影像诊断学：泌尿

1、Diagnostic Ultrasonography,Principles of ultrasound scanning,Approach to the patient Approach to the ultrasound machine General principles of ultrasound imaging Ultrasound machine settings and their meanings,Sonography Classfication,2D,3D,Contrast Enhanced ultrasound,Interventional ultrasound,Microw

2、ave RF HIFU,A mode B mode D mode M mode,Clinical application,Abdominal sonography digestive system, urinary, gynaecology and obstetrics, small part Cardiovascular sonography parenchyma of organ Gas, bone, calcification,Descriptive terminology,1)Anechoic or sonolucent (7)Homogeneous (2)Hypoechoic (8)

3、Shadowing (3)Isoechoic (9)Target sign (4)Hyperechoic (10)Pseudo-kidney sign (5)Strong echoic (11)Halo sign (6)Heterogeneous (12)Parallel channel sign,Launch / Receive backscatter signal,1) Anechoic or sonolucent No internal echoes. fluid-filled and transmit sound waves easily. vascular structures, b

4、ladder, gallbladder, cyst,2) Hypoechoic Low-level echoes. Lymph nodes, some tumors. (3) Isoechoic Very close to the normal parenchyma echogenicity pattern,4)Hyperechoic Reflects sound waves with a bright intensity without posterior shadowing. renal calyx. (5)Strong echoic Reflects sound waves with a

5、 bright intensity with posterior shadowing. stone, calcification,6)Heterogeneous Not uniform in texture or composition. many tumors have characteristics of both “cystic” and solid types. (7)Homogeneous Completely uniform in texture or composition. liver, thyroid, testis,8)Shadowing The sound beam is

6、 attenuated by a solid or calcified object. Air bubbles in the duodenum -“dirty shadow”. A stone-a sharp shadow. (9)Target sign Hypoechoic mass with an echogenic central core. abscess, metastasis, intussusception,10)Pseudo-kidney sign Characteristic of gastrointestinal wall thickening consisting of

7、an echogenic center (gas) and a hypoechoic rim. It looks like a kidney,11)Halo sign dark peritumoral band. hepatocellular carcinoma (12)Parallel channel sign Dilated common bile duct and portal vein are described as parallel channel sign,Urinary system,Kidney,Ureter,Bladder,Renal anatomy: Location,

8、shape, size The normal adult kidney measures between 9 cm and 13 cm in length. Renal sizes in adults: usually about 12 cm long and 5 cm wide,Structure There is a dense linear peripheral echo from the renal capsule,The substance (parenchymal thickness usually 2.5 cm): cortical: about 5 to 7 mm thick,

9、 the medulla (cone) : 8-15 renal pyramid. The renal sinus (collection system): renal pelvis, calyces and renal blood vessels, fat, etc,blood supply,Scanned with real-time ultrasound equipment. The transducer selected may be convex array. Gennerally a 3.5MHz transducer is used,Scan in the longitudina

10、l and transverse planes with the patient lying ideally in the anterior oblique or lateral position. To get the renal length, make sure that both poles of the kidney are shown on the same image, and the image is as long as it can be,Technique: Obtain coronal image by placing the probe in the flank/ri

11、b region, moving the probe posteriorly until the full kidney is in view. Scanning in the prone position is cumbersome in the frail and elderly but ideal in children in whom is ensures an easy and consistent approach for follow up measurement of renal size. Scanning is facilitated by using the liver

12、as a window on the right. On the left difficulties may arise because of the gastric fundal gas. Identify the spleen and use it as a window to access the left kidney moving the probe intercostally until the whole kidney is visualised,Capsules around kidney: distinct and smooth. Renal sinus: central p

13、ortion of kidney with high echoes(renal pelvis, calyx, fat, vascular) Renal parenchyma: slight hypoechoic to liver and spleen (divided into cortex and medulla,The renal parenchyma consists of intermediate echoes from the cortex surrounding the hypoechoic renal pyramids in the medulla. focal echo den

