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Computed Tomography of the Abdomen

Computed tomography of the Abdomen

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Computed Tomography of the Abdomen

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    1. Computed Tomography of the Abdomen Gastric leiomyosarcoma.Gastric leiomyosarcoma.

    2. Computed tomography of the Abdomen & Pelvis Routine Abdomen Liver Kidneys Pancreas KUB

    3. Indications CT Abdomen! Anatomy? What can go wrong? Where are the most common pathologies / anomalies

    4. Indications Abdominal pain (LLQ-suspect diverticulitis) (RLQ-suspect appendicitis) Diffuse (acute abdomen or chronic, pain) History of malignancy (lymphoma, cancer of colon, breast, stomach, lung, bladder, other) Abdominal or pelvic mass Fever and elevated white count, suspected abscess Trauma Miscellaneous: infection, weight loss, bowel obstruction, question of free air or pneumatosis on plain films, postoperative complication, follow up of complicated pancreatitis, follow up Ca screening. Follow up of ultrasound findings

    5. Contraindications Contraindications As per contrast contraindications according to contrast related contra indications. Patient preparation As per post contrast indications and contraindications.

    6. Patient preparation 4 hour fast Oral contrast for 1 hour prior to scan. Oral contrast Barium sulphate based solution Non ionic Intravenous contrast solution Water Patient changed into radiolucent gown Artifacts removed All clothing except underclothing Bra and garters should be removed

    7. Patient orientation / position Patient supine Feet first Patient to raise arms up above head, and elbows in. Landmark Xyphoid sternum In mid coronal plane

    10. Scan technique Scan type Anteroposterior and lateral scout Helical Coverage Superiorly from dome of diaphragm Inferiorly to include Iliac crests, include pelvis if required. Comments Images acquired during suspended inspiration. If lesion is demonstrated a 5 minute delay series may be required. For oesophageal or stomach mass, an additional glass of contrast is to be ingested via drinking straw while patient is on table.

    11. Contrast technique Volume 60-80mls Injection rate / type 2-3mls/second Pressure injected Scan delay 60-75 seconds bolus tracking Smartprep, surestart etc (cardiac output) Comments Rectal contrast: may be required for rectal carcinoma or perforated bowel. Vaginal contrast: tampons may be required for female patients having pelvic scans.

    12. Image reconstruction 1st reconstruction 7mm / 7mm (soft tissue/mediastinal) 2nd reconstruction 3mm / 3mm (MPRs)

    13. Filming Format 20 format Window width / window level 350ww / 40wl (soft tissue) (also called standard) Comment Inlcude lung bases with lung setting at end of study.

    14. Post processing Reformations Coronal MPR (to demonstrate pathology if required)

    15. Abdomen Axial standard

    20. Phase studies Pre (non) contrast Arterial phase Portal venous phase Delayed Phase normal liver parenchyma receives about 70% of its blood from the portal vein and 30% from the hepatic artery. Most primary and metastatic liver tumors, however, receive their blood from the hepatic artery.

    21. Arterial phase helical CT of the liver improves detection of some small, malignant hepatic neoplasms when performed in addition to portal venous scanning. The value is greatest in those patients who have hypervascular neoplasms.

    23. Computed tomography of the Abdomen / liver Routine Liver

    24. Indications CT Liver! Anatomy? What can go wrong? Where are the most common pathologies / anomalies

    25. Indications Haemangioma Metastases Abnormal ultrasound HaemangiomaHaemangioma

    26. Contraindications Contraindications As per contrast contraindications according to contrast related contra indications. Patient preparation As per post contrast indications and contraindications.

