Lecture 32: Radiology of Liver, Pancreas and Gallbladder

Question 1

What is the concept of MRI?

Answer 1

Manipulate Hydrogen protons with strong magnetic field

Detect signals

Question 2

How do you know liver is normal in MRI T1 and T2? Abnnormal?

Answer 2

Liver looks like the CSF fluid if normal

Liver looks like spleen if abnormal

Question 3

How do you differentiate metastasis and cysts/hemangiomas?

Answer 3

1. Metastatic disease have the same intensity as the spleen

2. Cysts and Hemangioma look like the CSF

Question 4

What are the characteristics of Hepatic steatosis?

Answer 4

1. Mostly asymptomatic
2. Vague RUQ pain
3. Elevated LFTs (AST and AlT elevated)

Question 5

What are the risk factors for hepatic steatosis?

Answer 5

1. Obesity
2. Metabolic Syndrome
3. Alcohol

Question 6

What is NASH?

Answer 6

Non Alcoholic SteatoHepatitis
Steatosis + Inflammation
#1 cause of “cryptogenic” cirrhosis lol
Hard to diagnose fatty liver but hard to diagnose NASH

Question 7

How do you diagnose fatty liver with T1?

Answer 7

Left image = fat and water signals are in phase
Right image = fat and water signals are out of phase
If there is a difference in “in phase” and “out of phase” images, then you have a fatty liver

Question 8

What are the characteristics of genetic hemochromatosis?

Answer 8

1. Autosomal recessive
   
   • most common genetic disorder in the US
2. increase iron absorption from gut
3. average patient sees 5 doctors and waits 5 years before diagnosis is made
4. Treatment with phlebotomy (if diagnosed early)
   
   • rid the body of iron

Question 9

How do you diagnose hemochromatosis?

Answer 9

In T1, the liver is much darker than in a normal liver

Question 10

What are the characteristics of gallstones?

Answer 10

1-3% of gallstones each year

Question 11

How do you develop biliary colic?

Answer 11

Stone in the cystic duct
Can go back to gall bladder (pain subsides)
Can go on to the common bile duct (causes jaundice)

Question 12

What are two tribes of Indians that get gall stones?

Answer 12

1. Pima
2. Chippawa
   Cholesterol stones
   They are prone to getting these stones because they lack HMGCoA reductase is screwed up (because cant make bile salts)

Question 13

What are the characteristics of pancreatic cancer?

Answer 13

1. 38000 new cases per year and 34000 deaths/year
2. > 80% of patients unresectable
3. 5 year survival <5%
4. Median survival = 6 months
5. Radiologists are supposed to say if mass is resectable or unresectable and to limit sequelae by bypassing the obstruction of the pancreas head mass (duodenal obstruction to common duct)

Question 14

How can you tell it is pancreatic cancer through MRCP?

Answer 14

1. Double duct sign
   The common bile duct and the pancreatic ducts are BOTH dilated
   Caused by obstructed head mass of the pancreas

Question 15

What are the most common causes of jaundice?

Answer 15

1. Pancreatic cancer

2. common bile duct stones