Abdominal film reading, lecture 1.

Dr/ ABD ALLAH NAZEER. MD.

Abnormal bowel gas. Too much too little gas.

Abnormal bowel gas. Too much gas.

Small bowel obstruction.

Sigmoid colon volvulus.

CT Anatomy.

Techniques for MDCT and MRI of the liver.

Autosomal dominant polycystic liver disease.

Prenatal US showing a large intra-hepatic cyst, and a normal gall bladder (*). CT scan at births confirmed a very large hepatic cyst and the normal gall bladder (*).

Prenatal MRI confirmed hepatic cyst located in segment IV and postnatal evolution in MRI realized preoperatively at 6 weeks of life. Postnatal US illustrated the rapid growing of hepatic cyst between days 2 of life (D2) and the first months of life (M1).

Hepatic hemangioma lesion at prenatal ultrasound.

Hepatic lesion at postnatal ultrasound; marked, peripheral Doppler blood flow.

Congenital hepatic hemangioma.

The caudate lobe lesion (arrowheads) presents subtle hypersignal on T2-weighted sequence and signal loss on T1-weighted out-of-phase sequence caused by the presence of intralesional fat. Such a lesion shows intense and homogeneous contrast uptake in the arterial-phase, with decay in the portal and delayed phases, presenting greater Hepatobiliary contrast uptake than the adjacent parenchyma, suggesting FNH as the first diagnostic hypothesis. Considering that the presence of intralesional fat in NFH is rare, the patient will be maintained under imaging follow-up. The lesions in segments VII and VIII (arrows) are similar, with marked hypersignal on T2-weighted, hyposignal on T1-weighted sequence, and nodular, peripheral and discontinuous uptake in the arterial phase, a characteristic of hemangiomas.

Multiple, well-defined focal hypervascular lesions, with intermediate signal intensity on T2-weighted sequence, with poor lesion-organ contrast-enhancement. However, the presence of intra lesional fat was detected on out-of-phase T1-weighted sequence. The presence of intra lesional fat is not usually found in FNH and suggests the diagnosis of adenoma – adenomatosis

Small HCC seen only in arterial phase in a patient with cirrhosis.

NECT, arterial and portal venous phase in a patient with Hepatitis C with two lesions in the liver (arrows).

LEFT: Diffusely enhancing tumor thrombus in HCC with portal vein invasion. RIGHT: Tumor thrombus with vessels within the thrombus.

Large HCC with mozaik pattern in a non cirrhotic patient.

Two liver nodules are seen in the segment VIII (arrows) as well as a larger nodule, in the segment VI (arrowheads), all of them contrast-enhanced in the arterial-phase, washout in the delayed-phase, and without uptake in the hepatobiliary-phase, characterizing HCCs.

Cholangiocarcinoma: portal venous and equilibrium phase.

Cholangiocarcinoma: Non enhanced, arterial, portal venous and equilibrium phase.

Colorectal metastasis with hyper-(rim)/hypo-/hypo- appearance. (a) Arterial phase image shows a homogeneously enhanced hyperattenuating rim (arrows). (b) Portal phase image shows that the lesion was homogeneously hypoattenuating. (c) Equilibrium phase image shows that the periphery of the metastasis is hypoattenuating (arrows) relative to the enhanced center of the lesion and the surrounding liver parenchyma.

Hepatic metastasis.

Analysis of dynamic vascular pattern(DVP) in ultrasound can be usedto distinguish benign from malignant flow patterns in focal liver lesions.

Four clinical cases show how DVP parametric images allow facilitated lesion characterization as benign or malignant in four typical clinical examples, with malignant lesions appearing in red, unlike benign lesions which are green or yellow-green in appearance.

Thank You.