Imaging in Genitourinary malignancies

Slides:



Advertisements
Similar presentations
Radiologic Imaging Defines the local extent of a tumor Can be used to stage malignant disease Aids in the diagnosis Monitoring tumor changes after treatment.
Advertisements

STAGING OF BRONCHOGENIC CA NSCLC STAGING TNM CLASSFICATION Adenocarcinoma Squamous cell carcinoma Large cell carcinoma T – Primary tumor N – Regional.
The Thyroid Incidentaloma
Brain Neoplasm. Benign –May have aggressive tendencies –May transition to more aggressive lesion –Tends to be slower growing Primary malignant –Age distribution.
Pelvis Lab. Case 1 36 year old woman with pelvic pain.
Imaging modalities in prostate cancer
CT Urography and applications in uroephithelial tumors
Bladder CA-Staging.
In biochemical recurrence after curative treatment of prostate cancer, Choline PET/CT 1- has a detection rate of 10-20% when PSA: 1-2 ng/ml 2- has a detection.
Metastatic involvement (M) M0 - No metastases M1 - Metastases present.
Imaging Studies Of Renal System
Background on: Breast Cancer, X-Ray and MRI Mammography
Update on 18 F-Fluorodeoxyglucose/Positron Emission Tomography and Positron Emission Tomography/ Computed Tomography Imaging of Squamous Head and Neck.
TUMOURS OF NASAL CAVITY & PARANASAL SINUSES
SYB Case 2 By: Amy. History 63 y/o female History of left breast infiltrating duct carcinoma s/p mastectomy in 1996 and chemotherapy ER negative, PR negative,
Chapter 28 Lung Cancer. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Objectives  Describe the epidemiology of.
WORK UPS. Ultrasound method of choice for the differentiation of cysts from solid masses and for guidance in interventional procedures. Benign: – solid.
Urinary Tract Dr. Nasr A. Mohammed FIBMS.
HUMAN ANATOMY LECTURE ONE BODY OVERVIEW. ANATOMY TOPICS Gross or macroscopic: structures examined without a microscope - Regional: studied by area - Systemic:
Neoplasms of the bladder
Genitourinary Imaging-----Prostate
Pelvis Lab Lab notes by Andrew Haims, MD. ©2004 Yale School of Medicine.
Grading And Staging Grading is based on the microscopic features of the cells which compose a tumor and is specific for the tumor type. Staging is based.
3. What work ups are needed, if any?
Bladder Diverticuli May be congenital May be congenital Usually secondary to chronic obstruction of bladder outflow. Usually secondary to chronic obstruction.
1. Clinical Impression? Differentials?. Thyroid Carcinoma commonly manifests as a painless, palpable, solitary thyroid nodule The patient's age at presentation.
Examination of Pathology Demonstration of Thyroid Nodules And the Post Thyroidectomy Neck.
Urinary system.
Characteristic Dynamic Enhancement Pattern of MR imaging for Malignant Thyroid Tumor XIX Symposium Neuroradiologicum Division of Head & Neck radiology.
Cervical cancer: radiation oncologist perespective
UROGENITAL Clinical cases
Supraclavicular metastasis from urothelial bladder carcinoma: A case report S. Farmahan, T. Mirza, P. Ameerally Oral Maxillofacial Department, Northampton.
Diseases of the prostate Osvaldo Rubinstein, MD. Normal urinary bladder with right and left ureters.
Figure 1: a 32-year-old woman presented with RT breast mass, MRI showed false positive diagnosis of cancer. Dynamic contrast enhanced MRI, axial subtraction.
Urinary system (Imaging)
46 Magnetic Resonance Imaging of the Female Pelvis.
Conventional Tomography :. Conventional Tomography Performed when there is overlap of bony or soft tissue structures at the area of interest, Multiple.
Radiology of urinary system
Radiological Anatomy & Investigations of Urinary System
CORRELATION OF PHYSICAL EVALUATION AND MRI OF CERVICAL LYMPH NODE WITH HISTOPATHOLOGICAL FINDINGS IN ORAL SQUAMOUS CELL CARCINOMA: AN AMBIDIRECTIONAL STUDY.
Zehra Nihal Dolgun, Ahmet Salih Altintas, Cihan Inan, Petek Balkanli
Radiology Renal System
Prostate cancer นพ.ชัชชัย หอมเกตุ.
Prostate Cancer Dr .Gehan Mohamed.
Urinary tract radiology
FDG PET-CT of Genitourinary and Gynecologic Tumors: Overcoming the Challenges of Evaluating the Abdomen and Pelvis  Leslie K. Lee, MD, Aoife Kilcoyne,
RADIOLOGY OF SKELETAL SYSTEM Lecture 1
Fig year-old man with lymph-node metastasis from pelvic extraskeletal Ewing sarcoma family of tumors. A. Axial contrast-enhanced computed tomography.
Radiology Renal System
CT of the abdomen.
Two lesions are seen within the lateral segment of the left lobe of the liver (yellow arrows). They appear mildly hyperintense on T2 images and mildly.
Pelvis & Perineum Anatomy
Magnetic Resonance Imaging of Anorectal Neoplasms
Magnetic resonance imaging of less common pancreatic malignancies and pancreatic tumors with malignant potential  D. Franz, I. Esposito, A.-C. Kapp, J.
Brett W. Carter, MD, Meinoshin Okumura, MD, Frank C
Pelvic Applications of Diffusion Magnetic Resonance Images
Liver Masses: A Clinical, Radiologic, and Pathologic Perspective
Inflammatory Pseudotumours in the Abdomen and Pelvis: A Pictorial Essay  Tony Sedlic, MD, Elena P. Scali, MD, Wai-Kit Lee, MD, Sadhna Verma, MD, Silvia.
Positron Emission Tomography in Lung Cancer
Annalisa K. Becker, MD, FRCPC, David K. Tso, MD, Alison C
Assessing the validity of Prostate Imaging Reporting and Data System version 2 (PI- RADS v2) scoring system in diagnosis of peripheral zone prostate cancer 
Multimodality Imaging of Tumour Thrombus
Kartik S. Jhaveri, MD, Waseem Mazrani, FRCR(UK), Tanya P
Cross-Sectional Imaging of Small Bowel Malignancies
Pancreatic and Extrapancreatic Features in Autoimmune Pancreatitis
Applications of Diagnostic Imaging X-Ray
Cross-Sectional Imaging of Small Bowel Malignancies
Diffusion Magnetic Resonance Imaging in the Head and Neck
MR-PET of the body: Early experience and insights
Radiological Anatomy & Investigations of Urinary System
Presentation transcript:

