《医学影像学 》课件：第六章第一部分 胃肠道

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1、The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1 1第六章第六章 消化系统和腹膜腔消化系统和腹膜腔附一院 潘克华第一部分第一部分 胃肠道胃肠道The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College2 2 教学要求教学要求 1.1.重点理解掌握胃肠道肿瘤

2、的重点理解掌握胃肠道肿瘤的X X线、线、CTCT表现；表现； 2.2.掌握良恶性溃疡的鉴别要点；掌握良恶性溃疡的鉴别要点； 3.3.了解胃肠道相对少见疾病的影像表现；了解胃肠道相对少见疾病的影像表现； 4.4.了解不同影像检查技术对胃肠道不同疾病的诊断价值了解不同影像检查技术对胃肠道不同疾病的诊断价值 和限度和限度The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3 3检查方法检查方法n n透视透视n n平片平片n nX

3、X线造影线造影：口服、灌注：口服、灌注 （首选）（首选） 钡餐钡餐 气钡双重造影气钡双重造影 注意注意：胃肠道准备：胃肠道准备 多体位多体位/ /时相时相 n nCTCT The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4 4The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Me

4、dical College5 5The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6 6一、正常影像学表现一、正常影像学表现 - 胃n n（一）（一）正常正常X X线（造影）表现线（造影）表现 解剖结构识别：解剖结构识别： 形态：牛角型、钩型、瀑布型、长钩型（无力型）形态：牛角型、钩型、瀑布型、长钩型（无力型） 黏膜像：均匀光滑的条纹状影黏膜像：均匀光滑的条纹状影 双对比造影：胃小区双对比造影：胃小区/ /胃小沟胃小沟 胃

5、蠕动与排空：胃蠕动与排空：2-4 2-4 小时排空小时排空 n n（二）（二）正常正常CTCT表现表现 壁厚度，浆膜，毗邻结构壁厚度，浆膜，毗邻结构The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College7 7牛角型牛角型无力型无力型瀑布型瀑布型鱼钩型鱼钩型The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital o

6、f Wenzhou Medical College8 8The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College9 9一、正常影像学表现一、正常影像学表现 - 十二指肠 DuodenumDuodenumn n（一）（一）正常正常X X线（造影）表现线（造影）表现 解剖结构识别：四部分解剖结构识别：四部分 十二指肠乳头十二指肠乳头 形态：形态： C C形形 黏膜像：球部黏膜像：球部-纵行、平行的条纹影纵行、平行的条纹影 降部以下降

7、部以下-羽毛状羽毛状 蠕动：可有逆蠕动蠕动：可有逆蠕动 n n（二）（二）正常正常CTCT表现表现 壁厚度，浆膜，毗邻结构壁厚度，浆膜，毗邻结构The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1010Treitz ligament duodenal papilla低张双对比造影低张双对比造影The First Affiliated Hospital of Wenzhou Medical CollegeThe First

8、Affiliated Hospital of Wenzhou Medical College1111一、正常影像学表现一、正常影像学表现 - 空回肠（小肠（小肠, , Small bowelSmall bowel）n n（一）（一）正常正常X X线（造影）表现线（造影）表现 解剖结构识别：解剖结构识别：位置、分组位置、分组 黏膜像：空肠黏膜像：空肠-羽毛状、雪花状羽毛状、雪花状 回肠回肠-纵行纵行/ /斜行斜行 充盈轮廓光滑充盈轮廓光滑 蠕动与排空：蠕动与排空： 推进性推进性 2-62-6小时小时 7-97-9小时小时 n n（二）（二）正常正常CTCT表现表现 壁厚度壁厚度-3-5 mm-3

9、-5 mm，肠系膜结构，肠系膜结构The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1212 粘膜相粘膜相 充盈相充盈相The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1313 小肠粘膜皱襞形态小肠粘膜皱襞形态 收缩时呈纵形收缩时呈纵形 舒张时呈横形

10、舒张时呈横形The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1414小肠CT图The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1515一、正常影像学表现一、正常影像学表现 - 大肠 （ColonColon）n n（一）（一）正常正常X X线（造影）

