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دانلود کتاب Primer of Diagnostic Imaging
دانلود کتاب آغازگر تصویربرداری تشخیصی
مشخصات کتاب
Primer of Diagnostic Imaging
دسته بندی: پزشکی بالینی ویرایش: 6 نویسندگان: Mukesh G. Harisinghani, John W. Chen, Ralph Weissleder سری: ISBN (شابک) : 9780323357746 ناشر: Elsevier سال نشر: 2018 تعداد صفحات: 2099 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 25 مگابایت
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توضیحاتی در مورد کتاب آغازگر تصویربرداری تشخیصی
ماموگرافی -- سرطان پستان -- ضایعات غیر سرطانی -- تشخیص افتراقی -- مطالب پیشنهادی -- 10 تصویربرداری مامایی -- سه ماهه اول -- حاملگی خارج رحمی -- بارداری چند جنینی -- سه ماهه دوم و سوم -- اندازه گیری و رشد -- ساختارهای جنینی - - تشخیص افتراقی -- قرائت های پیشنهادی -- 11 تصویربرداری کودکان -- دستگاه تنفسی -- دستگاه گوارش -- دستگاه ادراری تناسلی -- سیستم اسکلتی عضلانی -- تصویربرداری عصبی کودکان -- تشخیص افتراقی -- قرائت های پیشنهادی -- 12 تصویربرداری هسته ای -- تصویربرداری ریوی - تصویربرداری قلب - تصویربرداری از دستگاه گوارش - تصویربرداری از دستگاه تناسلی - تصویربرداری از استخوان - تصویربرداری تیروئید - توموگرافی انتشار پوزیترون - تکنیک‌های تصویربرداری متفرقه - تشخیص افتراقی - مطالب پیشنهادی - 13 عامل کنتراست - عوامل کنتراست اشعه ایکس - - عوامل کنتراست تصویربرداری تشدید مغناطیسی - درمان واکنش‌های کنتراست - مطالب پیشنهادی - 14 فیزیک تصویربرداری - فیزیک اشعه ایکس - فیزیک هسته‌ای - Radiobi علم -- فیزیک اولتراسوند -- فیزیک تصویربرداری تشدید مغناطیسی -- آمار -- مطالب پیشنهادی -- فهرست
توضیحاتی درمورد کتاب به خارجی
Mammography -- Breast Cancer -- Noncancerous Lesions -- Differential Diagnosis -- Suggested Readings -- 10 Obstetric Imaging -- First Trimester -- Ectopic Pregnancy -- Multifetal Pregnancy -- Second and Third Trimesters -- Measurements and Growth -- Fetomaternal Structures -- Differential Diagnosis -- Suggested Readings -- 11 Pediatric Imaging -- Respiratory Tract -- Gastrointestinal Tract -- Genitourinary Tract -- Musculoskeletal System -- Pediatric Neuroimaging -- Differential Diagnosis -- Suggested Readings -- 12 Nuclear Imaging -- Pulmonary Imaging -- Cardiac Imaging -- Gastrointestinal Imaging -- Genitourinary Imaging -- Bone Imaging -- Thyroid Imaging -- Positron Emission Tomography -- Miscellaneous Imaging Techniques -- Differential Diagnosis -- Suggested Readings -- 13 Contrast Agents -- X-Ray Contrast Agents -- Magnetic Resonance Imaging Contrast Agents -- Treatment of Contrast Reactions -- Suggested Readings -- 14 Imaging Physics -- X-Ray Physics -- Nuclear Physics -- Radiobiology -- Ultrasound Physics -- Magnetic Resonance Imaging Physics -- Statistics -- Suggested Readings -- Index
فهرست مطالب
Primer of Diagnostic Imaging Copyright Page Dedication Reviewers Preface Abbreviations 1 Chest Imaging Chapter Outline Imaging Anatomy Gross Lung Anatomy Segmental Anatomy (Figs. 1.1–1.2) Right Lung Left Lung Segmental Computed Tomography (CT) Anatomy (Fig. 1.3) Bronchial CT Anatomy (Fig. 1.4) Plain Radiograph Anatomic Landmarks (Figs. 1.5–1.9) Thoracic Inlet Lines Paratracheal Stripe Fissures Pulmonary Ligament Trachea Upper Lobe (Ul) 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, and Flow Rates Mediastinum (Fig. 1.14) Imaging Protocols Standard Chest CT Protocol Pulmonary Embolism (PE) CT Protocol Diagnostic Radiology Report (American College of Radiology [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 Measles Virus Pneumonia Radiographic Features Cytomegalovirus (CMV) Pneumonia Radiographic Features Swine-Origin Influenza a (H1N1) Virus Infection Severe Acute Respiratory Syndrome Radiographic Features Fungal Infections General Radiographic Features Histoplasmosis (Fig. 1.20): Pulmonary and Mediastinal 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) Semiinvasive Aspergillosis Radiographic Features Cryptococcosis Clinical Findings Radiographic Features Candidiasis Clinical Findings Radiographic Features Zygomycoses Radiographic Features Acquired Immunodeficiency Syndrome General Clinical Findings Opportunistic Infections Chest General Spectrum of Chest Manifestations (Fig. 1.27) Pneumocystis Jiroveci Pneumonia (PJP) (Figs. 1.28–1.30) General Radiographic Features Mycobacterial Infection Radiographic Features Fungal Infections Kaposi Sarcoma (KS) (Fig. 1.31) AIDS-Related Lymphoma Neoplasm General Location Classification of Pulmonary Neoplasm Lung Cancer Screening Percutaneous 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) American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) Staging System, Seventh Edition (Nonsmall Cell Lung Cancer) Unresectable Stages Summary of Treatment 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 Pericardial Metastasis Pathogenesis of Malignant Effusions Central Bronchial Involvement Metastases to Other Organs Specific Lung Tumors Adenocarcinoma Bronchioloalveolar Carcinoma Squamous Cell Carcinoma (SCC) Large Cell Carcinoma Pancoast Tumor (Superior Sulcus Tumor) Clinical Findings Radiographic Features (Fig. 1.38) Small Cell Carcinoma (SCC) (Neuroendocrine Tumor, Type 3) Carcinoid (Neuroendocrine Tumor, Types 1 and 2) Types Radiographic Features Hamartoma (Fig. 1.39) Radiographic Features Carney Triad Predominant in Young Women (<30 Years Old) Tracheobronchial Papillomatosis Radiographic Features Pulmonary Blastoma Radiographic Features Lung Metastases From Other Primary Lesions General Radiographic Features Calcified Metastases Giant Metastases (“Cannon Ball” Metastases) in Asymptomatic Patients Sterile Metastases Chronic Lung Disease Idiopathic Diseases Usual Interstitial Pneumonia (UIP) (50%–60% of Patients) 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 67Ga Scintigraphic Findings Nonspecific Interstitial Pneumonia (NSIP) (14%–36% of Patients) 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 Lymphocytic Interstitial Pneumonia (LIP) Pathology HRCT Features Acute Interstitial Pneumonia (AIP) Pathology HRCT Features Lymphoproliferative Disorders Types Plasma Cell Granuloma Radiographic Features (Fig. 1.44) Lymphangioleiomyomatosis (LAM) Clinical Findings Radiographic Features Tuberous Sclerosis Collagen Vascular Diseases Pearls Rheumatoid Arthritis (RA) Radiographic Features Ankylosing Spondylitis (AS) Systemic Lupus Erythematosus (SLE) Other Collagen Vascular Diseases With Pulmonary Manifestations Vasculitis and Granulomatoses Clinicoradiologic Features Suggestive of Vasculitis Wegener Granulomatosis Radiographic Features (Fig. 1.46) Lymphomatoid Granulomatosis Churg-Strauss Syndrome—Allergic Angiitis and Granulomatosis Radiographic Features Behçet Disease Radiographic Features Other Chronic Disorders Langerhans Cell Histiocytosis (Eosinophilic Granuloma) Idiopathic Pulmonary Hemorrhage Radiographic Features Amyloid Classification Radiographic Features Neurofibromatosis (NF) 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 Pathology 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 (More Than Three Needed) Radiographic Features Tracheobronchomalacia Radiographic Features Tracheobronchomegaly (Mounier-Kuhn Disease) Congenital Bronchial Atresia Chronic Bronchial Disease Chronic Obstructive Pulmonary Disease (COPD) Clinical Syndromes Radiographic Features Emphysema Clinical Findings Radiographic Features (Fig. 1.50) Pearls Asthma Types Radiographic Features Complications Bronchiectasis Types Radiographic Features Pearls Cystic Fibrosis (CF) Pathophysiology Radiographic Features Complications Bronchiolitis Obliterans Causes 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 Transplant Radiographic Features Pulmonary Vasculature Pulmonary Arterial Hypertension (PAH) General Causes of PAH Classification Radiographic Features Pulmonary Edema Causes of Pulmonary Edema Grading of Cardiogenic Pulmonary Edema (Figs. 1.61–1.63) Asymmetric Pulmonary Edema Pulmonary Embolism (PE) Types Risk Factors Clinical Findings Radiographic Features Imaging Algorithm Plain Radiograph CT Findings in PE Scintigraphy Angiography 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 With Chest Tube Technique: Chest Tube Persistent Pneumothorax in Patient With Chest Catheter Indication for Needle Aspiration Contraindications for Needle Aspiration Technique: Needle Aspiration 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 Nonhodgkin 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 Radiographs Directed Search in Apparently Normal Chest Radiographs Generic Approaches to Radiograph Interpretation The “Four Ds” Lesion Description Universal Differential Diagnosis Atelectasis Lobar, Segmental Atelectasis (Fig. 1.75) Signs of Lobar Atelectasis RUL Collapse (Figs. 1.76–1.77) RML Collapse RLL Collapse (Fig. 1.78) LUL Collapse (Fig. 1.79) LLL Collapse (Fig. 1.80) CT Findings of Lobar Collapse (Fig. 1.81) Types of Peripheral Atelectasis Consolidation Radiographic Features (Figs. 1.82–1.83) 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 Air Space 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 and 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 and 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 Anterior Mediastinal Masses (Fig. 1.96): Sternum to Line Anterior to the Heart and Great Vessels Cystic Anterior Mediastinal Mass Superior Mediastinal Mass Middle Mediastinal Mass Adenopathy Posterior Mediastinal Mass (Fig. 1.97): From Posterior Border of the Heart and Trachea to Anterior Surface of Thoracic Spine and Ribs Fluid-Containing Masses Cardiophrenic Angle Mass Fatty Mediastinal Lesions High-Density Mediastinal Lesions (Noncontrast CT) Densely Enhanced Mediastinal Mass Retrocrural Adenopathy Prominent Hila (Fig. 1.98) Eggshell Calcification in Hilar Nodes Pneumomediastinum Suggested Readings 2 Cardiac Imaging Chapter Outline Cardiac Imaging Techniques Plain Radiograph Interpretation Normal Plain Radiograph Anatomy Posteroanterior View (Fig. 2.1) Lateral View (Fig. 2.2) Oblique Views (Fig. 2.3 A–B) Radiographic Approach to Intensive Care Unit (ICU) Radiographs Pearls Endotracheal Tube (ET) Nasogastric (NG) Tube Complications Swan-Ganz Catheter Types Complications Intraaortic Balloon Pump (IABP) Complications Epicardial Pacing Wire (Fig. 2.4) Automatic Intracardiac Defibrillation Device Types of Automatic Implantable Cardioverter Defibrillator (AICDs) Central Venous Lines Pacemaker (Fig. 2.5) Complications Chest Tubes Complications Prosthetic Cardiac Valves Tissue Valves Mechanical Valves (Fig. 2.6) Angiography Cardiac Angiography Technique for Left Ventriculography Evaluation Ejection Fraction Wall Motion Abnormalities (Fig. 2.7) Coronary Angiography (Fig. 2.8) Contrast Medium Complications Interpretation Coronary Angiogram (Fig. 2.9 A–D) Projections (Fig. 2.10) Dominance Pitfalls Veins Magnetic Resonance Imaging (MRI) Cardiac Magnetic Resonance (MR) Is Tailored Extensively Depending on the Indication Magnetic Resonance (MR) Coronary Angiography Computed Tomography (CT) CT Angiography of Coronary Arteries Technique Optimization of Image Quality Coronary CT Angiography Coronary Calcium Scoring Radiation Exposure Ultrasound (US) M-Mode US (Fig. 2.12) Zone 1 Zone 2 (Fig. 2.13) Zone 3 Two-Dimensional (2D) Cardiac US Long-Axis View (Fig. 2.15) Short-Axis View (Fig. 2.16) Apical View (Fig. 2.17 A–B) 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 (Fig. 2.19) Pulmonary Vascularity Chamber Enlargement Situs Algorithm Classification (Fig. 2.20) 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 in Pediatric and Adult Populations Chest Radiograph Ultrasound Angiography Acyanotic CHD With Increased Pulmonary Vascularity Ventricular Septal Defect (Fig. 2.21) Types Clinical Findings Hemodynamics (Fig. 2.22) Radiographic Features Treatment Atrial Septal Defect (Fig. 2.23 A–B) Types (Fig. 2.23 C) Associations (Fig. 2.24) Clinical Findings Hemodynamics Radiographic Features (Fig. 2.25) Patent Ductus Arteriosus Clinical Findings Hemodynamics Radiographic Features Treatment Endocardial Cushion Defect (ECD) (Fig. 2.26) Types Clinical Findings (Fig. 2.27) Embryology Hemodynamics Radiographic Features (Fig. 2.28) Treatment Aortopulmonary Window (Fig. 2.29) Partial Anomalous Pulmonary Venous Connection (PAPVC) Associations Radiographic Features Acyanotic CHD With Normal Pulmonary Vascularity Valvular Pulmonary Stenosis (Fig. 2.30) Clinical Findings Types Hemodynamics Radiographic Features (Fig. 