Hepatobiliary scintigraphy uses radiolabeled tracers like Tc-99m mebrofenin to evaluate liver function and bile flow. It is indicated for conditions like neonatal jaundice, bile leaks, and gallbladder disease. The tracer is taken up by hepatocytes and secreted into bile for imaging. Imaging involves static and dynamic acquisition over hours. Interpretation looks for normal tracer flow and any delays, leaks, or other abnormalities that could indicate underlying bile disorders.
HIDA scan evaluates hepatobiliary function and anatomy. It involves injecting a radiotracer that is taken up by the liver and excreted in bile. Images track the radiotracer's flow from liver to gallbladder and small intestine. Findings are used to diagnose conditions like acute cholecystitis, bile duct obstruction, and leaks. A normal scan shows sequential activity in the liver, bile ducts, gallbladder, and small bowel within an hour, confirming a patent system.
This document discusses the use of nuclear imaging techniques in evaluating kidney diseases. It begins by describing radionuclides and their properties. Technetium-99m is highlighted as the most commonly used isotope due to its ideal characteristics. Renal scintigraphy is then outlined as a functional imaging test that can assess perfusion, obstruction, glomerular filtration rate, and provide anatomical information. The basic renal scan protocol and acquisition steps are provided. Finally, indications for renal scintigraphy are listed and specific radiotracers used to evaluate glomerular filtration, tubular secretion, and renal cortical function are described.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
This document discusses radionuclide imaging of the thyroid and parathyroid glands. It describes the use of various radiotracers like I-123, I-131, Tc-99m pertechnetate, and Tc-99m MIBI in thyroid scans, thyroid uptake measurements, and parathyroid scans to evaluate conditions like hyperthyroidism, thyroid nodules, thyroid cancer, and hyperparathyroidism. Imaging findings are presented for different pathological cases. Preparation, technique, interpretation and clinical indications for these nuclear medicine procedures are provided.
The document discusses the acute abdomen and various imaging modalities used to evaluate it. It covers:
1) The causes of acute abdomen including perforation, obstruction, inflammation and others.
2) The imaging modalities used including plain films, ultrasound, CT and their roles in evaluating specific causes.
3) How different conditions present on imaging including bowel obstruction, perforation, appendicitis and others.
A voiding cystourethrogram (VCUG) uses X-rays and contrast material to image the urinary system and check for problems. During the procedure, contrast material is inserted into the bladder using a catheter and X-rays are taken as the bladder fills and empties. This allows doctors to evaluate the structure and function of the bladder, urethra, and ureters. The procedure takes about 30 minutes with only a few minutes of actual radiation exposure. It can help detect issues like blockages but carries very small radiation risks.
HIDA scan evaluates hepatobiliary function and anatomy. It involves injecting a radiotracer that is taken up by the liver and excreted in bile. Images track the radiotracer's flow from liver to gallbladder and small intestine. Findings are used to diagnose conditions like acute cholecystitis, bile duct obstruction, and leaks. A normal scan shows sequential activity in the liver, bile ducts, gallbladder, and small bowel within an hour, confirming a patent system.
This document discusses the use of nuclear imaging techniques in evaluating kidney diseases. It begins by describing radionuclides and their properties. Technetium-99m is highlighted as the most commonly used isotope due to its ideal characteristics. Renal scintigraphy is then outlined as a functional imaging test that can assess perfusion, obstruction, glomerular filtration rate, and provide anatomical information. The basic renal scan protocol and acquisition steps are provided. Finally, indications for renal scintigraphy are listed and specific radiotracers used to evaluate glomerular filtration, tubular secretion, and renal cortical function are described.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
This document discusses radionuclide imaging of the thyroid and parathyroid glands. It describes the use of various radiotracers like I-123, I-131, Tc-99m pertechnetate, and Tc-99m MIBI in thyroid scans, thyroid uptake measurements, and parathyroid scans to evaluate conditions like hyperthyroidism, thyroid nodules, thyroid cancer, and hyperparathyroidism. Imaging findings are presented for different pathological cases. Preparation, technique, interpretation and clinical indications for these nuclear medicine procedures are provided.
The document discusses the acute abdomen and various imaging modalities used to evaluate it. It covers:
1) The causes of acute abdomen including perforation, obstruction, inflammation and others.
2) The imaging modalities used including plain films, ultrasound, CT and their roles in evaluating specific causes.
3) How different conditions present on imaging including bowel obstruction, perforation, appendicitis and others.
A voiding cystourethrogram (VCUG) uses X-rays and contrast material to image the urinary system and check for problems. During the procedure, contrast material is inserted into the bladder using a catheter and X-rays are taken as the bladder fills and empties. This allows doctors to evaluate the structure and function of the bladder, urethra, and ureters. The procedure takes about 30 minutes with only a few minutes of actual radiation exposure. It can help detect issues like blockages but carries very small radiation risks.