11、表现线（造影）表现 解剖结构识别解剖结构识别：结肠袋、半月襞、回盲瓣、阑尾：结肠袋、半月襞、回盲瓣、阑尾 黏膜皱襞：黏膜皱襞： 双对比造影：无名沟双对比造影：无名沟 蠕动与排空：蠕动与排空：24-48 24-48 小小时时 n n（二）（二）正常正常CTCT表现表现 壁厚度壁厚度-3-5 mm-3-5 mm，浆膜，直肠周围脂肪层，肠脂垂，浆膜，直肠周围脂肪层，肠脂垂The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1616

12、充盈相黏膜相气钡双对比相The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1717二、异常影像学表现二、异常影像学表现（一）（一）异常异常X X线（造影）表现线（造影）表现1. 1.轮廓异常轮廓异常2. 2.黏膜皱襞的改变黏膜皱襞的改变3. 3.管腔大小的改变管腔大小的改变4. 4.位置移动度的改变位置移动度的改变5. 5.功能性改变功能性改变 The First Affiliated Hospital of Wenzho

13、u Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1818二、异常影像学表现二、异常影像学表现（二）（二）异常异常CTCT表现表现1. 1.管壁增厚：管壁增厚：食道壁、小肠5 mm；胃壁10 mm；大 肠壁5 mm为可疑增厚，10 mm为确定 的异常增厚。继发管腔狭窄。2. 2. 肿块肿块: :腔内/外，大小、边缘、溃疡及坏死3. 3. 周围脂肪层改变：周围脂肪层改变：浆膜面，肠系膜4. 4. 邻近脏器浸润：邻近脏器浸润：脂肪间隙消失，邻近脏器内异常密度5. 5. 淋巴结转移：淋巴结转移：胃癌最常见

14、，一般15 mm6. 6. 远处脏器转移：远处脏器转移：肝脏最常见且易被发现 The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College1919三、临床应用及比较影像学三、临床应用及比较影像学n nX线造影检查首选（曾经）：多多体体位位，动动态态，可显示局可显示局 部与全貌、形态与功能部与全貌、形态与功能 限制限制-早期黏膜病变，黏膜下病变早期黏膜病变，黏膜下病变 主要用于病变范围的显示，术后吻合口观察主要用于病变范围的显示，术后

15、吻合口观察n nCT应用逐渐普及、价值突出：肿瘤分期肿瘤分期n nMR少用n n超声可选用，但具有局限性The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College202021温州医学院附属第一医院温州医学院附属第一医院X线平片影像诊断线平片影像诊断正常胸片肺炎肺炎浸润性肺结核浸润性肺结核肺癌肺癌心脏增大 二尖瓣型 主动脉型 普大型气胸气胸胸腔积液胸腔积液正常腹部平片胃肠道穿孔胃肠道穿孔肠梗阻肠梗阻泌尿系阳性结石长骨骨折肋骨骨折X线

16、胃肠道造影影像线胃肠道造影影像诊断诊断食管静脉曲张食管癌食管癌消化性溃疡消化性溃疡胃癌胃癌结肠癌结肠癌CT影像诊断影像诊断肺炎肺结核肺癌肝癌肝癌肝血管瘤肝血管瘤肝囊肿肝囊肿急性胰腺炎急性胰腺炎腹部外伤 肝肝 脾 肾肾损伤颅脑外伤 颅脑骨折 急性硬膜外（下）血肿脑出血脑出血脑梗死脑梗死 2222温州医学院附属第一医院温州医学院附属第一医院胃肠道穿孔胃肠道穿孔n最常见的急腹症，最常见原因溃疡n 骤然持续性上腹痛，不久可延及全腹n影像表现：最重要征象：气腹（膈下游离气体）2323温州医学院附属第一医院温州医学院附属第一医院膈下游离气体2424温州医学院附属第一医院温州医学院附属第一医院腹腹部部术术后

17、后膈膈下下游游离离气气体体2525温州医学院附属第一医院温州医学院附属第一医院肠梗阻n肠内容物不能正常运行、顺利通过肠道n机械性/动力性/血运性n 痛、呕、胀、闭n影像表现：肠管扩张积气/液，多发气-液平影注意梗阻病因的观察2626温州医学院附属第一医院温州医学院附属第一医院高位小肠梗阻 2727温州医学院附属第一医院温州医学院附属第一医院低低位位小小肠肠梗梗阻阻2828温州医学院附属第一医院温州医学院附属第一医院麻痹性肠梗阻2929温州医学院附属第一医院温州医学院附属第一医院粪块性肠梗阻粪块性肠梗阻3030温州医学院附属第一医院温州医学院附属第一医院直肠癌伴肠梗阻直肠癌伴肠梗阻3131温州医

