Final Flashcards
Know what prostate issue creates the greatest need for imaging.
Prostate cancer
BPH and prostatitis- does not require imaging
Know whether imaging is more important for prostate cancer screening or prostate cancer detection.
All imaging is used for detection, not screening
Know whether imaging is more important for determining Gleason scores or T-N-M scores, and why.
T-N-M scores are for staging and factor in how extensive the tumor is, if there is any spread to nearby lymph nodes, and if there is any metz to distant sites.
Gleason scores are done by pathologist (based on histology).
Know what is the first and most likely imaging test for the average treating doctor to order to evaluate the prostate.
Diagnostic ultrasound All imaging is for detection and not screening. Abnormal PSA or DRE Difficulty urinating BPH? Only if it becomes really annoying Detect neoplasia? (not definitive) Can also be used to guide biopsy
Know what TRUS is and what it is used for.
Transrectal ultrasound (B-mode-gray scale image- and doppler mode-blood flow-) used for the indications listed in the question above. Also used to see if a biopsy is indicated.
Diagnostic U/S to evaluate Prostate
Know what elastography is and whether it might have any use for prostate.
Provides a stiffness value. A push pulse slightly compresses the tissue leading to shear waves. The hardware is the same as normal US but different software is added.
Cancers are stiffer than normal tissues so this help differentiate different masses.
Know what the role is for prostate CT.
Used in looking for metz which is needed in T-N-M scoring
Know what the role is for prostate MRI.
Morphological T1 and T2 are done but also diffusion (DWI-MRI)and perfusion (PWI-MRI) capacities are usually added plus MR spectroscopy can be used. An endorectal receiver coil is used for better detail. MRI providers better soft tissue discrimination.
Could also use a high magnetic for better detail.
DWI-MRI follow water movement. Less water movement in tumors.
PWI-MRI uses GAD and follows blood.
MRI can be used to guide biopsy
Know what the most likely nuclear imaging study would be if the patient had known prostate cancer.
Bone scan (osteoscintigraphy) is used to detect prostate metz which would help stage the patient and help with prognosis
Know what is the first and most likely imaging test for the average treating doctor to order to evaluate the scrotum and testicles.
Diagnostic ultrasound
Know whether testicular ultrasound might be useful for differentiating between simple and complex hydrocele.
Simple- anechogenicity because it only contains water
Complex- would have a higher echogenicity because it contains other things like pus or blood.
Know what the average treating doctor should do if he/she suspects testicular torsion and how imaging is related.
Emergency situation. You only have a few hours to get the patient into surgery. As a referring doctor you would NOT order ultrasound.
In unusual equivocal cases where imaging is done the testicle will be more hypoechoic.
Know what the recommended imaging test is to evaluate breast masses in males.
Most commonly it is gynecomastia -usually bilateral- but could be breast cancer -usually unilateral- (no fibrotic changes in male breast like is seen in female breasts)
Mammography is the image of choice, US is usually not necessary
Know whether prostate calculi can be visualized on plain films, along with their significance.
Can see little gravel like calcifications within the prostate. These are very common esp. With advancing age, but if you see them in younger men it suggests they may have had multiple bouts of prostatitis. No clinical significance at all.
Know what sealed source radiation therapy is and whether there could be any residual evidence of it on plain films if a male had undergone this procedure.
May see metallic seeds left over from internal radiation on plain films.
Sealed source radiation- radioactive isotope is contained in wire or seeds
Unsealed source radiation- ingested or injected radioactive isotope combined with a substance that will help drive it to a certain area of the body.
External radiation- ionizing radiation up to multiple thousand of RADs.
Know the most common imaging presentation on plain films for metastasis to bone from prostate cancer.
Metz in the pelvis and lumbar spine. 90% of prostate metz are of the blastic type (extra dense). much less common to see a lytic or bone destructive pattern.
Know what a therapeutic bone scan is.
Semarium isotope used (Quadramet is the brand name), emits beta to diminish activity of the bone metz and gamma rays for metabolic activity can be visualized. An example of unsealed source of nuclear medicine therapy. Doesn’t cure anything, just provides pain relief.
Know whether there is any imaging for diabetes.
No imaging for diabetes
Know what role plain films might have for pancreas.
Can see calcifications incidentally but plain films are of no use for visualizing the pancreas.
Calcifications can commonly be seen in chronic pancreatitis and possibly around cysts.
Know what the primary imaging method is for pancreas.
CECT is the primary imaging method, but MRI is being increasingly used for further identification of pancreatic disease.
CECT is the primary choice for chronic pancreatitis. Calcifications are common in chronic pancreatitis and they increase as the disease progresses.
Know what ERCP is and what role it might play in pancreas evaluation.
Endoscopic retrograde cholangiopancreatography (ERCP) used for therapeutic procedures need to be done. Used to be used to visualize the pancreatic duct but not anymore.
A duodenoscope used to located the duodenal ampulla, then a catheter is advanced through the scope and contrast injected through the catheter and a fluoroscopic image is produced. A guidewire is advanced through the catheter and then a cytology brush is advanced over the wire. Stents can also be placed with this method.
Know what EUS is and what role it might play in pancreas evaluation.
Endoscopic ultrasound (EUS) approach is the same as ERCP and only available for the pancreas due to its location. Much more detailed than transabdominal US that used prior to this being available. Need to refer to gastroenterologist. Can also add doppler for vascularity. Can also used EUS to do fine needle aspiration (FNA), help with guidance of interventional procedures like neurolysis, or can be used to drain cysts and abscesses. Can be used to diagnose acute pancreatitis. EUS is the most sensitive for finding neuroendocrine tumors (NETs) and then FNA can be performed.
Know what role MRA (MR angiography) might play in pancreas surgical decisions.
Can be used to assess vessels around the pancreas because tumors that contain blood vessels are not resectable.
Know what MRCP is and what role it might play in pancreas evaluation.
Magnetic resonance cholangiopancreatography (MRCP) is a special sequence that can be added to MR image of the gallbladder or pancreas to visualize the pancreatic and bile ducts. The fluid that naturally resides in the ducts serve as their own contrast and can be visualized well on a heavily T2 sequence. GAD can be used but is not necessary. Gives similar information as ERCP without the risks of the more invasive procedure.
