Term
| MC areas of focal parenchymal sparing |
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Definition
| IVC, PV bifurcation, GB bed, subcapsular |
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Term
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Definition
US - Diffuse edema leading to decreased echogenicity – clued in by diffuse GB wall thickening
US - “Starry sky” because echogenic portal triads look even brighter |
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Term
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Definition
Coarse, heterogeneous texture, multiple nodules – non-specific appearance
Visualization of portal triads more difficult
EtOH – asymmetric right lobe shrinkage
Portalization of hepatic veins reversal of flow characteristic of veins during atrial contraction
2/2 decreased compliance of veins
Cysts/hemangiomas, even METS are rare in cirrhosis |
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Term
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Definition
Dilation of Portal V. > 13 mm
Dilation of SMV > 10 mm
Reverse PV flow (from periphery of liver towards porta) |
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Term
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Definition
Obstruction of hepatic venous outflow; 2/2 thrombosis from systemic or malignancy
No flow seen in 1 or more hepatic V or IVC
Can develop large tortuous veno-venous collaterals or tiny spider web collaterals
Caudate lobe enlarges – it drains directly into IVC unlike remaining liver so it’s spared and hypertrophies |
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Term
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Definition
bright center, dark rim
More likely malignant
DDx – mets, HCC, lymphoma, abscess |
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Term
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Definition
Hepatocytes which proliferate in an abnormal pattern
Can malig transform, surgical removal recommended
Larger than FNH w/o scar
MR – typically iso to hyper on T1, mile hyper T2; can hemorrhage or have fat.
MR – early enhancement (due to lack of PVs) with fading but persistent hyperintensity |
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Term
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Definition
Younger, normal liver
Central stellate SCAR sometimes with CALCs |
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Term
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Definition
Proliferation of non-neoplastic hepatocytes, fibrous tissues
Scar, NO CALCS (usually)
Colloid nucs diagnostic (cause it’s hepatocytes)
Biggest DDx is FL HCC (usually larger, T2 hypointense scar) and adenoma
MR – basically isointense on T1/T2; arterial enhancement followed by fading |
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Term
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Definition
Hepatic a. and portal v. flow TO liver as it is blood supply of liver (TO transducer - RED)
Hepatic v. flow AWAY from liver as it goes to IVC (AWAY from transducer – typically BLUE)
Normal hepatic v. waveform is triphasic; biphasic suggests decreased flow back to heart, possibly CHF, obstruction (clot, mets, cirrhosis, etc); monophasic is basically clot (Budd-Chi)
Normal hepatic a. waveform is pulsatile, low-resistance
Normal portal v. waveform is venous (mild variability)
Pulsatile = CHF
pHTN can lead to monophasic
PV > 13 mm is basically pathognomonic for pHTN
RI <0.5 is concerning for HA stenosis/thrombosis
Low RI is common in early post-transplant
Cavernous Transformation – chronic PV clot leading to numerous collaterals
BUDD-CHIARI – hepatic v. obstruction; Leads to absent/reverse/turbulent/dampened flow in HVs or IVC |
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Term
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Definition
Normal GB wall <3mm; greater than 5 is definitely thick
Normal IH ducts <2mm
Normal CHD 6-7 mm; grows 1mm with age (80 yrs = 8mm) and enlarges after CCx
Further distally it’s typically bigger
Peds = 2-3 mm
Dilated ducts typically show through-transmission while vessels do not |
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Term
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Definition
Impaction of stone at GB neck obstructing duct and inflaming wall
Stones, wall thickening, Murphy, perichole fluid, dilated GB, hyperemia
Acalculous – more common in peds; trauma, surgery, burns, immunocomp, IV hyperal; PROLONGED BILIARY STASIS
Gangrenous – striated wall, perforation
Linear echogenic membranes
Emphysematous – gas in wall and lumen, typical with gangrene
Gas causes band of bright echos w/ reverb or comet tail echoes
“effervescent GB” champagne in a glass appearance |
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Term
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Definition
Focal or diffuse wall thickening involving fundus
Echogenic comet-tail reverb artifact along the wall as a result of RA sinuses
Rokitanksy-Aschoff sinuses – pockets of herniated mucosa containing cholesterol crystals
No malignant potential |
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Term
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Definition
Peripheral – solitary intrahepatic mass, no cirrhosis, occasional calcs; DOESN’T INVADE VESSELS
Hilar – Klatskin; IHBD diffusely dilated, EHBD normal
Small, echogenic, poorly defined, dilation of ducts ends abruptly at hilum
Distal – extrahepatic causing biliary obstruction
Polypoid, echogenic at lumen of dilated CBD
Focal point of obstruction, nodular duct wall thickening, polypoid intraluminal mass |
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Term
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Definition
I – cystic dilation of CBD which may be diffuse, saccular, or fusiform
II – CBD diverticulum
