MRI diagnostician

Many organ diseases can be accompanied by similar symptoms and are difficult to distinguish even for an experienced doctor. An oversight in the diagnosis can slow down the treatment, lead the treatment in a different direction.

Therefore, the diagnosis of the disease occupies an important place in medicine. It is no secret that the X-ray machine is dangerous, and the invasive methods by which tests are obtained can seriously harm the patient. That's just a computer tomograph, magnetic resonance imaging is completely safe for humans.

It is important for the patient to have a general idea of ​​modern methods of diagnosing the body. That is why, having received a doctor's appointment to undergo a CT scan of the abdominal region, many patients are wondering: what does computed tomography of the abdominal cavity show?

What does a CT scan of the abdomen show?

This technique is widely used in the medical field. With its help, you can get an image of almost any organ, along with abdominal lymph nodes and vessels. The abdominal region is no exception.

Computed tomography shows layers of the peritoneal space. CT provides a three-dimensional image, identifying even the smallest changes in tissues. Additionally, we can note the high speed of scanning the cavity, which allows you to get results in 1.5-2 hours.

The resulting image allows you to assess not only the condition of the tissues, but also the size and location of the organs. That is why, any pathology cannot be overlooked, even at the earliest stage of its development. Computed tomography is one of the most accurate methods that can determine the development and spread of a malignant tumor.

The technique is based on scanning the human body using x-rays. Scan results are processed by programs. For research, a special substance is introduced into the body, which has a name. This fluid makes it possible to visually separate the organs from each other. The amount of the substance is selected individually for each individual patient. It is important to note that the contrast completely leaves the body in a day and does not entail negative consequences.

Preparation for tomography

CT scan of the abdominal cavity: what shows:

• determines a malignant tumor in the abdominal region;
• determines the presence of inflammation in the organs;
• makes it possible to identify abdominal injuries;
• determines any damage to the peritoneal area.

At the same time, there are a number of contraindications that make it unacceptable to undergo diagnostics in a given period of time:

1. Various diseases of the body;
2. Allergic reaction to the introduction of a contrast agent into the body;
3. Frequent bleeding;
4. Heart failure.

Therefore, in order to successfully complete the procedure, it is necessary to carefully prepare for it. First of all, it is necessary to adhere to a diet in nutrition, lead a healthy lifestyle, avoid nervous strain, and not overdo it with physical activity.

The main stages of preparation for computed tomography:

• a few days before the procedure, products that promote gas formation should be neglected;
• drink a laxative or do a bowel cleansing with an enema in the evening, before starting the diagnosis;
• In the morning, before the procedure, eat as light a breakfast as possible without eating food that has a solid state.

Which is better, MRI or CT?

Patients often have a question: what is better MRI or CT of the abdominal cavity? Most often, these methods have approximately the same information content. But there are also a number of differences that make it necessary to opt for one of the methods.

Computed tomography much more clearly shows the occurrence of solid formations in the organs, it also better distinguishes the density of tissues, which can change in the event of a specific disease. , in turn, is able to provide more informative information when working with soft tissues, inflammatory processes, as well as the occurrence of pathologies in cartilage tissues.

Therefore, what is better when examining the abdominal cavity: MRI or CT, it is almost impossible to find a definite answer. In fact, both methods help diagnose the human body, in particular the peritoneum, and give the necessary results to determine the method of treating the disease. And only a doctor can do right choice, taking into account the experience, the course of a particular disease, the symptoms and the uniqueness of the case.

Computed tomography combines special x-ray equipment with sophisticated computer programs to create a large number of images and images of any part of the body, which can be further examined on a computer, printed and transferred to different media. That is why this method is the most convenient and universal for determining almost any disease.

» CT and MRI of the abdomen. Which method is better and what is the difference?

CT and MRI of the abdomen. Which method is better and what is the difference?

Modern types of diagnostics offer people several options for a qualitative examination of internal organs at once. What to choose MRI or CT of the abdominal cavity? Consider the difference between the types of diagnostics, features and benefits.

Resonance diagnostics

What is an MRI? This is diagnostics by a magnetic field using a tomograph apparatus. Magnetic radiation is safe for health, because it has no effect on the body - it works with hydrogen molecules in the human body. The device creates a high voltage magnetic field and catches the response from the organ under study. Then the data is processed using a computer program and displayed on the monitor screen.

Note! Examination of the abdominal cavity MRI is completely safe for humans.

The only inconvenience during the procedure is the forced immobility of the body: magnetic resonance imaging is performed in a fixed position. Any movement during the procedure interferes with the scan. The device examines the organs in layers - through every millimeter. Therefore, during the movement, a fuzzy “blurred” image is created.

When is MRI ordered? Resonance tomography is carried out to study the soft structures of the body, the apparatus does not distinguish between solid parts of the body. For example, this tomograph will not detect stones in the abdominal organs, unlike MSCT or CT. To examine the intestines and stomach, it is better to do an MRI than a CT scan.

CT scan

Consider the features of a CT scanner. The examination is carried out using x-rays, as in conventional fluorography. This is a significant disadvantage of this type of diagnostics. Compared to an MRI, a CT scan does not take much time - there is no need to be in a fixed position for a long time.

In addition to this advantage, there are other positive features of CT:

• the procedure can be performed with any implants in the body - metal and electronic;
• examination is not contraindicated for those suffering from claustrophobia and epilepsy;
• the device does not create a lot of noise during operation and does not cause discomfort;
• the cost of the examination is much cheaper than using a magnetic tomograph.

Note! Modern computed tomography offers an improved research method using spiral diagnostics: its second name is multispiral.

What does it mean? This is a layer-by-layer scan of the organ under study, as in MRI. The device for one revolution creates about 300 images in different planes. Thanks to spiral scanning, it became possible to obtain objective information about abdominal organs and soft tissues, which was previously impossible.

The cost of MSC tomography is higher than conventional computed tomography, but good informative results are obtained. How is a patient examined with a spiral tomograph? Just like with conventional computer diagnostics.

