Russian National Research Medical University RADIOLOGY METHOD (IMAGING METHOD ) FOR DIAGNOSIS OF LIVER ABNORMALITIES

Name: Jeffrey Chong Zhe Hui Group: 34A Year: 2012

INTRODUCTION
About the Liver
The Liver is an organ on the right side of the body weighing about 1.5Kg. It is distinctly the largest and a key organ of a human body, characterized by its muddy red colour. It is strategically the first port of entry from the process of digestion before nutrients leave for the rest of the body. It is the only organ in the human body that can regenerate unless struck by disease.

What is imaging modalities?

Common interventional imaging modalities include fluoroscopy(X-rays) , computed tomography(CT) , ultrasound(US) , magnetic resonance imaging(MRI): fluoroscopy and computed tomography use ionizing radiation that may be potentially harmful to the patient and the interventional radiologist. However, both methods have the advantages of being fast and geometrically accurate. ultrasound suffers from image quality and tissue contrast problems, but is also fast and inexpensive. magnetic resonance imaging provides superior tissue contrast, at the cost of being expensive and requiring specialized instruments that will not interact with the magnetic fields present in the imaging volume.

Essential Functions of the Liver are:

Detoxification and excretion of substances that are no longer needed by the body Using Food to make chemicals for essential functions of the bod Processing drugs to modified forms that are easily absorbed Manufacturing essential substances Storage of nutrients

What is liver disease?

Liver disease is an acute or chronic damage to the liver, usually caused by infection which can be viral or non-viral, abnormal changes seen through growth of tumors or tumor-like processes, changes or abnormalities in the metabolic process or naturally through a congenital process. Diseases of the liver can also be categorized by the effect.

Hepatitis is inflammation of the liver cirrhosis involves scarring and progressive cell death stones develop and form blockages fatty liver and cancer are modification effects from causes that could be related to genetic defects, lifestyle, environment, or other diseases. All these prevent vital functions of the liver and may cause a build-up of damaging substances to the liver itself that could even be a threat to life. Liver diseases can be acute (usually for a short duration) or chronic (commonly lifelong).

1)Liver cysts
1)What are liver cysts? Liver cysts are abnormal sacs filled with fluid in the liver. 2)What causes liver cysts? The cause of most liver cysts is unknown. Liver cysts can be present at birth or can develop at a later time. They usually grow slowly and are not detected until adulthood. Some cysts are caused by a parasite, echinococcus that is found in sheep in different parts of the world. 3)What are the symptoms of liver cysts? Most liver cysts do not cause any symptoms. However, if cysts become large, they can cause bloating and pain in the upper right part of your abdomen. Sometimes, liver cysts become large enough that you can feel them through your abdomen. 4)What are the complications of liver cysts? Liver cysts can have rare complications of liver failure and liver cancer. 5)How are liver cysts diagnosed? Since most liver cysts do not cause any symptoms, they usually are detected only on ultrasounds or computerized tomography (CT) scans. If symptoms do occur, a doctor may perform an abdominal CT scan to look at the liver.
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A blood test will rule out a parasite as the cause of the liver cyst. 6)How are liver cysts treated? Most liver cysts do not need to be treated. However, if cysts get large and painful, they may need to be drained or surgically removed. Cysts also may be surgically removed if they are stopping bile from reaching your intestine. If a parasite is found, antibiotics are used for treatment. 7)What is polycystic liver disease? Polycystic liver disease (PLD) is the development of multiple cysts in the liver. PLD cysts may cause pain, but they usually do not affect liver function. If PLD starts affecting liver function or becomes too painful, surgery may be needed. However, cysts can reoccur after surgery. People with PLD are born with it, but usually do not have large cysts until they are adults. Polycystic liver disease is genetic. When it is found in one family member, all family members should be tested. PLD may be detected using an ultrasound or CT scan. It is more common in women than men.Most people with PLD also have polycystic kidney disease (PKD), which are cysts in the kidneys that can cause high blood pressure and kidney failure. Sometimes a liver transplant and a kidney transplant may be necessary.

Figure 1: This abdominal CT scan shows cysts in the liver and kidneys (polycystic disease). The liver is the large organ on the left side of the screen. The dark spots in the liver are cysts.

Figure 2: Ultrasound image description. Liver cyst,zoom

2)Cirrhosis of Liver
1)What is Cirrhosis of Liver

Cirrhosis of liver refers to the replacement of normal liver tissue with non-living scar tissue. It is always related to other liver diseases. Cirrhosis is the scarring of the liver where hard scar tissue replaces soft healthy tissue. As cirrhosis becomes worse, the liver will have less healthy tissue. If cirrhosis is not treated, the liver will fail and will not be able to work well or at all.

