Cover
Primer of Diagnostic Imaging, 5e
Title Page
Copyright 9780323065382
Dedication
Preface
Preface to the First Edition
Preface to the Second Edition
Preface to the Third Edition
Preface to the Fourth Edition
Reviewers
Abbreviations
1. Chest Imaging
Imaging Anatomy
Gross Lung Anatomy
Segmental anatomy ( Figs. 1-1 & 1-2)
Right Lung
Left Lung
Segmental CT anatomy ( Fig. 1-3)
Bronchial CT anatomy ( Fig. 1-4)
Plain film anatomic landmarks ( Figs. 1-5 through 1-9)
Lines
Paratracheal Stripe
Fissures
Upper Lobe Bronchi ( Figs. 1-10 & 1-11)
Parenchymal Anatomy
Acinus
Secondary pulmonary lobule
Epithelium
High-resolution computed tomography (HRCT) ( Fig. 1-12)
Technique
HRCT Anatomy
Pulmonary Function ( Fig. 1-13)
Lung volumes, capacities & flow rates
Mediastinum ( Fig. 1-14)
Imaging Protocols
Standard chest CT protocol
Pulmonary embolism CT protocol
Diagnostic radiology report (ACR)
Infection
General
Pathogens
Acquisition of pneumonia
Risk factors
Radiographic spectrum of pulmonary infections
Complications of Pneumonia
Resolution of pneumonia
Bacterial Infections
General
Common Pathogens
Clinical Findings
Streptococcal pneumonia
Radiographic Features
Staphylococcal pneumonia ( Fig. 1-15)
Radiographic Features
Pseudomonas pneumonia
Typical Clinical Setting
Radiographic Features
Legionnaires' disease
Radiographic Features
Haemophilus pneumonia
Radiographic Features
Mycoplasma pneumonia
Radiographic Features
Complications
Klebsiella (friedländer) pneumonia
Radiographic Features
Tuberculosis (TB) ( Fig. 1-16)
Primary Infection ( Fig. 1-17)
Secondary Infection ( Fig. 1-18)
Radiographic Features
Complications ( Fig. 1-19)
Nontuberculous mycobacterial (NTMB) infections
Radiographic Features
Nocardia pneumonia
Radiographic Features
Actinomycosis
Radiographic Features
Pulmonary abscess
Predisposing Conditions
Treatment
Sickle cell anemia
Viral Pneumonia
General
Classification
Occurrence
Spectrum of Disease
Influenza pneumonia
Radiographic Features
Varicella zoster pneumonia
Radiographic Features
CMV pneumonia
Radiographic Features
Swine-origin influenza a (H1N1) virus (S-OIV) infection
Fungal Infections
General
Radiographic Features
Histoplasmosis ( Fig. 1-20)
Clinical Findings
Radiographic Features
Mediastinal Histoplasmosis
Coccidioidomycosis ( Fig. 1-21)
Clinical Findings
Radiographic Features
North american blastomycosis ( Fig. 1-22)
Aspergillosis ( Fig. 1-23)
Allergic bronchopulmonary aspergillosis (ABPA)
Clinical Findings
Radiographic Features
Aspergilloma (mycetoma, fungus ball)
Radiographic Features
Invasive aspergillosis
Radiographic Features ( Fig. 1-25)
Semi-invasive aspergillosis
Radiographic Features
Cryptococcosis
Clinical Findings
Radiographic Features
Candidiasis
Clinical Findings
Radiographic Features
Zygomycoses
Radiographic Features
Aids
General
Epidemiology
Clinical findings
Opportunistic Infections
Chest
General
Spectrum of chest manifestations ( Fig. 1-27)
PCP infection ( Figs. 1-28 through 1-30)
Radiographic Features
Mycobacterial infection
Radiographic Features
Fungal infections
Kaposi sarcoma ( Fig. 1-31)
AIDS-related lymphoma
Neoplasm
General
Location
Classification of pulmonary neoplasm
Percutaneovus biopsy
Technique
Complications
Bronchogenic Carcinoma
Classification
Risk factors for bronchogenic carcinoma
Radiographic spectrum
Primary Signs of Malignancy ( Fig. 1-32)
Secondary Signs of Malignancy ( Fig. 1-33)
Paraneoplastic syndromes of lung cancer
Radiation pneumonitis
Radiographic Features
Tumor Staging ( Fig. 1-34)
TNM staging system, 7th edition (non–small cell lung cancer)
Unresectable Stages
5-Year Survival
Small cell cancer staging
Lymph node imaging
Anatomy ( Fig. 1-35)
American Thoracic Society Classification ( Fig. 1-36)
CT Criterion for Abnormal Nodes
Chest wall invasion
Radiographic Features ( Fig. 1-37)
Mediastinal invasion
Radiographic Features
Malignant pleural effusion
Pathogenesis of Malignant Effusions
Central bronchial involvement
Metastases to other organs
Specific Lung Tumors
Adenocarcinoma
Bronchioloalveolar carcinoma
Squamous cell carcinoma (SCC)
Pancoast tumor (superior sulcus tumor)
Clinical Findings
Radiographic Features ( Fig. 1-38)
Small cell carcinoma (neuroendocrine tumor, type 3)
Large cell carcinoma
Carcinoid (neuroendocrine tumor, types 1 & 2)
Types
Radiographic Features
Hamartoma ( Fig. 1-39)
Radiographic Features
Carney triad
Predominant in Young Women
Tracheobronchial papillomatosis
Radiographic Features
Pulmonary blastoma
Predominant in Males, Poor Prognosis
Radiographic Features
Lung Metastases from Other Primary Lesions
General
Radiographic Features
Calcified metastases
Giant metastases (“cannon ball” metastases) in asymptomatic patient
Sterile metastases
Chronic Lung Disease
Idiopathic Diseases
Usual interstitial pneumonia (UIP)
Clinical Findings
Pathology
Radiographic Features ( Figs. 1-40 & 1-41)
Sarcoid
Clinical Findings
Prognosis
Associations
Diagnosis
Radiographic Features ( Figs. 1-42 & 1-43)
CT Features
67 Ga Scintigraphic Findings
Nonspecific interstitial pneumonia (NSIP)
Pathology
HRCT Features
Respiratory bronchiolitis-associated interstitial pneumonia (RB-ILD)
Pathology
HRCT Features
Desquamative interstitial pneumonia (DIP)
Pathology
HRCT Features
Cryptogenic organizing pneumonia (COP)
Pathology
HRCT Features
Lymphoid interstitial pneumonia (LIP)
Pathology
HRCT Features
Acute interstitial pneumonia (AIP)
Pathology
HRCT Features
Types
Lymphoproliferative Disorders
Plasma cell granuloma
Radiographic Features ( Fig. 1-44)
Lymphangioleiomyomatosis (LAM)
Clinical Findings
Radiographic Features
Tuberous sclerosis
Pearls
Collagen Vascular Diseases
Rheumatoid arthritis (RA)
Radiographic Features
Ankylosing spondylitis (AS)
Systemic lupus erythematosus (SLE)
Other collagen vascular diseases with pulmonary manifestations
Vasculitis & Granulomatoses
Clinicoradiologic features suggestive of vasculitis
Wegener granulomatosis
Radiographic Features ( Fig. 1-46)
Lymphomatoid granulomatosis
Churg-strauss—allergic angiitis & granulomatosis
Radiographic Features
Behçet disease
Radiographic Features
Other Chronic Disorders
Langerhans cell histiocytosis (eosinophilic granuloma)
Idiopathic pulmonary hemorrhage (IPH)
Radiographic Features
Amyloid
Classification
Radiographic Features
Neurofibromatosis
Pulmonary alveolar microlithiasis
Radiographic Features
Alveolar proteinosis
Radiographic Features
Drug-induced lung disease
Inhalational Lung Disease
Pneumoconiosis
Types
International labor organization (ILO) classification ( Fig. 1-47)
Silicosis
Pathology
Clinical Findings ( Fig. 1-48)
Radiographic Features
Coal workers' pneumoconiosis (CWP)
Radiographic Features
Asbestos
Asbestos-related pleural disease
Focal Pleural Plaques
Diffuse Pleural Thickening
Pleural Calcifications
Benign Pleural Effusions
Round Atelectasis
Radiographic Features ( Fig. 1-49)
Asbestosis
Radiographic Features
Malignancy in asbestos-related disease
Antigen-Antibody–Mediated Lung Disease
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)
Radiographic Features
Chronic beryllium disease
Radiographic Features
Pulmonary infiltratEs with eosinophilia (PIE)
Types
Goodpasture syndrome
Radiographic Features
Toxin-Induced Interstitial Pneumonitis/Fibrosis
Drug-induced pulmonary toxicity
Silo filler disease
Airway Disease
Trachea
Malignant tracheal neoplasm
Types
Benign neoplasm
Types
Saber-sheath trachea
Tracheopathia osteoplastica (TPO)
Clinical Findings
Radiographic Features
Relapsing polychondritis
Diagnostic Criteria (>3 needed)
Radiographic Features
Tracheobronchomalacia
Radiographic Features
Tracheobronchomegaly (mounier-kühn disease)
Congenital bronchial atresia
Chronic Bronchial Disease
Chronic obstructive pulmonary disease (COPD)
Clinical Syndromes
Radiographic Features
Emphysema
Clinical Findings
Radiographic Features ( Fig. 1-50)
Asthma
Types
Radiographic Features
Complications
Bronchiectasis
Types
Radiographic Features
Pearls
Cystic fibrosis
Pathophysiology
Radiographic Features
Complications
Bronchiolitis obliterans
Etiology of Adult Bronchiolitis
CT Features
Lung Injury
Trauma
Pearls
Pneumothorax ( Fig. 1-52)
Radiographic Features ( Figs. 1-53 & 1-54)
Tension pneumothorax ( Fig. 1-55)
Radiographic Features
Percutaneous chest tube placement for pneumothorax
Indication
Technique for Heimlich Valve Placement (for Biopsy-Induced Pneumothorax)
Technique for Chest Tube Placement (Any Pneumothorax)
Contusion
Radiographic Features
Lung laceration ( Fig. 1-56)
Fat embolism
Radiographic Features
Tracheobronchial tear
Diaphragmatic tear
Radiographic Features ( Fig. 1-57)
Esophageal tear
Other injuries
Postoperative Chest
Complications of surgical procedures
Mediastinoscopy
Bronchoscopy
Wedge Resection
Median Sternotomy Complications
Chest Tube Placement
Pneumonectomy ( Fig. 1-58)
Radiographic Features
Lobectomy
(Sub)segmental Resection
Postpneumonectomy syndrome
Radiographic Features ( Fig. 1-59)
Bronchopleural fistula (BPF)
Radiographic Features
Torsion
Lobar Torsion
Cardiac Herniation
Radiographic Features ( Fig. 1-60)
Lung transplantation
Radiographic Features
Pulmonary Vasculature
Pulmonary Artery Hypertension
General
Causes of PAH
Classification
Radiographic Features
Causes of Pulmonary Edema
Pulmonary Edema
Grading of cardiogenic pulmonary edema ( Figs. 1-61 through 1-63)
Asymmetrical pulmonary edema
Types
Risk Factors
Clinical Findings
Radiographic Features
Imaging Algorithm
Plain Film
CT Findings in PE
Scintigraphy
Angiography
Pulmonary Embolism
Vasculitis
Venous Abnormalities
Pulmonary arteriovenous malformation (AVM)
Types
Radiographic Features
Complications
Pulmonary varices
Radiographic Features
Aortic Nipple
Pulmonary venoocclusive disease (PVOD)
Radiographic Features
Pleura
General
Normal pleural anatomy
Diagnostic thoracentesis
Indication
Technique
Therapeutic thoracentesis
Indication
Technique
Expansion Pulmonary Edema
Vacuthorax
Pneumothorax management
Indication for Intervention
Technique
Persistent Pneumothorax in Patient with Chest Catheter
Empyema drainage
Indication
Technique
Complications
Fluid Collections
Pleural effusions
Causes
Radiographic Features ( Fig. 1-64)
Empyema
Causes
Radiographic Features
Chylothorax
Causes
Pleural Tumors
Fibrous tumor of the pleura
Clinical Findings
Types
Radiographic Features
Malignant mesothelioma
Radiographic Features ( Figs. 1-65 & 1-66)
Other
Diaphragmatic paralysis
Clinical Findings ( Fig. 1-67)
Causes
Radiographic Features
Mediastinum
General
Approach to mediastinal masses
Normal variants causing a wide mediastinum
Anterior Mediastinal Tumors
Thymoma
Pathology
Radiographic Features ( Fig. 1-68)
Thymolipoma
Associations
Radiographic Features
Benign thymic hyperplasia
Causes
Radiographic Features
Thyroid masses
Radiographic Features
Germ cell tumors
Teratoma ( Fig. 1-69)
Seminoma
Embryonal Cell Carcinoma
Hodgkin lymphoma
Radiographic Features ( Fig. 1-70)
Pearls
Non-hodgkin lymphoma (NHL)
Radiographic Features
Middle Mediastinal Tumors
Bronchopulmonary foregut malformations ( Fig. 1-71)
Radiographic Features ( Fig. 1-72)
Castleman disease (giant benign lymph node hyperplasia)
Radiographic Features
Fibrosing mediastinitis
Posterior Mediastinal Tumors
Neural tumors
Radiographic Features ( Fig. 1-73)
Extramedullary hematopoiesis
Other Mediastinal Disorders
Pneumomediastinum
Radiographic Features
Differential Diagnosis
General
Approach to CXR ( Fig. 1-74)
Approach to ICU films
Directed search in apparently normal chest films
Generic approaches to film interpretation
The “4 Ds”
Lesion Description
Universal differential diagnosis
Atelectasis
Lobar, segmental atelectasis ( Fig. 1-75)
Signs of lobar atelectasis
RUL Collapse ( Figs. 1-76 through 1-78)
RML Collapse
RLL Collapse
LUL Collapse ( Fig. 1-79)
LLL Collapse
CT Findings of Lobar Collapse ( Figs. 1-80 & 1-81)
Types of peripheral atelectasis
Consolidation
Causes of consolidation
Fluid in Acini
Inflammatory Exudate in Acini
Tumor in Acini
Pulmonary renal syndromes
Acute respiratory distress syndrome (ARDS)
Radiographic Features
Causes
Chronic airspace disease
Pulmonary Masses
Approach to solitary pulmonary nodule ( Fig. 1-84)
CT Workup
Pearls
Hidden zones ( Fig. 1-85)
Solitary nodule
Multiple nodules
Causes
Miliary pattern ( Fig. 1-86)
Causes
Calcified lung nodules
Large (>6 CM) thoracic mass
Upper lung zone opacities with calcified adenopathy
Infection that can cause chest wall invasion
Infection with lymphadenopathy
Cystic & Cavitary Lesions ( Fig. 1-87)
Approach
Cysts ( Figs. 1-88 & 1-89)
Cavity
Air crescent sign in cavity
Small cystic disease ( Fig. 1-90)
Interstitial Lung Disease
Radiographic patterns of interstitial disease
Types of Densities
Kerley Lines (Linear Densities) ( Fig. 1-91)
Approach
Generic Approach
Crazy-paving appearance on HRCT
Pulmonary hemorrhage
Halo pattern of ground-glass opacity
Peripheral ground-glass opacity & consolidation
Honeycombing pattern on HRCT
Diseases spreading along bronchovascular bundle
Tree-in-bud appearance
Abnormal Density
Hyperlucent lung
Causes
Small lung ( Fig. 1-92)
Tracheobronchial Lesions
Endobronchial lesions
Causes
Diffuse tracheal luminal abnormalities
Bronchiectasis
Upper lobe bronchiectasis ( Fig. 1-93)
Mucoid (bronchial) impaction
Causes
Pleural Disease
Pleural-based mass ( Fig. 1-94)
Calcified pleural plaques
Elevated hemidiaphragm ( Fig. 1-95)
Mediastinum ( Fig. 1-96)
Anterior mediastinal masses
Cystic Anterior Mediastinal Mass
Superior mediastinal mass
Middle mediastinal mass
Adenopathy
Posterior mediastinal mass ( Fig. 1-97)
Cardiophrenic angle mass
Fatty mediastinal lesions
High-density mediastinal lesions (noncontrast CT)
Densely enhancing mediastinal mass
Retrocrural adenopathy
Prominent hila ( Fig. 1-98)
Eggshell calcification in hilar nodes
Pneumomediastinum
Suggested Readings
2.
