Cross Sectional Imaging & Anatomy

• Cross-sectional imaging


  Julianna Hapi RA503
• Modalities used


  • CT
  • MRI
• MRI


  Stands for Magnetic Resonance Imaging
• CT


  • Multi leveled X ray, which gives a more definitive and clearer images
• Pros (Advantages) of CT

  • Quick
  • A lot of information
  • Can view small structures in the kidney
• Cons (Disadvantages) of CT

  • Ionising radiation
  • Expensive
• CT image key


  White = bones and calcification, Grey = soft tissue, Black = air
• Pros (Advantages) of MRI

  • No ionising radiation (uses magnetic fields)
  • A lot of information
  • Can be used in pregnancy
• Cons (Disadvantages) of MRI

  • Time consuming
  • Expensive
• MRI image key


  White = high intensity, Grey to black = low intensity
• TASK


  1. Log in to the SECTRA platform and navigate to: https://epsectra.com/IDS7/3pstart.aspx?pat_id=HqPrf_ANONNS0F4A12H&acc_no=HqPrf_ENS0F4A1GG&exam_id=HqPrf_RNS0F4A1JG&mrn_integration_id=default&acc_no_integration_id=EduPortalWIN-70N51L4BKT8%3a7800&sop_uid=1.2.752.24.10.1.2004090077.1223930356.2441582764.210129944&frame_number=1

  2. Take your time to explore different planes and phases for a comprehensive understanding

  3. Label the identified structures on the paper sheet as you navigate through the CT scan
• Cysts


  Benign, common and predominantly incidental. It has well demarcated fluid inside, anechoic circular mass with clear borders, hypo-dense clear border mass in right kidney
• Stones


  Radio-opaque (can be seen in X-RAY), Radio-lucent (can't be seen in X-RAY)
• Best modality for diagnosis of renal stones

  Non-contrast CT
• Struvite stones


  Contrast CT will mask the stones because the whole area will become bright, non-contrast CT will only make the stones appear bright
• End-stage renal disease (ESRD)

  Causes kidney atrophy, right kidney hypertrophied to compensate
• Kidney tumors


  • Benign - Angiomyolipoma
  • Malignant - Renal cell carcinoma
• Congenital kidney diseases


  • Horseshoe Kidney
  • Ectopic Kidney
  • Polycystic Kidney Disease
• Cystitis


  Inflamed urinary bladder with thick surrounding walls, bladder with gas bubbles due to inflammation or infection
• Benign Prostate Hypertrophy


  Hypertrophied prostate causing the bladder to be compressed
• Patient pathway


  1. Lump presentation

  2. Non Hodgkin's lymphoma

  3. Lump that hasn't gone away

  4. Presents to dr

  5. Need a complete medical history, symptom history

  6. Check lymph node, spleen and liver to exclude if its just an infection

  7. Blood test- second test for infection markers
• Biopsy


  1. Part or all of a lymph node (or tumour) is removed for testing in a lab

  2. Is the only way to confirm a person has NHL

  3. Excisional or incisional biopsy: This is the most common type of biopsy

  4. Surgeon cuts through the skin to remove the lymph node

  5. If the doctor removes the entire lymph node, it is called an excisional biopsy

  6. If a small part of a larger tumour or node is removed, it is called an incisional biopsy
• Needle biopsy


  1. Less invasive than excisional or incisional biopsies, but the drawback is that they might not remove enough of a sample to diagnose lymphoma

  2. Most doctors don't use needle biopsies to diagnose lymphoma. But might they suspect that a lymph node is enlarged because of an infection or by the spread of cancer

  3. Fine needle aspiration (FNA) biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue from an enlarged lymph node or a tumour

  4. Core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue
• Imaging


  Method for biopsy = computed tomography (CT) scan or ultrasound
• Other types of biopsies

  1. Bone marrow aspiration and biopsy= if it has interrupted the bone marrow cortex, taken from the pelvis bone typically

  2. Lumbar puncture (spinal tap): Looks for lymphoma cells in the cerebrospinal fluid (CSF)

  3. Pleural (thoracentesis) or peritoneal fluid (paracentesis) sampling: Lymphoma in the chest or abdomen Can cause fluid to build up
• First presentation for imaging

  1. Chest xray for enlarged lymph nodes, check chest infection

  2. CT scans are useful for looking for lymphoma in the abdomen, pelvis, chest, head, and neck

  3. In the body we combine CT with PET: use of radioactive tracers FDG-18 (radioactive glucose)
• PET


  • The cells in your body absorb sugar
  • Cancer cells tend to use more energy than healthy cells
  • Produces a three-dimensional colour image to show whether the lymphoma has spread
  • Benefits: shows bone marrow involvement, can be combined with mri and ct
  • Disadvantages: low spatial resolution/ false positives
• MRI


  • Used to check the brain and spinal cord
  • Soft tissue more clearly than CT scans
  • Benefits: shows spread, combined with PET, clearly differentiate abnormal lymph nodes from normal fat, muscle, vessels, adult thymus, thyroid
  • Negatives: can not effectively differentiate between cancerous tumours and non cancerous tumours/ do not identify the most aggressive tumours
• Why don't be use mri more often
• There is no study material provided in the latest message.