This document discusses the CT scan appearance of benign focal liver lesions. It provides details on the optimal timing for different CT scan phases including arterial, portal, and delayed phases. It then describes common benign liver lesions that appear hyperenhancing on arterial phase including hemangioma, focal nodular hyperplasia (FNH), and adenoma. For each lesion, it gives characteristics visible on different CT phases as well as differential diagnosis. FNH is described as having a central scar visible on imaging with feeding arteries and draining veins connected to the hepatic vein. Ultrasound, CT, MRI, and nuclear medicine findings are outlined to identify features of FNH.
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT SOLID RENAL MASS , COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT ADRENAL MASS LESION DDX, COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
A triphasic, or triple-phase, CT scan is an enhanced CT technique mostly used to evaluate liver lesions. This technique acquires images at 3 different time points, or phases, following the administration of a contrast.
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
Pancreatic pseudocyst is the commonest cystic lesion of the pancreas but generally rare. It commonly complicates pancreatitis and resolves spontaneously with conservative management. Indications for intervention include complications and to rule out malignancy
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT SOLID RENAL MASS , COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT ADRENAL MASS LESION DDX, COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
A triphasic, or triple-phase, CT scan is an enhanced CT technique mostly used to evaluate liver lesions. This technique acquires images at 3 different time points, or phases, following the administration of a contrast.
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
Pancreatic pseudocyst is the commonest cystic lesion of the pancreas but generally rare. It commonly complicates pancreatitis and resolves spontaneously with conservative management. Indications for intervention include complications and to rule out malignancy
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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2. CT SCAN
Non contrast study:
Contrast study:
arterial phase: 20-40secs
Portal phase : 60-80secs
Early delayed: > 180 sec , best at 4 mins
Late delayed : 4-6hrs
3. Phases
Liver -dual blood
supply
Normal parenchyma -
80% portal vein
20% -hepatic artery
All liver tumors blood
supply from hepatic
artery
Tumors enhance in
arterial phase.
Liver will enhance in
the portal venous
phase
4. Arterial phase
20- 40 sec
Hypervascular tumors enhance
via the hepatic artery
Normal liver parenchyma not
yet enhanced
Hypervascular tumors enhance
optimally at 35 sec
Will be visible as hyperdense
lesions in a relatively
hypodense liver
5. Portal venous phase
60- 80 sec
To detect hypovascular
tumors
also called the hepatic phase
because there is
enhancement of the hepatic
veins
8. CT LIVER – FOCAL HYPERENHANCING LESIONS
During the arterial phase
1. Hepatocellular carcinoma.
2. Haemangioma.
3. Focal nodular hyperplasia.
4. Adenoma.
5. Metastases – particularly carcinoid and pancreatic islet cell.
Most metastases are hypovascular.
9. During the portal vein phase
1. Haemangioma.
2. Hepatocellular carcinoma – unusually. Most are isodense- or low-
attenuation during this phase.
3. Venous collaterals – from an obstructed SVC to the IVC via
hepatic veins.
10. During the equilibrium phase
1. Haemangioma – because of progressive fill-in.
2. Cholangiocarcinoma.
3. Solitary fibrous tumour.
4. Treated metastases.
11.
12. Hepatic cyst
• Single/multiple.
• Lined by single layer of cuboidal epithelium.
• Older adults
• Clinical presentation
– Asymptomatic
– Compressive symptoms (massive).
13. Autosomal dominant polycystic liver disease
• Multiple cysts (more than 10)
• Vary in size: 1-10 cm
• Water or hemorrhagic density
• Calcification of some cyst walls is seen
• No septations or mural nodularity
• Occasionally fluid levels seen
• Liver often distorted by innumerable cysts
14. usg
• Fine cystic lesion with
partial or complete
septa are often
visualized.
• In case of
complications –
debris, thickened septa
and complex internal
fluid.
