《医学影像学 Medical Imaging》课程教学课件（PPT讲稿，儿科，2020）肝胆系统的影像诊断

Section2ImagingofLiver,BiliarySystemPancreasandSpleen(Page188)

Section 2 Imaging of Liver, Biliary System, Pancreas and Spleen （Page 188）

Teaching Objectives and ContentsTo master imaging anatomy of the 1st and 2nd hepatic hilus;to master CT imaging features of hepatocellular carcinoma(HCC) and hepatic cavernous hemangioma (HCH)To be familiar with CT features of acute pancreatitis andtrauma of liver or spleenTo know CT and MRI manifestations of biliary system,pancreas and spleen and examination methodologies; to knowMRI manifestations of HCC,HCH, acute pancreatitis, andtraumaofliverorspleen2

Teaching Objectives and Contents ◆ To master imaging anatomy of the 1st and 2nd hepatic hilus; to master CT imaging features of hepatocellular carcinoma (HCC) and hepatic cavernous hemangioma (HCH) ◆ To be familiar with CT features of acute pancreatitis and trauma of liver or spleen ◆ To know CT and MRI manifestations of biliary system, pancreas and spleen and examination methodologies; to know MRI manifestations of HCC, HCH, acute pancreatitis, and trauma of liver or spleen 2

1. Liverthefirstmodality ofchoiceafterUSB(1）Imagingexaminationmodalites（影像检查技术）Ultrasonography:thefirst modality of choice（Nonenhancement（平扫）Contrastenhancement（增强）:multi-phaseCE,CTperfusionNonenhancement:T1WI,T2WI,MRCP,chemicalshiftimagingMRI-ContrastenhancementX-ray plain film**MRcP(magneticresonancecholangiopancreatography，磁共振胆胰管成像）；3chemicalshiftimaging（化学位移成像）

1. Liver (1) Imaging examination modalites（影像检查技术） ⚫ Ultrasonography: the first modality of choice ⚫ CT ⚫ MRI ⚫ X-ray plain film Nonenhancement （平扫） Contrast enhancement （增强）：multi-phase CE, CT perfusion 3 Nonenhancement: T1WI, T2WI, MRCP, chemical shift imaging Contrast enhancement the first modality of choice after USB **MRCP (magnetic resonance cholangiopancreatography, 磁共振胆胰管成像)； chemical shift imaging (化学位移成像)

(a) CT examination methodologiesOmnipaiquenonenhancementenhancementNECE

(a) CT examination methodologies ⚫ nonenhancement ⚫ enhancement NE CE 4 Omnipaique

Triple-phase contrast scan of liver(肝的三期增强扫描）Objectives: to improve detection and diagnosis ofintrahepaticlesionsPrinciples: different properties in blood supply betweenliver and intrahepatic lesionsMetholodies:+ i.v. bolus injection (2ml/s-3ml/s) of CT contrast agent+ scan performed separately at about 25s (arterial phase),60s (portal phase), 120s (equilibrium phase)5

Triple-phase contrast scan of liver (肝的三期增强扫描） ⚫ Objectives: to improve detection and diagnosis of intrahepatic lesions ⚫ Principles: different properties in blood supply between liver and intrahepatic lesions ⚫ Metholodies: † i.v. bolus injection (2ml/s-3ml/s) of CT contrast agent † scan performed separately at about 25s (arterial phase), 60s (portal phase), 120s (equilibrium phase) 5

Triple-phasecontrastscanofliverNEAterial (25s)EquilibrumPortal (60s)(120s)

6 NE Aterial (25s) Portal (60s) Equilibrum (120s) Triple-phase contrast scan of liver

(b) MRI examination methodologiesNonenhancement: MRCP, chemical shift imagingEnhancement: contrast agent (对比剂)Nonspecific agents: Gadolinium(Gd, )-based nonspecificCE (small molecule in size)Two liver-specific agents: SPIO (nanometer in size) andGd-based specific CE (small molecule in size)**USPlO(superparamagneticironoxide，超顺磁性氧化铁)1

(b) MRI examination methodologies ⚫Nonenhancement: MRCP, chemical shift imaging ⚫Enhancement: contrast agent (对比剂) ⚫ Nonspecific agents: Gadolinium(Gd, 钆)-based nonspecific CE (small molecule in size) ⚫ Two liver-specific agents: SPIO (nanometer in size) and Gd-based specific CE (small molecule in size) 7 **USPIO (superparamagnetic iron oxide, 超顺磁性氧化铁)

MRCP(MRcholangiopancreatography，磁共振胰胆管成像）MRCPhas almost completelyreplaced thegoldstandard methods ERCP（EndoscopicRetrogradeCholangiopancreatography,内镜下逆行胰胆管造影术）fortheevaluationofbileducts冠状位T2WMRCP横断位T2WERCP经内疏镜胆管造影（ERCP）指肠乳头导管于对准膜管及照总管开口注射造能2.顺管然示良好期管系统量示正常

8 MRCP has almost completely replaced the gold standard methods ERCP (Endoscopic Retrograde Cholangiopancreatography,内镜下逆行胰胆管造影术) for the evaluation of bile ducts. MRCP(MR cholangiopancreatography, 磁共振胰胆管成像) ERCP

Chemicalshift MRlimaging (Dual-echotechniques)MEl (multi-echoimaging)isaoneofthemostcommonlyusedsequencesofchemicalshiftimaging,abletodetectthelipidcomponentsofalesionCTIn-phaseHEstainOut-phase9

9 MEI (multi-echo imaging) is a one of the most commonly used sequences of chemical shift imaging, able to detect the lipid components of a lesion. Chemical shift MRI imaging (Dual-echo techniques) CT In-phase Out-phase HE stain

MRContrast EnhancementNonspecific: Gd-basednonspecific CE (small molecule in size, extracelluaragents)Two liver-specific: USPIO (nanometer in size) and Gd-based specificCE (smallmoleculeinsize,liver-specific agents)NECEVNonspecificCESPIO (T2*WI)Gd-EOB-DTPAT2WA: arterial phaseP: portal phaseD: hepatobiliary phase

Nonspecific: Gd-based nonspecific CE (small molecule in size, extracelluar agents) Two liver-specific: USPIO (nanometer in size) and Gd-based specific CE (small molecule in size, liver-specific agents ) NE CE 10 MR Contrast Enhancement Nonspecific CE SPIO (T2*WI) Gd-EOB-DTPA A p A: arterial phase D P: portal phase D: hepatobiliary phase 图 A P T1WI T2WI