    27. Patient preparation 4 hour fast Oral contrast for 1 hour prior to scan. Oral contrast Barium sulphate based solution Non ionic Intravenous contrast solution Water Patient changed into radiolucent gown Artifacts removed All clothing except underclothing Bra and garters should be removed

    28. Patient orientation / position Patient supine Feet first Patient to raise arms up above head, and elbows in. Landmark Xyphoid sternum In mid coronal plane

    31. Scan technique Scan type Anteroposterior and lateral scout Helical Coverage Superiorly from dome of diaphragm Inferiorly to include Iliac crests, include pelvis if required. Comments Images acquired during suspended inspiration. If lesion is demonstrated a 5 minute delay series may be required. For oesophageal or stomach mass, an additional glass of contrast is to be ingested via drinking straw while patient is on table.

    32. Contrast technique Volume 60-80mls Injection rate / type 2-3mls/second Pressure injected Scan delay 10-20 / 60-80 seconds bolus tracking Smartprep, surestart etc (cardiac output)

    33. Image reconstruction 1st reconstruction 7mm / 7mm (soft tissue/mediastinal) 2nd reconstruction 3mm / 3mm (MPRs)

    34. Filming Format 20 format Window width / window level 350ww / 40wl (soft tissue) (also called standard) 150ww / 40wl (liver if required) Comment Inlcude lung bases with lung setting at end of study.

    35. Post processing Reformations Coronal MPR (to demonstrate pathology if required)

    36. Liver Axial standard

    41. Liver window Burnt Toast

    43. Liver pathologies

    44. Cirrhosis with oesophageal varices.Cirrhosis with oesophageal varices.

    45. Cirrhosis.Cirrhosis.

    46. cirrhosis, splenomegaly.cirrhosis, splenomegaly.

    47. Fatty infiltration secondary to Ca.Fatty infiltration secondary to Ca.

    48. Hemangioma Hemangioma

    49. hemangioma abdo window.hemangioma abdo window.

    50. hemangioma liver window.hemangioma liver window.

    51. Hemangioma.Hemangioma.

    52. Hepatic abscess.Hepatic abscess.

    53. Hepatic adenoma recent bleed.Hepatic adenoma recent bleed.

    54. hepatic infarct.hepatic infarct.

    55. Hepatoma.Hepatoma.

    56. Liver abscess.Liver abscess.

    57. liver mets due to colon ca.liver mets due to colon ca.

    58. Metastatic renal cell carcinoma to the liver.Metastatic renal cell carcinoma to the liver.

    59. polycystic liver disease.polycystic liver disease.

    60. PV thrombosis, recurrent hepatoma.PV thrombosis, recurrent hepatoma.

    61. radiation thrpy changes.radiation thrpy changes.

    62. Computed tomography of the Abdomen / liver Routine Kidneys

    63. Indications CT Kidneys! Anatomy? What can go wrong? Where are the most common pathologies / anomalies

    64. Indications Acute flank pain, hematuria, suspected renal colic Renal mass Filling defect Hematuria Prior renal cell carcinoma (post partial nephrectomy or at high risk for bilateral tumors as in von HippelLindau or papillary renal cell carcinoma) History of bladder cancer, abnormal IVU suggesting upper tract disease Pyelonephritis unresponsive to antibiotics (pre contrast shows stones, enhanced and delayed views evaluate forpyelonephritis, abscess, obstruction. Perinephric haemorrhage, evaluate for renal tumour or other cause

    65. Contraindications nil

    66. Patient preparation No fasting required Patient changed into radiolucent gown Artifacts removed All clothing except underclothing Bra and garters should be removed

    67. Patient orientation / position Patient supine Feet first Patient to raise arms up above head, and elbows in. Landmark Xyphoid sternum In mid coronal plane

    70. Scan technique Scan type Anteroposterior and lateral scout Helical Coverage To include kidneys in their entirety. Comments Images acquired during suspended inspiration. Renal mass: Three phase, non contrast, arterial phase and portal venous phase. Filling defect: portal venous phase and 5 minute delayed. Include entire urinary tract if reqiured.

