ABDOMINAL IMAGING

1. IMAGING OF ABDOMEN AND PELVIS
Dr KANHU CHARAN PATRO
ICRO AROICON 2018
29th November 2018
Thiruvananthapuram
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2. ABDOMEN AND PELVIC IMAGING
WITH CLINICAL CORRELATION
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3. Where is the Target?
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4. PUSHING BACKWARD AND FORWARD
OAR
TARGET
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5. SYSTEMATIC ERROR
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6. HOW TO STUDY CROSS SECTIONAL IMAGE
• SLICE BY SLICE [MULTIPLE SCROLLS]
• MULTIPLE WINDOWS
• ORGAN WISE
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8. A. Brightness refers to the overall
lightness or darkness of the image.
Increasing the brightness every pixel in
the frame gets lighter.
B. Contrast is the difference
in brightness between objects in the
image.
C. Increasing the contrast makes light
areas lighter and dark area in the frame
becomes much darker.5/17/2019 8

9. Brightness- window level Contrast- window width
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10. WIDTH
LEVEL
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12. IMAGING
• Plain
• Contrast
I. ORAL
II. IV
•Arterial
•Venous
•Delayed5/17/2019 12

13. BARIUM CONTRAST
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14. ORAL NON-IONIC CONTRAST
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15. What to read?
• Organs
– OAR
– GTV
• Stomas
• Muscles & bone
• Vessels
• Nodal regions
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16. ORIENTATION
A
P
R L
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17. MULTIPLANAR
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18. Radiological Anatomy of
the Abdomen and Pelvis.
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28. IDENTIFYING JEJUNUM
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29. V
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30. SNAKE CRACKERS
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43. DIFFERENTIATING SMALL AND LARGE BOWEL
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44. SCALP
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CHARACTERISTIC SMALL BOWEL LARGE BOWEL
S
SPECIFIC CHARACTER PLICA CIRCULRIS
JEJUNUM
HUSTRATION
C
CALIBER SMALL LARGE
A
APPEARANCE BEST SEEN WITH ORAL
CONTRAST
MOTTLED/FILLED
WITH AIR
L
LOCATION CENTRAL PERIPHERAL
P
PATENCY COLLAPSED DILATED

45. •Colon has sacculations called
haustra as teniae coli are
shorter than the colonic wall
•Colon is relatively peripheral
but can be very mobile5/17/2019 45

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49. Non contrast
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50. Arterial phase
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51. Arterial phase
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52. Portal venous phase
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53. Portal venous phase
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54. Delayed phase
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55. Delayed phase
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56. Blood supply of liver
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61. Liver segments by hepatic vein
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62. Liver segments - clockwise
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64. Caudate lobe
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71. Common Bile Duct
• CBD contour should start at the first bifurcation or at its entry
to the portal triad inferiorly to the first portion of duodenum
• It passes posterior and medial to the duodenum and joins with
the pancreatic duct
• Irradiation of caudate lobe liver tumors may lead to high
radiation doses being received by the CBD
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86. WATER RATHER THAN CONTRAST
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87. Applied radiology
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88. IMAGING PROTOCOL- NEGATIVE/NEUTRAL CONTRAST
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89. 1. Use water rather than contrast
2. Pancreatic phase instead of the arterial phase.
Pancreatic phase refers to the late arterial
phase (typically 40-45 sec after contrast
injection) during IV contrast.
Pancreatic Protocol
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91. SAD-PUCKER
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109. Right common iliac vein.
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117. ANASTOMOSIS
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118. Whipples surgery
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120. PANCREATICO-JEJUNOSTOMY
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121. Remnant
Pancreas
Pancreaticojejuno
stomy
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122. Pancreaticogastro
stomy
Residual
Pancreas
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124. GASTRO-JEJUNOSTOMY
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125. • Spinal
– Psoas
– Erector spine
– Quadratus Lumbaram
• Anterior abdominal
– External oblique
– Internal oblique
– Transverse abdominis
– Rectus abdominis
Abdominal musculature
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136. MESORECTUM
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CRANIAL RECTOSIGMOID JUNCTION
CAUDAL ANORECTAL JUNCTION
POSTERIOR PRESACARAL AREA
ANTERIOR 1CM ANTERIOR TO THE BLADDER
LATERAL PELVIC BRIM-UPPER
LEVATOR ANI-LOWER
BOUNDARIES OF MESORECTUM

