The Abdomen and Ultrasound

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The Abdomen and Ultrasound R. Badea, US Department, Institute of Hepatology and Gastroenterology, University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj Napoca, România [email protected]

Transcript of The Abdomen and Ultrasound

Page 1: The Abdomen and Ultrasound

The Abdomen and Ultrasound

R. Badea, US Department, Institute of Hepatology and Gastroenterology, University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj Napoca, România

[email protected]

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Abdominal ultrasonography. What is specific?

¤  a “Real time” imaging technique based

on US of 2,5 – 5 MHz

¤  The picture is obtained by the examiner

himself which makes US a very important

clinical instrument!

¤  Sectional technique + 3D reconstruction

in the imagination of the examiner

¤  Information:

¤  anatomical – measurements –

structure characterization – organ

relations – spatial resolution = 1 mm!

¤  functional - movements – blood flows

¤  clinical - tenderness + compressibility

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A multi approach technique

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A multimodal technique

Nr. Procedure Importance/Application Characteristics

1. Grey scale 2D Main technique Morphology of the organs Sectional anatomy Discrimination between solid and cystic lesions Function of the organs e.g.. Heart beatings or digestive peristalsis

2. Grey scale 3D/4D Optional, educational application, 2 nd opinion

Spatial anatomy

3. Doppler spectral Vascular application Presence and direction of blood flow Characterization of the flow Quantifications: speed, resistance

4. Doppler CFM (color flow map)

Vascular application Presence & characteristics of the blood flow in large & medium vessels

5. Contrast enhanced ultrasonography

Vascular application Presence & characterization of the blood flow in microcirculation

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2D – palpation of the tumor

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3D

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Elastography – importance for targeting of tumor parenchyma

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Contrast enhanced harmonic ultrasonography

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Detection of abdominal diseases by ultrasound? When and how?

¤  By general scanning of the abdomen – to separate healthy people from those with diseases and to detect asymptomatic lesions

¤  Evaluation of the abdomen when unspecific symptoms are present - the role of ultrasonography as a “pick up” instrument for diagnosis – when the the clinics is not suggestive

¤  Evaluation of the abdomen when typical symptoms are present in chronic and acute situations in order to detect the cause and complications

¤  Ultrasound as a diagnostic tool integrated into diagnostic algorithms

¤  Evaluation of the abdomen when there is a risk for a specific disease in early stage – screening role

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General scanning of the abdomen. Prerequisites

To know and understand the sectional anatomy of the abdomen and the relation between the organs

To know and understand the ultrasound technology and technique of scanning

To know how to avoid artifacts and errors

To use a systematic approach in order to cover all the abdominal organs

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Scanning of the abdomen should be systematic and complete – agenesia of right kidney

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Typical symptoms are present – chronic diseases – duodenal ulcer

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Typical symptoms are present – acute diseases

Direct signs – acute pancreatitis

Indirect signs – bowel obstruction

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Ultrasonography as a “pick up” instrument for diagnosis – colonic tumor

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Ultrasonography for discrimination of similar diseases – liver angioma in a patient with breast

tumor and possible liver metastases

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m, 43 yrs, operation for paracolic abscess 3 months before US evaluation; re - evaluation because a suppuration at the site of the surgery

Ultrasound examination part of a diagnostic algorithm including clinical, CT, MRI etc

criteria

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CT Hydrosonography

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Screening in abdominal pathologies – HCC, liver cirrhosis

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Conclusions

¤ Ultrasonography is a safe, accurate, confortable (for patients & doctors) imaging technique

¤ Performances in abdominal pathology are often similar to CT/MRI

¤ Clinical approach is mandatory for a good and efficient diagnosis