18、学院附属第一医院温州医学院附属第一医院The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3232食管静脉曲张（Esophageal Varices）【临床与病理临床与病理临床与病理临床与病理】n n 门脉受阻门脉受阻 侧支血管侧支血管 食管粘膜下食管粘膜下V V、周围、周围V V丛丛n n 破裂出血破裂出血【影像学表现影像学表现影像学表现影像学表现】n n X X线造影：早期：黏膜皱襞增粗、稍迂曲，管壁边缘呈锯线造影：早期

19、：黏膜皱襞增粗、稍迂曲，管壁边缘呈锯齿状，尚柔软；进展期：齿状，尚柔软；进展期：串珠串珠/ /蚯蚓状充缺蚯蚓状充缺，管壁边缘不，管壁边缘不规则，蠕动减弱，排空延迟规则，蠕动减弱，排空延迟n n CTCT：管壁增厚，：管壁增厚，增强后黏膜下迂曲扩张静脉增强后黏膜下迂曲扩张静脉增强后黏膜下迂曲扩张静脉增强后黏膜下迂曲扩张静脉The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3333Esophageal VaricesEsoph

20、ageal VaricesThe First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3434食道静脉曲张食道静脉曲张腹腔侧枝腹腔侧枝循环开放循环开放The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3535溃疡溃疡（UlcerUlcer）（一）胃溃疡（一）胃溃

21、疡【临床与病理临床与病理临床与病理临床与病理】n n 好发胃小弯、胃角，次为胃窦，常单发好发胃小弯、胃角，次为胃窦，常单发n n 胃壁溃烂缺损（龛影），黏膜至肌层，圆形或椭圆形，胃壁溃烂缺损（龛影），黏膜至肌层，圆形或椭圆形，直径直径5-20 mm5-20 mm，深，深5-10 mm5-10 mm，溃疡口周围炎性水肿，溃疡口周围炎性水肿n n 穿透性溃疡穿透性溃疡/ /穿孔穿孔 n n上腹部痛：反复、周期、节律；恶心、呕吐、反酸、嗳上腹部痛：反复、周期、节律；恶心、呕吐、反酸、嗳气；出血、黑便气；出血、黑便n n 可恶变可恶变The First Affiliated Hospital of W

22、enzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3636【影像学表现影像学表现影像学表现影像学表现】n n X X线造影：线造影： 直接征象直接征象-双对比及加压法较易显示双对比及加压法较易显示l l龛影（轮廓外）：龛影（轮廓外）：钡剂充填胃壁缺损处的直接投影，切线位易观钡剂充填胃壁缺损处的直接投影，切线位易观察。察。l l透明带透明带-溃疡口部黏膜水肿带：溃疡口部黏膜水肿带： 项圈征项圈征/ /狭颈征狭颈征l l黏膜皱襞均匀性纠集黏膜皱襞均匀性纠集：慢性溃疡周围瘢痕收缩：慢性溃疡周围瘢

23、痕收缩 间接征象（功能改变）间接征象（功能改变）l l痉挛性改变；分泌增加；蠕动痉挛性改变；分泌增加；蠕动n nCTCT有助于显示并发症有助于显示并发症The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3737The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical Col

24、lege3838posterior gastric wall ulcer perforated with loculated fluid and gas in lesser sacThe First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College3939（二）十二指肠溃疡（二）十二指肠溃疡【临床与病理临床与病理临床与病理临床与病理】n n 较胃溃疡常见，好发球部（前后壁），次为降部，可多发较胃溃疡常见，好发球部（前后壁），次为降部，可多发

25、n n 临床症状与胃溃疡相仿临床症状与胃溃疡相仿【影像学表现影像学表现影像学表现影像学表现】n n X X线造影直接征象同胃溃疡线造影直接征象同胃溃疡n n 间接重要征象间接重要征象-球部痉挛球部痉挛/ /恒久变形恒久变形；激惹征；激惹征The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4040龛影龛影球部变形球部变形球部激惹球部激惹The First Affiliated Hospital of Wenzhou Medi

