Atlas of Gastrointestinal Imaging Figure 2.1.3 Severe ulcerative colitis

Dr. Perry Pickhardt

Aug 26, 2007

FIGURE 2.1.3 Severe ulcerative colitis. Transverse (A) and coronal (B) contrast-enhanced CT images show multiple enhancing polypoid lesions in the sigmoid colon, representing inflammatory pseudopolyps. Note the changes of long-standing UC, consisting of ahaustral foreshortening of the entire colon and mild uniform wall thickening. At colonoscopy (C), the pseudopolyps are evident and the mucosa appears friable and ulcerated. Contrast-enhanced CT images (D and E) from a second patient show marked low-attenuation wall thickening of the entire colon, with mucosal and serosal enhancement. Pancolitis in this case is more prominent than usual for UC, and the CT appearance may suggest Clostridium difficile or granulomatous colitis. Colonoscopy image (F) from a third patient shows extensive pseudopolyp formation with advanced hemorrhagic inflammation and mucosal friability.

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Images depict a 49-year-old female participant with cryptogenic cirrhosis who presented with a 3.2-cm liver lesion. This biopsy-confirmed hepatocellular carcinoma (HCC) with an initial categorization of Liver Imaging Reporting and Data System (LI-RADS) category LR-4 (probably HCC) at CT was upgraded to LR-5 (definitely HCC) at contrast-enhanced ultrasound (CEUS). (A) Precontrast CT images in the liver show vague hypoattenuation in the medial left hepatic lobe (arrows). (B) Arterial phase images demonstrate no definite arterial phase hyperenhancement (arrows). (C) Washout and an enhancing capsule (arrows) on a late-phase image resulted in an LR-4 categorization. (D) B-mode ultrasound shows a round hypoechoic nodule (arrows). (E) An early-phase CEUS image shows clear arterial-phase hyperenhancement (arrows); (F) No washout at one minute (arrows), and (G) late, mild washout at four minutes (arrows) resulted in a CEUS LR-5 categorization.

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Images depict a 49-year-old female participant with cryptogenic cirrhosis who presented with a 3.2-cm liver lesion. This biopsy-confirmed hepatocellular carcinoma (HCC) with an initial categorization of Liver Imaging Reporting and Data System (LI-RADS) category LR-4 (probably HCC) at CT was upgraded to LR-5 (definitely HCC) at contrast-enhanced ultrasound (CEUS). (A) Precontrast CT images in the liver show vague hypoattenuation in the medial left hepatic lobe (arrows). (B) Arterial phase images demonstrate no definite arterial phase hyperenhancement (arrows). (C) Washout and an enhancing capsule (arrows) on a late-phase image resulted in an LR-4 categorization. (D) B-mode ultrasound shows a round hypoechoic nodule (arrows). (E) An early-phase CEUS image shows clear arterial-phase hyperenhancement (arrows); (F) No washout at one minute (arrows), and (G) late, mild washout at four minutes (arrows) resulted in a CEUS LR-5 categorization.

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