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胃肠常见疾病的影像学诊断

Imageological Diagnosis of the GI Common Diseases

Department of Radiology,the First Affiliated


Hospital of Henan Medical University

Gao Xuemei
Imageological Diagnosis of the Esophageal Diseases
Imageological Diagnosis of the Esophageal Diseases

Esophagitis
 motor disorders of the
esophagus
Esophageal tumor
Other diseases
esophageal varices
Esophageal varices
 Pathogeny and pathology :
a complication of portal hypertension
cirrhosis of liver → portal
hypertension(PV↑)→blood obstructed in portal
vein →flow into latteralcirculation→varices of
submucosal and periesophageal v. →azygos
vein→SVC
clinical symptoms : hematemesis and melaena
Esophageal varices

X-ray barium swallow :


Early stage :
mucosal folds is widened slightly in the
end of the eso.
The wall of the eso is irregular slightly.
The barium meal passes through eso
without obstruction.
Esophageal varices
Advanced stage:
 Mucosalfolds are widened obviously, showing lucent,
worm-like or bead-like filling defects.
 Widened lumen of eso.and sawtooth contour of eso.
 The barium meal passes through slowly.
 Thefundus varices:grape-like or multiple polypoid filling
defects.
Esophageal tumors
 Leiomyoma of esophagus
others : polyp, hemangioma, fibroma,
lipoma, cyst, ets.
 Esophageal carcinoma
 carcinosarcoma of esophagus
esophageal carcinoma
Esophageal carcinoma
 Epidemiology : a common disease in Henan
province
 Pathology : squamous cell ,adenocarcinoma
early stage : protruded type,superficial
type,excavated type
advanced stage : medullary type, fungating
type, ulcerative type, scirrhous (strictured)
type, intracavitary type
 Clinical symptom : difficult swallow
 diagnosis : imaging,endoscopy
Esophageal carcinoma

X-ray findings of early esophageal carcinoma :


● Mucosal folds are widened,tortuous,coarse and
interrupted
● Samll crater, 2-0.4cm in size
● Small filling defect, 0.5cm in size
● Reduced flexibility of the local wall of
esophagus
Esophageal carcinoma

Early X-ray findings :


● flat type : mucosal folds are course, showing
pellet or meshes,poor dilatation of the wall of
eso.
● Protruded type : flat protrusion has lobular
appearance, and pellet or nodule on surface.
Small filling defect with barium swallow.
● Excavated type : multiple irregular and shallow
speck with barium, and peripheral protrusion.
Irregular edge of eso.
Esophageal carcinoma
X-ray findings in advanced stage:
 • Destruction,interruption or
disappearance of mucosal folds.
 • Rigidity of the wall of eso. and
obliteration of peristalsis.
• Narrowing of eso. And outlet obstruction.
Esophageal carcinoma
• Medullary type: irregular stricture, long range,
10cm in length
• fungating type: irregular filling defect and
lateral stricture
• ulcerative type: meniscus sign
• scirrhous type:localized and annular stricture.
• intracavitary type:giant filling defect
Esophageal carcinoma

Differential diagnosis :
 ●Peptic esophagitis
 ● Achalasia
● benign stricture
 ● varices
 ● Extraluminal compression of eso.
 ● Carcinosarcoma
胃部疾病的影像学诊断
Imageological diagnosis of the gastric diseases
gastric ulcer
Gastric ulcer
 Pathogeny : hydrochloric acid in gastric juice,
smoke, alcohol,coffee,medicine and spirit
 Pathology : mucosa ,submucosa and muscle
coat are corrupted –round or oval breach-crater
most at the lesser curve, single, 2cm in size
 Clinical symptom : chronic and epigastric pain
with regularity and rhythm
 Dianosis : imaging + endoscopy
X-ray findings of gastric ulcer

Round ulcer
Linear ulcer
Multiple ulcer
Ulcer at special position
Healing or recurrence of
ulcer
The main X-ray findings of round ulcer
 Crater
projecting beyond the lumen of the
stomach. <2cm
in profile : nipple-like or triangular
protrusion
en face: a round collection of barium
 粘膜线 (Hampton’s line)
lucent line at the edge of niche, 1-
2mm width
The main X-ray findings of round ulcer

 collarsign ( 项圈征 ):
a lucent zone at the edge of ulcer, 0.5-1.0cm in
width
 Narrow neck sign( 狭颈征 ) :
the edge of ulcer is very narrow like a long neck

 Protrusion around nitch:


a lucent zone with the same width around the nitch
 Radiating mucosal folds reaching the edge of nitch
The secondary X-ray findings of round ulcer

 incisura : a localized notch opposite the ulcer


due to spasm
 Rigidity or shortening at the great curve
 Enlargement of incisura angularis
 Hyperscretion of stomach,fast or slow
peristalsis
 Pyloric obstruction
 Localized tenderness
胃癌的影像学诊断
Imageological diagnosis of the gastric carcinoma
Gastric Carcinoma

 Pathogeny :
external cause: environment,diet
internal cause: many kinds
 Pathology :
early stage (Ⅰ 、Ⅱ、Ⅲ )
advanceed stage (BorrmannⅠ-Ⅳ)
 Diagnosis :imaging endoscopy
Gastric Carcinoma

