UltrasoundMedicine

WHATISULTRASOUND?Thefrequencyofsoundwaves

>20,000HzThefrequencyusedinultrasoundmachines1to12megahertz

SoundwavesTHETRANSDUCERPiezo-electriccrystalTransmitspulsesofsoundintotissueandlistensforechosMostofthetimeisspentlisteningforechoesTransducerPoweronPoweroffTransducerreceivingechoesULTRASOUNDPULSES

MAKINGTHEIMAGEMEMORYModernultrasonography-digitalprocessingofimage

Analoguepart–detectionsystem

Analogue-digitalconverters(ADC)

Digitalprocessingofsignal–possibilityofprogramming(preprocessing,postprocesssing),imagestorage(floppydiscs,CD,flashcardsetc.)ULTRASOUNDPULSES

MAKINGTHEIMAGESOUNDWAVESWAVELENGTHISVERYSMALLOBEYTHELAWSOFOPTICSSOUNDWAVES

GatheredintoanarrowbeamReflectedRefractedScatteredAbsorbedUndergointerferenceModesofUltrasonography

A-modeone-dimensionalB-modetwo-dimensionalM-modeD-mode(Dopplerflow)3D/4DDistancesbetweenreflectinginterfacesandtheprobeareshown.Reflectionsfromindividualinterfaces(boundariesofmediawithdifferentacousticimpedances)arerepresentedby

verticaldeflections

ofbaseline.

Ultrasonography

A-mode–one-dimensionalUltrasonography

A-mode–one-dimensionalUltrasonography

B-mode–two-dimensionalAtomogramisdepicted.StaticB-scanRepetitiveformationofB-modeimagesofexaminedareabyfastdeflectionofUSbeammechanically(inthepast)orelectronically?inrealtime“today.Ultrasonography

B-mode-dynamicUltrasonographyM-mode

chestwalllungsUltrasonography

D-mode

Christian.A.Doppler(1803-1853),Austrianphysicistandmathematician,formulatedhistheoryin

1842duringhisstayinPrague.WhatisDoppler?TheDopplereffect(frequencyshiftofwavesformedorreflectedatamovingobject)canbeusedfordetectionandmeasurementofbloodflow,aswellas,fordetectionandmeasurementofmovementsofsomeacousticalinterfacesinsidethebody(foetalheart,bloodvesselwalls)PrincipleofDopplereffectUSDopplerbloodflow-metersThefrequencyofreflectedwavesis(incomparisonwiththeemittedwaves)higherinforwardbloodflow(towardstheprobe),lowerinbackbloodflow(awayfromtheprobe)PrincipleofDopplereffectDopplermethodsPulsedWave–PWContinuousWave–CWColourDopplerImaging–CDIColourDopplerimaging

Theimageconsistsofblack-whiteandcolourpart.

rule–blueaway,redtowards.ColourDopplerimaging

Carotidbifurcation

Principleofthree-dimensional(3D)imagingFour-dimensional(4D)image

ThefourthdimensionistimeDiagnostic

device

sectorconvexlineartransvaginal/transrectaltransesophageal

TransducerClassificationofSonography

Sonographyusedin……Abdomen

GynecologyandObstetricsCardiacSuperficialpartsBiopsyUltrasonographyisanoninvasivemedicaltestthathelpsphysiciansdiagnoseandtreatmedicalconditions.Anabdominalultrasonographyproducesapictureoftheorgansandotherstructuresintheupperabdomen.AbdominalSonographyAbdominalSonographyKidneysLiverGallbladderPancreasSpleenAbdominalaortaandotherbloodvesselsWhataresomecommonusesoftheprocedure?AbdominalpainsAbnormalliverfunctionEnlargedabdominalorganAbnormalitiesintheabdomen:gallstones,livercirrhosis,cyst,tumor,etc.AnaneurysmintheaortaSonographicTerminology

DescriptiveterminologyHyperechoic---Hypoechoic(高回聲－低回聲)Isoechoic（等回聲）Anechoicorsonolucent（無回聲）Enhancement（回聲增強）Heterogeneous---Homogeneous（非均質(zhì)/均質(zhì)）Shadowing（聲影）SonographicEvaluationThesizeTheechoandattenuationoftheorganParenchyma實質(zhì)Thetexture質(zhì)地Thepresenceofvascularstructures,ligaments,andfissures裂隙Abnormality異常andmass占位

hepaticcystThesimplecysthasthreeacousticproperties－－anechoic－－h(huán)asawell-definedsmoothcapsule－－exhibitsposteriorenhancement

