The radiological methods of the

gastrointestinal system examination

Dr.Tatyana Lenchuk

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

The special contrast methods

- Double contrasting- Pneumoparietography of the stomach

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.

- 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.

peristalsis

narrowing (arc)

cardia

parallel

The folds of mucosa – parallel, longitudinal;

longitudinal

The X-ray anatomy and examination of the stomach1. 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.

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

trendelenburg

 Double-contrast gastrography

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

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

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.

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).

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

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.

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

N

The X-ray anatomy and examination of large intestine

1. The methods of examination:- Per os;- Irrigoscopy – contrast enema.

2. X-ray anatomy and parts of the large intestine:

- Caecum;- C. ascendens;- C. transversum;- C. descendens;- C. sygmoideum;- Rectum.

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.

N

 Double-contrast irrigoscopy

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 .

MRISometimes, 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.

The pathology of the gastrointestinal tract1. 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 )

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.

Radiographs of the esophagus with

achalasia cardia: visible sharply

narrowed terminal esophagus, supra-

stenotic extension of the esophagus,

stomach gas bubble is not defined.

Balon dilatation

Achalasia before after

Radiographs of esophageal perforation: taken by mouth radiopaque substance is distributed in the posterior mediastinum in the form of a large streaks.

Рис. 3. Рентгенограмма пищевода при перфорации: принятое через рот рентгеноконтрастное вещество распространяется в заднем средостении в виде большого затека.

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

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.

filling defectcancerfilling defect

cancer

filling defect

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.

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

PET CT (esophageal cancer)

- Burn of esophagus:The first examination is possible after 2-3

weeks.Symptoms:• Circular stenosis;• Flat contours;• Deformation – cone-, funnel-, ampullar.-Foreign substancesMethod by Ivanova : after 1-2 sips of

barium sulfate patient takes one sip of water, balances contrast are above the foreign body.

burn

Рентгенпозитивні сторонні тілаРентгенпозитивні сторонні тіла

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

- 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).

Chronic ulcer

niche

niche

nicheulcer

ulcer

niche

ulcer

niche

ulcerniche

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

Symptoms:• filling defect;• the absence of the folds of mucosa;• the absence of peristalsis at the defect

localization;• stenosis of the lumen.

Cancer of stomach:

filling defect

Cancer of stomach:

filling defect

Cancer of stomach:

filling defect

cancer

• filling defect

polyposis

filling defect

Malignant polyps of stomach

filling defect

Computed tomography tumor formation

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

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.

colitis

smoothness of haustrum

Colorectal polypClinical 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.

Diverticula of the colon

protrusion wall filled with contrast

foreign bodie

 Plain abdominal x-ray showing multiple foreign

bodies.

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

Cancer of the large intestine

filling defect

Cancer of the large intestine

filling defect

Cancer of the large intestine

filling defect

  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

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 .

The x-ray picture of the acute abdomen1. Bowel obstruction.- high;- low.Symptoms:- Kloyberg cups(at the background of

swallen bowel there is the presence of horisontal level of fluid).

Symptoms obstruction the small intestine:

Kloyberg cups located in the central parts of the image;

-Height is greater than their width; -Not see haustres.

Symptoms obstruction in the large intestine:

Kloyberg cups located in peripheral parts of the image;

Their width is greater than height; Haustres - see.

Kloyberg cups

Kloyberg cups

Bowel obstruction Kloyerg cups

2. Perforate ulcer.

- Symptom of sickle (the presence of air under the right cupola of the diaphragm).

Symptom of sickle