17. MR Findings
• Simple hepatic cyst & ADPLD
o T1WI: Hypointense
o T2WI: Hyperintense
o Heavily T2W images
• Markedly increased signal intensity
due to pure fluid content
• Sometimes indistinguishable from a
typical hemangioma
o MRCP: No communication with bile
duct
18. Differential diagnosis
1. Cystic or necrotic metastases
Demonstrate (e.g., ovarian
cystadenocarcinoma &
metastatic sarcoma)
o Debris
o Mural nodularity
o Thick septa
o Wall enhancement
19. Dd-2.Biliary cystadenocarcinoma
• Usually large in size
• Homogeneous, hypodense, water density
mass
o Rarely non septated
o Indistinguishable from large simple cyst
• Almost always has septations
• May show fine mural or septal
calcifications
• On contrast study
o Unilocular or multilocular
o Enhancement of capsule, septa & mural
nodules
20. Dd-3
Typical hepatic hemangioma
• Well-defined margins
• NECT: Isodense to blood
• CECT: Early peripheral nodular &
delayed centripetal
enhancement isodense to
enhanced vessels
• T1W: Hypointense
• T2WI: Markedly hyperintense
Sometimes indistinguishable from
simple hepatic cyst
21. DD-4 Pyogenic abscess
• Complex cystic mass
• Heterogeneous density
• Thick or thin multiple septations
• May show mural nodularity
• With or without hemorrhage
• May show fluid-debris levels
• Wall enhancement may be seen
• Absent or heterogeneous enhancement
of lesion
22. Dd-5 Hepatic hydatid cyst
• Large well-defined cystic liver
mass with numerous
peripheral daughter cysts
• With or without calcification &
dilated bile ducts
23. Cavernous hemangioma
• Most common
primary liver
tumor.
• All age groups.
• females >> males.
• Size less than 1
cm to 30 cm
(giant
hemangioma).
• No signs and
symptoms.
• When tumor
exceeds 4 cm
,abdominal
pain/discomfort or
a palpable mass.
• Rupture occurs
rarely.
24. characteristics
• Usually solitary.
• Borders are clear.
• Not encapsulated.
• Various degenerative changes are seen in its
centre.
– Old and new thrombus formation.
– Necrosis, scarring, hemorrhage & calcification.
28. Color Doppler
o Show filling vessels in periphery of
tumor
o No significant color Doppler flow in
center of lesion
• Power Doppler
o May detect flow within hemangiomas
o Flow pattern is nonspecific
o Similar flow pattern may be seen in
hepatocellular carcinoma & metastases
29. CT Findings
• NECT
o Small (1-2 cm) &
typical hemangioma (2-10 cm)
• Well-circumscribed, spherical to
ovoid mass isodense to blood
o Giant hemangioma (more than 10
cm)
• Heterogeneous hypodense mass
• Central decreased attenuation
(scar)
30. • CECT
o Small hemangiomas
("capillary"): Less than 2 cm
• Arterial & venous phases:
Show homogeneous
enhancement ("flash filling")
31. o Typical hemangiomas: 2-10 cm in
diameter
• Arterial phase:
Early peripheral, nodular or
globular, discontinuous enhancement
• Venous phase:
Progressive centripetal
enhancement to uniform filling, still
isodense to blood vessels
• Delayed phase:
Persistent complete filling
32. Giant hemangioma:
More than 10 cm in diameter
• Arterial phase:
Typical peripheral nodular or
globular enhancement
• Venous & delayed phases:
Incomplete centripetal
filling of lesion (scar does not
enhance)
33. o Atypical hemangioma: Inside to outside pattern
• Arterial phase:
No significant enhancement
• Venous & delayed phases:
Gradual enhancement
from center to periphery (centrifugal filling)
35. o Hyalinized (sclerosed) hemangioma
• Shows minimal enhancement
• Cannot be diagnosed with confidence by imaging
o Hemangioma in cirrhotic liver
• Flash-filling of small lesions
• May lose characteristic enhancement pattern
• Capsular retraction
• Decrease in size over time
36. MR Findings
TlWI
o Small & typical hemangiomas
• Well marginated
• Isointense to blood or hypointense
o Giant hemangioma
• Hypointense mass
• Central cleft like area of marked decreased intensity (scar or fibrous tissue)
T2WI
o Small & typical hemangiomas
• Hyperintense, similar to CSF
37. o Giant hemangioma
• Hyperintense mass
• Marked hyperintense center (scar or fibrosis)
• Hypointense internal septa
T1 C+
o Small hemangiomas (less than 2 cm)
• Homogeneous enhancement in arterial & portal phases
o Typical & giant hemangiomas
• Arterial phase: Peripheral, nodular discontinuous enhancement
• Venous phase: Progressive centripetal filling.
