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RAD512 > Common Pelvic And Urinary MRI > Flashcards

Common Pelvic And Urinary MRI Flashcards

1
Q

Zones of the prostate gland

A

Base, mid-gland, Apex

4 histological zones
- Anterior fibromuscular stromatolites
- Transitional zone (TZ) - surrounds the urethra (5% glandular tissue)
- central Zone (CZ =) - surrounds the ejactlatory ducts (20% glandular tissue)
-outer peripheral zone (PZ)(80% glandular tissue)

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2
Q

What is Prostate cancer and its rates within the PZ and TZ zones?

A

Uncontrolled division of glandular cells:
70-75% PZ
20-25% - TZ

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3
Q

Detection of Prostate cancer

A

Screening with PSA test - (PSA= prostate specific antigen)
DRE - rectal exam - hard irregular lumps in the prostate
Biopsy - Gleason score
Imaging to stage (NM, CT, MR)

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4
Q

Indications for prostate MRI

A

PSA > 4 ng/l
Abnormal DRE
Surveillance

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5
Q

What scale is used to grade prostate cancer?

A

Sequences assessed and each lesion graded on PI-RADs scale.
- 1 - 5 (1 very low to 5 very high likelihood of cancer)

PI - RADS = prostate imaging reporting and data system

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6
Q

What are the Sequences used for Prostate cancer?

A

T2 w - sag, cor and ax
DWI
T1W ax
T1 FS dynamic with gad contrast ax

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7
Q

How does a T2 prostate lesion appear?

A

Hypointesnse

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8
Q

What is Buscopan?

A

Antispasmodic

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9
Q

What are the Challenges of Prostate MRI?

A

Magnetic susceptibility - DWI
Motion artefact - peristalsis or respiration

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10
Q

What are the 2 parts of the Cervix?

what types of cells do they contain?

A

Internal os/ endocervix - columnar epithelial cells

External os / ectocervix - squamous epithelial cells

Between the two is the transformational zone - squamocolumnar cells

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11
Q

Where is cervical cancer usually found

A

Transformational zone

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12
Q

Cervical cancer

A

Most common in women < 45
Associated with HPV

Screening 25 - 64 every 3-5 years
Colposcopy/ biopsy
HPV vaccination - 2008

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13
Q

What are the Indications for cervix MRI?

A

Based on British gynaecological cancer society (BGCS) and RCR

  • cytogically proven cancer
  • response to chemo
  • reoccurance
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14
Q

How many days post biopsy can we scan?

What are the cervix MRI protocol?

A

7-10 days post biopsy to allow for healing

T1W - to ashes para-aortic and pelvic lymph nodes - presence of hydronephrosis

T2w - assess size, position and local tissue invasion

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15
Q

What are the specific challenges of cervical imaging?

A

Biopsy trauma can mimic Ca

Positioning of T2w axial coronal obliques - due to the nature of uterus positions

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16
Q

What are the 3 layers of the Uterus ?

A

Perimetrium - double membrane continuous with abdominal peritoneum

Myometrium - thick layer of muscle, which expands during pregnancy

Endometrium - in a mucous membrane, most superficial layer is shed during menstruation

17
Q

Endometrial cancer

A
  • uncontrolled proliferation of the endometrium
  • Most common, gynological cancer
  • Most common imposter, menopausal women
  • Increase prevalence due to obesity
  • Symptoms, post menopause, bleeding
  • symptomatic disease - no screening program
18
Q

What are the indications for endometrial MRI?

A

Based on BGCS guidelines

  • PMB - post-menopausal, bleeding
  • confirmed endometrial cancer - to decide treatment options
    - Staging to assess myometrial invasion and lymph nodes
    - Advanced disease- avoid hysterectomy, if no possibility of cure
19
Q

What are the protocols for Endometrial MRI?

A

T2W - to assess size position and local tissue invasion into myometrium, cervical stroma, parametric and Adnexa.
DWI - to asscess extent of myometrial invasion
T1FS - precontrast
T1FS - dynamic post contrast - to assess myometrium invasion
T1W ax - assess hilar abdominal and pelvic nodes

20
Q

What are the Challenges of endometrial MRI?

A

Biopsy trauma mimic Ca
Position of T2w ax / coronal obliques due to position of uterus

21
Q

What is Endometriosis?

