GASTROINTESTINAL

TRACT
RADIOLOGY

DR. BIJAY KUMAR YADAV

MBBS, MD (Radiology Resident)
 IMAGING MODALITIES IN GIT
1. Plain X-rays:
• Supine
• Erect
• Decubitus
2. Barium studies:
a. Barium Swallow
b. Barium Meal
c. Barium Follow through
d. Barium Enema
3. Ultrasound Abdomen
4. CT Scan
5. MRI Abdomen
6. ERCP
7. Cholangiography.
8. Angiography and Nuclear Medicine
 1. PLAIN ABDOMINAL X - RAY:
Basic Principles:

 Five Radiographic Densities:

 Gas /Air: Black
 Fat: Dark grey
 Soft Tissue / Water:
Light grey
 Bone/Calcium:
White
 Metals: Intense
white

 Interface/line only visible

when two of these densities
 Routine views:
i. Supine abdomen AP (KUB)
ii. Erect abdomen AP
iii. Lateral Decubitus

 Include part from

diaphragm to pubic
symphysis
 Lateral upside down –
Invertogram only for
imperforate anus
 Many structures are not clearly
defined on a radiograph of the
abdomen and therefore
cannot be fully assessed
Indications:
1. Acute Abdomen
2. Abdominal Pain
3. Intestinal Obstruction
4. Intestinal perforation
5. Imperforate anus

Contraindications:
6. Trauma
7. Solid organ assessment
8. Pregnancy
 Approach to a
AXR
i. Technical Assessment
ii. Projection
iii. Normal/Abnormal Calcifications
iv. Solid Organs
v. Bowel/Gas Shadows
vi. Lung bases and at the skeleton
Abdominal X-Ray
 AXR view
1. 11th Rib
2. Vertebral body (T 12)
3. Gas in stomach
4. Gas in colon (splenic flexure)
5. Gas in transverse colon
6. Gas in sigmoid
7. Sacrum
8. Sacroiliac joint
9. Femoral head
10. Gas in cecum
11. Iliac crest
12. Gas in colon (Hepatic flexure)
13. Psoas muscle
 Gas shadows in
Abdomen
Normal:
i. Stomach
ii. Colon
iii. Small Bowel.

Abnormal:
iv. Within the Lumen:
• Dilated bowel
• ? Obstruction

v. Outside the Lumen:

• Free ? perforation
• In a cavity ?
abscess
Large Bowel Obstruction Small Bowel Obstruction
Intestinal Perforation
 2. BARRIUM STUDY
It is contrast agent inert material when reaches to
gastrointestinal tract whether oral or per rectal route, it
opacifies the tract ( seen white on x-ray)

A. Barium Swallow
B. Barium Meal
C. Barium Follow through
D. Barium Enema
 Barium swallow

Barium meal

Barium
Barium follow through /
enema
Enteroclysis

Barium enema
1
3
 Contrast Media Used In GI Tract Imaging

1. Water soluble contrast media

1. Iopamidol (Gastromiro)
2. Meglumine diatrizoate and sodium diatrizoate
(Gastrografin)
2. Barium sulphate (barium carbonate is
poisonous)
 A. Barium Swallow
 It is a medical imaging procedure used to examine upper
gastrointestinal tract, which include the esophagus and to a
lesser extent of the stomach.
 The contrast used is Barium sulfate.
 Ask for Barium swallow:
– Paste like Barium
– Ask the patient to swallow
– X-ray under fluoroscopy in different views
Indication:
i. Dysphagia
ii. Anaemia
iii. Pain
iv. Assessment of tracheo-oesophageal fistula
v. Assessment of site of perforation

Contraindications:
vi. Suspected leakage from esophagus into the mediastinum or
pleura and peritoneal cavities
ii. Tracheo-esophageal fistula

Contrast medium:
• Double contrast 200-250% w/v, 100 ml/ more according to
need.
• Water soluble contrast agent if perforation is suspected
(Gastrograffin).
 Esophageal constriction
 Normal sites of narrowing of
Esophagus:

i. Superiorly: Level of Cricoid

cartilage (C6), juncture
with pharynx
ii. Middle: Crossed by aorta and
left main bronchi
iii. Inferiorly: Diaphragmatic
sphincter
• Cervical esophagus bordered anteriorly by trachea,
posteriorly by vertebral column and laterally by carotid
sheath and thyroid gland.

• Thoracic esophagus anteriorly lies the trachea, right

pulmonary artery, left main bronchus diaphragm.
Posteriorly it rest on vertebral column and closely
related to thoracic duct, azygus & hemiazygus vein.