2.31) Treatment Congenital Peripheral PA Stenosis Causes Types (Fig. 2.32) Radiographic Features Congenital Aortic Stenosis (AS) Clinical Findings Types Radiographic Features Coarctation of Aorta Types (Fig. 2.34) Associations Clinical Findings Hemodynamics (Fig. 2.35) Radiographic Features Treatment Cyanotic CHD With Decreased Pulmonary Vascularity Tetralogy of Fallot (Fig. 2.36) Clinical Findings Associations (Fig. 2.37) Hemodynamics Radiographic Features (Fig. 2.38) Treatment Tetralogy Variants Pink Tetralogy Pentalogy of Fallot Trilogy of Fallot Ebstein Anomaly (Fig. 2.40) Associations Clinical Findings Hemodynamics Radiographic Features (Fig. 2.41) Treatment Tricuspid Atresia (Fig. 2.42) Associations Hemodynamics Radiographic Features (Fig. 2.43) Treatment Cyanotic CHD With Increased Pulmonary Vascularity Transposition of Great Arteries (TGA) (Fig. 2.45) Types Complete Transposition of Great Arteries (D-TGA) (Fig. 2.46) Hemodynamics Radiographic Features (Fig. 2.47) Treatment Taussig–Bing Complex (Dorv II) Corrected Transposition of Great Arteries (L-TGA) Associations Radiographic Features (Fig. 2.48) Truncus Arteriosus (TA) Associations Types (Figs. 2.49–2.50) Hemodynamics Radiographic Features Treatment Total Anomalous Pulmonary Venous Connection (TAPVC) (Fig. 2.51) Types Associations Clinical Findings (Fig. 2.53) Hemodynamics Unobstructed Pulmonary Vein Obstructed Pulmonary Vein Radiographic Features (Fig. 2.54) Cardiac CT and MRI Treatment Single Ventricle Association Radiographic Features Double-Outlet Right Ventricle (DORV) Aorta Pseudocoarctation Associations Radiographic Features Interruption of Aortic Arch (IAA) Types Associations Radiographic Features Aortic Arch (AA) Anomalies (Figs. 2.56–2.57) Normal Development (Fig. 2.58 A–C) Pearls Left AA With Aberrant RSA (Fig. 2.59) Radiographic Features Associations Right AA With Aberrant LSA Radiographic Features Associations Right AA With Mirror-Image Branching (Fig. 2.60) Radiographic Features Associations Right Arch With Isolated LSA Radiographic Features Associations Double AA Radiographic Features Pulmonary Artery Pulmonary Sling (Fig. 2.61) Vascular Rings and Slings (Fig. 2.62 A–B) Types Situs Anomalies General Abdominal Situs (Fig. 2.63) Thoracic Situs (Fig. 2.64) Cardiosplenic Syndromes Other Hypoplastic Left Heart Clinical Findings Radiographic Features Treatment Cor Triatriatum (Fig. 2.65) Radiographic Features Persistent Fetal Circulation Causes of Neonatal Pulmonary HTN Azygos Continuation of the IVC (Fig. 2.66) Radiographic Features Down Syndrome Marfan Syndrome (Fig. 2.67) Turner Syndrome Surgical Procedures for CHD Acquired Heart Disease General Cardiomegaly (Fig. 2.68) Causes Chamber Enlargement LA Enlargement (Fig. 2.69 A) Left Ventricle (LV) Enlargement (Fig. 2.69 B) Right Ventricle (RV) Enlargement (Fig. 2.69 C) Right Atrium (RA) Enlargement (Fig. 2.69 D) Valvular Heart Disease Mitral Stenosis Causes Clinical Findings Hemodynamics Radiographic Features (Fig. 2.70) Mitral Regurgitation (Fig. 2.72) Causes Clinical Findings Hemodynamics Radiographic Features (Figs. 2.73–2.74) Aortic Stenosis (AS) Types Clinical Findings Radiographic Features (Fig. 2.75) Aortic Regurgitation (Fig. 2.77) Causes Radiographic Features Myocardium Delayed-Enhancement Cardiac Magnetic Resonance Imaging (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 CAD (Fig. 2.78) Risk Factors Treatment Annual Mortality Radiographic Features Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) Clinical Findings Radiographic Features Pericardium Normal Anatomy Congenital Absence of the Pericardium Radiographic Features Pericardial Cysts Radiographic Features Pericardial Effusion Causes Radiographic Features (Fig. 2.80) Constrictive Pericarditis Causes Radiographic Features Cardiac Masses Differential Diagnosis Congenital Heart Disease (CHD) Acyanotic Heart Disease (Figs. 2.81–2.84) 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 and Normal Lungs Skeletal Abnormalities and Heart Disease Inferior Rib Notching Superior Rib Notching DDx of CHD by Age of Presentation Aorta Right AA and CHD Associations Acquired Heart Disease (Fig. 2.85) 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 (Fig. 2.86) High-Cardiac Output States Congestive Heart Failure Pneumopericardium Coronary Aneurysm Pulmonary Artery PA Enlargement (Fig. 2.87) Pulmonary Arterial Hypertension Classification Pulmonary Venous Hypertension Eisenmenger Physiology Suggested Readings 3 Gastrointestinal Imaging Chapter Outline Esophagus General Anatomy Normal Esophageal Contour Deformities (Fig. 3.1) Gastroesophageal Junction (GEJ) Anatomy (Fig. 3.2) Peristaltic Waves Swallowing (Fig. 3.3) Esophageal Ultrasound (US) (Fig. 3.4) Esophageal Disease Schatzki Ring Esophageal Webs and Rings Associations Hiatal Hernia Imaging Features (Fig. 3.5) Associations Approach Diverticula Lateral Pharyngeal Pouches Zenker 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 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 (UGI) Series Patient Preparation Single-Contrast Technique (Fig. 3.15) Double-Contrast Technique Percutaneous Gastrostomy Indications Technique Contraindications Normal Appearance Anatomy (Fig. 3.16) Mucosal Relief Types of Gastric Lesions Mucosal Versus Extramucosal Location of Mass (Fig. 3.17) Peptic Ulcer Disease (PUD) Cause 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 Ménétrier Disease (Giant Hypertrophic Gastritis) Imaging Features Eosinophilic Gastroenteritis Clinical Findings Imaging Features Gastroduodenal Crohn Disease Zollinger-Ellison Syndrome Clinical Findings Causes Imaging Features Gastric Polyps Gastric Carcinoma Risk Factors Location Staging Imaging Features (Fig. 3.20) Gastric Lymphoma Risk Factors Imaging Features Gastrointestinal Stromal Tumor (GIST) Imaging Features Metastases Contiguous Spread Hematogenous Spread to Stomach (Target Lesions) Imaging Features Carney Triad (Rare) Benign Tumors Gastric Volvulus Gastric Varices Benign Gastric Emphysema Duodenum and 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 Gastrointestinal (GI) Surgery Complications of Surgery (Fig. 3.25) Bariatric Surgery Gastric Bypass (Fig. 3.27) Complications Adjustable Gastric Banding Complications Sleeve Gastrectomy Jejunum and Ileum Normal Appearance Normal Appearance of SB by SBFT Computed Tomography Jejunal and 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 GI 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 Ace-Inhibitor–Related Angioedema Colon General Barium Enema Patient Preparation Single-Contrast Technique Double-Contrast Technique Contraindications to Barium Enema (BE) Complications of Barium Enema Glucagon CT Colonography (CTC) Magnetic Resonance Enterography (MRE) Polyps Adenomatous Polyps Clinical Findings Location (Fig. 3.30) Differentiation of Benign and 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 Turcot Syndrome Colon Carcinoma General Modifiable Cancer Risk Factors Nonmodifiable Cancer Risk Factors Location Imaging Features (Fig. 3.32) Complications Staging (Fig. 3.33) Tumor-Node-Metastases (TNM) Classification Diagnostic Accuracy Rectal MRI Colitis Causes Imaging Features Crohn Disease (Regional Enteritis) (Fig. 3.34) Imaging Features (Fig. 3.35) Mural and Extramural Changes (CT Findings) Complications (Fig. 3.36) Ulcerative Colitis (UC) (Figs. 3.37–3.38) Associated Findings Imaging Features Complications Perianal Fistulas Cause Types Imaging Features Treatment Behçet Disease Intestinal Manifestations Extraintestinal Manifestations Infectious Colitis Cytomegalovirus (CMV) Colitis Imaging Features Typhlitis (Neutropenic Colitis) Clinical Findings Imaging Features Complications 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 Pseudoobstruction of the Large Bowel (Ogilvie Syndrome) Imaging Features Toxic Megacolon (TMC) Imaging Features Liver General Liver Anatomy (Fig. 3.48) Hepatic Ligaments Ligaments and Spaces (Fig. 3.49A–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 Hemochromatosis 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 Organ Procurement and Transplantation Network (OPTN) Criteria 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 Indications Procedure Complications Trauma Types (Fig. 3.53) Complications Vascular Abnormalities Portal Hypertension Causes Imaging Features Arterioportal Shunting in Liver Types Budd-Chiari Syndrome (BCS) Clinical Findings Causes Imaging Features Pearls PV Thrombosis Causes Imaging Features Pearls Hepatic Artery (HA) Aneurysm Transplant Milan Criteria Ucsf Criteria Complications CT Features (After Transplantation) Endoscopic Retrograde Cholangiopancreatography (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 CD 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 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 Hyperplastic Cholecystoses Adenomyomatosis US Features MR Features 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 InterventionS 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 (PD) (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 (CF) Imaging Features Annular Pancreas Ectopic Pancreatic Tissue Pancreatic Trauma Types of Injuries (Fig. 3.76) Imaging Features Delayed Complications Pancreatitis General Classification Causes Clinical Findings Imaging of Acute Pancreatitis CT Staging (Value of Predicting Clinical Outcome is in Dispute) Pearls Terminology and Complications Acute Peripancreatic Fluid Collections (Formerly Called Phlegmon) (Fig. 3.77) Pseudocyst (Fig. 3.78) Necrotizing Pancreatitis (Fig. 3.79) Walled-off Necrosis (see Fig. 3.79) Infected Fluid Collections (see Fig. 3.79) 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 CF 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 Neoplasm (IPMN) 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 Transplant (Fig. 3.84) Normal Imaging Features Complications 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 Splenomegaly (Fig. 3.87) Common Causes Tumors Cysts Hamartoma Hemangioma Imaging Features Sclerosing Angiomatoid Nodular Tumor 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 and 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 and Ileum Dilated Gas-Filled Bowel Loops (Fig. 3.104) Approach (Fig. 3.105A–B) Small Bowel Obstruction (SBO) Colonic Obstruction (Fig. 3.106A–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. 3.107A–B) Causes Nodules Stack-of-Coins Appearance SB Luminal Narrowing CT Bowel Target Sign Gracile SB SB 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. 