Digestive system Radio Flashcards
What is the gold standard for diagnostics of CRC ?
Complete Colonoscopy
what is a possible alternative for patients suspected for CRC who can not undergo complete colonoscopy ?
Double contrast barium enema
How do we stage CRC ?
PET (FDG)-CT
what are the imaging techniques for metastasis of CRC in the Abdomen ?
US
what are the imaging techniques for metastasis of CRC in the Thorax ?
Radiography (x-ray)
what are the imaging techniques for metastasis of CRC to the bone?
Bone scintigraphy with Tc-99m + MDP
What do we use for preoperative staging for CRC ?
CT of abdomen, pelvis, and chest with IV contrast and oral contrast.
What is the most typical metastasis for CRC ?
Hepatic and pulmonary
what is the 1st level imaging for liver cirrhosis ?
US
What are some indirect signs we see of liver cirrhosis using US ?
Irregular margins of nodules, and portal vein dilatation
What is the 2nd level imaging for liver cirrhosis ?
CT
What sign of liver cirrhosis can we see using CT for diagnosing the disease ?
Right lobe volume reduction
What imaging technique can recognize nodular regeneration and dysplastic nodules of the cirrhotic liver ?
MRI + contrast
1st line imaging Liver Hemangioma ?
US
How do we see liver hemangioma on the US ?
Homogenous and hyperechoic
2nd line imaging for Liver Hemangioma ?
CT + contrast
How does Liver hemangioma appear in the arterial phase on CT and contrast ?
Hyperdense
3rd line imaging for Liver hemangioma ?
MRI - Hypointense in T1
What is the imaging we use for the first identification and surveillance of high risk pt for HCC ?
US + doppler
What is the 2nd line imaging when we assess HCC patient for new liver nodules ?
CT/MRI with contrast
What do we look for when using CT for the investigation of new liver nodules ?
Transient Hepatic Attenuation Differences (THAD)
What phase of the triphasic with CT study we can can see neo-angiogenesis ?
Arterial phase
What are the most common malignant hepatic lesions ?
Metastasis
Liver metastasis is caused by few important tumors, which are ;
Pancreas, breast, lung, and kidney tumors.
1st line imaging for liver metastasis ?
US
How many lesions do we see in the liver metastasis on US ?
single or multiple lesions
What are the second instance investigation for Liver metastasis ?
CT
In what method does liver metastasis is more recognizable when using CT ? how do they appear?
In the Portal phase and they appear Hypodense
How does Liver metastasis appear on CT when it is secondary to hypervascularized tumors ?
In what phase they are more evident ?
More evident in the arterial phase, and appear hyperdense, due to their rich vascularization
What is the 3rd choice for liver metastasis imaging ?
MRI- use in doubtful cases
How do we see Liver metastasis, using MRI T1 weighted ?
Hypointense
How do we see Liver metastasis, using MRI T2 weighted ?
Hyperintense
what is the first line imaging used for billiary ?
US
What are the GOLD STANDARD for the imaging of biliary pathways ?
ERCP & PTC
ERCP stands for what ?
Endoscopic
Retrograde
Cholangio
Pancreatography
PTC stands for what ?
Percutaneous
Transhepatic
Cholangiography
What are the indication of ERCP and PTC ?
- Billiary obstruction
(location, extent, and malignant/ benign nature)
How do we use CT/MRI in biliary pathways ?
In a Complementary manner
In what cases do we prefer to use MRI in biliary imaging ?
Benign lithiasis-induced obstruction or when ERCP is contraindicated
What is the main indication for MRCP ?
Distinguish benign and malignant nature of the obstruction
if we use MRCP for biliary ducts, do we use T1/T2?
T2
what do we highlight when we use MRCP for imaging of biliary ducts ?
Static liquids i.e., like bile
What is the use of Abdominal X-ray in the imaging of Biliary ducts ?
Used for specific pathologies:
Calcium bile
Radio opaque lithiasis
Do we use contrast in MRCP (colangio RM) ?
No
What is the most frequent pathology of the biliary tract ?
Biliary lithiasis (Gallstone disease)
the two main Gallstone disease ?
cholecystolithiasis (gallstone in the gallbladder)
choledocholithiasis (gallstone in a bile duct)
What is the first method of choice for suspected Biliary lithiasis ?
Ultrasound
How do we see gallstones on US ?
Endoluminal
Hyperechoic
Posterior shadow cone
In what cases of biliary duct imaging we prefer using MRI ?
Benign lithiasic obstruction / not possible to do ERCP
How do we see gallstones on MRI ?
Oval or rounded formations of low signal
How do we see gallstones on CT ?
hyperdense formations
“target aspect”
How do we recognize biliary lithiasis with MR-CP ?
You will see a filling defect in the bile duct clouded by bile.
1st line imaging in acute cholecystitis ?
US (low cost, highly available)
What are some US signs we see with Acute cholecystitis ?
1.stones
2.overdistension of the lumen
3.Ultrasound Murphy’s sign
What is the 2nd line of imaging we use for Acute cholecystitis ?
CT
Used to complement non-direct or doubtful ultrasound examination
Acute cholecystitis common signs seen on CT without contrast
stones in the lumen, most often hyperdense
Acute cholecystitis common signs seen on CT (after contrast injection) ;
focal/diffuse thickening of the gallbladder wall
Non-specific inflammatory hyperemia
what are the 2 most common complications of Acute cholecystitis ?
1.Gangrenous cholecystitis
2.Perforation of the gallbladder
Which method appears to be superior in the identification of biliary tract dilation, site of obstruction, and localization of the stone ?
MRI appears to be superior
How do we access the biliary ducts with the ERCP technique ?
Through the papilla of Vater
which technique will you use in order to perform stent or biliary flushing ?
ERCP
initial diagnosis of acute pancreatitis ?
clinical and lab tests
what is the system that classifies the the severity of acute pancreatitis ?
Balthazar
What imaging is used for ACUTE PANCREATITIS staging ?
CT-Abdomen + IV contrast
what is the balthazat classification for ?
Divides the severity of acute pancreatitis into 5 grades (A-E)
How do you evaluate the severity of necrosis in acute pancreatitis?
US/CT - guided biopsy
3 Complications of acute pancreatitis
Necrotizing pancreatitis
Walled-off necrosis
sepsis
What are the labs seen in Acute pancreatitis ?
Increased Amylase and Lipase
Imaging used for Endocrine Pancreas Tumors ?
CT and MRI
what is considered the Gold-standard imaging for Acute pancreatitis ?
Contrast enhanced (IV) CT examination
***Allows to stage the severity of the disease
How do we diagnose Appendecitis ?
Clinically and US
What imaging technique can be used to study in detail the small intestine ?
Enteroclysis (with contrast)
it’s CT actually !!
What is the main indication of Double contrast enema ?
Crohn’s disease (especially good for lesion depth evaluation)
*barium contrast
Indications of Trans-rectal US
1.Prostate cancer
2.Anorectal pathologies
What is the most adequate investigation we can perform for transmural extent of inflammation and intraperitoneal/extraintestinal complications of crohn’s and UC ?
CT
What are the 2nd level investigations for Crohn’s disease ?
CT enterography and MR enterography
CT-more in emergency
results are quiet comparable, despite MRI has higher resolution !
liver metastasis on US, how do we see it, hyper/hypo-echoic?
hypoechoic
liver metastasis on US, how do we see the margins?
Well defined margins.
