoechoichypoechoicisoechoicnull*null*VI Differential Diagnoses*VI Differential DiagnosesCyst Hemangioma MetastasesPrimary Carcinomanull*null*hemangiomaSimple hepatic cystnull*null*hyperechoichypoechoichypoechoicisoechoicHepatic carcinomanull*Metastatic tumornull* 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. null*The gallbladderUltrasound 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 populationnull*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 demonstratednull*Reflectivity（hyperechoic） Shadowing MobilitySupine viewerect viewnull*The pancreasBecause 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.null*Acute pancreatitisMild 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.null*Necrotic tail of pancreas surrounded by exudatehypoechoic and bulky