Non invasive modalities for diagnosis of NAFLD
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This document discusses non-invasive modalities for diagnosing non-alcoholic fatty liver disease (NAFLD), including ultrasound, CT, and MRI techniques. Ultrasound is the first-line test, where fatty liver appears brighter than the kidney or spleen with poor organ delineation. CT can detect fatty liver as at least 10 HU less than the spleen. MRI uses in-phase and opposed-phase imaging where fatty liver loses signal intensity between images. MRI-PDFF precisely quantifies fat content and correlates with histological grading.
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Practical tips in sonography
1) USG is not always accurate in detecting small renal calculi less than 5mm or mid/lower ureteric calculi, while CT is the gold standard for detecting all calculi. However, CT should be used cautiously due to radiation risks.
2) USG is sensitive for detecting fatty liver but cannot detect inflammation or early fibrosis. Liver biopsy is currently needed to assess nonalcoholic steatohepatitis, though new techniques like fibroscan and MR elastography may provide noninvasive alternatives.
3) Lymph nodes need to be at least 10mm on USG to be considered significant or diagnostic of mesenteric adenitis in children.
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Recommended
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1) USG is not always accurate in detecting small renal calculi less than 5mm or mid/lower ureteric calculi, while CT is the gold standard for detecting all calculi. However, CT should be used cautiously due to radiation risks.
2) USG is sensitive for detecting fatty liver but cannot detect inflammation or early fibrosis. Liver biopsy is currently needed to assess nonalcoholic steatohepatitis, though new techniques like fibroscan and MR elastography may provide noninvasive alternatives.
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Prostatomegaly
The prostate gland is located below the bladder and surrounds the urethra. It secretes fluid that protects and nourishes sperm. The size and shape of the prostate can change with age due to conditions like benign prostatic hyperplasia (BPH) and prostate cancer. BPH involves noncancerous growth of the prostate and commonly causes urinary symptoms in older men. Prostate cancer develops from cells in the prostate and risks include family history and diet. Investigation may include a digital rectal exam and PSA testing while treatment options depend on cancer stage and severity of symptoms.
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The document discusses the anatomy and functions of the prostate gland. It notes that the prostate is located in the pelvic cavity below the bladder and surrounds the urethra. It secretes fluid that protects and nourishes sperm. The size and shape of the prostate changes with age due to the effects of hormones like testosterone and dihydrotestosterone. Benign prostatic hyperplasia is a common non-cancerous enlargement of the prostate in aging men.
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CT /MRI Plain X ray images
Diagnosis at US
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Elastography
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Criteria for fatty liver on USG
Grading of fatty liver
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Diagnosis at CT
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Potential pitfalls in Opposed-phase T1 include
Accuracy for Detection and Grading of Fat Deposition
Patterns of Fat Deposition
Diffuse Deposition.
Focal Deposition and Focal Sparing.
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Perivascular Deposition.
Subcapsular Deposition.
Focal Deposition and Focal Sparing
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This document provides an overview of neoplasms of the liver. It begins with the anatomy and physiology of the liver and then discusses both benign and malignant liver lesions. For benign lesions, it describes hemangioma, focal nodular hyperplasia, hepatic adenoma, and liver cysts. It provides details on symptoms, diagnosis, and treatment for each. For malignant lesions, it focuses on primary liver cancer, including hepatocellular carcinoma and fibro-lamellar carcinoma. It discusses the pathophysiology, presentation, diagnosis, grading, staging, and treatment options for hepatocellular carcinoma. The document concludes with an explanation of hepatic resection techniques for surgical treatment of liver tumors.
Gastrointestinal carcinoids
- Gastrointestinal carcinoid tumors most commonly occur in the small bowel and appendix. They arise from enterochromaffin cells and can produce symptoms if they secrete excess serotonin.
- Diagnosis is usually achieved through complementary imaging techniques such as somatostatin receptor scintigraphy, CT, MRI, and ultrasound. Somatostatin receptor scintigraphy is particularly useful for detecting primary tumors and metastases.
- Imaging findings include well-defined bowel masses that can invade the mesentery, associated lymphadenopathy, and liver metastases appearing as hypoechoic lesions that enhance with contrast.
Incidentaloma Dr. Khaled.pptx
1. The document discusses incidentalomas, which are adrenal masses discovered incidentally on imaging done for unrelated conditions. It provides recommendations on assessing and managing incidentalomas.
