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radiology > Liver > Flashcards

Liver Flashcards

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1
Q

What is the first line of examination?

A
  • Ultrasound
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2
Q

what are liver exploration thechniques?

A
  • Unprepared Abdomen (ASP)
  • Ultrasound and Echo-Doppler
  • CT Scan
  • MRI
  • Interventional radiology
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3
Q

what are the anomalies that can be seen in the ASP?

A
  • Diaphragmatic dome elevation.
  • Calcifications: *Gallstones
    * calcified hydatid cyst.
  • Air: *Aerobilia
    *Aeroportia
    *subphrenic abscess: Air-fluid level
  • Associated lung lesions: Pleural effusion
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4
Q

why the ultrasound is the first line of examination?

A
  • Accessible, harmless, and reproducible
  • Good liver study
  • Often sufficient for diagnosis
  • complementary to other exams
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5
Q

how the diagphragm appears in the US?

A

hyperechoic

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6
Q

how the gallbladder appears in the US?

A
  • cyst < anechoic
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7
Q

what are the techniques that can be used in Us

A
  • Deep prob: 3.5 MH, preferrable fasting before 6 hours- to keep the gallblader full with bile
  • Echo-doppler: tumoral and vascular patology
  • Contrast Ultrasound: doesn’t exist in Morocco
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8
Q

Limits of the US?

A

*Obesity
*Digestive gases
*Surgical cutaneous superficial scar: shadow
*Operator-dependent examination

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9
Q

cointerindication of US?

A

None

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10
Q

what is the normal echo-anatomy of the liver?

A
  • homogeneous echostructure
  • More echogenic than the renal cortex
  • Regular contours
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11
Q

what are the structures that can be seen in the US?

A
  • hepatic veins
  • Portal veins- Anechoic
  • Inferior Vena cave
  • Hepatic arteries: very small
  • Main bile duct
  • Hepatic segmentation: right and left- help the surgeon
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12
Q

what are the techniques used for CT scan?

A
  • with contrast
  • without contrast
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13
Q

what is the importance of CT-?

A
  • spontaneous density
  • hepatic calcifications
  • Hematoma-bleeding
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14
Q

what is the importance of CT-?

A
  • vascular phases < the vascular behevior of the lesion
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15
Q

what are the vascular phases in CT+?

A
  • arterial
    -portal
    -delayed: venous
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16
Q

what are the advantages of the MRI?

A
  • Non-invasive
  • More sensitive than CT scans: better resolution
  • Hepatic tumors+++
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17
Q

what are the disadvantages of the MRI?

A

*Expensive
* Limited availability
*Contraindications

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18
Q

Thechniques used in MRI?

A
  • without contrast: T1, T2, *In-phase (IP),
    out-of-phase (OP), Fatsat
  • with contrast- gadolinium: T1- vascular timing
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19
Q

the importance of interventional radiology?

A
  • Diagnostic purposes: Ultrasound++ or CT-guided biopsy
    -Therapeutic purposes:
  • drainage of abscesses.
  • In tumor pathology: Chemoembolization or radioembolization. Thermal
    ablations
  • Hemostasis embolization
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20
Q

what are the malignant tumors of the liver?

A
  • hepatic metastasis
  • hepatocellular carcinoma
  • Lymphoma
  • Cholangiocarcinoma: bile duct cancer, it might intrahepatic
  • Fibrolamellar carcinoma: blood or lymphatic vessels
  • Angiosarcoma
  • Hepatoblastoma: children
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21
Q

What are the begnin tumors of the liver?

A
  • hepatic hemangioma/ angioma
  • Focal nodular hyperplasia
  • hepatocellular adenoma
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21
Q

what is the most common hepatic malignant tumor?

A
  • hepatic metastases
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22
Q

how the hepatic metastases often detected?

A

Ultrasound

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23
Q

when the diagnosis of the hepatic metastases are straight forward?