Advanced gastric carcinoma


 The common x-ray findings of advanced gastric carcinoma
 x-ray findings of stomach at different position
 CT findings of advanced gastric carcinoma
 differential diagnosis of advanced gastric Ca.
Gastric Carcinoma
The common x-ray findings of advanced gastric carcinoma
 Irregular filling defect in the stomach
 Narrowing of stomach and rigidity of the wall of stomach
 Meniscus syndrome :
ulcer: irregular shape, meniscus-like, with even outer edge
and irregular inner edge
ulcer: in the outline of stomach
periphery of ulcer: a lucent zone with the different width
around ulcer , nodule on it is often seen
 Destruction , interruption and disappearance of mucosa
 Loss of peristalsis of the involved stomach
小肠疾病的影像学诊断
Imageological Diagnosis of the Small Intestine

Department of radiology,the Affiliated


Hospital of Henan Medical University

Gao Xuemei
Imageological Diagnosis of Duodenal diseases
Duodenal diseases

 Ulcer, diverticula
 Maligant tumor : carcinoma,
sarcoma,carcinoid 类癌
 Benign tumor : adenoma, leiomyoma
 TB
 extraluminal compression :
SMA 、 pancreas
Disease of jejunum and ileum

 tuberculosis
 Crohn disease
 Benign tumor : adenoma, leiomyoma
 Malignant tumor :
adenocarcinoma,lymphoma,carcinoid 类癌
 other : diverticula
Duodenal ulcer

location : bulb, 95%. A few , postbulb


pathology :
single, 1-10mm in size , round
,deformed bulb , inflammatory edema and
fibrosis on the periphery of ulcer
symptom : epigastric pain with regularity
and rhythm
diagnosis : imaging endoscopy
Duodenal ulcer

Direct signs :
 Nitch or crater :
en face : the ulcer shows round opaque with lucent
zone around the its periphery and radiating mucosal folds
toward the edge of nitch
in profile : nipple-like or lapper protrusion
 Deformed bulb : (due to scar)
unilateral or lateral
Duodenal ulcer

Indirect signs :
accelerating evacuation
Pyloric spasm
Hypersecretion of stomach
Fixed tenderness on bulb
Imageological Diagnosis of the Small Intestine
Intestinal tuberculosis

 Location: ileocecum 60-80%


 pathology-Xray :
caseous formation→ulcer→proliferation
→granuloma→filling defect
 symptoms : abdominal pain,diarrhea,
constipation, mass
 diagnosis : contrast examination laboratory
test
X-ray findings of Intestinal
tulerculosis
Ulcerative type :
• multiple and scalopped coutour on the surface of mucosal
folds
• line-like sign : due to spasm of intestine
•“skip sign” : cecum remains empty with barium meal
• normal at the two ends between the two lesion of intestine
X-ray findings of Intestinal tulerculosis

Hyperplastic type :
•multiple small polyp-like filling defect due to
hyperplasia
•cecum and ascending colon becomes short,
narrowing and irregular
•evacuation time of small intestine is delayed
Mixed type :
showing above both X-ray features
大肠疾病的影像学诊断
Imageological Diagnosis of the Large Intestine
Common diseases of large intestine

ulcerative colitis
Crohn’s disease of the colon
tuberculosis of the colon
colorectal carcinoma
colonic diverticulosis
Colonic polyps and polyposis syndrome

colonic polyps
polyposis syndrome ( 家族性结
familial
肠息肉综合征 )
Gardner 综合征 (Gardner syndrome)
Peutz-Jepher 综合征 (P-J syndrome)
Colonic polyps and polyposis syndrome

Turcot syndrome (Turcot 综合征 )

juvenile polyposis( 幼年性结肠息肉综合征 )

C-C syndrome (Cronknite-Canada 息肉综合征 )


Other colonic diseases

lymphoma of the colon( 结肠淋巴瘤 )


Carcionid( 结肠类癌 )
pseudo-obstruction( 结肠假性梗阻 )
pneumatosis cystoides( 结肠气囊肿症 )
大肠癌的影像学诊断
Imageological Diagnosis of Colorectal Carcinoma
Carcinoma of the large intestine

 pathology: hyperplasia type (54.2%),ulcerative


type (28.1%),infiltrative type
 symptoms : obstraction,having blood in stool
 diagnosis : imaging ,endoscopy
Main X-ray findings of advanced large intestine

Hyperplastic(polypoid)type :
 Irregular filling defect projecting into the
lumen of the bowel
 eccentric stricture
 Rigidity of the wall of intestine,destruction of
mucosa and loss of peristalsis
Main X-ray findings of advanced large intestine

Ulcerative type :
 Large and irregular ulcer seen in the lumen of
intestine
A lucent zone with different width around the ulcer
 Rigidityof the wall of intestine , destruction of
mucosa, loss of peristalsis
Main X-ray findings of advanced large intestine

Infiltrative type :
Irregular and annular stricture ,
obstruction
Destruction of mucosa, rigidity of the
wall of intestine, loss of haustration
Other X-ray findings of advanced large intestine

 Intussusception( 肠套叠)

 Involving the terminal ileum


 others : extraluminal
compression,adhesion

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