Kazan State Kazan State Medical UniversityMedical University

Department of radiologyDepartment of radiology

Liver, bile duct, pancreas and spleen

Overview of the abdomenOverview of the abdomen

by:Mahiby:Mahi

And hereAnd here, we are about to describe one of the most , we are about to describe one of the most important organ in the abdominal region.important organ in the abdominal region.

The liverThe liverThe liver is a large, The liver is a large, meaty organ that sits meaty organ that sits on the right side of the on the right side of the Abdomen . Weighing Abdomen . Weighing about 3 pounds, the about 3 pounds, the liver is reddish-brown in liver is reddish-brown in color and feels rubbery color and feels rubbery to the touchto the touch

by:Mahiby:Mahi

by:Mahiby:Mahi

Liver segments and lobulesLiver segments and lobules

The liver has two large The liver has two large sections, called the right sections, called the right and the left lobes.and the left lobes.And also consist of eight And also consist of eight segments.segments.The first segment is The first segment is cuadatecuadateThe right contain 4 The right contain 4 segmentssegmentsThe left are 3 segments . The left are 3 segments .

Diagram showing the segments

by:Mahiby:Mahi

liver’s functionliver’s functionThe liver's main job is to filter The liver's main job is to filter the blood coming from the the blood coming from the digestive tract, before passing it digestive tract, before passing it to the rest of the body. to the rest of the body. The liver also detoxifies The liver also detoxifies chemicals and metabolizes chemicals and metabolizes drugs. As it does so, the liver drugs. As it does so, the liver secretes bile that ends up back secretes bile that ends up back in the intestines. The liver also in the intestines. The liver also makes proteins important for makes proteins important for blood clotting and other blood clotting and other functions.functions.

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Blood supply and venous Blood supply and venous drainagedrainage

The blood supply of the liver The blood supply of the liver is delivered through the is delivered through the portal vein and the and the hepatic hepatic arteryartery. The . The hepatic arteryhepatic artery brings oxygenated blood to brings oxygenated blood to the hepatic tissues, while the the hepatic tissues, while the portal vein collects the portal vein collects the deoxygenated blood from the deoxygenated blood from the abdominal contents and filters abdominal contents and filters it, eliminating toxins and it, eliminating toxins and processing the nutrientsprocessing the nutrients

The The hepatic portal systemhepatic portal system is the system of is the system of veins comprising the comprising the hepatic portal vein and its and its tributaries. It is also called the tributaries. It is also called the portal venous system.portal venous system.

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Diagram for the vascular Diagram for the vascular system of liversystem of liver

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Biliary tractBiliary tract

RIGHT AND LEFT HEPATIC DUCTS RIGHT AND LEFT HEPATIC DUCTS

MERGES TO FORM THE MERGES TO FORM THE COMMON HEPATIC COMMON HEPATIC DUCTDUCT

COMMON HEPATIC DUCT COMMON HEPATIC DUCT LEAVEAS THE LIVER LEAVEAS THE LIVER AND GOINING TO AND GOINING TO CYSTIC DUCT CYSTIC DUCT TO FORM TO FORM THE THE COMMON BILE DUCT COMMON BILE DUCT

FINALLY DRAIN INTO FINALLY DRAIN INTO THE DOEDENUMTHE DOEDENUM

by:Mahiby:Mahi

And nowAnd now; ; it’s time to discover it’s time to discover how your abdomen looks like how your abdomen looks like inside this inside this Tunnel.Tunnel.

by:Mahiby:Mahi

MRIMRI1.MRI 1.MRI plain scan ：： SSequence——axial——axial 、、 coronal T1Wcoronal T1W 、、 T2WT2W FIESTAFIESTA 、、 DWIDWI 、、 double echodouble echo2. MRI 2. MRI enhancement scanning3. 3. MRAMRA4. MRCP 4. MRCP Magnetic Resonance

Cholangiopancreatography

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1. CORONAL PLANES1. CORONAL PLANES

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AXIAL PLANES

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3. SAGITTAL 3. SAGITTAL PLANESPLANES

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4. MR 4. MR ANGIOGRAPHYANGIOGRAPHY

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PositioningPositioning

Position the patient in supine position with head pointing Position the patient in supine position with head pointing towards the magnet (head first supine) .towards the magnet (head first supine) .

Position the patient over the spine coil and place the body coil Position the patient over the spine coil and place the body coil over the upper abdomen (nipple down to iliac crest) .over the upper abdomen (nipple down to iliac crest) .

Securely tighten the body coil using straps to prevent Securely tighten the body coil using straps to prevent respiratory artefacts .respiratory artefacts .

Give a pillow under the head and cushions under the legs for Give a pillow under the head and cushions under the legs for extra comfort .extra comfort .

Centre the laser beam localizer over xiphoid process of Centre the laser beam localizer over xiphoid process of sternum .sternum .

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Body Coil

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3 Survey ( Scout ) .3 Survey ( Scout ) .

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Coronal - Axial - SagittalCoronal - Axial - Sagittal

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The Sequences Before Inject The The Sequences Before Inject The Contrast Contrast

( Pre-Contrast )( Pre-Contrast )

1- Axial ( T2 – T1 – *T2 Heavy )1- Axial ( T2 – T1 – *T2 Heavy )

by:Mahiby:Mahi

Plan the Axial slices on the Coronal plane ;

* angle the position block across the liver as shown.

* Check the positioning block in the other two planes.

* Slices must be sufficient to cover the whole liver from the diaphragm down to the iliac crest by:Mahiby:Mahi

2- Coronal ( T2 – T1 ) 2- Coronal ( T2 – T1 )

by:Mahiby:Mahi

Plan the coronal slices on the axial image; Plan the coronal slices on the axial image;

* position the block across the liver as shown.* position the block across the liver as shown.

* Check in the other two planes , Slices must be sufficient to cover the * Check in the other two planes , Slices must be sufficient to cover the whole liver from the anterior abdominal wall to the posterior abdominal whole liver from the anterior abdominal wall to the posterior abdominal

wall . wall .

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The Sequences After Inject The Contrast The Sequences After Inject The Contrast +C+C

( Post-Contrast )( Post-Contrast )

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Arterial Arterial Pre Pre ( Befor +c )( Befor +c )

Dynamic post ( after Inject ) contrast T1 .Dynamic post ( after Inject ) contrast T1 .

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- Delayed- Delayed Porto-venous Porto-venous

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The Sequences +CThe Sequences +C

Axial T1Axial T1 (Arterial - Porto venous - Delayed ) (Arterial - Porto venous - Delayed )

Coronal T1Coronal T1 ( Porto venous ) ( Porto venous )

by:Mahiby:Mahi

34

5

6

T2WI

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34

5

6

T1WI

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ERCP normal biliary tract

Bile duct systemBile duct system

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MRCP

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Pancreas

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tail of pancreas body of pancreas

head of pancreas

MR T1WI

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head of pancreas

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T2T2 FFAT SATAT SAT

pancreas pancreatic duct

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Pancreatic headPancreatic head

head of pancreas Portal veingallbladder

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Hepatic cyst Congenital diseaseCongenital disease

MR MR Very low signal intensity on T1WI and very high Very low signal intensity on T1WI and very high

intensity on T2WIintensity on T2WI

by:Mahiby:Mahi

MR appearance Hepatic cyst

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Thank You Very Much

by:Mahiby:Mahi