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1、腹部電腦斷層做法簡介,嘉庚吳萬福,前言解剖學上之分類簡述各項疾病不同之做法病例討論結論,前言,隨著 MDCT 不斷地進步,掃描時間縮短,後處理能力增強,更能提供任意角度切面影像,也因此CT之掃描方式,將因不同疾病有著不同的掃描方式,而非傳統之“包 山包海“,只要全部包括進去即可.,解剖學上之分類,胃及十二指腸球疾病胰臟及十二指腸壺腹疾病肝膽疾病泌尿系統疾病大腸系統疾病女性生殖系統疾病,胃及十二指腸球疾病,胃之構造可分成四層(由內向外):1.黏膜層 2.黏膜下層 3.肌肉層 4.漿膜層,常見疾病,GastritisGastric ulcerGastric cancer,掃描方式,喝水3至 5杯C
2、-:whole gastric 5mm/15mmC+:(1)whole gastric 2.5mm(2)whole abdomen 5mm(3)delay urinary systemC+之第(1)組需reformat Axial 5mm 傳上 PACS,胰臟及十二指腸壺腹疾病,Acute pancreatitisChronic pancreatitisPseudocyst(tail)Pancreatic carcinoma(head-jaundice),掃描方式,喝水3至 5杯C-:whole pancreats 5mmC+:(1)whole pancreats 1.25mm(2)liver
3、 5mm(3)whole abdomen 5mm(4)delay urinary systemC+之第(1)組需reformat Axial 2.5mm 及做P-duct CPR image傳上 PACS,肝膽疾病,ChololithiasisCholecystitisCommon bile duct stoneCancer of gallbladderCholangio-carcinomaLiver abcessHepatitis,掃描方式,Routine abdomen scan modeC-:whole liver 5mm/15mmC+:(1)whole liver 5mm(2)whol
4、e abdomen 5mm(3)delay urinary system,肝臟疾病,Hepatocellular carcinomaHemeningioma,掃描方式,C-:liver 7.5mmC+:Triphase scan(1)Artery phase 2.5 mm(2)Portal phase 5 mm(3)Hepatic vein phase 5mm須注意 Recon 2 位置,若kidney hydronephrosis 需加作delay phase,泌尿系統疾病,Stone Hematuria Renal cell carcinomaHydronephrosisRenal cys
5、t,掃描方式,C-:whole urinary system 7.5mm/15mmC+:(1)whole liver 5mm(2)whole abdomen 5mm(3)delay urinary system(連切)需看到Renal pelvis,ureter,bladder 有藥,泌尿系統疾病,Bladder tumorTumor of urinary collecting system(Renal pelvis urethra Transitional epithelium cell carcinoma),掃描方式,C-:whole urinary system 7.5mm/15mmC+
6、:(1)Bladder 2.5mm(2)whole liver 5mm(3)whole abdomen 5mm(4)delay urinary system(連切)需看到Renal pelvis,ureter,bladder 有藥(1)組需reformat 5mm axial,sagital,coronal,腎臟血管性疾病,HypertensionR/O renal artery stenosis,掃描方式,CTA C-:whole kidney 5mm/11.25mmC+:(1)adrenal+kidney 2.5mm(2)whole abdomen 5mm(3)delay urinary
7、system(連切)需看到Renal pelvis,ureter,bladder 有藥MIP,VR image,大腸系統疾病,Colon carcinoma post opAppendicitis,掃描方式,Routine abdomen scan modeC-:Lesion 5mm/15mmC+:(1)whole liver 5mm(2)whole abdomen 5mm(3)delay urinary system,大腸系統疾病,Colon carcinoma pre operation,掃描方式,需 enemaC-:Lesion 5mm/15mmC+:(1)Lesion 1.25mm(2
8、)whole liver 5mm(3)whole abdomen 5mm(4)delay urinary system 需看到Renal pelvis,ureter,bladder 有藥(1)組需reformat 3.8mm axial,sagital,coronal(指平行及垂直tumor),女性生殖系統疾病,Ovary tumorCervical cancerEndometrial carcinoma,掃描方式,需 enemaC-:Lesion 5mm/15mmC+:(1)Lesion 2.5mm(2)whole liver 5mm(3)whole abdomen 5mm(4)delay urinary system 需看到Renal pelvis,ureter,bladder 有藥(1)組需reformat 5mm axial,sagital,coronal,病例討論-腦力激盪,(1)Rectal ca,liver meta,post operation(2)P-duct dilatation(3)RCC&TCC different(4)Bladder tumor,jaudice(5)Sigmoid ca,liver tumor favor HCC,
