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7/22/2019 Radio-imagistica in Specialitati Med.chir.
http://slidepdf.com/reader/full/radio-imagistica-in-specialitati-medchir 1/242
RADIO
-
IMAGISTICA
IN SPECIALITATILE
MEDICO
-
CHIRURGICALE
•
NEURO
-
RADIOLOGIE
•
OTO
-
RINO
-
LARINGOLOGIE
•
OFTALMOLOGIE
•
ENDOCRINOLOGIE
•
OBSTETRICA
-
GINECOLOGIE
© Rad/imag.IASI-1999-2003
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NEURO
-
RADIOLOGIE
METODE DE RADIO-IMAGISTICA :
-RADIOGRAFIA STANDARD:schelet cranian,col.vertebrala
-CT;ANGIO-CT (CT spiral,multidetector);
-ANGIOGRAFIA Rx (DSA): -arc aortic,carotida,verteb rala;
-IRM +ANGIO-RM=> metoda de electie:cea mai fidela metodade vizualizare a structurilor cerebrale si canalului/ maduveispinale;
-ECOGRAFIA DOPPLER:carotidiana;
-transcraniana;transfontanelara
-SCINTIGRAFIA:SPECT;PET=aplicatii limitate
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RADIOGRAFIE
CRANIU PROFIL
Examenul Rx al scheletuli-primul practicat in traumatologia craniana
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RADIOGRAFIE
A BAZEI DE
CRANIU:INCIDENTA
HIRTZ
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RADIOGRAFIE BAZA CRANIU:detaliu (Zoom digital)
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CT:CRANIU
AXIAL
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IRM CRANIO-CEREBRALA
PRIMA APLICATIE CLINICA IN URMA CU 23ANI;
-APLICATII ACTUALE= toata patologia cerebrala:
-Scleroza multipla (metoda unica,superioara CT);
-patologie vasculara :AVC,tromboze,infarcte,anevrisme;
-Malformatii A-V;anomalii de dezvoltare cerebrale;
-inventarul tumorilor – hipofiza, de fosa posterioara,nervi cr.;
-controlul rezultatelor dupa interventii terapeutice.
© Rad/Imag.2002
7/22/2019 Radio-imagistica in Specialitati Med.chir.
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T-1 T-2
ventriculi
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IRM:STRUCTURI
CEREBRALE,
ORBITARE,
OCULAREn.optic
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APLICATII ALERADIO- IMAGISTICII
DIAGNOSTIC
•MALFORMATII CONGENITALE (chiar fetale,in utero);
•TRAUMATISME CRANIO-VERTEBRALE:fracturi,hematom;
•PATOLOGIE VASCULARA:-MAV,angioame, -
ateromatoza: stenoze,ischemie,infarcte,ramolismente,anevrisme.
•INFECTII :-meningo-encefali te;abcese cerebrale;scleroza in placi;
•TUMORI :- PRIMITIVE:astrocitom,meningiom,meduloblastom
. -METASTATICE:de la cancer sin,pulmon,renal etc.
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IRM FETALA,in utero :
MALFORMATIE CEREBRALA :holoprosencefalie
© Rad/Imag.2002
-S.cerebrala absenta
temporo-occiptal,inlocuitacu lichid (hipersemnal
omogen T2)
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CT:
CHIST
ARAHNOIDIANTEMPORALSTG.
-formatiune expansiva cu
continut lichidian pur si
capsula periferica fina
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CT;
HIDROCEFALIE
SIST.VENTRICULAR
DILATAT
i d i
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CT nativ:HEMATOAME POST-TRAUMATICE:
A)EPIDURAL;B).INTRACEREBRAL
A BHiperdensitate
spontana
(singe),cu halou
limitant(edem,
meninge)
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CT:
HEMATOM EPIDURAL
POST-TRAUMATIC
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CT:INFARCT CEREBRAL
Zona hipodensa
neomogena cu stergerea
structurilor cerebrale si
partiala lichefiere
li i ib il i i l h i l i
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CT:
INFARCT
CEREBRAL
INTINS
Clinic:Fibrilatie atriala;hemiplegie
-zona hipodensa,lichefiata partial cu disparitia structurii
cerebrale occipital post.drept;
-moderat halou periferic-edem;
-zona nu capteaza contrastul
iodat,care este vizibil in vase
Pl i d l i lb
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© Rad/Imag.2002
IRM-AX & SAG:SCLEROZA MULTIPLA
IRM =singura
metoda cereveleazaleziuniledemielinizantedin SM
Placi de scleroza in s.albadominant periventricular :benzi de hipersemnal T2
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IRM :Tumora cerebrala parietala dr.:invazie sist.ventricular,edem,hemoragii intratumorale
© Rad/Imag.2002
axial
coronal
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IRM ,T-2 AX& SAGITAL
TUMORA FRONTALA STGA (astrocitom)
edem
T
masa expansiva incapsulata cu
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© Rad/Imag.2002
IRM CEREBRALA:
TUM. UNGHI PONTO-CEREBELOSNERV ACUSTICO-VESTIBULAR
(SCHWANOM)
-masa expansiva incapsulata cu
hipersemnal T2,compresiva pe
s.cerebrala hemi-cerebel dr.;
-captare contrast in T1;
-dilatare ventriculara secundara.
IRM TUMORA HIPOFIZARA EXTENZIE SUPRASELARA
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IRM:TUMORA HIPOFIZARA:EXTENZIE SUPRASELARA
AXIAL
SAGITAL CORONAL © Rad/Imag.2002
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CT:TUMORA CEREBRALA DE UNGHI PONTO-CEREBELOS
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CT:
TUMORA
CEREBRALA;
SD.EXPANSIV,EDEM,
COMPRESIA
VENTRICULULUI LAT.
