Endorectal Sonography in the Evaluation of Rectal and Perirectal Disease
|
|
- Carmella Barton
- 6 years ago
- Views:
Transcription
1 503 I. Pictorial Essay I Endorectal Sonography in the Evaluation of Rectal and Perirectal Disease Edward W. St. Ville,1 S. Zafan H. Jafri,1 Beatrice L. Madrazo,1 Duane G. Mezwa,1 Robert L. Bree,2 and Barbara F. Rosenberg3 Endorectal sonography initially was developed for evaluation of the prostate and now has been adapted for evaluation of rectal and perirectal disease. We used endorectal sonography to evaluate a spectrum of diseases, including primary and recurrent rectal carcinoma, metastases, villous adenoma, leiomyosarcoma, endometnosis, sacrococcygeal teratoma, chordoma, retroperitoneal cystic hamartoma, pelvic lipomatosis, diverticulitis, and perirectal abscess. The technique has been useful in localization of penrectal abscesses and in sonographically guided biopsy of perirectal masses. Knowledge of normal sonographic anatomy of the rectum is essential in the evaluation of rectal and perirectal disease. In this essay, we describe the technique of endorectal sonography and illustrate the sonographic findings in a variety of diseases. The rectum and peninectal space are the sites of numerous diseases, both benign and malignant. Because of the anatomic detail provided by endonectal sonography, it is useful for the evaluation of the direction of spread of rectal disease, depth of tumor penetration, and assessment of invasion of adjacent viscera [1, 2]. The technique provides accurate definition of the layers of the rectal wall and peninectal soft Fig. 1.-Sonogram and drawing show five layers of normal rectum: (1) interface between balloon and mucosa, (2) deep mucosa and muscularis mucosa, (3) interface between submucosa and musculans propria, (4) musculans propria, and (5) interface between musculans propna and penrectal fat. Received January 24, 1991; accepted after revision April 17, Presented at the annual meeting of the American Roentgen Ray Society, Washington, DC, May Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W. Thirteen Mile Rd., Royal Oak, Ml Address reprint requests to S. Z. H. Jafri. 2 of Diagnostic Radiology, Veterans Administration Hospital, 2215 Fuller Rd., Ann Arbor, Ml of Surgical Pathology, William Beaumont Hospital, Royal Oak, MI AJR 157: , september X/91/ American Roentgen Ray Society
2 504 ST. VILLE ET AL. AJR:157, September 1991 Fig. 2.-Primary rectal carcinoma confined to rec- Fig. 3.-Primary rectal carcinoma with local invasion. tal wall. Endorectal sonogram shows a well-defined A, Sonogram shows soft-tissue mass with muscularis propria in left anterolateral wall of rectum hypoechoic lesion confined to muscularis propria (arrows). (arrows). B, Sonogram obtained at a higher level reveals mass, which appears to disrupt muscularis propria (arrows) and invade penrectal fat planes. Fig. 4.-Primary rectal carcinoma with local invasion. A, Endorectal sonogram shows a well-defined mass of mixed echogenicity in posterior wall of rectum that disrupts muscularis layer and invades perlrectal fat (arrows). A well-defined hypoechoic area (arrowhead) represents extension of tumor to a perirectal lymph node. B, CT scan at same level shows a soft-tissue mass in posterior rectal wall with extension into perirectal fat (arrow). Microscopic section revealed invasive mucin-producing adenocarcinoma of rectum with extension into perirectal fat. Fig. 5.-Recurrent rectal carcinoma. Sonogram obtained after abdominoperineal resection shows diffuse thickening of rectal wall and disruption of muscularis propria (arrowheads). Enlarged perirectal lymph nodes also were identified (open arrow). Surgical suture is present in anterior rectal wall (solid arrow). Biopsy revealed recurrent rectal carcinoma. Fig. 6.-Villous adenoma. A, Endorectal sonogram shows a well-defined area of mixed echogenicity contained within muscularis propria layer in anterior rectal wall (arrows). B, Air-contrast barium enema shows marked mucosal irregularity in anterior rectal wall (arrow). Microscopic section of resected specimen showed characteristic frondlike appearance of villous adenoma.
