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AIIMS-MAMC-PGI’s Comprehensive Textbook of Diagnostic Radiology (3 Volumes)
Niranjan Khandelwal, Veena Chowdhury, Arun Kumar Gupta
SECTION 1: NEURORADIOLOGY INCLUDING HEAD AND NECK
CHAPTER 1:
Evaluation of Plain X-ray Skull: A Systematic Approach
INTRODUCTION
LATERAL VIEW OF SKULL
FRONTAL VIEW (FIG. 2)
TOWNE'S VIEW
BASAL VIEW
WATERS VIEW
CALDWELL'S VIEW
Abnormal Density
Abnormal Contour of the Skull
Abnormal Intracranial Volume
Single Radiolucent Defect
Sclerotic Areas of the Skull
Intracranial Calcification
CHAPTER 2:
Normal Anatomy of Brain on CT and MRI
INTRODUCTION
TECHNIQUES AND NORMAL APPEARANCE
General Considerations
Normal Anatomy of Brain
CEREBRAL HEMISPHERES
Lateral Surface of the Cerebral Hemisphere (Fig. 2A)
Medial Surface of the Cerebral Hemisphere (Fig. 2B)
Inferior Surface of the Cerebral Hemisphere (Fig. 2C)
BRAINSTEM AND CRANIAL NERVES
CEREBELLUM
WHITE MATTER OF THE CEREBRUM
VENTRICLES AND CISTERNS
GRAY MATTER NUCLEI AND ADJACENT STRUCTURES
CHAPTER 3:
Normal Cerebral Angiography
INTRODUCTION
Historical Background
Definition
Six Vessel Angiography
Indications
Contraindications
Patient Preparation
Requirement
Catheterization Equipment
Site of the Puncture
Preparation
Local Anesthesia
Artery Puncture
Puncture Technique
Seldinger Needle
Important Points to Remember
Postprocedural Management
Types of Angiographic Catheters
Arterial Anatomy
Venous Anatomy (Fig. 14)
Dural Sinuses
Cerebral Veins
CHAPTER 4:
Advances in Computed Tomography Technology
INTRODUCTION
MULTIDETECTOR COMPUTED TOMOGRAPHY
DUAL SOURCE COMPUTED TOMOGRAPHY
FLAT-PANEL VOLUME COMPUTED TOMOGRAPHY
DYNAMIC COMPUTED TOMOGRAPHY ANGIOGRAPHY
COMPUTED TOMOGRAPHY IN NEUROIMAGING
NONCONTRAST COMPUTED TOMOGRAPHY OF HEAD
Computed Tomography Angiography
Technique
Image Processing
APPLICATIONS
Extracranial Vasculature
Carotid Artery Stenosis
Dissections
Intracranial Vasculature
Aneurysms
Arteriovenous Malformations
Tumors
Computed Tomography Perfusion
Technique
CLINICAL APPLICATIONS
Computed Tomography Imaging of Acute Ischemic Stroke
Computed Tomography Venography
Technique
MULTIDETECTOR COMPUTED TOMOGRAPHY OF SPINE
CLINICAL APPLICATIONS
RADIATION CONCERNS
CONCLUSION
CHAPTER 5:
Advances in Neuroimaging Techniques: Magnetic Resonance Imaging
IMPROVEMENTS IN MR HARDWARE AND SOFTWARE TECHNOLOGY (GRADIENTS, COILS AND PARALLEL IMAGING)
LARGE FIELD OF VIEW IMAGING
HIGH FIELD STRENGTH MR IMAGING (3T AND BEYOND)
IMPROVEMENTS IN PULSE SEQUENCES
SHORT REVIEW OF PRINCIPLES BEHIND NEW MR PULSE TECHNIQUES
EFFICIENT DATA PROCESSING TECHNIQUES
CLASSIFICATION OF THE PULSE SEQUENCES (FLOW CHART 1)
FAST SPIN ECHO
Characteristics of FSE
FLUID ATTENUATED INVERSION RECOVERY
CLINICAL APPLICATION
Single Shot Techniques of FSE (HASTE, SSFSE)
Magnetic Resonance Myelography
Gradient Echo Imaging and its Variants
Susceptibility Weighted Imaging
Cranial and Extracranial MR Angiography
Steady State Variants of Gradient Echo Sequences
MR Cisternography Using CISS/SPACE
Special MR Techniques in Medial Temporal Sclerosis
Echo Planar Imaging
Clinical Applications of EPI
Diffusion Studies
Diffusion Tensor Imaging (DTI, Tractography or Fiber Tracking)
Clinical Applications
Perfusion Weighted Imaging
PWI in Stroke
PWI of Cerebral Tumors
Neuronal Activation Studies (fMRI)
Disadvantages
Magnetization Transfer
CHAPTER 6:
Magnetic Resonance Spectroscopy
INTRODUCTION
PRINCIPLE
Spectrum
Spectrum and Echo Time
Observable Biochemicals on MRS
Hydrogen 1 (1H-MRS)
Phosphorus 31 (31P-MRS)
LOCALIZATION TECHNIQUES
B1 Field Gradient Methods
Surface Coils
B0 Field Gradient Methods
Static Field Gradient
Slice-selective B0-gradient
Quantitative Spectroscopy
Data Acquisition and Analysis
CLINICAL APPLICATIONS OF MRS OF BRAIN
Differentiation of Intracranial Ring Enhancing Lesions
MRS IN PEDIATRICS
Prematurity and Birth Asphyxia
Metabolic Disorders and Leukodystrophies
MRS IN EPILEPSY
Lateralization in Temporal Lobe Epilepsy
MRS in Neurodegenerative Diseases
Alzheimer's Disease
Amyotrophic Lateral Sclerosis (ALS)
Idiopathic Parkinson's Disease (IPD) versus Other Parkinsonian Syndromes
Huntington's Disease (HD)
MRS IN DEMYELINATING DISEASES
Multiple Sclerosis
MRS IN HEAD TRAUMA
MRS IN STROKE
MRS IN PSYCHIATRIC DISEASES
MRS IN HIV/AIDS
CLINICAL SUCCESS
Future Developments
CHAPTER 7:
Functional Magnetic Resonance Imaging
INTRODUCTION
PRINCIPLE OF fMRI AND BOLD CONTRAST
LIMITATIONS OF BOLD TECHNIQUE
IMAGING ACQUISITION
FUNCTIONAL MRI EXAMINATION DESIGN
FUNCTIONAL MRI EXAMINATION TASK PARADIGM
POSTPROCESSING AND DATA ANALYSIS
CURRENT CLINICAL APPLICATIONS OF FUNCTIONAL MRI
Neurosurgical Planning
Dementia
Defining Disease Based on Patterns of Brain Function
Psychiatric Disorders
FUTURE DIRECTIONS
CHAPTER 8:
Imaging and Interventions in Cerebral Ischemia
INTRODUCTION
PATHOPHYSIOLOGICAL CONSIDERATIONS
Significance of a Penumbra
ROLE OF IMAGING IN ACUTE ISCHEMIC STROKE
Imaging of Ischemic Infarct
Computed Tomography
Magnetic Resonance Imaging
COMBINATION OF DIFFUSION AND PERFUSION MRI IN EVALUATION OF ACUTE STROKE
Vascular Imaging in Ischemic Stroke
Carotid Ultrasound (US)
Magnetic Resonance Angiography
CT Angiography
IMAGING IN DIFFERENT STROKE SUBGROUPS
Ischemic Stroke
Atherosclerotic Vascular Disease (ASVD)
Arterial Dissection
Aortoarteritis
Fibromuscular Dysplasia
Other Vasculopathies
Hemorrhagic Stroke
RECANALIZATION STRATEGIES
Intravenous TPA
European Cooperative Acute Stroke Study (ECASS) Trials I and II70
INTRA-ARTERIAL THERAPY
Technique
Intra-arterial Abciximab
COMBINED IA + I/V
MECHANICAL THROMBOLYSIS
Acute Stroke Imaging Protocol (Flow chart 1)
CHAPTER 9:
Imaging of Subarachnoid Hemorrhage
INTRODUCTION
INCIDENCE
CLINICAL FEATURES
GRADING SYSTEM OF SUBARACHNOID HEMORRHAGE
DIAGNOSIS
Lumbar Puncture (LP)
Computed Tomography
Magnetic Resonance Imaging
Cerebral Angiography
CT Angiography (CTA)
Magnetic Resonance Angiography (MRA)
Transcranial Doppler Ultrasound
ANEURYSMS
Clinical Presentation
Location
Multiple Aneurysms
Unruptured Aneurysms
Thrombosed Aneurysms
Giant Aneurysms
Mycotic Aneurysms
Flow-related Aneurysms
VASCULAR MALFORMATIONS
Parenchymal AVMs
Dural AVMs
Mixed Pial and Dural AVMs
CAPILLARY TELANGIECTASIAS
CAVERNOUS ANGIOMAS
VENOUS ANGIOMAS
TRAUMATIC SUBARACHNOID HEMORRHAGE
Subarachnoid Hemorrhage of Unknown Etiology
Nonaneurysmal SAH
SUMMARY
CHAPTER 10:
Endovascular Management of Intracranial Aneurysms
EPIDEMIOLOGY AND NATURAL HISTORY
PATHOPHYSIOLOGY
Diagnosis
Initial Assessment, Management and Grading
TIMING OF ANEURYSM OBLITERATION
POOR GRADE PATIENT
INTRACEREBRAL HEMORRHAGE
ACUTE INTRAVENTRICULAR HEMORRHAGE AND HYDROCEPHALUS
PREOPERATIVE CARE AND DIAGNOSTIC STUDIES
PHARMACOLOGIC THERAPY
ANEURYSM REPAIR SURGERY OR ENDOVASCULAR COILING
POSTPROCEDURAL MANAGEMENT
MONITORING CEREBRAL VASOSPASM AND IMPLEMENTING TREATMENT
SUMMARY
CHAPTER 11:
Endovascular Management of Arteriovenous Malformations
INTRODUCTION
THERAPEUTIC OPTIONS
Technique of Endovascular Intervention
Heparin Regimen
Flow-dependent Catheters
Guidewire Dependent Catheters
Guidewires
Embolic Agents
Liquid Agents: Acrylic Glue
Particulate Agents
Preoperative Embolization
Intraoperative Embolization
Preradiosurgery Embolization
Curative Embolization
Palliative (Partial) Embolization
Staging Embolization
COMPLICATIONS OF AVM EMBOLIZATION
DURAL ARTERIOVENOUS FISTULAE (DAVFs)
Classification
Radiological Evaluation
Therapeutic Options
Compression Therapy
Transarterial Embolization
Transvenous Embolization
Preoperative Embolization
Brain AVM Embolization with Onyx
INDICATION FOR TREATMENT
Onyx Liquid Embolic Agent
CONCLUSION
CHAPTER 12:
Endovascular Management of Carotid-cavernous Fistulas
INTRODUCTION
SEGMENTS OF INTRACAVERNOUS INTERNAL CAROTID ARTERY
Radiological Evaluation
CT Scan
Angiogram
Techniques of Embolization
Endovascular Management
Embolic Materials
