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radiology > Liver > Flashcards

Liver Flashcards

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
Q

how is the appearance of the hepatic metastses?

A
  • dependes on the appearance of the primary tumor
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25
Q

the characteristics of hepatic metastases on ultrasound?

A
  • Unique or multiple
  • nodular or confluent: irregular
  • hypoechoic, hyperechoic, isoechoic
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26
Q

what are the distinctives appearances on US of the hepatic metastasis?

A
  • Target sign: hypoechoic center in hyperechoic perepheries, or the opposite
  • Bull’s eye sign
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27
Q

characteristic appearance of the liver metastasis in the CT scan?

A
  • Multiple hypodense nodules
  • non-enhancing with contrast, maybe peripheral rim enhancement
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28
Q

how the neuroendocrine metastases apears in the ct contrast?

A
  • the took the enhancement i the arterial phase < hypervascularised
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29
Q

how the colic metastases appear in the ct contrast?

A

rim enhancement with center necrosis

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30
Q

when the liver is best enhanced- in which phase?

A

the liver most vascularized by the portal vein- most enhanced in the portal phase more than arterial < difference in contrast

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31
Q

what are the hypervascularized hepatic metastasis?

A
  • Endocrine tumors
  • kidney
  • thyroid
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32
Q

what are the cystic hepatic metastasis?

A
  • head and neck tumors- hypodense in CT
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33
Q

what are the hemorrhagic hepatic metastasis?

A
  • melanoma- hyperdense in CT without contrast- bleeding
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34
Q

what are the Calcified hepatic metastasis?

A
  • Colerectal cancer, ovarian cancer, osteosarcoma
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35
Q

what is the most common primary malignant hepatic tumor?

A
  • hepatocellular carcinoma - occurs at the setting of cirrhosis
36
Q

diagnosis of the HCC?

A
  • Clinical assessment
  • Laboratory test- alpha-fetoprotein
  • imaging
  • biopsy- sometimes, maybe the only cancer the we don’t need biopsy sometimes
37
Q

the imaging charcterstics of the HCC on Ultrasound?

A
  • 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
Q

it is HCC until proved the inverse?

A

portal HCC + Nodule

39
Q

how the portal vein thrombosis appears in the ultrasound?

A
  • isoechoic( should be hypoechoic) and dilated
40
Q

what is the role of ct scan in the HCC?

A
  • Staging and diagnosis
41
Q

imaging characteristics of HCC in the CT scan?

A
  • 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
Q

When we don’t need to perform biopsy to confirm HCC?

A
  • Cirrhosis+ the characteristic of the tumor
43
Q

the imaging characteristics of the lymphoma

A
  • primary or secondary
  • mostly multiple nodules
  • Hypoechoic, hypodense
  • hepatomegaly only without nodules
44
Q

differential diagnosis of the focal nodular hyperplasia?

A
  • Fibrolammellar carcinoma
45
Q

what is the most common hepatic benign tumors?

A
  • Hemangioma
46
Q

The characteristics of hemangioma?

A
  • Young women
  • Incidental discovery- asymptomatic
  • Never degenerates- can’t be malignant
  • Rarely hemrrhagic- big one < hemorrhage
47
Q

what is the appearance of the angioma on US?

A
  • 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
Q

what to do if we find accidentaly the hemangioma in a patient?

A
  • 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
Q

when we do ct scan in case of hemangioma appearance?

A
  • atypical features in US
  • size > 3 cm
50
Q

what is the characterstic appearance of angioma?

A
  • before contrast: Hypodense
  • After contrast: Progressive enhancement
  • Arterial phase: Peripheral contrast enhancement
  • Portal phase: Filling from periphery to center
  • Late phase: Homogeneous
51
Q

the characterstics of hemangioma in MRI?

A
  • Before contrast: Hypo in T1, Hyper in T2
  • After contrast: Filling from the
    periphery to the center
52
Q

the characteristics of the focal nodular hyperplasia?

A
  • The second most common benign tumor:
    *Young women
    *Incidental discovery- asymptomatic
    *Always benign
52
Q

the diagnosis of the focal nodular hyperplasia?

