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Learning Radiology > Ch.18 - Recognizing GI, Hepatic, and UT Abnormalities > Flashcards

Ch.18 - Recognizing GI, Hepatic, and UT Abnormalities Flashcards

1
Q

Radiologic findings of gastric ulcer:

A
  1. Persistent collection of barium that extends outward from the lumen beyond the normal contours of the stomach.
  2. Usually along the lesser curvature or posterior wall in the region of the body or antrum.
  3. May have radiating folds which extend to the ulcer margin and a surrounding margin of edema.
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2
Q

Key finding in gastric carcinoma:

A

Mass that protrudes into the lumen and produces a filling defect, displacing barium.

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3
Q

Gastric carcinomas may be associated with:

A
  1. Rigidity of the wall.
  2. Non distensibility of the lumen.
  3. Irregular ulceration or thickening of the gastric folds (>1cm).
  4. Especially localized to one area of the stomach.
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4
Q

Radiologic findings of duodenal ulcers include:

A
  1. Persistent collection of contrast.
  2. More often seen en face with surrounding spasm and edema.
  3. Healing of the duodenal ulcers produces scarring and deformity of the bulb.
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5
Q

Any imaging evaluation of the bowel should ideally be carried out with:

A

The bowel distended with air or contrast because collapsed and unopacified loops of bowel can introduce artifactual errors of diagnosis.

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6
Q

Key abnormal findings of bowel disease on CT:

A
  1. Thickening of the bowel wall.
  2. Submucosal edema or hemorrhage.
  3. Hazy infiltration of fat.
  4. Extraluminal air or contrast.
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7
Q

Imaging study of choice for diverticulitis:

A

CT.

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8
Q

CT findings of diverticulitis:

A
  1. Pericolonic inflammation.
  2. Thickening of the adjacent colonic wall (>4mm).
  3. Abscess formation and confined perforation of the colon.
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9
Q

Colonic polyps can be visualized with:

A
  1. Barium enema.
  2. CT virtual colonoscopy.
  3. Optical colonoscopy.
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10
Q

Imaging signs of colonic polyps:

A
  1. Persistent filling defect in the colon with or without a stalk.
  2. Some larger, villous adenomatous polyps have higher malignant potential and may contain barium within the interstices of their fronds.
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11
Q

Imaging findings of colonic carcinoma:

A
  1. Persistent, large, polypoid or annular constricting filling defect of the colon.
  2. May have frank or micro-perforation or large bowel obstruction and metastases, especially to the liver and the lungs.
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12
Q

Colitis of any etiology can cause:

A
  1. Thickening of the bowel wall.
  2. Narrowing of the lumen.
  3. Infiltration of the surrounding fat.
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13
Q

Study of choice in diagnosing appendicitis:

A

CT.

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14
Q

CT findings in appendicitis:

A
  1. A dilated appendix (>6mm) that does NOT fill with oral contrast.
  2. Periappendiceal inflammation.
  3. Increased enhancement of the wall of the appendix with IV contrast - sometimes identification of an appendicolith (fecolith).
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15
Q

CT findings in pancreatitis:

A
  1. Enlargement of the pancreas.
  2. Pancreatic stranding.
  3. Pancreatic necrosis.
  4. Pseudocyst formation.
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16
Q

Pancreatic adenocarcinoma:

A

Usually manifests as a focal hypodense mass - May be associated with dilation of the pancreatic and/or biliary ducts.

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17
Q

Fatty infiltration of the liver:

A
  1. Very common - can produce focal or diffuse areas of decreased attenuation that characteristically do NOT displace or obstruct the hepatic vessels.
  2. Liver appears less dense than the spleen.
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18
Q

In its later stages, cirrhosis produces:

A
  1. A small liver - especially the right lobe - with lobulated contour.
  2. Inhomogeneous appearance of the parenchyma.
  3. Prominent left + caudate lobes.
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19
Q

Evaluation of liver masses is frequently done utilizing a:

A

Triple-phase scan that includes:

  1. Precontrast scan.
  2. 2 Post contrast scans –> One in the hepatic-arterial phase and then another in the portal venous phase.
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20
Q

Metastases in the liver:

A

Multiple, low density masses that may necrose as they become larger.

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21
Q

HCC:

A

Usually solitary and typically enhance with IV contrast on CT.

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22
Q

Cavernous hemangiomas:

A

Characteristic centripetal pattern of enhancement and frequently retain contrast longer than the remainder of the liver.

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23
Q

Renal cysts:

A
  1. Very common.
  2. Frequently multiple and bilateral.
  3. Do NOT enhance - Sharp margins where they meet the normal renal parenchyma.
  4. On US –> Well-defined anechoic masses.
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24
Q

RCC - CT:

A

Usually a solid mass that enhances with IV contrast but remains less dense that the normal kidney.