This document discusses the appropriate use of ultrasound, CT, and MRI in liver imaging. It provides examples of using each modality to diagnose various common liver conditions like cirrhosis, fatty liver, hepatitis, and liver lesions. Ultrasound is useful as a first-line exam but has limitations. CT is the standard for assessing liver cancer patients but exposes patients to radiation. MRI is now the preferred method for evaluating cirrhosis and differentiating liver lesions as it uses tissue-specific contrast agents without radiation. Biopsy is still often needed where imaging results are doubtful.
Dual energy CT utilizes two different x-ray spectra to characterize tissues. It can help address challenges with single energy CT like lesion detection and image noise. Dual energy CT works by analyzing how materials attenuate x-rays differently at various energies, allowing differentiation of substances like iodine and calcium. There are several technical approaches to dual energy CT, including sequential acquisition with two scans, rapid voltage switching between two voltages, and dual-source CT with two tube-detector pairs. Post-processing involves material decomposition and differentiation using image-domain or projection-domain algorithms.
A nuclear renogram is a nuclear medicine scan that uses radioactive tracers injected intravenously to evaluate kidney function and detect obstructions over time. It provides information on perfusion, filtration, drainage and detects abnormalities. There are three main types of radiotracers - filtered agents show perfusion and drainage, excreted agents show tubular function, and cortical agents show scarring. A normal renogram will have uniform perfusion and prompt drainage curves for each kidney, while abnormalities like hydronephrosis or multicystic dysplastic kidney can be identified.
Hyperparathyroidism exists in three different forms: primary, secondary and tertiary. Primary hyperparathyroidism (pHPT) is the most frequent pathological condition of the parathyroid glands and one of the most frequent endocrine disorders overall. The most probable location of parathyroid gland is posterior to the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH), which is important for maintaining calcium, phosphate and vitamin D homeostasis, and ultimately bone health.
Primary hyperparathyroidism is characterized by increased production and secretion of parathyroid hormone. This condition causes nephrocalcinosis, urolithiasis, osteoporosis, gastrointestinal disturbances, neuromuscular manifestation and neuropsychiatric disorders. Parathyroidectomy is the only curative treatment for pHPT. pHPT is typically caused by a solitary parathyroid adenoma (80%-90%), hyperplasia (10%) and less frequently parathyroid carcinoma (5%).
Secondary hyperparathyroidism develops as a consequent to a chronic hypocalcemic condition that can be caused by renal failure, gastroinstinal malabsorption, dietary rickets and ingestion of drugs. Secondary hyperparathyroidism is a frequent and serious complication in haemodialysis patients. Tertiary hyperparathyroidism is a condition where parathyroid hyperplasia, secondary to chronic hypocalcemia, becomes autonomous with development of hypercalcemia. Tertiary hyperparathyroidism is used to designate hyperparathyroidism that persists or develops after renal transplantation.
Localization of hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Parathyroid glands can be imaged with multiple modalities, including scintigraphy, high-resolution ultrasonograhy, thin-section CT and MRI. Parathyroid scintigraphy may also be indicated for localization of hyperfunctioning parathyroid tissue in patients with persistent or
recurrent disease. For this situation scintigraphy is superior to any other radiological modalities, including MRI, CT scan, ultrasonography combined with needle aspiration and also some invasive techniques like arteriography, selective venography and mediastinoscopy.
This document discusses techniques for multidetector computed tomography angiography (MDCTA) of the hepatic, pancreatic, and splenic circulations. Key points include:
- MDCTA allows for acquisition of high spatial and temporal resolution data to delineate both vascular anatomy and parenchymal pathology for preoperative planning.
- Biphasic hepatic protocols include arterial and portal venous phases to detect hypervascular tumors. Pancreatic protocols include a parenchymal phase and portal venous phase.
- Dual-energy CT can generate virtual unenhanced images to reduce radiation dose and iodine-specific images to enhance contrast resolution. Low kVp imaging and virtual monochromatic images also improve hypervascular
Diuretic renal scans use radioactive tracers like DTPA, MAG3, or LLEC to evaluate kidney function and rule out obstruction. DTPA/MAG3 scans provide information on renal blood flow, GFR, tubular function, and excretion. DMSA scans use Technetium99m to visualize renal cortex and assess renal scarring. Bone scans use Technetium99m HDP to detect bone metastases, tumors, and infections. HIDA scans use Technetium99m Hepatolite to evaluate gallbladder function and detect causes of jaundice like cholecystitis. Lung V/Q scans use radioactive gas and injections to detect perfusion mismatches diagnostic of pulmonary embolism
An overview of Renography - the medical imaging of kidneys using Nuclear Medicine - including its advantages and disadvantages over other Radiographic imaging modalities.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
This document provides an overview of magnetic resonance cholangiopancreatography (MRCP). It discusses patient preparation, techniques, advantages, limitations, and clinical applications of MRCP. Key points include: MRCP uses heavily T2-weighted sequences to noninvasively visualize the biliary and pancreatic ducts. Patient preparation involves fasting and administering oral contrast. Thin-slab MRCP images provide high resolution of the ductal systems. MRCP is useful for evaluating biliary diseases, pancreatic diseases, and postoperative complications without radiation exposure. Limitations include inability to detect small stones and artifacts from gas or metal.
