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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Peran pemeriksaan pencitraan dalam diagnostik dan terapi neoplasma

PemeriksaanPENCITRAANNEOPLASMA

Peran Pemeriksaan Pencitraan dalam Diagnostik dan Terapi Neoplasma

dr. Lila Indrati, SpRad.


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




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


Prinsip kerja :

  • Inti atom bergetar dalam medan magnet

  • Tubuh manusia (H2O)  kosentrasi atom hidrogen tinggi ( + 70 %)

PEMERIKSAAN PENCITRAAN NEOPLASMA





FOTO POLOSMASIH MENJADI ANDALAN UNTUK DIAGNOSIS TUMOR TULANG


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 melibatkan:

  • 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)


Lokasi pada tulang tertentu umur

Lokasi pada tulang tertentu melibatkan:& Umur


Lokasi longitudinal dan transversal pada tulang panjang
Lokasi longitudinal dan transversal melibatkan:pada tulang panjang


Gastro Intestinal Malignacy melibatkan:

PEMERIKSAAN PENCITRAAN NEOPLASMA


Cancer of the oesophagus
Cancer of the Oesophagus melibatkan:

Barium meal

Oesophagography

PEMERIKSAAN PENCITRAAN NEOPLASMA


Varius type of lession caused by oesophageal carcinoma
Varius type of lession caused by Oesophageal Carcinoma melibatkan:

PEMERIKSAAN PENCITRAAN NEOPLASMA


  • Polypoid carcinoma of melibatkan:

  • 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


GASTRIC CANCER melibatkan:

Barium Meal examination

( O M D )

PEMERIKSAAN PENCITRAAN NEOPLASMA


Cancer of the melibatkan:

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


Differential Diagnosis melibatkan:

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


Polypoid and infiltrative melibatkan:

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


ADVANCE INFILTRATIVE melibatkan:

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


Colo Rectal Carcinoma melibatkan:

Barium Enema

( Colon in Loop)

PEMERIKSAAN PENCITRAAN NEOPLASMA


Colo-rectal diseases can be detected by Colon in loop melibatkan:

PEMERIKSAAN PENCITRAAN NEOPLASMA



Varius type of colorectal carcinoma and the distributionfrequency

PEMERIKSAAN PENCITRAAN NEOPLASMA


Double contrast enema distributionfrequency

Study demonstrate

A circumverential constricting ( apple

Core ) lession in proximal ascending colon

PEMERIKSAAN PENCITRAAN NEOPLASMA


Differential Diagnosis distributionfrequency :

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


Annulair Carcinoma distributionfrequency

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


Annulair and Polypoid distributionfrequency

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


Infiltratif and Polypoid distributionfrequency

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


Neoplasma pada Hepatobilier & Pancreas distributionfrequency

PEMERIKSAAN PENCITRAAN NEOPLASMA


PEMERIKSAAN PENCITRAAN NEOPLASMA


Hepatoma
Hepatoma distributionfrequency


Metastase hepar
Metastase hepar distributionfrequency


Karsinoma kandung empedu
Karsinoma kandung empedu distributionfrequency


CT : distributionfrequency

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


Differential Diagnosis : distributionfrequency

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


Terima Kasih distributionfrequency

PEMERIKSAAN PENCITRAAN NEOPLASMA


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