Imaging of GIT

Dr.Ghazala Malik
Fellow of College of Physicians & Surgeons Pakistan
Fellow of Royal College of Radiologists London
Consultant Radiologist

Objectives
To give an overview of basic radiology
modalities for GI tract imaging.
To describe the radiological anatomy seen on
these modalities.
To give an idea of and common abnormalities.
To highlight the concept of GIT emergency
cases.

Radiology Modalities for GIT

Imaging

Plain radiography
Barium studies
Ultrasonography
Computed tomography
Magnetic resonance
imaging
Isotope scanning
Angiography

Plain Radiography (Xray)

The X-ray tube is

focused on the man's
abdomen. X-rays will
pass through his body
and produce an image
on the specialized plate
below.

Radiolographic anatomy of the

abdomen

Key to densities in AXRs

Black--gas ,White--calcified
structures
Grey--soft tissues ,Darker
grey--fat
Intense white--metallic objects

Checklist for systematic

viewing of anAXR

1.Technical assessment - adequate image quality

2. Diaphragms - free air, pleural effusion
3. Liver - size, shape
4. Spleen - size, shape
5. Kidney, Ureter, Bladder - size, shape, calcifications
6. Uterus in females, prostate in males - calcifications
7. Psoas muscle - clear outlining
8. Bowel gas pattern - normal or abnormal
9. Abnormal extraluminal gas - freeair, biliary system, portal venous
system, bowel wall
10. Bones - osteoarthritis, fractures, metastasis, Paget's disease
11. Extra-abdominal fat and soft tissue - gas or calcifications
12. Calcifications - normal or abnormal
13. Artefacts - iatrogenic,projectional

What we look for on plain

radiograph?

Foreign body
Calcifications
Bowel dilatation
Air fluid level
Masses
Free air under the diaphragm

Foreign Body

Abdominal Calcification

Normal calcifications

Abnormal calcifications

Costal cartilage

Gallbladder

Mesenteric lymph nodes

Pancreas

Pelvic Phleboliths

Kidney & ureter & bladder

Prostate gland

Blood vessels
Tumours

Abdominal
Calcification

Intestinal Obstruction/perforation checklist

Where are the bowel loops located (central vs.
peripheral)?
Is there too much intraluminal gas?
What is the distribution of the gas in the abdomen?
What is the intraluminal calibre of the small and large
bowel?
Are there any dilatations of the small and/or large
bowel?
Is there any gas in the biliary tree or portal venous
system location?
Can you identify any air-fluid levels?
Are there any areas of faecal loading, i.e. any in the
colon

contd:,

Small bowel

Centrally located within numerous tight loops of small diameter (2.53.5cm),

Valvulae conniventes (Stack of coins), that stretch all the way across the small
bowel loops.

Large bowel

Has a mixture of gas and faeces located within loops of larger diameter (3
5cm) around the periphery
Haustra, that stretch only part-way across the diameter of the large bowel
loops.

Abnormal findings include:

Dilated loops of small or large bowel

Airfluid levels on erect AXRmore than 5 fluid levels, greater than 2.5cm in
length is abnormal
Intramural gas -ischaemic colitis
Intraperitoneal gasperforated viscus or penetrating abdominal
injury.However the sensitivity for detecting perforation on AXR is low
and is best confirmed as subdiaphragmatic air on erect CXR or with a
CT scan.

Contd;

Contd;

Pneumoperitoneum

Fluoroscopy-Barium
Studies

Patient Positioning

Fluoroscopy-Barium Studies
Fluoroscopy uses a continuous x-ray beam to create a sequence of images
that are projected onto a fluorescent screen, or television-like monitor.
When used with a contrast material, which makes the area appear bright
white, to view internal organs in motion.

