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Radiology of digestive system


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Radiology of digestive system

  1. 1. RADIOLOGY of DIGESTIVE SYSTEM Chen,Shaoqiong 陈少琼
  2. 2. Diagnosis technique <ul><li>Radiography : </li></ul><ul><ul><li>Plain Radiography </li></ul></ul><ul><ul><li>C ontrast E xaminatio n </li></ul></ul><ul><ul><ul><li>S ingle contrast radiograph </li></ul></ul></ul><ul><ul><ul><li>D ouble contrast radiograph </li></ul></ul></ul><ul><ul><ul><li>Angiography </li></ul></ul></ul><ul><li>CT : </li></ul><ul><li>MRI: </li></ul><ul><li>USG : </li></ul>
  3. 3. Plain Radiography <ul><li>A cute abdomen </li></ul><ul><li>S mall bowel obstruction </li></ul><ul><ul><li>  “ Coiled spring” appearance of the intestinal mucosa </li></ul></ul>
  4. 4. Barium Labelled Contrast Radiography <ul><ul><li>Barium swallow : pharynx and esophagus </li></ul></ul><ul><ul><li>Barium meal : upper GI Seris </li></ul></ul><ul><ul><li>Barium follow-through : small intestine </li></ul></ul><ul><ul><li>Ba rium enem a : Large Intestine </li></ul></ul><ul><ul><li>Announcement </li></ul></ul>
  5. 5. Barium Labelled Contrast Radiography <ul><ul><li>Technique : </li></ul></ul><ul><ul><ul><li>M ucosal coating view </li></ul></ul></ul><ul><ul><ul><li>Filling view </li></ul></ul></ul><ul><ul><ul><li>Compression view </li></ul></ul></ul>
  6. 6. Oral Contrast Radiography
  7. 7. Oral Barium Labelled Contrast Radiography mucosal pattern Fold sulci
  8. 8. Barium Labelled Contrast Radiography <ul><li>Gas-barium double Contrast Radiography : filling view </li></ul><ul><ul><li>胃充盈像 </li></ul></ul>
  9. 9. Barium Labelled Contrast Radiography Compression view : Duodenal bulb 十二指肠球部加压像
  10. 10. Barium Labelled Contrast Radiography Gas-barium double Contrast Radiography : Barium enema Sigmoid colon
  11. 11. Computed Tomography Finding: mass Spreading region Lymphatic metastasis Organ metastasis Blood supply
  12. 12. Technique ----CT Esophageal carcinoma lymphatic metastasis
  13. 13. Upper GI series (normal appearance) <ul><li>P harynx E piglottis 、 Sinus piriformis </li></ul><ul><li>E sophagus —— It is continuous with the the pharynx at the level of the C6 vertebra and connects to the cardia of the stomach . It has longitudinal fold and 25-30 cm long and 2~3cm wide. </li></ul><ul><li>Three parts : C ervical, T horacic, and A bdominal parts. </li></ul><ul><li>Three impression : aortic arch, left bronchus , left atrium </li></ul><ul><li>Two sphincter : the upper and lower sphincter ( cardiac sphincter ) </li></ul>
  14. 14. 会厌 (cavity upon epiglottis) 梨状窝 Sinus Piriformis
  15. 15. Right anterior obligue view
  16. 16. Right anterior obligue view left anterior obligue view
  17. 17. Normal X-ray appearance of the Gastri
  18. 18. Gastri <ul><li>The stomach is divided into four sections, each of which has different cells and functions. The sections are: </li></ul><ul><li>Cardia The upper part of the stomach. </li></ul><ul><li>Fundus Formed by the upper curvature of the organ. </li></ul><ul><li>Body or corpus The main, central region . </li></ul><ul><li>Pylorus or antrum The lower section of the organ </li></ul>
  19. 20. Steerhorn’ Type J-shaped Cascade Fishhook Type
  20. 21. 钩型胃 Fish-hook Type
  21. 22. 长型胃 Long type
  22. 23. cascade
  23. 25. 牛角型胃 horn’ type
  24. 26. 黏膜 fold
  25. 27. Normal gastric area Grid structure
  26. 29. area gastrica
  27. 31. Peristaltic wave