3.108A–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 US Signs of Intrahepatic Dilatation (Fig. 3.114) Multifocal Duct Narrowing Filling Defects Within Biliary System Periportal Enhancement GB Wall Thickening Diffuse (Concentric) Thickening (in Order of Decreasing Frequency) Focal (Eccentric) Thickening Hyperechoic Foci in GB Wall Dense GB 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 GI Manifestations by Organ System Low-Density LNs Abdominal Trauma Abdominal Complications After Cardiac Surgery Suggested Readings 4 Genitourinary Imaging Chapter Outline Kidneys General Anatomy Renal Pedicle (Fig. 4.1) Collecting System Orientation and Size of Kidneys Techniques Bolus IVP Technique Drip-Infusion Nephrotomogram Technique Retrograde Pyelogram Pretreatment Protocol for Intravenous (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 (Fig. 4.2) 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 (Fig. 4.3) 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) (Fig. 4.4) Types Imaging Features Adult Polycystic Kidney Disease (Apkd) (Fig. 4.5) Associated Findings Imaging Features Uremic Cystic Disease (UCD) Tumors Classification Renal Cell Carcinoma 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 Inflammation Urinary Tract Infection (UTI) Risk Factors Complications Acute Pyelonephritis Common Underlying Conditions Types Imaging Features Pyonephrosis Imaging Features Renal Abscess Imaging Features (Fig. 4.6) 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 TB (Fig. 4.7) Candidiasis Imaging Features Renal Manifestation of Acquired Immunodeficiency Syndrome (AIDS) Imaging Features Other Renal Abnormalities Prostate Abnormalities Testicular Abnormalities Nephrocalcinosis and Lithiasis Calculi Imaging Features Complications Treatment Options Extracorporeal Shock Wave Lithotripsy (ESWL) Indications for Percutaneous Nephrostomy Cortical Nephrocalcinosis (Fig. 4.8) Causes Imaging Features Medullary Nephrocalcinosis Causes Imaging Features Pelvicalyceal System (Fig. 4.9) Congenital Megacalyces Infundibulopelvic Dysgenesis (Pyelo)Calyceal Diverticulum Imaging Features Renal Papillary Necrosis (RPN) Causes Imaging Features (Fig. 4.10) Medullary Sponge Kidney (Benign Renal Tubular Ectasia; Cacchi-Ricci Disease) (Fig. 4.11) Associations (Rare) Imaging Features Obstruction of Collecting System (Fig. 4.12) Causes Imaging Features Whitaker Test Pyelorenal Backflow Types (Fig. 4.13) Trauma Renal Injury (Fig. 4.14) Mechanism Classification Imaging Features Vascular Abnormalities Renal Vein Thrombosis (RVT) Imaging Features Paroxysmal Nocturnal Hemoglobinuria Renal Infarcts (Fig. 4.15) Causes Renal Transplant Donor Evaluation Normal Renal Transplant Functional Evaluation of Transplanted Kidney Common Transplant Complications Acute Tubular Necrosis Imaging Features Rejection Pearls Vascular Complications Perirenal Fluid Collections Causes Bladder and Urethra Ureter Ectopic Ureter Clinical Findings Associations Insertion Sites Retrocaval Ureter Ovarian Vein Syndrome Pyeloureteritis Cystica (Fig. 4.16 A) Ureteral Pseudodiverticulosis (Fig. 4.16 B) Ureteral Diverticulum (Fig. 4.17) Malacoplakia Leukoplakia Ureteral Tumors Types Prognosis Imaging Features Ureteral Diversions Ileal Loop (Fig. 4.18) Colon Conduit Ureterosigmoidostomy Loopogram Bladder Congenital Urachal Anomalies (Fig. 4.19) 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 and Common Causes Leukoplakia Imaging Features Malacoplakia Imaging Features Bladder Diverticulum Types Malignant Bladder Neoplasm Clinical Finding Types and Underlying Causes Imaging Features Urachal Carcinoma Benign Bladder Tumors Bladder Calculi Bladder Outlet Obstruction Imaging Features (Fig. 4.20) Bladder Injuries Classification of Bladder Injury Radiographic Examinations in Suspected Bladder Injury Cystostomy Indication Technique Male Urethra Retrograde Urethrogram (RUG) (Fig. 4.21) Urethral Injuries (Fig. 4.22) Types Urethral Strictures and Filling Defects Infection Trauma Tumor (Rare) Female Urethra Anatomy Infection Carcinoma Diverticula Retroperitoneum General Anatomic Terms (Figs. 4.23–4.24) Perinephric Space (PRS) Benign Conditions Retroperitoneal Hematoma Causes Imaging Features Abscess Location and Causes Retroperitoneal Air Causes Retroperitoneal Fibrosis Causes Imaging Features Pelvic Lipomatosis Imaging Features Tumors Types 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 (Fig. 4.26) Adenoma Imaging Features Myelolipoma Imaging Features Adrenal Cyst Classification Imaging Features Adrenal Hemorrhage Causes Imaging Features Infection Functional Diseases Cushing Syndrome Causes Cortical Carcinoma, 10% Hyperaldosteronism Clinical Findings Types Imaging Features Adrenal Insufficiency Clinical Finding Types Imaging Features Male Pelvis Prostate Normal Anatomy Ultrasound-Guided Prostate Biopsy (Fig. 4.27) Indications Technique Prostate Magnetic Resonance Imaging (Fig. 4.28) Indication Technique Benign Prostatic Hyperplasia (BPH) Imaging Features (Fig. 4.29) Granulomatous Prostatitis Classification Imaging Features Prostate Cancer Screening (Controversial) Imaging Features (Fig. 4.30) Tumor–Node–Metastases (TNM) Staging Treatment Complications Seminal Vesicle (SV) and Spermatic Cord Seminal Vesicle Cysts Seminal Vesicle Agenesis or Hypoplasia Unilateral SV Agenesis (Embryonic Insult Occurs Before 7th Week of Gestation) Bilateral Seminal Vesicle Agenesis Other Seminal Vesicle Disease Tumors of Seminal Vesicle and Vas Deferens Spermatic Cord Hematospermia Testis and Epididymis General (Fig. 4.32) Arterial Supply (Fig. 4.33) MRI Evaluation of Testis Cryptorchidism Complications Torsion Types (Fig. 4.34) Imaging Features Treatment Epididymo-Orchitis (Fig. 4.35) Imaging Features Testicular Abscess US Features Varicocele Clinical Findings Location Ultrasound Features (Fig. 4.36) Hydrocele Types Trauma Types (Fig. 4.37) Cysts Types (Fig. 4.38) Testicular Microlithiasis Scrotal Pearl Malignant Testicular Tumors Types Imaging Features Pearls Benign Epidermoid Tumor Penis Peyronie Disease US Imaging Features Magnetic Resonance Imaging (MRI) Features Penile Fracture Vascular Impotence Imaging Features Penile Cancer Causes Pathology Imaging Features Female Pelvis General Pelvic Ultrasound Uterus Menstrual Cycle (Fig. 4.39) Ovary Hysterosalpingogram (HSG) Technique Technique for Tubal Occlusion Devices Complications Contraindications Pelvic Magnetic Resonance Imaging Techniques (Fig. 4.40) Signal Intensity on T2W Sequences Transvaginal Drainage Procedures Indications Complications Uterus Uterine Malformations (Fig. 4.41) Types Complications Associations In Utero Diethylstilbestrol (Des) Exposure Pelvic Inflammatory Disease (PID) Causes Ultrasound Features Asherman Syndrome Pyometra Causes Imaging Features Intrauterine Device (Iud) Complications Radiographic Feature Adenomyosis Clinical Findings Imaging Features (Fig. 4.42) Leiomyoma (Fig. 4.43) Clinical Findings Location Complications Imaging Features Extrauterine Leiomyomas Uterine Leiomyosarcomas Endometrial Hyperplasia Causes Types Ultrasound Features Tamoxifen Gartner Duct Cyst (Fig. 4.44) Endometrial Carcinoma Imaging Features Cervical Carcinoma Imaging Features Fallopian Tubes Hydrosalpinx (Fig. 4.45) Causes Imaging Features Salpingitis Isthmica Nodosa (SIN) Ovaries Classification of Cystic Ovarian Structures Follicular Cysts (Fig. 4.46) 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 Syndrome (PCOS, Stein-Leventhal Syndrome) Clinical Findings Imaging Features (Fig. 4.47) Endometriosis Types (Fig. 4.48) Imaging Features Ovarian Torsion Imaging Features Ovarian Vein Thrombosis Ovarian Cancer (Fig. 4.49) Risk Factors Types 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 (Fig. 4.51) Human Chorionic Gonadotropin (HCG) Clomiphene Citrate (Clomid) Pergonal Leuprolide Acetate (Lupron) Urofollitropin (Metrodin) Protocols Baseline Ultrasound Subsequent Scans Complications of Hormonal Treatment Ovarian Hyperstimulation Multiple Pregnancies Other Normal Pelvic Floor Anatomy Pelvic Floor Prolapse MRI Interpretation (Fig. 4.52) Differential Diagnosis Kidneys Renal Mass Lesions (Fig. 4.53) 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 (Fig. 4.54) Papillary Necrosis (Fig. 4.55) Delayed (Persistent) Nephrogram (Same DDx as Renal Failure) Extracalyceal Contrast Agent (Fig. 4.56) Dilated Calyces/Collecting System (Fig. 4.57) Bilaterally Enlarged Kidneys Bilaterally Small Kidneys Hypercalcemia Renal Vein Thrombosis Causes Ureter Dilated Ureter Ureteral Stricture Multiple Ureteral Filling Defects (Fig. 4.58) Ureteral Diverticula (Fig. 4.59) Deviated Ureters Lateral Deviation Medial Deviation Bladder Bladder Wall Thickening (Fig. 4.60) Bladder Filling Defect Bladder Neoplasm Bladder Calculi Bladder Wall Calcification Air in Bladder Teardrop Bladder (Fig. 4.61) 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 (Fig. 4.62) Female Pelvis Approach (Fig. 4.63) Uterus Thick Hyperechoic Ems (Fig. 4.64) Pearls Hypoechoic Structures in Hyperechoic Endometrium (Fig. 4.65) Fluid in Uterine Cavity (Fig. 4.66) Uterine Enlargement or Distortion Uterine Bleeding Uterine Size Small Uterus Large Uterus Pelvic Floor Cystic Masses Shadowing Structures in Endometrial Cavity (US) Ovaries and Adnexa Cystic Masses (Fig. 4.67) 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 Chapter Outline 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) Cartilaginous Joint Fibrous Joint Fracture Complications Orthopedic Procedures Types of Repair Orthopedic Hardware Spine Classification of Cervical Spine (C-Spine) Injuries Biomechanics (Figs. 5.4–5.5) Pearls Approach to C-Spine Plain Radiograph (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 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 and Lumbar Fractures General Radiographic Features Types of Fractures Spondylolysis Radiographic Features (Fig. 5.22) Spondylolisthesis (Fig. 5.23) Pseudospondylolisthesis (Fig. 5.24) Face Approach to Facial Fractures (Fig. 5.25) Orbital Fractures Pure Orbital Blow-Out Fracture (Fig. 5.26) Clinical Findings Radiographic Features (Figs. 5.27–5.28) Impure Orbital Blow-Out Fracture Orbital Blow-In Fracture Nasal Fractures (Fig. 5.29) Radiographic Features Mandibular Fractures (Fig. 5.30) Flail Mandible (Fig. 5.31 A–B) Zygoma Fractures (Figs. 5.32–5.33) Simple Arch Fractures Complex Arch Fractures (Tripod Fracture) Maxillary Fractures (Fig. 5.34) Dentoalveolar Fracture Sagittal Maxillary Fracture Le Fort Fractures (Figs. 5.35–5.36) Le Fort Type I Le Fort Type II Le Fort Type III Shoulder Fracture of the Clavicle (Fig. 5.37 A–B) Complications Fracture of the Scapula Fracture of Ribs Normal MRI Anatomy of Shoulder Joint (Fig. 5.38) Shoulder Ultrasound (US) Dislocations of the Glenohumeral Joint Anterior Dislocation (Fig. 5.39) Radiographic Features Posterior Dislocation (Fig. 5.41) Radiographic Features Inferior Dislocation Pseudodislocation of Glenohumeral Joint Rotator Cuff Tear (Figs. 5.42–5.43) Causes Radiographic Features Labral Tears Muscle Atrophy Adhesive Capsulitis (Frozen Shoulder) Radiographic Features AC Separation (Fig. 5.45) Radiographic Features Sternoclavicular Joint Injury (Fig. 5.46) Radiographic Features Arm Fractures of Proximal Humerus Four-Segment Neer Classification (Fig. 5.47) Radiographic Features Fractures of Distal Humerus (Figs. 5.48–5.49) Classification Complications Radial Head Fractures Treatment Radiographic Features (Fig. 5.50) Ulnar Fractures Olecranon Fracture Coronoid Fracture Elbow Dislocations Combined Radius-Ulna Fractures and Dislocations Monteggia Fracture-Dislocation Galeazzi Fracture-Dislocation Essex-Lopresti Fracture-Dislocation Colles Fracture (Fig. 5.51) Radiographic Features Complications Other Radial Fractures (Figs. 5.52–5.53) Barton Fracture Smith Fracture Reverse Barton Fracture (see Fig. 5.53) Chauffeur’s (or Hutchinson) Fracture (Fig. 5.54) Carpal Instability Elbow MRI Pearls Nerve Entrapment Syndromes Wrist/Hand Wrist Anatomy (Fig. 5.56) Lines of Articulations (Fig. 5.57) Ulnar Variance Scaphoid Fracture Radiographic Features Prognosis Fractures of Other Carpal Bones Triquetrum Hamate Lesser Arc Injury (Perilunate Injuries) (Fig. 5.58) Scapholunate Dissociation (Stage 1) (Fig. 5.59) Perilunate Dislocation (Stage 2) Midcarpal Dislocation (Stage 3) Lunate Dislocation (Stage 4) Carpal Instability (Figs. 5.60–5.61) Scapholunate Dissociation Volar Intercalated Segment Instability (VISI) Dorsal Intercalated Segment Instability Scapholunate Advanced Collapse (SLAC) CT of the Wrist Evaluation of Distal Radial Fractures (Fig. 5.62) Hand Anatomy (Fig. 5.63) First Metacarpal Fractures (Fig. 5.64) Bennett Fracture Rolando Fracture Boxer’s Fracture (Fig. 5.65) Gamekeeper’s Thumb (Skier’s Thumb) (Fig. 5.66) Stener Lesion Phalangeal Avulsion Injuries (Fig. 5.67) Baseball (Mallet) Finger Boutonnière (Buttonhole) Finger Avulsion of Flexor Digitorum Profundus Volar Plate Fracture Lower Extremity Hip Anatomy (Figs. 5.68–5.69) Pelvic Fractures (Fig. 5.70 A–B) Classification Fracture of the Acetabulum (Fig. 5.71 A–C) Classification (Letournel) Sacral Fractures (Fig. 5.71 D–E) Soft Tissue Injury (Fig. 5.72) Fractures of the Proximal Femur (Figs. 5.73–5.74) Classification Femoral Neck Fractures Treatment Complications Intertrochanteric Femoral Fractures Treatment Complications Dislocation of the Hip Joint Classification (Fig. 5.76) Athletic Pubalgia Osteitis Condensans Ilii Fracture of the Distal Femur Classification Fracture of the Proximal Tibia Classification (Müller) (Fig. 5.78) Radiographic Features Complications Tibial Stress Fracture Fracture of the Patella Osteochondral and Chondral Fracture Radiographic Features Osteochondritis Dissecans (Chronic Osteochondral Fracture) Radiographic Features Patellar Dislocation Radiographic Features Patellar Tendinitis (Jumper’s Knee) Meniscal Injury (Fig. 5.79) Types MRI Grading of Tears (Fig. 5.80) Pitfalls of Diagnosing Meniscal Tears by MRI (Fig. 5.81) Discoid Meniscus Meniscal Calcifications Meniscal Cysts Cruciate Ligament Tears (Fig. 5.82) Radiographic Features Segond Fracture (Fig. 5.83) Reverse Segond Fracture Collateral Ligaments Radiographic Features (Fig. 5.84) Tendon Injury Radiographic Features Knee Dislocation Avulsion Injury Sites Friction Syndromes at the Knee Ankle Ankle Anatomy (Fig. 5.85) Ankle Fractures Classification (Fig. 5.86) Approach Tibial Fractures Pilon Fracture (Fig. 5.87) Tillaux Fracture (Fig. 5.88) Wagstaffe-Le Fort Fracture Triplanar Fracture (Fig. 5.89) Tibial Insufficiency Fracture (Fig. 5.90) Fibular Injury Anatomy of Ligaments (Figs. 5.91–5.92) Tear of the MCL (Fig. 5.93) Tear of the LCL Tear of the Distal Anterior Tibiofibular Ligament Maisonneuve Fracture Foot Anatomy (Fig. 5.94) Calcaneal Fractures (Fig. 5.95) Lover’s Fracture Radiographic Features Calcaneal Stress Fractures (Fig. 5.96) Achilles Tendon Tear Haglund Disease Freiberg Infraction (Fig. 5.97) Talar Fractures Fractures of the Proximal Fifth Metatarsal (Fig. 5.98) Nutcracker Fracture of Cuboid Lisfranc Fracture-Dislocation (Fig. 5.99) Radiographic Features Orthopedic Procedures Joint Replacement Prosthetic Loosening Radiographic Features Other Complications Hip Replacement (Fig. 5.100) Types of Prostheses Types of Replacements (Fig. 5.101) Pearls Knee Replacement (Fig. 5.102) Types Other Procedures Arthrodesis Osteotomy Bone Graft Spinal Fusion Types Arthrography General General Principles Indications Contraindications Complications Preparation Type of Arthrogram Shoulder Arthrogram (Fig. 5.103) Patient Position Procedure Pearls MR Arthrography of the Shoulder Hip Arthrogram (Fig. 5.104) Injection Site Wrist Arthrogram (Fig. 5.105) Ankle Arthrogram (Fig. 5.106) 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. 