PPT 1

4,660 views

Published on

IMAGING ANATOMY OF LIVER BY DR RAVINDRA BANGAR DNB RESIDENT RADIODIGNOSIS KMIO BANGLORE

Published in: Education
0 Comments
8 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,660
On SlideShare
0
From Embeds
0
Number of Embeds
10
Actions
Shares
0
Downloads
346
Comments
0
Likes
8
Embeds 0
No embeds

No notes for slide
  • Describe segments here only
  • Intercostalapproch for shrunken cirrhotic liver
  • Incrsd density seen in glycognstrgd,hemochromatosis
  • Dual phase routinlyusdfr liver imaging.iodinated contrast is injectedabt 150 ml at 3-5ml/sec
  • Cobra cathater is used 20-30cc contrast
  • PPT 1

    1. 1. Dr Ravindra Bangar , DNB Resident KMIO. Moderators- Dr. Raghuram Dr.Jaipal
    2. 2.  Embryology  Gross anatomy  Blood supply  USG anatomy  CT anatomy  MRI anatomy  Other modalities  Conclusion
    3. 3.  During the third week of fetal life, the liver primordium appears as an outgrowth of endodermal epithelium at the distal end of the foregut, known as the hepatic diverticulum or liver bud .  Penetrate the septum transversum, which is the mesodermal plate.  Connection between the hepatic diverticulum and the distal foregut narrows, thus forming the bile duct.  Kupffer cells and connective tissue cells of the liver are derived from the mesoderm of the septum transversum.
    4. 4.  Largest solid organ in the human body  Weight - 1.2 to 1.4kg  Span - 13 to 15.5cm .more than 15.5cm  considered as hepatomegaly  Location - Right hypochondrium and part of  Epigastrium  Surfaces of the liver Diaphragmatic surface Visceral surface
    5. 5.  Divided into 2 anatomical regions: 1.Diaphragmatic surface: Smooth and dome-shaped surface Inferior to diaphragm Separated from diaphragm by subphrenic recess and from posterior organs {kidney and suprarenal glands} by hepatorenal recess Covered by peritoneum except On the posterior surface of liver is a region not invested in peritoneum this is the bare area
    6. 6.  Covered by visceral peritoneum except porta hepatis and gall bladder bed.  The visceral surface is related to:  Right side of the stomach i.e. gastric and pyloric areas  Superior part of the duodenum i.e. duodenal area  Lesser omentum  Gall bladder  Right colic flexure and right transverse colon ; colic area  Right kidney and suprarenal gland; Renal area
    7. 7.  Couinaud divided the liver into a functional left and right lobe by a main portal scissurae containing the middle hepatic vein.  This is known as CANTLIE'S LINE.  Cantlie's line runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly.
    8. 8.  8 segments  Have their own blood supply lymphatics and billiary drainage.  Right,middle and left hepatic veins divide liver longitudinally into 4 segments.  Each of these segments is further divided transversly by an imaginary plane passing thorugh right and left main portal pedicles.
    9. 9.  Right hepatic vein divides the right lobe into anterior and posterior segments.  Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.  Left hepatic vein divides the left lobe into a medial and lateral part.
    10. 10.  Portal vein divides the liver into upper and lower segments.  The left and right portal veins branch superiorly and inferiorly to project into the center of each segment.
    11. 11.  Because of this division into self-contained units, each segment can be resected without damaging those remaining. For the liver to remain viable, resections must proceed along the vessels that define the peripheries of these segments. This means, that resection- lines parallel to the hepatic veins.
    12. 12. ◦ BLOOD SUPPLY  2/3 FROM PORTAL VEIN  1/3 FROM HEPATIC ARTERY ◦ VENOUS DRAINAGE  HEPATIC VEINS (3) ◦ CAUDATE LOBE is considered autonomous
    13. 13.  Caudate lobe derives its arterial supply from both the right and left hepatic arteries and both the portal veins and its venous blood drains directly into the IVC.  Right lobe segments are supplied by right portal vein and right hepatic artery.  Left lobe segments by left portal vein and left hepatic artery.
    14. 14.  Common Hepatic artery  Branch of coeliac artery  In 18.5% patient it arise from SMA
