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05 - Basics of GI and HPB Imaging - 1

The document discusses anatomy and imaging of the gastrointestinal tract, hepatobiliary pancreatic system, and spleen. It covers topics like organ anatomy, imaging modalities including ultrasound, CT, MRI, X-ray, and nuclear medicine. Examples of normal anatomy and various pathologies are presented.

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Husam Abuodeh
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52 views

05 - Basics of GI and HPB Imaging - 1

The document discusses anatomy and imaging of the gastrointestinal tract, hepatobiliary pancreatic system, and spleen. It covers topics like organ anatomy, imaging modalities including ultrasound, CT, MRI, X-ray, and nuclear medicine. Examples of normal anatomy and various pathologies are presented.

Uploaded by

Husam Abuodeh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Tbilisi State Medical

University
Department of Radiology
Ultrasound Education Centre
“GEOJEFF”
Malkhaz Mizandari MD, PhD
Professor of Radiology
Radiology of GI, HPB
System, Spleen
Part 1 – Anatomy, Current imaging options
of GI tract and HPB system
Right Lateral
View
Left Lateral
View
Esophagus
In Situ
Topography
and
Shape
of
Esophagus
Stomach In Situ
Hypertonic Orthotonic
Stomach Stomach
Hypotonic Atonic
Stomach Stomach
Jejunum
Ileum
Large
Intestine
Regions and Planes of Abdomen
Arteries of
Posterior
Abdominal
Wall
Veins of
Posterior
Abdominal
Wall
Surfaces of Liver
Liver Segments
Liver Vessel and Duct
Distribution
Liver Structure: Scheme
Gallbladder and Extrahepatic
Bile Ducts
Pancreas in Situ
Arteries of
Liver,
Pancreas,
Duodenum
and Spleen
Variation in Pancreaic Duct
Spleen
Current imaging options
 X-Ray
 US
 CT
 MRI
 NM (including PET-CT)
 Invasive angiography
X-Ray
 Non-contrast X-Ray
(peritoneal air detection in perforation,
air-fluid levels in bowel obstruction,
calcifications – tumors, parasites,
infection, stones)
 Barium swallow&barium enema
 Biliary system&GB imaging by peroral
and intravenous contrast administration,
ERCP
Conventional radiograph -
pneumoperitoneum
Conventional Radiograph – Normal gas distribution
and air-fluid levels in overinflated
bowel loops, caused by bowel obstruction
Conventional radiograph - Calcifications
Contrast X-Ray modalities of GI
tract. HPB system and Spleen
GI tract X-Ray study principle – complete and partial
filling, double and triple contrast
X-Ray Patterns of GI Tract
Pathology
Dislocation
X-Ray Patterns of GI Tract
mucosa Pathology
Pathologic Changes of Mucosa
X-Ray Patterns of GI Tract and
tubular structure Pathology

Dilation
X-Ray Syndroms of GI Tract and
tubular structure Pathology
Narrowing
Intravenous contrast for GB and bile ducts
ERCP (Endoscopic Retrograde
Cholangiopancreatography)
Sesveneba
Ultrasound
Very Informative
Relatively Cheap

Non-Invasive
Ultrasound of GI Tract,
HPB system and Spleen
pathology
B-mode and Doppler studies
(Spectral, Color, Power Doppler)
Stomach before&after water
administration – 5 wall layers
Antrum – before and after
fluid administration
Jejunum – possibility of
peristalsis monitoring
Defects of gastric mucosa - Ulcer
Exophytic Gastric Masses

Polip Leiomyoma

Leiomyoma
“Pseudokidney” Sign – Neoplasm

Large bowel and stomach cancer

Gastic and small bowel lymphoma


L
A B

IVC
CAUDATE LOBE

L
CAUDATE
LOBE
L

CP
SAG

TRV
LEFT PORTAL VEIN

LPV
RPV
COMMO
CYSTIC
NHEPATI
DUCT
C DUCT

} COMMON
DUCT
COMMON
BILE
DUCT
GB
A
IVC
TRANSVERSE

SAGITTAL
JUNCTIONAl
L FOLD
PHRYGIAN
CAP
P
B
HA
D

MP
V
CHD HA

MPV
L

P P
Spleen
CT of GI tract, HPB system and
Spleen
 Intavenous and peroral contrast might be
used
 Detailed cross-sectional anatomy might be
assessed
 Contrast might be injected via drainage
catheters
Anatomy of abdominal cavity
Anatomy of abdominal cavity
CT
MRI and MRCP
MRCP and post PTBD CT
Cholangiography with 3D
recontsruction
Nuclear Medicine
γ- Hepatocholecystography
- Detector Position
γ- Hepatocholecystography
γ -Hepatocholcystography
Liver-Spleen scan – Tc-99m or sulfur colloid.
Normal liver/spleen scans
Liver-Spleen scan – Tc-99m or sulfur colloid. Ubnormal
liver/spleen scan in patient with liver cirrhosis – note the
small liver size and radiopharmaceutical shift to the bone
marrow and spleen
Hepatobiliary NM imaging – TC-99m –labeled
iminodiacdetic acid compunds – Tc disofenin or
Tc-mebrofenin. Normal hepatobiliary scan
Hepatobiliary NM imaging . Acute cholecystitis – the GB
never fills. Acute inflammation indicating “Hot rim”
around GB fossa is seen, when liver clears
PET-CT – patient with a history of colon cancer with poor
response to chemo. Large liver met with central necrosis and
2 smaller methastasis are revealed
Non-invasive angiography
Invasive angiography

Before
After TACE
Diagnosis of GI tract
diseases
Esohagus - primary and secondary achalasia

True (neurogenic?) achalazia Secondary – due to esophageal


cancer
Esophageal divetriculum (Zenker, traction, pulsion divetriculi)
Esophageal divetriculum (Zenker, traction, pulsion divetriculi)
Esophageal strictures – benign and malignant

Benign – due to chronic Malignant – due to esophageal


reflus esophagitis carcinoma
Gastric ulcer (benign&malignant)

Benign Malignant – infiltrated mucosa,


width is grater then depth
Gastric ulcer (benign&malignant)
Gastric mass lesions (benign - GIST, polyps, bezoar)

Oval shape filling defect is seen.


Benign GIST Benign polyp could be suggested;
polypod carcinoma was detected
Malignant gastric lesions - schirrous
carcinoma

Scirrhous carcinoma
Malignant gastric lesions - lymphoma
Malignant gastric lesions - GIST.

Arrow identifies an irregular ulcer, which


collects barium wthin its crater
Duodenal divetriclum, ulcer (niche)
Intraluminal duodenal
diverticulum

“Niche” in duodenal bulb


Diagnosis of small bowel pathology - SBFT and
enteroclysis
Diagnosis of small bowel pathology - Crohn disease

Terminal ileum, jejunal


segment and transverse
colon involvement
Diagnosis of small bowel pathology small bowel
mass lesions - adenocarcinoma

Adenocarcinoma of jejunum
Diagnosis of small bowel pathology small bowel
mass lesions - lymphoma

Normal mucosa
Bowel obstruction
Diagnosis of large bowel pathology - mass lesions (polyps)
Diagnosis of large bowel pathology - mass lesions
(colorectal adenocarcinoma)
Diagnosis of large bowel pathology - ulcerative
colitis

Multiple ulcers Stricture


Diagnosis of large bowel pathology -
diverticulosis, appendicitis
Diagnosis of large bowel pathology - appendicitis

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