A
  • Known primary cancer
  • Multiple lesions are present
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24
how is the appearance of the hepatic metastses?
- dependes on the appearance of the primary tumor
25
the characteristics of hepatic metastases on ultrasound?
- Unique or multiple - nodular or confluent: irregular - hypoechoic, hyperechoic, isoechoic
26
what are the distinctives appearances on US of the hepatic metastasis?
- Target sign: hypoechoic center in hyperechoic perepheries, or the opposite - Bull's eye sign
27
characteristic appearance of the liver metastasis in the CT scan?
- Multiple hypodense nodules - non-enhancing with contrast, maybe peripheral rim enhancement
28
how the neuroendocrine metastases apears in the ct contrast?
- the took the enhancement i the arterial phase < hypervascularised
29
how the colic metastases appear in the ct contrast?
rim enhancement with center necrosis
30
when the liver is best enhanced- in which phase?
the liver most vascularized by the portal vein- most enhanced in the portal phase more than arterial < difference in contrast
31
what are the hypervascularized hepatic metastasis?
- Endocrine tumors - kidney - thyroid
32
what are the cystic hepatic metastasis?
- head and neck tumors- hypodense in CT
33
what are the hemorrhagic hepatic metastasis?
- melanoma- hyperdense in CT without contrast- bleeding
34
what are the Calcified hepatic metastasis?
- Colerectal cancer, ovarian cancer, osteosarcoma
35
what is the most common primary malignant hepatic tumor?
- hepatocellular carcinoma - occurs at the setting of cirrhosis
36
diagnosis of the HCC?
- Clinical assessment - Laboratory test- alpha-fetoprotein - imaging - biopsy- sometimes, maybe the only cancer the we don't need biopsy sometimes
37
the imaging charcterstics of the HCC on Ultrasound?
- signs of cirrhosis - multiple nodules: unique or multiple - nodular diffuse - Hypoechoic, hyperechoic, isoechoic - small and gomogenous - Portal thrombosis- Portal hypertension - hypervascularization- Doppler, enhanced after the contrast
38
it is HCC until proved the inverse?
portal HCC + Nodule
39
how the portal vein thrombosis appears in the ultrasound?
- isoechoic( should be hypoechoic) and dilated
40
what is the role of ct scan in the HCC?
- Staging and diagnosis
41
imaging characteristics of HCC in the CT scan?
- before contrast: hypodense nodule/mass - After contrast: * Washing in: Hypervascular - arteries < hyperdense in arterial phase * Washout in portal venous phase: hypodense, but the liver is hyperdense <- contrast - Delayed phase: Peripheral capsule- Unconstent sign - Portal vein thrombosis - signs of cirrhosis
42
When we don't need to perform biopsy to confirm HCC?
- Cirrhosis+ the characteristic of the tumor
43
the imaging characteristics of the lymphoma
- primary or secondary - mostly multiple nodules - Hypoechoic, hypodense - hepatomegaly only without nodules
44
differential diagnosis of the focal nodular hyperplasia?
- Fibrolammellar carcinoma
45
what is the most common hepatic benign tumors?
- Hemangioma
46
The characteristics of hemangioma?
- Young women - Incidental discovery- asymptomatic - Never degenerates- can't be malignant - Rarely hemrrhagic- big one < hemorrhage
47
what is the appearance of the angioma on US?
- Typical appearance - hyperechoic nodule - posterior acoustic enhancement - Subcapsular or juxtavascular location - less than 3 cm- can be big - single or multiple( children- angiomatosis) - No doppler sign- no vascular circulation inside
48
what to do if we find accidentaly the hemangioma in a patient?
- small: Follow up by ultrasound - stablenand doesn't grow up - big: confirm the angioma - patient with other primary cancer < CT, or MRI to see if it is metatstases
49
when we do ct scan in case of hemangioma appearance?
- atypical features in US - size > 3 cm
50
what is the characterstic appearance of angioma?
- before contrast: Hypodense - After contrast: Progressive enhancement * Arterial phase: Peripheral contrast enhancement * Portal phase: Filling from periphery to center * Late phase: Homogeneous
51
the characterstics of hemangioma in MRI?
- Before contrast: Hypo in T1, Hyper in T2 - After contrast: Filling from the periphery to the center
52
the characteristics of the focal nodular hyperplasia?
