Spiral and Multislice Computed Tomography of the Body Mathias Prokop, M.D. Associate Professor of Radiology Department of Radiology University Medical Center Utrecht Utrecht, The Netherlands Co-editors: Aart J. van der Molen, M.D. Department of Radiology Leiden University Medical Cemter Leiden, The Netherlands With contributions by Michael Galanski, M.D. Professor and Chairman Department of Diagnostic Radiology Hanover Medical School Hanover, Germany Cornelia Schaefer-Prokop, M.D. Associate Professor of Radiology Department of Diagnostic Radiology University of Vienna Vienna, Austria C. Engelke, M. Jérgensen, K.J. Lehmann, A. Leppert, U. von Smekal 1972 Illustrations 332 Tables. Thieme Stuttgart * New York178 YAK 616-073.756.8 BBK 53.6 178 Bee npaca sauuuensi. Huxaxan nacme dannoit Kieu He Moxcem Goime socnpoussedena @.noGott opme u moGwatu cpedemoanu Ge nucmentioeo paxpeweuus a1aderoues aomopckux npag. 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Hosepxnocmnan dbacyua weu (IPI) npea- crablact CoGO! 3aNONeHHBli KHPOM AUCTOK COCAMHHTENHOH TKAHH, KOTOPbIli OKpY:KUET Icio H CONLepAKMT TAKKE NOBEPXHOCTHY!O MoILINY wien (platysma), NobepxnoctHtie aMdariyec- kue y3nbt, Heppbt 1 cocystbi. MayCoxas acuun met (FOU) cocronr 13 riosepxHocrHoro, cpeancro rayGoKoro caves (pue. 10.5). Tonepxtioemibii croit rayGoKoit acu wen, WIM OKYTEIBAIOWIAA acu, TAKKE NOAHOCTHIO OKPYAACT CIO H PONT OF OCHOBAHH Kepenta CBEPXY NO TPYAHD!, KHOYEM H slONaTOK BABY. Ona sakiiovaer TpaneuneBManylo M1 rpyanHo- KHOU YHO-COCILEBMAHYIO MBILIIBI, OKPYAKACT 11a~ POTILIHOe NpocTpANCTRO, OGpasyer dhacuunaabt1yIo NETO AI HIDKHErO GpOUIKa JONATOUHO-Nos- ASDIVHOF MBILIIbI H BHOCHT BKAIAT CEpesNH KO HA FalMive COHHO! apTepHH, CpeaHiit, SUI WeH0- PIOTOUNBIH (BHCLCpaTbHEN), CAoii FAyGoKO!A (pac IMM eH Goaee papHaGenen. OH Tak:Ke MpOxXoANT OF OcHOBAHHs Yepemta M rpaHMMWtT BHHY ¢ MepH- kapioM, MBiledHbiit colt noKpMeaeT MusiIINb! WHCpaxHOHMHO! ACHTEL, a BACUPAIbHAA YACTh — LUIOBHAKYIO MH NapauuToBHAHDIe Keaesb1, Top Tallb 1 TPaxelo W-TeM caMbiM bopMupyeT BueKe- PaibHoe HpocrpaneTBo. Dror cilolt OGpasyer nie- PeMMIOW rpaHKUy 3araoroYHOrO pocTpaHcTRA, a JATEPUIBHO — TAKKE HACTL COHHOTO BAPATALA. TayGoxini, 11 npeanossonoMnetit, C014 1 SoKOll acuH eH NpoXoANT OF OcHORANHA “e- ella, CAMBAsCL BHM CO CPeLHHM CaloeM 3TOH qhacinin, a 3areM nponowxaetes n cpexocreHme OH NoKpbiBaeT NpeEANOIBOHOYN HIE MBIUTUBT A MDI OCTHETHIX OTPOCTKOB, a TAKE CTR luieHenoro craeTeHMs, AMa>pArMATbUsAT HepB It nepredpanbHple cocystbl. ‘JTOT COL TIpHKpelt TCs K MOMIEpeUIILIM OTPOCTKAM MOSHOHKOR Ht OO- pasyer MepeaMIOW rpanwUy mpestOsHOHONHOTO mpoctpancrsa. JlatepanbHo OH BHOCHT BKAAT B OrpaHYeHe 3arnoTONHOFO NpoctpancTBa Ht conmoro nxaraamna. Ha octone 3tHx bacunaabiieix rpannu pain MaWoT pal Npoctpancrs, KoTOpHie JeNsT Ha poe TpaltcTba cynpaxnonanoi Hm MHhpaxHOHAHO! oGzacreti mien. Yerbipe npocrpanicrea, oOMMe Ht [UE HATOMESIHIHOT, MALI HOLNOADSSEIHOF oGaacTell, — 9To commoe mpoctparieTBO (Brara- JMULC), 3ALIOTOUHOC, TIPEANOSBOHOUHOE HW 3al- Hee wlenHoe Mpocrparcrra (puc. 10.5). Noaxon k paanonormueckon ouenKe natonoruueckix o6pazoBannii rnyGoxux npocrpaticrs nua n wen Tlocie sepiniennst naronornsecKoro oGpas0- RAHM UeH HeHoNbayeTeA AMATHOCTHYECKHIL noaxoa, KOTOpHI RKMONAET HEPEUACIEH MELE HH 2xe OTANI 1. Peuserine Bonpoca o Tom, sameres Bid SBICHHOE NOPAKCHME HETHHNOIt OMYXOsIHIO HH nieesMOONyXOAKO. 2. Peurente Houpoca 0 10M, 13 KaKOrO Npoe Tpalicrpa nexoaur obpaxonanue: + Tae Haxoasrrest uenrrp oGpasonanun? +B xakom Hanpawiennn cMeutenst oKpyxa- Joule eTPYKTYPLL HLTH MpoeTparicrna? 