Cover
Grainger & Allison's Diagnostic Radiology, 6th Edition
Copyright page
Preface
List of Section Editors
List of Contributors
Chapter 1 Medical Physics: Radiation Risks
Chapter Outline
Radiation Risks
Deterministic and Stochastic Effects
Fetal Exposure
Legislation and Principles of Radiation Protection
Patient Doses in Diagnostic Imaging
Estimating Patient Doses
Typical Patient Doses
Detectors for Radiography and Fluoroscopy
Optimising Patient Dose
Optimising Patient Dose in Nuclear Medicine
Areas of Special Attention
Pregnancy and Potential Pregnancy
Infants and Children
Research Exposures
Health Screening Programmes
High-Dose Techniques
Radiation Protection of Staff and Public
Distance, Time and Shielding
Personal Protection in Nuclear Medicine
Radiation Hazards from Nuclear Medicine Patients
Dose Monitoring
Pregnant Staff
Clinical Application of Radiation Dose Optimisation in CT
Introduction
Terms Describing CT Dose
Standard Dose
Optimised Dose
Low Dose
Radiation Dose Descriptors in CT
Volume Computed Tomography Dose Index (CTDIvol)
Dose–Length Products (DLPs)
How to Set Up a Dose Optimisation Process
AEC System: Principles and Pitfalls
Two Methods for Validating Dose Optimisation
Step-by-Step Reductions
Side-by-Side Comparisons of Standard and Optimised CT Studies
Parameter Optimisation
Tube Current–Time Product
Reconstruction Algorithm or Kernel
The Tube Potential
The Collimation and Reconstructed Slice Thickness
The Pitch Factor and the Concept of Effective mAs
Adequate References as Goals for Optimisation
Up-to-Date Optimised CT Parameters
CT of the Brain
CT of the Sinus
CT of the Thorax
CT of the Abdomen and Pelvis
CT of the Lumbar Spine
Summary and Conclusion
Further Reading
Online-only References
Chapter 2 Intravascular Contrast Media for Radiography, CT, MRI and Ultrasound
Chapter Outline
Introduction
Contrast Media for Radiography and CT
Barium-Based Contrast Agents
Iodine-Based Contrast Media
High-Osmolar Ionic Contrast Media (Fig. 2-3)
Low-Osmolar Ionic Contrast Media (Fig. 2-4)
Low-Osmolar Non-ionic Contrast Media (Fig. 2-5)
Iso-Osmolar Non-ionic Contrast Media (Fig. 2-6)
Pharmacokinetics
Quantity of Contrast Medium Required
Contrast Media for MR Imaging
Gadolinium-Based Contrast Media
Pharmacokinetics
Quantity of Contrast Medium Required
Iron-Based Contrast Media
Manganese-Based Contrast Media
Tissue-Specific MR Contrast Agents
Use of Extracellular MR Contrast Agents for Radiographic Examinations
Contrast Media for Ultrasound
Microbubbles
Pharmacokinetics
Effect on Echogenicity
Safety
Recommendations
Potential Developments
Informed Consent
Summary of Product Characteristics (sPc)
Off-Label Use
Adverse reactions
Types of Reactions
Idiosyncratic Reactions
Chemotoxic Reactions
Vasomotor Reactions
Acute Non-renal Adverse Reactions
Incidence
Treatment
Risk Factors
Prevention
Gadolinium-Based Contrast Agents
Acute Renal Adverse Reactions (Contrast-Induced Nephropathy)
Late Adverse Reactions
Very Late Adverse Reactions
Thyrotoxicosis
Nephrogenic Systemic Fibrosis (NSF)
Pregnancy and Lactation
Interaction
Extravasation
Measurement of Glomerular Filtration Rate
Further Reading
Online-only References
Chapter 3 Ultrasound
Chapter Outline
Nature of Ultrasound
Ultrasonic Transducers
Propagation in Tissue
Attenuation
Reflection
Ultrasound Methods
The Pulse-Echo Method
Beam Steering
Resolution
Artefacts
Interpretative Principles
Shadowing and Increased Through Transmission
Echogenicity
Doppler
Theoretical Basis of Doppler Studies
Characteristics of Blood Flow
Information in the Doppler Signal
Pulsatility Measurements
Spectral Content
Colour Doppler
Power Doppler
Volume Flow Measurement
Doppler Artefacts, Errors and Pitfalls
Sample Volume Size and Position
Velocity Information
Wall Filters
Colour Artefacts
Contrast Agents
Safety
Developments in Ultrasound
High Frequencies, 3D, Elastography
Ultrasound Therapy
Acknowledgements
Further Reading
Physics
Clinical
Safety
New Developments
Chapter 4 Computed Tomography
Chapter Outline
Computed Tomography (CT): A Brief History
Principles of Computed Tomography
CT Numbers and Image Matrix
Generations of CT Development
X-Ray Tubes
X-Ray Detectors
Slice Wars and Beyond
Image Reconstruction
Filtered Back Projection
Iterative Reconstruction
Helical CT
Reconstruction of Arbitrary Section Thickness and Orientation
Image Quality and Radiation Dose
Contrast Media
Preparation
Contrast Medium Injection
Potential Complications
Gastrointestinal Contrast Agents
Optimising Image Acquisition
CT Protocols
Planning
CT Parameters
CT Data Acquisition Timing
Image Analysis
CT-Guided Interventions
Planning and Patient Preparation
Procedure
Follow-Up
Advanced Techniques
Cardiac CT
Dual-Energy CT
Subtraction Imaging
CT Perfusion
Motion Analysis
Further Reading
Online-only References
Chapter 5 Magnetic Resonance Imaging
Chapter Outline
Historical Perspective
Spin Physics
Excitation and Relaxation: Free Induction Decay and Echoes
Signal Localisation: Techniques for Building Images
2D Encoding
3D Encoding
Fast and Alternative k-space Tranversal
Parallel Imaging
Pulse Sequences
Variations on a Spin Echo
Basic Two-Dimensional Spin-Echo Sequence
Multi-Spin Echo
Fast Spin Echo (FSE) or Turbo Spin Echo (TSE) or Rapid Acquisition with Relaxation Enhancement (RARE)
Single-Shot Fast Spin Echo (SS-FSE) or Half-Fourier Acquired Single-Shot Turbo Spin Echo (HASTE)
Inversion Recovery
Spin-Echo Echo Planar Imaging
Variations on a Gradient Echo/Field Echo
Basic Two-Dimensional Gradient-Echo Sequence
Three-Dimensional Gradient Echo
Magnetisation Prepared Rapid Acquisition Gradient Echo (MP-RAGE) or Turbo-FLASH or Inversion Recovery-Prepared Fast Spoiled Gradient-Recalled Echo
Gradient-Echo Echo Planar Imaging
Instrumentation
Magnets
Gradients
Radiofrequency
Computers
Physical Parameters That Provide Contrast
Proton Density
T1 (Longitudinal Relaxation Time or Spin–Lattice Relaxation Time)
T2 (Transverse Relaxation Time or Spin–Spin Relaxation Time)
T2* and Endogenous Susceptibility
Exogenous Contrast Agents
Chemical Shift
Proton Spectroscopy
Water/Fat Imaging
Flow
Time-of-Flight MRA
Phase Contrast MRA
Contrast-Enhanced MRA
Non-Contrast-Enhanced MRA (Fresh Blood Imaging)
Non-Contrast-Enhanced MRA (Balanced Steady-State Free Precession)
Perfusion (Microvascular Flow)
Diffusion
Safety Considerations
Static Magnetic Field
Time-Varying Magnetic Field Gradients
Radiofrequency Field
Conclusion
Further Reading
Online-only References
Chapter 6 Radionuclide and Hybrid Imaging
Chapter Outline
Introduction and General Principles
Basic Physics
Structure of the Atom
Radioactivity
Alpha Radiation
Beta Radiation
Positron Emission
X and Gamma Radiation
Definitions
Reactions that Produce X and Gamma Radiation
Interaction of X and Gamma Radiation with Matter
The Gamma Camera
Detection System
Collimators
Temporal Resolution
Techniques of Image Acquisition and Processing
Gamma Camera Limitations
Principles of Emission Tomography (PET and SPECT)
Tomographic Reconstruction
SPECT Design and Characteristics
PET Design and Characteristics
Hybrid Systems: SPECT-CT, PET-CT and PET-MRI
Quantification and Image Processing
General Processing
Quantification
Image Registration
Image Interpretation
Non-Imaging Applications
Radiopharmaceuticals
Further Reading
Online-only References
Chapter 7 Functional, Physiological and Molecular Imaging
Chapter Outline
Physiological Imaging with Contrast Media
Why Use Kinetic Modelling?
Contrast Agent Pharmacokinetics
Measurement of Tracer Concentration
Modelling and Mathematical Approaches
Perfusion
Wash-in Studies
Wash-out Studies
Bolus Passage
Fractional Vascular Volume
Direct and Indirect Indices of Permeability
Other Functional Indices
Summary
Principles of Molecular Imaging
Molecular Imaging and Hypoxia Inducible Factor-1
Direct Molecular Imaging
Surrogate Molecular Imaging
Indirect Molecular Imaging
Comparison of Molecular Imaging Strategies
Molecular Imaging and Biotechnology
Applications of Molecular Imaging
Combined Physiological and Molecular Imaging
Summary
Appendices
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5
Further Reading
Online-only References
Chapter 8 Techniques in Thoracic Imaging
Chapter Outline
Chest Radiography
Equipment Considerations
Additional Radiographic Views
Portable Chest Radiography
Novel Radiographic Techniques
Computed Tomography of the Thorax
Dual-Energy CT
Dose Considerations
Intravenous Contrast Medium Enhancement and Timing of CT Data Acquisition
Window Settings
High-Resolution Computed Tomography
Ultrasound
Endoscopic and Endobronchial Ultrasound
Magnetic Resonance Imaging
Ventilation–Perfusion Scintigraphy
Further Reading
Online-only References
Chapter 9 The Normal Chest
Chapter Outline
The Lungs
The Central Airways
The Lungs Beyond the Hila
The Hila
The Mediastinum
Computed Tomography and Magnetic Resonance Imaging
Radiographic Appearances
Junction Lines
Right Mediastinum above the Azygos Vein
Left Mediastinum above the Aortic Arch
Trachea and Retrotracheal Area in the Lateral View
Supra-aortic Mediastinum on the Lateral View
Right Middle Mediastinal Border below the Azygos Arch
Left Cardiac Border below the Aortic Arch
Paraspinal Lines
Retrosternal Line
The Diaphragm
Further Reading
Online-only References
Chapter 10 The Chest Wall, Pleura, Diaphragm and Intervention
Chapter Outline
The Chest Wall
Soft Tissues
Breasts
Muscles
Soft-Tissue Calcification
Subcutaneous Emphysema
Soft-Tissue Tumours
Bony Structures
Ribs
Sternum
Clavicles
Spine
The Pleura
Pleural Effusion
Imaging Pleural Effusion
Chest Radiograph
Free Pleural Fluid.
Loculated (Encysted, Encapsulated) Pleural Fluid.
Pleural Effusion in the Supine Patient.
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Some Specific Pleural Effusions
Exudates and Transudates
Bronchopleural Fistula
Chylothorax
Haemothorax
Pneumothorax
Primary Spontaneous Pneumothorax
Secondary Spontaneous Pneumothorax
Diagnosis
Typical Signs
Atypical Signs
Complications
Haemopneumothorax
Tension Pneumothorax
Pyopneumothorax
Adhesions
Re-expansion Oedema
Pleural Thickening and Fibrothorax
Pleural Calcification
Pleural Tumours
Localised Pleural Tumours
Diffuse Pleural Tumours
Intervention
Chest Wall Intervention
Pleural Intervention
Pleural Aspiration.
Chest Drains.
Pleural Biopsy.
The Diaphragm
Level
Eventration
Movement and Paralysis
Diaphragmatic Hernias
Diaphragmatic Trauma
Neoplasms of the Diaphragm
Further Reading
Online-only References
Chapter 11 The Mediastinum, Including the Pericardium
Chapter Outline
Mediastinal Diseases
Mediastinal Masses
Incidence
Imaging Techniques
Computed Tomography
Magnetic Resonance Imaging
Ultrasound
Radionuclide Examinations
Approach to Mediastinal Masses
Localise to the Mediastinum
Localise within the Mediastinum
Characterise on CT or MR
Thyroid Masses
Parathyroid Masses
Thymic Tumours
Thymomas
Thymic Carcinoma
Thymic Neuroendocrine Tumour (Thymic Carcinoid)
Thymolipomas
Lymphofollicular Thymic Hyperplasia and Rebound Thymic Hyperplasia
Thymic Cyst
Germ-Cell Tumours of the Mediastinum
Teratomas
Seminoma
Non-Seminomatous Germ-Cell Tumours
Mediastinal Lymphadenopathy
Malignant Lymphoma and Leukaemia
Lymph Node Calcification
Low-Attenuation Nodes
Enhancing Lymph Nodes
Lymph Node Enlargement
Sarcoidosis.
Tuberculosis and Histoplasmosis.
Metastatic Carcinoma.
Reactive Hyperplasia.
Thoracic Lymphadenopathy in AIDS.
Foregut Duplication Cysts
Bronchogenic Cysts
Oesophageal Duplication Cysts
Neurenteric Cysts
Mediastinal Pancreatic Pseudocyst
Neurogenic Tumours
Peripheral Nerve Sheath Tumours
Sympathetic Ganglion Tumours
Mediastinal Paragangliomas
Lateral Thoracic Meningocele
Extramedullary Haematopoiesis
Mesenchymal Tumours and Tumour-Like Conditions
Lymphangiomas (Cystic Hygromas)
Haemangiomas
Fatty Lesions in the Mediastinum
Mediastinal Lipomatosis
Fatty Tumours of the Mediastinum
Fat-Containing Hernias
Other Mediastinal Lesions
Acute Mediastinitis
Fibrosing Mediastinitis
Mediastinal Haemorrhage
Pneumomediastinum
Pericardium
Imaging Pericardial Disease
Developmental Anomalies
Congenital Absence of the Pericardium
Pericardial Cysts and Diverticula
Acquired Pericardial Disease
Pericardial Effusion
Cardiac Tamponade
Pericarditis
Constrictive Pericarditis
Pericardial Neoplasms
Acknowledgement
Further Reading
Online-only References
Chapter 12 Pulmonary Infection in Adults
Chapter Outline
Types of Pneumonias
Community-Acquired Pneumonia (CAP)
Hospital-Acquired Pneumonia (HAP)
Ventilator-Associated Pneumonia (VAP)
Health Care-Associated Pneumonia (HCAP)
Clinical Utility and Limitations of Chest Radiography and CT
Patterns of Pulmonary Infection
Complications of Pneumonia
Integrating Clinical and Imaging Findings
Lobar Pneumonia
Most Common Organisms
Streptococcus pneumoniae.
Klebsiella.
Legionella sp.
Chlamydia.
Moraxella catarrhalis.
Immunocompromised Host
Nocardia sp.
Actinomyces sp.
Endemic in Certain Geographic Areas
Coxiella burnetii (Rickettsial Pneumonia).
Francisella tularensis.
Bronchopneumonia
Most Common Organisms
Staphylococcus aureus.
Escherichia coli.
Pseudomonas aeruginosa.
Haemophilus influenzae.
Atypical Pneumonia
Mycoplasma pneumoniae.
Viral
Influenza A.
Adenovirus.
Respiratory Syncytial Virus (RSV).
Epstein–Barr Virus (EBV).
Varicella-Zoster Virus.
Herpes Simplex Virus Type 1 (HSV-1).
Hantaviruses.
Cytomegalovirus (CMV).
New Emerging Viruses
Human Metapneumovirus (hMPV).
Severe Acute Respiratory Syndrome Coronavirus.
Avian Flu (H5N1).
Swine Influenza (H1N1).
Changing Spectrum of HIV Infections: 30 Years Later
Mycobacterium tuberculosis
Primary Tuberculosis
Reactivation and Reinfection Tuberculosis
Pulmonary Non-Tuberculous Mycobacteria (NTMB)
Fungal Infection
Aspergillus Infection.
Candidiasis.
Pneumocystis jiroveci.
Mucormycosis.
Cryptococcosis.
Histoplasmosis.
Coccidioidomycosis.
Paracoccidioidomycosis (South American Blastomycosis).
North American Blastomycosis.
Parasitic Infections
Protozoa
Amoebiasis
Nematodes
Dirofilariasis
Cestodes
Echinococcosis (Hydatid Disease)
Trematodes
Paragonimiasis
Further Reading
Online-only References
Chapter 13 irway Disease and Chronic Airway Obstruction
Chapter Outline
Introduction
Tracheal Disorders
Post-Traumatic Strictures
Infectious Tracheobronchitis
Primary Malignant Neoplasms
Secondary Malignant Neoplasms
Benign Neoplasms
ANCA-Associated Granulomatous Vasculitis
Relapsing Polychondritis
Tracheobronchial Amyloidosis
Sarcoidosis
Inflammatory Bowel Disease
Tracheobronchopathia Osteochondroplastica
Sabre-Sheath Trachea
Tracheobronchomegaly (Mounier–Kuhn Syndrome)
Tracheobronchomalacia
Tracheobronchial Fistula and Dehiscence
Bronchiectasis
Radiographic Findings
CT Findings
Accuracy of CT
Cystic Fibrosis
Allergic Bronchopulmonary Aspergillosis (ABPA)
Dyskinetic Cilia Syndrome
Broncholithiasis
Bronchiolitis
Infective Bronchiolitis
Inflammatory (Non-Infective) Bronchiolitis
Obliterative (Constrictive) Bronchiolitis
Pathological Features
Radiological Findings
CT Assessment of Air Trapping
Chronic Obstructive Pulmonary Disease (COPD)
Pathological Findings
Inflammatory Changes in the Airways in COPD
Emphysema
Radiographic Findings
CT Findings
Small Airway Disease
Emphysema
Centrilobular Emphysema (CLE).
