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Abdominal Imaging Dr Catherine Grierson

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1 Abdominal Imaging Dr Catherine Grierson
Consultant Abdominal Radiologist University Hospital Southampton

2 Abdominal Imaging Specific presentations Imaging strategies
Gastrointestinal bleeding Inflammatory bowel disease Sepsis Imaging strategies

3 Gastrointestinal Bleeding
Presentations Gastrointestinal Bleeding

4 Gastrointestinal bleeding
Acute Haematemesis Melaena ‘Bright rectal bleeding’ Collapse Chronic Anaemia

5 Acute gastrointestinal bleeding
ENDOSCOPY IMAGING CT angiography Conventional angiography CT

6 CT angiography Detects acute bleeding
Patient needs to be actively bleeding (0.3ml/min) Requires rapid injection of large bolus of IV contrast (120 mls at 5 mls/sec) Consider: Renal function IV access

7 CT angiography Detects focus of bleeding in a blood-filled colon
Identifies small bowel source Clarifies upper GI or colonic origin Guides selective catheterisation for interventional radiologists

8 CT angiography

9 Conventional angiography
Advantages over CT angiography View of vessels over longer time-period Bleeding may be evident as inject contrast into individual vessels THERAPEUTIC Inject coils, glue, embolic particles Place covered stents

10 Conventional angiography

11 Abdominal CT May be useful outside the context of active bleeding to find cause Particularly relevant in patients who cannot tolerate endoscopy Relatively insensitive

12 Causes of acute GI bleeding
Colorectal adenocarcinoma

13 Causes of acute GI bleeding

14 Causes of acute GI bleeding
Linitis plastica Ulcerated gastric tumour

15 Causes of acute GI bleeding
Small bowel adenocarcinoma

16 Causes of acute GI bleeding
Splenic artery pseudoaneurysm

17 Chronic gastrointestinal bleeding
Looking for underlying malignancy Predominantly Colon Small bowel Patients in whom optical colonoscopy not possible

18 CT colonography ‘Virtual fly-through’
Sensitivity rates approaching those of colonoscopy for tumour and polyps > 6 mm

19 CT colonography Requires bowel preparation and ‘faecal tagging’
Picolax + Omnipaque Gastrografin Carbon dioxide insufflation Buscopan IV

20 CT colonography Prone acquisition (low dose)
Supine acquisition (+ IV contrast) Prone acquisition (low dose)

21 CT colonography 2D review

22 CT colonography 2D review 3D ‘fly through’ (x4)

23 CT colonography Current utilisation in UHS:
Needs request by gastroenterologist or colorectal surgeon Indications: Failed colonoscopy (immediately or electively) Warfarin Patient request Frailer patients

24 CT colon ‘Minimal preparation’ CT colon
5 x 25 mls gastrografin over 3 days Faecal tagging

25 CT colon

26 CT colon (Extraluminal findings)
Groin lymph nodes Abdominal aortic aneurysm Gallstones and GIST

27 Small bowel CT Oral mannitol IV contrast (Buscopan) ‘Negative’
1500 mls Osmotic IV contrast Portal venous phase +/- Arterial phase (Buscopan)

28 Acute inflammatory bowel disease
Presentations Acute inflammatory bowel disease

29 Inflammatory bowel disease
Known IBD Complications Extent New diagnosis Make diagnosis Type Distribution

30 Diagnosing colitis Acute colitis on AXR

31 Diagnosing colitis Chronic colitis on AXR

32 Diagnosing colitis Colitis on CT: Type?

33 Diagnosing colitis Colitis on MR

34 Diagnosing Crohns disease
Terminal ileitis on ultrasound

35 Diagnosing Crohns disease
Crohns disease on fluoroscopy

36 Diagnosing Crohns disease
Distal ileitis on CT

37 Diagnosing Crohns disease
Small bowel involvement on MR

38 Complications of IBD Terminal ileitis and abscess

39 Complications of IBD Perforated Crohns disease on CT

40 Complications of IBD Inflammatory mass on CT

41 Presentations sepsis

42 Biliary sepsis Cholecystitis on ultrasound

43 Biliary sepsis Biliary obstruction

44 Biliary sepsis Portal venous occlusion on ultrasound

45 Biliary sepsis Gallbladder empyema

46 Biliary sepsis Liver abscess and biliary dilatation

47 Biliary sepsis MRCP

48 Urinary sepsis Hydronephrosis on ultrasound

49 Urinary sepsis Renal calculi on US Ureteric calculi on CT

50 Sepsis of unknown origin
Diverticulitis Psoas abscess

51 conclusions

52 Conclusions Diverse uses for abdominal imaging in acute medical presentations Needs precise matching of modality to clinical question for maximum benefit

53 Any questions?

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