Imaging in Genitourinary malignancies

The evolution of imaging techniques . Imaging techniques used as tools for Diagnosis Staging Follow up

Diagnostic tool - Clinically efficient & cost effective manner . The ultimate goal of imaging – Safe and effective examination. Clinically relevant information for the treatment .

Imaging modalities Plain skygram Intravenous urography Ultrasound Computed tomography Magnetic Resonance Imaging Positron emission tomography

Strengths and weakness

Evaluation of GU neoplasm Combination of clinical and diagnostic imaging methods Role of imaging are :- Detecting & Characterizing mass. Supplementing clinical staging Pre-operative planning Assessment of Tumor recurrence.

Kidneys Sky gram KUB Bean shaped retroperitoneal organs Location D12-L1 level

Ultrasonography Extensively used and widely available method. Often first step in diagnostic workup. Sensitivity is less than CT. Still questions can be answered.

Ultrasonography Solid mass Cystic lesions diagnosis is based on Bosniak Classification System

Kidney tumour Diagnostic Modality of choice MDCT( multiphase contrast enhanced CT) Staging of tumour . Digital elements and post processing features. (multiplane reconstruction . 3D or virtual urography images can be generated any time from the primary database)

Renal mass invading left renal vein

Renal mass

MRI Can be used with similar diagnostic efficacy Advantages and disadvantages

Radiological diagnostics of collecting system disease ,Ureters and urinary bladder

Ureters Physiological stenosis Ureters are in retroperitoneam Cross superficial to iliac arteries Crosses posterior to the testicular artery/ovarian artery Also pass dorsally to uterine artery and spermatic cord

Radiologic imaging Needs contrast filling of the ureters It is achieved by anterograde or retrograde filling of the ureters by catheter insertion In cross-sectional imaging techinique (CT,MR)timed image acquisition is conducted in excretory phase (app 8-10 minutes)

Urinary Bladder Is Pelvic Organ in undistended condition Extends to abdomen when fully distended Divided into Vertex, Corpus and fundus Ureters enter the bladder through the posterocaudal part of the fundus (vesical trigone)

Radiographic imaging Definitive diagnosis can be established with Cystoscopy and biopsy . Imaging plays an important role in early detection and staging of the disease

IVU Bladder mass

Ultrasound Pre requirement is full distention of lumen Normal wall thickness is 3mm.

