peran pemeriksaan pencitraan dalam diagnostik dan terapi neoplasma
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Pemeriksaan PENCITRAAN NEOPLASMA. Peran Pemeriksaan Pencitraan dalam Diagnostik dan Terapi Neoplasma. dr. Lila Indrati, SpRad. Oncologic Imaging. Basic knowledge should be understood:. Imaging Diagnostic for Oncology :. Metastase dari GI dan UG

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oncologic imaging
Oncologic Imaging

PEMERIKSAAN PENCITRAAN NEOPLASMA

basic knowledge should be understood
Basic knowledge should be understood:

PEMERIKSAAN PENCITRAAN NEOPLASMA

imaging diagnostic for oncology
Imaging Diagnostic for Oncology :

PEMERIKSAAN PENCITRAAN NEOPLASMA

secondary tumor
Metastase dari GI dan UG

Hematogenous: discrete and circumscribed coarsenoduler

Limfangitis,pleural efusi

Secondary Tumor
slide12

Pemeriksaan dengan Barium

PEMERIKSAAN PENCITRAAN NEOPLASMA

barium meal
Barium Meal
  • Minum bubur barium
  • Barium  radio opaque
  • Dapat menilai :

Oesophagus, Gaster (Maag), Duodenum

  • Misalnya :

tumor oesophagus

varices oesopagus

atresia oesop

tumor gaster

PEMERIKSAAN PENCITRAAN NEOPLASMA

pemeriksaan barium enema colon in loop
Pemeriksaan Barium Enema (Colon In Loop)
  • Barium dimasukan kedalam rectum

(dengan canul) sampai mengisi seluruh colon

  • Dipompakan udara
  • Dapat menilai seluruh colon

misalnya Ca colon, colitis ulcerative,

polip, dll

  • Dilakukan dibawah fluoroskopi

PEMERIKSAAN PENCITRAAN NEOPLASMA

pemeriksaan dengan kontras cair ionik non ionik
Pemeriksaan dengan kontras cair (ionik –non ionik)
  • Disuntikkan intravena ( IV)
  • Tidak disuntikkan (dimasukkan)

PEMERIKSAAN PENCITRAAN NEOPLASMA

ultrasonografi usg
Ultrasonografi (USG)
  • Gelombang suara dengan frekuensi lebih tinggi dari kemampuan pendengaran telinga manusia
  • 1- 13 MHz
  • Dapat menilai :

hepar, lien, kandung empedu, ginjal, buli-buli, thyroid, testis, pembuluh darah dll

PEMERIKSAAN PENCITRAAN NEOPLASMA

computed tomography scan ct scan
Computed Tomography Scan (CT Scan)

PEMERIKSAAN PENCITRAAN NEOPLASMA

computed tomography scan ct scan1
Computed Tomography Scan (CT Scan)

PEMERIKSAAN PENCITRAAN NEOPLASMA

magnetic resonance imaging mri
Magnetic Resonance Imaging (MRI)

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide26
Prinsip kerja :
  • Inti atom bergetar dalam medan magnet
  • Tubuh manusia (H2O)  kosentrasi atom hidrogen tinggi ( + 70 %)

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide31

Peran Utama:

MENENTUKAN DERAJAT AGRESIFITAS DARI LESI TULANG

  • AGRESIF  GANAS
  • NON AGRESIF  JINAK
jinak vs ganas
Jinak vs. Ganas
  • Batas Lesi
  • Jenis reaksi periosteal
  • Besarnya massa jaringan lunak
diagnosis patologi harus melalui serangkaian analisis yang melibatkan
DIAGNOSIS PATOLOGI, harus melalui serangkaian analisis yang melibatkan:
  • Umur
  • Lokasi: a. pada tulang apa

b. pada bagian mana

3. Jenis kalsifikasi dari jaringan lunaknya

pendekatan diagnosis patologis
Pendekatan diagnosis patologis
  • Umur(perhatikan puncak insidensi tumor secara statistik)
  • Lokasi: pada tulang apa, lokasi longitudinal (dia-meta-epi fisis), lokasi transversal (cortex, medula, periosteal, par osteal)
  • Jenis kalsifikasi pada tumor matrix:

Osteoid matrix (lebih homogen/ sclerosis), Chondroid matrix (bercak-bercak)

slide37

Gastro Intestinal Malignacy

PEMERIKSAAN PENCITRAAN NEOPLASMA

cancer of the oesophagus
Cancer of the Oesophagus

Barium meal

Oesophagography

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide40

Polypoid carcinoma of

  • Lower oesophagus, involving Stomach .
  • The lower oesoph irregularly narrowed
  • Neoplastic tissue has infiltrated and destroyed the mucosal fold .
  • A large shelving defect project into oesophagus

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide41

GASTRIC CANCER

Barium Meal examination

( O M D )

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide42

Cancer of the

stomach

Polypoid carcinoma

Of Upper third of

Stomach :

A large irreguler mass

(small arrow) project

Into the air filled of the

Upper portion of the

Stomach . Tumor

Extensions surround

The cardia ( large

arrow) and invaded

the posterior soft

Tissue

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide43

Differential Diagnosis

OMD shows a giant

Excavating Gastric

Ulcer along the greater

Curvature (arrow heads)The projection of the ulcer Crater beyond the gastric

Lumen the sharp margination

and the smooth border Indicate a beign ulcer with peptic acid

Disease

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide44

Polypoid and infiltrative

Carcinoma of the gastric

Anthrum .

The gastric anthrum is

Grossly deformed by large

Filling defect along

The greater curvatura (large

Arrow) The lesser curvature

Is rigid and irregular ( small arrow) , with intra luminal

Polypoid defects ( black

Arrow )

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide45

ADVANCE INFILTRATIVE

CARCINOMA OF STOMACH

(LINNITIS PLASTICA)

The entire stomach except fundus has been infiltrated. The walls are rigid , and somewhat irregulair , and the mid portion of the stomach ( samll arrow) is fixed and narrowed. No mucosal

Fold are seen , nor peristalsis is evident in this portion . Ther is a fixed deformity of the greater curvature in the pre anthral area ( largearrow ) and the entire anthrum narrowed and fixed

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide46

Colo Rectal Carcinoma

Barium Enema

( Colon in Loop)

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide49

Varius type of colorectal carcinoma and the distributionfrequency

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide50

Double contrast enema

Study demonstrate

A circumverential constricting ( apple

Core ) lession in proximal ascending colon

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide51

Differential Diagnosis :

Many diseases are very

Similar with malignant

Disesease of the

Colorectal

This case was : amoebiasis

Of the Colon

A very carefull examination sbould be done before making diagnosis

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide52

Annulair Carcinoma

Of Descending Colon

The segment between arrow

Is narrowed , irregulair and rigid. And show loss of mucosal pattern .

Note the abrupt tarnsition to normal

Colon at the lower end with a small

Shoulder defect

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide53

Annulair and Polypoid

Carcinoma of descending colon

Full Filling posterio anterior film is difficult to find the lession , which is occurred by redundant splenic flexture

Oblique view

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide54

Infiltratif and Polypoid

Lession of Coecum and ascending

Colon

In the narrowed area the walls are iregularly infiltrated with polypoid masses

( arrowhead) replacing the mucosal Fold . Extension of the

Masses produce large

Shoulder defect in the proximal colon

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide55

Neoplasma pada Hepatobilier & Pancreas

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide56

Method of examination :

  • CT Scan
  • 2. Ultrasonography

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide60

CT :

Cystadeno

carcinoma

Of the

pancreas

The big, multi

lobulated mass arised

From the tail of the pancreas

And invading

the spleen

The head and

body

Pancreas are

normal.

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide61

Differential Diagnosis :

ACUTE PANCREATITIS : Enlargement and low

Density pancreas in 35 years old alcoholic . Inflamation of the anterior pancreas ( arrowhead) and thickening of the lateral conal fascia (arrow) Fat arround mesenteric vessels is preserved , which is typical of

Acute pancreatitis.

CHRONIC PANCREATITIS :

Enhanced CT : Enlarged head, Uncinate with punctate calcification. Pancreatic duct massively dilated

PEMERIKSAAN PENCITRAAN NEOPLASMA

slide62

Terima Kasih

PEMERIKSAAN PENCITRAAN NEOPLASMA

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