2. Assessment involves evaluating radiological features for malignancy risk, assessing for hormonal excess, and screening for associated conditions. Management depends on size, radiological characteristics, hormonal activity, and malignant risk. Masses with hormonal excess or malignancy are surgically removed.
3. Follow up involves repeat imaging and hormonal testing for indeterminate masses, and clinical monitoring for masses with possible autonomous cortisol secretion or related conditions. Treatment is individualized based on various clinical factors.
Dr maryam
1. Liver tumors are difficult to detect on non-contrast CT scans but enhance differently than normal liver tissue when IV contrast is administered.
2. Arterial phase imaging at 35 seconds optimally shows hypervascular tumors, while portal venous phase imaging at 75 seconds detects hypovascular tumors.
3. The main benign liver lesions are hemangiomas, focal nodular hyperplasia, and hepatic adenomas. Hemangiomas demonstrate peripheral nodular enhancement on CT and MRI while focal nodular hyperplasia shows a central scar and homogeneous enhancement.
Case study
This case involves a 76-year-old male with a history of open cholecystectomy who presented with abdominal pain. Previous attempts at extracting a large CBD stone via ERCP were unsuccessful. The patient underwent peroral cholangioscopy (Spyglass) which allowed for visualization and electrohydraulic lithotripsy of the large bile duct stone. A check cholangiogram showed complete stone clearance. Peroral cholangioscopy proved effective for managing this patient's difficult bile duct stone when standard ERCP failed.
Plain radiography in acute abdomen
- The document discusses the technical aspects and normal findings of abdominal radiography for non-traumatic emergencies. It outlines how to assess radiographs and what normal structures should be seen, including the bones, organs and bowel gas patterns. Common abnormal findings are also reviewed such as pneumoperitoneum which can indicate a perforated viscus. A list of non-traumatic abdominal emergencies that may present with acute abdominal pain is provided.
Adenoma morning.pptx
- A 2.1x1.5cm left adrenal mass was found on CT in a female patient complaining of bilateral flank pain.
- The mass had an average attenuation of -15% on non-contrast CT and showed an absolute post-contrast washout of 70% and relative post-contrast washout of 113%.
- These washout kinetics are characteristic of a benign adrenal adenoma.
MR imaging of liver
MRI is useful for evaluating various liver conditions. It is superior to CT for detecting small liver lesions and characterizing lesions. MRI can identify diffuse liver diseases affecting hepatocytes or reticuloendothelial cells, causing homogeneous or segmental changes. Cirrhosis appears as numerous low signal regenerative nodules on T2-weighted images. Hemangiomas are intensely hyperintense on T2-weighted images and enhance peripherally on contrast images. Dysplastic nodules are generally hypointense on T1-weighted images and do not enhance with contrast. MRI utilizes multiple sequences and techniques to comprehensively evaluate liver tumors, diffuse diseases, and incidental findings.
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Liver imaging snapshots role of CT USG MRI in liver imaging.
Liver imaging snapshots role of CT USG MRI in liver imaging.
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Diarrhea and IBD When to be woeeied ?
1. Diarrhea is defined as an increased frequency, fluidity, and volume of stool. It can be acute (<14 days), persistent (14-30 days), or chronic (>30 days).
2. The document discusses the pathophysiology, etiology, indications for referral to a gastroenterologist, initial evaluation, and recommendations for evaluating patients with chronic diarrhea.
3. The differential diagnosis and workup of inflammatory bowel diseases like Crohn's disease and ulcerative colitis are outlined, including relevant history, physical exam findings, diagnostic studies, endoscopy, histopathology, and radiology findings.
Gastrointestinal dysfunction in liver cirrhosis
This document discusses gastrointestinal dysfunction that is common in patients with liver cirrhosis. It can impact quality of life, nutritional status, and contribute to the development of cirrhosis complications. Specific issues covered include malnutrition prevalence of up to 80%, common GI symptoms in up to 80% of patients such as abdominal bloating and pain, impaired gastric functions like accommodation and emptying, increased intestinal permeability, and endoscopic findings including peptic ulcers in 24.1% of patients, gastroesophageal varices in over 50% of those with portal hypertension, and portal hypertensive gastropathy in around 80% of cirrhosis patients. The pathogenesis and management of these GI complications are also reviewed.
