Gastrointestinal

Imaging
Rima Zakiyah
PSPD FK UNISMA

Bismillah...

CONVENTIONAL X-RAY
FILMS

1-INTRA-ORAL FILMS

2-EXTRA-ORAL FILMS
- Panoramic

TYPES OF INTRA-ORAL
FILMS
1-PERIAPICAL FILMS
For children&adults with small mouth, anterior teeth in
adults, and standard film for anterior&posterior teeth in
adults
2-BITEWING FILMS
For posterior teeth in children, young children, adults(most
frequent film) and premolar or molar region
3-OCCLUSAL FILMS
To show large areas of upper or lower jaw

EXTRA-ORAL FILMS
INDICATIONS:
1-Px unable to open mouth
2-view large area of pathology
3-general view of mandible or maxilla
4-view more bones of the face(skull or sinuses)
5-impacted or unerupted teeth
6-fractures of jaws & localization of foreign bodies
7-TM joint

PANORAMIC

Pemeriksaan radiologi pada abdomen meliputi :

1. Radiologi konvensional :
a. Plain photo abdomen tanpa persiapan
(BOF = Buiek Oversich Film)
b. Plain photo abdomen dengan persiapan
(BNO = Buiek Nier Oversich, / KUB =
Kidney Urinary Bladder)

Pemeriksaan bisa dengan :

Foto Polos

BOF foto
( tanpa persiapan )

BNO foto
( dengan persiapan )

Cara Persiapan pemeriksaan Foto BNO :

1. 1 2 hari pre X-foto, pasien diberi makan bubur
kecap (low residual meal).
2. Malam hari diberi laksan, minum 3 4 gelas air
putih
3. Subuh pasien akan diarrhea
4. Pagi tidak boleh makan, minum, bicara, tertawa,
merokok
5. Pasien kemudian di foto

PEMERIKSAAN FOTO POLOS

ABDOMEN

FOTO POLOS ABDOMEN

Compare

Valvulae conniventes
Small bowel

Haustra
Large bowel

Know What Youre Looking For

PNEUMOPERITONEUM

Supine Double Bowel

Wall Sign

Outlining of
liver/GB

Harus diperhatikan pada BNO

1. Bagaimana distribusi gas dalam usus.
normal gas dalam gaster, duodenum, colon ( caecum sampai rectum )

2. Bagaimana gambaran hepar dan lien.

3. Bagaimana gambaran/ bayangan kedua ginjal
apakah ada bayangan (batu) radiopaqe disepanjang UG tract

4. Gambaran psoas line/ psoas shadow.

5. Bagaimana keadaan tulang-tulang.
6. Bagaimana keadaan flank area.

Barium Studies
(Video) Esophagogram
Barium Swallow
UGI series

ESOPHAGUS

Esophagogram or Barium
Swallow

Evaluates pharynx and esophagus

Limited evaluation of stomach
Double or Single Contrast
Mucosal contour and Motility

Locate the starting point

of Esophagus

Describe the course

of Esophagus
Identify gastro
esophageal junction.

What are the normal sites

of narrowing of Esophagus?

What are the normal

impressions in the Esophagus?

OESOPHAGUS

Penyempitan yang normal:

Sekitar Cartilago cricoid
Persilangan Arcus Aorta dan Bronchus kiri
Sebelum masuk diaphragma

Gambaran normal dari mukosa :

Biasanya lurus, parallel, tipis
Uniform

Body Habitus - Effect On Positioning

Hypersthenic
Horizontal and superior
Dependent portion above umbilicus
Asthenic
Vertical and inferior
Sthenic
Generally found between xyphoid process and iliac crest

Contrast media

Type of contrast media

Barium sulfate
Water soluble

Single Contrast vs
Double Contrast
Single Contrast
Generally uses just thin Barium
Distends lumen with high density material
Easier for patient but less mucosal detail

Double Contrast/Air Contrast

Thick barium coats lumen

Effervescent tablets ingested to distend lumen with air
Produces images with greater mucosal detail
Greater sensitivity for small lesions, polyps, ulcers

SINGLE
CONTRAST STUDY

DOUBLE
CONTRAST
STUDY

BARIUM SULFATE

WATER SOLUBLE
CONTRAST AGENT

PRINCIPLE
1. Extrinsic lesion
2. Intrinsic lesion
2.1 Protruded lesion mucosal fold,
polyp, tumor , varices
2.2 Depressed lesion ulcer,
diverticulum, perforation