• Central scar: No enhancement & remains hypointense
40. Angiographic Findings
• Conventional
o Dense opacification of lesion
o "Cotton wool" appearance
• Pooling of contrast medium within
hemangioma
o Normal-sized feeders
o No neovascularity
o No arteriovenous shunting
o Typically retain contrast beyond venous
phase
42. Hypervascular metastases
• Hyperdense in late arterial phase images
• Hypo-or isodense on NECT & portal venous phase
• Treated metastases may mimic hemangioma on imaging (e.g., breast)
43.
44. Focal nodular hyperplasia
• Second common
benign lesion.
• Female >> male. 8:1
• Reactive change to
abnormal circulation.
• Well defined lesion
characterized by a
central fibrous scar.
• Usually
asymptomatic.
• Epigastric pain
and
hepatomegaly
are seen
frequently.
45. characteristics
• Well-demarcated.
• Solitary mass without a capsule.
• Often located beneath the surface of liver.
• In central scar - feeding arteries, draining veins
connecting to hepatic vein.
• Necrosis and hemorrhage usually not seen.
46. Ultrasonographic Findings
• Real Time
o Well-demarcated liver lesion
o Mass: Mostly homogeneous &
isoechoic to liver
• Occasionally hypoechoic or
hyperechoic
o Central scar: Hypoechoic
o Prominent draining veins or
displacement of vessels
47. • Color Doppler
o "Spoke-wheel" pattern
• Large central feeding
artery with multiple small
vessels radiating
peripherally
o Large draining veins at
tumor margins
o High-velocity Doppler
signals
• Due to increased blood
flow or arteriovenous
shunts
48. Nuclear Medicine Findings
• Technetium Sulfur Colloid
o Normal or increased uptake
o Only FNH has both Kupffer cells & bile ductules
o Almost PATHOGNOMONIC in 60% of cases
• Tc-HIDA scan (hepatic iminodiacetic acid)
o Normal or increased uptake
o Prolonged enhancement (80%)
49.
50. CT:
• Homogenous hypodense mass with a central
scar showing more marked hypodense.
• Arterial phase- brisk homogenous
enhancement.
• Portal phase-early wash out.
• Delayed phase-barely visible.
• If vessels radiating from central scar to the
periphery of the tumor is visualized , a near
definite diagnosis of FNH.
51.
52.
53. MRI
• Iso - hypointense on T1.
• Hyper - isointense on
T2.
• Central scar
– Hypointense on T1.
– Hyperintense on T2.
54.
55. DIFFERENTIAL DIAGNOSIS
Hepatic adenoma
• Large tumor
• Symptomatic due to hemorrhage in 50%, scar atypical
• Usually heterogeneous due to hemorrhage, necrosis or fat
Cavernous hemangioma
• Only small ones with rapid enhancement simulate
FNH
• NECT: Isodense with blood vessels
• CECT: Peripheral enhanced areas stay isodense with
blood vessels
56. Fibrolamellar carcinoma
• Large (more than 12 cm)
heterogeneous mass
• Biliary, vascular & nodal
invasion
• Metastases (70% of cases)
• Fibrous scar
o Large & central or
eccentric with fibrous bands
&
calcification (68%)
o Hypointense scar on T2WI
60. Adenoma
• Rare benign
tumor in younger
age group
compared to
FNH.
• Solitary (80%).
• Females (90%).
• Predisposing factors-oral
contraceptives, anabolic
steroids and glycogen
storage disease.
• Abdominal
mass.
• Recurrent
abdominal pain.
• Acute abdomen
(tumor rupture).