Panlobular or Panacinar Emphysema (PLE).
Paraseptal Emphysema (PSE).
Bullae.
Emphysema Associated with Interstitial Pneumonias.
Large Airway Disease
CT Quantitative Analysis of Extent of Disease
Asthma
Radiographic Findings
CT Findings
Further Reading
Online-only References
Chapter 14 Pulmonary Lobar Collapse: Essential Considerations
Chapter Outline
Mechanisms and Causes of Lobar Collapse
Radiographic Considerations
Direct Signs of Volume Loss
Indirect Signs of Volume Loss
Ancillary Features of Lobar Collapse
Computed Tomography of Lobar Collapse
Technique
Utility
Potential Pitfalls
Other Imaging Techniques in Lobar Collapse
Patterns of Lobar Collapse
Right Upper Lobe Collapse
Left Upper Lobe Collapse
Right Middle Lobe Collapse
Right and Left Lower Lobe Collapse
Whole Lung Collapse
Combinations of Lobar Collapse
Further Reading
Online-only References
Chapter 15 Pulmonary Neoplasms
Chapter Outline
Bronchogenic Carcinoma
Histopathology
Genetic Factors
Epidermal Growth Factor Receptor (EGFR)
K-Ras
ALK
Lung Cancer and Other Environmental Factors
Smoking
Passive Smoking
General Environmental Pollutants
Asbestos
Radon
Lung Cancer Screening
Chest Radiographic Screening
CT Screening
Radiation Dose Considerations
The Future of Screening
Pulmonary Nodules
Management of Small Pulmonary Nodules
Nodule Size
Location, Shape and Morphology
Nodule Contour
Nodule Density
Ground-Glass Nodules
Other Forms of Nodule Assessment
Nodule Follow-Up
Nodule Enhancement
PET/CT
Tissue Sampling
Lung Cancer Staging—the 7Th Edition of the TNM Staging System for Lung Cancer
Additional Pulmonary Nodules in the Presence of Lung Cancer
N Descriptors
M Descriptors
Small Cell Lung Cancer
Bronchopulmonary Carcinoid Tumour
Summary
Imaging Protocols for Lung Cancer Staging
The Current Standards of CT Technology
Imaging Features of Bronchogenic Carcinoma
Peripheral Tumours
Tumour Shape and Margins
Cavitation
Calcification
Other Findings
Central Tumours
Collapse/Consolidation in Association with Central Tumours
Staging Intrathoracic Spread of Bronchial Carcinoma
Hilar Enlargement
Mediastinal Invasion
Chest Wall Invasion
Pleural Involvement
Summary
Extrathoracic Staging of Lung Cancer
Pulmonary Sarcoma and Other Primary Malignant Neoplasms
Benign Pulmonary Tumours
Hamartoma
Other Benign Pulmonary Neoplasms
Leiomyoma
Plasma Cell Granuloma
Sclerosing Haemangioma
Squamous Papillomas
Benign Lymphoproliferative Disorders
Lymphocytic Interstitial Pneumonia
Follicular Bronchiolitis
Malignant Lymphoproliferative Disorders
Lymphoma
Other Findings in Pulmonary Lymphoma
Leukaemia
Metastases
Lymphangitic Carcinomatosis
Unusual Patterns of Metastatic Cancer
Endobronchial Metastases
Miliary Metastases
Tumour Emboli
Further Reading
Online-only References
Chapter 16 High-Resolution Computed Tomography of Interstitial and Occupational Lung Disease
Chapter Outline
High-Resolution Computed Tomography Patterns of Diffuse Lung Disease
Reticular Pattern
Nodular Pattern
Ground-Glass Pattern
Mosaic Attenuation Pattern
Idiopathic Interstitial Pneumonias
Usual Interstitial Pneumonia/Idiopathic Pulmonary Fibrosis
Classic HRCT Findings
Non-Specific Interstitial Pneumonia
Classic HRCT Findings
Cryptogenic Organising Pneumonia
Respiratory Bronchiolitis–Interstitial Lung Disease and Desquamative Interstitial Pneumonia
Classic HRCT Findings
Acute Interstitial Pneumonia/Diffuse Alveolar Damage
Classic HRCT Findings
Lymphoid Interstitial Pneumonia
Classic HRCT Findings
Idiopathic Pleuroparenchymal Fibroelastosis
Classic HRCT Findings
Sarcoidosis
Lymphadenopathy
Parenchymal Changes
High-Resolution Computed Tomography Features
Classic HRCT Findings
Hypersensitivity Pneumonitis
Classic HRCT Findings
Langerhans Cell Histiocytosis
Classic HRCT Findings
Lymphangioleiomyomatosis
Classic HRCT Findings
Connective Tissue Diseases
Rheumatoid Disease
Classic HRCT Findings
Sjögren’s Syndrome
Classic HRCT Findings
Progressive Systemic Sclerosis (Scleroderma)
Classic HRCT Findings
Polymyositis/Dermatomyositis
Classic HRCT Findings
Systemic Lupus Erythematosus
Classic HRCT Findings
Systemic Vasculitides
Churg–Strauss Syndrome
Classic HRCT Findings
Drug-Induced Lung Disease
Diffuse Alveolar Damage
Interstitial Pneumonia
Organising Pneumonia
Eosinophilic Pneumonia
Classic HRCT Findings
Occupational Lung Disease
The International Labour Office Classification
Silicosis/Coal Worker’s Pneumoconiosis
Classic HRCT Findings
Asbestos-related Disease
Benign Pleural Effusions
Pleural Plaques
Diffuse Pleural Thickening
Round Atelectasis
Asbestosis
Classic HRCT Findings
Further Reading
Books/Book Chapters
Reviews/Papers
Online-only References
Chapter 17 Thoracic Trauma and Related Topics
Chapter Outline
Thoracic Trauma
Introduction
Types of Injury
Diagnostic Approach
Specific Thoracic Injuries Following Trauma
Heart
Acute Traumatic Aortic Injury (ATAI)
Mediastinum
Pleura
Lung Parenchyma
Chest Wall
Diaphragm
Thoracic Imaging in the Intensive Care Patient
Introduction
Cardiopulmonary Disease
Atelectasis
Aspiration
Pulmonary Oedema
Pneumonia
Pulmonary Embolism
Haemorrhage
Acute Respiratory Distress Syndrome (ARDS)
Extra-Pulmonary Air
Pleural Effusion
Support and Monitoring Apparatus
Airway
Intravascular
Post-Surgical Imaging in the Chest
Introduction
Post-Pneumonectomy
Lung Transplantation
Preoperative Imaging
Perioperative Imaging
Reperfusion Oedema.
Early Graft Dysfunction.
Postoperative Imaging
Infection.
Acute Rejection.
Bronchial Anastomotic Complications.
Obliterative Bronchiolitis.
Post-transplantation Malignant Disease.
Disease Recurrence.
Surgical Treatment of Emphysema
Bullectomy
Lung Transplantation
Lung Volume Reduction Surgery
Further Reading
Online-only References
Chapter 18 Airspace Diseases
Chapter Outline
Introduction
An Approach to the Radiological Diagnosis of Airspace Diseases
Anatomical Considerations
Radiological Signs of Airspace Disease
Pulmonary Oedema
Chest Radiography in Pulmonary Oedema
Vascular Changes
Interstitial Oedema
Alveolar Oedema
Radiographic Differentiation of Cardiogenic and Non-Cardiogenic Pulmonary Oedema
CT in Pulmonary Oedema
Diffuse Pulmonary Haemorrhage
Idiopathic Pulmonary Haemosiderosis
Antibasement Membrane Antibody Disease (Goodpasture’s Syndrome)
Wegener’s Granulomatosis (ANCA-Associated Granulomatous Vasculitis)
Organising Pneumonia
Eosinophilic Lung Disease
Simple Pulmonary Eosinophilia (Löffler’s Syndrome)
Acute Eosinophilic Pneumonia
Chronic Eosinophilic Pneumonia
Pulmonary Alveolar Proteinosis
Alveolar Microlithiasis
Further Reading
Books/Book Chapters
Reviews/Papers
Online-only References
Chapter 19 Cardiac Anatomy and Imaging Techniques
Chapter Outline
Normal Chest Radiography
Cardiac Magnetic Resonance
Cardiac Axis Imaging Planes
Body Axes Imaging Planes
Normal Anatomy on CMR Images
Computed Tomography Imaging Techniques
CT Imaging of Ventricles and Myocardial Tissue
Coronary Arteries by CT
Valves
Pulmonary Veins
Other Structures
Echocardiography
Valves
Acknowledgement
Further Reading
MRI
CT
Echo
Online-only References
Chapter 20 Congenital Heart Disease: General Principles and Imaging
Chapter Outline
Introduction
Clinical Presentation
Later Clinical Presentation
Morphological Description and Sequential Segmental Analysis
Sequential Segmental Analysis
Step 1—Atrial Situs
Step 2—Ventricular Morphology
Step 3—Ventriculo-arterial Connection
Step 4—Identification of Other Abnormalities
Physiological and Functional Assessment
Non-Invasive Imaging Techniques
Ultrasound
Magnetic Resonance Imaging
Computed Tomography
Conventional Radiology
Diagnostic Features
The Pulmonary Vasculature
Radiologically Normal Pulmonary Vascularity.
Increased Pulmonary Perfusion (Pulmonary Plethora).
Decreased Pulmonary Perfusion (Oligaemia).
Pulmonary Venous Congestion and Oedema.
Systemic-to-Pulmonary Collateral Vessels.
Pulmonary Arterial Hypertension.
Heart Size, Shape and Position
Specific Lesions
Acyanotic Lesions
Septal Defects
Atrial Septal Defects
Key Imaging Goals
Atrioventricular Septal Defects
Key Imaging Goals
Ventricular Septal Defects
Key Imaging Goals
Abnormalities of the Great Vessels
Patent Ductus Arteriosus
Key Imaging Goals
Coarctation of the Aorta
Key Imaging Goals
Interrupted Aortic Arch
Key Imaging Goals
Abnormalities of the Aortic Arch and Vascular Rings
Key Imaging Goals
Valvular Heart Disease
Aortic Valve Disease
Key Imaging Goals
Pulmonary Valve Disease
Key Imaging Goals
Ebstein’s Anomaly of the Tricupid Valve
Key Imaging Goals
Coronary Artery Abnormalities
Anomalous Coronary Arteries
Key Imaging Goals
Cyanotic Congenital Heart Disease
Tetralogy of Fallot
Key Imaging Goals
Transposition of the Great Arteries
Key Imaging Goals
Congenitally Correct Transposition of the Great Arteries
Key Imaging Goals
Pulmonary Atresia
Pulmonary Atresia with a Ventricular Septal Defect.
Key Imaging Goals
Pulmonary Atresia with an Intact Ventricular Septum.
Double Outlet Right Ventricle
Key Imaging Goals
Common Arterial Trunk
Key Imaging Goals
Anomalous Pulmonary Venous Drainage
Key Imaging Goals
Single Ventricles
Systemic-to-Pulmonary Artery Shunt
Key Imaging Goals Following Stage 1 (Pre-BCPC)
Bidirectional Glenn Circulation
Key Imaging Goals Following Stage 2 (Pre-TCPC)
Fontan Circulation
Key Imaging Goals Following Stage 3 (Post-TCPC)
Conclusion
Further reading
Online-only References
Chapter 21 Non-ischaemic Acquired Heart Disease
Chapter Outline
Role of Imaging
Chest Radiography
Echocardiography
Magnetic Resonance Imaging
Computed Tomography
Cardiomyopathies
Hypertrophic Pattern
Dilated Phenotype
Restrictive Phenotype
Arrhythmogenic Right Ventricular Cardiomyopathy
Unclassified Cardiomyopathy
Myocarditis
Valvular Heart Disease
Mitral Valve Disease
Mitral Valve Prolapse
Chordal Rupture
Functional Mitral Regurgitation
Mitral Stenosis
Rheumatic Mitral Valve Disease
Tricuspid Valve Disease
Aortic Valve Disease
Aortic Stenosis
Aortic Regurgitation
Prosthetic Cardiac Valves
Complications of Prosthetic Valves
Structure Fracture
Porcine Bioprosthesis
Infective Endocarditis
Valve Regurgitation
Thromboembolism
Tumours of the Heart
Metastasis
Primary Cardiac Tumours
Cardiac Myxoma
Lipomas
Rhabdomyomas
Fibroma
Papillary Fibroelastoma
Haemangioma
Hydatid Disease
Primary Malignant Tumours of the Heart
Sarcomas
Sarcomas with Myofibroblastic Differentiation.
Rhabdomyosarcoma.
Lymphoma
Pericardial Diseases
Anatomy
Pericardial Cysts
Pericardial Defects
Pericardial Diverticulum
Pericardial Effusion
Pericardial Inflammation
Constrictive Pericarditis
Pericardial Masses
Further Reading
Online-only References
Chapter 22 Ischaemic Heart Disease
Chapter Outline
Introduction
Pathophysiology of Ischaemic Heart Disease
Coronary Artery Imaging
Functional Imaging
Stress Imaging
Myocardial Infarct Imaging
Myocardial Viability Imaging
Imaging of Complications Related to Ischaemic Heart Disease
Prognosis Assessment in Ischaemic Heart Disease
Role of Conventional Chest Radiography in Ischaemic Heart Disease
Differential Diagnosis in Ischaemic Heart Disease
Further Reading
Online-only References
Chapter 23 Pulmonary Circulation and Pulmonary Thromboembolism
Chapter Outline
Pulmonary Circulation
Pulmonary Circulation Anatomy
Pulmonary Arteries
Pulmonary Veins
Bronchial Arteries
Pulmonary Circulation Physiology
Pulmonary Vascular Patterns
Pulmonary Venous Hypertension
Vascular Redistribution (Grade 1)
Interstitial Oedema (Grade 2)
Alveolar Oedema (Grade 3)
Pulmonary Arterial Hypertension
Vascular Signs
Cardiac Signs
Parenchymal Signs
Pulmonary Arteriovenous Malformations
Pulmonary Thomboembolic Disease
Acute Pulmonary Thromboembolism
Diagnosing Acute Pulmonary Embolism
Clinical (Pre-Test) Probability Estimate and D-Dimer Testing
Imaging Findings
Plain Chest Radiography
Transthoracic or Transoesophageal Ultrasound (Echocardiography)
Conventional Pulmonary Angiography
Compression Ultrasound of the Legs
Ventilation–Perfusion Scintigraphy
CT Pulmonary Angiography
CTPA Protocol.
Combined Protocols: One-Stop-Shop Procedure.
CTPA During Pregnancy.
CTPA Assessment.
CT Perfusion.
MR
Chronic Pulmonary Thromboembolism
Conclusion
Acknowledgements
Further Reading
Online-only References
Chapter 24 The Thoracic Aorta: Diagnostic Aspects
Chapter Outline
The Normal Aorta
Diagnostic Aspects
Acquired Aortic Abnormalities
Acute Aortic Syndrome
Aortic Dissection
Classification
Imaging
Intramural Haematoma
Penetrating Atherosclerotic Ulcer (PAU)
Traumatic Aortic Injury (TAI)
Imaging
Aortic Aneurysms
Atherosclerotic Aortic Aneurysms
Thoracic Aneurysms
Abdominal Aneurysms
Inflammatory Aneurysms
Mycotic Aneurysms
Aortic Sinus Aneurysms
Preoperative Evaluation of Acute Aortic Syndromes
Impending Aortic Rupture
Visceral Malperfusion
Preoperative or Pre-Interventional Evaluation
Postoperative Evaluation
Management of Aortic Diseases
Traumatic Aortic Injury (TAI)
Aortic Dissection
Type A Dissection.
Type B Dissection.
Endovascular Treatment of Type B Dissection.
Inflammatory Diseases of the Aorta and Mid-Aortic Syndrome
Mid-Aortic Syndrome
Aortic Occlusive Disease
Chronic Aortic Occlusive Disease
Investigation and Management.
Acute Aortic Occlusive Disease
Imaging and Management.
Congenital Aortic Abnormalities
Vascular Rings
Double Aortic Arch
Other Vascular Rings Associated with Aortic Arch Abnormalities
Right Aortic Arch with Aberrant Left Subclavian Artery and Left Ligamentum Arteriosum (Fig. 24-49).
Right Aortic Arch with Mirror-Image Branching and Retro-oesophageal Ligamentum Arteriosum.
Vascular Rings Associated with Left Aortic Arch
Aortic Arch Abnormalities without an Anatomic Ring
Anomalous Innominate Artery.