III – Choledochocele (dilation of CBD w/in duodenum)
IV – multiple cystic dilations of both IHBD and EHBD
V – Caroli |
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Term
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Definition
Congenital non-obstructing saccular/fusiform dilation of IHBD; EHBD are NORMAL
Complications – stones, recurrent cholangitis, fibrosis, pHTN
Associations – AR PCKD and medullary sponge kidney |
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Term
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Definition
IH and EH biliary fibrosis which leads to biliary cirrhosis and hepatic failure; peripheral atrophy, central hypertrophy
Focal and discontinuous areas of dilatation – “beaded” appearance which progresses to “pruned” appearance as a result of obliterated peripheral ducts; more obtuse angles of branches
Assoc w/ UC, Chron’s, RP fibrosis
Increased risk of cholangioCA
Biliary wall thickening, edema, and enhancement; periportal edema |
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Term
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Definition
Generally asymptomatic, can bleed esp >4 cm
“Wunderlich’s” – spontaneous extracap hemorrhage contained w/in perinephric fascia
Common in pts with TS
US - Homogeneous, hyperechoic mass
US - 10% can resemble RCC – shadowing supports AML, calcs/cystic/hypoecho halo suggests RCC
MR – bright on T2/STIR b/c of fat |
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Term
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Definition
Peak systolic velocity from Renal to abd aorta > 3.5
Peak velocity from main renal to interlobar > 5
Peak velocity in renal 180-200 cm/s (normal is 60-100) |
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Term
| Serous Cystadenoma (Panc) |
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Definition
Benign tumor consisting of a cluster of cysts (< 2cm)
Minimal septations and wall enhancement
May contain central scar
Lack of connection distinguishes from IPMN
Assoc w/ VHL |
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Term
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Definition
Hypointense on T1 compared to panc
Hypovascular following gad with gradual enhancement
“double duct” – dilation of both CBD and main panc duct
Atrophy of body/tail$ |
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Term
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Definition
Encasement of superior mesenteric vessels (180o)
Liver mets
Peritoneal implants
Peripancreatic spread
Size >3 cm
Mesenteric/RP adenopathy |
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Term
| BILIARY CYSTADENOMA/CYSTADENOCARCINOMA |
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Definition
Multilocular cystic lesion with thick walls, septations, mural nodules, usually large
Requires surgical resection as benign vs. malignant cannot be distinguished |
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Term
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Definition
US - Sharply marginated, lobulated, homogenous, hyperechoic, lots of thru transmission; No internal flow
MR – bright on T2; early nodular enhancement which progressively fills
“Flash filling” – early uniform hyperenhancement which persists – this distinguishes from other early enhancing lesions like FNH, HCC, mets, adenoma which all fade or washout
Giant Hemangioma (>4 cm) – typical hemangioma enhancement pattern but w/ central scar |
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Term
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Definition
MR – T1 hypo, T2 hyper, arterial enhancement (hypervascularity), washout, pseudocapsule enhancement, vascular invasion
Solitary, multiple nodules, diffuse infiltrating |
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Term
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Definition
Hypervascular – RCC, neuroendo, thyroid, breast, carcinoid, melanoma
Avid enhancement w/ continuous rim enhancement
“Donut” – T1 dark rim w/ darker center
“Lightbulb” – T2 bright rim w/ brighter center |
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Term
| THID (Transient Hepatic Intensity Differences) |
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Definition
Hyperintensity on HADP w/ isointensity on pre and delayed
Mimcs FNH
Sharp, linear borders, geographic distribution, triangular |
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Term
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Definition
T1 hyper, T2 hypo; usually <2 cm
Enhance w/ liver parenchyma
HCC is usually T2 hyperintense whereas dysplastic nodules are not
“Nodule w/in a nodule” – t2 hyper focus w/in t2 hypo nodule – focus of HCC |
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Term
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Definition
Usually multilocular and multiple
“Cluster sign” – multiple small cavities
Solid enhancement arterial and delayed, surround edema; NO CALCS, GAS (punctates hypointensities with susceptibility artifact) |
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Term
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Definition
Present less ill than pyogenic, extrahepatic manifestations
Appears similar to pyogenic – usually round/oval and hypoechoic with sharply defined walls
Rupture is a major complication
Commonly right lobe dude to SMV drainage |
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Term
| HYDATID CYST (ECHINOCOCCUS) |
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Definition
Lots of daughter cysts; calcification of walls
US - “water lily” – floating membranes w/in cystic mass = ruptured endocyst
Anaphylaxis rupture
MR – I = simple cyst, II = daughter, III = Ca2+, IV = rupture
T2 Hyperintense cyst with hypointense wall |
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Term
