肝脾疾病超声诊断.ppt

Diagnosis for Diseases of Liver and Spleen with Ultrasonography 肝脾疾病超声诊断 Preparations before Examination 1.fasting（禁食)for more than eight hours. 2.performing before barium meal（钡餐) and gastroscopy（胃镜). Ⅰ. Anatomy and Normal Ultrasonogram of TheLiver 肝脏解剖及正常声像图 Anatomy The liver is the largest organ in the human body and is situated in the right upper abdomen. The three fissures are the fossae (凹陷） pressed by inferior vena cava(IVC) and gallbladder, ligamentum teres(round ligament 圆韧带） and ligamentum venosum（静脉韧带），and porta hepatis(肝门). Posterior view Normal sonograms 1. Shape and Contour Shape: The shape of the liver on sonogram varies according to the section we scan. It can present a wedge(楔形）or a triangle（三角形）. Contour: There is a hyperechoic line around the liver that is smooth and regular.It’s the echo of liver’s capsule. 2. Size The maximal oblique diameter (最大斜径) of the right lobe is less than 14cm. The longitudinal dimension and the thickness of the left lobe are within 9cm and 6cm, respectively. 3. Parenchymal texture （实质） On the sonogram, the normal liver parenchyma has a homogeneous echo-texture. 4.Intrahepatic vessels and ducts On sonogram, within the homogeneous liver parenchyma lie the thin-walled hepatic veins (HV,肝静脉),the brightly reflective portal veins(PV，门静脉), the hepatic arteries（肝动脉) and bile duct(BD，胆管). The normal internal diameters of those vessels and ducts are as follows: PV :1-1.2cm HV: 0.5-0.9cm common bile duct ,CBD(胆总管) : 0.4- 0.6cm Ⅱ. Ultrasonic Diagnosis of Liver Diseases  Categories of Liver disease 1. Simple Cyst shape and wall: The shape of the cyst is round and its walls are thin. internal echo: No echoes can be seen in cyst( anechoic ,无回声 ). posterior enhancement（后方回声增强): The echoes of the area behind the cyst are brighter than that of area aside to it. 2.Primary Hepatic Cancer原发性肝癌 The hepatocellular cancer (HCC,肝细