Posts tagged ‘narrowing’

September 26, 2014

Save a Man’s Heart!

Obesity-waist circumference by Victovoi via Wikimedia Commons Copyright Public DomainHaving seen enough episodes of Grey’s Anatomy (or ER or any of a dozen other TV shows about medical practitioners) you may well know the amount of work a doctor can put in to save a man’s heart. OK, that is television and not real life.  As doctors, we love to save lives! We prefer to do it preventatively and proactively.

 

So… what does it take to save a man’s heart? It is easy; exercise, limited alcohol consumption, no cigarettes and a healthy BMI are the keys. The more items a man follows from this list, the better protection for the heart.

 

Here’s what blew our collective mind:

 

80% = the number of heart attacks in men that are preventable with a healthy lifestyle. Eighty!

36% = the risk reduction of heart attack by not smoking

12% = the risk reduction of heart attack by keep a waist measurement below 37”

3% = the risk reduction of heart attack by exercising on a regular basis

 

These numbers come from a recent study in The Journal of the American College of Cardiology. And also from the land of amazingly great news.

 

Get yourself or your man on the road to your best possible health by engaging in a healthier lifestyle and make those numbers work in your favor!

 

 

(Image credit: Obesity-waist circumference by Victovoi via Wikimedia Commons Copyright Public Domain)

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

August 4, 2014

We Love… Get Your Rear In Gear!

Katie Couric VF 2012 Shankbone 2 by via david_shankbone Flickr Copright Creative Commons Attribution 2.0 Generic (CC BY 2.0)To end this series on GI imaging, we thought we’d shine a light of hope and health by talking about an organization we love… Colon Cancer Coalition!

 

This is an amazing group of people dedicated to the knowledge that early detection of colon cancer saves lives! Their mission?

 

“Empower local communities to promote prevention and early detection of colon cancer and to provide support to those affected.”

 

Katie Couric, through her own personal loss and resilience, has helped make colorectal cancer a nationally known and talked about  issue (and for this we are grateful). The Colon Cancer Coalition reminds us to Get Your Rear In Gear! This program in cities across the US funnels money back into the participating cities, supporting local education and screening efforts. Check for events in your community here.

 

Early detection is the key to saving lives from colon cancer which is a largely preventable disease – in most cases, colon cancer starts from small growths called polyps. If these are found early, no colon cancer will develop! From a healthy diet and exercise to regular check-ups and knowing the signs of colon cancer, we can all make a difference. Regular screening with colonoscopy at age 50 for folks of average risk can and will make a difference.

 

Catch up with the Coalition on Twitter. (We follow them too.)

 

Time to celebrate life – and kick cancer’s butt!

 

 

(Image credit: Katie Couric VF 2012 Shankbone 2 by david_shankbone via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 30, 2014

MR Enterography

MR enterographyWhen investigating issues of the abdomen and intestines, there are multiple options, including small bowel series, small bowel enteroclysis and CT or MR enterography (entero- meaning intestine, our linguistic lesson for the day!).

 

Why would you need MR enterography?

 

MR enterography is performed for many of the same reasons as CT enterography. As with each imaging modality, there are nuances and benefits from the different techniques.

 

One of the reasons a patient may come in for MR enterography is due to an iodine allergy (iodine is the IV contrast agent for CT). MR technology uses a different IV contrast agent, one containing gadolinium.

 

Additionally, MR technology uses no radiation. This can be beneficial when the patient is pregnant (although only done in pregnancy after the first trimester). It is an ideal means for assessing younger patients with inflammatory bowel disease who may face the need for frequent, repeated imaging of the intestine.

 

How does a patient prepare for MR enterography?

 

Preparation for MR enterography is done similar to the CT version – fasting for up to 4 hours before the examination.

 

What can be expected when you have MR enterography?

 

As always, remember your basic MRI safety – no metal can enter the MR suite – this means all clothing with metal must be removed.

 

MR enterography relies on adequate distention of the small bowel, usually using the same oral contrast agent containing iodine as for CT enterography. Images of the abdomen and pelvis will be obtained while IV contrast containing gadolinium is injected. The imaging time is longer for MRI than for CT, usually close to 30 minutes total for MR. Holding still is important as any motion will cause loss of detail.

 

What can we find with MR enterography?