Comparative characteristics

What is better to prefer - CT or MRI of the abdominal cavity? The abdominal cavity contains most of the vital organs of the body - the digestive, urinary, and endocrine systems. Any organ included in the listed systems can be examined.

If the question concerns the information content of the examined organs, then both tomographs will be able to distinguish between malignant neoplasms and the features of the functioning of all systems. MRI and CT scan the stomach well, determine the pathology of the intestines and kidneys / liver. However, MRI will not see stones in the organs, so CT should be chosen to diagnose sand and stones in the kidneys / gallbladder.

What else can not cope with a magnetic tomograph? He will not be able to clearly visualize the skeletal system due to the features magnetic field- in dense structures there are no hydrogen molecules in sufficient quantities. The resonant tomograph does not work with the organ itself, but with the hydrogen molecules in it. Therefore, scanning of the skeletal system can only be performed using X-rays, as well as the abdominal lymphatic system.

Benefits of MRI:

• you can examine children from birth;
• the procedure is harmless to the body;
• no need to take tests before the examination;
• pregnant/nursing mothers can be examined;
• universality of diagnostics - a complete examination of the body in one procedure.

However, the cost of diagnostics is high - from 3000 rubles. and higher. This is a big minus. Therefore, patients choose computed tomography or ultrasound.

Benefits of CT:

• low cost compared to MRI;
• can be examined with implants in the body;
• there is no need to be immobilized for a long time;
• well defines stones/sand in abdominal organs;
• clear visualization of bone structures;
• the ability to identify tumors, cysts and internal bleeding.

Computed tomography can completely replace resonant if there are no contraindications to X-ray irradiation.

Outcome

What to choose from two types of diagnostics? The choice is determined by the subject of the survey. If you need to determine the presence of stones in the abdominal organs, you should choose CT. If the subject of the study is to identify the tumor and determine its nature, both tomographs will clearly cope with the task. In this case, an obstacle to MRI may be the price or availability of implants, and an obstacle to CT may be a previously made fluorogram or contraindications regarding the patient's health.

Human life often depends on the timely and accurate diagnosis of dangerous conditions and on timely treatment. Various injuries of internal organs, anomalies in their development, foci of inflammatory processes, neoplasms, aneurysms - these are just some examples of life-threatening diseases. In order to save a patient or preserve his health, providing medical care that exactly corresponds to the diagnosis, high medical professionalism is required. And in this case, with various pathologies of the abdominal organs, additional instrumental methods of examination help doctors of many specialties. Of these, X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) are the most informative.

The essence of the X-ray method of research

X-ray examination is the most traditional, old method, which does not provide high information content compared to new methods. But it is still widely used in many medical institutions. When conducting a survey x-ray of the abdominal organs, a person receives a certain dose of radiation without a guarantee of a clear, reliable picture in the picture, since the parenchyma (actual tissue) of the internal organs does not reflect the rays, but passes them. As a result, the shadows of the organs are superimposed on each other, and much of the image can be interpreted in different ways, leading to an erroneous diagnosis. But some dangerous conditions (intestinal perforation, acute intestinal obstruction) are detected immediately in the overview image, which allows you to immediately proceed to surgical intervention.

X-ray of a woman's abdomen after she swallowed a fork

To make the information more reliable, an x-ray with contrast is performed if there are no contraindications to it. And this means an additional load on the body with a barium mixture and repeated exposure several times a day (up to 6 shots with contrast, not counting survey shots). As a result, the doctor receives the necessary information within a whole day, and the patient receives a tangible radiation exposure.

The essence of computed tomography

Abdominal CT examination, which has been used for more than 40 years, also involves the use of X-rays, but its intensity is much less than that of an X-ray examination. As the patient moves through the machine, a series of images are taken. All data are immediately processed by a computer and sent to the monitor in the form of layer-by-layer "slices" of the area under study. The slice thickness is 1 mm, and the "step" of such images is 3-10 mm, and the doctor is able to see the organ, neoplasm or other anatomical structures in many details.

To increase the information content, CT is often performed with the use of contrast. This makes the picture on the monitor clearer, better processed by the computer system, which is invaluable for fast and accurate diagnosis. But there are some contraindications for the use of contrast, and this is a disadvantage of the method. In general, CT is better than X-ray in terms of the information content of the method and the speed of obtaining data, but it is still performed using X-rays and giving patients a certain radiation exposure.

The essence of magnetic resonance imaging

The most modern, safe and informative method for examining the abdominal cavity today is MRI, magnetic resonance imaging. The use of a magnetic field and radio waves is absolutely harmless to humans. Under the influence of the force of the magnetic field, the protons of hydrogen molecules play the role of radio waves, which are reflected by the molecules of their own tissues of internal organs in the form of certain signals. The computer collects a huge mass of these signals, processes and converts all the information into a series of layered images in the shortest possible time.

The distance between the scanned layers with MRI is very small, only 2-4 mm, that is, less than with CT. Before the eyes of a specialist, any organ of the abdominal cavity, a vascular bundle or a nerve trunk, literally “sorted out” appears. Such a high resolution is able to visualize the slightest structural disturbances, the development of an inflammatory focus, the degree of degenerative-dystrophic processes, the onset of malignancy (malignancy) of normal tissues, and the onset of a tumor. Importantly, MRI does not use ionizing radiation like CT or X-rays, which is better and safer for the patient.

Indications for x-ray, CT and MRI of the abdominal cavity

Examination of the abdominal cavity using x-rays (including with contrast) is used for:

• urolithiasis and cholelithiasis;
• pancreatitis, cholecystitis, presence of abscesses;
• intestinal obstruction;
• tumors, diverticulitis;
• penetrating and blunt trauma.

CT (including with contrast) is used to:

• detection and diagnosis of any pathological changes in the liver, gallbladder, pancreas, spleen (inflammatory nature or neoplasms);
• studies of congenital and acquired anomalies in the structure of the intestine, determining the presence of pathological processes in the stomach;
• obtaining maximum information in case of injuries of internal organs;
• studies of neurovascular bundles.

MRI is also performed to study the physical condition of all abdominal organs in diseases and injuries, but, unlike other methods, it allows you to determine the state of cellular metabolism. And this is very important in the diagnosis of early stages of tumors or local damage to the nerve pathways.