    15. 15.  Two most common variations are origin of the left hepatic artery from the left gastric artery and origin of all or some right hepatic artery branches from the superior mesenteric artery.
    16. 16.  The major portal veins are intrasegmental (within the segment), while the major hepatic veins are intersegmental (between the segments).  The intrahepatic portal triads, consisting of branches of the portal vein, hepatic arteries, and bile ducts, course through the central portions of the hepatic segments.  The portal vein is 7 to 10 cm long and 0.8 to1.4 cm in diameter and is without valves
    17. 17.  Right hepatic vein which lies between the right anterior and posterior hepatic segments, drains segments V, VI, and VII  Middle hepatic vein which lies in the interlobar plane, drains primarily segments IV, V, and VIII  Left hepatic vein which courses in the sagittal plane between the medial and lateral segments of the left lobe, drains segments II and III.
    18. 18.  Riedels lobe ◦ Extension of tip of right lobe inferiorly ◦ May be mistaken for pathological hepatomegaly  Lobar agenesis/ atrophy ◦ Absence of supplying vasculature / dilated bile ducts ◦ Differentiate from atrophy
    19. 19.  Limited role  Demostrate-  hepatomegaly  calcification
    20. 20.  Initial imaging modality for suspected liver pathology.  Position-Supine or left decubitus  Transducer-convex(3.5-5Mhz)  Approach-Subcostal Xiphisternal Intercostal
    21. 21.  Normal liver is fine homogeneous  Either hypo echoic or isoechoic compared to normal renal cortex  Hypoechoic compared to spleen
    22. 22. CAUDATE LOBE SAGG VEIW- ARROWS FISSURE FOR LIG VENOSUM
    23. 23. SAGGITAL IMAGE OF PORTA HEPATIS SHOWING CBD & MAIN PORTAL VEIN ENCLOSED IN THE HEPATODUODENAL LIGAMENT
    24. 24.  Normal liver is homogenous and has density higher than spleen .  Normal liver parenchyma – 40-80 HU  8-10 HU greater than spleen
    25. 25. Dual phase study ◦ Arterial (20sec) ◦ Portal (60 sec) Triphasic study o Early arterial phase(20sec) o Portal venous phase(60sec) o delayed phase(180)
    26. 26.  Primarily MRI has evolved as problem solving for liver lesions  It has higher contrast resolution ,multiplanar capability and lacks ionizing radiation
    27. 27. ◦ Liver parenchyma appears homogenous on both T1 and T2. ◦ Moderate signal intensity on T1 Wi similar to pancreas but hyperintense to spleen and kidneys o On T2 Wi liver appears dark and is hypointense to spleen
    28. 28. A comprehensive MRI liver protocol T1 weighted images T2 weighted images T1Post contrast(Triphasic studies as CT) STIR DWI(Mainly used in tumor imaging and assessing treatment response in tumors)
    29. 29. These can improve lesion detection & characterization ECF agents like gadolinium chelates such as Gd-DTPA & Gd-DOTA help in detection of hypervascular metastases or small hepatocellular lesions Reticuloendothelial agents like supermagnetic iron oxide particles coated with dextran, ferumoxides etc function as T2 relaxation promoters lowering normal signal of RES containing tissue Hepatobiliary agents like Mn-DPDP, Gd-EOB-DTPA & Gd- BOPTA which increase the signal intensity of normal liver & hepatocyte containing lesions on T1W images
    30. 30.  Approach-Femoral artery  Contrast is injected in coeliac axis and SMA or one or more of their branches  To study vascular anatomy and hemodynamics  In order to select proper angiointerventional treatment.
    31. 31.  Lacks anatomical specificity but good global view  Tc-sulphur colloid/ albumin colloid – which targets reticuloendothelial system.(to differentiate adenoma and FNH ,FNH lesions show uptake indicating intramural kupffer cells this is not seen in adenoma)  If hemangioma is suspected , Tc 99 labelled RBC are used instead.(lesion appear as hot spot ,as after radioisotope inj. increase in blood pool activity in hemangioma as compared to surrounding normal liver)  Colloid particle size – 0.01- 1 microns  Injected intravenously
    32. 32.  The ability of FDG-PET to estimate metabolic rates make it potentially valuable tool for monitoring therapy.  Highly sensitive for detecting hepatic metastasis.

    ×