涎腺疾病的影像学诊断.pptx

涎腺疾病的影像学诊断;病史 检查 影像学 细针吸活检 唾液流率 生化;病史 涎腺疾病相关症状 疼痛 肿胀，肿块 口腔干燥 唾液过多 味觉异常 全身疾病/用药史/手术史/放射治疗;检查 视诊 肿胀 神经损害情况 口腔粘膜 导管口 扪诊 腺体大小、质地、压痛 肿块;;Which group of diagnoses have to be taken into consideration? Additional examination required? Which examinations should be carried out? In what sequence? What extra information can be obtained? And how useful? Is the value of this information worthwhile in view of any contraindications, discomfort to the patient, or financial consequences?;Imaging diagnosis of salivary diseases introduction;X线平片 结石 相关骨改变;唾液腺造影 Rontogen 1895 discovery of X ray Carpy 1902 injection of mercury into Stensen’s duct in vitro Arcelin 1913 injection of bismuth into Warton’s duct in vivo for investigation of sialolith Sicard Forestier 1921 lipiodol as a contrast medium Barsony 1925 for the investigation of duct dilation/metal canula Wiskovsky 1925 Sialodochographie Jacobovici 1926 sialographie Rutney Shapsio 1950 rubber catheter;;Imaging diagnosis of salivary diseases Sialography;;;约21%的腮腺标本可见副腺体;Imaging diagnosis of salivary diseases Sialography;Scintigraphy in 1960, Richards was the first to suggest that technetium-99m might have useful medical applications the first article dedicated to salivary gland scintigraphy with Tc-pertechnetate was published by Borner in 1965 remains the only procedure with which the functional status of all major salivary glands can be studies simultaneously;Imaging diagnosis of salivary diseases Scintigraphy;正电子发射型断层计算机(Positron emission tomography, PET);;;正常回声表现，横切面与纵切面，换能器频率;CT 软组织分辨率好 可观察相关骨质改变及钙化 空间分辨率高 多方向观察，三维重建 显示病变位置、范围、与周围组织结构的关系 成像速度快 强化扫描可显示血管影像和病变的强化特征 辐射 造影剂 伪影;组织;腮腺密度－10～30HU，高于脂肪，低于肌肉，随增龄有改变;;;;MRI 软组织分辨率优于CT 强化扫描有助于增强软组织分辨能力 功能成像 动态增强MRI（DCE－MRI） 弥散加权成像（DWI） 波谱成像（MRS） 局限 扫描时间长 伪影 禁忌;腮腺在胚胎第六周开始发育 起源于上下颌突分叉处的外胚层上皮 颌下腺在胚胎第六周末开始发育 起源于颌舌沟近外侧的内胚层上皮 舌下腺在第7～8周开始发育 起源于颌舌沟近外侧的内胚层上皮 ;;;;;静止性骨腔（Stafne骨腔）;;;;;;唾液腺异位;;唾液腺结石病;sialolithiasis plain radiography submandibular gland occlusal radiograph posterior