Abdominal

Imaging
Xian LI
Dept. of Radiology, the Affiliated Hospital
of JiNing Medical College
Section 1
the liver
TEACHING OBJECT
Emphasis
Thecharacteristic findings of
common diseases of the liver
Comprehend
The liver imaging techniques
一、 Liver imaging
techniques
 X-ray examination
 Ultrasound (US)
 Compute tomography (CT)
 Magnetic resonance imaging (MRI)
（一） X-ray examination
The limited soft tissue contrast and projection acquisition
of plain radiographs
approximately estimate the liver contour and size

Plain film
useless in the diagnosis of
liver diseases.
 （ 二） Ultrasound

The normal echo texture of color Doppler imaging

the liver parenchyma is The vascular systems in the
homogeneous liver may be studied
（ 二） Ultrasound

widely available, easily performed

and has no contraindications.
a noninvasive and excellent screening
tool.
（ 三） CT
 Highspatial resolution and rapid
acquisition time
 The mainstay for hepatocellular imaging
（ 三） CT
 CT of the liver can be performed with or without
contrast material.
 The vascular structures can be identified by their
location on the unenhanced images and
confirmed by enhancement with intravenous
contrast.
Pre-contrast Enhance-CT

The liver parenchyma is homogeneous with

attenuation values of 55–65 HU, usually 8–10
HU greater than the spleen.
Precontrast
Enhance-CT
•the difference in attenuation between
parenchyma and tumor can be quite subtle
on the precontrast CT. Contrast-enhanced
imaging is widely used for the detection
and characterization of focal lesions.
Dynamic Contrast CT

 Arterial Phase: (delayed time:25-30s)

 Portal vein Phase: (delayed time:55-60s)
 Delayed Phase: (delayed time:90-200s)
The liver have a dual blood
supply
 approximately 75%
originating from the portal
venous system
25% arising from the
hepatic artery.
 arterial phase Portal vein phase
(when the contrast just (when the contrast
fills up the aorta and the disperses into the liver
main hepatic arterial parenchyma and mixes
structures) with portal blood)
 Multiplanar Reconstruction
MPR
True volume acquisition with isotropic voxels
rapid reformatting in other planes
（四） MRI
the liver is brighter than (hyperintense to) the
spleen on T1-weighted images and darker than
(hypointense to) the spleen on T2-weighted
images.
MRI
multiple sequences
multiplanar capability

T1WI

Fat saturation
T2WI
（四） MRI
MRI has many advantages over CT
high soft tissue contrast resolution
(can see smaller lesions)
multiple sequences
multiplanar capability
no radiation, no iodinated contrast·
etc.
二、 Common diseases of Liver

 Hepatocellular （ HCC ）
 Cavernous
haemangioma （ CH ）
 Hepatic metastasis
 Hepatic Cyst
Hepatic cirrhosis
1 、 Hepatocellular
Carcinoma
Clinical and pathology
 the commonest primary malignant neoplasm
of the liver
 Risk factors include: aflatoxin, chronic
hepatitis and cirrhosis
 Patients present with abdominal pain and
often have a palpable mass ,jaundice, weight
loss, and fever
 the serum alpha-fetoprotein is often elevated.
Hepatocellular Carcinoma
 Solitary mass
 Multifocal nodule
 Diffuse involvement
CT findings
Unenhanced
 an iso-hypodense mass.
 Large lesions may show internal heterogeneity,
due to haemorrhage, necrosis, or fat .
 Hypodense capsule rim-one of the more specific
signs indicating HCC
CT findings
Enhanced CT
 occurs and disappears earlier
 arterial phase : an early moderate to
high degree of homogeneous
enhancement
 portal vein phase: the lesion becomes
iso-or hypodense
 complications ： portal vein invasion
 Focal lesion: Contrast uptake dynamics

Arterial phase
Portal phase

delayed phase
 CT

Precontrast Arterial phase

Portal phase delayed phase

Tumorextends to portal vein

THROMBUS

NORMA
CT L
 CT
Intrahepatic
bile duct
dilation

NORMAL
 CT
Enlargment of
the lymph gland

normal
MRI findings
 T1 Weight images
 iso-hypointensity
 T2Weight images
 moderately increased signal
 the enhancement patterns with
gadolinium parallel those for enhanced
CT examination
MRI

