1、Good morning everyone!,唐光健,Liver, gallbladder and pancreas: imaging diagnosis,Method for learning,What is image? Image just is contrast!,Pathologic change to show the changes diagnosis,choice of imaging modality Available, Effectiveness -sensitivity, specificity Cost pathology-imaging (indirectly) C
2、orrelate among images of different modalities,Method for learning,adenoma,metastasis,metastasis,angioma,Angiography,CT,B-sonography,MRI,cyst,Method for learning,cancer,Mr. Diag,cancer,Imaging modalities,conventional radiology B-mode ultrasound computed tomography CT pancreatic-cholangiography angiog
3、raphy magnetic resonance imaging MRI,Liver,liver,Characteristics:poor natural X-ray contrast Luminal Structure biliary canal, vessel system -cholagiography, angiography Parenchyma surrounding adipose tissue -TOMOGRAPHIC IMAGING,liver,main modalities: BUS ERCP PTC CT Angiography MRIcharacteristics of
4、 normal liver homogeneous with parenchyma echo/density/signal of soft-tissue organized distribution and course of the vessels,liver,B mode sonography,t1,t2,t3,It1,It3,It2,liver-normal manifestation,B mode sonography,liver-normal manifestation,CT,liver-normal manifestation,CT,liver-normal manifestati
5、on,Plain scan,Arterial phase,Portal V. phase,angiography,DSA,Routine,liver-normal manifestation,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-lesions,Solid lesions malignant hepatic c
6、ell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-HCC,pathologic features correlate to imaging (bulky type) concentrated cellularity, no hepatic plate or sinus structures intracellula lipomicron,edema of the tissue lack of blood suppl
7、y, necrosis tumor vessel, 80% from HA, A-V shunt,liver-HCC,imaging manifestations B-sonography,hypo-/moderate/hyper-echogenic, hypoechogenic halo,liver-HCC,arterial flow,imaging manifestations color-Doppler flow imaging,liver-HCC,imaging manifestations CT,plain scan,contras enhancement,inhomogeneous
8、 low density mass, low enhancement,liver-HCC,imaging manifestations CT-double phase enhancement,plain scan,a. phase,P.V. phase,a. phase enhancing, fast in fast out,liver-HCC,T1WI,CE T1WI,T2WI,heavy T2WI,long T1 long T2, SI attenuate with heavy T2WI, +Gd enhancing,imaging manifestations-MRI,liver-HCC
9、,feeding A. thickening, tumor vessels, tumor staining, AVF,imaging manifestations angiography,liver-HCC,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-lesions,Solid lesions malignant h
10、epatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-cavernous angioma,pathologic features correlate to imaging micro-blood sinusoid & interstitial tissue between sinusoids slow blood flow intra-sinusiod,flow from peripheral to c
11、entral zone no capsule,liver-cavernous angioma,Hyperechogenic mostly,liver-cavernous angioma,imaging manifestations sonography,vein flow,liver-cavernous angioma,imaging manifestations Doppler color flow imaging,imaging manifestations CT,plain scan,arterial ph.,p. vein ph.,balance ph.,low density, tu
12、berculiform enhance peripherally, enhancing zone growing-fast in slow out,liver-cavernous angioma,blood pool, popcorn like, tumor stain slow,liver-cavernous angioma,imaging manifestations angiography,Long T1, long T2, no attenuation of T2 SI with heavy T2WI,T1,heavy T2,T2,liver-cavernous angioma,ima
13、ging manifestations-MRI,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cys
14、t abscess of liver cirrhosis of liver,pathologic features correlate to imaging cyst wall uniformly thin clear fluid inside the cyst without blood supply normal adjacent hepatic parenchyma, mass effect with large cyst,liver-cyst,anechoic, posterior echo-enhance, side-wall “lost”,liver-cyst,imaging ma
15、nifestations-US,edge sharp & smooth , “no wall”, fluid desity, no enhancement,plain scan,contrast enhance,liver-cyst,imaging manifestations-CT,T1WI,T2WI,Heavy T2WI,edge sharp & smooth, “no wall”, long T1 long T2, no SI attenuation with heave T2WI,liver-cyst,imaging manifestations-MRI,liver-lesions,S