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CT:EXAMEN
POST
CRANIOTOMIE
TUMORA
CHISTICA
IN EVOLUTIE
-volet operator
tensionat,cu
protruzia de l.c.r simasa tumorala la
exterior;edem masiv
si disparitia
structurilor cerebrale
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ECOGRAFIE cerebrala prin volet operator: TUMORA RESTANTA
Ventricul lateral
Tedem
Formatiune expansiva
solida,hiperecogena,cu
edem peritumoral (halou
hipoecogen)
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CT:
METASTAZECEREBRALE
(cancer mamar)
-noduli multipli in
substanta cerebrala,cu
densitate diferita dupa
contrastare:cerc opac
periferic si zonacentrala mai hipodensa
-zone multiple nodulare rotund-ovalare in hipersemnal
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IRM - T2:metastaze cerebeloase(cancer mamar operat de 2 ani)
© Rad/Imag.2002
zone multiple nodulare,rotund ovalare, in hipersemnal
T2 cu halou periferic
IRM :
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IRM :MAV CEREBELOASA hemoragica
nidus
© Rad/Imag.2002
-formatiune expansiva
cerebeloasa dr. cu
structura mixta,imagini
serpiginoase lichidiene
aspect vermicular (vase
angiomatoase);
-halou in hipersemnal
(hemoragie)
©
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ANGIO-IRM CEREBRALA :RAPOARTE VASCULARE CU TUMORA-incidente variate 3D
T
© Rad/Imag.2002
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Angio-RM cu contrast
•
Foloseste contrast paramagnetic tip Gadolinium( ex.:Magnevist-Schering AG);
•Injectarea iv.a contrastului manuala sau cu injectoare
automate ;
•Cantitatea de s.c.-01-02 mmol/Kg corp;
•Viteza de injectare fctie de vasele vizate=0,5-1,5 ml/sec
•Momentul inceperii achizitiei datelor este selectat fctie
de viteza /timpul de circulatie;soft-urile moderne deangio-RM permit detectare automata a fluxului de
contrast in zona cercetata-reducind neconcordantele
intre peak-ul maximal al concentratiei s.c. si achizitie.
ANGIO-RM:CAROTIDE & VERTEBRALE
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ANGIO-RM:CAROTIDE & VERTEBRALE
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VASELE CEREBRALE:ANGIO-IRM SI PREP. ANATOMIC
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ANGIO-RM:VENELE CEREBRALE
© R d/I 2002
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ARTERIO-IRM 3D- AXIAL: art.cerebrale normale
© Rad/Imag.2002
a.cerebr.ant
r.temporale
r.parietale
r.occipitale
a.cerebr.mijlocie
a.cerebr.posterioara
a.comunicantaanterioara
a.Comunicanta posterioara
© R d/I 2002
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a.cerebr.
mijlocie
a.cerebr.anterioara
a.tr.bazilar carotida
MIP coronal-aspect normal
© Rad/Imag.2002
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MIP sagital/oblic:aspect normal
© Rad/Imag 2002
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Angio-IRM,CORONAL:
TROMBOZA CAROTIDA DR.
MIP/SEGMENTARE
Carotida stga
© Rad/Imag.2002
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Angio-IRM/CONTRAST 3D - CORONAL:
STENOZA/TROMBOZA CAROTIDA STGA © Rad/Imag.2002
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Post-procesare:
Subtractie & segmentare
Angio-IRM /CONTRAST:stenoze carot.interna -bilateral
© Rad/Imag.2002
Post-procesare:
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Angio-IRM /CONTRAST:stenoze carot.interna -bilateral
Subtractie & segmentare
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AORTOGRAFIE-IRM,cu contrast:stenoza a.vertebrale
AORTOGRAFIE Rx-DSA:arc aortic=>carotide/vertebrale normale
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O OG S : c o c c o de/ve eb e o e
Carotida stga
Vertebrala stga
Carotida dr.
Vertebrala dr.
cateter
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AORTOGRAFIE Rx DSA TORACICA: stenoza carotida dr.;tromboza carotida com stga.
stenoza
tromboza
© Rad/Imag 200
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ANEV. A.CERBRALA MIJLOCIE:AIRM-CORONAL,MIP/SEGMENTARE
© Rad/Imag.200
MOVIE/AUTOPLAY
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ANEV. A.CERBRALA MIJLOCIE:
AIRM-CORONAL,MPR,SEMENTARE/SURFACE RECONSTR./SPIN
spaiuc
AngioIRM cerebrala
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g
FUZIUNE CU
CT -3D
STUDIUEXPERIMENTAL
1995 /ECR,VIENA/
INSTIT.MATEM.MED/BIOLOGIE
HAMBURG,Germania
ARTERIOGRAFIE Rx VERTEBRALA:anevrism bazilar
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A.Vertebrala
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Angio-IRM:MAV (Malformatie Arterio-Venoasa)Parietala stanga-in teritoriul Art.Cerebrale Mijlocii(ACM)
DSA
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ARTERIOGRAFIE Rx CAROTIDIANA:MALFORMATIE A-V
Vase aberante si lacuri vasculare in aria
art.cerebrale mijlocii-temporo-occipital
PA LAT
PA © Rad/Imag.2002
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ARTERIOGRAFIE RxCAROTIDIANA DSA;faza venoasa
MALFORMATIE
ARTERIO-VENOASA:lacuri opace venoaseabundente,conglomerate
LAT
© g
IRM:coloana vertebrala lombo-sacrata:
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IRM:coloana vertebrala lombo-sacrata:
discartroza
T1-Post-contrast i.v.(Gadolinium )
© Rad/Imag.2002
-hipersemnal subchondral platouri vertebrale L5-S1;-scaderea
grosimii discului intervertebral;captare contrast tip inflamator
T2 -nativ
-Masa solida de partimoi,ovoida,incapsulata;
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Post-contrast:captare
sagital
IRM CERVICALA:Meningiom,C3-4
coronal
, , p ;
capteaza intens contrast
paramagnetic-deci =
hipervascularizata;
-compresie /ingustare a
cordonului medular
C2
C4
Tcordonmedular compresat
nativ
nativ
Clinic:paraplegie m inferioare.
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IRM:MALFORMATIE A-V (arterio-venoasa)
VERTEBRO-MEDULARA
CORONAL
SAGITALAXIAL
© Rad/Imag.2002
Structuri vasculare
anormale,serpiginoase
vermiforme,in
hipersemnal T2 ce
ocupa canalul spinal si
se extind lateral ;structuri medulare
disparute
© Rad/Imag.2002
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© Rad/Imag.2002
MIELOGRAFIE-IRM CERVICALA:
Canal spinal ingustat prin osteofitozaproeminata;compresiune a structurilor medulare
sagital
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Clinic:traumatism forte cervical;tetraplegie de 1 luna.IRM:DISCARTROZA PREEXISTENTA;
MODIFICARI MEDULARE SECUNDARE: -stenoze canal spinal etajate;ingustare cordon medular si
cavitate siringomielica mica ,structura cordonala disparuta.
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Clinic:”Discopatie”;IRM=Metastaze vertebro-medulare
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p ;
mielo-IRM
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METASTAZE VERTEBRO-MEDULARE
(Clinic:Rezectie Transuretrala:-cancer prostata).
© Rad/Imag.2002 -distructii/tasari vertebrale multiple;-masatumorala invadanta in canalul spinal
sagital
axial
T
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NEURORADIOLOGIE
INTERVENTIONALA •ANGIOPLASTIE PERCUTANA TRANSLUMINALA:in stenozele arteriale ateromatoase carotidiene,vertebrale
•EMBOLIZARE TERAPEUTICA:FAV,anevrisme;•CHEMOTERAPIE INTRAARTERIALA selectiva: -tromboze vasculare,tumori maligne;
•IRADIERE INTERSTITIALA transcutana;
•“GAMMA KNIFE”:iradiere externa stereotactica,ghidata CT-in tumori maligne.
