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GI Radiology
Gastroenterology
| Question | Answer |
|---|---|
| Radiography common uses | Bowel Obstruction (adhesions, Hernias, Volvulus, intussusception); Adynamic Ileus; Free air (upright & LLD) |
| SBO on xray | dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); poss free air; may also be post-op ileus |
| US uses | Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids) |
| Normal GB on US | dark (anechoic); bright tissue interfaces (GB wall) |
| US: Cholecystitis findings | Wall thickening, pericholecystic fluid, sonographic Murphy’s sign |
| Fluoroscopy uses: Esophagus | motility disorders, structure abnormalities (hiatal hernia) |
| Fluoroscopy uses: Small bowel | Celiac sprue, Crohn disease, Midgut volvulus (children) |
| Fluoroscopy uses: Colon | cancer screening in setting of failed colonoscopy, sigmoid or cecal volvulus |
| Fluoroscopy uses: Congenital structural abnormalities | microcolon, anorectal malformation, Hirschsprung disease |
| Fluoro Esophagus | single contrast (barium alone) or double (barium & air) |
| CT uses: Abdominal pain | Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction |
| CT other uses: | Trauma; Malignancy (Detect / stage tumors) |
| CT uses: Complications of cirrhosis | HCC, varicosities, portal hypertension |
| CT uses: Complications of pancreatitis | abscess, pseudocyst, necrosis, hemorrhage |
| MRI uses: Liver lesion characterization | Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis |
| MRI uses: Pancreatic cystic lesion characterization | Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms |
| MRI uses: Biliary tract pathology | Obstructing stones, cholangiocarcinoma |
| Nuclear med: uses: Biliary imaging | Obstructed cystic duct (ie, cholecystitis); Bile leak |
| Nuclear med: uses: Lower GI bleeding | Diverticulosis, malignancy, anticoagulation |
| HIDA | If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity |
| Tc-99 tagged RBC scan | tagged RBCs accumulate in area of hemorrhage |
| Diverticulosis/diverticulitis: sx of inflammation: | fat or tissue stranding |
| Appendix: normal size | s/b no bigger than 6 mm diameter |
| Pancreatic cancer diagnostic studies | Abd US (shows biliary duct dilatation). CT (TOC: mass & ductal dilatation). ERCP if CT neg (double duct sx of CBD & panc duct). Lap for staging. |
| For resectable pancreatic tumors, aspiration bx is: | contraindicated (risk of spreading tumor) |
| Acute pancreatitis on KUB/CXR | Atelectasis. Effusion. Sentinel loop air in small bowel/LUQ |
| If suspect pancreatic necrosis (in pancreatitis), choose this test | Abd CT with contrast on day 3 |
| Acute panc: Abd US (purpose) | to r/o or establish GB/GS/BD dilatation; enlarged hypoechoic pancreas; poss pseudocyst, edema, calcification |
| MRI/MRCP in pancreatitis (purpose) | to detect necrosis, stones/ductal disruption |
| Role of endoscopic US in pancreatitis | Limited role acutely. Useful in occult biliary disease (microlithiasis) |
| Air fluid levels on upright abd plain film | SBO |
| Apple core lesion = | Colon Cancer |
| Ascending cholangitis on US = | gallstones & dilated common bile duct |
| Classic imaging modality for free air | plain film (abd flat & upright) |
| CXR is useful to identify: | calcifications; foreign bodies; free air; obstruction |
| CXR with barium is what type of study? | fluoroscopy (used to assess transit times and mucosal abnormalities) (no longer for : CRC screening or reflux) |
| Study of choice to diagnose pancreatic cancer | EUS (if not available: CT; may also do MRI/ERCP) |
| Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: | EUS (also used for aspirational bx) |
| Gold std to visualize small bowel | Video capsule endoscopy (VCE) |
| Video capsule endoscopy (VCE) contraindications | avoid in patients with GI distress, fistulas, pregnancy or swallowing disorders |
| Role of trans-abd US | often TOC in liver, biliary dz; TOC in pediatric appendicitis |
| GI imaging modalities that have both diagnostic and therapeutic uses | EGD; ERCP; EUS (has interventional use) |
| CT/MRI | CT: primary GI malig (liver, panc); MRI: liver lesions |
| Virtual colonoscopy | req bowel prep, rectal tube; low sens/spec; MRI cannot detect lesion <5 mm |
| Ischemic bowel on imaging | X-ray: dilated loops with edema (thumbprinting). Angiography. CT may show aortic dissection, bowel distention/edema, arterial calcification |