Embolization Procedure
Transarterial Embolization
Transvenous Embolization
Results of Endovascular Therapy
DISCUSSION
CONCLUSION
CHAPTER 13:
Central Nervous System Infections
NORMAL CRANIAL MENINGES AND EXTRA-AXIAL SPACES
PYOGENIC MENINGITIS
Clinical and Pathophysiologic Features
Imaging in Meningitis
COMPLICATIONS OR ALTERNATIVE MANIFESTATIONS OF BACTERIAL MENINGITIS
Hydrocephalus
Extra-axial Fluid and Pus Collections
Subdural Effusion and Hygroma
Subdural Abscess (Empyema)
Epidural Abscess (Empyema)
Cerebritis and Abscess
Imaging of Brain Abscess
Diffusion Tensor Imaging (DTI)
Distinction between Cerebral Abscesses and High Grade Neoplasms by Dynamic Susceptibility Contrast Perfusion MRI
Multiple Brain Abscesses Secondary to Septic Emboli
Central Nervous System Infarction
Ventriculitis
RECURRENT MENINGITIS
TUBERCULOSIS
Pathophysiology
TUBERCULOUS MENINGITIS
Clinical Manifestations
Computed Tomography
Magnetic Resonance
COMPLICATIONS
Hydrocephalus
Vasculitis
Cranial Neuropathies
GRANULOMATOUS TUBERCULOUS MENINGITIS
PACHYMENINGITIS
PARENCHYMAL TUBERCULOMAS
Noncaseating Granuloma
Caseating Solid Granuloma
Granulomas with Central Liquefaction
DISSEMINATED TUBERCULOMA
Paradoxic Expansion
TUBERCULOUS ABSCESSES
TUBERCULOSIS ENCEPHALOPATHY
FOCAL TUBERCULOUS CEREBRITIS
CENTRAL NERVOUS SYSTEM TUBERCULOSIS AND ACQUIRED IMMUNE DEFICIENCY SYNDROME
NEUROSARCOIDOSIS
FUNGAL INFECTIONS OF THE CENTRAL NERVOUS SYSTEM
ASPERGILLOSIS
CRYPTOCOCCAL INFECTION
MUCORMYCOSIS
Imaging Findings
CANDIDIASIS
Imaging Findings
COCCIDIOIDOMYCOSIS
HISTOPLASMOSIS
NOCARDIOSIS
NEUROCYSTICERCOSIS
Hosts
Clinical Features
Parenchymal Cysts
Intraventricular Cysticercosis
Subarachnoid Cysticercosis
SPINAL CYSTICERCOSIS
ORBITAL DISEASE
CENTRAL NERVOUS SYSTEM TOXOPLASMOSIS
Imaging Findings
Differentiation of Toxoplasmosis from CNS Lymphoma
HYDATID DISEASE
Imaging Findings
CONGENITAL INFECTIONS
CONGENITAL TOXOPLASMOSIS
Imaging Findings
SYPHILIS
Imaging Findings
RUBELLA
Imaging Findings
CYTOMEGALOVIRUS
Imaging Findings
HERPES SIMPLEX VIRUS
Imaging Findings
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Imaging Findings
ENCEPHALITIS
ACUTE INFECTIVE ENCEPHALITIS/HERPES SIMPLEX ENCEPHALITIS
Imaging Findings
Magnetic Resonance Spectroscopy
HERPES VARICELLA ZOSTER ENCEPHALITIS
JAPANESE ENCEPHALITIS
Imaging Findings
MEASLES ENCEPHALITIS
Acute Measles Encephalitis
Subacute Sclerosing Panencephalitis
Imaging Findings
Subacute Measles Encephalitis
ACUTE DISSEMINATED ENCEPHALOMYELITIS
Imaging Findings
RASMUSSEN'S ENCEPHALITIS
PRION INFECTIONS—CREUTZFELDT–JAKOB DISEASE
Imaging Findings
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND ITS RELATED CNS INFECTIONS
HUMAN IMMUNODEFICIENCY VIRUS ENCEPHALITIS
Imaging Findings
Progressive Multifocal Leukoencephalopathy
Imaging Findings
CYTOMEGALOVIRUS (CMV) ENCEPHALITIS
Imaging Findings
Immune Reconstitution Inflammatory Syndrome (IRIS)89
CHAPTER 14:
White Matter Diseases and Metabolic Brain Disorders
INTRODUCTION
MYELIN AND WHITE MATTER
DEMYELINATING DISEASES: CLASSIFICATION
Primary Demyelinating Diseases
Multiple Sclerosis
Disorders with Secondary Demyelination and Destruction of White Matter
Associated with Infectious Agents and/or Vaccination
Associated with Nutritional/Vitamin Deficiency
Associated with Physical/Chemical Agents or Therapeutic Procedures
IMAGING OF WHITE MATTER DISEASES
NEWER MAGNETIC RESONANCE TECHNIQUES
Proton Magnetic Resonance Spectroscopy
Magnetization Transfer Magnetic Resonance Imaging
Diffusion Magnetic Resonance
PRIMARY DEMYELINATING DISORDERS
Multiple Sclerosis
Diagnosis
Magnetic Resonance Findings
Distribution and Characteristics of Lesion in the Brain
Acute or Chronic Multiple Sclerosis?
T1 Black Holes: Chronic T1 Hypointense Lesions22,23
Characteristics and Distribution of Lesions in Spinal Cord
NORMAL APPEARING WHITE AND GRAY MATTER
Magnetization Transfer Imaging
Diffusion Tensor Imaging in Multiple Sclerosis
Proton Magnetic Resonance Spectroscopy in Multiple Sclerosis
Imaging of Basal Ganglia in Multiple Sclerosis
Perfusion Imaging
Functional Magnetic Resonance Imaging
High-Field Magnetic Resonance Imaging and Multiple Sclerosis
Monitoring Patients by Magnetic Resonance Imaging
Variants of Multiple Sclerosis
Acute Multiple Sclerosis (Marburg Type)
Schilder Type or Diffuse Sclerosis
Concentric Sclerosis (Balo Type)
Devic's Neuromyelitis Optica
TREATMENT
DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS LESION ON MAGNETIC RESONANCE
Ischemic White Matter Lesions/Small Vessel Ischemic Changes/Leukoaraiosis
Vasculitis
Migraine
Acute Disseminated Encephalomyelitis
Trauma
Space-occupying Lesions
DISORDERS WITH SECONDARY DEMYELINATION AND/OR DESTRUCTION OF WHITE MATTER
White Matter Diseases Associated with Viral Agents Viral Encephalitides
Acute Disseminated Encephalomyelitis
Acute Hemorrhagic Leukoencephalitis
Subacute Sclerosing Panencephalitis
Progressive Rubella Panencephalitis
Progressive Multifocal Leukoencephalopathy
Lyme Disease of the Central Nervous System
Human Immunodeficiency Virus Encephalopathy
METABOLIC CAUSES: WHITE MATTER DISEASES ASSOCIATED WITH NUTRITIONAL AND VITAMIN DEFICIENCY
Central Pontine and Extrapontine Myelinolysis (Osmotic Demyelination)
Chronic Alcoholism
Wernicke Encephalopathy
Marchiafava–Bignami Disease
Subacute Combined Degeneration of the Spinal Cord
VASCULAR CAUSES
Reversible Posterior Leukoencephalopathy
Eclampsia
Ischemia and Arteritis
Binswanger's Disease (Subcortical arteriosclerotic encephalopathy)70
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
Central Nervous System Vasculitis
Hypoxic–Ischemic Leukoencephalopathies
Global Hypoperfusion Syndromes
WHITE MATTER DISEASES ASSOCIATED WITH PHYSICAL/CHEMICAL AGENTS OR THERAPEUTIC PROCEDURES
Radiation and Chemotherapy
Solvent Vapor Abuse Leukoencephalopathy
CONCLUSION
CHAPTER 15:
Current Trends in Imaging of Epilepsy
INTRODUCTION
INDICATIONS FOR IMAGING1
IMAGING OF REFRACTORY SEIZURES
MRI Protocols
Structural Lesions in Chronic Epilepsy
Mesial Temporal Sclerosis
Disorders of Neuronal Migration and Cortical Organization
Tumors
Vascular Malformations
Other MR Features Associated with Epilepsy
NEWER ADVANCES IN IMAGING IN EPILEPSY
Reformatted Images
Quantitative MRI
Magnetic Resonance Spectroscopy
T2 Relaxometry (Mapping)
Diffusion Tensor Imaging
Tractography
Functional MR
Magnetoencephalography
Wada's Test
Positron Emission Tomography
Single-photon Emission Computed Tomography
CHAPTER 16:
Imaging of Supratentorial Brain Tumors
INTRODUCTION
CLASSIFICATION OF SUPRATENTORIAL BRAIN TUMORS
Primary Brain Tumors
Metastatic Tumors
Calvarial/Meningeal/Masses
GLIAL TUMORS
Astrocytoma
Low-grade Astrocytoma
Variants: Protoplasmic, Gemistocytic, Fibrillary, Mixed
Location
Imaging Features
Anaplastic Astrocytoma (Malignant) (WHO Grade III)
Imaging Features
Glioblastoma Multiforme (GBM) (WHO Grade IV)
Variants: Giant Cell Glioblastoma, Gliosarcoma
Location
Imaging Features (CT/MRI)
Advanced MR Imaging: Techniques in Glioma Grading and Apparent Diffusion Coefficient Value
Pleomorphic Xanthoastrocytoma (Noninvasive, WHO Grade I)
Imaging Features
Subependymal Giant Cell Astrocytoma
Imaging Features
Gliomatosis Cerebri
Imaging Features
Gliosarcoma
Imaging Features
Oligodendroglioma
Imaging Features
Ependymoma
Imaging Features
Subependymoma
Imaging Features
Choroid Plexus Papilloma
Imaging Features
Central Neurocytoma
Imaging Features
Dysembryoplastic Neuroepithelial Tumor
Imaging Features
Ganglioglioma
TUMORS OF THE MENINGES
Meningioma
Imaging Features
Pineal Region Tumors
Germ Cell Tumors
Pineal Germinoma and Teratoma
Pineal Cell Tumors
Imaging Features
Supratentorial Primitive Neuroectodermal Tumors
Primary Cerebral Neuroblastoma
Imaging Features
Cranial Nerve Tumors
Primary Central Nervous System Lymphoma
Imaging Features
Pituitary Adenoma and Craniopharyngioma
Imaging of Metastatic Tumors