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ANGIOPLASTIA CAROTIDEI
• INDICATII:
-stenoze strinse -60-70% -ce nu beneficiaza deendartrectomie chirurgicala (datorita unor contraindicatii)
-accidente vasculare tranzitorii repetate;-re-stenozarea dupa endarterectomie;
-leziuni inaccesibile chirurgical (la ostium sauinalte,retromandibular)
• CONTRAINDICATII:-tromboza completa;-hemoragie cerebrala;-atac ischemic major,cu
paralizii definitive;-tumori cerebrale.
Balon protectiea.vertebrala
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TEHNICA APT
CAROTIDA COMUNA STANGA
Abord transfemural
-cateter-balon pozitionat intra-
stenotic; balonul degonflat; -
balon protectie cerebrala gonflat
supra stenotic
axial
cerebrala
Balon terapeutic
degonflat
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Carotida
dreapta
Tr.brahio
cefalicTr.brahio
cefalic
© Rad/Imag.Iasi-2003
Balon protectie
b l
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TEHNICA APT
CAROTIDA COMUNA STANGA
Abord transfemural
-cateter-balon pozitionat intra-
stenotic; balonul gonflat
maximal;
-balon protectie cerebrala
gonflat
axial
cerebrala
Balon
terapeutic
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
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ENDOPROTEZARE PERCUTANA:introducerea protezei
montate pe cateter-balon prin teaca arteriala femurala
Balon protectie
b l
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ENDOPROTEZARE
CAROTIDA COMUNA STANGA
Abord transfemural
-Cateter-balon cu proteza
pozitionata intra-stenotic,dupa
pre-dilatatie;
-balonul degonflat,proteza
colabata pe balon;
-balon protectie cerebralagonflat suprastenotic
axial
Proteza
colabata
cerebrala
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Balon protectie
cerebrala
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ENDOPROTEZARE
CAROTIDA COMUNA STANGA
Abord transfemural
-cateter cu balonul gonflat
maximal; proteza expandata ;
-balon protectie cerebrala
gonflat
axial
proteza
cerebrala
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
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ENDOPROTEZARE
CAROTIDA COMUNA STANGA
Abord transfemural
CONTROL AORTOGRAFIC axial
proteza
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Balon protectiecerebrala
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ENDOPROTEZARE CAROTIDA
STANGA INTERNA-BIFURCATIE
Abord transfemural-proteza colabata pe balonul
degonflat,pozitionata intrastenotic,
dupa pre-dilatatie;-balon protectie cerebrala gonflat
proteza
axial
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Balon protectie
cerebrala
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cerebrala
proteza
ENDOPROTEZARE CAROTIDA
STANGA INTERNA-BIFURCATIE
Abord transfemural
- balonul terapeutic gonflat
maximal si proteza expandata;
-balon protectie cerebrala gonflat
axial
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Balon protectie
cerebrala
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cerebrala
proteza
ENDOPROTEZARE CAROTIDA
STANGA INTERNA-BIFURCATIE
Abord transfemural-aspirare fragmente aterom prin
cateterul-tutore,dupa extragerea
cateterului cu balon;
-balonul de protectie cerebralagonflat.
Cateter
tutore 8Fr aspira
Cateter-tutore
axial
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
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proteza
ENDOPROTEZARE CAROTIDA
STANGA INTERNA-BIFURCATIE
Abord transfemuralARTERIOGRAFIE de CONTROL
axial
Jet contrast
iodat
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
Balon protectiecerebrala
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Proteza
expandata
ENDOPROTEZARE CAROTIDA
DREAPTA INTERNA-BIFURCATIE
Abord transfemural- balonul gonflat maximal si
proteza expandata;
-balon protectie cerebrala gonflat
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
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Proteza
expandata
ENDOPROTEZARE CAROTIDA
DREAPTA INTERNA-BIFURCATIE
Abord transfemuralARTERIOGRAFIE CONTROL
contrast
© Rad/Imag.Iasi-2003
Procedura se executa sub control
fluoroscopic,cu contrast iodat
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stenoza
ANGIOPLASTIA & ENDOPROTEZAREA CAROTIDEI COMUNE DREPTE
1 2 3
4 5 6
Arteriografie pre-APT
balon
Cateterism selectiv Pozitionare/gonflare
Gonflare/expandare proteza
proteza
Angiografie finala DSA
lumen
recalibrat
Degonflare/retragere balon
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US – duplex (mod B& DOPPLER color)
STENOZA ATEROMATOASA A CAROTIDEI INTERNE: -placi proieminate in lumen,calcificate(vid sonic posterior);-flux turbionar (“mozaic”)intrastenotic
Cazul continua
A B C
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ANGIOPLASTIE CAROTIDIANA INTERNA:
A)arteriografie cu subtractie digitala pre-interventionala;
-stenoza ateromatoasa peste 60% a carotidei interne;B)cateter de angioplastie cu balonul gonflat intra-stenotic;
C)arteriografie de control:recalibrarea lumenului carotidian
A B C
POST-APT
(Studiul US Doppler-in pg.precedenta)
PRE-APT
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RADIO-IMAGISTICA
O.R.L. INDICATII;METODE:
OTO==> exam.urechii medii /interne: infectii,traumatisme,tumori
==>radiografii+tomo: incidente: Schűller,Stenvers,Hirtz;
==>CT;IRM;angioDSA (carotidiana).
RINO=> exam.sin.fetei,orif.nazale,rinofaringe: idem OTO;
==>rad+tomo:incidente:Blondeaux,Hirtz,cr.profil;
==>CT;IRM.
LARINGO-FARINGE: t.b.c.;tumori :c.vocale,vestibul ,glota etc.
==>CT;IRM;f luorograf ie +bar iu/L ipiodol(far inge)
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CT:EX.AXIAL PENTRU RINOFARINGE,
SFENOID,BAZA DE CRANIU,SINUSURI MAXILARE
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CT:STRUCTURA URECHII MEDII/INTERNE
CT
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CT:
SECTIUNI
OBLICE
PRIN
URECHEA
MEDIE/
INTERNA,BILATERAL
RADIOGRAFIE ASINUSURILOR MAXILO-
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FACIALE:
-tumora sinus maxilar dr.;
-ingrosare mucoasa sin max sting.
