1. Digestive system Diagnostic imaging department of xuzhou medical college of xuzhou medical college

2. liver masses

3. Characterization of liver masses Liver masses malignant benign Hepatocellular carcinoma Cyst Haemangioma FNH （focal nodular hyperplasia） Hepatic adenoma Liver masses malignant benign

4. Hepatic cyst precontrast contrast

6. Hepatocellular carcinoma 1. causes liver cirrhosis hepatitis B and C infection

7. Hepatocellular carcinoma 2. blood supply come mainly from the hepatic artery portal vein invasion is frequently present whereas hepatic vein occurs more rarely

8. Hepatocellular carcinoma 3. appearances of CT precontrast CT hypo-or isodense a tumor capsule most HCC appear homogeneous, some HCC appear in heterogeneous intrahepatic biliary duct dilatation

9. Hepatocellular carcinoma 3. appearances of CT Dynamic contrast enhanced CT arterial phase : homogeneous or heterogeneous enhancement hyperattenuating relative to normal parenchyma portal vein phase: enhancement discreased hypoattenuating relative to normal parenchyma wash-in and wash-out

10. precontrastArterial phase Portal venous phase HCC

12. precontrast Arterial phase Portal venous phase tumor vessel

13. Hepatocellular carcinoma

14. 4. appearances of MRI precontrast MRI T1WI: iso-or hypointense tumor capsule : hypointense T2WI: hyperintense DWI: hyperintense

15. Hepatocellular carcinoma T 1 WI T 2 WI

16. Hepatocellular carcinoma 4. appearances of MRI Dynamic contrast enhanced MRI similar to the appearances of dynamic contrast enhanced CT arterial phase : obviously enhancement portal vein phase: enhancement discreased wash-in and wash-out

17. Hepatocellular carcinoma

19. Hepatic cavernous haemangioma (CH) a very common benign liver tumor usually small (2cm diameter) and solitary, but 10% cases being multiple CH is composed of blood filled large or tortuous vascular cavities divided by thin, often incomplete, fibrous septa and lined by a single layer of flat endothelium

20. Hepatic cavernous haemangioma (CH) angiography has been used as the gold standard in the past now several noninvasive imaging methods are available such as US, CT, MRI

21. Hepatic cavernous haemangioma (CH) angiography

22. Hepatic cavernous haemangioma (CH) appearances of CT precontrast CT hypo-or isoattenuating homogeneous rounded mass usually smaller than 3cm diameter

23. Hepatic cavernous haemangioma (CH) appearances of CT dynamic contrast enhanced CT arterial phase :peripheral nodular enhancement pattern portal vein phase: a progressive “ fill- in ” of the lesion from the periphery towards the centre

24. Hepatic cavernous haemangioma (CH) precontrast arterial phase Portal venous phase

25. precontrast arterial phase Portal venous phaseequilibrium phase Hepatic cavernous haemangioma (CH)

27. 4. appearances of MRI precontrast MRI T1WI: low signal intensity T2WI: high signal intensity “ light bulb ”

28. 4. appearances of MRI Dynamic contrast enhanced MRI similar to the appearances of dynamic contrast enhanced CT arterial phase :peripheral nodular enhancement portal vein phase: a progressive “ fill- in ” from the periphery towards the centre

30. bile ducts

31. gallblader Pancreatic duct the ampulla of Vater Common hepatic duct Common bile duct Right hepatic duct left hepatic duct Normal bile ducts

32. Imaging investigation of jaundice 1. x-ray ERCP endoscopic retrograde cholangiopancreatography used for suspected distal biliary obstruction PTC percutaneous transhepatic cholangiography assess high biliary obstruction at the level of the porta

34. Imaging investigation of jaundice 2. ultrasound the initial investigation of choice to identify dilated bile ducts and confirm the presence of mechanical biliary obstruction

35. Imaging investigation of jaundice 3. computed tomography (CT) identifying dilated bile ducts and confirm the presence of mechanical biliary obstruction suggesting the site and cause of bile duct obstruction

36. Imaging investigation of jaundice 4. magnetic resonance imaging (MRI) identifying dilated bile ducts and confirm the presence of mechanical biliary obstruction suggesting the site and cause of bile duct obstruction MRCP magnetic resonance cholangiography may replace diagnostic ERCP

37. T2WIT1WI

39. Gallstones 1. gallstones are classified in three groups pure cholesterol stones: containing more than 90% cholesterol （胆固醇） mixed cholesterol stones: composed of more than 50% cholesterol pigmented ( 色素性 ) stones: composed mainly of calcium salt

40. Gallstones 2. x-ray only pigmented stones are visible on the AXR ERCP can present most of gallstones, but it is not used for the detection of gallstones because of the widespread availiability of ultrasound

41. Stones of the gallbladder

42. ERCP

43. Gallstones 3. CT pigmented stones are easily depicted on CT cholesterol stones usually have an attenuation value that is lower than bile and are visible on CT

44. cholesterol stones

45. pigmented stones

46. Mixed cholesterol stones

47. Stones of CBD

48. Stones of intrahepatic duct

49. Gallstones 4. MRI MRI and MRCP are able to visualize gallstones reliably ； presenting low signal intensity in T2WI

51. Stones of gallbladder

52. Stones of gallbladder and CBD