Which examination method to choose

If in a medical institution it is possible to conduct only an x-ray examination, then there is no need to choose. In these cases, it is necessary to take into account all contraindications (pregnancy, lactation, intolerance to contrast components, severe concomitant pathology) and the frequency of conduction, not more than 1 time per year.

With the availability of CT and MRI for the patient, when choosing a method, the features of the pathology and the presence of contraindications come to the fore. In the background - ionizing radiation in CT, the cost of the study and patient preferences. In any case, only the doctor decides what is best for the patient, and determines the indications for CT or MRI.

If there is suspicion of internal bleeding, an ulcer, acute intestinal obstruction, or an injury to the abdomen, then computed tomography is preferable. If oncological pathology, inflammatory processes, lesions of the nerve and vascular trunks are suspected, an MRI is necessary. It can be carried out several times a year and help in the dynamic monitoring of the patient. Pregnancy from 3 months and lactation are not contraindications.

The choice of the most informative method always remains with the doctor. Only he will be able to correctly determine the indications and take into account contraindications, so that the data obtained will help as much as possible in diagnosis and therapy.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

The rapid development of technology in recent decades led to the emergence of new, highly informative and accurate diagnostic methods, the capabilities of which exceed those of the old diagnostic methods that have been used for a long time (X-ray, ultrasound, etc.). These relatively new diagnostic methods include computed tomography (CT) and magnetic resonance imaging (MRI), each of which has its own advantages and disadvantages. These two new methods last years have become very popular, but, unfortunately, they are not always adequately and correctly prescribed and used. Moreover, one must clearly understand that it is impossible to simply and unambiguously choose the best of these two methods, since they have different diagnostic capabilities, and therefore each method turns out to be the best only in relation to a specific situation. Therefore, below we will consider the essence of CT and MRI, and also indicate how to choose the best of these two methods in relation to a particular situation.

Essence, physical principle, differences between CT and MRI

To understand how CT and MRI methods differ and to be able to choose the best one in each specific situation, one should know their physical principles, essence and diagnostic spectra. It is these aspects that we will consider below.

The principle of computed tomography is simple, it lies in the fact that focused X-rays pass through the examined part of the body or organ in different directions at different angles. In tissues, the energy of X-rays is weakened due to its absorption, and different organs and tissues absorb X-rays with unequal strength, as a result of which the rays are unevenly weakened after passing through various normal and pathological anatomical structures. Then, at the output, special sensors register already attenuated X-ray beams, transform their energy into electrical signals, on the basis of which the computer program builds the obtained layer-by-layer images of the studied organ or part of the body. Thanks to different fabrics weaken x-rays with unequal strength, in the final images they are clearly delineated and become clearly visible due to uneven coloring.

Used in the past step-by-step computed tomography, when, to obtain each subsequent cut, the table moved exactly one step corresponding to the thickness of the organ layer, and the X-ray tube described a circle around the examined part of the body. But currently used spiral CT, when the table moves constantly and evenly, and the X-ray tube describes a spiral trajectory around the part of the body being examined. Thanks to the technology of spiral CT, the images obtained have become voluminous, not flat, the thickness of the sections is very small - from 0.5 to 10 mm, which made it possible to detect even the smallest pathological foci. In addition, thanks to helical CT, it became possible to take pictures in a certain phase of the passage of a contrast agent through the vessels, which ensured the emergence of a separate angiography technique ( CT angiography), which is much more informative than X-ray angiography.

The latest achievement of CT was the advent of multislice computed tomography (MSCT), when the X-ray tube moves around the part of the body being examined in a spiral, and the attenuated rays that have passed through the tissues are captured by sensors standing in several rows. MSCT allows you to simultaneously obtain accurate images of the heart, brain, assess the structure of blood vessels and blood microcirculation. In principle, doctors and scientists believe that MSCT with contrast is the best diagnostic method, which, in relation to soft tissues, has the same informative value as MRI, but additionally allows visualization of both lungs and dense organs (bones), which MRI cannot .

Despite such a high information content of both spiral CT and MSCT, the use of these methods is limited due to the high radiation exposure that a person receives during their production. Therefore, CT should be performed only when indicated.

Magnetic resonance imaging is based on the phenomenon of nuclear magnetic resonance, which in a simplified form can be represented as follows. Under the action of a magnetic field on the nuclei of hydrogen atoms, they absorb energy, and then, after the termination of the influence of the magnetic field, they re-emit it in the form electromagnetic impulses. It is precisely such impulses, which are essentially oscillations of the magnetic field, that are captured by special sensors, converted into electrical signals, on the basis of which the image of the organ under study is built by a special computer program (as in CT). Since the number of hydrogen atoms in different normal and pathological tissues is not the same, the re-emission of the energy absorbed from the magnetic field by these structures will also occur unevenly. As a result, based on the differences in the re-radiated energy, the computer program builds layered images of the organ under study, and on each layer its structure and pathological foci that differ in color are clearly visible. However, due to the fact that MRI is based on exposure to hydrogen atoms, this technique allows obtaining high-quality images only of those organs where there are many such atoms, that is, containing a fair amount of water. And these are soft tissue structures - the brain and spinal cord, adipose tissue, connective tissue, joints, cartilage, tendons, muscles, genitals, liver, kidneys, bladder, blood in vessels, etc. But tissues that contain little water, such as bones and lungs, are very poorly seen on an MRI.

Given the physical principles of CT and MRI, it is clear that in each case the choice of examination method depends on the diagnostic goal. So, CT is more informative and preferable for examining the bones of the skeleton and skull, lungs, craniocerebral injuries, acute strokes. To diagnose circulatory disorders in various organs, as well as to identify anomalies in the structure of blood vessels, CT with contrast is used, when a special substance is injected intravenously that enhances the brightness of tissues. And MRI is more informative for examining "wet" organs and tissues containing a sufficiently large amount of water (the brain and spinal cord, blood vessels, heart, liver, kidneys, muscles, etc.).

