경희대학교 의과대학·의학전문대학원

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(1)

Radiologic Dx of GI Tract

Dong Ho LEE, M.D.

Department of Diagnostic

Radiology

Kyung Hee University Medical

Center

(2)

• Simple abdomen

• Barium study

• US

• CT

• MRI

(3)

Simple abdomen view

SB obstruction Pneumoperitoneu m

(4)

Esophageal cancer

• Squamous cell carcinoma

• Type

(5)

Esophageal cancer

• Staging

(6)

Esophageal leiomyoma

• Most common benign tumor

• Location

– Distal third 60% – Middle third 30% – Proximal third 10%

• Sharply outlined, discrete intraluminal

mass

• Right or obtuse angle with esophageal

wall

(7)
(8)

Reflux esophagitis

• Decreased lower esophageal

sphincter pressure

• Gastroesophageal reflux

• Radiologic findings

– Abnormal motility

– Mucosal nodularity

– Ulceration

– Thickened fold

Ulcer Fold thickening

(9)

Barrett esophagus

• Long-standing GE reflux and reflux

esophagitis

• Progressive columnar metaplasia of

distal esophagus

• Radiologic findings

– Midesophageal stricture

– High ulcer

– Sliding hiatal hernia

– GE reflux

(10)

Barrett esophagus

(11)

Benign gastric ulcer

Ulcer crater

(12)

Benign gastric ulcer

• Converging mucosal fold toward

ulcer

• Profile view

– Hampton’s line

– Ulcer collar

– Ulcer mound

Hampton’s line Ulcer collar or mound

(13)
(14)

EGC

EGC IIa

(15)
(16)

AGC

(17)

AGC

(18)
(19)

DDx of benign & malignant

ulcer

Benign Malignant Ulcer edge regular, round irregular

Depth deep,

penetrating shallow Site lesser curvature anywhere Radiating fold spokelike obliterated Profile view Hampton’s line

ulcer collar ulcer mound

Carman’s meniscus

(20)

Gastric submucosal tumor

• Benign GIST

• Malignant GIST

• Lymphoma

(21)

GIST

Benign Malignan

(22)
(23)

Duodenal ulcer

• Benign

(24)

Intestinal tuberculosis

• Inflammatory disease of terminal ileum

and colon by Mycobacterium tuberculosis

• Radiologic findings

– Fold thickening

– Transverse ulcer

– Inflammatory spasm

– Accelerated transit time

– Cecal retraction

– Shortening of A-colon

– Stricture

(25)

Intestinal tuberculosis

Cecal retraction Transverse ulcer

A-colon shortening Symmetric involvement

(26)

Crohn’s disease

• Crohn(1932)

• Inflammatory disease

of terminal ileum

with insidious onset,

weakness, fever and

non-bloody diarrhea,

distinguished from

intestinal

(27)

Crohn’s disease

Aphthous ulcer Sacculation Longitudinal ulcer Inflammatory pseudopolyp

(28)

Crohn’s disease

Deep ulcer Fissure

(29)

Crohn’s disease

Fistula Skip lesion

Multiple

involvement

(30)

Important findings of Crohn’s

disease

• Aphthous ulcer

• Segmental involvement

• Skip lesion

• Deep,

longitudinal ulcer

• Asymmetric

involvement

• Cobblestone

(31)

CT enterography of Crohn’s

disease

(32)
(33)

Ulcerative colitis

• Wilks(1859)

• Inflammation of colon

affected by discharge

of mucus and blood

• After death, whole

internal surface

presented vascular,

soft, red surface with

mucus

(34)

Ulcerative colitis

• Radiologic findings

– Mucosal granule

– Crypt abscess

– Collar button ulcer

– Loss of haustration

– Inflammatory pseudopolyp

– Continuous involvement

(35)

Ulcerative colitis

Crypt

(36)

Ischemic colitis

• Occlusion of mesenteric vessel

• Thumb-printing appearance by

submucosal hematoma

(37)

Acute appendicitis

• Radiologic findings

– Localized paralytic ileus in RLQ – Cecal spasm or fluid level

– Blurring of Rt. properitoneal fat line

– Indistinctness of Rt. psoas shadow

– Scoliosis and concavity to Rt. side

(38)

Acute appendicitis

• US and CT findings

– Distended appendix • 6mm in diameter – Mural thickening • 3mm

(39)

Acute appendicitis

(40)

Colonic diverticulosis

• Herniation of mucosa (submucosa)

through muscle layer

• False diverticulum

(41)

Colonic diverticulitis

• Associated inflammation with

diverticuli

• Inflammatory spasm

• Wall Thickening

(42)

Colonic polyp

• Adenoma

• Located at rectum &

S-colon

• Sessile or

(43)

Malignant polyp

• Size over 1-1.5 cm

• Irregular surface

• Base indentation

• Short, thick pedicle

• Rapid growth

(44)

Colon cancer

Infiltration Mass Apple core appearanc e

(45)
(46)

Colon cancer

(47)

Rectal cancer

CT MR T2WI MR CE MR sagittal MR coronal

(48)

Rectal cancer

• Staging

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