    71. Contrast technique Volume 60-80mls Injection rate / type 2-3mls/second Pressure injected Scan delay 10-20 / 60-80 seconds bolus tracking Smartprep, surestart etc (cardiac output)

    72. Image reconstruction 1st reconstruction 7mm / 7mm (soft tissue/mediastinal) 2nd reconstruction 3mm / 3mm (MPRs)

    73. Filming Format 20 format Window width / window level 350ww / 40wl (soft tissue) (also called standard)

    74. Post processing Reformations Coronal MPR (to demonstrate pathology if required)

    75. Kidneys Axial standard

    76. Renal Pathologies

    77. 2cm renal cell carcinoma pre contrast.2cm renal cell carcinoma pre contrast.

    78. 2cm renal cell carcinoma.2cm renal cell carcinoma.

    79. Acute pyelonephritis.Acute pyelonephritis.

    80. Obstruction 2 to distal stone with pyelonephritis.Obstruction 2 to distal stone with pyelonephritis.

    81. Polycystic kidney disease.Polycystic kidney disease.

    82. Polycystic kidneys.Polycystic kidneys.

    83. Renal cell carcinoma extends into renal vein and IVC.Renal cell carcinoma extends into renal vein and IVC.

    84. Renal cell carcinoma invades IVC.Renal cell carcinoma invades IVC.

    85. Renal cyst.Renal cyst.

    86. Renal lymphoma Renal lymphoma

    87. Renal lymphoma.Renal lymphoma.

    88. Renal TB Renal TB

    89. Transitional cell carcinoma of the right ureter.Transitional cell carcinoma of the right ureter.

    90. Computed tomography of the Adrenal glands Abdomen adrenal glands

    91. Indications Metastases Lipoma Adrenal cortical adenoma Evaluation of mass Cushing Syndrome (hypercortisolism) Conn syndrome (hyperaldosteronism; very thin sections needed as tumors are small) Virilization/feminization Characterize mass shown on screening CT with contrast Addison's disease (adrenal insufficiency)

    92. Contraindications Contraindications As per contrast contraindications according to contrast related contra indications. Patient preparation As per post contrast indications and contraindications.

    93. Patient preparation 4 hour fast Patient changed into radiolucent gown Artifacts removed All clothing except underclothing Bra and garters should be removed

    94. Patient orientation / position Patient supine Feet first Patient to raise arms up above head, and elbows in. Landmark Xyphoid sternum In mid coronal plane

    97. Scan technique Scan type Anteroposterior and lateral scout Helical Coverage Diaphragm to iliac crests. Comments Images acquired during suspended inspiration. 4 phases: pre contrast, arterial phase (20 seconds), portal venous phase (60-80 seconds), and 5 minute delayed

    98. Contrast technique Volume 60-80mls Injection rate / type 2-3mls/second Pressure injected Scan delay 10-20 / 60-70 seconds bolus tracking 5 minute delay Comments Rectal contrast: may be required for rectal carcinoma or perforated bowel. Vaginal contrast: tampons may be required for female patients having pelvic scans.

    99. Image reconstruction 1st reconstruction 3mm / 3mm (arterial phase) 2nd reconstruction 7mm / 7mm (portal venous phase, and delayed)

    100. Filming Format 20 format Window width / window level 350ww / 40wl (soft tissue) (also called standard)

    101. Post processing Reformations Coronal MPR (to demonstrate pathology if required)

    102. Adrenal glands Pathologies

    103. Adrenal adenoma (LT)Adrenal adenoma (LT)

    104. Adrenal adenoma.Adrenal adenoma.

    105. Adrenal carcinoma right.Adrenal carcinoma right.

    106. Adrenal carcinoma.Adrenal carcinoma.

    107. Adrenal lymphoma.Adrenal lymphoma.

    108. Adrenal metastases.Adrenal metastases.

    109. Adrenal metastases-lung cancer.Adrenal metastases-lung cancer.

    110. Adrenal neuroblastoma 2.Adrenal neuroblastoma 2.

    111. Adrenal neuroblastoma.Adrenal neuroblastoma.

    112. Computed tomography of the Pancreas Abdomen Pancreas

    113. Indications Acute pancreatitis (assess severity, presence of hemorrhage or necrosis; if extensive disease, usually add pelvis to look for complications there) Painless jaundice and weight loss (suspect pancreatic cancer) Islet cell tumour Chronic pancreatitis Characterize lesion seen on prior imaging (ultrasound, ERCP) Pancreatic mass

    114. Contraindications Contraindications As per contrast contraindications according to contrast related contra indications. Patient preparation As per post contrast indications and contraindications.