  28. 32. X-ray anatomy of the duodenum <ul><li>The duodenum is divided into four sections for the purposes of description . The first three sections form a &quot;C&quot; shape . Lies between the 1-3 lumbar vertebra </li></ul><ul><li>Duodenal bulb, descending, horizontal and ascending part </li></ul><ul><li>Papilla located on the descending part and 1.5cm diameter </li></ul><ul><li>Longitudinal fold in the bulb, and Feathery fold as jejunum in the other sections </li></ul>
  29. 37. Papilla
  30. 38. X - ray anatomy of the small intestine <ul><li>Mucosal fold —— feathery , circular </li></ul><ul><li>6 sections : </li></ul><ul><li>( 1 ) duodenum </li></ul><ul><li>( 2 ) proximal jejunum , on the left upper abdomen </li></ul><ul><li>( 3 ) distal jejunum , on the left middle abdomen </li></ul><ul><li>( 4 ) proximal ileum , on the right middle abdomen </li></ul><ul><li>( 5 )( 6 ) distal ileum , on the right lower abdomen or </li></ul><ul><li>pelvis cavity </li></ul><ul><li>emptying time : 2~6 hours </li></ul>
  31. 40. 1 2 3 4 5 6
  32. 43. X - ray anatomy of the large intestine <ul><li>Large intestine , which has three parts: </li></ul><ul><li>Cecum (the vermiform appendix is attached to the cecum). </li></ul><ul><li>Colon ( ascending colon , transverse colon , descending colon and sigmoid flexure ) </li></ul><ul><li>Rectum </li></ul><ul><li>haustra , mucosal fold —— longitudinal 、 transversal and o blique </li></ul>
  33. 44. Cecum right colic flexure (hepatic) transverse colon left colic flexure (splenic) descending colon sigmoid flexure ascending colon
  34. 45. sigmoid flexure Rectum
  35. 46. vermiform appendix haustra
  36. 47. 钡剂灌肠检查,分别显示充盈相和粘膜相
  37. 49. Sigmoid colon
  38. 51. X-ray finding of basic pathology <ul><li>Change of the wall </li></ul><ul><li>1 ) M ound : filling defect , intraluminal mass </li></ul><ul><li>2 ) Crater: collection of barium on dependent surface </li></ul><ul><li>3 ) Thickened wall </li></ul><ul><li>4 ) Rigidity : lack of distensibility </li></ul>
  39. 52. Filling Defect
  40. 55. Crater
  41. 58. Thickened wall
  42. 59. 憩室 diverticulum
  43. 61. Change of the mucosal folds <ul><li>1. 粘膜破坏 destruction of mucosa </li></ul><ul><li>2. 粘膜增粗 thickening mucosa </li></ul><ul><li>3. 粘膜平坦 flattening mucosa </li></ul><ul><li>4 . 粘膜纠集 radial folds </li></ul>
  44. 63. 黏膜破坏
  45. 64. Thickening mucosa
  46. 65. Flattening mucosa
  47. 66. Radial mucosa
  48. 67. Change of the lumen <ul><li>Narrow </li></ul><ul><li>Distension </li></ul>
  49. 68. eccentic narrowing
  50. 69. Distension
  51. 70. Change of the position or mobility
  52. 71. compression
  53. 72. Compression from gallbladder
  54. 74. Functional change <ul><li>Change of tension : chalasia or spasm </li></ul><ul><li>Change of peristalsis : strengthen or weaken </li></ul><ul><li>Change of motility : accelerate or weaken </li></ul><ul><li>Change of secrete function: decreased or increased </li></ul>
  55. 76. Diseases <ul><li>Carcinoma of the Esophagus </li></ul><ul><li>Radiologic types : 1 ) Polypoid form; 2 ) Ulcerating form ; 3 ) Infiltrating form; 4) Narrowing form </li></ul><ul><li>Radiology findings : </li></ul><ul><li>1 ) Destruction or disappear of mucosa </li></ul><ul><li>2 ) Narrow of the lumen , rigidity of the wall </li></ul><ul><li>3 ) Filling defect in the lumen </li></ul><ul><li>4 ) irregular crater </li></ul><ul><li>5) Weakened or disppear of peristalsis </li></ul>
  56. 77. Narrowing type Narrowing type
  57. 79. Polypoid form
  58. 81. Filling defect crater mound
  59. 82. crater 环堤 Ulcerating form
  60. 85. E arlier period esophygeal carcinoma: destruction of mucosa, small barium collection, rigidity and irreguler of the wall