A
  • MRI > CT > US
53
Q

the imaging appearance of the focal nodular hyperplasia?

A
  • isoechoic
  • homogenous
  • Lobulated contours
  • Hypervascular in the arterial phase- arterial enhancemnt- hepatocitic< like HCC
  • Central fibrous scar: late enhancement in the delayed phase
54
Q

in which gender the hepatocellular adenoma is more common?

A

women

55
Q

risk factor of hepatocellular adenoma?

A
  • oral contraceptive
56
Q

the characteristics of hepatocellular adenoma?

A
  • Hemorrhage
  • degeneration
  • acute pain
57
Q

diagnosis of the hepatocellular adenoma

A
  • Biopsy- histology
58
Q

the treatment of hepatocellular adenoma?

A
  • surgery
59
Q

the imaging appearance of the hepatocellular adenoma?

A
  • No suggestive appearance
  • Hypervascular- hepotocitic
  • homogeneous or not
  • fat content- MRI nor ct scan
  • unique or multiple
  • it might be multiple
60
Q

What are the cystic pathology of the hepatocellular adenoma?

A
  • the bile cyst
  • hydatid cysts
  • liver abscess
61
Q

what is the other name for bile cyst?

A
  • hepatic cyst
  • no ile inside, just seroud- liquid
62
Q

what are the characteristics of bile cyst?

A

*Simple cyst
*Asymptomatic
*Incidental discovery
*Single or multiple (hepatic polycystic disease)

63
Q

the imaging characteristics of bile cyst?

A
  • cystic lesion
  • wall not visible
  • well defined
64
Q

the appearance of bile cyst on US?

A
  • Pure anechoic image
  • With posterior enhancement
65
Q

the appearance of bile cyst on CT?

A

Non-enhanced hypodense lesion

66
Q

the appearance of bile cyst on MRI?

A
  • T1 hyposignal
  • T2 hypersignal
  • Non-enhanced
67
Q

the differential diagnosis of the bile cyst?

A
  • type 1 hydatid cyst( with visible wall)
68
Q

Diagnosis of the hydatid cyst?

A

US

69
Q

the Gharbi classifiction of the hydatid cyst?

A
  • 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
Q

complications of the hydatid cyst?

A
  • sureinfection
  • fissure
  • rupture+++
71
Q

the role of CT or MRI- Chose one?

A
  • Pre-operative assessment
  • Differential diagnosis (Type IV)
  • Complications
72
Q

contrast in hydatid cyst?

A

absent except in complications

73
Q

the clinicl signs of liver abscess?

A

Right hypochondrium pain
* Fever
* Hepatomegaly
* Leukocytosis

74
Q

the appearance of liver abcess on the US?

A
  • Hypoechoic lesion
  • Posterior enhancement
  • Wall with indistinct margins- irregular
75
Q

the appearance of liver abcess on the CT?

A

Hypodense lesion
* Peripheral contrast enhancement

76
Q

the differential diagnosis of the liver abcess?

A
  • Metastasis with necrosis in the center
  • hydatic cyst type 4
  • hematoma
77
Q

Diffuse non-tumoral pathology of the liver?

A
  • Fatty liver (steatosis)
  • liver cirrhosis
78
Q

what is steatosis?

A
  • Lipid overload in hepatocytes
79
Q

risk factors of the steatosis?

A
  • diabetes, obesity, hyperlipidemia
80
Q

the appearance of the steatosis on US?

A
  • Liver of normal or increased size
    *Homogeneous hyperechoic appearance
81
Q

the indication of MRI- fatsat+++ or CT scan in case of steatosis?

A
  • heterogeneous nodular forms , might be cancer
82
Q

Histological definition of cirrhosis?

A

fibrosis and regenerative nodules

83
Q

the causes of cirrhosis?

A
  • hepatitis B-C, alcohol, primary biliary cirrhosis
84
Q

complications of cirhhosis?

A
  • *Hepatocellular insufficiency
    *Portal hypertension
    *Hepatocellular carcinoma (HCC)
85
Q

the imaging signs of cirrhosis?

A
  • 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
Q

the appearance of traumatic injury US, and CT scan?

A
  • 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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