2/16/2012
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Abdominal Imaging: The practicalUtility of Radiography andUltrasound
Jonathan Hayles, DVM, MS, Dipl ACVR
Life is hard
• Internist• Surgeon• Oncologist• Neurologist• Dermatologist• Radiologist!!! The digital era has lightened the load
© 2012 Veterinary Imaging Center of San Diego
Question?
• Patient Concerns– In need of imaging
• Client Concerns– $$$
• Logistics– New DR System
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Imaging Selection
History
ClinicalPresentation
PhysicalExamFindings
CBCChemUA
DDX
© 2012 Veterinary Imaging Center of San Diego
Imaging Selection
© 2012 Veterinary Imaging Center of San Diego
Imaging Selection Radiology Report
History:Intermittent vomiting, elevated liverenzymes
Findings:Blah, blah, blah
Conclusions:Blah, blah, blah
Recommendations:
ABDOMINALULTRASOUND!!!
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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The Pros and Cons
PRO
S
• Bone• Gas• Comfort• $$• Digital• Independent• Availability• Spatial Res
CON
S
• Super• Contrast• Radiation
PRO
S
• Super• Contrast• Radiation• Digital
CON
S
• Bone• Gas• Comfort• $$• Dependent• Availability
© 2012 Veterinary Imaging Center of San Diego
Approaching the Rad(Interpretation Paradigm)
1. Extra-ab structures2. Peritoneal/Retro space3. GI +4. Urogenital +
© 2012 Veterinary Imaging Center of San Diego
Can youidentify the
colon?
Canine
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Chino
• 14 yr MN Shepherd X• 1 month Hx of Wt. loss• Inappetence,
intermittent vomitingand diarrhea• PE: BCS 3/9 and
palpable soft, gas filledbowel• Blood
Chem/CBC/UA/T4: WNL
© 2012 Veterinary Imaging Center of San Diego
Possible differentials for Chino:
• Abdominal mass orobstruction• Rads, US, Exlap
• Nonprimary GI dz• R/O with labs
• Primary GI dz• Inflammatory (-itis, IBD)• Partial obstruction• Motility disorder
© 2012 Veterinary Imaging Center of San Diego
Chino
Radiographicdiagnosis: Smallintestinal obstruction
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Chino’s Ultrasound:
Ultrasound Diagnosis:Small intestinalobstruction secondary toSI mass
Jejunal Adenocarcinoma © 2012 Veterinary Imaging Center of San Diego
• Cross sectional study of acutely V dogs (82)• Definitive Results– Rads 27/82 (33%)– US 80/82 (97%)
• Concluded both are accurate• BUT… US had >accuracy <equivocal results
>confidence
Vet Rad 2011
© 2012 Veterinary Imaging Center of San Diego
Can youidentify the
colon?
Feline
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Sweetie
• 10 yr MN DSH• Vomiting
Mattoon, WSU © 2012 Veterinary Imaging Center of San Diego
Sweetie
© 2012 Veterinary Imaging Center of San Diego
Sweetie
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Sweetie
• Radiographic Findings:markedly distendedsegment of smallintestine• Radiographic Diagnosis:
small intestinalobstruction• Surgical Diagnosis:
Terminal ileal neoplasm
© 2012 Veterinary Imaging Center of San Diego
Reba
• 4 yr FI DobermanPinscher• History of abdominal
distention (5 hrs)• Vomiting and ptyalism
© 2012 Veterinary Imaging Center of San Diego
Radiographic Diagnosis: GDV
Reba
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Reba’s Ultrasound:
© 2012 Veterinary Imaging Center of San Diego
Little Bill
• 8 yr MN DSH• History of hematochezia
with otherwise normalfeces• Elevated renal values
© 2012 Veterinary Imaging Center of San Diego
Little Bill
Radiographic diagnosis: Irregularkidneys, left nephrolith, mineralbody in right retroperitoneal,unremarkable colon
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Little Bill Right Kidney 24 hrs later
© 2012 Veterinary Imaging Center of San Diego
Little Bill Right Kidney 24 hrs later
© 2012 Veterinary Imaging Center of San Diego
Little Bill
Pneumocolon
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Abby
• 12 yr FS JRT
• 3 week history ofhematuria, culturepositive UTI/MIC
• Hematuria continueddespite abx treatment
© 2012 Veterinary Imaging Center of San Diego
AbbyNormal survey radiographs
© 2012 Veterinary Imaging Center of San Diego
Abby IVPDiagnosis: Left hydronephrosis, Lefthydroureter, filling defect in UB
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Abby IVPDiagnosis: Left hydronephrosis, Lefthydroureter, filling defect in UB
© 2012 Veterinary Imaging Center of San Diego
Sady
• 10 yr FS Labrador
• 3 week history oflethargy and losingweight
• No vomiting or diarrhea
• CBC/Blood chemistrypending
© 2012 Veterinary Imaging Center of San Diego
Sady
Findings: Slight loss of abdominalserosal detail in the mid abdomen
© 2012 Veterinary Imaging Center of San Diego
2/16/2012
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Sady
• Differentials?
• Small amount ofperitoneal effusion
• Focal peritonitis
• Mesentericlymphadenopathy
Next step?
ABDOMINAL ULTRASOUND!!!
© 2012 Veterinary Imaging Center of San Diego
Sady© 2012 Veterinary Imaging Center of San Diego
Sady’ Thorax
2/16/2012
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The Human Side
sciencephoto.com
• 1000 Medicare patients 1996 to 2005• Abdominal imaging inc. 25% overall• Greatest growth in CT/CT contrast
(141%)• Ultrasound had a 12% increase• Plain abdominal radiography deceased
-13%• Radiologists dominate market share at
90%
JACR 2008
© 2012 Veterinary Imaging Center of San Diego
The Human Side
sciencephoto.com
• 1000 Adults on ED visits from 1990 to2009• The number of CT examinations
increased 17-fold and US increased52%• Radiography decreased 82%• Conclusion: CT has replaced
radiography as the most commonimaging modality for ED visits
Int J Emerg Med 2011
A.S. Raja et al
© 2012 Veterinary Imaging Center of San Diego
Conclusion
• Abdominal radiography and ultrasound work welltogether
• Some cases warrant ultrasound examinationwithout X-rays
• Abdominal radiographs infrequently provide adefinitive diagnosis
• Save up for a new 64-slice CT scanner© 2012 Veterinary Imaging Center of San Diego
