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Oncology Imaging

Oncology Imaging. Principal Imaging Modalities. Plain films (images) Ultrasound (US) Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Nuclear Medicine. Contrast media. Barium sulphate Organic iodine preparations Ultrasound contrast agents

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Oncology Imaging

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  1. Oncology Imaging

  2. Principal Imaging Modalities • Plain films (images) • Ultrasound (US) • Computed Tomography (CT) • Magnetic Resonance Imaging (MRI) • Nuclear Medicine

  3. Contrast media • Barium sulphate • Organic iodine preparations • Ultrasound contrast agents • Magnetic Resonance Imaging contrast agents. ＊Contrast media may have allergic reactions.

  4. Reactions related to Iodinated contrast media • Minor reactions: nausea, vomiting, urticarial rash, headache. • Intermediate reactions: hypotension, bronchospasm • Major reactions: convulsions, pulmonary oedema, cardiac arrhythmias, cardiac arrest.

  5. Radiation Protection (1) • Although ionizing radiation is deemed to be potentially hazardous, the risks should be weighed in context of benefits to the patient.

  6. Radiation Protection (2) • Clear requests with relevant clinical details. • Discussion of complex cases with radiologists.

  7. Radiation Protection (3) • Ultrasound }Lack of ionizing radiation • M R I

  8. Digital Radiography The principal advantages of digital radiography are: • significant reduction in radiation exposure; • digital enhancement ensures all images are of an adequate quality; • transfer of images out of the radiology department to other sites;

  9. Digital Radiography • elimination of storage problems associated with conventional films: • no missing films; • rapid retrieval of previous images and reports for comparison; • ease of availability of examinations to clinicians.

  10. Ultrasound USES • Brain: Imaging the neonatal brain. • Thorax: Confirms pleural effusions and pleural masses. • Abdomen: Visualizes liver, gallbladder, pancreas, kidneys, etc. • Pelvis: Useful for monitoring pregnancy, uterus and ovaries. • Peripheral: Assesses thyroid, testes and soft-tissue lesions.

  11. Ultrasound Advantages • Relatively low cost of equipment. • Non-ionizing radiation and safe. • Scanning can be performed in any plane. • Can be repeated frequently, for example pregnancy follow up.

  12. Ultrasound Advantages • Detection of blood flow, cardiac and fetal movement. • Portable equipment can be taken to the bedside for ill patients. • Aids biopsy and drainage procedures.

  13. Ultrasound Disadvantages • Operator dependent. • Inability of sound to cross an interface with either gas or bone causes unsatisfactory visualization of underlying structures. • Scattering of sound through fat produces poor images in obesity.

  14. Computed Tomography USES • Any region of the body can be scanned; brain, neck, abdomen, pelvis and limbs. • Staging primary tumours such as colon and lung for secondary spread, to determine operability or a baseline for chemotherapy. • Radiotherapy planning. • Exact anatomical detail when ultrasound is not successful.

  15. Computed Tomography Advantages • Good contrast resolution. • Precise anatomical detail. • Rapid examination technique, so valuable for ill patients. • In contrast to ultrasound, diagnostic images are obtained in obese patients as fat separates the abdominal organs.

  16. Computed Tomography Disadvantages • High cost of equipment and scan. • Bone artefacts in brain scanning, especially the posterior fossa, degrade images. • Scanning mostly restricted to the transverse plane, although reconstructed images can be obtained in other planes. • High dose of ionizing radiation for each examination.

  17. Magnetic Resonance Imaging USES • Central nervous system (CNS): technique of choice for brain and spinal imaging. • Musculoskeletal: accurate imaging of joints, tendons, ligaments and muscular abnormalities. • Cardiac: imaging with gating techniques related to the cardiac cycle enables the diagnosis of many cardiac conditions.

  18. Magnetic Resonance Imaging USES • Thorax: assessment of vascular structures in the mediastinum. • Abdomen: abdominal organs are well visualized, surrounded by high signal from surrounding fat. • Pelvis: staging of prostate, bladder and pelvic neoplasms.

  19. Magnetic Resonance Imaging Advantages • Can image in any plane-axial, sagittal or coronal. • Non-ionizing and hence believed to be safe to use. • No bony artefacts due to lack of signal from bone.

  20. Magnetic Resonance Imaging Advantages • Excellent anatomical detail especially of soft tissues. • Visualizes blood vessels without contrast: magnetic resonance angiography (MRA). • Intravenous contrast utilized much less frequently than CT.

  21. Magnetic Resonance Imaging Disadvantages • High operating costs. • Poor images of lung fields. • Inability to show calcification with accuracy.