Diagram

A
mucosal mass

B
submucosal or
intramural mass

C
extrinsic mass

Extrinsic lesion

MASS

Protruded lesion

mucosal mass

Polyp

Diagram

submucosal or
intramural mass

Depressed lesion
A
B
C

Double
contrast

upright

Single
contrast

En-face Profile

CARCINOMA

CARCINOMA (2)

Esophageal carcinoma

PSEUDO-ACHALASIA caused by
direct spread to the distal esophagus
from gastric carcinoma
Radiographic findings :
1. Irregularly, narrowed and
nodular( arrowhead),
sometimes ulcerated (arrow),
lesion at distal esophagus
2. Rapid transition between
normal and abnormal part.
3. Dilatation of proximal
esophagus.

STOMACH

Pemeriksaan Gaster &

Duodenum
Bentuk mukosa gaster yang normal :
Bentuk mozaik di daerah fundus
Lurus-lurus (magenstrasse) di corpus
Convergeren di pylorus

Bentuk mukosa duodenum yang normal :

Halus seperti bulu ayam
Pd. Pars desc. Ada lekuk kecil=papilla Vateri
Sekitar bulbus duodindentasi vesica felea,

KELAINAN YANG TAMPAK

PADA MUKOSA
Filling defect :
Bisa dari luar sudut tumpul, atau dari dalam lumen
tajam
Bisa massa benigna tepi halus/ rata,
atau maligna tepi irreguler
Additional defect/ Shadow :
- Bayangan tambahan di luar lumen.
- Bentuk menentukan jinak/ ganas
- Ulcus atau diverticle

Radiographic appearances of benign gastric ulcer

Radiographic appearances of benign gastric ulcer

Radiographic appearances of benign gastric ulcer

Radiation of smooth thickened folds (arrow) extending

directly to the edge of the crater (arrowhead) on profile
view(A) and en-face view (B)

Cart wheel phenomen

Duodenal Ulcer

Duodenal Diverticulum

bulb

stomac
h

Gastric Diverticulum

Gastric cancer
Polypoid mass
- Produce filling defect
(arrow) on barium
study

Gastric cancer

Focal constricting lesion:

localized infiltrating
carcinoma or localized
scirrhous carcinoma
Annular filling defect
(arrow)

Gastric cancer

fundus

bulb

antrum

body

Focal constricting
lesion
: localized infiltrating
carcinoma or localized
scirrhous carcinoma
- circumferential
irregular narrowing of
the lumen with
rigidity (as figure;
involved body and
antrum)

Radiographic Exams

COLON

Colonic
Diverticulosis

Colonic Diverticulosis

CARCINOMA COLON
Ada 3 bentuk
1. Fungative type
2. Polypoid type
3. Annuler type
Gambaran radiologis : adanya filling
defect dan obstruksi, merupakan tanda
yang terpenting secara radiologis.
76

Colonic Carcinoma
Annular Carcinoma
(green arrow) with
shelf-like margin
(black arrow)

Colonic Carcinoma
Polypoid Carcinoma
(arrow)

PEMERIKSAAN PANKREAS
1. Foto Polos Abdomen.
2. UGI foto/ Barium meal (pendesakan o.k. Kelainan Pancreas)
3. Ultra Sonografi. (USG Abdomen)
4. Endoscopic Retrograde Cholangio Pancreatography (ERCP)
5. Computed Tomography Scanning (CT Scan)
6. Magnetic Resonance Imaging (MRI)
7. Angiography

Kelainan PANCREAS

Tanda radiologis
67 % menyebabkan pergeseran gaster
41% invasi ke gaster
67% menekan gaster dan duodenum
Perubahan mucosa duodenum
Inverted 3 sign
Gangguan fungsi

86

GAMBARAN USG
PANCREAS

Arah probe transversal, anterior

pararenal space
Tergantung pemeriksa, akurasinya bisa
95%
Reflektivitas hiperechoic homogen,
lebih tinggi dari liver

87

TEHNIK USG

Transabdominal
Doppler USG
Endoscopic ultrasonography
Intra operative ultrasonography
88

Chronic Pancreatitis (horisontal section). Irregular contour

(arrowheads); strongly echogenic foci (long curved arrow)
and dilated section of main pancreatic duct (straight arrow)89

Small pancreatic
carcinoma in the head
with dilatation
of the main pancreatic
duct (curve arrow).
There is a very uniform
echo pattern within this
small tumour

90

USG LIVER

91

Alhamdulillah...

94