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Deng-Bin WANG, MD, PhD Dept. of Radiology, Rui Jin Hospital SJTU

Abdominal Imaging. Deng-Bin WANG, MD, PhD Dept. of Radiology, Rui Jin Hospital SJTU. The Biliary Tract Liver Pancreas Spleen. Imaging of the Biliary Tract. Methods of examination Normal anatomy and X-ray findings Common diseases. Methods of examination (I).

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Deng-Bin WANG, MD, PhD Dept. of Radiology, Rui Jin Hospital SJTU

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  1. Abdominal Imaging Deng-Bin WANG, MD, PhD Dept. of Radiology, Rui Jin Hospital SJTU

  2. The Biliary Tract • Liver • Pancreas • Spleen

  3. Imaging of the Biliary Tract • Methods of examination • Normal anatomy and X-ray findings • Common diseases

  4. Methods of examination (I) • Plain film: calcium (10~20%) • Oral cholecystography • Intravenous cholangiography • T tube cholangiography • Endoscopic retrograde cholangio- pancreatography, ERCP • percutaneous transhepatic cholangiography, PTC

  5. Plain film — gallstone

  6. Oral cholecystography

  7. T tube cholangiography

  8. ERCP

  9. PTC

  10. Method of examination (II) • Ultrasonography (US) • Angiography • Computed tomography (CT) spiral CT cholangiography (SCTC) • Magnetic resonance imaging (MRI) MR cholangiopancreatography (MRCP)

  11. MRCP

  12. Normal gallbladder anatomy • right 12th rib level • Round, oval or pear-shaped • 7~10cm in length, 3~4cm in width • four parts: funds, body, infundibulum, neck • cystic duct: • 3cm in length, 2~3cm in width

  13. Normal biliary tract findings Intrahepatic bile duct left、right hepatic duct common hepatic duct (3~4cm in length, 4~6mm in width) cystic duct common bile duct (6~10cm in length, 4~8mm in width)

  14. Normal gallbladder and biliary tract anatomy

  15. Normal CT finding of gallbladder • Position: between the left and right lobes of liver, at the porta section or below it. • Shape: oval • Size: 4 × 5cm • Density: lower, a little higher than water, homogeneous Common bile duct : 1/3 is visualized Intrahepatic ducts are not visualized

  16. Common diseases of biliary tract • Gallstone • Cholecystitis • Gallbladder cancer

  17. Gallstones (I) • composition: cholesterol, bile pigment, calcium • shape: round, multi-facet, shell-like • location: gallbladder, intra- or extra-hepatic bile duct

  18. Gallstones (II) • opaque stone (+): 10~20% plain film (differentiate: renal stone) • non-opaque stone (-): 80~90% contrast study: filling defect

  19. Gallstones – non-opacifying

  20. Gallstones – non-opaque stone

  21. Gallstones – opaque stone

  22. Gallstones – opaque stone

  23. Stones in common bile duct

  24. Stones in common bile duct

  25. Hepatic bile duct stone

  26. Gallstones and hepatic duct stones

  27. Differentiation of calculi Calcification of Lymph node Gallstones Ureteral calculi

  28. Acute cholecystitis • Causes: bile duct stone、infection、reflux of pancreatic secretion • Pathology:c congestion and edema of gallbladder mucosa, gallbladder enlarged and its wall thichened • X-ray finding: gallbladder enlarged, gas in the gallbladder lumen or wall. • CT: thickening , irregular and wall(>4mm) ，vague margin.

  29. Chronic cholecystitis • Non-opacifying gallbladder (excluding: inadequate absorption or excretion) • Faint opacifying with vague margin • slower rate of emptying

  30. Chronic cholecystitis

  31. Gallbladder Carcinoma

  32. Hepatic Hilar Cholangiocarcinoma

  33. Biliary ductal system 23 sec Breath-hold

  34. Biliaryductalsystem High spatial resolution of the entire pancreaticobiliary tract and of the adjacent soft tissue 3D FRSFSE • SSFSE & 3D FRFSE 2D Fast GRE T1 w. Fat Sat 2D SSFSE Sl. thickness: 20 mm. Matrix: 512 x 384 Sl. thickness: 2 mm. Matrix: 384x224 Sl. thickness: 3 mm. Matrix: 512 x 192 After Contrast Media Injection FGRE T1 w. Fat Sat Sl. thickness: 7 mm. Matrix: 512 x 256 Sl. thickness: 5 mm. Matrix: 512 x 256 FGRE T1 w. Fat Sat

  35. 2D SSFSE Biliary ductal system • SSFSE & 3DFRFSE 3D FRSFSE 3D FRSFSE 2D SSFSE 2D SSFSE

  36. Biliary ductal system Hepatobiliary system • 2D FIESTA Fat Sat FS FIESTA FS FIESTA SSFSE long TE SSFSE long TE Sl. thickness: 3 mm Matrix 224x224 Zip 512 1 sec / slice

  37. High Resolution T1 w. 3D MRCP - Functional information - Biliary ductal system • LAVA after mangafodipir trisodium administration (Teslascan ) Sl. Thickness 3 mm (ov -0.8 mm) Matrix: 256x224 – ZIP 512 Acq. time: 18 sec

  38. LiverImaging • Plain film • US, CT, MRI • contrast study • GI double contrast • ERCP / PTC • DSA

  39. Plain film

  40. Angiography

  41. CT

  42. CT

  43. Patient preparation 4 elements phase-array coil -> huge anatomical coverage -> high SNR -> Asset compatible Torso coil

  44. MRI

  45. Liver and Pancreas:Dynamic Contrast- enhanced Scanning Protocol for CT or MRI • Early Phase: (delayed time:25-30s) • Portal Phase: (delayed time:55-60s) • Delayed Phase: (delayed time:90-200s)

  46. Common diseases of Liver • Abscess • Hemangioma • Cancer • Cyst • Cirrhosis

  47. Abscess • Causes：pyogenic、amebic • Clinic：fever、pain、enlargement of liver • CT finding：low-density or cystic mass，20 – 40Hu，with contrastcnhancement of the wall, A surrounding low-density halo.

  48. Abscess - MRI

  49. Hemangioma Well-defined, low-density lesion. Dynamic scans after a bolus of intravenous contrast show dense peripheral enhancement at 15’s, with gradual infilling so that the lesion becomes isodense.

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