3esvas b超-pankreas ultrasound chen臨床放射學(xué)部門

Pancreatic胰腺的超聲檢PatrickDivisionofClinicalRadiology臨床放射學(xué)部門DepartmentofClinicalVeterinaryMedicine臨床獸醫(yī)學(xué)系VetsuisseFaculty–Bern伯爾尼大學(xué)獸醫(yī)學(xué)院Pancreatic胰腺的超聲檢Notaneasy這可不是一個(gè)簡單的工作Sonographic超聲解剖Pancreas胰Rightlobe(duodenal)Body體部Leftlobe左葉（胃Sonographic超聲解剖Pancreaticechogenicity胰腺的回聲Usuallyiso-toslightlyhypoechoictothesurroundingfat同周圍的脂肪相比，其回聲性通常在相同回聲性至低回聲性的范Homogeneousechotexture具有均質(zhì)的回聲特SonographicPancreaticsize&shape胰腺的大小&形Leaf-likeortriangularincrossSmoothSmoothbordersSonographicPancreaticsize&shape胰腺的大小&形1-9 >101－9 10歲以Lt3.4-4.7-Rt2.8-Mean±RangeLt6.5±4.6-6.4±4.6-Rt4.3±3-Etueetal.(2001)VetRadiol

Hechtetal.VetRadiolSonographicMajorduodenalpapilla十二指腸SonographicSonographicMinorduodenal十二指腸小

Cats貓:Dogs狗Additional副SonographicPancreaticduct胰Alongthelongitudinalaxisofthepancreas沿著胰腺的縱軸延伸Centrallylocated→landmark(pancreas位于位置→位標(biāo)（鑒別胰腺SonographicPancreaticductsize胰管大?。ㄘ圴ariable–age Oldercatslarger老年貓→SonographicPDsize(doesitreally胰管的大?。ㄟ@真的是個(gè)問題嗎Mean±平均值±誤范1-9years1－9歲1.3±0.06–10years10歲0.8±0.05–aHechtetal.(2006);VetRadiolbEtueetal.(2001);VetRadiolSonographicPancreaticductsize(cat)胰管大?。ㄘ圲nknownclinicalsignificanceSonographicScanningtechniqueBeflexible:noapproachworks100%要學(xué)會(huì)變通：沒有100％成功的固定掃描Dogsrightlobelargerthantheleftone狗：右葉比左葉要Catsleftlobelargerthantherightone貓：左葉比右葉要Animalposition動(dòng)物的Rightlateralrecumbencyasastarting從右側(cè)臥保定位置開Leftlateral/dorsalrebumbencysometimes左側(cè)臥/背側(cè)保定有時(shí)也是很有用Trytrytry!試了再試Sonographiclt胰腺左rt胰腺右SonographicScanningtechnique掃描技LeftlobeStomachSpleenColonLeftkidneySonographicScanning掃描技Rightlobe右Dorso-medial背側(cè)－中Portalvein門靜Lateral外NottoomuchTodolist掃描列表Scanningtechnique掃描技PancreasSize&shape大小&形狀Duodenalpapilla十二指腸Echogenicity回聲性(Pancreaticduct)（胰管）Todolist掃描列表Scanningtechnique掃描技Cranialabdominal(especiallyperipancreatic)前腹部（特別是胰周的）脂F(xiàn)reefluid游離液Present?有否Localizedaroundthe位于胰腺周圍Lymphnodes淋Todolist掃描列表Scanningtechnique掃描技Stomach/duodenum胃/Fluidcontaining?Corrugated?液性內(nèi)容物？有無Biliarysystem膽道系統(tǒng)EHBTO?肝外膽管阻塞？Let’stry讓我們?cè)嘚ever(almost)alignedat絕不可能（大多數(shù)情況在第一次嘗試時(shí)就找對(duì)位置…again,butmore...再來一次，但是更難Pancreatitis胰腺Thetypicalcase典型”病Pancreatitis(dogvsPancreatitis(dogvsChronic>acute慢Vagueclinicalsigns“Always”aclinical“總是”一個(gè)臨床鑒別的項(xiàng)LessobvioussonographicPossiblynormal…..可能是正常的