Retro-Oesophageal Right Subclavian Artery with an Otherwise Normal Left Arch.
Imaging
Coarctation of the Aorta
Management
Pseudocoarctation
Aortic Atresia
Further Reading
Online-only References
Chapter 25 Current Status of Imaging of the Gastrointestinal Tract: Imaging Techniques and Radiation Issues
Chapter Outline
The Plain Abdominal Radiograph
Abnormal Gas Distribution
Pneumoperitoneum
Gas in Bowel Wall
Gas in Retroperitoneum
Gas in Other Organs
Dilatation of Bowel
Gastric Dilatation
Distinction between Small- and Large-Bowel Dilatation
Small-Bowel Dilatation
Large-Bowel Dilatation
Pseudo-Obstruction
Large-Bowel Obstruction
Abnormal Bowel Wall Pattern
Small-Bowel Ischaemia
Large-Bowel Ischaemia
Inflammatory Bowel Disease
Pseudomembranous Colitis
Acute Abdominal Inflammatory Conditions
Ultrasound in Appendicitis
Computed Tomography in Appendicitis
Other Inflammatory Conditions
Imaging the Abdomen with CT: Radiation Issues
Automatic Tube Current Modulation
Iterative Reconstruction Algorithms
CT Dose Reduction in Clinical Practice
Further Reading
Online-only References
Chapter 26 The Oesophagus
Chapter Outline
Anatomy and Function
Anatomy (Table 26-1)
Embryology
Function
Examination
Plain Radiography
Ultrasound
Fluoroscopy
Endoscopy
CT
MRI
Endoscopic Ultrasound
Radionuclide Radiology Including PET-CT
Pathological Features
Oesophageal Cancer
CT for Oesophageal Cancer
EUS for Oesophageal Cancer
PET-CT for Oesophageal Cancer
Treatment of Oesophageal Cancer
Other Oesophageal Neoplasms
Benign Lesions
Malignant Lesions
Hiatus Hernia
Gastro-Oesophageal Reflux Disease
Complications of GORD
Reflux Oesophagitis.
Columnar-Lined Oesophagus.
Other Varieties of Oesophagitis
Oesophageal Diverticula
Motility Disorders
Achalasia
Diffuse Oesophageal Spasm
Presbyoesophagus
Systemic Disorders
Neuromuscular Disorders
Miscellaneous Conditions
Oesophageal Varices
Schatzki Ring
Dysphagia Lusoria
Dysphagia Aortica
Trauma
Congenital Conditions
Further reading
Online-only References
Chapter 27 The Stomach
Chapter Outline
Anatomy
Radiological Techniques
Fluoroscopy
Cross-Sectional Imaging
Multidetector Computed Tomography (MDCT)
Magnetic Resonance Imaging (MRI)
FDG-PET and FDG-PET-CT
Gastric Pathology
Inflammatory Disease and Infiltrative Diseases
Helicobacter pylori and Diseases of the Stomach
Gastric Ulcer
Gastric Erosions
Gastritis
Atrophic Gastritis
Infectious Gastritis
Crohn’s and Other Granulomatous Diseases
Hypertrophic Gastritis
Ménétrier’s Disease
Zollinger–Ellison Syndrome
Eosinophilic Gastroenteritis
Corrosive Ingestion
Amyloidosis
Neoplastic Diseases
Mucosal Polyps
Mesenchymal Tumours
Gastric Carcinoma
Early Gastric Cancer
Advanced Gastric Cancer
Staging of Gastric Cancer
Gastric Lymphoma
Carcinoid
Metastatic Disease
Miscellaneous Conditions
Positional Abnormalities
Hiatus Hernia
Gastric Volvulus
Gastric Pneumatosis
Prepyloric Web (Antral Mucosal Diaphragm)
Diverticula
Hypertrophic Pyloric Stenosis
Varices
Gastric Distention
Ectopic Pancreas
The Postoperative Stomach
Bariatric Surgery for Obesity
Other Surgeries
Complications of Gastric Surgery
Advances in Gastric Imaging
Further Reading
Online-only References
Chapter 28 The Duodenum and Small Intestine
Chapter Outline
The Duodenum
Anatomy and Normal Appearances
Radiological Investigation
Barium Studies
Other Imaging Techniques
Peptic Ulceration
Postbulbar Ulceration
Complications of Peptic Ulceration
Gastric Heterotopia
Diverticula
Neoplasms
Benign Neoplasms
Malignant Neoplasms
Primary Carcinoma
Secondary Involvement
Other Conditions
Pancreatitis
Crohn’s Disease
Tuberculosis
Progressive Systemic Sclerosis
Intramural Haematoma
Traumatic Rupture
Vascular Conditions
The Small Intestine
Anatomy and Normal Appearances
Radiological Investigation
Plain Radiographs
Barium Studies
Enteroclysis
Computed Tomography
Ultrasound
Magnetic Resonance Imaging
Angiography
Nuclear Medicine Studies
Radionuclide Imaging of Meckel’s Diverticulum
The Abnormal Small Intestine
Crohn’s Disease
Radiological Appearances
Coeliac Disease
Neoplasms
Malignant Neoplasms
Carcinoid Tumour
Adenocarcinoma
Lymphoma
Gastrointestinal Stromal Tumours
Secondary Neoplasms
Benign Neoplasms
Infections and Infestations
Mesenteric Adenitis
Tuberculosis
Yersiniosis
Actinomycosis
Chronic Radiation Enteritis
Mechanical Small Intestinal Obstruction
Acute Mesenteric Ischaemia
Vasculitis
Occult Gastrointestinal Bleeding
Diverticula and Blind Loops
Jejunal Diverticula
Meckel’s Diverticulum
Blind Loops
Ileal Diverticula
Neuromuscular Disorders
Nodular Lymphoid Hyperplasia and Immunoglobulin Deficiency
Whipple’s Disease
Intestinal Lymphangiectasia
Eosinophilic Gastroenteritis
Mastocytosis
Angio-Oedema
Amyloidosis
Acquired Immune Deficiency Syndrome
Behçet’s Disease
Graft-Versus-Host Disease
Non-steroidal Anti-Inflammatory Drug Enteritis
Further Reading
Online-only References
Chapter 29 The Large Bowel
Chapter Outline
Anatomy
Radiological Investigation
Tumours
Polyps
Polyposis Syndromes
Familial Adenomatous Polyposis.
Hereditary Non-polyposis Colorectal Cancer (Lynch Syndrome).
Peutz–Jeghers Syndrome.
Rare Polyposes.
Radiographic Features of Polyps
CT Colonography.
MR Colonography.
Double-Contrast Barium Enema.
Colorectal Cancer
Colon Cancer
Rectal Cancer
Anal Cancer
Appendix Tumours
Lymphoma
Secondary Cancers
Diverticulitis
Epiploic Appendagitis
Colitis
Imaging Features of Colitis
Inflammatory Bowel Disease
Differential Features
Disease Activity in Inflammatory Bowel Disease
Carcinoma in Colitis
Other Common Causes of Colitis
Ischaemic Colitis
Radiation Colitis
Behçet’s Syndrome
Infectious Colitis
Pseudomembranous Colitis
Neutropenic Colitis
Parasitic Colitis
Tuberculosis
Amoebiasis
Acquired Immunodeficiency Syndrome
Defunctioned Colon
Acute Fulminant Colitis
Perforation
Miscellaneous Conditions
Large-Bowel Strictures
Pseudodiverticula
Appendicitis
Lipomatous Disorders of the Large Bowel
Pneumatosis Coli
Volvulus
Intussusception
Endometriosis
Retrorectal Lesions
Functional Disorders of the Anorectum
Anal Fistula
Further Reading
Online-only References
Chapter 30 Imaging of the Peritoneum, Mesentery and Omentum
Chapter Outline
Anatomical Considerations
Introduction
Peritoneal Spaces
Supramesocolic Space
Inframesocolic Space
Peritoneal Reflections
The Mesenteries
The Omentum
Pathological Considerations
Ascites
Intraperitoneal Air
Developmental/Congenital Anomalies
Rotational Anomaly
Developmental Defects
Mesenteric Cysts
Infections–Inflammations
Tuberculosis
Hydatid Disease
Crohn’s Disease
Mesenteric Lymphadenitis
Acute Pancreatitis
Whipple’s Disease
Mesenteric Panniculitis–Sclerosing Mesenteritis
Sclerosing Peritonitis
Non-inflammatory Oedema
Epiploic Appendagitis
Omental Infarction
Neoplastic Diseases
Neoplastic Diseases of Peritoneum
Direct Spread Along Mesenteric and Ligamentous Attachments
Intraperitoneal Seeding and Peritoneal Carcinomatosis
Primary Neoplasms
Neoplastic Diseases of Mesentery
Primary Neoplasms
Secondary Neoplasms
Secondary Carcinoma.
Intraperitoneal Tumour Dissemination.
Embolic Metastases.
Lymphatic Dissemination.
Carcinoid.
Neoplastic Diseases of the Omentum
Further reading
Online-only References
Chapter 31 The Liver and Spleen
Chapter Outline
Liver
Anatomy
Subdivisions (Fig. 31-2)
Lobar Agenesis/Atrophy (Figs. 31-3 and 31-4)
Vascular Anatomy Variation (Fig. 31-5)
Liver Imaging Techniques
Plain Radiography
Ultrasound
Technique
Normal (Fig. 31-6)
Computed Tomography
Technique (Fig. 31-9)
Normal
Magnetic Resonance Imaging
Techniques (Fig. 31-11)
Intravenous Contrast Agents (Fig. 31-12)
Normal
Scintigraphy
Technique
Normal
Angiography
Diffuse Disease
Benign Diffuse Disease
Hepatic Steatosis
Cirrhosis
Viral Hepatitis
Haemochromatosis and Iron Overload
Wilson’s Disease
Malignant Diffuse Disease
Focal Disease
Calcification
Pneumobilia
Portal Vein Gas
Parenchymal Gas
Benign Cystic Lesions
Cysts
Hydatid Disease
Abscess
Malignant Cystic Lesions
Metastases
Benign Solid Lesions
Haemangioma
Atypical Haemangiomas
Focal Nodular Hyperplasia
Hepatic Adenoma
Focal Fat
Focal Confluent Fibrosis
Biliary Hamartomas (Fig. 31-44)
Atypical Regenerative Nodules
Malignant Solid Lesions
Hepatocellular Carcinoma
Fibrolamellar Carcinoma (FLC) (Fig. 31-53)
Hepatoblastoma
Epithelioid Haemangioendothelioma
Hepatic Lymphoma
Angiosarcoma (Fig. 31-55)
Metastases
Vascular Lesions
Budd–Chiari Syndrome
Veno-Occlusive Disease
Portal Venous Hypertension
Portal Vein Thrombosis
Arterioportal Shunts
Intrahepatic Portosystemic Shunts
Arteriovenous Shunts
Hepatic Trauma
Liver Transplantation
Background and Indications
Recipient Assessment
Living Donor Assessment
Perioperative Imaging
Graft Failure
Liver Biopsy
Liver Biopsy, Aspiration and Drainage
Devices
Approach Routes
Practical Procedural Issues
Complications and Safety84–88
Spleen
Anatomy
Congenital Variations
Accessory Spleen or Splenunculus (Fig. 31-74)
Polysplenia and Asplenia (Fig. 31-75)
Acquired Diseases
Trauma (Fig. 31-76)
Infections (Fig. 31-77)
Infarction (Figs. 31-78 and 31-79)
Benign Lesions
Cysts (Fig. 31-80)
Haemangioma (Fig. 31-81)
Hamartomas and Lymphangiomas (Fig. 31-82)
Malignant Lesions
Angiosarcoma (Fig. 31-83)
Lymphoma (Fig. 31-84)
Metastases (Fig. 31-85)
Leukaemia
Other Problems
Portal Hypertension/Splenic Vein Thrombosis
Sarcoidosis
Amyloidosis
Haemosiderosis
Extramedullary Haematopoiesis
Gaucher’s Disease
Further Reading
Online-only References
Chapter 32 The Biliary System
Chapter Outline
Biliary Anatomy
Gallbladder Anatomical Variants
Methods of Investigation
Ultrasound
Computed Tomographic Cholangiography
Magnetic Resonance Cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography
Percutaneous Transhepatic Cholangiography
Intraoperative Cholangiography
T-Tube Cholangiography
Hepatobiliary Scintigraphy
Endoscopic Ultrasound
Disorders of the Gallbladder
Gallbladder Stones
Sludge
Milk of Calcium Bile
Cholecystitis
Acute Calculous Cholecystitis
Gangrenous Cholecystitis
Emphysematous Cholecystitis
Acalculous Cholecystitis
Gallbladder Mucocele
Gallbladder Fistulae
Porcelain Gallbladder
Adenomyomatous Hyperplasia
Gallbladder Polyps
Gallbladder Carcinoma
Gallbladder Metastases and Lymphoma
Role of Radiology in Investigation of Jaundice
Benign Bile Duct Pathology
Choledocholithiasis
Ultrasound
Unenhanced CT
Cholangiography
Hepatolithiasis
Benign Biliary Strictures
Postoperative Strictures
Primary Sclerosing Cholangitis
Mirizzi’s Syndrome
Pancreatitis
IgG4-related Sclerosing Disease
HIV Cholangiopathy
Acute Bacterial Cholangitis
Recurrent Pyogenic Cholangitis
Parasitic Infections
Ascaris lumbricoides
Hydatid
Fascioliasis
Biliary Leaks and Bile Duct Injuries
Biliary Cystic Disease
Neoplastic Bile Duct Pathology
Cholangiocarcinoma
Metastases and Lymphoma
Pancreatic and Ampullary Tumours
Miscellaneous Biliary Tumours
Liver Atrophy
Lobar or Segmental Duct Obstruction
Haemobilia
Interventional Techniques
Percutaneous Cholecystostomy
Percutaneous Transhepatic Biliary Catheterisation
Malignant Disease
Hilar Strictures—Special Considerations
Benign Disease
Percutaneous Transjejunal Biliary Intervention
Gallstone Extraction Via T-Tube Track
Biopsy Techniques
Further Reading
Online-only References
Chapter 33 The Pancreas
Chapter Outline
Embryology
The Normal Pancreas
Congenital Anomalies
Pancreas Divisum
Annular Pancreas
Pancreatic Agenesis, Hypoplasia and Ectopic Pancreas
Acute Pancreatitis
Imaging in Acute Pancreatitis
Interstitial Oedematous Pancreatitis
Necrotising Pancreatitis
Pancreatic and Peripancreatic Collections
Pseudocyst
Acute Necrotic Collection (ANC)
Walled-Off Necrosis (WON)
Pseudocysts
Vascular Complications
Gastrointestinal Involvement
Chronic Pancreatitis
Groove Pancreatitis
Autoimmune Pancreatitis
Pancreatic Neoplasms
Ductal Adenocarcinoma
Imaging Techniques
Imaging Appearances
Local Staging
Distant Metastases
Follow-Up
Neuroendocrine Pancreatic Tumours (NET)
Functioning Tumours
Non-functioning NETs
Cystic Masses
What To Do With Small Incidental Cystic Lesions
Rare Pancreatic Neoplasms
Multisystem Diseases with Involvement of the Pancreas
Cystic Fibrosis
Von Hippel–Lindau Disease
Polycystic Kidney Disease
Osler–Weber–Rendu Disease
Trauma
Pancreatic Transplant Imaging
Interventional Radiology
Biopsy of Pancreatic Lesions
Drainage of Pancreatic/Peripancreatic Fluid Collections
Further Reading
Online-only References
Chapter 34 Common Uroradiological Referrals:
Chapter Outline
Haematuria
Renal Tract Calcifications
Imaging of Renal and Ureteric Stones
Imaging of Renal and Ureteric Tumours
Risk Stratification of Patients with Haematuria for Triage to Computed Tomography
Imaging Features of Urothelial Tumours on Computed Tomography
Loin Pain
Imaging of Patients with Loin Pain
Radiography
Ultrasound
MR Urography
Computed Tomography
Intravenous Urography
Useful Signs on Unenhanced CT and Potential Pitfalls
Renal Failure
Chronic Renal Failure
Autosomal Dominant Polycystic Kidney Disease (Adult Polycystic Kidney Disease)
Tuberous Sclerosis
Acquired Cystic Kidney Disease (ACKD)
Renovascular Disease
Contrast Medium-Induced Nephrotoxicity
Nephrogenic Systemic Fibrosis
Infection
Acute Pyelonephritis
Imaging of Acute Pyelonephritis
Intravenous Urography.
Ultrasound.
Computed Tomography.
Magnetic Resonance Imaging.
Renal Scintigraphy.
Renal and Perirenal Abscess
Imaging of Renal and Perirenal Abscess
Emphysematous Pyelonephritis
Imaging of Emphysematous Pyelonephritis
Xanthogranulomatous Pyelonephritis (XGP)
Imaging of XGP
Pyonephrosis
Imaging of Pyonephrosis
Chronic Pyelonephritis
Imaging of Chronic Pyelonephritis
Renal Tuberculosis
Imaging of Renal Tuberculosis
Cystitis
Imaging of Cystitis
Prostatitis
Acute Bacterial Prostatitis and Prostatic Abscess
Imaging of Acute Prostatitis and Prostatic Abscess.
