Abdomen and pelvis

CT ANATOMY

MAMDOUH MAHFOUZ MD
mamdouh.m5@gmail.com

www.ssregypt.com
 CT
ABDOMEN
Indications
 Patient preparation
 Patient position
 Scanogram

• To assess equivocal imaging findings

• Staging of hepatic neoplasms
• Metastatic workup of primary malignancies
• Diagnosis of abdominal masses
• Assessment of biliary problems
• Diagnosis of vascular lesions
• Assessment of suspected post-traumatic complications
Patient preparation
 Oral contrast material to opacity the
gastrointestinal tract [gastrographin
38% diluted by water to 4%]
- Timing?
 Not indicated in
 Acute abdominal trauma
 Acute renal colic
 Dehydrated patients
 CT
ABDOMEN
Indications
 Patient preparation
 Patient position
 Scanogram

No required preparation unless the patient is going to be sedated

or injected with contrast material
FASTING FOR 4 - 6 HOURS
 Scanogram Frontal
 10mmscan intervals [ 5mm sections are necessary
for pancreas, suprarenal glands, urinary bladder]
 Window setting
 Soft tissue window
 Lung window [scans at the lung bases]
 Bone window [lesions in the spine or pelvic bones]
Patient preparation
IV contrast material [urographin,…] 60ml
• Fasting 4-6 hours ?!
• Pre contrast scans [ liver, kidney, urinary bladder]
• Triphasic scan for liver [ arterial, portal, delayed]

Detailed examination
of the Superior
Mesenteric Artery and
Celiac Artery. Scan time
= 9.4 seconds. 1mm
slice thickness
Value of precontrast study
 Arterial phase

Hyper vascular deposits

Value of arterial phase
images in hepatic
lesion detection
Male
pelvis
Female
pelvis
 LS
MS

AS

PS
Hepatic segmental anatomy
 MS LS

AS

PS
 MS LS

AS

PS
Contrast enhanced CT
or MRI

No focal lesions
?!!
?!
Diffuse hepatic diseases?!!
Fatty liver
Cirrhosis
Storage diseases
No dilated biliary radicals ?!!
Intrahepatic bile duct dilatation
 Vessels in the
 Hepatic artery
liver ?!!
 Hepatic veins
 Portal veins
CT Portography
CT Portal venography
showing portal
hypertension with GE
varicosities

CT Portal venography in a
56Y Male with portal vein
thrombosis
Normal
variants
Agenesis of the anterior segment of the right
hepatic lobe
Porta-hepatis
Hepatic artery
Portal vein
cbd
Pancreas
Anatomy
 Anterior pararenal space,
retroperitonium
 Head (3cm) neck, body (2.5cm)
and tail (2cm)
 Pancreatic density is similar to
unopacified bowel and vessels
 5mm sections
 Pancreas does not have a firm
capsule
Pancreatic atrophy with fatty infiltration, age related
Pancreatitis, acute Pancreas, normal
Pancreatic
anatomy
Pancreatic head, superior mesenteric artery and vein
Suprarenal glands
F 35Y
 QUIZ
CASES

1
2
3
MRI
Coil selection

 Body coil
 Phased – array multicoils
• Increases signal/ noise
ratio
• Allows smaller field of view
• High cost
• Very high signal of
subcutaneous fat
Examination protocol

• Coronal localizer
• Axial T1 and T2 WIs
• Coronal T1 and T2 WIs
• Axial T2 fat suppression
• Dynamic post contrast axial T1 WIs
[Arterial , portal and delayed phases with or without fat suppression ]
 Normal liver is of similar or higher signal to muscles [T1]
 Normal liver shows intermediate signal [T2]
 Spleen shows increased signal compared to the liver [T2]
MRI normal spleen
Multiple Angiomyolipomas
T1, T1 Fat sat, T1 fat sat +c
MR advantages
 MR is more sensitive in detection
and characterization of hepatic hemangioma
[high signal on heavily T2 weighted sequences]
 MR can differentiate focal fatty changes from deposits
 In diffuse fatty infiltration hypo dense deposits may
be masked by the hypo dense background of fatty
liver on CT .On MR the background is relatively high
signal in T1 WIs while deposits are of low signal,
Hemangio
so increases the difference
mas
 MR is sensitive for detection of hemorrhage
demonstrat
ed by
heavily
weighted
Normal renal
MRI.
 Normal renal
MRI.
[Fat suppression]

T T T1+
1 2 C
 T1 weighted images
 Normal liver is of similar or higher signal to muscles
• T1 spin echo sequences
• T1 breath hold gradient echo images SPGR/ FLASH
Short TE 5 msec TR> 100mesc
Flip angle 80-90 degrees
Magnetization prepared T1 weighted GRE images [STIR]
very short TR < 10mesc
flip angle 40 degrees
Inversion time 500
 T2 weighted images

 Normal liver shows intermediate signal

 Spleen shows increased signal compared to the liver
• Conventional T2 spin echo sequences
• T2 with rapid acquisition and relaxtion enhancement FSE
Difference from T2 SE
• Higher signal intensity of fat on FSE
•  magnetic susceptibility artifacts of metals on FSE
• ↑ magnetization transfer effect in FSE→ signal of solid lesions
MRI
Fat suppression
Advantages
• Decrease motion artifacts
• Improve signal/ noise and
contrast/ noise ratios of focal hepatic lesions
‫‪Thank‬‬
‫‪you‬‬

‫سبحانك الهم و بحمدك @ نشهد ان ال اله اال انت @ نستغفرك و نتوب اليك‬
Diaphragmatic attachment of
the liver
Malignant Colonic polyp