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‫بسم هللا الرحمن الرحمن الرحيم‬

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Diagnostic &Interventional Radiology

By

Dr. Ahmed Nada
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Assistant Professor of surgery Cairo University

Conventional radiology
• Depend on the differential absorption by soft tissue, bone, gas and fat of X-rays passing through the body. • Plain X-rays remain the primary diagnostic tool in the chest and abdomen, and in trauma and orthopaedics.
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• When X-rays strike a fluorescent screen, light is emitted which, by means of an imaging intensifier, can be projected on a television screen. • This is the basis of fluoroscopy (screening) which allows continuous monitoring of a moving process.
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ureters and bladder are successively demonstrated and recorded over approximately 30 minutes following contrast injection. 5 .• Contrast injected intravenously is excreted rapidly by the kidneys which forms the basis of the intravenous urogram(IVU) where the nephrographic (renal parenchymal) and pelvicalyceal (collecting system) phases.

.Ultrasound • Ultrasound depends on the generation of highfrequency sound waves. • Sound is reflected by tissue interfaces in the body and the echoes generated are picked up by the same transducer and converted into an image 6 which is then displayed in real time on a monitor. usually of between 3 and 7 MHz. by a transducer placed on the skin.

quick. • It is technically demanding and requires an experienced operator to maximise the potential of the examination.• Ultrasound is inexpensive. reliable and noninvasive and is an excellent initial investigation for a wide range of clinical problems. 7 .

there are still problems with gas (which reflects sound completely) and obese patients. who are often unsuitable for ultrasound. 8 .• Despite the advances in technology.

• probes combined with fibre-optic endoscopes to visualise the gut wall at echo endoscopy . • endoluminal probes for transvaginal and trans-rectal scanning 9 .

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Doppler ultrasound • Doppler ultrasound measures the shift in frequency between transmitted and received sound and can therefore measure blood flow. 11 .

Dopplex 12 .

Computerised tomography 13 .

14 . a thinly collimated beam of X-rays passes through an axial ‘slice’ of tissue and strikes an array of very sensitive detectors which can distinguish very subtle differences in tissue density.• To create a CT scan.

behave like small spinning bar magnets and align with a strong external magnetic field. most prevalent in water molecules.Magnetic resonance imaging • The basic principle of (MRI) depends on the concept that the nuclei of hydrogen. 15 .

emit gamma radiation detected by a gamma 16 camera. • These radiopharmaceuticals are injected intravenously and. in general. .Radionuclide imaging • Radionuclides can be tagged to substances which concentrate selectively in certain tissues of the body.

interventional radiology techniques have replaced the conventional surgical approach. removing the need for a general anaesthetic with consequent decreased morbidity and length of hospital stay. with similar patient outcome.Interventional radiology • The speciality has developed from angiographic techniques. with guidewires and catheters as key ingredients. 17 . • In some instances.

the shortest route from skin to lesion is chosen if no vital structure intervenes 18 . In general.Percutaneous biopsy • Percutaneous biopsy is possible for most radiologically detected abnormalities .

• Fluoroscopy usually provides suitable guidance for biopsy of large parenchymal or peri hilar masses in the chest. Ultrasound or CT guidance is most commonly employed in the abdomen. 19 . Ultrasound is quick and flexible and allows the needle path to be followed in real time without additional radiation burden to the patient. CT guidance may be necessary for small lesions.

abdomen or pelvis may be considered for percutaneous catheter drainage. which has largely replaced surgery as the treatment of choice 20 .Drainage of abscesses and fluid collections • Almost any fluid collection in the chest.

• percutaneous creation of a communication between the portal and hepatic venous systems for the relief of portal hypertension Transjugular intrahepatic portosystemic shunt (TIPSS) 21 .

usually as a result of intimal hyperplasia. This may require reintervention with balloon dilatation or a second stent insertion. 22 .• The major complication is hepatic encephalopathy which can develop following the procedure. Shunt occlusion may develop.

Oesophageal Stent 23 .

Oesophageal Stent • A stent is a tube that is permanently placed in the oesophagus over the blocked area . 24 . There are various types of stents – the most commonly used is a self-expanding wire mesh stent .The stent will not cure the cause of the blockage but it may improve your swallowing.

Biliary procedures • Drainage of an obstructed biliary system is usually achieved by ERCP. and the majority of strictures can be bypassed and stented by this approach 25 .Endoscopic cannulation of the ampulla allows the passage of guidewires and catheters.