Chronic Prostatitis
Imaging of Chronic Prostatitis.
Online-only References
Chapter 35 The Urinary Tract: Anatomy, Techniques and Radiation Issues
Chapter Outline
Introduction
Anatomy of the Urinary Tract
Embryology
Normal Urinary Tract Anatomy
Congenital Abnormalities of the Urinary Tract
Renal
Ureter and Pelvis
Bladder and Urethra
Techniques
Conventional Radiography
Intravenous Urography (IVU)/Excretory Urography
Retrograde Urography
Retrograde Urethrography and Voiding Cystourethrogram
Ultrasound
Nuclear Medicine
CT
MRI
Radiation Issues
Radiation Exposure from Medical Imaging
Conventional Radiography
IVU
CT
Conclusion
Further Reading
Online-only References
Chapter 36 Renal Masses: Imaging and Biopsy
Chapter Outline
Methods of Analysis
Plain Abdominal Radiography
Intravenous Urography
Radionuclide Imaging
Ultrasound
Computed Tomography
MRI
Renal Arteriography
Needle Aspiration and Biopsy
Non-Neoplastic Renal Masses
Pathological Renal Masses
Renal Cysts
Serous Renal Cyst
‘Complicated Cysts’
Parapelvic and Peripelvic Cysts
Adult Polycystic Kidney Disease (ADPKD)
Multicystic Renal Dysplasia
Localised Cystic Disease of the Kidney
Hydatid (Echinococcal) Cysts of the Kidney
Inflammatory Masses
Renal Abscesses
Acute Focal Pyelonephritis
Malacoplakia
Vascular Masses
Haematomas
Intrarenal Vascular Masses
Angiomyolipomas
Focal Hydronephrosis
Renal Sinus Lipomatosis
Non-Renal Masses
Neoplastic Renal Masses
Benign
Adenoma and Oncocytoma
Haemangioma
Multilocular Cystic Nephroma
Malignant
Parenchymal
Renal Cell Carcinoma.
Staging of Renal Cancer.
Wilms’ Tumour in the Adolescent and Adult.
Sarcoma.
Lymphoma and Leukaemia.
Tumours Metastatic to the Kidney.
Non-Parenchymal
Urothelial Tumours
Transitional Cell Carcinoma (see Figs. 36-25 and 36-26).
Squamous Cell Carcinoma.
Further Reading
Online-only References
Chapter 37 Renal Transplantation: Imaging
Chapter Outline
History of Transplant
Surgical Technique
Technique of Examination
Vascular Complications: Early
Infarction
Acute Rejection
Acute Tubular Necrosis
Non-vascular Complications
Urinoma
Lymphocele
Ureteric Strictures
Renal Calculi
Vascular Complications: Intermediate to Late
Renal Artery Stenosis
Chronic Rejection
Cancer and Transplant
Infection and Renal Transplantation
Use of Isotope Studies and Renal Transplant
Renal Transplant Biopsy
Radiological Evaluation of Potential Donor Kidneys
Further Reading
Online-only References
Chapter 38 Urothelial Cell Cancer, Upper Tract and Lower Tract
Chapter Outline
Upper Tract Urothelial Carcinoma
Definition
Epidemiology
Risk Factors
Identification of Prognostic Factors
Management
Biopsy
Imaging Upper Tract Urothelial Carcinoma
Definition of CT Urography
Indications and Contraindications for CT Urography
Optimisation of CT Urography Technique
Quality Control
Radiation Dose Optimisation Strategies
Diagnostic Accuracy of CT Urography for UTUC
Diagnostic Imaging Strategies for UTUC
Problems and Solutions
Conclusions and Summary
Bladder Cancer
Introduction
Classification of Urothelial Cancers
By Growth Pattern
By Histology
By Grade
Clinical Detection
Imaging Detection
Technique of CT Urography and MR Urography
CT and MR Urographic Appearance of Bladder Cancers
Sensitivity and Specificity of CT and MR Urography in Detecting Bladder Cancers
Risks of CT and MR Urography
Use of Positron Emission Tomography for Detecting and Evaluating Bladder Cancers
Staging
Imaging for Local Staging of Bladder Cancer
Imaging for Detection of Regional and Distant Metastatic Disease
Upper Tract Evaluation
Treatment and Follow-Up
Clinical and Imaging Follow-up of Patients after Topical Treatment of Bladder Cancer
Imaging of Patients Following Neoadjuvant Chemoradiation and before Surgery
Imaging Follow-up of Patients after Cystectomy
Use of Imaging to Identify Tumour Response to Chemotherapy
Uncommon Bladder Neoplasms
Squamous Cell Carcinomas
Adenocarcinomas
Cancers in Bladder Diverticula
Other Bladder Malignancies
Benign Bladder Lesions
Further Reading
Upper Tract Urothelial Cancer
Bladder Cancer
Online-only References
Chapter 39 Prostate
Chapter Outline
Multi-Parametric Prostate MRI
Introduction
Anatomy
Histology
MR Imaging
T2-Weighted MR Imaging
T1-Weighted MR Imaging
DCE MR Imaging
DWI MR Imaging
MRSI
Local Staging
Aggressiveness
1.5 Versus 3.0
Recurrence
Biopsy
Protocols
Detection and Localisation of Primary or Recurrent PCa
Staging of PCa
Further Reading
Online-only References
Chapter 40 Male Genitourinary Tract
Chapter Outline
Methods of Examination
Anatomy
Scrotal Masses
Testicular Masses
Malignant Testicular Pathology
Staging Testicular Malignancy
Computed Tomography
Non-Primary Testicular Malignancies, Lymphoma and Leukaemia
Non-Malignant Focal Testicular Lesions
Non-Focal Testicular Abnormalities
Tubular Ectasia
Testicular Microlithiasis
Extratesticular Scrotal Lesions
Hypoechoic Lesions
Solid Extratesticular Lesions
Acute Epididymitis
Testicular Atrophy
Testicular Trauma
Cryptorchidism
Testicular Torsion
Imaging of Male Sexual Dysfunction
Subfertility with Normal Sexual Function
Erectile Failure
Evaluation of the Soft Tissues of the Penis
Further Reading
Online-only References
Chapter 41 Gynaecological Cancer
Chapter Outline
Imaging Techniques
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography/Computed Tomography
Endometrial Carcinoma
Detection, Diagnosis and Staging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Stage I.
Stage II.
Stage III.
Stage IV.
Positron Emission Tomography/ Computed Tomography
Recommended Imaging Approach
Carcinoma of the Cervix
Detection, Diagnosis and Staging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Stage I.
Stage II.
Stages III and IV.
Positron Emission Tomography/ Computed Tomography
Recommended Imaging Approach
Ovarian Carcinoma
Detection, Diagnosis and Staging
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography/ Computed Tomography
Recommended Imaging Approach
Conclusion
Acknowledgements
Further Reading
Online-only References
Chapter 42 Benign Gynaecological Disease
Chapter Outline
Imaging Techniques
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Hysterosalpingography and Fallopian Tube Catheterisation
Sonohysterography
Congenital Anomalies of the Female Genital Tract
Müllerian Duct Anomalies
Class I: Uterine Agenesis or Hypoplasia
Class II: Unicornuate Uterus
Class III: Uterus Didelphys
Class IV: Bicornuate Uterus
Class V: Septate Uterus
Class VI: Arcuate Uterus
Class VII: Diethylstilbestrol Related
Vaginal Anomalies
Imaging of Ambiguous Genitalia
Benign Uterine Conditions
Fibroids
Ultrasound
Magnetic Resonance Imaging
Computed Tomography
Hysterosalpingography
Endometrial Polyps
Endometrial Hyperplasia
Adenomyosis
Ultrasound
Magnetic Resonance Imaging
Pelvic Pain
Endometriosis
Ultrasound
Magnetic Resonance Imaging
Pelvic Inflammatory Disease
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Pelvic Varices
Benign Ovarian Conditions
Functional Ovarian Cysts
Polycystic Ovaries
Magnetic Resonance Imaging
Benign Tumours of the Ovary
Epithelial Tumours
Germ Cell Tumours
Stromal Cell Tumours
Ovarian Torsion
Vaginal Cysts
Further Reading
Online-only References
Chapter 43 Genitourinary Tract Trauma
Chapter Outline
Introduction
Renal Injury
Clinical Aspects
CT Technique for Renal Injury
Grading of Renal Injury and Implications for Management
CT of Grade I–III Renal Injury
CT of Grade IV Renal Injury
CT of Grade V Injury
Penetrating Renal Trauma
Intervention in Renal Injury
Ureteral Injury
Bladder Injury
Diagnostic Technique
Classification
Urethral Injury
Scrotal Injury
Penile Injuries
Further Reading
Online-only References
Chapter 44 Adrenal Imaging
Chapter Outline
The Adrenal Glands
Anatomy and Physiology
Anatomy
Physiology
Incidentally Detected Adrenal Mass
Computed Tomography (CT)
Lesion Size and Contour
Intracellular Lipid Content of the Adrenal Mass
Contrast Enhancement and Contrast Washout Characteristics
Histogram Analysis Method
Magnetic Resonance Imaging
Conventional Spin-Echo Imaging
Gadolinium-Enhanced Magnetic Resonance Imaging
Chemical Shift Imaging
Positron Emission Tomography
Percutaneous Adrenal Biopsy
Adrenal Scintigraphy
Incidentally Detected Non-Functioning Adrenal Masses
Adrenal Cysts
Myelolipoma
Imaging Functional Disorders of the Adrenal Gland
Hyperfunctioning Adrenal Cortical Disorders
Cushing’s Syndrome
ACTH-Independent Cushing’s Syndrome.
Adrenal Adenomas.
Adrenal Carcinoma.
Primary Pigmented Nodular Adrenocortical Disease (PPNAD).
ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH).
ACTH-Dependent Cushing’s Syndrome.
Primary Hyperaldosteronism (Conn’s Syndrome)
Virilisation
Congenital Adrenal Hyperplasia (CAH).
Adrenal Virilising Tumours.
Hyperfunctioning Adrenal Medullary Disorders
Phaeochromocytomas
Adrenal Medullary Hyperplasia (AMH)
Neuroblastoma and Ganglioneuroblastoma
Adrenal Hypofunction (Addison’s Disease)
Primary Adrenal Hypofunction
Secondary Adrenal Hypofunction
Conclusion
Further Reading
Online-only References
Chapter 45 Imaging Techniques and Fundamental Observations for the Musculoskeletal System
Chapter Outline
Introduction
Imaging Techniques Available
Radiography
Benefits
Disadvantages
Advances and Variations
Stress Views.
Fluoroscopy.
Arthrography.
Tomosynthesis.
Ultrasound (US)
Benefits
Disadvantages
Advances and Variations
Elastography.
Contrast-enhanced US.
Computed Tomography (CT)
Benefits
Disadvantages
Advances and Variations
Dual-energy CT.
Magnetic Resonance Imaging (MRI)
Benefits
Disadvantages
Advances and Variations
MR Arthrography.
Cartilage Imaging.
MR Elastography (MRE).
Diffusion-weighted MRI.
Nuclear Medicine
Benefits
Disadvantages
Advances and Variations
Normal Imaging Appearances
Radiography
Bones and Joints
Soft Tissues
Ultrasound
Bone and Joints
Soft Tissues
Fat.
Muscle, Tendons and Ligaments.
Ligaments.
Nerves.
Computed Tomography
Bone
Soft Tissues
MRI
Bone and Joints
Soft Tissues
Specific Radiological Scenarios
Soft-tissue Calcification and Ossification
Dystrophic Calcification
Arterial Vascular Calcification.
Venous Vascular Calcification.
Trauma.
Calcium Hydroxyapatite Deposition Disease.
Congenital Causes for Soft-tissue Calcification.
Infection
Bacterial and Fungal Infection.
Parasitic Infection.
Autoimmune
Dermatomyositis.
Progressive Systemic Sclerosis (Scleroderma).
Neoplastic.
Metabolic Calcification.
Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD)
Tumoral Calcinosis
Malignant Calcification
Gas in the Soft Tissues
Periosteal Reaction
Non-aggressive Periosteal Reaction
Congenital.
Genetic.
Arthritis.
Trauma.
Metabolic.
Drugs.
Tumours.
Vascular.
Aggressive Periosteal Reaction.
Further Reading
Online-only References
Chapter 46 Internal Derangements of Joints: Upper and Lower Limbs
Chapter Outline
Introduction
The Shoulder
Rotator Cuff Disease
GHJ Instability
Superior Labral Tears
The Acromioclavicular Joint
The Sternoclavicular Joint
The Elbow
Tendons
Bone and Cartilage
Ligaments
Hand and Wrist
Bone
Wrist Ligaments
Triangular Fibrocartilage
Wrist Tendons
Median Nerve
UCL of Thumb
The Hip
Labrum and Cartilage
Muscle and Tendon
Bone
Bursae
The Knee
Menisci
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral Ligament Complex and Posterolateral Corner
The Extensor Mechanism and Patellofemoral Joint
Bone and Cartilage
Bursae
The Ankle and Foot
Ligaments
Tendons
Bone
Tarsal Coalition
Other Soft-Tissue Abnormalities
Further Reading
Online-only References
Chapter 47 Bone Tumours (1): Benign Tumours and Tumour-Like Lesions of Bone
Chapter Outline
General Characteristics of Bone Tumours
Age at Presentation
Radiological Assessment of Bone Tumours
Location
Rate of Growth
Periosteal Reaction2
Matrix Mineralisation
CT and MRI in Diagnosis and Staging
Benign Bone Tumours
Cartilage Tumours
Osteochondroma
Radiological Features
(En)Chondroma
Radiological Features
Less Common Varieties of Chondroma
Periosteal Chondroma.
Enchondromatosis (Ollier’s Disease).
Enchondromatosis with Haemangiomas (Maffucci’s Syndrome).
Chondroblastoma
Radiological Features
Chondromyxoid Fibroma
Radiological Features
Osteogenic Tumours
Osteoid Osteoma (OO)
Radiological Features
Osteoblastoma
Radiological Features
Fibrogenic Tumours
Desmoplastic Fibroma
Radiological Features
Fibrohistiocytic Tumours
Fibrous Cortical Defect
Non-Ossifying Fibroma
Radiological Features
Benign Fibrous Histiocytoma
Radiological Features
Giant Cell Tumour
Giant Cell Tumour
Radiological Features
Vascular Tumours
Haemangioma
Radiological Features
Smooth Muscle Tumours
Leiomyoma
Lipogenic Tumours
Intraosseous Lipoma
Parosteal Lipoma
Neural Tumours
Schwannoma of Bone
Miscellaneous Lesions
Aneurysmal Bone Cyst
Radiological Features53
Simple Bone Cyst
Radiological Features
Fibrous Dysplasia
Radiological Features
Osteofibrous Dysplasia
Radiological Features
Langerhans Cell Histiocytosis (LCH)
Radiological Features
Erdheim–Chester’s Disease
Further Reading
Online-only References
Chapter 48 Bone Tumours (2): Malignant Bone Tumours
Chapter Outline
Introduction
Bone Metastases
Distribution of Bone Metastases
Diagnosis of Bone Metastases
Clinical
Radiological Features
Prostate.
Breast.
Lung.
Kidney.
Melanoma.
Radiological Investigation of Bone Metastases
Bone Metastases in Children
Primary Malignant Neoplasms of Bone
Chondroid Origin
Chondrosarcoma
Clinical Presentation
Imaging Features
Other Chondrosarcoma Variants
Periosteal Chondrosarcoma
Mesenchymal Chondrosarcoma
Clear Cell Chondrosarcoma
Osteoid Origin
Osteosarcoma
Central Osteosarcomas
Conventional Central Osteosarcoma
Clinical Presentation.
Imaging Features.
Other Varieties of Central Osteosarcoma.
Surface Osteosarcomas.
Parosteal Osteosarcoma.
Periosteal Osteosarcoma.
High-Grade Surface Osteosarcoma.
Secondary Osteosarcoma.
Paget’s Sarcoma.
Post-Radiation Sarcoma.
Fibrous Origin
Marrow Tumours
Ewing’s Sarcoma and Primitive Neuroectodermal Tumour (PNET)
Imaging Features
Notochordal Origin
Chordoma
Miscellaneous Tumours
Malignant Vascular Tumours
Adamantinoma
Further Reading
Online-only References
Chapter 49 Soft Tissue Tumours
Chapter Outline
Introduction
Imaging Characterisation of Soft Tissue Masses
Radiographs
Computed Tomography (CT)
Ultrasound (US)
Magnetic Resonance Imaging (MRI)
World Health Organization Classification of Soft Tissue Tumours
Lipomatous (Adipocytic) Tumours
Lipoma
Radiographs
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Other Benign Adipocytic Tumours
Lipoblastoma
Hibernoma
Atypical Lipomatous Tumour/Well-Differentiated Liposarcoma (ALT/WDL)
Other Adipocytic Malignancies
Dedifferentiated Liposarcoma
Myxoid Liposarcoma
Fibroblastic/Myofibroblastic Tumours
Nodular Fasciitis (NF)
Elastofibroma (EF)
Fibromatoses
Superficial Fibromatosis
Palmar Fibromatosis (Dupuytren’s Disease).