  61. 92. esophageal-airway fistulae
  62. 93. Tracheoesophageal fistula
  63. 94. esophageal-airway fistulae
  64. 95. Disease’s diagnosis <ul><li>Esophageal varices : </li></ul><ul><li>C omplication of portal hypertension : </li></ul><ul><li>Dilated submucosal veins due to increased collateral blood flow from portal venous system to azygos system </li></ul><ul><li>Radiology finding : </li></ul><ul><li>Thikening t ortuous folds look like worm or bead-like filling defect </li></ul><ul><li>The wall is still flexible and can distend and contract easily </li></ul>
  65. 96. Endoscopy
  66. 97. Esophageal varices (CT)
  67. 98. Advance stage: Thickening and tortuous folds like Worm
  68. 99. Thickened and interrupted mucosal folds dash line
  69. 101. (earliest sign)
  70. 102. Peptic ulcer
  71. 103. G astric U lcer s( 胃溃疡 ) <ul><li>1 ) Ulcer crater : Lesser curvature , round, linear </li></ul><ul><li>neck of ulcer : Hampton’s line ; Ulcer collar ; narrow neck sign </li></ul><ul><li>2 ) radial folds </li></ul><ul><li>3 ) Function change : </li></ul><ul><li>spastic incisura ; increased secretion </li></ul><ul><li>Increased or decreased peristalsis </li></ul><ul><li>4 ) C icatricle change , gastric deformation and narrow </li></ul>
  72. 104. G astric U lcer s( 胃溃疡 ) <ul><li>Ulcer crater- collection of barium on dependent surface which usually projects beyond anticipated wall of stomach in profile </li></ul><ul><li>• Hampton’s line -1 ~2 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa </li></ul><ul><li>• Ulcer collar - 0.5~1cm, smooth, thick, lucent band at neck of ulcer in profile view representing thicker rim of edematous gastric wall </li></ul>
  73. 107. 1 mm thin straight line at neck of ulcer in profile view
  74. 108. Hamptons line-ulcer
  75. 112. spastic incisura
  76. 114. P erforating U lcer narrow neck sign
  77. 115. Linear ulcer
  78. 118. appear linear
  79. 119. Tadpole-like
  80. 120. Duodenal Ulcer <ul><li>( 1 ) More than 90% located in duodenal bulb, most in the anterior or posterior wall </li></ul><ul><li>( 2 ) Crater: round,ovoid </li></ul><ul><li>Folds radiating to edge of ulcer </li></ul><ul><li>( 3 ) Deformation of the bulb </li></ul><ul><li>( 4 ) I rritation sign 、 pylorospasm 、 gastric secretion increased and change of tension </li></ul><ul><li>( 5 ) T enderness on bulb </li></ul>
  81. 122. Secretion increased
  82. 126. 胃癌 <ul><li>分型:蕈伞型;浸润型;溃疡型 </li></ul><ul><li>X 线: 1 )充盈缺损 </li></ul><ul><li>2 )胃腔狭窄,胃壁僵硬 </li></ul><ul><li>3 )龛影——位于胃的轮廓之内,不规 </li></ul><ul><li>则半月形,内缘有尖角 </li></ul><ul><li>龛影周围:环堤、结节状和指状压迹 </li></ul><ul><li>4 )粘膜皱襞破坏消失 </li></ul><ul><li>5 )癌病区蠕动消失 </li></ul>
  83. 127. Features of early gastric cancer: <ul><li>Carcinomas restrict s in mucosa or submucosa </li></ul>
  84. 128. Polypoid lesion >5mm Superficial lesion Excavated lesion 5mm
  85. 129. Type Ⅰ filling defect
  86. 130. Type Ⅰ Polypoid lesion
  87. 131. Type Ⅱa Superficial lesion
  88. 134. Excavated lesion
  89. 135. Carcinoma of the Stomach <ul><li>Advanced gastric carcinoma </li></ul><ul><li>Polypoid/fungating carcinoma </li></ul><ul><li>Ulcerating/penetrating carcinoma (70%) </li></ul><ul><li>Infiltrating/scirrhous type=linitis plastica </li></ul>
  90. 136. Carcinoma of the Stomach <ul><li>Malignant ulcer — benign ulcer but demonstrate microscopic foci of malignancy, usually at the edge of the ulcer </li></ul><ul><li>Ulcerating malignancy —is a carcinoma present as a mass which also contains a persistent collection representing an ulcer; the mucosa is frequently nodular and the folds do not radiate to the base of the ulcer </li></ul><ul><li>Linitis plastica (scirrhous carcinoma) —is a diffuse involvement of the wall of the stomach, frequently with flattening of the mucosa, and poor distensibility and contraction of the wall; usually associated with significant fibrosis and muscular hypertrophy; very frequently a signet ring cell type </li></ul>