26、cal CollegeThe First Affiliated Hospital of Wenzhou Medical College4141The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4242【影像学表现影像学表现影像学表现影像学表现】n n X X线造影：线造影：早期早期-黏膜粗乱变平，肠壁边缘尖刺状影黏膜粗乱变平，肠壁边缘尖刺状影 进展期进展期-特征性表现：卵石征，非对称性，节段性或特征性表现：卵石征，非对称性

27、，节段性或 跳跃性分布跳跃性分布 晚期晚期-瘘管或窦道形成瘘管或窦道形成 n n CTCT：节段性肠壁增厚节段性肠壁增厚 分层现象，肠系膜改变，梳样征分层现象，肠系膜改变，梳样征（小肠）克罗恩病（小肠）克罗恩病（CrohnCrohn） 了解了解了解了解【临床与病理临床与病理临床与病理临床与病理】n n 好发青壮年，胃肠道非特异性节段性肉芽肿性炎好发青壮年，胃肠道非特异性节段性肉芽肿性炎n n 可累及全消化道，以末端回肠和结肠最常见可累及全消化道，以末端回肠和结肠最常见n n 病理特征：肠壁纵行溃疡，全层肠壁肉芽肿性炎，纤维增生，淋巴病理特征：肠壁纵行溃疡，全层肠壁肉芽肿性炎，纤维增生，淋巴管阻

28、塞管阻塞 n n 腹泻、腹痛等腹泻、腹痛等 The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4343卵石征卵石征The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4444【影像学表现影像学表现影像学表现影像学表现】n n X X线造影：线造影：非特异

29、非特异 跳跃征，黏膜粗大紊乱跳跃征，黏膜粗大紊乱 纤维增生纤维增生-肠管狭窄、变形、挛缩肠管狭窄、变形、挛缩 n n CTCT：肠壁增厚肠壁增厚 较长范围，肠系膜较长范围，肠系膜LNLN增大、钙化增大、钙化肠结核肠结核 （了解）（了解）（了解）（了解）【临床与病理临床与病理临床与病理临床与病理】n n 好发回肠末端、回盲部，多继发肺结核好发回肠末端、回盲部，多继发肺结核n n 肠源性、血源性、周围脏器蔓延肠源性、血源性、周围脏器蔓延n n 病理特征：溃疡型、增殖型、混合型病理特征：溃疡型、增殖型、混合型n n 腹泻、腹痛等腹泻、腹痛等 The First Affiliated Hospital

30、 of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4545增殖型肠结核：增殖型肠结核：CT与与X线对照线对照The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4646【影像学表现影像学表现影像学表现影像学表现】n n X X线：线：无特征性，粪石，局部肠管推移无特征性，粪石，局部肠管推移 n n CTCT：直

31、接征象直接征象-阑尾增粗肿大，壁增厚，腔积液，粪石阑尾增粗肿大，壁增厚，腔积液，粪石 间接征象间接征象-周围炎性渗出，脓肿，穿孔表现周围炎性渗出，脓肿，穿孔表现阑尾炎阑尾炎及周围脓肿及周围脓肿【临床与病理临床与病理临床与病理临床与病理】n n 常见病，阑尾及局部炎症，穿孔常见病，阑尾及局部炎症，穿孔周围脓肿周围脓肿n n 转移性右下腹痛转移性右下腹痛 The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4747The Fir

32、st Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4848The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College4949胃肠道肿瘤胃肠道肿瘤n n良性良性/ /恶性恶性/ /交界性交界性n n上皮源性肿瘤：上皮源性肿瘤：息肉、腺瘤、癌息肉、腺瘤、癌 非上皮性肿瘤：非上皮

33、性肿瘤：平滑肌瘤、间质瘤、脂肪瘤、神经源性瘤平滑肌瘤、间质瘤、脂肪瘤、神经源性瘤 （上皮下肿瘤）（上皮下肿瘤） 血管瘤血管瘤 平滑肌肉瘤，淋巴瘤平滑肌肉瘤，淋巴瘤n n腔内腔内/ /壁内壁内/ /壁外壁外 癌猛于虎！癌猛于虎！The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5050n癌最常见：食管癌、胃癌、结直肠癌发病率均居所有恶性肿瘤前10位。n其次主要有淋巴瘤、间质瘤、类癌、肉瘤。The First Affiliat

