Ebook Computed body tomography with MRI correlation (4/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Computed body tomography with MRI correlation (4/E): Part 2
Ebook Computed body tomography with MRI correlation (4/E): Part 2
Liver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2ocal and diffuse hepatic diseases. It has become established as the imaging method of choice for routine screening of the liver. However, magnetic resonance imaging (MRI) has proved to be at least as effective as intravenous contrast-enhanced CT for detecting and characterizing most hepatic abnormal Ebook Computed body tomography with MRI correlation (4/E): Part 2ities. Each method has strengths and limitations. Regardless of the imaging method used, however, the technique of conducting the examination is cruciEbook Computed body tomography with MRI correlation (4/E): Part 2
al to its diagnostic performance.This chapter highlights the use of CT and MR1 for evaluating both focal and diffuse hepatic abnormalities. Various CTLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2tomy of the liver and the CT and MRI appearances of important pathologic processes involving the liver are detailedANATOMYGross MorphologyThe liver is the largest organ in the abdomen, occupying most of the right upper quadrant It varies considerably among individuals in size and configuration. Supe Ebook Computed body tomography with MRI correlation (4/E): Part 2riorly, laterally, and anteriorly the liver is bordered by and conforms to the undersurface of the diaphragm. Prominent diaphragmatic leaves may indenEbook Computed body tomography with MRI correlation (4/E): Part 2
t the surface of the liver as they insert on the ribs, producing hypoattenuating or low-signal-intensity defects that should nor be misinterpreted as Liver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2e of the colon, and posteriorly by the right kidney. The superior portion of the right adrenal gland borders the medial aspect of the posterior superior right hepatic segment (segment VII).The liver is covered by peritoneum, except for the surfaces apposed to the inferior vena cava (IVC). the gallbl Ebook Computed body tomography with MRI correlation (4/E): Part 2adder fossa, and the posterosuperior aspect of the diaphragm (the ■■bare area"). It is attached to the diaphragm anterosu-periorly by the falciform liEbook Computed body tomography with MRI correlation (4/E): Part 2
gament and posteriorly by the coronary ligaments. The surface of the liver between the superior and inferior coronary ligaments is devoid of peritoneuLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2er and the diaphragm in this area. Fluid identified posterior to the liver in this region IS located in the pleural space (425). in the superior recess of the retroperitoneum. or beneath the liver capsule Laterally the superior and inferior coronary ligaments come together to form the left and right Ebook Computed body tomography with MRI correlation (4/E): Part 2 triangular ligaments.Three hepatic fissures help define the margins of the hepatic lobes and the major hepatic segments (148). The interlobar fissureEbook Computed body tomography with MRI correlation (4/E): Part 2
is an incomplete structure on the inferior margin of the liver that is oriented along a line passing through the gallbladder fossa inferiorly and theLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2The interlobar fissure forms the inferior margin of the border between the right and left hepatic lobes. The left intersegmental fissure (fissure for the liga-mentum teres), which forms a well-defined sagittally on-ented cleft in the caudal aspect of the left hepatic lobe, divides the lobe into medi Ebook Computed body tomography with MRI correlation (4/E): Part 2al and lateral segments (Figs. 12-2 and 12-3). The ligamentum teres, which is usually surrounded by a small amount of fat. runs through the fissure afEbook Computed body tomography with MRI correlation (4/E): Part 2
ter entering it via the free margin of the falciform ligament. A third fissure, the fissure for the ligamentum veno-sum. IS oriented in a coronal or oLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2apter 12Figure 12-1 Hepatic pseudolesion. Contrast-enhanced CT image A: shows a low attenuation detect in the medial segment of the left hepatic lobe (arrow). A more cephalad image B: demonstrates that the appearance is due to indentation from the adjacent diaphragm.Figure 12-2 Hepatic segmental ana Ebook Computed body tomography with MRI correlation (4/E): Part 2tomy as viewed in the transaxial plane at different levels through the liver. The transverse scissura, described by the left and right portal vein braEbook Computed body tomography with MRI correlation (4/E): Part 2