Intravenous urography (IVU) is an x-ray imaging technique used to examine the urinary tract after injecting iodine contrast media intravenously. It was developed in 1929 by American urologist Moses Swick. An IVU allows visualization of the kidneys, ureters, and bladder to detect abnormalities. The procedure involves injecting low-osmolar contrast media intravenously and taking x-ray images over time as the contrast passes through and outlines the urinary system. Radiologists examine the IVU images for any signs of obstruction, masses, stones, or other abnormalities in the kidneys, ureters, or bladder. IVU remains a useful technique
CT enteroclysis involves placing a nasojejunal tube and using it to instill contrast into the small bowel under fluoroscopy. CT enterography involves having the patient drink oral contrast. Both techniques use IV contrast to evaluate the bowel wall, enhancement, blood vessels, and for signs of bleeding. CT enteroclysis allows for more distal small bowel evaluation but enterography is more comfortable for patients. Indications include investigating Crohn's disease, small bowel obstruction, and unexplained GI bleeding. The procedure involves bowel preparation, premedication, and imaging the abdomen with thin slices during arterial and venous phases to fully evaluate the small bowel and other organs.
Dual energy CT uses two x-ray spectra to distinguish materials based on their differential attenuation properties. This allows reconstruction of various image sets and material-specific images without contrast. Key applications include bone removal, virtual non-calcium imaging, uric acid stone differentiation, gout detection, perfusion imaging, and differentiating enhancing lesions from calcification. Dual energy CT provides material-specific information useful for diagnosis and treatment planning in various clinical contexts.
The document discusses adrenal gland imaging and characterization of adrenal masses. It describes the normal anatomy and histology of the adrenal glands. It then covers characterization of different types of adrenal masses including adenomas, metastases, pheochromocytomas, adrenocortical carcinomas, myelolipomas, lymphomas, hemorrhages, and cysts. Imaging features on CT and MRI that can help differentiate benign and malignant etiologies are provided.
This document discusses Magnetic Resonance Cholangiopancreatography (MRCP), a non-invasive MRI technique used to investigate biliary and pancreatic pathologies. It works by exploiting the inherent differences in T2-weighted contrast between fluid-filled structures and soft tissue. Static or slow moving fluids within the biliary tree and pancreatic duct appear as high signal intensity on MRCP, while surrounding tissue has reduced signal intensity. The document outlines the MRCP technique, imaging parameters, indications including biliary and pancreatic diseases, advantages over ERCP, and some pitfalls.
Perfusion MRI (DSC and DCE perfusion techniques) for radiology residentsRiham Dessouky
This document provides an overview of perfusion weighted MR imaging techniques. It discusses three main types: dynamic susceptibility contrast (DSC) MR perfusion, dynamic contrast enhanced (DCE) MR perfusion, and arterial spin labeling (ASL) MR perfusion. DSC relies on signal loss from gadolinium contrast to measure parameters like relative cerebral blood volume (rCBV) and flow (rCBF). DCE uses T1 shortening effects of contrast to calculate permeability and perfusion. Both techniques are used to evaluate brain tumors and strokes by analyzing signal intensity curves. DCE is also used in breast MRI to classify enhancement curves and measure permeability with the Ktrans parameter.
This document provides information on the hepatobiliary system and various imaging modalities used to evaluate it. It begins with an overview of ultrasound, CT, MRI, ERCP, and nuclear medicine techniques. Key anatomical structures such as the bile ducts and their drainage patterns are described. Various imaging protocols for MRCP, CT cholangiography, and secretin-enhanced MRCP are outlined. Advantages and limitations of different modalities like ERCP are also discussed.
i made this ppt for presentation in class............i have added some already prepared ppts...
i think it wil be useful to some residents out there who dont find time in busy work schedules....all the best
This document discusses acute pancreatitis, including its anatomy, etiology, diagnosis, assessment of severity, treatment, complications, and management guidelines. It covers the key roles of the pancreas in enzyme and electrolyte secretion. Common causes of pancreatitis like gallstones and alcohol are described. Diagnosis involves serum markers, imaging, and severity scores. Treatment focuses on hydration, nutrition, and managing complications. Local complications like pseudocysts and necrosis are defined and approaches to their management are provided. Surgical debridement indications and timing are outlined.
This document discusses the appropriate use of ultrasound, CT, and MRI in liver imaging. It provides examples of using each modality to diagnose various common liver conditions like cirrhosis, fatty liver, hepatitis, and liver lesions. Ultrasound is useful as a first-line exam but has limitations. CT is the standard for assessing liver cancer patients but exposes patients to radiation. MRI is now the preferred method for evaluating cirrhosis and differentiating liver lesions as it uses tissue-specific contrast agents without radiation. Biopsy is still often needed where imaging results are doubtful.
Dual energy CT utilizes two different x-ray spectra to characterize tissues. It can help address challenges with single energy CT like lesion detection and image noise. Dual energy CT works by analyzing how materials attenuate x-rays differently at various energies, allowing differentiation of substances like iodine and calcium. There are several technical approaches to dual energy CT, including sequential acquisition with two scans, rapid voltage switching between two voltages, and dual-source CT with two tube-detector pairs. Post-processing involves material decomposition and differentiation using image-domain or projection-domain algorithms.
A nuclear renogram is a nuclear medicine scan that uses radioactive tracers injected intravenously to evaluate kidney function and detect obstructions over time. It provides information on perfusion, filtration, drainage and detects abnormalities. There are three main types of radiotracers - filtered agents show perfusion and drainage, excreted agents show tubular function, and cortical agents show scarring. A normal renogram will have uniform perfusion and prompt drainage curves for each kidney, while abnormalities like hydronephrosis or multicystic dysplastic kidney can be identified.
Hyperparathyroidism exists in three different forms: primary, secondary and tertiary. Primary hyperparathyroidism (pHPT) is the most frequent pathological condition of the parathyroid glands and one of the most frequent endocrine disorders overall. The most probable location of parathyroid gland is posterior to the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH), which is important for maintaining calcium, phosphate and vitamin D homeostasis, and ultimately bone health.
Primary hyperparathyroidism is characterized by increased production and secretion of parathyroid hormone. This condition causes nephrocalcinosis, urolithiasis, osteoporosis, gastrointestinal disturbances, neuromuscular manifestation and neuropsychiatric disorders. Parathyroidectomy is the only curative treatment for pHPT. pHPT is typically caused by a solitary parathyroid adenoma (80%-90%), hyperplasia (10%) and less frequently parathyroid carcinoma (5%).
Secondary hyperparathyroidism develops as a consequent to a chronic hypocalcemic condition that can be caused by renal failure, gastroinstinal malabsorption, dietary rickets and ingestion of drugs. Secondary hyperparathyroidism is a frequent and serious complication in haemodialysis patients. Tertiary hyperparathyroidism is a condition where parathyroid hyperplasia, secondary to chronic hypocalcemia, becomes autonomous with development of hypercalcemia. Tertiary hyperparathyroidism is used to designate hyperparathyroidism that persists or develops after renal transplantation.
Localization of hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Parathyroid glands can be imaged with multiple modalities, including scintigraphy, high-resolution ultrasonograhy, thin-section CT and MRI. Parathyroid scintigraphy may also be indicated for localization of hyperfunctioning parathyroid tissue in patients with persistent or
recurrent disease. For this situation scintigraphy is superior to any other radiological modalities, including MRI, CT scan, ultrasonography combined with needle aspiration and also some invasive techniques like arteriography, selective venography and mediastinoscopy.
This document discusses techniques for multidetector computed tomography angiography (MDCTA) of the hepatic, pancreatic, and splenic circulations. Key points include:
- MDCTA allows for acquisition of high spatial and temporal resolution data to delineate both vascular anatomy and parenchymal pathology for preoperative planning.
- Biphasic hepatic protocols include arterial and portal venous phases to detect hypervascular tumors. Pancreatic protocols include a parenchymal phase and portal venous phase.
- Dual-energy CT can generate virtual unenhanced images to reduce radiation dose and iodine-specific images to enhance contrast resolution. Low kVp imaging and virtual monochromatic images also improve hypervascular
Diuretic renal scans use radioactive tracers like DTPA, MAG3, or LLEC to evaluate kidney function and rule out obstruction. DTPA/MAG3 scans provide information on renal blood flow, GFR, tubular function, and excretion. DMSA scans use Technetium99m to visualize renal cortex and assess renal scarring. Bone scans use Technetium99m HDP to detect bone metastases, tumors, and infections. HIDA scans use Technetium99m Hepatolite to evaluate gallbladder function and detect causes of jaundice like cholecystitis. Lung V/Q scans use radioactive gas and injections to detect perfusion mismatches diagnostic of pulmonary embolism
An overview of Renography - the medical imaging of kidneys using Nuclear Medicine - including its advantages and disadvantages over other Radiographic imaging modalities.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
This document provides an overview of magnetic resonance cholangiopancreatography (MRCP). It discusses patient preparation, techniques, advantages, limitations, and clinical applications of MRCP. Key points include: MRCP uses heavily T2-weighted sequences to noninvasively visualize the biliary and pancreatic ducts. Patient preparation involves fasting and administering oral contrast. Thin-slab MRCP images provide high resolution of the ductal systems. MRCP is useful for evaluating biliary diseases, pancreatic diseases, and postoperative complications without radiation exposure. Limitations include inability to detect small stones and artifacts from gas or metal.