3 Fig. 7.-Leiomyosarcoma. Endorectal sonogram obtained at level of palpable rectal mass in a patient with chronic active ulcerative colitis shows a uniform hypoechoic lesion limited by muscularis propria layer (arrows). Microscopic section revealed a discrete area of malignant spindle cell proliferation corresponding to a 1.5-cm Ieiomyosarcoma found in gross pathologic specimen. This neoplasm was confined to muscularis propna. Overlying submucosa and mucosa are obliterated as a result of chronic active ulcerative colitis. Fig. 8.-carcinoma of prostate. A, Sonogram shows large, pooriy defined hypoechoic mass disrupting perirectal soft-tissue planes anteriorly between prostate (P) and rectum (arrows). B, CT scan at same level shows a soft-tissue mass posteriorly between prostate and perirectal soft-tissue planes with extension into anterior rectal wall (arrowheads). Diagnosis of carcinoma was confirmed by results of transrectal biopsy. Fig. 9.-Malignant melanoma. A, Endorectal sonogram shows a hypoechoic mass in left seminal vesicle (arrow) in a patient with malignant melanoma. B, Sonogram obtained at a lower level shows a well-defined hypoechoic metastasis in left lobe of prostate that disrupts and Invades anterior rectal wall (arrow). Fig. 10.-Endometriosis. Sonogram shows a well-demarcated area (arrows) interposed between muscularis propria and mucosa. Lesion is confined by and does not extend beyond muscularis propria. Histologic examination showed a focus of endometriosis, which was delimited by muscularis propria. Fig. 11.-Lipomatosis. A, Sonogram shows pelvic lipomatosis with perlrectal deposition of fat causing anterior displacement of left seminal vesicle (small arrow). Note asymmetry of echo texture of perirectal tissue between seminal vesicle and rectum, with decreased echogenicity on left (larg. arrow) simulating a mass. B, Ti-weighted MR image of pelvis shows a uniform circumferential ring of increased signal Intensity In perirectal soft tissues consistent with lipomatosis. Note more anterior location of left seminal vesicle relative to right (arrow). No masses were Identified. A B
4 506 ST. VILLE ET AL. AJR:157, September 1991 Fig. 12.-Chordoma. A, Endorectal sonogram shows a complex mass posteriorly that lies outside rectal wall. Mass is mostiy hypoechoic and poorly defined and contains several bright reflectors (arrow) caused by tiny calcifications. B, CT scan at same level shows soft-tissue mass posterior to rectum that contains tiny calcifications and appears to extend into coccyx (ar. row). Fig. 13.-Diverticulitis. A, Sonogram shows hypoechoic area in anterior rectal wall outside muscularis propria. Fluid extends into penrectal soft tissues (arrows). B, CT scan of pelvis confirms edema and thickening of wall of rectosigmoid colon (arrows). A B Fig. 14.-Perirectal abscess. A, CT scan in a patient with inflammatory bowel disease shows perirectal abscess anterior to rectum (arrow) that could not be found during surgery. B, Endorectal sonogram obtained after surgery shows a poorly defined hypoechoic area anterior to rectum (arrows). C, Under sonographic guidance, a guidewire (arrows) was inserted and secured to skin. Surgery was repeated, and guidewire was used successfully to locate abscess cavity.
5 AJR:157, September 1991 SONOGRAPHY IN RECTAL DISEASE 507 Fig. 15.-Sacrococcygeal teratoma. Endorectal Fig. 16.-Retroperitoneal cystic hamartoma (tailgut cyst). sonogram shows a well-defined hypoechoic mass, A, Sonogram shows a homogeneous well-circumscribed hypoechoic mass (M) compressing with acoustic enhancement outside posterior rectal rectum (arrow). wall. B, CT scan at level of tailgut cyst (arrow) correlates with endorectal sonogram, revealing a perirectal soft-tissue mass (M) in presacral space that narrows rectal lumen. tissues (Fig. 1). Anatomic changes caused by soft-tissue masses, cysts, calcification, and fluid collections can be detected. In this essay, we describe the technique of endonectal sonognaphy and illustrate the sonognaphic findings in a variety of diseases. Pathologic verification of sonognaphic findings was available in all cases. Technique An axial, transversely oriented radial scanner (model 1850, BnUel & Kjaen, Copenhagen, Denmark) is used most commonly. The total length of the rigid probe with the transducer is 24 cm. The transducer rotates at a rate of two to three cycles pen second. Scanning radial to the long axis of the rectal probe provides a 360#{176} display of the rectum and surrounding tissues. The transducer, covered by a disposable latex sheath and lubricated with a scanning gel, is introduced into the rectum. A minimum luminal diameter of 25 mm is necessary to insert the probe. The sheath is filled with 60 ml of degassed water to provide an acoustic window. Images routinely are obtained at 1 -cm intervals from approximately cm above the anus, which is the usual maximal depth of insertion. The transducer also can be inserted via a nectoscope to evaluate the rectum. During simultaneous withdrawal of the probe and the rectoscope, the region of interest is scanned in a stepwise fashion. Depending on the extent of the lesion, the examination takes mm. Sonographic Anatomy of the Normal Rectum When a 7-MHz transducer is used, sonograms show five layers in the rectal wall; three are hyperechoic and two are hypoechoic. The first echogenic line corresponds to the interface between the water balloon and the mucosa. The innermost hypoechoic line represents the deep mucosa and musculanis mucosa. The third and most echogenic line is produced by the submucosa. The outer, widen hypoechoic line delineates only the musculans propna. This is of clinical importance