There are many other investigations, which you can do
within a patient with a haemotological condition,
but imaging is key in many cases.
This is looking at the anatomy of the body using
procedures such as x-rays or these investigations:
ultrasound, CT scan, MRI and PET imaging.
Lets look at these in a little bit more detail.
An ultrasound is particularly useful in assessing the
size of some of the abdominal organs such as the
liver and the spleen. We will see on the right there,
representation of a liver.
Splenomegaly is common in a range of haematological
disorders and certain examination of the spleen
is a key component when examining a patient with a
A CT, a computed tomography scan is very commonly used
in patients with disorders such as a lymphoma.
You will see on the right, they give very detailed
assessment of the anatomy of the body,
usually a contrast medium is given to the patient and
that helps to increase the resolution of the scan
and improve the information that can be derived from it.
Of course, CT scans do involve the use of x-rays and an
abdominal CT use quite considerable dose of x-rays.
Let us look that example on the right of the CT scan.
Imagine yourself looking out from the patient's feet
into that CT scan, you will see obviously the
vertebral column in the middle and on either side, two
kidneys and just at the left you'll see the liver
starting to appear and just right to the liver, just
above the kidney, you will see a massive lymphoid tissue
and this is a patient with swollen lymph nodes within
the abdomen, in this case a lymphoma.
Magnetic resonance imaging is more recent technique
that's now widely used in hospitals around the world.
MRI scans generate very highly accurate images
of the body that is superb for examining the brain
or neuromuscular images. They do take longer than a
CT scan, but usually they don't use x-rays
and for that reason they can sometimes be preferred.
You'll see on the example here, a very beautiful
example of the vertebral column and the spinal cord
taken using magnetic resonance imaging
and I dont know if you spotted the abnormality
within that picture, but if you look down
the vertebral column, you will see that one of the
vertebrae is highly compressed and that is the patient
who had the malignant disease and one of the
vertebrae has collapsed.
Now a relatively new imaging technique which is widely
used now in particularly in lymphoma management
is the Positron Emission Tomography or PET scan. This is
really quite interesting and sophisticated approach
and in this, a radiolabelled form of glucose is
injected into the patient.
it is quite interesting that most, if not all cancers
take up a lot of glucose to fuel their growth,
It's glycolysis which we do not entirely understand.
Scientists call it the Warburg effect.
This means that when we inject this glucose into a
patient who has the malignant disease,
the malignant tissue tends to take up this radiolabelled
glucose and then we can use scanners
to see where the label has gone. We can combine this
PET imaging with CT scans and PET/CT is a very
powerful way of looking for areas of malignant disease.
You'll see on the right a nice example
of a PET scan with the colored areas, not the blue,
but the green and the red showing where cells
have taken up the radiolabelled glucose.
The bottom, you can see the bladder is lit up
because that's where the urine has got the label and
that is going to excreted, so we can ignore that.
If you look at the areas of green in the abdomen
and in the upper thorax, those are all lymph nodes
involved in lymphoma avidly taking up this
So we now know where the disease is.
PET scans as it says at the bottom there, are not
just useful in diagnosis, but we can also use them to
guide the treatment because they might be used
to tell us when we can stop therapy or when we need
to give more therapy so they can be used to tailor
the treatment of individual patients so as
not to give too much chemotherapy than is needed.
But all these information has to come together:
history, examination and investigation.
This requires input from a range of experts
and these days most patients can discuss at
meetings of all sorts of specialists, doctors,
nurses, pathologists, x-ray doctors.
Now an accurate diagnosis can be made in
the great majority of cases.
So in summary, the history, examination and investigation
must be used together to make an appropriate diagnosis.
The blood count is a crucial first step and
i've shown you that
there are many important facts and information
that can be derived from a blood count.
But a range of investigations are now available to us
to use: detailed blood tests, bone marrow examinations,
genetic analysis and imaging tests and together these can
be used to get the correct diagnosis for your patient.
Thank you for watching the lecture.