3. Oucrixa paanonornieckix xapakTepHeritk OparoRaAnHs, BK MOYAR: + NpOTSOKEHHOCTe OGpazoNANHEt, + 9posiit HiK HiBasiH0 OKPYxAIOUMN KocTelt H xpauuteit, + mepHHeBpanbHoe pacrpocrpanenne mp0. ueeca. 4, Conocraniene KiMMiHeckHY H panHo.o- riMeckHnX xapakTepHeTHK OGpazoRAninst C AMMpdde- PeHUMAADILO-ANArHocTHeCKHM prutOM, Crem - dbuweck 4M JuWs aHHOrO MpocTpaneTBa, 5. Fpeapsmtenne Kanniuntcty HanGoace ac PostTHOTO aMypepenitATEHO-ANArHOCTHMECKO~ TO pala € COOTHETeTRYIOMMUM OGOCHOBAHHEM (MaKCHMANIBHO H3 Tpex HOSOAOTHMECKHX (opm).Anarommueckne npoctpalcrBa Wey 4 4x aHayeHMe 8 naTononwH Puc. 10.5. Caox ray6oxor pacuna Wen w npocrpasct- eHam aHaTOMNS WeK: ac INeHaR CYNpAXROMHaA \uea — porornorka (a), akc ibaa mHcbpaxAoURHaa ues — uunTOBIAHaR ene 1a (6), cbponrancte Ha YPOBHE COPeAMHb! ABLIKA (B). NLUN = nepenvee weroe poctpaxctao, UW — wesHioe npocrpaxcreo; #1 = connoe npacrpaucrao; KT] — >KeaaTembHoe Npoc- mpancrao; NOX — npoctparcrao oKono: yusnoii xene3bi (naporiasy ve} OFT — oxonarnotosnioe (na pacbepunreanstoe) npoc- IpaHicTs0; FICK = npocrpancteo cauauc 10M oBonowK rrorkH; {ILM — seanee weinoe npoc- ipancreo; FINN ~ npeanossoro-noe (npeeeprebpanbioe) npoc- ipancrso, NY — nepepis: vate, 34 — sagHas vacTD; 3M — 3arnotooe (petpoda- ounireanbHoe) npoctparcra0, HOON — Hanceynogas wacrs owaTensHoro npocrpaHcTBa TAN — nogerseHde mpoc- pancreo; 14M] — noawemoctHoe npoc- pancreo; AN — BHCYepanvHoe Npoc pancreo wn ner yes — xn an nynnn orn — nox nox om ———«n an 3uun aun) sunnn sxnnn— a nun Bn nun an cn rynnn aun aun a4nnn 6 HOKN HOKN *i «fT ner om om nan nan nun: myn — Nosepxroctit cnoi rnyBoxor wednioi pacumn Cpeniani cna rnyBoxoi wevniom pacuan — TnyboRint cnow rmy6ox0r werHom docu aes Npocrpancras onackoc 1920 10. tes Npocrpancrsa cynpaxuongHoii vactn wen OxonornotouHoe npocrpancreo (OFM) OFT uveer opmy rtepevepryroit rapaabi, pacnpocrpansieTcs Or ocHOBAHM Yeperia HO NOMvASLEMOH! KOCTH HeKHT cnlepemu OF 1MAIO~ nivMHoro oTpocTKa. CuepestH Ht BHHBY OHO rpAUtH ‘iAT € MoaseMOcTHDIM NpoctparicTRoM, Conep- XT [1ABHbIM: OOPAZOM HP Mt slBANIeTCA KOE BhIM MpOCTPaHCTBOM B CytIPAaXHOMAHO!T Wee, Tak Kak eFO CMELLEHM! MOFYT ObITs Herloab30RAN! JUL OUEHKM TpOCTPAHET, HS KOLOPHIA HEXOILIT narauornueckite O6pazovanis Conepxumoe OFT *KHp; + BOCNONAILIAS MOTO aprepHa: + nerait HivxHeuEOCTHOFO Hepea (V5); * MMOTOUHOE (KPHUTOBHAHOC) BEHOsHOS CII Tense; + BHYTPeHHAS BepxHedenOcTHaN aprepus (Ha HapyKHOH COMHOH aprepuH); + OCTATKH MALIBIX CIIOHHDIX ENE, * CMILMMHTOAapH Heal bHbIC MBI. OFT pacnosaraetes: Mey MHOrHMi apyrH- MH Mpoctpantcraayut: MensuIbHO OHO OIe.TeHO OF NpOeTpANCTBA CHHBHCTON OGONONKH HOTK s1aTepaNbHO NPHAEKNT K ACHATEMLOMY H TApO- THANOMY NpOcTPatcTRAM Me NOx rpaHUEAT € COHHLIM H1pocrparicrBoM. HarononiteckHe o6pa- sonar, ncxoasinne 43 OFT (HanpuMep, HEE PHHOMBE HIKHTeMCMOCTHOFO HepBa WAH Pak Ma JIMIX CHOHMDIX xKeUES), RETPEHAOICH peaKo. HO 270 MpocTpaHteTRO MOET CAYAHTH lyre pa Hpocrpanienia Onyxoulelt WAH WHMbeKLUMiT K HOA NeMOCTHOMY NpocTpAHcray HIM K OCHOBAHMIO 4epena. Tlopaxeiia sroro npocrpancrna Han6o- sige ¥ACTO BOSHUKEIOT B ripouecce pacHPOCTPAHC- HMA NATOAOPHNECKHX HIMECHCHHIT W3 COCeAHHX npocrpauers (pe. 10.6, 10.7; Tada. 10.2). Npoctpancrso cansucron o6onouKin rok qncr) TICE akmowaer cansneryo 1 noaenisHeTyio 0G004KH HOCOIMOTKH, MoTOETH pra, porors1OTKH H ropratorsiorkit, ITH CAMSHETbIE OGOTOUKH 110 KPAITHI Tice RMOMHOFOCAOHMBINE UAMApHEECK Nt WI MHOFOCAOMHDIM MLIOCKHM oTHEEFesIHeM, 13 KO- TOPOrO MOXET HEXOUTH ILIOCKOKETOUNBI Pak roonbl H men. TICE oKpyxcno cxaan 1 Aare PAHO CPELHUM COM PIYGOKOH dacuNN Wer (FOU), Koropax 5 Bepxneli sactH noKpbiBaer TAKKE SUIHIOIO HOBEPXHOCTP POTONHIO-OaaHAap- Hoit cbacnnm (PB). Sra dbacuns