Professional Documents
Culture Documents
Why CT Anatomy
Improved accuracy
Communication
Why CT Anatomy
Improved accuracy
Differential diagnosis
Primary tumors
Pattern of metastatic disease
Communication
Example
Example
Example
Thyroidectomy and
radioiodine ablation
Completed
RoRx
Example
Why CT Anatomy
Improved accuracy
Communication
Results
Biopsy planning
Therapy planning
Sample Report
67 year old man
Nasal carcinoma
surgical resection
radiation therapy
Head and neck: Again seen are postsurgical changes of prior rhinectomy
and septectomy, stable in the interim. There is no hypermetabolism in or
adjacent to the surgical bed. Intense tracer activity is seen in the anterior
oral cavity. This region is partially obscured on the CT portion of the
examination by dense metallic streak artifact from non removable dental
hardware, but the activity appears to localize to the geniohyoid
musculature. There are no hypermetabolic lymph nodes along the cervical
chains. Slight asymmetry in radiotracer activity in the prevertebral
musculature is likely physiologic.
increased in size and density since the prior examination. There is now a
coalescent region of peripheral consolidation measuring approximately 11
x 5 cm (previously 5 x 2 cm) which is diffusely hypermetabolic on PET
(SUV=15.4). Subpleural consolidation at the left lung base posteriorly has
also increased in density, measuring 3.3 x 1.5 cm. This region is also
intensely hypermetabolic on PET scanning, with an SUV of 10.0. Regions
of subpleural septal thickening in the posterobasal segments of the lower
lobes bilaterally demonstrate low-grade radiotracer uptake. There are
changes of centrilobular emphysema in the mid and upper lungs. Intense
myocardial activity is physiologic. There is no nodal hypermetabolism in
the chest. There is low-grade (SUV=3.2) radiotracer activity in the right
and left pulmonary hila. There is no nodal hypermetabolism in mediastinal,
axillary, or supraclavicular chains. There are no pleural or pericardial
effusions.
Chest
Selected Topics
Lungs
Lungs
Lungs
Pulmonary Lobes
Pulmonary Fissures
Upper Lobes
Lower Lobes
Middle Lobe
Lingula
Pulmonary Lobes
Left Fissure
Pulmonary Lobes on CT
U
L
M
U
U
L
Pulmonary Segments
Right Lung:
10 Segments
Right Upper Lobe
Apical
Anterior
Posterior
Superior
Medial basal
Lateral basal
Anterior basal
Posterior basal
Left Lung:
9 Segments
Left Upper Lobe
Apicoposterior
Anterior
Superior lingular
Inferior lingular
Superior
Medial basal
Lateral basal
Anterior basal
Posterior basal
Slides are not to be reproduced
without permission of author.
Metastatic Tumors
- No
- Lung
- Breast
- Colon
- Melanoma
- Bladder
- Renal cell cancer
- Osteosarcoma
- Etc.
Primary Tumors
- Non-small cell cancer
- Small cell cancer
- Carcinoid tumor
- Lymphoma
Infection/Inflammation
- Histoplasmosis
- Tuberculosis
- Sarcoidosis
Trachea
Carina
Slides are not to be reproduced
without permission of author.
Heart
4 Chambers
Pulmonary circuit
Right atrium venous blood from body
Right ventricle pumps blood to lungs
Systemic circuit
Left atrium oxygenated blood from lungs
Left ventricle pumps blood to body
Slides are not to be reproduced
without permission of author.
Left Ventricle
Right Ventricle
Left Ventricle
Left Ventricle
Right Ventricle
Left Ventricle
Right Ventricle
Aortic Root
Left Ventricle
Right Ventricle
Aortic Root
Left Ventricle
LeftSlidesAtrium
are not to be reproduced
without permission of author.
Right Ventricle
Aortic Root
Left Ventricle
Right Atrium
LeftSlidesAtrium
are not to be reproduced
without permission of author.
Pulmonary Outflow
Aorta
Right Atrium
Slides are not to be reproduced
without permission of author.
Left Atrium
Pulmonary Arteries
Infection/Inflammation
- No
- Atherosclerosis
- Vasculitis
Primary Tumors
- Rare
Metastatic Tumors
- Rare
Takayasus arteritis
Lymphatics
Lymphatics
Hilar groups
Right hilar
Lymphatics
Hilar groups
Right hilar
Left hilar
Lymphatics
Thoracic groups above the hila
Precarinal
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Left paratracheal
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Left paratracheal
Aortopulmonary
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Left paratracheal
Aortopulmonary
Prevascular
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Left paratracheal
Aortopulmonary
Prevascular
Retrosternal
Lymphatics
Thoracic groups above the hila
Precarinal
Azygous
Right paratracheal
Left paratracheal
Aortopulmonary
Prevascular
Retrosternal
Superior Mediastinal
Slides are not to be reproduced
without permission of author.
Lymphatics
Thoracic groups below the hila
Subcarinal
Lymphatics
Thoracic groups below the hila
Subcarinal
Azygoesophageal
Lymphatics
Thoracic groups below the hila
Subcarinal
Azygoesophageal
Retrocrural
Lymphatics
Extrathoracic groups
Scalene
Lymphatics
Extrathoracic groups
Scalene
Supraclavicular
Lymphatics
Extrathoracic groups
Scalene
Supraclavicular
Axillary
Digestive System
Esophagus
Stomach
Small intestine
Large intestine
Esophagus
Infection/Inflammation
- Yes (+/-)
- Reflux esophagitis
- Candida
- Mucositis (RoRx)
Primary Tumors
- Squamous cell cancer
- Adenocarcinoma
- Lymphoma
Metastatic Tumors
- Rare
Esophageal Cancer
Stomach
Stomach
Fundus
Body
Antrum
Infection/Inflammation
- Yes
Primary Tumors
- Adenocarcinoma
- Leiomyosarcoma
- Lymphoma
Benign Conditions
- Leiomyoma
Metastatic Tumors
- Uncommon
- Breast
Slides are not to be reproduced
without permission of author.