because it defines a sonognaphic criterion for determining intramural or extramural invasion. The most peripheral line, the fifth echogenic line, corresponds to the interface between the musculanis propria and peninectal fat. Sonographic Findings in Rectal and Penrectal Disease Endorectal sonognaphy initially was developed for evaluation of carcinoma of the prostate and recently has been adapted for staging of rectal carcinoma and evaluating a spectrum of benign and malignant rectal and penirectal conditions [3]. Rectal carcinoma appears on endonectal sonograms as a low-echogenicity lesion that abruptly interrupts the normal sequence of layers (Figs. 2 and 3). In order to stage the tumor precisely, it is necessary to determine the relationship between the neoplasm and the outer hypoechoic layer (musculanis propnia). When no infiltration has taken place, this layer has a smooth regular course and is separated by the thin echogenic line of submucosa. Disappearance of submucosa may indicate infiltration of the musculanis propnia. This pattern is most difficult to determine. Tumor with minimal extrarectal spread could therefore be understaged also. Extension into the pennectalfat is represented by the interruption of the musculanis propnia by the neoplasm (Fig. 4). In addition, infiltration into the adjoining pelvic organs and penmrectal lymph nodes should be sought. Lymphadenopathy caused by metastases or lymph-node hyperplasia resulting from local sepsis commonly is seen with endorectal sonography. When no lymph nodes are visible in
6 508 ST. VILLE ET AL. AJR:157, September 1991 metastases is low [4]. The enlarged nodes may be hyperechoic and hypoechoic. Hypenechoic lymph nodes are enlarged because of nonspecific inflammatory change. When enlarged lymph nodes are hypoechoic, metastases are most likely, although nonspecific inflammation cannot be excluded. Preoperative assessment of the depth of tumor invasion is important in the treatment of rectal carcinoma, particularly when local excision is being considered. A major value of endonectal sonognaphy is to determine the depth of tumor invasion. The procedure can be used to detect local recurrence after low anterior resection or local excision. Extent of primary on recurrent tumor infiltration is defined more exactly with endorectal sonography than with CT (Fig. 5). The high spatial resolution of endonectal sonography also has proved useful in characterizing the nature and extent of numerous rectal and penirectal disease entities. Endonectal sonognaphy shows villous adenoma (Fig. 6), leiomyosancoma (Fig. 7), metastases (Figs. 8 and 9), endometniosis (Fig. 10), and pelvic lipomatosis (Fig. 11) as nonspecific, solid masses within the rectal wall and perirectal soft tissues. Calcification within a chordoma (Fig. 12) and pennectal fluid collections seen in diverticulitis and peninectal abscess can be demonstrated (Figs. 13 and 14). Sacnococcygeal tenatoma (Fig. 15) and netnopenitoneal cystic hamartoma (Fig. 1 6) are seen as wellcircumscribed masses outside of the rectal wall. Endonectal sonognaphy also has been useful for localization of peninectal abscess and needle biopsy of peninectal masses. REFERENCES 1. Orrom WJ, Wong WD, Rothenberger DA, Jensen LL, Goldberg SM. Endorectal ultrasound in the preoperative staging of rectal tumors: a leaming experience. Dis Colon Rectum 1990;33: Konishi F, Ugajin H, Kanazawa K. Endorectal ultrasonography with a 7.5 MHz linear array scanner for the assessment of invasion of rectal carcinoma. Int J Colorectal Dis 1990;5: Beynon J, Foy DM, Temple LN, Channer JL, Virgee J, Mortenson NJ. The endosonic appearances of normal colon and rectum. Dis Colon Rectum 1986;29: Glaser F, Schlag P, Herfarth C. Endorectal ultrasonography for the assessments of invasion of rectal tumors and lymph node involvement. Br J Surg 1990;77: LIST OF BOOK AND VIDEOTAPE REVIEWS 480 Detection and Treatment of Early Breast Cancer. Fentiman! 490 The Radiologic Clinics of North America. Interventional Radiology of the Biliary Tract. Burhenne HJ, ed. 494 RSNA Today, Vol. 4, No, 5. Casareila WJ, moderator 498 Atlas of Roentgenographic Measurement, 6th ed. Keats TE 516 Magnetic Resonance Imaging of Carcinoma of the Urinary Bladder. Barentsz JO, Debruyne FMJ, Ruijs SHJ 520 Textbook of Uroradiology. Dunnick NR, McCailum RW, SandIer CM 526 MRI of the Musculoskeletal System, 2nd ed. Berquist TH, ed. 532 The Language of Fractures, 2nd ed. Schultz RJ 544 Obstetrics and Gynecology. Berman MC, ed. 584 Neuroradiology Test and Syllabus. Weinberg PE, section ed. 602 Gamuts and Pearls in MRI. Pomeranz SJ 608 A Short Textbook of Clinical Imaging. Sutton D, Young JWR, eds.
Alison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD
November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationINTRAUTERINE DEVICE = IUD INTRAUTERINE DEVICE = IUD CONGENITAL DISORDERS Pyometra = pyometrea is a uterine infection, it is accumulation of purulent material in the uterine cavity. Ultrasound is usually
More informationRECTAL CARCINOMA: A DISTANCE APPROACH. Stephanie Nougaret
RECTAL CARCINOMA: A DISTANCE APPROACH Stephanie Nougaret stephanienougaret@free.fr Despite the major improvements that have been made due to total mesorectal excision (TME) management of rectal cancer
More informationHandling & Grossing of Colo-rectal Specimens for Tumours. for Medical Officers in Pathology
Handling & Grossing of Colo-rectal Specimens for Tumours for Medical Officers in Pathology Dr Gayana Mahendra Department of Pathology Faculty of Medicine University of Kelaniya Your Role in handling colorectal
More informationUltrasonography of the Neck as an Adjunct to FNA. Nicole Massoll M.D.