Cardiac Imaging
Cardiac Imaging Techniques
Plain Film Interpretation
Normal plain film anatomy
Posteroanterior (PA) View
Lateral View
Oblique Views
Radiographic approach to intensive care unit (ICU) films
Pearls
Endotracheal tube (ET)
Nasogastric tube
Complications
Swan-ganz catheter
Types
Complications
Intraaortic balloon pump (IABP)
Complications
Epicardial pacing wire
Automatic intracardiac defibrillation device
Types of AICDs
Central venous lines
Pacemaker
Complications
Chest tubes
Complications
Prosthetic cardiac valves
Tissue Valves
Mechanical Valves
Angiography
Cardiac angiography
Technique for Left Ventriculography
Evaluation
Ejection Fraction
Wall Motion Abnormalities
Coronary angiography
Contrast Medium
Complications
Interpretation
Coronary angiogram
Projections
Dominance
Pitfalls
Veins
Magnetic Resonance Imaging
MR coronary angiography
Computed Tomography
CT angiography of coronary arteries
Technique
Optimization of Image Quality
Coronary CT angiography
Coronary calcium scoring
Radiation exposure
Ultrasound
M-mode ultrasound
Zone 1
Zone 2
Zone 3
Two-Dimensional Cardiac Ultrasound
Long-Axis View
Short-Axis View
Apical View
Apical four-chamber view
Apical Two-Chamber View (RAO View of the LV) ( Fig. 2-18)
Suprasternal Notch View
Doppler
Color doppler
Congenital Heart Disease
General
Incidence
Approach
Pulmonary Vascularity
Chamber Enlargement
Situs
Algorithm
Classification
Acyanotic CHD with Increased Pulmonary Vascularity
Acyanotic CHD with Normal Pulmonary Vascularity
Cyanotic CHD with Decreased Pulmonary Vascularity
Cyanotic CHD with Increased Pulmonary Vascularity (Admixture Lesions)
CHD with PVH/CHF
Use of imaging modalities for evaluation of CHD
Chest Film
Ultrasound
Angiography
Magnetic Resonance Imaging (MRI)
Acyanotic CHD with Increased Pulmonary Vascularity
Ventricular septal defect (VSD)
Types
Clinical Findings
Hemodynamics
Radiographic Features
Treatment
Atrial septal defect (ASD)
Types
Associations
Clinical Findings
Hemodynamics
Radiographic Features
Patent ductus arteriosus (PDA)
Clinical Findings
Hemodynamics
Radiographic Features
Treatment
Endocardial cushion defect (ECD)
Types
Clinical Findings
Embryology
Hemodynamics
Radiographic Features
Treatment
Aortopulmonary window
Partial anomalous pulmonary venous connection (PAPVC)
Associations
Radiographic Features
Acyanotic CHD with Normal Pulmonary Vascularity
Valvular pulmonary stenosis (PS)
Clinical Findings
Types
Hemodynamics
Radiographic Features
Treatment
Congenital peripheral pulmonary artery stenosis
Causes
Types
Radiographic Features
Congenital aortic stenosis
Clinical Findings
Types
Radiographic Features
Coarctation of aorta
Types
Associations
Clinical Findings
Hemodynamics
Radiographic Features
Treatment
Cyanotic CHD with Decreased Pulmonary Vascularity
Tetralogy of fallot
Clinical Findings
Associations
Hemodynamics
Radiographic Features
Treatment
Tetralogy variants
Pink Tetralogy
Pentalogy of Fallot
Trilogy of Fallot
Ebstein anomaly
Associations
Clinical Findings
Hemodynamics
Radiographic Features
Treatment
Tricuspid atresia
Associations
Hemodynamics
Radiographic Features
Treatment
Cyanotic CHD with Increased Pulmonary Vascularity
Transposition of great arteries (TGA)
Types
Complete transposition of great arteries (D-TGA)
Hemodynamics
Radiographic Features
Treatment
Taussig-bing complex (DORV II)
Corrected transposition of great arteries (L-TGA)
Associations
Radiographic Features
Truncus arteriosus
Associations
Types
Hemodynamics
Radiographic Features
Treatment
Total anomalous pulmonary venous connection (TAPVC)
Types
Associations
Clinical Findings
Hemodynamics
Unobstructed Pulmonary Vein
Obstructed pulmonary vein
Obstruction Has Three Consequences:
Radiographic Features
Treatment
Single ventricle
Association
Radiographic Features
Double-outlet right ventricle (DORV)
Aorta
Pseudocoarctation
Associations
Radiographic Features
Interruption of aortic arch
Types
Associations
Radiographic Features
Aortic arch anomalies
Normal Development
Pearls
Left aortic arch with aberrant right subclavian artery
Radiographic Features
Associations
Right aortic arch with aberrant left subclavian artery
Radiographic Features
Associations
Right aortic arch with mirror image branching
Radiographic Features
Associations
Right arch with isolated left subclavian artery
Radiographic Features
Associations
Double aortic arch
Radiographic Features
Pulmonary Artery
Pulmonary sling
Vascular rings & slings
Types
Situs Anomalies
General
Abdominal Situs
Thoracic Situs
Cardiosplenic Syndromes
Other
Hypoplastic left heart (shone syndrome)
Clinical Findings
Treatment
Cor triatriatum
Radiographic Features
Persistent fetal circulation
Causes of Neonatal Pulmonary Hypertension
Azygos continuation of the IVC
Radiographic Features
Down syndrome
Marfan syndrome
Turner syndrome
Surgical procedures for congenital heart disease
Acquired Heart Disease
General
Cardiomegaly
Causes
Chamber enlargement
LA Enlargement
LV Enlargement
RV Enlargement
RA Enlargement
Valvular Heart Disease
Mitral stenosis
Causes
Clinical Findings
Hemodynamics
Radiographic Features
Mitral regurgitation
Causes
Clinical Findings
Hemodynamics
Radiographic Features
Aortic stenosis
Types
Clinical Findings
Radiographic Features
Aortic regurgitation
Causes
Radiographic Features
Myocardium
Delayed-enhancement cardiac MRI (DE-CMRI)
Acute myocardial infarction (AMI)
Complications of AMI
Aneurysm
Cardiomyopathies
Causes
Pearls
Lipomatous hypertrophy of the interatrial septum
Arrhythmogenic right ventricular dysplasia (ARVD)
Myocardial noncompaction
Takotsubo cardiomyopathy
Coronary Arteries
Variants/anomalies of coronary arteries
Atherosclerotic coronary artery disease (CAD)
Risk Factors
Treatment
Annual Mortality
Radiographic Features
Kawasaki disease (mucocutaneous lymph node syndrome)
Clinical Findings
Pericardium
Normal anatomy
Congenital absence of the pericardium
Radiographic Features
Pericardial cysts
Radiographic Features
Pericardial effusion
Causes
Radiographic Features
Constrictive pericarditis
Causes
Radiographic Features
Cardiac Masses
Differential Diagnosis
Congenital Heart Disease
Acyanotic heart disease
Increased Pulmonary Vascularity (L-R Shunt)
Normal Pulmonary Vascularity
Cyanotic heart disease
Normal or Decreased Pulmonary Vascularity
Pearls
Pulmonary edema in newborns
Massive cardiomegaly in the newborn
Boot-shaped heart
CHD with normal heart size & normal lungs
Skeletal abnormalities & heart disease
Inferior rib notching
Superior rib notching
Differential diagnosis of CHD by age of presentation
Aorta
Right aortic arch & CHD
Associations
Acquired Heart Disease
Approach
Abnormal left heart contour
Abnormal right heart contour
Small heart
Left atrial enlargement
Delayed myocardial enhancement (MRI)
Cardiac masses
T1 bright cardiac lesions
Pericardial effusion
Pneumopericardium
High-cardiac output states
Chf
Pneumopericardium
Coronary aneurysm
Pulmonary Artery
Pulmonary artery enlargement
Pulmonary arterial hypertension (PAH)
Classification
Pulmonary venous hypertension (PVH)
Eisenmenger physiology
Suggested Readings
3.
Gastrointestinal Imaging
Esophagus
General
Anatomy
Normal Esophageal Contour Deformities ( Fig. 3-1)
Gastroesophageal Junction (GEJ) Anatomy ( Fig. 3-2)
Peristaltic Waves
Swallowing
Esophageal ultrasound ( Fig. 3-4)
Esophageal Disease
Schatzki's ring
Esophageal webs & rings
Associations
Hiatal hernia
Imaging Features ( Fig. 3-5)
Associations
Approach
Diverticula
Lateral Pharyngeal Pouches
Zenker's Diverticulum ( Fig. 3-6)
Killian-Jamieson Diverticulum ( Fig. 3-7)
Epiphrenic Diverticulum
Traction Diverticulum
Pseudodiverticulosis
Associated Findings
Imaging Features
Esophagitis
Types
Imaging Features
Infectious Esophagitis ( Fig. 3-8)
Inflammatory Eosinophilic Esophagitis
Barrett's esophagus ( Fig. 3-9)
Imaging Features
Boerhaave syndrome ( Fig. 3-10)
Imaging Features
Mallory-weiss tear
Imaging Features
Achalasia
Types
Clinical Findings
Diagnosis
Imaging Features ( Fig. 3-11)
Complications
Treatment
Scleroderma ( Fig. 3-12)
Imaging Features
Diffuse dysmotility ( Fig. 3-13)
Types
Imaging Features
Chagas disease (american trypanosomiasis)
Imaging Features
Benign esophageal neoplasm
Malignant esophageal neoplasm
Types
Associations
Imaging Features ( Fig. 3-14)
Lymphoma
Esophageal foreign body
Imaging Features
Stomach
Types of Barium Studies
Upper Gastrointestinal Series
Single-Contrast Technique ( Fig. 3-15)
Double-Contrast Technique
Percutaneous Gastrostomy
Indications
Technique
Contraindications
Normal Appearance
Mucosal Relief
Types of Gastric Lesions
Mucosal versus Extramucosal Location of Mass ( Fig. 3-17)
Peptic Ulcer Disease (PUD)
Detection
Imaging Features ( Fig. 3-18)
Gastritis (95% of all ulcers)
Symptoms mimic PUD
Imaging Features
Treatment
Malignant Ulcers (5% of All Ulcers)
Complications of Gastric Ulcer ( Fig. 3-19)
Pearls
Imaging Features
Clinical Findings
Imaging Features
Clinical Findings
Causes
Imaging Features
Risk Factors
Location
Staging
Imaging Features ( Fig. 3-20)
Imaging Features
Imaging Features
Hematogenous Spread to Stomach (Target Lesions)
Imaging Features
Ménétrier Disease (Giant Hypertrophic Gastritis)
Eosinophilic Gastroenteritis
Gastroduodenal Crohn Disease
Zollinger-Ellison Syndrome
Gastric Polyps
Gastric Carcinoma
Gastric Lymphoma
Gastrointestinal Stromal Tumor (GIST)
Metastases
Carney's Triad (Rare)
Benign Tumors
Gastric Volvulus
Gastric Varices
Benign Gastric Emphysema
Duodenum & Small Bowel
Duodenum
Normal appearance
Mucosal Relief
Papilla ( Fig. 3-23)
Duodenal ulcer ( Fig. 3-24)
Predisposing Factors
Imaging Features
Duodenal trauma
Location of Intestinal Trauma
Types of Injuries
Imaging Features
Surgical Treatment
Benign tumors
Types
Antral mucosal prolapse
Imaging Features
Malignant tumors
Types
Upper GI surgery
Complications of Surgery ( Fig. 3-25)
Bariatric surgery
Gastric bypass ( Fig. 3-27)
Complications
Adjustable gastric banding
Sleeve gastrectomy
Jejunum & Ileum
Normal appearance
Normal Appearance of Small Bowel by SBFT
Ct
Jejunal & ileal diverticuli
Blind loop syndrome
Malabsorption
Imaging Features
Sprue
Imaging Features
Associated Disorders
Complications
Mastocytosis
Clinical Findings
Imaging Features
Amyloidosis
Imaging Features
Intestinal lymphangiectasia
Imaging Features
Gastrointestinal lymphoma
Graft-versus-host (GVH) reaction
Imaging Features
Scleroderma
Imaging Features
Whipple disease
Clinical Findings
Imaging Features
Enteric fistulas
Types
Radiographic Workup
Therapy
Drug chemotherapy-induced enteritis
Infectious Enteritis
Cryptosporidiosis
Imaging Features
Intestinal helminths
Ascariasis ( Fig. 3-29)
Imaging Features
Carcinoid tumors
Carcinoid syndrome
Imaging Features
Complications
Radiation enteritis
Colon
General
Barium enema (BE)
Patient Preparation
Single-Contrast Technique
Double-Contrast Technique
Contraindications to BE
Complications of BE
Glucagon
CT Colonography (CTC)
MR enterography (MRE)
Polyps
Adenomatous polyps
Clinical Findings
Location ( Fig. 3-30)
Differentiation of Benign & Malignant Polyps
Advanced adenoma ( Fig. 3-31)
Hyperplastic polyps
Imaging Features
Postinflammatory polyps (PIPS)
Imaging Features
Polyposis syndromes
Familial Polyposis
Gardner Syndrome
Peutz-Jeghers Syndrome
Juvenile Polyposis
Cowden Disease
Lhermitte-Duclos Disease
Turcot Syndrome
Colon Carcinoma
General
Cancer risk factors
Location
Imaging Features ( Fig. 3-32)
Complications
Staging ( Fig. 3-33)
TNM Classification
Diagnostic Accuracy
Imaging Features
Colitis
Crohn disease (regional enteritis) ( Fig. 3-34)
Imaging Features ( Fig. 3-35)
Mural & Extramural Changes (CT Findings)
Complications ( Fig. 3-36)
Ulcerative colitis (UC) ( Figs. 3-37 & 3-38)
Associated Findings
Imaging Features
Complications
Perianal fistulas
Etiology:
Types
Imaging Features
Treatment
BehçEt Disease
Intestinal Manifestations
Extraintestinal Manifestations
Infectious colitis
Cytomegalovirus (CMV) colitis
Imaging Features
Typhlitis (neutropenic colitis)
Clinical Findings
Imaging Features
Pseudomembranous colitis (PMC)
Clinical Findings
Imaging Features ( Fig. 3-39)
Amebiasis ( Fig. 3-40)
Imaging Features
Intestinal tuberculosis (TB)
Types
Imaging Features
Colitis cystica profunda
Rectal lymphogranuloma venereum
Other Colonic Diseases
Diverticular disease ( Fig. 3-41)
Diverticulosis
Diverticulitis ( Fig. 3-42)
Pearls
Giant sigmoid diverticulum
Complications
Appendix
Appendicitis ( Fig. 3-43)
Imaging Features ( Figs. 3-44 & 3-45)
Mucocele of the appendix
Imaging Features
Epiploic appendagitis
Ischemic bowel disease
Imaging Features
Volvulus ( Fig. 3-46)
Sigmoid Volvulus
Imaging Features
Cecal Volvulus ( Fig. 3-47)
Cecal Bascule
Pseudo-obstruction of the large bowel (ogilvie syndrome)
Imaging Features
Toxic megacolon (TMC)
Imaging Features
Liver
General
Liver anatomy ( Fig. 3-48)
Hepatic ligaments
Ligaments & Spaces ( Fig. 3-49, A - C)
US Doppler Waveforms ( Fig. 3-50)
Types of Contrast-Enhanced CT Techniques (CECT)
Dynamic Bolus CT (Portal Venous Phase Imaging for Hypovascular Lesions)
Dynamic Bolus CT (Arterial Phase Imaging for Hypervascular Lesions)
Delayed Equilibrium CT
Delayed High-Dose CT ( Fig. 3-51)
Liver MRI
MR elastography
Diffuse Liver Disease
Hepatitis
Causes
Imaging Features
Cirrhosis
Types
Causes
Imaging Features
Complications
Fatty liver
Causes
Imaging Features
Focal confluent fibrosis
CT Findings
Glycogen storage disease
Imaging Features
Gaucher disease
Clinical Findings
Imaging Features
Hemachromatosis
Types
Imaging Features
Complication
Infections
Pyogenic abscess
Causes
Imaging Features
Amebic abscess
Imaging Features
Treatment
Echinococcus (hydatid disease)
Imaging Features ( Fig. 3-52)
Classification of Cysts
Complications
Percutaneous Drainage
Peliosis hepatis
Tumors
Types of hepatic tumors
Hemangioma
Imaging Features
Focal nodular hyperplasia (FNH)
Imaging Features
Adenoma
Complications
Imaging Features
Hepatocellular carcinoma (HCC)
Incidence
Risk Factors
Imaging Features
Fibrolamellar HCC
Metastases
Sensitivity for Lesion Detection
Imaging Features
Unsuspected hepatic lesions
Angiosarcoma
Epithelioid hemangioendothelioma
Alcohol ablation of liver tumors
Indication
Procedure
Complications
Outcome
Radiofrequency ablation of liver tumors
Indication
Procedure
Complications
Types ( Fig. 3-53)
Complications
Trauma
Vascular Abnormalities
Portal hypertension
Causes
Imaging Features
Arterioportal shunting in liver
Types
Budd-chiari syndrome (BCS)
Clinical Findings
Causes
Imaging Features
Pearls
Portal vein thrombosis
Causes
Imaging Features
Pearls
Hepatic artery aneurysm
Transplant
Criteria
Complications
CT Features (after Transplantation)
ERCP Findings (after Transplantation)
Passive hepatic congestion
Hepatic sarcoidosis (boeck disease)
Hellp syndrome
Biliary System
General
Ductal anatomy ( Fig. 3-54)
Variations of Intrahepatic Biliary Anatomy
Variations of Cystic Duct Insertion ( Fig. 3-55)
Variations of Papillary Insertion (Ducts within Papilla = Ampulla) ( Fig. 3-56)
US Measurements of CHD ( Fig. 3-57)
Gallbladder
US Measurements
Variants
Endoscopic retrograde cholangiopancreatography (ERCP)
Magnetic resonance cholangiopancreatography (MRCP)
Advantages of MRCP over ERCP
Disadvantages of MRCP
Technique
Pitfalls
Biliary Lithiasis
Cholelithiasis
Types
Predisposing Factors
US Features
Clean versus Dirty Shadows
Choledocholithiasis
Papillary stenosis
Sphincter of Oddi spasm; treat with papillotomy. Causes:
Sludge
Implications
Milk of calcium bile
Mirizzi syndrome ( Fig. 3-60)
Biliary-enteric fistulas
Causes
Types
Inflammation
Acute cholecystitis ( Fig. 3-61)
Causes
US Features
Complications
Chronic cholecystitis
US Features
Acalculous cholecystitis ( Fig. 3-62)
Imaging Features
Xanthogranulomatous cholecystitis
Imaging Features
AIDS ( Fig. 3-63)
Acute cholangitis
Causes
Imaging Features
Recurrent pyogenic cholangitis (oriental cholangiohepatitis)
Imaging Features ( Fig. 3-64)
Complications
Sclerosing cholangitis ( Fig. 3-66)
Types
Imaging Features
Complications
Adenomyomatosis
US Features
Hyperplastic Cholecystoses
Cholesterolosis (strawberry GB)
US Features
GB adenoma
Tumors
GB carcinoma
Associations
Imaging Features
Cholangiocarcinoma
Locations
Associations ( Fig. 3-68)
Imaging Features
Intrahepatic Cholangiocarcinoma
Imaging Features
Biliary Cystadenoma
Imaging Features
Bile duct hamartoma or adenoma (von meyenburg complex)
Imaging Features
Peribiliary cysts
Cystic Diseases
Choledochal cyst ( Fig. 3-69)
Caroli disease subset
Associations
Imaging Features
Chemotherapy cholangitis
Intervention
Laparoscopic cholecystectomy
Technique
Contraindications
Complications (0.5%-5%)
Bismuth Classification of Bile Duct Injury ( Fig. 3-70)
Cholecystostomy
Indications
Technique
Management
