Your SlideShare is downloading. ×
Er Mr Talk
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Er Mr Talk

385
views

Published on

Body MR imaging in the emergenecy setting. Focus on application where MRI provides diagnostic information for patient management in the emergency department, without radiation exposure.

Body MR imaging in the emergenecy setting. Focus on application where MRI provides diagnostic information for patient management in the emergency department, without radiation exposure.

Published in: Health & Medicine, Technology

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
385
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Body MR in the Emergency Setting Lloyd Stambaugh, M.D.
  • 2. CT and Cancer Risk
    • CT scans/year
      • 1980 3 million
      • 2007 62 million (4M in children)
    • Radiation dose estimate
      • CT 10-20 mSv (per scan)
      • 30-60 mSv for multi-phase
      • CXR 0.2 mSv
  • 3. CT and Cancer Risk
    • Recent NEJM article estimates that as much as 1.5 – 2 % of all cancers in the U.S. may be the result of radiation from CT scans.
    • There is NO ionizing radiation exposure from MRI
  • 4. MR Small Bowel
    • Development of rapid breath-hold sequences
    • High T2 signal of water
    • Intrinsic MR tissue contrast
    • Multi-planar imaging
  • 5. 3T MR—normal small bowel
  • 6. 3T MR—MR enterography
  • 7. Normal post-contrast small bowel
  • 8. 3T MR—Normal multiphase post-Gd small bowel
  • 9. MRI Appendicitis
    • In a study of 51 pregnant patients, MRI was 100% sens and 94% specific in diagnosing appendicitis
    • Additional studies report ranges of 97-100 % sensitivity and 92-94% specificity.
  • 10. MR Appendicitis
    • Dilated fluid-filled appendix
    • Peri-appendiceal edema
    • Thickened wall
    • Enhancement (if Gd is given)
  • 11. Normal appendix
  • 12. Normal Appendix
  • 13. Normal Appendix
  • 14. Copyright ©Radiological Society of North America, 2006 Appendiceal phlegmon in 29-year-old pregnant woman
  • 15. Copyright ©Radiological Society of North America, 2007 Patel, S. J. et al. Radiographics 2007;27:1705-1722 Acute appendicitis in a pregnant woman with right lower quadrant pain
  • 16. Copyright ©Radiological Society of North America, 2007 Acute appendicitis in a nonpregnant patient
  • 17. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Acute appendicitis in a 21-year-old pregnant patient
  • 18. Copyright ©Radiological Society of North America, 2006 Pedrosa, I. et al. Radiology 2006;238:891-899 Appendiceal phlegmon in pregnant woman
  • 19. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Perforating appendicitis in a 16-year-old girl
  • 20. Copyright ©Radiological Society of North America, 2006 Pedrosa, I. et al. Radiology 2006;238:891-899 Mild acute appendicitis in a 27-year-old pregnant woman (gestational age, 13 weeks)
  • 21. Copyright ©Radiological Society of North America, 2006 Pedrosa, I. et al. Radiology 2006;238:891-899 MR images in 33-year-old pregnant woman (gestational age, 20 weeks) with acute appendicitis
  • 22. Copyright ©Radiological Society of North America, 2007 Acute appendicitis in a 20-year-old pregnant patient
  • 23. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Gangrenous appendicitis in a pregnant patient
  • 24. MRI Crohn’s
    • MRI’s inherent tissue contrast allows effective imaging of bowel and inflammation
    • Crohn’s patients tend to be young and will often have multiple imaging studies, making radiation exposure from CT an issue
  • 25. MRI Crohn’s
    • 59 Crohn’s patients were evaluated with MR
    • T2 and post-Gd T1 had 98% sens and 78% spec for ileal lesions
    • T2 images found:
      • 90% of severe strictures
      • 71% of entero-enteric fistulas
      • all abscesses
  • 26. Copyright ©Radiological Society of North America, 2005 Maccioni, F. et al. Radiology 2005;238:517-530 28-year-old man with known Crohn disease
  • 27. Copyright ©Radiological Society of North America, 2005 Maccioni, F. et al. Radiology 2005;238:517-530 Recurrence of Crohn disease in a 52-year-old man
  • 28. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Crohn disease
  • 29. Crohn’s with Ileo-ileo fistula
  • 30. Crohns with reactive lymph nodes—3T image
  • 31. 3T MR—Crohns disease Comb sign—engorged vasa recta
  • 32. 3T MR—Crohns disease Neo-terminal ileum with ulceration
  • 33. Diverticulitis with colovesicle fistula
  • 34. 3T MR Colonography Cecal cancer
  • 35. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Acute epiploic appendagitis
  • 36. Post-adhesiolysis for SBO; mild resolving ileus
  • 37. MR GU Pathology
    • High T2 water signal gives MR an advantage in imaging the renal collecting systems
    • Intrinsic MR tissue contrast provides detailed imaging of the uterus and ovaries
  • 38. 3T MR—Normal renal collecting systems
  • 39. MR Urography
    • MR urography is similar in accuracy to CT in assessing renal obstruction
    • MR is superior in showing peri-renal edema
    • Post-Gd MR better at showing urinary calculi (filling void) than T2-urography
    • MR of 23 high-risk patients found 5 renal & 8 ureteral TCC’s; remaining patients negative on F/U for 1 year.
  • 40. Hydronephrosis & Pregnancy
    • Hydro of pregnancy
    • Usually mild
    • Right > Left
    • ureter tapers between uterus and psoas
    • No perinephric edema
    • Ureteral obstruction
    • Perinephric edema
    • Ureter cutoff below or above uterus
    • May see filling defect
    • Don’t be fooled by flow artifact on HASTE/SSFSE
  • 41. NF Mild hyronephrosis of pregnancy
  • 42. Mild hydronephrosis of pregnancy
  • 43. Distal left ureter obstruction
  • 44. Distal right ureter obstruction
  • 45. 3T MR—partial obstructing mid L ureter stone
  • 46. 3T MR—distal R ureter susceptibility artifact… Not ureter stone
  • 47. 3T MR—renal pelvis stone
  • 48. Copyright ©Radiological Society of North America, 2007 Singh, A. et al. Radiographics 2007;27:1419-1431 Adnexal torsion
  • 49. Ovarian torsion
  • 50. Ovarian fibroma
  • 51. 3T MR—tubo-ovarian abscess
  • 52. Smoker with index finger ulcer
  • 53.