In general, CT has fewer limitations and contraindications than MRI, therefore, despite the radiation exposure, this method is used more often. So, CT is contraindicated if the patient cannot hold his breath for 20-40 seconds, his body weight exceeds 150 kg, or if he is a pregnant woman. But MRI is contraindicated with a body weight of more than 120 - 200 kg, claustrophobia, severe heart failure, in the first trimester of pregnancy, as well as the presence of implanted devices (pacemakers, nerve stimulators, insulin pumps, ear implants, artificial heart valves, hemostatic clips on large vessels ), which can move or stop working under the influence of a magnet.

When is CT better and when is MRI better?

MRI and CT may be the first choice if the indications for their production are correctly defined, since in such cases their results will answer all diagnostic questions.

MRI is more preferable for diagnosing diseases of the head, spinal and bone marrow(tumors, strokes, multiple sclerosis, etc.), pathologies of the soft tissues of the spine (intervertebral hernias, disc protrusions, spondylitis, etc.), diseases of the pelvic organs in men and women (prostate gland, uterus, bladder, fallopian tubes, etc.) and circulatory disorders. In addition, MRI has an advantage over CT and in the diagnosis of joint diseases, as it allows you to see the menisci, ligaments and cartilaginous articular surfaces in the pictures. Also, MRI is more informative in assessing the anatomy and functional activity of the heart, intracardiac blood flow and myocardial blood supply. One cannot fail to mention such an advantage of MRI over CT as the ability to visualize blood vessels without the introduction of contrast. However, MRI makes it possible to judge only the state of blood flow, since during this study only the blood flow is visible, and the vascular wall is not visible, and therefore nothing can be said about the state of the walls of the vessels based on the MRI results.

MRI, due to its low information content, is practically not used to diagnose the pathology of the lungs, stones in the gallbladder and kidneys, fractures and fractures of bones, diseases of the gallbladder, stomach and intestines. Low information content in the detection of pathologies of these organs is due to the fact that they contain little water (bones, lungs, kidney or gallstones), or they are hollow (intestines, stomach, gallbladder). As for low-water organs, it is impossible to increase the information content of MRI in relation to them at the current stage. But regarding hollow organs, the information content of MRI in relation to the detection of their diseases can be increased by introducing oral (through the mouth) contrasts. However, exactly the same contrasts for the diagnosis of pathologies of hollow organs will have to be taken for the production of CT scans, so in such cases, MRI has no obvious advantages.

The diagnostic capabilities of CT and MRI are approximately equal in detecting tumors of any organs, as well as in diagnosing diseases of the spleen, liver, kidneys, adrenal glands, stomach, intestines, and gallbladder. However, MRI is better for diagnosing hepatic hemangiomas, pheochromocytomas, and invasion of vascular structures in the abdominal cavity.

When choosing between CT and MRI, you need to remember that each method has its own diagnostic capabilities, and it is not at all necessary to use these methods for any disease. After all, many diseases are perfectly diagnosed by much simpler, more accessible, safer and cheaper methods, such as x-rays, ultrasound, etc. For example, a huge number of lung diseases and bone injuries are perfectly diagnosed using x-rays, which should be chosen as the primary method of examination for suspected lung or bone pathology. Diseases of the pelvic organs in men and women, the abdominal cavity and the heart are no less well diagnosed using conventional ultrasound. Therefore, when examining the pelvis, abdominal cavity and heart, one should first of all do an ultrasound scan, and only if its results are questionable, resort to CT or MRI.

Thus, it is obvious that the choice of examination method depends on the specific situation and what kind of pathology and in which organ is suspected. Yes, CT the best way suitable for diagnosing lung diseases, traumatic bone injury, detecting coronary heart disease during CT coronary angiography. MRI is optimal for diagnosing pathologies of the spinal cord, brain, joints, heart, and pelvic organs. But to diagnose diseases of the abdominal organs, kidneys, mediastinum and blood vessels with relatively equal diagnostic capabilities of MRI and CT, doctors prefer CT, since this study is simpler, more accessible, cheaper and much shorter in duration.

CT or MRI for diseases of various organs

Below we will consider in detail when it is better to use CT, and when MRI is better for various diseases of certain organs and systems. We will present these data in order to be able to generally find out what kind of research is still better for a person to undergo if a specific disease of a particular organ is suspected.

CT or MRI in the pathology of the spine and spinal cord

If any disease of the spine is suspected, neither CT nor MRI is done in the first place. First, an x-ray is taken in frontal and lateral projections, and it is he who in many cases makes it possible to make a diagnosis or clarify existing assumptions about the nature of the pathology. And after there are sufficiently clear assumptions about the nature of the pathology, either CT or MRI is selected for further clarifying diagnosis.

In general, the main method of clarifying diagnosis in relation to the pathology of the spine and spinal cord is MRI, as it allows you to see the spinal cord, and spinal roots, and nerve plexuses, and large nerve fibers, and vessels, and soft tissues (cartilage, ligaments, tendons, muscles , intervertebral), and measure the width of the spinal canal, and evaluate the circulation of cerebrospinal fluid (CSF). And CT does not allow such an accurate view of all the soft structures of the bone marrow, making it possible to visualize the bones of the spine to a greater extent. But since the bones are quite well visible on x-rays, CT is not the best method for clarifying the diagnosis of diseases of the spine and spinal cord. Although, if MRI is not available, then it is quite possible to replace it with contrast-enhanced CT, since it also gives good, highly informative results.

Despite the fact that, in general, MRI is better for diagnosing pathologies of the spinal cord and spine, below we will indicate which specific diseases are suspected by CT and which MRI should be chosen.

So, if there is a pathology of the cervical spine, which is combined with brain symptoms (dizziness, headaches, memory impairment, attention, etc.), then the method of choice in this case is an MRI examination of the vessels (MR angiography).

If a person has a deformity of the spinal column (kyphosis, scoliosis, etc.), then, first of all, an x-ray is performed. And if, according to the results of the X-ray, damage to the spinal cord is suspected (for example, compression, infringement of the roots, etc.), then it is recommended to perform an additional MRI.