• . mechanical lithotripsy or balloon sweepage of the duct. In gallstone obstruction of the common bile duct. endoscopic stone removal can be achieved following sphincterotomy by basket retrieval. 26 .

PTC • Percutaneous transhepatic cholangiography involves puncture of an intrahepatic bile duct with a fine needle from a right intercostal approach. Successful visualisation of the ducts is achieved in almost all patients with dilated ducts and over 85 per cent of patients with nondilated ducts 27 .

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simple external drainage. 29 . external/internal drainage.Options include the following: • • • • balloon dilatation. endoprosthesis — plastic or expanding metal.

30 .Angioplasty and Vascular Stenting • Angioplasty and angioplasty with vascular stenting are minimally invasive procedures performed to improve blood flow in the body's arteries .

a long. thin plastic tube.• In the angioplasty procedure. imaging techniques are used to guide a balloon-tipped catheter . into an artery and advance it to where the vessel is narrow or blocked. deflated and removed . The balloon is then inflated to open the vessel. 31 .

which is often performed with angioplasty. There are two types of stents: bare stents (wire mesh) and covered stents (with an additional artificial wall .) 32 .• In vascular stenting. a small wire mesh tube called a stent is permanently placed in the newly opened artery to help it remain open.

• coronary artery disease 33 .some common uses • Atherosclerosis • peripheral vascular disease (PVD) and peripheral artery disease (PAD) • renal vascular hypertension • carotid artery disease.

Catheter-directed Thrombolysis Thrombolysis is a • minimally invasive treatment that dissolves abnormal in blood blood clots vessels to help improve blood flow and prevent damage .to tissues and organs 34 .

or thrombus.turning from a free-flowing liquid to a semi-solid gel. or embolization. A blood clot. or blood clots. 35 . In some patients. that forms within a blood vessel may continue to grow.• When blood does not flow smoothly through a vessel. blood clots come from other sources and dislodge in relatively small vessels causing a blockage. blocking off the blood supply to certain parts of the body and causing damage to tissues and organs. it can begin to coagulate .

36 .• Untreated. a vascular blockage due to thrombosis or embolization. can result in the loss of an organ or extremity. with potentially life-threatening consequences .

37 .• In a catheter-directed thrombolysis procedure .x-ray imaging is used to help guide a special medication or medical device to the site of blood clots to eliminate the blockage .

38 . posing serious risk if part of it breaks off and travels to the lungs. This type of clot may grow big enough to completely block the vein. a condition in which a blood clot forms in a main vein that returns blood flow from the extremities back to the heart and lungs.some common uses • thrombosis in the vascular bed of the diseased arteries. such as thrombosis in the extremity artery that has severe narrowing due to atherosclerosis • deep vein thrombosis.

thrombosis of the portal vein and other mesenteric veins 39 . thrombosis of the dialysis fistulas or grafts . pulmonary embolism .• • • • embolism .

however.) or via the arm veins with one design 40 .the internal jugular vein (the large vein in the neck. meaning that they are inserted via the blood vessels. With modern filters which can be compressed into much thinner catheters. access to the venous system can be obtained either via the femoral vein (the large vein in the groin).• VC filters are placed endovascularly.

also IVC filter a type of vascular filter.Inferior vena cava filter • An inferior vena cava filter . is a medical device that is implanted into the inferior vena cava to prevent pulmonary emboli 41 .

eg development of deep vein thrombosis (DVT) or pulmonary emboli (PE) despite adequate anticoagulation . • Contraindications to anticoagulation .Indications • Failure of anticoagulation . or a patient about to undergo major surgery • Large clots in the vena cava or iliac veins • Patients at high risk of having a PE 42 . such as a recent bleed into the brain.eg a patient at risk of PE who has another condition that puts them at risk of bleeding.

Catheter Embolization • Embolization is a minimally invasive treatment that occludes. • In a catheter embolization procedure. one or more blood vessels or vascular channels of malformations (abnormalities). or blocks. medications or synthetic materials called embolic agents are placed inside a blood vessel to prevent blood flow to the area. 43 .

some common uses • control or prevent abnormal bleeding e. especially when the tumor is difficult or impossible to remove • arteriovenous malformation (AVM) or arteriovenous fistula (AVF • aneurysms 44 .g small bowel lesion. Uterine Fibroid Embolization • occlude or close off the vessels that are supplying blood to a tumor.

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