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The Value of Coronal Images in Abdominal Imaging

February 26, 2009
Written by: , Filed in: Abdominal Imaging
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I feel strongly that if you have the capability to send coronal images to your PACS system you will find them to be extremely valuable.

Most of us at my institution interpret axial images. I will review the axial images, but before I sign off on the report, I will get the coronal images and scroll through them.

It is surprising what sometimes pops out at you when you look at the coronal images. I cannot tell you how many times I have seen little nodular implants around the spleen and liver that I just did not appreciate on the axial images.

There are also some small kidney cancers that you might not appreciate on the axial images which you can see on coronal images. You are scrolling through the coronals and all of a sudden it is clear to you that there is a lesion there.

I find coronal images to be extremely helpful for localization of a kidney stone, where it is in the upper, mid, or lower part of the kidney. Coronal images help me measure its size, and where it is along the course of the ureters.

Another example of how useful coronal images can be in reference to abdominal imaging is with regard to the appendix. If I cannot see the appendix on the axial image, sometimes I will take a look on the coronal.

I also find coronal images to be of value in the patient with small bowel obstruction in localizing the zone of transition. And once you have localized that zone of transition, how you determine what the etiology of the obstruction is.

Most of this is automated at the CT console, and it is not a whole lot of work for the technologist. The coronal images on your PACS system really do add value in general to the interpretation.

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Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
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Abdominal Imaging CME

There can be many different imaging manifestations, especially at CT.

For example, take the case of a young woman who comes in with abdominal pain. You see some sort of soft tissue thing in the abdomen or pelvis and you think of endometriosis. We have had endometriotic implants on the ovaries. You always have to keep that in your differential diagnosis when you see a large adnexal mass.

I have seen endometriosis stuck to the cecum, after the cul-de-sac in the ventral aspect of the rectosigmoid junction. That is the most common location for extragonadal endometriosis, but the second most common place is really stuck on the appendix, the ileocecal region. So, in young women, always keep in the back of your mind, could this possibly be endometriosis? You might miss this if you were only looking at the axial image, while the coronal image would be able to highlight it.

A lot of people have abdominal pain, and we never find anything. They get labeled as irritable bowel disease. But, sometimes there are some very subtle things that we just cannot see, like little tiny endometriotic implants. Sometimes MRI is a little better for that.

But you do see endometriosis on CT, and that is certainly something that you should always keep in your differential diagnosis. I think we as radiologists can really make a major impact in triaging patients if we use both axial and coronal images in abdominal imaging.

Author: Michael Macari, MD

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Body Imaging: Abdominal, Thoracic and Vascular
University of California, San Francisco, Department of Radiology
This CME program carries 18.5 AMA PRA Category 1 Credits and is designed for the radiologist in clinical practice.
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Read more or order: Body Imaging: Abdominal, Thoracic, and Vascular

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