IMAGING INVESTIGATION OF

GASTRITIS AND ULCERS

dr. Mashuri, Sp.Rad.,M.Kes

12th Block Lecture

GI System
Semester IV
 Plain
photo-BNO (Blass = Kandung Kemih, Nier = Ginjal,
Overzicht = Pemeriksaan)
 Maag-Duodenography (MD) atau Oesophago-Maag-
Duodenography (OMD)
 USG

 CT scan abdomen
 MRI

IMAGING INVESTIGATION
 Barium Meal (OMD), Double Contrast
(Supine Position) Supine Position:
Note Barium Distribution
in the Fundus due to
gravity

Angular Notch
Incisura Angularis

Antrum Body
 Barium Meal

DJJ: Barium Meal

Normal Position= Left side

Angular Notch
Incisura Angularis
Duodenal Cap

Pyloric Canal

2nd Part of
Duodenum

3rd Part of Body Jejunum:

Duodenum Plica Circularis on the
Antrum outer border

Ileum

Barium
Follow-Through
CT scan abdomen VS OMD
7
GASTROINTESTINAL
INFLAMMATION
 Mucosal changes
 Direct and Indirect evaluation
 Evaluate lumen and effect on lumen
 Degree of mucosal involvement determines the imaging findings
 Superficial – little effect
 Penetrating – affect adjacent areas

GASTROINTESTINAL INFLAMMATION
 Superficial process
 Little imaging finding
 Spasm
 Mucosal edema and irregularity
 Penetrating process
 Ulcer development
 Perforation
 Adjacent inflammatory process

GASTROINTESTINAL INFLAMMATION
 Acute gastritis
 Chronic gastritis

GASTROINTESTINAL INFLAMMATION
 Gastritisinflammation of gastric mucosa
 Etiology: infection H. pylori (most common)
 Transient inflammation
 Bleeding and erosion
 Sloughing of mucosa

ACUTE GASTRITIS
 Mucosal atrophy
 Intestinal metaplasia
 No-erosion (usually)
 Epithelial changes maydysplasiabasis for carcinoma
 Most important etiologic associationH. pylori

CHRONIC GASTRITIS
 OMD
 US
 CT ABD

IMAGING
 Location: Gastric antrum on
crests of rugal folds
 Multiple punctate or slit-like
collections of barium
 Erosions surrounded by
radiolucent halos of
edematous, elevated mucosa
 Scalloped or nodular antral
folds
 Epithelial nodules or polyps
(chronic)

EROSIVE GASTRITIS, COMPLETE OR VARIOLIFORM

EROSIONS (MOST COMMON TYPE)
 Thickened folds, spasm or decreased distensibility
 Scalloped or lobulated folds oriented longitudinally or transverse
folds
 Crenulation or irregularity of lesser curvature
 Prolapse of antral mucosa through pylorus

ANTRAL GASTRITIS
 Location: Antrum, body, or occasionally fundus; diffuse or
localized
 Thickened, lobulated gastric folds
 Enlarged areae gastricae (≥ 3 mm in diameter)

H. PYLORI GASTRITIS
 Location: Fundus and
body
 Markedly thickened,
lobulated gastric folds

HYPERTROPHIC GASTRITIS
 Narrowed, tubular, nondistensible
stomach
 Smooth, featureless mucosa, ↓ folds

ATROPHIC GASTRITIS
 Craters (ulcers) extending to below the muscularis mucosa of
stomach/duodenum
 Chronic, most often solitary lesions
 Duodenum (initial position 4:1)
 Stomach (antrum)
 GE junction
 Duodenum, stomach, and or jejunum

PEPTIC ULCER DISEASE

GASTRIC ULCER

 Barium projection from lesser curve –

ulcer crater (arrow)
 Line of edema (arrowheads)
GASTRIC ULCER
*

 Overhead film with ulcer on greater

curve (arrows)
 Lucent halo of edema base of ulcer
(arrowhead)
 Ulcer extends outside expected mucosal
margin
 Incidental note of contrast in gallbladder
(*)
PYLORIC CHANNEL ULCER

 Spot film
 Projection of barium from pyloric
channel
 Edematous halo
 Barium collection just beyond the
duodenal bulb greater curve aspect
(large arrow)
 Probable small ulcer lesser curve aspect
as well (small arrow)

POST-BULBAR DOUDENAL ULCER

 Ulcer mound
Incisula defect
Chronic duodenal ulcer : Deformity of the duodenal bulb from fibrotic healing
- Cloverleaf deformity (A) : symmetric narrowing of the midportion of the bulb with
dilatation of the inferior and superior recesses at the base of the bulb (arrow)
- Pseudodiverticulum (B) : asymmetric narrowing of the bulb
 Both benign and malignant origins
 Primary imaging techniques include barium

GI NEOPLASM
ESOPHAGEAL NEOPLASM

 Narrowing of mid esophagus

 Irregular mucosa (arrows)
ESOPHAGEAL
CARCINOMA
ESOPHAGEAL
NEOPLASM
ESOPHAGEAL CARCINOMA
NEOPLASM IN STOMACH WALL

 Silhouette
 Tumor mass as a
filling defect
extending into
barium column
GASTROINTESTINAL STROMAL TUMOR
WITH ULCERATION
GASTRIC
NEOPLASM
SCIRRHOUS NEOPLASM STOMACH
ULCERATING ANTRAL NEOPLASM
GASTRIC LYMPHOMA DIFFUSE
METASTATIC
MELANOMA

 Filling defects in the

antrum
 Aspiration of barium
 Irregular filling defect in the fundus of
stomach (arrows)
 Space occupying

STOMACH NEOPLASM
 LINITIS PLASTICA

 Diffusenarrowing
of the proximal
stomach
 Diffuse
infiltration
of lymphoma in
the wall of the
stomach
 No motion on
fluoroscopy
 Diffuse narrowing of the proximal stomach
 Diffuse infiltration of lymphoma in the wall of the
stomach
 No motion on fluoroscopy

LINITIS PLASTICA
THANK YOU