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1、Deng-Bin WANG, MD, PhD Dept. of Radiology, Rui Jin Hospital SJTU,Abdominal Imaging,The Biliary Tract Liver Pancreas Spleen,Imaging of the Biliary Tract,Methods of examination Normal anatomy and X-ray findings Common diseases,Methods of examination (I),Plain film: calcium (1020%) Oral cholecystograph
2、y Intravenous cholangiography T tube cholangiography Endoscopic retrograde cholangio- pancreatography, ERCP percutaneous transhepatic cholangiography, PTC,Plain film gallstone,Oral cholecystography,T tube cholangiography,ERCP,PTC,Method of examination (II),Ultrasonography (US) Angiography Computed t
3、omography (CT) spiral CT cholangiography (SCTC) Magnetic resonance imaging (MRI) MR cholangiopancreatography (MRCP),MRCP,Normal gallbladder anatomy,right 12th rib level Round, oval or pear-shaped 710cm in length, 34cm in width four parts: funds, body, infundibulum, neck cystic duct: 3cm in length, 2
4、3cm in width,Normal biliary tract findings,Intrahepatic bile duct left、right hepatic duct common hepatic duct (34cm in length, 46mm in width) cystic duct common bile duct (610cm in length, 48mm in width),Normal gallbladder and biliary tract anatomy,Position: between the left and right lobes of liver
5、, at the porta section or below it. Shape: oval Size: 4 5cm Density: lower, a little higher than water, homogeneous Common bile duct : 1/3 is visualized Intrahepatic ducts are not visualized,Normal CT finding of gallbladder,Common diseases of biliary tract,Gallstone Cholecystitis Gallbladder cancer,
6、Gallstones (I),composition: cholesterol, bile pigment, calcium shape: round, multi-facet, shell-like location: gallbladder, intra- or extra-hepatic bile duct,Gallstones (II),opaque stone (+): 1020% plain film (differentiate: renal stone) non-opaque stone (-): 8090% contrast study: filling defect,Gal
7、lstones non-opacifying,Gallstones non-opaque stone,Gallstones opaque stone,Gallstones opaque stone,Stones in common bile duct,Stones in common bile duct,Hepatic bile duct stone,Gallstones and hepatic duct stones,Differentiation of calculi,Ureteral calculi,Calcification of Lymph node,Gallstones,Acute
8、 cholecystitis,Causes: bile duct stone、infection、reflux of pancreatic secretion Pathology:c congestion and edema of gallbladder mucosa, gallbladder enlarged and its wall thichened X-ray finding: gallbladder enlarged, gas in the gallbladder lumen or wall. CT: thickening , irregular and wall(4mm) ，vag
9、ue margin.,Chronic cholecystitis,Non-opacifying gallbladder (excluding: inadequate absorption or excretion) Faint opacifying with vague margin slower rate of emptying,Chronic cholecystitis,Gallbladder Carcinoma,Hepatic Hilar Cholangiocarcinoma,Biliary ductal system,23 sec Breath-hold,Biliary ductal
10、system,SSFSE & 3D FRFSE,Sl. thickness: 3 mm. Matrix: 512 x 192,2D SSFSE,3D FRSFSE,2D Fast GRE T1 w. Fat Sat,Sl. thickness: 5 mm. Matrix: 512 x 256,Sl. thickness: 2 mm. Matrix: 384x224,Sl. thickness: 7 mm. Matrix: 512 x 256,Sl. thickness: 20 mm. Matrix: 512 x 384,High spatial resolution of the entire
11、 pancreaticobiliary tract and of the adjacent soft tissue,After Contrast Media Injection,FGRE T1 w. Fat Sat,FGRE T1 w. Fat Sat,Biliary ductal system,SSFSE & 3D FRFSE,3D FRSFSE,3D FRSFSE,2D SSFSE,2D SSFSE,2D SSFSE,Biliary ductal system,2D FIESTA Fat Sat,Sl. thickness: 3 mm Matrix 224x224 Zip 512 1 se
12、c / slice,FS FIESTA,FS FIESTA,SSFSE long TE,SSFSE long TE,Hepatobiliary system,Biliary ductal system,LAVA after mangafodipir trisodium administration (Teslascan ),Sl. Thickness 3 mm (ov -0.8 mm) Matrix: 256x224 ZIP 512 Acq. time: 18 sec,High Resolution T1 w. 3D MRCP - Functional information -,Liver
13、Imaging,Plain film US, CT, MRI contrast study GI double contrast ERCP / PTC DSA,Plain film,Angiography,CT,CT,Torso coil,4 elements phase-array coil - huge anatomical coverage - high SNR - Asset compatible,Patient preparation,MRI,Liver and Pancreas: Dynamic Contrast- enhanced Scanning Protocol for CT
14、 or MRI,Early Phase: (delayed time:25-30s) Portal Phase: (delayed time:55-60s) Delayed Phase: (delayed time:90-200s),Common diseases of Liver,Abscess Hemangioma Cancer Cyst Cirrhosis,Abscess,Causes：pyogenic、amebic Clinic：fever、pain、enlargement of liver CT finding：low-density or cystic mass，20 40Hu，w
15、ith contrastcnhancement of the wall, A surrounding low-density halo.,Abscess - MRI,Hemangioma,Well-defined, low-density lesion. Dynamic scans after a bolus of intravenous contrast show dense peripheral enhancement at 15s, with gradual infilling so that the lesion becomes isodense.,Hemangioma-angiogr
16、aphy,Cancer primary HCC,Pathology：Hepatocellular carcinoma（90%）, cholangiocarcinoma and mixed form. Categories：solitary mass、multifocal nodule、diffuse involvement. CT findings： Plain scan reveals well or poor defined, low-density mass with irregular margin. Enhancement occurs and disappears earlier.,Hepatocellular carcinoma,Hepatocellular carcinoma diffuse involvement,Vascular mapping: Portal system,Vascular mapp
