a gastrointestinalis tractus képalkotó vizsgálata ... · department of radiology, university of...
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![Page 1: A gastrointestinalis tractus képalkotó vizsgálata ... · Department of Radiology, University of Szeged, Hungary Female pelvis • Pregnancy • – normal – pathologic – ectopic](https://reader030.vdocuments.mx/reader030/viewer/2022040416/5d4a719688c9931a7c8bc96b/html5/thumbnails/1.jpg)
Department of Radiology, University of Szeged, Hungary
Imaging of the pelvis
Angela Csomor
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy – normal
– pathologic
– ectopic
• Uterus – congenital disorders
– inflammation, infection
– neoplasm
• Adnexes – inflammation, infection,
abscess
– cyst
– endometriosis
– neoplasm
• No pelvic X-ray/CT in fertile females (except emergency)
• US (max 3 in normal pregnancy incl baby movie)
– transabdominal
– transvaginal
• MR (limit its use in first trimester)
– pelvic
• Intervention – selective
embolisation/chemotherapy
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Department of Radiology, University of Szeged, Hungary
Decrease risks of ionizing radiation
• Fertile female, not pregnant: (except emergency)
– avoid direct pelvic examination any time
– X-ray/CT of other regions in first two weeks of the cycle only
• Pregnancy:((except emergency
– avoid direct pelvic examination any time
– emergency X-ray/CT of other regions in second/third trimester only
– direct pelvic radiation in first trimester of unknown pregnancy: consider termination
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Department of Radiology, University of Szeged, Hungary
• Xray, CT, CTA
– NO in pregnant!
– Only when it is really indicated in fertile women!
Decrease risks of ionizing radiation
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Department of Radiology, University of Szeged, Hungary
Provides overwiew of the pelvis
Well distended bladder • acoustic window
• displacement of bowel loops from pelvic region
Transabdominal sonography
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Department of Radiology, University of Szeged, Hungary
Normal endometrium
Premenopausal patients
depeds on the phase of the menstrual cycle
during menstruation: 2-4mm
proliferative, secretory phase: 5-16mm
Postmenopausal patients: <5mm
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Department of Radiology, University of Szeged, Hungary
gestational sack ovarian follicula
Transvaginal sonography
• empty bladder
• US probe is closer to the examined
structures
• provides better resolution
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Department of Radiology, University of Szeged, Hungary
MRI
normal uterus
zonal anatomy
• outer myometrium (intermediate intensity)
• inner myometrium or junctional zone ( low intensity)
• endometrium (high intensity)
• the T2 contrast between the outer myometrium and the
junctional zone becomes less marked in the postmenopausal
uterus
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Department of Radiology, University of Szeged, Hungary
Pregnancy, sonography
• gestational sac (5-6. week)
• fetal node (6-7. week)
• heart beat (7. week)
• head (14. week)
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Department of Radiology, University of Szeged, Hungary
Pregnancy, 28th week- MRI
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
Arnold-Chiari,
20th week
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Department of Radiology, University of Szeged, Hungary
Duplication cyst of the stomach
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
Ectopic pregnancy
• transabdominal, transvaginal US
• transabdominal scan provides a wider
overview of the abdomen
• transvaginal scan is more sensitive
tubal ring sign ring of fire sign
empty uterine cavity
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
arcuate, bicornuate uterus
uterus duplex
Abnormal fusion of the pair of Müllerian ducts
normal uterine
zonal anatomy.
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
•diagnose the presence and monitor the growth of fibroids
•uncomplicated leiomyomas are usually hypoechoic, but can be
isoechoic, or even hyperechoic compared to normal
myometrium
•calcification - echogenic foci with shadowing
•necrosis- cystic areas
US
Leiomyomas
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Department of Radiology, University of Szeged, Hungary
Leiomyomas
• degeneration
necrotic
cystic
calcification
Localisation
subserosal
intramural
submucosal
Signal intensity
• no degeneration
T1 intermediate
T2 low
Enhancement
variable
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Department of Radiology, University of Szeged, Hungary
Endometrial cc
tickening of the endometrium or polypoid mass
• premenopausal patients
depeds on the phase of the menstrual cycle
during menstruation: 2-4mm
proliferative, secretory phase: 5-16mm
• postmenopausal patients: <5mm
US
transvaginal
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Department of Radiology, University of Szeged, Hungary
Endometrial cc MRI
invasion of parametrium
disruption of junctional zone
invasion of myometrium
local staging:
MRI is superior to CT
distant metastasis:
CT, MRI
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Department of Radiology, University of Szeged, Hungary
Cervix tumor
MRI
hyperintensity, more
enhancement relative to the
cervical stroma
local staging:
MRI is superior to CT
distant metastasis:
CT, MRI
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
evaluation
of the shape of the uterine cavity
patency of the tubes
injection of a contrast material into
the cervical canal under fluoroscopic controll
normal result:
• filling of the uterine cavity
• bilateral filling of the fallopian tube
Hysterosalpingography (HSG)
infertility
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Department of Radiology, University of Szeged, Hungary
2 sided intramural
blockage of tubas
2 sided
hydrosalpings normal
HSG
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Endometriosis
– Neoplasm
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Department of Radiology, University of Szeged, Hungary
Tubo-ovarial abscess
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Department of Radiology, University of Szeged, Hungary
Inflamation
intrauterine device
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Neoplasm
– Endometriosis
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Department of Radiology, University of Szeged, Hungary
Simple cyst
•anechoic •unilocular •thin, smooth walls •no solid or vascularized part
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Department of Radiology, University of Szeged, Hungary
Cystic ovarial lesions-US
Premenopausa
simple cyst<30mm- normal physiologic finding.