Parenchymal Metastases
Imaging Features
Leptomeningeal Metastases
Imaging Features
Dural Metastases
Calvarial Metastases
Recent Advances in Brain Tumors
MAGNETIC RESONANCE SPECTROSCOPY IN BRAIN
Tumor Imaging
Magnetic Resonance Perfusion Imaging
MAGNETIC RESONANCE SPECTROSCOPY
Positron-emission Tomography in Neuro-oncology
Radiologic Pitfalls Encountered in Imaging of Brain Tumor
Late Diagnosis of Gliomatosis Cerebri
Differentiation between Peripherally Located Glioma (Gliosarcomas) and Meningioma
Localized Enhanced Meninges (Meningeal Tail) or Meningioma
Differentiation of Radiation Effect from Recurrent or Residual Neoplasm
Radiation Necrosis versus Glioma Recurrence
Conventional MR Imaging Clues to Diagnosis
Differentiation of Hemorrhagic Metastasis or Gliomas from Hematoma
MR Features of Tumoral Hemorrhage
Differentiation of Infarcts from Glioma
Differentiating Multicentric Glioma/Multifocal Gliomas from Metastasis
Differentiating Inflammatory Meningitis from Leptomeningeal Carcinomatosis32,33
Cerebrospinal Fluid Examination
Imaging Features of Normal Meningeal Enhancement
CONCLUSION
CHAPTER 17:
Imaging of Infratentorial Tumors
INTRODUCTION
CLASSIFICATION OF INFRATENTORIAL TUMORS BASED ON TOPOGRAPHY1
Cerebellar Hemispheres and Vermis
Medulloblastoma
Ependymoma
Pilocytic Astrocytoma
Atypical Teratoid/Rhabdoid Tumor
Hemangioblastoma
Metastases
Dysplastic Cerebellar Gangliocytoma
Brainstem and Cervicomedullary Junction
Brainstem Gliomas
Cerebellopontine Angle and Internal Auditory Canal
Vestibular Schwannomas
Meningiomas
Epidermoid and Dermoid
Arachnoid Cyst
Facial Nerve Schwannomas
Cerebellopontine Angle/Internal Auditory Canal Lipomas
Metastatic Disease
Primary Parenchymal Neoplasms
Endolymphatic Sac Tumor
Paraganglioma
Fourth Ventricle
Choroid Plexus Papillomas
Subependymoma
CONCLUSION
CHAPTER 18:
Sellar and Parasellar Lesions
INTRODUCTION
NORMAL ANATOMY AND APPLIED PHYSIOLOGY
IMAGING MODALITIES
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
PATHOLOGY OF THE SELLAR AND PARASELLAR REGION
TUMORS
Pituitary Adenoma
Types of Adenomas
Imaging of Adenomas
Atypical Presentations of Adenomas
Postoperative Sella
Craniopharyngioma
Pituicytoma
Meningioma
Germinoma and Teratoma
Dermoid and Epidermoid Tumors
Chiasmatic/Hypothalamic Glioma
Schwannoma
SKULL BASE LESIONS
Chordoma
Metastasis
Congenital and Metabolic Abnormalities of Pituitary Gland
Developmental Anomalies of Pituitary Gland
Pituitary Hypoplasia and Congenital Pituitary Deficiency Disorders
Empty Sella
Diabetes Insipidus
Hemochromatosis
TUMOR LIKE LESIONS
Pituitary Hyperplasia
Arachnoid Cysts
Rathke's Cleft Cysts
Tuber Cinereum Hamartoma
INFECTIVE CONDITIONS
Fungal Infection
INFLAMMATORY/GRANULOMATOUS CONDITIONS
Langerhans Cell Histiocytosis
Lymphocytic Hypophysitis
Sarcoidosis
Tolosa-Hunt Syndrome
VASCULAR LESIONS
Aneurysms and Vascular Loops
Carotid Cavernous Fistula and Cavernous Malformations
Sheehan's Syndrome
CHAPTER 19:
Intraventricular Lesions
INTRODUCTION
IMAGING MODALITIES
Lateral Ventricular Masses
Choroid Plexus Papilloma (CPP)
Astrocytoma
Subependymal Giant Cell Astrocytoma (SGCA)
Ependymoma
Meningioma
Metastases
Primary CNS Lymphoma
Central Neurocytoma
Subependymoma
Vascular Malformations
Choroid Plexus Cysts and Xanthogranulomas
Third Ventricular Masses
Anterior Third Ventricular Masses
Colloid Cyst
Astrocytoma
Ependymoma
Germinoma
Metastases
Craniopharyngioma
Epidermoid and Dermoids
Cysticercosis
Pituitary Tumor
Posterior Third Ventricular Masses
Glial Tumors
Germinoma
Teratoma
Pineoblastoma
Pineocytoma
Vascular Masses
Fourth Ventricular Masses
Cerebellar Astrocytoma
Medulloblastoma
Ependymoma
Brainstem Gliomas
CHAPTER 20:
Imaging of the Temporal Bone
INTRODUCTION
COMPUTED TOMOGRAPHY TECHNIQUE
MAGNETIC RESONANCE IMAGING
CONGENITAL ANOMALIES OF THE TEMPORAL BONE
Anomalies of the External and Middle Ear
Inner Ear Abnormalities
Complete Labyrinthine Aplasia or Michele Aplasia
Common Cavity
Cochlear Aplasia
Cochlear Hypoplasia
Incomplete Partition or Dilatational Defects
Congenital Dilatation of the Vestibular Aqueduct
Vestibular Anomalies
Vascular Anomalies
Temporal Bone Fractures
Inflammatory Diseases of the Temporal Bone
Inflammatory Conditions of the External Ear
Inflammatory Condition of the Middle Ear
COMPLICATIONS
Acquired Cholesteatomas
OTHER COMPLICATIONS
RADIOLOGICAL EVALUATION OF VASCULAR TINNITUS AND VASCULAR TYMPANIC MEMBRANE
Causes of Pulsatile Tinnitus33
Normal Vascular Variants
Pathological Vascular Causes
Arterial Causes
Arteriovenous Causes
Venous Tinnitus
Otosclerosis
DYSPLASTIC CONDITIONS OF THE TEMPORAL BONE
Tumors of the Temporal Bone
CHAPTER 21:
Imaging of the Globe and Orbit
INTRODUCTION
NORMAL ANATOMY
Radiographic Views
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
PATHOLOGICAL CONDITIONS
OCULAR LESIONS
Ocular Detachments
Vitreous Hemorrhage
Retinoblastoma
Persistent Hyperplastic Primary Vitreous
Coats’ Disease
Uveal Malignant Melanoma
Choroidal Metastases
Foreign Body
Parasitic Infestation
Congenital Anomalies
ORBITAL LESIONS
ORBITAL TUMORS
Hemangioma
Capillary Hemangioma
Cavernous Hemangioma
Lymphangioma
Lacrimal Gland Tumors
Optic Nerve Glioma
Meningioma
Sphenoid Wing Meningioma
Optic Nerve Sheath Meningioma
Meningioma Arising from Arachnoid Cells Rests Within the Orbit
Rhabdomyosarcoma
Lymphoma
Schwannoma/Neurofibroma
Orbital Metastases
Developmental Cysts
INFLAMMATORY LESIONS
Pseudotumor
Endocrine Orbitopathy
Parasitic Cysts
VASCULAR LESIONS
Carotico-cavernous Fistula
Orbital Varices
Osseous Lesions
Trauma
CHAPTER 22:
Imaging of the Paranasal Sinuses
INTRODUCTION
PARANASAL SINUS EMBRYOLOGY
IMAGING MODALITIES AND TECHNIQUE OF EVALUATION
Conventional Radiography
Computed Tomography
MAGNETIC RESONANCE IMAGING
NORMAL ANATOMY AND ANATOMIC VARIATIONS12-14
Normal Anatomy
Nasal Structures
Draining Pathways
Anatomic Variations
Concha Bullosa
Nasal Septum Deviation
Paradoxical Middle Turbinate
Variations in the Uncinate Process
INFLAMMATORY SINUS DISEASE
Acute Sinusitis
Chronic Sinusitis
Post-FESS Scanning
Mucocele
Fungal Sinusitis
Allergic Fungal Rhinosinusitis (AFRS)
Invasive Fungal Sinusitis
Noninvasive Chronic Fungal Sinusitis
GRANULOMATOUS DISEASES
Polyps and Cysts
NEOPLASTIC LESIONS OF THE PARANASAL SINUSES
Epithelial Tumors of the PNS
Epithelial Tumors of Glandular Origin
NONEPITHELIAL TUMOR OF PARANASAL SINUSES
Angiofibroma
Lymphomas
Plasmacytoma
Olfactory Neuroblastoma (Olfactory Neuroepithelioma/Esthesioneuroblastoma)
Neurogenic Tumors
Neurofibromas
FIBROSSEOUS LESIONS OF CRANIOFACIAL BONES45,46
Osteoma
Ossifying Fibroma
Paget's Disease
CHAPTER 23:
Imaging of the Neck Spaces
INTRODUCTION
NORMAL RADIOLOGICAL ANATOMY OF SUPRAHYOID AND INFRAHYOID NECK
Superficial or Investing Layer
Masticator Space
Parotid Space
Submandibular Space
Visceral or Pretracheal Layer
Pharyngeal Mucosal Space
Parapharyngeal Space
Buccal Space
Retropharyngeal Space
Deep Layer of Deep Cervical Fascia or Prevertebral Fascia
Carotid Space
Prevertebral Space
IMAGING TECHNIQUES
Perfusion Computed Tomography
Magnetic Resonance Imaging
Diffusion-weighted MRI of Nodes
Perfusion MR Imaging
Dynamic Contrast-enhanced CT and MRI of the Nodes
Proton MR Spectroscopy
Lymph Node Specific MR-contrast Agents
Tumor Recurrence versus Treatment Changes: Positron-emission Tomography
NODAL NECK MASSES
Staging
Imaging Characteristics: Cross-sectional Imaging
Lymph Node Size and Contour
Nodal Necrosis
Nodal Calcification
Extracapsular Neoplastic Spread
Skull Base and Vertebral Invasion
NON-NODAL NECK MASSES
MASSES OF DEVELOPMENTAL ORIGIN
Branchial Cleft Cysts
Ranula
Lymphangioma
Imaging Features
Thyroglossal Duct Cyst
Dermoid and Epidermoid Cysts
Tornwaldt's Cyst
Imaging Features
MASSES OF INFLAMMATORY ORIGIN
Tonsillitis and Peritonsillar Abscess
Imaging Features
Acute and Chronic Parotitis
Acute Parotitis
Chronic Parotitis
Sialolithiasis
