1.62k likes | 2.2k Views
Computed tomography of the Abdomen
E N D
1. Computed Tomography of the Abdomen Gastric leiomyosarcoma.Gastric leiomyosarcoma.
2. Computed tomography of the Abdomen & Pelvis Routine
Abdomen
Liver
Kidneys
Pancreas
KUB
3. Indications CT Abdomen!
Anatomy?
What can go wrong?
Where are the most common pathologies / anomalies
4. Indications Abdominal pain (LLQ-suspect diverticulitis) (RLQ-suspect appendicitis) Diffuse (acute abdomen or chronic, pain) History of malignancy (lymphoma, cancer of colon, breast, stomach, lung, bladder, other) Abdominal or pelvic mass Fever and elevated white count, suspected abscess Trauma Miscellaneous: infection, weight loss, bowel obstruction, question of free air or pneumatosis on plain films, postoperative complication, follow up of complicated pancreatitis, follow up Ca screening.
Follow up of ultrasound findings
5. Contraindications Contraindications
As per contrast contraindications according to contrast related contra indications.
Patient preparation
As per post contrast indications and contraindications.
6. Patient preparation 4 hour fast
Oral contrast for 1 hour prior to scan.
Oral contrast
Barium sulphate based solution
Non ionic Intravenous contrast solution
Water
Patient changed into radiolucent gown
Artifacts removed
All clothing except underclothing
Bra and garters should be removed
7. Patient orientation / position Patient supine
Feet first
Patient to raise arms up above head, and elbows in.
Landmark
Xyphoid sternum
In mid coronal plane
10. Scan technique Scan type
Anteroposterior and lateral scout
Helical
Coverage
Superiorly from dome of diaphragm
Inferiorly to include Iliac crests, include pelvis if required.
Comments
Images acquired during suspended inspiration.
If lesion is demonstrated a 5 minute delay series may be required.
For oesophageal or stomach mass, an additional glass of contrast is to be ingested via drinking straw while patient is on table.
11. Contrast technique Volume
60-80mls
Injection rate / type
2-3mls/second
Pressure injected
Scan delay
60-75 seconds bolus tracking
Smartprep, surestart etc (cardiac output)
Comments
Rectal contrast: may be required for rectal carcinoma or perforated bowel.
Vaginal contrast: tampons may be required for female patients having pelvic scans.
12. Image reconstruction 1st reconstruction
7mm / 7mm (soft tissue/mediastinal)
2nd reconstruction
3mm / 3mm (MPR’s)
13. Filming Format
20 format
Window width / window level
350ww / 40wl (soft tissue) (also called standard)
Comment
Inlcude lung bases with lung setting at end of study.
14. Post processing Reformations
Coronal MPR (to demonstrate pathology if required)
15. Abdomen Axial standard
20. Phase studies Pre (non) contrast
Arterial phase
Portal venous phase
Delayed Phase
normal liver parenchyma receives about 70% of its blood from the portal vein and 30% from the hepatic artery.
Most primary and metastatic liver tumors, however, receive their blood from the hepatic artery.
21. Arterial phase helical CT of the liver improves detection of some small, malignant hepatic neoplasms when performed in addition to portal venous scanning. The value is greatest in those patients who have hypervascular neoplasms.
23. Computed tomography of the Abdomen / liver Routine
Liver
24. Indications CT Liver!
Anatomy?
What can go wrong?
Where are the most common pathologies / anomalies
25. Indications Haemangioma
Metastases
Abnormal ultrasound
HaemangiomaHaemangioma
26. Contraindications Contraindications
As per contrast contraindications according to contrast related contra indications.
Patient preparation
As per post contrast indications and contraindications.
27. Patient preparation 4 hour fast
Oral contrast for 1 hour prior to scan.
Oral contrast
Barium sulphate based solution
Non ionic Intravenous contrast solution
Water
Patient changed into radiolucent gown
Artifacts removed
All clothing except underclothing
Bra and garters should be removed
28. Patient orientation / position Patient supine
Feet first
Patient to raise arms up above head, and elbows in.