Plantar Fibromatosis (Ledderhose Disease).
Other Forms.
Desmoid-Type Fibromatosis
Fibroma of the Tendon Sheath (FTS)
So-Called Fibrohistiocytic Tumours
Pigmented Villonodular Synovitis (PVNS) and Giant Cell Tumour of the Tendon Sheath (GCTTS)
Diffuse-Type Pigmented Villonodular Synovitis (Diffuse-Type Giant Cell Tumour)
Vascular Tumours
Haemangioma
Radiographs
Ultrasound
MRI
Chondro-Osseous Tumours
Soft Tissue Chondromas
Tumours of Uncertain Differentiation
Myxoma
Soft Tissue Sarcomas (STSs)
Synovial Sarcoma (SS)
Tumours of Nerves
Benign Nerve Sheath Tumours
Malignant Nerve Tumours
Malignant Peripheral Nerve Sheath Tumours (MPNSTs)
Tumour-Like Lesions Arising from Nerves (Pseudotumours)
Nerve Sheath Ganglion (Intraneural Ganglion)
Traumatic Neuroma
Morton’s Neuroma
Lipomatosis of Nerve
Non-Neoplastic Tumour Mimics
Accessory Muscles
Traumatic Lesions
Infection/Inflammation
Synovial Disorders
Further Reading
Online-only References
Chapter 50 Metabolic and Endocrine Skeletal Disease
Chapter Outline
Bone Physiology and Pathophysiology
Bone Cells
Bone Formation and Turnover
Bone Growth and Development
Osteoporosis
Definition and Epidemiology
Radiological Features
Spine in Osteoporosis
Vertebroplasty and Kyphoplasty
Osteoporotic Fractures
Aetiology
Regional Osteoporosis
Generalised Osteoporosis
Idiopathic Juvenile Osteoporosis (IJO).
Osteoporosis of Young Adults.
Postmenopausal Osteoporosis.
Senile Osteoporosis.
Secondary Osteoporosis.
Osteogenesis Imperfecta
Type I
Type II (Lethal Perinatal)
Type III (Severe Progressive)
Type IV (Moderately Severe)
Quantitative Assessment of the Skeleton
Dual Energy X-ray Absorptiometry (DXA)
Quantitative Computed Tomography (QCT)
Quantitative Ultrasound
Radiogrammetry
Vertebral Morphometry
Other Research Methods
Parathyroid Disorders
Hyperparathyroidism
Primary Hyperparathyroidism
Secondary Hyperparathyroidism
Clinical Presentation
Treatment
Radiological Findings
Subperiosteal Erosions.
Intracortical Bone Resorption.
Chondrocalcinosis.
Brown Tumours (Osteitis Fibrosa Cystica).
Osteosclerosis.
Osteoporosis.
Metastatic Calcification.
Hypoparathyroidism
Aetiology
Radiological Abnormalities
Pseudohypoparathyroidism (PHP)
Radiographic Abnormalities
Pseudo-Pseudohypoparathyroidism (PPHP)
Rickets and Osteomalacia
Vitamin D Deficiency
Genetic Disorders of Vitamin D Metabolism
Oncogenic Osteomalacia
Radiological Appearances
Rickets.
Osteomalacia.
Azotaemic Osteodystrophy
Renal Tubular Defects
X-linked Hypophosphataemia (XLH).
Other Causes of Rickets and Osteomalacia (Not Related to Vitamin D Deficiency or Hypophosphataemia)
Hypophosphatasia
Other Metabolic Bone Disorders
Osteopetrosis
Autosomal Recessive Lethal Type of Osteopetrosis
Benign, Autosomal Dominant Type of Osteopetrosis (Albers-Schönberg Disease)
Hyperphosphatasia
Miscellaneous
Vitamin D Intoxication
Hypervitaminosis A
Fluorosis
Other Endocrine Diseases
Cushing’s Disease
Thyroid Disease
Acromegaly
Further Reading
Online-only References
Chapter 51 Arthritis
Chapter Outline
Imaging of Joint Disease
Plain Radiographic Interpretation; General Principles
Soft-Tissue Swelling
Alteration in Joint Space
Bone Changes
Osteopenia.
Erosion.
Entheseal Disease.
Bone Alignment
Distribution of Joint Involvement
Osteoarthritis
Primary Osteoarthritis
Secondary Osteoarthritis
Radiographic Findings
Radiographic Changes at Specific Joints
Knee
Hip
Hands and Wrists
Spine
Advanced Imaging
Erosive (Inflammatory) Osteoarthritis
The Inflammatory Arthritides
Rheumatoid Arthritis
Radiographic Features
Radiographs in Treated Inflammatory Disease
Sero-Negative Arthritis
Ankylosing Spondylitis
Sacroiliitis.
Spinal Disease.
Peripheral Joint Involvement.
Psoriatic Arthritis
Joints of the Hands and Feet.
Spinal and Large Joint Disease.
Reactive Arthritis
Enteropathy-Associated Arthritis
The Crystal Arthritides
Gout
Acute Intermittent Gout.
Chronic Tophaceous Gout.
Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease
Imaging Findings.
Pyrophosphate Arthropathy.
Calcium Hydroxyapatite Crystal Deposition Disease
Periarticular HA Deposition Disease.
Intra-articular HA Deposition Disease.
Connective Tissue Disease
Scleroderma
Dermatomyositis and Polymyositis
Systemic Lupus Erythematosus
Rheumatic Fever (Jaccoud’s Arthropathy)
Mixed Connective Tissue Disease (MCTD)
Miscellaneous Joint Disease
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Haemophilic Arthropathy
Other Musculoskeletal Manifestations of Haemophilia.
Neuropathic Arthropathy
Synovial (Osteo)-Chondromatosis
Pigmented Villonodular Synovitis (PVNS)
Lipoma Arborescens
Amyloid
Sarcoid
Hypertrophic Pulmonary Osteoarthropathy (HPOA)
Multicentric Reticulohistiocytosis
Haemochromatosis
Further Reading
Online-only References
Chapter 52 Appendicular and Pelvic Trauma
Chapter Outline
General Considerations
Describing Fracture Types
The Shoulder
The Acromio-Clavicular Joint
The Elbow
Children
Adults
The Wrist
Radius and Ulna
Children
Adults
Carpal Injuries
Injuries of the Metacarpals and Phalanges
Pelvic and Acetabular Fractures
Introduction
Pelvic Ring Fractures
Anatomy
Classification
Anterior Compression Injuries.
Lateral Compression (LC) Injury.
Vertical Shear.
Complex Injuries.
Acetabular Fractures
Anatomy
Classification
Elemetary Patterns
Anterior Wall Fractures.
Posterior Wall Fractures.
Anterior and Posterior Column Fractures.
Transverse Fractures.
Complex Fractures.
Avulsion Injuries
Insufficiency and Stress Fractures
Pathological Fractures
The Hip
The Knee
The Ankle
Foot Injuries
Further Reading
Online-only References
Chapter 53 Bone, Joint and Spinal Infection
Chapter Outline
Introduction
Epidemiology
Classification
Paediatric Musculoskeletal Infections
Pathophysiology
Clinical Features
Investigations and Management
Plain Radiographs
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine
Chronic Recurrent Multifocal Osteomyelitis (CRMO)
SAPHO Syndrome
Sclerosing Osteomyelitis of Garré
Necrotising Fasciitis
Adult Musculoskeletal Infections
Pathogenesis
Clinical Features
Investigations and Management
Plain Radiographs
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine
Osteomyelitis Secondary to Prosthetic Devices
Diabetic Foot
Plain Radiography
Magnetic Resonance Imaging
Septic Arthritis
Musculoskeletal Tuberculosis
Pathogenesis
Investigations (Table 53-2)
Plain Radiography
Computed Tomography
Magnetic Resonance Imaging
Unusual Musculoskeletal Infections
Atypical Mycobacterial Musculoskeletal Infections
Hydatid Disease
Bone Infections in Sickle Cell Disease
Musculoskeletal Fungal Infections
Musculoskeletal Infections in HIV Patients
Differential Diagnosis
Management
Spinal Infection
Vertebral Osteomyelitis
Pyogenic Vertebral Osteomyelitis
Symptoms
Investigations
Plain Radiographs.
Computed Tomography.
Magnetic Resonance Imaging.
Nuclear Medicine.
Treatment
Tuberculous Vertebral Osteomyelitis
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Unusual Spine Infections
Further Reading
Online-only References
Chapter 54 Imaging Techniques and Anatomy
Chapter Outline
Anatomy
Osseous Elements
Vertebral Body
Neural Arch
Spinous and Transverse Processes
Joints
Facet Joints
Intervertebral Disc—Symphysis
Ligaments
Longitudinal Ligaments
Ligamentum Flavum
Interconnecting Ligaments
Neural Structures—Spinal Cord, Spinal Nerves, Dura Mater
Vascular Structures
Craniocervical Junction
Imaging Techniques
Plain Radiography
Myelography
Spinal Angiography
Computed Tomography
Magnetic Resonance Imaging
Spin-Echo T1-Weighted Imaging
Contrast-Enhanced T1-Weighted Imaging
Spin-Echo and Fast Spin-Echo T2-Weighted Imaging
Gradient-Echo Imaging
Short Tau Inversion Recovery
Diffusion-Weighted Imaging
Fluid-Attenuated Inversion Recovery
Three-Dimensional (3D) Imaging
Artefacts
Susceptibility Artefacts
Motion Artefacts
Truncation Artefacts
Cerebrospinal Fluid Pulsation Artefacts
Further Reading
Online-only References
Chapter 55 Degenerative Disease of the Spine
Chapter Outline
Introduction
Degenerative Disc Disease
Nomenclature and Classification
Age-related Changes in the Intervertebral Disc
Degenerative Disc Disease
Annular Tears
Disc Heriation
Spontaneous Regression of Disc Herniation
Vertebral Endplates and Bone Marrow Changes
Pathology of the Posterior Elements
Osteoarthritis of the Facet Joints
Associated Soft-Tissue Changes
Degenerative Cysts Arising from the Facet Joints
Cysts of the Ligamentum Flavum
Ligamentum Flavum Hypertrophy
Degenerative Changes of the Neural Arch
Neural Arch Intervertebral Neoarthrosis
Spinous Process Abnormalities and Associated Ligamentous Changes
Degenerative Spondylolisthesis
Degenerative Spinal Stenosis
Degenerative Spinal Canal Stenosis
Degenerative Foraminal Stenosis
Further Reading
Online-only References
Chapter 56 Spinal Tumours
Chapter Outline
Radiological Investigations in Spinal Tumours
Plain Film Radiography
Computed Tomography
Magnetic Resonance Imaging
Diffusion-Weighted Imaging
Bone Scintigraphy
Positron Emission Tomography
Classification of Spinal Tumours
Intramedullary Tumours
Ependymoma
Myxopapillary Ependymoma
Astrocytoma
Haemangioblastoma
Ganglioglioma
Less Frequent Intramedullary Tumours
Metastasis.
Spinal Cord Tumour Mimics
Cavernous Malformation (Cavernoma).
Intradural Extramedullary Tumours
Nerve Sheath Tumours: Schwannoma and Neurofibroma
Meningioma
Metastases
Less-Frequent Extramedullary Tumours
Intradural Extramedullary Tumour Mimics
Extradural Tumours
Metastatic Spine Disease
Primary Vertebral Tumours
Benign Primary Vertebral Tumours
Vertebral Haemangioma
Osteoid Osteoma/Osteoblastoma
Osteoblastoma
Aneurysmal Bone Cyst
Eosinophilic Granuloma
Benign Notochordal Cell Tumours
Locally Aggressive Primary Vertebral Tumours
Chordoma.
Giant Cell Tumours.
Primary Malignant Vertebral Tumours
Multiple Myeloma and Plasmacytoma
Chondrosarcoma
Ewing’s Sarcoma
Osteosarcoma
Further Reading
Online-only References
Chapter 57 Non-tumoural Spinal Cord Lesions
Chapter Outline
Inflammatory Disease
Multiple Sclerosis
Acute Disseminated Encephalomyelitis
Acute Transverse Myelitis
Neuromyelitis Optica
Systemic Lupus Erythematosus
Sarcoidosis
Demyelinating Polyneuropathies
Guillain–Barré Syndrome
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Vascular Diseases
Spinal Dural Arteriovenous Fistula (SDAVF)
Spinal Arteriovenous Malformations (SAVMs)
Spinal Cord Cavernous Malformation (SCCM)
Spinal Cord Infarction
Spinal Cord Vasculitis
Spinal Cord Infection
Developmental and Cyst-Like Lesions
Intramedullary Lipoma
Lipomyelomeningodysplasias
Diastematomyelia
Neuroenteric and Other Developmental Cysts
Chiari Malformations
Chiari Type I Lesion (Cerebellar Ectopia)
Chiari Type II Malformations
Meningoceles
Anterior Sacral Meningocele
Lateral Thoracic Meningocele
Anterior Thoracic Meningocele with Ventral Herniation of Spinal Cord
Intraspinal Arachnoid Cyst
Syringomyelia
Neurodegenerative and Metabolic Diseases
Motor Neuron Disease (MND)
Spinal Muscular Atrophy (SMA)
Spinocerebellar Ataxia
Friedreich’s Ataxia (FRDA)
Subacute Combined Degeneration of the Spinal Cord (SCD)
Further Reading
Online-only References
Chapter 58 Postoperative Spine
Chapter Outline
Introduction
Principles of Spinal Surgery
Imaging Techniques in Postoperative Spine
Intraoperative and Perioperative Complications
Early Complications
Late Complications
Failed Back Surgery Syndrome
Image-Guided Percutaneous Cement Bone Augmentation
Further Reading
Online-only References
Chapter 59 Spinal Trauma
Chapter Outline
Clinical Aspects
Imaging Techniques and Evaluation
Cervical Spine
Conventional Radiographs
CT
MRI
Thoracolumbar Spine
Conventional Radiographs
CT
Specific Injury Patterns
Cervical Spine
Atlanto-Occipital Dissociation
C1 Injuries
Rotatory Subluxation
Jefferson Fracture
C2 Injuries
Odontoid Fractures
Hangman’s Fracture
Hyperflexion Injuries
Hyperflexion Rotation Injury
Hyperextension Injuries
Thoracic and Lumbar Spine
Classification Systems
Flexion Compression and Flexion Distraction Injuries
Burst Fractures
Fracture Dislocation
The Rigid Spine
Neurological Injury
Spinal Cord
Brachial Plexus Injury
Further Reading
Online-only References
Chapter 60 Overview of Anatomy, Pathology and Techniques; Aspects Related to Trauma
Chapter Outline
Overview of Anatomy, Pathology and Techniques
Anatomy of the Brain and Vascular System
Embryology
Cerebral Cortex, Lobar Anatomy and Deep Grey Matter Structures
White Matter Centre
Limbic System, Hypothalamus and Pituitary Gland
Ventricular System and Subarachnoid Space
Cerebellum
Brainstem
Cerebral Vasculature
Anterior Circulation
Posterior Circulation
External Carotid Artery
Anastomotic Pathways
Intracranial Veins
Techniques for Imaging the Brain and Cerebral Vasculature
Computed Tomography
Indications, Risks and Benefits
Technique and Protocols
Viewing the Images
Magnetic Resonance Imaging
Indications, Risks and Benefits
Technique and Protocols
Diffusion-Weighted Imaging
MR Perfusion Imaging
Magnetic Resonance Spectroscopy
Functional MRI
Nuclear Medicine
Single-Photon Emission Computed Tomography
Positron Emission Tomography
Vascular Imaging Techniques
Conventional Catheter Digital Subtraction Angiography
Computed Tomography Angiography (CTA)
Magnetic Resonance Angiography
Trauma to the Skull and Brain
Head Injury
Skull Fractures
Traumatic Haemorrhage
Extradural Haemorrhage
Subdural Haemorrhage
Primary Cerebral Damage in Closed Head Injury
Superficial Primary Cerebral Damage
Deep Primary Cerebral Damage
Primary Brainstem Injuries
Other Types of Intracranial Haemorrhage after Closed Head Injury
Subarachnoid Haemorrhage
Intraventricular Haemorrhage
Isolated Large Intracerebral Haemorrhage
Secondary Cerebral Damage with Closed Head Injury
Other Complications with Closed Head Injuries
Penetrating Head Injuries
Further Reading
Online-only References
Chapter 61 Benign and Malignant Intracranial Tumours in Adults
Chapter Outline
Radiological Investigations in Intracranial Tumours
Computed Tomography
Magnetic Resonance Imaging
Structural MRI
Advanced Physiological and Molecular Imaging Methods
MR Perfusion Imaging
MR Diffusion Imaging
MR Spectroscopy
fMRI
Positron-Emission Tomography (PET)
Classification of Intracranial Tumours
Intra-Axial Tumours
Neuroepithelial Tumours
Gliomas
Astrocytic Tumours
The Role of Advanced Physiological MR Imaging in Glial Tumours
Tumours of Predominantly Neuronal Cell Origin
Gangliogliomas and Gangliocytomas
Pineal Region Tumours
Embryonal Neuroepithelial Neoplasms
Lymphomas
Metastases
Intraventricular Tumours
Ependymoma
Central Neurocytoma
Choroid Plexus Tumours
Colloid Cyst
Meningioma
Extra-Axial Tumours
Meningiomas
Cranial Nerve Sheath Tumours
Epidermoid and Dermoid Tumours
Meningeal Metastases
Skull Base Tumours
Chordomas
Glomus Jugulare Tumours
Pituitary Region Tumours
Pituitary Adenomas
Craniopharyngiomas
Rathke’s Cleft Cysts
Other Sellar Region Tumours
Further Reading
Online-only References
Chapter 62 Neurovascular Diseases
Chapter Outline
Stroke
Pathophysiology
The Penumbra Model
Stroke Classification
Causes
Large Vessel Thromboembolic Stroke (40%)
Cardioembolic Stroke (15–30%)
Small Vessel or Lacunar Stroke (15–30%)
Borderzone Infarction
Global Hypoxic–Ischaemic Injury
Imaging Strategies and Goals in Acute Stroke
Standard Imaging
Objectives of NECT in Acute Stroke
Hyperacute Infarct Imaging Signs
ASPECTS Infarct Size Scoring System
Advanced Imaging
Objectives of Penumbral Imaging
Perfusion Imaging.
