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Abdomen and Pelvis CT ANATOMY Abdomen and pelvis CT ANATOMY MAMDOUH MAHFOUZ MD [email protected] www.ssregypt.com CT ABDOMEN Indications Patient preparation Patient position Scanogram To assess equivocal imaging findings • • Staging of hepatic neoplasms • Metastatic workup of primary malignancies • Diagnosis of abdominal masses • Assessment of biliary problems • Diagnosis of vascular lesions • Assessment of suspected post-traumatic complications Patient preparation Oral contrast material to opacity the gastrointestinal tract [gastrographin 38% diluted by water to 4%] - Timing? Not indicated in Acute abdominal trauma Acute renal colic Dehydrated patients CT ABDOMEN Indications Patient preparation Patient position Scanogram No required preparation unless the patient is going to be sedated or injected with contrast material FASTING FOR 4 - 6 HOURS Scanogram Frontal 10mmscan intervals [ 5mm sections are necessary for pancreas, suprarenal glands, urinary bladder] Window setting . Soft tissue window . Lung window [scans at the lung bases] . Bone window [lesions in the spine or pelvic bones] Patient preparation IV contrast material [urographin,…] 60ml • Fasting 4-6 hours ?! • Pre contrast scans [ liver, kidney, urinary bladder] • Triphasic scan for liver [ arterial, portal, delayed] Detailed examination of the Superior Mesenteric Artery and Celiac Artery. Scan time = 9.4 seconds. 1mm slice thickness Value of precontrast study Arterial phase Hyper vascular deposits Value of arterial phase images in hepatic lesion detection Male pelvis Female pelvis LS MS AS PS Hepatic segmental anatomy MS LS AS PS MS LS AS PS Contrast enhanced CT or MRI No focal lesions ?!! ?! Diffuse hepatic diseases?!! .Fatty liver .Cirrhosis .Storage diseases No dilated biliary radicals ?!! Intrahepatic bile duct dilatation Vessels in the liver ?!! . Hepatic artery . Hepatic veins . Portal veins CT Portography CT Portal venography showing portal hypertension with GE varicosities CT Portal venography in a 56Y Male with portal vein thrombosis Normal variants Agenesis of the anterior segment of the right hepatic lobe Porta-hepatis Hepatic artery Portal vein cbd Pancreas Anatomy Anterior pararenal space, retroperitonium Head (3cm) neck, body (2.5cm) and tail (2cm) Pancreatic density is similar to unopacified bowel and vessels 5mm sections Pancreas does not have a firm capsule Pancreatic atrophy with fatty infiltration, age related Pancreatitis, acute Pancreas, normal Pancreatic anatomy Pancreatic head, superior mesenteric artery and vein Suprarenal glands F 35Y QUIZ CASES 1 2 3 MRI Coil selection Body coil Phased – array multicoils • Increases signal/ noise ratio • Allows smaller field of view • High cost • Very high signal of subcutaneous fat Examination protocol • Coronal localizer • Axial T1 and T2 WIs • Coronal T1 and T2 WIs • Axial T2 fat suppression • Dynamic post contrast axial T1 WIs [Arterial , portal and delayed phases with or without fat suppression ] Normal liver is of similar or higher signal to muscles [T1] Normal liver shows intermediate signal [T2] Spleen shows increased signal compared to the liver [T2] MRI normal spleen Multiple Angiomyolipomas T1, T1 Fat sat, T1 fat sat +c MR advantages MR is more sensitive in detection and characterization of hepatic hemangioma [high signal on heavily T2 weighted sequences] MR can differentiate focal fatty changes from deposits In diffuse fatty infiltration hypo dense deposits may be masked by the hypo dense background of fatty liver on CT .On MR the background is relatively high signal in T1 WIs while deposits are of low signal, Hemangio so increases the difference mas MR is sensitive for detection of hemorrhage demonstrat ed by heavily weighted T2 MRI Normal renal MRI. Normal renal MRI. [Fat suppression] T T T1+ 1 2 C T1 weighted images Normal liver is of similar or higher signal to muscles • T1 spin echo sequences • T1 breath hold gradient echo images SPGR/ FLASH Short TE 5 msec TR> 100mesc Flip angle 80-90 degrees Magnetization prepared T1 weighted GRE images [STIR] very short TR < 10mesc flip angle 40 degrees Inversion time 500 T2 weighted images Normal liver shows intermediate signal Spleen shows increased signal compared to the liver • Conventional T2 spin echo sequences • T2 with rapid acquisition and relaxtion enhancement FSE Difference from T2 SE • Higher signal intensity of fat on FSE • magnetic susceptibility artifacts of metals on FSE • ↑ magnetization transfer effect in FSE→ signal of solid lesions MRI Fat suppression Advantages • Decrease motion artifacts • Improve signal/ noise and contrast/ noise ratios of focal hepatic lesions Thank you سبحانك الهم و بحمدك @ نشهد ان ﻻ اله اﻻ انت @ نستغفرك و نتوب اليك Diaphragmatic attachment of the liver Malignant Colonic polyp .
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