oncology imaging principal imaging modalities
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Oncology ImagingOncology ImagingOncology ImagingOncology Imaging
Principal Imaging ModalitiesPrincipal Imaging Modalities
Plain films (images) Ultrasound (US) Computed Tomography (CT) Magnetic Resonance Imaging
(MRI) Nuclear Medicine
Contrast mediaContrast media
Barium sulphate Organic iodine preparations Ultrasound contrast agents Magnetic Resonance Imaging cont
rast agents.* Contrast media may have allergic
reactions.
Reactions related to Iodinated Reactions related to Iodinated contrast mediacontrast media
Minor reactions: nausea, vomiting, urticarial rash, headache.
Intermediate reactions: hypotension, bronchospasm
Major reactions: convulsions, pulmonary oedema, cardiac arrhyt
hmias, cardiac arrest.
Radiation Protection (Radiation Protection (11) )
Although ionizing radiation is deemed to be potentially hazardous, the risks should be weighed in context of benefits to the patient.
Radiation Protection (2)Radiation Protection (2)
Clear requests with relevant clinical details.
Discussion of complex cases with radiologists.
Radiation Protection (Radiation Protection (33))
Ultrasound
}Lack of ionizing radiation
M R I
Digital RadiographyDigital Radiography
The principal advantages of digital radiography are: significant reduction in radiation e
xposure; digital enhancement ensures all i
mages are of an adequate quality; transfer of images out of the radiol
ogy department to other sites;
Digital RadiographyDigital Radiography
elimination of storage problems associated with conventional films:
no missing films; rapid retrieval of previous
images and reports for comparison;
ease of availability of examinations to clinicians.
UltrasoundUltrasound
USES Brain: Imaging the neonatal brain. Thorax: Confirms pleural effusions
and pleural masses. Abdomen: Visualizes liver, gallbladder, pancreas, kidneys, etc. Pelvis: Useful for monitoring
pregnancy, uterus and ovaries. Peripheral: Assesses thyroid, testes and soft-tissue lesions.
UltrasoundUltrasound
Advantages
Relatively low cost of equipment.
Non-ionizing radiation and safe.
Scanning can be performed in any plane.
Can be repeated frequently, for example pregnancy follow up.
UltrasoundUltrasound
Advantages
Detection of blood flow, cardiac and fetal movement.
Portable equipment can be taken to the
bedside for ill patients.
Aids biopsy and drainage procedures.
UltrasoundUltrasound
Disadvantages Operator dependent. Inability of sound to cross an
interface with either gas or bone causes unsatisfactory visualization of underlying structures.
Scattering of sound through fat produces poor images in obesity.
Computed TomographyComputed Tomography
USES Any region of the body can be scanned;
brain, neck, abdomen, pelvis and limbs. Staging primary tumours such as colon
and lung for secondary spread, to determine operability or a baseline for chemotherapy.
Radiotherapy planning. Exact anatomical detail when ultrasou
nd is not successful.
Computed TomographyComputed Tomography
Advantages Good contrast resolution. Precise anatomical detail. Rapid examination technique, so
valuable for ill patients. In contrast to ultrasound,
diagnostic images are obtained in obese patients as fat separates the abdominal organs.
Computed TomographyComputed Tomography
Disadvantages High cost of equipment and scan. Bone artefacts in brain scanning, espe
cially the posterior fossa, degrade images.
Scanning mostly restricted to the transverse plane, although reconstructed images can be obtained in other planes.
High dose of ionizing radiation for each examination.
Magnetic Resonance ImagingMagnetic Resonance Imaging
USES Central nervous system (CNS):
technique of choice for brain and spinal imaging.
Musculoskeletal: accurate imaging of joints, tendons, ligaments and muscular abnormalities.
Cardiac: imaging with gating techniques related to the cardiac cycle enables the diagnosis of many cardiac conditions.