IRM IN OTO RINO
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IRM IN OTO-RINO-
LARINGOLOGIEAPLICATII :Diagnostic de prezenta,etiologie si extenzie inurmatoarele afectiuni:
-CANCER HIPO/RINOFARINGE,LARINGE;
-TUMORI BENIGNE-NEURINOM,FIBROM;
-SUPURATII;
-CHISTURI ,SINUZITE,MUCOCEL;
-DECELAREA CANCERELOR OCULTE,CU METASTAZEGANGLIONARE CERVICALE PRECESIVE.
SINUSITA CRONICA
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SINUSITA CRONICA&
CHIST SIN.MAXILAR
© Rad/Imag.2002
AX
CORONAL
IRMN:
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IRMN:
BAZA
CRANIULUIINCIDENTA
AXIALA:
NEURINOMDE
ACUSTICminiatural
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IRM CERVICALA:CANCER LARINGIAN
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IRM CERVICALA:CANCER LARINGIAN
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Angio-DSA
CAROTIDA:
TUMORA
JUGALA
MALIGNA
Vase de
neoformatie
alimentate de
ramuri
carotida
externa
(maxilara)
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IMAGISTICA
OFTALMOLOGICAOBIECTIV:Vizualizarea directa a globului ocular+anexe
si a orbitei
METODE:-IRM=>met.de electie pt.toate structurile;
-US==>corpi straini,dezlipire retina,tumori.
-CT=>tumori+invazie orbitara;-Rad.clasica:orbite,baza cr.,gauri optice;
-Rad.cu grila de caroiaj==>corpi straini opaci Rx
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ECOGRAFIE OCULARA:CORP STRAIN
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ECOGRAFIE OCULARA:
MODIFICARI POST-TRAUMATICE
-dezlipire de retina;-sinechii in
vitros;scaderea sfericitatii-ratatinare
decolare retiniana
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US OCULARA:
-sinechii in vitros;-dezlipire retina
Clinic:traumatism ocular direct
Mod TM
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ECOGRAFIE OCULARA:DEZLIPIRE DE RETINA
Mod TM
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ECOGRAFIE OCULARA:TUMORA RETROOCULARA
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US:TUMORA RETRO-OCULARA
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IRM IN OFTALMOLOGIE
APLICATII :
-TUMORI ORBITARE,GLOB OCULAR;
-SUPURATII ORBITARE;
-NEVRITE,MIOZITE.
-DG.DIFERENTIAL AL EXOFTALMIEI.
© Rad/Imag.2002
IRM:STRUCTURI
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IRM:STRUCTURI
CEREBRALE,
ORBITARE/
OCULARE=normale
--nodul ovoid in
hipersemnal acolat la structurile
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IRM T2:MELANOAMEOCULARE
hipersemnal,acolat la structurile
parietale ale globului ocular;
-stergerea interfetei externe a
tumorii sugereaza extenzia
extraglobulara.
coronal
axial
cristalinul
IRM,T2:sagital
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MUCOCELSINUS FRONTAL
Exoftalmiecompresivasecundara
Glob ocular
colectie
RADIO
-
IMAGISTICA IN
ENDOCRINOLOGIE
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ENDOCRINOLOGIEAPLICATII IN STUDIUL:-TIROIDEI/PARATIROIDELOR;
-OVARELOR -GL.MAMARE;
-TESTICULULUI;
-GL.SUPRARENALE;-HIPOFIZEIMETODE:-ULTRASONOGRAFIE- mod B & DOPPLER;
-CT;-SCINTIGRAFIE;-IRM;
-ANGIOGRAFIE:rar indicata;
-flebografie spermatica-pt.localizarea unui testiculectopic nedecelat prin alte metode;embolizare varicocel ininfertilitatea masculina secundara.
GLANDA TIROIDA
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GLANDA TIROIDAMETODE:-SCINTIGRAMA I-131;US-7-10 Mhz+Dopplercolor&Angio Power;CT;IRMN,RAD.STANDARD (torax).
ASPECTE:-marime,structura (toate met.);-functie(Scintigrafia-iodocaptare)
INDICATII: -TIROIDITE,-GUSA ENDEMICA-TIROIDA PLONJANTA,-ABERANTA,
-CHISTURI,
-ADENOAME,-CANCER.
RAD.INTERVENTIONALA:punctii ecoghidate,scleroterapiaprin alcoolizare=>chisturi,adenoame.
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V jugulara
US mod B & Doppler:TIROIDA NORMALA
LARINGE
Lob dr.
istm
Lob stg
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US:GUSA NODULARA:hipertrofie bilobara;noduli
hipoecogeni,mai evidenti si voluminosi in lobul drept
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US mod B & Doppler:lob dr.tiroidian hipertrofiat;nodul
adenomatos cu halou vasculat periferic
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US TIROIDIANA:NODULI HIPOECOGENI,CALCIFICARI
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US DOPPLER POWER ANGIO COLOR:NODULI TIROIDIENI HIPERVASCULARIZATI
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US.DOPPLER ANGIO POWER COLOR-TIROIDA
NODUL ADENOMATOS-HIPERVASCULARIZAT
GLANDE PARATIROIDE
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METODE:-SCINTIGRAFIE=>tehnica dublului trasor:I-131 +
+Tallium 201;-ULTRASONOGRAFIE mod B & Doppler
INDICATII:-ADENOM SECRETANT (parathormon=hiper-
paratiroidie) – din boalaRECKLINGHAUSEN
(osteozaparatiroidiana);se examineaza Rx intregul schelet,care prezintamodificari caracteristice:osteoporoza,rezorbtii chistice etc.
LOCALIZAREA ADENOMULUI se poate face prin:-US si IRM=tumori > de 8 mm;
-SCINTIGRAFIE;-ARTERIOGRAFIE SELECTIVA (tr.tiro-scapulo-vertebral)
RAD.INTERVENTIONALA:punctie cu fin acecoghidata => siscleroterapie percutana prin alcoolizare
OVARE
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METODE:-ULTRASONOGRAFIA TRANSABDOMINALA;
-ENDOSONOGRAFIA TRANSVAGINALA
-IRM- pelvis/abdomen (sd.malformative complexe)
INDICATII: -OVARE POLICHISTICE;
-TUMORI OVARIENE SECRETANTE;
-SD.MALFORMATIVE:agenezii uter/ovar etc.
(Vezi si “ginecologie”)
GLANDA MAMARA
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GLANDA MAMARAMETODE:-MAMOGRAFIA;
-ULTRASONOGRAFIA mod B,7-10Mhz,Doppler ;
-GALACTOGRAFIA;
-IRMINDICATII:-MASTOZA FIBRO-CHISTICA;
-MAMELA SECRETANTA;
-FIBROADENOMUL;-CANCERUL MAMAR-(ginecologie).