MDCT & MRI Extent of propogation of disease Nodal involvement Distant metastasis Virtual endoluminal images can be reconstructed from excretory phase series

Urinary bladder mass

Urinary bladder mass

Urinary bladder mass

Prostate (USG) The base line imaging modality It is performed Perabdominal Transrectal route (TRUS) Elastography TRUS guided biopsy

PROSTATE Familiarity with Zonal classification of prostate is necessary for the understanding of basic clinical and radiological concepts of prostatic disease.

Prostate

Prostate

CT Scan Poor in delineating zonal anatomy Strength is in evaluating regional and distant metastasis

MRI Delineates zonal anatomy well Provides most accurate information to date about anatomy and location of tumour . Capsule invasion Seminal vesicle invasion Bony metastasis

Normal MRI appearance of Prostate Normal prostate has homogenous low signal on T1WI Zonal anatomy is best demonstrated on T2WI Comprise of low signal central zone and higher signal peripheral zone TZ and CZ appears similar in SI and loosely termed the central gland

Normal T2 appearance of Prostate At the base of bladder: The anterior fibromuscular stroma (arrow) consists of nonglandular tissue and appears dark. Note the symmetric homogeneous muscular stroma layer (arrowheads) in the posterior prostate base Midprostate level : Homogeneously bright peripheral zone (arrowheads) surrounding the central gland (white arrows). The central gland is composed of the transition zone and central zone, which cannot be resolved at imaging. Therefore, they are referred to jointly as the central gland. Note the neurovascular bundles at the 5-o’clock and 7-o’clock positions (black arrows). At prostate apex : The homogeneous peripheral zone (arrowheads) surrounding the urethra (U). Note that the volume of the peripheral zone increases from the base to the apex.

Strength of MRI Contrast enhanced dynamic scan MRS Diffusion Imaging Biopsy

50-year-old male with prostate cancer. Axial T2WI showing low signal within the rightward aspect of the peripheral zone (∗). Note the normal-appearing contralateral peripheral zone (PZ) comprised of glandular elements. Also, the right rectoprostatic angle appears slightly ill-defined, although no definite bulge is seen. 50-year-old male with prostate cancer. (b) Axial T1WI showing an enlarged right external iliac chain lymph node, a regional lymph node according to the TNM staging system. This would comprise N1 disease, which would fall under Stage IV category.

Axial T2WI showing a right anterior transitional zone tumor within the midgland with the tumor creating a slight anterior bulge.

Multifocal peripheral zone tumors

MR SPECTROSCOPY OF PROSTATE NORMAL METABOLITES OF PROSTATE Citrate : Produced by normal epithelial cells of prostate Normal Peak at 2.6 ppm Choline : Precursor of phospholipids cell membrane Normal Peak at 3.2 ppm Creatine : Involved in cellular energy Normal peak at 3 ppm

Normal MR Spectroscopy MR spectroscopic spectrum, obtained at 1.5 T shows a high citrate (Ci) peak (resonance at 2.6 ppm) and a low choline (Ch)peak (resonance at 3.2 ppm), characteristics of benign tissue. The choline and creatine (Cr)peaks are overlapping. At 3 T : Good separation of the choline (Cho)and creatine (Cr)peaks at higher magnetic field strength. The spectrum is normal, with a high concentration of citrate (Ci)and low concentration of choline. At 1.5 T At 3 T

Radionuclide Scintigraphy For metastatic work up

PET CT

Testicular Imaging Ultrasonography is the best modality for rapid and accurately assessing scrotal masses Can determine truly intra or extra testicular masses Facilitates testicular examination in presence of hydrocele

chest skygram/CT/MRI 85-90% of lung metastasis is detected by skygram CT is the modality for evaluation of retropertoneum MRI has no additional value

PET Scan Beneficial in evaluation of residual masses after treatment perticularly viable carcinoma.

Uterus Ultrasound CT MRI

uterus

Uterus CT Scan

Endometrial carcinoma MDCT :- Thin slices ,isotropic database & reconstruction in multiple user defined planes. Can detect myometrial invasion. Assessment of nodes. Distant metastasis Recurrence.

Uterine Cervical Carcinoma Lesion size Extension into the uterine corpus. Depth of stromal invasion . Parametrial spread. Loco-regional spread Pelvic lymphadenopathy Distant metastasis

Ovarian tumors C.T is used to Adnexal masses are common findings and the key is to distinguish benign from potentially malignant . C.T is used to Characterize an adnexal mass Assess for metastatic disease Stage patient for metastatic disease.

Conclusion Imaging is the key to evaluate the clinically diagnosed mass All modalities have their strength and weakness. we need to understand them. We have to be wise enough to use various modalities judiciously for ultimate benefit of the patient