Radiological Anatomy of

Abdomen
Indications
•Abdominal pain
•Abdominal sepsis
•Postoperative complications
•Trauma
•Vascular compromise, e.g. aortic aneurysm
•Bowel obstruction
•Bowel perforation
•Colon cancer
•Intra-abdominal trauma
Basics of contrast-enhancement
The purpose of contrast-enhanced CT (CECT) is to find pathology by enhancing
the contrast between a lesion and the normal surrounding structures.
Sometimes a lesion will be hypovascular compared to the normal tissue and in
some cases a lesion will be hypervascular to the surrounding tissue in a certain
phase of enhancement.
Different type of phases are:-
• Non-enhanced CT (NECT)
Helpful in detecting calcifications, fat in tumors, fat-stranding as seen in inflammation like appendicitis,
diverticulitis, omental infarction etc.
• Early arterial phase - 15-20 sec p.i. or immediately after bolus tracking
This is the phase when the contrast is still in the arteries and has not enhanced the organs and other soft
tissues.
• Late arterial phase - 35-40 sec p.i. or 15-20 sec after bolus tracking. Sometimes also called "arterial phase"
or "early venous portal phase", because some enhancement of the portal vein can be seen. All structures that
get their blood supply from the arteries will show optimal enhancement.
• Hepatic or late portal phase - 70-80 sec p.i. or 50-60 sec after bolus tracking. Although hepatic phase is the
most accurate term, most people use the term "late portal phase". In this phase the liver parenchyma enhances
through blood supply by the portal vein and you should see already some enhancement of the hepatic veins.
• Nephrogenic phase - 100 sec p.i. or 80 sec after bolus tracking. This is when all of the renal parenchyma
including the medulla enhances. Only in this phase you will be able to detect small renal cell carcinomas.
• Delayed phase - 6-10 minutes p.i. or 6-10 minutes after bolus tracking. Sometimes called "wash out phase"
or "equilibrium phase".
• There is wash out of contrast in all abdominal structures except for fibrotic tissue, because fibrotic tissue has
a poor late wash out and will become relatively dense compared to normal tissue.
Timing of CECT
• Timing of CT-series is important in order to grab the right moment of maximal
contrast differences between a lesion and the normal parenchyma.
• The CT-images show an early arterial phase in comparison to a late arterial
phase.
Total amount of contrast
• In many protocols a standard dose is given related to the weight of the patient:
• Weight < 75kg : 100cc
• Weight 75-90kg: 120cc
• Weight > 90kg : 150cc
• In some protocols a maximum dose of 150cc is given for visualization a
pancreatic carcinoma or liver metastases.
Injection rate
5cc/sec through a 18 gauge i.v. catheter
• For all indications, but especially for GI-bleeding, liver tumor characterization,
pancreatic carcinoma, pulmonary emboli.
• Hold the arm stretched.
3-4cc/sec through a 20 gauge pink venflon
• If 5cc/sec is not possible or not needed because you are only interested in the
late portal phase.
• The upper images are of a patient with liver cirrhosis and multifocal
hepatocellular carcinoma examined after contrast injection at 2.5ml/sec.
Because of poor enhancement the examination was repeated at 5ml/sec.
There is far better contrast enhancement and better tumor detection.
IV non ionic contrast media used are-
Iopamiron , iohexol, ioxaglate, metrizamide
Oral contrast-