Angiographic Imaging.
Assessment of Collateral Flow.
Additional Advanced Imaging Techniques.
CT or MRI?
Subacute and Chronic Infarct Imaging Signs
Atheromatous Extracranial Vascular Disease
Imaging Options for Carotid Stenosis
Vessel Plaque Imaging.
Imaging Signs
Non-Atheromatous Extracranial Vascular Narrowing
Arterial Dissection
Fibromuscular Dysplasia (FMD)
Intracranial Vascular Disease
Ischaemic Microangiopathy
Moya Moya
Vasculitis
Cerebral Venous Thrombosis (CVT)
Non-Traumatic Intracranial Haemorrhage
Subarachnoid Haemorrhage (SAH)
Initial Investigation of Acute SAH
Aneurysmal SAH
Angiography in Acute SAH
Imaging of Incidental Intracranial Aneurysms
Intracerebral Haemorrhage
Appearance on CT and MRI
Angiography in Intracerebral Haemorrhage
Arteriovenous Malformations
Subdural and Extradural Haemorrhage
Further Reading
Online-only References
Chapter 63 Intracranial Infections
Chapter Outline
Bacterial Infections
Bacterial Meningitis
Cerebritis and Brain Abscess
Epidural Abscess and Subdural Empyema
Ventriculitis
Tuberculosis
Neurosyphilis
Fungal Infections
Viral Infections
Herpes Simplex Encephalitis
Other Viral Encephalitides
Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
HIV Encephalopathy
HIV and Vascular Disease
Progressive Multifocal Leukoencephalopathy
Immune Reconstitution Inflammatory Syndrome (IRIS)
ParasItic Infections
Toxoplasmosis
Cysticercosis
Echinococcus (Hydatid Disease)
Malaria
Further Reading
Online-only References
Chapter 64 Inflammatory and Metabolic Disease
Chapter Outline
Idiopathic Inflammatory-Demyelinating Disorders of the Central Nervous System
Multiple Sclerosis
MR Imaging
Brain.
Multiple Sclerosis Variants
Marburg’s Disease
Schilder’s Disease
Baló’s Concentric Sclerosis
Tumefactive or Pseudotumoural IIDDs
Devic’s Neuromyelitis Optica
Acute Disseminated Encephalomyelitis
Acute Disseminated Encephalomyelitis Variants
Bickerstaff’s Encephalitis.
Acute Disseminated Necrohaemorrhagic Leucoencephalitis.
Primary and Secondary Vasculitis
Central Nervous System Vasculitis
Primary Central Nervous System Vasculitis
Secondary Central Nervous System Vasculitis
Primary Systemic Vasculitis with Central Nervous System Involvement
Giant Cell Arteritis.
Takayasu’s Arteritis.
Kawasaki’s Disease.
Wegener’s Granulomatosis.
Polyathritis Nodosa.
Neurosarcoidosis
Behçet’s Disease
Systemic Lupus Erythematosus
Metabolic and Toxic Disorders in the Adult
Ethanol Intoxication
Marchiafava–Bignami Disease
Wernicke’s Encephalopathy
Subacute Combined Degeneration
Osmotic Myelinolysis
Methanol Poisoning
Diethylene Glycol
Hepatic Encephalopathy
Carbon Monoxide
Heavy Metal Poisoning
Organic Solvent Poisoning
Cocaine
Ecstasy
Opioids and Derivatives
Excytotoxic Oedema
Further Reading
Online-only References
Chapter 65 Neurodegenerative Diseases and Epilepsy
Chapter Outline
Ageing and Dementia—Introduction and Clinical
Normal Ageing Phenomena in the Brain
Dementia—Imaging Approach
Indications for Imaging
Protocol for CT and MRI
Alzheimer’s Disease and Other Primary Neurodegenerative Dementias
Alheimer’s Disease
Frontotemporal Lobar Degeneration
Vascular Dementia
Large-Vessel VaD
Small-Vessel VaD
CADASIL, Fabry’s Disease and CAA
Systemic Causes of VaD
Differential Diagnosis of WM Disorders in Dementia
Rapidly Progressive and Other Atypical Dementias
Infectious and Inflammatory Disease
HIV and PML
Prion Disease
Autoimmune Limbic Encephalitis
Toxic/Metabolic Disorders
Parkinson’s Disease and Related Disorders
Idiopathic Parkinson’s Disease and Differential Diagnosis
Dementia with Parkinsonism
Neurodegeneration and Other Movement Disorders
Epilepsy—Introduction and Clinical
Classification of Seizures
Epilepsy—Imaging Approach
Indications for Imaging
Imaging Protocol
Epilepsy—Congenital Disorders
Migration and Gyration Disorders
Genetic Syndromes
Epilepsy—Acquired Diseases
Hippocampal Sclerosis
Neoplasms
Post-Traumatic Epilepsy
Infections
Online-only References
Chapter 66 Orbit
Chapter Outline
The Orbit
Introduction
Orbital Anatomy
Imaging of the Orbit
Orbital Pathology
Congenital Disease
Coats’ Disease
Persistent Hypertrophic Primary Vitreous (PHPV)
Retinopathy of Prematurity
Coloboma
Dermoid
Disorders of Globe Size or Shape
Degenerative Disease
Drusen
Orbital Inflammatory Disease
Idiopathic Orbital Inflammation
Thyroid Orbitopathy
Systemic Inflammatory Diseases with Orbital Involvement
Orbital Infection
Benign Neoplasms and Mass-Like Lesions
Pleomorphic Adenoma
Nerve Sheath Tumour
Optic Nerve Glioma
Optic Nerve Sheath Meningioma
Vascular Lesions of the Orbit
Cavernous Haemangioma
Capillary Haemangioma
Venous Varix
Venous Lymphatic Malformation
Arteriovenous Malformations (AVMs)
Carotid-Cavernous Fistula
Malignant Neoplasms
Uveal Melanoma
Metastatic Disease
Lymphoproliferative Malignancy
Adenoid Cystic Carcinoma
Paediatric Neoplasms
Retinoblastoma
Rhabdomyosarcoma
Medulloepithelioma
Ischaemia
Orbital Trauma
The Retro-Orbital Visual Pathway
Introduction
Anatomy
Pathologies of the Anterior Visual Pathway (Optic Nerves, Chiasm and Optic Tracts)
Congenital
Intrinsic Tumours
Inflammatory/Demyelinating Lesions
Extrinsic Compression
Pathologies of the Posterior Visual Pathway (Lateral Geniculate Nucleus, Optic Radiation and Visual Cortex)
Other Neuro-Ophthalmological Conditions
Idiopathic Intracranial Hypertension
Recurrent Ophthalmoplegic Cranial Neuropathy
Further Reading
Online-only References
Chapter 67 ENT, Neck and Dental Radiology
Chapter Outline
Introduction
The Ear, Paranasal Sinuses And Nasal Cavity
The Auricle and External Auditory Canal
Anatomy
Pathology
Chronic Stenosing Otitis Externa
Exostoses and Osteoma of the External Auditory Canal
Keratosis Obturans
External Auditory Canal Cholesteatoma
Necrotising Otitis Externa (NOE)
Squamous Cell Carcinoma of the Auricle and External Auditory Canal
Congenital Atresia/Stenosis of the External Auditory Canal
The Middle Ear
Anatomy and Physiology
Pathology
Cholesteatoma
Tympanosclerosis
Otosclerosis
Fenestral.
Retrofenestral or Cochlear.
Ossicular Disruption
Venous Sinus Thrombosis
Intracranial Complications
The Inner Ear
Anatomy and Physiology
Pathology
Vestibular Schwannoma
Trauma
Congenital Malformations
Facial Palsy
Glomus Tumours (Paragangliomas)
Cochlear Electrode Implantation
The Paranasal Sinuses and Nasal Cavity
Anatomy and Physiology
Radiology and Pathology
Rhinosinusitis
Nasal Polyposis
Antrochoanal Polyp
Mucocoeles
Epistaxis
Nasal and Paranasal Sinus Tumours
Osteoma
Inverted Papilloma
Juvenile Angiofibroma
Sinonasal Malignancy
The Neck
The Suprahyoid Neck
Anatomy
The Parapharyngeal Space
The Parotid Space
Anatomy and Radiology.
The Retropharyngeal and Danger Spaces (RPS and DS)
Anatomy.
Pathology.
The Masticator Space
The Carotid Space
Anatomy.
Pathology
Carotid Artery Dissection.
Carotid and Vagal Paragangliomas.
Schwannoma.
The Pharyngeal Mucosal Space (PMS)
Anatomy.
Nasopharynx
Anatomy.
Radiology and Pathology
Nasopharyngeal Malignancy.
Oropharynx
Anatomy.
Radiology and Pathology.
Perivertebral Space (PVS)
The Infrahyoid Neck
Anatomy
Hypopharynx
Anatomy.
Radiology and Pathology.
Larynx
Anatomy and Physiology.
Radiology and Pathology
Laryngeal Malignancy.
Laryngeal SCC.
Chondrosarcoma.
Adenoid Cystic Carcinoma.
Laryngocoele.
Thyroid and Parathyroid
Anatomy.
Radiology
Ultrasound.
Nuclear Medicine.
MRI and CT.
Thyroid Pathology
Thyroiditis.
Thyroid Malignancy.
Parathyroid Pathology.
Recurrent Laryngeal Nerve.
Cervical Lymph Nodes
Radiology and Pathology.
Dental and Maxillofacial
Disorders of Bone
Developmental Disorders
Fibro-Osseous Lesions
Inflammatory Disorders
Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ)
Metabolic, Endocrine and Haematological Disorders of Bone
Tumours of Bone
Fractures of the Facial Skeleton
Fractures of the Zygomatic Complex
Orbital Blow-Out Fractures
Radiological Investigation of Maxillary Fractures
Fractures of the Mandible
Temporomandibular Joint Disoders
Developmental Abnormalities
Temporomandibular Joint Dysfunction
Arthritides
Injury
Salivary Gland Disorders
Anatomy
Radiological Techniques and Their Application
Calculi and Duct Strictures
Sialectasis
Inflammatory Conditions
Salivary Gland Tumours
Trauma
Disorders of Function
Soft Tissues
Anatomy of Teeth and Supporting Structures
Introduction
Anatomy
Tooth Eruption
Normal Eruption
Disorders of Tooth Eruption
Disorders of Tooth Development
Variation in Tooth Number
Variation in Tooth Size
Variation of Tooth Form
Disturbances in Structure of Teeth
Enamel
Dentine
Cementum
Miscellaneous Conditions
Dental Caries
Disorders of the Pulp
Periapical Periodontitis
Cysts of the Jaws
Odontogenic Cysts
Non-Odontogenic Cysts
Cyst-Like Lesions
Disease of the Periodontium
Introduction
Odontomes and Odontogenic Tumours
Imaging in Implantology
Trauma
Teeth
Further Reading
Online-only References
Chapter 68 Principles of Oncological Imaging
Chapter Outline
Introduction
Diagnosis
Primary Diagnosis
Confirmation of Diagnosis
Staging
Staging Systems
Principles of Staging Investigations
Primary Tumour Staging
Rectal Cancer
Non-Small Cell Lung Cancer
Breast Cancer
Prostate Cancer
Staging Distant Metastatic Disease
Assessment of Treatment Response
The Role of Imaging
Objective Response Assessment
Imaging Residual Masses
Imaging of Treatment Toxicity
Lung
Bone and Bone Marrow
Neurotoxicity
Hepatic Toxicity
Cardiotoxicity
Surveillance and Restaging
Surveillance of Asymptomatic Patients
Restaging of Symptomatic Patients
Conclusion
Further Reading
Online-only References
Chapter 69 The Breast
Chapter Outline
Methods of Examination
Mammography
Standard Projections
Additional Projections
Breast Compression
Radiation Dose
The Detector
Digital Mammography in Clinical Practice
Computer-Aided Detection
Digital Breast Tomosynthesis
Ultrasound
Ultrasound Technique
Normal Anatomy
Breast Pathology
Benign Mass Lesions
Cysts
Fibroadenomas and Related Conditions
Papilloma
Lipoma
Hamartoma
Invasive Carcinoma
Classification of Invasive Breast Cancer
Imaging Appearance of Invasive Breast Cancer
Mammography.
Ultrasound.
The Differential Diagnosis of Malignancy
Microcalcifications
Benign Microcalcifications
Malignant Microcalcifications
Additional Imaging Technologies
Magnetic Resonance Imaging
Technique
Lesion Characterisation
Indications for Breast MRI
Managing MRI-Detected Lesions
Controversies Surrounding the Use of Breast MRI
MRI for Imaging Breast Implants
Nuclear Medicine Techniques
Breast Cancer Screening
Introduction
The Evidence for Screening
Which Age Groups Should be Screened?
The Screening Process and Assessment
Interval Cancers
How Does Mammographic Screening Reduce Breast Cancer Mortality?
Quality Assurance (QA)
Interventional Breast Radiology
Fine-Needle Aspiration for Cytology and Needle Core Biopsy
Vacuum-Assisted Biopsy
Guidance Methods for Breast Needle Biopsy
Number of Samples
MRI-Guided Biopsy
Managing the Result of Needle Biopsy
Preoperative Localisation of Impalpable Lesions
Conclusion
Further Reading
Online-only References
Chapter 70 Reticuloendothelial Disorders: Lymphoma
Chapter Outline
Epidemiology
Age
Infectious Agents
Immunosuppression
Genetic Factors
Gender and Race
Histopathological Classification
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma
Staging, Investigation and Management
Hodgkin’s Lymphoma
Clinical Features and Staging
Prognosis and Treatment
Localised Disease (Stages IA and IIA).
Advanced Disease (Stages IIB, IIIA/B and IVA/B).
Non-Hodgkin’s Lymphoma
Clinical Features and Staging
Prognosis and Treatment
Lymph Node Disease in Lymphoma
Imaging Nodal Disease
Choice of Imaging Technique
Neck
Thorax
Abdomen and Pelvis
Extranodal Disease in Lymphoma
Thorax
Pulmonary Parenchymal Involvement
Primary Pulmonary Lymphoma
Pleural Disease
Pericardium and Heart
Thymus
Chest Wall
Breast
Hepatobiliary System and Spleen
Liver
Spleen
Gastrointestinal Tract
Stomach
Small Bowel
Colon and Rectum
Oesophagus
Pancreas
Genitourinary Tract
Kidneys
Bladder
Prostate
Testis
Female Genital Tract
Adrenal Glands
Musculoskeletal System
Bone Marrow
Bone
Central Nervous System
Primary
Secondary
Orbit
Head and Neck Lymphoma
Waldeyer’s Ring
Salivary Glands
Thyroid
Mucosa-Associated Lymphoid Tissue Lymphomas
Burkitt’s Lymphoma
LYMPHOMA in the Immunocompromised
Lymphomas Associated with HIV
Post-transplant Lymphoproliferative Disorders
Monitoring Response to Therapy
Prognostication
Response Criteria
Complete Remission (CR)
Complete Remission, Unconfirmed (CRu)
Partial Response (PR)
Stable Disease (SD)
Progressive Disease (PD)
Residual Masses
Computed Tomography
MRI
Functional Imaging
FDG-PET in Response Assessment
Surveillance and Detection of Relapse
Conclusion
Further Reading
Online-only References
Chapter 71 Bone Marrow Disorders: Haematological Neoplasms
Chapter Outline
Primary Myelofibrosis
Clinical Features
Radiological Features
Systemic Mastocytosis
Clinical Features
Radiological Features
Leukaemia
Clinical Features
Radiological Features
Lymphoma
Primary Lymphoma of Bone
Clinical Features
Radiological Features
Hodgkin’s Lymphoma
Clinical Features
Radiological Features
Non-Hodgkin’s Lymphoma
Clinical Features
Radiological Features
Burkitt’s Lymphoma
Clinical Features
Radiological Features
Plasma Cell Disorders
Plasmacytoma
Clinical Features
Radiological Features
Multiple Myeloma
Clinical Features
Radiological Features
Further Reading
Online-only References
Chapter 72 Bone Marrow Disorders: Miscellaneous
Chapter Outline
Disorders of Red Cells
The Anaemias
Chronic Haemolytic Anaemias
The Haemoglobinopathies
Thalassaemia
Clinical Features.
