Imaging-of-Urinary-system--精品医学课件.ppt
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Imaging-of-Urinary-system--精品医学课件.ppt
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ImagingofUrinarysystem,Imagingtechnique,Radiography:
plainfilm/urographyAngiographyComputedtomographyMagneticResonanceimaging(MRI)UltrasonographyRadionuclideimaging,X-ray,PlainabdominalradiographsUrographyExcretoryurography(intravenouspyelography,IVP)RetrogradeurographyCystography&urethrographyPercutaneousurography,Plainfilm-Kidneyureterbladder(KUB),Forideavisualization-bowelpreparationAfull-lengthfilmincluding:
Thoracicvertebra11tobladderbaseTheprostaticurethra(inthemale)Investigation:
CalcificationTheposition,shape,sizeofthekidneys,NormalKUB,Theposition,shape,sizeofthekidneysCalcification,KUB平片上,肾脏略呈豆状。
其上缘约在第12胸椎上缘,下缘在第3腰椎下缘水平。
肾影的长轴自内上斜向外下,与腰大肌长轴平行,其延长线与脊柱形成的夹角称为肾脊角,正常为1525正常输尿管不显示,ItemstoLookforonaPlainAbdominalImage,GasPatternsStomach,smallbowel,andrectosigmoidAbnormalorectopiccollectionsOrganShapesandSizesLiverSpleenKidneysSofttissuepelvicmasses,CalcificationAsymmetricpsoasmarginsSkeletonBasilarlungabnormalitiesKUB,kidneys,ureter,bladder.,静脉性肾盂造影,含碘水溶性对比剂于静脉注入后,由肾小球滤过而排入肾盏和肾盂内,能显示肾盏、肾盂、输尿管及膀胱形态(内腔),且可大致了解双肾的排泄功能。
Excretoryurography-Intravenouspyelography,IVP,RadiographicexaminationoftheurinarytractwithintravenousinjectionofcontrastmediumBowelpreparationBladdershouldbeemptyPreliminaryradiographsshouldbeobtainedtodemonstratepossiblecalcifications,calculiorotherabnormalities,Intravenouspyelography,IVP,Purpose:
AssessmentofthehollowpartsoftheurinarytractAnindicationofrenalfunctionMethod:
Normaldosage(300mg-600mg/kg)DoubledosageApplicationofabdominal(ureteric)compressiontodistanturetersandmadeiteasilyvisible,Intravenouspyelography,IVP,Earlynephrogramofrightkidney(15-20seconds).RenaloutlineCortex(star),Intravenouspyelography,IVP,5-or10-minutepostinjectionradiographofthekidneysDemonstratecontrastfillingofthecalycesandpelvicsystemandproximalureters,Intravenouspyelography,IVP,15-minuteradiographoftheentireurinarytractAfterreleaseoftheabdominalcompressionShowmaximumcontrastfillingoftheureters,逆行性肾盂造影,是尿路造影检查的一种,经借助膀胱镜插入输尿管内的导管注入对比剂后摄片检查,适用于排泄性尿路造影显影不佳者。
Retrogradeurography,DelineatethesiteofuretericorrenalpelvispathologywhichcannotbedemonstratedotherwiseMethod:
cystoscopic-guidedcatheterizeintotheselectedureterContrastmedia:
10-25%Iodinatedcontrastmedia5-10ml,thedosagecanbeincreasewhenhydronephrosispresentsContraindications:
thelowerurinarytractinfection,Retrogradeurography,NegativecontrastmediumToobservethepelvicalicealsystemandtheureterStonescouldnotbeseenontheabdominalradiograph.Anairpyelogramdemonstratedtwolargestones(arrows).,Retrogradeurography,PositivecontrastmediumToobservethepelvicalicealsystemandtheureterafterinjected,Percutaneousurography,DirectpercutaneouspunctureofthepelvicalicealsystemwithafineneedleDiagnosisandtreatment,Cystography,Radiographicexaminationoftheurinarybladderbyfillingofthebladderwithcontrastmedium.Applications:
bladdermass,diverticulum,compressionofadjacentorganMethod:
Antegrade(viasuprapubicbladderpuncture)andRetrograde(viaUrethra)Contrastmedia:
3-5%iodinatedcontrastmedia300-400ml,air,orbothofthem(Doublecontrastcystography),Normalcystography,IodinatedcystographyAircystographyThesizeandcontourofthebladdervarywiththedegreeoffilling.Whendistended,thenormalbladderisroughlyspherical.,Urethrography,RadiographicexaminationoftheurethraduringvoidingApplications:
StenosisofurethraMethod:
AntegradeandRetrogradeContrastMedia:
15-25%iodinatedcontrastmedia,Urethrography,Obliqueview(45ofmaleurethraduringvoidingNotetheposterior(largearrow)andanterior(openarrow)urethra,Urethrography,Voidingurethrograhyinafemale.Wideningofthebladderneck(whitearrow)areapparent,血管造影检查,包括腹主动脉造影(abdomianlaortography)与选择性肾动脉造影(selectiverenalarteriography),主要用于诊断肾血管疾病,也用于观察肾或肾上腺肿瘤供血情况,常与介入治疗同时进行。
Angiography,RenovasculardiseaseTumor(combinewithinterventionaltherapy),Congenitalarteriovenousmalformation.Atangleofvesselsisseenintherightkidney,Renalarteryaneurysm.Excretoryurogramshowsarenalpelvicdefect(arrow).Selectiverenalarteriographyshowsarenalarteryaneurysm(arrow)intheexactpositionoftherenalpelvicdefect.,Theleftandrightmainrenalarteries,Stenosisoftheleftrenalartery,Ultrosonography,Actastheinitialurinarytractscreeningtechniqueinpatientswhohavecontrastmaterialcontraindicationsandcannotundergourography.Distinguishcysticfromsolidspace-occupyingrenallesionsCanbeusedasaguidancetechniqueforavarietyofinvasiveprocedures,includingpercutaneousnephrostomy,percutaneousrenalbiopsy,andpercutaneousabscessdrainage.,CT,Computedtomographyangiography(CTA)Computedtomography(CT)hasbecomeamajorimagingtechniqueformanyurinarytractdiseasesandislargelyresponsibleforthedeclineintheuseofexcretoryurography.CTUrography(CTU)CTcanbeusedforawidevarietyoflesions,includingtumors,trauma,vascularabnormalities,cysticdisease,obstruction,postoperativecomplications,congenitalanomalies,andcertainmetabolicdiseases,CTA,Computedtomographicangiography.Highgradestenosisoftheproximalleftrenalartery,CTU,输尿管结石,VRT示左侧输尿管上段较对侧扩张,下段未见明显显影,VE显示左侧输尿管中段高密度结石,MR,HavesimilaruseasCTdoesMRIurograms(MRU)isimagesthatrevealthecollectingsystems,ureters,andbladderbyusingstronglyT2-weightedimageswithfatsaturationsubjectedtoproduceaurogramNocontrastmedialbeused,磁共振尿路造影,主要用于诊断尿路梗阻。
其成像原理是尿液中游离水的T2值要明显长于其它组织和器官,因此选用重T2WI成像时,含尿液的肾盂、肾盏、输尿管和膀胱为高信号,周围软组织等背景结构为极低信号,犹如X线尿路造影所见并可多个角度进行观察。
NormalMRU,膀胱出口梗阻膀胱增大,多发憩室,双侧肾盂肾盏,双侧输尿管积水,左侧明显,Radionuclide,Radioisotoperenogram:
AcutetubularnecrosisUrinarytractobstructionRenaltransplantrejectionDiureticrenogramDifferentiatingfunctionallyinsignificanturinarytractdilation,Amatomykidney,RenalparenchymaCortexMedullaCollectingcaveCalycesPelvis,Amatomykidney,Thekidneysarepaired,retroperitonealstructuresthatparallelthepsoasmuscleTheleftkidneyisusuallyslightlyhigherthantherightandisslightlymoremediallylocated.Theverticalaxisofthekidneysisapproximately20,withthetopofthekidneysclosertothespine.Thereisoftenconsiderablemotilityofeachkidney,whichvarieswithrespirationandwithbodyposition,NormalKUB,FromthesuperiorlineofTh12totheinferiorlineofL3Therightkidneyisusuallylocatedmoreinferiorlythantheleft.Size:
5-612-13cmTheaxisofkidney:
15-25degreeThemovementofkidneyislessthantheheightofonevertebra.,NormalpelvisandcalycesObservetheposition,shape,borderlineanddensityofthem,MinorrenalcalixMajorrenalcalixRenalpelvisUreteropelvicjunctionUreter,Normalpelvisandcalyces,DifferentformofpelvisANormalformBBranchform(withoutpelvis)CAmpullaeform(withoutcalycesmajor),AmpullaeformThepelvesisdirectlyconnectedwithminorcalycesTheshapeofpelvisarefullBranchformThemajorcalycesaredirectlyconnectedwithureter,withoutpelvis,Cross-sectionofkindey,KidneyAortaVenacava,inferiorBowel,Cross-sectionofkindey,KidneyLiverRenalarteryPsoasmuscle,Coronaryview,Reflux,OftenseeninretrogradepyelogramCausedbythepressinthecollectingsystemTubularrefluxSinusrefluxVenousrefluxLymphaticreflux,Tubularreflux:
itislikesectorintheupperpoleofleftkidney,Tubularreflux(redarrow)Sinusreflux(bluearrow)Lymphaticreflux(blackarrow),Tubularrefluxandsinusreflux,Lymphaticreflux,Venousbackflow.Contrastmediumisseenintherenalvein(V)aswellasthelymphatics(arrow)andrenalsinusduringthisretrogradepyelogram.,Ureter,Fibromusculartubewhichconveysurinefromthekidneytothebladder25cmlong3physiologicalnarrowsUreteropelvicjunctionEnterthepelvisUreterovesicaljunction,ThenormalCapacityofbladderisabout300400ml.,Urethra,Themaleurethraisdividedintotwoparts:
theanteriorandtheposteriorurethra.Ithas2curvatureand3physiologicalnarrowing.,Normalurethralanatomyisshown(Pprostaticurethra,shortarrowincisura,longarrowverumontanum,精阜),Normalmaleurethra(APandObliqueposition),Normalfemaleurethra,ShorterthanmaleMorecommontoinfection,泌尿系统基本病变-鉴别,按CT密度分:
含脂肪密度病变,血管平滑肌脂肪瘤;水样密度病变,见于各种类型肾囊肿;软组织密度病变:
多为各种类型良、恶性肾肿瘤或炎性肿块;较高密度病变:
可见于外伤后血肿及肾囊肿出血。
钙化病变:
主要为泌尿系结石,也可见于结核、肿瘤、囊肿或血管源性疾病。
钙化的位置及形态有助于病变的诊断,如肾盂结石典型者呈鹿角样,肾癌常为细点状及絮状,肾结核呈点片状甚至全肾钙化(肾自截),肾囊肿则多为弧线状钙化,肾血管钙化可为平行轨道样等。
a.结节性硬化,双肾多发错构瘤,脂肪密度。
b.双肾多发肾囊肿,水样密度。
c.多发囊肿,双肾囊肿,左肾上极囊肿并线条样钙化,左肾下极高密度囊肿。
d.肾癌,右肾上极软组织密度影。
按MR信号分,信号强度与游离水一致,常见于肾囊肿及肾盂积水;T1WI和T2WI均为低信号,常见于结石及钙化;T1WI和T2WI上均为高信号,见于含蛋白量较高或有出血的肾囊肿及外伤后亚急性血肿;实性混杂信号肿块内含有脂肪信号,血管平滑肌脂肪瘤;混杂信号的肿块,脂肪抑制像上信号无改变,增强检查呈不均一强化,为肾癌常见表现。
a.T1WIb.T2WI左肾囊肿,典型水样信号,长T1,长T2表现。
c.同相位d.反向位左肾血管平滑肌脂肪瘤,含脂肪病变,同相位高信号,反向位信号受抑制。
e.同相位f.反向位g.T2WIh.增强扫描延迟期肾癌病人,混杂信号的肿块,无脂肪成分,增强扫描不均一强化。
集合系统异常,肾显影异常(见于IVP):
显影浅淡、延迟、不显影,见于梗阻、积水及肾功能减退等;肾盂肾盏受压:
肾内占位(血肿、脓肿、囊肿、肿瘤)及肾周病变;肾盂肾盏破坏:
肾结核、黄色肉芽肿性肾盂肾炎,肾盂癌和肾癌侵犯肾盂;肾盂肾盏、输尿管及膀胱充盈缺损:
气泡、血块、结石、肿瘤;肾盂肾盏、输尿管及膀胱扩张:
梗阻性(血块、结石、囊肿、肿瘤);非梗阻性(先天巨肾盂、输尿管等、神经源膀胱)。
a.CTU结石并积水,示左肾积水,显影浅淡,延迟。
b.IVP肾盂癌左肾盂肾盏受压,破坏c.CTU右侧输尿管下段结石,致近段肾盂,输尿管扩张d.MRU膀胱出口梗阻肾盂,肾盏及输尿管扩张。
集合系统异常,膀胱输尿管反流:
先天性异常、尿路感染、膀胱出口梗阻及输尿管膀胱入口损伤等输尿管管壁增厚:
较长段均匀输尿管壁增厚常见于炎症,串珠样不规则增厚常见于输尿管结核,局灶性增厚伴肿块则提示输尿管肿瘤。
膀胱大小、形态异常:
膀胱增大常由于各种原因的尿道梗阻所致,而膀胱减小主要见于慢性炎症或结核所致膀胱挛缩。
膀胱呈囊袋状突出是膀胱憩室表现。
膀胱受压见于膀胱周围肿瘤及盆腔脂肪增多症。
膀胱肌肉小梁增生、肥厚,膀胱多发憩室,呈“圣诞树”或“松塔”样外形见于神经源性膀胱。
膀胱壁增厚:
弥漫性增厚见于炎症或慢性尿路梗阻,局限性增厚主要见于膀胱肿瘤。
e.CTU输尿管结核输尿管形态异常,串珠样不规则增厚表现。
f.IVP肾脏及膀胱结核膀胱形态异常,挛缩膀胱改变,同时可见肾盂狭窄,远端扩张积水,肾脓肿形成。
g.前列腺增生,膀胱形态异常,神经源性膀胱,膀胱底部可见前列腺压迹h.CT膀胱癌膀胱右侧壁局限性增厚,突向腔内。
肾脏先天变异,肾脏数目及大小异常-先天性,最常见的肾脏数目异常为肾不发育(renalagenesis),又称孤立肾肾发育不全(RenalHypoplasia)又称小肾或侏儒肾。
表现为肾实质组织学结构正常,但肾单位、锥体和肾叶的数量减少。
a.b.横断位及冠状位右肾体积明显变小,肾皮质较正常薄,肾外形光滑,无瘢痕凹陷,对侧肾显增大,肾脏位置异常-异位肾,Renalectopia,AbnormalpositionofthekidneyandthepresenceofassociatedabnormalitiesEctopickidneysaremoresusceptibletoinfection,obstruction,blunttraumaandinadvertentintraoperativei
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