Ultrasonography of the Neck as an Adjunct to FNA Nicole Massoll M.D. Basic Features of Head and Neck Ultrasound and Anatomy Nicole Massoll M.D. University of Arkansas for Medical Sciences, Little Rock
More informationBrief History. Identification : Past History : HTN without regular treatment.
Brief History Identification : Name : 陳 x - Admission : 94/10/06 Gender : male Age : 75 y/o Chief Complaint : Urinary difficulty for months. Past History : HTN without regular treatment. Brief History
More informationCOLORECTAL CANCER STAGING in 2010
COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON
More informationIMAGING GUIDELINES - COLORECTAL CANCER
IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and
More informationUS in non-traumatic acute abdomen. Lalita, M.D. Radiologist Department of radiology Faculty of Medicine ChiangMai university
US in non-traumatic acute abdomen Lalita, M.D. Radiologist Department of radiology Faculty of Medicine ChiangMai university Sagittal Orientation Transverse (Axial) Orientation Coronal Orientation Intercostal
More informationColon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition
Colon and Rectum Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix are excluded. Protocol revision date: January
More informationEfficacy of High Resolution Transabdominal Sonography of the Fluid Filled Stomach in the Evaluation of Gastric Carcinomas
4-67 421 Efficacy of High Resolution Transabdominal Sonography of the Fluid Filled Stomach in the Evaluation of Gastric Carcinomas S SINGH, V CHOWDHURY ABSTRACT AIM: To evaluate the efficacy of high-resolution
More informationDisorders of Cell Growth & Neoplasia. Histopathology Lab
Disorders of Cell Growth & Neoplasia Histopathology Lab Paul Hanna April 2010 Case #84 Clinical History: 5 yr-old, West Highland White terrier. skin mass from axillary region. has been present for the
More informationAccuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis
Accuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis A.Salem, Kh. Fakhfakh, S. Mehiri, Y. Ben Brahim, F. Ben Amara, H. Rajhi, R. Hamza,
More informationPenis and Prostate. Holly White Jennifer Zang September 7, Penis and Prostate. 1) Other Names None
Penis and Prostate Penis and Prostate Holly White Jennifer Zang September 7, 2006 1) Other Names None 2) Definition/ Location The prostate is a doughnut-like gland that lies inferior to the urinary bladder
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationThyroid Nodules: US Risk Stratification. Alex Tessnow, MD, FACE, ECNU University of Texas Southwestern Associate Professor of Medicine Dallas, Texas
Thyroid Nodules: US Risk Stratification Alex Tessnow, MD, FACE, ECNU University of Texas Southwestern Associate Professor of Medicine Dallas, Texas Which of the following is true? A. All echogenic foci
More informationNormal Sonographic Anatomy
hapter 2:The Liver DUNSTAN ABRAHAM Normal Sonographic Anatomy Homogeneous, echogenic texture (Figure 2-1) Measures approximately 15 cm in length and 10 12.5 cm anterior to posterior; measurement taken
More informationRole of MRI for Staging Rectal Cancer
Role of MRI for Staging Rectal Cancer High-resolution MRI has supplanted endoscopic ultrasound for staging rectal cancer. High-resolution MR images closely match histology and can show details such as
More informationAbdominal ultrasound:
Abdominal ultrasound: Non-traumatic acute abdomen Wittanee Na-ChiangMai, MD Department of Radiology ChiangMai University 26/04/2017 Contents Technique of examination Normal anatomy Emergency conditions
More informationColorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015
Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015 1 Contents Page No. 1. Objective 3 2. Imaging Techniques 3 3. Staging of Colorectal Cancer 5 4. Radiological Reporting 6
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationPatient Information. Prostate Tissue Ablation. High Intensity Focused Ultrasound for
High Intensity Focused Ultrasound for Prostate Tissue Ablation Patient Information CAUTION: Federal law restricts this device to sell by or on the order of a physician CONTENT Introduction... 3 The prostate...
