Radiologi Onkologi

Muhammad Iqbal
Dr. Rony Rustam, SpB(K)Onk
tumour
• In most published studies, cross-sectional imaging
techniques (CT, ultrasound, MRI) are more accurate in
staging advanced (T3, T4) than early (T1, T2) diseases
• In gut tumours, endoscopic ultrasound is more accurate
than CT or MRI in the local staging of early disease (T1 and
T2) by virtue of its ability to demonstrate the layered
structure of the bowel wall and the depth of tumour
penetration
• MRI is extremely valuable in bone and soft-tissue tumour
staging and in intracranial and spinal disease.
Nodes
• A size criterion of 8–10 mm is often adopted, but it is not usually
possible to distinguish benign reactive nodes from infiltrated nodes.
This is a particular problem in patients with intrathoracic neoplasms,
in whom enlarged benign reactive mediastinal nodes are common.
• The echo characteristics of nodes at endoscopic ultrasound have been
used in many centres to increase the accuracy of nodal staging, and
nodal sampling is possible via either mediastinoscopy or
transoesophageal biopsy under endoscopic ultrasound control. PET-
CT is of increasing use in detecting nodal metastases from a wide
range of malignancies, with the capacity to coregister the area of
increased FDG uptake with a precise anatomical location. Novel MRI
contrast agents may help in the identification of non-enlarged
tumour-infiltrated nodes
Metastases
• CT is the most sensitive technique for the detection of lung
deposits
• Ultrasound and CT are most frequently used to detect liver
metastases
• Recent studies suggest that MRI may be more accurate than
CT in demonstrating metastatic disease
• The technique of PET/CT with FDG, an analogue of glucose, is
becoming a powerful tool in oncological imaging.
• This functional and anatomical imaging technique reflects
tumour metabolism and allows the detection of otherwise
occult metastases.
• The most common indications for PET/ CT have been staging
of lymphoma, lung cancer, particularly non-small cell lung
cancer, and preoperative assessment of potentially
resectable liver metastases, such as colorectal carcinoma
metastases
Figure 14.42 (a) Surgical lobes of the liver (after Couinaud). IVC, inferior vena cava; LHV, left hepatic vein; LT, ligamentum teres;
MHV, middle hepatic vein; RHV, right hepatic vein. (b) Segmental anatomy on computed tomography scan at the level of the
hepatic veins. (c) Segmental anatomy at the level of the portal veins. (d) Segmental anatomy below the level of the portal
veins.
Figure 14.43 Positron emission tomography shows fluorodeoxyglucose uptake in a carcinoma of the lung (short
arrow) and mediastinal lymph nodes (long arrow).