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Imaging of the cirrhotic liver

Anatomy, embryology, pathophysiology Anatomy and embryology of the liver is presented in Chapter 15 . This chapter will continue with pathophysiology of cirrhosis. ◼ Cirrhosis is the final stage of chronic liver disease, which is characterized by diffuse parenchymal necrosis, regeneration and scarring with abnormal tissue reconstruction ( Fig. 16.1 ). ◼ Pathophysiology: Short-term or repetitive liver injury causes hepatocyte death. Collagen producing stellate cells are…

Chronic liver disease

Anatomy, embryology, pathophysiology ◼ The liver is located in the right upper quadrant of the abdomen below the diaphragm. It is mostly covered by ribs but the lower portion of the liver is palpable below the right costal margin. The liver is divided into four anatomic lobes: right, left, quadrate and caudate. ◼ At the anterior surface of the liver, the falciform ligament separates the left…

Cystic pancreatic lesions

Anatomy, embryology, pathophysiology ( fig. 14.1 ) ◼ Serous cystadenoma: inactivation of von Hippel-Lindau ( VHL ) gene. ◼ Mucinous cystic neoplasms (MCNs): closeness of left primordial gonad to the dorsal pancreatic bud during development, with possible incorporation of ovarian stroma into developing pancreatic bud, has been suggested to play a role in the cause of MCNs. This observation could explain the female occurrence and predilection…

Solid pancreatic masses

Anatomy, embryology, pathophysiology ◼ Adenocarcinoma: inactivation of multiple antioncogenes, as well as issues with deoxyribonucleic acid mismatch repair ( BRCA2 ). Smoking, diet high in meat and solvent exposure are risk factors. ◼ Neuroendocrine tumors: multiple chromosomal losses. Associated with Von-Hippel Lindau syndrome and multiple endocrine neoplasia. ◼ Pancreatic lymphoma: usually non-Hodgkin lymphoma. ◼ Acinar cell carcinoma: mutations in adenomatous polyposis coli beta-catenin gene and loss…

Pancreatitis

Anatomy, embryology, pathophysiology ◼ The pancreas is a lobulated, unencapsulated gland located in the anterior pararenal space of the retroperitoneum. ◼ Pancreatic development: two outpouchings or buds develop from the endodermal lining of the duodenum. The ventral bud will eventually form the posterior pancreatic head and uncinate process whereas the dorsal bud will form the anterior pancreatic head, body, and tail. The pancreatic buds have their…

Right lower quadrant pain

Anatomy, embryology, pathophysiology ◼ There are three major anatomic regions that may contribute to right lower quadrant pain. Organ systems with differential diagnoses include: ◼ Gastrointestinal system: cecum, ascending colon, appendix. ◼ Acute appendicitis. ◼ Acute cecal diverticulitis. ◼ Inflammatory bowel disease. ◼ Bowel obstruction, ileus. ◼ Mesenteric lymphadenitis. ◼ Meckel diverticulum. ◼ Genitourinary/gynecological system: right ovary, right fallopian tube. ◼ Tuboovarian abscess. ◼ Ovarian cyst…

Right upper quadrant pain

Anatomy, embryology, pathophysiology ◼ There are three major anatomic regions that may contribute to right upper quadrant pain. Organ systems with differential diagnoses include: ◼ Gastrointestinal system: liver, biliary, pancreas, and duodenum. ◼ Liver. ◼ Hepatic steatosis. ◼ Infectious hepatitis. ◼ Alcoholic hepatitis. ◼ Autoimmune hepatitis. ◼ Toxin-related hepatitis. ◼ Hepatic abscess. ◼ Portal vein thrombosis. ◼ Budd-Chiari syndrome. ◼ Perihepatic inflammation (Fitz-Hugh-Curtis syndrome). ◼ Biliary…

Colorectal cancer and screening

Anatomy ◼ Adenomas can develop anywhere in the colon or rectum but are seen with the greatest frequency in the sigmoid colon. ◼ The frequency of polyp occurrence in each section of the colon is approximately as follows: rectum 15%; sigmoid colon 25%; descending colon 10%; transverse colon 20%; ascending colon 20%; and cecum 10%. Pathophysiology ◼ Colon cancer is the third most commonly diagnosed cancer…

Mesenteric ischemia

Anatomy ◼ The arterial supply of the small bowel is predominantly from the celiac axis and superior mesenteric artery (SMA). ◼ The inferior mesenteric artery (IMA) and the internal iliac arteries may become important contributors in the setting of arterial disease. ◼ The celiac artery gives origin to the left gastric artery, and then it bifurcates into the splenic and common hepatic arteries ( Fig. 8.1…

