RADIOLOGY and MEDICAL IMAGING

Cours

Conf.Dr.Ioana Lupescu (imaging, dig., Neuro) Asist univ.Dr.Razvan Capsa (thorax) SL.Dr.Mugur Grasu (osteo) SL.Dr.Mihai Lesaru (renal)

WS

Asist univ.Dr.Gelu Popa Asist univ.Dr.Stefanita Dima

Conventional tomography

IMAGING
Ultrasound (US) 2. Computed tomography (CT) Magnetic Resonance Imaging (MRI)
1.

3.

Ultrasound Imaging
diagnosis; treatment

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to highfrequency sound waves (2-7,5 MHz) to produce pictures of the inside of the body. Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel, including the body's major arteries and veins in the abdomen, arms, legs and neck.

Abdominal Ultrasound Pediatric Ultrasound Breast Ultrasound Carotid Ultrasound Imaging Ultrasound - Obstetric Musculoskeletal Ultrasound Scrotal Ultrasound Thyroid Ultrasound Vascular Ultrasound Biopsy, Ultrasound-Guided

What are some common uses of the procedure?

Abdominal ultrasound imaging is performed to evaluate the: liver gallbladder kidneys pancreas spleen Abdominal aorta and other blood vessels of the abdomen Ultrasound is used to help diagnose a variety of conditions, such as: abdominal pains inflamed appendix enlarged abdominal organ stones in the gallbladder or kidney an aneurysm in the aorta

Angio-power doppler

Doppler ultrasound images can help the physician to see and evaluate:

blockages to blood flow (such as clots) narrowing of vessels (which may be caused by plaque) tumors and congenital malformation

Color Doppler

Power Doppler

HIPOECHOGENIC

FLUID lesion

HIPERECHOGENIC

Artifacts

What are the benefits vs. risks?

Benefits Ultrasound scanning is noninvasive (no needles or injections) and is usually painless. Ultrasound is widely available, easy-to-use and less expensive than other imaging methods. Ultrasound imaging uses no ionizing radiation. Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images. Ultrasound causes no health problems and may be repeated as often as is necessary if medically indicated. Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration of fluid in joints or elsewhere. Risks For standard diagnostic ultrasound there are no known harmful effects on humans.

What are the limitations of Abdominal Ultrasound Imaging?

Ultrasound waves are reflected by air or gas; therefore ultrasound is not an ideal imaging technique for the bowel. Barium exams and CT scanning are the methods of choice for bowel-related problems. Ultrasound waves do not pass through air; therefore an evaluation of the stomach, small intestine and large intestine may be limited. Intestinal gas may also prevent visualization of deeper structures such as the pancreas and aorta.

Patients who are obese are more difficult to image because tissue attenuates (weakens) the sound waves as they pass deeper into the body.

What is CT Scanning

Computed tomography (CT)sometimes called CAT scanuses special x-ray equipment to obtain image data from different angles around the body then uses computer processing of the information to show a crosssection of body tissues and organs. CT imaging is particularly useful because it can show several types of tissue with great clarity, including the mediastinum, lungs, vessels, head, spine and organs like the liver, spleen, pancreas and kidneys. Using specialized equipment and expertise to create and interpret CT scans of the lower gastrointestinal (GI) tract, the colon and the rectum, an experienced radiologist can accurately diagnose many causes of abdominal pain such as an abscess in the abdomen, an inflamed colon or colon cancer, diverticulitis and appendicitis.

How does the procedure work?

In many ways CT scanning works very much like other x-ray examinations. Very small, controlled amounts of x-ray radiation are passed through the body while different tissues absorb the radiation at different rates. With plain radiology, an image of the inside of the body is captured when special film is exposed to the absorbed x-rays. With CT, the film is replaced by an array of detectors that measure the x-ray profile. Inside the CT scanner is a rotating gantry that has an x-ray tube mounted on one side and an arc-shaped detector mounted on the opposite side. During each full rotation, as the fanshaped x-ray beam is emitted through the patient's body, an image of a thin section is acquired.

With conventional CT, small lesions may frequently go undetected when a patient breathes differently on consecutive scans, as a lesion may be missed by unequal spacing between scans. With spiralor helicalCT, refinements in detector technology support faster, higher-quality image acquisition with less radiation exposure. The current spiral CT scans are called multidetector CT and are most commonly four- or 16-slice systems. CT scanners with 64 detectors are now available. These instruments should provide either faster scanning or higher resolution images. Using 16-slice scanner systems the radiologist can scanning the chest or abdomen in 10 seconds or less. Such speed is beneficial in all patients but especially in populations in which the length of scanning was often problematic, such as elderly, pediatric or critically-ill patients. The multidetector CT also allows applications like CT angiography to be more successful.

