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Oncology Imaging Principal Imaging Modalities


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Oncology Imaging Principal Imaging Modalities

  1. 1. Oncology ImagingOncology Imaging
  2. 2. Principal Imaging ModalitiesPrincipal Imaging Modalities  Plain films (images)  Ultrasound (US)  Computed Tomography (CT)  Magnetic Resonance Imaging (MRI)  Nuclear Medicine
  3. 3. Contrast mediaContrast media  Barium sulphate  Organic iodine preparations  Ultrasound contrast agents  Magnetic Resonance Imaging contrast agents. * Contrast media may have allergic reactions.
  4. 4. Reactions related to IodinatedReactions related to Iodinated contrast mediacontrast media  Minor reactions: nausea, vomiting, urticarial rash, headache.  Intermediate reactions: hypotension, bronchospasm  Major reactions: convulsions, pulmonary oedema, cardiac arrhythmias, cardiac arrest.
  5. 5. 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.
  6. 6. Radiation Protection (2)Radiation Protection (2)  Clear requests with relevant clinical details.  Discussion of complex cases with radiologists.
  7. 7. Radiation Protection (Radiation Protection (33))  Ultrasound }Lack of ionizing radiation  M R I
  8. 8. Digital RadiographyDigital Radiography The principal advantages of digital radiography are:  significant reduction in radiation exposure;  digital enhancement ensures all images are of an adequate quality;  transfer of images out of the radiology department to other sites;
  9. 9. 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.
  10. 10. 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.
  11. 11. 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.
  12. 12. 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.
  13. 13. 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.
  14. 14. 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 ultrasound is not successful.
  15. 15. 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.
  16. 16. Computed TomographyComputed Tomography Disadvantages  High cost of equipment and scan.  Bone artefacts in brain scanning, especially 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.
  17. 17. 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.
  18. 18. Magnetic Resonance ImagingMagnetic Resonance Imaging USES  Thorax: assessment of vascular structures in the mediastinum.  Abdomen: abdominal organs are well visualized, surrounded by high signal from surrounding fat.  Pelvis: staging of prostate, bladder and pelvic neoplasms.
  19. 19. Magnetic Resonance ImagingMagnetic Resonance Imaging Advantages  Can image in any plane-axial, sagittal or coronal.  Non-ionizing and hence believed to be safe to use.  No bony artefacts due to lack of signal from bone.
  20. 20. 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.
  21. 21. Magnetic Resonance ImagingMagnetic Resonance Imaging Disadvantages  High operating costs.  Poor images of lung fields.  Inability to show calcification with accuracy.
  22. 22. Magnetic Resonance ImagingMagnetic Resonance Imaging Disadvantages  Fresh blood in recent haemorrhage not as well visualized as by CT.  MRI more difficult to tolerate with examination times longer than CT.  Contraindicated in patients with pacemakers, metallic foreign bodies in the eye and arterial aneurysmal clips (may be forced out of position by the strong magnetic field).
  23. 23. Respiratory TractRespiratory Tract
  24. 24. Modalities for Respiratory TractModalities for Respiratory Tract InvestigationsInvestigations  Plain films (images)  Computed tomography (CT)  Ultrasound (US)  Isotopes  Pulmonary angiography  Magnetic resonance imaging (MRI)
  25. 25. 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.
  26. 26. US for Respiratory tractUS for Respiratory tract  Presence of the pleural effusions and loculated fluid.  Biopsy of pleural lesions.
  27. 27. MRI-for respiratory tractMRI-for respiratory tract  Evaluation of mediastinal masses, aortic dissection and staging bronchial carcinoma.  Evaluation of vascular invasion.
  28. 28. Bronchial carcinomaBronchial carcinoma A common primary tumour Histological types: squamous, small (oat) cell, anaplastic, adenocarcinoma, alveolar cell carcinoma.