Ludwig's Angina
Ranula
Osteomyelitis
Inflammatory Pathology of the Carotid Space
Inflammatory Disease of the Retropharyngeal Space
Imaging Features
Inflammatory Lesions of the Prevertebral Space
Imaging Features
MASSES OF NEOPLASTIC ORIGIN
Benign Tumors
Juvenile Nasopharyngeal Angiofibroma
Benign Tumors of the Parotid
Warthin's Tumor
Lipomas
Neurogenic Tumors
Hemangiomas and Lymphangiomas
Malignant Tumors
Nasopharyngeal Carcinoma
Oropharyngeal Carcinoma
Non-Hodgkin's Lymphoma
Imaging Features
Nasopharyngeal Rhabdomyosarcoma
Malignant Tumors of the Salivary Glands
Imaging Patterns on CT and MR
Primary Malignant Lesions in the Prevertebral Space
MASSES OF NEURAL ORIGIN
Imaging Features
Neurofibromas
Imaging Features
MASSES OF VASCULAR ORIGIN
Aneurysm
Paragangliomas
Imaging Features
Diffusion-weighted Imaging in Paragangliomas51
MASSES OF MESENCHYMAL ORIGIN
CHAPTER 24:
Thyroid Imaging
INTRODUCTION
THYROID GLAND
Embryology
Anatomy
Endocrinology
CLINICAL MANIFESTATIONS OF THYROID DISEASE
THYROID IMAGING
Plain Radiographs
Nuclear Scintigraphy
Ultrasonography
Cross-sectional Imaging
PATHOLOGY OF THE THYROID GLAND DEVELOPMENTAL ANOMALIES
Lingual Thyroid
Thyroglossal Duct Cyst
Imaging Features
DIFFUSE THYROID DISEASE
Diffuse Nontoxic Goiter
Imaging Features
Graves’ Disease (Diffuse Toxic Goiter)
Imaging Features
Chronic Autoimmune Lymphocytic (Hashimoto's) Thyroiditis
Imaging Features
Silent Painless Thyroiditis and Postpartum Thyroiditis
Acute Suppurative Thyroiditis
Imaging Features
Subacute Granulomatous Thyroiditis (de Quervain's Disease)
Imaging Features
Invasive Fibrous Thyroiditis (Riedel's Struma)
Imaging Features
MISCELLANEOUS THYROID CONDITIONS
Nodular Thyroid Disease
Imaging Features
DIFFERENTIATION OF BENIGN AND MALIGNANT THYROID NODULES
Ultrasound-elastography
Contrast-enhanced Ultrasound for Evaluation of Thyroid Nodules
Diffusion-weighted MRI (DW-MRI)
Thyroid Incidentalomas
MANAGEMENT OF THYROID NODULES DETECTED AT ULTRASOUND
Percutaneous Aspiration and Biopsy
ULTRASOUND-GUIDED THYROID NODULE ALCOHOL ABLATION
BENIGN NEOPLASMS
Thyroid Adenoma
Imaging Features
MALIGNANT NEOPLASMS
Papillary Carcinoma
Imaging Features
Follicular Carcinoma
Imaging Features
Hurthle Cell Neoplasms of the Thyroid
Medullary Carcinoma
Imaging Features
Anaplastic Carcinoma
Imaging Features
Primary Lymphoma
Imaging Features
Metastatic Disease
CHAPTER 25:
Malignancies of Upper Aerodigestive Tract
INTRODUCTION
ORAL CAVITY
Floor of Mouth
Oral Tongue
Lip
Gingivoalveolus
Buccal Mucosa
Hard Palate
Retromolar Trigone
Staging of Oral Cavity Cancers
Imaging Strategies in Oral Cavity Cancer
Treatment of Oral Cavity Cancers
NASOPHARYNX
Nasopharyngeal Carcinoma
Staging of Nasopharyngeal Carcinoma
Imaging Strategies in Nasopharyngeal Carcinoma
Treatment of Nasopharyngeal Carcinoma
OROPHARYNX
Carcinoma of Tonsil
Carcinoma of Soft Palate
Carcinoma of Base of Tongue
Treatment of Carcinoma of Oropharynx
HYPOPHARYNX
Carcinoma of Posterior Wall of Hypopharynx
Carcinoma of the Pyriform Sinus
Carcinoma of the Postcricoid
Treatment of Carcinomas of Hypopharynx
LARYNX
Supraglottic Carcinoma
Glottic Carcinoma
Subglottic Carcinoma
Imaging Strategies in Carcinoma of Larynx
Cartilage Invasion by Carcinoma of Larynx
Treatment of Carcinoma of Larynx
CERVICAL LYMPH NODES
Imaging of Cervical Lymph Nodes
Management of Cervical Lymph Nodes
Cervical Lymphadenopathy with Carcinoma of Unknown Primary Site (CUPS)
Distant Metastases and Second Primary Tumors
MISCELLANEOUS TUMORS
Minor Salivary Gland Tumors
Rhabdomyosarcoma
Lymphoma
POST-TREATMENT IMAGING
Postradiotherapy Neck
Late Effects of Radiotherapy
Postoperative Neck
CHAPTER 26:
Imaging of Skull Base Lesions
INTRODUCTION
ANATOMICAL DIVISION
IMAGING TECHNIQUES AND THEIR ROLE
ANTERIOR SKULL BASE
Anatomy
Pathology
Lesions Arising from Below
Sinonasal Lesions
Orbital Lesions
Lacrimal Gland Tumors
Lesions Arising from Above
Olfactory Groove Meningioma
Lesions of the Proper Skull Base
Trauma and CSF Leak
Osteoma
MIDDLE SKULL BASE
Anatomy
Pathology
Midline Sagittal Central Skull Base Lesions
Sphenoid Mucocele
Clival Chordoma
Pituitary Macroadenoma
Craniopharyngioma
Meningiomas
Encephaloceles
Other Miscellaneous Lesions
Parasagittal, Central Skull Base Lesions
Peripheral Nerve Sheath Tumors
Perineural Spread
Juvenile Nasopharyngeal Angiofibroma
Cavernous Sinus Lesions
Chondroid Tumors
Lateral Central Skull Base Lesions
Meningioma
Temporomandibular Joint Lesions
POSTERIOR SKULL BASE
Anatomy
Pathology
Jugular Foramen Lesions
Glomus Jugulare Paraganglioma
Nerve Sheath Tumors
Lesions Extending into the Jugular Foramen
Jugular Bulb Pseudolesion
Large or High Riding Jugular Bulb
Petrous Apex Lesions
Nonaggressive Cystic Expansile Lesions
Aggressive Appearing Solid Lesions
Foramen Magnum Lesions
DIFFUSE/NONSITE-SPECIFIC SKULL BASE LESIONS
Metastases
Fibrous Dysplasia
Paget's Disease
Miscellaneous Conditions
CONCLUSION
CHAPTER 27:
Maxillofacial Imaging: Imaging of Cysts, Tumors and Tumor-like Conditions of the Jaw
INTRODUCTION
IMAGING MODALITIES
Plain Radiography
Intraoral Radiographs
Extraoral Radiographs
Computed Tomography
Dental Computed Tomography Reformatting Programs
Cone-Beam Computed Tomography
Magnetic Resonance Imaging
CLASSIFICATION
CLINICAL FEATURES
RADIOLOGICAL FEATURES/APPROACH
Anatomical Location/Site
Relation to Dentition
Relation to Mandibular Canal
Size
Shape
Radiodensity and Internal Architecture of Lesion
OUTLINE/DEFINITION/MARGINATION
Effect on Surrounding Structures
Teeth
Surrounding Bone
Surrounding Soft Tissues
WELL-DEFINED RADIOLUCENT LESIONS
Jaw Cysts
Odontogenic Cysts
Nonodontogenic Cysts
TUMORS OR TUMOR-LIKE CONDITIONS
Odontogenic Tumors
Ameloblastoma
Ameloblastic Fibroma
Nonodontogenic Lesions
Central Giant Cell Granuloma
Eosinophilic Granuloma
Central Hemangioma
Arteriovenous Malformation
Radiolucent Lesions with Ill-defined Margins
Osteomyelitis
Malignant Tumors
Primary Tumors
Mixed-Density Lesions
Odontogenic Lesions
Nonodontogenic Lesions
Radiopaque Lesions
Odontogenic Lesions
Nonodontogenic Lesions
CONCLUSION
CHAPTER 28:
Craniovertebral Junction Anomalies
INTRODUCTION
ANATOMY AND EMBRYOLOGY
Skeletal Anatomy (Figs 1A to D)
Foramen Magnum and the Occiput
Atlas
Ligamentous Anatomy (Figs 2A and B)
Embryology
BIOMECHANICS
CLINICAL PRESENTATION
CRANIOMETRY
CLASSIFICATION OF CVJ ANOMALIES12
Congenital Anomalies and Malformations of the Craniovertebral Junction
Developmental and Acquired Abnormalities of the CVJ
INCIDENCE
NEURORADIOLOGIC INVESTIGATIONS
SPECIFIC CONDITIONS
Basilar Invagination
Assimilation of Atlas
Atlas Arch Anomalies
Dens Dysplasias
Os Terminale
Os Odontoideum
Atlantoaxial Instability
Classification of AAI
Inflammatory, Arthritic and Infectious Disorders
TRAUMA
SYNDROMES INVOLVING THE CVJ35
Klippel-Feil Syndrome
Down Syndrome
Arnold-Chiari Malformation
Chiari I Malformation
Chiari II Malformation
Chiari III Malformation
Achondroplasia
Mucopolysaccharidoses
Osteogenesis Imperfecta
SUMMARY
CHAPTER 29:
Endovascular Management of Craniofacial Vascular Lesions
INTRODUCTION
EMBOLIC AGENTS
PRETHERAPEUTIC EVALUATION
IMPORTANT ANATOMIC CONSIDERATION
POSTEMBOLIZATION CARE
NASOPHARYNGEAL ANGIOFIBROMAS
PARAGANGLIOMA
CRANIOFACIAL VASCULAR LESIONS
Vascular Tumor
Hemangiomas
Vascular Malformations
Aneurysms
MISCELLANEOUS LESIONS
Epistaxis
SUMMARY
CHAPTER 30:
Imaging of Head Trauma
INTRODUCTION
TBI CLASSIFICATION
Broad Classification
According to Location of Lesions
According to Mechanism
According to Clinical Severity [Glasgow Coma Scale (GCS)]3
Marshall CT Classification of Head Injury4
Categories
GOALS OF NEUROIMAGING
IMAGING TECHNIQUES
Plain Radiographs
Evidence Based Guidelines for Imaging Patients with Head Injury
IMAGING FINDINGS
Scalp Injury
Types of Scalp Injury
Skull Fractures
Types of Skull Fractures
Recommendations
TEMPORAL BONE FRACTURES
When to Suspect Temporal Bone Fractures?
