教学片6-消化系统3

消化系统（三）温州医学院医学影像学系DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC肝脏各段的划分Couinaud&Mercadier肝左叶：尾状叶（1段）S1外上侧段（2段）S2外下侧段（3段）S3

内侧段（4段、方叶）S4肝右叶：前下段（5段）S5

后下段（6段）S6

后上段（7段）S7

前上段（8段）S8DepartmentofRadiologyWMCDepartmentofRadiologyWMCDepartmentofRadiologyWMC肝硬化伴结节性肝癌DepartmentofRadiologyWMC重度脂肪肝DepartmentofRadiologyWMC肝癌平扫与动脉期增强DepartmentofRadiologyWMC肝癌静脉期增强表现DepartmentofRadiologyWMC块型肝癌DepartmentofRadiologyWMC肝癌CT血管成像DepartmentofRadiologyWMC肝癌－MR的T2WI呈混杂高信号肿块＋假包膜征像T1动脉期混杂强化DepartmentofRadiologyWMCDepartmentofRadiologyWMC肝癌CT特点小结CT平扫：肝内低密度灶，边界清晰，有占位效应，有时可见“假包膜”，肿瘤较大时，中心常可见更低密度坏死区CT增强：“快进快出”动脉期快速达到峰值，（肝癌多为肝动脉供血）门脉期强化程度快速减退，强化程度低于肝脏实质（肝脏为门静脉供血）平衡期强化程度继续下降DepartmentofRadiologyWMC肝脏血管瘤DepartmentofRadiologyWMC肝血管瘤增强动态变化DepartmentofRadiologyWMC肝血管瘤：T2显著较均匀高信号－亮灯征；T1均匀低信号DepartmentofRadiologyWMC肝脏血管瘤的特点CT平扫：肝脏实质内圆形或类圆形低密度肿块CT增强：“两快一慢”注射速度要快，开始扫描要快，延迟时间要长。“早出晚归”平扫低密度，增强早期从边缘开始强化，程度接近同层的大动脉，逐渐向病灶中心扩展，延迟扫描，病灶呈等密度充填。DepartmentofRadiologyWMC肝脏多发转移瘤－牛眼征DepartmentofRadiologyWMC肝脓肿－壁强化蜂窝征与晕征DepartmentofRadiologyWMCDepartmentofRadiologyWMC肝包虫囊肿－水上百合征DepartmentofRadiologyWMCDepartmentofRadiologyWMC肝囊肿：无壁强化的液性密度囊腔DepartmentofRadiologyWMC单纯肝囊肿DepartmentofRadiologyWMC多囊肝DepartmentofRadiologyWMCDepartmentofRadiologyWMC“T”管造影—正常胆道解剖

DepartmentofRadiologyWMCERCP显示正常胆道解剖

DepartmentofRadiologyWMC“T”管造影—胆总管下端结石DepartmentofRadiologyWMC经皮肝穿胆造影(PTC)：总胆管结石扩张

DepartmentofRadiologyWMC肝内胆管扩张、结石DepartmentofRadiologyWMC胆囊癌：分叶状肿块DepartmentofRadiologyWMC鉴