RAD.INTERVENTIONALA:PUNCTIA GHIDATA IMAGISTICin scop diagnostic (cito-biopsie) si terapeutic (chisturi,abcese).
(vezi si “ginecologie”)
TESTICUL
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TESTICUL
METODE:-ULTRASONOGRAFIA-mod B ,Doppler color;
-IRM;
-FLEBOGRAFIA SPERMATICA;
INDICATII:-CRIPTORHIDIA:detectia testicul necoborit-ectopic;
-TUMORI SECRETANTE(LEIDIG)(ginecomastie..);
-VARICOCEL=>INFERTILITATE MASCULINA;
RAD.INTERVENTIONALA:-EMBOLIZARE V.SPERMATICA
PENTRU VARICOCEL=>reduce infertilitatea sec.masculina 50%
LICHID
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HIDROCEL
TUMORA TESTICULARA
LICHIDtesticul
-nodul hipoecogen,structura
neomogena,contur capsulat ,
neregulat
-imagine transsonica
omogena ce inconjura
testiculul-(reflectogen)
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US TESTICUL:ORHITA SUPURATA;microabcese
-imagini ovoide hipoecogene cucontur neregulat si interfata mai
reflectogena(membrana piogena)
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US DOPPLER COLOR TESTICULARA:ORHITA ACUTA
-edem si congestie
abundenta ;
-hipervascularizare cu
distributie normala
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US mod B:TESTICUL ECTOPIC in canalul inghinal
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GLANDE SUPRARENALEMETODE:-ULTRASONOGRAFIA mod B & Doppler color;
-CT+CONTRAST;-IRM;-ARTERIOGRAFIA SELECTIVA(a.diafragmatica,ren.)
INDICATII:-B.ADISSON (insuficienta suprarenala);-HIPERPLAZII GLANDULARE CORTICALE:
- b.Cushing,sd.adreno-genital;-TUMORI MEDULARE SECRETANTE:Clinic=HTA:
-adenom CONN (hiperaldosteronism primar);-feocromocitom
US:SD.ADRENO-GENITAL:hiperplazie suprarenaliana(virsta-6 luni)
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SR
REN
FICAT
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US:TUMORA DE SUPRARENALA STG
REN
© Rad/Imag.Iasi-2002
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US:TUMORA SUPRARENALA DREAPTA
© Rad/Imag.Iasi-2002
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US:TUMORA SUPRARENALA DR.:feocromocitom
VCI
ficat
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US: TUMORA SUPRARENALA DREAPTA.
renT
© Rad/Imag.Iasi-2002
-formatiune expansiva
reflectogena,cu impedanta
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FICAT
REN
US: TUMORA SUPRARENALIANA DREAPTA
de tip parenchimatos
© Rad/Imag.Iasi-2002
coronal
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© Rad/Imag.Iasi-2002
IRM & URO-IRM:
TUMORA SUPRARENALA DR.
(FEOCROMOCITOM)
axial
© Rad/Imag.Iasi-2002
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IRM ,T1 CORONAL:TUMORA SUPRARENALA
(CORTICOSUPRARENALOM)
HIPOFIZA
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HIPOFIZA
METODE:-DIRECTE:IRM,CT;
-INDIRECTA=>Rad.standard +tomo plana- sellara
INDICATII:-ADENOMUL HIPOFIZAR CROMAFIL=>
exces de hormon somatotrop=> GIGANTISM(copil);
=>ACROMEGALIA(adult);
Ex.complementare :radiografierea pieselor scheletice afectate
-ADENOM HIPOFIZAR CROMOFOB=>
exces de LDH=>sd.clinic caracteristic (galactoree/amenoree)
(Vezi si “Neuroradiologie”)
-masa expansiva intraselara
ce largeste spatiul
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CT:ADENOM
HIPOFIZAR IN
ACROMEGALIE
T
interclinoidian;
-captare neomogena a
contrastului,care cresteopacitatea masei tumorale
Sectiuni axiale fine-2mm
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CT:ADENOM HIPOFIZAR:mica tumora incapsulata,intens opacefiata cu contrast iodat
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SELLA TURCICA GOALA (“EMPTY SELLA”):-clinic,unii pacienti prezinta insuficienta hipofizara
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IMAGISTICA IN
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IMAGISTICA IN
OBSTETRICA/GINECOLOGIEMETODE:-US: -pelvis,gl mamara;
-IRM:-pelvis ,gl.mamara;
-CT :pelvi-abdominala ,in tumori;
-HISTEROSALPINGOGRAFIA;
-MAMOGRAFIA;
-GALACTOGRAFIA.
IMAGISTICAGINECOLOGICA:indicatii
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G N CO OG C : d catI.PELVIS:-METRITE,ANEXITE;PELVIPERITONITE;
-TUMORI BENIGNE:-fibrom uterin;chisturi ovar;-TUMORI MALIGNE:-cancer col/corp uterin;-cancer ovarian;
Se apreciaza :-prezenta,natura,
-extenzia loco-regionala,metastazarea.-ENDOMETRIOZA;DG.INFERTILITATII.II.MAMARA:-DISPLAZII MAMARE:mastoza fibro-chistica;
-TUMORI BENIGNE:-fibroadenom;-papilom intraductal;
-TUMORI MALIGNE: 90%=carcinom ductalRAD.INTERVENTIONALA:-punctii eco-ghidate (cy,tumori);-embolizare hipogastrica in metroragii intratabile (tumori);-recoltare de ovul cu ghidaj US=>pt.fertilizare in vitro
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US-3D:UTER NORMAL:endometru
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US 3D:UTER SEPTAT,BIFID
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INSTRUMENT INTRAUTERIN ANTICONCEPTIE (sterilet)
Noduli hipoecogeniincapsulati,cu
calcificari, in grosimea
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US PELVIS:FIBROAME UTERINE
interstitiului miometrial
vezica
-nodul reflectogenincapsulat in
grosimea peretelui
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US:FIBROM UTERIN
uterin
© Rad/Imag.2002
Masa endocavitaracu numeroase vase
neoformate
© Rad/Imag.2002
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US mod B & DOPPLER COLOR:
ADENOCARCINOM DE ENDOMETRU
periferice si
centrale (Doppler)
vezica
-nodul hipoecogen,contur
neregulat ce mareste
di t l i l i
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US:CANCER DE COL UTERIN
vezica
diametrul reg.cervix-ului
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US TRANSVAGINALA:OVAR POLICHISTIC
Formatiune expansivatranssonica incapsulata
parauterina
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US:CHIST OVARIAN VOLUMINOS
vezica
Formatiune expansiva
hipoecogena cu vase
f if i i
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US-DOPPLER COLOR:TUMORA DE OVAR
vezica
uter
neoformate periferice si
centrale
uter Masa expansiva de tip
solid cu vase neoformate
© Rad/Imag.2002
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TUMORA MALIGNA DE
OVAR:
STUDIU US DOPPLER ANGIO POWER COLOR
vezica
tum
solid,cu vase neoformate
abundente central,in
topografie parauterinadreapta
Mod B
-masa reflectogena cu
contur anfractuos, aderenta
la peretele pelvian si vezica;
it t i i
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ASCITA
TUM
US:CANCER DE OVAR
-ascita =zona transsonica in
pelvis,conturind tumora
Masa expansivasolida,hipoecogena,cu
zone centrale transsonice
li h fi i
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TUMASCITA
US:CANCER OVARIAN
-lichefiere necrotica
tumorala.