Intravenous urography (IVU) is an x-ray imaging technique used to examine the urinary tract after injecting iodine contrast media intravenously. It was developed in 1929 by American urologist Moses Swick. An IVU allows visualization of the kidneys, ureters, and bladder to detect abnormalities. The procedure involves injecting low-osmolar contrast media intravenously and taking x-ray images over time as the contrast passes through and outlines the urinary system. Radiologists examine the IVU images for any signs of obstruction, masses, stones, or other abnormalities in the kidneys, ureters, or bladder. IVU remains a useful technique
CT enteroclysis involves placing a nasojejunal tube and using it to instill contrast into the small bowel under fluoroscopy. CT enterography involves having the patient drink oral contrast. Both techniques use IV contrast to evaluate the bowel wall, enhancement, blood vessels, and for signs of bleeding. CT enteroclysis allows for more distal small bowel evaluation but enterography is more comfortable for patients. Indications include investigating Crohn's disease, small bowel obstruction, and unexplained GI bleeding. The procedure involves bowel preparation, premedication, and imaging the abdomen with thin slices during arterial and venous phases to fully evaluate the small bowel and other organs.
Dual energy CT uses two x-ray spectra to distinguish materials based on their differential attenuation properties. This allows reconstruction of various image sets and material-specific images without contrast. Key applications include bone removal, virtual non-calcium imaging, uric acid stone differentiation, gout detection, perfusion imaging, and differentiating enhancing lesions from calcification. Dual energy CT provides material-specific information useful for diagnosis and treatment planning in various clinical contexts.
The document discusses adrenal gland imaging and characterization of adrenal masses. It describes the normal anatomy and histology of the adrenal glands. It then covers characterization of different types of adrenal masses including adenomas, metastases, pheochromocytomas, adrenocortical carcinomas, myelolipomas, lymphomas, hemorrhages, and cysts. Imaging features on CT and MRI that can help differentiate benign and malignant etiologies are provided.
This document discusses Magnetic Resonance Cholangiopancreatography (MRCP), a non-invasive MRI technique used to investigate biliary and pancreatic pathologies. It works by exploiting the inherent differences in T2-weighted contrast between fluid-filled structures and soft tissue. Static or slow moving fluids within the biliary tree and pancreatic duct appear as high signal intensity on MRCP, while surrounding tissue has reduced signal intensity. The document outlines the MRCP technique, imaging parameters, indications including biliary and pancreatic diseases, advantages over ERCP, and some pitfalls.
Perfusion MRI (DSC and DCE perfusion techniques) for radiology residentsRiham Dessouky
This document provides an overview of perfusion weighted MR imaging techniques. It discusses three main types: dynamic susceptibility contrast (DSC) MR perfusion, dynamic contrast enhanced (DCE) MR perfusion, and arterial spin labeling (ASL) MR perfusion. DSC relies on signal loss from gadolinium contrast to measure parameters like relative cerebral blood volume (rCBV) and flow (rCBF). DCE uses T1 shortening effects of contrast to calculate permeability and perfusion. Both techniques are used to evaluate brain tumors and strokes by analyzing signal intensity curves. DCE is also used in breast MRI to classify enhancement curves and measure permeability with the Ktrans parameter.
This document provides information on the hepatobiliary system and various imaging modalities used to evaluate it. It begins with an overview of ultrasound, CT, MRI, ERCP, and nuclear medicine techniques. Key anatomical structures such as the bile ducts and their drainage patterns are described. Various imaging protocols for MRCP, CT cholangiography, and secretin-enhanced MRCP are outlined. Advantages and limitations of different modalities like ERCP are also discussed.
i made this ppt for presentation in class............i have added some already prepared ppts...
i think it wil be useful to some residents out there who dont find time in busy work schedules....all the best
This document discusses acute pancreatitis, including its anatomy, etiology, diagnosis, assessment of severity, treatment, complications, and management guidelines. It covers the key roles of the pancreas in enzyme and electrolyte secretion. Common causes of pancreatitis like gallstones and alcohol are described. Diagnosis involves serum markers, imaging, and severity scores. Treatment focuses on hydration, nutrition, and managing complications. Local complications like pseudocysts and necrosis are defined and approaches to their management are provided. Surgical debridement indications and timing are outlined.
This document defines and describes mechanical and functional ileus. Mechanical ileus is caused by an obstruction blocking intestinal contents, which can be due to adhesions, hernias, tumors or inflammation. Functional ileus involves reduced bowel wall contractions and can occur after surgery or due to drugs, metabolic issues or poor perfusion. The document discusses evaluation, conservative treatment including bowel rest and contrast studies, and indications for surgery such as failure of conservative measures or signs of strangulation. It also covers specific types of functional ileus like postoperative or opioid-induced ileus, and intestinal pseudo-obstruction.
The document discusses acute pancreatitis, including its definition, classification, etiologies, pathogenesis, clinical presentation, diagnosis, management, and complications. Acute pancreatitis is an inflammatory condition of the pancreas characterized by abdominal pain and elevated pancreatic enzymes. It is classified based on the extent of tissue necrosis and disease severity. Common causes include gallstones, alcohol use, and traumatic injury to the pancreas. Management involves conservative treatment like NPO, IV fluids, and antibiotics, with surgery reserved for complications like pancreatic necrosis or abscess formation.