The Fluoroscopic exams that we perform include:

Barium Swallow (Esophagram)
Upper Gastrointestinal Series (UGI)
Small Bowel Series

Barium Enema

Barium Studies Indications

Dyspepsia
Dysphagia
Abdominal Pain
Constipation and diarrhea
Reflux
Assessment of fistulae and perforation
Weight loss

Pre operative anatomical demonstration

Barium
Swallow
Anatomy

Aortic knuckle
Left bronchus
Left atrium

Barium
Swallow
Shape
Gastroesophageal
sphincters
Peristalsis
Stricture
Filling defect
Normal impression

strict
ure

Neuromuscular
abnormality
Dilated oesophagus .
Smooth tapered
narrowing

Carcinoma .
Usually circumferential stricture .
Irregular lumen with shouldered
edges

Barium meal

cardia

pylorus

Gre
ate
rc

body

ur v

Le
sse

atu

re

rc
ur v
atu

re

fundus

Barium meal

Barium meal

Size and shape of stomach

Any filling defect
Mucosal folds
Pyloric canal

Stomach ulcer

Gastric ulcer

Hiatus
hernia
Paraesophageal (rolling)
hiatal hernia: the cardia
remains in its normal position.
The fundus extends through
the esophageal hiatus.

Sliding hiatal hernia: the

abdominal esophagus, cardia,
and fundus slide superiorly
through the esophageal
hiatus..

Parts of the
duodenum

The mucous membrane of most of the duodenum is thrown into numerous

circular folds (plicae circulares). .

Divided into 4 parts which can be visualized by x-ray The 1 st part extends
from the pylorus upwards backwards and to the right .
Greater omentum

Angular notch

Pe
r
wa istalt
ic
ve

l
na
ca

Pyloric antrum

ic
lor
Py

Pyloric
sphincter

Descending duodenum

Duodenal
cap

Duodenal (peptic)
ulcer

Mostly occur in
the posterior
wall of the
duodenal cap.
Perforation
permit the
Gas under the
diaphragm in
contents to
perforated duodenal
enter the
ulcer
peritoneal cavity
causing Gastroduodenal artery
peritonitis.

Endoscopic view of duodenal ulcer

Barium meal showing duodenal ulcer

 1)duodenal bulb
2)descending
portion
3)transverse
portion

Upper G.I Barium Follow

Through Study
Plicae circulares

jejunum

Large and close together in the proximal

half of the jejunum.
Gradually disappearing almost wholly in
the distal ileum

ileum

Small Bowel
Enema

Barium
enema
hepatic flexure

splenic flexure

Transverse colon

Asc.colon

um in
minal ileum

sigmoid
rectum

Although the ileocecal junction may be termed as

valve, its functional reality remains doubtful.

Inflammatory bowel
disease

 Out pocketing of the mucosa of the

large intestine, usually in the sigmoid,
through the muscle wall.

Ultrasoun
d
Pulse echo principle

Abdominal organ echogenicity

mnemonic
From most to least
echogenic.
Positioned Superiorly Left
Kidney
Pancreas
Spleen
Liver
Kidneys

CBD
Portal
vein
Hepatic
Vein
IVC

Gall
blladder

Liver
Pathology

PANCRE
AS

Sectional anatomy of the

abdomen

Dr. Akram Jaffar

Sections are arranged to match CT

& MRI sections
(as if looking at the body from
below)

Dr. Akram Jaffar

CT SCAN

Internal of a CT
scanner
T

X RAY TUBE

X RAY
DETECTORS

X RAY BEAM

GANTRY
ROTATION

CROSS
SECTIONAL
ANATOMY OF
G.I.T

Fissure for ligamentum

venosum
liver
Caudate lobe
IVC
aorta

stomach

spleen

liver
stomach

Caudate lobe
IVC

aorta

spleen

CT of the
gallbladd
er
stomach
stomach

GB

GB
Portal v.

pancreas

IVC

liver

Portal v.
pancreas

aorta
IVC

spleen

aorta

L. kidney
liver

spleen

Axial CT

Parts and position of

the pancreas
Because the pancreas usually slopes slightly upwards, its
whole length is not necessarily seen in one axial section.
The neck lies anterior to the portal vein.

Portal v.

neck

body
?

?
?
?

Hepatic
lesions

Infections

Magnetic Resonance
Imaging

Coronal MRI
lung

spleen

liver

10
R.kidney

11

L.kidney

MRI of the
gallbladder

stomach
GB

liver
stomach

Portal v.
liver

pancreas

IVC

an
Tr

s
er
sv

lon
co

GB with
stones

Coronal MRI

spleen

MRCP

It is very important to
view an AXR
systematically. So, once
you have found your
system, stick to it allthe
time!

u
o
y
k
n
a
h
T