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25
RCC - US:
Frequently echogenic masses.
26
Imaging study of choice in evaluation of female pelvis:
US.
27
Esophageal diverticula occur in:
1. Neck --> Zenker. 2. Around the carina --> Traction. 3. Just above the diaphragm --> Epiphrenic. - -> Only Zenker tends to produce symptoms.
28
A single contrast study (also called full column) usually refers to ...?
A GI imaging procedure in which only barium is used as the contrast agent.
29
A double contrast (sometimes called air contrast) usually refers to ...?
A study of the GI tract using both thicker barium and air.
30
A biphasic examination is used to study ...?
The upper GIT --> utilizes double contrast study followed by a single contrast agent to optimize the study.
31
What is a filling defect?
A lesion, usually of soft tissue density, that protrudes into the lumen and displaces the intraluminal contrast (eg a polyp is a filling defect).
32
What is the study of choice for diagnosing and documenting aspiration?
Video esophagography.
33
Fluoroscopic observation of the esophagus may reveal ...?
Tertiary waves - Non specific abnormality of esophageal motility.
34
The 3 locations of the esophageal diverticula?
1. Neck. 2. Around the carina. 3. Just above the diaphragm.
35
Diverticula at the level of the carina may be due to ...?
Extrinsic inflammatory disease like TB (traction diverticula).
36
Epiphrenic diverticula?
Diverticula just above the esophagogastric junction.
37
What is frequently the initial study in patients with symptoms, like dysphagia?
Barium esophagograms.
38
Esophageal carcinomas may appear in one or more of several forms, including ...?
1. An annular-constricting lesion. 2. Polypoid mass. 3. A superficial infiltrating lesion or ulceration. 4. Irregularity of the wall. - -> Most often they present as a mixture of several of these patterns.
39
A Schatzki ring marks ...?
The position of the EG junction so that its appearance ABOVE the diaphragm indicates the presence of a sliding hiatal hernia.
40
Double contrast UGI series have a sensitivity that exceeds ...% in detecting duodenal ulcers.
90%.
41
Complications of duodenal ulcers are best demonstrated by ...?
CT.
42
Orally administered contrast is routinely given for most abdominal CT scans. Exceptions:
1. Those performed for trauma. 2. The stone search study. 3. Studies specifically directed towards evaluating vascular structures such as the aorta.
43
Oral contrast used for CT exam is either ... or ...?
Either a dilute solution containing barium or iodinated contrast.
44
There are several important findings common to any part of the bowel, which are key to the diagnosis of bowel abnormalities (4):
1. Thickening of the bowel. 2. Submucosal edema or hemorrhage. 3. Hazy or strandlike infiltration of the surrounding fat. 4. Extraluminal contrast or extraluminal air.
45
Thickening of the bowel?
Normal small bowel does NOT exceed about 2.5cm in diameter, and the wall is usually no thicker than 3mm. --> The COLONIC wall does NOT exceed 3mm with the lumen distended.
46
Submucosal infiltration produces various degrees of ...?
Thumbprinting --> Nodular indentations into the bowel lumen representing focal areas of submucosal infiltration.
47
The intraluminal surface of the colon is most often studied with ...?
Optical or virtual colonoscopy or double contrast barium enema exam.
48
Structures outside the colon are usually studied by ...?
CT of the abdomen and pelvis with oral or rectal contrast.
49
What is the modality of choice for the diagnosis of diverticulitis?
CT --> The pericolonic soft tissues can be visualized using CT, which is impossible with wither barium enema or optical endoscopy.
50
CT findings of diverticulitis (5):
1. Presence of diaverticula. 2. Thickening of the adjacent colonic wall >4mm. 3. Pericolonic inflammation --> Hazy areas of increased attenuation. 4. Abscess formation --> Small bubbles of air or pockets of fluid. 5. Perforation of the colon --> Extraluminal air or contrast.
51
3 ways to visualize polyps?
1. Barium enema. 2. CT (virtual colono). 3. Colonoscopy.
52
Intussusception may produce a characteristic ...?
COILED-SPRING appearance on barium enema.
53
Imaging findings of carcinoma of the colon include?
1. Presence of a persistent, large, polypoid filling defect. 2. Annular constriction of the colonic lumen producing an apple core lesion. 3. Frank or microperforation.
54
Other imaging findings of carcinoma of the colon can include?
LBO + Metastases to the liver/lungs.
55
What is of paramount importance in colitis?