This document discusses functional hepatobiliary diseases, including chronic acalculous cholecystitis, gallbladder ejection fraction testing, and sphincter of Oddi dysfunction. It provides details on protocols for gallbladder ejection fraction testing using cholecystokinin cholescintigraphy or fatty meal stimulation. An abnormal ejection fraction below 35% may indicate gallbladder dyskinesia. Sphincter of Oddi dysfunction can cause post-cholecystectomy pain and be diagnosed using cholescintigraphy by detecting delayed biliary clearance after CCK administration. Therapies may include sphincterotomy or drugs to relax the sphincter of Oddi.
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
Питер Сутерс "Проблемные вопросы лечения свищей"rnw-aspen
Доклад с 15 Межрегиональной научно-практической конференции "Искусственное питание и инфузионная терапия больных в медицине критических состояний" 21-22 мая 2015 г
1. Acute pancreatitis is inflammation of the pancreas that presents with abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are the most common causes.
2. The pathogenesis involves premature activation of digestive enzymes within the pancreas due to obstruction of pancreatic ducts or direct injury to acinar cells. This leads to autodigestion of the pancreas.
3. Management involves hydration, pain control, treating complications, and considering surgery for gallstone pancreatitis to prevent recurrence.
This document summarizes guidelines for the postnatal management of infants with antenatal hydronephrosis. It discusses the timing of initial ultrasound, grading and diagnosis of postnatal hydronephrosis, postnatal monitoring with repeat ultrasounds, indications for micturating cystourethrogram and diuretic renography, and signs requiring surgical intervention. The main points are to closely monitor infants based on the severity of hydronephrosis and to identify and treat any underlying obstructive causes or loss of renal function.
This document discusses chronic pancreatitis, including its causes, pathogenesis, classification, clinical presentation, diagnostic evaluation, complications, and surgical and non-surgical management. Some key points include:
- Gallstone disease is the most common cause, accounting for 70% of cases. Other causes include alcoholism, trauma, genetic factors.
- Pathogenesis involves reflux of infected bile or duodenal contents into the pancreatic ducts, causing inflammation and activation of pancreatic enzymes.
- Classification is based on etiology, presence of pancreatic duct obstruction, and clinical features such as pain pattern.
- Presentation includes recurrent upper abdominal pain, weight loss from malabsorption, and endocrine and exocrine pancreatic insufficiency
This document discusses the approach to patients with pancreatic diseases, including acute and chronic pancreatitis. It begins with definitions of incidence and diagnostic tests used. It then describes the etiology, pathogenesis, clinical features, management, and complications of acute pancreatitis. Etiology of recurrent pancreatitis is discussed. Chronic pancreatitis is defined, and its pathophysiology, imaging, treatment, and complications are outlined. Throughout, key definitions from the Revised Atlanta Classification are provided to stage and characterize pancreatic conditions.
1) Acute pancreatitis is an inflammation of the pancreas that can range from mild to severe. It involves autodigestion of the pancreas by its own enzymes.
2) There are two main types - edematous pancreatitis which is mild and necrotizing/hemorrhagic pancreatitis which is more severe and can lead to loss of pancreatic function.
3) Causes include gallstones, alcohol abuse, medications, trauma, hyperlipidemia and sometimes the cause is unknown. Clinical features include severe abdominal pain, nausea and tenderness on examination. Investigations include blood tests and imaging. Management involves IV fluids, nil by mouth, antibiotics if infected, and sometimes
Pancreatitis is an inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and can range from mild to severe, with severe cases involving organ failure. Chronic pancreatitis is characterized by irreversible damage to the pancreas that typically causes pain and loss of pancreatic function over time. Treatment for acute pancreatitis depends on severity and may involve hospitalization, IV fluids, monitoring for organ failure, and antibiotics for severe cases. Treatment for chronic pancreatitis focuses on pain management, treating complications, and sometimes surgical interventions.
This document discusses imaging modalities for evaluating obstructive jaundice and biliary pathologies. It describes the role of various imaging modalities like ultrasound, CT, MRI/MRCP, and ERCP in identifying the level and cause of biliary obstruction. Common causes of obstruction include gallstones, strictures, pancreatitis, and malignancies. Rare causes like choledochal cysts, Caroli's disease, and biliary atresia are also reviewed. The document provides an overview of the appearance of different biliary diseases on imaging and guidelines for selecting the appropriate imaging test.