Percutaneous biliary procedures
Transhepatic Cholangiogram
Biliary Drainage ( Fig. 3-71)
Biliary Stent Placement
Pancreas
General
Pancreatic anatomy
Pancreatic Duct ( Fig. 3-72)
Variations ( Fig. 3-73)
Pancreas Dimensions ( Fig. 3-74)
Fatty Infiltration ( Fig. 3-75)
Secretin Stimulation Test
Congenital Anomalies in Adults
Cystic fibrosis
Imaging Features
Annular Pancreas
Ectopic Pancreatic Tissue
Types of Injuries ( Fig. 3-76)
Imaging Features
Delayed Complications
Pancreatic Trauma
Pancreatitis
General
Classification
Causes
Clinical Findings
Imaging of acute pancreatitis
CT Staging (Value of Predicting Clinical Outcome is in Dispute)
Pearls
Terminology & complications
Pancreatic Necrosis ( Fig. 3-77)
Acute Fluid Collections (Formerly Called Phlegmon) ( Fig. 3-78)
Pseudocyst ( Fig. 3-79)
Pancreatic Abscess
Infected Necrosis
Hemorrhage
Percutaneous therapy
Needle Aspiration
Percutaneous Drainage
Chronic pancreatitis ( Fig. 3-80)
Causes
Imaging Features
Complications
Autoimmune pancreatitis
Imaging Features
Groove pancreatitis
Imaging Features
Heterotopic pancreas
Pancreatitis in cystic fibrosis
Imaging Features
Tropical pancreatitis
Imaging Features
Hereditary pancreatitis
Types of pancreatic tumors
Adenocarcinoma (PDAC)
Clinical Findings
Imaging Features ( Fig. 3-81)
Cystic neoplasm
Classification
Differentiation of cystic lesions by fluid content
Intraductal papillary mucinous tumor (IPMT) of pancreas
Types ( Fig. 3-82)
Associations
Imaging Features
Mucinous cystic neoplasms ( Fig. 3-83)
Pancreatoblastoma
Solid pseudopapillary neoplasm
Acinar cell carcinoma
Islet cell neoplasm
Classification
Insulinoma (Most Common Functional Tumor)
Gastrinoma (Second Most Common)
Nonfunctioning Islet Cell Tumors (Third Most Common)
Rare Islet Cell Tumors
Metastases
Normal Imaging Features
Complications
Transplant ( Fig. 3-84)
Whipple surgery ( Fig. 3-85)
Complications of Pancreatoduodenectomy
Spleen
General
Anatomic variations
Accessory Spleen (in 40% of Patients)
Lobulations (Very Common)
Wandering Spleen
Polysplenia
Asplenia
CT appearance
Common Causes
Splenomegaly ( Fig. 3-87)
Tumors
Cysts
Hamartoma
Hemangioma
Imaging Features
Metastases
Trauma
Injury
Mechanism
Spectrum of Injuries
Imaging Features
Splenosis
Location
Imaging Features
Vascular
Splenic infarct
Causes
Aids
Causes of Splenic Lesions
Peritoneum & Abdominal Wall
General
Peritoneal spaces ( Figs. 3-88 & 3-89)
Peritoneum
Abscess drainage ( Figs. 3-90 & 3-91)
Trocar Technique
Seldinger Technique
Peritoneal metastases ( Fig. 3-92)
Imaging Features
Peritoneal infection
Pseudomyxoma peritonei
Imaging Features
Abdominal hernias
Terminology ( Fig. 3-93)
Diaphragmatic Hernias
Abdominal Wall Hernias
Internal Hernias (Rare)
Groin hernias ( Fig. 3-94)
Types
Malignant mesothelioma
Imaging Features
Abdominal Wall
Abdominal wall metastases
Imaging Features
Abdominal wall hematoma
Causes
Imaging Features
Mesenteric panniculitis
Imaging Features
Sclerosing peritonitis
Imaging Features
Mesenteric fibromatosis (desmoid tumor)
Desmoplastic small round cell tumor
Imaging Features
Differential Diagnosis
Esophagus
Diverticular disease ( Fig. 3-95)
Luminal narrowing ( Fig. 3-96)
Megaesophagus ( Fig. 3-97)
Esophageal tears (contrast extravasation, fistula)
Solitary filling defects (mass lesions)
Thickened folds
Air-fluid level
Stomach
Approach to UGI studies ( Fig. 3-98)
Gastritis
Target (bull's eye) lesions ( Fig. 3-99)
Filling defect (mass lesion)
Submucosal lesions
Giant rugal folds
Linitis plastica
Antral lesions ( Fig. 3-100)
Ram's horn antrum
Free intraperitoneal air
Duodenum
Filling defects
Neoplastic Filling Defects
Other Filling Defects ( Fig. 3-101)
Luminal outpouchings ( Fig. 3-102)
Postbulbar narrowing ( Fig. 3-103)
Duodenal fold thickening
Papillary enlargement
Jejunum & Ileum
Dilated gas-filled bowel loops ( Fig. 3-104)
Approach ( Fig. 3-105, A & B)
Small Bowel Obstruction (SBO)
Colonic Obstruction ( Fig. 3-106, A & B)
Paralytic (adynamic) ileus
Mechanical SBO
Malabsorption patterns
Predominantly Thick/Irregular Folds
Predominantly Thick/Straight Folds
Predominantly Dilated Loops, Normal Folds
Thick folds without malabsorption pattern (edema, tumor hemorrhage) ( Fig. 3-107, A & B)
Causes
Nodules
Small Bowel Stack of Coins Appearance
Small Bowel Luminal Narrowing
CT Bowel Target Sign
Gracile Small Bowel
Small bowel tumors
Mesenteric bowel ischemia
Shortened transit time
Colon
Mass lesions
Polyps
Ulcers
Aphthoid Ulcers (Superficial)
Deep Ulcers
Bowel wall thickening (thumbprinting)
Tumor-like colonic deformity ( Fig. 3-108, A & B)
Long (>10 cm) colonic narrowing ( Fig. 3-109)
Ahaustral colon
Colonic obstruction
Megacolon
Adult intussusception ( Fig. 3-110)
Pneumatosis coli
Ileocecal deformities
Proctitis
Liver
Liver masses
Abnormal liver density (CT)
Increased Liver Density
Decreased Liver Density
Hypervascular liver lesions
Fat-containing liver masses
Focal liver lesions with capsular retraction
Focal liver lesions with central scar
Liver nodules in cirrhosis
Hyperechoic liver lesions
Round Lesions ( Fig. 3-111)
Linear Lesions
Multiple hypoechoic liver lesions
Gas in liver ( Fig. 3-112)
Biliary System
Extrahepatic biliary dilatation ( Fig. 3-113)
Levels of Obstruction
Types of Obstruction
Ultrasound Signs of Intrahepatic Dilatation ( Fig. 3-114)
Multifocal duct narrowing
Filling defects within biliary system
Periportal enhancement
Gallbladder wall thickening
Diffuse (Concentric) Thickening (in order of decreasing frequency)
Focal (Eccentric) Thickening
Hyperechoic foci in gallbladder wall
Dense gallbladder (CT)
Pancreas
Focal pancreatic signal abnormality
Paraduodenal pancreatitis
Cystic pancreatic lesions
Differential Diagnosis by Features ( Figs. 3-115 & 3-116)
Differential Diagnosis by Incidence
Pancreatic calcifications
Fatty replacement of pancreas
Hyperechoic pancreas
Spleen
Focal splenic lesions
Rim-calcified cystic lesions
Calcified foci on CT
Splenomegaly
Peritoneal Cavity
Peritoneal fluid collections
Intraperitoneal calcifications
Other
Aids
Common Gastrointestinal Manifestations by Cause
Common Gastrointestinal Manifestations by Organ System
Low-density lymph nodes
Abdominal trauma
Abdominal complications after cardiac surgery
Suggested Readings
4.
Genitourinary Imaging
Kidneys
General
Anatomy
Renal Pedicle
Collecting System
Orientation & Size of Kidneys
Techniques
Bolus IVP
Technique
Drip-infusion nephrotomogram
Technique
Retrograde pyelogram
Pretreatment protocol for IV iodinated contrast in patients with previous allergic reaction
CT protocols of the kidney/ureters
Hematuria Protocol
Stone Protocol
Renal Mass Protocol
Percutaneous nephrostomy (PCN)
Indications
Technique
Congenital Anomalies
Duplicated collecting system
Bifid Renal Pelvis
Incomplete Ureteral Duplication
Complete Ureteral Duplication
Horseshoe kidney
Associations
Complications
Imaging Features
Other renal variants
Cystic Disease
Classification
Simple cysts
Imaging Features
Pearls
Complicated cysts
Bosniak Classification
Imaging Features
Cyst aspiration
Indications for Cyst Aspiration
Cyst Ablation
Other cystic structures
Milk of Calcium Cyst
Parapelvic Cyst
Peripelvic Cyst
Perinephric Cyst
Localized cystic disease
Medullary cystic disease (MCD)
Types
Imaging Features
Adult polycystic kidney disease (APKD)
Associated Findings
Imaging Features
Uremic cystic disease (UCD)
Tumors
Classification
Renal cell carcinoma (RCC)
Clinical Findings
Pathology
Risk Factors
Prognosis
Imaging Features
Staging
Therapy
Radiofrequency ablation of RCC
Indications
Technical Factors
Complications
Renal mass biopsy criteria
Established
Emerging
Lymphoma
Imaging Features
Metastases
Angiomyolipoma (AML)
Associations
Imaging Features
Adenoma
Oncocytoma
Imaging Features
Juxtaglomerular Tumor (Reninoma)
Renal pelvis tumors
Inverted Papilloma
Transitional Cell Carcinoma (TCC)
Squamous Cell Carcinoma (SCC)
Collecting Duct Carcinoma
Imaging Features
Renal masses: what the urologists would like to know
Indications for partial nephrectomy in patients with RCC
Risk Factors
Complications
Inflammation
Acute pyelonephritis
Common Underlying Conditions
Types
Imaging Features
Pyonephrosis
Imaging Features
Renal abscess
Imaging Features
Complications
Perinephric abscess
Emphysematous pyelonephritis
Imaging Features
Treatment
Xanthogranulomatous pyelonephritis (XGP)
Imaging Features
Replacement Lipomatosis
Imaging Features
Tuberculosis
Sites of Involvement
Imaging Features of Renal Tuberculosis
Candidiasis
Imaging Features
Renal manifestation of AIDS
Imaging Features
Other Renal Abnormalities
Prostate Abnormalities
Testicular Abnormalities
Nephrocalcinosis & Lithiasis
Calculi
Imaging Features
Complications
Treatment Options
Extracorporeal Shock Wave Lithotripsy (ESWL)
Indications for Percutaneous Nephrostomy
Cortical nephrocalcinosis
Causes
Imaging Features
Medullary nephrocalcinosis
Causes
Imaging Features
Pelvicalyceal System
Congenital megacalyces
Infundibulopelvic dysgenesis
(PYELO)Calyceal diverticulum
Imaging Features
Renal papillary necrosis (RPN)
Causes
Imaging Features
Medullary sponge kidney (benign renal tubular ectasia; Cacchi-Ricci Disease) ( Fig. 4-11)
Associations (Rare)
Imaging Features
Obstruction of collecting system
Causes
Imaging Features
Whitaker test
Pyelorenal backflow
Types
Trauma
Renal injury
Mechanism
Classification
Imaging Features
Vascular Abnormalities
Renal vein thrombosis (RVT)
Imaging Features
Paroxysmal nocturnal hemoglobinuria
Renal infarcts
Causes
Renal Transplant
Donor evaluation
Normal renal transplant
Functional evaluation of transplanted kidney
Common transplant complications
Acute tubular necrosis (ATN)
Imaging Features
Rejection
Pearls
Vascular complications
Perirenal fluid collections
Causes
Bladder & Urethra
Ureter
Ectopic ureter
Clinical Findings
Associations
Insertion Sites
Retrocaval ureter
Ovarian vein syndrome
Pyeloureteritis cystica
Ureteral pseudodiverticulosis
Ureteral diverticulum
Malacoplakia
Leukoplakia
Ureteral tumors
Types
Prognosis
Imaging Features
Ureteral diversions
Ileal Loop
Colon Conduit
Ureterosigmoidostomy
Loopogram
Bladder
Congenital urachal anomalies
Bacterial cystitis
Acute Cystitis
Predisposing Factors
Imaging Features
Chronic cystitis
Imaging Features
Emphysematous cystitis
Imaging Features
Tuberculosis
Imaging Features
Schistosomiasis (bilharziosis)
Imaging Features
Other types of cystitis
Neurogenic bladder
Types
Bladder fistulas
Types & Common Causes
Leukoplakia
Imaging Features
Malacoplakia
Imaging Features
Bladder diverticulum
Types
Malignant bladder neoplasm
Clinical Finding
Types & Underlying Causes
Imaging Features
Urachal Carcinoma
Benign bladder tumors
Bladder calculi
Bladder outlet obstruction
Imaging Features
Bladder injuries
Classification of Bladder Injury
Radiographic Examinations in Suspected Bladder Injury
Cystostomy
Indication
Technique
Male Urethra
Retrograde urethrogram (RUG)
Urethral injuries
Types
Urethral strictures & filling defects
Infection
Trauma
Tumor (Rare)
Female Urethra
Anatomy
Infection
Carcinoma
Diverticula
Retroperitoneum
General
Anatomic terms
Perinephric space
Benign Conditions
Retroperitoneal hematoma
Causes
Imaging Features
Abscess
Location & Causes
Retroperitoneal air
Causes
Retroperitoneal fibrosis
Causes
Imaging Features
Pelvic lipomatosis
Imaging Features
Types
Tumors
Liposarcoma
Imaging Features
Leiomyosarcoma
Imaging Features
Adrenal Glands
General
Arterial Supply
Venous Drainage
Physiology
Imaging Appearance
Medullary Tumors
Pheochromocytoma
Classification of Paraganglioma
Clinical Findings (Excess Catecholamines)
Pharmacologic Testing
Associations
Imaging Features
Multiple endocrine neoplasia (MEN) type II
Types
Cortical Tumors
Approach to adrenal masses
Adrenocortical carcinoma
Imaging Features
Adrenal metastases
Imaging Features
Adenoma
Imaging Features
Myelolipoma
Imaging Features
Adrenal cyst
Classification
Imaging Features
Adrenal hemorrhage
Causes
Imaging Features
Infection
Functional Diseases
Cushing syndrome
Causes
Hyperaldosteronism
Clinical Findings
Types
Imaging Features
Adrenal insufficiency
Clinical Finding
Types
Imaging Features
Male Pelvis
Prostate
Normal anatomy
US-guided prostate biopsy
Indications
Technique
Prostate MRI
Indication
Technique
Benign prostatic hyperplasia (BPH)
Imaging Features
Granulomatous prostatitis
Classification
Imaging Features
Prostate cancer
Screening (Controversial)
Origin
Imaging Features
TNM staging
Treatment Complications
Seminal Vesicle & Spermatic Cord
Seminal vesicle cysts
Seminal vesicle agenesis or hypoplasia
Unilateral SV Agenesis (Embryonic Insult Occurs Before 7th Week of Gestation)
Bilateral SV Agenesis
Other seminal vesicle (SV) disease
Tumors of seminal vesicle & vas deferens
Spermatic cord
Hematospermia
Testis & Epididymis
General
Arterial Supply
MRI evaluation of testis
Cryptorchidism
Complications
Torsion
Types
Imaging Features
Treatment
Epididymoorchitis
Imaging Features
Testicular abscess
US features
Varicocele
Clinical Findings
Location
US Features
Hydrocele
Types
Trauma
Types
Cysts
Types
Testicular microlithiasis
Scrotal pearl
Malignant testicular tumors
Types
Imaging Features
Pearls
Benign epidermoid tumor
Penis
Peyronie disease
Imaging Features
Penile fracture
Vascular impotence
Imaging Features
Penile cancer
Etiology
Pathology
Imaging Features
Female Pelvis
General
Pelvic US
Uterus
Menstrual Cycle
Ovary
Hysterosalpingogram (HSG)
Technique
Complications
Contraindications
Pelvic MRI
Techniques
SI on T2W Sequences
Transvaginal drainage procedures
Indications
Uterus
Uterine malformations
Types
Complications
Associations
In utero diethylstilbestrol (DES) exposure
Pelvic inflammatory disease (PID)
Causes
US Features
Asherman syndrome
Pyometra
Causes
Imaging Features
Intrauterine device (IUD)
Complications
Radiographic Feature
Adenomyosis
Clinical Findings
Imaging Features
Leiomyoma
Clinical Findings
Location
Complications
Imaging Features
Extrauterine Leiomyomas
Uterine Leiomyosarcomas
Endometrial hyperplasia
Causes
Types
US Features
Tamoxifen
Gartner's duct cyst
Endometrial carcinoma
Imaging Features
Cervical carcinoma
Imaging Features
Fallopian Tubes
Hydrosalpinx
Causes
Imaging Features
Salpingitis isthmica nodosa (SIN)
Ovaries
Classification of cystic ovarian structures
Follicular cysts
Clinical Findings
Imaging Features
Corpus luteum cyst (CLC)
Clinical Findings
Imaging Features
Theca lutein cysts
Imaging Features
Parovarian cysts
Imaging Features
Peritoneal inclusion cysts
Imaging Features
Ovarian remnant syndrome
Postmenopausal cysts
Polycystic ovarian disease (PCO, stein-leventhal syndrome)
Clinical Findings
Imaging Features
Endometriosis
Types
Imaging Features
Ovarian torsion
Imaging Features
Ovarian vein thrombosis
Ovarian cancer
Types
Risk Factors
Screening
Imaging Features
Dermoid, teratoma
Imaging Features of Dermoid
Pearls
Other ovarian tumors
Dysgerminoma
Yolk Sac Tumors
Endometrioid Tumor
Clear Cell Carcinoma
Brenner Tumor
Granulosa Cell Tumors (Estrogen)
Sertoli-Leydig Cell Tumors
Thecoma, Fibroma
Krukenberg Tumor
Meigs Syndrome
Pearls
Infertility
General
Role of Ultrasound
Sonographic Signs During Menstrual Cycle
Drug treatment for ovulation induction
Human Chorionic Gonadotropin
Clomiphene Citrate (Clomid)
Pergonal
Leuprolide Acetate (Lupron)
Urofollitropin (Metrodin)
Protocols
Baseline US
Subsequent Scans
Complications of hormonal treatment
Ovarian Hyperstimulation
Multiple Pregnancies
Other
Normal pelvic floor anatomy
Pelvic floor prolapse
MRI Interpretation
Differential Diagnosis
Kidneys
Renal mass lesions
Solid renal neoplasm
Cystic renal masses
Hyperechoic renal mass
Renal sinus mass
Wedge-shaped renal lesion
Masses in the perinephric space
Diffusely hyperechoic kidneys
Renal calcifications
Fat in kidney
Renal hemorrhage
Hypoechoic perirenal fat
Filling defect in collecting system
Papillary necrosis
Delayed (persistent) nephrogram (same differential diagnosis as renal failure)
Extracalyceal contrast agent
Dilated calyces/collecting system
Bilaterally enlarged kidneys
Bilaterally small kidneys
Hypercalcemia
Renal vein thrombosis (RVT)
Causes
Ureter
Dilated ureter
Ureteral stricture
Multiple ureteral filling defects
Ureteral diverticula ( Fig. 4-59)
Deviated ureters
Lateral Deviation
Medial Deviation
Bladder
Bladder wall thickening
Bladder filling defect
Bladder neoplasm
Bladder calculi
Bladder wall calcification
Air in bladder
Teardrop bladder
The “female prostate”
Adrenal Glands
Adrenal masses
Cystic Masses
Bilateral Masses
Adrenal calcifications
Adrenal pseudotumors
Testes
Solid testicular masses
Extratesticular abnormalities
Epididymal mass
Prostate
Cystic lesions
Female Pelvis
Approach
Uterus
Thick hyperechoic endometrial stripe (EMS)
Pearls
Hypoechoic structures in hyperechoic endometrium
