Radiological diagnostics of Gastro-Intestinal System

1. The radiological
methods of the
gastrointestinal system
examination

2. The main methods of
examination
- Fluoroscopy
-Radiography
-CT
-MRI
-Ultrasound
-Radionuclide methods (PET, SPECT)

3. The special contrast methods
- Double contrasting
- Pneumoparietography of the stomach

4. The X-ray anatomy and
examination of esophagus
- Width – 1,5-2 см ;
- Length – 25-26 см;
- The parts of esophagus:
А) cervical;
Б) thoracic;
В) abdominal.

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6. - Three physiologic narrowings:
А) at the level of cricoid cartilage;
Б) at the level of aortic arc;
В) at the level of cardia.
The velocity of contrast movement is
4-6 sec.

7. peristalsis
narrowing (arc)
cardia

8. parallel
The folds of mucosa – parallel, longitudinal;
longitudinal

9. The X-ray anatomy and
examination of the stomach
1. The survey fluoroscopy.
2. The first stage of examination – the
patient drinks 1-2 swallows of contrast
barium sulfate (we can evaluate the
folds of mucosa of the stomach).
3. The second stage of examination –
tight filling. We can determine the
shape, size and position of stomach.

10. 4. The stomach peristalsis:
- Superficial;
- Medium depth;
- Deep;
- Segmental;
- The velocity of peristaltic wave is 21 sec.

11. trendelenburg

12. Double-contrast gastrography

13. 5. Parts of the stomach:
- Fundus;
- Cardiac part;
- Body;
- Sinus (or angle);
- Antrum;
- Pyloric part;
- Minor and major curvature.

15. Ultrasound and MRI of the stomach is assigned
fairly rare, due to the fact that the procedure is
less effective for cavity organs than other methods
of investigation. Assign to detect metastases
gastric cancer to other organs

16. Ultrasound of the stomach
 Ultrasound of the stomach is not included in the number of
studies performed during a standard ultrasound
examination of the abdomen. Typically, this is due to the
fact that the visualization of the stomach significantly
impeded due to its anatomical location , content, and the
presence of a gas bubble in the stomach.
What parts are available at ultrasound of the stomach :
 When conducting ultrasound examination of the stomach
well visualized terminal , the output sections . This part of
the body of the stomach , large and small curvature of the
stomach , the antrum , the pyloric sphincter ( the place of
transition into the duodenum ) , an ampoule of the
duodenum. Visualization of other structures in the stomach
ultrasound can not in all cases. Since the majority of
lesions of the stomach is concentrated just in the output
section , holding ultrasound of the stomach is quite
appropriate.

17.  Computed tomography of the stomach is used
mainly for the detection of neoplastic diseases of
the stomach. .
 During the CT scan of the stomach help to produce
image slice wall of the stomach, which allow the
detection of the thickness and elasticity of the gastric
wall in the lesion. This sensitivity allows you to
determine the nature of the growth of the tumor, lesion
volume, distribution, germination of neighboring
organs involved in the regional lymph nodes.
 Also, the benefits of CT scan of the stomach is no
need for oral contrast agent (necessary to conduct X-
ray). Before the computer scanning is smoothing the
stomach wall by introducing into its cavity of an inert
gas (air scan).

18. . normal
Stomach wall thickening . Endoscopy was suggested
for biopsy.Biopsy - Carcinoma

19. The x-ray anatomy and examination
of duodenum and small intestine
1. The duodenum comes after stomach
and it has three parts:
- Superior (bulb of triangular shape);
- Descending (covers the head of
pancreas);
- Inferior.

20. 2. Small intestine:
- duodenum;
- jejunum;
- ileum;
- Kerckring's folds of the mucosal layer.

21. N

22. The X-ray anatomy and
examination of large intestine
1. The methods of examination:
- Per os;
- Irrigoscopy – contrast enema.

23. 2. X-ray anatomy and parts of the large
intestine:
- Caecum;
- C. ascendens;
- C. transversum;
- C. descendens;
- C. sygmoideum;
- Rectum.

24. 3. Irrigoscopy:
- The first stage of examination – tight
filling of the bowel.
А) shape;
Б) size;
В) localization.
- The second stage of examination– the
evaluation of the mucosa folds (after
depletion of patient);
- The third stage of examination– double
contrasting (inflation of large intestine
with barium sulfate by Bobrov device).
The elasticity of the walls is determined.

25. N

29. Double-contrast irrigoscopy

30. MRI of the internal organs - a method of
medical research , which is to apply a
magnetic field to produce images and three-
dimensional images of the examined organ
and tissue . The patient is placed in a
magnetic field such that its abdomen was at
the center of radiation. Then, the doctor
performs a complete scan of the selected
region receives digital images and three-
dimensional model on a computer screen.
One advantage of MRI bowel that does not
require long preparation. Thus , the
preparation for bowel MRI includes a
conversation with the patient to identify the
information about the presence of iron-bearing
elements in the body ( body piercing ,
implants , pins , tattoos of special materials) ,
which is a contraindication for the procedure .