Types of Temporal Bone Fractures23 (Figs 8A and B)
EXTRA-AXIAL INJURY9,22
Epidural Hematoma
Imaging Features
Ominous Sign
Management25
Subdural Hematomas
Imaging Features
Challenges during Interpretation9,22
Subdural Hematoma Evolution on MRI
Subarachnoid Hemorrhage
Magnetic Resonance Imaging of SAH
Intraventricular Hemorrhage
INTRA-AXIAL INJURY
Diffuse Axonal Injury
VASCULAR INJURY
CAROTID CAVERNOUS FISTULA
Types of Carotid Cavernous Fistula31
Treatment of Carotid Cavernous Fistula31
ACUTE SECONDARY CHANGES
Diffuse Cerebral Swelling
Imaging Features of Cerebral Edema
Brain Herniation
Subfalcine Herniation
Uncal Herniation
Transtentorial Herniation
Infarction or Ischemia
CHRONIC SECONDARY CHANGES
Traumatic Hydrocephalus
Encephalomalacia
Cerebrospinal Fluid
Imaging32,33
CT Imaging
Magnetic Resonance Imaging
Computed Tomography Cisternography
Leptomeningeal Cyst or “Growing Fracture”
CONCLUSION
CHAPTER 31:
Imaging of Facial Trauma
INTRODUCTION
IMAGING TECHNIQUES
FACIAL BUTTRESSES AND REGIONAL CLASSIFICATION OF INJURIES5,6
Importance of Facial Buttresses14
CLASSIFICATION OF MAXILLOFACIAL FRACTURES
Regional Facial Fractures
Frontal Sinus Fractures
Nasal Fractures
Central Midface Fractures
Le Fort Fractures
Lateral Midface Fractures
Blowout Fractures of the Orbit
Sphenoid Sinus Fractures
Mandibular Fractures
PEDIATRIC FACIAL FRACTURES
CLINICAL ASPECTS OF MAXILLOFACIAL IMAGING
CHAPTER 32:
Imaging of Acute Spinal Trauma
INTRODUCTION
IMAGING INDICATIONS
IMAGING MODALITIES
Plain Radiography
Computed Tomography
Magnetic Resonance Imaging
CLASSIFICATION OF SPINAL TRAUMA
Level of Injury
Severity of Injury
Mechanism of Injury
Stable versus Unstable Fracture
RADIOLOGICAL INTERPRETATION OF SPINAL TRAUMA (ABCS)
CERVICAL SPINE INJURY
Upper Cervical Spine Injuries
Atlanto-occipital Dislocation
Atlantoaxial Injuries
Fractures of the Atlas (C1)
Fractures of the Axis (C2)
Lower Cervical Spine Injury (C3-C7)
THORACOLUMBAR SPINE INJURY
Compression or Wedge Fracture
Burst Fracture
Lap Seat-belt Type Fracture or Chance Fracture
Fracture Dislocation
NONOSSEOUS INJURY
Spinal Cord Injuries
Subacute and Chronic Injuries
SCIWORA
Whiplash Injury
Vascular Injury
SUMMARY
CHAPTER 33:
Imaging of Spinal Neoplasms
INTRODUCTION
CLASSIFICATION OF LESIONS
INTRAMEDULLARY TUMORS
Solitary Lesions
Ependymomas
Myxopapillary Ependymoma
Subependymoma
Astrocytomas
Gangliogliomas
Hemangioblastomas
Paraganglioma
Multiple Lesions
Intramedullary Lymphoma
Intramedullary Metastases
INTRADURAL-EXTRAMEDULLARY TUMORS
Solitary Lesions
Meningiomas
Nerve Sheath Tumors
Intradural Metastases
EXTRADURAL TUMORS
Multiple Lesions
Metastatic Disease
Multiple Myeloma
Lymphoma
Hemangioma
Solitary Lesions
Aneurysmal Bone Cyst
Giant Cell Tumor
Osteoid Osteoma
Osteoblastoma
Osteosarcoma
Osteochondromas
Chordoma
Chondrosarcoma
Chondroblastoma
EPIDURAL LESIONS
Angiolipoma
Epidural Lipomatosis
CONCLUSION
CHAPTER 34:
Spinal Vascular Malformations
INTRODUCTION
SPINAL DURAL ARTERIOVENOUS FISTULA
SPINAL CORD PERIMEDULLARY ARTERIOVENOUS FISTULA
SPINAL CORD AVMS
SPINAL VASCULAR MALFORMATIONS
CHAPTER 35:
Imaging of Low Backache
IMAGING OF LOW BACK PAIN
When to Image
Conditions Causing Back Pain
IMAGING MODALITIES
Radiographs
Magnetic Resonance Imaging, Computed Tomography, Myelography, Myelography/CT
Magnetic Resonance Imaging
Computed Tomography
Myelography/CT
Discography, CT Discography
Isotope Bone Scan
TRANSITION VERTEBRA
SPONDYLOLYSIS AND SPONDYLOLISTHESIS
Imaging
SCHEUERMANN'S DISEASE
Clinical Presentation
Imaging and Diagnosis
DEGENERATIVE DISEASES OF LUMBAR SPINE
Degenerative Changes in the Anterior Elements
Degenerative Changes in the Posterior Elements
Complications of Degenerative Spinal Disease
Presentation
DEGENERATIVE CHANGE OF THE NUCLEUS PULPOSUS
Normal Disk
MR Appearance of Normal Disk
Abnormal Nucleus
Points to Remember
Annular Tears
MR Appearance
Disk Herniation (Abnormalities in Disk Morphology)
Points to Remember
Method of Quantifying the Severity of Disk Disease
Location of Focal Disk Abnormalities
Significance of Disk Contour Abnormalities
Intraosseous Disk Herniations
Presentation
Points to Remember
OSSEOUS DEGENERATIVE CHANGES
Vertebral Bodies
Osteophytes
Endplates
Facet Joints
Normal Facet Joints
Facet Joint Arthropathy
Posterior Spinous Processes
Spinal Stenosis
Causes
Types of Involvement
Failed Back Syndrome
Seronegative Spondyloarthropathy
INFECTIONS
Tubercular Infection
CT Features
MR Features
Uncommon Patterns
Differential Diagnosis
Pyogenic Infection
TUMORS
Benign Tumors
Hemangioma
Osteoid Osteoma
Osteoblastoma
Aneurysmal Bone Cyst
Giant Cell Tumor
Malignant Tumors
Chordoma
Metastases
Multiple Myeloma (Figs 28A to D)
Lymphoma
CONCLUSION
CHAPTER 36:
Localization in Clinical Neurology
LOCALIZATION IN CLINICAL NEUROLOGY
Clinical Diagnosis and Lesion Localization
APPROACH TO NEUROLOGICAL DISORDER
OLFACTORY NERVE (CRANIAL NERVE I)
Anosmia
OPTIC NERVE (CRANIAL NERVE II)
Visual Pathway Localization (Fig. 2)
OCULOMOTOR SYSTEM (CRANIAL NERVE III, IV, VI) (TABLE 1)
Supranuclear Lesions
Nuclear Lesions
Internuclear Ophthalmoplegia
Infranuclear Lesions
Other Disorders of Oculomotor System
TRIGEMINAL NERVE (CRANIAL NERVE V)
FACIAL NERVE (CRANIAL NERVE VII)
Localization of Facial Nerve Lesions (Fig. 3)
Supranuclear Palsy
Infranuclear Facial Nerve Palsy
VESTIBULOCOCHLEAR NERVE (CRANIAL NERVE VIII)
GLOSSOPHARYNGEAL AND VAGUS NERVE (CRANIAL NERVE IX, X)
SPINAL ACCESSORY NERVE (CRANIAL NERVE XI)
HYPOGLOSSAL NERVE (CRANIAL NERVE XII)
DISORDERS OF MOTOR SYSTEM
Muscle Bulk
Power Testing
Muscle Tone
Spasticity
Extrapyramidal Rigidity
Reflexes
Biceps Jerk
Supinator Jerk
Triceps Jerk
Knee Jerk
Ankle Jerk
Hoffman Reflex
Abnormalities of Tendon Reflexes
Superficial Reflexes
Abdominal Reflexes
Cremasteric Reflex
Anal Reflex
Plantar Reflex
Other Important Reflexes
Grasp Reflex
Forced Grasping Reflex
Sucking Reflex
Glabellar Tap
Coordination
Finger Nose Test
Heel-Knee Test
Dysdiadochokinesis
Past Pointing Test
Sensory System
Gait
DISORDERS OF SPEECH
Dysarthria
Dysphasia
APRAXIA
AGNOSIA
PARIETAL LOBE DYSFUNCTIONS
CONCLUSION
CHAPTER 37:
Basic Neuropathology
REMOVAL OF THE BRAIN FROM SKULL
REMOVAL OF VENOUS SINUS, CAVERNOUS SINUS AND MIDDLE EAR EXAMINATION
EXAMINATION OF THE BRAIN
Gross Features to be Noted
Slicing of Brain
Appearance of the Ventricles
Choice of Blocks for Histology
Pediatric Brain Examination
INFECTIONS
Routes of Infection
Consequences of Infection
Leptomeningitis
Acute Meningitis
Tubercular Meningitis (Figs 3B to 6)
Chronic Meningitis
Fungal Meningitis/Encephalitis
Subdural Empyema
Brain Abscess
Purulent Encephalitis Associated with Subacute Bacterial Endocarditis
Viral Encephalitis (Fig. 10)
Postmortem Examination in Cases of Suspected Viral Encephalitis
Macroscopic Examination of the CNS and the Choice of Blocks for Microscopy
Pathological Features Common to Most Forms of Viral Encephalitis
NEUROVASCULAR DISEASES
Arterial Infarcts or Territorial Infarcts
Embolic Infarcts
Cerebral Venous Infarcts (Fig. 13)
Lacunar Infarcts
Practical Considerations
Intracranial Hemorrhage
Aneurysm
Arteriovenous Malformations
Demyelinating Disease and Multiple Sclerosis
Gross Features
Inherited Metabolic Diseases
TUMORS
Postmortem Examination of Cases of CNS Tumor
General Guidelines
Tumors of Neuroepithelial Tissue
SECTION 2: RECENT ADVANCES AND APPLIED PHYSICS IN IMAGING
CHAPTER 38:
Ultrasound Instrumentation: Practical Applications
INTRODUCTION
MACHINE CONTROLS
FREQUENCY OF TRANSDUCERS
TYPES OF TRANSDUCERS
Doppler
Tissue-harmonic Imaging
Spatial-compound Imaging
EXTENDED FIELD OF VIEW
Elastography
3D and 4D Ultrasound
Gynecology
Obstetrics
Limitations
Fusion Imaging
CLINICAL APPLICATIONS OF FUSION IMAGING
Limitations
Therapeutic Applications of Ultrasound
Ultrasound-based Molecular Imaging and Oncotherapy
Ultrasound-image Artifacts
CHAPTER 39:
Image Optimization in Ultrasound
INTRODUCTION
GRAYSCALE IMAGING
Basic Guidelines2-5
Factory Presets
Transducer Selection
Overall Gain
Time-gain Compensation
Depth Setting
Focal-zone Setting
Zoom
Dynamic Range
ARTIFACTS IN B MODE IMAGING3,5-7
Beam-width Artifact
Slice-thickness Artifact
Side-lobe and Grating-lobe Artifacts
Artifacts Associated with Multiple Echoes
Reverberation Bands
Mirror-image Artifact
Artifacts Associated with Velocity Errors
Refractory Errors
Attenuation Errors
Acoustic Shadowing
Edge Shadowing
Increased through Transmission or Distal Bright-up’
Noise
SPECTRAL AND COLOR DOPPLER EXAMINATION
Basic Guidelines7
Optimizing Color Doppler and Spectral Doppler Settings7-11
Color Box or Color Doppler Sampling Window
Doppler or Color Gain
Velocity Scale
Gate Size or Sample Volume Box
Sample Volume or Gate Position
Angle Correction
Color-write Priority
Baseline
Wall Filters
Inversion of Flow
Directional Ambiguity
Slow Flow
Anatomically Related Artifacts
Artifacts Unrelated to Blood Flow
Perivascular or Color-bruit Artifact
SPECIAL IMAGING MODES1-3,10,13-16
Tissue-harmonic Imaging
COMPOUND IMAGING
Spatial-compound Imaging
Coded-pulse Excitation
Adaptive-image Processing
Photopic-ultrasound Imaging
Extended Field of View Imaging
B-Mode Flow Imaging
3D–4D Ultrasound
CONCLUSION
CHAPTER 40:
Ultrasound Elastography: Principles and Application
INTRODUCTION
BASIC PHYSICS
Stress
Strain
Elasticity
Viscosity
Viscoelasticity
Poroelasticity
DEPICTION OF ELASTOGRAMS
DIFFERENT ELASTOGRAPHY TECHNIQUES
Compression Elastography
Limitations
Acoustic Radiation Force Impulse
Principle and Technique
Measurement
Quantitative versus Qualitative
Advantages
Disadvantages
Safety
Shear-wave Imaging
Principle and Technique
Measurement
Qualitative versus Quantitative
Advantages
Disadvantages
Advances in Shear-wave Imaging
Harmonic-motion Imaging
Technique
Application
Shear-dispersion Ultrasound Vibrometry
Technique
Measurement
Mechanical Imaging
Measurement
Application
ELASTOGRAPHY APPLICATIONS
Breast
Elastosonographic Score (Fig. 3)
Elastographic Appearances of the Breast Masses
Liver
Diffuse Liver Diseases: Fibrosis, Cirrhosis, Acute Hepatitis, Nonalcoholic Fatty Liver Disease
Factors Influencing Liver Stiffness
Ultrasound Elastography
Comparison Between ARFI, Real-time Elastography and Transient Elastography for Liver Stiffness Measurement (Table 1)
Focal Liver Lesions
Prostate
Lymph Nodes
Thyroid
