Imaging and Oncology Flashcards
Imaging in the Management of Cancer: Indications for Imaging?
- Screening
- Making the diagnosis
- Staging
- Operative planning
- Response to treatment
- Follow-up (recurrence)
- What kind of X-rays are used for cancer dx?
- Bone scans options? 2
- What are the other two imaging options? 2
1.
- Plain films
- CT scans
- Fluoroscopy
- Mammography
2. Bone scans - SPECT scans
- PET scans
3.
- MRI
- Ultrasound
XRAYS
- Relies on what for imaging?
- Ionizing radiation can cause what complications? 2
- Good for what? 5
- Not as good for what? 2
- Disadvantage?
- Relies on differential absorption
- air, fat, water, bone densities - Ionizing radiation can damage tissue
- developmental issues,
- cancer - Good for
- lungs,
- kidney/gall stones,
- bones
- anywhere there are air/fluid contrasts
- or bone/soft tissue contrasts - Not as good for
- soft tissues
- brain - Pathology can be hidden by normal structures
What is going on in each film?
1 Normal PA chest film
2 Mediastinal masses – lymph nodes
What is going on in each film?
On the right – solitary nodule, might be benign or resectable
On the left - pulmonary mets from rectosigmoid cancer
What is going on in the CXR below?
Small nodule by right main stem bronchus
What is going on in the picture below?
LARGE TUMOR L UPPER LOBE WITH IRREGULAR EDGES, LUNG CANCER
What is going on in the pic below?
Probable Diagnosis
BRONCHOALVEOLAR CELL CARCINOMA
Irregular mass in the central portion upper lobe of the right lung lung cancer
- What is the most valuable initial imaging technique for bone lesions?
- What should we look at with the imgaing we ordered? 4
- What will a benign finding look like?
- What will a malignant finding look like?
- X-RAYS most valuable initial imaging technique
2.
- Look at the nature of the bone matrix
- Look at interface of lesion and bone
- Is the cortex intact? Which part of the bone is involved?
- Most lesions at metaphysis near major growth centers
3. Benign: Well-defined, no cortical destruction or periosteal reaction
4. Malignant: Ill-defined, destructive, infiltrative, lytic or blastic
- What are CT scans best at evaluating? 2
- MRI is good for what? 2
- Bone scans are good for what? 2
- CT SCANS
- best for evaluating subtle bone changes
- Good for areas hard to see on plain films - MRI better for
- soft-tissue and
- infiltrative marrow lesions - BONE SCANS
- show metabolic activity, looking for metastases
- PET/CT becoming imaging of choice
What is going on in each of the following pictures?
- What are latent lesions surrounded by?
- How would you describe active lesions?
- How would you describe aggressive lesions?
What is the following picture showing?
Extra-cortical involvement
- DDx for bone lesions? 4
- DDx for aggressive bone lesions? 3
- In general
- trauma,
- benign lesions
- infection,
- inflammatory condition - Aggressive bone lesions:
- metastatic tumor
- primary malignant bone tumor
- infection
What are the following pictures showing?
- LYTIC AREA BELOW PHYSIS AND IN METAPHYSIS AND PERIOSTEAL NEW BONE – LEUKEMIA
- LOCULATED CYSTIC TUMOR DISTAL RADIUS – CORTEX EXPANDED BUT INTACT – GIANT CELL TUMOR
- DIFFUSE LYTIC PROCESS DISTAL RADIUS - OSTEOMYELITIS
What are the following showing?
- Bone forming tumor extending past cortex and invading soft tissues, osteogenic sarcoma
- and 3. benign appearing lytic lesion distal tibia – non-ossifying fibroma
- Blastic lesions throughout the pelvis – prostatic CA
- Multiple ytic lesions of pelvis and femurs – multiple myeloma
- What is Fluoroscopy?
- Can be used to help with what?
- Prolonged procedures can lead to what?
- Small risk of what?
- Continuous X-rays used to obtain real time moving images of internal structures
- Can use to help guide fine needle biopsies
- Prolonged procedures can lead to skin burns
- Small cancer risk
Upper GI studies are a combination of what?
Contrast allows for exam of what? 3
Evaluation of which pathologies? 5
- Barium swallow + fluoroscopy
- Contrast allows for exam of
- esophagus,
- stomach, and
- duodenum - Evaluation of
- ulcers,
- GERD,
- vomiting,
- blood loss,
- hiatal hernia
What are the following pictures showing?
1 & 2. - irregular mass encroaching into the lumen of the esophagus – esophageal cancer
- Irregular mass partially filling the stomach – gastric cancer
- Smooth outpouching from the esophagus – benign diverticulum
- CT scans are part of what other scans? 2
- Subject to what? 2
- When do you get your best images?
- Part of PET and SPECT scans.
- Subject to artifacts and distortion
- Best images with highest doses
of radiation
Advantages of CT scans
8
Greater detail than regular x-rays
- Can differentiate structures of close physical density
- Eliminates superimposition of organs
- Show calcified and hemorrhagic lesions
- Can be shown in multiple planes or even as a 3D image
Particular use in neoplastic disease
- Very good in the abdomen for staging
- Very good for evaluation of masses in the chest
- Can do virtual colonoscopy – screening for colorectal tumors
- Most intracranial neoplasms are visible on CT
CT Scans….Downsides
4
- Risk of cancer (may increase as CTs used more)
radiation dose of abdominal CT scan = 200 chest x-rays
1 study, 0.4% of cancers in US due CT (29,000/year)
- worse in children and immunocompromised patients
2. When contrast agents used
allergic reactions: 1-3% non-ionic and 7-12% ionic contrast agent
anaphylaxis: old ionic agents 1%, now 2-30/million
contrast-induced nephropathy in 2-7%
- Expensive
- Observer variation
What do you see in the following?
Left – smooth – benign
Right – spiculated, infiltrative margin – bronchiole leads to it
What do you see in the following?
What do you see in the following?
Irregular mass with infiltrations, perhaps to the pleura
Peripheral lesion – pleuritic chest pain – could be asymptomatic
- What are pancoast’s tumors?
- What kind of pain?
- Extension of tumor at apex of the lung involving C8, T1, T2, nerves and possible destruction of ribs
- Shoulder pain radiating in the ulnar distribution
What is happening in the following picture?
BRONCHOALVEOLAR CELL CARCINOMA