5.107) Pattern of Bone Destruction (Fig. 5.108) Radiographic Patterns of Lytic Bone Lesions Pattern of Bone Repair (Fig. 5.109) Tissue Characterization Pearls (Fig. 5.110) Location of a Lesion in the Skeleton Location Within Anatomic Regions Axial Location Within a Bone (Fig. 5.111) 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 Clinical Findings Types Location of Conventional OSA Radiographic Features Pearls Telangiectatic OSA Radiographic Features Multicentric OSA Parosteal OSA Radiographic Features Periosteal OSA Radiographic Features Cartilage-Forming Tumors Enchondroma Location Radiographic Features Pearls Enchondromatosis (Ollier Disease) Radiographic Features Maffucci Syndrome Osteochondroma (Osteocartilaginous Exostosis) (Fig. 5.112) Radiographic Features Complications Multiple Osteocartilaginous Exostoses (Moce) Bizarre Parosteal Osteochondromatous Proliferation (BPOP, Nora Lesion) Dysplasia Epiphysealis Hemimelica (Trevor Disease) Chondroblastoma (Codman Tumor) Chondromyxoid Fibroma Chondrosarcoma Radiographic Features Fibrous Lesions Fibrous Cortical Defects (FCD) and NOF Radiographic Features (Fig. 5.113) Fibrous Dysplasia (Lichtenstein-Jaffe Disease) Associations Types Radiographic Features Variants (Fig. 5.114) 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. 5.116) 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 (Fig. 5.117) Location Radiographic Features Aneurysmal Bone Cyst (Fig. 5.118) Location Radiographic Features Hemophiliac Pseudotumor Radiographic Features Giant Cell Tumor (Fig. 5.119) 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. 5.120) Radiation-Induced Changes Bone Growth Osteonecrosis Radiation-Induced Bone Tumors Soft Tissue Masses and 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 Peripheral Nerve Sheath Tumor Morton Neuroma Arthritis General Approach Types of Arthritis (Fig. 5.121) Degenerative Arthritis General Clinical Findings Radiographic Features (Fig. 5.122) Treatment Options OA in Specific Locations Hip Knee Hand (Fig. 5.123) Shoulder Spine (Fig. 5.124) Erosive OA Radiographic Features (Fig. 5.125) Degenerative Disk Disease Radiographic Features Spondylosis Deformans (Fig. 5.126) Diffuse Idiopathic Skeletal Hyperostosis (Dish, Forestier Disease) Radiographic Features Inflammatory Arthritis General Adult RA Epidemiology Pathogenesis Diagnosis Radiographic Features (Fig. 5.127) Extraarticular Manifestations of RA RA in Specific Locations Hand (Fig. 5.128) Feet Shoulder (Fig. 5.129) Elbow Hip Spine Robust RA Scleroderma (Systemic Sclerosis) Radiographic Features Systemic Lupus Erythematosus (SLE) (Fig. 5.130 A) Radiographic Features Dermatomyositis (Fig. 5.130 B) Ankylosing Spondylitis (AS) Radiographic Features (Fig. 5.131) Associations Differentiation of Lumbar Osteophytes Osteophytes Syndesmophytes Reactive Arthritis (Reiter Syndrome) (Figs. 5.132–5.134) Clinical Findings Radiographic Features Psoriatic Arthritis Types (Fig. 5.135) Radiographic Features Pearls Enteropathic Arthropathies Metabolic Arthritis General (Fig. 5.136) Presentations Types Gout (Fig. 5.137) Causes Radiographic Features (Fig. 5.138) CPPD Disease Terminology Radiographic Features (Fig. 5.139) Associations Calcium Hydroxyapatite Deposition Disease (HADD) 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 Definitions Radiographic Features Tuberculous (TB) Arthritis Radiographic Features Disk Space Infection Radiographic Features Spectrum of Osteomyelitis and Septic Arthritis on Plain Radiograph Chronic Recurrent Multifocal Osteomyelitis (CRMO) Sarcoidosis Neuropathic Arthritis (Charcot Joint) Causes Radiographic Features Metabolic Bone Disease General Osteopenia Types Osteoporosis Classification Radiographic Features (Fig. 5.140) Quantitative Bone Densitometry (Fig. 5.141) Transient Osteoporosis of Hip Joint Osteomalacia Radiographic Features Renal Osteodystrophy Radiographic Features Scurvy Radiographic Features (Fig. 5.143) Endocrine Bone Disease Hyperparathyroidism (HPT) Radiographic Features (Fig. 5.144) Thyroid Acropachy Radiographic Features Acromegaly (Fig. 5.145) Radiographic Features Bone Marrow Disease Classification Gaucher Disease Clinical Findings Radiographic Features (Fig. 5.146) Complications Sickle Cell Anemia Clinical Findings Radiographic Features (Fig. 5.147) Thalassemia (Cooley Anemia) Radiographic Features Myelofibrosis Clinical Findings Radiographic Features Paget Disease (Osteitis Deformans) (Fig. 5.148) 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. 5.149) 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. 5.150) New Bone Formation in Arthritis Calcifications and Arthropathy (Fig. 5.151) Chondrocalcinosis Soft Tissue Swelling in Arthritis DDx 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 Asymmetric Periosteal Reaction Symmetric Periosteal Reaction in Adults Hypertrophic Pulmonary Osteoarthropathy Causes Differential Diagnosis Skull Solitary Lytic Lesion Diffuse Skull Lesions Multiple Lytic Lesions Basilar Invagination Spine (Fig. 5.152) Vertebral Body Sclerotic Pedicle Vertebral Outgrowths (Fig. 5.153) 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. 5.154) Platyspondyly Pelvis Protrusio Acetabuli (Fig. 5.155) Sacroiliitis Lytic Lesions of the Sacrum Lytic Lesion of Ilium Widened Pubic Symphysis Lower Extremity Erlenmeyer Flask Deformity (Fig. 5.156) Gracile Bones (Fig. 5.157) Femoral Head Avn Medial Tibial Spur (Fig. 5.158) 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 Fourth/Fifth Metacarpals Madelung Deformity (Fig. 5.159) Missing Distal Clavicle High-Riding Shoulder Distal Clavicular Erosions Soft Tissues Soft Tissue Calcification Soft Tissue Masses Psoas Abscess Suggested Readings 6 Neurologic Imaging Chapter Outline Imaging Anatomy Parenchymal Anatomy Lobar Anatomy (Fig. 6.1) Basal Ganglia (Fig. 6.2) Thalamus (Fig. 6.3) Central Sulcus (Fig. 6.4) Inferior Frontal Gyrus Anatomy (Fig. 6.5) Brain Myelination (Fig. 6.6) Characteristic MRI Appearance Ventricular System Anatomy (Fig. 6.7) Cavum Variants Cavum Septum Pellucidum Cavum Vergae Cavum Velum Interpositum Pineal Region Anatomy (Fig. 6.8) Sella Turcica Pituitary Gland (Fig. 6.9 A–B) Suprasellar Cistern Cavernous Sinus (Fig. 6.10) Meckel Cave (Trigeminal Cave) Vascular System External Carotid Artery (ECA) (Fig. 6.11) Internal Carotid Artery (Fig. 6.12) Vertebrobasilar System (Fig. 6.13) Segments and Branches of VAs (Fig. 6.14) Circle of Willis (Fig. 6.15) Cerebral Arteries Anterior Cerebral Artery (ACA) (Fig. 6.16) Middle Cerebral Artery (MCA) (see Fig. 6.16) Posterior Cerebral Artery (PCA) Normal Variants of Vascular Anatomy Internal Carotid Artery (ICA) (Fig. 6.17) External Carotid Artery (ECA) Circle of Willis Anastomoses Between Arteries Meninges and Venous Sinuses (Fig. 6.18) Meningeal Spaces Sinuses (Fig. 6.19) Vascular Territories (Fig. 6.20) Ultrasound (US) of Carotid Arteries B-Mode Imaging (Fig. 6.21) Doppler Imaging (Flow) (Fig. 6.22) Color Doppler US Pearls Transcranial Doppler (TCD) Spine Spinal Canal (Fig. 6.25) Neural Structures Vascular Disease Intracranial Hemorrhage (Fig. 6.27) CT Appearance of Intracranial Hemorrhage MRI Appearance of Intracranial Hemorrhage (Fig. 6.28) Hypertensive Hemorrhage Location Imaging Features Tumor Hemorrhage Aneurysm Types Saccular Aneurysm Imaging Features (Fig. 6.29) 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 (Fig. 6.30) Complications Vascular Malformation Types of Vascular Malformations Arteriovenous Malformation (AVM) Types Imaging Features (Fig. 6.31) Spetzler Criteria Complications Capillary Telangiectasia Imaging Features Cavernous Malformation (Fig. 6.32) Clinical Findings Imaging Features (Fig. 6.33) Developmental Venous Anomaly (Anomalous Vein) Imaging Features (Fig. 6.34) Vein of Galen AVM Imaging Features Stroke Causes Atherosclerotic Disease Imaging Features Cerebral Ischemia and Infarction Causes Imaging Features Pearls Diffusion and 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 Reversible Cerebral Vasoconstriction Syndrome (RCVS) Cadasil MRI Features Venoocclusive Disease Venous Sinus Thrombosis Causes Imaging Features (Fig. 6.35) Trauma General Classification of Injury Mechanism of Traumatic Brain Injury (TBI) Glasgow Coma Scale Score Primary Brain Injury Epidural Hematoma (EDH) (Fig. 6.37) Types Imaging Features Subdural Hematoma (SDH) (Fig. 6.38) Imaging Features Subdural Hygroma Imaging Features Diffuse Axonal Injury (DAI) Imaging Features (Fig. 6.39) Cortical Contusion (Fig. 6.40) Imaging Features Secondary Brain Injury Cerebral Herniation (Fig. 6.41) Types Imaging Features (Fig. 6.42) 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 Pearl Location Frequency of Tumors (Fig. 6.44) Tumor Extent Brain Edema Mass Effect Magnetic Resonance Spectroscopy (MRS) (Fig. 6.45) Gliomas Diffuse Astrocytic Tumors Classification Diffuse Astrocytoma Imaging Features Anaplastic Astrocytoma Imaging Features Glioblastoma Multiforme (GBM) Imaging Features Gliomatosis Cerebri Imaging Features Diffuse Midline Glioma (Fig. 6.46) Clinical Findings Imaging Features Localized Astrocytic Tumors Pilocytic Astrocytoma Imaging Features Pleomorphic Xanthoastrocytoma Imaging Features Oligodendroglial Tumors Imaging Features Ependymal Tumors Ependymoma Imaging Features DDx for Supratentorial Ependymoma Subependymoma Choroid Plexus Papilloma/Carcinoma Imaging Features Meningeal and Mesenchymal Tumors Meningioma Classification Location Imaging Features (Fig. 6.47) Anaplastic (Malignant) Meningioma Solitary Fibrous Tumor/Hemangiopericytoma Hemangioblastoma Cerebellar Hemangioblastoma, 80% Spinal Hemangioblastoma, 10% Neuronal and Mixed Glial/ Neuronal Tumors Ganglioglioma Dysembryoplastic Neuroepithelial Tumor (DNET) Dysplastic Gangliocytoma of Cerebellum (Lhermitte-Duclos Disease) Central Neurocytoma Embryonal Tumors Types Medulloblastoma Imaging Features (Fig. 6.51) Primary Cerebral Neuroblastoma Imaging Features Nerve Sheath Tumors Schwannoma (Fig. 6.52) Imaging Features Pearls Neurofibroma Pineal Region Tumors (Fig. 6.53) Germinoma Teratoma Pinealoblastoma Pineocytoma Pineal Parenchymal Tumor of Intermediate Differentiation Tumor Like Lesions Epidermoid/Dermoid (Fig. 6.54) Hypothalamic (Tuber Cinereum) Hamartoma Imaging Features Lipoma Imaging Features Hematopoietic Tumors Cns Lymphoma (Fig. 6.55) Types Imaging Features Aids-Related Primary CNS Lymphoma Metastases Imaging Features Pearls Carcinomatous Meningitis Cystic Lesions Arachnoid Cyst (Leptomeningeal Cyst) (Fig. 6.56) Imaging Features Colloid Cyst (Fig. 6.57) Clinical Findings Imaging Features Rathke Cleft Cyst Imaging Features Pineal Cyst Neuroepithelial/Neuroglial Cysts Degenerative and White Matter Disease General