Computed Tomography of the Abdomen

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Computed Tomography of the Abdomen
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Computed tomography of the Abdomen Pelvis

• Routine
• Abdomen
• Liver
• Kidneys
• Pancreas
• KUB

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Indications

• CT Abdomen!
• Anatomy?
• What can go wrong?
• Where are the most common pathologies / anomalies

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Indications

• Abdominal pain    (LLQ-suspect diverticulitis)
     (RLQ-suspect appendicitis) Diffuse    
  (acute abdomen or chronic, pain) History of
  malignancy     (lymphoma, cancer of colon,
  breast, stomach, lung, bladder, other) Abdominal
  or pelvic mass Fever and elevated white count,
  suspected abscess Trauma Miscellaneous
  infection, weight loss, bowel obstruction,
  question of free air or pneumatosis on plain
  films, postoperative complication, follow up of
  complicated pancreatitis, follow up Ca screening.
• Follow up of ultrasound findings

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Contraindications

• Contraindications
• As per contrast contraindications according to
  contrast related contra indications.
• Patient preparation
• As per post contrast indications and
  contraindications.

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Patient preparation

• 4 hour fast
• Oral contrast for 1 hour prior to scan.
• Oral contrast
• Barium sulphate based solution
• Non ionic Intravenous contrast solution
• Water
• Patient changed into radiolucent gown
• Artifacts removed
• All clothing except underclothing
• Bra and garters should be removed

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Patient orientation / position

• Patient supine
• Feet first
• Patient to raise arms up above head, and elbows
  in.
• Landmark
• Xyphoid sternum
• In mid coronal plane

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Scan technique

• Scan type
• Anteroposterior and lateral scout
• Helical
• Coverage
• Superiorly from dome of diaphragm
• Inferiorly to include Iliac crests, include
  pelvis if required.
• Comments
• Images acquired during suspended inspiration.
• If lesion is demonstrated a 5 minute delay series
  may be required.
• For oesophageal or stomach mass, an additional
  glass of contrast is to be ingested via drinking
  straw while patient is on table.

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Contrast technique

• Volume
• 60-80mls
• Injection rate / type
• 2-3mls/second
• Pressure injected
• Scan delay
• 60-75 seconds bolus tracking
• Smartprep, surestart etc (cardiac output)
• Comments
• Rectal contrast may be required for rectal
  carcinoma or perforated bowel.
• Vaginal contrast tampons may be required for
  female patients having pelvic scans.

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Image reconstruction

• 1st reconstruction
• 7mm / 7mm (soft tissue/mediastinal)
• 2nd reconstruction
• 3mm / 3mm (MPRs)

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Filming

• Format
• 20 format
• Window width / window level
• 350ww / 40wl (soft tissue) (also called standard)
• Comment
• Inlcude lung bases with lung setting at end of
  study.

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Post processing

• Reformations
• Coronal MPR (to demonstrate pathology if
  required)

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Abdomen Axial standard
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Anteroposterior Scout image
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Lateral Scout image
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Phase studies

• Pre (non) contrast
• Arterial phase
• Portal venous phase
• Delayed Phase
• normal liver parenchyma receives about 70 of its
  blood from the portal vein and 30 from the
  hepatic artery.
• Most primary and metastatic liver tumors,
  however, receive their blood from the hepatic
  artery.

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• Arterial phase helical CT of the liver improves
  detection of some small, malignant hepatic
  neoplasms when performed in addition to portal
  venous scanning. The value is greatest in those
  patients who have hypervascular neoplasms.

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Non contrast
Arterial phase
Portal venous phase
Portal venous phase
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Computed tomography of the Abdomen / liver

• Routine
• Liver

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Indications

• CT Liver!
• Anatomy?
• What can go wrong?
• Where are the most common pathologies / anomalies

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Indications

• Haemangioma
• Metastases
• Abnormal ultrasound

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Contraindications

• Contraindications
• As per contrast contraindications according to
  contrast related contra indications.
• Patient preparation
• As per post contrast indications and
  contraindications.

