Body MRI from the Liver to the Bladder I Want You! Audience Participation Methodist Hospital Continuing Education Seminar Jordan Swensson, MD November 7, 2015 Objectives Observe the uses of MRI for organs throughout the abdomen and pelvis Gain a deeper understanding of a variety of abdominal/pelvic pathology Appreciate some of the radiologist s thought process for approaching cases Explore what happens to patients after they leave the MRI suite Discover the particular utility of MRI for answering certain clinical questions Why? Medicine is a black box, even if you re in it! Radiologists and radiologic technologists are part of the same pathway But what we do all day can still be opaque So today, you re on the job! Case 1 54 year old female with liver failure and elevated hepatic enzymes 1
POLL: What is the abnormality???? Budd-Chiari Syndrome Case 2 Global or segmental obstruction of the hepatic outflow tracts (IVC and hepatic veins) Heterogeneous appearance of the liver parenchyma 72 year old male with right upper quadrant pain Blood flow gets non-uniform and irregular Usually caused by hypercoagulable state Medical therapy, TIPS, liver transplant 2
POLL: What s going on here? Mirizzi Syndrome Compression of the common hepatic duct by a gallstone in the gallbladder neck or cystic duct Usually in patients with chronic gallstones Very difficult to diagnose accurately without imaging! Important to diagnose accurately, because treatment is often biliary reconstruction Case 3 61 year old male, EtOH cirrhosis, screening for HCC 3
POLL: Vent your spleen, answer now Gamna-Gandy Bodies Splenic siderotic nodules Tiny deposits of metal (calcium, iron) in the splenic parenchyma Usually from insignificant micro-bleeds associated with portal hypertension, sickle cell or other anemias Not everything that looks like a mass is cancer, or even something to worry about! Case 4 23 year old male, abdominal pain 4
POLL: Click on the intestinal abnormality Crohn Disease One of the syndromes under the umbrella of inflammatory bowel disease Granulomatous inflammation of the alimentary tract Anywhere from the mouth to the anus Immunomodulating drugs are the key Case 5 79 year old male, pelvic pain, difficulty with urination 5
POLL: What is the abnormality? Bladder Diverticula Outpouching of the urinary bladder wall May be congenital or acquired Clinically important due to urinary stasis POLL: What CAUSED the diverticula? 6
Benign Prostatic Hypertophy Overgrowth of the central portion of the prostate gland Constricts the proximal urethra, leading to difficulty with urination Severe cases can lead to obstruction of the bladder, hydronephrosis MRI can help distinguish BPH from prostate cancer Case 7 21 year old female, right lower quadrant pain So why are we imaging this patient?? POLL: Click on the abnormality 7
Acute Appendicitis in Pregnancy Abdominal pain in pregnancy is common Non-ionizing modalities are preferred (though CT can be used) A dilated, fluid filled appendix is the finding of choice on MRI 90+% sensitive and specific Gadolinium? Surgery? Case 8 21 year old female, right lower quadrant pain POLL: What is abnormal? 8
Pyelonephritis in Pregnancy Not everything that quacks in pregnancy is appendicitis! Infection of the renal tubules, interstitium; often ascending Striated nephrogram on cross sectional imaging Can be focal, look like a mass Treatment is antibiotics, supportive Bonus Case 39 year old male, recurrent pancreatitis POLL: What s the abnormality? Pancreas Divisum 9
Objectives Redux Observe the uses of MRI for organs throughout the abdomen and pelvis Gain a deeper understanding of a variety of abdominal/pelvic pathology Appreciate some of the radiologist s thought process for approaching cases Explore what happens to patients after they leave the MRI suite Discover the particular utility of MRI for answering certain clinical questions Thank you! Radiologists 10