RADIOLOGY MODALITIES
Dr. Haneen Owienah
Radiologist
MD, Palestinian board, Arab Board
Arab Istishari Hospital
ULTRASOUND (US)
Is an imaging technology that uses high-
frequency sound waves to characterize tissue.
TRANSDUCER
IT SENDS AN ULTRASOUND PULSE
INTO TISSUE AND THEN RECEIVES
ECHOES BACK.
It sends an ultrasound pulse into tissue and
then receives echoes back.
ADVANTAGES
• Ultrasound uses non-ionizing sound waves and has not been associated
with carcinogenesis - this is particularly important for the evaluation of the
fetal and gonads
• In most centers, ultrasound is more readily available than more
advanced cross-sectional modalities such as CT or MRI
• Ultrasound examination is less expensive to perform than CT or MRI
• Ultrasound is straightforward to perform portably, unlike CT/MRI
• There are few (if any) contraindications to the use of ultrasound, compared
with MRI or contrast-enhanced CT
ADVANTAGES
• The real-time nature of ultrasound imaging is useful for the evaluation of
physiology as well as anatomy (e.g. fetal heart rate)
• Doppler evaluation of organs and vessels adds a dimension of physiologic data,
not available on other modalities (with the exception of some MRI sequences)
• Ultrasound images may not be as adversely affected by metallic objects, as
opposed to CT or MRI
• An ultrasound exam can easily be extended to cover another organ system or
evaluate the contralateral extremity
DISADVANTAGES
• Training is required to accurately and efficiently conduct an ultrasound exam
and there is non-uniformity in the quality of examinations ("operator
dependence")
• Ultrasound is not capable
/
of evaluating the internal structure of tissue types
/
with high acoustical impedance (e.g. bone, air). It is also limited in evaluating
structures encased in bone (e.g. cerebral parenchyma inside the calvaria)
• Ultrasound has its own set of unique artifacts which can potentially degrade
image quality or lead to misinterpretation
• Some ultrasound exams may be limited by abnormally large body habitus
ECHOGENICITY
ANECHOIC
HYPOECHOIC
HYPERECHOIC
when structures behind a highly
is a phenomenon where structures reflective or dense object appear
behind an anechoic or hypoechoic
&
darker (hypoechoic or anechoic)
object (like a fluid-filled structure) because they receive less
appear brighter than surrounding ultrasound energy.
tissues.
• Cause: This occurs because the
• Cause: It occurs because
ultrasound waves pass through
P O ST ER IO R ACO UST IC EN H A N CEM EN T A N D ultrasound waves are either
absorbed, reflected, or blocked
fluid (which is a poor attenuator) SH A D OW I N G by dense structures (like bone or
-
with minimal loss of energy. As a calcifications), leading to a
result, the tissues immediately shadow behind the structure
behind the fluid-filled structure where fewer sound waves reach.
receive more ultrasound energy,
making them appear brighter.
DOPPLER ULTRASOUND
Detect a frequency shift in echoes, and
determine whether the tissue is moving
toward or away from the transducer.
THREE-DIMENSIONAL
(3D) ULTRASOUND
is a technique that converts standard 2D
grayscale ultrasound images into a volumetric
dataset.
CONTRAST-ENHANCED
ULTRASOUND (CEUS)
-
• Contrast-enhanced ultrasound (CEUS)
involves the administration of intravenous
contrast agents consisting of microbubbles.
• Microbubbles consist of a gas surrounded
by a lipid, lipopolymer, or polymer shell
ELASTOGRAPHY
• A newer technique that exploits the fact that a pathological process alters the
elastic properties of the involved tissue.
• This change in elasticity is detected and imaged using elastography.
Elastography is an advanced ultrasound imaging technique used to assess the stiffness or elasticity of tissues. It is often utilized to detect and
evaluate abnormalities in tissues, particularly the liver, breast, thyroid, and prostate, as well as to assess musculoskeletal conditions.
