Liver,bile duct,pancreas and spleen

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Transcript of Liver,bile duct,pancreas and spleen

  • 1. Liver, bile duct, pancreas and spleen Chen,Shaoqiong)

2. 3. Technique and methods

  • Liver angiography
  • CT
  • MRI
  • C ontrast examinationof the bile duct
  • O ral cholecystography
  • I ntravenous cholecystocholangiography
  • Direct cholangiography
  • T -tube Cholangiography

PTC --------Percutancous transhepatic cholangiography ERCP------Endoscopic retrograde cholangiopancreatography 4. Technique and methods T -tube Cholangiography 5. Technique and methods PTC 6. ERCP 7. CT

  • 1. CT plain scan
  • 1 Slice thick 10MM 5MM
  • 2 Region: cover the whole organ
  • 2.E nhancement scanning :
  • 1 P urpose resolution diagnosis.
  • vessels
  • 2 Methods Arterial phase 20-25 portal phase 60 delayed phase 5-7

8. Imaging of the hepatic vessels Artery Portal vein Hepatic vein 9. Hepatic vessels

  • Hepatic artery Celiac trunk common hepatic A. Proper
  • hepatic A Lt. and Rt. hepatic A.
  • Portal vein left branch right branch
  • Hepatic vein left intermediate right

10. Normal anatomy 11. Properhepatic A Gastro-duodenal A. splenic artery SMA superior mesenteric artery 12. 13. 14. CE MRA 3ml/s 20mlGd-DTPA 15. hepatic portal vein 16. Portal vein and hepatic vein 17. Hepatic vein right intermediateleft 18. 19. V 20. Celiac trunk Splenic artery Common hepatic a . 21. Hepatic artery 22. Left branch of hepatic portal vein 23. Right branch of hepatic portal vein 24. Hepatic vein 25. Liver lobes

  • Lobes C audate lobe( S1 ) Left lobe S2 3) Quadrate lobe S4 Right lobe S5 6 7 8

26. Liver lobes Quadrate lobe Left lobe Caudate lobe Quadrate lobe Left lobe Right lobe 1 Right lobe 27. ( )Couinaud( 8 ) 28. CT 29. 4 8 7 2 30. 2 4 8 7 31. 2 4 8 7 1 32. 2/3 4 8 7 1 33. 1 3 4 8/5 7/6 34. 3 4 5 6 1 35. 3 4 5 6 36. 5 6 37. 5 6 38. MR 39.

  • MRI
  • 1.MRIplain scan
  • S equence axial coronalT1W T2W
  • FIESTA DWI double echo
  • 2. MRIenhancement scanning
  • 3.MR A
  • 4. MRCP Magnetic Resonance Cholangiopancreatography

40. 3 4 5 6 T2WI 41. 3 4 5 6 T1WI 42. ERCP Bile duct system 43. Intrahepatic bile duct 44. MRCP 45. P ancreas 46. CT body of pancreas head of pancreas splenic vein Portal vein 47. tail of pancreas body of pancreas head of pancreas MRT1WI 48. head of pancreas 49. T2FAT SAT pancreatic duct 50. head of pancreas Portal vein gallbladder 51. 23 4 78 65 GB 52. 7 8 65 6 5 53. 78 65 M 54. 55. 76 SP 56. Disease of the liver 57. Hepatic cyst

  • C ongenital disease
  • CT SCAN
  • Delicate, round, smooth, thin-walled hypodense lesion
  • Homogeneous,waterdensity(0-15HU)
  • No enhancement
  • MR
  • Very low signal intensity on T1WI and very high intensity on T2WI

58. CT AppearanceHepaticC yst -Cvenousphase arterial phase 59. CT AppearanceHepaticC yst Polycystic disease 60. MR appearanceHepatic cyst 61. Hepatic Abscess P yogenic abscess bacterium orAmoeba 62. Plain Radiography 63. CT Appearance of hepatic abscess

  • Hypodense hyperden s e hypodense
  • necrosismembraneedema
  • 20-40HU
  • Gas or fluid level

64. 65. 66. MR Appearance of abscess

  • low signal intensity on T1WI and high intensity on T2WI ---inside cavity
  • Intensity is decreased than the center in the wall

67. T 1 WI T 2 WI septum T 1 WI T 2 WI 68. Common hepatic tumors

  • Benign tumor
  • Cavernous hemangioma
  • Hepatocellular adenoma
  • Hamartoma
  • F ocal nodular hyperplasia FNH
  • Malignant tumour
  • H epatocellular carcinoma
  • C holangiocellular carcinoma
  • Liver metastasis

69. H emangiomas of liver

  • H emangiomasis the most common benign tumor of the liver--C avernous hemangioma

70.

  • CT appearance of h emangiomas
  • A.P lain scan
  • 1 L ow density CTvalue-about30HU
  • 2 Homogeneous(In homogeneous -centrally lower density in large tumor, Ca or hemorrage)
  • B.E nhancement scanning
  • 1 rapidly enhance
  • 2 filling in centripetally to become isodensity with the adjacent parenchyma
  • 3 The time for complete in-filling has been
  • > 3 usually7 15 most long20 60

71. Plain scan P ortal phase D elayed phase A rterial phase 72. 73. 74. 75. Plain Scan E nhancement D elayed scan 76.

  • MRIappearance
  • 1. Round, Clear margin 2. Intensity Hypointense onT1WI Hyperintense onT2WI long TE 120ms long T2 value lampb ulb , homogeneously
  • Inhomogeneous caused by thrombosis and scar in the center
  • 3.E nhancement scanning

77. 78. 79. C avernous hemangioma 80. Hepatocellular carcinoma

  • Hepatocellular carcinoma(HCC )
  • V iralhepatitideinfection ( hepatitis BorC )
  • C i rrhosis( alcoholism )

81. CT

  • On CT, HCC can have three distinct patterns of growth:
  • Massive type --- A single large tumor5cm
  • N odular type ---Multiple tumors