Classification of Degenerative Diseases Degeneration and Aging WM Disease Classification Multiple Sclerosis Revised McDonald Criteria Imaging Features (Fig. 6.58) Acute Disseminated Encephalomyelitis (ADEM) Posterior Reversible Encephalopathy Syndrome (PRES) Common Causes Radiation/Chemotherapy-Induced Cns Abnormalities Common Causes Osmotic Demyelination Syndrome (ODS) Imaging Features Leukodystrophies General Categories Imaging Features Metachromatic Leukodystrophy Imaging Features Adrenoleukodystrophy (ALD) (Fig. 6.60) Imaging Features GM Disease Dementia Types Alzheimer Disease Imaging Features Frontotemporal Dementia (Pick Disease) (Fig. 6.61) Vascular Dementia Types Parkinson Disease Clinical Findings Types Imaging Features Parkinson-Plus Syndromes (Patients WHO Respond Poorly to Antiparkinson Medication) (Fig. 6.62) Multisystem Atrophy (MSA) Progressive Supranuclear Palsy (PSP) Imaging Features Corticobasal Degeneration Imaging Features Amyotrophic Lateral Sclerosis (ALS) Basal Ganglia Disorders Basal Ganglia Calcification Causes Huntington Chorea (Fig. 6.63) Imaging Features Wilson Disease Imaging Features Fahr Disease Leigh Disease Diagnosis Imaging Features Neurosarcoidosis Radiologic Features Toxic/Infectious Creutzfeldt-Jakob Disease (CJD) Imaging Features Co Poisoning Alcoholic and Wernicke Encephalopathy Imaging Features Seizure Medication Hydrocephalus General Classification Approach (Fig. 6.64) Shunt Complications Noncommunicating Hydrocephalus Causes Imaging Features Communicating Hydrocephalus Causes Imaging Features 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 Fungal Infections Causes Imaging Features Parasitic Infections Neurocysticercosis (Fig. 6.65) Imaging Features Lyme Disease Viral Infections Herpes Simplex Virus (HSV) Encephalitis Imaging Features Congenital Infections Causes Imaging Features (Fig. 6.66) AIDS HIV Encephalopathy Imaging Features (Fig. 6.68) Toxoplasmosis Imaging Features (Fig. 6.69) Cryptococcosis Progressive Multifocal Leukoencephalopathy (PML) Imaging Features (Fig. 6.70) CMV Meningoencephalitis Congenital Disease General Classification (Fig. 6.71) Neural Tube Closure Defects Chiari Malformations Overview of Chiari Malformations Chiari I Malformation (Fig. 6.72) Clinical Findings Associations Imaging Features Chiari II Malformation Associations Imaging Features (Fig. 6.73) Cephalocele Location Cerebral Hemisphere Defects Agenesis of Corpus Callosum (ACC) Imaging Features (Fig. 6.75) Holoprosencephaly Imaging Features (Fig. 6.76) Facial Abnormalities Pearls Cerebral Hemiatrophy (Dyke-Davidoff) Imaging Features Interhemispheric Lipoma Associations Imaging Features Septooptic Dysplasia Imaging Features Malformations of Cortical Development (Fig. 6.78) Microcephaly Focal Cortical Dysplasia Mesial Temporal Sclerosis Imaging Features Hemimegalencephaly Heterotopias Lissencephaly (Smooth Brain Surface) Schizencephaly (Split Brain) Polymicrogyria Posterior Fossa Malformations DW Malformation Clinical Findings Associations Imaging Features (Fig. 6.79) DW Variant Imaging Features (Fig. 6.80) Rhombencephalosynapsis Joubert Syndrome Phakomatoses Neurofibromatosis (NF) Diagnostic Criteria Imaging Features of NF1 Imaging Features of NF2 Pearls VHL Disease Clinical Findings Imaging Features Pearls Tuberous Sclerosis (Bourneville Disease) (Figs. 6.81–6.82) Imaging Features Sturge-Weber-Dimitri Syndrome (Encephalotrigeminal Angiomatosis) Clinical Findings Imaging Features Sellar and Juxtasellar Regions Neoplasm Pituitary Adenoma Functioning Pituitary Microadenoma Types Imaging Features (Fig. 6.83) Nonfunctioning Pituitary Macroadenoma Imaging Features (Fig. 6.84) Craniopharyngioma Clinical Findings Types Imaging Features Pearls Other Empty Sella Postsurgical Sella Imaging Features Ectopic Neurohypophysis Pituitary Apoplexy Causes Spine Congenital Spinal Dysraphism Classification (Fig. 6.85) Dorsal Dermal Sinus Lipomyelomeningocele (Fig. 6.87) Clinical Findings Imaging Features Tethered Spinal Cord (Fig. 6.88) Clinical Findings Imaging Features Diastematomyelia (One of the “Split Notochord Syndromes”) Associations Other Imaging Features Hydrosyringomyelia Infection Spondylitis and Diskitis Causes Imaging Features Spinal TB (Pott Disease) Arachnoiditis Causes Imaging Features Guillain-Barré Syndrome Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Acute Transverse Myelopathy Imaging Features Subacute Combined Degeneration Degenerative Abnormalities Disk Herniation (Fig. 6.89) Spectrum of Intervertebral Disk Herniation Posterior Disk Herniation (Fig. 6.90) Imaging Features MRI Features (Fig. 6.91) Spinal Stenosis Causes (Fig. 6.92) Imaging Features Spinal Block Foraminal Stenosis Postoperative Spine Imaging Features 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) CPA Mass Pineal Region Mass Cystic Masses Tumors With CSF Seeding Underlying Causes of Hemorrhage Causes 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 Restricted Diffusion 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 and Neck Imaging Chapter Outline Temporal Bone General External Auditory Canal (EAC) Middle Ear (Figs. 7.1–7.2) Inner Ear (Fig. 7.3) Internal Auditory Canal (IAC) (Fig. 7.4) Facial Nerve (Figs. 7.5–7.6) Hearing Loss Types Pulsatile Tinnitus Causes Trauma Temporal Bone Fractures Clinical Findings Radiographic Features Fracture Complications Indications for Surgery in Temporal Bone Fractures Inflammation Acute Inflammation Potential Complications Bell Palsy Acquired Cholesteatoma (Fig. 7.8) Radiographic Features Complications of Acquired Cholesteatoma Congenital Cholesteatoma (Epidermoid) Cholesterol Granuloma (Cholesterol Cysts) Radiographic Features Malignant or Necrotizing External Otitis Radiographic Features Labyrinthitis Ossificans Tumors Glomus Tumors Types Clinical Findings Radiographic Features Other Benign Temporal Bone Tumors Malignant Temporal Bone Tumors Otodystrophies and Dysplasias Otosclerosis (Otospongiosis) Types Semicircular Canal Dehiscence Syndrome Other Otodystrophies and Dysplasias Congenital Anomalies Congenital Abnormalities of the Inner Ear Petrous Malformations Associated With Recurrent Meningitis Overview of Syndromes Skull Base, Foramina, and Cranial Nerves General Anterior and Central Skull Base Anatomy Central Nervous System (CNS), Foramina, and Cavernous Sinus (Figs. 7.9–7.10) Pterygopalatine Fossa (PPF) (see Fig. 7.10) Anterior Skull Base Lesions Neoplasms: Benign and Malignant Nonneoplastic Lesions Central Skull Base Lesions Neoplasms: Benign and Malignant Nonneoplastic Lesions Perineural Tumor Spread General Differential Diagnosis (DDx) Orbit General Orbital Spaces (Figs. 7.11–7.12) Orbital Structures Orbital Septum Globe Retinoblastoma Radiographic Features Pearls Melanoma Radiographic Features (Fig. 7.14) Persistent Hyperplastic Primary Vitreous (PHPV) (Fig. 7.15) Radiographic Features Retrolental Fibroplasia (Retinopathy of Prematurity) Coats Disease Radiographic Features Drusen Globe-Shape Abnormalities (Fig. 7.16) Leukokoria Retinal Detachment (Fig. 7.17) Choroidal Detachment (see Fig. 7.17) Optic Nerve Optic Nerve Glioma Radiographic Features Optic Nerve Meningioma Radiographic Features Optic Neuritis Clinical Findings Causes Radiographic Features (Acute Phase) Extraocular Tumors and Vascular Lesions Vascular Lesions Dermoid Cyst Radiographic Features Lacrimal Gland Tumors Rhabdomyosarcoma Radiographic Features Metastases Infectious, Inflammatory, and Infiltrative Lesions Orbital Infection Radiographic Features Thyroid Ophthalmopathy Radiographic Features (Figs. 7.18–7.19) Idiopathic Orbital Inflammation (Orbital Pseudotumor) Clinical Findings Variants Radiographic Features (Fig. 7.20) Trauma Other Erdheim-Chester Disease Ocular Manifestations of Phakomatoses Lymph Nodes Anatomy Imaging Characteristics of Pathologic LNs Size Nodal Clustering or Grouping Internal Architecture: Evaluation of Nodal Inhomogeneity or Necrosis Node Morphology: Rounded Shape Node Contour or Periphery Other Characteristics Other Techniques Oral Cavity, Suprahyoid and Infrahyoid Neck, and Larynx Anatomy Oral Cavity (OC) (Fig. 7.22) Shn and Ihn Neck (Figs. 7.23–7.24) Pharynx Subdivisions Larynx (Figs. 7.25–7.26) Laryngeal Cartilages Innervation to Larynx: Branches of Vagus (CN X) Axial CT Anatomy (see Fig. 7.26) Variations in Cord Position With Different Respiratory Maneuvers Pathology Oral Cavity Malignant Lesions Benign Masses Nasooropharynx Oropharyngeal (Mucosal Space) Lesions Hypopharynx and Larynx Benign Laryngeal Tumors and Other Rare Lesions Laryngocele (Fig. 7.27) Laryngeal Trauma Vocal Cord Paralysis (Fig. 7.28) Postsurgical Larynx Retropharyngeal Abscess (Fig. 7.30) Radiographic Features Other Lesions Branchial Cleft Cyst Radiographic Features Thyroglossal Duct Cyst Location Radiographic Features Glomus Tumors (Paraganglioma, Chemodectoma) Associations Location Sinuses, Nasal Cavity General Normal Anatomy and Variants (Fig. 7.32) Nasal Cavity Sinuses Osteomeatal Unit (OMU) (see Fig. 7.32) Frontal Recess Main Drainage Pathways Anatomic Variants and Cells Important Anatomic Relations Pterygopalatine Fossa (Fig. 7.33; see Fig. 7.10) Sphenopalatine Foramen Pterygoid (Vidian) Canal Foramen Lacerum Pathology Sinusitis Types Imaging Findings and Potential Complications (Figs. 7.34–7.36) Imaging Pearls Acute Sinusitis Mucus Retention Cyst (see Figs. 7.35–7.36) Radiographic Features Polyps Radiographic Features Destructive Sinus Lesion Causes Mycetoma Radiographic Features Allergic Fungal Sinusitis Radiographic Features Invasive Fungal Sinusitis Radiographic Features Mucocele (Fig. 7.37) Radiographic Features Inverted Papilloma Radiographic Features Antrochoanal Polyp Radiographic Features Benign Tumors and Fibroosseous Lesions Juvenile Angiofibroma Other Malignant Tumors Types Imaging Characteristics Tumor Spread Other Abnormalities and Lesions Functional Endoscopic Sinus Surgery (FESS) Glands and Periglandular Region General Superficial Neck Anatomy (Fig. 7.39) Glandular Structures in the Neck Salivary Gland Pathology Sialolithiasis (Calculi) Radiographic Features Sialosis Associations Sialoadenitis Acute Sialoadenitis Chronic, Recurrent Sialoadenitis Infections and Idiopathic Processes Also Affecting Intraglandular or Juxtaglandular LNs Sjögren Syndrome Clinical Findings Radiographic Features (Neck) Cystic Salivary Lesions Parotid Tumors Types Clinically Important Anatomic Landmarks and Reporting Pleomorphic Adenoma (Benign Mixed Tumor) Radiographic Features Malignant Tumors Radiographic Features Parathyroid (Fig. 7.40) Hyperparathyroidism (HPT) Types Clinical Findings Effect of PTH Radiographic Features Parathyroid Adenoma Radiographic Features Hypoparathyroidism Causes Radiographic Features Thyroid (see Fig. 7.40) 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 and Maxilla Cystic Masses Overview Odontogenic Cysts (Fig. 7.41) Dentigerous Cyst (Follicular Cyst) (see Fig. 7.41) Radiographic Features Odontogenic Keratocyst (Keratocystic Odontogenic Tumor) Radiographic Features Primordial Cyst Residual Cyst Osteoradionecrosis Benign Tumors Overview Ameloblastoma (Adamantinoma) Odontoma Odontogenic Myxoma Cementoma (Cementoblastoma) Basal Cell Nevus (Gorlin) Syndrome Malignant Tumors Overview Primary Odontogenic Malignancies Classification Temporomandibular Joint (TMJ) Anatomy (Fig. 7.42) Disk Displacement Types Degenerative Changes of TMJ Differential Diagnosis Temporal Bone (Fig. 7.43) Approach Soft Tissue Mass in Middle Ear Vascular Lesion in Middle Ear Intracanalicular IAC Masses Jugular Fossa Mass Mastoid Bone Defect Petrous Apex Lesions Orbit Approach to Orbital Masses (Fig. 7.44) Orbital Masses by Cause Extraconal Disease Conal and Intraconal Disease Vascular Orbital Lesions Optic Nerve Sheath Enlargement Tramtrack Enhancement of Optic 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 Prevertebral Mass Other Neck Lesions Parapharyngeal (Prestyloid) Space Masses Cystic Extrathyroid Lesions Cystic Thyroid Lesions Solid Neck Mass Vascular Head and Neck Masses Acquired Immunodeficiency Syndrome (AIDS) Suggested Readings 8 Vascular Imaging Chapter Outline Techniques General Preprocedure Evaluation Access Types of Arterial Approach 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 (see Chapter 13) Catheter-Related Complications Pearls