Gynecology
Cervical Elastography
Cervical Cancer
Fibroids
Fibroids vs Adenomyosis
Endometrial Pathologies
Musculoskeletal
Appearance of Normal Tendons
OTHER APPLICATIONS
Renal Transplant Assessment
Cardiovascular Applications
Venous Thrombosis
Skin and Soft Tissue
Endoscopic Ultrasonography
Limitations of EUS Elastography
Pitfalls
CONCLUSION
CHAPTER 41:
Computed Tomography Hardware: An Update
BASIC WORKFLOW OF CT SCANNER
DETERMINANTS OF AN OPTIMAL IMAGE
Spatial Resolution
Temporal Resolution
Contrast Resolution
ADVANCES IN HARDWARE
Advances in CT Tube
Advances in Detectors
Advances in Reconstruction
Rebinning Algorithms
SPECIAL COMPUTED TOMOGRAPHY
Cone-beam CT/Volume CT
Cone-beam Geometry
Flat-panel Detector
Reconstruction
Radiation Dose
Applications
C-arm Based CBCT
Navigation Systems
CONCLUSION
CHAPTER 42:
Dual-energy Computed Tomography
INTRODUCTION
HISTORICAL PERSPECTIVE
PRINCIPLE
DUAL-ENERGY RATIO
Spectral Separation and Selective-photon Shield
Dual-source DECT
Single-source DECT
Dual-energy CT with Layered Detectors
Processing of Data and Image Reconstruction in Dual-energy Imaging
Image Display in DECT
APPLICATIONS OF DECT
Applications in Abdomen
Renal Applications
Applications in Adrenal
Adrenal Adenoma
Hepatic Mass Characterization
Application in Pancreas
Pulmonary Applications
Musculoskeletal Applications
Applications in Head and Neck
Vascular Applications
Cardiac Applications
Applications in Neuroimaging
DOSE CONSIDERATIONS
Limitation
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 43:
Computed Tomography Perfusion Imaging
INTRODUCTION
PERFUSION COMPUTED TOMOGRAPHY TECHNIQUE BASIC PRINCIPLE
PERFUSION COMPUTED TOMOGRAPHY PROTOCOLS
Unenhanced CT Acquisition
Dynamic CT Acquisition
Technique of CT Perfusion
Contrast Medium
Acquisition Parameters
COMPUTED TOMOGRAPHY PERFUSION IN ACUTE ISCHEMIC STROKE
COMPUTED TOMOGRAPHY PERFUSION IN ONCOLOGY
HEPATIC COMPUTED TOMOGRAPHY PERFUSION35-39
Perfusion Parameters of Normal Liver
CT Perfusion in Hepatocellular Carcinoma
CT Perfusion in Metastatic Disease
CT Perfusion in Focal Liver Lesions
COMPUTED TOMOGRAPHY PERFUSION IN PANCREATIC NEOPLASMS
COMPUTED TOMOGRAPHY PERFUSION IN COLORECTAL CARCINOMA
COMPUTED TOMOGRAPHY PERFUSION IN PROSTATE CANCER
COMPUTED TOMOGRAPHY PERFUSION IN LYMPHOMA
COMPUTED TOMOGRAPHY PERFUSION IN BRAIN TUMORS
COMPUTED TOMOGRAPHY PERFUSION IN HEAD AND NECK TUMORS
COMPUTED TOMOGRAPHY PERFUSION IN LUNG CANCER
OTHER APPLICATIONS
Nephrology
Chronic Liver Diseases
CT Perfusion in Liver Transplantation
Acute Pancreatitis
RADIATION ISSUES
CONCLUSION
CHAPTER 44:
Magnetic Resonance Instrumentation: An Update
INTRODUCTION
THE MAGNET
PREPOLARIZED MRI
Superconducting Magnet
Quench
MAGNET GEOMETRY
Shim Coils
3 TESLA AND HIGHER-MAGNET STRENGTHS
Gradient System
Radiofrequency System
MULTICHANNEL RF COILS AND PARALLEL IMAGING
Computer
Data Processing and Image Reconstruction
ADVANCED MR APPLICATIONS AND HARDWARE
Magnetic Resonance-High-Density Focussed Ultrasound (or MRgFUS)
Magnetic Resonance Elastogram
MR Surgical Suite: Interventional MRI
Magnetic Resonance–Positron Emission Tomography
CHAPTER 45:
Image Optimization in Magnetic Resonance Imaging
INTRODUCTION
SIGNAL-TO-NOISE RATIO
Field Strength
Proton Density
Coil Type and Position
Repetition Time
Echo Time
Flip Angle
Number of Signal Averages
Slice Thickness
Receiver Bandwidth
CONTRAST-TO-NOISE RATIO
Administration of a Contrast Agent
Magnetization Transfer Constant
Chemical Suppression
Echo-train Length
Time from Inversion
SPATIAL RESOLUTION
Voxel Volume, FOV, Matrix
SCAN TIME
TR
Number of Excitations
Phase Matrix
Number of Slice Encodings in 3D Sequences
ARTIFACTS
Motion Artifacts (Phase Mismapping)
Ghosting and Smearing
Pulsatile Flow-related Artifacts
Artifacts Due to Measurement Technique/Parameters
Aliasing
Moiré /Fringe Artifact
Chemical-shift Artifacts
Advantage
Chemical Shift in Echoplanar Imaging
Phase-cancellation Artifact
Advantage
Truncation Artifacts
Magnetic Susceptibility Difference Artifacts
Advantage
Section Cross Talk
Parallel-imaging Artifact
External Artifacts
Artifacts Caused by Field Distortions
Spike (Herringbone) Artifact
Advantage
Zipper Artifact
CONCLUSION
CHAPTER 46:
Diffusion Weighted Magnetic Resonance Imaging
INTRODUCTION
BASIC PRINCIPLE
B VALUE
ADC AND EXPONENTIAL IMAGE
DWI SEQUENCES AND OPTIMIZATION
Echo Planar Imaging
Turbo Spin Echo Sequences or Half-Fourier-acquisition Single-shot Turbo-spin Echo
Steady-state Free-precession
ARTIFACTS AND PITFALLS
T2 Shine Through
T2 Washout
T2 Blackout
Eddy Current Artifacts
Susceptibility Artifacts
Chemical-shift Artifacts
Motion Artifacts
Effect of Contrast Media
ADVANCED DW TECHNIQUES
Diffusion Tensor Imaging
Whole Body Diffusion-weighted Imaging
DIFFUSION KURTOSIS IMAGING
Intravoxel Incoherent Motion
Histogram Analysis of ADC
CLINICAL APPLICATIONS OF DWI
Brain
Head and Neck
Pediatric Applications
Thorax
Breast
Liver
Gallbladder and Biliary Ducts
Pancreas
Kidneys and Adrenal
Prostate
Female Pelvis
CONCLUSION
CHAPTER 47:
Functional Magnetic Resonance: Perfusion and Dynamic Contrast-enhanced Magnetic Resonance Imaging
PERFUSION MAGNETIC RESONANCE IMAGING
Magnetic-contrast Agents in Neural Tissues
Imaging Techniques and Methods
Dynamic-susceptibility Contrast-enhanced MR Perfusion
MRI Sequence Type
Dynamic Contrast-enhanced MR Perfusion
Arterial-spin Labeling MR Imaging
DYNAMIC CONTRAST-ENHANCED MRI
CHAPTER 48:
Magnetic Resonance Angiography
HISTORY AND INTRODUCTION
FLOW PHENOMENA
Outflow-related Signal Loss (Washout Effect, T2 Flow Void)
Inflow-related Signal Enhancement (Inflow Effect)
Phase Effects
TIME-OF-FLIGHT ANGIOGRAPHY: TECHNIQUES
Important Points for Optimization of TOF Angiography5-7
Pitfalls with TOF MRA
PHASE-CONTRAST ANGIOGRAPHY
Magnitude-contrast Technique
Phase-contrast Technique
Optimization
CONTRAST-ENHANCED MR ANGIOGRAPHY
CE-MRA Advantages14
Parallel Imaging12
Time Resolved/4D CE-MRA
Advantages of Time-resolved MRA
Limitation
Future Perspectives
CHAPTER 49:
Magnetic Resonance Imaging Pulse Sequences: An Evolution
INTRODUCTION
BASIC TERMINOLOGIES
TYPES OF SEQUENCES
Conventional Spin-echo Sequences
Fast-spin-echo Sequences
Half-fourier Acquisition Single-shot Turbo Spin Echo
Inversion Recovery Sequence
Gradient-echo Sequences
Steady State Sequences
Coherent-gradient-echo Sequence
CISS/FIESTA-C
Ultrafast Sequences
T2*-Weighted Ultrafast Sequences
Ultrafast-gradient-echo Sequence
3D Ultrafast-gradient-echo Sequence
Hybrid Sequences
Gradient/Spin-echo Hybrid
CHAPTER 50:
Digital Radiography: An Update
INTRODUCTION
LIMITATIONS OF FILM SCREEN RADIOGRAPHY
ADVANTAGES OF DIGITAL RADIOGRAPHY2,3
EVOLUTION OF DIGITAL RADIOGRAPHY
PHYSICS BEHIND DIGITAL RADIOGRAPHY
PRINCIPLE OF DIGITAL RADIOGRAPHY
DIGITAL-RADIOGRAPHY SYSTEMS
Computed Radiography
Advantages of Storage Phosphor Systems
Drawbacks of CR/Storage Phosphor Systems
Direct-digital Radiography
Direct Conversion
Selenium Drum-based System of Direct Conversion
Thin-film Transistor—Direct Conversion
Thin-film Transistor—Indirect Conversion
TYPES OF SCINTILLATORS
Charged-coupled Devices
Photon-counting Type DR System
IMAGE PROCESSING
ASPECTS OF IMAGE QUALITY
Pixels
Detector Size
Grayscale
Spatial Resolution
Contrast Resolution and Dynamic Range
Modular Transfer Function
Detective-quantum Efficiency
Radiation Exposure
Newer Applications in CR
Newer Applications in DR
Exposure Indicator for Digital Radiography
ACR Practice Guideline for Digital Radiography
CONCLUSION
CHAPTER 51:
Digital Mammography
INTRODUCTION
DIGITAL MAMMOGRAPHY
BASIC PHYSICS OF DIGITAL MAMMOGRAPHY
Detectors
Spatial Resolution
Analog to Digital Units
Processing Algorithms
Dynamic Range
Comparison between Digital Mammograms and Film/Screen Mammograms
Storage of Digital Images
Display of Digital Images
Artifacts
APPLICATIONS OF DIGITAL MAMMOGRAPHY
Computer-aided Detection and Diagnosis
Dual-energy Subtraction Mammography
Contrast-enhanced Digital Mammography
Digital Breast Tomosynthesis
Technique
Radiation Dose
Potential Benefits of Clinical Breast Imaging with Tomosynthesis
Clinical Tomosynthesis Evaluations
Teleradiology Applications
Stereotactic Breast Biopsy
Stereo Mammography
CONCLUSION
CHAPTER 52:
Fluoroscopy and Digital Subtraction Angiography
OVERVIEW
FLUOROSCOPY
Components of Fluoroscopic System
Image Intensifier
Input Screen
Electrostatic Lens
Output Phosphor and Anode
Properties of Image Intensifier
Limitations of Image-intensifier System
Optical Coupling and Video System
Optical Distributor System
Video System
Digital Fluoroscopy
Postprocessing Techniques
DIGITAL SUBTRACTION ANGIOGRAPHY
Flat-panel Detector
Advantages and Limitations of FPD Systems
Automatic Exposure Control
Recording Fluoroscopic Images
Direct-film Recording
Indirect Recording
Recording Motion
Types of Fluoroscopic Equipment
Radiography – Fluoroscopy Unit with Under-couch Tube
Radiography – Fluoroscopy Unit with Over-couch Tube
Fixed C-arm Fluoroscopic System
Mobile C-arm System
Factors Affecting Image Quality
Radiation Safety in Fluoroscopy
Patient Dose Monitoring Methods
Dose-reduction Techniques
SUMMARY
CHAPTER 53:
Tools in Interventional Radiology
INTRODUCTION
PUNCTURE NEEDLES
DILATORS
SHEATHS
CATHETERS
Parts of Catheter
Materials
Sizes
Shapes and Holes
Balloon Catheters
GUIDEWIRE
Selection of Guidewires
FINE NEEDLE ASPIRATION CYTOLOGY AND BIOPSY NEEDLE
STENT
Vascular Stent
Biliary Stent
Ureteral Stents
EMBOLIZING AGENTS
Permanent Proximal Occluders
Permanent Distal Occluders
Temporary Proximal Occluders
Temporary Distal Occluders
CHAPTER 54:
Magnetic Resonance Contrast Media
INTRODUCTION
BASIC PRINCIPLES OF MR CONTRAST AGENTS
CLASSIFICATION OF MR CONTRAST AGENTS
Magnetic Properties
Paramagnetic Contrast Agents
Superparamagnetic Contrast Agents
Image Enhancement
Biodistribution
Extracellular-fluid Agents
Intravascular Agents
Tissue-specific Agents
GADOLINIUM-BASED CONTRAST AGENTS
Interaction between Extracellular MRI Contrast Agents with Clinical Tests
Adverse Effects of GBCAs
Contrast-induced Nephropathy
Extravasation
Nephrogenic Systemic Fibrosis
Risk Factors for NSF
Guidelines on GBCA Usage
GBCA Administration in Children20
GBCAs during Pregnancy and Lactation20
MANGANESE-BASED CONTRAST AGENTS
IRON OXIDE-BASED CONTRAST AGENTS
ORAL-CONTRAST AGENTS