 

This can show vascular lesions of the wall of the GI tract, masses and mucosal lesions as can be seen with inflammatory bowel disease. It also allows us to see detail in the bowel wall and in the adjacent soft tissues. Fistulas (abnormal communications from bowel loops), strictures and blockages, and abscesses can be seen in patients, often in those with inflammatory bowel disease. Problems with the blood vessels going to the bowel will be shown, such as narrowings or aneurysms.

 

And after the exam?

 

To flush the excess contrast from your system – drink lots of water!

 

MR enterography is one more tool in the arsenal for imaging the small intestines able to produce beautiful images helping us keep you on the path to your best health.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 23, 2014

CT Ent-enter-entero-enterography! Whew!

Screen Shot 2014-07-23 at 2.52.56 PMWhen investigating issues of the abdomen and intestines, your doctor may order a small bowel series or enteroclysis. However, CT technology is also an excellent noninvasive way of looking at internal organs. It also allows us to better see the tissues adjacent to the small bowel. If a dedicated view of the bowel and adjacent soft tissues is needed there is a special procedure called CT enterography which may be used.

 

Why would you need CT enterography?

 

There are many potential reasons why a patient may come in for CT enterography, with the goal of precisely defining anatomy and potential causes of symptoms. Symptoms can include:

 

  • Abdominal pain (especially in the left or right lower quadrant)
  • Blood in stool
  • Possible bowel obstruction, usually partial blockages of the small bowel which can be difficult to diagnose and difficult to find the cause of
  • Inflammatory bowel disease – with CT enterography we can see not just the disease of the bowel, but any complications in adjacent tissues which are frequent
  • Hernias
  • Masses
  • Narrowings or strictures
  • Infections
  • Masses in the mesentery or adjacent organs that can affect the GI tract

 

How does a patient prepare for CT enterography?

 

Patient prep for this type of imaging is fairly basic: fasting (no food or drink) for 4 hours before the CT may be requested. At times the study may be done without preliminary fasting.

 

What can be expected when you have CT enterography?

 

Typically, CT enterography uses fairly large volumes of oral contrast agents which are iodine-based and iodine-based IV contrast. The oral contrast material helps distend the bowel, so that the wall is well seen. The blood vessels and any inflammatory changes are best seen with the IV contrast highlighting the vessels.  If you have allergies, let us know so we can plan ahead. CT uses radiation, so this exam in general is not done in those that are pregnant or who may be pregnant.

 

What might we see with CT enterography?

  • Inflammatory bowel disease – bowel wall thickening, abnormal enhancement of the wall of the bowel, strictures, fistulas (abnormal communication between bowel loops), adjacent abscesses all may be signs of inflammatory bowel disease and imaging with CT enterography can help assess its degree of activity
  • Masses – benign polyps and cancers
  • Vascular problems to the small or large bowel, including narrowings of vessels or aneurysms (small saccular outpouchings)
  • Blockages – we can not only see the site of obstruction but many times can find the cause of the blockage
  • Infections

 

 

CT enterography is a fusion of the best of CT technology, allowing us to see the soft tissues in the abdomen, and enterography which distends the small bowel, allowing us to best see the wall. With this technique, small bowel diseases are beautifully demonstrated.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 21, 2014

Intestinally Yours

small bowelIn our continuing series on gastrointestinal imaging, today we’re talking about the small bowel or small intestine. The small intestine is key in absorbing nutrients in our food.

 

Why would you need an imaging study of the small bowel?

 

The small bowel is a coiled tube in the abdomen up to 23 feet in length connecting the stomach and the colon.  In contrast to the stomach and colon which are easy to evaluate by endoscopy, much of the small bowel is beyond the reach of endoscopes.

 

Symptoms which might prompt a small bowel evaluation include:

 

  • diarrhea
  • blood in stools
  • abdominal pain
  • malabsorption
  • suspected partial small bowel obstruction
  • inflammatory bowel disease
  • anemia

 

There are two types of fluoroscopy exams a patient can have to evaluate the small bowel: a small bowel series or a small bowel enteroclysis.

 

How does a patient prepare for small bowel imaging?

 

The prep for these studies is simple: no food or drink by mouth for 4 hours. Clothing with metal will need to be removed. Radiation is used, so these studies are not performed in pregnant women. If you have an allergy or sensitivity to oral barium please advise the radiologist.

