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Abdominal CT scan made easy

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Abdominal CT anatomy with clue for interpretation

Publicado en: Salud y medicina
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Abdominal CT scan made easy

  1. 1. Abdominal CT Scan Crossing the barrier in bedside interpretation
  2. 2. DR. MASRUR AKBAR KHAN MBBS, FCPS (Surgery)
  3. 3. Can a Clinician interpret CT scan like a Radiologist?
  4. 4. OVERVIEW
  5. 5. • Introduction • CT anatomy abdomen • CT section with pathology • Take home message
  6. 6. INTRODUCTION
  7. 7. • Series of X-ray images taken from different angles. • Uses computer processing to create cross-sectional images.
  8. 8. TERMINOLOGY
  9. 9. DENSITY
  10. 10. • Hyperdense (more dense): • When an abnormality is bright (white) on CT.
  11. 11. • Isodense (the same density): • When an abnormality is the same density as the reference structure
  12. 12. • Hypodense (less dense): • When an abnormality is less dense than the reference structure
  13. 13. HOUNSFIELD UNITS
  14. 14. • Radiodensity on CT, Range from -1000 to +1000. • By definition water (CSF) = 0.
  15. 15. • Air is -1000 because it is the least dense structure. • Bone is the most dense and measures +1000.
  16. 16. • Fat is less dense than water and therefore measures -100. • Brain parenchyma is more dense than water and ranges from +20 to +40. • White matter is less dense than gray matter due to the fat within the myelin within the white matter.
  17. 17. • Acute blood is bright on CT and measures + 55 to +75 HU. C • Calcification is more dense than blood and will measure in the low 100's.
  18. 18. ATTENUATION
  19. 19. • Reductions in intensity of x-ray beam as it traverses matter either by absorption or deflection.
  20. 20. • High attenuation – Absorption of x-ray photon – Presented as white on image • Low attenuation – Free passage of photon – Presented as black on image
  21. 21. SCOUT VIEW/SCANOGRAM
  22. 22. • It is a mode of operating a CT system. • Used to display slice locations rather than for direct diagnosis.
  23. 23. WINDOWING
  24. 24. • Different “Windows" can be created to highlight specific structures. • Adjustments in gray scale/shade according to the specific attenuation properties of tissue
  25. 25. • Brain windows are useful to evaluate the parenchyma
  26. 26. • Bone windows are useful for evaluating fractures and the paranasal sinuses.
  27. 27. PHASIC SCAN/ CONTRAST ENHANCED SCAN
  28. 28. • Iodinated intravenous contrast – Increases the density of blood vessels and organs – Lymph nodes distinguished from blood vessels – Abnormal lesions in solid organs become easier to distinguish from normal surrounding parenchyma
  29. 29. • Iodinated oral contrast – During abdominal CT – Opacify the small bowel – This makes it easier to distinguish normal bowel from pathological lymph nodes or other mesenteric masses
  30. 30. SECTION/SLICES/PLANES/VIEW
  31. 31. • Standard 64 slice gives cross section with 0.5 mm thickness • 256 and 320 slices provide higher accuracy
  32. 32. INTERPRETING CT SCAN
  33. 33. Read the information on the CT scan
  34. 34. Do not get disoriented
  35. 35. Hold the film in the proper orientation
  36. 36. • Always begin cranial and gradually move caudally. • Assess structures from superficial to deep, first analyze tissues of abdominal wall and then progress to internal structures
  37. 37. • Begin by following one organ • Track it through entire sequence. • With experience, follow organs that lie in same transverse plane.
  38. 38. CT ANATOMY ABDOMEN (LABELED)
  39. 39. Follow the IV contrast filled Aorta as we descend caudally. Branches and points of interest will be noted.
  40. 40. Azygous Vein. Hemiazygous Vein
  41. 41. This is an excellent image of the right, middle and left hepatic veins draining into the Inferior Vena Cava. Don’t confuse this structure with the IVC, this is the esophagus at the level of the Lower esophageal sphincter, page up and down to confirm this.
  42. 42. The outline of the Inferior Vena Cava is more distinct in this image.
  43. 43. Portal Vein Branching into the Liver Liver Stomach
  44. 44. More portal vein branching into the liver lobes
  45. 45. Splenic Artery. Splenic Vein. Scroll up and down to confirm. Spleen
  46. 46. Splenic Vein
  47. 47. Proper Hepatic Artery. Splenic Vein Portal vein Adrenal Glands
  48. 48. You can see the Celiac artery starting to branch from the Aorta. You can follow this down in the next four images Proper Hepatic Artery is labeled in the upper right The splenic vein and artery are in the lower left
  49. 49. Proper Hepatic Artery and Splenic Artery (the splenic artery is the circle). Splenic Vein
