Preliminary Diagnosis: Hepatic Cysts
I. What imaging technique is first-line for this diagnosis
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Gray scale and color Doppler ultrasound
II. Describe the advantages and disadvantages of this technique for diagnosis of hepatic cysts.
Advantages
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Highly portable
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Inexpensive
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Highly sensitive and specific in evaluating simple cysts
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Does not expose patients to ionizing radiation
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Helps guide biopsy
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Highly specific in evaluating the vascularity of an hepatic cystic lesion
Disadvantages
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Less adept in detailing and evaluating the surrounding anatomic structures
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Highly operator dependent
III. What are the contraindications for the first-line imaging technique?
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No specific contraindications to ultrasound imaging exist.
IV. What alternative imaging techniques are available?
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CT of the abdomen and pelvis with IV contrast
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MR of the abdomen and pelvis with IV contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatic cysts.
CT of the abdomen and pelvis with IV contrast
Advantages
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Offers more exquisite detail of any enhancing cystic component and is better able to characterize and qualify the hepatic cystic lesion than ultrasound
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Offers more exquisite detail of the surrounding anatomic structures
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May help guide treatment and percutaneous biopsy
Disadvantages
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Exposes patients to ionizing radiation
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Less operator dependent
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Less portable imaging modality
MR of the abdomen and pelvis with IV contrast
Advantages
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Does not expose patients to ionizing radiation
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May better characterize the type of fluid within the cyst than other imaging modalities
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May detect any enhancing soft tissue component
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Offers better delineation of the surrounding soft tissues than ultrasound
Disadvantages
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Expensive
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Time-consuming
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Requires significant patient cooperation to minimize motion artifact
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Less adept in guiding treatment
VI. What are the contraindications for the alternative imaging techniques?
CT of the abdomen and pelvis with IV contrast
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May be contraindicated in pregnant patients
MR of the abdomen and pelvis with IV contrast
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Contraindicated in patients with non-MR compatible hardware
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