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42 Cards in this Set

  • Front
  • Back
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