Fluid in uterine cavity
Uterine enlargement or distortion
Uterine bleeding
Uterine size
Small Uterus
Large Uterus
Pelvic floor cystic masses
Shadowing structures in endometrial cavity (US)
Ovaries & Adnexa
Cystic masses
Complex pelvic masses
Pearls
Masses with homogeneous low-level echoes
Solid ovarian mass lesions
Dilated tubes (hydrosalpinx, pyosalpinx, hematosalpinx)
Tubal filling defects (HSG)
Tubal irregularity
Pseudokidney sign (US)
Suggested Readings
5. Musculoskeletal Imaging
Trauma
General
Fracture
Fracture Healing ( Fig. 5-1)
Terminology for Description of Fractures
Specific Fractures
Relevant anatomy ( Fig. 5-2)
Long Bones
Types of Joints
Synovial Joint ( Fig. 5-3)
Fracture complications
Orthopedic procedures
Types of Repair
Orthopedic Hardware
Spine
Classification of C-spine injuries
Biomechanics ( Figs. 5-4 & 5-5)
Pearls
Approach to C-spine plain film ( Figs. 5-6 & 5-7)
Approach to cervical spine injuries
Jefferson fractures ( Fig. 5-8)
Radiographic Features
Fractures of the odontoid process (dens) ( Fig. 5-9)
Radiographic Features
Hangman's fracture ( Fig. 5-10)
Causes
Radiographic Features
Burst (compression) fracture
Flexion teardrop fracture (flexion fracture-dislocation)
Radiographic Features ( Fig. 5-11)
Clay-shoveler's fracture ( Fig. 5-12)
Radiographic Features
Wedge fracture
Radiographic Features
Extension teardrop fracture ( Fig. 5-13)
Radiographic Features
Facet dislocation
Bilateral Facet Dislocation (Unstable) ( Fig. 5-14)
Radiographic features
Unilateral Facet Dislocation (Stable)
Radiographic features
Anterior subluxation (hyperflexion sprain) ( Fig. 5-15)
Radiographic Features
Hyperextension Fracture-Dislocation ( Fig. 5-16)
Radiographic Features
Atlantooccipital dissociation ( Fig. 5-17)
Radiographic Features
Thoracic & Lumbar Fractures
General
Radiographic Features
Types of fractures
Spondylolysis
Radiographic Features ( Fig. 5-20)
Spondylolisthesis ( Fig. 5-21)
Pseudospondylolisthesis ( Fig. 5-22)
Face
Approach to facial fractures ( Fig. 5-23)
Orbital fractures
Pure Orbital Blow-out Fracture ( Fig. 5-24)
Clinical findings
Radiographic features ( Figs. 5-25 & 5-26)
Impure Orbital Blow-out Fracture
Orbital Blow-in Fracture
Nasal fractures ( Fig. 5-27)
Radiographic Features
Mandibular fractures ( Fig. 5-28)
Flail Mandible ( Fig. 5-29, A & B)
Zygoma fractures ( Figs. 5-30 & 5-31)
Simple Arch Fractures
Complex Arch Fractures (Tripod Fracture)
Maxillary fractures ( Fig. 5-32)
Dentoalveolar Fracture
Sagittal Maxillary Fracture
Le fort fractures ( Figs. 5-33 & 5-34)
Le Fort Type I
Le Fort Type II
Le Fort Type III
Shoulder
Fracture of the clavicle ( Fig. 5-35, A & B)
Complications
Fracture of the scapula
Fracture of ribs
Normal mri anatomy of shoulder joint ( Fig. 5-36)
Shoulder ultrasound
Dislocations of the glenohumeral joint
Anterior Dislocation ( Fig. 5-37)
Radiographic features
Posterior Dislocation ( Fig. 5-38)
Radiographic Features
Inferior Dislocation
Pseudodislocation of glenohumeral joint
Rotator cuff tear ( Figs. 5-39 & 5-40)
Causes
Radiographic Features
Anterior-to-posterior lesions of the superior labrum (slap lesions)
Muscle atrophy
Adhesive capsulitis (frozen shoulder)
Radiographic Features
Acromioclavicular separation ( Fig. 5-41)
Radiographic Features
Sternoclavicular (SC) joint injury ( Fig. 5-42)
Radiographic Features
Arm
Fractures of proximal humerus
4-Segment Neer Classification ( Fig. 5-43)
Radiographic Features
Fractures of distal humerus ( Figs. 5-44 & 5-45)
Classification
Complications
Radial head fractures
Treatment
Radiographic Features ( Fig. 5-46)
Ulnar fractures
Olecranon Fracture
Coronoid Fracture
Elbow dislocations
Ulnar collateral ligament tear
Combined radius-ulna fractures & dislocations
Monteggia Fracture-Dislocation
Galeazzi Fracture-Dislocation
Essex-Lopresti Fracture-Dislocation
Colles fracture ( Fig. 5-47)
Radiographic Features
Complications
Other radial fractures ( Figs. 5-48 & 5-49)
Barton Fracture
Smith Fracture
Hutchinson Fracture ( Fig. 5-50)
Carpal instability
Wrist/Hand
Wrist anatomy ( Fig. 5-51)
Lines of articulations ( Fig. 5-52)
Ulnar Variance
Scaphoid fracture
Radiographic Features
Prognosis
Fractures of other carpal bones
Triquetrum
Hamate
Wrist dislocations ( Fig. 5-53)
Scapholunate Dissociation (Stage 1)
Perilunate Dislocation (Stage 2) ( Fig. 5-54)
Midcarpal Dislocation (Stage 3)
Lunate Dislocation (Stage 4)
Carpal instability ( Figs. 5-55 & 5-56)
Scapholunate Dissociation
Volar Intercalated Segment Instability (VISI)
Dorsal Intercalated Segment Instability (DISI)
Scapholunate advanced collapse (SLAC)
CT of the wrist
Evaluation of distal radial fractures ( Fig. 5-57)
Hand anatomy ( Fig. 5-58)
First metacarpal fractures ( Fig. 5-59)
Bennett Fracture
Rolando Fracture
Boxer's fracture ( Fig. 5-60)
Gamekeeper's thumb (skier's thumb) ( Fig. 5-61)
Stener's lesion
Phalangeal avulsion injuries ( Fig. 5-62)
Baseball (Mallet) Finger
Boutonnière (Buttonhole) Finger
Avulsion of Flexor Digitorum Profundus
Volar Plate Fracture
Lower Extremity
Hip anatomy ( Figs. 5-63 & 5-64)
Pelvic Fractures ( Fig. 5-65, A & B)
Classification
Fracture of the acetabulum ( Fig. 5-66, A-C)
Classification (Letournel)
Sacral fractures ( Fig. 5-66, D & E)
Soft tissue injury ( Fig. 5-67)
Fractures of the proximal femur ( Figs. 5-68 & 5-69)
Classification
Femoral neck fractures
Treatment
Complications
Intertrochanteric femoral fractures
Treatment
Complications
Dislocation of the hip joint
Classification ( Fig. 5-71)
Fracture of the distal femur
Classification
Fracture of the proximal tibia
Classification (Müller) ( Fig. 5-72)
Radiographic Features
Complications
Tibial stress fracture
Fracture of the patella
Osteochondral & chondral fracture
Radiographic Features
Osteochondritis dissecans (chronic osteochondral fracture)
Radiographic Features
Patellar dislocation
Radiographic Features
Patellar tendinitis (jumper's knee)
Meniscal injury ( Fig. 5-73)
Types
MRI Grading of Tears ( Fig. 5-74)
Pitfalls of Diagnosing Meniscal Tears by MRI ( Fig. 5-75)
Discoid meniscus
Meniscal calcifications
Meniscal cysts
Cruciate ligament tears ( Fig. 5-76)
Radiographic Features
Segond fracture ( Fig. 5-77)
Reverse segond fracture
Collateral ligaments
Radiographic Features ( Fig. 5-78)
Tendon injury
Radiographic Features
Knee dislocation
Ankle
Ankle anatomy ( Fig. 5-79)
Ankle fractures
Classification ( Fig. 5-80)
Approach
Tibial fractures
Pilon Fracture ( Fig. 5-81)
Tillaux Fracture ( Fig. 5-82)
Wagstaffe-Le Fort Fracture
Triplanar Fracture ( Fig. 5-83)
Tibial Insufficiency Fracture ( Fig. 5-84)
Fibular injury
Anatomy of Ligaments ( Figs. 5-85 & 5-86)
Tear of the Medial Collateral Ligament ( Fig. 5-87)
Tear of the Lateral Collateral Ligament
Tear of the Distal Anterior Tibiofibular Ligament
Maisonneuve Fracture
Foot
Anatomy ( Fig. 5-88)
Calcaneal fractures ( Fig. 5-89)
Lover's Fracture
Radiographic Features
Calcaneal Stress Fractures ( Fig. 5-90)
Achilles Tendon Tear
Freiberg Infraction ( Fig. 5-91)
Talar Fractures
Jones Fracture (Dancer's Fracture)
Nutcracker Fracture of Cuboid
Lisfranc fracture-dislocation ( Fig. 5-92)
Radiographic Features
Orthopedic Procedures
Joint replacement
Prosthetic loosening
Radiographic Features
Other Complications
HIP replacement ( Fig. 5-93)
Types of Prostheses
Types of Replacements ( Fig. 5-94)
Pearls
Knee replacement ( Fig. 5-95)
Types
Other procedures
Arthrodesis
Osteotomy
Bone Graft
Spinal fusion
Types
Arthrography
General
General Principles
Indications
Contraindications
Complications
Preparation
Type of Arthrogram
Shoulder arthrogram ( Fig. 5-96)
Patient Position
Procedure
Pearls
MR arthrography of the shoulder
HIP arthrogram ( Fig. 5-97)
Injection Site
Wrist arthrogram ( Fig. 5-98)
Ankle arthrogram ( Fig. 5-99)
Biopsies of the Musculoskeletal System
Indications
Contraindications
Technique
Complications
Percutaneous Periradicular Steroid Injection
Indications
Technique
Complications
Percutaneous cementoplasty
Indications
Contraindications
Complications
Bone Tumors
General
Approach to tumors ( Fig. 5-100)
Pattern of Bone Destruction ( Fig. 5-101)
Radiographic Patterns of Lytic Bone Lesions
Pattern of Bone Repair ( Fig. 5-102)
Tissue Characterization
Pearls ( Fig. 5-103)
Location of a Lesion in the Skeleton
Location within Anatomic Regions
Axial Location within a Bone ( Fig. 5-104)
Incidence
Bone biopsies
Bone-Forming Tumors
Osteoid osteoma
Radiographic Features
Osteoblastoma
Location
Radiographic Features
Other benign bone-forming lesions
Bone Island (Enostosis)
Osteopoikilosis
Osteopathia striata
Osteoma
Osteosarcoma (OSA)
Clinical findings
Types
Location of Conventional OSA
Radiographic Features
Pearls
Telangiectatic OSA
Radiographic Features
Multicentric OSA
Parosteal OSA
Radiographic Features
Periosteal Osteosarcoma
Radiographic Features
Cartilage-Forming Tumors
Enchondroma
Location
Radiographic Features
Pearls
Enchondromatosis (ollier disease)
Radiographic Features
Maffucci syndrome
Osteochondroma (osteocartilaginous exostosis) ( Fig. 5-105)
Radiographic Features
Complications
Multiple osteocartilaginous exostoses (MOCE)
Bizarre parosteal osteochondromatous proliferation (BPOP, NORA lesion) ( Fig. 5-106)
Dysplasia epiphysealis hemimelica (trevor disease)
Chondroblastoma (codman tumor)
Chondromyxoid fibroma
Chondrosarcoma
Radiographic Features
Fibrous Lesions
Fibrous cortical defects (FCD) & nonossifying fibroma (NOF)
Radiographic Features ( Fig. 5-107)
Fibrous dysplasia (lichtenstein-jaffe disease)
Associations
Types
Radiographic Features
Variants ( Fig. 5-108)
Complications
Pearls
Ossifying fibroma
Radiographic Features
Desmoplastic fibroma (intraosseous desmoid)
Radiographic Features
Malignant fibrous histiocytoma (MFH)
Location
Radiographic Features
Fibrosarcoma
Liposclerosing myxofibrous tumor (LSMFT)
Radiographic Features
Bone Marrow Tumors
Marrow conversion
Eosinophilic granuloma (EG)
Radiographic Features
Extraskeletal Manifestation
Multiple myeloma
Clinical Findings
Types ( Fig. 5-110)
Radiographic Features
Complications
Poems syndrome
Ewing tumor
Location
Radiographic Features
Primary lymphoma
Radiographic Features
Metastases
General
Spread of Metastases
Radiographic Features
Secondary lymphoma
Radiographic Features
Other Bone Tumors
Unicameral (simple) bone cyst (UBC) ( Fig. 5-111)
Location
Radiographic Features
Aneurysmal bone cyst (ABC) ( Fig. 5-112)
Location
Radiographic Features
Hemophiliac pseudotumor
Radiographic Features
Giant cell tumor ( Fig. 5-113)
Radiographic Features
Intraosseous hemangioma
Radiographic Features
Adamantinoma
Radiographic Features
Chordoma
Location
Radiographic Features
Intraosseous lipoma
Hemangioendothelioma
Angiosarcoma
Massive osteolysis (gorham disease)
Radiographic Features
Glomus tumor
Miscellaneous Lesions
Mastocytosis
Myeloid metaplasia (myelofibrosis)
Radiographic Features
Pyknodysostosis ( Fig. 5-114)
Radiation-induced changes
Bone Growth
Osteonecrosis
Radiation-Induced Bone Tumors
Soft tissue masses & tumors
Nodular Fasciitis
Fibroma of the Tendon Sheath
Elastofibroma
Fibromatoses
Malignant Fibrous Histiocytoma
Liposarcoma
Synovial Cell Sarcoma
Lipoma arborescens
Synovial (osteo)chondromatosis
Pigmented villonodular synovitis (PVNS)
Radiographic Features
Arthritis
General
Approach
Types of Arthritis ( Fig. 5-115)
Degenerative Arthritis
General
Clinical Findings
Radiographic Features ( Fig. 5-116)
Treatment Options
Osteoarthritis in specific locations
Hip
Knee
Hand ( Fig. 5-117)
Spine ( Fig. 5-118)
Erosive osteoarthritis
Radiographic Features ( Fig. 5-119)
Degenerative disk disease
Radiographic Features
Spondylosis deformans ( Fig. 5-120)
Diffuse idiopathic skeletal hyperostosis (dish, forestier disease)
Radiographic Features
Inflammatory Arthritis
General
Adult rheumatoid arthritis
Epidemiology
Diagnosis
Radiographic Features ( Fig. 5-121)
Extraarticular Manifestations of Rheumatoid Arthritis
Rheumatoid arthritis in specific locations
Hand ( Fig. 5-122)
Shoulder ( Fig. 5-123)
Hip
Spine
Scleroderma (systemic sclerosis)
Radiographic Features
Systemic lupus erythematosus (SLE) ( Fig. 5-124A)
Radiographic Features
Dermatomyositis ( Fig. 5-124B)
Ankylosing spondylitis (AS)
Radiographic Features ( Fig. 5-125)
Associations
Differentiation of lumbar osteophytes
Osteophytes
Syndesmophytes
Reiter syndrome ( Figs. 5-126 through 5-128)
Clinical Findings
Radiographic Features
Psoriatic arthritis
Types ( Fig. 5-129)
Radiographic Features
Pearls
Enteropathic arthropathies
Metabolic Arthritis
General ( Fig. 5-130)
Presentations
Types
Gout ( Fig. 5-131)
Causes
Radiographic Features ( Fig. 5-132)
Calcium pyrophosphate dihydrate deposition (CPPD) disease
Terminology
Radiographic Features ( Fig. 5-133)
Associations
Basic calcium phosphate (BCP) deposition disease
Radiographic Features
Hemochromatosis arthropathy
Radiographic Features
Wilson disease
Radiographic Features
Intraarticular hydroxyapatite crystal deposition disease: milwaukee shoulder
Radiographic Features
Alkaptonuria (ochronosis)
Radiographic Features
Amyloid arthropathy
Radiographic Features
Multicentric reticulohistiocytosis
Radiographic Features
Hemophilia
Radiographic Features
Tumoral calcinosis
Infectious Arthritis
General
Organism
Radiographic Features
Tuberculous arthritis
Radiographic Features
Disk space infection
Radiographic Features
Spectrum of osteomyelitis & septic arthritis on plain film
Neuropathic arthritis (charcot joint)
Causes
Radiographic Features
Metabolic Bone Disease
General
Osteopenia
Types
Osteoporosis
Classification
Radiographic Features ( Fig. 5-134)
Quantitative Bone Densitometry ( Fig. 5-135)
Transient osteoporosis of hip joint
Osteomalacia
Radiographic Features
Renal osteodystrophy
Radiographic Features
Scurvy
Radiographic Features ( Fig. 5-137)
Endocrine Bone Disease
Hyperparathyroidism (HPT)
Radiographic Features ( Fig. 5-138)
Thyroid acropachy
Radiographic Features
Acromegaly ( Fig. 5-139)
Radiographic Features
Bone Marrow Disease
Classification
Gaucher disease
Clinical Findings
Radiographic Features ( Fig. 5-140)
Complications
Sickle cell anemia
Clinical Findings
Radiographic Features ( Fig. 5-141)
Thalassemia (cooley anemia)
Radiographic Features
Myelofibrosis
Clinical Findings
Radiographic Features
Paget disease (osteitis deformans) ( Fig. 5-142)
Stages
Clinical Findings
Radiographic Features
Complications
Pearls
Osteonecrosis
Radiographic Features
Complications
Kienböck disease
Radiographic Features
Spontaneous osteonecrosis of the knee
Differential Diagnosis
Focal Bone Lesions
Focal lesions
Bone tumors
Malignant Bone Tumors by Age
Bubbly lesions of the bone (helms)
Lytic epiphyseal lesions ( Fig. 5-143)
Sclerotic metastases
Permeative lesions in children
Permeative lesions in adults
Cortical saucerization
Bony sequestrum
Malignant transformation of bony lesions
Focal sclerotic lesion
Osteonecrosis
Joints
Degenerative joint disease (DJD)
Inflammatory arthritis
Jaccoud arthropathy
Periarticular osteopenia
Subchondral cysts
Acroosteolysis ( Fig. 5-144)
New bone formation in arthritis
Calcifications & arthropathy ( Fig. 5-145)
Chondrocalcinosis
Soft tissue swelling in arthritis
Differential diagnosis of arthritis by distribution
Monoarticular arthritis
Neuropathic Joint
Clinical Syndromes Associated with Arthropathies
Atlantoaxial Subluxation
Bone Density
Diffuse osteosclerosis (dense bones)
Osteopenia
Multiple sclerotic lesions
Periosteum
Asymmetrical periosteal reaction
Symmetrical periosteal reaction in adults
Hypertrophic pulmonary osteoarthropathy (HPO)
Causes
Skull
Solitary lytic lesion
Diffuse skull lesions
Multiple lytic lesions
Basilar invagination
Spine ( Fig. 5-146)
Vetebral body
Sclerotic pedicle
Vertebral outgrowths ( Fig. 5-147)
Posterior spinal fusion
Vertebral Body Lesion
Posterior element lesion
Solitary vertebral lesions
Posterior vertebral scalloping
Calcified disks
Anterior vertebral scalloping
Anterior vertebral body beak ( Fig. 5-148)
Platyspondyly
Pelvis
Protrusio acetabuli ( Fig. 5-149)
Sacroiliitis
Lytic lesions of the sacrum
Lytic lesion of ilium
Widened pubic symphysis
Lower Extremity
Gracile bones ( Fig. 5-151)
Femoral head AVN
Medial tibial spur ( Fig. 5-152)
Tibial diaphyseal cortical lesion
Heel pad thickening
Well-circumscribed lytic lesion in calcaneus
Pseudoarthrosis with bent/bowed bones
Digit overgrowth
Widened intercondylar notch
Upper Extremity
Lytic lesion of the finger
Digital amputation
Hooked osteophyte (hand)
Enlarged epiphysis
Spade tufts
Expanded marrow (hand)
Arachnodactyly
Ulnar deviation
Radial hypoplasia
Short 4th/5th metacarpals
Madelung deformity ( Fig. 5-153)
Missing distal clavicle
High-riding shoulder
Distal clavicular erosions
Soft Tissues
Soft tissue calcification
Soft tissue masses
Psoas abscess
Suggested Readings
6.