16、olid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,l
17、iver-abscess,pathologic features correlate to imaging cystic purulent cavity + inflammatory wall edema of the adjacent tissue ! Inflammatory process,liver-abscess,plain scan,contrast enhancement,fluid density cyst; thick wall lower density, may be enhanced; liver adjacent lesion lower density; intra
18、-cystic gas,liver-abscess,imaging manifestations-CT,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angioma Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,liver-lesions,Solid lesions malignant hepatic cell carcinoma ( HCC ) benigncavernous angiom
19、a Cystic lesions hepatic cyst abscess of liver cirrhosis of liver,pathologic features correlate to imaging regenerative nodules (large style & small style) hepatic fissure widen caudal lobe enlarge portal vein hypertension- thickening of the portal v., collateral circulation, splenomegaly, ascites,l
20、iver-hepatic cirrhosis,liver-cirrhosis,imaging manifestations CT,nodule-like edge, collateral shunt,liver-cirrhosis,imaging manifestations CT,enlargement of caudle lobe, hypotrophy of right lobe,liver-cirrhosis,imaging manifestations CT,ascitessplenomegaly,billiary,system,Characteristics:poor natura
21、l X-ray contrast Luminal Structure biliary tree, gall bladder -cholagiography, sonography very small amount of parenchyma not good for tomographic imaging,Biliary system,Biliary system,imaging modalities B-mode sonography X-ray: cholangio-, cholecystography endoscopic retrograde cholangiopancreatogr
22、aphy, ERCP percutaneous transhepatic cholangiography, PTC CT, 3D reformation MIP, MPR MRI, hydrographyMRCP,cholecystography-oral Iopenoic acid,after graphy,before graphy,after fat meal,Biliary system -normal manifestation,ERCP,Biliary system -normal manifestation,B-mode sonography,Biliary system -no
23、rmal manifestation,CTC & MR hydrography MRCP,CTC,Biliary system -normal manifestation,MRCP,CTC & MR hydrography MRCP,Biliary system -normal manifestation,curved MPR,Biliary system -normal manifestation,MSCT & MPR,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-c
24、holecystitis：acute/chronic malignant-carcinoma of gallbladder,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：achute/chronic malignant-carcinoma of gallbladder,Biliary system gall stones,pathologic features correlate to imaging intra the cavity wit
25、hin bile fluid without calcification/with calcification lack of water,imaging modalities B-mode sonography first choice X-ray filming: X-ray negative stone: cholecystography ERCP-with therapy X-ray negative stone undiagnosable detect complicated cholecystitis,Biliary system gall stones,imaging manif
26、estations X-ray filming,X-ray positive stone: plain film,Biliary system gall stones,imaging manifestations X-ray filming,Biliary system gall stones,X-ray nagative stone: cholecystography,imaging manifestations X-ray filming,Biliary system gall stones,X-ray nagative stone: trans T-tube cholangiograph
27、y,imaging manifestations B-mode sonography,Biliary system gall stones,X-ray negative stone: CT cholangiography,imaging manifestations-CT,Biliary system gall stones,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：achute/chronic malignant-carcinoma o
28、f gallbladder,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：acute/chronic malignant-carcinoma of gallbladder,Biliary systemcholecystitis, acute,pathologic features correlate to imaging edema & thickening of the wall hyperemia & edema of mucosa an
29、d serous membrane commonly complicated with stone,Biliary systemcholecystitis, acute,Double counter sign,Biliary systemcholecystitis, acute,imaging manifestations B-mode sonography,plain scan,contrast enhance,enlargement, thick wall, “sandwich” sign of the bladder,Biliary systemcholecystitis, acute,