2)What Causes Cirrhosis of Liver

Cirrhosis is caused by chronic (long-term) liver diseases that damage liver tissue. It can take many years for liver damage to lead to cirrhosis. Other factors which causes Cirrhosis of Liver 1. Chronic Alcoholism Chronic alcoholism is the leading cause of cirrhosis in the United States. Drinking too much alcohol can cause the liver to swell, which over time can lead to cirrhosis. The amount of alcohol that causes cirrhosis is different for each person. 2. Chronic Viral Hepatitis Chronic hepatitis C is the second leading cause of cirrhosis in the United States. Hepatitis C causes the liver to swell, which over time can lead to cirrhosis. About one in four people with chronic hepatitis C develop cirrhosis. Chronic hepatitis B and hepatitis D also can cause cirrhosis. 3. Nonalcoholic steatohepatitis (NASH) Fat build up in the liver that is not caused by alcohol use, is nonalcoholic steatohepatitis (NASH). NASH can cause the liver to swell and can lead to cirrhosis. People with NASH often have other health issues including diabetes, obesity, high cholesterol, coronary artery disease and poor eating habits. 4. Bile Duct Disease Bile duct disease limits or stops bile from flowing to the small intestine. The bile backs up in the liver causing the liver to swell and can lead to cirrhosis.

Two common bile duct diseases are primary schlerosing cholangitis and primary biliary cirrhosis. 5. Genetic diseases Some genetic diseases can lead to cirrhosis. These diseases include Wilson disease, hemochromatosis, glycogen storage diseases, Alpha-1 antitrypsin deficiency, and autoimmune hepatitis.

3)Symptoms and Complication of Cirrhosis

There are usually no symptoms of cirrhosis in its early stage. Over time, cirrhosis may cause symptoms and complications:

Symptoms

Loss of appetite Tiredness Nausea Weight loss Abdominal pain Spider-like blood vessels Severe itching

Complications

Jaundice, a yellow discoloration of the skin and whites of the eyes Gallstones Bruising and bleeding easily Fluid build up and painful swelling of the legs (edema) and abdomen (ascites) Hepatic Encephalopathy (HE), a buildup of toxins in the brain that causes both mental and physical complications.

4)How to Diagnose Cirrhosis

Cirrhosis is diagnosed by symptoms, blood tests, medical history, and physical examination. A liver biopsy may be needed to check how much of the liver has been damaged. During a biopsy, a small piece of liver tissue is removed and studied in the lab.

Liver cirrhosis with chronic viral hepatitis

Liver Biopsy . Cirrhosis is seen

Physical Examination
The cirrhotic liver is firm and often enlarged in early stages of the disease. The liver may feel rock-hard. (In advanced stages of cirrhosis, the liver may become small and shriveled.) If the abdomen is swollen, the doctor will check for ascites by tapping the flanks and listening for a dull thud and feeling the abdomen for a shifting wave of fluid. The doctor will also check for signs of jaundice, muscle wasting, and (in male patients) breast enlargement. Bilirubin. One of the most important factors indicative of liver damage is bilirubin, a red-yellow pigment that is normally metabolized in the liver and then excreted in the bile. In patients with hepatitis, the liver cannot process bilirubin, and blood levels of this substance rise, sometimes causing jaundice.

Imaging Test
Magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound are all imaging techniques that are useful in detecting and defining the complications of cirrhosis, such as ascites and hepatocellular carcinoma. These imaging tests can also provide information on the extent of liver damage.

MRI for cirrhosis of liver

CT scan of a child with Liver cirrhosis

Ultrasound of Liver Cirrhosis

5)Treatment for Cirrhosis of Liver

DIETARY AND LIFESTYLE CHANGES All patients with cirrhosis can benefit from certain types of lifestyle interventions. These include: Stop drinking alcohol . Restrict dietary salt . Salt can increase fluid buildup in the body. Eating a variety of foods every day can help you limit the amount of salt you are getting. It is best to eat fresh vegetables and fruits whenever possible and to avoid eating processed foods. Eat a healthy diet . People with cirrhosis are typically malnourished and require increased calories and nutrients. (Excess protein, however, can trigger hepatic encephalopathy.) They also need to avoid certain foods, such as raw seafood or shellfish, which carry risks of blood poisoning (septicemia). A dietician may help provide you with dietary guidelines. Get vaccinations . Patients with cirrhosis should ask their doctors which vaccinations (such as hepatitis A, hepatitis B, influenza, pneumococcal pneumonia) they need.

When cirrhosis cannot be treated, the liver will not be able to work and a liver transplant may be needed. Doctors will determine whether a liver transplant is the best treatment option.

3)Fatty liver (steatosis)

1)What is non-alcoholic fatty liver disease?
Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% - 10% percent of the livers weight is fat, then it is called a fatty liver (steatosis).

2)Who is likely to have NAFLD?

NAFLD tends to develop in people who are overweight or obese or have diabetes, high cholesterol or high triglycerides. Rapid weight loss and poor eating habits also may lead to NAFLD. However, some people develop NAFLD even if they do not have any risk factors. NAFLD affects up to 25% of people in the United States.