A

Material tissue implants outside of the uterus, either with the female reproductive system or distant organs
: Such as bladder, bowel, lungs brain, skin

Most commonly on ovaries, where it forms endometriomas (chocolate cysts)

During the menstrual cycle, and the tissue breakdown and bleeds.
Patients experience , heavy bleeding, pelvic pain and infertility

22
Q

What are the Indications for an MRI for Endometriosis?

A

NICE guidelines
Not used as a primary tool yet but to assess deep endometriosis involving bladder, bowel and ureter

Surgical planning

23
Q

What are the protocols for endometriosis?

What are they assessing on the MRI?

A

T2w, T1W and T1FS

Asses for Adenomyosis, endometrial plaques/ foci, endometriomas, hydrosalpinx and hydronephrosis

24
Q

What are the Specific challenges for diagnosing endometriosis?

A

Negative us and MRI can’t rule out endometriosis

25
Q

Renal cancer

A

RCC - renal cell carcinoma - 9/10 cancers

primary malignant adenocarcinoma
Commonly from epithelium within the renal tubules of the medulla
- 70% - 80% clear cell (proximal convoluted tubules)
- 13% - 20% Papillary RCC (distal convoluted tubules)

26
Q

How are Renal cancers diagnosed?

A

Usually by CT - lower cost and greater capacity compared to MRI

MRI - marginally better than CT as it can indicate subtype and presence of thrombus in renal vein/ IVC - expensive and less available

27
Q

What are the indications for an RCC MRI?

A

Staging of RCC with venous invasion
When CT iodinated contrast can’t be used
Pregnancy

28
Q

What are the MRI protocols for RCC?

A

T1W Ax - to observe primary tumour, venous invasion, lymph nodes involvement
T2w ax
T1wFS ax
T1FS ax post contrast ax - 20s, 50s, 80s
(20s - arterial supply to inform partial nephrectomy , 80 sec - nephrogenic phase)

T1W sag and cor

29
Q

What are the Specific challenges of renal scanning?

A

Respiratory artefact
Metal artefact
Peristalsis

30
Q

What are the causes of Renal artery stenosis?

How do we diagnose RAS?

A

75% - atherosclerosis
20 % - fibromuscular dysplasia

Diagnosis on MRI or CT

31
Q

What is RAS - fibromuscular dysplasia?

A

The muscle and fibre tissues in the arteries thicken, causing the vessels to narrow- string of beads, appearances

Causing stenosis, aneurysms and dissections to small, medium sized arteries

Can lead to severe hypertension, ischaemic or haemorrhagic stroke

32
Q

What are the Indications for renal artery MRI?

A

Hypertension that is resistant to medication or of late onset with no family history
Poor renal function

33
Q

What are the Renal artery MRI protocols?

A

T2w HASTE
T1W FLASH 3D - pre and post con
Or TWIST - 3D MRA with gad which acquires multiple images through the arterial mixed and venous phases which can be reconstructed into MIPS

34
Q

What does MIP stand for?

A

Maximum intensity projection

35
Q

Rectal cancer facts

A

2nd most common cancer in uK
Affects males > females

Most commonly affects 60-80 years old

Screening program 60-74

Symptomatic - pain, blood in stools, change in bowel habit, anaemia

36
Q

What is Rectal cancer?

A

Uncontrolled proliferation of epithelial cells (surface of mucosa)

98% adenocarcinomas which form from malignant transformation of polyps ( benign, adenomas)

Malignant cells invade layers of rectum, and can invade beyond to lymph nodes and distant organs, such as liver and lungs.

37
Q

What are the indications for Rectal cancer MRI?

A

Staging local disease in upper rectal and sigmoid cancers

Surveillance

38
Q

What are the Rectal cancer Protocols?

A

T2w sag - to measure distance from anal verge and length of tumour

T2w axial - to look for pelvic disease outside of the mesorectum

T2w ax oblique ( perpendicular to long axis of rectum) - to measure tumour and assess spread within the mesorectum( L5, S1)

T2w coronal oblique ( parallel to the long axis of the rectum) - to measure tumour and spread within the mesorectum ( L5 - S1)

Report to stage TNM

RAD512 (26 decks)

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