If any degenerative-dystrophic disease of the spine is suspected (osteochondrosis, spondylosis, spodilarthrosis, hernia / protrusion of the intervertebral disc, etc.), then X-ray and MRI are optimal. Separately, it should be noted that CT can be used to diagnose a herniated disc in the lumbar region if MRI is not possible. Diagnosis of hernias in all other parts of the spine is carried out only with the help of MRI.

If you suspect a narrowing of the spinal canal and compression of the spinal cord or its roots, it is optimal to do both CT and MRI, since the simultaneous use of both methods will reveal the cause of the narrowing, its exact localization, and the degree of brain compression. If, when narrowing the spinal canal, it is necessary to assess the condition of the ligaments, nerve roots and the spinal cord itself, then it is enough to perform only an MRI.

If a tumor or metastases to the spine or spinal cord are suspected, then both CT and MRI are performed, since only the data of both examination methods provide the most complete picture of the type, size, location, shape, and nature of the growth of the neoplasm.

If it is necessary to check the patency of the subarachnoid space, then an MRI is performed, and in case of insufficient information content, a CT scan with the introduction of contrast endolumbally (like epidural anesthesia) is performed.

If inflammatory processes in the spine (various types of spondylitis) are suspected, both CT and MRI can be done.

If inflammatory processes in the spinal cord are suspected (myelitis, arachnoiditis, etc.), MRI should be used.

When there is a traumatic spinal injury, the choice between MRI and CT depends on the presence of neurological symptoms as a sign of spinal cord injury. So, if the victim has a spinal injury in combination with neurological symptoms (impaired coordination of movements, paresis, paralysis, numbness, loss of sensation in any parts of the body, etc.), then he should undergo an x-ray + MRI to detect bone damage spine and spinal cord injury. If the victim with a spinal injury does not have neurological symptoms, then an X-ray is performed for him, and then a CT scan is prescribed only in the following cases:

• Poor visibility of the structures of the spine in the region of the upper cervical and cervicothoracic regions;
• Suspicion of damage to the central or posterior vertebrae;
• Severe compression wedge-shaped fractures of the vertebrae;
• Planning for spinal surgery.

Below in the table we present the preferred primary and clarifying diagnostic methods for various diseases of the spine.

Pathology of the spine or spinal cord	Primary examination method	Clarifying method of examination
Osteochondrosis	x-ray	MRI or functional X-ray
Herniated disc	MRI	-
Spinal tumor	x-ray	CT + MRI
spinal cord tumor	MRI	-
Metastases to the spine or spinal cord	Osteoscintigraphy	MRI + CT
Spondylitis	x-ray	MRI, CT
Multiple sclerosis	MRI	-
Syringomyelia	MRI	-
multiple myeloma	x-ray	MRI + CT

CT or MRI for brain pathology

Since CT and MRI are based on different physical principles, then each examination method allows obtaining different data on the state of the same structures of the brain and skull. For example, CT visualizes skull bones, cartilage, fresh hemorrhages well, while MRI visualizes blood vessels, brain structures, connective tissue, etc. Therefore, in the diagnosis of brain diseases, MRI and CT are complementary rather than competing methods. Nevertheless, below we will indicate in which brain diseases it is better to use CT, and in which - MRI.

In general terms, it can be said that MRI is better suited to detect changes in the posterior cranial fossa, structures of the brainstem and midbrain, which are manifested by very characteristic neurological symptoms, such as headache, not relieved by painkillers, vomiting when changing body position, slow heart rate, reduced muscle tone, impaired coordination of movements, involuntary movements of the eyeballs, swallowing disorders, "loss" of voice, hiccups, forced position of the head, increased body temperature, inability to see up, etc. And CT is generally better suited for damage to the bones of the skull, with suspicions of a fresh hemorrhagic stroke, or the presence of seals in the brain.

In case of traumatic brain injury, CT should be done first of all, since it allows diagnosing damage to the bones of the skull, meninges and blood vessels in the first hours after the injury. MRI is carried out no earlier than three days after the injury to detect brain contusions, subacute and chronic cerebral hemorrhages and diffuse axonal injuries (ruptures of neuronal processes, which is manifested by uneven breathing, different levels of standing of the pupils of the eyes horizontally, strong muscle tension in the back of the head, involuntary fluctuation of the whites of the eyes in different directions, arms bent at the elbows with freely hanging brushes, etc.). Also, MRI for traumatic brain injury is performed on people in a coma with suspected cerebral edema.

For brain tumors, both CT and MRI should be done, since only the results of both methods allow us to clarify all the details about the nature of the neoplasm. However, if a tumor is suspected in the region of the posterior cranial fossa or pituitary gland, which is manifested by reduced muscle tone, headache in the back of the head, impaired coordination of movements on the right or left side of the body, involuntary movements of the eyeballs in different directions, etc., then only MRI. After operations to remove a brain tumor, it is better to use MRI with contrast to monitor the effectiveness of therapy and detect relapses.

If a tumor of the cranial nerves is suspected, it is better to use an MRI. CT is used only as an additional examination method for suspected destruction of the pyramid of the temporal bone by a tumor.

In acute cerebrovascular accident (CVA), CT is always done first, as it makes it possible to clearly and accurately distinguish between ischemic and hemorrhagic strokes, the treatment of which is different. On the CT scans, hemorrhagic strokes and hematomas formed from a damaged blood vessel are clearly visible. In cases where hematomas are not visible on CT scans, the stroke is ischemic, caused by a sharp hypoxia of a part of the brain due to vasoconstriction. In ischemic stroke, in addition to CT, MRI is performed, since it allows you to identify all foci of hypoxia, measure their size and assess the degree of damage to brain structures. To diagnose stroke complications (hydrocephalus, secondary hemorrhage), a CT scan is performed a few months after an episode of stroke.

If an acute cerebral hemorrhage is suspected, a CT scan should be done on the first day of the development of such a disease, since it is this method that allows you to identify a fresh hematoma, assess its size and exact location. But if three days or more have passed after the hemorrhage, then MRI should be performed, since during this period it is more informative than CT. Two weeks after a cerebral hemorrhage, CT becomes generally uninformative, therefore, in the later stages after the formation of a hematoma in the brain, only MRI should be done.