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Patient preparation

• 4 hour fast
• Oral contrast for 1 hour prior to scan.
• Oral contrast
• Barium sulphate based solution
• Non ionic Intravenous contrast solution
• Water
• Patient changed into radiolucent gown
• Artifacts removed
• All clothing except underclothing
• Bra and garters should be removed

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Patient orientation / position

• Patient supine
• Feet first
• Patient to raise arms up above head, and elbows
  in.
• Landmark
• Xyphoid sternum
• In mid coronal plane

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Scan technique

• Scan type
• Anteroposterior and lateral scout
• Helical
• Coverage
• Superiorly from dome of diaphragm
• Inferiorly to include Iliac crests, include
  pelvis if required.
• Comments
• Images acquired during suspended inspiration.
• If lesion is demonstrated a 5 minute delay series
  may be required.
• For oesophageal or stomach mass, an additional
  glass of contrast is to be ingested via drinking
  straw while patient is on table.

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Contrast technique

• Volume
• 60-80mls
• Injection rate / type
• 2-3mls/second
• Pressure injected
• Scan delay
• 10-20 / 60-80 seconds bolus tracking
• Smartprep, surestart etc (cardiac output)

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Image reconstruction

• 1st reconstruction
• 7mm / 7mm (soft tissue/mediastinal)
• 2nd reconstruction
• 3mm / 3mm (MPRs)

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Filming

• Format
• 20 format
• Window width / window level
• 350ww / 40wl (soft tissue) (also called standard)
• 150ww / 40wl (liver if required)
• Comment
• Inlcude lung bases with lung setting at end of
  study.

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Post processing

• Reformations
• Coronal MPR (to demonstrate pathology if
  required)

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Liver Axial standard
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Anteroposterior Scout image
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Lateral Scout image
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Liver window

• Burnt Toast

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Liver pathologies
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Computed tomography of the Abdomen / liver

• Routine
• Kidneys

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Indications

• CT Kidneys!
• Anatomy?
• What can go wrong?
• Where are the most common pathologies / anomalies

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Indications

• Acute flank pain, hematuria, suspected renal
  colic
• Renal mass
• Filling defect
• Hematuria
• Prior renal cell carcinoma (post partial
  nephrectomy or at high risk for bilateral tumors
  as in von Hippel Lindau or papillary renal cell
  carcinoma)
• History of bladder cancer, abnormal IVU
  suggesting upper tract disease
• Pyelonephritis unresponsive to antibiotics (pre
  contrast shows stones, enhanced and delayed views
  evaluate for pyelonephritis, abscess,
  obstruction.
• Perinephric haemorrhage, evaluate for renal
  tumour or other cause

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Contraindications

• nil

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Patient preparation

• No fasting required
• Patient changed into radiolucent gown
• Artifacts removed
• All clothing except underclothing
• Bra and garters should be removed

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Patient orientation / position

• Patient supine
• Feet first
• Patient to raise arms up above head, and elbows
  in.
• Landmark
• Xyphoid sternum
• In mid coronal plane

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Scan technique

• Scan type
• Anteroposterior and lateral scout
• Helical
• Coverage
• To include kidneys in their entirety.
• Comments
• Images acquired during suspended inspiration.
• Renal mass Three phase, non contrast, arterial
  phase and portal venous phase.
• Filling defect portal venous phase and 5 minute
  delayed.
• Include entire urinary tract if reqiured.

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Contrast technique

• Volume
• 60-80mls
• Injection rate / type
• 2-3mls/second
• Pressure injected
• Scan delay
• 10-20 / 60-80 seconds bolus tracking
• Smartprep, surestart etc (cardiac output)

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Image reconstruction

• 1st reconstruction
• 7mm / 7mm (soft tissue/mediastinal)
• 2nd reconstruction
• 3mm / 3mm (MPRs)

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Filming

• Format
• 20 format
• Window width / window level
• 350ww / 40wl (soft tissue) (also called standard)

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Post processing

• Reformations
• Coronal MPR (to demonstrate pathology if
  required)

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Kidneys Axial standard
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Renal Pathologies
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Computed tomography of the Adrenal glands

• Abdomen
• adrenal glands

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Indications

• Metastases
• Lipoma
• Adrenal cortical adenoma
• Evaluation of mass
• Cushing Syndrome (hypercortisolism)
• Conn syndrome  (hyperaldosteronism very thin
  sections needed as tumors are small)
• Virilization/feminization Characterize mass
  shown on screening CT with contrast
• Addison's disease (adrenal insufficiency)

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Contraindications

• Contraindications
• As per contrast contraindications according to
  contrast related contra indications.
• Patient preparation
• As per post contrast indications and
  contraindications.