Neurologic Imaging
Imaging Anatomy
Parenchymal Anatomy
Lobar anatomy
Basal ganglia
Thalamus
Central sulcus (CS)
Inferior frontal gyrus anatomy
Brain myelinization
Characteristic MRI Appearance
Ventricular System
Anatomy
Cavum variants
Cavum Septum Pellucidum
Cavum Vergae
Cavum Velum Interpositum
Pineal region anatomy
Sella Turcica
Pituitary gland
Suprasellar cistern
Cavernous sinus
Meckel's cave (trigeminal cave)
Vascular System
External carotid artery (ECA)
Internal carotid artery (ICA)
Vertebrobasilar system
Segments & Branches of Vertebral Arteries
Circle of willis
Cerebral arteries
Anterior Cerebral Artery (ACA)
Middle Cerebral Artery (MCA)
Posterior Cerebral Artery (PCA)
Normal variants of vascular anatomy
Internal Carotid Artery
External Carotid Artery
Circle of Willis
Anastomoses between arteries
Meninges & venous sinuses
Meningeal Spaces
Sinuses
Vascular territories
US of carotid arteries
B-Mode Imaging
Doppler Imaging (Flow)
Color Doppler Ultrasound
Pearls
Transcranial doppler (TCD)
Spine
Spinal canal
Neural structures
Vascular Disease
Intracranial Hemorrhage
Ct Appearance Of Intracranial Hemorrhage
MRI appearance of intracranial hemorrhage
Hypertensive hemorrhage
Location
Imaging Features
Tumor hemorrhage
Aneurysm
Types
Saccular aneurysm
Imaging Features
Complications
Giant aneurysm
Clinical Findings
Imaging Features
Infectious (mycotic) aneurysm
Causes
Imaging Features
Fusiform (atherosclerotic) aneurysm
Imaging Features
Complications
Dissecting aneurysm
Imaging Features
Subarachnoid hemorrhage (SAH)
Causes
Imaging Features
Complications
Vascular Malformation
Types of vascular malformations
Arteriovenous malformation (AVM)
Types
Imaging Features
Spetzler's Criteria
Complications
Capillary telangiectasia
Imaging Features
Cavernous malformation
Clinical Findings
Imaging Features
Venous anomaly (anomalous vein)
Imaging Features
Vein of galen AVM
Imaging Features
Causes
Stroke
Atherosclerotic disease
Imaging Features
Cerebral ischemia & infarction
Causes
Imaging Features
Pearls
Diffusion & perfusion imaging in stroke
Interpretation
Role of CT/CTA in acute stroke
Technique
Therapeutic options
Lacunar infarcts
Imaging Features
Basilar artery thromboembolic occlusion
Risk Factors
Top of Basilar Artery Syndrome
Imaging Features
Central nervous system (CNS) vasculitis
Causes
Imaging Features
Moyamoya DISEASE
Imaging Features
Amyloid angiopathy
Imaging Features
Cadasil
MRI Features
Venoocclusive disease
Venous sinus thrombosis
Causes
Imaging Features
Trauma
General
Classification of injury
Mechanism of traumatic brain injury (TBI)
Glasgow coma scale
Score
Primary Brain Injury
Epidural hematoma (EDH)
Types
Imaging Features
Subdural hematoma (SDH)
Imaging Features
Subdural hygroma
Imaging Features
Diffuse axonal injury (DAI)
Imaging Features
Cortical contusion
Imaging Features
Secondary Brain Injury
Cerebral herniation
Types
Imaging Features
Diffuse cerebral edema
Imaging Features
Arterial dissection
Underlying Causes
Imaging Features
Complications
Carotid-cavernous sinus fistula (CCF)
Types
Imaging Features
Neoplasm
General
Classification of primary brain tumors
Pearls
Location
Frequency of tumors
Tumor extent
Brain edema
Mass effect
MR Spectroscopy
Gliomas
Astrocytomas
Classification
Associations
Low-grade astrocytoma (AI, AII)
Imaging Features
Anaplastic astrocytoma (AAIII)
Imaging Features
Glioblastoma multiforme (GBM)
Imaging Features
Gliomatosis cerebri
Imaging Features
Brainstem glioma
Clinical Findings
Imaging Features
Pilocytic astrocytoma
Imaging Features
Pleomorphic xanthoastrocytoma
Imaging Features
Oligodendroglioma
Imaging Features
Ependymal tumors
Ependymoma
Imaging Features
Differential Diagnosis for Supratentorial Ependymoma
Subependymoma
Choroid plexus papilloma/carcinoma
Imaging Features
Meningeal & Mesenchymal Tumors
Meningioma
Classification
Location
Imaging Features
Malignant meningioma
Hemangioblastoma
Cerebellar Hemangioblastoma, 80%
Spinal Hemangioblastoma, 10%
Neuronal & Mixed Glial/Neuronal Tumors
Ganglioglioma/ganglioneuroma
Dysembryoplastic neuroepithelial tumor (DNET)
Central neurocytoma
Primitive neuroectodermal tumor (PNET)
Types
Medulloblastoma
Imaging Features
Primary cerebral neuroblastoma
Imaging Features
Dysplastic gangliocytoma of cerebellum (Lhermitte Duclos)
Nerve Sheath Tumors
Schwannoma
Imaging Features
Pearls
Neurofibroma
Pineal Region Tumors
Germinoma
Teratoma
Pinealoblastoma
Pineocytoma
Tumor-like Lesions
Epidermoid/Dermoid
Hypothalamic (tuber cinereum) hamartoma
Imaging Features
Lipoma
Imaging Features
Hematopoietic Tumors
Central nervous system lymphoma
Types
Imaging Features
AIDS-related primary cns lymphoma
Imaging Features
Pearls
Metastases
Carcinomatous meningitis
Cystic Lesions
Arachnoid cyst (leptomeningeal cyst)
Imaging Features
Colloid cyst
Clinical Findings
Imaging Features
Rathke's cleft cyst
Imaging Features
Pineal cyst
Neuroepithelial/neuroglial cysts
Degenerative & White Matter Disease
General
Classification of degenerative diseases
Degeneration & aging
White Matter Disease
Classification
Multiple sclerosis (MS)
Imaging Features
Acute disseminated encephalomyelitis (ADEM)
Posterior reversible encephalopathy syndrome (PRES)
Common Causes
Radiation/chemotherapy-induced CNS abnormalities
Common Causes
Central pontine myelinolysis (CPM)
Imaging Features
Leukodystrophies
General Categories
Imaging Features
Metachromatic leukodystrophy
Imaging Features
Adrenoleukodystrophy (ALD)
Imaging Features
Gray Matter Disease
Dementia
Types
Senile dementia, alzheimer type (SDAT)
Imaging Features
FRONTOTEMPORAL DYSPLASIA (Pick disease)
Vascular cortical dementia
Types
Parkinson disease
Clinical Findings
Types
Imaging Features
Parkinson plus syndromes (patients who respond poorly to antiparkinson'S medication) ( Fig. 6-62)
Multisystem Atrophy (MSA)
Progressive Supranuclear Palsy (PSP)
Imaging Features
Amyotrophic lateral sclerosis (ALS)
Basal Ganglia Disorders
Basal ganglia calcification
Causes
Huntington chorea
Imaging Features
Wilson disease
Imaging Features
Fahr disease
Leigh disease
Imaging Features
Neurosarcoidosis
Radiologic Features
Toxic/Infectious
Creutzfeldt-jakob disease (CJD)
Imaging Features
Carbon monoxide poisoning
Alcoholic & wernicke encephalopathy
Imaging Features
Seizure medication
Hydrocephalus
General
Classification
Approach
Shunt complications
Causes
Imaging Features
Causes
Imaging Features
Noncommunicating Hydrocephalus
Communicating Hydrocephalus
Normal pressure hydrocephalus (NPH)
Imaging Features
Spontaneous intracranial hypotension
Infection
General
Classification by infectious agent
Classification by location of infection
Bacterial Infections
Bacterial meningitis
Causes
Imaging Features
Complications
Tuberculous meningitis
Imaging Features
Empyema
Imaging Features
Brain abscess
Common Organism
Mechanism
Imaging Features
Imaging Features
Fungal Infections
Parasitic Infections
Neurocysticercosis
Imaging Features
Lyme disease
Viral Infections
Herpes simplex virus (HSV) encephalitis
Imaging Features
Congenital infections
Causes
Imaging Features
Aids
HIV encephalopathy
Imaging Features
Toxoplasmosis
Imaging Features
Cryptococcosis
Progressive multifocal leukoencephalopathy (PML)
Imaging Features
CMV encephalitis
Congenital Disease
General
Classification
Neural Tube Closure Defects
Chiari malformations
Overview of Chiari Malformations
Chiari I Malformation
Clinical Findings
Associations
Imaging Features
Chiari II Malformation
Associations
Imaging Features
Cephalocele
Location
Cerebral Hemisphere Defects
Agenesis of corpus callosum (ACC)
Imaging Features
Holoprosencephaly
Facial Abnormalities
Pearls
Imaging Features
Cerebral hemiatrophy (dyke-davidoff)
Imaging Features
Interhemispheric lipoma
Associations
Imaging Features
Septooptic dysplasia
Imaging Features
Migration & Sulcation Abnormalities
Lissencephaly (smooth brain surface)
Schizencephaly (split brain)
Polymicrogyria
Cortical heterotopia
Hemimegalencephaly
Posterior Fossa Malformations
Dandy-walker malformation
Clinical Findings
Associations
Imaging Features
Dandy-walker variant
Imaging Features
Phakomatoses
Neurofibromatosis
Diagnostic Criteria
Imaging Features of NF1
Imaging Features of NF2
Pearls
Von hippel-lindau (VHL) disease
Clinical Findings
Imaging Features
Pearls
Tuberous sclerosis (bourneville disease)
Imaging Features
Sturge-weber-dimitri syndrome (encephalotrigeminal angiomatosis)
Clinical Findings
Imaging Features
Mesial temporal sclerosis
Imaging Features
Sellar & Juxtasellar Regions
Neoplasm
Pituitary adenoma
Functioning pituitary microadenoma
Types
Imaging Features
Nonfunctioning pituitary macroadenoma
Imaging Features
Craniopharyngioma
Clinical Findings
Types
Imaging Features
Pearls
Other
Empty sella
Postsurgical sella
Imaging Features
Ectopic neurohypophysis
Pituitary apoplexy
Causes
Spine
Congenital
Spinal dysraphism
Classification
Dorsal dermal sinus
Lipomyelomeningocele
Clinical Findings
Imaging Features
Tethered spinal cord
Clinical Findings
Imaging Features
Diastematomyelia (one of the “split notochord syndromes”)
Associations
Other
Imaging Features
Hydrosyringomyelia
Infection
Spondylitis & diskitis
Causes
Imaging Features
Spinal tuberculosis (pott disease)
Arachnoiditis
Causes
Imaging Features
Guillain-barré syndrome
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Degenerative Abnormalities
Disk herniation
Spectrum of Intervertebral Disk Herniation
Posterior disk herniation
Imaging Features
MRI Features
Spinal stenosis
Causes
Imaging Features
Spinal block
Foraminal stenosis
Postoperative spine
Imaging Features
Acute transverse myelopathy
Imaging Features
Subacute combined degeneration
Tumors ( Fig. 6-93)
Approach
Intramedullary tumors
Types
Imaging Features
Astrocytoma
Imaging Features
Ependymoma
Imaging Features
Hemangioblastoma
Imaging Features
Metastases
Nerve sheath tumors
Types
Imaging Features
Synovial cyst
Neoplasms of the filum terminale
Vertebroplasty/kyphoplasty ( Fig. 6-94)
Indications
Absolute Contraindications
Risks
Kyphoplasty
Differential Diagnosis
Tumors
Approach to intracranial mass lesion ( Fig. 6-95) stir
Extraaxial masses ( Fig. 6-96)
Intraaxial masses ( Fig. 6-97)
Multiple lesions
Corpus callosum lesions
Intrasellar masses ( Fig. 6-98)
Suprasellar masses
Thickened enhancing pituitary stalk
Posterior fossa tumors
Approach
Causes
Brain tumors in infants (≤ 2 years)
Intraventricular tumors ( Fig. 6-99)
Cerebellopontine angle (CPA) mass
Pineal region mass
Cystic masses
Tumors with CSF seeding
Underlying causes of hemorrhage
Etiology of intraaxial (intraparenchymal) hemorrhage
Hyperdense lesion (CT)
T2W hypointense lesions (MRI)
T1W hyperintense lesions (MRI)
Temporal lobe T2W hyperintense lesions
Multiple susceptibility hypointense lesions (MRI)
Abnormal Enhancement
Lesions with no enhancement
Lesions with strong enhancement
Ring enhancement
Diffuse meningeal enhancement
Basilar meningeal enhancement
Ependymal enhancement ( Fig. 6-100)
Normally enhancing structures
Diffuse sulcal flair hyperintensity
Basal Ganglia Signal Abnormalities
T2W hypointense basal ganglia lesions
T2W hyperintense basal ganglia lesions
T1W hyperintense basal ganglia lesions
Basal ganglia calcification (increased CT density)
Neurodegenerative diseases
Volume loss
Focal T2 abnormalities+
Dwi+
Congenital Abnormalities
Spectrum of cystic supratentorial congenital abnormalities ( Fig. 6-101)
Posterior fossa cystic abnormalities
Spine
Spinal cord compression
Criteria
Causes
Intramedullary lesions
Intradural extramedullary tumors
Extradural lesions
Cystic spinal lesion (syringohydromyelia) ( Fig. 6-102)
Causes
Enhancing nerve roots in the filum terminale
Suggested Readings
7.