139. The mesorectum
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140. URINARY SYSTEM
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141. KIDNEY
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142. URETER
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143. VESCICO-URETERIC JUNCTION
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144. SEMINAL VESICLE AND PROSTATE
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152. IT IS GOOD TO SEARCH FOR GUD
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155. Contour the GTV: Prostate
Levator ani can help visualize apex of prostate,
but avoid including it in your prostate contour
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156. Contour the GTV: Prostate
The most inferior prostate contour should
be one slice above the GU diaphragm
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157. The neurovascular bundale
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161. THE PARAMETRIUM
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1. The parametrium is a band of fibrous tissue
that separates the supravaginal portion of
the cervix from the bladder.
2. It extends on to its sides and laterally between
the layers of the broad ligaments.
3. The uterine artery and ovarian ligament are
located in the parametrium

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VAGINAL WALL IN POST OP CERVIX

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165. See the continuity
See the contour
See the location
Follow the vessel
0.7 to 2.5 cm margin to vessel
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166. DIFFERENTIATING NODE FROM VESSEL
8 C
• CLINICAL
• CONTRAST
• CONTINUITY
• CONTUR
• CONTRALATERALITY
• CONGLOMERATION
• CYSTIC COMPONENET
• CIRCULAR
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CRURAL GROUP
MIDDLE COLIC

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GASTRO ESOPHAGEAL
ANTERIOR DIAPHRAGMATIC

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LT GASTRIC
GREATER
CURVATURE
PHRENIC

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HEPATIC ARTERY
GROUP

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PYLORIC

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COFLIC GROUP

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SUPERIOR
MASENTRIC
GASTRO DUODENAL

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SUPERIOR
MASENTRIC

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PERIPORTAL

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PANCREATICO
DUODENAL

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RENAL HILAR

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AORTOCAVAL

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RENAL HILAR

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PARAAORITC

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PARAAORITC

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INFERIOR
MASENTRIC

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COMMON ILIAC

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199. Lymphatic drainage of pelvic organs
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215. SUMMARY OF INGUINAL NODES
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216. Bony land marks
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217. STOP PRESACRAL HERE-PYRIFORMIS
MUSCLE
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Stop external iliac delineation here

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START OBTURATOR HERE

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227. STOP OBTURATOR NODE DELINEATION
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231. STOP ANORECTAL CONTOURING HERE
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232. OAR
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233. BOWEL BAG
VS
INDIVIDUAL BOWEL LOOP
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236. Start with OARs: Rectum
Use the SAGITTAL
view to make sure
you are following
the contour of the
rectum!
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237. Start with OARs: Rectum
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238. For liver contouring
• Gallbladder should be excluded
• IVC should be excluded when it is discrete from the liver
• Portal vein (PV) should be included in the liver contour
when Segment (Seg) I (caudate lobe) is seen to the left
of PV
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240. THE TEAR DROP-PENILE BULB
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241. Penile Bulb
Axial view
The penile bulb is
often teardrop-
shaped, located
posterior to the base
of the penis
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242. Femoral head
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243. Conclusions
1. The primary imaging modalities for the abdomen
and pelvis are plain film, ultrasound, and CT.
2. Basic anatomic knowledge can improve the
diagnostic value of the radiological imaging.
3. Correct use of anatomic terms facilitates
communication with referring clinicians.
4. Choice of modality depends upon clinical symptoms,
patient age & gender, and findings on physical exam.
5. Mastery of the anatomy within each quadrant
can help explain particular symptoms, clinical
presentations, and/or imaging findings.
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244. LONG LIVE
ICRO
&
AROI
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245. Thank You.
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