Radiology of Hepatobiliary
system and Pancreas
Dr. K. M. Das, MD
Associate Professor, Radiology
CMHS
Radiology of Hepatobiliary system and
Pancreas
Ultrasonography
Computed tomography
MRI: Magnetic resonance Imaging
Radiology of Hepatobiliary system and
Pancreas- Goal
Detection of lesion
Extent of disease
Etiology
Patient management: Further studies, Biopsy,
Surgery
Radiology of Hepatobiliary system and
Pancreas
Liver
Gall bladder
Pancreas
Common Hepatic lesions
Hepatic cysts
Hemangiomas
Focal Nodular hyperplasia
Hepatic adenoma
Hepatoma
Metastases
Hepatic cysts
Hepatic cyst
Multiple cysts
Polycystic Kidney Disease
D/D Hepatic cyst: Liver abscess
Early Presentation
Late Presentation
Ovarian cancer : Metastases
Hepatic Cyst
Simple cyst
Malignant cyst
CT angiography
Hepatic Cyst
Simple cyst
Malignant cyst
Common Hepatic lesions
Hepatic cysts
Hemangiomas
Focal Nodular hyperplasia
Hepatic adenoma
Hepatoma
Metastases
Hemangioma of Liver
Hemangioma of Liver
Hemangioma of Liver
Common Hepatic lesions
Hepatic cysts
Hemangiomas
Focal Nodular hyperplasia
Hepatic adenoma
Hepatoma
Metastases
Focal Nodular hyperplasia
Second most common tumor of Liver
Most common in reproductive-aged women
Hyperplastic hepatocytes/ Hamartoma
No bleed / Malignant transformation
the liver
Focal Nodular hyperplasia (FNH)
Focal Nodular hyperplasia (FNH)
Arterial
Venous
Delayed
Abnormal vessel
Common Hepatic lesions
Hepatic cysts
Hemangiomas
Focal Nodular hyperplasia
Hepatic adenoma
Hepatoma
Metastases
Hepatic adenoma: facts
More common in woman
Contraceptive
Contain Fat and Glycogen
Known to bleed
Transform to Hepatoma
Hepatic adenoma: facts- CT findings
Hepatic adenoma: facts- CT
findings
Hepatic adenoma: facts- CT findings
Bleed
Hepatic adenoma: facts- CT findings
Very difficult to differentiate a
hepatic adenoma from
Hepatoma
Hepatoma (HCC) : Facts
Most common primary hepatic malignancy
Incidence : 2.4 per 100,000 per year
Hepatoma is the leading causes of death in patients
with Cirrhosis.
Hepatoma : HCC-Hepatocellular carcinoma.
Hepatoma : HCC-Hepatocellular
carcinoma.
Arterial Phase
Venous Phase
Hepatoma : Facts. 3D Map
Gall bladder
Gall bladder : Ultrasonography
Acoustic shadowing
Acute cholecystitis
Gall bladder : Ultrasonography
Mirizzi syndrome
is a rare complication of
gallstone disease in which a
gallstone becomes impacted in
the cystic duct or neck of the
gallbladder causing compression
of the common bile duct (CBD)
Mirizzi syndrome
Gall Bladder perforation
Gall Bladder perforation- Gall stone ileus.
Gall Bladder Cancer
Most aggressive cancer.
Surgical resection: 50% survive 5 years.
Non Surgical: 5% survive 5 years.
Gall Bladder Cancer
Gall Bladder Cancer
Gall Bladder Cancer: Invading liver
Pancreas
Acute Pancreatitis: CT
Best screening modality: CT
Disease severity and the outcome prediction
Identify complications and
Guide interventions
Acute Pancreatitis: CT
Normal Pancreas
Adenocarcinoma Pancreas
4th Leading cause of Cancer
mortality
Poor prognosis with <5% survival
at 5 years
<20% of patients are candidates
for curative surgery
Adenocarcinoma of Pancreas: CT
Adenocarcinoma Pancreas : CT
MRI : Indication
Equivocal diagnosis
Elastography Cirrhosis of Liver
Chemical shift Imaging
Biliary duct pathology
Endoscopic retrograde
cholangiopancreatography (ERCP)
MRCP : Magnetic resonance cholaniopancreatography
MRCP : Magnetic resonance cholaniopancreatography
Primary sclerosing cholangitis
MRCP
ERCP
MR: Chemical shift imaging
In Phase
Out of Phase
MR Elastography (MRE)
stiffness value of 2.1 kPa
stiffness value of 2.1 kPa
Normal < 2.9 kPa
stiffness value of 4.8 kPa
stiffness value of 8 kPa
Summary 1
Increased lesion detection does not
necessarily mean a more accurate
study. In fact, most mm size lesions are
benign cyst or hemangiomas
Summary 2
Lesion detection is not enough
Creating a long differential diagnosis is not the key
Creating a decisive diagnosis is the key