Landmark
Xyphoid sternum
In mid coronal plane
31. Scan technique Scan type
Anteroposterior and lateral scout
Helical
Coverage
Superiorly from dome of diaphragm
Inferiorly to include Iliac crests, include pelvis if required.
Comments
Images acquired during suspended inspiration.
If lesion is demonstrated a 5 minute delay series may be required.
For oesophageal or stomach mass, an additional glass of contrast is to be ingested via drinking straw while patient is on table.
32. Contrast technique Volume
60-80mls
Injection rate / type
2-3mls/second
Pressure injected
Scan delay
10-20 / 60-80 seconds bolus tracking
Smartprep, surestart etc (cardiac output)
33. Image reconstruction 1st reconstruction
7mm / 7mm (soft tissue/mediastinal)
2nd reconstruction
3mm / 3mm (MPR’s)
34. Filming Format
20 format
Window width / window level
350ww / 40wl (soft tissue) (also called standard)
150ww / 40wl (liver if required)
Comment
Inlcude lung bases with lung setting at end of study.
35. Post processing Reformations
Coronal MPR (to demonstrate pathology if required)
36. Liver Axial standard
41. Liver window Burnt Toast
43. Liver pathologies
44. Cirrhosis with oesophageal varices.Cirrhosis with oesophageal varices.
45. Cirrhosis.Cirrhosis.
46. cirrhosis, splenomegaly.cirrhosis, splenomegaly.
47. Fatty infiltration secondary to Ca.Fatty infiltration secondary to Ca.
48. Hemangioma Hemangioma
49. hemangioma abdo window.hemangioma abdo window.
50. hemangioma liver window.hemangioma liver window.
51. Hemangioma.Hemangioma.
52. Hepatic abscess.Hepatic abscess.
53. Hepatic adenoma recent bleed.Hepatic adenoma recent bleed.
54. hepatic infarct.hepatic infarct.
55. Hepatoma.Hepatoma.
56. Liver abscess.Liver abscess.
57. liver mets due to colon ca.liver mets due to colon ca.
58. Metastatic renal cell carcinoma to the liver.Metastatic renal cell carcinoma to the liver.
59. polycystic liver disease.polycystic liver disease.
60. PV thrombosis, recurrent hepatoma.PV thrombosis, recurrent hepatoma.
61. radiation thrpy changes.radiation thrpy changes.
62. Computed tomography of the Abdomen / liver Routine
Kidneys
63. Indications CT Kidneys!
Anatomy?
What can go wrong?
Where are the most common pathologies / anomalies
64. Indications Acute flank pain, hematuria, suspected renal colic
Renal mass
Filling defect
Hematuria
Prior renal cell carcinoma (post partial nephrectomy or at high risk for bilateral tumors as in von Hippel Lindau or papillary renal cell carcinoma)
History of bladder cancer, abnormal IVU suggesting upper tract disease
Pyelonephritis unresponsive to antibiotics (pre contrast shows stones, enhanced and delayed views evaluate for pyelonephritis, abscess, obstruction.
Perinephric haemorrhage, evaluate for renal tumour or other cause
65. Contraindications nil
66. Patient preparation No fasting required
Patient changed into radiolucent gown
Artifacts removed
All clothing except underclothing
Bra and garters should be removed
67. Patient orientation / position Patient supine
Feet first
Patient to raise arms up above head, and elbows in.
Landmark
Xyphoid sternum
In mid coronal plane
70. Scan technique Scan type
Anteroposterior and lateral scout
Helical
Coverage
To include kidneys in their entirety.
Comments
Images acquired during suspended inspiration.
Renal mass: Three phase, non contrast, arterial phase and portal venous phase.
Filling defect: portal venous phase and 5 minute delayed.
Include entire urinary tract if reqiured.