 

What can be expected of a small bowel imaging procedure?

 

Both exams will start with a preliminary film which is used to assess the gas in the intestine. Signs of obstruction or bowel perforation may lead to the exam being cancelled or modified.

 

1. Small bowel series

For this procedure, the patient will be given barium to drink. Sufficient barium is necessary in order to fill up the small bowel in order to image it. Next, we will take a series of x-rays to follow the barium through the entire small bowel all the way to the cecum (first part of colon). Additionally, we will take images with gentle compression of the small intestine including the  terminal ileum which is the point at which small bowel ends and joins the colon. Please note it can take up to 4 hours for the contrast to travel all the way through!

2. Small bowel enteroclysis

This procedure uses a tube placed through the mouth or nose until the tip is in the first part of the small bowel. This tube is used to instill a solution of barium at a rate which distends the small intestine and limits normal peristalsis (those normal contractions which move food along). Images are then taken in the same method as above. The entire study can take up to 3-4 hours to complete.

 

So, what are radiologists looking for? What can we expect to find?

 

Images from either method will allow a beautiful depiction of your small bowel anatomy and a little about how it is functioning. Imaging can find:

  • tumors – benign polyps and cancers
  • inflammatory bowel disease IBD (inflammatory bowel disease)
  • infections
  • strictures or narrowings which might partially block small bowel – frequent in patients with IBD
  • fistulas or abnormal communication between bowel loops – frequently found in patients with IBD
  • celiac disease

 

After a small bowel exam, drink lots of fluids! This will help flush out the contrast that was introduced for the exam.

 

The small bowel series and small bowel enteroclysis are methods of viewing the elusive small intestine. The resulting images can be phenomenal. We love being able to see into the human body to get you on the road to your best possible health!

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

July 18, 2014

Imaging of the Lower GI

Barium and Air lower GIYou would probably not consider a barium enema an exam to add to your bucket list, but this imaging study of the colon has the potential to save lives and diagnose many different conditions of the large intestine. While not the most pleasant test we perform, it does create beautiful (ok – we think they’re beautiful!) images of the colon, allowing us to find problems and prevent future ones.

 

So, why would you need an imaging study of the lower gastrointestinal (lower GI) tract?

 

A barium enema shows the anatomy of the large intestine or colon. Colonoscopy allows direct visualization of the mucosal lining and the inside of your colon through a long endoscope, and is often the first study performed for evaluation of the colon. Barium enema is an alternative means of imaging the colon that is less invasive, but not as sensitive at finding some things (especially smaller polyps). Your doctor may recommend lower GI imaging if you have the following symptoms:

 

  • blood in stools
  • change in bowel habits
  • constipation
  • excessive or chronic diarrhea
  • inexplicable weight loss
  • irritable bowel syndrome (IBS)
  • pain in the abdominal region
  • to screen for colon cancer – colonoscopy or CT colonography are often the studies of choice; if colonoscopy cannot reach all of the colon, barium enema may be used to screen the part of the colon not seen; screening for colon cancer is important as most colon cancers start as small growths called polyps – if such polyps are removed, no cancer will develop!

 

How do you prepare for lower GI imaging? What’s to expect?

 

Tests of the lower GI are performed… carefully. In order to find masses or abnormalities of the mucosal lining, the colon must be completely empty. A preliminary prep to accomplish this is necessary for most studies. It will require fasting for a time period, around 24 hours. The prep will include a combination of laxatives and enemas with the goal that all particulate matter is eliminated from your system by the morning of the test. Any medications necessary should be taken with a small amount of water.

 

We occasionally do the study on children. Special preparations may or may not be necessary depending on the age of the child and the conditions being evaluated.

 

The test involves radiation, so will not be used on pregnant women or those who might be pregnant. Let your radiologist know if you have an allergy to latex.

 

We will start the procedure with a preliminary x-ray or film of your abdomen. This allows the radiologist to make sure the prep has worked and the colon is empty. It also allows us to assess for signs the test should not be done, such as when there is a possible obstruction or bowel perforation. The exam involves placing a catheter into the rectum, where a small balloon is inflated. Barium is introduced through the catheter into the rectum by gravity. Room air is then introduced. We use fluoroscopy to get the right amount of barium and air into and coating the colon. This will involve changing your position on the table (lots of rolling!) and changing the table position. Once the colon mucosa is coated with barium and distended with air, a series of x-rays in dedicated positions will be taken so that all parts of your colon will be seen.