Low-low Intensity (Dark Lumen)
High-high or Bright Lumen
High-low Intensity
Low-high Intensity
ONGOING RESEARCH AND FUTURE TRENDS
CONCLUSION
CHAPTER 55:
Ultrasound Contrast Agents
INTRODUCTION
EVOLUTION OF UCAS
TECHNIQUE OF CEUS
SAFETY OF UCAs
DIAGNOSTIC APPLICATIONS OF UCAs
Applications in Hepatic Imaging
Detection of Focal Liver Lesions by CEUS
Characterization of FLL
CEUS Patterns of Benign Focal Liver Lesions (Table 3)
CEUS Patterns of Malignant Focal Liver Lesions (Table 4)
Guidance for Interventional Procedures
Assessment of Treatment Response of Malignant Tumors and Plan Additional Treatment
Hepatic Vein Transit Time Estimation
Liver Transplant
Applications in Pancreatic Imaging
Detection of Focal Pancreatic Lesions
Differentiation of Cystic Pancreatic Tumors from Pancreatic Pseudocyst
Detection of Pancreatic Necrosis in Acute Pancreatitis
Contrast-enhanced Endoscopic Ultrasound
Applications in Renal Imaging
Characterization of Renal Masses
Differentiation of Renal Tumors from Pseudotumors
Renal Vascular Lesions
Renal Tumor Ablation under CEUS Guidance
Application in Abdominal Trauma
Applications in Breast Imaging
Characterization of Breast Masses
Assessment of Tumor Response after Chemotherapy in Breast Cancer
Application in Prostatic Imaging
Miscellaneous Intravascular Applications
Intracavitary Applications
Upcoming Applications
ACKNOWLEDGMENTS
CHAPTER 56:
Iodinated Contrast Media: An Update
INTRODUCTION
HISTORY OF DEVELOPMENT OF ICM
BASIC CHEMISTRY OF ICM
Types of ICM
ICM PHARMACOKINETICS
Basic Properties
Pulmonary Effects of ICM
Effects of ICM on Blood and Endothelium
General Policies for ICM Administration
Guidelines for Intravenous Administration of ICM
Dosage of Iodinated Contrast Media Administration
Adverse Reactions
ICM Interaction with Other Drugs and Clinical Tests
Guidelines for Selective Use of LOCM
Iso-osmolar Dimeric Contrast Media
FUTURE OF ICM
CONCLUSION
CHAPTER 57:
Contrast Reactions and Its Management
INTRODUCTION
TYPES OF ADVERSE REACTION
IDIOSYNCRATIC ANAPHYLACTOID REACTIONS
Mechanism of Idiosyncratic Anaphylactoid Reactions1,3-7
Risk Factors for Acute Idiosyncratic Drug Reactions8
Prevention of Acute Idiosyncratic Reactions9-11
Types and Management of Acute Idiosyncratic Reactions1
NONIDIOSYNCRATIC REACTIONS22-25
Extravasation of Contrast26-30
Clinical Features
Contrast-extravasation Treatment
Contrast-induced Nephropathy
Diagnosis
Acute Kidney Injury Network: Definition of Acute Kidney Injury28,31
Pathogenesis
Risk Factors for CIN
Renal Dialysis Patients and the Use of Iodinated Contrast Medium1
Recommendation of Contrast Agents Based on Serum Creatinine Level
Contrast Administration and Pregnancy1
Contrast Administration and Lactation1
Contrast Administration in Patients on Metformin1
Comorbidities for Lactic Acidosis with Use of Metformin
Contrast Administration and Interleukin-2 Therapy47,11
Contrast Administration and Thyroid Dysfunction11
Prophylaxis of Contrast Induced Thyrotoxicosis
Contrast Administration in Pheochromocytoma and Paraganglioma11
Contrast and Drug Interaction47
Delayed Adverse Events to Iodinated Contrast Media
Treatment
Recommendations for the Departments Performing Contrast-related Investigations54,55
CHAPTER 58:
Picture Archiving and Communication System and Radiology Information System
INTRODUCTION
PICTURE ARCHIVING AND COMMUNICATION SYSTEM
Components and Architecture of PACS
Workflow
Mini-PACS
Teleradiology
Acquisition
Image Compression
Types of Image Compression
Bits and Bytes
Database Server
Storage
Storage Hardware
Workstation
Display Monitors
Radiologist Reading Stations
Physician Review Stations
Network
System Architecture
Client/Server-based Systems
Distributed Systems
Web-based Systems
Related Applications
Industry Standards
RADIOLOGY INFORMATION SYSTEM
CHAPTER 59:
Evidence-based Radiology
INTRODUCTION
BACKGROUND
WHY EVIDENCE-BASED PRACTICE?
How does Evidence-based Radiology Differ from Evidence-based Medicine?
Limitations of Evidence-based Practice
CONCLUSION
CHAPTER 60:
Radiation Hazards and Radiation Units
INTRODUCTION
RADIATION HAZARDS
DAMAGE TO DNA BY THE RADIATION
THE EFFECT OF RADIATION
Stochastic and Nonstochastic (Deterministic) Effects
Radiation Doses and Expected Effect
Radiation Effect on Embryo
Ten-day Rule
Protection of Patient, Staff and Public from Radiation
Radiation Risk
Radiation Protection Guidelines and LNT Model
Justification
Radiation Units
Fluence
Flux
Energy Fluence
Exposure
Absorbed Dose
Kerma
Equivalent Dose
Effective Dose
Radiation Dose Measurement in CT
Computed-Tomography Dose Index
Radiation Dose Measurement in Fluoroscopy
CHAPTER 61:
Radiation Protection
HISTORICAL PERSPECTIVE
RADIATION UNITS
Conventional Units
SI Units
SPECIFIC QUANTITIES AND THEIR ASSOCIATED UNITS EXPOSURE
Absorbed Dose
Units
BIOLOGICAL IMPACT
Dose Equivalent
Effective Dose Equivalent (Effective Dose)
INTERACTION OF RADIATION WITH MATTER RADIATION TYPES AND SOURCES
BIOLOGICAL EFFECT OF RADIATION
CLASSIFICATION OF RADIATION INJURY
Malignancies Associated with Radiation Exposure
Genetic Effects of Radiation
DETERMINISTIC EFFECTS AS DOCUMENTED FROM RADIATION ACCIDENTS
Acute Total-body Irradiation
Chronic Radiation Effects
THE REGULATORY BODIES
Role of AERB
Radiation Protection Survey and Program (Flow chart 1)
PROTECTION AGAINST RADIATION HAZARD PRINCIPLES OF RADIATION PROTECTION
CARDINAL PRINCIPLE OF RADIATION PROTECTION
Time
Distance
Shielding
X-ray Tube Shielding (Source Shielding)
Room Shielding (Structural Shielding)
Exposure Calculations
Shielding of the X-ray Control Room
Personnel Shielding
Patient Shielding
Equipment
SAFETY OF RADIOGRAPHIC IMAGING DURING PREGNANCY
RECOMMENDED DOSE LIMITS TO PREGNANT WOMEN18,19
RADIATION DETECTION AND MEASUREMENT
Methods of Detection
Ionization
Photographic Effect
Luminescence
Scintillation
PERSONNEL DOSIMETRY
Pocket Dosimeter
Film Badge Monitoring
Thermoluminescent Dosimetry Monitoring
Electronic Dosimeters
Wearing the Dosimeter
During Radiography
During Fluoroscopy
COMPUTED TOMOGRAPHY (RADIATION EXPOSURE AND DOSE MODULATIONS)
Radiation Dose Measures: CT Specific
Conventional Radiographic Projections
CT Radiation Projections
TYPICAL DOSE MEASUREMENTS
Multiple Scan Average Dose
Computed Tomography Dose Index (CTDI)
CTDI100
CTDIW
CTDIvol
Dose-length Product (DLP)
Techniques for Controlling Radiation Dose at CT
USING AUTOMATED EXPOSURE CONTROL
MODIFYING THE ACQUISITION PARAMETERS
Reducing the Milliampere-seconds Value
Increasing Pitch
Varying the Milliampere-seconds Value by Patient Size
Optimum Tube Potential47
ITERATIVE RECONSTRUCTION
CONCLUSION
CHAPTER 62:
Planning a Modern Imaging Department
INTRODUCTION
PLANNING AND ORGANIZATION
Divisions of the Radiology Department
LOCATION
LAYOUT
EQUIPMENT
Conventional Radiography
Darkroom
Digital Radiography
Storage Phosphor Radiography (Computed Radiography)
Dual-reading CR systems
Parallel Reading (Line Scanning)
Needle-crystalline CR Detectors
Flat-panel Direct Detector Systems
CCD Detector Technology
Slot-scanning CCD Technology
Computer-aided Diagnosis
Dual-energy Subtraction
Temporal Subtraction
Digital Tomosynthesis
Mobile Image Intensifiers Units
MAMMOGRAPHY
COMPUTED TOMOGRAPHY
ULTRASOUND
Magnetic Resonance Imaging
Digital Subtraction Angiography
Nuclear Imaging Systems
PICTURE ARCHIVING AND COMMUNICATION SYSTEMS
SAFETY STANDARDS AND QUALITY ASSURANCE
TELERADIOLOGY
CHAPTER 63:
Recent Advances in Positron Emission Tomography/Computed Tomography and Positron Emission Tomography/Magnetic Resonance
INTRODUCTION
POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY
Clinical Applications of PET/CT
Diagnosis
Initial Staging
Treatment-response Evaluation
Restaging/Recurrence/Prognosis
POSITRON EMISSION TOMOGRAPHY/MAGNETIC RESONANCE
Clinical Applications of PET/MR
Oncology
Radiotherapy Treatment Planning
Neurology
Cardiology
ACKNOWLEDGMENTS
CHAPTER 64:
Common Drugs Used in an Imaging Department
INTRODUCTION
DRUGS FOR PATIENT PREPARATION: SEDATIVES
Local Anesthetics
Methods of Administration
Infiltration Anesthesia
Adverse Effects
Sting Free LA
DRUGS USED FOR OPTIMIZING IMAGING EVALUATION: DIURETICS
Uses
Contraindications
Vasodilators
Papaverine
Nimodipine
Milrinone
Patient Preparation in Suspected Pheochromocytoma
Drugs for Cardiac Imaging
Cardiac CT
β-blockers
Ivabradine
Cardiac Stress MRI
Dobutamine
Adenosine
DRUGS AFFECTING COAGULATION: PROCOAGULANTS
Thrombin
Anticoagulants
Heparin
Thrombolytics
Classification of Thrombolytics
Contraindications
Antiplatelets
Cyclooxygenase-1 Inhibitor
Thienopyridines
Phosphodiesterase Inhibitors
SCLEROSANTS AND EMBOLIC AGENTS
GELATIN FOAM
POLYVINYL ALCOHOL
TRIS-ACRYL GELATIN MICROSPHERES
N-BUTYL-2 CYANOACRYLATE
ETHYLENE VINYL ALCOHOL COPOLYMER
ABSOLUTE ALCOHOL
SODIUM TETRADECYL SULFATE
Transarterial Chemoembolization
CHAPTER 65:
Molecular Imaging
INTRODUCTION
MOLECULAR IMAGING PROBES IN NUCLEAR MEDICINE
CLINICAL APPLICATIONS OF NUCLEAR MOLECULAR IMAGING
Oncology
Diagnosis and Staging
Assessment of Response to Treatment
Role in Drug Development
CENTRAL NERVOUS SYSTEM DISORDERS
Epilepsy
Dementia
Movement Disorders
CARDIOVASCULAR DISORDERS
Myocardial Viability
Coronary Flow Reserve
Atherosclerosis
INFECTIOUS AND INFLAMMATORY PROCESSES
Newer Agents for Imaging Infection/Inflammation
CONCLUSION
CHAPTER 66:
Ethical and Legal Issues in Radiology
ETHICAL ISSUES
DOCTOR-PATIENT RELATIONSHIP
RADIATION ISSUES
Patient Protection
Staff Protection
Public Protection
Protection During Interventions
LEGAL ISSUES
Image Interpretation and Reporting
First Study the Images
Know How the Examination was Performed
How to Look (Detect the Abnormalities)
When an Abnormality is Found
Reach a Conclusion
When to Make the Report
Giving the Report a Title
Proofread the Report
General Format
Length of the Report
Negative Reporting
Internal Architecture
LAWS/LEGAL ACTS APPLICABLE TO MEDICINE
PCPNDT Act
Consumer Protection Act (1986)
Radiologist as a Defendant
In a Malpractice Claim
Duty of Care
Consent
Archiving and Ownership of Diagnostic Imaging Data
Patient Referral
Radiologist as a Witness
As Expert Witness
Writing a Radiological Opinion
Comments on Other Radiological Reports
Appearing in Court
Personal Communication by the Radiologists
Issue of Self-referral
TELERADIOLOGY: WHO IS RESPONSIBLE?