nches, demarcates the cranially located segments (II. VII, and VIII) from the caudally located segments (III. VI. and V. respectively). RHV, right hepLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2sure for the liga-mentum venosum; RPV. right portal vein (A. anterior branch; p. posterior branch); LPV, left portal vein; u, umbilical segment; FL. falciform ligament; ILF. interlobar fissure; GB. gallbladder.Liver 83112-3). This fissure, which is iu continuity with (be intersegmental fissure, cont Ebook Computed body tomography with MRI correlation (4/E): Part 2ains a portion of (he gastrohepatic ligament (lesser omentum). It is best seen on images obtained cephalad to the fissure for the ligamentum teres.TheEbook Computed body tomography with MRI correlation (4/E): Part 2
caudate lobe may be considered an autonomous part of (he liver from a functional viewpoint because it has separate blood supply, bile drainage, and vLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2ansaxial images A-F: The main hepatic veins (b/adc arrowheads. A-F) form the major vertical scissurae that divide the hepatic segments. The right and left poital veins, shown in c, form the transverse scissura. Open airow. fissure for the ligamentum venosum; curved arrow, umbilical segment of left p Ebook Computed body tomography with MRI correlation (4/E): Part 2ortal vein; straight arrow, fissure for the ligamentum teres; PV, portal vein; LPV. left portal vein; RPV, right portal vein; LLPV, left lateral segmeEbook Computed body tomography with MRI correlation (4/E): Part 2
nt portal veil branch; ARPV, anterior blanch of right portal vein; PRPV, posterior blanch of the right portal vein. VWxte arrow, accessory right hepatLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2er 12Figure 12-3 (continued) Coronal images (G-L) ordered from most anterior (G) to most posterior (L): The hepatic segments are numbered according to the system of Couinaud as modified by Bismuth. G: Arrow, left lateral portal vein branch to segment III. Arrowheads. left hepatic vein branches drain Ebook Computed body tomography with MRI correlation (4/E): Part 2ing segments II and III. Curved arrow, fissure for the llgamentum teres, open arrow, interlobar fissure (gallbladder fossa)” H: Arrow. umbilical segmeEbook Computed body tomography with MRI correlation (4/E): Part 2
nt of the left portal vein. Curved arrow, left hepatic vein. Arrowhead, middle hepatic vein. Open arrow, interlobar fissure (gallbladder fossa). WhiteLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2ddle hepatic vein, open arrow, left lateral portal vein branch to segment II. J: PV. main portal vein. RPV, right portal vein. LPV. left portal vein Curved arrow, left hepatic vein Arrowhead. middle hepatic vein. K: Curved arrow, left hepatic vein. Arrowhead, middle hepatic vein. PV, main portal vei Ebook Computed body tomography with MRI correlation (4/E): Part 2n. RPV, right portal vein.Livor 833Figure 12-3 (continuerfl L: IVC, inferior vena cava. Arrow, right hepatic vein. Images prepared by Brett Gratz, MD.Ebook Computed body tomography with MRI correlation (4/E): Part 2
of the liver that extends medially from the right lobe between the IVC and porta! vein (see Figs. 12-2 and 12-3). The isthmus, which occupies the posiLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2e porta hepatis. the papillary process may appear separate from the rest of the liver and may be mistaken for an enlarged lymph node (18.162) Multiplanar viewing or careful analysis of consecutive CT or MR! sections IS essential to avoid this potential pitfail.Segmental AnatomyAn understanding of th Ebook Computed body tomography with MRI correlation (4/E): Part 2e segmental anatomy of the liver IS critical for localization and appropriate management of hepatic neoplasms. Confusion regarding hepatic segmental aEbook Computed body tomography with MRI correlation (4/E): Part 2
natomy relates primarily to differences between American and European nomenclature (754). The system proposed by Goldsmith and Woodburne (242) and useLiver©■'wwJay p. Heiken Christine o. Menias Khaled ElsayesFor more than 25 years, computed tomography (CT) has been widely used for evaluating both fo Ebook Computed body tomography with MRI correlation (4/E): Part 2d by Couinaud (139) and later modified by Bismuth (54) provides the surgically relevant information and is easily applicable to cross-sectional imaging techniques such as CT. MRI. and ultrasound (754). Table 12-1 shows the correspondence among these three nomenclatures. An additional nomenclature ad Ebook Computed body tomography with MRI correlation (4/E): Part 2opted at the World Congress of the International Hepato-Pancreato-Biliary .Association in Brisbane. Australia in 2000 (786) also will be described.TheEbook Computed body tomography with MRI correlation (4/E): Part 2
system of Goldsmith and Woodburne is the most basic and divides the liver into right and left lobes, with each lobe having two segments. The right loGọi ngay
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