(increasedthroughtransmissionofsound)HepatichemangiomaSmallsolitaryormultiplenodularlesionRoundedwell-definedHyperechoicmassUsuallynotvisualizecolourflowMasseffectPathologictypesofhepatictumorsBenignhepatictumors

hemangioma,hepatocellularadenoma,hepaticcystadenoma,FNH(focalnodularhyperplasia)etc.Malignanttumors

hepatocarcinoma,hepatocholangiocarcinoma,

metastases,lymphomaetcUSGFindingsHemangiomaSolitaryormultipleRoundorovalWell-definedborderHyperechoic（mostparts）ColorflowPrimaryCaSolitaryormultipleInfiltrative,diffuseHypoechoic,isoechoic,hyperechoicPortalveins/hepaticveinsinvadedthrombusMetastases轉(zhuǎn)移性肝癌SolitaryormultipleWell-,ill-definedHypoechoicorhyperechoicDiffusedistortionofbull’seyepatternThegallbladderUltrasoundisanessentialfirst-lineinvestigationinsuspectedgallbladderandbiliaryductdiseaseItishighlysensitive,accurateandcomparativelycheapGallbladderpathologyiscommonandisasymptomaticinover13%ofthepopulationReflectivity（hyperechoic）ShadowingMobilityrenalcystNephrolithrenalcellularcarcinomabreastcyst邊清壁薄的無回聲團塊clearboundary

,wallthinfreeechogenicmass後方回聲增強Theposterioracousticenhancement側(cè)方聲影l(fā)ateralshadow

breastfibroadenoma左乳上方低回聲團塊

形態(tài)規(guī)則，邊界清晰

內(nèi)部見少量彩色血流Theleftbreastaboveisahypoechoicmass,witharegularshape,clearboundaryandafewcolorbloodsignalsbreastinfiltratingductalcarcinoma低回聲團塊Hypoechoicmass,邊界不清，形態(tài)不規(guī)則

obscureboundary,irregularshape,內(nèi)部回聲不均，內(nèi)見散在沙礫樣鈣化internalheterogeneousecho,sometimesgrittycalcificationcanbefoundhysteromyoma子宮肌壁間肌瘤intramuraluterinemyoma子宮粘膜下肌瘤submucosalmyomaofuterus子宮漿膜下肌瘤subserousmyomaofuterus

corpuscarcinoma

早期聲像圖多無特異性改變Earlysonographicoftennon-specificchanges子宮增大，內(nèi)膜增厚Theuterusincreases,intimalthickening宮腔內(nèi)不規(guī)則強弱不等團塊狀回聲Theirregularmasswithheterogeneousechointheuterinecavity血流信號豐富Abundantbloodflowsignalsovariantumor根據(jù)其病變的物理性質(zhì)不同，在聲象圖上大致可分為三大類：Accordingtothedifferentphysicalnatureofthelesions,acousticimagecanberoughlydividedintothreecategories:囊性cystic實質(zhì)性parenchyma混合性腫塊mixedmasses

chocolatecystofovary卵巢子宮內(nèi)膜異位囊腫ovarianendometrriosiscyst主要病理變化為異位內(nèi)膜隨卵巢的功能變化，週期性出血和周圍纖維化Themainpathologicalchangesareectopicendometriumchangeswithovarianfunction,periodichemorrhageandfibrosisaround而逐漸形成囊腫，囊內(nèi)為巧克力樣陳舊性血液。Andgraduallyformedcysts,intracapsularaschocolate-likeoldblood

malignanttumorofovary

卵巢的實質(zhì)性腫瘤多為惡性。Mostoftheparenchymatumorsfromovaryaremalignant為實質(zhì)不均勻腫塊，邊界不規(guī)則，界限不清晰，內(nèi)部光點分佈紊亂，有時可出現(xiàn)不規(guī)則壞死液化的無回聲區(qū)。Themassperformsasaheterogeneousparenchyma,withaunclearandirregularborder,theinternalecho-pointdistributeirregularly,necrosisandsonolucentechozone.多數(shù)病例伴有腹水。Ascitescanbefoundinmostcases.

Apicalfour-chamberview

Apicalfour-chamberview二尖瓣狹窄（MS）先天性心病congenitalheartdisease

UCG能直接顯示房缺（ASD）、室缺（VSD）、動導(dǎo)（PDA）、法四、Ebstain畸形等，另外可確診右室雙出口，大血管移位等紫紺型先心病。UCGcandirectlydisplaytheatrialseptaldefect(ASD),ventricularseptaldefect(VSD),patentductusarteriosus(PDA),tetralogyofFallot,Ebstainmalformation,what’smore,cyanoticcongenitalheartdiseasecanalsobeconfirmed,suchasdoubleoutletofrightventricle,transpositionofthegreatvesselsandsoon.室間隔缺損（VSD）

USG-GuidedLiverBiopsy

Whatarethebenefitsvs.risks?Benefitsnoninvasive(noneedlesorinjections)andisusuallypainless.widelyavailable,easy-to-useandlessexpensivethanotherimagingmethods.usesnoionizingradiation.givesaclearpictureofsofttissuesthatdonotshowupwellonx-rayimages.causesnohealthproblemsandmayberepeatedasoftenasisnecessary.providesreal-timeimaging,makingitagoodtoolforguidingminimallyinvasiveproceduressuchasinjections,ne