 

It will help you tolerate the study if you concentrate on breathing – this actually relaxes the muscles in the wall of the colon, lessening any cramping you may experience.

What do we look for when imaging the lower intestinal tract?

 

We can find a wealth of information from the health of the mucosal lining to blockages. We will assess for normal anatomy and look for signs that all of your colon, from the rectum to the cecum,  is seen. We can evaluate for:

 

  • tumors – both benign polyps and cancers
  • diverticular disease – diverticula are saccular outpouchings from the colon wall which can become inflamed
  • inflammation as can be seen in inflammatory bowel disease or colitis
  • strictures or narrowings
  • blockages in children, as from Hirschsprung’s disease or from intussusception, which can also be treated and reduced with a barium enema

 

What happens after a lower GI exam?

Your radiologist will review all of the films. Once all areas of the colon have been well-seen, the catheter will be removed and you will be allowed to the restroom. Images after using the restroom may or may not be needed.

 

Your radiologist will evaluate all of your images and the final report will be sent to your referring physician.

 

Be sure to drink plenty of water following the procedure. This is needed to flush the remaining contrast agents from you system. You can resume your normal diet immediately.

 

The well-being of your gastrointestinal system is important, and the barium enema is an imaging tool which can provide valuable information, keeping you on the road to your best possible health.

 

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

February 14, 2014

Heart Health: CT Coronary Angio

Here is an image from a CT coronary angiogram showing the aorta (the main blood vessel coming out of the heart and bringing blood to the body) with the coronary arteries coming off the aorta and going around/to the heart – the heart has been removed from the image so we can see the vessel, much like is seen on a heart catheterization. These arteries show no significant narrowings.

Here is an image from a CT coronary angiogram showing the aorta (the main blood vessel coming out of the heart and bringing blood to the body) with the coronary arteries coming off the aorta and going around/to the heart – the heart has been removed from the image so we can see the vessel, much like is seen on a heart catheterization. These arteries show no significant narrowings.

Now that we’ve covered CT coronary calcium scores, we’d like to talk more about noninvasive heart imaging.

There are several ways of studying artery narrowing or blockages of the coronary arteries of the heart. Two common exams are the CT angiogram of coronary arteries and the coronary angiogram, also known as a heart catheterization or “heart cath.”

For a CT angiogram, radiologists use CT technology and intravenous contrast to noninvasively image the arteries. A heart catheterization, usually performed by a cardiologist, uses a small catheter threaded through the blood vessels to the heart to inject contrast into the arteries.  The exam may require light sedation, and the use of catheters in the heart has risks including but not limited to blood vessel damage, arrhythmias, bleeding and stroke.

It has been shown that 40% of heart catheterization procedures in women and a smaller percentage in men are normal.  In those cases, nothing is wrong with the arteries and nothing requires treatment like angioplasty or stenting.  Having a less invasive, safer exam to evaluate people at risk for heart disease or symptoms of heart disease is a bonus – particularly for those patients with lower risk and potentially normal coronary arteries.

CT angiography of the coronary arteries uses CT, EKG, intravenous contrast and sophisticated 3D post processing techniques to create 3D images of the heart and heart arteries for analysis. Both soft plaques and calcified arterial plaques can be imaged and analyzed for severity. The determination for noninvasive or invasive treatments can be made from this study. The  procedure takes approximately 30 – 60 minutes, requires little preparation and the results are shared with the ordering physician for further review.

For patients at high risk for coronary artery disease, or those likely needing intervention such as angioplasty (treating narrowed arteries with a balloon) or stenting, a traditional heart catheterization is recommended. This allows diagnosis to be followed by immediate treatment.

CT coronary angiography can be considered for the following patients among others:

  • Patients with a strong family history of heart disease.
  • Patients with multiple risk factors for heart disease such as hypercholesterolemia, hypertension, diabetes.
  • Patients with atypical chest pain.

Talk to your medical provider if you have questions regarding this examination or questions regarding your personal risk for heart disease.