Basic CT Imaging of Abdomen
For Non Radiologist
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
[email protected] Indications for Abdominal
CT imaging
To assess equivocal imaging findings
Staging neoplasms of solid and hollow viscera
Metastatic workup of primary malignancies
Diagnosis of diffuse hepatic diseases
Assessment of biliary disease and tumour.
Congenital anomalies.
Assessment of suspected post-traumatic injuries
CT Anatomy
Patient preparation
Patient position
[frontal]
Scanogram.
No required preparation unless the patient is going
to be sedated or injected with contrast material
FASTING FOR 4 - 6 HOURS
Rt Ventricle
Rt Atrium
Lt Ventricle
IVC
Lt Atrium
Espohagus
Aorta
Azygous
Hepatic Veins
Liver
IVC
Aorta
Lt Portal Vein Lt Lobe Liver
Diaphragm
Stomach
Rt Lobe Liver
Falciform Spleen
IVC Ligament
Falciform Lig
Stomach
Rt Portal
Vein
IVC Spleen
Pylorous Stomach
Gallbladder
Pancreas
Splenic artery
Portal Vein
Lt Kidney
Celiac Artery
IVC
Crura of
diaphragm
Pylorous Stomach
Splenic Flexure
GB
Pancreas
Splenic V
2nd part
Duodenum
IVC
SMA Lft Kidney
SMV SMA
Hepatic Splenic
Flexure flexure
Pancreatic
Head
Spleen
IVC
Lt Renal V
Lt Renal
Artery
SMV
SMA
Jejunum
2nd portion
duodenum
Pancreatic Head
Tran. colon
Mesentery
Des. colon
Asc. colon
3rd portion
duodenum
Ileum
Des. Colon
Asc. Colon
Common Iliac
Arteries
Ileum
Asc. Colon
Desc. Colon
Terminal Ileum
Lft Iliac Art
Lt Iliac V
Small Bowel
Ext Iliac Art
Iliopsoas
Glut. Minimus Ext Iliac V
Glut. Medius
Glut. Max
Internal iliac A. & V.
Pyriformis
Rectosigmoid
Bladder
Fem Artery
Prostate Rectum
Ovaries
Uterus
Rectum
Sacrum
Hepatic pathology
Benign Malignant Diffuse lesions
lesions lesions
Liver cysts. Hepatocellular Fatty liver
Hemangioma. carcinoma. Cirrhosis
Adenoma. Fibrolamellar carcinoma. Storage diseases
Focal nodular Hepatoblastoma.
hyperplasia. Metastasis.
Hepatic cysts
Congenital lesions but detected late
Isolated or associated with congenital cystic disease
Usually asymptomatic
Complications [ rupture or hage ] lead to symptoms
Few mms to several cms in size
Hepatic
Hepatic abscess
[ Pyogenic ]
Frequently indolent with no signs of infection
May present with profound septicemia
Micro abscesses (>2cm) cluster or scattered
Macro abscesses :Unilocular or multilocular
Marginal enhancement 6% ?!
Gas containing abscesses uncommon
Amebic abscess
Peripheral edema is
evident
Hydatid cyst
FNHFocal Nodal Hyperplasia
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.
Hepatocellular
carcinoma
Single or multiple masses that are hypo dense to normal liver
Calcification may be seen
After contrast injection [ should be Triphasic study]
Arterial phase : Very early arterial perfusion.
Portal phase : contrast washout
Hepatocellular carcinoma
Detects a greater number of HCC than usual scanning
Detects intravascular thrombosis [ portal vein]
Better delineation of tumour capsule in capsulated lesions
Detects early arteriovenous shunting [ sign of malignancy]
Hepatoblastoma
The most common 1ry hepatic neoplasm in children below 5 years
Usually presents with abdominal mass with elevated AFP
Large diffuse or multifocal hypodense lesion is seen on CT
Matrix calcification and septations may be seen
Cholangiocarcino
Thema
2 most common primary malignant tumor
nd
Arise from bile duct epithelium [ 3 TYPES ]
Intrahepatic arises from small ducts
Or the major ducts near the helium
Or at the bifurcation of the CHD [ Klatskin tumor]
HCC: intrahepatic cholangiocarcinoma =
10:1
No strong association with cirrhosis
No specific MR appearance
Hepatic
deposits
Most of hepatic deposits are hypo vascular
Hepatic neoplasms receive most of their blood supply via hepatic artery
Hyper vascular deposits should be assessed by dual phase CT or dynamic MRI
CTAP and intra operative US are the most sensitive methods for detection of deposits
Diffuse Hepatic Disease
Cirrhosis
Fatty Changes
Storage diseases(hemochromatosis &hemosidrosis)
Neoplastic diseases [ HCC , Deposits , Lymphoma ]
Cirrhosis
Repeated episodes of hepatic injury fibrosis + regeneration
Small fibrotic right lobe with regenerative enlargement of the caudate and left lobe
Caudate/ right lobe ratio = 0.65 or more
Portal vein diameter more that 1.3 cm
Splenomegaly, ascites
Dilated perisplenic collateral venous channels
Diffuse Neoplastic
disease
Lymphoma 35% of patients with secondary hepatic lymphoma
show either diffuse or mixed pattern (focal+ diffuse)
Imaging findings are non specific
An abdominal and pelvic CT scan(IV contrast but no oral
contrast) showed marked lymphadenopathy (arrows) in
the retroperitoneum and mesentery .
Two metastatic para-aortic lymph nodes in a 49-year-old man
with gallbladder cancer.
Computed tomography (CT) scan showing para-aortic
metastatic lymphadenopathy,
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
CT IVU
Ectopic thoracic Kidney and contra-lateral ureteral
Horse shoe kidneys (IVP and CT) with fusion of the kidney
anterior to the spine.
Congenital polycystic kidney disease.
Bilateral stag-horn Left renal stag-horn
Thank You