71. Contrast technique Volume
60-80mls
Injection rate / type
2-3mls/second
Pressure injected
Scan delay
10-20 / 60-80 seconds bolus tracking
Smartprep, surestart etc (cardiac output)
72. Image reconstruction 1st reconstruction
7mm / 7mm (soft tissue/mediastinal)
2nd reconstruction
3mm / 3mm (MPR’s)
73. Filming Format
20 format
Window width / window level
350ww / 40wl (soft tissue) (also called standard)
74. Post processing Reformations
Coronal MPR (to demonstrate pathology if required)
75. Kidneys Axial standard
76. Renal Pathologies
77. 2cm renal cell carcinoma pre contrast.2cm renal cell carcinoma pre contrast.
78. 2cm renal cell carcinoma.2cm renal cell carcinoma.
79. Acute pyelonephritis.Acute pyelonephritis.
80. Obstruction 2º to distal stone with pyelonephritis.Obstruction 2º to distal stone with pyelonephritis.
81. Polycystic kidney disease.Polycystic kidney disease.
82. Polycystic kidneys.Polycystic kidneys.
83. Renal cell carcinoma extends into renal vein and IVC.Renal cell carcinoma extends into renal vein and IVC.
84. Renal cell carcinoma invades IVC.Renal cell carcinoma invades IVC.
85. Renal cyst.Renal cyst.
86. Renal lymphoma Renal lymphoma
87. Renal lymphoma.Renal lymphoma.
88. Renal TB Renal TB
89. Transitional cell carcinoma of the right ureter.Transitional cell carcinoma of the right ureter.
90. Computed tomography of the Adrenal glands Abdomen
adrenal glands
91. Indications Metastases
Lipoma
Adrenal cortical adenoma
Evaluation of mass
Cushing Syndrome (hypercortisolism)
Conn syndrome (hyperaldosteronism; very thin sections needed as tumors are small)
Virilization/feminization Characterize mass shown on screening CT with contrast
Addison's disease (adrenal insufficiency)
92. Contraindications Contraindications
As per contrast contraindications according to contrast related contra indications.
Patient preparation
As per post contrast indications and contraindications.
93. Patient preparation 4 hour fast
Patient changed into radiolucent gown
Artifacts removed
All clothing except underclothing
Bra and garters should be removed
94. Patient orientation / position Patient supine
Feet first
Patient to raise arms up above head, and elbows in.
Landmark
Xyphoid sternum
In mid coronal plane
97. Scan technique Scan type
Anteroposterior and lateral scout
Helical
Coverage
Diaphragm to iliac crests.
Comments
Images acquired during suspended inspiration.
4 phases: pre contrast, arterial phase (20 seconds), portal venous phase (60-80 seconds), and 5 minute delayed
98. Contrast technique Volume
60-80mls
Injection rate / type
2-3mls/second
Pressure injected
Scan delay
10-20 / 60-70 seconds bolus tracking
5 minute delay
Comments
Rectal contrast: may be required for rectal carcinoma or perforated bowel.
Vaginal contrast: tampons may be required for female patients having pelvic scans.
99. Image reconstruction 1st reconstruction
3mm / 3mm (arterial phase)
2nd reconstruction
7mm / 7mm (portal venous phase, and delayed)
100. Filming Format
20 format
Window width / window level
350ww / 40wl (soft tissue) (also called standard)
101. Post processing Reformations
Coronal MPR (to demonstrate pathology if required)
102. Adrenal glands Pathologies
103. Adrenal adenoma (LT)Adrenal adenoma (LT)
104. Adrenal adenoma.Adrenal adenoma.
105. Adrenal carcinoma right.Adrenal carcinoma right.
106. Adrenal carcinoma.Adrenal carcinoma.
107. Adrenal lymphoma.Adrenal lymphoma.
108. Adrenal metastases.Adrenal metastases.
109. Adrenal metastases-lung cancer.Adrenal metastases-lung cancer.
110. Adrenal neuroblastoma 2.Adrenal neuroblastoma 2.
111. Adrenal neuroblastoma.Adrenal neuroblastoma.
112. Computed tomography of the Pancreas Abdomen
Pancreas
113. Indications Acute pancreatitis (assess severity, presence of hemorrhage or necrosis; if extensive disease, usually add pelvis to look for complications there) Painless jaundice and weight loss (suspect pancreatic cancer) Islet cell tumour Chronic pancreatitis Characterize lesion seen on prior imaging (ultrasound, ERCP)
Pancreatic mass
114. Contraindications Contraindications
As per contrast contraindications according to contrast related contra indications.