How Elastography Works
• Tissues in the body have different levels of stiffness or elasticity. For example, normal tissues are usually softer, while fibrotic tissues, tumors,
or malignant lesions tend to be stiffer.
• Elastography measures how tissues deform in response to applied pressure or vibrations. This deformation, or lack thereof, is then visualized
using ultrasound.
Interpretation of Elastography Results
• Results are usually presented as a color map or quantitative measurements (in kilopascals, kPa).
• Blue colors typically indicate softer tissues.
• Red colors represent stiffer tissues.
• In shear wave elastography, higher stiffness values correlate with conditions like fibrosis or malignancy.
USES
• Differentiating malignant and benign neoplasms
(especially breast)
• Identifying early traumatic changes in muscles
and tendons
• Aiding in deciding the biopsy site more
accurately, reducing negative biopsy rates
• Assessing liver fibrosis
• Assessing liver steatosis (eg non-alcoholic fatty
liver disease and steatohepatitis)
X-RAYS
§ X-rays (or much more rarely, and usually
historically, x-radiation or Roentgen rays)
represent a form of ionizing electromagnetic
radiation.
§ They are produced by an x-ray tube, using a high
voltage to accelerate the electrons produced by its
cathode. The produced electrons interact with the
anode, thus producing x-rays. The x-rays produced
include Bremsstrahlung and the characteristic
radiation for the anode element.
FIVE BASIC DENSITIES ON X-RAY
RADIODENSITY
RAD-OPAQUE RENAL
STONES
FLUOROSCOPY
CONTRAST MEDIA
• Contrast media are a group of chemical agents developed to aid in the characterization
of pathology by improving the contrast resolution of an imaging modality:
v Barium sulfate contrast media
v Iodinated contrast media
v MRI contrast media are most commonly gadolinium-based contrast agents (GBCAs)
v Ultrasound contrast media CEUS
T
microbubbles
surrounded by
gas
lipide lipopolymers, polymers
,
COMPUTED TOMOGRAPHY
(CT)
• Computed tomography (CT), also known as,
especially in the older literature and textbooks,
computerized axial tomography (CAT), is an
imaging modality that uses x-rays to build cross-
sectional images ("slices") of the body.
• Cross-sections are reconstructed from
measurements of attenuation coefficients of x-ray
beams passing through the volume of the object
studied.
HOUNSFIELD NUMBER
• Sir Godfrey Hounsfield, the co-developer of CT, chose a scale that reflects the
four basic x-ray densities in the human body, with the following values:
v air = -1000 HU (Hounsfield units)
v fat = -60 to -120 HU
v water = 0 HU
v compact bone = +1000 HU
while
Gaenter
A
20 30 40
muscle
HOUNSFIELD NUMBER
CT VIEWS
CT VIEWS
CT WINDOW
• Once IV contrast has been injected, it flows
around the vascular system in a predictable
fashion:
Pulmonary artery
CT WITH IV CONTRAST
Aorta (~20 seconds)
Contrast behavior Spleen and portal system
(~60 seconds)
Inferior vena cava (~100
seconds)
CONTRAST PHASES
EARLY ARTERIAL PHASE (CTA) PORTAL VENOUS PHASE
COMPLIC ATIONS
Anaphylaxis
Renal
Extravasation
dysfunction
M AG N E T I C R E S O N A N C E
I M AG I N G
v MRI is an imaging modality that uses non-
ionizing radiation to create useful diagnostic
images.
v In simple terms, an MRI scanner consists of a
large, powerful magnet in which the patient
lies.
v A radiofrequency (RF) transmitter is used to
send signals to the body and then
a radiofrequency receiver detects the emitted
signals.
v These returning signals are converted into
images by a computer attached to the scanner.
v Imaging of any part of the body can be
obtained in any plane.