If defects or anomalies in the structure of the cerebral vessels (aneurysms, malformations, etc.) are suspected, an MRI is performed. In doubtful cases, MRI is supplemented by CT angiography.

If you suspect inflammatory processes in the brain (meningitis, encephalitis, abscess, etc.), it is better to use MRI.

If you suspect various demyelinating diseases (multiple sclerosis, amyotrophic lateral sclerosis, etc.) and epilepsy, MRI with contrast should be chosen.

In case of hydrocephalus and degenerative diseases of the central nervous system (Parkinson's disease, Alzheimer's disease, frontotemporal dementia, progressive supranuclear palsy, amyloid angiopathy, spinocerebral degeneration, Huntington's disease, Wallerian degeneration, acute and chronic inflammatory demyelination syndrome, multifocal degenerative leukoencephalopathy syndrome), it is necessary to carry out and CT and MRI.

CT or MRI for diseases of the paranasal sinuses

If there is a disease of the paranasal sinuses, then X-ray is performed first of all, and CT and MRI are additional clarifying examination methods used when X-ray data is not enough. Situations in which CT and MRI are used for diseases of the paranasal sinuses are shown in the table below.

When is CT better for diseases of the paranasal sinuses?	When is MRI better for diseases of the paranasal sinuses
Chronic unusually flowing sinusitis (frontitis, ethmoiditis, sinusitis)	Suspicion of the spread of a purulent inflammatory process (complication of sinusitis) to the orbit of the eye and to the brain
Suspicion of an unusual structure of the paranasal sinuses	To distinguish a fungal infection of the paranasal sinuses from a bacterial one
Developed complications of rhinitis or sinusitis (subperiosteal abscess, osteomyelitis of the skull bones, etc.)	Tumors of the paranasal sinuses
Polyps of the nasal cavity and paranasal sinuses
Wegener's granulomatosis
Tumors of the paranasal sinuses
Before elective sinus surgery

CT or MRI for eye diseases

In diseases of the eye and orbit, ultrasound, CT and MRI are used. So, MRI is the best diagnostic method for suspected retinal detachment, subacute or chronic hemorrhage in the eye, idiopathic pseudotumor of the orbit, optic neuritis, lymphoproliferative diseases of the orbit, tumor of the optic nerve, melanoma of the eyeball, the presence of non-metallic foreign objects in the eye. CT is the best diagnostic method for suspected eye diseases: vascular tumors of the orbit, dermoid or epidermoid of the orbit, eye trauma. The complex use of both CT and MRI is necessary for suspected tumors of the eye and lacrimal gland, as well as an orbital abscess, since in these cases data from both types of research are needed.

CT or MRI for diseases of the soft tissues of the neck

MRI is preferred only in cases where it is necessary to identify and assess the prevalence of the tumor process in the tissues of the neck. In all other situations, when the pathology of the soft tissues of the neck is suspected, the best diagnostic methods are ultrasound + X-ray in the lateral projection. In general, in diseases of the soft tissues of the neck, the information content of CT and MRI is lower than that of ultrasound, so these methods are only additional and are rarely used.

CT or MRI for ear diseases

If intracranial complications of diseases of the middle ear are suspected, as well as lesions of the vestibulo-cochlear nerves against the background of hearing loss, then the best method for their diagnosis is MRI. If developmental anomalies or any diseases of the inner ear, as well as a fracture of the temporal bone, are suspected, then CT is the best diagnostic method.

CT or MRI for diseases of the pharynx and larynx

When a tumor is suspected or inflammatory process in the pharynx or larynx, then an MRI is better. If it is impossible to perform MRI, it can be replaced by contrast-enhanced CT, which is not much inferior to MRI in terms of information content in such cases. In all other cases, with diseases of the larynx and pharynx, the best diagnostic method is CT.

CT or MRI for jaw diseases

For acute, chronic and subacute inflammatory diseases of the jaws (osteomyelitis, etc.), as well as for suspected tumors or cysts of the jaw, CT is the best diagnostic method. If a malignant tumor is detected according to the results of CT, then an MRI should be additionally performed to assess the stage of the oncological process. After the treatment of jaw cancer, both CT and MRI are used to detect relapses, the information content of which in such cases is equivalent.

CT or MRI for diseases of the salivary glands

The main methods for detecting pathology of the salivary glands are ultrasound and sialography. CT is not very informative for diagnosing the pathology of these glands. And MRI is used only if malignant tumors in the area of ​​the salivary glands are suspected.

CT or MRI for diseases of the temporomandibular joint (TMJ)

With functional disorders of the TMJ, the best method of examination is MRI, and in all other cases, the combined use of CT + MRI is necessary, since it is necessary to assess the condition of both soft tissues and bones of the joint.

CT or MRI for injuries of the maxillofacial region

In case of traumatic injuries of the bones of the face and jaws, the optimal method is CT, which allows visualizing even small cracks, displacements or other damage to the bones.

CT or MRI for diseases of the chest (except the heart)

If any pathology of the chest organs (lungs, mediastinum, chest wall, diaphragm, esophagus, trachea, etc.) is suspected, CT is the best diagnostic method. MRI for the diagnosis of chest organs is not very informative, since the lungs and other hollow organs are poorly visible on MRI images due to their low water content, and also due to the fact that they are constantly moving during breathing. The only cases in which it is indicated to perform MRI in addition to CT is a suspicion of malignant tumors or metastases in the chest organs, as well as a suspicion of a pathology of large blood vessels (aorta, pulmonary artery, etc.).

CT or MRI for breast diseases

If a pathology of the mammary glands is suspected, first of all, mammography and ultrasound are performed. If a lesion of the milk ducts is suspected, then ductography is performed. MRI is the best method for examining the mammary glands for suspected tumors. Also, MRI is considered the best method of examination, when women have breast implants, and the use of ultrasound and mammography gives poor results due to the interference created by the implants. CT is not used in the diagnosis of diseases of the mammary glands, since its information content is not much higher than that of mammography.