61. Characteristics
• Clear border
• No capsule (fibrous capsule in some cases)
• Core - bleeding, necrosis, scar tissue
• Contains-fat & glycogen
• Neither portal vein nor bile ducts
62. Ultrasonographic Findings
• Real Time
o Well-defined, solid, echo genic mass
o Complex hyper & hypoechoic
heterogeneous mass with anechoic areas
• Due to fat, hemorrhage, necrosis &
calcification
• Color Doppler- Hypervascular tumor
o Large peripheral arteries & veins
o Intratumoral veins present
• Absent in FNH
• Useful discriminating feature for HCA
63. Nuclear Medicine Findings
• Technetium Sulfur Colloid
o Usually "cold" (photopenic): In 80%
o Uncommonly "warm": In 20%
• Due to uptake in sparse Kupffer cells
• HIDA scan
o Increased activity
• Gallium Scan
o No uptake
64. CT Findings
• NECT
o Well-defined, spherical mass
o Isodense to hypodense (due to
lipid)
o Hemorrhage: Intratumoral,
parenchymal or
subcapsular
o Fat or calcification seen (less
often than on MR)
•
65. CECT
o Arterial phase
• Heterogeneous, hyperdense enhancement
o Portal venous phase
• Less heterogeneous
• Hyper-, iso-, hypodense to liver
o Delayed phase (10 min)
• Homogeneous, hypodense
• Enhancement does not persist (due to arteriovenous shunting)
• Pseudocapsule: Hyperattenuated to liver & adenoma
o Large adenomas
• More heterogeneous than smaller lesions
66.
67.
68.
69. MR Findings
• TlWI
o Mass: Heterogeneous signal intensity
• Increased signal intensity (due to fat & recent hemorrhage), more evident on MR
than CT
• Decreased signal intensity (necrosis, calcification, old hemorrhage)
o Rim (fibrous pseudocapsule): Hypointense
• T2WI
o Mass: Heterogeneous signal intensity
• Increased signal intensity (old hemorrhage/necrosis)
• Decreased signal intensity (fat, recent hemorrhage)
o Rim (fibrous pseudocapsule): Hypointense
•
70. T1 C+
o Gadolinium arterial phase
• Mass: Heterogeneous enhancement
o Delayed phase
• Pseudocapsule: Hyperintense to liver & adenoma
• Superparamagnetic iron oxide (SPIO)
o No uptake in adenoma
o Few cases take up SPIO (due to active Kupffer cells)
• Resulting in a decreased signal on T2WI
• Indistinguishable from FNH for these cases
• Uptake varies based on number of Kupffer cells
74. DIFFERENTIAL DIAGNOSIS
Hepatocellular carcinoma (HCC)
• May have identical imaging features as hepatic adenoma
• Histologically: May be difficult to distinguish well-differentiated
HCC from adenoma
• Biliary, vascular, nodal invasion & metastases establish that lesion is
malignant
75. Hepatic abscess
• Commonly – pyogenic,amebic and fungal.
• Via – portal vein, hepatic artery or bile duct.
• Solitary or multiple.
76. • Pyogenic – double structured hypodense area.
– CECT : double target sign.( arterial phase)
• Thick ring like stain (portal and venous phase)
• Amoebic – CECT- enhanced mural structure with hypodense
area at its lateral side owing to the presence of oedema.
• Fungal – CECT – faint ring like enhancement (arterial
phase)
– Hypodense (venous phase).
77.
78. Hydatid cyst
• All age group.
• Caused by larva stage of adult tape worm.
79. Ct and mri
• Thick walled cystic lesions with internal round
periphery daughter cysts.
• Attenuation and signal intensity in mother
cyst is more than daughter cyst.
80.
81. Pre contrast Arterial Phase Portal venous
phase
Delayed
Hepatocelluar Ca Low attenuation Homogenous
enhancement
Washout of
lesion
Isodense
Adenoma Low attenuation Homogenous
enhancement 85%
Iso or
hypodense
Iso or hypodense
Haemangioma Low attenuation Peripheral puddles Partial Fill in Complete fill in
FNH Iso/Low
attenuation
Homogenous
enhancement
Hypodense Isodense
Hypervascular Mets Low attenuation Homogenous
enhancement
Hypodense
Metastasis Low attenuation Hypodense Hypodense
Cyst Low attenuation No enhancement
Abscess Low attenuation may
have irregular margins
Transient regional
enhancement
Ring
enhancement