Patient preparation
As per post contrast indications and contraindications.
115. Patient preparation 4 hour fast
Water contrast (500ml) prior to scan
Patient changed into radiolucent gown
Artifacts removed
All clothing except underclothing
Bra and garters should be removed
116. Patient orientation / position Patient supine
Feet first
Patient to raise arms up above head, and elbows in.
Landmark
Xyphoid sternum
In mid coronal plane
119. Scan technique Scan type
Anteroposterior and lateral scout
Helical
Coverage
Diaphragm to iliac crests.
Comments
Images acquired during suspended inspiration.
4 phases: pre contrast, arterial phase (20 seconds), portal venous phase (60-80 seconds), and 5 minute delayed
120. Contrast technique Volume
60-80mls
Injection rate / type
2-3mls/second
Pressure injected
Scan delay
10-20 / 60-70 seconds bolus tracking
5 minute delay
121. Image reconstruction 1st reconstruction
3mm / 3mm (arterial phase)
2nd reconstruction
7mm / 7mm (portal venous phase, and delayed)
122. Filming Format
20 format
Window width / window level
350ww / 40wl (soft tissue) (also called standard)
123. Post processing Reformations
Coronal MPR (to demonstrate pathology if required)
124. Pancreas Axial standard
127. Pancreatic pathologies
128. Acute pancreatitis.Acute pancreatitis.
129. Carcinoma of the tail of the pancreas.Carcinoma of the tail of the pancreas.
130. Cystadenocarcinoma of the pancreas 2.Cystadenocarcinoma of the pancreas 2.
131. Cystadenocarcinoma of the pancreas.Cystadenocarcinoma of the pancreas.
132. Cystadenoma pancreasCystadenoma pancreas
133. Pancreatic abscess Pancreatic abscess
134. Pancreatic abscess Pancreatic abscess
135. Pancreatic abscess.Pancreatic abscess.
136. Pancreatic cancer with vessel encasement.Pancreatic cancer with vessel encasement.
137. Splenic artery aneurysm simulates a pancreatic mass.Splenic artery aneurysm simulates a pancreatic mass.
139. Other pathologies Stomach
Spleen
Colon
Trauma
140. Stomach
141. Carcinoma of the gastric antrum.Carcinoma of the gastric antrum.
142. Severe gastritisSevere gastritis
143. Gastric leiomyosarcomaGastric leiomyosarcoma
144. Spleen
145. Infarcted spleenInfarcted spleen
146. Melanoma metastatic to the spleen.Melanoma metastatic to the spleen.
147. Moire spleen.Moire spleen.
148. Splenic hemangioma Splenic hemangioma
149. Splenic hemangioma.Splenic hemangioma.
150. Colon
151. Burkitts lymphoma of the colon.Burkitts lymphoma of the colon.
152. Cecal carcinoma with intussusception.Cecal carcinoma with intussusception.
153. Ischemic descending colon.Ischemic descending colon.
154. Pseudomembranous colitis.Pseudomembranous colitis.
155. Trauma
156. Hepatic laceration.Hepatic laceration.
157. Lung contusion with pneumothorax lung.Lung contusion with pneumothorax lung.
158. Lung contusion with pneumothorax soft.Lung contusion with pneumothorax soft.
159. Renal laceration and clot in renal pelvis.Renal laceration and clot in renal pelvis.
160. Renal laceration pre contrast.Renal laceration pre contrast.
161. Rupture of the diaphragm.Rupture of the diaphragm.
162. Subtle hepatic laceration.Subtle hepatic laceration.
163. Splenic rupture.Splenic rupture.