  91. 137. Nodular lobulated
  92. 138. Mass protrude in the lumen
  93. 140. Caman meniscous sign cusp angle
  94. 141. Caman meniscous sign
  95. 144. Ulcerating carcinoma Lymphatic metastasis
  96. 145. 浸润型胃癌 linitis plastica
  97. 148. Differential diagnosis of ulcers <ul><li>Parameter Benign Ulcer Malignant Ulcer </li></ul><ul><li>Crater Round, ovoid irregular </li></ul><ul><li>Mucosal folds Thin, regular, extend up to Thick, irregular, do not </li></ul><ul><li>the margin of ulcer crater extend to crater edge </li></ul><ul><li>Penetration Extends beyond projected Ulcers lie within (thickened) wall; </li></ul><ul><li>Margin of the wall Caman meniscous sign </li></ul><ul><li>Location Centrally within mound of Eccentrically in tumor mound </li></ul><ul><li>edema </li></ul><ul><li>Collar Hampton’s line: 1-2mm Thick, nodular, irregular </li></ul><ul><li>lucent line around the ulcer </li></ul><ul><li>Other Normal peristolsis Abnormal peristalsis </li></ul><ul><li>Incisura: invagination of Limited distensibility </li></ul><ul><li>the wall </li></ul>
  98. 149. T uberculosis of intestine <ul><li>Position: ileocecal junction </li></ul>
  99. 150. T uberculosis of intestine <ul><li>Spasm and irritability </li></ul><ul><li>Spiculated, serrated bowel margins from tiny, multiple ulcerations </li></ul><ul><li>Coarser, more granular mucosa </li></ul><ul><li>Shortening of the colon , Loss of haustrations on left side of colon </li></ul><ul><li>Postinflammatory polyps= filiform polyps =long worm-like lesions </li></ul>
  100. 154. Colon Carcinoma <ul><li>Type </li></ul><ul><li>Polypoid form- Polypoid filling defect </li></ul><ul><li>Ulcerating form- irregular ulcer apple-core </li></ul><ul><li>Infiltrating form- Annular constricting </li></ul>
  101. 155. Polypoid form
  102. 156. Infiltrating form
  103. 157. Infiltrating form
  104. 158. Apple core
  105. 159. Ulcerating form
  106. 160. C olonic P olyp <ul><li>Round filling defect </li></ul><ul><li>Clear margin </li></ul><ul><li>Slightly movable </li></ul><ul><li><5mm </li></ul>
  107. 161. double contrast
  108. 163. Multiple polyposis cobblestone
  109. 164. A cute abdomen <ul><li>G astrointestinal perforation </li></ul><ul><li>Intestinal obstruction </li></ul><ul><li>Intussuception </li></ul><ul><li>Sigmoid Volvulus </li></ul>
  110. 165. A cute abdomen <ul><li>G astrointestinal perforation </li></ul><ul><li>Presence of free air in the peritoneal cavity pneumoperitoneum </li></ul>
  111. 166. free air under the diaphragm Erect position
  112. 167. Erect position Lateral decubitus
  113. 168. gastrointestinal perforation
  114. 169. Free gas
  115. 170. Intussusception <ul><li>Telescoping of a segment of bowel (the intussusceptum) into another, usually more distal, segment of bowel (the intussuscipiens) </li></ul>
  116. 171. Intussusception <ul><li>Clinical Findings </li></ul><ul><li>·         Children <2-year-old </li></ul><ul><li>o       Cyclical, colicky abdominal pain </li></ul><ul><li>o       Vomiting </li></ul><ul><li>o       “Currant jelly” stools (diarrhea with mucus and blood) or other blood in stool </li></ul><ul><li>§         Classic triad occurs in about 1/3 of patients; most have 2 of the 3 </li></ul><ul><li>o       Palpable abdominal mass, often in right upper quadrant </li></ul>
