git imaging

Imaging of GITDr.Ghazala MalikFellow of College of Physicians & Surgeons PakistanFellow of Royal College of Radiologists LondonConsultant Radiologist

Objectives To give an overview of basic radiology modalities for GI tract imaging.

To describe the radiological anatomy seen on these modalities.

To give an idea of and common abnormalities.

To highlight the concept of GIT emergency cases.

Radiology Modalities for GIT ImagingPlain radiography Barium studies Ultrasonography Computed tomography Magnetic resonance imaging Isotope scanning Angiography

Plain Radiography (Xray)The X-ray tube is focused on the man's abdomen. X-rays will pass through his body and produce an image on the specialized plate below.

Key to densities in AXRs Black--gas ,White--calcified structures Grey--soft tissues ,Darker grey--fat Intense white--metallic objects Radiolographic anatomy of the abdomen

Checklist for systematic viewing of anAXR 1.Technical assessment - adequate image quality 2. Diaphragms - free air, pleural effusion 3. Liver - size, shape 4. Spleen - size, shape 5. Kidney, Ureter, Bladder - size, shape, calcifications 6. Uterus in females, prostate in males - calcifications 7. Psoas muscle - clear outlining 8. Bowel gas pattern - normal or abnormal 9. Abnormal extraluminal gas - freeair, biliary system, portal venous system, bowel wall 10. Bones - osteoarthritis, fractures, metastasis, Paget's disease 11. Extra-abdominal fat and soft tissue - gas or calcifications 12. Calcifications - normal or abnormal 13. Artefacts - iatrogenic,projectional

What we look for on plain radiograph?Foreign body Calcifications Bowel dilatation Air fluid level Masses Free air under the diaphragm

Foreign Body

Abdominal Calcification

Normal calcificationsAbnormal calcificationsCostal cartilageGallbladderMesenteric lymph nodesPancreasPelvic PhlebolithsKidney & ureter & bladderProstate glandBlood vesselsTumours

Abdominal Calcification

Intestinal Obstruction/perforation checklist

Where are the bowel loops located (central vs. peripheral)? Is there too much intraluminal gas?What is the distribution of the gas in the abdomen? What is the intraluminal calibre of the small and large bowel? Are there any dilatations of the small and/or large bowel? Is there any gas in the biliary tree or portal venous system location?Can you identify any air-fluid levels? Are there any areas of faecal loading, i.e. any in the colon

Small bowel Centrally located within numerous tight loops of small diameter (2.53.5cm), Valvulae conniventes (Stack of coins), that stretch all the way across the small bowel loops.Large bowel Has a mixture of gas and faeces located within loops of larger diameter (35cm) around the peripheryHaustra, that stretch only part-way across the diameter of the large bowel loops.Abnormal findings include: Dilated loops of small or large bowelAirfluid levels on erect AXRmore than 5 fluid levels, greater than 2.5cm in length is abnormalIntramural gas -ischaemic colitisIntraperitoneal gasperforated viscus or penetrating abdominal injury.However the sensitivity for detecting perforation on AXR is low and is best confirmed as subdiaphragmatic air on erect CXR or with a CT scan..

contd:,

Contd;

Pneumoperitoneum

Fluoroscopy-Barium Studies

Patient Positioning

Fluoroscopy-Barium StudiesFluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which makes the area appear bright white, to view internal organs in motion.

The Fluoroscopic exams that we perform include:Barium Swallow (Esophagram)Upper Gastrointestinal Series (UGI)Small Bowel SeriesBarium Enema

Barium Studies Indications DyspepsiaDysphagiaAbdominal PainConstipation and diarrheaRefluxAssessment of fistulae and perforationWeight lossPre operative anatomical demonstration

Dr. Akram JaffarDr. Akram Jaffar

Barium Swallow AnatomyAortic knuckleLeft bronchusLeft atrium


Barium SwallowShapeGastroesophageal sphinctersPeristalsisStrictureFilling defectNormal impression


strictureCarcinoma .Usually circumferential stricture .Irregular lumen with shouldered edges Neuromuscular abnormality Dilated oesophagus .Smooth tapered narrowing


Lesser curvatureGreater curvaturebodyfunduscardiapylorusBarium meal


Barium meal

Barium meal Size and shape of stomachAny filling defectMucosal foldsPyloric canal

Stomach ulcerGastric ulcer


Hiatus herniaParaesophageal (rolling) hiatal hernia: the cardia remains in its normal position. The fundus extends through the esophageal hiatus. Sliding hiatal hernia: the abdominal esophagus, cardia, and fundus slide superiorly through the esophageal hiatus..


Parts of the duodenumPyloric antrumPyloricsphincterPyloric canalAngular notchDescending duodenumPeristalticwaveDuodenalcapGreater omentumThe mucous membrane of most of the duodenum is thrown into numerous circular folds (plicae circulares). .Divided into 4 parts which can be visualized by x-ray The 1st part extends from the pylorus upwards backwards and to the right.


Duodenal (peptic) ulcerMostly occur in the posterior wall of the duodenal cap.Perforation permit the contents to enter the peritoneal cavity causing peritonitis.Gastroduodenal arteryGas under the diaphragm in perforated duodenal ulcerBarium meal showing duodenal ulcerEndoscopic view of duodenal ulcer


1)duodenal bulb2)descending portion3)transverse portion


Upper G.I Barium Follow Through StudyPlicae circularesLarge and close together in the proximal half of the jejunum.Gradually disappearing almost wholly in the distal ileumjejunumileum


Small Bowel Enema


Barium enemaAlthough the ileocecal junction may be termed as valve, its functional reality remains doubtful. Asc.colonTransverse colonsigmoidrectumsplenic flexurehepatic flexureBarium inTerminal ileum


Inflammatory bowel disease


Out pocketing of the mucosa of the large intestine, usually in the sigmoid, through the muscle wall.


UltrasoundPulse echo principle


Abdominal organ echogenicity mnemonicFrom most to least echogenic. Positioned Superiorly Left Kidney Pancreas Spleen Liver Kidneys


CBDPortal veinHepatic VeinIVC


Gall blladder


Liver Pathology


PANCREAS


Sectional anatomy of the abdomen

Sections are arranged to match CT & MRI sections(as if looking at the body from below)


CT SCAN


Internal of a CT scanner

T

D

X

RX RAY TUBE

X RAY DETECTORS

X RAY BEAM

GANTRY ROTATION


liverIVCspleenCaudate lobeFissure for ligamentumvenosumaortastomachCaudate lobestomachIVCliveraortaspleenCROSS SECTIONAL ANATOMY OF G.I.T


CT of the gallbladderAxial CTGBliverIVCaortaL. kidneyspleenPortal v.pancreasstomachGBliverIVCaortaspleenPortal v.pancreasstomach


Parts and position of the pancreasBecause the pancreas usually slopes slightly upwards, its whole length is not necessarily seen in one axial section.The neck lies anterior to the portal vein.

bodyneckPortal v.??????


Hepatic lesions


Infections


Magnetic Resonance Imaging


Coronal MRI91011spleenlungL.kidneyliverR.kidney


MRI of the gallbladderCoronal MRIGB withstonesGBliverIVCPortal v.pancreasstomachliverstomachspleenTransverse colon


MRCP


It is very important to view an AXR systematically. So, once you have found your system, stick to it allthe time!


Thank you

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