  29. 29. Bronchial carcinomaBronchial carcinoma Haemoptysis Respiratory symptoms
  30. 30. Bronchial carcinomaBronchial carcinoma Radiological features  Lobulated or spiculated mass but sometimes 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.
  31. 31. Bronchial carcinomaBronchial carcinoma CT/MRI -Assesses spread. -Determines operability.
  32. 32. Differential diagnosis ofDifferential 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.
  33. 33. Bronchial carcinomaBronchial carcinoma Common sites of distant metastases - Brain - Bone - Adrenals - Liver
  34. 34. Mediastinal massMediastinal mass Imaging modalities – Plain film CT MRI
  35. 35. Mediastinal massMediastinal mass  Anterior mediastinal masses - thyroid , thymus , teratodermoid  Middle mediastinal masses - lymphoma, metastases, sarcoid or tuberculosis.  Posterior mediastinal masses - neurogenic tumours neurofibromas ganglioneuroma
  36. 36. Gastrointestinal tractGastrointestinal tract (GI)(GI)
  37. 37. Gastrointestinal tract (GI)Gastrointestinal tract (GI) Imaging modalities -Plain films (images) -Barium studies -Angiography -Computed tomography -Ultrasonography -Magnetic resonance imaging
  38. 38. Gastrointestinal tract (GI)Gastrointestinal tract (GI) CT - to assess for operability by staging oesophageal, gastric and colonic tumours. - to evaluate adjacent infiltration and secondary deposits.
  39. 39. Esophageal CarcinomaEsophageal Carcinoma  Squamous cell type  Distal third Male > Female  Predisposing factors - Achalasia - Barrett’s esophagus
  40. 40. Esophageal CarcinomaEsophageal Carcinoma Imaging modalities - Barium - CT: tumour confinement to the wall or extraluminal spread. - US: secondary deposits
  41. 41. 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.
  42. 42. Gastric CarcinomaGastric Carcinoma A general decrease in the incidence of gastric carcinoma.
  43. 43. Gastric CarcinomaGastric Carcinoma Clinical Presentations: Dyspepsia , anorexia, nausea, vomiting, Body weight loss, Haematemesis or melaena.
  44. 44. Gastric CarcinomaGastric Carcinoma Imaging modalities - Barium meal - CT }preoperative evaluation - US
  45. 45. Gastric CarcinomaGastric Carcinoma Radiological features Barium meal  Polypoidal type - soft-tissue mass causing a filling defect.  Ulcerating type - ulcerating within the margin of the stomach.
  46. 46. 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 narrowing at the site of the tumour.
  47. 47. Colonic carcinomaColonic carcinoma  Commonest malignancy of GI tract.  Usually adenocarcinoma
  48. 48. Colonic carcinomaColonic carcinoma Imaging modalities - Plain films. - Barium - Ultrasound - CT/MRI colonoscopy staging
  49. 49. Colonic carcinomaColonic carcinoma Radiological features  Annular carcinoma - irregular luminal narrowing , apple-core deformity.  Polypoidal mass - intraluminal filling defect.
  50. 50. Colonic carcinomaColonic carcinoma Complications - Obstruction - Perforation - Fistula formation
  51. 51. Colonic carcinomaColonic carcinoma Differential diagnosis of colonic narrowing - Diverticular disease - Crohn's disease - Ulcerative colitis
  52. 52. Colonic carcinomaColonic carcinoma Differential diagnosis of colonic narrowing - Extrinsic: inflammatory/neoplastic infiltration. - Radiotherapy - Tuberculosis. - Ischaemia.
  53. 53. HepatocellularHepatocellular carcinomacarcinoma
  54. 54. Hepatocellular carcinomaHepatocellular carcinoma  Common tumour in Chinese.  Chronic hepatitis B carriers.  Fungal aflatoxin food contamination.
