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ABDOMINAL DYNAMIC CT
ELYSANTI DWI MARTADIANI
UDAYANA MEDICAL FACULTY / SANGLAH GENERAL
HOSPITAL
OVERVIEW
Goal of Contrast Administration
Multiphase Abdominal CT
Contrast Dose and Injection Rate
Oral contrast
Hepatic Dynamic CT
Take Home Points
PRE CONTRAST
POST CONTRAST
ABDOMINAL
DYNAMIC CT
OVERVIEW
Goal of Contrast Administration
Multiphase Abdominal CT
Contrast Dose and Injection Rate
Oral contrast
Hepatic Dynamic CT
Take Home Points
Multiphase in abdominal CT
Non-enhanced CT (NECT) / Plain CT
Contrast enhanced CT (CECT)
Early arterial phase
Late arterial phase ( early venous portal phase)
Hepatic ( late portal phase )
Nephrogenic phase
Delayed phase ( wash out phase / equilibrium phase)
http://www.radiologyassistant.nl/en/p52c04470dbd5c
/ct-contrast-injection-and-protocols.html
http://posterng.netkey.at/esr/viewing/index.php?module=viewin
g_poster&task=viewsection&pi=117&ti=7230&searchkey
=
Hepatic /
late portal venous phase
Important to evaluate :
Portosystemic
collateral in
http://posterng.netkey.at/esr/viewing/index.php?module=viewimage&task
=&mediafile_id=533120&201312301609.gif
liver chirrosis
Thrombus inside of
the portal venous
http://eurorad.org/eurorad/view_figure.php?pubid=9807&figid=
29153&nr=1
Nephrogenic phase
Approx. 100 second
post injection or 80 sec
after bolus tracking
All of the renal
parenchyma including
the medulla enhances.
Enable to detect small
renal cell carcinomas.
Sanchez et al. ECR 2010 / C-1342 MDCT and MR in the diagnosis,
characterization and staging of renal cell carcinoma. Radiologicpathologic correlation. http://
posterng.netkey.at/esr/viewing/index.php?module=viewing_po
ster&task=viewsection&pi=101337&ti=304222&searchkey
MULTIPHASE IN KIDNEY CT
Non enhanced CT look for the stone
Phases of enhancement :
Cortical angiogram
occur within a few second, not routinely
Glomerulogram
Cortical nephrogram : corticomedullary
differentiation
Tubular nephrogram / nephrographic phase
Delayed / excretory phase
Non contrast
Corticomedull
ary phase
Nephrogenic
phase
Delayed
phase
Sanchez et al. ECR 2010 / C-1342 MDCT and MR in the diagnosis, characterization and staging of renal cell carcinoma.
Radiologic-pathologic correlation.
http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=101337&ti=304222&sea
OVERVIEW
Goal of Contrast Administration
Multiphase Abdominal CT
Contrast Dose and Injection Rate
Oral contrast
Hepatic Dynamic CT
Take Home Points
18 gauge i.v
catheter 5 cc /
sec
For all indication
Especially for GIbleeding,
liver tumor
characterisation,
pancreatic carcinoma
Hold the arm stretched
20 gauge pink
venflon 3-4
cc / sec
Indication :
- If 5cc/sec is not
possible
- Only interested in
the
late portal phase
http://www.radiologyassistant.nl/en/p52c04470dbd5c/ct-contrast-injection-andprotocols.html
OVERVIEW
Goal of Contrast Administration
Multiphase Abdominal CT
Contrast Dose and Injection Rate
Oral contrast
Hepatic Dynamic CT
Take Home Points
ORAL CONTRAST
POSITIVE ORAL CONTRAST
Has some disadvantages
Usually only a portion of
the bowel is filled with
contrast
More radiation is needed
in areas of positive
contrast to get the same
quality of images
Enhancement of the bowel
wall is obscured
LOW SUSPENSION
BARIUM
NEGATIVE ORAL CONTRAST
Water
Advantage :
Enhancement of the bowel wall is not
obscure
Positive oral
contrast
http://www.ijri.org/viewimage.asp?img=In
dianJRadiolImaging_2013_23_4_373_125594_
u1.jpg
http://www.med.harvard.edu/JPNM/TF99_00/Mar7/CTsple
en.gif
Negative oral
contrast
http://www.ijri.org/viewimage.asp?img=IndianJRa
diolImaging_2013_23_4_373_125594_u1.jpg
http://pubs.rsna.org/doi/full/10.1148/rad
iology.211.3.r99jn25870
OVERVIEW
Goal of Contrast Administration
Multiphase Abdominal CT
Contrast Dose and Injection Rate
Oral contrast
Hepatic Dynamic CT
Take Home Points
HEPATIC DYNAMIC CT
LIVER
Dual blood supply : 80% by the portal vein
20% by the hepatic artery
On a non enhanced CT-scan (NECT) liver tumors
are not visible, because the contrast between
tumor tissue and the surrounding liver
parenchyma is too low.
LIVER
Minimal parenchymal enhancement in the
late arterial phase at 35-40 second post
injection
Parenchyma will enhance maximally in the
hepatic phase / late portal phase ( at 70-80
second post injection)
Hypovascular
lesions in late
venous portal /
hepatic phase :
Metastase
Cysts
Abscess
http://www.radiologyassistant.nl/en/p446f010d8f420/liver-masses-icharacterization.html
http://www.radiologyassistant.nl/en/p446f010d8f420/liver-masses-icharacterization.html
Hypervascular liver
tumor
Arterial phase :
hypervascular
FNH
Portal venous
phase:
hypovascular
metastasis
Equilibrium phase :
dense
cholangiocarcinoma
http://www.radiologyassistant.nl/en/p446f010d8f420/liver-masses-icharacterization.html
LIVER
HEMANGIO
MA
http://www.scielo.br/scielo.php?pid=s0100-39842006000300013&script=sci_a
rttext&tlng=en
THANK YOU