Gastric carcinoma
Gastric carcinoma
Gastric sarcoma
Gastric lymphoma
Small Intestine
Duodenum
Jejunum
Slides are not to be reproduced
without permission of author.
Ileum
Slides are not to be reproduced
without permission of author.
Infection/Inflammation
- Yes
- Crohns disease
- Other entertitis
Primary Tumors
- Lymphoma
- Adenocarcinoma (rare)
Metastatic Tumors
- Melanoma
Metastatic melanoma
Ileocecal Valve
Appendix
Appendix
CT Imaging: Colon
Cecum
Appendix
Ascending Colon
Hepatic Flexure
Transverse Colon
Splenic Flexure
Descending Colon
Sigmoid Colon
Rectum
Anal canal
Infection/Inflammation
- Yes
- Crohns disease
- Ulcerative colitis
- Other colitis
Primary Tumors
- Adenocarcinoma
- Mucinous carcinoma
Benign Conditions
- Adenomatous polyps
Metastatic Tumors
- Rare
Colon cancer
Colon cancer
Adenomatous
polyp
CT Imaging: Liver
Lobar Anatomy
Lobar Anatomy
Lateral left
Medial left
Anterior right
Posterior right
Caudate
Segmental Anatomy
Segmental Anatomy
Bifurcation of right
and left portal venous
branches
Segmental Anatomy
Segment II
Segment IVA
Segment VIII
Segment VII
LHV
MHV
RHV
Segmental Anatomy
Falciform ligament
Gallbladder fossa
Right hepatic vein
Segmental Anatomy
Segment III
Segment IVB
Segment V
Segment VI
Segmental Anatomy
Segment I
VIII
IVa
III
IVb
V
VI
Caudate: I
Slides are not to be reproduced
without permission of author.
Infection/Inflammation
- Yes
- Hepatic abscess
- Cholangitis
Primary Tumors
- Hepatocellular carcinoma
- Cholangiocarcinoma
Metastatic Tumors
- Colon
- Breast
- Pancreas
- Gastric
- Renal
Benign Conditions
- Hemangioma
- Cyst
- Hepatic adenoma
- Focal nodular hyperplasia
Segment V
Segment VII
Segment VI
All Segments
Metastasis
Gallstones
Abdominal Vasculature
Abdominal Aorta
5 Major Branches
Celiac Trunk
Superior Mesenteric Artery
Renal Arteries
Inferior Mesenteric Artery
Iliac Arteries
Celiac
CeliacTrunk
Trunk
Renal Arteries
Mid Aorta
Aortic Bifurcation
Femoral Arteries
Femoral Veins
Iliac Veins
Renal Veins
Portosplenic Confluence
Portal Vein
Abdominal groups
Abdominal groups
Gastrohepatic
Abdominal groups
Gastrohepatic
Portocaval
Abdominal groups
Gastrohepatic
Portocaval
Aortocaval
Abdominal groups
Gastrohepatic
Portocaval
Aortocaval
Left paraaortic
Abdominal groups
Gastrohepatic
Portocaval
Aortocaval
Left paraaortic
Mesenteric
Abdominal groups
Gastrohepatic
Portocaval
Aortocaval
Left paraaortic
Mesenteric
Aortic bifurcation
Pelvic groups
Pelvic groups
Common iliac
Pelvic groups
Common iliac
Internal iliac
Pelvic groups
Common iliac
Internal iliac
External iliac
Pelvic groups
Common iliac
Internal iliac
External iliac
Pelvic groups
Common iliac
Internal iliac
External iliac
Inguinal
Pelvic groups
Common iliac
Internal iliac
External iliac
Inguinal
Spleen
Accessory Spleen
Accessory Spleen
Infection/Inflammation
- No
- G-CSF
- Sarcoidosis
Primary Tumors
- Lymphoma
Metastatic Tumors
- Uncommon
- Melanoma
- Colon cancer
Slides are not to be reproduced
without permission of author.
G-CSF effect
Metastatic
colon cancer
Lymphoma
Adrenal Glands
Body
Medial Limb
Lateral Limb
Infection/Inflammation
- No
- Adrenal adenoma
Primary Tumors
- Pheochromocytoma
- Adrenocortical carcinoma
Metastatic Tumors
- Lung cancer
- Melanoma
- Renal cell cancer
Slides are not to be reproduced
without permission of author.
Metastatic lung
carcinoma
Bilateral adrenal
metastases
Follow up CT
1 year later
Metastatic lung
carcinoma
Pancreas
Pancreatic
body and tail
Pancreatic
head
Uncinate process
Infection/Inflammation
- No
- Pancreatitis
Primary Tumors
- Pancreatic cancer
- Islet cell tumors
Metastatic Tumors
- Unusual
- Renal cell cancer
Slides are not to be reproduced
without permission of author.
Conclusion
Basic anatomic knowledge can improve
the diagnostic value of PET
Correct use of anatomic terms facilitates
communication with referring clinicians
Anatomy is destiny.
- Sigmund Freud