Radiological Features
Untreated Thalassaemia Major.
Hypertransfusion.
DFX Therapy.
Sickle-Cell Disease
Clinical Features.
Radiological Features.
Marrow Hyperplasia.
Bone Infarction.
Osteomyelitis.
Miscellaneous Disorders
Gaucher’s Disease
Radiological Features
Disorders of Blood Coagulation
Haemophilia (Haemophilia A)
Christmas Disease (Haemophilia B)
Von Willebrand’s Disease
Radiological Features
Further Reading
Online-only References
Chapter 73 Imaging for Radiotherapy Planning
Chapter Outline
Types of Radiotherapy
External Beam Radiotherapy
Conventional External Beam Radiotherapy
Three-Dimensional Conformal Radiotherapy
Intensity-Modulated Radiotherapy (IMRT)
Stereotactic Body Radiotherapy (SBRT)
Brachytherapy
Particle Therapy
The Radiotherapy Process
Radiotherapy Treatment Volume Definition
Clinical Volume Definition (Non-imaging-Based)
Conventional Simulation
CT Simulation
Image Fusion
Treatment Planning and Verification
Image Guidance during Radiotherapy Delivery
Planar (2-Dimensional) Imaging
Volumetric (3-Dimensional) Imaging
Four-Dimensional (4D) Imaging
Functional Imaging in the Radiotherapy Process
Inclusion of Biological Information to the Treatment Process
18F-Misonidazole Positron Emission Tomography
Cu-ATSM Positron Emission Tomography
Blood Oxygenation Level-Dependent Magnetic Resonance Imaging (BOLD-MRI)
Further Reading
Online-only References
Chapter 74 Functional and Molecular Imaging for Personalised Medicine in Oncology
Chapter Outline
Personalised Medicine in Oncology
Dynamic Contrast-Enhanced Computed Tomography (DCE-CT)
Contrast Agent Kinetics
Magnetic Resonance Imaging (MRI)
Dynamic Contrast-Enhanced MRI (DCE-MRI)
Diffusion-Weighted Imaging (DWI)
MR Spectroscopy (MRS)
Positron Emission Tomography (PET)
Fluorodeoxyglucose-PET (FDG-PET)
Non-FDG-PET Tracers
Emerging Molecular Imaging Techniques and Theranostics
Ultrasound
Optical Imaging
Conclusion: Role of Functional and Molecular Imaging in Oncology
Further Reading
Online-only References
Chapter 75 Challenges and Overview of Special Features and Techniques
Chapter Outline
Projection Radiography
Fluoroscopy
Computed Tomography (CT)
320-Row MDCT
Dual-Source CT
Dual-Energy Dual-Source CT
Radiation Dose Consideration
Patient Care
Dental Cone Beam CT
Magnetic Resonance Imaging (MRI)
Patient Preparation
Radiofrequency Coils
Motion Artefact Reduction
Tissue Contrast
Image Resolution
Imaging Planes
Practical Consequences
Further Reading
Online-only References
Chapter 76 The Neonatal and Paediatric Chest
Chapter Outline
The Neonatal Chest
Normal Anatomy and Artefacts
Normal Lung Development
Idiopathic Respiratory Distress Syndrome
Transient Tachypnoea of the Newborn (TTN)
Meconium Aspiration Syndrome
Neonatal Pneumonia
Air Leaks
Pleural Effusions
Surfactant Dysfunction Disorders
Lines and Tubes
The Chest in Older Children
The Chest Radiograph
Normal Variants
Cardiac or Respiratory?
The Lungs
Pulmonary Infection
Bacterial vs Viral
Features of Infection
Round Pneumonia
Necrotising/Cavitatory Pneumonia
Specific Infections
Tuberculosis
Mycoplasma pneumoniae
Late Complications of Infection
Pleural Effusion
The Acutely Wheezing Child
Asthma
Inhaled Foreign Bodies
Stridor
Congenital Chest Abnormalities
Bronchopulmonary Foregut Malformations
Congenital Thoracic Cysts
Congenital Pulmonary Airway Malformations
Congenital Diaphragmatic Hernia
Pulmonary Sequestration
Congenital Lobar Overinflation
Bronchial Atresia
Lung Agenesis-Hypoplasia Complex
Congenital Venolobar Syndrome— Scimitar Syndrome
Malignancy
Mediastinal Masses
Anterior Mediastinum.
Middle Mediastinum.
Posterior Mediastinum.
Pulmonary and Endobronchial Tumours
Chest Wall Tumours
Cystic Fibrosis
Immunodeficiency
Human Immunodeficiency Virus (HIV).
Infectious Pulmonary Complications of Immunodeficiency
Pneumocystis jiroveci (carinii) Pneumonia.
Invasive Pulmonary Aspergillosis (IPA).
Non-infectious Pulmonary Complications
Lymphoproliferative Disease (LPD) and Lymphocytic Interstitial Pneumonia (LIP).
Diffuse Alveolar Haemorrhage (DAH).
Idiopathic Pneumonia Syndrome (IPS).
Summary
Further Reading
Online-only References
Chapter 77 Paediatric Abdominal Imaging
Chapter Outline
Introduction
The Neonate
Visible Abnormalities of the Anterior Abdominal Wall
Gastroschisis
Omphalocele
Bladder Exstrophy—Epispadias—Cloacal Exstrophy Complex
Respiratory Distress and Choking
Oesophageal Atresia and Tracheo-Oesophageal Fistula
Early Post-Surgical Radiology.
Longer-Term Problems.
Non-bilious Vomiting
Obstruction of the Stomach
Enteric Duplication Cysts
Microgastria
Gastric Perforation
Bilious Vomiting
Small Bowel Malrotation and Volvulus
Management
Duodenal Atresia and Stenosis
Small Bowel Atresia and Stenosis
Abdominal Distension
Necrotising Enterocolitis (NEC)
Colon Atresia
Intra-abdominal Lymphangioma
Megacystis-Microcolon-Intestinal Hypoperistalsis (Berdon’s) Syndrome
Delayed Passage of Meconium
Hirschsprung’s Disease
Functional Immaturity of the Colon and Meconium Plug Syndrome
Meconium Ileus
Distal Ileal Atresia
Anorectal and Cloacal Malformations
The Infant and Older Child
Abdominal Pain
Acute Appendicitis
Mesenteric Lymphadenitis
Inflammatory Bowel Disease
Ultrasonography (US).
Conventional Barium Studies.
Magnetic Resonance Imaging (MRI).
Computed Tomography (CT).
Intussusception
Constipation
Intestinal Motility Disorders
Acute Dysmotility.
Chronic Motility Disorders.
Chronic Intestinal Pseudo-obstruction.
Henoch-Schönlein Purpura
Abdominal Distension
Enteric Duplication Cysts
Mesenteric Cysts
Non-bilious Vomiting
Gastro-oesophageal Reflux Disease
Organoaxial Torsion and Gastric Volvulus
Malrotation with Chronic Intestinal Obstruction or Intermittent Volvulus
Hypertrophic Pyloric Stenosis
Omphalomesenteric (Vitelline) Duct Remnants
Meckel’s Diverticulum
Gastrointestinal Malignancies
The Immunocompromised Child
Gastrointestinal Manifestations of Acquired Immune Deficiency Syndrome
Abdominal Manifestations of Cystic Fibrosis
Abdominal Trauma
Liver
Imaging Techniques
US
MRI
CT
Angiography
Imaging Anatomy
Liver Involvement in Congenital Malformation and Infections, Syndromes and Systemic Conditions
Non-obstructive Jaundice
Infection
Chronic Liver Disease
Cirrhosis
Fibrosis
Non-alcoholic Fatty Liver Disease (NAFLD)
Fibropolycystic Liver Disease
Suprahepatic Chronic Liver Disease
Portal Vein
Portosystemic Shunts
Extrahepatic Portal Vein Occlusion
Portal Hypertension
Portal Venous Gas
Preduodenal Portal Vein
Mass Lesions
Imaging Features
Hepatoblastoma (Fig. 77-47)
Vascular Neoplasms
Mesenchymal Hamartoma (Fig. 77-48)
Liver Metastases and Other Multifocal Lesions
Trauma
Transplant
Biliary System
Imaging Techniques
Imaging Anatomy
Jaundice
Biliary Atresia (Fig. 77-50)
Choledochal Malformation (Choledochal Cyst (Fig. 77-51))
Inspissated Bile
Persistent Intrahepatic Cholestasis
Sludge and Gallstones
Spontaneous Perforation of the Bile Ducts
Cholangitis
Sclerosing Cholangitis
Neoplasia
Pancreas
Imaging Techniques
Imaging Anatomy
Congenital Abnormalities and Associations
Pancreas Divisum (Fig. 77-52)
Annular Pancreas (Fig. 77-53)
Other
Systemic Disorders
Cystic Fibrosis
Other
Pancreatitis
Trauma
Congenital Hyperinsulinism
Neoplasms
Spleen
Imaging Techniques
Imaging Anatomy
Imaging Findings
Splenomegaly
Wandering Spleen
Focal Lesions
Lateralisation Disorders (Fig. 77-59)
Infarction
Trauma
Neoplasia
Further Reading
Online-only References
Chapter 78 Imaging of the Kidneys, Urinary Tract and Pelvis in Children
Chapter Outline
Overview
Imaging Techniques
Plain Radiography
Ultrasound
Standard Technique
Normal Gonadal Imaging in Girls
Normal Gonadal Imaging in Boys
Cystography
Micturating (Voiding) Cystogram (MCUG/VCUG)
Indications.
MCUG Technique.
Contrast-Enhanced Ultrasonography (ce-VUS)
Technique.
Nuclear Medicine
Direct Radio-Isotope Cystogram (DIC)
Technique.
Indirect Radio-Isotope Cystogram
Static Renal Scintigraphy; 99mTc-DMSA Scans
Dynamic Renography
Technique.
Urography (Plain Radiograph and Intravenous Urogram)
Computed Tomography
Method
Magnetic Resonance Imaging
Method
Interventional Procedures
Angiography
Antegrade Pyelogram
Nephrostomy
Retrograde Pyelogram
Renal Biopsy
Congenital Anomalies
Renal Anomalies
Renal Agenesis
Abnormal Migration and Fusion of the Kidneys
Renal Ectopia
Abnormalities of Renal Fusion
Cross Fused Renal Ectopia
Duplex Kidneys
Imaging
Anomalies of the Renal Pelvis and Ureter
Pelviureteric Junction Obstruction
Imaging
Megaureter and Hydroureter
Imaging
Bladder Anomalies
Prune-Belly Syndrome
Functional Bladder Disturbance and Neurogenic Bladder
Urethral Anomalies
Posterior Urethral Valves (PUV)
Imaging
Anterior Urethral Abnormalities
Urethral Stricture
Rectourethral Fistula
Duplication of the Urethra
Uterus and Vagina
Undescended Testis
Antenatal Diagnosis of Hydronephrosis
Prenatal Diagnosis of Renal/Urological Abnormality and Differential Diagnosis
Bilateral Renal Pelvic Dilatation
Unilateral Renal Pelvic Dilatation
Megaureter
Renal Failure
Renal Vein Thrombosis (RVT)
Urinary Tract Infection and Vesicoureteric Reflux
Clinical Setting
Imaging
Renal Abscess
Xanthogranulomatous Pyelonephritis
Renal Cystic Disease
Cystic Dysplasia
Multicystic Dysplastic Kidney (MCDK)
Simple Cysts
Localised Cystic Disease of the Kidney
Acquired Cystic Renal Disease
Genetic Cystic Disease
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Imaging
Tuberous Sclerosis
Autosomal Recessive Polycystic Kidney Disease
Juvenile Nephronophthisis/Medullary Cystic Disease
Imaging
Nephrocalcinosis
Renal Calculi
Tumours
Benign Tumours
Nephroblastomatosis
Mesoblastic Nephroma
Multilocular Cystic Nephroma (MCN)
Angiomyolipoma
Malignant Tumours
Wilms’ Tumour
Clear Cell Sarcoma of the Kidney
Rhabdoid Tumour of the Kidney
Renal Cell Carcinoma
Lymphoma and Leukaemia
Rhabdomyosarcoma
Inflammatory Diseases of the Scrotum
Scrotal Masses
Ovarian Masses
Ovarian Cysts
Ovarian Tumours
Presacral Masses
Hypertension
Trauma
Renal Transplantation
Pre-Transplantation
Post-Transplantation
Further Reading
Online-only References
Chapter 79 Skeletal Radiology in Children: Non-Traumatic and Non-Malignant
Chapter Outline
Consitutional Disorders of Bone
Nomenclature
Prevalence
Diagnosis
Prenatal Diagnosis
Imaging
Making the Diagnosis
Assessing Complications
Postoperative Imaging
Management
Genetic Counselling
Osteochondrodysplasias
Chromosomal Disorders
Trisomy 21 (Down’s Syndrome)
45XO (Turner’s Syndrome)
Localised Disorders of the Skeleton
Sprengel Deformity (Congenital Elevation of the Scapula)
Madelung Deformity
Developmental Dysplasia of the Hip
Femoral Dysplasia (Idiopathic Coxa Vara/Proximal Focal Femoral Deficiency Spectrum)
Idiopathic Coxa Vara
Proximal Focal Femoral Deficiency
Tibia Vara
Talipes
Idiopathic Avascular Necrosis of the Femoral Head (Perthes Disease)
Slipped Capital Femoral Epiphysis (SCFE)
Scoliosis
Neurocutaneous Syndromes
Neurofibromatosis
Tuberous Sclerosis
Juvenile Idiopathic Arthritis (JIA)
Juvenile Dermatomyositis
Non-Inflammatory Disorders
Haemophilia
Pigmented Villonodular Synovitis
Synovial Osteochondromatosis
Metabolic and Endocrine Disorders
Metabolic Disorders
Rickets
Renal Osteodystrophy
Vitamin D-Dependent Rickets
Vitamin D-Resistant Rickets
Tumour Rickets
Neonatal Rickets
Scurvy
Gaucher’s Disease
Endocrine Disorders
Hyperparathyroidism
Hypoparathyroidism
Pseudohypoparathyroidism and Pseudo-Pseudohypoparathyroidismm
Hypothyroidism
Toxic Disorders
Fluorosis
Lead Poisoning
Haemoglobinopathies
Sickle Cell Disease
Thalassaemia
Infection of the Bones and Joints
Osteomyelitis
Chronic Recurrent Multifocal Osteomyelitis
Infective Arthritis
Infection of the Spine (Discitis and Osteomyelitis)
Further Reading
Online-only References
Chapter 80 Paediatric Musculoskeletal Trauma and the Radiology of Non-accidental Injury and Paediatric Factures
Chapter Outline
Physeal Injuries
The Upper Limb
Shoulder/Humerus
Elbow
Forearm/Wrist/Hand
The Lower Limb
Pelvis
Acetabular, Hip and Femur
Knee
Tibia/Ankle/Foot
Tibia
Ankle
Foot
Cervical Spinal Injuries
Non-accidental injury
Clinical Presentation and the Role of the Radiologist
Injury Patterns
Shaken Baby Syndrome
General Imaging Strategies
Skeletal Injury
The Skeletal Survey
Bone Scintigraphy
Magnetic Resonance Imaging (MRI)
Ultrasound
Fracture Patterns in Accidental vs Non-Accidental Injury
Rib Fractures
Metaphyseal Injury
Long Bone Fractures
Unusual Fractures
Fracture Healing
Differential Diagnosis
Birth Trauma
Accidental Injury
Generalised Bone Disease
Brain Injuries
Pathophysiology of Skull, Brain and Spinal Canal Lesions
Imaging in NAHI
Skull Fractures
Extra-Axial Haemorrhages
Parenchymal Brain Injuries
Diffuse Hypoxic-Ischaemic Lesions
Intraspinal Lesions
Strategy and Prognosis
Abdominal and Chest Injuries
Imaging
Online-only References
Chapter 81 Bone Tumours and Neuroblastoma in Children
Chapter Outline
Bone Tumours
Malignant Bone Tumours
Osteosarcoma
Ewing’s Sarcoma Family of Tumours (ESFTs)
Bone Metastases
Rare Malignant Bone Tumours in Children
Benign Bone Tumours
Bone-Forming Tumours
Osteoid Osteoma
Osteoblastoma
Tumours of Fibrous Tissue Origin
Non-Ossifying Fibroma and Metaphyseal Fibrous Cortical Defects (Synonyms: Fibroxanthoma, Benign Fibrous Histiocytoma)
Fibrous Bone Dysplasia
Osteofibrous Bone Dysplasia
Cartilage-Forming Tumours
Osteochondroma (Exostosis)
Chondroblastoma
Vascular and Other Connective Tissue Tumours
Myofibromatosis
Gorham’s Disease
Locally Aggressive Tumours
Chondromyxoid Fibroma
Tumour-Like Lesions
Simple Bone Cyst (Synonyms: Juvenile, Solitary or Unicameral Bone Cyst)
Aneurysmal Bone Cyst
Langerhans Cell Histiocytosis (LCH)
Neuroblastoma
Imaging
Radiographs
Ultrasound
Computed Tomography and Magnetic Resonance Imaging
Radionuclide Radiology
Emerging Imaging Techniques
NB Staging
Differential Diagnosis
Further Reading
Online-only References
Chapter 82 Paediatric Neuroradiology
Chapter Outline
Normal Brain Maturation
Normal Myelination
Normal Gyral Development
Other Postnatal Maturational Changes
Brain Malformations and Developmental Abnormalities
Posterior Fossa Abnormalites
Cerebellar Hypoplasia
Dandy–Walker Malformation and Its Variants
Joubert’s Syndrome and Related Disorders (JSRD)
Other Posterior Fossa Malformations or Developmental Disorders
Rhombencephalosynapsis.