Clinical history --> Many forms of colitis appear similarly radiographically.
56
CT findings of colitis (3)?
1. Thickening of the bowel wall. 2. Irregular narrowing of the bowel lumen due to edema (thumbprinting). 3. Infiltration of the surrounding fat.
57
Imaging findings in mesenteric ischemia?
1. Lack of bowel enhancement with IV contrast. | 2. There may also be intramural or portal venous GAS present!
58
What is the modality of choice in diagnosing appendicitis?
CT.
59
What other options do we have to diagnose appendicitis?
US and MRI.
60
An appendicolith is a calcified concretion found in the appendix of about ...% of all people.
15%.
61
Key CT findings of appendicitis:
1. A dilated appendix >6mm. 2. The appendix does NOT fill with oral contrast. 3. Periappendiceal inflammation. 4. Increased contrast enhancement of the wall of the appendix due to inflammation.
62
Perforation of the appendix occurs in up to 30% of cases. How is it recognized?
By small quantities of periappendiceal extraluminal air or a periappendiceal abscess.
63
Since obstruction of the appendiceal lumen is a prerequisite for appendicitis ...?
The presence of free intraperitoneal air should point to another diagnosis.
64
What is the accordion sign?
Represents contrast that is trapped between enlarged folds and indicates the presence of marked edema or inflammation, but it is NOT specific for C.difficile colitis.
65
Pancreatitis is a clinical diagnosis. What is the role of CT?
CT serves to document either the CAUSE (gallstones) or COMPLICATION (pseudocyst).
66
Recognizing ACUTE pancreatitis on CT (4):
1. Enlargement of all or part of the pancreas. 2. Peripancreatic stranding or fluid collections. 3. Low attenuation lesions in the pancreas from necrosis. 4. Pseudocyst formation.
67
Normal measurements for the pancreas:
3cm for the head. 2.5cm for the body. 2cm for the tail.
68
Areas of NON VIABLE pancreas ...?
Usually develop EARLY --> Requires IV admin of contrast and is important in predicting PROGNOSIS.
69
Pseudocyst formation:
Fibrous tissue encapsulates a WALLED-OFF collection of pancreatic juices released from inflamed pancreas.
70
Imaging hallmarks of chronic pancreatitis:
Multiple, amorphous calcifications that form within the DILATED DUCTS of the atrophied gland.
71
Recognizing a pancreatic adenocarcinoma on CT:
1. Focal pancreatic mass, usually HYPODENSE to the remainder of the gland. 2. Ductal dilatation, usually involving BOTH the pancreatic (
72
CT evaluation of liver masses is usually done with a combination of scans ...?
Before + After the IV contrast injection.
73
Post contrast scans are obtained in 2 phases:
One is done QUICKLY (hepatic-arterial) and a second is done about a minute later (portal-venous phase).
74
This combination of 3 separate scans done without contrast and then during the arterial phase followed by the venous phase is called ...?
A triple phase scan.
75
Hepatic MRI is particularly useful in the evaluation of ... compared to CT.
In the evaluation of SMALL (1cm or less).
76
For routine MRI of the liver, an IV contrast agent called ... is typically administered.
Gadolinium.
77
What is the pad sign of a pseudocyst?
The indentation on a loop of a bowel by an extrinsic mass is called a pad sign.
78
Fatty infiltration of the liver (hepatic steatosis) - Findings:
Normally --> On non contrast CT, the liver is always denser than or equally dense to the spleen. With fatty infiltration --> The spleen is denser than the liver without IV contrast.
79
Fatty infiltration may be focal or diffuse. Focal may mimic tumor. How will we differentiate?
1. Fatty infiltration usually produces NO MASS EFFECT. | 2. Has the ability to appear and disappear in a matter of WEEKS.
80
What is the most accurate modality in the evaluation of a fatty liver?
MRI.
81
Which phenomenon does MRI use in order to detect the presence of microscopic, intracellular lipid present in such a liver?
Chemical shift - Relates to the way that lipid and water protons behave in the magnetic field.
82
Recognizing cirrhosis on CT:
1. EARLY --> May demonstrate diffuse fatty infiltration. 2. As the disease progresses --> Liver becomes lobulated. 3. Liver shrinks --> Right lobe more (especially in alcoholic cirrhosis). 4. Mottled, inhomogeneous appearance to the liver parenchyma, following IV contrast due to mixture of: Nodules, focal fatty infiltration, and fibrosis. 5. PHTN --> Dilated vessels around the stomach, splenic hilum, esophagus. 6. Splenomegaly may develop. 7. Ascites may be present.
83
Ascites vs pleural effusion?
Important to differentiate.
84
Recognizing liver metastases on CT and MRI:
1. Usually multiple, low attenuation masses. 2. Larger metastases may demonstrate areas of NECROSIS --> Low attenuation. 3. Mucin-producing carcinomas (stomach, ovaries, colon) may calficy. - -> MRI is as sensitive as CT --> Used as problem-solving.
85
Most HCC are solitary, but ... out of ... can be multiple, mimicking metastases.
1 out of 5.
86
Vascular invasion of HCC?
It is common --> Portal system particularly.
87
The 3 patterns of presentation of HCC:
1. Solitary mass. 2. Multiple nodules. 3. Diffuse infiltration throughout the segment, lobe, or entire liver.
88
On CT most HCCs:
1. Low density or the same density as normal liver (isodense) without contrast. 2. Enhance on the arterial phase with IV contrast (hyperdense). 3. And then return to HYPODENSE or ISODENSE on the VENOUS phase. 4. Low attenuation areas from necrosis are common. 5. Frequent calcifications.
89
Role of MRI in HCC:
1. Can demonstrate certain features that are fairly specific for HCC. 2. Detect intrahepatic metastases + venous invasion. 3. HCC show washout of the contrast material.
90
Cavernous hemangiomas of the liver on CT:
1. Usually HYPODENSE lesions on unenhanced CT scans. 2. Characteristic nodular enhancement from the periphery inward following injection of IV contrast and become ISODENSE in the venous phase. 3. Contrast tends to be retained within the numerous vascular spaces of the lesion so that they characteristically appear denser than the rest of the liver on delayed (10minute) scans.
91
What is frequently the preferred modality in the evaluation of hemangiomas?
MRI - More sensitive than nuclear medicine tagged RBC scan + more SPECIFIC than a multiphase CT scan.
92
Hemangioma on MRI:
Same thing as with CT.
93
Hepatic cysts - CT:
1. Sharply marginated. 2. Spherical lesions. 3. LOW attenuation (fluid density) on BOTH unenhanced/enhanced CT scans.
94
CT or MRI for hepatic cysts?
MRI is much better than CT at characterizing cysts --> Solitary + Homogenous.
95
MRCP is ...?
A NON INVASIVE way to image the biliary tree WITHOUT requiring injection of contrast material.
96
MRCP is excellent at depicting?
1. Biliary or ductal strictures. 2. Ductal dilatation. 3. Stones in the bile ducts (choledocholithiasis). 4. Gallstones. 5. Adenomyomatosis of the gallbladder. 6. Choledochal cysts. 7. Pancreas divisum.
97
MRCP - If there is a concern for malignancy (pancreatic adenoca, or cholangioca) ...?
Then additional pulse sequences following the administration of gadolinium can be obtained. --> Contrast administration allows better detection of malignancy.
98
Renal cysts on CT:
1. Tend to have a sharp margin, where they meet normal parenchyma. 2. Hounsfield numbers of -10 to +20 (water density). 3. They do NOT contrast enhance.
99
Renal cysts on US exam?
1. Echo-free (anechoic). 2. Strong transmission of the US signal. 3. Sharp borders where they meet the renal parenchyma. 4. Round/oval shapes. 5. Thickening of the wall or dense internal echoes raise suspicion for a malignant lesion!
100
Recognizing RCC on CT:
1. A dedicated CT for RCC --> Consists of images obtained BEFORE or AFTER IV contrast administration. 2. Range from completely solid to completely cystic. Usually solid. 3. Low attenuation areas of necrosis. 4. Even though they enhance with IV contrast --> Still remain LOWER in density than the surrounding normal kidney.
101
Renal vein invasion occurs in ... in ... cases.
1 in 3 cases.
102
On U/S, smaller RCCs are usually ...?
Hyperechoic.
103
On U/S, as the lesion increases in size and undergoes necrosis it may be ...?
HYPOechoic.
104
The primary role of MRI of the kidneys is in the ...?
Evaluation of small masses (
105
What is the study of first choice in evaluation of suspected abnormalities of the female pelvis?
US.
106
Pelvis - MRI can be particularly useful in evaluating ...?
1. Ovarian dermoid cysts. 2. Endometriosis. 3. Hydrosalpinges = Fluid-filled fallopian tubes. 4. Determining whether an ovarian cystic lesion is simple (benign) or contains a solid compound (often malignant).
107
Bladder tumor - The primary tumor appears as ...?
Focal thickening of the bladder wall or may produce a filling defect in the contrast-filled bladder.
108
Recognizing the CT findings of a lymphoma:
1. Multiple enlarged lymph nodes --> Pelvic lymph nodes are considered pathologically enlarged IF they exceed 1cm in their shortest dimension. 2. Conglomerate masses of coalesced nodes. 3. Classical displacement of the aorta and/or vena cava ANTERIORLY. 4. Other malignancies or benign diseases.

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