ADVANTAGES
• Ability to image without the use of ionizing x-rays, in contradistinction to CT scanning
• Images may be acquired in multiple planes (axial, sagittal, coronal, or oblique) without repositioning
the patient. CT images have only relatively recently been able to be reconstructed in multiple planes
with the same spatial resolution (i.e. isotropic voxels)
• MRI images demonstrate superior soft-tissue contrast as compared to CT scans and plain
radiographs making it the ideal examination of the brain, spine, joints, and other soft-tissue body parts
• Some angiographic images can be obtained without the use of contrast material, unlike CT or
conventional angiography
• Advanced techniques such as diffusion, spectroscopy, and perfusion allow for precise tissue
characterization rather than merely 'macroscopic' imaging
• Functional MRI allows visualization of active parts of the brain during certain activities and also
understanding of the underlying networks
DISADVANTAGES
• MRI scans are more expensive than CT scans
• MRI scans take significantly longer to acquire than CT and patient comfort can be
an issue, maybe exacerbated by:
• MR image acquisition is noisy compared to CT
• MRI scanner bores tend to be more enclosed than CT with associated claustrophobia
• MR images are subject to unique artifacts that must be recognized and mitigated
against.
• MRI scanning is not safe for patients with some metal implants and foreign bodies.
Careful attention to safety measures is necessary to avoid serious injury to patients
and staff, and this requires special MRI compatible equipment and stringent
adherence to safety protocols.
INTENSITY
• When describing most MRI sequences we refer to the shade of grey of tissues
or fluid with the word intensity, leading to the following absolute terms:
v Hyperintense = brighter than the thing we are comparing it to
v Isointense = same brightness as the thing we are comparing it to
v Hypointense = darker than the thing we are comparing it to
T1 W E IGHTE D S E QU E NCE S
T2 W E IGHTE D S E QU E NCE S
FLUID ATTENUATED
FAT SUPPRESSED
P ROTO N DE NS ITY-
W E IGHTE D S E QU E NCE S
S U S CE P TIB ILITY
S E NS ITIVE S E Q U E NCE S
DIFFUSION-WEIGHTED SEQUENCES
MR ANGIOGRAPHY
MR SPECTROSCOPY
PERFUSION WEIGHTED
IMAGING
D I F F U S I O N T E N S O R I M AG I N G
A N D F I B E R T R AC TO G R A P H Y
S I N G L E P H OTO N E M I S S I O N C O M P U T E D TO M O G R A P H Y
( S P E C T ) A N D P O S I T R O N E M I S S I O N TO M O G R A P H Y ( P E T )
• Single photon emission computed tomography (SPECT) and positron
emission tomography (PET) are nuclear medicine imaging techniques that provide
metabolic and functional information, unlike CT and MRI.
• They have been combined with CT and MRI to provide detailed anatomical and
metabolic information.
P O SIT RO N EM ISSIO N
TO M O GR A P H Y ( P E T )
• Very expensive
• Uses positron-emitting
radioisotope (tracer) -F-18
fluorodeoxyglucose (FDG)
• Gives better contrast and
spatial resolution (cf. SPECT)
APPLICATIONS
• Oncologic
o detection, staging, response to treatment
o differentiation between radiation necrosis and recurrence
• Neurologic
o early diagnosis of Alzheimer disease
o localization of seizure focus in interictal phase
o localizing eloquent areas (e.g. speech, motor function)
• Cardiac
o identification of hibernating myocardium
• Infection/inflammation
o pyrexia of unknown origin (PUO)
o vasculitis
SINGLE-PHOTON EMISSION COMPUTED
TOMOGRAPHY (SPECT):
• Is lower cost
• Uses gamma-emitting radioisotope (tracer):
v Technetium-99m
v Iodine-123
v Iodine-131
• Gives poorer contrast and spatial resolution (cf. PET)
USES
v Tc-99m sestamibi myocardial perfusion study
v Brain imaging (perfusion and receptor-binding
radiotracers)
v Tc-99m sestamibi parathyroid scan
v white cell scan
v Bone scan