- 1000 UH air-----------------0 UH water-------------------+1000 UH bone Calcification: more than 100 UH Haematoma: 60-80 UH Lipoma: - 20/ -80 UH

CT with non ionic iv.contrast

CT -Lung window

CT-Bone window

MIP CTA

Trauma

HYPERDENSE LESIONS

Trauma

HYPODENSE LESIONSLacunar infarcts

Aortic dissection

Abdominal aortic aneurysm rupture and RP haematoma

Polikystic Kydneys HIPODENSE

Liver fracture

CT

A contrast agent (e.g., iodine-based ) may be administered prior to CT scan to allow organs and structures to be seen more easily. Contrast agents can be administered through a vein (IV), by injection, or taken orally. Patients usually are instructed not to eat or drink for a few hours prior to contrast injection or IV because the dye may cause stomach upset. Patients may be required to drink an oral contrast solution 12 hours before CT scan of the abdomen or pelvis

CT without and with nonionic contrast

Hemorrhage and calcifications

What are the benefits vs. risks?

Benefits Viewing a CT scan an experienced radiologist can diagnose many causes of pain with very high accuracy enabling faster treatment and often eliminating the need for additional, more invasive diagnostic procedures. Unlike other imaging methods, CT scanning offers detailed views of many types of tissue, including the lungs, bones, soft tissues and blood vessels. CT scanning is painless, noninvasive and accurate. CT examinations are fast and simple. For example, in emergency cases they can reveal internal injuries and bleeding quickly enough to help save lives. Diagnosis made with the assistance of CT can eliminate the need for invasive exploratory surgery and surgical biopsy. CT scanning can identify normal and abnormal structures, making it a useful tool to guide radiotherapy, needle biopsies and other minimally invasive procedures. CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems.

What are the benefits vs. risks?

Risks CT does involve exposure to radiation in the form of x-ray, but the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose from this procedure is about 10 mSv, which is about the same as the average person receives from background radiation in three years. See the Safety page for more information about radiation dose.

Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.
Nursing mothers should wait for 24 hours after contrast material (iodine) injection before resuming breast feeding. The risk of serious allergic reaction to iodine-containing contrast material is rare, and radiology departments are well-equipped to deal with them.

What are the limitations of CT Scanning

The exam is not generally indicated for pregnant women.

What is MRI

Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field to provide remarkably clear and detailed pictures of internal organs and tissues. The technique has proven very valuable for the diagnosis of a broad range of pathologic conditions in all parts of the body including cancer, heart and vascular disease, stroke, and joint and musculoskeletal disorders.

MRI requires specialized equipment and expertise and allows evaluation of some body structures that may not be as visible with other imaging methods.

What are some common uses of the MRI procedure?

Because MRI can give such clear pictures of soft-tissue structures near and around bones, it is the most sensitive exam for spinal and joint problems. MRI is widely used to diagnose sports-related injuries, especially those affecting the knee, shoulder, hip, elbow and wrist. In addition, MRI of the heart, aorta, coronary arteries and blood vessels is a fast, noninvasive tool for diagnosing coronary artery disease and heart problems.

Organs of the chest and abdomenincluding the lungs, liver, kidney, spleen, pancreas and abdominal vesselscan also be examined in high detail with MRI, enabling the diagnosis and evaluation of tumors and functional disorders.
MRI is growing in popularity as an alternative to traditional x-ray mammography in the early diagnosis of breast cancer. Because no radiation exposure is involved, MRI is often the preferred diagnostic tool for examination of the male and female reproductive systems, pelvis and hips and the bladder.

T2 weighted CSPHYPERINTENSE

T1 weighted

CFSHYPOINTENSE

T1 SE

T1 FSPGR

HYPERINTENSE

Abdominal aneurysm

MRA- MIP

Portal Cavernoma

Gadolinium

MR angiography

Brest MRI

What are the benefits vs. risks?

Benefits Images of the soft-tissue structures of the bodysuch as the heart, lungs, liver and other organsare clearer and more detailed than with other imaging methods.

MRI can help physicians evaluate the function as well as the structure of many organs. The detail makes MRI an invaluable tool in early diagnosis and evaluation of tumors. MRI contrast material is less likely to produce an allergic reaction than the iodinebased materials used for conventional x-rays and CT scanning. MRI enables the detection of abnormalities that might be obscured by bone with other imaging methods. MRI provides a fast, noninvasive alternative to x-ray angiography for diagnosing problems of the heart and cardiovascular system.

What are the benefits vs. risks?

Risks An undetected metal implant may be affected by the strong magnetic field.

MRI is generally avoided in the first 12 weeks of pregnancy. Doctors usually use other methods of imaging, such as ultrasound, on pregnant women unless there is a strong medical reason to use MRI.

What are the limitations of MRI ?

Bone is better imaged by conventional x-rays in some cases and CT is preferred for patients with severe bleeding. MRI may not always distinguish between tumor tissue and edema fluid and does not detect calcium when this is present within a tumor. In most cases the examination is safe for patients with metal implants, with the exception of a few types of implants, so patients should inform the technician of an implant prior to the test. The examination must be used cautiously in early pregnancy. MRI typically costs more than CT scanning

Pancreatic pseudokyst

NHL

Liver cirrhosis.

Duodenal diverticulum

Cerebral malformation

Lacunar infarction

Intrasellar adenoma

Vertebral TBC

Multiple sclerosis

Contraindications

Absolute

- cardiac pacemaker - metalic implants - fat people (130 Kg)