IRM PELVIS FEMININ
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IRM PELVIS FEMININ
APLICATII IN GINECOLOGIE:
-TUMORI UTER,ANEXE,COL UTERIN;
-STADIALIZARE TNM a cancerelor ;
APLICATII IN OBSTETRICA:
-malformatii fetale (in studiu…)
© Rad/Imag.2002
© Rad/Imag.2002CORONAL
-masa multinodulara
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IRM PELVINA:Fibromatoza uterina;
anexita dreapta
SAGITAL
-masa multinodulara
ocupanta,contur policiclic,ce
mareste global uterul
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VUCANCER COL UTER St.IIb
IRM -T2/SAGITAL
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CANCER COL UTER St.IIIbIRM -T2/SAGITAL
Invazie vezicala
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URO-IRM+T2 pelvin:CARCINOM COL UTERIN,st.III.
HIDRONEFROZA princompresiune/invazieureterala data deadenopatii retroperitoneale
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Cancer de col uterin st.IIIb
invazie vezicala
Ultrasonografie
IRM -AX
IRM NATIV:Cancer ovar;ascita;mts hepatice
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HISTEROSALPINGOGRAFIE:HIDROSALPINX
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HISTEROSALPINGOGRAFIE: OBSTRUCTIE TUBARA
PATOLOGIA GLANDEI
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MAMARE• Radio-imagistica constituie o parte
importanta din explorarile diagnostice pre-
terapeutice in toata patologia mamara si
indeosebi in:- cancerul mamar
- patologia mamara benigna: mastita,mastopatia
fibro-chistica, fibro-adenoame- Metodele aplicate:mamografia Rx,US,IRM
MAMOGRAFIA
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INDICATII:1)-SCREENING=>populatia cu risc:40-70 ani
- examinare anual/la 2 ani;risc carcinogen=0;
2)-Nodulul palpabil solitar;
3)-Mamela secretanta/singerinda=>completata cugalactografia (ductografia).
TEHNICA:2 incidente obligatorii:Cranio-Caudal (CC);
Medio-Lateral-Oblic(MLO)
- compresiunea sinului;- tehnici complementare:incid laterala,marire(zoom)
marcare cutanata opaca a nodulului etc.
TEHNICA EXECUTARII
MAMOGRAFIILOR:
A
A
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POZITIA PACIENTEI SI
COMPRESIUNEA SINULUI
A)-INCIDENTA CranioCaudala
B)-INCIDENTA MedioLaterala/Oblica
B
INTERPRETAREAMAMOGRAFIEI
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RADIOLOGUL SPECIALIZAT,CERCETEAZA:
-CALCIFICARI IN TES.GLANDULAR;
-MASE OPACE NODULARE;
-MODIFICARILE ARHITECTONICEI GLANDEI;
-MODIFICARI VOLUMETRICE;
-MODIFICARI CUTANATE (ingrosare,retractie);
-ADENOPATII AXILARE;
-Examenul clinic al sinului,bilateral=OBLIGATORIU
© Rad/Imag.Iasi-2002
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MAMOGRAFIE INCIDENTA CRANIO-CAUDALA: ADENOAME MAMARE MULTIPLE
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CANCER DUCTAL INVAZIV:NODULI< DE 1 CM(screening)
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MAMOGRAFIE MARITA :cancer ductal =>microcalcificari
-lacune in opacitatea
contrastului din canalul
galactofor afectat.
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GALACTOGRAFIE:PAPILOAME DUCTALE
© Rad/Imag.2002-Iasi
-injectia de contrast iodat cu
ac fin, prin mamelon ,direct
intraductal,
INDICATII
1)Metoda primara la femei sub 30 ani,simptomatice;
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ULTRASONOGRAFIA
) p , p ;
2)Caracterizarea oricarui nodul solitar descoperit clinic±mamografie incerta;
3)Examenul sinului hiperdens, la gravide,lactatie;
4)In tandem cu mamografia la sinul foarte dens;
5)Sinul operat;sinul iradiat;
6)Sinul cu proteza (implant)
© Rad/Imag.Iasi-2002
TEHNICA
ULTRASONOGRAFIEI
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-punct reper=mamelon;
-scanare sectoriala,
-metodica,contigua,
-uniforma;
-incidente variate;
-decubit+decubit lateral,
ortostatism;
-scanarea axilei si a reg.
Supraclaviculare.
EX.BILATERAL !!
CRITERII GENERALE DE
BENIGNITATE
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ULTRASONOGRAFIA
1)ORIENTAREA=>orizontala:”mai lat decit inalt”;
2)CONTURUL=>regulat,capsular,interfata pastrata tes.vecine;
3)STRUCTURA=>uniforma,omogena;
4)CALCIFICARI=>grosiere,circulare,rotunde;
5)VID SONIC POSTERIOR=>tangent,marginal,liniar(interfata)
6)INTARIRE ECOU POST.=>mare(chist),medie/mica(adenom);
7)COMPRESIBILITATE=>evidenta.
Rad/imag.Iasi-2002
NODUL MAMAR BENIGN
:
CARACTERE SONOGRAFICE PARTICULARE
1)FIBROADENOM=>ovoid,capsulat,intarire de ecou post.;
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ASO OG A A
2)CHIST=>anecoic(“transsonic),capsula/septuri subtiri,contur int/ext.neted;intarire ecou post=maximala;
3)LIPOM=>hiperreflectogen,oval,incapsulat,multiplu;
4)ABCES=>continut neomogen,contur sters/capsular(cr),canale dilatate;edem.
5)HEMATOM=>partial lichidian,apoi neomogen/=>lichidian
N.B.:ORICE DUBIU SE REZOLVA PRIN PUNCTIE ! NB.2:IRM MAMARA,INAINTE DE PUNCTIE !
