radcards GU radiology
Terms
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- how can one distinguish an adrenal adenoma from malignancy on MRI
- a spoiled gradient echo sequence using a TR=120 and TEs of 2.1 and 4.2 can be used. this technique is "in (4.2) and out of phase imaging"
- what is the MR appearance of pelvic side wall involvement in cervical cancer staging
-
increased T2 signal intensity in the muscle
vascular encasement - how does cervical cancer appear on MR
-
high signal on T2WI
thickening of vaginal cuff - how does parametrial involvement in cervical cancer appear on MR
-
focal bulge
discontinuity of parametrial fat - what are causes of low signal on T2WIs in the peripheral zone of the prostate on MR
-
carcinoma
dysplasia
prosatitis
hemorrhage
radiation - how is post-biopsy hemorrhage distinguished from cancer
- hemorrhage is high on T1
- what are the essential aspects of prostate cancer TNM staging
-
T1 no MR finding
T2 tumor entirely within gland
T3 tumor thru capsule
T4 tumor fixed to adjacent organs - what is the importance of the 'T' part of TNM stage in prostate cancer
-
T1 and T2 treated surgically
T3 and T4 are treated non surgically - what is the gleason score
- prostate cancer path grading - tissue is graded on a 5 point scale based on glandular pattern
- what is the normal uterine appearance on MR
-
endometrium - high T2
junctional zone - low T1 and T2
myometrium - intermediate signal - what is the normal cervical appearance on MR
-
mucosa - high T2
fibroelastic stroma - low T1 and T2
outer layer - continuous with myometrium of uterus - what is the MR evidence of cervical ca
- high signal in the fibroelastic stroma
- what is the staging of cervical cancer
-
stage 1 - confined to cervix
stage 2 - extension beyond cervix but not lower 1/3 of vagina or pelvic wall
A - no parametrial involvement
B - parametria involved
stage 3 - extension to pelvic side wall, lower 1/3 of vagina or ureteral obstruction
stage 4 - extension beyond true pelvis
A - spread to adjacent organ
B - distant mets - ddx: benign bladder neoplasm
-
Little People Never Have Problems Finding A Hat
Leiomyoma
Polyp
Neurofibroma
Hemangioma
Pheochromocytoma
Fibroma
Adenoma
Hamartoma - ddx: malignant bladder neoplasm
-
MR SALT
mets
rhabdomyosarcoma
squamous cell ca
adenoca
lymphoma
TCC - what is the critical question in staging of cervical ca, why
-
whether the parametrium is involved (stage 2A vs 2B)
2A is treated surgically
2B is treated with radiation - ddx: endometrial thickening
-
polyp
hyperplasia
carcinoma - what is the appearance of an endometrial polyp
-
intermediate on T1 and high on T2 WI as compared to endometrium
may have dark fibrous stroma - what are contraindications to hysterosalpingography
-
acute infection
contrast allergy
later phase of cycle - ddx: tubal occlusion
-
STPs
SIN
tubal endometriosis
PID
peritubal occlusion - ddx: ovarian tumor
-
Every Tumor Gets Everyone Sad and Mad
Endometrioma
Teratoma
Germ cell neoplasm
Epithelial tumor
- serous
- mucinous
- clear cell
- endometrioid
- brenner
sex cord tumor
mets - which epithelial tumor is most often bilateral
- serous
- which tumor is more commonly malignant, serous or mucinous
- serous - 50%
- ddx: asherman's syndrome
-
curettage
septic abortion
PID
TB - ddx: hydrosalpinx
-
PID
endometriosis
TB
post-op adhesion - what is the most common site of tubal obstruction, second most common
-
intramural
infundibular - what are the HSG findings in genital TB
-
fallopian tube calcifications
SIN
'cotton wool' plug in tube
beaded appearance of tubes
tubal obstruction
uterus
-synechia
-irregular lumen
-small volume - ddx: renal medullary calcification
-
medullary sponge kidney
hyperparathyroidism
RTA type 1 - ddx: renal cortical calcifications
-
oxalosis
acute cortical necrosis
chronic glomerulonephritis
alport's syndrome -
what is the treatment for each ofd the following stages of prostate ca:
- no extracapsular extension
- extracapsular extension +/- seminal vesicle involvement
- mets -
- radical prostatectomy or XRT
- XRT or cryosurgery
- hormonal therapy - what featurex on MR suggest prostate capsular invasion by ca
-
broad contact
smooth capsular bulge
gross extracapsular extension
invasion of neuromuscular bundle
invasion of seminal vesicle - what are the features of prostate cancer staging
-
confined to prostate = stage A or B, TNM stage 1 or 2
unilateral extracapsular extension = stage C, TNM stage 3a
bilateral extension = stage C, TNM stage 3b
seminal vesicle - stage C, TNM stage 3c - what technique is used for prostate MRI
-
a digital rectal exam should preceed placement of an endorectal coil
ax T1
ax, sag, cor fast spin echo T2
large fov T1 after removal of endorectal coil - ddx: adrenal cyst
-
prior hemorrhage
congenital endothelial cyst
cystic adenoma
parasitic infection - how do you diagnose an adrenal adenoma on CT
-
HU:
< 10 HU unenhanced = adenoma
10-20 HU = possible adenoma
>20 HU = unlikely adenoma
size:
>6cm = unlikely adenoma
enhancement:
if adenoma, 30 min post-contrast should be <30-35 HU - ddx: low signal intensity within peripheral zone of prostate
-
prostate ca
chronic prostatitis
intraglandular dysplasia
post bx hemorrhage
post XRT
post hormonal therapy - ddx: bilateral hydronephrosis
-
posterior urethral valves
urethral polyp
tumor
ureterocele
ureteral atony (infection)
ilateral reflux
ureteral ectopia
prune belly
neuropathic bladder
obstructive megaureter - ddx: renal vasculitis
-
We PISS
wegener's
PAN
IV drug abuse
scleroderma
SLE - ddx: chronic medical renal disease
-
MAD CHAP
medullary cystic disease
arteriolar nephrosclerosis
DM
chronic glomerulonephritis
hereditary chronic nephritis
amyloidosis
papillary necrosis - ddx: large hyperechoic kidneys
-
acute glomerulonephritis
goodpasture's
lupus
DM
AIDS - ddx: renal vein thrombosis
-
membranous glomerulonephritis
DM
SLE
amyloid
dehydration
hypotension
sepsis - ddx: striated nephrogram
-
pyelonephritis
obstruction
trauma
renal vein thrombosis