HBV and HCC
The document discusses recommendations for treatment of two patients with hepatitis B virus (HBV) who presented to an HBV clinic. For the first patient, a 30-year old female with early stage liver disease, treatment of HBV is recommended. For the second patient, a 55-year old male who was treated for hepatocellular carcinoma, assessment of cirrhosis severity is recommended to guide further treatment. The document also reviews tumor markers, imaging techniques and clinical staging systems for hepatocellular carcinoma diagnosis and management.
Esophageal cancer
1. Esophageal cancer is the 8th most common cancer worldwide and the 6th most common cause of cancer death. Squamous cell carcinoma is most common globally while adenocarcinoma is more common in Western countries.
2. Several risk factors are discussed including gender, H. pylori infection, NSAID use, smoking, alcohol, obesity, gastroesophageal reflux disease, and Barrett's esophagus.
3. Diagnostic tests discussed include imaging studies, endoscopy, endoscopic ultrasound, and biopsy. Treatment recommendations include endoscopic resection for early stage cancer and chemotherapy, radiation, surgery or stents for advanced disease.
HCC 2018
Liver cancer is the fifth most common cancer and the second leading cause of cancer death globally. Hepatocellular carcinoma (HCC) represents about 90% of primary liver cancers. Major risk factors for HCC development include cirrhosis, viral hepatitis, toxins like alcohol and aflatoxins, metabolic conditions, and genetic disorders. Diagnosis involves non-invasive testing of tumor markers like AFP, AFP-L3, DCP, and imaging, or invasive biopsy. Surgical resection offers the best chance of cure for eligible early-stage patients with small tumors, while other treatments include cryosurgery, transplantation, and immunotherapy.
Role of DAA'S in extrahepatic manfestations of Hepatitis C
70-74% of hepatitis C patients may develop extrahepatic manifestations during the course of the disease, which can include nonspecific symptoms like fatigue as well as more specific conditions like vasculitis, lymphomas, renal disease, and neurological issues. Mixed cryoglobulinemia vasculitis is a small vessel vasculitis caused by HCV in around 80% of cases, commonly involving the skin and joints, and ranging from mild to life-threatening. Antiviral treatment for HCV has been shown to improve and resolve extrahepatic manifestations. A 54-year-old female presented with foot ulcers and pain found to have HCV and cryoglobulinemia responded well to direct-acting antiviral treatment by resolving her
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- 5. Imaging modalities • Diagnosis at US • Diagnosis at CT • Diagnosis at MR Imaging • Elastography
- 7. Diagnosis at US is the first-line imaging test used in clinical practice Fatty liverNormal Liver Liver echogenicity exceeds that of renal cortex and spleen Echogenicity of the normal liver equals or minimally exceeds that of the renal cortex or spleen Poor delineation of the intrahepatic architecture Intrahepatic vessels are sharply demarcated Loss of definition of diaphragm Posterior aspects of the liver are well depicted
- 10. To avoid false-positive interpretations, fatty liver should not be considered present if only one or two of these criteria are fulfilled
- 11. Diagnosis at CT Fatty liverNormal Liver Attenuation of the liver is at least 10 HU less than that of the spleen or attenuation of fatty liver is less than 40 HU The normal liver has slightly greater attenuation than the spleen and blood • In severe cases, intrahepatic vessels may appear hyperattenuated relative to fat-containing liver tissue • Intrahepatic vessels are visible as hypoattenuated structures
- 13. Diagnosis at Magnetic resonance based techniques Chemical shift gradient-echo(GRE) imaging with in-phase and opposed-phase acquisitions is the most widely used MR imaging technique for the assessment of fatty liver. Fatty liverNormal Liver The signal intensity loss on opposed-phase images in comparison with inphase images. The signal intensity of the normal liver parenchyma is similar on in-phase and opposed-phase images MRI-derived proton density fat fraction (MRI-PDFF) It uses MRI-visible protons that combine with fat in the liver to quantify steatosis by dividing all protons in the liver. MRI-PDFF is significantly associated with the histological steatosis grade MRI-PDFF is superior to other imaging tools for the assessment of hepatic steatosis and its performance is not affected by obesity H-MRS magnetic resonance spectroscopy
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