Hardware Catheters Generic Types Measurements Materials Pearls Guidewires Measurements Pharmacologic Manipulation Angiographic Interventions Embolization Indication General Principles Embolic Agents Complications Hepatic Chemoembolization Hepatic Radioembolization Thrombolysis Indication General Principles (Fig. 8.1) Techniques Contraindications Angioplasty Indication General Principles Prognostic Indicators PTA Results Complications Intravascular Stents Indications for Metallic Stents Indications for Stents in Revascularization Procedures Stent Results Transjugular Intrahepatic Portosystemic Shunt (Tips) Established Indications Controversial Indications General Principles Contraindications Technique (Fig. 8.3) Results Complications Signs of Malfunction Alternatives to Tips Transjugular Liver Biopsy Technique Venous Access Central Venous Access Catheters Complications of Central Venous Catheter Placement Vascular US General Continuous Wave Doppler Pulsed Wave Doppler Power Doppler US Aliasing Magnetic Resonance Imaging Noncontrast Imaging Techniques Gadolinium (GD)-Enhanced MRA Spinal GD MRA Other Techniques Digital Subtraction Angiography (DSA) Venous DSA Arterial DSA Petrosal Vein Sampling Lymphography Conscious Sedation Coagulation General (Fig. 8.6) Normalization of Prolonged Coagulation Times Monitoring Heparin Therapy Anticoagulation Drugs and Procedures Heparin Coumadin (Warfarin) Fragmin (Dalteparin) Argatroban Arixtra (Fondaparinux) Plavix (Clopidogrel) ReoPro (Abciximab) Other Antiplatelet Agents Antibiotics Recommended Not Recommended Thoracic Aorta and Great Vessels General Anatomy (Fig. 8.7) Imaging Principles Computed Tomography Magnetic Resonance Imaging Aortography Transesophageal Echocardiography Thoracic Aortography Technique Thoracic Aortic Aneurysm General Causes Pearls Atherosclerotic Aneurysm Complications Radiographic Features Computed Tomography Cystic Medial Necrosis Radiographic Features (Fig. 8.9) Syphilitic Aneurysms Radiographic Features (Fig. 8.10) Mycotic Aneurysms Aortic Dissection General Clinical Findings Causes Types (Fig. 8.11) Treatment Indications for Imaging (Fig. 8.12) Goals of Imaging Studies Angiographic Features CT Features (Fig. 8.13) MRI Features Pearls Variants Aortic Wall Hematoma (Fig. 8.14) Penetrating Aortic Ulcer Chronic Dissection Traumatic Aortic Injury General Location Approach Chest Radiograph Computed Tomography (CT) CTA/Angiography Pearls Aortitis Takayasu Arteritis (Pulseless Disease) Types (Fig. 8.16) Radiographic Features Giant Cell Arteritis Syphilitic Aortitis Complications Radiographic Features Abdomen and Pelvis Inferior Vena Cava Congenital Variants Abdominal Aorta Anatomy (Fig. 8.17) Abdominal Aortic Aneurysm Radiographic Features (Fig. 8.18) Other AAAs Inflammatory AAA Mycotic AAA Risk Factors Aortoiliac Occlusive Disease Radiographic Features Abdominal Aortic Coarctation Radiographic Features Aortic Interventions and Surgery Endovascular Stent Grafts Endoleak Classification (White) Types of Grafts Aortic Bifurcation Grafts (Onlay Grafts, Inverted Y Grafts) Aortic Onlay Graft (Figs. 8.20–8.21) End-to-End Y Graft Wrapped Graft (Tube Graft) (Fig. 8.22) Surgical Graft Complications Infrainguinal Graft Failure Mesenteric Vessels (Fig. 8.23) Celiac Axis Hepatic Vasculature Hepatic Arteries Hepatic Veins Splenic Artery Branches Superior Mesenteric Artery (SMA) (Fig. 8.24) Branches Inferior Mesenteric Artery (Fig. 8.25) Branches Mesenteric Collaterals (Figs. 8.26–8.27) Pelvic Arteries (Fig. 8.28) Upper Gastrointestinal (UGI) Hemorrhage Causes Radiographic Features Angiographic Intervention Lower GI Hemorrhage (Fig. 8.29) Causes Radiographic Features Angiographic Intervention (Fig. 8.30) Intestinal Ischemia Causes Radiographic Features Angiodysplasia Radiographic Features Varicocele Liver Arterial Imaging Venous Imaging (Figs. 8.31–8.32) Indications Imaging Modalities Portal HTN Causes Radiographic Features PV Thrombosis Causes Complications Radiographic Features Angiography Splenic Vein Occlusion (Isolated) Budd-Chiari Syndrome (BCS) Causes Radiographic Features Treatment Kidneys Anatomy Arteries (Fig. 8.34) Variants Veins Indications for Renal Angiography Diagnostic Renal Arteriography Renal Venography Angiographic Interventions Renal Artery Stenosis (RAS) (Fig. 8.35) Causes Radiographic Features Renal Artery Atherosclerosis Radiographic Features (Fig. 8.36) Fibromuscular Dysplasia (FMD) Distribution Radiographic Features Pearls Renal Arterial Aneurysm Polyarteritis Nodosa Radiographic Features Renal Vein Thrombosis Causes Radiographic Features Spleen Splenic Artery Aneurysm Chest General Anatomy Pulmonary Arteries (Fig. 8.37) Thoracic Veins (Figs. 8.38–8.39) Angiographic Techniques Pulmonary Angiography Indications Technique Pearls Complications Bronchial Arteriography (Fig. 8.40) Indication Technique Complications Bronchial Artery Embolization Indication Technique Complications Pulmonary Thromboembolism Risk Factors (Same as for DVT) CT Pulmonary Angiography (CTPA) Indications for Performing Pulmonary Angiography Radiographic Features Other Pulmonary Vascular Diseases Pulmonary AVM or AVF Causes Radiographic Features PA Pseudoaneurysm Extremities Anatomy Lower Extremity Arteries Branches (Fig. 8.42) Collaterals Persistent Sciatic Artery Lower Extremity Veins (Fig. 8.44) Upper Extremity Arteries (Fig. 8.45) 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 Uterine Artery Embolization Endovenous Laser Treatment (EVLT) of Varicose Veins Deep Vein Thrombosis (DVT) Locations Radiographic Features (Figs. 8.46 and 8.47) Pearls IVC Filters Types Technique Complications Vascular Compression Syndromes May-Thurner Syndrome Median Arcuate Ligament Syndrome Radiographic Features SMA Syndrome Nutcracker Syndrome 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 AVF for Hemodialysis Access Major Disorders for AVF 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 PA Stenosis Asymmetric Pa Enlargement Pulmonary Venous Hypertension Diminished Pa Pulmonary (Pseudo)Aneurysms Subclavian Steal Svc Obstruction Abdomen Hyperreninemic HTN Renal Tumors Renal Arterial Aneurysm Soft Tissue Density Around Aorta IVC Tumor Thrombus Suggested Readings 9 Breast Imaging Chapter Outline Mammography Mammography Techniques Mammographic Views (Fig. 9.1) MLO View CC View Exaggerated Craniocaudal (Xccl) View Lateral Views: Mediolateral (ML and Lateromedial (Lm) Axillary Tail View (Cleopatra View) Cleavage Valley View Spot Compression Views Magnification Views Tangential View Rolled Views (Fig. 9.2) Proper Positioning Compression Lesion Localization Triangulation (Fig. 9.3) Mammography Technical Standards Viewing Conditions Image Labeling Quality Control Mammography Interpretation (Fig. 9.5) Pertinent Patient History Mammography Reporting (Fig. 9.6) Breast Composition Mass Margins Shape Density Other Features Calcifications Morphology Typically Benign Morphology (Fig. 9.8) Distribution Architectural Distortion Asymmetries Skin, Nipple, and Trabecular Changes Abnormal Ducts Lymph Node Abnormalities Asymmetry of Breast Tissue Structured Reporting Ultrasound (US) Indications Interpretation Ultrasound Appearance of Common Lesions Galactography Indications Technique Magnetic Resonance Imaging (MRI) Indications Advantages Limitations Technique BI-RADS Lexicon Fibroglandular Tissue (FGT) Background Parenchymal Enhancement (BPE) Lesions Enhancement Kinetics Associated Features MRI Features of Common Benign Lesions Evaluation of Implants Technique Signs of Rupture (See Later Section on Implants in This Chapter) Breast Imaging Guided Procedures Mammographically Guided Wire Localization for Surgical Biopsy/Excision (Fig. 9.10) Technique for Wire Localization of a Lesion Seen Only on a Single View (Triangulation) (Fig. 9.11) Core Biopsy 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 Breast Cancer Staging Lymph Nodes (Fig. 9.12) Staging System Metastatic Spread Sensitivity of Detection Specific Neoplasm Pathology Classification (Fig. 9.13) Ductal Carcinoma in situ (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 Benign Processes Fibrocystic Changes (Fig. 9.17) Risk Cystic Disease (Fig. 9.18) Radiographic Features Fibroadenoma Clinical Spectrum Radiographic Features (Fig. 9.19) Giant Fibroadenoma Complex Fibroadenoma Phyllodes Tumor Fibrosis Adenosis (Fig. 9.20) 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 Pearls Implants Radiographic Features (Fig. 9.21) 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 Well-Circumscribed Masses Developing Asymmetry on Mammogram Fat-Containing 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) Ring-Like Peripheral Calcification in Mass Focal Skin Thickening Basic Workup for Common Findings Suggested Readings 10 Obstetric Imaging Chapter Outline First Trimester General Reference Role of Imaging First Trimester Second Trimester Third Trimester Prenatal Screening Screening Tests Alpha-Fetoprotein (AFP) (Fig. 10.2) Beta-Human Chorionic Gonadotropin Amniocentesis Chorionic Villus Sampling (CVS) NT Measurement Nasal Bone First-Trimester Imaging Approach to First-Trimester Sonogram (Fig. 10.3) Normal Pregnancy Early Development (Fig. 10.4) Amniotic and Chorionic Membranes (Fig. 10.5) Double Decidual Sac Sign (Fig. 10.6) Yolk Sac Fetal Heart Pearls Gestational Sac Normal Gestational Sac Correlation of MSD and β-HCG Levels (Fig. 10.8) Diagnosis of Pregnancy Failure Threatened Abortion Terminology of Abortion Subchorionic Hemorrhage US Features (Fig. 10.9) Ectopic Pregnancy General Location (Fig. 10.10) Clinical Findings Risk Factors Diagnosis Diagnostic Tests US Features Pearls Treatment Multifetal Pregnancy General Types Placental Unit (Fig. 10.14) US Imaging Approach US Features Pearls Complications Overview of Complications in Twin Pregnancies (Fig. 10.15) Twin-Twin Transfusion Syndrome (Fig. 10.16) 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 and Third Trimesters General Pearls Fetal Neural Axis Anatomy Normal Central Nervous System (CNS) Structures (Fig. 10.17) Signal Intensities (Fig. 10.18) Spine (Fig. 10.19) Holoprosencephaly US Features (Fig. 10.20) Pearls Agenesis of Corpus Callosum (ACC) US Features Hydranencephaly Porencephaly Ventriculomegaly (Fig. 10.21) US Features Cystic Structures Cystic Teratoma Choroid Plexus Cysts (CPCs) Arachnoid Cysts Hemorrhage DW Syndrome (Fig. 10.22) US Features Large Cisterna Magna (Fig. 10.23) US Features Neural Tube Defect (NTD) Anencephaly (Fig. 10.24) Encephalocele (Fig. 10.25) Associations US Features Spina Bifida and Myelomeningocele (Fig. 10.26) US Features Pearls Algorithm for Intracranial Malformations (Fig. 10.29) Face and Neck Cystic Hygroma US Features Other Anomalies of the Face and 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 Pulmonary Airway Malformation (CPAM) Types US Features Bronchopulmonary Sequestration Types Associations (Extralobar, 65%; Intralobar, 10%) US Features Congenital Diaphragmatic Hernia (Bochdalek Hernia) US Features (Fig. 10.30) Mediastinal Masses Pleural Effusion Causes US Features Abdomen Normal Anatomy Umbilical Vessels (Fig. 10.31) 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 (Fig. 10.32) Gastroschisis US Features (Fig. 10.33) Omphalocele US Features (Fig. 10.34) Amniotic Band Syndrome (ABS) US Features (Fig. 10.35) Limb/Body Wall Complex (LBWC) US Features Urinary Tract Normal Development Potter Syndrome (Figs. 10.36–10.37) Renal Agenesis US Features Urinary Tract Obstruction Approach Ureteropelvic Junction (UPJ) Obstruction (Figs. 10.38–10.39) UVJ Obstruction Bladder Outlet Obstruction Prenatal Predictors of Poor Postnatal Renal Function Renal Cystic Disease MCDK Disease US Features (Fig. 10.40) Autosomal Recessive Polycystic Kidney Disease (ARPCKD) (Infantile Polycystic Kidney Disease) US Features (Fig. 10.41) 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 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 (T21) (Down syndrome) Trisomy 18 (T18) (Edwards Syndrome) Trisomy 13 (Patau Syndrome) Meckel-Gruber Syndrome Measurements and Growth Measurements Recommendations Estimated Gestational Age (EGA) Gestational Sac (Fig. 10.42) Crown–Rump Length (CRL) Head Measurements Biparietal Diameter (BPD) Cephalic Index (Fig. 10.45) Corrected BPD Head Circumference (HC) (Fig. 10.46) Abdominal Measurements (Fig. 10.47) Fl Measurement (Fig. 10.48) Estimated Fetal Weight (EFW) Growth Abnormalities Abnormally Small Fetus (IUGR) Asymmetric IUGR (90%) Symmetric IUGR (10%) Sonographic Determination Abnormally Large Fetus Risk Factors Complications Biophysical Profile (BPP) Clinical Relevance Mortality Fetomaternal Structures General Approach (Fig. 10.49) Placenta Normal Development (Fig. 10.50) Decidua (Maternal Endometrium) Chorion (Fetal Component) Placental Unit (Fig. 10.51) US Features (Fig. 10.52) Normal Placenta Placental Variants Placental Grading Placenta Previa Types (Fig. 10.53) US Features Placental Separation Complications Types (Fig. 10.54) US Features Placenta Accreta Types (Fig. 10.55) Complications Imaging Features Normal Intraplacental Lesions Chorioangioma US Features Gestational Trophoblastic Disease (GTD) Classification Modified National Institutes of Health (NIH) Classification Hydatidiform Mole Clinical Findings US Features (Fig. 10.56) Prognosis Variants Incomplete or Partial Mole Coexistent Trophoblastic Disease and 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 (Fig. 10.57) Vasa Previa Two-Vessel Cord Straight Cord Masses Uterus and Adnexa Incompetent Cervix Clinical Findings Causes US Features (Fig. 10.58) Management Issues Uterine Fibroids Adnexal Masses Corpus Luteum Cyst (CLC) US Features Other Adnexal Masses Pelvimetry Measurements (Fig. 10.59) Fetal MRI Differential Diagnosis First Trimester First-Trimester Bleeding (Fig. 10.60) Pregnancy-Related (Common) Unrelated to Pregnancy (Rare) Empty Sac Echogenic Central Cavity Complex Intrauterine Mass AFP Abnormalities (Fig. 10.61) Elevated MSAFP (Two Multiples of Median) Low MSAFP (<0.5 Multiples of Median) Predictors of Poor Outcome Second and Third Trimesters Placenta Size Diffusely Enlarged Placenta (>4 cm Thick) Small Placenta (Hypoperfusion) Abnormal Placental Echotexture Umbilical Cord Abnormalities Solitary UA 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 and 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 (Fig. 10.63) Double Bubble (Associated With Polyhydramnios) (Fig. 10.64) Dilated Bowel (Fig. 10.65) 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 Chapter Outline Respiratory Tract Upper Airway Approach Normal Appearance Laryngomalacia Tracheomalacia Webs Tracheal Stenosis (Fig. 11.3) Subglottic Stenosis Epiglottitis Clinical Findings Radiographic Features (Figs. 11.4–11.5) Pearls Croup Clinical Findings Radiographic Features (Fig. 11.6) Pearls Retropharyngeal Abscess Clinical Findings Radiographic Features Tonsillar Hypertrophy Radiographic Features (Fig. 11.7) Airway Foreign Body Radiographic Features (Fig. 11.8) Congenital Pulmonary Abnormalities Bronchopulmonary Foregut Malformation (BFM) Pulmonary Sequestration Clinical Findings Pathology Radiographic Features Bronchogenic Cyst Radiographic Features (Fig. 11.9) Congenital Pulmonary Airway Malformation (CPAM) Types Pearls Radiographic Features (Fig. 11.10) Congenital Lobar Emphysema Causes Radiographic Features (Fig. 11.11) Pulmonary Hypoplasia Types of Pulmonary Underdevelopment Scimitar Syndrome (Hypogenetic Lung Syndrome, Pulmonary Venolobar Syndrome) Radiographic Features (Fig. 11.12) Congenital Diaphragmatic Hernia (CDH) Incidence Types Radiographic Features (Fig. 11.13) Kartagener Syndrome Radiographic Features Pneumonia Viral Pneumonia Pearls Bacterial Pneumonia Radiographic Features Round Pneumonia Recurrent Infections Aspiration Pneumonia (Fig. 11.14) Causes Radiographic Features Sickle Cell Anemia Radiographic Findings Neonatal Respiratory Distress Respiratory Distress Syndrome (RDS) (Fig. 11.15) Radiographic Features (Fig. 11.16) Pulmonary Interstitial Emphysema Radiographic Features Bronchopulmonary Dysplasia 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 Pneumomediastinum Causes Gastrointestinal Tract General Embryology Rotation Fixation Canalization Umbilical Artery (UA) Line (Fig. 11.18) Umbilical Vein (UV) Line (Fig. 11.19) Esophagus Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) Types (Fig. 11.20) Associations Radiographic Features Ge Reflux Causes Radiographic Features Esophageal Foreign Body (Fig. 11.21) Radiographic Features Stomach Hypertrophic Pyloric Stenosis (HPS) Clinical Findings Associations Radiographic Features Pylorospasm Associations Radiographic Features Volvulus Chronic Granulomatous Disease Clinical Findings Duodenum, Pancreas, SB Congenital Duodenal Atresia, Stenosis Associations Radiographic Features Duodenal Diaphragm (Fig. 11.24) Annular Pancreas Pancreatic Tumors Types Malrotation and Midgut Volvulus Associations Radiographic Features Ladd Bands (Fig. 11.27) Ladd Procedure SB Atresia Radiographic Features Meconium Ileus Radiographic Features (Fig. 11.28) Other Meconium Problems Meconium Plug Syndrome Meconium Peritonitis Meconium Ileus Equivalent Intussusception Types Clinical Findings Complications Radiographic Features Intussusception Reduction (80%+ Success) Henoch-Schönlein Purpura Radiographic Features Duplication Cysts Radiographic Features Omphalomesenteric Duct Anomalies (Fig. 11.29) Meckel Diverticulum Radiographic Features Colon Appendicitis Radiographic Features Necrotizing Enterocolitis (NEC) Radiographic Features (Fig. 11.30) Complications Hirschsprung Disease Complications Radiographic Features (Fig. 11.31) Congenital Anorectal Anomalies (Fig. 11.32) Radiographic Features Liver, Biliary Tract Biliary Atresia Types (Fig. 11.33) 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 (Fig. 11.34) Genitalia (Fig. 11.35) Wolffian Duct Müllerian Duct Cloaca Urachus (Fig. 11.36) 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 (Fig. 11.38) Complications Radiographic Features (Lebowitz) (Fig. 11.39) Ureterocele (Fig. 11.40) Radiographic Features Congenital UPJ Obstruction Radiographic Features Primary Megaureter Radiographic Features Circumcaval Ureter Radiographic Features Bladder Exstrophy-Epispadias Complex (Fig. 11.41) Radiographic Features Cloacal Exstrophy Clinical Findings Prune-Belly Syndrome (Triad Syndrome, Eagle-Barrett Syndrome) Radiographic Features Posterior Urethral Valves (PUVs) (Fig. 11.42) 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 (Fig. 11.43) Radiographic Features Multicystic Dysplastic Kidneys (MCDK) Radiographic Features Multilocular Cystic Nephroma (MLCN) Radiographic Features Hydrophenrosis 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 (Fig. 11.46) Clinical Findings Radiographic Features Staging Mesoblastic Nephroma (Hamartoma) Radiographic Features Angiomyolipoma Ossifying Renal Tumor of Infancy Metanephric Adenoma Posttransplantation Lymphoproliferative Disorder (PTLD) Radiographic Appearances Ovarian Masses Mature Cystic Teratoma (Dermoid Cyst) Immature Teratoma Embryonal Carcinoma Amputated Ovary Cyst Other Rhabdomyosarcoma Neonatal Adrenal Hemorrhage Radiographic Features Renal Artery Stenosis Renal Vein Thrombosis Musculoskeletal System Trauma General Types of Fractures (Fig. 11.47) Fracture Healing Pearls Normal Variants Frequently Confused With Disease Salter-Harris Fractures (Fig. 11.48) Elbow Injuries Common Types (Fig. 11.51) Little League Elbow Avulsion Fractures (Fig. 11.52) Osteochondrosis Dissecans (Fig. 11.53) Radiographic Features Toddler’s Fracture Stubbed Toe Battered Child (Trauma X) (Figs. 11.54–11.55) Radiographic Features Infection Hematogenous Osteomyelitis Pathogenesis Location (Fig. 11.56) Radiographic Features Chronic Osteomyelitis Radiographic Features Congenital Infections Rubella Radiographic Features Syphilis Radiographic Features Degenerative and Chronic Traumatic Disease Overview (Fig. 11.58) DDH (Congenital Dislocation of the Hip) (Fig. 11.59) Clinical Findings Radiographic Features Pearls Lcp Disease Radiographic Features (Fig. 11.61) Slipped Capital Femoral Epiphysis (SCFE) Radiographic Features (Fig. 11.62) Complications Osteochondrosis Scheuermann Disease (Adolescent Kyphosis) Radiographic Features (Fig. 11.63) Radioulnar Synostosis Blount Disease (Congenital Tibia Vara) Clinical Findings Radiographic Features (Fig. 11.64) Osgood-Schlatter Disease Radiographic Features Freiberg Disease Foot Angles (Figs. 11.65–11.66) Clubfoot (Talipes Equinovarus) (Fig. 11.67) Congenital Vertical Talus (Fig. 11.68) Tarsal Coalition (Fig. 11.69) Varus and Valgus (Fig. 11.70) Metabolic Abnormalities Rickets (Fig. 11.71) Radiographic Features (Fig. 11.72) Congenital Anomalies Dwarfism (Figs. 11.73–11.74) Pearls Osteogenesis Imperfecta (OI) Classification Radiographic Features Achondroplasia Radiographic Features (Figs. 11.75–11.76) Asphyxiating Thoracic Dystrophy (Jeune Syndrome) Radiographic Features Chondroectodermal Dysplasia (Ellis-Van Creveld Syndrome) Radiographic Features Mucopolysaccharidosis Radiographic Features Cleidocranial Dysostosis Osteopetrosis 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 Radiographic Features Pediatric Neuroimaging Cranial US Coronal Views (Six Sections) (Fig. 11.77) Sagittal Views (Six Sections) (Fig. 11.78) Indications for Cranial US Germinal Matrix Hemorrhage (Fig. 11.79) Causes of Hemorrhage Radiographic Features Other Types of Hemorrhage (see Chapter 6) Periventricular Leukomalacia Location (in Watershed Areas of Arterial Blood Flow) Radiographic Features Choroid Plexus Cyst (CPC) Ventriculoperitoneal (VP) Shunt Complications Skull Sutures (Fig. 11.81) Craniosynostosis (Fig. 11.82) Causes Types Multiple Lacunae (Fig. 11.83) Causes Wormian Bones (Fig. 11.84) Causes Skull Fractures Choanal Atresia Spine Development (Fig. 11.85) Scoliosis Types Preoperative Radiographic Features (Figs. 11.87–11.88) Postoperative Radiographic Features Cervical Spine Injuries (Fig. 11.89) Pseudosubluxation Differential Diagnosis Chest Stridor, Wheezing Upper Airway Obstruction Bubbly Lungs in Neonates (Fig. 11.90) Mass Lesions in the Airways Neonatal Lung Masses (Fig. 11.91) Hyperlucent Lung Neonatal Pneumothorax Small Solitary Pulmonary Nodule (Fig. 11.92) Multiple Pulmonary Nodules Pediatric Interstitial Pattern Reticular Opacities in A Newborn Pediatric Chest Wall Tumors Abdomen Dilated Stomach (Fig. 11.93) Double Bubble (Fig. 11.94) Proximal Bowel Obstruction (Fig. 11.95) Distal Bowel Obstruction (Fig. 11.96) 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 GB Cholecystitis Bilary Strictures Fatty Replacement of Pancreas Chronic Pancreatitis GU System Cystic Renal Masses (Fig. 11.97) 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 (CNS) Poor Mineralization 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 (Fig. 11.98) 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 Symmetric Periosteal Reaction in Children (Fig. 11.99) Deformed Epiphysis (Fig. 11.100) Enlarged Epiphysis (Fig. 11.101) Stippled Epiphysis Transverse Metaphyseal Lines Widened Growth Plate Metaphyseal Fragments (Fig. 11.102) 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 (Fig. 11.104) Disk Space Narrowing Enlarged Disk Space Intervertebral Disk Space Calcification Pediatric Sacral Abnormalities Radial Ray Deficiency Polydactyly Syndactyly Abnormal Fourth Metacarpal Short Metacarpal Long Metacarpal Delayed Bone Age Hemihyperplasia (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 Chapter Outline Pulmonary Imaging Radiopharmaceuticals 133Xenon (XE) 99Mtc Diethylenetriaminepentaacetic Acid (DTPA) Aerosol 99Mtc Macroaggregated Albumin (MAA) Pharmacokinetics Technique Indications Contraindications Protocol Imaging Normal Images Xe Ventilation Perfusion (Fig. 12.2) Pulmonary Embolism (PE) Modified Prospective Investigation of Pulmonary Embolism Detection (PIOPED) Criteria for Scan Interpretation Implications of Scan Results V̇/Q̇ Scan to Monitor Sequelae/Resolution of PE Pearls Other Patterns Stripe Sign (Fig. 12.4) Reverse Mismatch Pulmonary Edema (PE) Bullae, Emphysema, COPD Pulmonary Arterial Hypertension (PAH) Evaluation of Lung Function (Fig. 12.5) Cardiac Imaging Radiopharmaceuticals 201Thallium (TI) Chloride Pharmacokinetics Use 99Mtc Sestamibi (Fig. 12.6) Pharmacokinetics Tetrofosmin (UpToDate) Pharmacokinetic 99MTC Red Blood Cell (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 Regadenoson Test (From the Massachussetts General Hospital [MGH] Protocol) Dobutamine Test Rest and Redistribution Study 99Mtc Sestamibi Imaging Contraindications for Nuclear Cardiology Stress Test