upuxpenasier TIOTKY H BEPXHMt KOHETPHKTOD POTKHt K OCHO Ta6nnua 10.2. AucipepenuvanbHaa puarvoctvKka Ropaxeniin oxonornoTosMoro npocrpakcrea Ncesgoonyxon4 — ACMMMeTpHHHOe KDbINOBUAHOR penoaHoe cmmeresne KucrosHuie ATunisble KUCTEI BTOpEDE nopaxenna >xabeprbx ene Bocnanurenbreie Pacnpocrpateune acueccoe 43 nopaxenin NpHNeXxaUIMK WeAHEIX Npo CTpaHcTS: aNeHOMDHON W Heb- ec munyyanu (TCT), ogoH- rorenHnx OKIT), OkNOYWMOF xeneats (NOX) AoGpokavectzen- Avnomer ible Onyxonld —IneoMoprpliasl agenoMa Wa OcraTKOS CMOHHBNX xceNes SnoKauecrBeHere ‘onyxona MykosnugepmounHbiit 4 ane- HoMaHeI pak OcTarKos cnioH- Hbix Kene3 Tpamoe pacnpoctpanenve cny- xoneli 3 npwnexaunx npo cTpaHcre: — nnockakneroHHoro paKa, He- xoppRnuiHer on Punacpontss (TICE) — caprome! (KN) — MykoanpepMOMRHOTo ane HonaHoro KiicTO3HOro paxa (ner, nO) narito vepena. Meum, noanmMaiomias HeGHyio BAHABECKY, MH CHYXOBA TPYGA NPOXOIIT CKROIH TB® swepx n aarepaipno 4epes cnye Mopra- bu, ITO OGecneuBaeT NyTe pacnpocrpanenina OnyXouleit HOCOLIOTKH K OCHOBAHMO Heperta TaGrya 10.3. Anbdepenunanenan nnarnocrace Nopaxkenwa npocrpancrea cAvaHCTOr| OBonoYKH rnorkis Neesnoonyxonn — Acimmerpusmast snaca Posen. meosinepa Mudexunonibii nnn noctpa- AVAUOHHEIM cbaphirar Kactooe Kuctur Topreanpara nopaxenus Becnanuerbkbie AgeHoMAHbie Hn 1ie6HLe nopaxeHia TOHSMANMToI Min aGCueCcHH HocreacnanmrenbHise PeTeHUMOHHEIE KUCTEI AoGpoxevectsen- Mneomopdyaa ageHoma Manx HbIe ONyXON —— CHIOHHBIX KeNea BnoKavectaenitbie onyxonna NnockoKneto-tiit pak ChusHCTOR OONOURY COTE HexogxkviHckaa NvMoMa Myxooniigepmonniibis wna eHOURHEIA KUCTOSHEW pax.Ana TOMHNeCKHe NPOCTAHCTAA Wier 4 Ux sHaYeNHe 8 naTonorMu TICE conepxur + CAUBHETYIO Obo.IONKY MHOTKH: * DHMOHANYI TKAHb — MIILLUIHIEbI, BRIIO- as aleHONAH Ee; + aioe cmonitbse KeuIe abr + TpyOnetit natin; + nepxintit cpeatmit KOHCTPHKTOPE! PIOFKH + HeStO-ABLUNYIO Muay; + HeGHO-rAGTOUHYIO MBI. + MII, TOMMMAIOUyIO HebHyIo sattanee- ny + canemmntro-dapurireaiomuste mitt (Mb bl, HaMHHAIOLUMeca OF CAYXOBOI TpYGDI H NDUKPeMIHOUUMECA K HeOHO-rnoTOUHOM Se + raoToUtlo-Gaanampnyto dbacum. HanGonce swxnmie naronornueckue oGpasona- i, Neonat Ha TCT, — 270 A1eKoKuIeTON- bull pak CHMEIMCTOH OGOADYKH HOCOLIOTKH, Po= FOFAOTKH H FopTaHOrAOTEH (pHe. 10.7, Ta6x. 10.3) Npoctpancrso oKxonoywHoh xenesbt (M02) Npoctpancrno oxonoyumor xenesM pacno~ JarAereA NOLIN -KeBATEABNOH METTLE HECK Heit wemoctitHstatepanbHee OFT, Oxo nosHoc- ‘TiO MOKDLATO pACMLENLACHIBIM NowepxtfoeTiiinM caoew niyGoxoit dbacuim men, Basie GpIOWKE AbyOpIOMHOH MoI MoxET ObpasopaTin BAaB- JIEHHE 3AIMEMEAHANBHOML MOBEPXHOCTH OKOIO- yinHoit KexesHL, M10 NoMoraeT AMhepeHLNpo- BATb NOpWAKCHHS TOBEPXHOCTHO! OH OT Nopa- XCHMI FayGOKol AoAM KeHESM. TOK conep- MT: * OKOMOYUIHYIO KEACSY; + nmuenoit Heps (1atepanbHee petpomanan- Gyaspuoit next); + petpowananGyaspHyio weHty + nuyTpHinapornaniiie ssMebaTH4eCKHE Ys; * HAPYAHYIO COHHYIO ApTepHlO (MeAHaTILHO); + NporoK oxosoyMINOH KEES (CTEHOHOB).. ner oe x" Pac. 10.6. Cxema pacnpocrpane- an vs naronorawecex o6pa3083- nox hiv 8 CynpaxHowpere MpoctpaH- nox orn Teax wer (HanpaBeritA NOKa3a- cn el cTpenkant). Cnpana — nato- ii floriveckne abpazokanve xena- ; fwann resibHoro npocrpanctea, csIeBa — 3ynnn sunnn JopazoBaHne 3arnoTOsHorO NpoC Ipavctea (npagaa 4 neBax cropo vis), Kak 8 KT-1306paxeHiex) (nognvea — cw. pac. 10.5) ner orn Sia on Puc, 10.7. Cxewa pacnpoctpane nox hs naronoraveckux o6pazoga nox orn vit 8 cynpaxmorareix npocrpat i cn Tax uiew (HanpaBneHe NOKa3a . viol erpenkanen). Cnpasa — naro ant cannn normveckoe o6pazosanite npoc- Sei supna \panct¥a OKONOUIHOR KeNeab! nega — O6pasoBanue npocTpaHt ta CRUBHCTOR OBoAOMKiA EnOTKH (nognien — em. pac. 10.5) a22 10, Wen TaGnnua 10.4. Aucdepenunanbiiss AMEMOCTHka NopaxeHith NPOCTpPAHCTeA chuaHiCTOA OBoNOUKM HOT Yundoxanbipie nopaxenna Nceemoonyxonu Knctosnbie nopaxexnna Bocnanwrenbible nopaxeHiAn Mo6ponavecraeunie onyxonn BnoKauectseHHete onyxonn Mynetwoxanbibie nopaxenna Acesgoonyxonn Kuictoanbie nopaxkeHin o6poxavectsennuie onyxonn 3noKasectaeHHble onyxon Tuneptpodue xesaTenbHOA Mb) Hobasostitie oxonoyuliie xeneani Kuta nepsom xaGepHon ujenn Robpoxavecraennuie nawcposnixrennantiibie KUCTEI (CIM) Sivmcparrvioma (y fete) Maporetr uni aBcuecces oKonoyilinorh xene3s: Peantvnas MunipesieHor1arAn Cumapow Llierpena Tevanrnoma Ineomopoyar aneoma Onyxone Yopmava (naebomaroavan uncraaeHoma) Heepiaoma sueBoro Hepsa Myxoonvinepmonaneiit pax AfenOnAHsIA KUCTO3HSIA pak AnenoKapunona Hexomkxwickan nuwdbowa — nepeiuviag nv meTacraTHHeckan Meracrasbi 8 numcariveckne yanbi (nnOCKoKNeTO4HOTO paxe KOKI, paka MONOMHOM Kene3bi, Paka nerKoro) Tepnnespansioe pacnpocrpavienie onyxonel no xony nayeBoro nepsa Dospoxavectseniitie nvmchoanuTennansnsie kactet (CUD) Curapow Llierpera Onyxonu Yoprana (namcomarosvaa ynctaneHoma) Hexonxcnncxas nawpoma Meracraaei 8 numdaraveckie yan (nAOCKOKNETOAHOTO Paka KOKM, Paka MONONHOM KeNesbI, Paka NerKoro) B stom npocrpancrie HanGoree RAKHI NATO AOrMHeckHe OGpasonaltits OKOOYUIHOM Kee Ib Ou oGosHasarores kak METpaapoTIuLtbte, ECAH Gouiee 50% epHMeTpA oBpasonania oKpyxcHO HOPMAIbHOM TKARBIO Kees, ITH OOpaxoBanHa WaCTO PACMPOCTPAHSIOTEH MO ULH-TOBILAHO=HIK- HeNeOCTHOMY TYHHEMO, KOTOPBI MOKeT ObITE pacusnpent onyxoabio (pyc. 10.7; 1aG.. 10.4), Npoctpanictao conHon aprepun Napumte conse npoctpanerma (C1) 11poxo- AAT OT APEMMBIX OTREPCTHIL B OCHORAHIH Nepera 10 AYCM BOPTEL HE TAKHM OGPaIOM pacnio.taraiores WB Ma-, HB HOMOABsLSBIHHON HacTAX eH. OHH SIOKUINAYIOTEA KBAMH H MesLMaTbHO OF OFT H .1a~ TepacibHee saLMoTOMHOrO rpocrpaneTsa (311). Bee pH eros FLL casaiores B ToeToe KapO- THAHOS BIATAIMULe, KOTOPOE NpensaTeTByeT pac- TpoctpaHeHino naroxOrHYeckHX NpoueCcoR. CM cosepaxut: + obtiyyIo (BHYTPeHHMOL) CONHYWO aprepitO; + BHYTpeHMIO. apeMuyio ney; s aepennpre Hepsot: IX, XI, XH (aepxiow acts); + uepennoii neps X (Bepxmoid 1 HiDKHIOW actu); + cUMMaTHMecKoe enmerenHe: + rayGoKMe WeriHble AUMCbATHHeCKHe YIIb1, Hopaxenms, nosuuKaouine a CI, oGnan0 FpaHHMar © CONMOM aprepHeli HAN ApeMolt pe Holl MMcIOT TyGyaIpHyto WU KepereHooGpas- Hylo dbopy. HaliGonee saxkinie 43 HHX — MeTa~ rast Bamiubariieckite ysii6t CYGOKOIL Let HOM ueno4KH (yponitn I-IV) y Bapocamix 1 Helipo- Teutitute onryxomi y Aerett (raG.t. 10.5). Jusqparit- NeckHe YIIbI UleH Gores NospOGHO OCBEUIEHiA B rane 24AxaTomuueckne npoctpaicrea wie 4x 3Hayenne & naTononay >KesatenbHoe npocrpanctso (KT) 2Kenarempsioe Mpoctpancrao Haxoiurres KRe- pean or FO%K, cnepenit # aarepanbrio or OFT 1 Cou OT MeMHOre npoerpancrHa (LLL). Oxo, UMCeT HaHOGABLIYIO POTSCKCHHOCTH & KPAHHO- AAYAQALHOM Harpanteniiit H pacnpocrpanserea OF BEPXHECO Kpast BHCOMHOM MBILLLM 20 HID HE Lo Kpast HIPAHE HemMOCTH., Ero MOKHO NpewCTAB- ire ce6e KAK 18a HeNpephIBHAIX IIpocTpancTsa: HAUICKYNOBOE H HOCOPOTOF-IOTOUHOE. ITO BAKO HIDH BUSYAAMSALUK AKCHAIBHBIC CpEsbL LOLKHD! cera PACHpOCTpANsTECH BDILE CKYIOBOIT MYTH KOFIA XOTST NONYHHTD HEOGPAKCHH ITOO NPOC- rpanicrba (eM, pic. 10.9). AKT] oKpy-kEHO ABy ML LUCTXAMM MoBEPXHOCTHOrO c:ton FLL, KoTOpHIe oxan4iBAIOTEH HEPXY ¥ OcHOBANH “teperta, Me \wanbitee OnatsHoro oTBeperiia. Hepes 91OT HyTD uiopaxenis KIT MoryT cooomarbes ¢ KpaHWasib- HiMit CTpykTYpaMu (KabepHOsHbtii cHHyc). HMe~ abnvua 10.5, Dudxbepenunanceiaa qvariocraka NopaxeHuit COMHOTO "poctpanciBa Nceagoonyxonn — Acumuerpuunas