Pontine Tegmental Cap Dysplasia.
Lhermitte-Duclos or Dysplastic Cerebellar Gangliocytoma.
Chiari II Malformation
Chiari I Malformation
Supratentorial Abnormalities
Disorders of Dorsal Induction
Anencephaly.
Cephalocele.
Chiari II Malformation (Arnold–Chiari).
Disorders of Ventral Induction
Holoprosencephaly.
Malformations of Commissural and Related Structures
Agenesis of the Septum Pellucidum.
Commissural Agenesis or Dysgenesis.
Agenesis of the Corpus Callosum.
Agenesis of the Corpus Callosum with Interhemispheric Cyst.
Malformations of Cortical Development—Histogenesis, Neuronal Migration and Cortical Organisation
Polymicrogyria
Schizencephaly
Lissencephaly–Agyria–Pachygyria
Grey Matter Heterotopia
Hemimegalencephaly
Focal Cortical Dysplasia (FCD)
Neurocutaneous Syndromes
Neurofibromatosis Type 1
Tuberous Sclerosis
Sturge–Weber Syndrome
Neurofibromatosis Type 2
Other Neurocutaneous Syndromes
Spinal Malformations
Normal Development
Definitions
Open Spinal Dysraphism
Closed Spinal Dysraphism
Dorsal Dermal Sinus
Diastematomyelia
Neurenteric Cysts
Disorders of the Caudal Cell Mass/Caudal Regression Syndrome
Segmental Spinal Dysgenesis
Inborn Metabolic Brain Disorders
Craniosynostosis
Neonatal Nasal Obstruction: Nasal Cavity Stenosis/Atresia
Choanal Atresia and Pyriform Stenosis
Skeletal Dysplasias
Brain Tumours
The Children’s Cancer and Leukaemia Group (CCLG) Guidelines
Posterior Fossa Tumours
Suprasellar Tumours
Craniopharyngioma
Hypothalamic–Optic Pathway Glioma
Infundibular Tumours
Pituitary Tumours
Pineal Region Tumours
Central Nervous System Germ Cell Tumours
Primary Pineal Tumours: Pineoblastoma and Pineocytoma
Supratentorial Hemispheric Tumours
Astrocytomas
Ependymomas
Supratentorial Primitive Neuroectodermal Tumours
Desmoplastic Infantile Gangliomas
Choroid Plexus Tumours
Dysembryoplastic Neuroepithelial Tumours
Cerebrovascular Disease and Stroke
Hypoxic–Ischaemic Injury in the Developing Brain
Introduction
Encephalopathy of Premature Neonate—Patterns of Injury
Periventricular Leukomalacia
Brain Haemorrhagic Disease
Encephalopathy of Term Neonate—Patterns of Injury
Miscellaneous Acquired Toxic or Metabolic Disease
Intracranial and Intraspinal Infections
Congenital Infections (TORCH)
Meningitis
Pathophysiology
Uncomplicated Meningitis
Imaging of Complications (Table 82-4)
Tuberculous Infection
Bacterial Infection: Cerebritis and Abscess Formation
Neurocysticercosis
Viral Encephalitis
Infection in Immunocompromised Children
Spinal Infections
Brain and Cord Inflammation
Trauma
Birth Trauma
Growing Skull Fractures
Spinal Trauma
Atlanto-Axial Rotatory Fixation
Non-Accidental Head Injury
Hydrocephalus
Summary
Further Reading
Online-only References
Chapter 83 Basic Clinical Requirements of Interventional Radiology
Chapter Outline
IR
Training
Clinical Involvement
Informed Consent
IR Checklist
Coagulation
Contrast Medium Allergy
Kidney Function
Sedation and Pain Management
Benzodiazepines
Opioids
Intravenous Anaesthetics
Complications Register
The Interventional Radiology Suite
Inventory
Online-only References
Chapter 84 Angiography: Principles, Techniques and Complications
Chapter Outline
Introduction
Multidetector CT Angiography (Mdcta) Techniques
Magnetic Resonance Angiography (MRA) Techniques
Contrast Mechanisms
Unenhanced Time-of-Flight (TOF) MRA
Phase-Contrast MRA
Contrast-Enhanced MRA (CEMRA)
New Non-Contrast Techniques
Clinical Applications of CTA and MRA
Thorax
Thoracic Aorta and Great Arteries
Pulmonary Arteries
Abdomen
Abdominal Aorta and Abdominal Veins
Renal, Mesenteric and Hepatic Arteries
Carotid and Vertebral Arteries and Intracranial Arteries
Peripheral Arteries
Future Directions
Catheter Arteriography
Technique
Preparation of the Patient
Contraindications
Anaesthesia
Arterial Puncture
Retrograde Femoral Artery Puncture (Fig. 84-13)
Antegrade Femoral Artery Puncture
Selective Catheterisation
Digital Subtraction Angiography
Aftercare
Complications
Contrast Medium Reactions
Puncture Site Complications
Haemorrhage
Intramural and Perivascular Contrast Medium Injection
Catheter-Related and General Complications
Further Reading
Online-only References
Chapter 85 Aortic Intervention
Chapter Outline
Introduction
Stent-Grafts and Basic Principles of Stent-Grafting
Surveillance Imaging and Complications
Endoleak
Type 1 Endoleak (Fig. 83-3A)
Type 2 Endoleak (Figs. 85-3B and C)
Type 3 Endoleak (Fig. 85-3D)
Types 4 and 5 Endoleak
Device Migration, Dislocation, Kinking and Occlusion
Infrastructure and Staffing
Thoracic Aortic Intervention
Anatomical Considerations
Thoracic Aortic Aneurysm
Outcomes of Endovascular Repair and Comparison with Surgery
Acute Aortic Syndrome
Thoracic Aortic Dissection
Management
Complicated Type B Dissection
Chronic Dissection and Aneurysmal Development
Outcomes of Endovascular Repair and Comparison with Surgery
Acute Intramural Haematoma and Penetrating Ulcer
Traumatic Lesions of the Thoracic Aorta
Penetrating Injury to the Thoracic Aorta
Aortic Coarctation
Abdominal Aortic Aneurysm
Anatomical Considerations in AAA repair
Risks and Timing of Repair
Outcomes of Endovascular Repair and Comparison with Surgery
Endovascular Repair of Ruptured AAA
Thoraco-Abdominal Aneurysms
Aortic Stenoses and Occlusions
Summary and Conclusion
Further Reading
Online-only References
Chapter 86 Peripheral Vascular Disease Intervention
Chapter Outline
Interventional Radiology Techniques
Angioplasty
Stenting
Embolisation
Thrombolysis
Arterial System
Pelvic and Lower Extremity Arteries
Angiographic Anatomy (Fig. 86-5)
Arterial Disease Affecting the Lower Extremity
Angiographic Diagnosis
Treatment of Chronic Limb Ischaemia
Iliac Artery Disease
Stenosis.
Occlusions.
Common Femoral Artery and Profunda Femoris
Superficial Femoral Artery
Stenosis.
Occlusions.
Popliteal Artery
Calf Vessels
Treatment of Acute Lower Limb Ischaemia
Upper Extremity Arteries
Anatomy
Pathology
Endovascular Treatment
Gastrointestinal System
Angiography (Fig. 86-11)
Mesenteric Haemorrhage
Visceral Artery Aneurysms
Occlusive Mesenteric Vascular Disease
Bronchial Artery Embolisation
The Carotid Arteries
Imaging
Angiography
Endovascular Treatment of Carotid Artery Stenosis
Venous System
Lower Extremity Venous System
Upper Extremity Venous Obstruction
Inferior Vena Cava Filters
Complications of Endovascular Procedures
Further Reading
Online-only References
Chapter 87 Image-Guided Biopsy and Ablation Techniques
Chapter Outline
Image-Guided Biopsy
Introduction
Principles of Image-Guided Biopsy
Case Selection
Pre-Procedural Assessment
Core Biopsy vs Fine Needle Aspiration
Biopsy Needles
Fine Needle Aspiration Cytology Needles
Core Biopsy Needles
Menghini Technique Biopsy Needles, e.g. Surecut
Sheathed Biopsy Needles
Manual, e.g. Tru-Cut
Semi-Sutomatic, e.g. Temno, SuperCore (Fig. 87-1)
Fully Automatic, e.g. Biopty gun, Achieve, Biopince, Bard Max-Core (Fig. 87-3)
Coaxial Technique
Imaging Modalities for Biopsy
Ultrasound
CT
MRI
PET CT
Fluoroscopy
Stereotactic
Endoscopy/Endoscopic Ultrasound (EUS) and Bronchoscopy/Bronchoscopic Ultrasound
Tips and Tricks
‘Look Before you Leap’—Procedural Set Up
Avoiding Inadequate Samples
Improving Needle Tip Visualisation in Ultrasound-Guided Biopsy
Post-Procedural Care
Specimen Handling
Complications and Safety Issues
Track Seeding
Conclusion
Image-Guided Tumour Ablation
The Case for Tumour Ablation
The Principles of Tumour Ablation
Ablative Energies
Radiofrequency Ablation
Microwave Ablation
Cryoablation
Focused Ultrasound
Irreversible Electroporation
Interstitial Laser Photocoagulation
Chemical Ablation
Image Guidance
Pre-Procedural Planning
Procedural Targetting
Peri-Procedural Monitoring
Post-Procedural Imaging
Understanding and Modifying Tumour Pathophysiology
Specifics and Current Outcomes
Renal Cancer
Hepatocellular Carcinoma
Colorectal Liver Metastases
Lung Tumour Ablation
Bone Tumour Ablation
Summary
Further reading
Online-only References
Chapter 88 Image-Guided Drainage Techniques
Chapter Outline
Indications and Contraindications
Imaging Guidance
Patient Preparation and Care
Catheter Insertion
Catheter Management
Specific Drainage Techniques
Chest
Hepatic Parenchyma
Biliary System
Pancreas and Peripancreatic Region
Gallbladder
Urinary Tract
Spleen
Subphrenic Collections
Gastrointestinal Drainage
Peritoneum
Deep Pelvic Collections
Organ Traversal
Paediatric Patients
Complications
Conclusion
Further Reading
Online-only References
Chapter 89 Hepatobiliary Intervention
Chapter Outline
Introduction
Management of Biliary Obstruction
Background
Percutaneous Transhepatic Cholangiography
Biliary Drainage: External, Internal–External
Biliary Stenting: Metal, Plastic
Benign Disease
Benign Strictures
Calculous Disease
Percutaneous Biliary Intervention Complications
Vascular Interventional Techniques in the Liver
Chemoembolisation
Background
Indications
TACE Contraindications
Pre-Procedure Medication/Sedation/Analgesia
Performing the Procedure
Post-Procedure Complications
Imaging Post-Chemoembolisation
TACE Literature
Radioembolisation
Background
Patient Selection
Performing the Procedure: Planning
90Y Administration
90Y Complications
Imaging Post-Radioembolisation
Radioembolisation Results
Hepatic Arterial Embolisation for Haemorrhage
Transjugular Intrahepatic Portosystemic Shunt
Background
Imaging
Pre-Procedure Evaluation
Performing the Procedure
Post-Procedure
Complications
Portal Vein Embolisation
Background
Performing the Procedure
Hepatic Venous Interventions: Budd–Chiari Syndrome
Background
Diagnosis
Treatment
Further Reading
Online-only References
Chapter 90 Vascular Genitourinary Tract Intervention
Chapter Outline
Kidney
Renal Artery Stenosis
Background
Aetiology and Pathology
Diagnosis of RAS
Atheromatous Renovascular Disease (ARVD)
Clinical Presentation of ARVD.
Treatment of ARVD.
Renal Revascularisation Trials.
Technique for Renal Angioplasty and Stenting
Renal Angioplasty.
Renal Stenting.
Fibromuscular Disease.
Takayasu Arteritis.
Neurofibromatosis.
Williams Syndrome.
Renal Denervation (RDN)
Background
History of Sympathectomy
Pathophysiology
Technique
Indications
Results
Renal Tumours
Benign
Malignant
Renal Arteriovenous Malformation (AVM)
Renal Artery Aneurysms
Technique
Trauma Embolisation
Kidney
Ureter
Bladder
Prostatic Artery Embolisation
Fibroid Embolisation
Uterine Artery Embolisation (UAE)
Treatment Options
Imaging
Technique
Safety and Efficacy
Obstetric Haemorrhage
Post Partum Haemorrhage
Causes of PPH
Management of PPH
Technique
Abnormal Placentation
Management of Abnormal Placentation.
Complications of Embolisation and Balloon Occlusion
Results of Haemorrhage Control for PPH
Ectopic Pregnancy and Spontaneous Abortion
Pelvic Congestion Syndrome
Treatment
Varicocoele
Treatment
Further Reading
Online-only References
Chapter 91 Non-vascular Genitourinary Tract Intervention
Chapter Outline
Introduction
Percutaneous Renal Access—Important Anatomical Factors
Renal Position
Relations of the Kidney
Pelvicalyceal Anatomy of the Kidney
Renal Vascular Anatomy
Other Anatomical Factors Important for Renal Access
Renal Anatomy and Percutaneous Entry
General Equipment for Renal Access
Access Needle
Guidewires
Catheters
Percutaneous Nephrostomy (PCN)
Techniques
Patient Preparation and Procedure
Single Puncture Ultrasound-Guided PCN
Single Puncture Fluoroscopically Guided PCN
Double Puncture Combined Ultrasound and Fluoroscopy-Guided PCN
CT-Guided Nephrostomy
Catheter Fixation and Removal
Difficult or Complicated Nephrostomy
Non-dilated Kidneys
Horseshoe Kidney
Transplant Kidney
Paediatric Nephrostomy
Pregnancy
Complications of PCN and Management
Percutaneous Nephrolithotomy (PCNL)
Technique of PCNL
Tract Planning
Tract Dilatation
Complications of PCNL and Management
Antegrade Ureteric Stents
Indications for Ureteric Stents
Ureteric Stents versus Percutaneous Nephrostomy
Types of Ureteric Stents
Plastic Stents
Metal Stents
Pathological and Functional Changes after Stenting
Clinical Efficacy of Current Stents
Practical Aspects of Antegrade Stenting
Technique of Antegrade Stenting
Stent Lumen Size
Stent Length
Type of Stent
Insertion of a Plastic Stent
Insertion of a Metal Ureteric Stent
Further Issues about Ureteric Stents
Retroperitoneal Looping of Stent/Wire
False Passage Created during Stricture Cannulation
Stenting of Ureteroileal or Ureterocolic Anastomosis
Tortuous Ureter
Tight or Rigid Stricture
A Stent Cannot Be Advanced across the Stricture, Even after Dilatation
Improvement in Stent Position
The Thread Loops Will Not Disengage
Extra-anatomical Stenting
Monitoring Ureteric Stents
Exchanging or Removing Stents
Balloon Dilatation of Ureteric Strictures
Treatment of Urinary Leaks and Fistulas
Suprapubic Bladder Catherisation
Managing a Non-Deflatable Urinary Catheter Balloon
Percutaneous Cystolithotripsy (PCCL)
Interventional Procedures in the Prostate Gland and Seminal Vesicles
Drainage of Prostate and Perirectal Abscess
Seminal Vesiculography and Cyst Sampling
Prostate Brachytherapy, Cryotherapy and HIFU Prostate Ablation
Ablation of Renal Cysts or Lymphoceles
Further Reading
Online-only References
Chapter 92 Venous Access and Interventions
Chapter Outline
General Assessment of Patients before Vascular Access Procedures
General Patient and Interventional Suite Preparation for Central Venous Access
Insertion of Tunnelled Central Venous Catheter
Hickman Line
Groshong Catheter
Port-a-Cath Placement
Peripherally Inserted Central Catheters
Catheter Maintenance
Catheter Repositioning
Tunnelled Dialysis Catheters
Dialysis Catheter Maintenance
Further Reading
Online-only References
Chapter 93 Spinal Interventions
Chapter Outline
Introduction
Image-Guided Vertebral Biopsy
Patient Preparation
Image Guidance
Performing the Procedure
Results
Spinal Injection Procedures
Lumbar Disc Herniation
Indications
Technique
Complications
Pulsed Radiofrequency Ablation
Facet Joint Syndrome
Technique
Cervical Spine
Percutaneous Disc Decompression
Technique
Percutaneous Vertebral Augmentation
Ablation of Spinal Tumours
Complications
Osteoid Osteomas
Embolisation of Spinal Tumours
Further Reading