- The second most common benign tumor: *Young women *Incidental discovery- asymptomatic *Always benign
52
the diagnosis of the focal nodular hyperplasia?
- MRI > CT > US
53
the imaging appearance of the focal nodular hyperplasia?
- isoechoic - homogenous - Lobulated contours - Hypervascular in the arterial phase- arterial enhancemnt- hepatocitic< like HCC - Central fibrous scar: late enhancement in the delayed phase
54
in which gender the hepatocellular adenoma is more common?
women
55
risk factor of hepatocellular adenoma?
- oral contraceptive
56
the characteristics of hepatocellular adenoma?
- Hemorrhage - degeneration - acute pain
57
diagnosis of the hepatocellular adenoma
- Biopsy- histology
58
the treatment of hepatocellular adenoma?
- surgery
59
the imaging appearance of the hepatocellular adenoma?
- No suggestive appearance - Hypervascular- hepotocitic - homogeneous or not - fat content- MRI nor ct scan - unique or multiple - it might be multiple
60
What are the cystic pathology of the hepatocellular adenoma?
- the bile cyst - hydatid cysts - liver abscess
61
what is the other name for bile cyst?
- hepatic cyst - no ile inside, just seroud- liquid
62
what are the characteristics of bile cyst?
*Simple cyst *Asymptomatic *Incidental discovery *Single or multiple (hepatic polycystic disease)
63
the imaging characteristics of bile cyst?
- cystic lesion - wall not visible - well defined
64
the appearance of bile cyst on US?
* Pure anechoic image * With posterior enhancement
65
the appearance of bile cyst on CT?
Non-enhanced hypodense lesion
66
the appearance of bile cyst on MRI?
* T1 hyposignal * T2 hypersignal * Non-enhanced
67
the differential diagnosis of the bile cyst?
- type 1 hydatid cyst( with visible wall)
68
Diagnosis of the hydatid cyst?
US
69
the Gharbi classifiction of the hydatid cyst?
- Type 1: Univascular cyst (≠ biliary cyst): anechoic, visible wall, posterior enhancement - Type 2: Cyst with detached membrane- posterior enhancement - Type 3: Multivesicular cyst - Type 4: Heterogeneous pseudo-tumoral cyst (≠ abscess, tumor) - Type 5: Calcified cyst- hyperechoic with posterior shadow
70
complications of the hydatid cyst?
- sureinfection - fissure - rupture+++
71
the role of CT or MRI- Chose one?
* Pre-operative assessment * Differential diagnosis (Type IV) * Complications
72
contrast in hydatid cyst?
absent except in complications
73
the clinicl signs of liver abscess?
Right hypochondrium pain * Fever * Hepatomegaly * Leukocytosis
74
the appearance of liver abcess on the US?
* Hypoechoic lesion * Posterior enhancement * Wall with indistinct margins- irregular
75
the appearance of liver abcess on the CT?
Hypodense lesion * Peripheral contrast enhancement
76
the differential diagnosis of the liver abcess?
- Metastasis with necrosis in the center - hydatic cyst type 4 - hematoma
77
Diffuse non-tumoral pathology of the liver?
- Fatty liver (steatosis) - liver cirrhosis
78
what is steatosis?
* Lipid overload in hepatocytes
79
risk factors of the steatosis?
- diabetes, obesity, hyperlipidemia
80
the appearance of the steatosis on US?
* Liver of normal or increased size *Homogeneous hyperechoic appearance
81
the indication of MRI- fatsat+++ or CT scan in case of steatosis?
- heterogeneous nodular forms , might be cancer
82
Histological definition of cirrhosis?
fibrosis and regenerative nodules
83
the causes of cirrhosis?
- hepatitis B-C, alcohol, primary biliary cirrhosis
84
complications of cirhhosis?
- *Hepatocellular insufficiency *Portal hypertension *Hepatocellular carcinoma (HCC)
85
the imaging signs of cirrhosis?
- Liver parenchyma anomalies: *Heterogeneous, granular texture *Nodules of variable size (isoechoic, non-vascularized)- deformities on the periphery of the lever - Hepatic dysmorphia: *Irregular contours *Hepatic dysmorphia: hypertrophy-Left part or atrophy- right part - Signs of portal hypertension: * Portal vein diameter > 12mm * Splenomegaly * Reversal of portal flow- Doppler * Porto-caval shunts- Alternative pathways * Ascites, potal thrombosis without any mass
86
the appearance of traumatic injury US, and CT scan?
- Intrahepatic hematome( hyperechoic, isoechoic, hypoechoic) - Perihepatic hematoma (subcapsular) - contusions - fracture - Peritoneal effusion - in case of doubt complete with ct scan with contrast

radiology (3 decks)

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