Head & Neck Imaging
Temporal Bone
General
External auditory canal (EAC)
Middle ear
Inner ear
Internal auditory canal (IAC)
Facial nerve
Skull base
Cranial nerves
Trauma
Temporal bone fractures
Clinical Findings
Radiographic Features
Fracture Complications
Indications for Surgery in Temporal Bone Fractures
Inflammation
Acute inflammation
Complications
Bell palsy
Mastoiditis
Types
Acquired cholesteatoma
Radiographic Features
Complications of Acquired Cholesteatoma
Congenital cholesteatoma (epidermoid)
Radiographic Features
Cholesterol granuloma (cholesterol cysts)
Radiographic Features
Malignant external otitis
Radiographic Features
Labyrinthitis ossificans
Hearing loss
Types
Pulsatile tinnitus
Causes
Tumors
Glomus tumors
Types
Clinical Findings
Radiographic Features
Benign temporal bone tumors
Malignant temporal bone tumors
Congenital Anomalies
Overview of syndromes
Congenital abnormalities of the inner ear
Petrous malformations associated with recurrent meningitis
Otodystrophies & Dysplasias
Otosclerosis
Types
Superior semicircular canal dehiscence syndrome (tullio syndrome)
Causes
Other otodystrophies & dysplasias
Orbit
General
Orbital Spaces
Orbital Structures
Orbital Septum
Globe
Retinoblastoma
Radiographic Features
Pearls
Melanoma
Radiographic Features
Persistent hyperplastic primary vitreous (PHPV)
Radiographic Features
Retrolental fibroplasia
Coats disease
Radiographic Features
Drusen
Globe-shape abnormalities
Leukokoria
Retinal detachment
Choroidal detachment
Optic Nerve
Optic nerve glioma
Radiographic Features
Optic nerve meningioma
Radiographic Features
Optic neuritis
Clinical Findings
Causes
Radiographic Features
Extraocular Tumors
Hemangioma
Types
Dermoid cyst
Radiographic Features
Lymphangioma
Radiographic Features
Lacrimal gland tumors
Rhabdomyosarcoma
Radiographic features
Metastases
Inflammatory & Infiltrative Lesions
Orbital infection
Radiographic Features
Thyroid ophthalmopathy
Radiographic Features
Orbital pseudotumor
Clinical Findings
Causes
Radiographic Features
Acute infections
Trauma
Other
Erdheim-chester disease
Ocular manifestations of phakomatoses
Pharynx, Larynx
General
Anatomy
Axial CT anatomy
Parapharyngeal space
Contents
Lymphatics
Paraganglia
Fluoroscopic vocal cord examination
Nodal stations
Pathologic Adenopathy Size Criteria
Nasooropharynx
Thornwaldt cyst
Radiographic Features
Retropharyngeal abscess
Radiographic Features
Juvenile angiofibroma
Clinical Findings
Radiographic Features
Pearls
Squamous cell carcinoma (SCC)
Location
Radiographic Features
Staging of Nasopharyngeal SCC
Pearls
Other neoplasms
Hypopharynx, Larynx
Vocal cord paralysis
Radiographic Features
Laryngocele
Laryngeal trauma
Cause
Benign laryngeal tumors
Laryngeal carcinoma
Histology
Types
Radiographic Features
Pearls
Postsurgical larynx
Vertical Hemilaryngectomy
Horizontal Hemilaryngectomy (Supraglottic)
Total Laryngectomy
Radical Neck Dissection
Parapharyngeal Space
Branchial cleft cyst
Radiographic Features
Thyroglossal duct cyst
Location
Radiographic Features
Glomus tumors (paraganglioma, chemodectoma)
Sinuses, Nasal Cavity
General
Sinuses
Osteomeatal Complex (OMC)
Cells
Anatomic Variation (may potentially lead to obstruction)
Nasofrontal Duct
Anatomic spaces
Pterygopalatine Fossa
Sphenopalatine Foramen
Pterygoid (Vidian) Canal
Foramen Lacerum
Sinuses
Acute sinusitis
Types
Radiographic Features
Pearls
Mucus retention cyst
Radiographic Features
Polyps
Radiographic Features
Destructive sinusitis
Causes
Fungal sinusitis
Radiographic Features
Mucocele
Radiographic Features
Inverted papilloma
Benign tumors
Malignant tumors
Types
Tumor Spread
Endoscopic sinus surgery
Nose
Cocaine septum
Rhinolith
Sincipital encephalocele
Nasal glioma
Glands & Periglandular Region
General
Floor of mouth
Superficial neck anatomy
Glandular structures in neck
Salivary Glands
Sialolithiasis (calculi)
Radiographic Features
Sialosis
Sialoadenitis
Acute Sialoadenitis
Chronic, Recurrent Sialoadenitis
Granulomatous Inflammation
Sjögren disease
Clinical Findings
Radiographic Features
Cystic salivary lesions
Parotid tumors
Types
Pleomorphic adenoma (mixed tumor)
Radiographic Features
Malignant tumors
Radiographic Features
Parathyroid
Hyperparathyroidism
Types
Clinical Findings
Effect of PTH
Radiographic Features
Parathyroid adenoma
Radiographic Features
Hypoparathyroidism
Cause
Radiographic Features
Thyroid
Thyroid nodule
Surgical Removal
Thyroid follicular adenoma
Thyroiditis
Radiographic Features
Graves disease (diffuse goiter)
Radiographic Features
Thyroid cancer
Risk Factors
Poor Prognostic Factors
Staging
Radiographic Features
Medullary Thyroid Cancer
Mandible & Maxilla
Cystic Masses
Overview
Odontogenic Cysts
Dentigerous cyst (follicular cyst)
Radiographic Features
Odontogenic keratocyst
Radiographic Features
Osteoradionecrosis
Benign Tumors
Overview
Ameloblastoma (adamantinoma)
Odontoma
Odontogenic myxoma
Cementoma
Basal cell nevus (gorlin) syndrome
Malignant Tumors
Overview
Primary odontogenic malignancies
Classification
Temporomandibular Joint
Anatomy
Disk displacement
Types
Degenerative changes of TMJ
Differential Diagnosis
Temporal Bone
Approach
Soft tissue mass in middle ear
Vascular mass in middle ear
Intracanalicular internal auditory canal masses
Jugular fossa mass
Mastoid bone defect
Petrous apex lesions
Orbit
Approach to orbital masses
Orbital masses by etiology
Extraconal disease
Intraconal disease
Vascular orbital lesions
Optic nerve sheath enlargement
Tramtrack enhancement of orbital nerve
Third nerve palsy
Ocular muscle enlargement
Cystic lesions of the orbit
T1W hyperintense orbital masses
Globe calcifications
Sudden onset of proptosis
Lacrimal gland enlargement
Diffuse bone abnormality
Sinuses
Radiopaque sinus
Nasooropharynx
Mucosal space mass
Parapharyngeal & carotid space masses
Prevertebral mass
Neck
Cystic extrathyroid lesions
Cystic thyroid lesions
Solid neck mass
Vascular head & neck masses
Aids
Suggested Readings
8.
Vascular Imaging
Techniques
General
Preprocedure evaluation
Access
Types of Arterial Approaches
Right Femoral Approach (Preferred)
Standard Femoral Approach: Seldinger Technique
Advantage of Puncturing Symptomatic Extremity
Disadvantage of Puncturing Symptomatic Extremity
Axillary Artery Approach
Translumbar Approach (TLA)
Antegrade Femoral Approach
Angiography complications
Puncture Site Complications
Contrast Complications
Catheter-Related Complications
Pearls
Hardware
Catheters
Generic Types
Measurements
Material
Pearls
Guidewires
Measurements
Pharmacologic Manipulation
Angiographic Interventions
Embolization
Indication
General Principles
Embolic Agents
Complications
Hepatic chemoembolization
Hepatic radioembolization
General Principles
Techniques
Contraindications
Indication
General Principles
Prognostic Indicators
PTA Results
Complications
Thrombolysis
Angioplasty
Intravascular stents
Indications for Metallic Stents
Indications for Stents in Revascularization Procedures
Stent Results
Transjugular intrahepatic portosystemic shunt (TIPS)
Established Indications
Possible Future Indications
General Principles
Contraindications
Technique
Results
Complications
Signs of Malfunction
Transjugular liver biopsy
Technique
Venous Access
Central venous access catheters
Complications of central venous catheter placement
Vascular Ultrasound
General
Continuous wave doppler
Pulsed wave doppler
Power doppler us
Aliasing
Mri
Noncontrast imaging techniques
Gadolinium-enhanced MRA
Spinal GD-MRA
Other Techniques
Digital subtraction angiography (DSA)
Venous DSA
Arterial DSA
Petrosal vein sampling
Lymphography
Conscious Sedation
Coagulation
General
Normalization of prolonged coagulation times
Monitoring Heparin Therapy
Anticoagulation drugs & procedures
Heparin
Coumadin (Warfarin)
Fragmin (Dalteparin)
Argatroban
Arixtra (Fondaparinux)
Plavix (Clopidogrel)
ReoPro (Abciximab)
Other Antiplatelet Agents
Not recommended
Antibiotics
Thoracic Aorta & Great Vessels
General
Anatomy
Imaging principles
Ct
Mri
Aortography
Transesophageal Echocardiography
Thoracic Aortography Technique
Thoracic Aortic Aneurysm
General
Causes
Pearls
Atherosclerotic aneurysm
Complications
Radiographic Features
Ct
Cystic medial necrosis
Radiographic Features
Syphilitic aneurysms
Radiographic Features
Mycotic aneurysms
Aortic Dissection
General
Clinical Findings
Causes
Types
Treatment
Indications for Imaging
Goals of Imaging Studies
Angiographic Features
CT Features
MRI Features
Pearls
Variants
Aortic Wall Hematoma
Penetrating Aortic Ulcer
Chronic Dissection
Traumatic Aortic Injury
General
Location
Approach
Chest Radiograph
Ct
Angiography
Pearls
Aortitis
Takayasu arteritis (pulseless disease)
Types
Radiographic Features
Giant cell arteritis
Syphilitic aortitis
Complications
Radiographic Features
Abdomen & Pelvis
Abdominal Aorta
Anatomy
Abdominal aortic aneurysm (AAA)
Radiographic Features
Other abdominal aortic aneurysms
Inflammatory AAA
Mycotic AAA
Risk Factors
Aortoiliac occlusive disease
Radiographic Features
Abdominal aortic coarctation
Radiographic Features
Aortic Interventions & Surgery
Endovascular stent grafts
Endoleak Classification (White)
Types of grafts
Aortic bifurcation grafts (onlay grafts, inverted Y grafts)
Aortic Onlay Graft
End-to-End Y Graft
Wrapped graft (tube graft)
Surgical graft complications
Infrainguinal graft failure
Mesenteric Vessels
Celiac axis
Hepatic vasculature
Hepatic Arteries
Hepatic Veins
Splenic artery
Branches
Superior mesenteric artery (SMA)
Branches
Inferior mesenteric artery (IMA)
Branches
Mesenteric collaterals
Pelvic arteries
Upper GI hemorrhage
Causes
Radiographic Features
Angiographic Intervention
Lower GI hemorrhage
Causes
Radiographic Features
Angiographic Intervention
Intestinal ischemia
Causes
Radiographic Features
Angiodysplasia
Radiographic Features
Median arcuate ligament syndrome
Radiographic Features
Varicocele
Liver
Arterial imaging
Venous imaging
Indications
Imaging Modalities
Portal hypertension
Causes
Radiographic Features
Portal vein thrombosis
Causes
Complications
Radiographic Features
Angiography
Splenic Vein Occlusion (Isolated)
Budd-Chiari syndrome (BCS)
Causes
Radiographic Features
Treatment
Kidneys
Anatomy
Arteries
Variants
Veins
Indications for renal angiography
Diagnostic Renal Arteriography
Renal Venography
Angiographic Interventions
Renal artery stenosis (RAS)
Causes
Radiographic Features
Renal artery atherosclerosis
Radiographic Features
Fibromuscular dysplasia (FMD)
Distribution
Radiographic Features
Pearls
Renal arterial aneurysm
Polyarteritis nodosa (PAN)
Radiographic Features
Renal vein thrombosis
Causes
Radiographic Features
Spleen
Splenic artery aneurysm
Chest
General Anatomy
Pulmonary arteries
Thoracic veins
Angiographic Techniques
Pulmonary angiography
Indications
Technique
Pearls
Complications
Bronchial arteriography
Technique
Complications
Indication
Bronchial artery embolization
Indication
Technique
Complications
Risk Factors (same as for DVT)
CT Pulmonary Angiography (CTPA)
Pulmonary Thromboembolism
Indications for performing pulmonary angiography
Radiographic features
Other Pulmonary Vascular Diseases
Pulmonary arteriovenous malformation (AVM) or fistula (AVF)
Causes
Radiographic Features
Pulmonary artery pseudoaneurysm
Extremities
Anatomy
Lower extremity arteries
Branches
Collaterals
Persistent Sciatic Artery
Lower extremity veins
Upper extremity arteries
Branches
Lower Extremity
Lower extremity occlusive disease
Atherosclerotic occlusive disease
Radiographic Features
Treatment
Atherosclerotic aneurysmal disease
Clinical Findings
Arteriomegaly
Arterial thromboembolism
Causes
Radiographic Features
Treatment
Buerger disease
Location
Radiographic Features
Small vessel atherosclerosis
Cholesterol or atheroma emboli
Ergotism
Postcatheterization groin complications
Risk Factors
Radiographic Features
May-thurner syndrome
Uterine artery embolization
Endovenous laser treatment (EVLT) of varicose veins
Deep vein thrombosis (DVT)
Locations
Radiographic Features
Pearls
IVC filters
Types
Technique
Complications
Upper Extremity
General
Diseases
Technique
Thoracic outlet syndrome
Causes
Subclavian steal syndrome
Giant cell arteritis
Primary subclavian vein thrombosis
Radiographic Features
Treatment
Hypothenar hammer syndrome
AV fistulas for hemodialysis access
Major Disorders for AV Fistulas
Trauma
Indications for angiography in extremity trauma
Traumatic injuries
Pearls
Differential Diagnosis
General
Aneurysm
Ischemia
Peripheral vascular disease
Popliteal “dog-leg” sign (acute bend in the lumen of the popliteal artery)
Emboli
Angiographic tumor features
“Many vessels”
Thorax
Aortic enlargement
Aortic stenosis
Pulmonary artery stenosis
Asymmetrical pulmonary artery enlargement
Pulmonary venous hypertension
Diminished pulmonary artery
Pulmonary (pseudo)aneurysms
Subclavian steal
SVC obstruction
Abdomen
Hyperreninemic hypertension
Renal tumors
Renal arterial aneurysm
Soft tissue density around aorta
IVC tumor thrombus
Suggested Readings
9.
Breast Imaging
Breast Imaging Techniques
Mammography Techniques
Mammographic views
Mediolateral Oblique (MLO) View
Craniocaudal (CC) View
Exaggerated Craniocaudal (XCCL) View
Lateral Views: Mediolateral (ML) & Lateromedial (LM)
Axillary Tail View (Cleopatra View)
Cleavage Valley View
Spot Compression Views
Magnification Views
Tangential View
Rolled Views
Proper positioning
Pearls
Compression
Patient interaction
Obtain history
Mammography Interpretation
Viewing conditions
Image labeling
Double reading
Evaluation of the mammogram
Quality control
Mammography Reporting
Mass
Margins
Other Features
Calcifications
Malignant Calcifications
Benign Calcifications
Architectural distortion
Skin, nipple & trabecular changes
Abnormal ductal patterns
Breast lesions that arise in main segmental ducts
Breast lesions arising in terminal ducts
Lymph node abnormalities
Asymmetry of breast tissue
Skin calcifications
Dictation
Pearls
Reasons for missing breast cancer
Commonly missed lesions
Interpretation
Technique
Advantages
Limitations
Technique
Bi-Rads
Contrast Enhancement by MRI
Evaluation of Implants (see later section on implants in this chapter)
Evaluation of Malignancy
Ultrasound
Galactography
Mri
Biopsy
Needle localization for surgical biopsy/excision
Technique for localizing lesion seen only on a single view (triangulation)
Alternative Technique
Lesion seen on CT but not easily seen mammographically
Core biopsy
Indications
Technique
Specimen radiography
Breast Cancer
General
Incidence
Risk Factors
Screening
General
Health Insurance Plan (HIP) Study, New York
Breast Cancer Detection Demonstration Program (BCDDP)
Screening recommendations (ACR January 2010)
Prognosis
Breast cancer survival rate
Staging
Lymph Nodes
Staging System
Metastatic Spread
Sensitivity of detection
Specific Neoplasm
Pathology
Classification
Pearls
DCIS (comedocarcinoma, cribriform)
Invasive ductal carcinoma (NOS)
Medullary carcinoma
Papillary carcinoma
Tubular carcinoma
Inflammatory carcinoma
Paget disease
Lobular neoplasia (lobular carcinoma in situ, LCIS)
Infiltrating lobular carcinoma
Phyllodes tumor
Metastases
Lymphoma
Mammographic Signs of Malignancy
Noncancerous Lesions
Normal Breast
Anatomy
Denseness of breast tissue
Benign Processes
Fibrocystic changes
Risk
Cystic disease
Radiographic Features
Fibroadenoma
Clinical Spectrum
Radiographic Features
Giant Fibroadenoma
Complex Fibroadenoma
Phyllodes tumor
Fibrosis
Adenosis
Radiographic Features
Ductal ectasia
Radiographic Features
Papilloma with fibrovascular core
Solitary Intraductal Papillomas
Papillomatosis
Radial scar
Pseudoangiomatous stromal hyperplasia ( pash)
Benign Masses
Tubular adenoma
Lipofibroadenoma (hamartoma)
Lipoma
Tension cysts
Galactocele
Desmoid
Sebaceous cyst
Inflammation
Mastitis
Types
Radiographic Features
Fat necrosis
Radiographic Features
Implants
Radiographic Features
Postsurgical breast
Postreduction Mammography
Transverse Rectus Abdominis Musculocutaneous (TRAM) Reconstruction
Postradiation breast
Radiographic Features
Male Breast
Gynecomastia
Causes
Radiographic Features
Male breast cancer
Differential Diagnosis
Mass Lesions
Spiculated masses
Mass with microlobulation
Mass with macrolobulation
Well-circumscribed masses (rounded densities)
Approach
Developing density on mammogram
Lucent lesions (fatty lesions)
Giant masses (>5
cm)
Breast mass during pregnancy/lactation
Other
Architectural distortion
Nipple retraction
Nipple discharge
Prominent ducts
Trabecular thickening
Male breast enlargement
Shrinking breast
Skin
Diffuse skin thickening (>2.5 mm)
Ringlike peripheral calcification in mass
Focal skin thickening
Basic Workup for Common Findings
Suggested Readings
10.