| CXR with barium is no longer used for: | CRC screening or reflux |
| Gold standard for dx appendicitis | CT (>7 mm & >2mm thick = appy) |
| Imaging used for appy in kids: | US |
| Gall stones: dx imaging | US best; plain films only 15%; CT; HIDA (dye) |
| Acute pancreatitis: plain films | calcified gall stone/panc; sentinel loop of sm bowel; colon cut-off sx (no air distal to splenic flexure) |
| Acute pancreatitis: US/CT | US: enlarged hypoechoic pancreas; CT: enlarged panc, peripancreatic edema |
| Imaging of choice for pancreatic parenchyma | CT |
| Chronic pancreatitis findings on abdominal plain film: | Pancreatic calcifications (classic finding) |
| Chronic pancreatitis findings on CT | Pancreatic calcifications, atrophied pancreas |
| Chronic pancreatitis findings on MRCP/ERCP | Chain of lakes (areas of dilation / stenosis along pancreatic duct) |
| Pancreatic cancer: dx modalities | CT; MRI; EUS (if no lesion on CT/MRI & still have high suspicion) |
| Achalasia imaging | CXR (air fluid level in enlarged fluid filled esoph); Barium esophagography (birds beak: smooth symmetric tapering; esophageal dilatation; loss of peristalsis); upper endoscopy |
| Diffuse esophageal spasm: findings on Barium Esophagography | corkscrew contraction; rosary |
| Diffuse esophageal spasm: findings on manometry | intermittent simultaneous contraction |
| Achalasia: dx gold standard = | manometry; see complete absence of peristalsis, with simultaneous, low amplitude waves; very tight LES, lack of contractions in esophagus |
| Gastric cancer: imaging | EGD; EUS; Barium Swallow (Upper GI); CT/MRI |
| Study of choice to dx pancreatic cancer | EUS (if not avail: CT) (may also do MRI/ERCP) |
| Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: | EUS (also used for aspirational bx) |
| Trans-abdominal US is often test of choice in: | Liver & biliary dz; pediatric appendicitis |
| Esophageal ca on CXR | mediastinal widening, lung or bony mets |
| barium esophagram: polypoid, infiltrative, or ulcerative lesion = | esophageal ca adiography: GI indications: |
| SBO on xray | dilated bowel (SB > 3 cm, LB > 6 cm, cecum > 9 cm); possible free air; may also be post-op ileus |
| US uses | Cholecystitis; Liver cirrhosis; Patency of hepatic vessels; Intussusception (kids); Appendicitis (kids) |
| Normal GB on US | dark (anechoic); bright tissue interfaces (GB wall) |
| US: Cholecystitis findings | Wall thickening, pericholecystic fluid, sonographic Murphy’s sign |
| CT uses: Abdominal pain | Appendicitis, diverticulitis, bowel obstruction, cholecystitis, biliary tract obstruction |
| CT uses: Complications of cirrhosis | HCC, varicosities, portal hypertension |
| CT uses: Complications of pancreatitis | abscess, pseudocyst, necrosis, hemorrhage |
| MRI uses: Liver lesion characterization | Focal nodular hyperplasia, hepatic adenoma, HCC, hemochromatosis, hemosiderosis |
| MRI uses: Pancreatic cystic lesion characterization | Pseudocyst, mucinous or serous neoplasms, intraductal papillary mucinous neoplasms |
| MRI uses: Biliary tract pathology | Obstructing stones, cholangiocarcinoma |
| Nuclear med: uses: Biliary imaging | Obstructed cystic duct (ie, cholecystitis); Bile leak |
| Nuclear med: uses: Lower GI bleeding | Diverticulosis, malignancy, anticoagulation |
| HIDA scan: normal findings (ie, patent ducts) | If cystic duct is patent: GB accumulates radioactivity; if CBD is patent: sm bowel will accumulate radioactivity |
| Tc-99 tagged RBC scan | tagged RBCs accumulate in area of hemorrhage |
| Diverticulosis/diverticulitis: sx of inflammation on imaging | fat or tissue stranding |
| Normal-size appendix should be no bigger than: | 6 mm diameter |
| US: useful in biliary dz to: | Detect GS; eval dilation of biliary ducts (limits: obesity; eval liver parenchyma/panc) |
| Gold standard for gall stones | US; sensitivity > 95% for stones > 2mm (less sensitive for stones in CBD); GS best seen after 8hrs of fast; Stones seen as echogenic, mobile objects with acoustic shadow |
| ace of spades deformity on barium enema imaging signifies: | sigmoid volvulus |
| PUD perforation: diagnostic imaging | free air on CXR; US; CT to confirm |
| IBS Imaging/Invasive Testing (by age groups) | Pt < 40 y.o. with diarrhea: flex sig. Pt >40 y.o.: ACBE or colonoscopy |
| IBD imaging | CD: UGI, ABCE, capsule endoscopy; UC: abd film; colonoscopy, sigmoidoscopy |
Created by:
Abarnard
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