Imaging procedures of the abdomen and pelvis include computed tomography CT including CT colonography , magnetic resonance imaging MRI , ultrasound US , and gastroenterology GI and genitourinary GU fluoroscopy including hysterosalpingography. Members of the Division of Abdominal Imaging work closely with various clinical services to optimize individualized care to each patient. We participate in numerous multidisciplinary conferences and discuss specific patient issues with teams of physicians from multiple specialties, including oncology, surgery, hepatology, gastroenterology and pathology.
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Members of our division are an integral part of transplant and oncologic care. Multiphase CT examinations are very important for the detection and characterization of certain clinical conditions, but should not be generalized for every patient undergoing CT of the abdomen and pelvis. A recent survey demonstrated that many physicians are routinely performing multiphase CT for the majority of patients in an attempt to prospectively characterize potential lesions detected during the scan.
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However, unindicated multiphase CT examinations are an important source of medical radiation that does not contribute to the care of patients. Adherence to published standards such as the ACR Appropriateness Criteria can both decrease medical radiation and optimize imaging for the specific clinical indication.
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Login to your personal dashboard for more detailed statistics on your publications. Edited by Dongqing Wang. Edited by Theophanides Theophile. We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Lee Jr. Potential CT phases The different phases that are possible with state-of-the-art CT scanners are myriad and include scanning before and after contrast administration, delayed imaging, venous and arterial phases, and several others table 1.
Provides excellent solid organ visualization sec Venous Imaging Evaluate for venous thrombosis sec Delayed Cholangiocarcinoma minutes Adrenal adenoma minutes Extravasation i. Table 1. Common indications for multiphase CT. Use of multiphasic CT Multiphase CT examinations are extremely useful in a certain subset of patients.
Unenhanced CT Non-contrast CT scans Figure 1a left and 1b right are of limited use for the differentiation of soft tissue structures. Contrast-enhanced CT Contrast enhanced CT examinations can be acquired at a variety of specific time points after intravenous contrast injection timing is dependent on the phase of contrast enhancement needed and organ system being evaluated. Portal venous phase The most common technique is to perform portal venous phase imaging in the abdomen and pelvis approximately seconds after contrast administration, figure 2.
Early arterial phase CT Angiography CTA CT angiography CTA is highly effective for evaluation of the arterial system, and has largely replaced conventional angiography due to the lower risk profile and ability to survey the entire abdomen. Late arterial phase The late arterial phase is timed to correspond to the peak concentration of contrast material in highly vascular tumors and is performed approximately seconds after the injection of intravenous contrast.
Systemic venous phase imaging CT imaging specific for the venous structures is performed uncommonly. Delayed phase Delayed phase imaging figure 5 encompasses scanning at a variety of different times following contrast administration, and depends on the pathology in question. Organ specific considerations 4.
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Hepatic masses When evaluating hepatic masses, it can be advantageous to have both late arterial and portal venous phase images biphasic imaging, figure 4 since some tumors enhance briskly during the arterial phase hepatocellular carcinoma, hepatic adenoma, follicular nodular hyperplasia FNH , and hypervascular metastasis , but may be occult or difficult to characterize on portal venous phase imaging alone figure 6. Renal masses Detection and characterization of renal parenchymal masses is a frequent indication for CT.
CT urography CT urography CTU is commonly used in the evaluation of hematuria, and specifically tailored to image the renal collecting system, ureters and bladder in addition to the renal parenchyma. Conclusion Multiphase CT examinations are very important for the detection and characterization of certain clinical conditions, but should not be generalized for every patient undergoing CT of the abdomen and pelvis.
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Timing after contrast injection. Identify calcifications. Contrast Enhanced. Evaluate vascular anatomy. Arterial phase. Arterial structures.here
Hypervascular tumors. Portal venous phase. Majority of routine imaging is performed with this phase. Provides excellent solid organ visualization. Venous Imaging. Evaluate for venous thrombosis. Extravasation i. Corticomedullary phase.
Identification of renal cortical abnormalities. Nephrogenic phase. Characterization and improved visualization of renal masses. Find a Clinical Location.
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Sign Up for News. Like Us on Social Media. Donate Now. The Abdominal Imaging Division is composed of board-certified, subspecialty-trained radiologists with clinical and research interests involving both inflammatory and neoplastic diseases of the solid organs, soft tissues, and bowel. Members are responsible for services at Parkland Hospital, William P. Clements Jr. University Hospital, and Zale Lipshy Pavilion.
Evaluation of diseases of the abdomen and pelvis using computed tomography, magnetic resonance, ultrasound, and plain film is an essential part of patient care.