Obstetric Imaging
First Trimester
General
Reference
Role of imaging
1st Trimester
2nd Trimester
3rd Trimester
Prenatal screening
Screening Tests
Reasons for Prenatal Screening
a -Fetoprotein (AFP)
b-HCG
Amniocentesis
Indications
Chorionic villus sampling (CVS)
Fetal blood sampling
Nuchal lucency thickening
First-Trimester Imaging
Approach to 1st-trimester sonogram
Normal Pregnancy
Early development
Amniotic & chorionic membranes
Double Decidual Sac Sign
Yolk sac
Fetal heart
Pearls
Gestational Sac
Normal gestational sac
Correlation of MSD & ß -HCG levels
Criteria for the diagnosis of abnormal gestational sacs
Minor Criteria
Small gestational sac
Empty gestational sac
Pseudogestational sac
Threatened Abortion
Terminology of abortion
Embryonic demise (dead embryo)
Bradycardia
Subchorionic hemorrhage
US Features
Ectopic Pregnancy
General
Location
Clinical findings
Risk factors
Diagnosis
Diagnostic tests
US features
Pearls
Treatment
Multifetal Pregnancy
General
Types
Placental unit
US imaging
Approach
US features
Pearls
Complications
Overview of complications in twin pregnancies
Twin-twin transfusion syndrome
US Features
Conditions associated with demise of a twin
Vanishing Twin (“Blighted Twin”)
Fetus Papyraceus
Twin-Twin Embolization Syndrome
Acardiac Parabiotic Twin
Fetal Structural Abnormalities
Conjoined Twins
Ectopic Twin Pregnancy
Second & Third Trimesters
General
Pearls
Fetal Neural Axis
Anatomy
Normal CNS Structures
Signal Intensities
Spine
Holoprosencephaly
US Features
Pearls
Agenesis of corpus callosum (ACC)
US Features
Hydranencephaly
Porencephaly
Ventriculomegaly
US Features
Cystic structures
Cystic Teratoma
Choroid Plexus Cysts
Arachnoid Cysts
Hemorrhage
Dandy-walker (DW) syndrome
US Features
Large cisterna magna
US Features
Neural tube defect (NTD)
Anencephaly
Encephalocele
Associations
US Features
Spina bifida & myelomeningocele
US Features
Pearls
Algorithm for intracranial malformations
Face, Neck
Cystic hygroma
US Features
Other anomalies of the face & neck
Types
Associations
Heart
Detection
Maternal risk factors for CHD
Fetal arrhythmias (use M-mode or doppler us for evaluation)
Thorax
Pulmonary hypoplasia
Types
US Features
Congenital cystic adenoid malformation
Types
US Features
Bronchopulmonary sequestration
Types
Associations (Extralobar, 65%; Intralobar, 10%)
US Features
Congenital diaphragmatic hernia (bochdalek hernia)
US Features
Mediastinal masses
Pleural effusion
Causes
US Features
Abdomen
Normal anatomy
Umbilical Vessels
Stomach
Bowel
Adrenal Glands
Other
Gastric abnormalities
Duodenal atresia
Radiographic Features
Meconium
Ascites
Causes
Adrenal Gland
Neuroblastoma
Abdominal Wall
Anatomy
Pearls
Anterior wall defects
Algorithm for anterior abdominal wall defects
Gastroschisis
US Features
Omphalocele
US Features
Amniotic band syndrome (ABS)
US Features
Limb/body wall complex (LBWC)
US Features
Urinary Tract
Normal development
Potter syndrome
Renal agenesis
US Features
Urinary tract obstruction
Approach
Ureteropelvic Junction (UPJ) Obstruction ( Figs. 10-38 & 10-39)
Ureterovesical Junction (UVJ) Obstruction
Bladder Outlet Obstruction
Antenatal predictors of poor postnatal renal function
Renal cystic disease
Multicystic Dysplastic Kidney (MCDK) Disease
US Features
Autosomal Recessive Polycystic Kidney Disease (ARPCKD) (Infantile Polycystic Kidney Disease)
US Features
Cystic Renal Dysplasia
Meckel-Gruber Syndrome
Megacystis Microcolon—Intestinal Hypoperistalsis Syndrome
Exstrophy
Bladder Exstrophy
Cloacal Exstrophy
Hydrops Fetalis
General
US Features
Types
Approach
Immune hydrops fetalis (IHF)
Pathophysiology
Role of Prenatal US
Nonimmune hydrops fetalis (NIHF)
Causes
Complications of Fetal Hydrops
Extremities
Skeletal dysplasias (dwarfism)
Approach (see also Chapter 11)
Thanatophoric Dwarf
Homozygous Achondroplasia
Achondrogenesis (Type I)
Osteogenesis Imperfecta (Type II)
Congenital Lethal Hypophosphatasia
Short Rib/Polydactyly Syndromes
Camptomelic Dysplasia
Chondrodysplasia Punctata
Heterozygous Achondroplasia
Asphyxiating Thoracic Dysplasia (Jeune Syndrome)
Chondroectodermal Dysplasia (Ellis-van Creveld Syndrome)
Diastrophic Dysplasia
Clubfoot (talipes)
Types
US Features
Extremity abnormalities
Short Radial Ray (Radial Hypoplasia)
Limb Anomalies
Sirenomelia
Arthrogryposis multiplex
US Features
Syndromes
Trisomy 21 (Down syndrome)
Trisomy 18 (Edwards Syndrome)
Trisomy 13 (Patau Syndrome)
Meckel-Gruber Syndrome
Measurements & Growth
Measurements
Recommendations
Estimated gestational age (EGA)
Gestational sac
Crown-rump length (CRL)
Head measurements
Biparietal Diameter (BPD)
Cephalic Index
Corrected Biparietal Diameter
Head Circumference
Abdominal measurements
Femur length measurement
Estimated fetal weight (EFW)
Growth Abnormalities
Abnormally small fetus (IUGR)
Asymmetric IUGR (90%)
Symmetric IUGR (10%)
Sonographic Determination
Abnormally large fetus
Risk Factors
Complications
Clinical Relevance
Mortality
Biophysical Profile (BPP)
Fetomaternal Structures
General
Approach
Placenta
Normal development
Chorion (Fetal Component)
Placental Unit
US features
Normal Placenta
Placental Variants
Placental Grading
Placenta previa
Types
US Features
Placental separtion
Complications
Types
US Features
Placenta accreta
Types
Complications
Imaging Features
Normal intraplacental lesions
Chorioangioma
US Features
Gestational Trophoblastic Disease
Classification
Modified NIH Classification
Hydatidiform mole
Clinical Findings
US Features
Prognosis
Variants
Incomplete or Partial Mole
Coexistent Trophoblastic Disease & a Living Fetus
Hydropic Degeneration of the Placenta
Choriocarcinoma
Metastases
Amnion
Normal amniotic fluid
Volume
Echogenicity
Pearls
Polyhydramnios
Causes
Oligohydramnios
Causes
Umbilical Cord
Cord anatomy
Vasa previa
Two-vessel cord
Straight cord
Masses
Uterus & Adnexa
Incompetent cervix
Clinical Findings
Causes
US Features
Management Issues
Uterine fibroids
Adnexal masses
Corpus Luteum Cyst (CLC)
US Features
Other Adnexal Masses
Pelvimetry
Measurements
Fetal MRI
Differential Diagnosis
First Trimester
First-trimester bleeding
Pregnancy Related (Common)
Unrelated to Pregnancy (Rare)
Empty sac
Echogenic central cavity
Complex intrauterine mass
AFP abnormalities
Elevated MSAFP (2 multiples of median)
Low MSAFP (<0.5 multiples of median)
Predictors of poor outcome
Second & Third Trimesters
Placenta size
Diffusely Enlarged Placenta (>4 cm thick)
Small Placenta (Hypoperfusion)
Abnormal placental echotexture
Umbilical cord abnormalities
Solitary Umbilical Artery
Enlargement of Umbilical Cord
Other
Risk factors for preterm delivery
Abnormal lower uterine segment
Third-trimester bleeding
Masses during pregnancy
Frequently missed lesions
Fetal death
Fetal Head & Spine
Cystic CNS structures
Hydrocephalus
Cystic head and/or neck masses
Cystic back masses
Hyperechoic brain mass
Incomplete mineralization of the skull
Skull deformities
Lemon Sign
Cloverleaf Skull
Strawberry Skull
Kyphoscoliosis
Fetal Chest
Cystic thoracic masses
Solid (echogenic) masses
diffusely echogenic lungs
Pleural effusion
Fetal Abdomen
Abnormal stomach
Absent Stomach Bubble
Double Bubble (Associated with Polyhydramnios) ( Fig. 10-64)
Dilated bowel
Pearls
Echogenic bowel content
Abdominal calcification
Hydronephrosis
Common renal anomalies
Echogenic kidneys
Cystic abdominal structures
Liver
Hepatic Calcifications
Hepatic Cysts
Hepatic Masses
Splenomegaly
Ascites
Anterior wall defects
Anomalies in sacral region
Fetal Extremities
Fractures
Polydactyly
Suggested Readings
11.
Pediatric Imaging
Respiratory Tract
Upper Airway
Approach
Normal appearance
Laryngomalacia
Tracheomalacia
Webs
Tracheal stenosis
Subglottic stenosis
Epiglottitis
Clinical Findings
Radiographic Features
Pearls
Croup
Clinical Findings
Radiographic Features
Pearls
Retropharyngeal abscess
Clinical Findings
Radiographic Features
Tonsillar hypertrophy
Radiographic Features
Airway foreign body
Radiographic Features
Congenital Pulmonary Abnormalities
Bronchopulmonary foregut malformation
Pulmonary sequestration
Clinical Findings
Pathology
Radiographic Features
Bronchogenic cyst
Radiographic Features
Congenital cystic adenoid malformation (CCAM)
Types
Radiographic Features
Congenital lobar emphysema
Causes
Radiographic Features
Pulmonary hypoplasia
Types of Pulmonary Underdevelopment
Scimitar Syndrome (Hypogenetic Lung Syndrome, Pulmonary Venolobar Syndrome)
Radiographic Features
Congenital diaphragmatic hernia (CDH)
Incidence
Types
Radiographic Features
Kartagener syndrome
Radiographic Features
Pneumonia
Viral pneumonia
Pearls
Bacterial pneumonia
Radiographic Features
Round Pneumonia
Recurrent Infections
Aspiration pneumonia
Causes
Radiographic Features
Sickle cell anemia
Radiographic Findings
Neonatal Respiratory Distress
Respiratory distress syndrome (RDS)/hyaline membrane disease ( Fig. 11-15)
Evolving Terminology
Radiographic Features
Pulmonary interstitial emphysema (PIE)
Radiographic Features
Bronchopulmonary dysplasia (BPD)
Prognosis of Stage 4
Meconium aspiration syndrome
Radiographic Features
Complication
Neonatal pneumonia (NP)
Pathogenesis
Radiographic Features
Transient tachypnea of the newborn (TTN)
Causes
Radiographic Features
Extracorporeal membrane oxygenation (ECMO)
Complications
Mediastinum
Thymus
Common mediastinal tumors
Pearls
Gastrointestinal Tract
General
Embryology
Rotation
Fixation
Canalization
Umbilical artery (UA) line
Umbilical vein (UV) line
Esophagus
Esophageal atresia (EA) & tracheoesophageal fistula (TEF)
Types
Associations
Radiographic Features
Gastroesophageal reflux
Causes
Radiographic Features
Esophageal foreign body
Radiographic Features
Stomach
Hypertrophic pyloric stenosis (HPS)
Clinical Findings
Associations
Radiographic Features
Pylorospasm
Radiographic Features
Volvulus
Chronic granulomatous disease
Clinical Findings
Duodenum, Pancreas, Small Bowel
Congenital duodenal atresia, stenosis
Associations
Radiographic Features
Duodenal diaphragm
Annular pancreas
Pancreatic tumors
Malrotation & midgut volvulus
Associations
Radiographic Features
Ladd's bands
Small bowel atresia
Radiographic Features
Meconium ileus
Radiographic Features
Other meconium problems
Meconium Plug Syndrome
Meconium Peritonitis
Meconium Ileus Equivalent
Intussusception
Types
Clinical Findings
Radiographic Features
Intussusception Reduction (80% Success Rate)
Henoch-schönlein purpura
Radiographic Features
Duplication cysts
Radiographic Features
Omphalomesenteric duct anomalies
Meckel's Diverticulum
Radiographic Features
Colon
Appendicitis
Radiographic Features
Necrotizing enterocolitis (NEC)
Radiographic Features
Complications
Hirschsprung disease
Complications
Radiographic Features
Congenital anorectal anomalies
Radiographic Features
Liver, Biliary Tract
Biliary atresia
Types
Radiographic Features
Hemangioendothelioma
Complications
Radiographic Features
Mesenchymal hamartoma
Hepatoblastoma
Associations
Radiographic Features
Hepatocellular carcinoma (HCC)
Associations
Radiographic Features
Hypovolemic shock
Genitourinary Tract
General
Renal development
Genitalia
Wolffian Duct
Müllerian Duct
Cloaca
Urachus
Uterus
Ovaries
Congenital Anomalies
Renal anomalies
Anomalies of Position
Anomalies of Form
Anomalies of Number
Complications of Renal Congenital Anomalies
Horseshoe kidney
Radiographic Features
Renal ectopia
Ureteral duplication
Complications
Radiographic Features (Lebowitz)
Ureterocele
Radiographic Features
Congenital ureteropelvic junction (UPJ) obstruction
Radiographic Features
Primary megaureter
Radiographic Features
Circumcaval ureter
Radiographic Features
Bladder exstrophy-epispadias complex
Radiographic Features
Cloacal exstrophy
Clinical Findings
Prune-belly syndrome (triad syndrome, eagle-barrett syndrome)
Radiographic Features
Posterior urethral valves (PUVs)
Clinical Findings
Types
Radiographic Features
Male hypospadias
Associations
Radiographic Features
Caudal regression
Types of Sacral Agenesis
Renal Cystic Disease
Autosomal recessive kidney disease (ARKD)
Types
Radiographic Features
Multicystic dysplastic kidneys (MCDK)
Radiographic Features
Multilocular cystic nephroma (MLCN)
Radiographic Features
Inflammation
Urinary tract infection (UTI)
Modalities for Imaging of the UTI/VUR Complex
Vesicoureteral reflux (VUR)
Complications
Incidence
Radiographic Features
Voiding cysturethrogram (VCUG)
Tumors
Wilms tumor
Clinical Findings
Associations
Radiographic Features
Nephroblastomatosis
Radiographic Features
Renal cell carcinoma (RCC)
Clear cell sarcoma
Rhabdoid tumor
Radiographic Features
Neuroblastoma
Clinical Findings
Radiographic Features
Staging
Mesoblastic nephroma (hamartoma)
Radiographic Features
Angiomyolipoma
Ossifying renal tumor of infancy
Metanephric adenoma
Posttransplantation lymphoproliferative disorder (PTLD)
Radiographic Appearance
Teratoma
Amputated Ovary
Ovarian Masses
Other
Rhabdomyosarcoma
Neonatal adrenal hemorrhage
Radiographic Features
Renal artery stenosis
Renal vein thrombosis
Musculoskeletal System
Trauma
General
Types of Fractures
Fracture Healing
Pearls
Normal variants frequently confused with disease
Salter-harris fractures
Elbow injuries
Common Types
Little league elbow
Avulsion fractures
Osteochondrosis dissecans
Radiographic Features
Toddler's fracture
Stubbed toe
Battered child (trauma X)
Radiographic Features
Infection
Hematogenous osteomyelitis
Pathogenesis
Location
Radiographic Features
Chronic osteomyelitis
Radiographic Features
Congenital infections
Rubella
Radiographic Features
Syphilis
Radiographic Features
Degenerative & Chronic Traumatic Disease
Overview
Developmental dysplasia of the hip (DDH) (congenital dislocation of the hip) ( Fig. 11-59)
Clinical Findings
Radiographic Features
Pearls
Legg-calvé-perthes (LCP) disease
Radiographic Features
Slipped capital femoral epiphysis (SCFE)
Radiographic Features
Complications
Osteochondrosis
Scheuermann disease (adolescent kyphosis)
Radiographic Features
Radioulnar synostosis
Blount disease (congenital tibia vara)
Clinical Findings
Radiographic Features
Osgood-schlatter disease
Radiographic Features
Freiberg disease
Foot angles
Clubfoot (talipes equinovarus)
Congenital vertical talus
Tarsal coalition
Varus & valgus
Metabolic Abnormalities
Rickets
Radiographic Features
Congenital Anomalies
Dwarfism
Pearls
Osteogenesis imperfecta (OI)
Classification
Radiographic Features
Achondroplasia
Radiographic Features
Asphyxiating thoracic dystrophy (jeune syndrome)
Radiographic Features
Chondroectodermal dysplasia (ellis-van creveld syndrome)
Radiographic Features
Mucopolysaccharidosis
Radiographic Features
Cleidocranial dysostosis
Radiographic Features
Complications
Arthritis
Juvenile rheumatoid arthritis (JRA)
Radiographic Features
Other Disorders
Caffey disease (infantile cortical hyperostosis)
Radiographic Features
Short stature
Classification
Approach
Fibromatosis colli
Radiographic Features
Sacrococcygeal teratoma
Altman Classification
Radiographic Features
Klippel-trénaunay syndrome
Clinical Findings
Radiographic Features
Pediatric Neuroimaging
Cranial Ultrasound
Coronal views (6 sections)
Sagittal views (6 sections)
Indications for cranial US
Germinal matrix hemorrhage
Causes of Hemorrhage
Radiographic Features
Other types of hemorrhage (see also chapter 6)
Periventricular leukomalacia
Location (in watershed areas of arterial blood flow)
Radiographic Features
Choroid plexus cyst
Ventriculoperitoneal (VP) shunt complications
Skull
Sutures
Craniosynostosis
Causes
Types
Multiple lacunae
Causes
Wormian bones
Causes
Skull fractures
Choanal atresia
Spine
Development
Scoliosis
Types
Preoperative Radiographic Features
Postoperative Radiographic Features
Cervical spine injuries
Pseudosubluxation
Differential Diagnosis
Chest
Stridor, wheezing
Upper airway obstruction
Bubbly lungs in neonates
Mass lesions in the airways
Neonatal lung masses
Hyperlucent lung
Neonatal pneumothorax
Small solitary pulmonary nodule
Multiple pulmonary nodules
Pediatric interstitial pattern
Reticular opacities in a newborn
Pediatric chest wall tumors
Abdomen
Dilated stomach
Double bubble
Proximal bowel obstruction
Distal bowel obstruction
Microcolon
Causes
Pearls
Pediatric pneumatosis intestinalis
Gasless abdomen
Causes
Abdominal calcifications
Common abdominal mass lesions
Gastric filling defect
Thick folds
GI hemorrhage
Pediatric liver lesions
Fatty liver
Pediatric cholelithiasis
Hydrops of gallbladder
Cholecystitis
Bilary strictures
Fatty replacement of pancreas
Chronic pancreatitis
Genitourinary System
Cystic renal masses
Hydronephrosis
Solid renal masses
Diffusely hyperechoic renal kidney in newborn
Echogenic kidney (cortex similar to spleen or liver with preserved corticomedullary differentiation)
Loss of normal corticomedullary differentiation
Medullary nephrocalcinosis
Congenital ureteric obstruction
Adrenal mass
Cystic structure in or near bladder wall (US)
Large abdominal cystic mass
Presacral mass
Interlabial mass
Central Nervous System
Poor mineralizaton of skull
Enlarged head (macrocephaly)
Small head (microcephaly)
Widened anterior fontanelle
Thick skull
Lytic skull lesions
Intracranial calcification
Enlarged sella turcica
Musculoskeletal System
Common pediatric bone tumors
Tumors with Fluid-Fluid Level
Widened joint space
Bowed bones
Diffuse pediatric osteopenia
Diffusely dense bones in children
Abnormal rib shape
Slender ribs
Widened ribs
Expansile ribs
Abnormal size or shortening of ribs
Symmetrical periosteal reaction in children
Deformed epiphysis
Enlarged epiphysis
Stippled epiphysis
Transverse metaphyseal lines
Widened growth plate
Metaphyseal fragments
Metaphyseal irregularity
Aggressive clavicular lesion
Vertebral abnormalities
Vertebra Plana (Localized Platyspondyly)
Generalized Platyspondyly (Decreased Height of Vertebral Body) ( Fig. 11-103)
Fused Vertebrae
Large Vertebral Body, or Other Abnormal Shapes
Altlantoaxial subluxation
Disk space narrowing
Enlarged Disk Space
Intervertebral Disk Space Calcification
Pediatric sacral abnormalities
Radial ray deficiency
Polydactyly
Syndactyly
Abnormal 4th metacarpal
Short Metacarpal
Long Metacarpal
Delayed bone age
Hemihypertrophy
Pubic symphysis diastasis
Other
Down syndrome
Williams syndrome (infantile idiopathic hypercalcemia)
Beckwith-wiedemann syndrome
Premature infants
Malignancy by age
Suggested Readings
12.