14、sities may be seen within the renal pyramids due to reflections from the arcuate vessels,In children, the kidneys grow steadily with the height of the child. However, the lengths at any given age are rather variable. It is particularly important to measure the lengths of the kidneys every time they

15、are examined as follow-up can be used to check on normal growth,The renal sinus (collection system) : The calyces, the renal pelvis, blood vessels, and fat. Elliptic high echo area, boundary is coarse, irregular Width: 1/2 2/3 of the kidney. The echo intensity: the renal sinus pancreas liver spleen

16、kidney cortex renal medulla,Ultrasound findings: Strong echoes within renal sinus with posterior shadowing. Better visualized if hydronephrosis is present,Flash artifact,1.Renal cysts (1)anywhere in the kidney, but usually in cortex. (2)Round or ovoid. (3)Anechoic, thin, well-defined walls. (4)poste

17、rior acoustic enhancement. (5)No color flow or Doppler,Complex renal cystic lesion,2.Polycystic kidney disease (1)Bilateral enlarged kidneys. (2)Multiple cysts of various size. (3)Lose reniform shape and normal renal parenchyma. (4)cysts in liver, pancreas, and spleen,ADPKDautosomal-dominant polycys

18、tic kidney disease,Differential diagnosis: Hydronephrosis Pitfalls and abnormalities HydronephrosisSeparation of sinus echoes may be due to causes other than hydronephrosis: normal variant in association with an extrarenal pelvis Associated with a distended bladder especially in children parapelvic

19、cyst reflux rather than obstruction,ARPKD autosomal-recessive polycystic kidney disease,1.Renal angioleiomyolipoma Ultrasound findings: Usually echogenic homogenous mass with well-defined borders,2.Renal carcinoma Ultrasound findings: (1)varied, solid parenchymal mass. (2) Irregular margins,3) hyper

20、echoic, hypoechoic, cystic or complex mass. (4)oppress renal pyramids and invade renal architecture. (5)Renal vein or IVC thrombosis,Cystic kidney cancer: Size Single room or multi-room Capsule wall Solid echo Blood flow,46,The B-mode evaluation of the lesion was based on established criteria of the

21、 appearance of the lesions including definition and lobulation of margins, shape, orientation, lesion boundary, echogenicity, echotexture and acoustic transmission. CDFI,Pitfalls and abnormalities PseudotumourTumours in the kidney may be mimicked by: Prominent column of Bertin representing cortex be

22、tween pyramids. The echogenicity within the column is identical to that of the adjacent cortex and there is no distortion of the adjacent calyceal echoes,Column of Bertin : embryonic kidney development 3cm low echo, same with the renal cortex,3. Renal embryoma Wilms tumor 2-4 years old larger, growi

23、ng fast, easy to transfer,Ultrasound findings: bigger, round or oval smooth surface, clear boundary. internal heterogeneous echo with degeneration necrosis hydronephrosis. residual kidney tissues are squeezed, not easy to be found. lymph node metastases,In the extrapulmonary tuberculosis, in additio

24、n to lymph node tuberculosis, the most common type. Accounted for 30% 41% of extrapulmonary tuberculosis cases. After starting from renal parenchyma lesions, spread to other parts of the urinary tract,Ultrasonographic: Renal volume increase, irregular form. Involvement of the renal parenchyma swelli

25、ng thickening or thinning. Calyx echo vague and irregular. Hydronephrosis. Abscess formation. Renal tuberculosis calcification,Nodular type Hollow type Hydronephrosis type Calcified type,Ureteral mucosa thickening, luminal stenosis and expansion,Normal ureters are difficult to see because of small c

26、alibre and retroperitoneal location. Intramural portion of the distal ureters are usually visualised terminating as two small projections in the trigone on both sides of the midline of the posterior bladder wall. intermittent jets of urine within the bladder lumen near the trigone are visualised normally on ultrasound,Ureteral calculus ultrasound findings: three narrow place strong echo with posterior shadowing completely obstruction without intermit