-contur-structura-intarire ecoutes vecine
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SEMEIOLOGIE ULTRASONOGRAFICA d l b i
-tes.vecine
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US:mastopatie fibro-chistica
-chisturi-transsonice,intarire deecou posterioara;
-noduli hipoecogeni mici,ovali;
-ccalcificari grosiere,de tip benign
cy n
calcificari
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ULTRASONOGRAFIE: mastoza fibro-chistica
-imagini transsonice
multiple,ovoide,ax
lung orizontal;-intarire posterioara
de ecou
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US t ti fib hi ti hi t i i l ifi i i t l
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US mod B& Doppler color: FIBROADENOM MAMAR
-nodul ovoid,solid, hipoecogen, cu
contur net,capsulat; -axul lung este
orientat orizontal;hipovascular.
CRITERII GENERALE DE MALIGNITATE
1)ORIENTAREA=>verticala:”mai inalt decit lat ”;
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ULTRASONOGRAFIA
1)ORIENTAREA=>verticala: mai inalt decit lat.. ;
2)CONTURUL =>neregulat,spiculat,lobulat;-anterior=hiper-reflectogen (“coroana”,”halou malign” (Takehara));-posterior=sters,umbrit=>vid sonic posterior;
3)STRUCTURA =>neomogena,mixta;
4)IMPEDANTA ACUSTICA:-hipoecogenicitate;
5)CALCIFICARI=>micro;”in masa”;
6)COMPRESIBILITATE=>absenta,redusa
ULTRASONOGRAFIACARACTERE SONOGRAFICE PARTICULARE
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1)Carcinom ductal invaziv=>canale dilatate adiacent tumorii;
2)Carcinom medular=>contur lobulat,relativ net -adenomlike
dar mai reflectogen;
3)Carcinom mucoid=>aspect pseudochistic,dar contur maineregulat intern…dg.dificil ;necesita punctie/cito/bio;
4)Chisto-sarcomul philodes=>structura mai neomogena decit
chisturile,septare groasa;contur intern anfractuos/edem ext.;
CRITERII S ibili % S ifi i %
VALOAREA CRITERIILOR US
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CRITERII Sensibilitate % Specificitate%
Orientare 68 95
Contur 42 81
Structura 32 39
Impedanta 44 55
Microcalcificari 68 89
Compresibilitate 67 87
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SEMEIOLOGIE ULTRASONOGRAFICA: CANCER DUCTAL
calcificari
Vid sonic
Coroana Takehara
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Vidsonic
US mod B:CANCER MAMAR MIC
Carcinom ductal St.T-1
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US:-PROBA COMPRESIUNII ESTE NEGATIVA IN
NODULUL MALIGN:la apasare cu traductorul nodulul nuse aplatizeaza(un chist sau adenom se aplatizeaza)(cancerductal T 2)
compresiune
Infiltratie pectoral
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US:Carcinom mamar:microcalcificari
HISTOGRAMA
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US:Carcinom invaziv T-2
-nodul hipoecogen cu
contur neregulat,
structura neomogena,
microcalcificari,ax mare
vertical, cu discret con
de umbra posterior.
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US mod B:microcalcificari abundente
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US:CANCER MAMAR cu NECROZA CENTRALA
-macronodul reflectogen cu
contur neregulat, dintat,cu
zona centrala anfractuoasa
hipoecogena/ partial chiar
transsonica
DIAGNOSTIC SIMPLU CLINIC SI USTRATAMENT PALIATIV:FAZA CURABILA DEPASITA
Rad/Imag.Iasi-2002
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ULTRASONOGRAFIE: CANCER VOLUMINOS T-3-4
Ce mai e de facut ..?! (doctor suparat)
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CARCINOM DUCTAL in situ
Canal dilatat
Canal dilatat -nodul reflectogen
in lumenul unui
canal galactofor
dilatat(transsonic);
-nodulul nu are
delimitare neta
parietala,are baza
sesila si peretele
ductal este
ingrosat.
SEMIOLOGIE DOPPLER
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STUDIUL DOPPLER CFI SI ANGIO POWER:
•TIPURI DE VASCULARIZATIE TUMORALA:
-vase de neoformatie vizibile intratumoral-central ;
-vase de neoformatie vizibie-periferic (halou);
-hipovascularitate (1-2 vase discrete);
-avascularitate-nu se evidentiaza vase de neoformatie
SEMNALUL DOPPLER CRESTE INTENS DUPASUBSTANTA DE CONTRAST ULTRASONIC I.V.
Rad/Imag.Iasi-2002
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US Doppler Angio Power
Halou periferic
Vase centrale
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CANCER MAMAR hi l (D l CFI)
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20”
30” 60”
1 2
34CANCER MAMAR:DOPPLER &
Levovist ®
Vase neoformate cusemnal Doppler intensDupa LEVOVIST
FARA CONTRAST i.v.
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Cancer mamar T-4 c:adenopatia axilara
-ganglion marit ,
globulos cu zonehipoecogene in
strucura,cu vase
neoformate la
examinare Doppler
TERMOGRAFIA
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METODA DE VIZUALIZARE IN COD DE CULORIA TEMPERATURILOR CUTANATE:RECE=ROSU;
CALD=ALBASTRU;FOLOSESTE: RADIATIAINFRAROSIE(teletermografie),CONTACT(folie cu
cristale de colesterol) sau MICROUNDELE.
In voga mare in anii „75-80,are o acuratete indoielnica si ospecificitate redusa deoarece nu pune in evidenta directtumora si nu o poate masura;confuzia cu infectii si stari dehiperactivitate hormonala mamara este frecventa si deaceea METODA este in curs de a fi ABANDONATA INMAJORITATEA CENTRELOR MARI DE ONCOLOGIE
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TERMOGRAFIE:CANCER DUCTAL=>STINGA
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TERMOGRAFIE:CANCER MAMAR=> DREAPTA
Imagistica cu Rezonanta
Magnetica
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METODA RECENT INTRATA IN ARSENALUL IMAGISTICIIFoloseste antene de radiofrecventa speciale,”phased array”,
dedicate explorarii mamare.
Rezolutia detaliilor structurale este mare,imaginile se obtinatit pentru mase nodulare cit si pentru studiul vaselor de
neoformatie.Semeiologia IRM a patologiei mamare este inca incurs de studiere.
Metoda este insa prohibitiva ca pret si nu este folsita ca metoda
rutiniera sau de screening in patologia mamara,ci numai in dg.diferential al unor noduli incerti ,in aprecierea extenziei canceruluimamar si vizualizarea cancerelor multiple in acelasi sin.