This document discusses the management of pancreatic fistulas. It defines pancreatic fistulas as leakage of pancreatic fluid resulting from pancreatic duct obstruction, which can be iatrogenic such as from surgery or ERCP, or non-iatrogenic due to conditions like pancreatitis. Initial management involves controlling pancreatic secretions with drain placement or TPN, correcting electrolyte imbalances, and evaluating the pancreatic duct with imaging. Most fistulas close spontaneously with drainage alone. For persistent fistulas, octreotide can help while ERCP with stenting has closure rates over 80%. Surgery is reserved for failures of other methods and involves duct decompression or resection. Risk factors for postoperative fistulas include duct size, texture, jaundice, and
This document provides an overview of small bowel obstruction (SBO), including its causes, symptoms, diagnosis, and treatment. It notes that SBO accounts for 12-16% of acute abdominal surgical admissions. Causes include adhesions (75% of cases), hernias (25% of cases), and other factors like inflammation, ischemia, and masses. Symptoms range from mild discomfort to shock. Diagnosis involves physical exam, lab tests, and imaging like CT scan or contrast radiographs. Treatment depends on the severity and cause of the obstruction, but generally involves resuscitation, monitoring, and surgery if signs of strangulation or ischemia are present or if conservative measures fail.
This document discusses kidney transplantation in patients with abnormal bladders. It begins by noting that structural urological abnormalities can lead to end-stage renal disease in 15-30% of patients. An abnormal bladder is no longer a contracontraindication for transplantation. The document then discusses different types of abnormal bladders and how they are evaluated. Urodynamic testing assesses bladder capacity and function. The goals for managing an abnormal bladder are outlined. General principles and issues related to pre-transplant, peri-transplant, and post-transplant management are covered. Complications are also reviewed. The conclusion is that with proper knowledge and management, transplantation can be successful even in patients with abnormal bladders.
1. Despite successful valve ablation in PUV patients, intrinsic bladder dysfunction can lead to deterioration of the upper urinary tracts and incontinence due to detrusor abnormalities, high pressure voiding, or detrusor-sphincter dyssynergia.
2. Anticholinergic drugs like oxybutynin and alpha-blockers like terazosin can help improve bladder function and reduce post-void residuals in PUV patients with bladder dysfunction. Clean intermittent catheterization may also be needed.
3. Longterm follow up of PUV patients is important to monitor renal function, attain urinary continence, and assess if interventions like augmentation cystoplasty or renal
Mr. T, a 56-year-old man, presented with acute pancreatitis symptoms including epigastric pain and nausea. Investigations confirmed elevated pancreatic enzymes. He was initially treated conservatively but his condition deteriorated, requiring ICU admission and intubation. Imaging showed acute pancreatitis with peripancreatic fluid collection. Antibiotics were started after he developed a fever. Complications of acute pancreatitis like pancreatic necrosis and pseudocyst formation were discussed. The role of antibiotics, ERCP, and surgical or radiologic drainage of infected collections was also outlined.
Similar to Mebrofenin scintigraphy in bile disorders (20)
3. Hepatobiliary scintigraphy evaluates
hepatocellular function and the biliary
system by tracing the production and flow
of bile from the formative phase in the
liver, and its passage through the biliary
system into the small intestine.
9. Albumin delivers the radiotracer to the space of Disse. Tc-99m HIDA is taken up by the
hepatocyte and secreted into bile canaliculi in free form where it mixes with the hepatic bile
and serves as an ideal in vivo tracer for imaging of the entire hepatobiliary tree
10. NPO for 4–6 hours (2 hours for infants)
no opiates for 4 to 8 hours prior to exam
Explain the procedure
PATIENT PREPARATION
12. Camera: Large field of view
Collimator: LEAP/ LEHR
Computer Set-up
◦ Static Images: 500,000–1 million counts
◦ Flow Studies: 2 sec/frame for 60 seconds, then
immediate blood pool image
◦ Dynamic Studies: 60 sec/frame for 60–90
minutes
◦ Delayed images may be needed till 24 hrs
13. Positioning:
◦ patient supine
◦ camera anterior
◦ liver in upper left quadrant of field of view
15. Cholecystokinin:
◦ If patient is NPO for many hours, GB becomes
inactive, may be full of bile or sludge and so
may not visualize. CCK is used to contract
gallbladder so that visualization of bowel may
occur after refilling
◦ 0.02 µg/ kg body wt. slow IV
◦ Contraindication: recent positive ultrasound
examination for gallstones.
16. Morphine Sulphate :
◦ When acute cholecystitis is suspected and the
gallbladder is not seen by 30–60 min, 0.04
mg/kg morphine sulfate may be administered
slow I.V.
◦ If the cystic duct is patent, flow of bile into the
gallbladder will be facilitated by morphine-
induced temporary spasm of the sphincter of
Oddi
◦ Imaging is continued for another 30–60 min
after morphine administration.
17. ◦ Imaging after morphine injection distinguishes
between acute [no visualization] and chronic
[eventual visualization] cholecystitis.
◦ Contraindications:
increased intracranial pressure in children
respiratory depression in non-ventilated patients
allergic to morphine
history of pancreatitis
18. Phenobarbital
◦ 5 mg/ kg/day in two equally divided doses, for
5–7 days prior to cholescintigraphy.
◦ Phenobarbital stimulates bile production and
increases the secretion of the radiotracer into
bile, enabling better delineation of bile ducts
and duodenum in infants with neonatal
hepatitis, but not in those with congenital
biliary atresia
20. Normal Results
◦ Visualization of liver 5–15 seconds after
injection
◦ hepatic and common bile duct and gallbladder
5–60 minutes.