More informationEssentials of Clinical MR, 2 nd edition. 73. Urinary Bladder and Male Pelvis
73. Urinary Bladder and Male Pelvis Urinary bladder carcinoma is best locally staged with MRI. It is important however to note that a thickened wall (> 5 mm) is a non-specific finding seen in an underfilled
More informationContents. Basic Ultrasound Principles and Terminology. Ultrasound Nodule Characteristics
Contents Basic Ultrasound Principles and Terminology Basic Ultrasound Principles... 1 Ultrasound System... 2 Linear Transducer for Superficial Images and Ultrasound-Guided FNA... 3 Scanning Planes... 4
More informationStaging Challenges in Lower GI Cancers. Disclosure of Relevant Financial Relationships. AJCC 8 th edition and CAP protocol updates
Staging Challenges in Lower GI Cancers Sanjay Kakar, MD University of California, San Francisco March 05, 2017 Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education
More information[A RESEARCH COORDINATOR S GUIDE]
2013 COLORECTAL SURGERY GROUP Dr. Carl J. Brown Dr. Ahmer A. Karimuddin Dr. P. Terry Phang Dr. Manoj J. Raval Authored by Jennifer Lee A cartoon about colonoscopies. 1 [A RESEARCH COORDINATOR S GUIDE]
More informationUltrasound - Prostate
Scan for mobile link. Ultrasound - Prostate Ultrasound of the prostate uses sound waves to produce pictures of a man s prostate gland and to help diagnose symptoms such as difficulty urinating or an elevated
More informationCT of the Abdominal Wall
1207 CT of the Abdominal Wall PhilipGoodma& 2 and Bharat Raval1 CT is an excellent method for evaluating the abdominal wall. Various abnormalities including hernia, hematoma, abscess, tumor, and neuromuscular
More informationStaging of rectal cancer on MRI: What the surgeons want to know.
Staging of rectal cancer on MRI: What the surgeons want to know. Poster No.: C-1108 Congress: ECR 2014 Type: Educational Exhibit Authors: G. Ayub, R. Chittal, A. Lowe, A. S. Punekar ; Leeds/, 1 2 1 2 2
More informationShadow because the air
Thyroid Ultrasound Thyroid US examination needs: 1. high frequency transducer 2. extended patient's neck 3. check all the neck area because the swelling could be in areas other than the thyroid such as
More informationCT Evaluation of Bowel Wall Thickening. Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University.
CT Evaluation of Bowel Wall Thickening By Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University. The CT findings of bowel wall thickening includes 1 Degree of thickening.
More informationGallbladder & Pancreas Ultrasonography
복부초음파 : 담낭과췌장 Gallbladder & Pancreas Ultrasonography 김정훈 Department of Radiology 1 Interaction of sound with matter (1) 반사 (Reflection) (2) 굴절 (Refraction) (3) 흡수 (Absorption) (4) 산란 (Scattering) 음향저항
More informationMEDICAL POLICY SUBJECT: TRANSRECTAL ULTRASOUND (TRUS)
MEDICAL POLICY SUBJECT: TRANSRECTAL ULTRASOUND 06/16/05, 05/18/06, 03/15/07, 02/21/08 PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under
More informationUpdate on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD
Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant
More informationUltrasound - Pelvis. What is Pelvic Ultrasound Imaging?
Scan for mobile link. Ultrasound - Pelvis Ultrasound imaging of the pelvis uses sound waves to produce pictures of the structures and organs in the lower abdomen and pelvis. There are three types of pelvic
More informationUltrasound of the Breast BASICS FOR THE ORDERING CLINICIAN
Ultrasound of the Breast BASICS FOR THE ORDERING CLINICIAN Breast Ultrasound Anatomy Skin Breast Parenchyma Pectoralis Fascia Pectoralis Breast Ultrasound Anatomy Indications for Breast Ultrasound Palpable
More informationColorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY
Colorectal Cancer Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth DD MM YYYY S1.02 Clinical details
More informationThyroid Nodules: US Risk Stratification and FNA Guidelines
Thyroid Nodules: US Risk Stratification and FNA Guidelines Mark A. Lupo, MD, FACE, ECNU Thyroid & Endocrine Center of Florida Assistant Clinical Professor of Medicine Florida State University, College
More informationACRIN 6666 IM Additional Evaluation: Additional Views/Targeted US
Additional Evaluation: Additional Views/Targeted US For revised or corrected form check box and fax to 215-717-0936. Instructions: The form is completed based on recommendations (from ID form) for additional
More informationGenitourinary Imaging Pictorial Essay
rown et al. MRI of the Female Pelvis Genitourinary Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.202.41 on 12/17/17 from IP address 37.44.202.41. Copyright RRS. For personal use only;
More informationperformed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationSigmoid Diverticulitis: Value of Transrectal Sonography in Addition to Transabdominal Sonography
lois Hollerweger 1 Thomas Rettenbacher 1 Peter Macheiner 1 Walter Brunner 2 Norbert Gritzmann 1 Received ugust 17, 1999; accepted after revision March 17, 2000. 1 Department of Radiology and Nuclear Medicine,
More informationThe radiologic workup of a palpable breast mass
Imaging in Practice CME CREDIT EDUCTIONL OJECTIVE: The reader will consider which breast masses require further workup and which imaging study is most appropriate Lauren Stein, MD Imaging Institute, Cleveland
More informationWhat is Ultrasound? What is Ultrasound? B A. Basic Principles of Ultrasound. Basic Principles of Ultrasound. Basic Principles of Ultrasound
Introduction to Ultrasound Principles Mani Montazemi, RDMS Baylor College of Medicine Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology Manager, Maternal Fetal Center Imaging
More informationExercise 15: CSv2 Data Item Coding Instructions ANSWERS
Exercise 15: CSv2 Data Item Coding Instructions ANSWERS CS Tumor Size Tumor size is the diameter of the tumor, not the depth or thickness of the tumor. Chest x-ray shows 3.5 cm mass; the pathology report
More informationmalignant polyp Daily Challenges in Digestive Endoscopy for Endoscopists and Endoscopy Nurses BSGIE Annual Meeting 18/09/2014 Mechelen
Plan Incidental finding of a malignant polyp 1. What is a polyp malignant? 2. Role of the pathologist and the endoscopist 3. Quantitative and qualitative risk assessment 4. How to decide what to do? Hubert
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.29 MRI in Clinically Suspected Uterine and
More informationLOINC. Clinical information. RCPA code. Record if different to report header Operating surgeon name and contact details. Absent.