Absolute Relative Normal Images and Variants (Fig. 12.9) Variations Image Interpretation Abnormal Scan Patterns Hibernating Myocardium Stunned Myocardium Positron Emission Tomography (PET) Imaging 82Rubidium 13N-ammonia 18F-Fluorodeoxyglucose (FDG) Indications for PET Ventricular Function Imaging General Indications Protocol Image Interpretation Qualitative Image Assessment Quantitative Image Assessment Pearls Gastrointestinal Imaging Radiopharmaceuticals General 99Mtc Sulfur Colloid Pharmacokinetics Pearls 99Mtc Hepatobiliary Agents (Fig. 12.16) Pharmacokinetics Res Colloid Imaging Indications Image Interpretation Hepatobiliary Imaging Normal Scan Protocol Interpretation (Fig. 12.17) Pharmacologic Intervention if GB Is Not Visualized (Fig. 12.18) Acute Cholecystitis (Fig. 12.19) Indications for Scintigraphic Imaging Imaging Findings Chronic Cholecystitis Liver Tumors Bowel Imaging Hemorrhage Protocol Imaging Findings Meckel Scan Technique Imaging Findings Gastric Emptying (Fig. 12.20) Indications Liquid-Phase Emptying (Usually in Children, “Milk Scan”) Solid-Phase Emptying (Usually for Adults) Genitourinary Imaging Radiopharmaceuticals 99Mtc Diethylenetriaminepentaacetic Acid (DTPA) Pharmacokinetics 99Mtc MAG3 (Fig. 12.21) Pharmacokinetics Renal Imaging Indications Protocol Normal Images (Figs. 12.22–12.23) Interpretation Transplant Evaluation With MAG3 Obstruction (Fig. 12.24) Technique Imaging Findings False-Positive Furosemide (Lasix) Renal Scans Renal Cortical Imaging Technique Interpretation Retrograde Radionuclide Cystogram Technique Interpretation Adrenal Imaging Metaiodobenzylguanidine (MIBG) Technique Interpretation Bone Imaging Radiopharmaceuticals 99Mtc Phosphonates (Fig. 12.25) 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 Complex Regional Pain Syndrome (CRPS) Prosthesis Total Hip Replacement (THR) 18F Sodium Fluoride PET Thyroid Imaging Radiopharmaceuticals Overview (Figs. 12.26–12.28) 123Iodine (I) Pharmacokinetics 131Iodine (I) Indications Complications of 131I Treatment Pertechnetate Applications Pharmacokinetics Thyroid Imaging I Uptake Test Technique Increased Uptake Decreased Uptake Normal Imaging Patient Examination Appearance of Normal Thyroid Scans (Fig. 12.29) Interpretation Cold Nodule (Fig. 12.30) Hot Nodule (Fig. 12.31) Discordant Nodules Hyperthyroidism (Fig. 12.32) Multinodular Goiter (Fig. 12.33) Congenital Organification Defect/Dyshormonegenesis Whole-Body Thyroid Cancer Imaging Parathyroid Imaging 99Mtc Sestamibi and 99Mtc Pertechnetate Subtraction Imaging (Society of Nuclear Medicine Practice Guidlines for Parathyroid Scintigraphy 4.0) Technique Interpretation 99Mtc Sestamibi Imaging of Parathyroid Advantages Positron Emission Tomography 18Fdg-PET Imaging 18Fdg Basic Mechanism (Fig. 12.34) 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 Ca Pancreatic Ca Lymphoma and Leukemia Breast Cancer FDG-PET Brain Imaging Normal Uptake Pattern Refractory Seizure Memory Loss (Alzheimer Dementia) Other Neurodegenerative Disorders Other PET Tracers/Agents Approved Agents Used Less Commonly 82Rubidium 13N-ammonia 18F-fluoride List of Agents in Clinical Development Cancer Pathways Relevant to PET Imaging (Fig. 12.35) Centers for Medicare and Medicaid Services (Cms) Coverage of PET Miscellaneous Imaging Techniques 67Ga Citrate Imaging Isotope (Fig. 12.36) Leukocyte Imaging Preparation Indications Technique Radiation Normal Imaging (Fig. 12.37) Other Infection Imaging Agents Brain Imaging 99Mtc Hexamethylpropyleneamine Oxime (HMPAO) (Fig. 12.38) Pharmacokinetics Brain Death Study (Fig. 12.39) Technique Imaging Findings HMPAO/ECD SPECT Imaging Indications Technique Acetazolamide Challenge Test Indications Contraindications 201Ti Brain Imaging 111In DTPA Cisternography Lymphoscintigraphy Agents Filtered 99mTc Sulfur Colloid 99mTc Tilmanocept Tumor Imaging Agents Oncoscint (111In DTPA-Labeled B72.3 Monoclonal Antibody [MAb]) Prostascint (111In-Labeled B72.3 MAb) Carcinoembryonic Antigen (CEA) Scan (99Mtc DTPA-Labeled Anti-CEA) Somatostatin Octreotide Imaging (Fig. 12.40) Differential Diagnosis Radiopharmaceuticals Quality Assurance for Radiopharmaceuticals Pulmonary V̇/Q̇ Mismatch (Fig. 12.41) Causes of PE Matched V̇/Q̇ Defect (Fig. 12.42) Decreased Perfusion in One Lung Cardiovascular (Fig. 12.43) False-Negative Sestamibi Studies False-Positive Sestamibi Study Paradoxical Septal Movement Fixed Defect Gastrointestinal Patterns in HIDA Studies (Fig. 12.44) 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 99mTc 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 and Excretion (Renal Failure) Nonvisualized Kidney Bone Focal Hot Lesions (Fig. 12.45) 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 Chapter Outline X-Ray Contrast Agents Iodinated Contrast Agents Classification Iodine (I) Content High-Osmolarity Contrast Agents (HOCAs) (Fig. 13.1) Low Osmolarity Contrast Agents (LOCAs) (Fig. 13.2) Pharmacology (Fig. 13.3) Acute Contrast Reactions Overview Type and Timing of Acute Reactions Premedication Other Adverse Events Related to Iodinated Contrast Contrast-Induced Nephropathy (CIN) Contrast Extravasation Miscellaneous Considerations Metformin Pregnancy Breastfeeding Thyroid Scan Oral X-Ray Contrast Agents Water-Soluble Iodinated Oral Contrast Agents Barium Negative Oral Contrast Agents Magnetic Resonance Imaging Contrast Agents Classes (Fig. 13.4) Paramagnetic Agents Gd Chelates (Fig. 13.6) Pharmacology Safety Special Considerations Nephrogenic Systemic Fibrosis (NSF) Pregnant Patients Breastfeeding Gd Deposition in the Brain Other Agents Eovist (Gadoxetate Disodium; Bayer) (Fig. 13.7) Oral Contrast Agents Supraparamagnetic Agents Ferumoxtran-10 (Combidex) and Ferumoxytol (Feraheme) Treatment of Contrast Reactions Treating Adverse Reactions Emergency Treatment Suggested Readings 14 Imaging Physics Chapter Outline X-Ray Physics Production of X-Rays X-Ray Tube (Fig. 14.1) Cathode Anode X-Ray Tube Output (Fig. 14.2) Milliampere (mA) Voltage Exposure Time Heat Unit (Fig. 14.3) Rating Charts (Fig. 14.4) Example Answer Focal Spot (FS) FS and Resolution Measurement of FS Size Pinhole Method Star Test Pattern Magnification (Fig. 14.5) Unsharpness Radiation Exposure and Distance Example Answer Spectrum of X-Rays Bremsstrahlung (Fig. 14.6) Characteristic Radiation (Fig. 14.7) Heel Effect (Fig. 14.8) X-Ray Generators Transformer (Fig. 14.9) Circuits of X-Ray Generators (Fig. 14.10) Autotransformer High-Voltage Transformer Timer Rectifier (Fig. 14.11) Filament Circuit Types of Generators Three-Phase Generators (Fig. 14.12) Advantages of Three-Phase Generators Mobile Generators (Fig. 14.13) Capacitor Discharge Generators Phototimers Interaction Between X-Rays and Matter Coherent Scattering (Fig. 14.14) Photoelectric Effect (Fig. 14.15) Pearls Compton Scattering (Fig. 14.16) Probability of Compton Scatter Pearls Other Types of Interactions Pair Production Photodisintegration Comparison of Interaction (Fig. 14.18) Pearls Attenuation Attenuation Coefficients Linear Attenuation Coefficient (cm−1) Mass Attenuation Coefficient Monochromatic Radiation Example Answer K-Edge (Fig. 14.19) Polychromatic (Typical X-Ray) Radiation (Fig. 14.20) Example Answer Filters Restrictors (Fig. 14.21) Grids Grid Ratio (Fig. 14.22) Types of Grids (Fig. 14.23) Linear Grid Crossed Grid Focused (Convergent) Grid Moving Grid (Bucky Grid) Grid Performance (Fig. 14.24) Contrast Improvement Factor Bucky Factor (BF) Pearls Primary Transmission Grid Artifacts (Fig. 14.25) Upside-Down Focused Grid Focus-Grid Distance Decentering Lateral Decentering Combined Lateral and Focus-Grid Distance Decentering Air Gap Techniques (Fig. 14.26) Screens (Figs. 14.27–14.28) Digital Radiography (DR) Quantum Mottle Image Quality Contrast Line Spread Function (Fig. 14.32) Modulation Transfer Function (MTF) (Figs. 14.33–14.34) Fluoroscopy Image Intensifier (Fig. 14.35) (Included for Historical Purposes) Input Phosphor and Photocathode (Fig. 14.36) Brightness Gain Example Answer Minification Gain Example Answer Resolution of Intensifiers Distortion of Intensifiers Mammography Key Differences From Traditional Radiography Target Filter Combinations Technical Requirements of Mammography Digital Mammography Tomography/Tomosynthesis (Fig. 14.37) Disadvantages of Tomography Stereoscopy (Fig. 14.38) Computed Tomography (CT) (Helical, Multislice) (Fig. 14.39) Overview CT Numbers CT Components X-Ray Tube and Gantry Slip Ring Filtration Detectors CT Scanner Generations Helical CT Multislice CT Limitations Dual-Energy CT (Fig. 14.40) Image Reconstruction (Fig. 14.41) Iterative Reconstruction CT Image Quality Factors That Affect Image Quality Window Width and Level (Fig. 14.42) CT Artifacts CT Scanner-Based Radiation Dose Estimation Risk Estimates for CT Scans Recommendations for Reducing CT Radiation Dose Memory Nuclear Physics Atomic Structure Forces (Fig. 14.44) Example Answer Nuclides Decay Alpha Decay (Fig. 14.46) Beta Decay Beta (−) Electron Emission (Figs. 14.47–14.48) Beta (+) Positron Emission (Fig. 14.49) Electron Capture (Positron → Neutron) (Fig. 14.50) Gamma Decay (Fig. 14.51) Example Answer Decay Schemes (Figs. 14.52–14.53) Range of Charged Particles Radioactivity Units Number of Nuclei Mass Calculation Specific Activity Half-Life 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 (Fig. 14.54) Cyclotron (Charged Particle Bombardment) Examples (Fig. 14.55) Fission Example Generators Generator Operation Equilibrium (Fig. 14.59) Efficiency of a Generator Dosimetry Cumulative Dose Example Answer Dose Detectors Types of Detectors Efficiency (E) of a Detector Dead Time of a Detector (Fig. 14.60) Gas-Filled Detectors (Fig. 14.61) PM Tubes (Fig. 14.63) Well Counters Calculation of Photopeak Count Rate Example Answer Liquid Scintillation Detectors Scanners Anger Camera (Fig. 14.65) Information Density Image Uniformity Collimator (Fig. 14.66) Pearls Single Photon Emission Computed Tomography (SPECT) Positron Emission Tomography (PET) (Fig. 14.67) Spatial Resolution Detector Systems (Fig. 14.68) Sensitivity Quality Assurance (QA) QA for Planar Imaging Peaking/Energy Window Field Uniformity (Fig. 14.69) Resolution and Linearity QA for Spect QA for Dose Calibrator Precision and Accuracy Linearity Radiobiology General (Fig. 14.70) Linear Energy Transfer (LET) (Fig. 14.71) Radiation Units Exposure Example Answer Absorbed Dose (Fig. 14.72) 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 and Radiosensitivity (Fig. 14.73) Dose-Response Curves (Fig. 14.74) Risk in Humans (Fig. 14.75) Acute Radiation Effects Pearls Late Radiation Effects Genetically Significant Dose (GSD) Fetus Fetal Dosimetry 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 (Fig. 14.76) Wavelength (Fig. 14.77) Acoustic Impedance (Z) Intensity Decibels (dBs) Example Answer Example Answer Pearls Characteristics of US Beam (Fig. 14.78) Angle of Divergence (Dispersion) Fresnel Zone Reflection Pearls Refraction (Fig. 14.79) Absorption Components Transducer Piezoelectric Crystal Resonance Frequency Transducer Q Factor (Fig. 14.80) Backing Block Quarter Wave Matching Layer US Equipment Types A (Amplitude) Mode Time Motion (Tm) Mode Binary Mode Brightness Mode (B-Mode) or Real-Time Mode (Fig. 14.81) Controls (Fig. 14.82) Resolution (Fig. 14.83) Axial Resolution Pearls Lateral Resolution (Fig. 14.84) Scan Time Doppler US (Figs. 14.85–14.86) Pearls Spectral Broadening Continuous Wave Doppler Pulsed Doppler Color Flow Doppler Pearls Artifacts Reverberation Artifact Mirror Image Artifact (Specular Reflection) Ring-Down Artifact Shadowing and Enhancement Nonspecular Reflections Aliasing Other Artifacts Magnetic Resonance Imaging Physics General (Figs. 14.88–14.89) Magnetization Magnetic Resonance (MR) Signal Localization K-Space Spin-Echo Imaging (Fig. 14.92) Fast Spin-Echo (FSE) Acquisition Inversion Recovery Imaging (Fig. 14.93) T2* Imaging Signal-to-Noise Ratio (SNR) Imaging Parameters 3D Imaging MR Angiography Techniques Artifacts Statistics Testing Measurements Statistical Testing Accuracy, Precision (Fig. 14.94) Sensitivity (Fig. 14.95) Specificity Predictive Values Positive Predictive Value (PPV) Negative Predictive Value (NPV) Receiver Operating Characteristic (ROC) Analysis (Fig. 14.96) Suggested Readings
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