Acutechronic急性>OftenclinicallyHighclinicalsuspicion臨很容易察覺MoreobvioussonographicThestarting出發(fā)HyperechoicDiffuseLocalizedPeritonealeffusionPancreatitis胰腺Pancreatitis胰腺Acutepancreatitis急性胰腺HypoechoicEnlargedpancreasInhomogeneousIrregularshapeandbordersPancreatitis胰腺胰腺外病Colangitis/colangiohepatitisPancreatitis胰腺Extrapancreaticlesions胰腺外病Gastritis胃DiffuselyhypoechoicswollenFluidcontentFluidcontentPancreatitis胰腺Extrapancreatic胰腺外病Corrugatedsmallbowel小腸皺Pancreatitis胰腺Extrapancreatic胰腺外病EHBTO肝外膽管阻Pancreatitis胰腺胰腺外病?Pancreatitis胰腺Thesadtruth可悲的事Abdominalfatchanges腹部脂肪會(huì)對(duì)影像造成改變OftenverypoorimagequalityPancreatic胰腺假性囊CommonCommonsequelaofpancreatitishumansmoninsmallCollectionoffluidscontainingenzymesandcellularCanleadtopancreaticatrophyandglandulartissuedestructionPancreatic胰腺假性囊++important→differentiatefrompancreatic很重要→同胰腺膿腫區(qū)Pancreatic胰腺膿Collectionofsepticexudate膿性+++secondarytoaninfectionofpancreatictissueor129321-Pancreatic胰腺膿Chronic慢性胰腺 obularfibrosis→diffuse個(gè)別的小葉纖維化→彌漫性纖維Commoninclinicallynormaldogsandcats在臨診的狗和貓中很常Pancreatic胰腺包Neoplasia(cats→rare;dogs→lessrarebut 腫瘤（貓→罕見；狗→不是那么罕見，但是仍然是不常見的Exocrinetumors外腫Adenocarcinoma(mostcommon)（最為常見as(fewreports)肉瘤（少量Endocrine內(nèi)腫Insulinomadogs)胰島素瘤（狗Otherneoplasia a)其他腫瘤（淋巴肉瘤Nodularhyperplasia(cats→ 結(jié)節(jié)性增生（貓→常見 2EuropeanshorthairedcatMC9y去勢公貓－9HistoryandclinicalfindingsAnorexiaandapathysince4daysSince4monthsvomitingonaratherregular(1-2xNoweightlossQuestionableabdominalpainRightRightsCaudalrightsftpancreas& 2PancreaticmassCarcinomaNeuroendocrineneoplasia(gastrinoma) y不能完全排除是神經(jīng)內(nèi)腫瘤（胃泌素瘤LeftpancreasPancreatitisPeritonealnoduleIdenticaltothepancreaticmassNodularhyperplasia(vs結(jié)節(jié)性增生（同腫瘤比較Cats貓非常常Benigncondition良Incidenceage-發(fā)生率有相關(guān)Hypoechoic低回聲的結(jié)Oftenmultiple通常是多Diameter2cm直徑Hechtandcoll.,VetHechtandcoll.,VetRadiol&US結(jié)節(jié)性增生（同腫瘤比較Whatiswhat?什么Insulinoma胰島素Mostcommonpancreaticendocrine最常見的胰腺內(nèi)腫Mediumtolargebreeds中到大型品種犬易Irishsetter,germanshepherd,boxer,golden愛爾蘭長毛，德國牧羊犬，拳師犬，金毛尋回Middle-agedtoolddogs(mean9y)中年犬易患（平均9歲）Nogenderpredisposition無傾向Insulinoma:biologic胰島素瘤：生物學(xué)特HumansBenignneoplasiaDogs~50%havemetastasesattimeof在做出時(shí)已經(jīng)有近50％的MetastasesLiverLymphnodes淋Insulinoma:diagnostic胰島素瘤 性影像Pre-operativediagnostics術(shù)前Usually 通常是第一步檢Nuclearscintigraphy核素閃爍CT計(jì)算機(jī)X射線斷層造Insulinoma:胰島素瘤：超聲檢Sonographic超聲檢查所Pancreaticnodules胰腺結(jié)節(jié)Round–globoid圓形的球狀體Hypo-toanechogenic具有低回聲至無回聲的性Usuallywelldelineated通常能很好的被描記出Usuallyinthepancreaticbody通常在胰體Leftlimbproximal左葉的近Insulinoma:胰島素瘤：超聲檢Sensitivity敏感primary性腫Sensitivity敏感hepatic肝臟轉(zhuǎn)移Sensitivity敏感l(wèi)ymphnodes淋轉(zhuǎn)移Lamb16