The First Affiliated Hospital

of Harbin Medical University

Medical Imaging
Teaching and Research Office

Zhang Ying

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 Medical
The First Affiliated Hospital of HMU
Imaging

哈尔滨医科大学附属第一医院
Self-introduction

Name Zhang Ying

Title Resident Doctor

Mailbox 13945011724@163.com

Tel 13945011724

WeChart 13945011724

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 第X章 Digestive
System

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The First Affiliated Hospital of HMU
Teaching outline
Master ：
CT findings of cirrhosis of liver,
cavernous hemangioma,
hepaticellular carcinoma.
Differential diagnosis of
cavernous hemangioma and
hepaticellular carcinoma. CT
findings of acute and chronic
pancreatitis and pancreas
cancer.
Medical
Imaging
Familiarize
CT findings of hepatic cyst, hepatic
abscess, liver metastases, spleen
trauma, cholangiocarcinoma,
cholecystitis, cholecystolithiasis and
carcinoma of gallbladder.
Understand
CT techniques of liver, gallbladder,
pancreas, and spleen. CT findings of
splenic tumor, splenic abscess and
splenic cyst.
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Segments of liver

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portal venous phase

left medial
lobe
Hepatic vein
left, middle and right left lateral
hepatic vein
lobe

right anterior
lobe

stomach
right posterior
lobe

abdominal aorta
inferior vena cava
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 left lobe

liver caudate lobe

middle hepatic vein

stomach

right lobe
inferior vena cava

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 bile duct

hepatic artery

liver caudate lobe

portal vein

inferior vena cava

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 Left medial lobe left lateral lobe
left hepatic vein

medial hepatic
stomach
vein

Right anterior lobe

right hepatic vein

Right posterior
lobe

inferior vena cava abdominal aorta

 medial hepatic
right hepatic vein vein left hepatic vein

stomach

Spleen

inferior vena cava abdominal aorta

 medial hepatic
vein Left branch of caudate lobe
portal vein

stomach

Spleen

right hepatic vein

inferior vena cava abdominal aorta

 first hepatic hilum
caudate lobe
medial hepatic
vein stomach

right branch of
portal vein

Spleen
right hepatic
vein

inferior vena cava abdominal aorta Left kidney

 gallbladder
portal vein

medial hepatic
vein

right branch of
portal vein

Spleen
right hepatic
vein

Left kidney
inferior
right kidney vena cava abdominal aorta
 gallbladder portal vein splenic vein pancreas

Right anterior
lobe

Right posterior
lobe

inferior
right kidney abdominal aorta Left kidney
vena cava
 Hepatic cyst

• round or oval
• homogeneously hypoattenuation lesion with
attenuation values between 0 and 20HU
•variable size
•solitary or multiple
•If cyst is accompanied by hemorrhage and infection, its
density will heighten.
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no enhancement, smooth interface with the liver parenchyma

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 Polycystic liver

Polycystic liver is a congenital liver disease which may be

autosomal dominant.

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 Hepatic abscess
solitary (frequent) or multiple, round or ovoid area of varying
size with fluid attenuation (2-36HU) and a faint border.
ring-shaped edema band around the wall of abscess in acute
stage.

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Enhanced CT demonstrates the ring sign: the outer
hypoattenuation ring is an edema strip. the inner
enhancement ring is the wall of abscess.
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In abscess gas bubbles or even an air fluid level (--characterized
sign) may be present in 20% cases.

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liver cirrhosis

Size:
•early stage: the liver parenchyma may appear normal or
hepatomegaly
•later stage: there is overall loss of volume as well as volume
redistribution
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Liver cirrhosis

2.Contour and shape :The increased nodularity of the liver

borders is well displayed. It appears an outer concave contour.

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Liver cirrhosis
3 Density
•Plan scan: inhomogeneous attenuation (due to focal
fatty degeneration or fibrosis)
•Enhanced CT: inhomogeneous enhancement
•sometimes larger and multiple regeneration nodules
manifest hyperattenuating and isoattenuating relative
to the liver parenchyma
4 Hepatic hilum and Liver fissure widen

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Liver cirrhosis

Secondary changes
Portal veins and splenic vein dilatation and circuity.

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liver cirrhosis
－－ ascites
splenomegaly

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Ascites and pleural effusion Differential
point:
The fluid behind
the bare area of
liver (without
peritoneum
covering) is pleural
effusion.
The fluid before
diaphragma is
ascites.

diaphragma

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Cavernous hemangioma(CH)

•Most CH appear as round or oval mass with well-defined edge.