Complete as narrative or use the structured format below 55752-0 17.02.28593 Clinical information 22027-7 17.02.30001 Record if different to report header Operating surgeon name and contact details 52101004
More informationProbe Selection A high frequency (7-12 MHz) linear array transducer should be used to visualize superficial structures (Image 1).
! Teresa S. Wu, MD, FACEP Director, Emergency Ultrasound Program & Fellowships Co-Director, Women s Imaging Fellowship Maricopa Medical Center Associate Professor, Emergency Medicine Director, Simulation
More informationA215- Urinary bladder cancer tissues
A215- Urinary bladder cancer tissues (formalin fixed) For research use only Specifications: No. of cases: 45 Tissue type: Urinary bladder cancer tissues No. of spots: 2 spots from each cancer case (90
More informationCase Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.
Case Scenario 1 July 10, 2010 A 67-year-old male with squamous cell carcinoma of the mid thoracic esophagus presents for surgical resection. The patient has completed preoperative chemoradiation. This
More informationAACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016
AACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016 This 9mm left inferior nodule should remind us all why we re here! There is no absolute number of images required for documentation
More informationBackground & Indications Probe Selection
Teresa S. Wu, MD, FACEP Director, EM Ultrasound Program & Fellowship Co-Director, Simulation Based Training Program & Fellowship Associate Program Director, EM Residency Program Maricopa Medical Center
More informationTake Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules
Take Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules Case 1 72 year old white female presents with a nodular thyroid. This was biopsied in
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 3 Sigmoidorectal Intussusception Presenting as Prolapse Per Anus in an Adult Venugopal Hg Hasmukh B. Vora Mahendra S. Bhavsar SMT.NHL
More informationCHAPTER 7 Concluding remarks and implications for further research
CONCLUDING REMARKS AND IMPLICATIONS FOR FURTHER RESEARCH CHAPTER 7 Concluding remarks and implications for further research 111 CHAPTER 7 Molecular staging of large sessile rectal tumors In this thesis,
More informationEctopic Prostatic Tissue in the Rectum: A Case Report 직장에발생된이소성전립선조직 : 증례보고
Case Report pissn 1738-2637 / eissn 2288-2928 https://doi.org/10.3348/jksr.2017.76.2.91 Ectopic Prostatic Tissue in the Rectum: A Case Report 직장에발생된이소성전립선조직 : 증례보고 Myung Jin Seol, MD 1, Kyung Hee Noh,
More informationCT EVALUATION OF GASTRIC LESIONS:
CT EVALUATION OF GASTRIC LESIONS: Pictural essay Hasni Bouraoui I, Kahloun A, Jemni H, Elouni F, Moulahi H, Daadoucha A, Ben Ali A, Sriha B, Tlili Graies K Departments of Radiology, Gastro enterology,
More informationImages In Gastroenterology
Images In Gastroenterology Thong-Ngam D, et al. THAI J GASTROENTEROL 2005 Vol. 6 No. 2 May - Aug. 2005 105 Imaging of Gastrointestinal Stromal Tumors Pornpim Fuangtharnthip, M.D. Narumol Hargroove, M.D.
