CLB NGOẠI KHOA TRƯNG VƯƠNG

CTSCAN BỤNG
CƠ BẢN
Lê Kim Long
CLB Ngoại Khoa Trưng Vương

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 NỘI DUNG
• Khái niệm về chụp cắt lớp điện toán
• Một số khái niệm cơ bản
• Các thì trong CTScan bụng
• Phân chia thuỳ gan trên CTScan
• Động mạch thân tạng
• Bó mạch mạc treo tràng trên

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 CT vs MRI

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 ĐẬM ĐỘ (DENSITY)
• Đậm độ cao (Hyperdense)
• Đậm độ thấp (Hypodense)
• Isodense

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 ĐẬM ĐỘ (DENSITY)
• Đậm độ cao (Hyperdense)
• Đậm độ thấp (Hypodense)
• Isodense

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 Hounsfield scale

Sir Godfrey Hounsfiled 1919-2004

Nobel prize, 1979

2005 Joshu Broder

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 Cửa sổ (Windows)

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 Cửa sổ (Windows)

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 Cửa sổ (Windows)

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 Phases of enhancement
• Non-enhanced CT (NECT)
• Early arterial phase
• Late arterial phase 
• Hepatic or late portal phase
• Nephrogenic phase
• Delayed phase 

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 Non-enhanced CT (NECT)
Helpful in detecting:
calcifications, fat in tumors, fat-stranding as seen in
inflammation.

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 Early arterial phase
 15-20 sec p.i. or immediately after bolustracking
This is the phase when the contrast is still in the arteries
and has not enhanced the organs and other soft tissues.

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 Late arterial phase 
35-40 sec p.i. or 15-20 sec after bolustracking. Sometimes also
called "arterial phase" or "early venous portal phase", because some
enhancement of the portal vein can be seen. All structures that get
their bloodsupply from the arteries will show optimal enhancement.

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 Hepatic or late portal phase 
70-80 sec p.i. or 50-60 sec after bolustracking. Although hepatic phase is the most
accurate term, most people use the term "late portal phase". In this phase the liver
parenchyma enhances through bloodsupply by the portal vein and you should see
already some enhancement of the hepatic veins.

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 25% of total liver blood flow being supplied from the hepatic artery and 75% from
the portal vein
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 Delayed phase 
6-10 minutes p.i. or 6-10 minutes after bolustracking. Sometimes called
"wash out phase" or "equilibrium phase". There is wash out of contrast in all
abdominal structures except for fibrotic tissue, because fibrotic tissue has a
poor late wash out and will become relatively dense compared to normal
tissue. This is comparable to late enhancement of infarcted scar tissue in
cardiac MRI.

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 ĐỘNG MẠCH vs TĨNH MẠCH

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 ĐỘNG MẠCH vs TĨNH MẠCH

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 Clinically Important Hepatic Anatomy
• Falciform ligament defines right from left lobe
• Blood supply:
– 70% via portal vein
– 30% via hepatic artery
• Left, middle, and right hepatic veins converge with IVC
• Each of 8 liver segments have: Portal triad
Portal vein, Hepatic artery, and bile duct

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 GAN

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 GAN

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 The level of
Hepatic Vein Junction
The superior liver segments are divided by the hepatic veins (2, 4A, 8 and 7)

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 The level of
The left portal vein
The left portal vein divides
the left lobe of the liver into:
•The superior segments
(2 and 4A)
•The inferior segments
(3 and 4B)

The left portal vein is at a

higher level than the right
portal vein.
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 The level of
The Right Portal Vein
The right portal vein divides
the right lobe of the liver into:
•The superior segments (7
and 8)
•The inferior segments (5
and 6)

The level of the right portal

vein is inferior to the level of
the left portal vein.

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 The level of
The splenic vein
Below the level of the right portal vein,
only the inferior segments are seen. (3, 4B, 5, 6)

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 SPLEEN

CT ATTENUATION
(a) without enhancement:
40–60 HU (= 5–10 HU less than liver)
(b) with enhancement: normal heterogeneous
enhancement during first minute after bolus
injection ← different blood flow rates through
the cords of the red + white pulp
√ arciform (alternating bands of high + low
attenuation) / focal / diffuse heterogeneity
√ heterogeneity resolved in portal venous phase

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 (a) RED PULP = numerous vascular sinuses
(b) WHITE PULP = lymphoid follicles + cells
of RES
Development: ratio of white to red pulp
increases with age + progressive antigenic
stimulation

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 Tuyến
Thượng Thận
(Adrenals)

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 Tuyến Thượng Thận – Vị Trí

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 Tuyến Thượng Thận – Hình dạng

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 Key arterial anatomy of the GI tract
Celiac artery (axis)
• Arises form the ventral surface of the aorta
• Just below the diaphragm
• At the level of the lower half of T12
Superior mesenteric artery (SMA)
• Arises form the ventral surface of the aorta
• Approximately 1 cm below the origin of the celiac
• At the level of the upper half of L1
Inferior mesenteric artery (IMA)
• Arises from the ventral surface of the aorta
• At the level of L3
• Approximately 3 cm above the aortic bifurcation

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 PANCREAS

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 Ôn Tập

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 Câu hỏi?

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 Câu hỏi?

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 25% of total liver blood flow being supplied from the hepatic artery and 75% from
the portal vein
(GREENWAY and STARK 1971)

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