Imaging of the postoperative bowel

Types of bowel surgeries, their indications, and postprocedural anatomy Esophagectomy All esophagectomy techniques involve partial or complete resection of the esophagus with a new anastomosis to esophagus, stomach, or bowel. Benign indications include esophageal perforation (iatrogenic from endoscopy/biopsy/balloon dilation, traumatic or self-induced from Boerhaave syndrome), refractory strictures from peptic ulcers/radiation/caustic ingestion, and esophageal fistulas (congenital or iatrogenic from trachea or bronchi). The most common malignant causes…

Bowel wall thickening

Anatomy, embryology, pathophysiology ◼ Most of the small and large bowels originate from the midgut, except the proximal duodenum (up to the ampulla of Vater), which originates from the foregut, and the portion of the colon distal to the proximal two-thirds of the transverse colon, which originates from the hindgut. ◼ The blood supply follows the same distribution, where the bowel arising from the midgut receives…

Small bowel obstruction

Anatomy, embryology, pathophysiology ◼ The small bowel is a long, mobile, and compressible tubular structure located in the mid-abdomen, surrounded circumferentially by the large bowel. ◼ The small bowel caliber is normally smaller than 3 cm (outer wall to outer wall). ◼ The small bowel wall is normally smaller than 3 mm in width. ◼ Valvulae conniventes are the small bowel’s characteristic circumferential mucosal markings. They…

Hollow viscus perforation

Anatomy, embryology, pathophysiology ◼ Extraluminal air is a worrisome finding that should immediately heighten the suspicion of the radiologist to a potentially life-threatening complication. ◼ The gastrointestinal (GI) tract is lined by inner circular and outer longitudinal muscularis layers, except for the stomach, which contains a trilaminar muscularis externa. ◼ True diverticula (e.g., Meckel diverticulum) contain all three layers of intestinal wall, whereas false diverticula (such…

Gastric wall thickening/masses

Anatomy, embryology, pathophysiology ◼ The stomach is anatomically subdivided into the cardia, fundus, body, and antrum, with inflow regulated by the lower esophageal sphincter and outflow by the pyloric sphincter. ◼ The incisura angularis represents the acute angle formed on the lesser curvature, which marks the transition from body to antrum. ◼ The gastric wall is composed of four layers: the mucosa (containing the epithelium and…

Gastrointestinal fluoroscopy

Techniques ◼ Fluoroscopy is an imaging modality where continuous x-ray images are obtained to evaluate the body in real time, often with the aid of administered radiopaque contrast material ( Fig. 2.1 ). ◼ Fluoroscopic examinations attempt to answer specific questions, and therefore understanding the indications and limitations of each examination is crucial. ◼ Imaging with fluoroscopy is heavily operator controlled, allowing for wide customization and…

Abdominal radiography

Anatomy, embryology, pathophysiology ◼ There are five distinct densities in plain radiography, four of which are natural: gas (black), fat (dark gray), soft tissue (medium gray), calcifications (white), and metal (intense white). ◼ Dedicated assessment of each density is essential in any search pattern. Techniques ◼ The standard abdominal radiograph is obtained in a supine projection, with x-rays passing from anteroposterior (AP). Field of view should…

The Future of Medical 3D Printing in Radiology

Introduction Looking back on the previous 30 years of progress in medical three-dimensional (3D) printing, it is astounding to consider just how far the field has come, with radiology playing a key, central role. Despite the dual infancies of medical imaging and 3D printing technologies in the late 1980s and early 1990s, a few pioneering individuals and organizations endeavored to bring the distinct technologies and communities…

Considerations for Starting a 3D Printing Lab in the Department of Radiology

Introduction Medical three-dimensional (3D) printing provides essential services within the modern hospital system. Patient-specific 3D printed anatomic models are used clinically to provide improved understanding of anatomy, more exact pathology evaluation, and more precise surgical intervention. 3D printed anatomic models can be used for many applications including presurgical planning, intraoperative guidance, trainee education, and patient counseling. Furthermore, 3D printed anatomic guides created from the patient’s imaging…

3D Printed Imaging Phantoms

Introduction To reproducibly and precisely characterize the ability of a medical imaging system to safely produce accurate images, it is useful to image objects which have properties similar to human tissues for the imaging method being tested, have geometries and compositions that are known exactly, and can remain in an exact location in the imaging system for indefinite periods of time. For this purpose, imaging phantoms are…

3D Printing in Forensic Radiology

Introduction Forensic radiology has been described as the use of imaging in both the antemortem and postmortem setting in order to detect and document various pathologies for medicolegal purposes. While considered small in comparison to other subspecialties within radiology, the field’s origins date back over 120 years within the United States (US) with the first reported case of X-rays being used as illustrative/demonstrative evidence in 1896.…