30、imaging manifestations-CT,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：achute/chronic malignant-carcinoma of gallbladder,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：achute/chronic malignant
31、-carcinoma of gallbladder,pathologic features correlate to imaging chronic inflammatory thickening of the gall bladder wall-slight, uniformly with gall stone mostly imaging modalities BUS CT oral cholecystography, may be fail to show stones, seldom use,Biliary systemcholecystitis, chronic,uniformly
32、thickening of the GB wall,Biliary systemcholecystitis, chronic,imaging manifestations B-mode sonography,wall thickening, enhancing, with gall stone,Biliary systemcholecystitis, chronic,imaging manifestations-CT,plain scan,contrast enhance,Biliary system -lesions,intra-cavity lesions gallstones thick
33、ening of the wall benign-cholecystitis：achute/chronic malignant-carcinoma of gallbladder,Biliary system -lesions,intra-cavity lesions gallstones thickening of the wall benign-cholecystitis：achute/chronic malignant-carcinoma of gallbladder,Biliary systemgallbladder carcinoma,pathologic features corre
34、late to imaging polyp like thickening or mass neoplastic vascularity consecutive liver invasion,Biliary systemgallbladder carcinoma,imaging modalities BUS CT oral cholecystography, -low achievement ratio due to occlusion ERCC,Biliary systemgallbladder carcinoma,retrograde cholecystography ERCC filli
35、ng defect or no filling,Biliary systemgallbladder carcinoma,computed tomography CT tubercular type-nodule: soft tissue density, enhancing with CE, adjacent tissue invasion,Biliary systemgallbladder carcinoma,computed tomography CT tubercular type-nodule: soft tissue density, enhancing with CE, adjac
36、ent tissue invasion,Biliary systemgallbladder carcinoma,computed tomography CT wall thickened type-irregular thickened wall, enhancing with CE, adjacent tissue invasion,Biliary systemgallbladder carcinoma,computed tomography CT massive type-soft tissue density mass, GB disappeared,Biliary systemgall
37、bladder carcinoma,computed tomography CT massive type-soft tissue density mass, GB disappeared,pancreas,Pancreas,Anatomic characteristics:poor natural X-ray contrast retroperitoneal, deep lobelet, interlobular fat adipose tissue around pancreas luminal structure,Pancreas,imaging modalities upper gas
38、trointestinography: low sensitivity, seldom use BUS：low satisfactory rate of sonography X ray：ERCP CT：high sensitivity, first choice mostly MRI：not routine exam,ERCP,pancreas-normal manifestation,US,pancreas-normal manifestation,CT,pancreas-normal manifestation,pancreas-pancreatitis, acute,pathologi
39、c features correlate to imagingedema, necrosis, hemorrhage, infection imaging modality: CT,pancreas-pancreatitis, acute,pancreas-pancreatitis, acute,imaging manifestations-CT,plain scan,contrast enhance,slight intumesce; homogeneous enhancing; edge blurring; edema of adjacent fat, renal fascia; effu
40、sion in anterior pararenal space,pancreas-pancreatitis, acute,imaging manifestations-CT,pancreas-carcinoma (p. head),pathologic features correlate to imaging local mass micronecrosis & hemorrhage ischemic necrosis of central part obstruction of CBD/pancreatic duct,pancreas-carcinoma (p. head),反3字征,p
41、ancreas-carcinoma (p. head),imaging manifestations-X ray ( upper gastrointestinography),hypo-echoic mass, hyper-spots inside, echo attenuation posteriorly,pancreas-carcinoma (p. head),imaging manifestations-US,pancreas-carcinoma (p. head),imaging manifestations-CT,inhomogeneous density mass, inhomog
42、eneous & lower enhancement, intro- and extro-bile duct dilatation, hypotrophy of pancreas body,pancreas-carcinoma (p. head),imaging manifestations-CT,Questions for thinking of,A male, 55, obstructive jaundice, upper abdomen pain but the history not clear. How to choice the imaging modalities and what are your evidences for the choise? A hepatic mass was found with B-US in other hospital, the manifestations were not clear. Who to choice the imaging modalities?,
