EJCAP Online 22(4), December 2012, English

10 Looking at the liver

10 Looking at the liver

Imaging the liver

Check out this video on ultrasound examination of the liver, with Kimberly Palgrave (BCF Technology).

This video was kindly provided by BCF technology

Federica Rossi

Clinica Veterinaria dell’Orologio

Via Gramsci 1/4

Sasso Marconi (Bologna)

Italy

E-mail: chiccarossi@yahoo.it

Federica Rossi DVM DipECVDI graduated from the University of Bologna in 1993 and received the “Rotary Degree Award” for the best academic curriculum in Veterinary Medicine of the year. She started working in private practice, alternating periods of training in diagnostic imaging in Italy and in another European country.

In 1997, she obtained the Italian Diploma of Specialist in Veterinary Radiology. After completing a radiology residency at the University of Bern (Switzerland), she obtained the Diploma of European College of Veterinary Diagnostic Imaging (ECVDI) in 2003.

Since 2003, she has been working in her Referral Centre in Diagnostic Imaging (Bologna) and since 2009 at the Oncologic Centre (Bologna), as one of the founder members.

In 2006, she was elected President of the European Association of Veterinary Diagnostic Imaging (EAVDI) and in 2010, President of SCIVAC (Italian small animal veterinary society).

She is closely involved in the continuing education activities in Italy and Europe, and is coordinator of the SCIVAC Diagnostic Imaging Group and of various imaging courses.

She is author of several papers and co-author of diagnostic imaging books.

© Ingrid Gielen, FVM, UGent

Lung metastases

CT study of the cranial abdomen and thorax, from caudal to cranial, of a dog with metastasis in the lung lobes (visible between 00:11 and 00:58 seconds). Multiple poorly marginated nodules are seen.

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Extrahepatic porto-azygos PSS in a cat, 2D reconstruction along the sagittal plane (A) and 3D reconstruction (B) . The PSS arises from the portal vein (PV) and ends in the azygos vein.

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Intrahepatic left divisional PSS in a dog, 3D reconstruction. The PSS arises from the portal vein (PV), it curves ventrally, after that it turns dorsally and ends in the left hepatic vein (LHV).

Ao= aorta, RK= right kidney, LK= left kidney.

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Dorsal reconstruction of the cranial abdomen of a dog: the CBD, severely distended, is visible extending from the GB to the duodenum (D).

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Transverse CT image of a dog with liver metastatic neoplasia: numerous hypodense nodules are visible in the parenchyma.

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Transverse CT image (A) and dorsal reconstruction (B) of the cranial abdomen in a dog. An heterogeneous, left-sided liver mass (M, hepatic carcinoma) is visible invading the CVC.

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Transverse CT image of the mid abdomen of a cat. A voluminous liver cyst (C) extends in the mid and caudal abdomen. The cyst is heterogeneous and divided by internal septae. L= right

liver lobe.

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A: liver nodule in a dog, confirmed to be a metastasis from an adrenal carcinoma, previously removed. B: CEUS shows that the nodule is highly perfused with evident vessels through the lesion. C: CEUS after ablation. The nodule is completely avascular due to coagulation necrosis.

Large hepatic cyst in a cat; this should not be confused with the gallbladder.

A focal hypoechoic nodule cytologically confirmed to be an abscess in a dog.

Dog with large hepatic lipoma, well marginated and hyperechoic.

Dog, GB: sludge and hyperechoic round calculi associated with shadowing. Some sludge is also present.

Liver metastases from splenic haemangiosarcoma; the lesions are visible as non-perfused nodule during the entire study.

Liver nodule in a dog, confirmed to be a metastasis from an adrenal carcinoma, previously removed.

Example of liver of a diabetic dog; the hepatic parenchyma is diffusely hyperechoic and the distal attenuation of the US beam is clearly visible as hypoechoic region in the far field.

Dog with acute hepatitis. The liver shows rounded margins and increased size and is markedly hypoechoic to the surrounding fat.

Multicentric lymphoma in a cat with involvement of the liver (A), spleen, pancreas, lymph nodes (B) and small intestine (C).

S = spleen, P = pancreas, L = lymph node.

Cholecystitis in a dog; the GB wall is severely thickened, the content is hyperechoic.

Mucocele in a dog.

A: The typical stellate (“kiwi-like”) pattern is visible in the GB.

B (Doppler study): the common biliary duct (CBD) is severely dilated, tortuous, with hypoechoic content.

This table shows the main causes and ultrasound features of diffuse hepatic diseases

Click on the disorders in red to see an example of an ultrasound image.

This table shows the main causes and ultrasound features of focal hepatic diseases

Click on the disorders in red to see an example of an ultrasound image.

INTRODUCTION

Imaging the liver and the biliary system includes different modalities – most commonly used

are radiology (R), conventional ultrasonography (US), contrast-enhanced ultrasound (CEUS)

computed tomography (CT) and magnetic resonance (MRI). These are complementary techniques

and should be chosen considering different aspects, including the suspected diagnosis suggested

by clinical presentation and laboratory results, the type of information needed for therapy

(medical or surgical), the opportunity to perform a general anaesthesia, the availability of the equipment and the costs for the owners. Radiology and US are normally the first approach, can be quickly performed everywhere and enable an accurate evaluation of the liver parenchyma and the biliary system. They are often sufficient to reach the diagnosis and to take decisions for therapy.

CEUS, CT and MRI are second step modalities, indicated if more information about the organ or

lesion vascularity and perfusion are needed and if a better spatial representation of the liver

and associated lesions is required. Scintigraphy (S) has also specific indication for liver diseases, however is technically more demanding, because of the low availability of the equipment and the use of radioactive tracers.

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Volume 22(4), December 2012 SPECIAL ISSUE

Imaging the liver

Check out this video on ultrasound examination of the liver, with Kimberly Palgrave (BCF Technology). Click on the image to watch the video by BCF Technology

This video was kindly provided by

BCF technology on YouTube.

A different look at the liver

Radiology and ultrasound are the first approach for the evaluation of the liver and the biliary system. Contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) are second-step modalities, indicated if more information about the organ or lesion vascularity and perfusion are needed. They also provide a better spatial representation.

Click on the picture above to see a slideshow with examples.

Hyper, hypo

or hetero?

Tables showing the main causes and ultrasound features of diffuse hepatic diseases and focal hepatic diseases.

Click on the disorders in red to see an example of an ultrasound image.

Click to read more about this author

by Federica Rossi

Commissioned paper

Looking at the liver

Imaging the liver and biliary system

Read more...

Imaging the liver and the biliary system includes different modalities – most commonly usedare radiology (R), conventional ultrasonography (US), contrast-enhanced ultrasound (CEUS)computed tomography (CT) and magnetic resonance (MRI). These are complementary techniques and should be chosen considering different aspects, including the ...