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Body - US/MR
Final
55
Medical
Professional
01/26/2014

Additional Medical Flashcards

 


 

Cards

Term
MC areas of focal parenchymal sparing
Definition
IVC, PV bifurcation, GB bed, subcapsular
Term
Hepatitis
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
Term
CIRRHOSIS
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
Term
PORTAL HTN sizes
Definition
Dilation of Portal V. > 13 mm

Dilation of SMV > 10 mm

Reverse PV flow (from periphery of liver towards porta)
Term
BUDD-CHIARI
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
Term
“TARGET LESIONS”
Definition
bright center, dark rim

More likely malignant

DDx – mets, HCC, lymphoma, abscess
Term
ADENOMA
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
Term
FIBROLAMELLAR
Definition
Younger, normal liver

Central stellate SCAR sometimes with CALCs
Term
FNH
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
Term
DOPPLER
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
Term
BILIARY DILATION
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
Term
ACUTE CHOLE
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
Term
ADENOMYOMATOSIS
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
Term
CHOLANGIOCARCINOMA
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
Term
CHOLEDOCHAL CYSTS
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
Term
CAROLI
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
Term
PSC
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
Term
ANGIOMYOLIPOMA
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
Term
RAS
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)
Term
Serous Cystadenoma (Panc)
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
Term
PANC ADENO CA
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$
Term
Unresectable Panc CA
Definition
Encasement of superior mesenteric vessels (180o)
Liver mets
Peritoneal implants
Peripancreatic spread
Size >3 cm
Mesenteric/RP adenopathy
Term
BILIARY CYSTADENOMA/CYSTADENOCARCINOMA
Definition
Multilocular cystic lesion with thick walls, septations, mural nodules, usually large

Requires surgical resection as benign vs. malignant cannot be distinguished
Term
CAVERNOUS HEMANGIOMA
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
Term
HCC
Definition
MR – T1 hypo, T2 hyper, arterial enhancement (hypervascularity), washout, pseudocapsule enhancement, vascular invasion

Solitary, multiple nodules, diffuse infiltrating
Term
Liver Mets
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
Term
THID (Transient Hepatic Intensity Differences)
Definition
Hyperintensity on HADP w/ isointensity on pre and delayed
Mimcs FNH
Sharp, linear borders, geographic distribution, triangular
Term
DYSPLASTIC NODULES
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
Term
PYOGENIC ABSCESS
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)
Term
AMEBIC ABSCESS
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
Term
HYDATID CYST (ECHINOCOCCUS)
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
Term
BILOMA
Definition
Anechoic with acoustic enhancement – needs confirmation with nucs
Term
GB CA
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
Term
MIRIZZI
Definition
Obstructive jaundice caused by hepatic duct obstruction 2/2 stone at confluence of cystic and common hepatic ducts
Term
ASCENDING CHOLANGITIS
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
Term
CYSTIC NEOPLASMS - Panc
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
Term
ISLET CELL TUMORS
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
Term
PANC LYMPHOMA
Definition
Very rare
Low T1, variable T2, typically low enhancement
Can cause ductal dilatation but to a lesser degree than typical panc mass
Term
MUCINOUS CYSTIC NEOPLASM - Panc
Definition
Multiple cysts filled with thick mucin; tail prevalence
Hi T1, hi T2
Term
SOLID-CYSTIC PAPILLARY EPITHELIAL NEOPLASM (SPEN) - Panc
Definition
Well-defined mixed solid/cystic with hemo necrosis and calcification; malig potential but low
Black or Asian women 20s-30s
Term
Bright on T1
Definition
Term
Bright on T2
Definition
Term
Dark on T1
Definition
Term
Dark on T1
Definition
Term
Early enhancement
Definition
HCC - quick washout
Adenoma - fades but persists
Term
MULTILOCULAR CYSTIC NEPHROMA (MLCN)
Definition
Benign multiloculated cystic lesion, thin septal enhancement, herniation into renal pelvis, no solid component
Usually kids and older women (50s-60s)
Term
ONCOCYTOMA
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
Term
RCC
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
Term
ADENOMA - Adrenal
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
Term
MYELOLIPOMA
Definition
Macroscopic fat w/ swirls of hematopoietic elements (myelo = bone marrowish)
Myelo products = high on T2 and enhancement
Term
PHEO
Definition
Arises from medulla, chromaffin cells, catecholamines
Rule of 10s = bilateral, malignant, extra-adrenal, inherited, calcified, kids, no HTN
“Lightbulb bright” T2, avid enhancement
Term
RP FIBROSIS
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
Term
RP LYMPHOMA
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
Term
Tamoxifen effect on uterus (MR)
Definition
diffuse endometrial hyperplasia
polyps
cystic atrophy
potentially endo CA
Term
Asherman's (MR)
Definition
Intrauterine adhesions 2/2 traumatic
linear enhancing T2 hypointensities which span the endo cavity
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