34、ed Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5151胃肠道癌的基本特点n n病病理理学学分分型型：起起源源于于黏黏膜膜，鳞鳞癌癌、腺腺癌癌；早早期期癌癌与与进进展展期癌。期癌。n n形态学（形态学（X X线）基本分型：线）基本分型： 早期早期-浅表型，隆起型，凹陷型浅表型，隆起型，凹陷型 进展期进展期-肿块型，浸润型，溃疡型肿块型，浸润型，溃疡型 食道癌食道癌4 4分型分型-髓质、髓质、蕈蕈伞、溃疡、缩窄伞、溃疡、缩窄 进进展展期期胃胃癌癌Borrma

35、nnBorrmann分分型型-肿肿块块、溃溃疡疡、浸浸润润溃溃疡疡、浸润浸润n n临床表现：临床表现：早期一般都无症状早期一般都无症状 食管癌食管癌-吞咽困难吞咽困难 其他其他-腹痛，消化道出血等腹痛，消化道出血等The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5252胃肠道癌的基本影像学表现n n X X线造影表现：线造影表现：1. 1.轮廓异常轮廓异常2. 2.黏膜皱襞的改变黏膜皱襞的改变3. 3.管腔大小的改变管腔

36、大小的改变4. 4.位置移动度的改变位置移动度的改变5. 5.功能性改变功能性改变 CT CT表现：表现：1.1.管壁增厚管壁增厚2.2.肿块肿块3.3.周围脂肪层改变周围脂肪层改变4.4.邻近脏器浸润邻近脏器浸润5.5.淋巴结转移淋巴结转移6.6.远处脏器转移远处脏器转移 The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5353n n（一）食管癌（一）食管癌（一）食管癌（一）食管癌髓质型髓质型蕈伞型蕈伞型溃疡型溃疡型缩

37、窄型缩窄型The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5454The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5555型型型型：突突突突向向向向腔腔腔腔内内内内充充充充缺缺缺缺影影影影The First Affiliated Hospital

38、of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5656型：溃疡型型：溃疡型型：溃疡型型：溃疡型半月综合征半月综合征-环堤征、指压征、裂隙征环堤征、指压征、裂隙征The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5757型：溃疡型型：溃疡型型：溃疡型型：溃疡型The First Affiliated Hosp

39、ital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5858弥漫浸润：皮革胃弥漫浸润：皮革胃型：浸润型型：浸润型型：浸润型型：浸润型The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College5959型：浸润型型：浸润型型：浸润型型：浸润型（局部）（局部） XX线、线、线、线、CTCT对照对照对照对照The Fi

40、rst Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6060胃癌胃癌胃癌胃癌CTCT平扫、增强：平扫、增强：平扫、增强：平扫、增强：通常中度以上强化（更易分辨）通常中度以上强化（更易分辨）通常中度以上强化（更易分辨）通常中度以上强化（更易分辨）The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou M

41、edical College6161胃胃胃胃癌癌癌癌淋淋淋淋巴巴巴巴结结结结与与与与肝肝肝肝脏脏脏脏转转转转移移移移The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6262n n（三）结肠直肠癌（三）结肠直肠癌（三）结肠直肠癌（三）结肠直肠癌早期早期进展期进展期增生肿块型、溃疡型、浸润型增生肿块型、溃疡型、浸润型增生肿块型、溃疡型、浸润型增生肿块型、溃疡型、浸润型增生肿块型增生肿块型增生肿块型增生肿块型The First

42、 Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6363溃疡型溃疡型溃疡型溃疡型MDCTMDCT虚拟内窥镜虚拟内窥镜虚拟内窥镜虚拟内窥镜The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6464浸润型浸润型浸润型浸润型The First Affiliated Hosp

43、ital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6565直直肠肠癌癌MRThe First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6666胃肠道癌肿X线、CT表现总结及比较影像学直接征象n n肿块：肿块：不规则形充盈缺损，分叶状，表面不整，不规则形充盈缺损，分叶状，表面不整， 常常2 cm2 cm，广基底，

