Liver CTC Flashcards
what is brighter on T1, liver or spleen?
liver
what is brighter on T2, liver or spleen?
spleen (spleen is a big bag of water that collects blood)
most likely case being shown if given a view of the gallbladder fossa
some kind of fatty lesion problem - like focal fatty infiltration or sparing
fat related artifacts on MR
Type 1 “chemical shift” Type 2 “india ink” (ip and oop)
chemical shift type 1 artifact occurs in what direction?
frequency encoding
how do you decrease chemical shift type 1 artifct
increase the rBW (broader bandwidth decreases the artifact)
what will make chemical shift type 1 artifact worse?
narrow receiver bandwidth or HIGH field strength (worse on 3T compared to 1.5T)
with what sequences do you see chemical shift type 1 artifact?
spin echo and gradient echo sequences
type 2 artifact only occurs on what type of sequence?
Gradient only
drop of signal in the liver on in phase imaging`
iron in the liver
what phase do you have to scan first in regards to in phase and out of phase imaging
HAVE to do OOP first, otherwise you can’t tell a an iron laden liver from a fatty liver
primary hemochromatosis involves the liver and _____
pancreas primary = “p” for pancreas
secondary hemochromatosis involves the liver and __________
spleen secondary = “s” for spleen
epidemiology of hemachromatosis
white dudes
hooked osteophytes on metacarpal heads
hemochromatosis
super dense liver
AMIODARONE should be your first thought others include: Wilsons/hemochromatosis, Thorotrast, Glycogen storage disease
Caroli’s disease associations
ADPKD, Medullary sponge kidney, cholangiocarcinoma
what biliary disease is associated with ADPKD and medullary sponge kidney
Caroli disease
PSC gender predisposition
PSC is way more common in males
male with biliary strictures
PSC
associated with PSC
UC
UC is associated with what biliary pathology?
PSC
when is cholangiocarcinoma unresectable?
second order radicles, main portal vein is encased or occluded contralateral hepatic artery and portal vein are involved
hepatic capsular retraction in a male patient with PSC
cholangiocarcinoma
big bloody hepatic mass in a young person (female or young dude on roids)
hepatic adenoma
blood hepatic mass in a cirrhotic
HCC
can hepatic adenomas undergo malignant degeneration?
yes the “beta catenin mutated” ones
why do they resect hepatic adenomas>?
two things: 1) risk of bleeding, and 2) risk of malignant transformation (beta catenin)
transporter that allows Eovist into hepatocytes
OATP (not present in cancer cells –> HCC and other cancers are big black holes on Eovist scans)
most common location for a hepatic adenoma
right lobe, subcapsular (85%)
multiple hepatic adenomas, systemic disease association
glycogen storage disease (Von Gierke’s)
glycogen storage disease (Von Gierke’s) is associated with what hepatic finding
multiple hepatic adenomas
what signal characteristic is your main differentiator between dysplatic nodule and HCC?
T2! HCC will be T2 bright
your tech tells this pt that they have cancer and you are called to the scanner to console the patient. What is your next step?
get delayed imaging. See if it fills in and is a cavernous hemangioma
FNH
nuc med study = sulfur colloid (Kupffer cells in the FNH are hungry for colloid)
biliary hamartomas (Von meyenberg complexes)
key on MRCP –> the bright cysts don’t connect to the biliary system
young dude with UC
PSC
is PET good for HCC
No, PET is absolute shit to evaluate for HCC
secondary hemochromatosis
Secondary = Spleen
primary hemochromatosis
Primary = Pancreas
sickle cell, auto infarcted spleen
Iron overload
“drop” of signal on In phase
Fatty liver
Obese, drop of signal on Out of phase
heaptic veins are out
if show hepatic veins out…Budd Chiari
if showed reflux of contrast into IVC..Right heart failure
“rocky liver” = calcificaiton in the liver
mucinous adenocarcinoma met (CRC)
key imaging feature of fibrolamellar HCC?
it calcifies!
18 yo F
fibrolamellar HCC
calcifies, central scar, young people\
rare AF
has HIV and likes IV drugs
infection, infection, infection
elevated LFTs
hepatitis
GB wall thickness >1cm is NOT acute cholecystitis
hepatitis
periportal edema without anyother imaging clues for other etiologies
is there any situation when an adult can get HCC in a non cirrhotic liver
HBV
hot quadrate lobe + chest wall collaterals
= SVC syndrome
what is the most likely diagnosis?
biliary necrosis secondary to hepatic artery stenosis
describe the following waveforms and what they are indicative of
what waveform is sensitive for severe hepatic artery stenosis
elevated diastolic flow
sensitive AND specific signs for severe proximal stenosis
Elevated diastolic flow AND tardus parvus
What other imaging should you get?
Get a brain MRI to look for brain abscesses.
This is HHT –> right to left shunt –> bugs to brain
pregnant lady
HELLP
