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Radiology
Liver, Biliary Tree, and Gallbladder
Built from Fundamentals of Diagnostic Radiology
What’s inside
10 sections · 184 slides
Imaging the liver
MDCT, MR, US, and radionuclide approaches to the liver
- Imaging methods for the liver
- Multidetector CT multiphase protocol
- MDCT acquisition phases
- MR sequences and contrast agents
- Ultrasound and radionuclide roles
Liver anatomy
Couinaud segments, blood supply, and perfusion variants
- Couinaud segments
- Segmental planes of the liver
- Segment numbering
- Couinaud liver segments
- International nomenclature for anatomic liver segments
- Blood supply of the liver
- Perfusion abnormalities
- Recognizing a perfusion anomaly
- Causes of altered liver perfusion
- Portal versus arterial causes
- CT and MR attenuation baselines
- Third-inflow perfusion defect in segment 4b
Diffuse liver disease
Hepatomegaly, fatty liver, hepatitis, cirrhosis, and vascular disorders
- Hepatomegaly
- Causes of hepatomegaly
- Fatty liver and its causes
- 15%
- Nonalcoholic fatty liver disease
- Fatty liver on ultrasound
- Fatty liver on CT
- Fatty liver on MR
- Patterns of fatty deposition
- Fatty liver patterns
- Diffuse fatty liver — CT
- Diffuse fatty liver — MR
- Focal fatty liver and focal sparing
- Focal fatty liver
- Fatty infiltration with focal sparing
- Multifocal, perivascular, and subcapsular fat
- Multifocal fatty liver
- Acute and chronic viral hepatitis
- Cirrhosis
- Morphologic changes of cirrhosis
- Extrahepatic signs of cirrhosis
- Cirrhosis on US, CT, and MR
- Conditions that mimic cirrhosis
- Cirrhosis and portal hypertension
- Nodules in a cirrhotic liver
- Nodule pathway to cancer
- Regenerative nodules
- Dysplastic nodules
- Siderotic nodules
- Regenerative nodules in cirrhosis
- Causes of nodules in a cirrhotic liver
- LI-RADS and its major criteria
- LI-RADS ancillary features
- Small hepatocellular carcinoma
- LI-RADS categories and management
- Small hepatocellular carcinoma — MR
- Small hepatocellular carcinoma — MR (duplicate view)
- Hypertrophic pseudomass and confluent fibrosis
- Confluent fibrosis
- Portal hypertension
- Portosystemic collaterals
- Portal vein thrombosis
- Portal vein thrombosis — hepatocellular carcinoma
- Budd–Chiari syndrome
- Budd–Chiari syndrome
- Passive hepatic congestion
- Hemochromatosis
- Patterns of iron deposition
- Hemochromatosis — reticuloendothelial pattern
- Gas in the portal venous system
- Portal venous gas versus pneumobilia
Liver masses
Metastases, hepatocellular carcinoma, and benign focal lesions
- Characterizing a liver mass
- Benign versus malignant MR features
- Causes of hyperintensity in focal liver lesions on MR T1WI
- Causes of hypointensity in focal liver lesions on MR T2WI
- Hypervascular lesions by liver type
- Metastases
- Hypo- and hypervascular metastases
- Metastases
- Causes of multiple small (10 mm) lesions in the liver
- Cavernous hemangioma
- Hemangioma on US, CT, and MR
- Hemangioma cautions
- Cavernous hemangioma
- Hepatocellular carcinoma
- HCC growth patterns
- HCC enhancement and MR signal
- Features of large HCC
- Hepatocellular carcinoma — solitary massive — CT
- Hepatocellular carcinoma — solitary massive — MR
- Fat-containing lesions in the liver
- Focal nodular hyperplasia
- FNH on US, CT, and MR
- Focal nodular hyperplasia — MR
- Hepatic adenoma
- Adenoma imaging
- Hepatic adenoma — MR
- Fibrolamellar carcinoma
- Fibrolamellar hepatocellular carcinoma — CT
- Lymphoma and hematomas
- Primary hepatic lymphoma — CT
- Hereditary hemorrhagic telangiectasia
- Hereditary hemorrhagic telangiectasia — CT
- Peliosis hepatis
- Benign hepatic cyst
- Hepatic cysts — CT
- Polycystic liver disease
- Polycystic liver disease — MR
- Biliary hamartomas
- Biliary hamartomas — MR
- Biliary cystadenoma
- Biliary cystadenoma — MR
- Pyogenic abscess
- Pyogenic abscess — CT
- Amebic abscess
- Amebic abscess — CT
- Hydatid cyst
- Hydatid cyst — CT
- Cystic or necrotic tumor and tiny lesions
- Too small to characterize
Biliary tree
Imaging and anatomy of the intra- and extrahepatic bile ducts
- Imaging the biliary tree
- MRCP, ERCP, and PTC
- Biliary anatomy
- Common bile duct course
- Normal duct measurements
- Biliary anatomic variants
- Normal MRCP
- Causes of filling defects in the bile ducts
Biliary dilatation
Obstruction, stones, strictures, cholangitis, cysts, and tumors
- Biliary dilatation versus obstruction
- Signs of biliary dilation
- Benign versus malignant obstruction
- Biliary dilation — CT
- Causes of biliary tract obstruction
- Choledocholithiasis
- Obstructing stone in common bile duct — CT
- Choledocholithiasis — MR
- Benign stricture and pancreatitis
- Primary sclerosing cholangitis
- Primary sclerosing cholangitis — ERCP
- HIV-associated cholangitis
- Acute bacterial cholangitis
- Acute bacterial cholangitis — CT
- Recurrent pyogenic cholangitis
- Caroli disease
- Caroli disease — MR
- Choledochal cysts
- Todani classification
- Classification of congenital biliary cysts
- Choledochal cyst — Type I — ERCP
- Pancreatic, ampullary, and metastatic causes
- Cholangiocarcinoma
- Cholangiocarcinoma by site
- Peripheral cholangiocarcinoma
- Cholangiocarcinoma — peripheral — CT
- Hilar cholangiocarcinoma (Klatskin tumor)
- Cholangiocarcinoma — hilar — PTC
- Extrahepatic cholangiocarcinoma
- Intraductal papillary mucinous tumor
Gas in the biliary tract
Pneumobilia and biliary-enteric fistulas
- Pneumobilia
- Causes of gas in the biliary tract
- Choledochoduodenal fistula — UGI
Gallbladder
Gallstones, cholecystitis, and gallbladder carcinoma
- Imaging methods for the gallbladder
- Gallbladder anatomy
- Gallbladder measurements
- Gallstones
- Gallstone detection
- Cholelithiasis
- Gallbladder lesions mistaken for stones
- Acute cholecystitis
- Acute cholecystitis — CT
- Acalculous cholecystitis
- Sludge
- Complications of acute cholecystitis
- Emphysematous cholecystitis — CT
- Chronic cholecystitis
- Chronic cholecystitis variants
- Porcelain gallbladder
- Gallbladder wall thickening
- Adenomyomatosis
- Gallbladder carcinoma
- Gallbladder carcinoma
Takeaways
The messages to carry into practice
- Liver, biliary tree, and gallbladder — key points
References
Suggested readings from the chapter
- Suggested readings
- Suggested readings
- Suggested readings
- Suggested readings
- Brant and Helms' Fundamentals of Diagnostic Radiology