nyxonuia ‘COHHOI aprepusa ann pacwnpeHve coHHOM aprepna ACAMMETpHHHaR APEMHAR BEA KuctosHpie ATmusstisie KHCTe BTOPOA nopaxeHan xabepHon wena Cocyauctoie TpoMm6os connom aptepin, pac- nopaxeHian ‘chanpanne €e CTeHKM, aHe- spv3ma, Ncesnoaviespu3Ma BocnanwtensHeie Llenmonur nny abcueccs! nopaxewwn ——-PeaxTianias nn rHomHaR unacbasje4onaiis TyGepxynesHbi nuM@aneHinT Jlobpokavectsen- laparaxrntomts kaporaanoro Hole onyxona Tena, BarycHoro wn wrynsap- Horo momyca Weartoma, HeApoduGpoma epentibix nit CaMnaTHNeCKO- Fro Hepeos HeiapoCnactoma Metiniroma (c pocrom 4epe3 ApeMHoe orBepcTue) 3noka4ecrsenHie ‘onyxoum OGpacrarine nnockoxneToXtitim paKoM no NPOROMKEHHIO Mertacta3bi 8 nuMipatmueckue yanti (nnockoKnerosnbia pak, pak uyrrosuaHoi xene3es, menanona) XomaKuicKan HENOBDxKMHICKAR MAMC>OMA Metactasbi 8 numcpatnyeckne yan (pak slerkoro v1 OpraHos xueora) TaGsimua 10.6. Dndapepenunansian quarnocrana NopaxeHnu xeBaTenb4Oro NPOCTPAHCTBA Nceegoonyxonn — obasounas oKonoyusHas >xene3a Mneptpodur xesarensHor eats Axpocbus XesaTenNbHbix MENLIL, abaBaHHAR Nenepeauvnen Vs BochanarensHbie OgonTorennbie e6cyecct nopaxeHus Octeommennt HixkHe” HemocTH Mo6poxavecrses- enanrnoma bie onyxoma — SlumepaHrvoma Slevomvoma OccnhumpyiouMia M“O34T NneoMopdyes aneHowa UWeawome, Mempoqn6poma 3noKauecrBeHHeIe ‘onyxonn 3noKavectsentaa (bu6posiien TMCTHOUMTOMa, paGgomno- capKoma, NeVCMMOCAPKOMA XougpocapKoma, ocreocapkoma 3noxavectBeHHaa WBaHHoMa Mlepurespanboe pacnpoctpavenve onyxoner no xopy BeTAK Hepaa V> HexomeuHckan mum@ome MnockoxNeTONHeIt pak poTornorku (perpowonspHit tpeyronstiex) €ICH TAKE BOSMOAKHOCTS COOGULEHIIA © KPBUIO- HeOHoit siMKOIt RRepxY H METABO Hepes KPEI- JOBNALO-BePXHEMEAHOCTHYIO Uke. JKT conepxu: + eTBb H JaNHHe OTMeAI TEI HIDKHElL He OCT + OKCHATENDHYIO MUMITLY; + MenIauTbHYIO H JlaTepLIbAyIO KpBUFOBHAHBIE Msttitbts + BHCOUHYIO MBLIY; + HLIOKHIOW @UIbBEONSIPHYIO aprepHWO 1 BEHY; + werent kenarexbHoro Hepra (V3); + nerait HiDKHErO abBeonapHoro HepBa (Vs). Capcom (MarkoTKaHH ble, XOHutpocapKOMb! Ht OCTeOTEHHDIE CAPKONb!) AABIAIOTEA 3u1eCb HaNtGO- alee OflacH| ANH HOpavkeHMsIMAL HL MOry pacnpocT- PaHsTbcs! NepHHERPAIbHO Mo OCHORAHHA Heperia NO NOAY -KeDaTeALHOCO I HIGKHENO ANbBEONAPHO- ro Hepuon (raGut, 10.6) LUWesHoe npocrpancreo (LM) ULM npeucraniser co6oii sortarsytoe rio ropH~ 3OHTAIH NpocTpaHcTBO No Xosy nepeaHelt 4acTH MPOTOKA OKOAOYINHO! KeEsHi M HE ABAIIETER HC- 2324 10. Wea Ta6ninya 10.7. Dadypepenunansiian auarsoctinca Nopaxeritt wesHoro npocrpancrea ceanoonyxona — Jlobacouvian oKonoyuineA >xenesa Knctostbie Camnotete Kner nopaxeHun BocnanuTenbible Pacnpocrpaneane MHipeKLiMA 13 Ropaxerun punexauynx npocrpaHicto xn} Peakronan namanenonaran HlobpoKavectaen- Femaurnoma Hele onyxoum —Slnowa @nGpomaros 3nocavectaenHsle MnockoKneTouinih pak — npA- onyxorin Mam wHBasia unin ueracTazel 8 fumipaTuveccne y3rb! HexomekuncKan ninmcboma Mykooniaepmonanei unin ANeHOUAHDIA KUCTOSHEIA pak Manbix cmon xenes CapKomel Msrkix TKaHent THHHLIM MIpoctpancTBoM, orpanMsenneia dbac- lunann, OHO HexKHT MeKMY >KEDATEALIOF MoI elt MeAH@AbHO H NoRepAHOCTHBIMIL MUMUMeCKH- Mit MSIL LAMM taTepaLibIIO (eM. pH. 10.5 a). Dro. NPOCTpanierao NOWTH NoAHOETDIO KANONHEHO KH POM HHMeeT TaABUCBHAHEe Nponow REHM: ta TePAHHO MO XOAy OKONOYLUHO! KeTeIbL, MenH AUIbNO NO MenHaToHolt NoBeprHOCTH HILKHEI Ne JOC BBEPX NO OGEHM CTOpOHAM RHCOUHOI MBM LIN conepaxur: + MeUHYIo KHPORYIO oAyUNKy; + Mable cmonHbie xes1e3b1; * OKOAOYLINBIH NPOTOK (CTeHOHOR MpoToK): + anucryio aprepiio W anuenol HepB; + MeUHEIe BETPH MUeROFO H HHEKHEIEOCT- Horo HepBOB: + Wedubie aMMiparivieckHe yauIbl. ‘aMO€ YACTOR MOPAXe!He B ITOM Mpocrpaner- Be — MeTaCTasbl IIOCKUK:ETONNIOFO Paka B ti Hbtc JIMMCbaTHMecKHe Yate WIM NopaKeHia, pac NpoctparsMounecn H3 APYEHX Mpoerpaners — ARM wu TYTT (raGa. 10.7). Onyxoum saunnix COHOHHBIX KEN BETPEAHOTes eC penKo. 