37-Dr Ahmed Esawy imaging oral board of liver part I CT triphasic liver
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Transcript of 37-Dr Ahmed Esawy imaging oral board of liver part I CT triphasic liver
The Art of Radiology
CT OF THE LIVER
Helical CT application of the liver include
SIZE OF THE LIVER
15cm
LIVER DENSITY
Principles of Hepatic Contrast Enhancement
Non- contrast scan
Single phase CECT
Dual- phase CECT
TRIPHASIC CYCLE
PVP
Equilibrium phase
(C,D )corresponding PVP images obtained 40 seconds later show substantial hepatic parenchymal enhancement due to influx of
enhanced blood via the portal vein (arrows)
Homogenous hypervascularOnly arterial phase enhancment
Homogenous hypovascularPorto-venous
Only arterial Porto-venous enhancment
Heterogenous PatterenHyper or hypo
DELAYED ENHANCMENT
RING enhancment
Abscess
NODULAR ENHANCMENT
NO ENHANCMENT
MULTIPLE LIVER LESION
CT scan of the abdomen reveals multiple abscess cavitieswithin the liver (arrow) and spleen (arrowheads).
(hepatosplenomegally)
CALCIFICATION
Capsule
Fat
Hemorrhage
HCC
CT
[arterial phase]
HEPATOCELLULAR CARCINOMA
PATTEREN OF ENHANCMENTOF HCC
Hepatocellular carcinoma. Spiral CT shows two masses, with hyperattenuation of the small mass in the right lobe, large mass
demonstrates less enhancement than the small one
HCC AT HAP
HCC AT HAP
HCC AT HAP
HCC AT PVP
HCC AT HAP
HCC AT PVP
HCC AT HAP
HCC AT PVP
HCC AT HAP
HCC AT PVP
Portal node
This abdominal CT scan in axial view demonstrates a large mass that occupies most of the posterior right lobe of the liver. This is an hepatocellular
carcinoma. These cancers can appear as one large mass, or there may be small surrounding satellite nodules, or multifocal masses. The serum alpha-
fetoprotein (AFP) is often elevated with hepatocellular carcinoma
This abdominal CT scan reveals an hepatocellular carcinoma, with areas of less attenuation from extensive tumor necrosis, involving the inferior margin of the right
lobe of the liver. In the view above, this carcinoma has invaded through the liver capsule and extended to the abdominal wall. Note the presence of ascitic fluid as well. Hepatocellular carcinomas that rupture through the liver capsule may also produce a
hemoperitoneum
Figure 2a. Hepatitis C and HCC that was not prospectively diagnosed at triphasic contrast-enhanced helical CT in a 57-year-old man. (a) Transverse
nonenhanced CT image shows cirrhotic liver without an contrast
HCC AT HAP
C-HCC AT PVP
HEPATOMA IN CIRRHOTIC LIVERCT FINDINGS
Hepatitis C, alcohol-related liver disease, and HCC that was prospectively diagnosed at triphasic contrast-enhanced helical CT in a 45-year-old man. (a) Transverse nonenhanced CT image
shows nodular cirrhotic liverhypodense lesion
Same case show enhancement at HAP
C-hypodense at PVP
CT scan of the upper abdomen showing an widespread (disseminated) carcinoma of the liver (hepato cellular carcinoma). The liver is the large organ on the left side
of the picture. Note the
Cystic hepatocellular carcinoma. (b) Arterial-phase contrast-enhanced CT scan obtained in a 55-year-old man shows indirect signs of liver cirrhosis: atrophy of the
right hepatic lobe, hypertrophy of the caudate lobe, contour irregularities, and ascites. In addition, an
Focal nodular hyperplasia FNH
Focal nodular hyperplasia FNH Imaging
Focal nodular hyperplasia (FNH)
Focal nodular hyperplasia. A: Unenhanced CT image shows a slightly hypoattenuating mass (arrow heads) with a small central lower attenuation
scar (open arrow).
B: The mass enhances homogenously, except for the Scar .
2A-Typical CT findings of focal nodular hyperplasia in 30-year-old woman. Unenhanced CT scan shows lesion in left lobe of liver
(arrowheads), which is slightly hypodense to remainder of liver. Note more hypodense central scar (arrow).
2B Arterial phase contrast-enhanced CT scan shows strong homogeneous enhancement of lesion, caused by arterial vascular supply.Note focal central
area of low attenuation, representing central scar
Contrast-enhanced CT scan during the portal venous phase shows lesion being slightly hypoattenuating compared with surrounding liver because of
rapid contrast material washout
2D-Typical CT findings of focal nodular hyperplasia in 30-year-old woman. Delayed phase contrast-enhanced CT scan shows
persistent enhancement of central scar (arrowhead).
FNH AT ARTERIAL PHASE
DELAYED SCAN
FNH AT HAP
FNH HAP
FNH AT PVP
HAP
Multiplicity of lesions Multiple focal nodular hyperplasias in 28-year-old woman. Contrast-enhanced CT scan during arterial phase shows multiple hypervascular lesions disseminated
throughout liver
1a. Transverse CT scans obtained in a 41-year-old woman with FNH.
a) Section obtained during the hepatic arterial phase shows a round mass that demonstrates intense homogeneous enhancement with a smooth
margin and a small central scar (arrow
1b.). Section obtained during the portal venous phase at the same level. The mass (solid arrows) is isoattenuating with the normal hepatic parenchyma and can be
identified by the scar (open arrow) that has decreased in size due to partial enhancement
2c. Images obtained in an 18-year-old woman with fibrolamellar HCC. (a) Unenhanced transverse CT scan demonstrates a large, heterogeneous
hypoattenuating mass that replaces most of the left hepatic lobe. The central scar is not well seen, but there are central coarse calcifications (arrow) .
2c. Images obtained in an 18-year-old woman with fibrolamellar HCC. (b) Hepatic arterial phase image obtained at the same level shows
heterogeneous intense enhancement of the same mass (open arrows). There are two satellite lesions (solid white arrows), and the surface lobulation,
central scar (solid black arrow), and calcifications within the scar are seen more clearly .
3b. Transverse CT scans obtained in a 67-year-old man with a large hemangioma. (a) Section obtained during the hepatic arterial phase shows a large lobulated mass (solid arrows) that replaces the right hepatic lobe and demonstrates nodular enhancement
(open arrows) that is isoattenuating with the aorta. There is an irregular, cleftlike, central hypoattenuating scar
3b. Transverse CT scans obtained in a 67-year-old man with a large hemangioma.. (b) Section obtained during the portal venous phase at the same level shows more nodular enhancement of the mass, which is still isoattenuating with the aorta. The irregular, elongated, hypoattenuating
central scar (arrow) is seen more clearly with the increase in lesion enhancement
HEPATIC ADENOMA
hepatic adenoma
Fig. 3A. —44-year-old woman with hepatocellular adenoma (straight arrow) in right liver lobe (subcapsular). Arterial phase CT scan shows lesion is slightly
hyperdense and shows feeding artery (curved arrow)
b
ADENOMA
ADENOMA
HAP PVP
REGENERATING NODULES AT HAP
REGENERATING NODULES AT PVP
Case 2
Case 3