3)What are the risks linked to NAFLD?

NAFLD may cause the liver to swell (steatohepatitis). A swollen liver may cause scarring (cirrhosis) over time and may even lead to liver cancer or liver failure.

Non-alcoholic steatohepatitis (NASH) The more severe form of NAFLD is called non-alcoholic steatohepatitis (NASH). NASH causes the liver to swell and become damaged. NASH tends to develop in people who are overweight or obese, or have diabetes, high cholesterol or high triglycerides. However, some people have NASH even if they do not have any risk factors. Most people with NASH are between the ages of 40 and 60 years. It is more common in women than in men. NASH often has no symptoms and people can have NASH for years before symptoms occur. NASH is one of the leading causes of cirrhosis in adults in the United States. Up to 25% of adults with NASH may have cirrhosis.

4)What are symptoms of NAFLD? NAFLD often has no symptoms. When symptoms occur, they may include: fatigue weakness weight loss loss of appetite nausea abdominal pain, spider-like blood vessels yellowing of the skin and eyes (jaundice) itching, fluid build up and swelling of the legs (edema) and abdomen (ascites) mental confusion.

5)How is NAFLD diagnosed? NAFLD is initially suspected if blood tests show high levels of liver enzymes. However, other liver diseases are first ruled out through additional tests. Often, an ultrasound is used to confirm the NAFLD diagnosis. 6)How is NAFLD treated? There are no medical treatments yet for NAFLD. Eating a healthy diet and exercising regularly may help prevent liver damage from starting or reverse it in the early stages. 1. 2. 3. 4. 5. 6. See a doctor who specializes in the liver regularly Talk to your doctor about ways to improve your liver health Lose weight, if you are overweight or obese Lower your cholesterol and triglycerides Control your diabetes Avoid alcohol

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Fatty Liver

4) Benign Liver Tumour

1)What is tumor?
A tumor is an abnormal growth of cells or tissues. Some tumors are malignant, or cancerous. Others are benign, or noncancerous. Cancerous liver tumors can be fatal. Most of the time, cancerous tumors in the liver started in another organ and spread to the liver. This form of liver cancer is called metastatic liver cancer. Cancerous liver tumors that start in the liver are relatively rare in the United States. This form of liver cancer is called primary liver cancer. Noncancerous, or benign, liver tumors are common. They do not spread to other areas of the body, and they usually do not pose a serious health risk.

2) How to detect benign tumor?

In most cases, benign liver tumors are not detected because they cause no symptoms. When they are detected, it is usually because a patient required a medical imaging test, such as an ultrasound, CT test or MRI, for another condition.

3)Types of Benign Liver tumor

The three most common types of benign liver tumors are called: Hemangioma Focal nodular hyperplasia Hepatocellular adenoma

1. Hemangioma Hemangiomas are the most common form of benign liver tumors. They are a mass of abnormal blood vessels. Up to 5 percent of adults in the United States may have small hemangiomas in their liver. Women are more likely than men to develop them.
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Usually these benign tumors produce no symptoms and do not need to be treated. In very rare cases, an infant with a large hemangioma may need to have it removed surgically to prevent clotting and heart failure. 2. Focal Nodular Hyperplasia Focal nodular hyperplasia is the second most common form of benign liver tumor after hemangiomas. These tumors occur mainly in women between the ages of 20 and 30. Like the other forms of benign liver tumors, they are generally discovered during imaging tests for other conditions. Sometimes referred to as FNH, these tumors usually do not cause symptoms or require treatment. If they are large, doctors may recommend that they be removed surgically to avoid the risk of rupture, but this is very uncommon. 3. Hepatocellular adenoma Hepatocellular adenomas are less common benign liver tumors. They occur most often in women of childbearing age. They used to be linked to oral contraceptives, when higher doses of estrogen were used. Since these tumors generally do not cause symptoms, most are never detected. In rare cases, these tumors may rupture and bleed into the abdominal cavity. When doctors discover a large adenoma, they may recommend that it be surgically removed to prevent that possibility. Hepatocellular adenomas may enlarge in women who take hormone pills, so doctors will often recommend discontinuing birth control pills or postmenopausal hormone replacement therapy to female patients who have this kind of tumor. Ultrasound of Hemangioma in the liver

CT scan of Hemangioma in the liver

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MRI of Hemangioma in the liver

4)Symptoms
Some hemangiomas may cause bleeding or interfere with organ function, depending on their location. Most cavernous hemangiomas do not produce symptoms. In rare cases, a cavernous hemangioma may rupture.

5)Treatment
Most cavernous hepatic hemangiomas are treated only if there is persistent pain. Treatment for infantile hemangioendothelioma depends on the child's growth and development. The following treatments may be needed: Inserting a material in a blood vessel of the liver to block it (embolization) Tying off (ligation) a liver artery Medications for heart failure Surgery to remove the tumor

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