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Definition
| Anechoic with acoustic enhancement – needs confirmation with nucs |
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Term
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Definition
Polypoid soft tissue mass > 2cm is likely CA; high velocity doppler helps distinguish from sludge
Gallstones very common (60-90%)
Lo T1, hi T2 relative to liver |
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Term
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Definition
| Obstructive jaundice caused by hepatic duct obstruction 2/2 stone at confluence of cystic and common hepatic ducts |
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Term
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Definition
Central IH bil-dil as compared to peripheral as in PSC
Smooth, circumferential wall thickening and enhancement
Recurrent - Clonorchis and other parasites – Asia and Hong Kong
Diffuse dilatation of I/EHBD w/ numerous calculi |
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Term
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Definition
Serous Cystadenoma – small cysts, honeycomb
Mucinous Cystic – larger cysts, internal septa, papillary projections, solid components
Intraductal Papillary – focal multicystic masses or diffuse dilation of panc duct
Papillary Epithelium |
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Term
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Definition
Low T1, high T2, hypervascular
Insulinoma (MC) – hypoglycemia, usually <2cm, full enhancement
Gastrinoma (2nd MC) – ZE, MEN, smooth rim enhancement, usually b/t cystic duct, duod, panc neck, <4cm, frequently malignant
VIP, Glucagon, Somatostatin – larger, full enhancement |
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Term
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Definition
Very rare
Low T1, variable T2, typically low enhancement
Can cause ductal dilatation but to a lesser degree than typical panc mass |
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Term
| MUCINOUS CYSTIC NEOPLASM - Panc |
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Definition
Multiple cysts filled with thick mucin; tail prevalence
Hi T1, hi T2 |
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Term
| SOLID-CYSTIC PAPILLARY EPITHELIAL NEOPLASM (SPEN) - Panc |
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Definition
Well-defined mixed solid/cystic with hemo necrosis and calcification; malig potential but low
Black or Asian women 20s-30s |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
HCC - quick washout
Adenoma - fades but persists |
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Term
| MULTILOCULAR CYSTIC NEPHROMA (MLCN) |
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Definition
Benign multiloculated cystic lesion, thin septal enhancement, herniation into renal pelvis, no solid component
Usually kids and older women (50s-60s) |
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Term
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Definition
Benign neoplasm of renal epithelium, can undergo partial nephrectomy
Stellate central scar and “spokewheel” enhancement
More often nonspecific imaging with homo enhancement and well demarcated solid mass |
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Term
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Definition
Arises from renal tubular epithelium in cortex
Clear Cell – MR – hetero hyperintense on T2 w/ hypervascularity
Papillary – MR – homo hypointense, hypovasc
MR – solid components are nodular, hi T2, avid enhacement |
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Term
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Definition
Benign cortical lesions, majority nonfunctioning (less than 2 cm); functioning tend to be > 2cm
Iso to hypo on T2
Prompt homo enhancement then washout
Microscopic Fat = dropout on OOP = BENIGN!; compare to spleen dropout
f/u imaging is done to document size stability |
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Term
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Definition
Macroscopic fat w/ swirls of hematopoietic elements (myelo = bone marrowish)
Myelo products = high on T2 and enhancement |
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Term
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Definition
Arises from medulla, chromaffin cells, catecholamines
Rule of 10s = bilateral, malignant, extra-adrenal, inherited, calcified, kids, no HTN
“Lightbulb bright” T2, avid enhancement |
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Term
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Definition
Drugs, radiation, autoimmune, hemorrhage, malignancies but MC is idiopathic (Ormond’s)
Rind of soft tissue enveloping the aortic, IVC, ureters w/o lifting away from the spine (which lymphoma does)
MR – initially hi T2, avid enhancement and ill-defined but eventually sharpens and decreases in signal and enhancement
INFLAMMATORY ABD AORTIC ANEURYSM – same principle but just involves aorta |
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Term
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Definition
Displaces IVC from spine
Soft so doesn’t obstruct ureters like fibrosis or cause mass effect
Faintly homo bright on T2 and mild homo enhancement |
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Term
| Tamoxifen effect on uterus (MR) |
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Definition
diffuse endometrial hyperplasia
polyps
cystic atrophy
potentially endo CA |
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Term
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Definition
Intrauterine adhesions 2/2 traumatic
linear enhancing T2 hypointensities which span the endo cavity |
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