• Abdominal esophagus its right border is continuous

with lesser curvature & left border is demarcated from
fundus by esophago-gastric angle of implantation
(angle of His)
Normal impressions in the esophagus
 B. Barium Meal
Diagnostic test used to detect abnormalities of the
esophagus, stomach and small bowel using X-ray imaging

Methods
i. Double Contrast - The method of choice to
demonstrate mucosal pattern
ii. Single Contrast: uses :
• Children - since it is not usually necessary to
demonstrate mucosal pattern
• Very ill adults – To demonstrate gross pathology
only
 Indications: Contraindications:
i. Dyspepsia i. Complete large bowel
obstruction
ii. Weight loss
iii.Upper abdominal mass
iv. Gastrointestinal Contrast Medium :
haemorrhage or • Double contrast
unexplained iron 120 ml of high density
deficiency anaemia barium 250 % W/V
v. Partial obstruction • Single Contrast
vi. Assessment of site of Sufficient 100 % W/V
perforation – it is
essential that water
soluble contrast medium
e.g. Gastrografin or
Dionosil aqueous is used.
Barium Meal
Barium Meal
 C. Barium Follow Through
 Barium Follow Through is designed to demonstrate the small
bowel from the duodenum to the ileoceacal region encompassing the
duodenum, jejunum and ileum including the junctions
superiorly with the stomach and inferiorly with the ascending
colon by oral administration of contrast media (Barium)
 Also known as Barium Meal Follow Through (BMFT) & Small
Bowel Follow Through (SBFT)

Methods:
i. Single contrast
ii. With addition of effervescent agent
 Indications: Contraindications:

• Crohn’s disease (most • Complete Bowel Obstruction

common) • Suspected Perforation
• Diarrhoea • Paralytic ileus
• Very ill Patient
• Weight loss • Recently Operated Patient
• Anemia (Gastro-intestinal
Bleeding)
• Partial Obstruction
Contrast medium:
• Mal-absorption (Dyspepsia)
• Barium sulphate solution 100%
• Abdominal Mass w/v 300 ml (150 ml if
• Suspected Tubercular Lesion performed immediately after
• Lesions such as strictures, barium meal)
neoplasms, Meckel’s
diverticulum
Barium Meal Follow Through Multiple Strictures - String Sign
 D. Barium Enema
 Radiographic study of large bowel by administration of
contrast medium through the rectum
 Currently the overall volume of BARIUM ENEMA study has
decreased in modern medical practice because of greater use
of other diagnostic test such as colonoscopy, CT- Scan
and most recently CT-
COLONOGRAPHY
 But Barium Enema remains a valuable technique for
evaluating patients with variety of colorectal diseases
Methods:
i. Single contrast
ii. Double contrast
 Both single and double contrast barium enemas have the ability to
demonstrate variety of intramural and extrinsic abnormalities of
involving colon that are more difficult to recognize at colonoscopy
 Indications : Contraindications :
i. Colorectal neoplasia i. Allergy to barium
ii. Malabsorption ii. Peritonitis
iii. Debilitated, unconscious,
iii. Inflammatory bowel inability to cooperate
iv. Large bowel iv. History of recent rectal /
obstruction colonic biopsy - can be
v. Small bowel done after 6 weeks
disease v. Pregnancy
vi. Lower GI
blood loss Contrast medium :
vii. Polyposis 125% w/v; 500 ml (or more)
viii. Diverticulos
is
Barium Enema, Single Contrast
 Barium Enema, Double Contrast

Hepatic Flexure

Effect of gravity

Right Lateral Decubitus

 ULTRASOUND ABDOMEN
Indications: Advantages:
i. Acute Abdomen i. Cost effective
ii. Obstructive jaundice ii. Adequate visceral
iii. Abdominal masses visualization
iv. Collections iii. Best for GB
v. Free fluid iv. No radiation
vi. Follow up- tumors

Disadvantages:
i. Operator dependent
ii. Poor in Obesity
iii. Bowel gasses
iv. Bones / Calcifications
portal vein
The common hepatic artery
Hepatic veins
The hepatic veins have a rabbit ear configuration in the transversal plane (at the
level of the basis) – the so-called (playboy) bunny sign
Gallbladder
The right kidney in sagittal and transversal directions
Bladder in the transversal plane
Spleen in sagittal direction
Pancreas in the transversal direction
Normal pancreas in the sagittal direction
Abdominal aorta in the transversal plane
Normal aorta in the transversal plane
Examples of normal intestinal loops
Ultrasound examination of the appendix
Normal appendix
 CT SCAN ABDOMEN
Indications: Advantages:
i. Acute abdomen, i. Accurate & quick
ii. Abdominal mass, tumor ii. Bowel/ gasses/ bones
iii. staging/follow up, iii. Reformation and angio
iv. Appendicitis/abscesses,
Post op
v. complications

Disadvantages:
i. Radiation (250 CXR)
ii. Renal failure
iii. Contrast reaction
CT of abdomen without contrast. There is lack of distinction between
abdominal organs
CT scan of abdomen with intravenous contrast. Notice better visualization
of the kidneys and blood vessels
Intestinal Obstruction
 MRI
Advantages:
ABDOMEN
Disadvantages:
i. Multiplaner i. Bowel motion/ contrast
ii. Renal failure ii. Calcifications
iii. MRCP iii. Metallic implant
iv. Liver specific contrasts iv. Relatively long procedure
time
v. Claustrophobia
Indications:
i. Diffuse hepatic disease
ii. Focal liver lesions
iii. Pre- and postoperative liver evaluation
iv. Biliary tract pathology
v. Pancreatic disease
vi. Inflammatory bowel disease
vii. Rectal tumors
THANK YOU