CT or MRI for cardiovascular diseases

The method of primary diagnosis of heart diseases is EchoCG (echocardiography) and its various modifications, since it allows you to get enough information about the condition and degree of heart damage.

CT is indicated for suspected atherosclerosis of the heart vessels, chronic pericarditis, and the presence of X-ray negative blood in the heart. foreign bodies.

CT coronary angiography as a replacement for conventional coronary angiography is used to detect atherosclerosis, anomalies in the development of cardiac vessels, assess the condition and patency of stents and shunts on the coronary arteries, and also to confirm the narrowing of the coronary (heart) vessels.

The combined use of CT and MRI is indicated only for suspected tumors, cysts of the heart or pericardium, and for heart injuries.

CT or MRI for vascular pathology

Diagnostics various diseases arteries and veins, it is optimal to start with duplex or triplex ultrasound, which is highly informative and allows you to make a diagnosis in most cases. CT and MRI are used only after vascular ultrasound as additional methods when it is necessary to clarify the nature and severity of vascular damage.

Thus, CT angiography is optimally used for diagnosing various diseases of the aorta and its branches, intracranial and extracranial arteries, vessels of the chest and abdominal cavity, as well as arteries of the arms and legs (aneurysm, narrowing, wall dissection, structural anomalies, traumatic injuries, thrombosis, etc.). .d.).

MR angiography is optimal for diagnosing diseases of the leg arteries.

For the diagnosis of diseases of the veins of the lower extremities (thrombosis, varicose veins, etc.) and the assessment of the state of the valve apparatus of the veins, triplex ultrasound is considered optimal. However, such an ultrasound can be replaced by an MRI. The informativeness of CT in the diagnosis of diseases of the veins of the lower extremities is low, much lower than that of MRI.

CT or MRI in the pathology of the digestive tract

Ultrasound and x-rays are used to detect foreign bodies in the abdominal cavity. Ultrasound is the best method to detect free fluid in the abdominal cavity. Diagnosis of internal fistulas is carried out in a complex manner, and CT + ultrasound is used in its course. If peritoneal tumors are suspected, CT is the best way to detect them.

Diagnosis of diseases of the esophagus, stomach and duodenum is carried out using esophagogastroduodenoscopy (EFGDS) and X-ray with contrast, since these methods have excellent information content and allow to detect almost any pathology of these organs. CT is used only when cancer of the stomach or esophagus is detected in order to detect metastases. CT is also used to diagnose esophageal perforation in thoracic region. The informative value of MRI in diagnosing the pathology of the esophagus, stomach and duodenum is low due to the fact that these organs are hollow, and in order to obtain high-quality images, they will still have to be filled with contrast. And images of hollow organs with contrast are much more informative in CT. Accordingly, in the pathology of the esophagus, stomach and duodenum, CT is better than MRI.

Diagnosis of diseases of the colon is made using colonoscopy and irrigoscopy, which make it possible to detect almost any colonic pathology. CT is prescribed only for malignant tumors of the colon to assess the extent of the oncological process. MRI is not very informative for intestinal pathology, since it is a hollow organ, and in order to obtain a decent image of it, it will be necessary to fill the intestine with contrast. And images with contrast are much more informative when performing CT, which means that CT is better than MRI in the diagnosis of pathologies of the large intestine. The only situations when MRI is better than CT in the diagnosis of colon pathologies are paraproctitis (inflammation of the tissue located in the small pelvis around the rectum). Therefore, if paraproctitis is suspected, it will be rational and correct to perform an MRI.

The possibilities of X-ray, CT and MRI in the diagnosis of diseases of the small intestine are limited due to the fact that it is a hollow organ. Therefore, studies are limited to the study of the passage of contrast through the intestines. In principle, the information content of CT and X-ray with contrast in the diagnosis of intestinal diseases is still slightly higher than MRI, therefore, if necessary, CT should be chosen.

CT or MRI for pathology of the liver, gallbladder and biliary tract

The method of choice for the primary examination of the liver, gallbladder and biliary tract is ultrasound. Therefore, when symptoms of diseases of these organs appear, ultrasound should be performed first, and CT or MRI should be used only in cases where the setting accurate diagnosis turned out to be difficult.

If ultrasound data show the presence of any diffuse liver disease (hepatitis, hepatosis, cirrhosis), then neither CT nor MRI is additionally needed, since ultrasound data is quite comprehensive for these pathologies. Of course, in the CT and MRI images, the doctor will see the picture of damage more clearly, but this will not add anything significant and fundamentally new to the ultrasound data. The only situation when periodic MRI (once every 1-2 years) is indicated for diffuse diseases is the long-term existence of liver cirrhosis, against which there is high risk development of hepatocellular carcinoma, detected precisely by MRI.

CT or MRI for pathology of the reproductive system in men and women

The first and main method of examination for suspected diseases of the genital organs of men and women is ultrasound. In the vast majority of cases, ultrasound is quite enough to make the correct diagnosis and assess the severity and prevalence of the pathological process. CT and MRI are additional methods in the diagnosis of diseases of the genital organs of men and women. Usually, MRI is used in cases where, according to the results of ultrasound, it is not possible to understand in which particular organ a pathological formation was found due to their close proximity. relative position and changes in normal anatomy due to disease. CT is rarely used in the diagnosis of diseases of the genital organs, since its information content is lower than that of MRI.

If, according to ultrasound, ovarian or uterine cancer is detected, then to determine the extent of the oncological process, CT with contrast or MRI with contrast is done, and the information content of MRI is slightly higher than that of CT.

If cervical cancer is detected / suspected in women or prostate cancer in men, then an MRI is additionally performed to determine the stage and extent of the oncological process.

After treatment of genital cancer, MRI is used for early detection of relapses, since in such situations it is more informative than CT.

If, according to ultrasound, lymphadenopathy (enlarged, inflamed lymph nodes) in the small pelvis is detected, then to clarify the causes and nature of the lesion of the lymphatic system, it is optimal to do CT with contrast. MRI is used only in cases where CT gave questionable results.

If complications such as abscesses, fistulas, etc. occur after surgical interventions on the genitals, then MRI is optimal to assess their location and severity. If MRI is not available, it can be replaced by contrast-enhanced CT.

