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Liver

Anatomy In 2000 the Terminology Committee of the International Hepato-Pancreato-Biliary Association refined the accepted terminology of hepatic anatomy and liver resections. The international classification system divides the liver into eight independent segments (Couinaud [pronounced “kwee-NO”] segments) ( Fig. 11.1 , Tables 11.1 and 11.2 ). Each segment is a self-contained unit that can be surgically resected without damaging the remainder of the liver. Each segment has…

Abdominal Trauma

Multidetector CT (MDCT) is the imaging method of choice for the diagnosis of intra-abdominal injury following blunt abdominal trauma. Treatment is directed by characterization of the precise nature of the injury, or by the reliable demonstration of the absence of significant injury. CT is particularly valuable when physical examination of the abdomen is equivocal or unreliable, such as with head trauma or impairment of consciousness caused…

Peritoneal Cavity, Vessels, Nodes, and Abdominal Wall

Peritoneal Cavity Anatomy The various recesses and spaces of the peritoneal cavity are easiest to recognize on CT when ascites is present. Identifying the precise compartment that an abnormality is in goes a long way toward identifying the nature of the abnormality and deciding on a plan for intervention. The peritoneum is a thin membrane that produces serous fluid, which lubricates the abdominal and pelvic cavity.…

Introduction to CT of the Abdomen and Pelvis

Despite marked advances in limiting image times for magnetic resonance imaging, CT remains the primary modality for most indications for imaging the abdomen and pelvis. The technology of multidetector CT (MDCT) scanners continues to advance, with progressive increases in the number of detectors, now exceeding 128 detector rows, and progressive decrease in acquisition times. Concern is now focused on CT radiation dose and overuse as thin-slice…

Pleura, Chest Wall, and Diaphragm

Technical Considerations In general, the pleura and chest wall are adequately evaluated with routine thoracic CT techniques. Contrast medium infusion is helpful in showing pleural thickening and in allowing its differentiation from pleural fluid. Soft-tissue window settings and bone windows are most suitable for evaluating pleural abnormalities, the chest wall, and the diaphragm. It should be kept in mind that the diaphragm and posterior pleural space…

Lung Disease

On CT, normal lung varies in appearance, depending on the window settings used. With a window mean of –600 to –700 Hounsfield units (HU) and a width of 1000 to 1500 HU, the lungs appear dark, but not as black as the air visible in the trachea or bronchi. This slight difference in attenuation between lung parenchyma and air should be sought in choosing an appropriate…

The Pulmonary Hila

CT is helpful in the diagnosis of endobronchial lesions, hilar and parahilar masses, and hilar vascular lesions. Technique In most patients the hila are adequately assessed with spiral CT with a 5-mm slice thickness (it takes about 15 contiguous 5-mm slices to image the hila), but thinner slices are optimal in identifying some findings such as bronchial abnormalities, small lymph nodes, and hilar vessels. Scans with…

Mediastinum: Lymph Node Abnormalities and Masses

Lymph Node Groups Mediastinal lymph nodes are generally classified by location. Most descriptive systems are based on a modification of Rouvière’s classification of lymph node groups. The names used in describing lymph nodes groups for the purpose of lung cancer staging may differ and are reviewed in Table 4.1 . TABLE 4.1 Relationship of the International Association for the Study of Lung Cancer Lymph Node Zones…

Mediastinum: Vascular Abnormalities and Pulmonary Embolism

Aortic Abnormalities Computed tomography (CT) is commonly used to diagnose abnormalities of the aorta or its branches when they are suspected clinically or because of radiographic abnormalities. Congenital Anomalies Congenital abnormalities of the aorta and its branches are readily diagnosed with CT, and no other study is usually needed unless the anomaly is complex or is associated with congenital heart disease. Aberrant Right Subclavian Artery Aberrant…

Mediastinum: Introduction and Normal Anatomy

Computed tomography (CT) is commonly used in patients suspected of having a mediastinal mass or vascular abnormality (e.g., an aortic aneurysm). In general, CT is performed in two situations. First, in patients with a mediastinal abnormality visible on plain radiographs, CT is almost always the preferred imaging procedure. CT is used to confirm the presence of a significant lesion, determine its location and relationship to vascular…

Introduction to CT of the Thorax: Chest CT Techniques

S piral (helical) computed tomography (CT) allows the entire chest to be imaged in a few seconds or less (i.e., during a single breath hold), with volumetric acquisition of scan data. Two- and three-dimensional reformations may be performed if desired. Because scanning is rapid, contrast agents can be injected quickly, excellent vascular opacification can be achieved, and reduced volumes of contrast agent can be used. Multidetector…

Emergency Procedures for Spills of Radioactive Materials and Special Circumstances

Spills of Radioactive Materials Accidental spillage of radioactive material is rare; however, spills may occur in the laboratory, in public areas such as facility hallways, in elevators, or in any hospital room or ward through contamination by patient body fluids. Spill procedures should be posted in the restricted areas where radioactive materials are used or stored and should specifically state the names and telephone numbers of…

Sample Techniques for Nuclear Imaging

This appendix is provided as a guide to the technical aspects of various imaging procedures. Some of the less common procedures have not been included, and the procedures described herein may need to be adjusted, depending on the equipment available and user preferences. The protocols for positron emission tomography (PET) examinations are at the end of this appendix. Each nuclear medicine laboratory should have a standardized…