3arnorounoe npocrpancrao (3FN) 310 poeTparicrBO pacnosoxcHo no cpenneit AMHMN Mo3amH BoRtyXOHOCHBIX flyTefi H MpoAON- 2ACICA OT OCHOAHHA Neperta 10 BePxHerO cpe- aocrenis, OHO 3aKilIO4eHO Mex Mpoctpancr- Tanya 10.8. Madibeperyvansian anarsocri«a nopaxerinit zarnoro-ore NpoctpaHcrea Neesnoonyxonn — Pacumperiias Cowan aprepua Moctpanraynontiei oreK in obcipyKunn BHyTpeHHer apeMHO! BeHEL Bocnanurenskeie Lenmonut ana abcyecct (or nopaxenun MannanaH wn aneHonso8) Peaxrnpias uni rHoian sumapageonanas Dobporavectaen- Fewanrvoma Hole onyxonn — Tanoma BroKarectBeniibie onyxonit Miprmoe pacnpoctpanenue nockoKnerosHoro paka Wa Apwnexauyux npoctpancra (ncr) Meracrasbi § nawcbarnuectue YyaNbi MenaHoM!, paKa LiUATO- BNAHOI KeNeStI, AMMDOMEI, nopaxeria npw neiiko3e Mocrrpasmanie- Boazyx cue vaMeHeHMA Otek, rewaroma BOM CIMSHCTOH OGoHONKH FOTKH H NpeATOsAD- HOWHIBIM NpOCTpatieTHOM HL OrpAHAeHO cpeaHuM cnoem TOLL cnepean 1 rayGoKHM cloeM oToit dhacunn c3ann. Ero sarepansiaa creka o6pa30- bavia anerkaun POLL, Koropbie Hoay sw Hta- SbAHMe KpLUIOBMAHON cbacunn. Fpozonxenne prom qbacuinn Kilepenit neat 3TTT na ana non npoctpaicrsa. Sanne 43 9THx Howipoerpaniern HASbIBAIOT xeNe3, MpegcTatenbHon OXENEIb|, LUMTOBUAHOM -KeNe- 301, OMe Npamoe pacnpoctpanerie nno- ‘cKoKneTONHOro paka 8 FINN Hexonpaxunexan nuncboma (sropsiias) Pabgommacapkoma Nocrpasmarnye- cxne WaMeHeHiss Otek, rematoma weilMie osBoRKH aueKu; + napaveprespaaniine wpmmunt (3amtee mpo- ctpancrso); + anadparmatbHenit Hepes (3amHee npocrpan- cro); MBIWICHHIe BETBH JABHTATENbHBIX HepBoB Gaatiee npocrpanterno) Nopaxenis nepernero noanpoctpanerBa OGbIt- HO EMEILAOT rIpeRepreGpANDH Ae MEALIIBE BEDE, B sutntem npocipancroe KUP eMeneTen Ka sa TepautbHo (raG.1, 101.9). Kannnuecki 6 910M rIpoc- TPALCTHE HaHGoNee RAKHI 3AGO.AERALHS KOCTET Me MexnozBonouitte NogpaseisHoe npoctpancreo (NAN) Yawesnanoit Gopi nombsspiimoe npoc- TPAHETHO PACHONOREHO LYOOKO HOA HILIKOM BbILE MH MCAMA/I HEE YEMOCTHO- NOAH II HON MtUbI (AHA HOOCTH pra) 1 saTepambHee NOL GopoaoNNO-saHIIHHIX H HOAGOPOLOUHO-HOA- ADUMNBX MULL Fpoetpalicrno He orparlncHo qacwsstn Hn awiteTeH MponOAKeHHEM 3auUle- BePXHeH YaCTH MoOA4eMOCTHOTO NpocrpaHeTBa Kaan Ww KHuBy. Tem caMbM mopaxeHiiA 3TorO Tpocrpanictsa GecripensiterBeHHo pacripoctpa- HAIOTCA Ha NOAYETOCTHYIO OOMCTH. Ta®nnua 10.10. Ducdpepennaneias quarnociuKe opaxKeHMi NOAbASBYHOFO MPOCTPaHCTBS Neesaocnyxann — Arpocpuxt menu aaeixa nip MOpaKEHAX NOABAIEINHOFO Hepea Jiuursanbsbie ckonnenus Tupeow.AMor Thai Kucroaniie NopaxeHnn Slumicbaurvioma — KucTosHan Farpowa Panyna unin norpyxeHHan panyna Alepmoug — anvnepmona Uennonir uni a6cyecces oH TOreHHHOH Npuponty ‘Asratia Sionpvra, Pacuimpexiie nporoKos nopwe- MOCTHEIX KeNes, OBYCHOBNCH: Hoe kaMHAMi Bocnanurenb pie nopaxenis DoGpoxayecraes- Temarruowa Hele onyxon —Mnecmopspuaa anenowa (3 ogeAaeMHOH eNe3bi) GnoxavectaeHHiie WHpa3v9 NNocKOKNeETOUHBIM: onyxoma aKOM nepeniero oraena unin KOBHA A3bIKa Myxoanwaepmountit ANEHOVAHDIA KYCTOIHBIA pak NoRNeMocTHon xenesbI2 70. Len TAN conepxuer + HepemMoI NonDsAIBIYHO-AIDNNYKO MBLILYS + sabIUHBie aprepitio 1 BeHY; + sepenmie nept IX, XU; + sapiannit Hepa (V5); + rayGoKyi0 LOO NOAVEMOCTHOH KCIESbI; + noaYemocTHO! MpotoK (RapTOHOS); + MO ASEMIC AETESHI HK MPOTOKS; + nosrbstansuntbie AMMCbaTHecKHe yatbt STO MpoctpaHteTHO BAXKHO MPH MGeKOKICTOM- HOM pake si3bika, Ontyxou nepenveti YacTH Asbi- ka mipaanpyior TIT] » Hanpannensn cnepxy BH, @ KOPIUA ABLIKA — B HaNpasteHHM cat xrepean (ra61. 