    115. Patient preparation 4 hour fast Water contrast (500ml) prior to scan Patient changed into radiolucent gown Artifacts removed All clothing except underclothing Bra and garters should be removed

    116. Patient orientation / position Patient supine Feet first Patient to raise arms up above head, and elbows in. Landmark Xyphoid sternum In mid coronal plane

    119. Scan technique Scan type Anteroposterior and lateral scout Helical Coverage Diaphragm to iliac crests. Comments Images acquired during suspended inspiration. 4 phases: pre contrast, arterial phase (20 seconds), portal venous phase (60-80 seconds), and 5 minute delayed

    120. Contrast technique Volume 60-80mls Injection rate / type 2-3mls/second Pressure injected Scan delay 10-20 / 60-70 seconds bolus tracking 5 minute delay

    121. Image reconstruction 1st reconstruction 3mm / 3mm (arterial phase) 2nd reconstruction 7mm / 7mm (portal venous phase, and delayed)

    122. Filming Format 20 format Window width / window level 350ww / 40wl (soft tissue) (also called standard)

    123. Post processing Reformations Coronal MPR (to demonstrate pathology if required)

    124. Pancreas Axial standard

    127. Pancreatic pathologies

    128. Acute pancreatitis.Acute pancreatitis.

    129. Carcinoma of the tail of the pancreas.Carcinoma of the tail of the pancreas.

    130. Cystadenocarcinoma of the pancreas 2.Cystadenocarcinoma of the pancreas 2.

    131. Cystadenocarcinoma of the pancreas.Cystadenocarcinoma of the pancreas.

    132. Cystadenoma pancreasCystadenoma pancreas

    133. Pancreatic abscess Pancreatic abscess

    134. Pancreatic abscess Pancreatic abscess

    135. Pancreatic abscess.Pancreatic abscess.

    136. Pancreatic cancer with vessel encasement.Pancreatic cancer with vessel encasement.

    137. Splenic artery aneurysm simulates a pancreatic mass.Splenic artery aneurysm simulates a pancreatic mass.

    139. Other pathologies Stomach Spleen Colon Trauma

    140. Stomach

    141. Carcinoma of the gastric antrum.Carcinoma of the gastric antrum.

    142. Severe gastritisSevere gastritis

    143. Gastric leiomyosarcomaGastric leiomyosarcoma

    144. Spleen

    145. Infarcted spleenInfarcted spleen

    146. Melanoma metastatic to the spleen.Melanoma metastatic to the spleen.

    147. Moire spleen.Moire spleen.

    148. Splenic hemangioma Splenic hemangioma

    149. Splenic hemangioma.Splenic hemangioma.

    150. Colon

    151. Burkitts lymphoma of the colon.Burkitts lymphoma of the colon.

    152. Cecal carcinoma with intussusception.Cecal carcinoma with intussusception.

    153. Ischemic descending colon.Ischemic descending colon.

    154. Pseudomembranous colitis.Pseudomembranous colitis.

    155. Trauma

    156. Hepatic laceration.Hepatic laceration.

    157. Lung contusion with pneumothorax lung.Lung contusion with pneumothorax lung.

    158. Lung contusion with pneumothorax soft.Lung contusion with pneumothorax soft.

    159. Renal laceration and clot in renal pelvis.Renal laceration and clot in renal pelvis.

    160. Renal laceration pre contrast.Renal laceration pre contrast.

    161. Rupture of the diaphragm.Rupture of the diaphragm.

    162. Subtle hepatic laceration.Subtle hepatic laceration.

    163. Splenic rupture.Splenic rupture.

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