More informationA CASE OF A Huge Submandibular Pleomorphic Adenoma
ISPUB.COM The Internet Journal of Head and Neck Surgery Volume 4 Number 2 S VERMA Citation S VERMA.. The Internet Journal of Head and Neck Surgery. 2009 Volume 4 Number 2. Abstract Pleomorphic adenoma
More informationFive Views of Transitional Cell Carcinoma: One Man s Journey
September 2006 Five Views of Transitional Cell Carcinoma: One Man s Journey Amsalu Dabela, Harvard Medical School III Outline Overview: Renal Anatomy Our Patient s Story Diagnostic Imaging Studies Appearance
More informationFHS Appendicitis US Protocol
FHS Appendicitis US Protocol Reviewed By: Shireen Khan, MD; Sarah Farley, MD; Anna Ellermeier, MD Last Reviewed: May 2018 Contact: (866) 761-4200 **NOTE for all examinations: 1. If documenting possible
More informationSonographic Features of Thyroid Nodules & Guidelines for Management
Sonographic Features of Thyroid Nodules & Guidelines for Management Mark A. Lupo, MD, FACE, ECNU Thyroid & Endocrine Center of Florida Assistant Clinical Professor of Medicine Florida State University,
More informationEndometrioma With Calcification Simulating a Dermoid on Sonography
Case Report Endometrioma With Calcification Simulating a Dermoid on Sonography Kiran A. Jain, MD Several investigators have explored the sonographic diagnostic criteria of endometriomas. Endometriomas
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationBladder Case 1 SURGICAL PATHOLOGY REPORT. Procedure: Cystoscopy, transurethral resection of bladder tumor (TURBT)
Bladder Case 1 February 17, 2007 Specimen (s) received: Bladder Tumor Pre-operative Diagnosis: Bladder Cancer Post operative Diagnosis: Bladder Cancer Procedure: Cystoscopy, transurethral resection of
More informationBilateral Primary Fallopian Tube Carcinoma: Findings on Sequential MRI
Hosokawa et al. MRI in Fallopian Tube Carcinoma Women s Imaging Case Report WOMEN S IMAGING Chisa Hosokawa 1 Mitsuo Tsubakimoto 2 Yuichi Inoue 3 Tetsuo Nakamura 2 Hosokawa C, Tsubakimoto M, Inoue Y, Nakamura
More informationUltrasonographic Evaluation of Cervical Lymphadenopathy with Cytological Correlation
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/74 Ultrasonographic Evaluation of Cervical Lymphadenopathy with Cytological Correlation Suresh Kumar 1, Sonjjay Pande
More informationRole of imaging in RCC. Ultrasonography. Solid lesion. Cystic RCC. Solid RCC 31/08/60. From Diagnosis to Treatment: the Radiologist Perspective
Role of imaging in RCC From Diagnosis to Treatment: the Radiologist Perspective Diagnosis Staging Follow up Imaging modalities Limitations and pitfalls Duangkamon Prapruttam, MD Department of Therapeutic
More informationNeoplasia part I. Dr. Mohsen Dashti. Clinical Medicine & Pathology nd Lecture
Neoplasia part I By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 2 nd Lecture Lecture outline Review of structure & function. Basic definitions. Classification of neoplasms. Morphologic features.
More informationGeneral information about prostate cancer
Prostate Cancer General information about prostate cancer Key points Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. Signs of prostate cancer include
More informationProstate MRI. Overview. Introduction 2/20/2015. Prostate cancer is most frequently diagnosed noncutaneous cancer in males (25%)
Prostate MRI John Bell, MD Introduction Prostate Cancer Screening Staging Anatomy Prostate MRI overview Functional MRI Multiparametric Approach Indications Example Cases Overview Introduction Prostate
More informationCOLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE PROFESSOR OF SURGERY & DIRECTOR, PROFESSIONAL DEVELOPMENT CENTRE J I N N A H S I N D H M E D I C A L U N I V E R S I T Y faisal.siddiqui@jsmu.edu.pk
More informationSEER Summary Stage Still Here!
SEER Summary Stage Still Here! CCRA NORTHERN REGION STAGING SYMPOSIUM SEPTEMBER 20, 2017 SEER Summary Stage Timeframe: includes all information available through completion of surgery(ies) in the first
More informationHypoechoic Rim of Chronically Inflamed Prostate, as Seen at TRUS: Histopathologic Findings
Hypoechoic Rim of Chronically Inflamed Prostate, as Seen at TRUS: Histopathologic Findings Hak Jong Lee, MD 1 Ghee Young Choe, MD 2 Chang Gyu Seong, MD 3 Seung Hyup Kim, MD 4 Index terms: Prostate Prostate,
More informationBasic of Ultrasound Physics E FAST & Renal Examination. Dr Muhammad Umer Ihsan MBBS,MD, DCH CCPU,DDU1,FACEM
Basic of Ultrasound Physics E FAST & Renal Examination Dr Muhammad Umer Ihsan MBBS,MD, DCH CCPU,DDU1,FACEM What is Sound? Sound is Mechanical pressure waves What is Ultrasound? Ultrasounds are sound waves
More informationEndoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy
Diagnostic and Therapeutic Endoscopy, Vol. 3, pp. 35-40 Reprints available directly from the publisher Photocopying permitted by license only (C) 1996 OPA (Overseas Publishers Association) Amsterdam B.V.
