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Contrast media
Barium sulphate
Organic iodine preparations
Ultrasound contrast agents
Magnetic Resonance Imaging
contrast agents.
Contrast media may have
allergic reactions.
Ultrasound
radiation
MR I
}Lack of ionizing
Digital Radiography
Digital Radiography
Ultrasound
USES
Brain:
Imaging the neonatal brain.
Thorax: Confirms pleural effusions and
pleural masses.
Abdomen: Visualizes liver, gallbladder,
pancreas, kidneys, etc.
Pelvis: Useful for monitoring pregnancy,
uterus and ovaries.
Peripheral: Assesses thyroid, testes and
soft-tissue lesions.
Ultrasound
Advantages
Ultrasound
Advantages
Ultrasound
Disadvantages
Operator dependent.
Inability of sound to cross an
interface with either gas or bone
causes unsatisfactory
visualization of underlying
structures.
Scattering of sound through fat
produces poor images in obesity.
Computed Tomography
USES
Any region of the body can be scanned;
brain, neck, abdomen, pelvis and limbs.
Staging primary tumours such as colon
and lung for secondary spread, to
determine operability or a baseline for
chemotherapy.
Radiotherapy planning.
Exact anatomical detail when
ultrasound is not successful.
Computed Tomography
Advantages
Good contrast resolution.
Precise anatomical detail.
Rapid examination technique, so
valuable for ill patients.
In contrast to ultrasound,
diagnostic images are obtained in
obese patients as fat separates the
abdominal organs.
Computed Tomography
Disadvantages
Respiratory Tract
Ultrasound (US)
Isotopes
Pulmonary angiography
Evaluation of mediastinal
masses,
aortic dissection and
staging bronchial carcinoma.
Evaluation of vascular
invasion.
Bronchial carcinoma
A common primary tumour
Histological types:
squamous, small (oat) cell,
anaplastic, adenocarcinoma,
alveolar cell carcinoma.
Bronchial carcinoma
Haemoptysis
Respiratory
symptoms
Bronchial carcinoma
Radiological features
Bronchial carcinoma
CT/MRI
-Assesses spread.
-Determines operability.
Differential diagnosis of
solitary lung mass
Metastasis:
-Breast, kidney, colon,
testicular tumours.
Tuberculoma
Benign neoplasms
-Bronchial adenoma , hamartoma
round pneumonia, hydatid cyst,
haematoma , arteriovenous
malformation.
Bronchial carcinoma
Common sites of distant
metastases
-
Brain
Bone
Adrenals
Liver
Mediastinal mass
Imaging modalities
Plain film
CT
MRI
Mediastinal mass
Anterior mediastinal masses
- thyroid , thymus ,
teratodermoid
Middle mediastinal masses
- lymphoma, metastases,
sarcoid or tuberculosis.
Posterior mediastinal masses
- neurogenic tumours
neurofibromas
ganglioneuroma
Gastrointestinal
tract (GI)
Esophageal Carcinoma
Distal third
Male > Female
Predisposing factors
- Achalasia
- Barretts esophagus
Esophageal Carcinoma
Imaging modalities
- Barium
- CT: tumour confinement to the
wall or extraluminal
spread.
- US: secondary deposits
Esophageal Carcinoma
Radiological features
Gastric Carcinoma
A general decrease in
the
incidence of gastric
carcinoma.
Gastric Carcinoma
Clinical Presentations:
Dyspepsia , anorexia, nausea,
vomiting,
Body weight loss,
Haematemesis or melaena.
Gastric Carcinoma
Imaging modalities
- Barium meal
- CT
}preoperative evaluation
- US
Gastric Carcinoma
Radiological features
Barium meal
Polypoidal type - soft-tissue mass causing
a
filling defect.
Ulcerating type - ulcerating within the
margin of the
stomach.
Gastric Carcinoma
narrowing
at the site of the
tumour.