  55. 55. Hepatocellular carcinomaHepatocellular carcinoma  Clinical Presentation - upper abdominal pain - weight loss - fever
  56. 56. Hepatocellular carcinomaHepatocellular carcinoma Three principal types - Multinodular - Infiltrative - Solitary mass
  57. 57. Hepatocellular carcinomaHepatocellular carcinoma Radiological features - CT/MRI precontrast : low/isodense mass arterial phase : hypervascular mass delayed phase : wash-out mass
  58. 58. Hepatocellular carcinomaHepatocellular carcinoma The tumor should be assessed for invasion of the vascular system and the biliary system.
  59. 59. Hepatocellular carcinomaHepatocellular carcinoma About 20% ( ? ) are suitable for liver resection.
  60. 60. Liver MetastasesLiver Metastases The liver is the most common organ of secondary deposits. The primary sites are : colon, stomach, pancreas, breast and lung.
  61. 61. Pancreatic carcinomaPancreatic carcinoma  The most frequent pathological type arises from the pancreatic duct epithelium (Adenocarcinoma).
  62. 62. Pancreatic carcinomaPancreatic carcinoma  Clinical Presentation - Abdominal pain - Weight loss, anorexia. - Obstructive jaundice. - Malabsorption, diarrhoea. - Diabetes.
  63. 63. Pancreatic carcinomaPancreatic carcinoma Clinical symptoms usually occur late and at the time of presentation there is often local invasion of blood vessels or bowel.
  64. 64. Pancreatic carcinomaPancreatic carcinoma  Radiological features US/CT - focal pancreatic enlargement with a hypoechoic/hypodense mass. - pancreatic and bile duct dilatation - distended gallbladder.
  65. 65. Pancreatic carcinomaPancreatic carcinoma MRI – Reduced signal from pancreas on T l sequence.
  66. 66. The Urinary TractThe Urinary Tract
  67. 67. The Urinary TractThe Urinary Tract  Imaging modalities - KUB - Intravenous urography (IVU) - Retrograde pyelography - Antegrade pyelography
  68. 68. The Urinary TractThe Urinary Tract  Imaging modalities - Percutaneous nephrostomy - Micturating cystogram - Urethrography
  69. 69. The Urinary TractThe Urinary Tract  Imaging modalities - Ultrasound - Computed Tomography - Arteriography
  70. 70. 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
  71. 71. 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
  72. 72. Testicular tumourTesticular tumour US – extremely effective in evaluation of well defined low echogenicity mass
  73. 73. MR imaging of clinical stage I and IIaMR imaging of clinical stage I and IIa cervical carcinoma: a reappraisal ofcervical carcinoma: a reappraisal of efficacy and pitfallsefficacy 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 IIBstage IIB MRI: 96.7%, Clinical staging: 80.6%MRI: 96.7%, Clinical staging: 80.6% Europ Radiol 2001Europ Radiol 2001
  74. 74. Skeletal systemSkeletal system Imaging modalities  Plain films (images) – still remain the mainstay of investigation  Isotopes – Tc 99m phosphate compounds  US/CT/MR – for tumour vascularity, infiltration of surrounding tissure relationship to nerves and vessels
  75. 75. OsteosarcomaOsteosarcoma Plain films (images) Radiological features  Irregular medullary destruction  Periosteal reaction  Cortical destruction  Soft tissure mass  New bone formation
  76. 76. 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
  77. 77. Bone metastasesBone metastases - Most frequent primary are Breast Prostate Lung Kidney Thyroid Adrenal gland
  78. 78. Multiple myelomaMultiple myeloma Radiological features Plain films (images) - Generalized osteoporosis - Compression fracture of vertebral bodies - Scattered ‘pounch-out’ lytic lesions with well-defined margins - Bone expansion with soft-tissue masses
  79. 79.  Choose the most appropriateChoose the most appropriate imaging modality is the keyimaging modality is the key for accurate effectivefor accurate effective diagnosis and treatment.diagnosis and treatment.