  117. 172. Intussusception <ul><li>    Plain radiographs are not sensitive or specific </li></ul><ul><ul><ul><li>Soft tissue mass surrounded by a crescent of gas </li></ul></ul></ul><ul><ul><ul><li>Evidence of distal small bowel obstruction </li></ul></ul></ul><ul><ul><ul><li>Absence of or decreased gas in the colon </li></ul></ul></ul><ul><ul><ul><li>Pneumoperitoneum </li></ul></ul></ul><ul><ul><ul><li>May be normal </li></ul></ul></ul>
  118. 173. Intussusception <ul><li>Barium (gas) enema (diagnostic and therapeutic) </li></ul><ul><li>-          “Coiled spring” appearance </li></ul><ul><li>o       Barium in lumen of the intussusceptum and in the intraluminal space </li></ul><ul><li>Between the intussusceptum and the intussuscipiens </li></ul>
  119. 174. 肠套叠 <ul><li>多见 2 岁以下小儿,阵发性哭闹,果酱样大便。 </li></ul><ul><li>X 线: </li></ul><ul><ul><li>低位小肠梗阻 </li></ul></ul><ul><ul><li>空气灌肠: 24h 内 </li></ul></ul><ul><ul><li>复位成功标志:杯口影或肿块影消失,气体进入近段肠腔,症状消失,患儿安静入睡 </li></ul></ul>
  120. 175. “ Coiled spring” appearance
  121. 176. Intussusception
  122. 177. Cupping of the head
  123. 180. 急腹症 --- 肠套叠
  124. 181. Gas enema ( )为导管 ( )为气囊
  125. 182. I ntestinal obstruction <ul><li>It is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. </li></ul>
  126. 183. Mechanical SBO Causes <ul><li>Adhesions </li></ul><ul><li>Hernia* </li></ul><ul><li>Volvulus </li></ul><ul><li>Gallstone ileus* </li></ul><ul><li>Intussusception </li></ul>*Cause may be visible on plain film
  127. 184. Mechanical LBO Causes <ul><li>Tumor </li></ul><ul><li>Volvulus </li></ul><ul><li>Hernia </li></ul><ul><li>Diverticulitis </li></ul><ul><li>Intussusception </li></ul>
  128. 185. I ntestinal obstruction <ul><li>Simple small intestinal obstrution </li></ul><ul><li>Strangulated intestinal obstrution </li></ul><ul><li>Paralytis intestinal obstrution </li></ul><ul><li>Colon obstruction </li></ul>
  129. 186. I ntestinal obstruction <ul><li>X-ray Features </li></ul><ul><li>Multiple gas distended intestinal loops with fluid levels on erect film </li></ul>
  130. 187. distended intestinal loops 空肠:肠腔内环状皱襞密集 回肠起始段:肠腔内较多环状皱襞 回肠末段:肠腔内不见环状皱襞 结肠:可见结肠袋的间隔 jejunum Terminal ileum 空肠 ileum 回肠末段 colon
  131. 188. Stack-of-coins
  132. 190. “ Coiled spring” appearance of the intestinal mucosa
  133. 191. “ Coiled spring” appearance of the intestinal mucosa
  134. 194. Supine position
  135. 196. Intraluminal mass <ul><li>Simple small intestinal obstrution </li></ul>
  136. 197. <ul><li>Simple small intestinal obstrution </li></ul>Gallbladder stone falled into the small intestine
  137. 198. 150 Strangulated intestinal obstrution- volvulus 空肠主要位于右上腹部,位置固定
  138. 199. Strangulated intestinal obstrution- volvulus 空肠主要位于右上腹部,位置固定
  139. 200. Strangulated intestinal obstruction-pseudotumor sign
  140. 201. Strangulated intestinal obstruction-pseudotumor sign 立卧位平片见下腹部无肠气充盈区,位置固定,似肿瘤占位
  141. 202. Strangulated intestinal obstruction-coffee bean sign 咖啡豆
  142. 203. SMA 栓塞至血运性肠梗阻;右肾梗塞 volvulus
  143. 204. <ul><li>Causes: acute peritonitis, septicopyemia, postoperation, injury, shock…… </li></ul><ul><li>X-ray findings </li></ul><ul><li>diffuse bowel dilatation with gas </li></ul><ul><li>Little fluid </li></ul><ul><li>Decreased motility </li></ul>Paralytis intestinal obstrution
  144. 205. Paralytis intestinal obstrution
  145. 206. Paralytis intestinal obstrution 大小肠普遍性胀气呈蜂窝状,未见气液平面
  146. 207. Paralytis intestinal obstrution 大小肠普遍性胀气呈蜂窝状,未见气液平面
  147. 208. Sigmoid Volvulus
  148. 209. A huge,distended,gas-filled loop of sigmoid colon Eagle’s beak
  149. 213. The end