© Rad/Imag.Iasi-2002
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IRM STIR/SAG:SIN CU STRUCTURA NORMALA
SEMIOLOGIE IRM
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• BENIGN:-lobular=40%;-rotund=32%;
-contur net,regulat,neted=78%
-contrastare:lenta,tardiva,persistenta,central-
centrifugala;
• MALIGN:-rotund/neregulat-85%;
-contur anfractuos,sters,difuz,spicular-80%;
-contrastare;precoce,rapida,intensa,periferi-ca-cecentripeta;+-fugace
PLACARD
© Rad/Imag.Iasi-2002
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IRM T2/SAG.:MASTOZA FIBROCHISTICA
cy
cy
-imagini
numeroase
© Rad/Imag.Iasi-2002
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MFK :CHISTURI NUMEROASE,FIBROZA
rotunde ,netconturate,cu
intens
hipersemnal
T2-(lichid)
-macronodul
cu contur
net,capsular,cu
septuri fine si
© Rad/Imag.Iasi-2002
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IRM STIR SAG.:FIBROADENOM
septuri fine si
regulate intern,cu hipersemnal
T2 mediu
Diag.diferential
-regulat,omogen;cu
contur net;neinvaziv
© Rad/Imag.Iasi-2002
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SEMIOLOGIE IRM :
Chist cu sediment
versus
Carcinom ductal
CRITERII dg.dif.:
-forma
-contur-structura-tesutul perilezional
subtractieT
-neregulat;neomogen;cu
prelungiri;invaziv
cy
Gado-90”
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Carcinom ductal invaziv:
Studiu post-contrast(MAGNEVIST,Schering AG)
Gado-360”
-captare rapida,intensa,dela periferie spre centrul nodulului
© Rad/Imag.Iasi-2002
© Rad/Imag.Iasi-2002
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T1-post-Gado +subtractie:
limfangita
limfangita
© Rad/Imag.Iasi-2002
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-dupa contrast
paramagnetic i.v. se
vizualizeaza vase
intratumorale
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ANGIO-RM:
Cancer ductalinvaziv – T-3:vase deneoformatie
dispuse anarhiccentral si circular-in
halou la periferie
PUNCTIA & REPERAJUL
PREOPERATOR
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GHIDATE IMAGISTIC
1)GHIDARE MAMOGRAFICA STEREOTACTICA
2)GHIDARE GALACTOGRAFICA
2)GHIDARE ULTRASONOGRAFICA
TEHNICA PUNCTIEI GHIDATE US Acul se introduce sub unghi de 30°fata de fasciculul
US,pentru a fi vizualizat in timp real
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30˚
ac
ac
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ac
PUNCTIE-BIOPSIEAC FIN IN
CANCER MAMAR
Rad/imag.Iasi
ac
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PUNCTIE-CITOLOGIE ECO-GHIDATA :A)nodul mic,ac reflectogen ,vizibil in centrul nodulului;B)frotiul obtinut:celule maligne (carcinom ductal T-1)
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CANCER DUCTAL MIC: A)US; B)reperaj mamografic cu fir-cu cirlig(“hook wire”)
IMAGISTICAOBSTETRICALAI )SARCI NA NORMALA: -DG.PRECOCE (2 SAPT);
-VIABILITATE;MASURATORI;
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V ; SU O ;
-VIRSTA SARCINII;- monitorizare:DBP,LF,CA etc
-sex fetal probabil;
-data probabila a nasterii:
II)SARCINA PATOLOGICA: -avort iminent/in evolutie;-sarcina extrauterina;
-malformatii embrio-fetale;
-anomalii fetale (6-9 luni)RAD.INTERVENTIONALA:-transfuzie in utero-i ncompati-bilitate de Rh,ghidata US;-manipulare ecoghidata intrauterishunt pt.hidrocefalie,drenaj urinar pt megaureter etc.
Metoda…istorica..
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RX abdominale:sarcina la termen GEMELARA
Craniu 1
Craniu 2
Col vert.
EMBRION
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PLACENTA
US:SARCINA NORMALA ENDOUTERINA=>5 SAPTAMINI
Reconstructie de suprafata
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US 3D: SARCINA 11 SAPTAMINI;embrion,lichid amniotic
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US : SARCINA 12 SAPTAMINI; procesare tridimensionalaprin reconstructie de suprafata.
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US:SARCINA GEMELARA(2 SACI OVULARI)-4 SAPT.
Reconstructie de suprafata
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US 3D:SARCINA GEMELARA BIAMNIOTICA,BICORIONICA
Reconstructie de suprafata
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US 3D:SARCINA GEMELARA MONOCORIONICA
Diametrul bi-parietal
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US 3D:FACIES SI MINA FETALA IN RECONSTRUCTIE DE
Mina fetala
DIAMETRUL
BI-PARIETAL
(DBP)
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US:CRANIU FETAL LA 32 SAPTAMINI DE GESTATIE
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US DOPPLER COLOR:CORDON OMBILICAL
RECONSTRUCTIE DE SUPRAFATA
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US 3D:COL.VERTEBRALA FETALA SCOLIOTICA
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US 3D,reconstructie de suprafata:m.inferioare fetale si sex.
MÎNA FETALA-24 SAPT
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US 3D
Reconstructie de suprafata
Reconstructie de suprafata
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US 3D:SEX FETAL…FEMININ
US 3D
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SEX FETAL….MASCULIN
Reconstructie de suprafata
US 3D
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…SEX…IN UTERO…….
SCROT
PENIS
Mîna
Reconstructie de suprafata
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US 3D:FACIES FETAL LA 30 SAPTAMINI
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US mod B & Doppler:PROFIL FETAL:SEMNUL “SUPTULUI”(DOPPLER)
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US 3D:FAT SUGINDU-SI POLICELE
US 3D:FETUS 24 SAPT
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“BOXERUL…..”
US- 3D:FACIES SI MEMBRE
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..”GÎNDITORUL..”
US 3D:fat 12 saptamini:facies si m.superioare
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“FLAUTISTUL…”
US 3D:FETUS 11 SAPT.
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…….”VAI DE CAPUL MEU….”
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US 3D:PROFILURI FACIALE FETALE NORMALE
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US 3D:BUZA DESPICATA(“DE IEPURE”)
DOWN MICROGNATIE SD.APERT
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US 3D:PROFIL de FACIES FETAL;MALFORMATII
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US 3D:PROFIL FETAL:ACHONDROPLAZIE
-sac ovular cudecolare,halou
transsonic in jur
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US: AVORT IN EVOLUTIE
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US: SARCINA INTRAUTERINA & FIBROM
Sac ovular
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US: SARCINA EXTRAUTERINA-ANEXA DR.
Sac ovular
Lichid in
Douglas
uter
vezica
-formatiune
lichidiana in
anexa stanga
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US:SARCINA EXTRAUTERINA
vezica
uter
FAT 32 SAPTAMINI
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PROFIL FETAL 3D-spinCLICK-pe imagine
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