T1WI

T2WI T2WI
 MRI

Pre-constrast

Arterial phase

Portal vain phase

 小 HCC

Arterial phase Portal vain phase

 male,44Y

Arterial phase

Portal phase
CT
CT delayed phase
 Same case

T2WI

Arterial phase

MRI Portal
DWIphase
embolism with Iodinated Oil
 CT is frequently the first examination;
however, MRI has superior contrast
resolution and may better detect lesions less
than 1 cm in diameter.
2. Cavernous Hemangioma CH
 the commonest benign hepatic tumors.
 the lesions are usually asymptomatic but
large tumors may cause abdominal
discomfort or pain,
 Commonly multiple lesions
 Focal fibrosis, cystic spaces, necrosis
frequently present in large lesions
 CT findings
Unenhanced CT :
Low attenuation (dark)
large lesions ： the thromboses ,necrotic or
fibrotic areas are lower in attenuation
CT findings
 Enhanced images
 Arterialphase: a peripheral, discontinuous, intense
nodular enhancement
 Portal vein phase: later centripetal filling to
uniform enhancement
 Foci of no enhancement (focal fibrosis, necrosis,
cyst)
Low attenuation
CT

Peripheral enhancement of one or more

nodular or globular strcture which
encircled the tumor
CT

progressive infilling of the lesion form

the peripheral towards the centre
CT

Complete filling in
 CT

Arterial phase

Portal vein phase

Delayed phase
MRI findings
 T1WI low signal intensity
 T2WI homogeneously marked high signal
“light bulb”
 Gd-DTPA (Gadolinium)
similar to that observed on contrast enhanced
dynamic CT
MRI

T1WI T2WI-FS
MRI

T2WI T1WI
 MRI

Arterial phase

Portal vein phase

Delayed phase
 MRI is now considered the most sensitive
and specific imaging examination for the
diagnosis of haemangioma. This is based
primarily on T2w characteristics but also
using the enhancement pattern on T1w
images following IV Gd-DTPA.
The world is a book, and those
who don’t travel read only a
page
 Interleave Joke

A: I’m so glad I wasn’t born

in
the United States.
B: Why?
A: Because I can’t speak
English.
3. Hepatic metastases
Pathogenesis:
 the most common malignant mass in the
liver.
 the three most common sources of
metastasis to the liver:
 Primary tumors of the GI tract (e.g. tumors
of the colon, pancreas, or stomach)
 Breast tumors
 Lung tumors
CT

multiple low
attenuation

multiple low attenuation

Contrast CT
 Some may have rim enhancement.
 Hypervascular masses are enhanced
during the arterial phases. (Many are also
well visualized during the portal venous
phase.)
CT

rim enhancement, the central is

hypodense
 insulinoma

Hypervascular masses are

enhanced during the arterial
phases.
MRI

T1-weighted MRI: mostly hypo-

isointense, can also be hyperintense.
T2-weighted MRI: Iso-hyperintense.
 MRI

T2WI T1WI
Target sign: Doughnut sign: low
hyperintense center signal rim around
surrounded by less even lower signal
intense rim. center
4. absess of liver
Causes ： pyogenic 、 amebic
Clinic ： fever 、 pain 、 enlargement of liver
Bacteria gain access to liver via the portal or
biliary system.
Most pyogenic abscesses occur in the right lobe.
 CT
 Round or ovoid
 inhomogeneous fluid
attenuation
 20% contain gas bubbles.
 A surrounding low-
density halo.
 on contrast-enhanced
CT
“ring sign”
 T1WI
MRI
Abscess ： Liquid
signal areas ；
T1WI: a slightly low
signal ring surrounding
the lesion T2WI
T2WI ： a slightly
low signal ring
5. hepatic cyst
 Pathogenesis
 The most common liver masses.
 May be solitary or multiple.
 ~40% of patients with polycystic kidney
disease have liver cysts. ~ 60% of
patients with multiple liver cysts have
polycystic kidney disease.
CT
 Noncontrast CT:
density of less than 20 HU
well-defined

margins ， homogenous
 Contrast CT:
no enhancement
 平扫

动脉期

静脉期

刘某 ，肝囊
肿
 MRI
a.T1-weighted: homogeneously hypointense
(arrowhead);
b. T2-weighted: homogeneously hyperintense
(arrow) due to water property

T1WI T2WI
 Note: cysts can be confused with
hemangiomas on T2-weighted MRI.
However, on T1-weighted with Gd-DTPA,
cysts do not enhance whereas hemangiomas
do in a centripetal manner.
6.cirrhosis of liver
Pathogenesis:
 Causes of cirrhosis include:
a) alcohol
b) postnecrotic (hepatitis)
C) metabolic disease.
 Cirrhosis pathology consists of hepatocyte
necrosis, fibrosis, and nodular regeneration.
 Cirrhosis increases risk of developing
hepatocellular carcinoma.
 CT
 Loss of volume
 The increase nodularity
of the liver
 The increase in the
caudate lobe/right lobe
ratio
 The widing liver fissure
Ascitic fluid
Enlargement of spleen
 Esophageal varices

extensive collateral vessels

question
thanks