Abdominal Imaging of

Liver

Dr Mohamed El Safwany , MD.

Intended Learning Outcomes

The

student should be able at the end of the

lecture to recognize ultrasound principles of
the liver

 Anatomy
Protocols
Normal

Ultrasound
Findings

Anatomy of the
Liver

The Liver occupies all of the

right hypochondrium, the
greater part of the epigastrium,
and left hypochondrium. The
ribs cover the greater part of the
right lobe .In the epigastric
region, the liver extends several
centimeters below the xiphoid
process. Most of the left lobe of
the liver is covered by the rib
cage.

Lobes of the Liver

Right lobe: The right lobe of the liver is the largest

of the livers lobes. It occupies the right
hypochodrium.
Left lobe: The left lobe of the liver lies in the
epigastric and left hypochondriac region.
Caudate lobe: The caudate lobe is a small lobe
situated on the posterosuperior surface of the left
lobe opposite the tenth and eleventh thoracic
vertebrae .

Hepatic Nomenclature
Couinauds

system of hepatic
nomenclature provides the anatomic basis
for hepatic surgical resection. By using this
system , the radiologist may be able to
precisely isolate the location of a lesion for
the surgical team

Couinauds hepatic segments divide the liver

into eight segments . The hepatic veins are the
longitudinal boundaries . The transverse plane
is defined by the right and left portal pedicles .

Hepatic Segmental Anatomy

The caudate lobe (segment) is

situated posteriorly.
Segment includes the caudate
lobe.
Segment and includes the left
superior and inferior lateral
segment.
Segment a and b includes
the medial segment of the left
lobe.
Segment and are caudal to
the transverse plane .
Segments and are
cephalad to the transverse plane.

Vascular Supply: Portal vein

The portal venous

system is a reliable
indicator of various
ultrasonic tomographic
planes throughout the
liver.
80% of vascular supply
Main portal vein
Right main portal vein
Left main portal vein

 Hepatic

artery : branch of abdominal aorta

Enters liver through porta hepatis
20%of arterial supply to liver
Divides in the liver into right and left branches

Hepatic veins
The hepatic veins are divided into three
components: right,middle,and left.

Distinguishing Characteristics of Hepatic

and Portal Veins

The best way to distinguish

the hepatic from the portal
vessels is to trace their
points of entry to the liver.
The hepatic vessels flow into
the inferior vena cava,
whereas the splenic veins
and superior mesenteric vein
join together to form the
portal venous system.

Distinguishing Characteristics of Hepatic

and Portal Veins

The walls of hepatic veins are thin-walled ,and the walls

of portal veins are brightly reflective veins

The hepatic veins are easily differentiated from

bile ducts and portal veins .
They are not surrounded by an echogenic wall
They originate close to the diaphragm , and can
be traced into the inferior vena cava

Sonographic Evaluation of the Liver

Evaluation

of the hepatic structure is one of

the most important procedures in sonography
for many reasons. The normal , basiclly
homogenerous parenchyma of the liver
allows imaging of the neighboring anatomic
structures in the upper abdomen.

The appropriate transducer depends

on the patients body habitus and size
The average adult abdomen usually
requires a 3.5MHz

 The

basic instrumentation should be adjusted

in the following parameters :
Time gain compensation
Overall gain
Transducer frequency and type
Depth and focus

Sagittal image of
gallbladder

Gallbladder and Biliary System

Normal size of
gallbladder:
7~9cm in length ;
3~4cm in width;
Wall thickness : 2~3mm
Normal size of bile
ducts :
right /left intrahepatic
duct just to proximal
CHD: 2-3mm
CBD:8mm =dilated

Sagittal image of liver /right

kidney

The normal liver parenchyma should have a

softer , more homogenerous texture than the
dense medulla and hypoechoic renal cortex

Transverse Scan Plane

Multiple transverse scans are made across the upper

abdomen to record specific areas of the liver. The
transducer should be angled in a steep cephalic
direction to be as parallel to the diaphragm as possible.

Transverse Scan Plane

The transducer is then directed slightly inferior to

record the left portal vein as it flows into the left
lobe of the liver.

The gallbladder may be seen in this scan as an

anechoic structure medial to the right lobe and
anterior to the right kidney.

Common bile duct

Diameter <0.8cm

Sonographic Evaluation of The Liver

Adequate

scanning technique demands that

each patient be examined with the following
assessment
The size of the liver in the longitudinal plane
The attenuation of the liver parenchyma
Liver texture
The presence of hepatic vascular structures,
ligaments ,and fissures

Pathology of the Liver

Evaluation

of the liver parenchyma

includes the assessment of its size ,
configuration, homogeneity , and contour.

The Normal attenuation of the liver parenchyma

Normal: Liver texture=homogeneous
Assessment of its size , configuration, homogeneity ,
and contour

Suggested Readings
David

Suttons Radiology

Assignment
Two

students will be selected for assignment

Question
Describe

the vascular supply of the liver.

Thank you for your attention!