Magnetic Resonance ImagingMagnetic Resonance Imaging
USES Thorax: assessment of vascular struct
ures in the mediastinum. Abdomen: abdominal organs are well
visualized, surrounded by high signal from surrounding fat.
Pelvis: staging of prostate, bladder and pelvic neoplasms.
Magnetic Resonance ImagingMagnetic Resonance Imaging
Advantages
Can image in any plane-axial, sagittal or coronal. Non-ionizing and hence believed to be s
afe to use. No bony artefacts due to lack of signal fr
om bone.
Magnetic Resonance ImagingMagnetic Resonance Imaging
Advantages
Excellent anatomical detail especially of soft
tissues. Visualizes blood vessels without
contrast: magnetic resonance angiography
(MRA). Intravenous contrast utilized much less frequently than CT.
Magnetic Resonance ImagingMagnetic Resonance Imaging
Disadvantages High operating costs. Poor images of lung fields. Inability to show calcification
with accuracy.
Magnetic Resonance ImagingMagnetic Resonance Imaging
Disadvantages Fresh blood in recent haemorrhag
e not as well visualized as by CT. MRI more difficult to tolerate with
examination times longer than CT. Contraindicated in patients with p
acemakers, metallic foreign bodies in the eye and arterial aneurysmal clips (may be forced out of position by the strong magnetic field).
Respiratory TractRespiratory Tract
Modalities for Respiratory Tract Modalities for Respiratory Tract InvestigationsInvestigations
Plain films (images)
Computed tomography (CT)
Ultrasound (US)
Isotopes
Pulmonary angiography
Magnetic resonance imaging (MRI)
CT for Respiratory tractCT for Respiratory tract
Excellent detail for localizing and staging mediastinal masses and bronchial neoplasms.
Assesses hilar areas to identify lymphadenopathy, and to differentiate from prominent pulmonary arteries.
Visualizes accurately pleural masses, plaques and fluid associated with asbestos exposure.
US for Respiratory tractUS for Respiratory tract
Presence of the pleural effusions and
loculated fluid.
Biopsy of pleural lesions.
MRI-for respiratory tractMRI-for respiratory tract
Evaluation of mediastinal masses,
aortic dissection and staging bronchial carcinoma.
Evaluation of vascular invasion.
Bronchial carcinomaBronchial carcinoma
A common primary tumour
Histological types:
squamous, small (oat) cell, anaplastic, adenocarcinoma, alveolar cell carcinoma.
Bronchial carcinomaBronchial carcinoma
Haemoptysis
Respiratory symptoms
Bronchial carcinomaBronchial carcinomaRadiological features Lobulated or spiculated mass but sometim
es with a smooth outline.
Tumours at the lung apex (Pancoast's tumour) can invade the brachial plexus, resulting in shoulder and arm pain with wasting of the hand, or invasion of the sympathetic chain may give rise to Horner's syndrome.
Bronchial carcinomaBronchial carcinoma
CT/MRI
-Assesses spread.
-Determines operability.
Differential diagnosis of Differential diagnosis of solitary lung masssolitary lung mass
Metastasis: -Breast, kidney, colon,
testicular tumours. Tuberculoma Benign neoplasms
-Bronchial adenoma , hamartoma round pneumonia, hydatid cyst, haematoma , arteriovenous malformation.
Bronchial carcinomaBronchial carcinoma
Common sites of distant metastases
- Brain - Bone - Adrenals - Liver
Mediastinal massMediastinal mass
Imaging modalities –
Plain film
CT
MRI
Mediastinal massMediastinal mass Anterior mediastinal masses - thyroid , thymus , teratodermoi
d Middle mediastinal masses - lymphoma, metastases, sarcoid or tuberculosis. Posterior mediastinal masses - neurogenic tumours neurofibromas ganglioneuroma
Gastrointestinal Gastrointestinal tract (GI)tract (GI)
Gastrointestinal tract (GI)Gastrointestinal tract (GI)
Imaging modalities
-Plain films (images)-Barium studies-Angiography-Computed tomography
-Ultrasonography -Magnetic resonance imaging
Gastrointestinal tract (GI)Gastrointestinal tract (GI)
CT - to assess for operability by stagin
g oesophageal, gastric and colonic tumours. - to evaluate adjacent infiltration and secondary deposits.