CT or MRI for pathology of the endocrine system

If we are talking about the pathology of the pituitary gland and parasellar structures of the brain, then the best diagnostic method is MRI.

If thyroid pathology is suspected, then conventional ultrasound is the optimal primary method of examination. If a nodular formation is detected on ultrasound, then under the control of the same ultrasound, its puncture is performed, followed by a histological examination to determine the nature of the formation (cyst, benign, malignant tumor). Further, if a malignant tumor is detected thyroid gland, then a CT scan is performed to determine the extent of the oncological process.

If a pathology of the parathyroid glands is suspected, ultrasound is the best diagnostic method.

If a primary bone tumor is suspected, CT is the best way to detect it. MRI is performed additionally if it is necessary to establish the stage and extent of the oncological process.

If acute osteomyelitis or exacerbation of chronic osteomyelitis is suspected, then MRI is the best method for its diagnosis, since CT and X-ray reveal characteristic changes only 7–14 days from the onset of the pathological process.

In chronic osteomyelitis, the optimal diagnostic method is CT, which perfectly detects bone sequesters and fistulas. If fistulous passages are detected, fistulography is additionally performed.

If acute aseptic bone necrosis is suspected, MRI is the best diagnostic method, since neither CT nor X-ray shows characteristic changes in the early stages such a pathological process. However, in the late stages of aseptic bone necrosis, when at least two weeks have passed from the onset of the disease, CT is the best diagnostic method.

As for joint diseases, the most informative diagnostic method is precisely MRI. Therefore, if possible, with articular pathology, MRI should always be done. If MRI cannot be performed immediately upon suspicion of joint pathology, then CT + ultrasound is done first. It should be remembered that in the diagnosis of sacroiliitis and damage to the knee and shoulder joints, the main and best diagnostic method is MRI.

When a disease of the soft tissues of the musculoskeletal system (ligaments, tendons, muscles, nerves, adipose tissue, articular cartilage, menisci, articular membrane) is suspected, ultrasound is performed first, and in case of insufficient information content, MRI. You should know that MRI is the best method for diagnosing soft tissue pathology of the musculoskeletal system, therefore, if possible, this study should be performed immediately, neglecting ultrasound.

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In the world of medicine, there are a large number of research methods human body. One of the highly informative methods is tomography of the abdominal cavity: computed tomography (CT) and magnetic resonance imaging (MRI). These two types of diagnostics make it possible not to make a mistake with the diagnosis and prescribe appropriate treatment in time.

Tomography of the abdominal cavity includes the study of the digestive tract and retroperitoneal space. The organs of the gastrointestinal tract include the liver, small and large intestines, spleen, pancreas, and gallbladder. The kidneys, urinary system, adrenal glands, and vessels adjoin the retroperitoneal space.

With the help of CT and MRI, an image of any internal organ is well obtained, namely: the structure, size and location. In this regard, it is almost impossible to miss any pathological changes in human organs. These research methods can be called the most reliable in the presence of a malignant tumor at an early stage.

The advantages of CT include its quite adequate price, which is affordable for many. At the same time, its research efficiency and results are equated with the newest technologies.

MRI is more expensive than CT, but magnetic resonance imaging has its own advantages (for example, the safety of the study, which allows diagnostics without restrictions, which cannot be said about CT).

The study of computed tomography of the abdominal organs is based on the principle of scanning the body of the subject with x-rays. After that, the data is carefully processed by special programs.

The principle of the study of magnetic resonance imaging is the effect of a magnetic field on hydrogen atoms, which fill all the cells of the body. Moreover, this effect does not carry any harmful effects for cells.

What can an abdominal CT scan show?

On computed tomography of the abdominal cavity, you can see:

• inflammatory processes;
• neoplasms and metastases;
• what injuries are caused by various abdominal injuries;
• foreign bodies;
• various problems with the musculoskeletal system.

For an accurate assessment of the state of a particular organ, CT is performed with contrast. The task of the contrast agent is to visually delimit the internal organs among themselves in order to simplify the task for specialists. CT with contrast is not performed due to some contraindications. These include: bleeding, an allergic reaction to a contrast agent, severe liver disease.

How much such a substance is needed is determined by a specialist on an individual basis. The contrast does not cause a detrimental effect on the organs and is excreted from the body in a day.

Indications for referral for abdominal CT may also be: acute pain of unknown etiology, the question of deciding on surgical intervention, sudden weight loss.

What can an abdominal MRI show?

Abdominal MRI shows:

• cirrhosis of the liver;
• deviations in development;
• acute pancreatitis;
• tumors and metastases;
• inflammation;
• circulatory disorders.

MRI of the abdominal cavity has many advantages: the images are of high quality, which allows you to examine the organ to the smallest detail. In addition, this method is the safest of all research methods.

This diagnosis can also be carried out with contrast. The intravenously administered substance shows the most reliable information about the organ under study. Almost 85% of MRIs are performed with contrast. The most commonly used drugs for this are Omnipaque and Vizipak.

Preparing for an abdominal tomography

These diagnostic procedures (CT and MRI) do not require any special effort from the patient. But there are some limitations for the study in preparation:

• it is necessary to refuse food six to eight hours before the planned diagnostics. Also, do not drink liquids 6 hours before a CT scan or MRI;
• in a few days, it is necessary to exclude from your diet all foods and drinks that can cause strong gas formation (black bread, cabbage, muffins, beer, kvass);
• the day before a CT scan or MRI, it is necessary to prepare the intestines by making a cleansing enema.

On an individual basis, in preparation for one of the two types of tomography, the patient may be prescribed a diet with no carbohydrates.

Which is better: MRI or CT?

This question is quite complicated, since these are fundamentally different research methods, which in some cases can complement each other. MRI may be better in terms of its relative harmlessness, since this examination does not have a detrimental effect on human organs (a magnetic field is used). CT uses X-rays, which should not be used frequently. But when examining bones, it is still better to undergo a CT scan.

Decision: which of the diagnostics is better to choose, CT or MRI. remains with the attending physician.

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