  50. 50. Here the Splenic Vein is emptying into the portal vein. Follow this up and down. Pancreas
  51. 51. This is the Superior Mesenteric Artery Branching off the Aorta.
  52. 52. Rt. and Lt. Kidneys Pancreas Head
  53. 53. Renal Veins emptying into the IVC. We also see the right renal artery branching off the Aorta, follow it down till you see it enter the right kidney. The Superior Mesenteric Vein is outlined on the top of this image. If you follow the SMV up, you will see it empty into the Portal Vein.
  54. 54. Here we see the right and left renal vein entering into the Inferior Vena Cava. We Also see the left renal artery branching off the aorta and heading toward the left kidney. Page up and down to trace these vessels.
  55. 55. Superior Mesenteric Vein – follow it up as it joins the Splenic Vein to form the Portal Vein
  56. 56. Transverse Colon Small Bowell
  57. 57. Note inferior mesenteric artery emerging from aorta Inferior mesenteric vein extends cephalad to join smv.
  58. 58. Aorta bifurcates into common illiac arteries Appendix is noted coiling in Rt. Lower quadrant Note air in lumen on adjacent scans Psoas muscles
  59. 59. NORMAL ANATOMY (LABELED)
  60. 60. MALE ANATOMY (NOT LABELED)
  61. 61. CT SECTION FEMALE (NOT LABELED)
  62. 62. CORONAL SECTION (LABELED)
  63. 63. Paracolic gutters
  64. 64. Coronal reconstruction ( anterior to posterior) 1, liver 2, body of stomach. 3, transverse colon.
  65. 65. 1, Ileal loop 2, Right and left lobe of liver.
  66. 66. • 1, GB. • 2, Pyloric antrum. • 3, Liver. • 4, Body of stomach. • 5, crus of diaphragm. • 6, Transverse colon. • 7, Small bowel.
  67. 67. • 1, small bowel. • 3, transverse colon. • 4, external oblique. • 5, internal oblique • 6, transverse abdominis
  68. 68. • 1, Body and neck of pancreas • 2, pyloric antrum. • 3,sigmoid colon. • 4, descending colon. • 5, cecum.
  69. 69. • 1, portal vein. • 2,. splenic vein • 3, superior mesentric vein • 4, superior mesentric artery • 5,spleen
  70. 70. • 1, jejunal loop • 2, SMA • 3, Descending colon. • 4, spleen. • 5, Iliac wing. • 6,UB
  71. 71. • 1, duodenal- descending, horizontal, ascending part. • 2, spleen and splenic vein. • 3, fundus of stomach. • 4, tail of pancreas. • 5, left colic and right colic vein. • 6, ascending and descending colon. • 7, right and left external iliac vein • 8, inferior mesentric vein. • 9,IVC
  72. 72. • 1, caudate lobe of liver • IVC and left renal vein. • 2, abdominal aorta and right common iliac aretry. • 3, splenic vein. • 4,celiac trunk and superior mesentric artery. • 5,inferior mesentric vein. • 6, right colic vein
  73. 73. • 1,.abdominal aorta and renal artery • 2, IVC. • 3, Spleen • 4,Right and Left kidney. • 5, Gluteus medius and minimus muscle. • 6, Iliac and psoas muscle. • 8, Asc. and Desc. colon. • 9, UB.
  74. 74. • Right and left crus of diaphragm. • Both kidneys • Right lobe of liver • Spleen • Psoas and iliac muscle. • Right and left common iliac artery and vein.
  75. 75. • Liver ,spleen ,kidneys • Rectum • Anal canal
  76. 76. • Spinal cord • Lumbar vertebrae • Quadratus lumborum • Sacrum
  77. 77. CORONAL SECTION (NOT LABELED)
  78. 78. SAGITTAL SECTION LABELLED
  79. 79. Sagittal reconstruction (left to right) • Spleen • Ext. ,Int. oblique and transverse abdominis muscle.
  80. 80. • Left kidney • Splenic flexure • Descending colon • Iliac muscle
  81. 81. • Transverse colon • Body of stomach • Jejunal loops • Left kidney • Erector spinae and quadratus lumborum. • Iliac and psoas muscle. • Gluteus medius • Gluteus maximus
  82. 82. • Splenic vessel posterior to the tail of pancreas. • Left lobe of liver. • Pyloric antrum • Jejunal loop. • Left common iliac artery , • Left external iliac artery • Left common iliac vein • Left external iliac vein
  83. 83. • Abdominal aorta • Celiac trunk • SMA • Pyloric antrum • Body of pancreas with splenic artery and vein behind it. • Duodenum
  84. 84. • IVC • Head of pancreas • Horizontal part of duodenum • Portal vein • Left lobe of liver • Jejunal loop • Transverse colon • Sigmoid colon • Rectum • UB
  85. 85. • IVC • Portal vein • Psoas muscle • Common iliac vessel • Rectus abdominis muscle
  86. 86. • Right lobe of liver • GB • Right kidney • Hepatic flexure of colon • Quadratus lumborum • Erector spinae muscle
  87. 87. • Right lobe of liver • Transverse colon • Ascending colon
  88. 88. Can an isolated slice of CT scan confirm diagnosis?
  89. 89. CT SECTION WITH PATHOLOGY
  90. 90. Can a Clinician interpret CT scan like a Radiologist?
  91. 91. TAKE HOME MESSAGE
  92. 92. • Be competent in interpretation of CT scan • Beware of superiority complex • Never underestimate your Radiologist colleague.
  93. 93. Don’t let a CT scan replace you clinical acumen
  94. 94. Queries & Comments

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