Nuclear Imaging
Pulmonary Imaging
Radiopharmaceuticals
133 Xenon
127 Xenon
81M Krypton
99M Tc Dtpa Aerosol
99M Tc Macroaggregated Albumin
Pharmacokinetics
Technique
Indications
Contraindications
Protocol
Imaging
Normal Images
Xenon Ventilation
Perfusion ( Fig. 12-2)
Pulmonary Embolism
Scheme for Interpretation (Prospective Investigation of Pulmonary Embolism Diagnosis [PIOPED])
PISAPED (Prospective Investigative Study of Pulmonary Embolism Diagnosis) Criterion for Interpretation of Perfusion Lung Sc ...
Implications of Scan Results
Scan to Monitor Sequelae/Resolution of PE
Modified PIOPED Criteria for Scan Interpretation
Pearls
Other Patterns
Stripe Sign ( Fig. 12-4)
Reverse Mismatch
Pulmonary Edema
Bullae, Emphysema, COPD
Pulmonary Arterial Hypertension
Transplant
EVALUATION OF LUNG FUNCTION ( Fig. 12-5)
Cardiac Imaging
Radiopharmaceuticals
201 Thallium Chloride
Pharmacokinetics
Use
99M TC SESTAMIBI ( Fig. 12-6)
Pharmacokinetics
99M Tc Teboroxime
Pharmacokinetics
99M Tc Rbc Labeling
Uses
Methods of Labeling Autologous RBCs
Causes of Poor RBC Labeling
Pearls
Myocardial Perfusion Scintigraphy
GENERAL ( Figs. 12-7 & 12-8)
Techniques
Treadmill Test
Dipyridamole Test
Adenosine Test
Dobutamine Test
Rest & Redistribution Study
99M Tc Sestamibi Imaging
Contraindications For Nuclear Cardiology Stress Test
Absolute
Relative
NORMAL IMAGES & VARIANTS ( Fig.12-9)
Variations
Image Interpretation
Abnormal Planar Scan Patterns
Spect Imaging
Advantages
Technique
Interpretation
Hibernating Myocardium
Stunned Myocardium
Pet Imaging
82 Rubidium
13 N-ammonia
Acute Myocardial Infarct (Ami) Imaging
99M TC PYROPHOSPHATE IMAGING ( Fig. 12-14)
Technique
Interpretation
Resting 201 Thallium Scan
Recommended Tests for Intermediate or High Likelihood of CAD
Indications for PET
Ventricular Function Imaging
General
Indications
Protocol
Image Interpretation
Qualitative Image Assessment
Quantitative Image Assessment
Pearls
Gastrointestinal Imaging
Radiopharmaceuticals
General
99M Technetium Sulfur Colloid
Pharmacokinetics
Pearls
99M TC HEPATOBILIARY AGENTS ( Fig. 12-17)
Pharmacokinetics
Res Colloid Imaging
Indications
Image Interpretation
Hepatobiliary Imaging
Normal Scan
Protocol
Interpretation ( Fig. 12-18)
Pharmacologic Intervention If GB Is Not Visualized ( Fig. 12-19)
ACUTE CHOLECYSTITIS ( Fig. 12-20)
Indications for Scintigraphic Imaging
Imaging Findings
Chronic Cholecystitis
Liver Tumors
Bowel Imaging
Hemorrhage
Protocol
Imaging Findings
Hemangioma Imaging
Meckel Scan
Technique
Imaging Findings
GASTRIC EMPTYING ( Fig.12-21)
Indications
Liquid-Phase Emptying (Usually In Children, “Milk-Scan”)
Solid-Phase Emptying (Usually for Adults)
Genitourinary Imaging
Radiopharmaceuticals
99M Tc Dtpa
Pharmacokinetics
99M TC MAG 3 ( Fig. 12-22)
Pharmacokinetics
Renal Imaging
Indications
Protocol
NORMAL IMAGES ( Fig. 12-23)
Interpretation ( Fig. 12-24)
Transplant Evaluation
RENOVASCULAR HYPERTENSION ( Fig. 12-25)
Technique
Interpretation ( Fig. 12-26)
OBSTRUCTION ( Fig. 12-27)
Technique
Imaging Findings
False-Positive Furosemide (Lasix) Renal Scans
Renal Cortical Imaging
Technique
Interpretation
Retrograde Radionuclide Cystogram
Technique
Interpretation
Testicular Imaging
Indication
Protocol
Normal Images
Interpretation
Torsion
Imaging Findings ( Fig. 12-28)
Adrenal Imaging
Metaiodobenzylguanidine (Mibg)
Technique
Interpretation
Bone Imaging
Radiopharmaceuticals
99M TC PHOSPHONATES ( Fig. 12-29)
Pharmacokinetics
Bone Marrow Agents
Indications
Bone Imaging
Indications
Technique
Normal Images
Tumors
Indications for Obtaining a Bone Scan
Imaging Features
Osteomyelitis
Pearls
Fractures
Indications for Bone Scans
Scintigraphic Features
Reflex Sympathetic Dystrophy (Rsd)
Total Hip Replacement (THR)
Prosthesis
Marrow Imaging
Technique
Imaging Features
[18F] Sodium Fluoride Pet:
Thyroid Imaging
Radiopharmaceuticals
OVERVIEW ( Figs 12-30 , 12-31 & 12-32)
123 Iodine
Pharmacokinetics
131 Iodine
Indications
Calculation of 131 Iodine Therapeutic Dose
Complications of 131 Iodine Treatment
Pertechnetate
Applications
Pharmacokinetics
Thyroid Imaging
Iodine Uptake Test
Technique
Increased Uptake
Decreased Uptake
Normal Imaging
Patient Examination
Appearance of Normal Thyroid Scans ( Fig. 12-33)
Interpretation
COLD NODULE ( Figs. 12-34 & 12-35)
Hot Nodule
Discordant Nodules
HYPERTHYROIDISM ( Fig. 12-36)
MULTINODULAR GOITER ( Fig. 12-37)
Congenital Organification Defect/Dyshormonegenesis
Whole Body Thyroid Cancer Imaging
Parathyroid Imaging
99M Tco 4 − / 201 Tl Subtraction Imaging
Technique
Interpretation
99M Tc Sestamibi Imaging Of Parathyroid
Advantages:
Pet Imaging
18 Fdg-Pet Imaging
18 FDG BASIC MECHANISM ( Fig. 12-38)
Practical Aspects Of Pet Imaging
Integrated Pet-Ct Imaging
Imaging Systems
Imaging Protocol
PET-CT Scanning Artifacts
Normal Fdg-Pet Scan
False-Positive Pet Scan
False-Negative Pet Scan
Fdg-Pet In Lung Cancer
Melanoma
Colorectal Carcinoma
Pancreatic Carcinoma
Lymphoma & Leukemia
Breast Cancer
Fdg-Pet Brain Imaging
Normal Uptake Pattern
Refractory Seizure
Tumor Recurrence Versus Radiation Necrosis
Memory Loss (Alzheimer Dementia)
Other Neurodegenerative Disorders
Other Pet Tracers & Agents
Approved Agents Used Less Commonly
82 Rubidium
13 N-ammonia
15 O-oxygen
18 F-fluoride
List Of Agents In Clinical Development
CANCER PATHWAYS RELEVANT TO PET IMAGING ( Fig. 12-39)
Centers For Medicare & Medicaid Services (Cms) Coverage Of Pet
Miscellaneous Imaging Techniques
Gallium Imaging
ISOTOPE ( Fig. 12-40)
Pharmacokinetics
Radiation
Technique
NORMAL IMAGES ( Fig. 12-41)
Applications
Chest
Other Applications
Leukocyte Imaging
Preparation
Indications
Radiation
Other Infection Imaging Agents
NORMAL IMAGING ( Fig. 12-42)
Brain Imaging
99M TC HMPAO ( Fig. 12-43)
Pharmacokinetics
BRAIN DEATH STUDY ( Fig. 12-44)
Technique
Imaging Findings
Hmpao/Ecd Spect Imaging
Indications
Technique
Acetazolamide Challenge Test
Indications
Contraindications
201 Thallium Brain Imaging
111 In Dtpa Cisternography
Lymphoscintigraphy
Agents
Sulfide Colloid
Human Serum Albumin (HSA) Nanocolloid
Tumor Imaging
Agents
Oncoscint ( 111 In Dtpa Labeled B72.3 Monoclonal Antibody)
Prostascint ( 111 In-Labeled B72.3 Monoclonal Antibody)
Cea-Scan ( 99M Tc Dtpa-Labeled Anti-Cea)
Somatostatin
OCTREOTIDE IMAGING ( Fig. 12-45)
Differential Diagnosis
Radiopharmaceuticals
Quality Assurance for Radiopharmaceuticals
Pulmonary
MISMATCH ( Fig. 12-46)
Causes Of Pulmonary Embolism
MATCHED DEFECT ( Fig. 12-47)
Decreased Perfusion In One Lung
Cardiovascular ( Fig. 12-48)
False-Negative Thallium Studies
False-Positive Thallium Study
Paradoxical Septal Movement
Fixed Defect
Pyrophosphate Uptake
Gastrointestinal
PATTERNS IN HIDA STUDIES ( Fig. 12-49)
GB Not Visualized
Biliary System Not Visualized
Low Hepatic Activity, Renal Activity
Bowel Not Visualized
Abnormal Tracer Collections
False-Negative HIDA Study
False-Positive HIDA Study
Focal Liver Uptake With 99m Tc Sulfur Colloid
Bleeding Studies
Rlq Activity On Meckel Scan
Rapid Gastric Emptying
Delayed Gastric Emptying
Hot Quadrate Lobe
Genitourinary
Patterns
Focal Renal Defects
Focal Hot Renal Lesions
Dilated Ureter or Collecting System
Delayed Uptake & Excretion (Renal Failure)
Nonvisualized Kidney
Increased Uptake
Ring Sign
Testicular Anomalies
Bone
FOCAL HOT LESIONS ( Fig. 12-50)
Focal Cold Bone Lesions
Superscan
Diffuse Periosteal Uptake (Tramtrack Sign)
Extraosseous Activity
Diffuse Bone Uptake On Pet
Thyroid
Diffusely Increased Thyroid Uptake
Diffusely Decreased Thyroid Uptake
Heterogeneous Thyroid Uptake
Suggested Readings
13.
Contrast Agents
X-ray Contrast Agents
General
Cost of contrast agents
Average Cost Estimates per Patient Dose
Iodinated Contrast Agents
Classification
Iodine Content
Meglumine versus Sodium Salts
HOCAs
Nonionic LOCAs
Ionic LOCA
Pharmacology
Side effects
Types of Reactions
Risk Factors
Other Risk Factors
Premedication
Contrast-Induced Nephropathy
Breast-Feeding
Contrast Extravasation
Metformin (Glucophage)
Other Iodinated Agents
Gastrografin
Complications
Sinografin
Iopanoic acid (telepaque)
Barium
Composition
Complications
MRI Contrast Agents
Classes
Paramagnetic Agents
Gadolinium chelates
Pharmacology
Safety
Nephrogenic systemic fibrosis (NSF)
Mangafodipir trisodium (Mn-DPDP, teslascan, nycomed)
Eovist (gadoxetate disodium; bayer)
Superparamagnetic Agents
Ferumoxtran-10 (combidex) & ferumoxytol (feraheme)
Treatment of Contrast Reactions
Treating Adverse Reactions
Emergency Treatment
14.
Imaging Physics
X-ray Physics
Production of X-rays
X-ray tube
Cathode
Anode
X-ray tube output
Milliampere
Voltage
Exposure Time
Heat unit
Rating charts
Example
Answer
Focal spot
Focal spot & resolution
Measurement of focal spot size
Pinhole Method
Star Test Pattern
Magnification
Unsharpness
Radiation exposure & distance
Example
Answer
Spectrum of X-rays
Bremsstrahlung
Characteristic Radiation
Heel effect
X-ray Generators
Transformer
Circuits of X-ray generators
Autotransformer
High-Voltage Transformer
Timer
Rectifier
Filament Circuit
Types of generators
Three-Phase Generators
Advantages of 3-phase generators
Mobile Generators
Capacitor Discharge Generators
Phototimers
Interaction Between X-Rays & Matter
Coherent scattering
Photoelectric effect
Pearls
Compton scattering
Probability of Compton Scatter
Pearls
Other types of interactions
Pair Production
Photodisintegration
Comparison of interaction
Pearls
Attenuation
Attenuation coefficients
Linear Attenuation Coefficient (cm −1)
Mass Attenuation Coefficient
Monochromatic radiation
Example
Answer
K-edge
Polychromatic (typical X-ray) radiation
Example
Answer
Filters
Restrictors
Grids
Grid ratio
Types of grids
Linear Grid
Crossed Grid
Focused (Convergent) Grid
Moving Grid (Bucky Grid)
Grid performance
Contrast Improvement Factor
Bucky Factor
Pearls
Primary Transmission
Grid artifacts
Upside-down Focused Grid
Focus-Grid Distance Decentering
Lateral Decentering
Combined Lateral & Focus-Grid Distance Decentering
Air gap techniques
Screens
Absorption efficiency
Sensitivity & speed
Image blur
Rare earth screens
Quantum mottle
Film
Composition
Film Base
Emulsion
Supercoating
Processing
Film density
Optical Density (OD)
Example
Answer
HD curve
Film Contrast
Shape of HD Curve
Example
Answer
Density
Speed
Latitude
Darkroom Safelights
Image quality
Contrast
Line Spread Function
Modulation Transfer Function (MTF)
Fluoroscopy
Image intensifier
Input Phosphor & Photocathode
Brightness Gain
Example
Answer
Minification Gain
Example
Answer
Resolution of Intensifiers
Distortion of Intensifiers
TV recording system
Video Signal
TV Monitor
Interlaced Horizontal Scanning
Kell Factor
Example
Answer
Mammography
Target filter combinations
Technical requirements of film screen mammography
Disadvantages of Tomography
Pearls
Tomography
Stereoscopy
CT (Helical, Multislice)
Overview
CT numbers
CT components
X-ray Tube & Gantry
Slip Ring
Filtration
Detectors
CT scanner generations
Helical CT
Multislice CT
Limitations
Image reconstruction
CT image quality
Factors That Affect Image Quality
Window Width & Level
CT Artifacts
CT scanner-based radation dose estimation
Risk Estimates for CT scans
Recommendations for Reducing CT Radiation Dose
Digital Radiography
General
Image plate
Image reading
Memory
Example
Answer
Nuclear Physics
Atomic Structure
Forces
Example
Answer
Nuclides
Decay
Alpha decay
Beta decay
Beta (–) Electron Emission
Beta (+) Positron Emission
Electron Capture (Positron → Neutron)
Gamma decay
Example
Answer
Decay schemes
Range of charged particles
Radioactivity
Units
Number of nuclei
Mass calculation
Specific activity
Half-life
Example
Answer
Example
Answer
Effective half-life
Example
Answer
Cumulative activity
Radioactivity statistics
Confidence Calculations
Example
Answer
Count Rate Calculations
Example
Answer
Count Time Calculations
Example
Answer
Radionuclide Production
Reactor (neutral particle bombardment)
Examples
Cyclotron (charged particle bombardment)
Examples
Fission
Example
Generators
Generator operation
Equilibrium
Efficiency of a Generator
Dosimetry
Cumulative dose
Example
Answer
Dose
Detectors
Types of detectors
Efficiency (E) of a Detector
Dead Time of a Detector
Gas-filled detectors
Photomultiplier (PM) tubes
Well counters
Calculation of Photopeak Count Rate
Example
Answer
Liquid scintillation detectors
Scanners
Anger camera
Information Density
Image Uniformity
Collimator
Pearls
Single-photon emission computed tomography (SPECT)
Positron emission tomography (PET)
Spatial Resolution
Detector Systems
Sensitivity
Quality Assurance (QA)
QA for planar imaging
Peaking
Field Uniformity
Resolution & Linearity
QA for SPECT
QA for dose calibrator
Precision & Accuracy
Linearity
Radiobiology
General
Linear energy transfer (LET)
Radiation Units
Exposure
Example
Answer
Absorbed dose
Biologic impact
Radiation Effect
Target theory of radiation effect
Indirect theory of radiation effect
Reactions in macromolecules
Cellular damage
DNA Repair Processes in Cells
Cell Cycle & Radiosensitivity
Dose-response curves
Risk in Humans
Acute radiation effects
Pearls
Late radiation effects
Genetically Significant Dose (GSD)
Fetus
Pearls
Diagnostic X-ray doses
Risk in mammography
Risk in Nuclear Medicine
Radiation Protection
Film badge
Apron
X-ray equipment
Pearls
Radiation in working areas
Guidelines for exposure limits
Environmental Radiation
Radon
Risk of death from environmental sources
Ultrasound Physics
Characteristics of Sound
Velocity of sound
Attenuation
Frequency
Wavelength
Acoustic impedance (Z)
Intensity
Decibels
Example
Answer
Example
Answer
Pearls
Angle of Divergence (Dispersion)
Fresnel Zone
Characteristics of US Beam
Reflection
Pearls
Refraction
Absorption
Components
Transducer
Piezoelectric Crystal
Resonance Frequency
Transducer Q Factor
Backing Block
Quarter Wave Matching Layer
US equipment types
A (Amplitude) Mode
TM (Time Motion) Mode
B (Binary) Mode
Real-Time Mode
Controls
Resolution
Axial Resolution
Pearls
Lateral Resolution
Scan time
Pearls
Spectral Broadening
Doppler US
Continuous Wave Doppler
Pulsed Doppler
Color Flow Doppler
Pearls
Artifacts
Reverberation artifact
Mirror image artifact (specular reflection)
Ring-down artifact
Shadowing & enhancement
Nonspecular reflections
Aliasing
Other artifacts
MRI Physics
General
Magnetization
MR Signal Localization
K-Space
Spin-Echo Imaging
Fast Spin-Echo (FSE) Acquisition
Inversion Recovery Imaging
T2* Imaging
Signal-to-Noise Ratio (SNR)
Imaging Parameters
3-D Imaging
MR Angiography
Techniques
Artifacts
Statistics
Testing
Measurements
Statistical testing
Accuracy, Precision
Sensitivity
Specificity
Predictive values
Positive Predictive Value (PPV)
Negative Predictive Value (NPV)
ROC analysis
Suggested Readings
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z