◦ Intestinal activity within 10–60 minutes
◦ Gallbladder filling implies a patent cystic duct
and excludes acute cholecystitis with a high
degree of certainty
22. Bile leak
◦ present when tracer is found in a location other
than the liver, gallbladder, bile ducts, bowel, or
urine
◦ Causes:
Post procedural: M.C.
◦ cholecystectomy, liver transplant
Trauma to right upper quadrant area
23.
24.
25. Biliary atresia
◦ Non visualization of Extra hepatic biliary tree &
failure of tracer to enter the gut
◦ d/d:
hepatocellular disease
26. Efficacy of cholescintigraphy, ultrasonography, and liver biopsy in the
differential diagnosis of congenital biliary atresia from neonatal
hepatitis
28. Bile reflux
◦ Activity reflux from the duodenum into the
stomach.
◦ Spontaneously in ~8%
◦ post op.
vagotomy,
hemigastrectomy
Bilroth II gastrojejunostomy
30. Acute cholecystitis
◦ persistent gallbladder non-visualization after
3–4 hr. of passive imaging or 30 min. after
morphine administration
◦ pericholecystic hepatic band of increased
activity (rim sign) has been associated with
severe phlegmonous or gangrenous acute
cholecystitis, a surgical emergency
32. ◦ Morphine-augmented hepatobiliary scintigraphy
has sensitivity, specificity, positive predictive
value, and negative predictive value of 95%,
99%, 97%, and 98%, respectively
(c/f USG Abd: positive predictive value of
>90% in detecting acute cholecystitis)
33. Chronic cholecystitis
◦ gallbladder visualization within 30 min of
morphine administration or on 3-4 hr delayed
images
◦ gallbladder that is not visualized until after the
time that the bowel is visualized correlates
significantly with chronic cholecystitis.
34. Gallbladder EF
◦ Normal: ≥ 35%
◦ Abnormal: < 35%
suggestive of
◦ chronic cholecystitis
◦ cystic duct syndrome
◦ sphincter of Oddi spasm
◦ gallbladder dyskinesia
36. ◦ The finding of reduced gallbladder ejection
fraction in response to Cholecystokinin is a
strong indicator of the need for surgical
intervention
◦ Negative predictive value of a normal
gallbladder ejection fraction is >91%,
37. False positives False negatives
(gallbladder non-visualization (gallbladder visualization in
in the absence of acute the presence of acute
cholecystitis) cholecystitis)
Insufficient fasting bile leak due to gallbladder
perforation
Prolonged fasting bowel loop simulating gallbladder
Previous cholecystectomy Acute acalculous cholecystitis
38.
39.
40.
41. Causes of enterogastric reflux
Spontaneously in ~8%
post op.
◦ vagotomy,
◦ hemigastrectomy
◦ Bilroth II gastrojejunostomy
42. pathophysiology
mechanism of reflux is related to the lack of
normally functioning gallbladder.
In the absence of the usual storage of bile
with release on cholecystokinin (CCK)
stimulation, the patient develops a constant
drip of bile into the duodenum.
After meals there is a postdigestive phase of
food leaving the stomach, mixing with the
bile pancreatic and duodenal secretions, and
all being swept downstream in the normal
fashion
43. Two hours after a meal and especially
during extended periods of fast, e.g.,
during sleep, the bile pools in the
duodenum, most going downstream and
some refluxing backward through the
pylorus into the antrum.
In time, the presence of the biliary
pancreatic duodenal secretions in the
stomach produces such an irritant effect
that significant gastritis and esophagitis
result.
44. criteria for the diagnosis of reflux
gastritis:
◦ constant burning epigastric pain
◦ worse after meals
◦ unrelieved by antacids and diet
◦ endoscopic demonstration of a gastric bile pool
◦ endoscopic biopsy proof of gastritis and
esophagitis
◦ hypochlorhydria.
45. treatment
Medical:
◦ Bland diet
◦ Metoclopromide
Surgical:
◦ Roux-en-Y drainage of the biliary system and
Braun enteroenterostomy (BEE)
46. Dose Range
◦ Adults:
3–5 mCi
higher doses (upto 15 mCi) for patients with
elevated bilirubin levels (causes less hepatic
uptake, more background activity, and greater
renal excretion).
◦ For children:
0.05–0.07 mCi per kg
minimum dose = 0.3 mCi
47. Ensure patient
Ensure patient has had. Injection and
imaging may be postponed 4 hours if
patient has been injected with this type of
medication.
Explain the procedure; usually runs ~1
hour but baseline studies can go as long
as 4 hours with up to 24-hour delays
required in some instances.
50. Sequential (or dynamic) images of the
liver, biliary tree, and gut are obtained.
Computer acquisition and analysis,
including pharmacologic interventions, are
used according to varying indications and
an individual patient’s needs.
51. No bowel excretion or gallbladder visualization is noted
small arrowhead: kidney activity
large arrowhead:bladder