Radiologic Anatomy - Abdomen/Pelvis

Question 1

Broad Topic-Indications for Abdominal Imaging

Answer 1

Abdominal Complaints

Gastrointestinal: Liver, Biliary Tract, Pancreas, Trauma

Genitourinary (women’s health included here)

Question 2

GI Imaging modalities

Answer 2

Metal salts (barium sulfate0
Capsule endoscopy
Luminal Contrast-Mucosal changes
CT Scan- All things abdomen, neoplasm, etc
MRI-Like CT, small mucosal/focal lesions not well detected
Ultrasound-Mainly for solid organs and biliary tract ie Gallbladder
Endoscopy-Visualize mucosa from esophagus to colon

Question 3

CT indications for Abdomen

Answer 3

All things abdomen, neoplasm, etc

Question 4

MRI indications for Abdomen

Answer 4

small mucosal/focal lesions not well detected

Question 5

Ultrasound indications for abdomen

Answer 5

Mainly for solid organs and biliary tract ie Gallbladder

Question 6

Endoscopy use for abdomen

Answer 6

Visualize mucosa from esophagus to colon

Question 7

Luminal contrast indications for abdomen

Answer 7

Looks at mucosal changes

Question 8

What we look for with Upper GI Endoscopy

Answer 8

dysphagia, chest pain, bleeding (ulcers), dyspepsia (pharynx to duodenum)

Question 9

Small bowel endoscopic or barium edema can look for:

Answer 9

bleeding not localized to upper or colon,
diarrhea, inflammatory bowel disease(IBD), obstruction, malignancy, fistula (duodenum to ileum)

Question 10

Colonoscopy can look for

Answer 10

Rectal bleeding, IBD, malignancy, obstruction, length of colon

Question 11

What is Positron Emission Tomography
(PET Scan)

Answer 11

Uses radioactive tracer to pinpoint areas of high metabolic activity
- Interacts with protein target
- FDG for glucose metabolism in tumors
Combined with CT for anatomic clarity

Question 12

Modality to use for Esophageal Cancer, GERD, Stricture,Peptic Ulcers

Answer 12

Endoscopy most commonly used.

Question 13

Modality to use for Crohn’s Disease, Meckel’s diverticulum, cancer, SBO

Answer 13

Capsule endoscopy, CT, MRI (SBO, Crohn’s disease)

Question 14

What modality to use for Diverticulosis, colitis, polyps, cancer, volvulus

Answer 14

Colonoscopy, MRI, CT (diverticulitis). Barium enema with larger polyps, severe diverticulosis.

Question 15

What modality to use for Diffuse Hepatic: Cirrhosis

Answer 15

CT first choice. Good survey scan, moderately sensitive

Question 16

What modality to use for Focal Hepatic: Liver mass

Answer 16

Ultrasound often used initially then CT if needed. MRI can f/u on findings with survey scans obtained by U/S and CT

Question 17

What modality to use for abdominal trauma

Answer 17

CT is gold standard. Bedside ultrasound (eFAST). MRI not used at this point in trauma-Why??

Question 18

Modality to use for Pancreatic Inflammation/Tumor

Answer 18

Initial study CT. U/S limited use

Question 19

Pros/Cons of plain films for assessing Kidney, ureters and bladder

Answer 19

“Gas, mass, bones, stones”
Renal outline can be seen, ureters not so much
Urinary tract calcifications-less sensitive than previously thought (40-60% vs. 80% sensitivity)
Rarely, masses are detected
Bony lesions can be seen eg. prostate cancer metastasis

Question 20

Multi-detector (spiral) CT has had greatest impact and Essentially eliminated the intravenous pyelogram (IVP) in what area

Answer 20

GU

Question 21

Advantages of GU CT (spiral)

Answer 21

Exams are quick and thin slices allow for detailed exams
CT without contrast for renal/ureteral stones-Why without contrast??
CT with IV contrast for hematuria, mass vs cyst detection, renal anatomy (too small or too large), staging renal CA, trauma, vascular structures

Question 22

Advantages of Ultrasound for GU imaging

Answer 22

widely available, no contrast, no radiation

Question 23

Hypoechoic vs. Hyperechoic in Ultrasound

Answer 23

Hypoechoic-darker than surrounding tissue
Hyperechoic-lighter than surrounding tissue

Question 24

Why can an MRI be advantageous for GU in someone with normal renal function?

Answer 24

overall safer to give Gadolinium vs. iodine contrast (CT)

Question 25

Supine view can also be called _____

Answer 25

“flat plate”

Question 26

Seeing air fluid levels is always ___

Answer 26

bad

Question 27

Reading a plain film of abdomen

Answer 27

1. Once-over glance
2. Liver and spleen
3. Psoas shadows
4. Renal contours and position
   5 Abdominal calcifications
   Kidney Stones
   Gallstones
   Others: Aorta, renal arteries
5. Intestinal Gas Pattern
6. Bones