31. MRI
Sometimes, during a bowel MRI uses a special ingredient - a contrast that
promotes visualization of certain structures. Contrasts help to check the
blood flow and to identify certain types of cancer and detect areas of
inflammation or infection. MRI with contrast is most often used in the
diagnosis of small bowel .
MRI of the intestine , usually assigned in the following cases:
- To detect tumors or problematic points in the tissues. Contrast allows you
to determine the nature of the tumor (malignant or benign) .
- Body checking for the presence of congenital anomalies , as well as
bleeding.
- The so-called hydro- MRI is able to identify problems that can not be
diagnosed by x-ray or by ultrasound. For MRI hydro intestines filled with
water, which facilitates unfolding of the walls.
Diagnosis of diseases of the intestine with MRI recognized most effective
and informative among other research body ( such as X-rays ,
ultrasound , etc.). MRI is capable of early detection of the presence of
malignant tumors.

32. The pathology of the
gastrointestinal tract
1. Esophagus:
- Esophageal diverticuli:
А) pulsational;
Б) tractional;
В) functional.
-Achalasia of esophagus ( subdiaphragmatic
segment narrowing of the esophagus and the delay in its
contrast mass )

34.  Causes of esophageal diverticula may vary. Of congenital esophageal
diverticulum is usually associated with the primary weakness of the
muscular layer of the esophagus wall in a particular area.

In the development of acquired diverticula of the esophagus significant
role played by inflammation of the upper gastrointestinal tract and
mediastinum. Often the formation of esophageal diverticulum preceded
by a long course of esophagitis and gastroesophageal reflux disease
mediastinit , tuberculosis of intrathoracic lymph nodes, fungal infection
of the esophagus ( oesophageal candidiasis ). Also, the development of
oesophageal diverticulum can cause esophageal injury ,
ezofahospazm , achalasia cardia, esophageal stricture.

Formation of pulsation diverticulum caused by of the esophagus
violation esophageal motility, leading to spastic contractions of muscles,
the internal pressure and bulging walls of the weaknesses (often above
functional or organic narrowing).

Development traction diverticulum of the esophagus promote fusion of
connective tissue wall of the esophagus with inflammatory mediastinal
lymph nodes that cause tension and displacement esophageal wall
toward the mediastinum to form abnormal protrusion.

39.  Radiographs of the esophagus with
achalasia cardia: visible sharply
narrowed terminal esophagus, supra-
stenotic extension of the esophagus,
stomach gas bubble is not defined.

40. Balon dilatation
Achalasia before
after

41. Radiographs of esophageal
perforation: taken by mouth
radiopaque substance is
distributed in the posterior
mediastinum in the form of a
large streaks.
ма пищевода при перфорации: принятое через рот рентгеноконтрастное вещество распространяется в заднем средостении в ви

42. - Cancer of esophagus:
А) scirrhous;
Б) bowl-shaped ;
В) medullar shape.

43. The symptoms of cancer:
- Stenosis of esophagus;
- Filling defect;
- Irregular borders;
- The delay of contrast media above the
level of stenosis;
- Deformation and absence of the folds;
- The absence of peristalsis at the level of
defect.

44. filling defect
cancerfilling defect
cancer

45. filling defect

46. Computed tomography (CT)
of the esophagus to determine the
boundaries of lesions of the
esophagus, to identify the affected
organs and metastatic lymph nodes,
as well as the suspected growing into
adjacent organs.
 At a cancer, esophageal ultrasound
is used to detect metastases in
abdominal organs and remote lymph
nodes.

47. Positron Emission Tomography (PET ) study, which allows you to
simultaneously identify all the malignant tumor in the body lesions larger
than 5 -10mm .
Before examining a patient is injected into the vein of a small amount of
radioactive glucose ( sugar). After that rotates around the body scanner that
detects areas of increased accumulation of radioactive glucose in the body.
Malignant tumor cells rapidly accumulate glucose they need for active growth
Therefore , the images obtained from a scanner , malignant tumor foci
appear much brighter than the surrounding tissue. PET value in treating
cancer of the esophagus , now constantly increases

48. PET CT (esophageal cancer)

49. - Burn of esophagus:
The first examination is possible after 2-3
weeks.
Symptoms:
• Circular stenosis;
• Flat contours;
• Deformation – cone-, funnel-, ampullar.
-Foreign substances
Method by Ivanova : after 1-2 sips of
barium sulfate patient takes one sip of
water, balances contrast are above the
foreign body.