  22. Magnetic Resonance Imaging Disadvantages • Fresh blood in recent haemorrhage not as well visualized as by CT. • MRI more difficult to tolerate with examination times longer than CT. • Contraindicated in patients with pacemakers, metallic foreign bodies in the eye and arterial aneurysmal clips (may be forced out of position by the strong magnetic field).

  23. Respiratory Tract

  24. Modalities for Respiratory Tract Investigations • Plain films (images) • Computed tomography (CT) • Ultrasound (US) • Isotopes • Pulmonary angiography • Magnetic resonance imaging (MRI)

  25. CT for Respiratory tract • Excellent detail for localizing and staging mediastinal masses and bronchial neoplasms. • Assesses hilar areas to identify lymphadenopathy, and to differentiate from prominent pulmonary arteries. • Visualizes accurately pleural masses, plaques and fluid associated with asbestos exposure.

  26. US for Respiratory tract • Presence of the pleural effusions and loculated fluid. • Biopsy of pleural lesions.

  27. MRI-for respiratory tract • Evaluation of mediastinal masses, aortic dissection and staging bronchial carcinoma. • Evaluation of vascular invasion.

  28. Bronchial carcinoma A common primary tumour Histological types: squamous, small (oat) cell, anaplastic, adenocarcinoma, alveolar cell carcinoma.

  29. Bronchial carcinoma • Haemoptysis • Respiratory symptoms

  30. Bronchial carcinoma Radiological features • Lobulated or spiculated mass but sometimes with a smooth outline. • Tumours at the lung apex (Pancoast's tumour) can invade the brachial plexus, resulting in shoulder and arm pain with wasting of the hand, or invasion of the sympathetic chain may give rise to Horner's syndrome.

  31. Bronchial carcinoma CT/MRI -Assesses spread. -Determines operability.

  32. Differential diagnosis of solitary lung mass • Metastasis: -Breast, kidney, colon, testicular tumours. • Tuberculoma • Benign neoplasms -Bronchial adenoma , hamartoma round pneumonia, hydatid cyst, haematoma , arteriovenous malformation.

  33. Bronchial carcinoma Common sites of distant metastases - Brain - Bone - Adrenals - Liver

  34. Mediastinal mass Imaging modalities – Plain film CT MRI

  35. Mediastinal mass • Anterior mediastinal masses - thyroid , thymus , teratodermoid • Middle mediastinal masses - lymphoma, metastases, sarcoid or tuberculosis. • Posterior mediastinal masses - neurogenic tumours neurofibromas ganglioneuroma

  36. Gastrointestinal tract (GI)

  37. Gastrointestinal tract (GI) Imaging modalities -Plain films (images) -Barium studies -Angiography -Computed tomography -Ultrasonography -Magnetic resonance imaging

  38. Gastrointestinal tract (GI) CT - to assess for operability by staging oesophageal, gastric and colonic tumours. - to evaluate adjacent infiltration and secondary deposits.

  39. Esophageal Carcinoma • Squamous cell type • Distal third Male > Female • Predisposing factors - Achalasia - Barrett’s esophagus

  40. Esophageal Carcinoma Imaging modalities - Barium - CT: tumour confinement to the wall or extraluminal spread. - US: secondary deposits

  41. Esophageal Carcinoma Radiological features • Polypoidal type: an intraluminal mass protrudes out into the oesophageal lumen causing a filling defect in the barium column. • Infiltrative type: the tumour spreads under the oesophageal mucosa without extending into the lumen, causing narrowing. Later there is mucosal infiltration resulting in ulceration and an irregular outline to the oesophagus.

  42. Gastric Carcinoma A general decrease in the incidence of gastric carcinoma.

  43. Gastric Carcinoma Clinical Presentations: Dyspepsia , anorexia, nausea, vomiting, Body weight loss, Haematemesis or melaena.

  44. Gastric Carcinoma Imaging modalities - Barium meal - CT }preoperative evaluation - US

  45. Gastric Carcinoma Radiological features Barium meal • Polypoidal type - soft-tissue mass causing a filling defect. • Ulcerating type - ulcerating within the margin of the stomach.

  46. Gastric Carcinoma • Diffuse infiltrating type - diffuse submucosal infiltration ( linitis plastica) small rigid stomach ( leather bottle stomach) { poor distensibility • Local infiltrating type - focal area of mucosal irregularity and narrowing at the site of the tumour.

  47. Colonic carcinoma • Commonest malignancy of GI tract. • Usually adenocarcinoma

  48. Colonic carcinoma Imaging modalities - Plain films. - Barium - Ultrasound - CT/MRI colonoscopy staging

  49. Colonic carcinoma Radiological features • Annular carcinoma - irregular luminal narrowing , apple-core deformity. • Polypoidal mass - intraluminal filling defect.

  50. Colonic carcinoma • Complications - Obstruction - Perforation - Fistula formation

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