医学影像学英文课件：钱黎俊 胃肠道影像

Ulcerated AGCs usually appear as irregular ulcer crater eccentrically located in a tumor mass. Double-ring shadow: inner ring = the ulcer edge, outer ring = edge of the tumor. The Carman’s meniscus sign 半月征: the malignant ulcer is a semicircular or meniscoid ulcer with a convex inner margin, where there is a flattened polypoid mass with a broad central ulceration.
Normal anatomy of stomach on barium study
A = Antrum B = Body D = Duodenum F = Fundus
Influence of body habitus
• Hypersthenic • Hyposthenic • Asthenic
normal
Cancer
Cancer
Cancer
Esophageal carcinoma 浸润型
Filling defect
Irregular surface
Narrowing
Esophageal carcinoma
Rough & irregular surface
Filling defect
Narrowing
abnormalities on barium studies
• Shape alterations
Ulcer (niche 龛影) Filling defect Diverticulum
• Mucosal folds
Disruption
• Lumen
Narrowing, distention
虫（蚯蚓）状充盈缺损
Varices 静脉曲张
Achalasia 贲门失弛缓
dilation
• Tapering of the distal esophagus with “bird’s beak sign” 食管下段
缓慢狭窄，形成鸟嘴样改变
• Dilation of the upstreaming esophageal body 上游食管明显扩张 • difficulty to clear the barium 钡剂难以下行至胃内
horizontal
ascending
Peptic ulcer
• Gastric ulcer
Most common: lesser curvature or posterior wall of the antrum or body of the stomach
round or ovoid, project beyond the contour of gastric wall in profile view smooth, symmetric radiating folds on the edge of the ulcer = retraction Hampton’s line, ulcer collar, and ulcer mound
Single- and double-contrast study
• Barium sulfate
Water insoluble, not absorbed by GI tract Safe, free from poisoning or allergic reaction
• Air
negative contrast Barium + Air = double contrast !
溃疡浸润型，溃疡较大，边缘不清楚，周围及深部浸润明显
Borrmann IV - infiltrating
浸润型
Radiologic findings in AGC
• Polypoid, ulcerating, scirrhous 增生、溃疡、硬化（弥漫） • Disruption of gastric mucosa folds 胃黏膜皱襞破坏、消失或中断 • Gastric wall rigidity, loss of peristalsis 胃壁僵硬，胃蠕动消失 • Filling defect with irregular margins in the gastric lumen 突出腔内的充盈缺
• Gastric-duodenum
Peptic ulcer Gastric cancer
• Colon
Diverticula Colon cancer
The frequently used examination methods
• Esophageal barium swallow: 食道吞钡
Tapering, smooth
Bird’s beak
Achalasia
Diverticulum
pouch that protrudes outward in a weak portion of the esophageal wall Soft, smooth margin Barium may accumulate inside Normal mucosa
损影
• +/- ulceration 癌肿表面常有溃疡形成
Polypoid AGC
Filling defect of protruding mass into lumen with irregular and lobulated surface
Ulcerating AGC (malignant ulcer)
• Mucosa folds
Longitudinal, thin, parallel lines
• Extrinsic impressions (外来压迹)
Aortic arch 主动脉弓 Left main bronchus 左主支气管 Left atrium 左心房
Aortic arch
Benign ulcer: the Hampton’s line, ulcer collar, and ulcer mound
Hampton’s Line: 粘膜线 a thin, straight line at neck of ulcer in profile view = thin rim of undermined gastric mucosa. Ulcer collar: a smooth, soft-tissue mass ulcer = the edematous mucosa Ulcer mound: smooth, thick, lucent band at neck of ulcer in profile view = evere edema and inflammation
Gastric ulcer – Benign ulcer
01-A
01-B
02
03
Duodenal ulcer
Scarred duodenal bulb ulcer 十二指肠瘢痕（陈旧性）溃疡
Bulbar deformity with multiple pseudodiverticula 形变伴多发假憩室形成 Clover leaf appearance
Gastrointestinal radiology 胃肠道影像
Outline
• Introduction of barium study • Normal anatomy on barium study • Esophagus
Esophageal carcinoma Diverticula Achalasia Varices
• Movement
filling defect 充盈缺损
Ulcer Diverticulum Compression
溃疡
憩室
外来压迹
=
niche 龛影
Esophagus
** Esophageal carcinoma Diverticula Varices Achalasia
esophagus
Normal anatomy of esophagus on barium study
• Duodenal ulcer
Most common: posterior wall of duldenal bulb Findings similar to gastric ulcer Scarred ulcer: bulbar deformity with multiple pseudodiverticula, clover leaf
• Fluoroscopy (透视) • Contraindication: GI tract perforation
May cause chemical peritonitis Using iodine contrast for suspected perforation or leakage
Normal
Borrmann classification of advanced gastric cancer (AGC)
Borrmann I - polypoid
结节蕈伞型
Borrmann II - Ulcerating
溃疡型，溃疡较深，边缘隆起，周围浸润不明显。
Borrmann III - Infiltrating-ulcerating
• Thickened mucosal folds parallel to the direction of esophagus 平行于长轴的
增宽加深粘膜皱襞
• Tortuous radiolucencies of variable size and location 不同大小和位置迂曲的透亮
影
• “Worm-like” smooth filling defects
Gastric mucosa
Gastric area 胃小区 Gastric pit 胃小沟
Normal anatomy of small intestine on barium study
• Duodenum
Bulb
Descending horizontal
asc损，粘膜面结节状或溃疡改变
• Rigidity of esophagus wall 食管管壁僵硬 • Asymmetric narrowing of esophageal lumen 不对称狭窄
Esophageal carcinoma
Disruption of mucosa
folds
filling defect Narrowing Irregular surface
Irregular surface
Esophageal carcinoma
ulceration
Filling defect
Esophageal carcinoma
Varices 静脉曲张
• Downhill & uphill varices
Downhill: e.g. SVC syndrome Uphill: e.g. PV hypertension
L. bronchus
mucosa folds
Esophageal carcinoma: findings on barium study
• Disruption of esophageal mucosa folds 食管黏膜皱襞中断破坏 • Filling defect with irregular, nodular or ulcerated mucosal surface 充盈缺
Introduction to barium study
• Provide morphologic assessment of GI tract
e.g. achalasia
• Provide functional and kinetic information
e.g. gastroesophageal reflux
appearance
Gastric ulcer (benign ulcer)
Regular, smooth margin Hampton’s line, ulcer collar, ulcer mound (not shown) symmetric, radiating folds reaching ulcer project beyond gastric contour
Pharynx esophagus
• Upper GI: 上消化道钡餐
Pharynx duodenum
• Upper GI + Small bowel follow through: 胃肠钡餐
Pharynx ileocecal region
• Barium enema: 钡剂灌肠
Rectum entire colon