51. burn

53. Рентгенпозитивні сторонні тілаРентгенпозитивні сторонні тіла

54. 2. Stomach:
- Gastritis:
А) acute;
Б) chronic;
В) chronic hyperthrophic gastritis;
Г) rigid antral gastritis.

55. - The ulcer of stomach and duodenum:
Symptoms:
• “niche”;
• inflammative elevation of mucosa;
• folds convergention;
• the symptom of “pointing finger”.
Complications:
• hemorrhage;
• perforation;
• penetration;
• malignisation (transformation into
cancer).

56. Chronic ulcer
niche

57. niche

58. niche
ulcer

59. ulcer
niche

60. ulcer
niche
ulcer
niche

61. - Cancer of stomach:
• polypous;
• bowl-shape;
• ulcerative cancer;
• diffuse;
• cancerous ulcer;
• cancer from polyp.

62. Symptoms:
• filling defect;
• the absence of the folds of mucosa;
• the absence of peristalsis at the defect
localization;
• stenosis of the lumen.

63. Cancer of stomach:
filling defect

64. Cancer of stomach:
filling defect

65. Cancer of stomach:
filling defect

66. cancer

67. • filling defect

68. polyposis
filling defect

69. Malignant polyps of stomach
filling defect

70. Computed tomography
tumor formation

71.  Radiographs: an extensive filling defect with
clear smooth rounded contours in the upper
third of the stomach - submucosal tumor
(leiomyoma)
 Computed tomography before intravenous
contrast: between the small curvature of the
stomach and the left lobe of the liver detected
tumor formation
 Computed tomography after intravenous
contrast: a significant increase in the radiopacity
of the tumor with clear smooth contours

72. 3. Large intestine:
- Inflammations:
А) colitis;
Б) chronic colitis;
В) chronic spastic colitis;
Г) unspecific ulcerative colitis.
Symptoms:
• spasm of intestine;
• smoothness of haustrum;
• smoothness of the folds of mucosa.

73. colitis
smoothness of haustrum

74. Colorectal polyp
Clinical presentation: Usually colon polyps are
asymptomatic and constitute an accidental finding.
They can bleed, thus a positive fecal blood test
can draw attention to their existence. They are
also considered precancerous lesions. Polyps
larger than 2 cm are potentially malignant.
A round lesion with sharp edges protrudes
into the intestinal lumen.

75. Diverticula of the colon
protrusion wall filled with contrast

76. foreign bodie

77. Plain abdominal x-ray showing multiple foreign
bodies.

78. - Cancer of the large intestine
Symptoms:
• filling defect;
• irregular contours;
• circular stenosis;
• the absence of the folds of mucosa;
• evacuation disorders.

79. Cancer of the large intestine
filling defect

80. Cancer of the large intestine
filling defect

81. Cancer of the large intestine
filling defect

82.
Transvaginal ultrasound
In the pelvic cavity , posterior to the stump of the
uterus, is determined the area of the intestine
( the size 6.8 x2, 9x7,4 cm, thick up to 0.5-0.6 cm
wall decreased echogenicity . Peristalsis in this
projection is absent, the inner lumen is
differentiated clearly. The contents of the intestine
practically defined .
In Doppler mode with ultrasonic angiography
in the wall is determined by the presence of
pronounced vascularisation vessels with blood type
spectrum (Vmax 14,4 cm / s , RI 0 , 74) .
Conclusion. Condition after supravaginal
hysterectomy . . Ultrasonic signs of tumors
of the rectum, pelvic formation

83.  ПриПри биопсии биопсииПри биопсии
Conclusion MRI. Suspected mass lesion distal sigmoid colon (the spread
on the proximal colon; manifestations of moderate lymphadenopathy).
Suspected secondary changes in bone structure at the studied levels.
Condition after supravaginal amputation. Uterine cysts . Suspected
cervical polyp. Cystiform formation of the right ovary
Histological report - Rectosigmoid tumor .

84. The x-ray picture of the acute
abdomen
1. Bowel obstruction.
- high;
- low.
Symptoms:
- Kloyberg cups(at the background of
swallen bowel there is the presence of
horisontal level of fluid).

85. Symptoms obstruction the small
intestine:
 Kloyberg cups located in the central
parts of the image;
 -Height is greater than their width;
 -Not see haustres.

86. Symptoms obstruction in the large
intestine:
 Kloyberg cups located in peripheral parts
of the image;
 Their width is greater than height;
 Haustres - see.

87. Kloyberg cups

88. Kloyberg cups

89. Bowel obstruction Kloyerg cups

90. 2. Perforate ulcer.
- Symptom of sickle (the presence of air
under the right cupola of the diaphragm).
Symptom of sickle