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Radiology > Hepatocilliary System I (liver) > Flashcards

Hepatocilliary System I (liver) Flashcards

1
Q

radilogical modalities for hepatobiliary system:

A
  1. US, CT, MRI, SPECT
  2. MRCP (non invasive)
  3. ERCP (invasive)
  4. Percutaneous transhepatic cholangiogram

MRCP = MR cholangiopancreatography
ERCP = Endoscopic retrograde cholangiopancreatogram

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2
Q

examples for Diffuse liver diseases

A
  1. hepatic steatosis
  2. hepatic fibrosis
  3. infections
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3
Q

Uss of hepatic steatosis:

A

++ parenchymal echogenicity
Loss of visualization of the portal triads

Severe steatosis causes sound-beam attenuation, which will obscure visualization of the deep portions of the liver, & lesions like metastasis.

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4
Q

Hepatic steatosis on CT

A

decreased attention of hepatic parenchyma
HU is lower than the speen by more than 10 on non-contrast exams (and >25 HU with contrast)
Appearanceof Hyperdense vessels on non contrast exam
My obscure lesions that are normally hypodense compared to background liver

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5
Q

Moderate to severe steatosis if either (HU):

A

For non-contrast CT:
Liver attenuation < 40 HU
Liver attenuation > 10HU less than spleen

With IV contrast (portal venous phase):
Liver attenuation > 25 HU less than spleen

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6
Q

Steatosis on MRI

A

Loss of signal on out-of-phase imaging relative to in-phase imaging

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7
Q

describe hepatic steatosis radiologically (review)

A
  1. by US –> increased parenchymal echogenicity
  2. by CT –> Decreased attenuation (less than 40 HU)
  3. by MRI –> loss of signal on out-of-phase imaging relative to in-phase imaging.
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8
Q

review

HU of fatty liver compared to spleen ([HU of spleen] - [HU of fatty liver]) = …..

A

25 HU or more

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9
Q

Other MR techniques for hepatic steatosis

A

MR spectroscopy
MR Elastography
T1 mapping

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10
Q

the fatty liver may make the diagnosis of some diseases difficult radiologically, explain why?

A
  1. by US –> severe steatosis can cause sound-beam attenuation, which will obscure visualization of lesions like metastasis.
  2. by CT –> May obscure lesions that are normally hypodense
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11
Q

Role of imaging in cases of viral hepatitis

A

Image try to exclude biliary obstruction or neoplasm

Image evaluate parenchymal damage non-invasively

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12
Q

Image of …… usually sufficient to suggest dx of acute viral hepatitis and imaging surveillance of patients with hepatitis C prior to the development of heterogeneous nodular fibrotic, cirrhosis.

A

Ultrasound

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13
Q

Ultrasound has poor sensitivity and specificity for detection of:

A

Hepatocellular carcinoma in cirrhotic liver

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14
Q

Image …. or …. is mandatory for HCC surveillance among cirrhotic patients

A

Multiphasic Contrast-enhanced CT
MRI

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15
Q

Grayscale ultrasound of acute viral hepatitis

A

• ++ liver and spleen size
• decrease echogenicity of liver
• increase echogenicity of portal venous walls (starry sky)
• Thickened gallbladder wall
• periportal hypo-/anechoic area (hydropic swelling of hepatocytes)

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16
Q

Grayscale ultrasound of chronic viral hepatitis and cirrhosis

A
  • increase echogenicity of liver and coarsening of parenchymal texture.
  • “silhouetting” of portal vein wall(loss of definition of portal veins).
  • Adenopathy un porta hepatis
17
Q

review

US of acute viral hepatitis

A
  1. increase in size
  2. decrease in echogenicity of liver
  3. increase in echogenicity of portal venous walls (starry sky)
18
Q

describe US of chronic viral hepatitis

A

silhouetting of portal vein walls (i know you like this word Silhouette)

19
Q

Major screening tool for cirrhosis and its complications

A

Ultrasound

20
Q

Gold standard for dx of liver cirrhosis

A

Ultrasound-guided liver biopsy

21
Q

Ultrasound of liver cirrhosis

A

Nodular liver contour
Increased echogenicity
Rught hepatic lobe atrophy with caudate lobe hypertrophy

In advanced disease : shrunken liver

22
Q

Ultrasound of portal hypertension

A

Collateral veins
Increased portal vein diameter
Decreased flow in the portal circulation (doppler)

23
Q

review

which one of these goals, only US is sufficient:
1. suggestion of acute viral hepatitis
2. confirm the diagnosis diagnose
3. detection of HCC in cirrhotic liver

A

only 1 is correct
2. diagnosis is confirmed by serology + biopsy
3. for HCC in cirrhotic liver US has poor sensitivity and specificity

24
Q

review

what is the most useful technique for diagnosis of liver cirrhosis

A

Ultrasonography elastography

25
Q

elastography can be performed by which imaging modality

A

US or MRI (MRE)

26
Q

review

(T/F)
for early liver cirrhosis US is useful, CT is sensitive but costly

A

false (CT is costly and insensitive 😂)

27
Q

DD of multiple liver lesion

A
  1. multiple abscesses
  2. multiple cysts
  3. multiple haemangiomas
  4. multiple metastasis
  5. multiple regenerating nodules in cirrhosis
28
Q

Multiple hepatic nodules of different sizes within the liver is nearly always due to …..

A

metastasis

29
Q

what is the study of choice for evaluating liver metastases

A

CT

30
Q

(T/F)
for liver metastases CT is useful, MRI is sensitive but costly

A

false (MRI is costly and less sensitive 😂)

31
Q

hallmarks for liver abscess (compared to mets)

A
  1. ring enhancement
  2. history of infection
32
Q

common site of liver hemangioma

A

subcapsular - posterior - right lobe

33
Q

(T/F)
liver hemangioma mainly calcified?

A

false (rarly < 10%)
CALCIFICATION of hemangiomata is rare everywhere

34
Q

hepatic adenoma, is …. neoplasm common in …. due to …. and typically [solitary/multiple]

A
  • benign solid
  • young woman
  • oral contraceptives
  • solitary
35
Q

according to benign liver tumors which one is common in woman or men

A

in women hepatic adenoma
in men focal nodular hyperplasia

otherwise “🌈” both 😂

36
Q

special sign for focal nodular hyperplasia:

A

by US spokeweel sign
by enhanced CT = central fibrosis

37
Q

hepatoma is benign?

A

no (Hepatocellular carcinoma is malignant)

38
Q

HCC can be in three forms:

A

focal
multifocal
infiltrative

39
Q

AAST grading system of liver injury

A
  1. less than 1cm
  2. 1-3cm
  3. less than 25% of hepatic lobe
  4. 25-50% of hepatic lobe
  5. > 50% of hepatic lobe
  6. hepatic avulsion

Radiology (37 decks)

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