Esophageal CarcinomaEsophageal Carcinoma
Squamous cell type
Distal thirdMale > Female
Predisposing factors - Achalasia - Barrett’s esophagus
Esophageal CarcinomaEsophageal Carcinoma
Imaging modalities
- Barium
- CT: tumour confinement to the wall or extraluminal spread.
- US: secondary deposits
Esophageal CarcinomaEsophageal Carcinoma
Radiological features
Polypoidal type: an intraluminal mass protrudes out into the oesophageal lumen causing a filling defect in the barium column.
Infiltrative type: the tumour spreads under the oesophageal mucosa without extending into the lumen, causing narrowing. Later there is mucosal infiltration resulting in ulceration and an irregular outline to the oesophagus.
Gastric CarcinomaGastric Carcinoma
A general decrease in the
incidence of gastric carcinoma.
Gastric CarcinomaGastric Carcinoma
Clinical Presentations:
Dyspepsia , anorexia, nausea, vomiting,
Body weight loss,
Haematemesis or melaena.
Gastric CarcinomaGastric Carcinoma
Imaging modalities
- Barium meal
- CT }preoperative evaluation
- US
Gastric CarcinomaGastric Carcinoma
Radiological features
Barium meal Polypoidal type - soft-tissue mass causin
g a filling defect. Ulcerating type - ulcerating within the margin of the stomach.
Gastric CarcinomaGastric Carcinoma
Diffuse infiltrating type - diffuse submucosal infiltration ( linitis plastica) small rigid stomach
( leather bottle stomach) { poor distensibility
Local infiltrating type - focal area of mucosal irregularity and narrowi
ng at the site of the tumour.
Colonic carcinomaColonic carcinoma
Commonest malignancy of GI tract.
Usually adenocarcinoma
Colonic carcinomaColonic carcinoma
Imaging modalities
- Plain films. - Barium - Ultrasound - CT/MRI colonoscopy staging
Colonic carcinomaColonic carcinoma
Radiological features
Annular carcinoma - irregular luminal narrowing , apple-core deformity. Polypoidal mass - intraluminal filling defect.
Colonic carcinomaColonic carcinoma
Complications
- Obstruction - Perforation - Fistula formation
Colonic carcinomaColonic carcinoma
Differential diagnosis of colonic narrowing
- Diverticular disease - Crohn's disease - Ulcerative colitis
Colonic carcinomaColonic carcinoma
Differential diagnosis of colonic narrowing
- Extrinsic: inflammatory / neoplastic infiltration. - Radiotherapy - Tuberculosis. - Ischaemia.
Hepatocellular carcinHepatocellular carcinomaoma
Hepatocellular carcinomaHepatocellular carcinoma
Common tumour in Chinese.
Chronic hepatitis B carriers.
Fungal aflatoxin food contamination.
Hepatocellular carcinomaHepatocellular carcinoma
Clinical Presentation
- upper abdominal pain - weight loss - fever
Hepatocellular carcinomaHepatocellular carcinoma
Three principal types
- Multinodular - Infiltrative - Solitary mass
Hepatocellular carcinomaHepatocellular carcinoma
Radiological features
- CT/MRI precontrast : low/isodense mass arterial phase : hypervascular
mass delayed phase : wash-out mass
Hepatocellular carcinomaHepatocellular carcinoma
The tumor should be assessed for invasion of the vascular system and the biliary system.
Hepatocellular carcinomaHepatocellular carcinoma
About 20% ( ? ) are suitable
for liver resection.
Liver MetastasesLiver Metastases
The liver is the most common organ of secondary deposits.
