Richard Semelka, M.D. Professor and Director of Magnetic Resonance Imaging, Vice Chair of Quality and Safety,
University of North Carolina Hospitals, U.S.A
Episode 12: Vascular Abnormalities
Episode 12: Vascular Abnormalities
CASE 1 FREE PREVIEW ONLY: This program is a “Pay To View” program. To view the entire episode and obtain CME credits you must first purchase the program. Once purchased links will be provided from within your “MyAR Archives” page for access to the program and the online exam to earn CME credit.
Program Summary:
In this episode, Dr. Semelka reviews the usefulness of MRI in various cases of vascular abnormalities. He emphasizes portal venous pathology including common causes of portal vein thrombosis such as liver cirrhosis, diffuse hepatocellular carcinoma and ascending cholangitis. He describes the important point of how to distinguish between tumor and bland thrombus
Demonstration is also made of MR sequences to employ in a motion resistant protocol that should be used to image the noncooperative patient for the diagnosis of vascular abnormalities..
Case 1: Diffuse Hepatocellular Carcinoma with Portal Vein Thrombosis. This case illustrates MR findings of coexisting tumor and bland thrombus in the portal venous system. This also demonstrates diffuse hepatocellular carcinoma with portal vein thrombosis on 3T motion resistant protocol for non-cooperative patients.(FREE Preview Provided)
Case 2: Advanced Liver Cirrhosis with Bland Thrombus. This case illustrates ancillary features of liver cirrhosis and portal hypertension. How to distinguish flow artifact from actual venous thrombosis are also demonstrated.
Case 3: Ascending Cholangitis with Infected Thrombus. This case illustrates a good example of infected thrombus in the right portal vein. This case shows transient early enhancement in lobar distribution attributed to increased hepatic arterial supply secondary to portal vein thrombosis.
Case 4: Diffuse Hepatocellular Carcinoma with Tumor Thrombus. This case illustrates important features for the diagnosis of malignant portal vein thrombosis in the setting of diffuse hepatocellular carcinoma.
Case 5: Chronic Liver Disease with Cavernous Transformation. This case demonstrates a nice example of cavernous transformation secondary to chronic portal vein thrombosis on 3T MRI.
Case 6: Diffuse Hepatocellular Carcinoma with Tumor Thrombus. This case emphasizes important teaching points of tumor thrombus, which may show the enhancement pattern of tumor.
Case 7: Reflux of Contrast into IVC and Hepatic Veins. This case shows how to recognize reflux of contrast media into IVC and hepatic veins. Also demonstrated is a nice example of splenorenal shunt.
Case 8: Iatrogenic Occluded Metallic Coil in Right Portal Vein. This case depicts occluded metallic coil in the right portal vein associated with liver, lymph node and peritoneal metastasis from colon cancer.
Case 9: Liver Cirrhosis with Bland Thrombus. This case illustrates the typical appearance of extensive bland thrombus in the main portal vein and SMV-splenic vein confluent.
Approximate Episode Run Time: 57 Minutes
Learning Objectives:
Upon completion of this activity participants will have a better understanding of the following:
• How to construct an MR protocol to fit the patient and clinical questions
• Which MR imaging tools can benefit your review of MRI cases
• Circumstances that can help or hinder your review
• Making the final diagnosis
Claiming CE Credit:
To receive CME credits for participating in this activity you must view the program, successfully complete the online post examination and the following evaluation. Online examinations return an immediate grade report. Upon receiving a passing grade of 70% or higher, a letter of credit will be available for printing and indefinitely available in your “MyAR” Archives.
Accreditation Statement:
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Institute for Advanced Medical Education (IAME) and WebMedEd. IAME is accredited by the ACCME to provide continuing medical education for physicians.
IAME designates this activity for a maximum of one (1) AMA/PRA Category 1 CME Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation.
Program Viewing Instructions:
To begin program review click the appropriate tab above. To start the video presentation, position your cursor over the video player Icon and click. To pause or stop the presentation, position your cursor over the video and click. To view full screen size, cursor over the player to reveal the player controls. Once revealed, click the icon at the far right side of the player with 2 arrows. To advance and rewind the video, click and drag the program timeline to left to rewind and to the right to advance.
System Hardware/Software and Internet Connection Requirements:
The following information is provided for your reference in conjunction with review of this program.
Operating Systems: Windows 2000 or higher, MAC OSX 10.3 or higher.
General System and Internet Requirements: Speakers or Headphones, High Speed Internet connection, Web browsers: Internet Explorer, Firefox, Safari and Chrome.
Disclaimer:
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Case 1: Diffuse Hepatocellular Carcinoma with Portal Vein Thrombosis. This case illustrates MR findings of coexisting tumor and bland thrombus in the portal venous system. This also demonstrates diffuse hepatocellular carcinoma with portal vein thrombosis on 3T motion resistant protocol for non-cooperative patients.
Viewing Instructions:
To begin position your cursor over the image above and click. To pause or stop the presentation, position your cursor over the video and click. To view full screen size, cursor over the player to reveal the player controls. Once revealed click the icon at the far right side of the player with 2 arrows. To advance and rewind the video, click and drag the program timeline to left to rewind and to the right to advance.
Case 2: Advanced Liver Cirrhosis with Bland Thrombus. This case illustrates ancillary features of liver cirrhosis and portal hypertension. How to distinguish flow artifact from actual venous thrombosis are also demonstrated.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 3: Ascending Cholangitis with Infected Thrombus. This case illustrates a good example of infected thrombus in the right portal vein. This case shows transient early enhancement in lobar distribution attributed to increased hepatic arterial supply secondary to portal vein thrombosis.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 4: Diffuse Hepatocellular Carcinoma with Tumor Thrombus. This case illustrates important features for the diagnosis of malignant portal vein thrombosis in the setting of diffuse hepatocellular carcinoma.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 5: Chronic Liver Disease with Cavernous Transformation. This case demonstrates a nice example of cavernous transformation secondary to chronic portal vein thrombosis on 3T MRI.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 6: Diffuse Hepatocellular Carcinoma with Tumor Thrombus. This case emphasizes important teaching points of tumor thrombus, which may show the enhancement pattern of tumor.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 7: Reflux of Contrast into IVC and Hepatic Veins. This case shows how to recognize reflux of contrast media into IVC and hepatic veins. Also demonstrated is a nice example of splenorenal shunt.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 8: Iatrogenic Occluded Metallic Coil in Right Portal Vein. This case depicts occluded metallic coil in the right portal vein associated with liver, lymph node and peritoneal metastasis from colon cancer.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.
Case 9: Liver Cirrhosis with Bland Thrombus. This case illustrates the typical appearance of extensive bland thrombus in the main portal vein and SMV-splenic vein confluent.
Viewing Instructions:
TO VIEW THIS AND THE OTHER CASES IN THIS EPISODE YOU MUST PURCHASE THE PROGRAM.
To select the course for purchase Click Here and add program to cart. Once purchased a link to the full program materials will be provided from within your MyAR Archives section of this website.