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 Gastritis Gastric ulcer Gastric cancer

掃描方式 喝水3至 5杯 C- : whole gastric 5mm / 15mm (2) whole abdomen 5mm (3) delay urinary system C+之第(1)組需reformat Axial 5mm 傳上 PACS

胰臟及十二指腸壺腹疾病 Acute pancreatitis Chronic pancreatitis Pseudocyst (tail) Pancreatic carcinoma (head-jaundice)

掃描方式 喝水3至 5杯 C- : whole pancreats 5mm C+: (1) whole pancreats 1.25mm (2) liver 5mm (3) whole abdomen 5mm (4) delay urinary system C+之第(1)組需reformat Axial 2.5mm 及做P-duct CPR image傳上 PACS

肝膽疾病 Chololithiasis Cholecystitis Common bile duct stone Cancer of gallbladder Cholangio-carcinoma Liver abcess Hepatitis

掃描方式 Routine abdomen scan mode C- : whole liver 5mm / 15mm (2) whole abdomen 5mm (3) delay urinary system

肝臟疾病 Hepatocellular carcinoma Hemeningioma

掃描方式 C- : liver 7.5mm C+ : 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 carcinoma Hydronephrosis Renal cyst

掃描方式 C- : whole urinary system 7.5mm / 15mm C+ : (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 tumor Tumor of urinary collecting system ( Renal pelvis – urethra –Transitional epithelium cell carcinoma)

掃描方式 C- : whole urinary system 7.5mm / 15mm C+ : (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 Hypertension R/O renal artery stenosis

掃描方式 CTA C- : whole kidney 5mm / 11.25mm C+ : (1)adrenal + kidney 2.5mm (2) whole abdomen 5mm (3) delay urinary system (連切) 需看到Renal pelvis , ureter, bladder 有藥 MIP , VR image

大腸系統疾病 Colon carcinoma post op Appendicitis

掃描方式 Routine abdomen scan mode C- : Lesion 5mm / 15mm C+ : (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 enema C- : Lesion 5mm / 15mm C+ : (1)Lesion 1.25mm (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 3.8mm axial , sagital , coronal (指平行及垂直tumor )

女性生殖系統疾病 Ovary tumor Cervical cancer Endometrial carcinoma

掃描方式 需 enema C- : Lesion 5mm / 15mm C+ : (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