The primary sites are : colon, stomach, pancreas, breast and lung.
Pancreatic carcinomaPancreatic carcinoma
The most frequent pathological type arises from the pancreatic duct epithelium (Adenocarcino
ma).
Pancreatic carcinomaPancreatic carcinoma
Clinical Presentation - Abdominal pain - Weight loss, anorexia. - Obstructive jaundice. - Malabsorption, diarrhoea. - Diabetes.
Pancreatic carcinomaPancreatic carcinoma
Clinical symptoms usually occur late and at the time of presentation there is often local invasion of blood vessels or bowel.
Pancreatic carcinomaPancreatic carcinoma
Radiological features US/CT
- focal pancreatic enlargement with a hypoechoic /hypodense mass. - pancreatic and bile duct dilatation - distended gallbladder.
Pancreatic carcinomaPancreatic carcinoma
MRI –
Reduced signal from pancreas on T l sequence.
The Urinary TractThe Urinary Tract
The Urinary TractThe Urinary Tract
Imaging modalities
- KUB- Intravenous urography (IVU)
- Retrograde pyelography - Antegrade pyelography
The Urinary TractThe Urinary Tract
Imaging modalities
- Percutaneous nephrostomy - Micturating cystogram - Urethrography
The Urinary TractThe Urinary Tract
Imaging modalities
- Ultrasound- Computed Tomography- Arteriography
Renal carcinomaRenal carcinoma
Radiological features Plain film – Renal mass (calcifications) IVP – Renal Mass, pelvicalyceal distortion and irregularity US – Solid mass with increase vascularity CT/MRI – Useful for staging, perinephric tissue invasion, venous invasion, lymph node metastasis
Bladder carcinomaBladder carcinoma
Radiological features IVP – Filling defect in the bladder Irregular mucosa CT/MRI – Useful for staging Intramural /extramural spread , local invasion , lymph node metastasis
Testicular tumourTesticular tumour
US – extremely effective in evaluation of well defined low echogenicity mass
MR imaging of clinical stage I anMR imaging of clinical stage I and IIa cervical carcinoma: a reapd IIa cervical carcinoma: a reap
praisal of efficacy and pitfallspraisal of efficacy and pitfalls Parametrial invasion: 96.7%Parametrial invasion: 96.7% Vaginal invasion: 87%Vaginal invasion: 87% LAP: 87%LAP: 87% Staging accuracyStaging accuracy MRI: 83.8%, Clinical staging: 61.3%MRI: 83.8%, Clinical staging: 61.3% stage IIa vs. stage IIa vs. stage IIB stage IIB MRI: 96.7%, Clinical staging: 80.6%MRI: 96.7%, Clinical staging: 80.6%
Europ Radiol 2001Europ Radiol 2001
Skeletal system Skeletal system
Imaging modalities Plain films (images) – still remain th
e mainstay of investigation Isotopes – Tc 99m phosphate compo
unds US/CT/MR – for tumour vascularity,
infiltration of surrounding tissure relationship to nerves and vessels
OsteosarcomaOsteosarcoma
Plain films (images)Radiological features
Irregular medullary destruction Periosteal reaction Cortical destruction Soft tissure mass New bone formation
Bone metastasesBone metastases
Plain films (images)Radiological features
- Lytic deposits : poor definition of margins,
pathological fracture - Sclerotic deposits : an area of ill- defined increased density
Bone metastasesBone metastases
- Most frequent primary are Breast
Prostate Lung Kidney Thyroid Adrenal gland
Multiple myelomaMultiple myeloma
Radiological featuresPlain films (images)- Generalized osteoporosis- Compression fracture of vertebral
bodies- Scattered ‘pounch-out’ lytic lesions
with well-defined margins- Bone expansion with soft-tissue masses
Choose the most Choose the most appropriate appropriate
imaging modality is the key imaging modality is the key for accurate effective for accurate effective diagnosis and treatment.diagnosis and treatment.