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