Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases
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Ct Imaging of Abdomen Dr. Muhammad Bin Zulfiqar
1. Basic CT Imaging of Abdomenโ
For Non Radiologist
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
radiombz@gmail.com
2. โขTo assess equivocal imaging findings
โขStaging neoplasms of solid and hollow viscera
โขMetastatic workup of primary malignancies
โขDiagnosis of diffuse hepatic diseases
โขAssessment of biliary disease and tumour.
โขCongenital anomalies.
โขAssessment of suspected post-traumatic injuries
Indications for Abdominal CT
imaging
4. ๏ท Patient preparation
๏ท Patient position
๏ท Scanogramโฆ.[frontal]
No required preparation unless the patient is going to be
sedated or injected with contrast material
FASTING FOR 4 - 6 HOURS
24. Hepatic cysts
๏ท Congenital lesions but detected late
๏ท Isolated or associated with congenital cystic disease
๏ท Usually asymptomatic
๏ท Complications [ rupture or hage ] lead to symptoms
๏ท Few mms to several cms in size
Hepatic cysts
25. Hepatic abscess [ Pyogenic ]
๏ท Frequently indolent with no signs of infection
๏ท May present with profound septicemia
๏ท Micro abscesses (>2cm) cluster or scattered
๏ท Macro abscesses :Unilocular or multilocular
๏ท Marginal enhancement 6% ?!
๏ท Gas containing abscesses uncommon
30. The arterial supply is derived from the hepatic artery whereas the venous drainage is into
the hepatic veins. FNH does not contain portal venous supply9.
FNHโFocal Nodal Hyperplasia
31. ๏ท Single or multiple masses that are hypo dense to normal liver
๏ท Calcification may be seen
๏ท After contrast injection [ should be Triphasic study]
๏ท Arterial phase : Very early arterial perfusion.
๏ท Portal phase : contrast washout
Hepatocellular carcinoma
32. Hepatocellular carcinoma
๏ท Detects a greater number of HCC than usual scanning
๏ท Detects intravascular thrombosis [ portal vein]
๏ท Better delineation of tumour capsule in capsulated lesions
๏ท Detects early arteriovenous shunting [ sign of malignancy]
33. Hepatoblastoma
๏ท The most common 1ry hepatic neoplasm in children below 5 years
๏ท Usually presents with abdominal mass with elevated AFP
๏ท Large diffuse or multifocal hypodense lesion is seen on CT
๏ท Matrix calcification and septations may be seen
34. Cholangiocarcinoma
๏ท The 2nd most common primary malignant tumor
๏ท Arise from bile duct epithelium [ 3 TYPES ]
๏ท Intrahepatic arises from small ducts
๏ท Or the major ducts near the helium
๏ท Or at the bifurcation of the CHD [ Klatskin tumor]
๏ท HCC: intrahepatic cholangiocarcinoma = 10:1
๏ท No strong association with cirrhosis
๏ท No specific MR appearance
35. Hepatic deposits
๏ท Most of hepatic deposits are hypo vascular
๏ท Hepatic neoplasms receive most of their blood supply via hepatic artery
๏ท Hyper vascular deposits should be assessed by dual phase CT or dynamic MRI
๏ท CTAP and intra operative US are the most sensitive methods for detection of deposits
37. ๏ง Repeated episodes of hepatic injury ๏ฎ fibrosis + regeneration
๏ง Small fibrotic right lobe with regenerative enlargement of the caudate and left lobe
๏ง Caudate/ right lobe ratio = 0.65 or more
๏ง Portal vein diameter more that 1.3 cm
๏ง Splenomegaly, ascites
๏ง Dilated perisplenic collateral venous channels
Cirrhosis
38. Diffuse Neoplastic disease
Lymphoma 35% of patients with secondary hepatic lymphoma
show either diffuse or mixed pattern (focal+ diffuse)
Imaging findings are non specific
39.
40.
41.
42. An abdominal and pelvic CT scan(IV contrast but no oral contrast) showed
marked lymphadenopathy (arrows) in the retroperitoneum and mesentery .
45. Lymphoma. A non-Hodgkin lymphoma has para-aortic and mesenteric lymphadenopathy
(arrows) along with splenomegally (arrowhead), on a contrast-enhanced, axial CT scan of the
abdomen