• Most CH appear as homogenous hypoattenuation relative to the
adjacent liver parenchyma.

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 Hepatic arterial phase: peripheral
enhancement of one or more mural vascular
nodular structures which may partially
encircle the tumor; the density is equal to the
artery density.
artery
•Portal venous phase: a progressive ‘fill-in’ of
the lesion from the periphery towards the
center seems to start from these periphral
vascular lakes. The enhancement density
venous gradually degrade.

•Delayed phase: the lesion is completely or

partly filled and become isoattenuation or
slightly hyperattenuation.

delayed
•fast rise ane slow descend
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Hepatocellular
carcinoma(HCC)

Shape :expansive(one or more);diffused

Density:low density(inhomogeneous more)
Edge :ill-defined mostly(well-defined with pseudocapsule)
pseudocapsule
Contour deformity

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 Contrast enhanced
CT
• arterial phase: an early moderate to high degree
artery
of enhancement because of its blood supply
mainly from the hepatic artery; homogeneous
or inhomogeneous.

• venous phase and delayed phase: the contrast

enhancement is transient and the lesion
venous becomes hypodensity.

• Pseudocapsule;vessel invasion;lymph node

delayed

Enhancement :fast rise and fast descend

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A B

portal venous phase CT images show the carcinoma thrombus (arrow) in the left
portal vein.

Carcinoma thrombus in the right portal vein 28

 Hepatic metastases
Multiple nodules
Round or oval
Low densiy mostly(high:calcification)
Various in size
Faint or well-defined
Rim enhancement(bull’s-eye configuration feature)

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Hepatic metastases from pancreas cancer

bull's-eye configuration-feature
arterial or portal venous phase, some lesions with rim enhancement,
the peripheral is hypodensity and the center is more hypodensity
delayed phase: no enhancement.

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Hepatic metastases from rectal cancer

calcification

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Cholecystolithiasis
Density :high;low;isodensity(invisible)
Single or multiple cumulate
Punctiform or annular
Position :change with patient’s posture

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 Cholecystitis
Acute Chronic
Size large≧4.5mm small
Wall thickness≧4mm thickening
Density Low( wall) normal
higher than water
Edema around nought
Cholecystolithiasis maybe common

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Acute cholecystitis

Chronic cholecystitis

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Gallbladder Carcinoma
Various imaging appearances
① intral-luminal lession
② infiltrating mass replacing the gallbladder
③ diffuse mural thickening
• the tumor and the wall enhanced

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Cholangiocarcinoma(CCA)

mass
bile ducts obstructed
intrahepatic bile ducts dilation
enhancement

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Acute pancreatitis
Edema Hemorrhage

Size Enlargement Enlargement

Density Low High
Enhancement lightly Necrosis
Nought(low)
Gland margins Blurring normal
Peripancreas Thickening of the prerenal fascia;
peripancreatic fluid

Complications Phlegmon;abscess;pscudocyst
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enlargement, low density (edema) or high density
(hemorrhage); blurring of gland margins (inflammation);

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 Chronic pancriatitis

Size :atrophy or focal enlargement or normal

Pancreatic calcifications
Ductal dilation
Pancreatic pseudocyst
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Pancreatic carcinoma
Derict sign:mass
low or isodensity
dim border
no enhancement of the tumor
Inderict sign:double duct sign

carcinoma of the head of the pancreas

Common bile duct Main pancreatic duct

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Arterial phase
Parenchymal phase

Enhanced CT: Most duct cell

carcinoma are ‘hypovascular’ as
compared to the normal
pancreas. The normal pancreas
parenchyma—markedly
enhanced, while the tumorous
area—a much lower degree of
contrast enhancement, resulting
in a clearer depiction of the tumor.
Venous phase 54
 Pancreatic cancer （ +C ）

Debouch-ampulla
Double duct sign
atrophy of pancreatic parenchyma distal to the tumor, dilation
of the pancreatic duct and dilation of both the common bile
duct and the main pancreatic duct (‘double duct’ sign)
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Can you diagnose these diseases?

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The 1st case

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The 2nd case

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The 3rd case

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The 4th case

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The 5th case

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The 6th case

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The 7th case

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The 8th case

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The 9th case

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The 10th case

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The 11th case

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The 12th case

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The 13th case

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The 14th case

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The 15th case

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• The 16th case

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• The 17th case

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• The 18th case

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• The 19th case

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• The 20th case

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