10.10). Dro npoctpaerso Yacro Hopaxkaetes TaK:KC pH PacsipocrpaneHitHt O20H- TOPEHHBIX BOCTATHTEABHEIX TIPOUECCOB. Toguemoctaoe npoctpancrso (NUN) ToaKerooGpasnoit dbopma noauenocrHoe MpocTpAancTBO PAcMonOxXCHO BHIUIE NOADAIBI~ Holl KOCTH, WLKe MW JlaTepaabHee “esOCTHO- nogyssHHOl MEuTub, Ero nepeanas Yacth OFPaHMeHa PacuHaAHbIMH AHCTKAMH TOBEpX- TaGanua 10.11. AucpepenunaneHaa jiraraocrKa nopaxerni nomvemoctroro npocrpaHicTea Meesnoonyxon —Arpodua ABy6piowHor w MeniocTHo-NOALASBHOM MIL (QBMraTeNbHbIe: nopaxevins V3) KuctoaHete nopaxeniia KvicTol BTOpor aGepHo” went Cynpaxnowmybie KACTEI WHTO- sspiNHOTO MpoToKa Kiacto3Hble r4rpoMet u@aist YON! Morpyxxennuie palrynts Sramepaovatet — epwonnes Uennionur uni aBeueccet Peakrustan agenonatva Bocnanenne npoToKos homventocrHbix xeNe3, ‘obycnoRneHHOe KaNHsMin BocnanurensHpie nopaxenna DoGpoKavecteen- Hble onyxonlt Tewanrvoma Tusnoma TineoMopdHan anenowa (H3 NOADAIBMHOM KENe3BI, XOOCTA OKONoyLIHO xeNeSD:) BnoKayectseHHuie onyxomm Meracta3bi nnockoxserosHoro paka nvuia Winn nonocta pra 8 muamadbaraveckie y3me Suanacbonta Myroaninepmongyeia wna ANeHOMMHDIM KUCTOSHEIA pak AOAYENOCTHON xeENe3Et nocrHioro cnos POL, 3annss vaers He HMeer chacunaaLtioro orpannmennst 1 s2eck FYE nepe- xoant # FIAT, a Goace nosepxHocTHo — B HIDK- nee OPH, Jro cosmaer moTeHUMaNbUBLIL nyt PACHIPOCTPANEHN HATOLOTHIECKHX tIpOUECCOR 13 logsesnocTHO#l ObnacTH K OcHORAHING Yepena Ha yponne noxbasprinoit xocrat FYI cooGwaer- ca C nepeaHHstis mieiinsIMN ipoeTpancrRaMi< TYE conepaxur: + nepeniee GpiourKo AByOpIOUNHOM MBE; + amutensie aprepiio 1 ReHt + MPxTHOIO NeTAW HomLSIBIIOTO HepB + HOBEPKHOCTHYIO AON HORMEMOCTHOA Ke- nese; + noeAocTHEIE H HoAGopOAOUHELE sMMpa- THMECKMe y31b1; + Kup. BpoxacHnnie kuicrosBie NopaxcHins, ropa 2KCHHS NOMEMOCTHBIK 2Ke1E3 M METACTAD! B JNM charmicckne yanbt — HanGonee YacrBle HaTonOTH- MeCKHe H3MCHCHHS B ITOH OONACTH B 3ABHCHMOC- Tit oF pospacta ranueHra (ran. 10.11). Topaake: nisi TINT peaxo pacripocrpansiorest F131 Npoctpacrea uudppaxnoaHor 4actn wen Bucuepanbroe npocrpancreo (BN) PacnonoxeHnoe no cpeanel nHinM Breue- PAILHOE NIPOCTPAHCTRO sMRIAETCH YHUKATHHBIN, MpocrpavieTnom HuCpaxHoHAHO! sacTH uIeH 1 HOJHOCTHO NOKPMTO HaCTAMM CpemHEro Cos TOLL in sucuepansuo;t sbactutett. Ono naxonver- cA cHiepea OF sarIOTONHOTO H SAUHerO MIeNOTO MPOCTPaHcrs 1 CyApAMeANAbHO OT OOONX COHMBIX npocrpanicrs. B npakTHNeckHX UeAsX 970 Mpoc- TPaHCTHO MOKHO pastes Ha FOPTAHHYIO, MLHTO- BILAHYIO, MapallTTOBHLAHYIO H MHULeBOMHYIO YaACTH. BI conepxnt: + WUNTORIHYIO H MapanurTonnTHBIe XeNC3BI; + naparpaxcarbitbie THM baTHMecKHe Y3.IbI; + ropranorsorky; + roprattn; * WeHHBIM OTAeT NMUIeBOsa; + rpaxeio. Bucuiepaibiioe mpoctpanerno KrMHHYECKH HaNGOIee BAKHO MPH MOpaxeHieX uUTTOBH OT 1} napallLATORHANMEIX KCC 1 MPH M:IOCKOKIETON- HOM pake POPTAHH H FOpIaHOrMOTKH, a TAKE ammepariueckux yaton (prc. 10,8, a6. 10.12) Nepenuee weitoe npocrpatcrso (MUN) Dro Manenbkoe HapHoe MIpocTpaHcTBO pacro- naraetes B nepemenaTepambHor YacT Hid>pa-AnaTOMHHBCKHE NOCTPaHCTBa LEH 4 mx sHaYeHHIe 8 NaTONOTHHA JnOnvua 10.12. Dndbepenunanbyan avartoctuKa opaxeHin BUCEPAN’HOrO NpocTpAHCTBa Nleeanoonyxonn — fupawiwtanbiiaA Aone UwATOBMANOM ENED! Beictynaiouaa nepeweek UWMTOBUAHOA weNe3e! Pactanyrbi nuweson 8 Ta6nnuia 10.13. JucpepenunansHan avarnocTKa hopaxeHu’ nepeaHero weviHoro NpocTpaHcTBa Teepnoonyxon —YeenvMerivar nepenna pentHaa 8eHa Kucrostbe Kitcto) Brop0% maGepHow wenn nopaxenna ——_KUCTO3HBIe FArpOMbI — Miah Tome Bocnanwrenbibie Uennonar uni abcyeccnt nopaxKkeHna AoGporavectsen- Avnowes Hie onyxona nokavectsenniie Pacnpoctparenne paka WHTO: onyxonu BHO KENeSbI, NUMCPOMb! 