More informationTerminology Tissue Appearance
By Marc Nielsen, MD Advantages/Disadvantages Generation of Image Ultrasound Machine/Transducer selection Modes of Ultrasound Terminology Tissue Appearance Scanning Technique Real-time Portable No ionizing
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationLocal Excision for early rectal cancer
Local Excision for early rectal cancer M. Trompetto, E. Ganio, G. Clerico, A. Realis Luc, RJ Nicholls Colorectal Eporediensis Centre Clinica S. Rita Vercelli Gruppo Policlinico di Monza Mortality Morbidity
More informationCarcinoma of the Urinary Bladder Histopathology
Carcinoma of the Urinary Bladder Histopathology Reporting Proforma (Radical & Partial Cystectomy, Cystoprostatectomy) Includes the International Collaboration on Cancer reporting dataset denoted by * Family
More informationLearning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma
MOLECULAR AND CLINICAL ONCOLOGY 2: 1085-1090 Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma ZUO-LIANG LIU 1, TONG ZHOU 1, XIAO-BO LIANG 2, JUN-JIE MA 2 and GUANG-JUN
More informationGlossary of Terms Primary Urethral Cancer
Patient Information English Glossary of Terms Primary Urethral Cancer Advanced cancer A tumour that grows into deeper layers of tissue, adjacent organs, or surrounding muscles. Anaesthesia (general, spinal,
More informationAbdominal Complications After Bone Marrow Transplantation in Children: Sonographic and CT Findings
1023 Pictorial Essay Abdominal Complications After Bone Marrow Transplantation in Children: Sonographic and CT Findings Ellen C. Benya,1 2 Carlos J. Sivit, 2 and Ralph R. Quinones2 3 Bone marrow transplantation
More informationOptimizing Breast Sonography
Optimizing Breast Sonography Cindy Rapp BS, RDMS, FSDMS, FAIUM Denver, Colorado Breast Sonography general goal to make a more specific diagnosis than can be made with clinical and mammographic findings
More informationLeonard M. Glassman MD
BI-RADS The New BI-RADS Leonard M. Glassman MD FACR Former Chief of Breast Imaging American Institute for Radiologic Pathology Washington Radiology Associates, PC Breast Imaging Reporting and Data System
More informationPediatric Retroperitoneal Masses Radiologic-Pathologic Correlation
Acta Radiológica Portuguesa, Vol.XVIII, nº 70, pág. 61-70, Abr.-Jun., 2006 Pediatric Retroperitoneal Masses Radiologic-Pathologic Correlation Marilyn J. Siegel Mallinckrodt Institute of Radiology, Washington
More informationValue of MRI in Characterizing Adnexal Masses
The Journal of Obstetrics and Gynecology of India (July August 2015) 65(4):259 266 DOI 10.1007/s13224-015-0730-9 PHOTO ESSAY Value of MRI in Characterizing Adnexal Masses Alpana Karnik 1 Raina Anil Tembey
More informationLesions of the pancreaticoduodenal groove, a pictorial review
Lesions of the pancreaticoduodenal groove, a pictorial review Poster No.: C-2131 Congress: ECR 2013 Type: Educational Exhibit Authors: E. Ni Mhurchu, L. Lavelle, I. Murphy, S. Skehan ; IE, Dublin/ IE Keywords:
More informationThe Frequency and Significance of Small (15 mm) Hepatic Lesions Detected by CT
535 Elizabeth C. Jones1 Judith L. Chezmar Rendon C. Nelson Michael E. Bernardino Received July 22, 1991 ; accepted after revision October 16, 1991. Presented atthe annual meeting ofthe American Aoentgen
More informationPrenatal and Neonatal MRI of Sacrococcygeal Teratoma With Surgical Correlation
Prenatal and Neonatal MRI of Sacrococcygeal Teratoma With Surgical Correlation Ali Mahmood, M.D., and Nadia F. Mahmood, M.D. Citation: Mahmood A, Mahmood NF. Prenatal and Neonatal MRI of Sacrococcygeal
More informationIn-situ and invasive carcinoma of the colon in patients with ulcerative colitis
Gut, 1972, 13, 566-570 In-situ and invasive carcinoma of the colon in patients with ulcerative colitis D. J. EVANS AND D. J. POLLOCK From the Departments of Pathology, Royal Postgraduate Medical School
More informationAppendix 9: Endoscopic Ultrasound in Gastroenterology
Appendix 9: Endoscopic Ultrasound in Gastroenterology This curriculum is intended for clinicians who perform endoscopic ultrasonography (EUS) in gastroenterology. It includes standards for theoretical
More informationDiagnosis and classification
Patient Information English 2 Diagnosis and classification The underlined terms are listed in the glossary. Signs and symptoms Blood in the urine is the most common symptom when a bladder tumour is present.
More informationAmerican Journals of Cancer Case Reports. A Rare Case of Rectal Metastasis from Sarcomatoid Variant of Urothelial Carcinoma: A Case Report
American Journals of Cancer Case Reports Lin JYJ et al. American Journals of Cancer Case Reports 2014, 3:1-5 http://ivyunion.org/index.php/ajccr Page 1 of 5 Vol 3 Article ID 20140539, 5 pages Case Report
More informationOutline - MRI - CT - US. - Combinations of imaging modalities for treatment planning
Imaging Outline - MRI - CT - US - Combinations of imaging modalities for treatment planning Imaging Part 1: MRI MRI for cervical cancer high soft tissue contrast multiplanar imaging MRI anatomy: the normal
More informationLocal staging of colon cancer: the current role of CT
Local staging of colon cancer: the current role of CT Poster No.: C-2699 Congress: ECR 2018 Type: Authors: Keywords: DOI: Educational Exhibit A. P. Pissarra, R. R. Domingues Madaleno, C. Sanches, L. Curvo-
More information