44、广基底n n浸润：浸润：管壁不规则增厚，管腔狭窄伴梗阻，局限性管壁不规则增厚，管腔狭窄伴梗阻，局限性n n溃疡：溃疡：较大的腔内龛影，较大的腔内龛影，环堤征、裂隙征、指压迹征环堤征、裂隙征、指压迹征 龛影口黏膜中断破坏龛影口黏膜中断破坏间接征象n nX X线功能改变：管壁僵硬蠕动消失线功能改变：管壁僵硬蠕动消失n nCTCT显示有无浆膜面及周围脂肪层的变化，有无淋巴结的转显示有无浆膜面及周围脂肪层的变化，有无淋巴结的转移，有无邻近脏器的侵犯及远处脏器的转移移，有无邻近脏器的侵犯及远处脏器的转移n nMRMR在直肠癌上的优势在直肠癌上的优势The First Affiliated Hospita

45、l of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6767n n 胃肠道最常见的原发性间叶源性肿瘤胃肠道最常见的原发性间叶源性肿瘤n n 胃最常见，次为小肠，可发生在胃肠道外胃最常见，次为小肠，可发生在胃肠道外n n 恶性潜能恶性潜能 评判重要指标：评判重要指标： 1 1、大小（、大小（5cm5cm）、密度、边缘、囊变）、密度、边缘、囊变/ /坏死坏死/ /出出血血 2 2、有无浸润周围组织及转移、有无浸润周围组织及转移n n CTCT和和MRMR是检出和诊断的主要方法是检出和

46、诊断的主要方法n n 肿块肿块肿块肿块 密度常不均匀，向腔内或腔外生长，较大时中心密度常不均匀，向腔内或腔外生长，较大时中心多发生坏死，可出血、囊变，表面易溃疡而与胃肠道穿多发生坏死，可出血、囊变，表面易溃疡而与胃肠道穿通通三、胃肠道间质瘤三、胃肠道间质瘤（GIST）The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College6868腔外肿块腔外肿块The First Affiliated Hospital of Wenzhou M

47、edical CollegeThe First Affiliated Hospital of Wenzhou Medical College6969腔内肿块腔内肿块腔外肿块腔外肿块壁间肿块壁间肿块The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College7070十十二二指指肠肠间间质质瘤瘤伴伴转转移移The First Affiliated Hospital of Wenzhou Medical CollegeThe First

48、Affiliated Hospital of Wenzhou Medical College7171直直肠肠间间质质瘤瘤The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College7272五、胃肠道良性肿瘤五、胃肠道良性肿瘤【临床与病理临床与病理临床与病理临床与病理】n n 主要腺瘤、平滑肌瘤、脂肪瘤、血管瘤主要腺瘤、平滑肌瘤、脂肪瘤、血管瘤n n 大多为上皮下肿块，膨胀性生长，圆形或椭圆形，大多为上皮下肿块，膨胀性生长，圆形或椭圆

49、形，n n 常无明显症状常无明显症状n n【影像学表现影像学表现影像学表现影像学表现】n n X X线造影：充缺影线造影：充缺影-境界光滑锐利境界光滑锐利 （局限性）（局限性） 黏膜一般无破坏，管壁尚柔软黏膜一般无破坏，管壁尚柔软 难以显示肿瘤全貌以及评价肿瘤良恶性难以显示肿瘤全貌以及评价肿瘤良恶性n n CTCT：肿块，壁间：肿块，壁间/ /外生长外生长 定性有时比较困难，某些具有特征性定性有时比较困难，某些具有特征性-脂肪瘤脂肪瘤The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hosp

50、ital of Wenzhou Medical College7373（食管）平滑肌瘤（食管）平滑肌瘤（食管）平滑肌瘤（食管）平滑肌瘤（LeiomyomaLeiomyoma）The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College7474胃肠腔内脂肪瘤胃肠腔内脂肪瘤胃肠道脂肪瘤胃肠道脂肪瘤胃肠道脂肪瘤胃肠道脂肪瘤（lipomalipoma）The First Affiliated Hospital of Wenzhou Medical CollegeThe First Affiliated Hospital of Wenzhou Medical College7575THANK YOU THANK YOU ！