3 pune xauyyx Npoctpancts XnonmMoli aien AaTepanbHO oF NetTpaNbHOro BHEUEPAAMILOTO NPOCTPAHCTAA, MeAUAABHO OF J TCPMILHOM MbLLICYHOM JICHTbE M PpyAMHO-KITO- UMYHO-COCHE BHLHOM MBILILbI H Crepes OT COH- huix nmpocrpalicTs. PacumaabHoe orrpanmuerne 910ro TIpoctpanteTBa CAOAKHOE, C YIACTHEM f HEM Beex Tpex cnoen TIL, Baepxy ono nepexounT B MOMUEMIOCTHOe —MpocTpaneTRO M, MlOCKONBKY mexiy muni Het acum, ropaxeHiia TMT 6o- TYT pacnpocrpanLATECA Ha BallQIHEHHOE xHpOM nun, TILA coaepkut TOALKO KUD. HanGouee BaKHIE NOpaxKeHHs ITOTO NIpoc- “Tpanicrna — onyxo.aH Ht ROcTIaaeHIHs — Mepexont Ha Hero 43 COCeAHHN NpocTpanters (1aG.a. 10,13), tpaxeosamareanbron 6oposye BocnanwTensHbie Uenmonur anu abcueccet nopaxeHin PeaktwpHaa ageHonaTa Nlopaxkenaa Jlapwrrouenc: roprasm Anockoxnetosttoilt pak Xonppocapkoma Uwrosuanas Kuctol undbpaxnonayor 4acra xene3a WirT0-5a6I4HOFO NpOTOKA KONMOWMHbIC KUCTBI 306, Ccrpeit uni xponuveckiait Tmpeonaut AMPHOMDI WIV TOBH AHO KeNe3bI Pak uywroBMAHOn xeNeabI nanwanapHeia, connnxynap- Holl, MeRYAIAPHEIA 4 TN. SkCTpaHOAANbHaA HEXORKKMH- cea nnwehoma (nepaHsiHan iis weracrarecksa) Napaumrosma- ‘Kucte Huie Kenia! AgeHoMe! Nopaxenms Uehkeposckuii auaepTaKyn nawesona ‘Pax nmuyesona Jlpyrne anoxaye- Meractassi nnockoxneTosnoro, ‘CTeeHHbIe OAy- aka 8 NuMcbaTHMYecKHe y3nb! xomm Honanbuaa nueaoma Bn wn cn aun Puc. 10.8. Cxetea pacnpoctpane nia naronoriaeckHx Npoueccos (vanpasnenan noxa3arb: CTpenKa uit) B BINCUEpaN’HOM NpOCTpAH- cae MacppaxhongHod o6nactA ue (nognven — cm. pac. 10.5),28 10, Wea 3agnee weiHoe npoctpancreo (31M) SLUM, rakke napiioe, pacnouiaraetes 8 samHe- jiaTepaanoli sacri cynpa- w nHdbpaxnonanolt ICH H NOAHOCTHIO 3AKTIONAeT B CeGe NapabepTed- PAIbHBIE MBILIL) B MapawepreGpaisnoMm nmpoc- Tparicrne. OHO HMceT HAKTOH KIUINE M TpeyromTh~ Hyio opmy, cooterernys eyGoKUNMMTALILHOMY W NloaKIOMHIHOMY TPeyromMAKAM nosatit rpy- AMHO-KHOWHHO-COCHEBHAHOM MBILIUBI. Dac- wrutbHoe orpanavenite SLIT] cxoxoe. [ry60- kui cnoit FOUL omenser ero or oxoroMIOsN0- HoO4HOrO MpocrpaHetA, a HOBEPXHOCTHBII CAOI POL orrpantuneaer or MomKOXHO! KAKI HL IpyaiHo-KNOUO-COCLEDILIHOM MULL. BLUM coaepaxntr + KUD: + TipeakcHJsipHyIO HacTb MuIeNEBOTO CILIETE- nis * uretiriyto vacre XI uepemuioro Hepea; + aopcasibnbiii aoriatodublii HepB; + auMdbarHuecknte yb NO XOAy UNeHiNOM ac~ TH NOGABOIHOTO Hepsa. Hopaxenus, sosnukaomue 8 31, nok Her pacronaratbca 6 HelTpe KHPOBOM! TKAHH, H OTe asworess or CAL roHKoii sterol xnpa. Ho ato TpABHLIO He BHLLCPANBACTCH B cyNpaXHOHAHOit obactH, me 3LUFT oven’ ato. B stom nipoc- TpaicTne HaHGorce BAAHDI AMMKbOMa HAH MeTa~ cTa3bi MOCKOKTETONHOTO Paka, A TAKKE pyre OnyxXon iH, Hopaxkaioune auMMebarimecKHe ya1bl NO XO;Y CNMHHOMOTORO! YACTH O6aBOsHOTO Hep- a (TaGut. 10.14), Tabinuua 10.14, Dudxdeperumansnan avarwoctiKa Nopaxeuuit zagHero WeMoro Mpocrpavicrsa Nceanconyxonn — Faneprporpnposaitiian Mbiua, nonHmarouiar nonaTky KicroaHbie KucrosHule rurpomel — nixbar- nopaxenne moms Kucter Theteeit xa6epHom wien BocnanurensHive Llennoniat ani a6cuecces Nopaxenvia —PeakTiBHaa WM rHOvHAA savebaneronana TyBepxynestil aaeHuT DoGporevectsen- Nunoma Hie onyxonn — FeMaHrMoMa LWsaHHoMma, HeMpod“6poma BnoxayecTeeHiibie ‘onyxonut Metacrasbi nnockoKnerosHoro paka (nocornorkit) 6 mawcba Taeckine yanbi XORKRUNCEAR Y HEXORXKHH- aA NUMDOME| Susnocapxom (peaKo) Naronoruueckue o6pasonanus, 3aHMNMalo- une HECKOnbKo NpocTpaHcTs wen Hexoropnte 3aG0.1enaitHia He Orpanlu4nBavores, OHM AHaTOMHMECKHM fpocTpaHerBoM Hui TO Paxkalor MHOTHE NPOCTPAHCTHA, KAK CMCAHBIC, TaK H oTaatentbte (TaG.1. 10.13). TaGninua 10.15. 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