no follow-up
Pre- and postmenopausa:
simple cyst <70mm almost certainly benign
follow-up, CT, MRI
Symple cysts > 70mm, or any other cyst
possible neoplasm
MR and surgical evaluation
http://www.radiologyassistant.nl/en/p4cdf9b5de7d3b/
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Department of Radiology, University of Szeged, Hungary
Ovarial cancer
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Department of Radiology, University of Szeged, Hungary
Mucinous adenocarcinoma
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Department of Radiology, University of Szeged, Hungary
Krukenberg tumour
metastasis in the ovary (usualy) from the
gastrointestinal tract
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Department of Radiology, University of Szeged, Hungary
Teratoma-mature
skin ,hair , blood, fat, bone, nails, thyroid tissue, teeth
diameter < 10 cm
Contains:
mature tissues from at least two of the three germ cell layers
(ectoderm, mesoderm, and endoderm).
X ray
CT
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Department of Radiology, University of Szeged, Hungary
Teratoma-immature
large, encapsulated masses
Contains:
solid part + components seen in a mature teratoma
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Department of Radiology, University of Szeged, Hungary
Female pelvis
• Pregnancy
– Normal
– Pathologic
– Ectopic
• Uterus
– Congenital disorders
– Inflammation, infection
– Neoplasm
• Adnexes
– Inflammation, infection, abscess
– Cyst
– Neoplasm
– Endometriosis
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Department of Radiology, University of Szeged, Hungary
Endometriosis presence of endometrial tissue outside the uterine cavity
T2- and T1-weighted : low to intermediate signal intensity
T1-weighted images with fat saturation: High signal- indicating the presence of hemorrhage
http://www.radiologyassistant.nl/en/p4da490c32edcc/
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Department of Radiology, University of Szeged, Hungary
Endometriosis of the rectal wall
Endometrioma (chocolate cyst) of the ovary
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
• US
– Transabdominal
– transrectal
• MRI
– Pelvic
– Transrectal
• DSA, CT
– of little use
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostata – acute inflammation, abscessus
– chronic inflammation
– hyperplasia
– tumor
• Testis – congenitalis abnormalities
– inflammation
– trauma, torsio
– tumor
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Department of Radiology, University of Szeged, Hungary
Transrectal sonography
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Department of Radiology, University of Szeged, Hungary
hyperplasia (normal volume < 40 cm3)
retential cyst
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Abscess, transrectal ultrasound
retential cyst
anechoic
sharp contour abscess internal echoes irregular or lobulated borders
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
normal size : 3.8 x 2.5 x 3.2 cm normal volume < 40 cm3
hyperplasia- the transition zone next to the urethra- compression of the urethra
Benign
prostatic hyperplasia
lower urinary tract symptoms
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Prostate tumor
US
Usually:
• outer gland (peripheral zone)
• hypoechoic relative to prostatic
parenchyma
Indication:
• elevated serum PSA level or abnormal DRE
• core biopsies
Limitation:
• not all hypoechoic prostatic nodules are
malignant
• poor sensitivity in detection of capsular
penetration
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Department of Radiology, University of Szeged, Hungary
Prostata tumor MRI
• determine if there is extracapsular extension • detect and localize cancer when the PSA is persistently
elevated, but TRUS biopsy is negative. • T1: useful for detection of prostate contour,
extracapsular extension • T2: low signal within a normally high signal peripheral
zone
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Department of Radiology, University of Szeged, Hungary
Prostata tumor MRI
http://www.medscape.com/viewarticle/742986_3
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Normal testicle US
• primary imaging method
• 9-15 MHz
• homogeneous echogenicity
• low resistance arterial flow
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Retentio testis
• undescended testicle (inguinalis, abdominalis)
• risk factor for testicular cancer
• early diagnosis and treatment is important
preserve fertility
prevent for testis cancer
reduce the risk of torsion
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Department of Radiology, University of Szeged, Hungary
Varicocele
• dilatation (>2-3mm) and serpentine appearance of
many small veins in the spermatic cord
• impairment of sperm production and function
• treatment: embolization
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Orchidoepididymitis
• testis, epididimys
inhomogeneity
enlargement
hypervascularization
• hydrocele
• skin
thickening
hypervascularization
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Testicle injury
• contusion
heterogenous echotexture
fluid
• ruptura
testicular contour abnormality
disruption of the echogenic line of
tunica albugenia
absence of vascularity
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Department of Radiology, University of Szeged, Hungary
Testicular torsion result: cutting off of blood supply.
•impaired or absence of blood flow
•increase in size of the testis and epididymis
•homogeneous echotexture - before necrosis
•heterogeneous echotexture –after necrosis
•reactive hydrocoele
•reactive thickening of the scrotal skin with hyperaemia
•< 6 hours: ~100% salvage
•6-12 hours: 50%
•12-24 hours: 20%
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Department of Radiology, University of Szeged, Hungary
Male pelvis
• Prostate
– Acute inflammation,
abscess
– Chr. inflammation,
hypertrophy
– Tumor
• Testicle
– Congenital disorder
– Inflammation
– Trauma, torsion
– Tumor
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Department of Radiology, University of Szeged, Hungary
Testicular seminoma
• risk factors
undescended testis
testicular misrolithiasis
infections
• homogeneous intratesticular mass of
low echogenicity
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Department of Radiology, University of Szeged, Hungary
Retentio testis - seminoma