Colonic carcinoma
Commonest
malignancy of
GI tract.
Usually
adenocarcinoma
Colonic carcinoma
Imaging modalities
- Plain films.
- Barium
- Ultrasound
- CT/MRI
colonoscopy
staging
Colonic carcinoma
Radiological features
Annular carcinoma - irregular luminal
narrowing ,
applecore deformity.
Polypoidal mass
- intraluminal filling
defect.
Colonic carcinoma
Complications
- Obstruction
- Perforation
- Fistula formation
Colonic carcinoma
Differential
diagnosis of
colonic narrowing
- Diverticular disease
- Crohn's disease
- Ulcerative colitis
Colonic carcinoma
Differential
diagnosis of colonic
narrowing
- Extrinsic: inflammatory / neoplastic
infiltration.
- Radiotherapy
- Tuberculosis.
- Ischaemia.
Hepatocellular
carcinoma
Hepatocellular carcinoma
Hepatocellular carcinoma
Clinical
Presentation
Hepatocellular carcinoma
Three
principal types
- Multinodular
- Infiltrative
- Solitary mass
Hepatocellular carcinoma
Radiological
features
- CT/MRI
precontrast : low/isodense mass
arterial phase : hypervascular
mass
delayed phase : wash-out mass
Hepatocellular carcinoma
The
tumor should be
assessed for invasion of
the vascular system and
the biliary system.
Hepatocellular carcinoma
About
20% ( ? ) are
suitable
for liver resection.
Liver Metastases
The
Pancreatic carcinoma
The
Pancreatic carcinoma
Clinical
Presentation
Abdominal pain
Weight loss, anorexia.
Obstructive jaundice.
Malabsorption, diarrhoea.
Diabetes.
Pancreatic carcinoma
Clinical
symptoms usually
occur late and at the time of
presentation there is often
local invasion of blood
vessels or bowel.
Pancreatic carcinoma
Radiological
features
US/CT
- focal pancreatic enlargement with
a hypoechoic /hypodense mass.
- pancreatic and bile duct dilatation
- distended gallbladder.
Pancreatic carcinoma
MRI
modalities
- KUB
- Intravenous urography (IVU)
- Retrograde pyelography
- Antegrade pyelography
modalities
- Percutaneous
nephrostomy
- Micturating cystogram
- Urethrography
modalities
- Ultrasound
- Computed Tomography
- Arteriography
Renal carcinoma
Radiological features
Plain film Renal mass (calcifications)
IVP Renal Mass, pelvicalyceal
distortion
and irregularity
US Solid mass with increase
vascularity
CT/MRI Useful for staging,
perinephric tissue invasion,
venous invasion,
lymph node metastasis
Bladder carcinoma
Radiological features
IVP Filling defect in the bladder
Irregular mucosa
CT/MRI Useful for staging
Intramural /extramural
spread , local invasion ,
lymph node metastasis
Testicular tumour
US extremely effective
in evaluation of well
defined low
echogenicity mass
Skeletal system
Imaging modalities
Plain films (images) still remain
the mainstay of investigation
Isotopes Tc 99m phosphate
compounds
US/CT/MR for tumour vascularity,
infiltration of surrounding tissure
relationship to nerves and vessels
Osteosarcoma
Plain films (images)
Radiological features
Irregular medullary destruction
Periosteal reaction
Cortical destruction
Soft tissure mass
New bone formation
Bone metastases
Plain films (images)
Radiological features
- Lytic deposits : poor definition of
margins,
pathological fracture
- Sclerotic deposits : an area of illdefined increased
density
Bone metastases
- Most frequent primary are
Breast
Prostate
Lung
Kidney
Thyroid
Adrenal gland
Multiple myeloma
Radiological features
Plain films (images)
- Generalized osteoporosis
- Compression fracture of vertebral
bodies
- Scattered pounch-out lytic lesions
with well-defined margins
- Bone expansion with soft-tissue
masses