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Patient preparation

• 4 hour fast
• Patient changed into radiolucent gown
• Artifacts removed
• All clothing except underclothing
• Bra and garters should be removed

94
Patient orientation / position

• Patient supine
• Feet first
• Patient to raise arms up above head, and elbows
  in.
• Landmark
• Xyphoid sternum
• In mid coronal plane

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Scan technique

• Scan type
• Anteroposterior and lateral scout
• Helical
• Coverage
• Diaphragm to iliac crests.
• Comments
• Images acquired during suspended inspiration.
• 4 phases pre contrast, arterial phase (20
  seconds), portal venous phase (60-80 seconds),
  and 5 minute delayed

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Contrast technique

• Volume
• 60-80mls
• Injection rate / type
• 2-3mls/second
• Pressure injected
• Scan delay
• 10-20 / 60-70 seconds bolus tracking
• 5 minute delay
• Comments
• Rectal contrast may be required for rectal
  carcinoma or perforated bowel.
• Vaginal contrast tampons may be required for
  female patients having pelvic scans.

99
Image reconstruction

• 1st reconstruction
• 3mm / 3mm (arterial phase)
• 2nd reconstruction
• 7mm / 7mm (portal venous phase, and delayed)

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Filming

• Format
• 20 format
• Window width / window level
• 350ww / 40wl (soft tissue) (also called standard)

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Post processing

• Reformations
• Coronal MPR (to demonstrate pathology if
  required)

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Adrenal glands Pathologies
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Computed tomography of the Pancreas

• Abdomen
• Pancreas

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Indications

• Acute pancreatitis    (assess severity, presence
  of hemorrhage or necrosis if extensive disease,
  usually add pelvis to look for complications
  there) Painless jaundice and weight loss
  (suspect pancreatic cancer) Islet cell tumour
  Chronic pancreatitis Characterize lesion seen
  on prior imaging (ultrasound, ERCP)
• Pancreatic mass

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Contraindications

• Contraindications
• As per contrast contraindications according to
  contrast related contra indications.
• Patient preparation
• As per post contrast indications and
  contraindications.

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Patient preparation

• 4 hour fast
• Water contrast (500ml) prior to scan
• Patient changed into radiolucent gown
• Artifacts removed
• All clothing except underclothing
• Bra and garters should be removed

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Patient orientation / position

• Patient supine
• Feet first
• Patient to raise arms up above head, and elbows
  in.
• Landmark
• Xyphoid sternum
• In mid coronal plane

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Scan technique

• Scan type
• Anteroposterior and lateral scout
• Helical
• Coverage
• Diaphragm to iliac crests.
• Comments
• Images acquired during suspended inspiration.
• 4 phases pre contrast, arterial phase (20
  seconds), portal venous phase (60-80 seconds),
  and 5 minute delayed

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Contrast technique

• Volume
• 60-80mls
• Injection rate / type
• 2-3mls/second
• Pressure injected
• Scan delay
• 10-20 / 60-70 seconds bolus tracking
• 5 minute delay

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Image reconstruction

• 1st reconstruction
• 3mm / 3mm (arterial phase)
• 2nd reconstruction
• 7mm / 7mm (portal venous phase, and delayed)

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Filming

• Format
• 20 format
• Window width / window level
• 350ww / 40wl (soft tissue) (also called standard)

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Post processing

• Reformations
• Coronal MPR (to demonstrate pathology if
  required)

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Pancreas Axial standard
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Pancreatic pathologies
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Other pathologies

• Stomach
• Spleen
• Colon
• Trauma

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Stomach
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Spleen
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Colon
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Trauma
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