Purpose of this presentation is to educate non radiologist about basic CT anatomy of abdominal viscera and basic interpretation of very common diseases

1. Basic CT Imaging of Abdomen—
For Non Radiologist
Dr. Muhammad Bin Zulfiqar
PGR IV FCPS Services Institute of Medical Sciences / Hospital
radiombz@gmail.com

2. •To assess equivocal imaging findings
•Staging neoplasms of solid and hollow viscera
•Metastatic workup of primary malignancies
•Diagnosis of diffuse hepatic diseases
•Assessment of biliary disease and tumour.
•Congenital anomalies.
•Assessment of suspected post-traumatic injuries
Indications for Abdominal CT
imaging

3. CT Anatomy

4.  Patient preparation
 Patient position
 Scanogram….[frontal]
No required preparation unless the patient is going to be
sedated or injected with contrast material
FASTING FOR 4 - 6 HOURS

5. Rt Ventricle
Espohagus
Azygous
Rt Atrium
Lt Atrium
Lt Ventricle
IVC
Aorta

6. Hepatic Veins
IVC
Aorta
Liver

7. IVC
Diaphragm
Lt Portal Vein
Rt Lobe Liver
Lt Lobe Liver
Stomach
SpleenFalciform
Ligament

8. Stomach
Rt Portal Vein
Falciform Lig
IVC Spleen

9. Pancreas
Crura of
diaphragm
Portal Vein
Gallbladder
Pylorous Stomach
IVC
Splenic artery
Lt Kidney
Celiac Artery

10. Pancreas
Lft KidneySMA
GB
Pylorous Stomach
Splenic Flexure
Splenic V
2nd part
Duodenum
IVC

11. SMV
Pancreatic
Head
IVC
Lt Renal Artery
Lt Renal V
Spleen
Splenic flexure
SMA
Hepatic
Flexure

12. SMV
2nd portion
duodenum
Pancreatic Head
Jejunum
SMA

13. Mesentery
Asc. colon
3rd portion
duodenum
Des. colon
Tran. colon

14. Ileum
Asc. Colon
Common Iliac
Arteries
Des. Colon

15. Ileum
Asc. Colon
Terminal Ileum
Lt Iliac V
Lft Iliac Art
Desc. Colon

16. Small Bowel
Iliopsoas
Rectosigmoid
Pyriformis
Glut. Minimus
Glut. Medius
Glut. Max
Ext Iliac V
Ext Iliac Art
Internal iliac A. & V.

17. Bladder
Prostate Rectum
Fem Artery

18. Ovaries
Uterus
Sacrum
Rectum

23. Hepatic pathology
Diffuse lesionsBenign lesions Malignant
lesions
Hepatocellular carcinoma.
 Fibrolamellar carcinoma.
 Hepatoblastoma.
 Metastasis.
Liver cysts.
 Hemangioma.
 Adenoma.
Focal nodular hyperplasia.
Fatty liver
 Cirrhosis
 Storage diseases

24. Hepatic cysts
 Congenital lesions but detected late
 Isolated or associated with congenital cystic disease
 Usually asymptomatic
 Complications [ rupture or hage ] lead to symptoms
 Few mms to several cms in size
Hepatic cysts

25. Hepatic abscess [ Pyogenic ]
 Frequently indolent with no signs of infection
 May present with profound septicemia
 Micro abscesses (>2cm) cluster or scattered
 Macro abscesses :Unilocular or multilocular
 Marginal enhancement 6% ?!
 Gas containing abscesses uncommon

26. Amebic abscess
Peripheral edema is
evident

27. Hydatid cyst

30. The arterial supply is derived from the hepatic artery whereas the venous drainage is into
the hepatic veins. FNH does not contain portal venous supply9.
FNH—Focal Nodal Hyperplasia

31.  Single or multiple masses that are hypo dense to normal liver
 Calcification may be seen
 After contrast injection [ should be Triphasic study]
 Arterial phase : Very early arterial perfusion.
 Portal phase : contrast washout
Hepatocellular carcinoma

32. Hepatocellular carcinoma
 Detects a greater number of HCC than usual scanning
 Detects intravascular thrombosis [ portal vein]
 Better delineation of tumour capsule in capsulated lesions
 Detects early arteriovenous shunting [ sign of malignancy]

33. Hepatoblastoma
 The most common 1ry hepatic neoplasm in children below 5 years
 Usually presents with abdominal mass with elevated AFP
 Large diffuse or multifocal hypodense lesion is seen on CT
 Matrix calcification and septations may be seen

34. Cholangiocarcinoma
 The 2nd most common primary malignant tumor
 Arise from bile duct epithelium [ 3 TYPES ]
 Intrahepatic arises from small ducts
 Or the major ducts near the helium
 Or at the bifurcation of the CHD [ Klatskin tumor]
 HCC: intrahepatic cholangiocarcinoma = 10:1
 No strong association with cirrhosis
 No specific MR appearance

35. Hepatic deposits
 Most of hepatic deposits are hypo vascular
 Hepatic neoplasms receive most of their blood supply via hepatic artery
 Hyper vascular deposits should be assessed by dual phase CT or dynamic MRI
 CTAP and intra operative US are the most sensitive methods for detection of deposits

36. Diffuse Hepatic Disease
 Cirrhosis
 Fatty Changes
 Storage diseases(hemochromatosis &hemosidrosis)
 Neoplastic diseases [ HCC , Deposits , Lymphoma ]

37.  Repeated episodes of hepatic injury  fibrosis + regeneration
 Small fibrotic right lobe with regenerative enlargement of the caudate and left lobe
 Caudate/ right lobe ratio = 0.65 or more
 Portal vein diameter more that 1.3 cm
 Splenomegaly, ascites
 Dilated perisplenic collateral venous channels
Cirrhosis

38. Diffuse Neoplastic disease
Lymphoma 35% of patients with secondary hepatic lymphoma
show either diffuse or mixed pattern (focal+ diffuse)
Imaging findings are non specific

42. An abdominal and pelvic CT scan(IV contrast but no oral contrast) showed
marked lymphadenopathy (arrows) in the retroperitoneum and mesentery .

43. Two metastatic para-aortic lymph nodes in a 49-year-old man with gallbladder
cancer.

44. Computed tomography (CT) scan showing para-aortic metastatic
lymphadenopathy,

45. Lymphoma. A non-Hodgkin lymphoma has para-aortic and mesenteric lymphadenopathy
(arrows) along with splenomegally (arrowhead), on a contrast-enhanced, axial CT scan of the
abdomen

46. CT IVU

47. Ectopic thoracic Kidney and contra-lateral ureteral duplication.

48. Horse shoe kidneys (IVP and CT) with fusion of the kidney anterior to the
spine.

49. Congenital polycystic kidney disease.

51. Bilateral stag-horn stones. Left renal stag-horn stone.

52. Thank You