SECTION 3: GASTROINTESTINAL AND HEPATOBILIARY IMAGING
CHAPTER 67:
Current Status of Conventional Techniques and Advances in Gastrointestinal Tract Imaging
INTRODUCTION
DEVELOPMENT OF GASTROINTESTINAL RADIOLOGY
CONVENTIONAL TECHNIQUES: PRESENT SCENARIO
ADVANCES IN GASTROINTESTINAL TRACT IMAGING
Ultrasonography (US) in GIT
CT Enteroclysis (Fig. 2)
Technique of CT Enteroclysis
Indications
CT Enterography
MRI and MR Enteroclysis (MRE)
PET-CT Enteroclysis and PET-CT Colonography
Nuclear Scintigraphy
CHARACTERISTIC
Tuberculosis
Crohn's Disease
Imaging in Small Bowel Obstruction
Mesenteric Ischemia
Neoplasms Malignant
CONCLUSION
CHAPTER 68:
Nontraumatic Acute Abdomen
INTRODUCTION
DIAGNOSTIC WORK-UP
CT Technique
Plain Radiographs in Evaluation of the Acute Abdomen
Perforation
Intestinal Obstruction
Miscellaneous Conditions
Role of Cross-sectional Imaging in Specific Disease Entities
Acute Appendicitis
Acute Cholecystitis
Acute Pancreatitis
Intra-abdominal Abscess
Intestinal Obstruction
Bowel Perforation
Mesenteric Ischemia
Vascular Causes
Pelvic Disease
MISCELLANEOUS
Diverticulitis
Toxic Megacolon
Acute Pyelonephritis
Acute Urinary Colic
Acute Epiploic Appendagitis, Omental Infarction
CHAPTER 69:
Imaging in Abdominal Trauma
INTRODUCTION
DIAGNOSTIC IMAGING
Plain Radiography
Ultrasonography
Radionuclide Scanning
Magnetic Resonance Imaging
Angiography
Computed Tomography
Computed Tomography Technique
CT Signs in Blunt Abdominal Trauma10
ORGAN TRAUMA
Peritoneal Cavity
Pneumoperitoneum
Hemoperitoneum
SPLEEN
LIVER AND BILIARY TRACT
PANCREAS
URINARY TRACT
ADRENAL
HOLLOW VISCUS, OMENTAL AND MESENTERIC INJURY
DIAPHRAGM
RETROPERITONEUM
ABDOMINAL WALL INJURY
PENETRATING ABDOMINAL TRAUMA
CONCLUSION
CHAPTER 70:
Imaging of the Esophagus
INTRODUCTION
Pharyngeal and Esophageal Anatomy
Physiology of Swallowing
CLINICAL PERSPECTIVE
Investigation of Dysphagia
Examination Technique
Barium Studies
Cross-sectional Studies
Pharynx
Esophagus
Endoscopic Ultrasound
Others Techniques for Evaluation of Esophagus
Videoendoscopic Swallowing Study
Esophageal Scintigraphy
Esophageal Manometry
Ambulatory pH Monitoring
Oropharyngeal Lesions
Neuromuscular Disease
Cricopharyngeal Prominence
Cricopharyngeal Webs
Pharyngeal Diverticula and Pouches
Pharyngeal Tumors
Pharyngeal Foreign Bodies
Esophageal Motility Disorders
Primary
Nonspecific Esophageal Motility Disorder
Diffuse Esophageal Spasm
Achalasia
Nutcracker Esophagus
Secondary Motility Disorders
ESOPHAGITIS
Gastroesophageal Reflux Disease and Barrett's Esophagus
Infectious Esophagitis
Candida Esophagitis
Viral Esophagitis
Tuberculosis
Caustic Esophagitis
Drug-induced Esophagitis
Radiation-induced Esophagitis
Miscellaneous Causes
ESOPHAGEAL DIVERTICULA
Intramural Pseudodiverticulosis
ESOPHAGEAL VARICES
TRAUMATIC LESIONS
Foreign Bodies
MISCELLANEOUS LESIONS
ESOPHAGEAL TUMORS
Benign Tumors
Malignant Tumors
Carcinoma
Metastases
INDENTATIONS AND DISPLACEMENT
RECENT ADVANCES AND FUTURE DIRECTIONS
CHAPTER 71:
Benign Lesions of Stomach and Small Intestine
INTRODUCTION
Techniques of Examination
Hypotonic Duodenography
MDCT and 3D Imaging Techniques
Magnetic Resonance Imaging
Erosive and Ulcerative Lesions of Stomach and Duodenum
NARROWING OF STOMACH
THICKENED GASTRIC FOLDS AND FILLING DEFECTS
REDUCED OR ABSENT RUGAL FOLDS
GAS IN WALL OF STOMACH
GASTRIC OUTLET OBSTRUCTION
GASTRIC DILATATION WITHOUT OBSTRUCTION
POSITIONAL ABNORMALITIES
THICKENING OF DUODENAL FOLDS
DUODENAL FILLING DEFECTS
DUODENAL NARROWING OR OBSTRUCTION
EXTRINSIC IMPRESSION ON BULB
WIDENING OF DUODENAL SWEEP
MISCELLANEOUS ABNORMALITIES
CONCLUSION
CHAPTER 72:
Malignant Lesions of the Stomach and Small Intestine
INTRODUCTION
CARCINOMA OF THE STOMACH
Risk Factors for Gastric Cancer
Clinical Features
Pathology
Diagnosis
Barium UGI Series Features of Gastric Cancer
Staging
CT Features of Gastric Cancer
Limitations of CT
Other Investigations for Preoperative Staging of Gastric Cancer
Treatment and Prognosis
CARCINOMA OF THE SMALL BOWEL
Adenocarcinoma of the Small Bowel
Clinical Features
Barium Studies of the Small Bowel
Barium Study Features of Carcinoma of the Small Bowel
CT of the Small Bowel
CT Features of Adenocarcinoma of the Small Bowel
MRI of the Small Bowel
Staging
Treatment and Prognosis
Follow-up
Carcinoid
Carcinoids of the Stomach and Duodenum
Imaging Features of Gastric and Duodenal Carcinoids
Small Bowel Carcinoids
Imaging Features of Small Bowel Carcinoids
Differential Diagnosis of Carcinoids
Treatment and Prognosis
GASTROINTESTINAL STROMAL TUMORS
Imaging Features of GIST
Treatment of GIST
METASTASES TO THE STOMACH AND SMALL BOWEL
MISCELLANEOUS MALIGNANT TUMORS OF STOMACH AND SMALL BOWEL
CHAPTER 73:
Abdominal Tuberculosis
INTRODUCTION
Pathological Findings
Clinical Spectrum
TUBERCULOUS PERITONITIS
Peritoneum
Omentum
Small Bowel Mesentery
TUBERCULAR LYMPHADENITIS
GASTROINTESTINAL TUBERCULOSIS
ESOPHAGEAL TUBERCULOSIS
GASTRIC TUBERCULOSIS
DUODENAL TUBERCULOSIS
TUBERCULOSIS ENTERITIS
ILEOCECAL TUBERCULOSIS
Group 1
Group 2
Group 3
Group 4
APPENDICEAL TUBERCULOSIS41
COLONIC TUBERCULOSIS
ANORECTAL TUBERCULOSIS29
Enterolithiasis
VISCERAL TUBERCULOSIS
Liver and Spleen
Pancreas
Vascular Involvement in Gastrointestinal Tuberculosis
AIDS AND TUBERCULOSIS
Percutaneous Biopsy in the Diagnosis of Abdominal Tuberculosis
NUCLEAR IMAGING
CONCLUSION
CHAPTER 74:
Nontubercular Inflammatory Bowel Diseases
INFLAMMATORY BOWEL DISEASES
RADIOLOGY
ULCERATIVE COLITIS
CROHN'S DISEASE
Complications of IBD
Extraintestinal Complications
Ulcerative Colitis versus Crohn's Disease
Crohn's Disease versus Tuberculosis
Distribution of Disease
OTHER INFLAMMATORY BOWEL DISEASES
Ischemic Bowel Disease
Appendicitis
Epiploic Appendagitis
Diverticulitis
Radiation Colitis
Pseudomembranous Colitis
Amebic Colitis
Typhilitis
Celiac Disease
Eosinophilic Enteritis
Amyloidosis
CHAPTER 75:
Colorectal Malignancies
EPIDEMIOLOGY
RISK FACTORS
PATHOGENESIS
CLINICAL FEATURES
PATHOLOGY
ROUTE OF SPREAD
STAGING
Primary Tumor (T)
Regional Lymph Node (N)
Distant Metastasis (M)
Stage Grouping24
ROLE OF RADIOLOGY
Screening for Colorectal Cancer
DIAGNOSTIC METHODS
Plain Radiographs
Barium Enema
Problem Areas in Barium Studies
Ultrasound
Computed Tomography
CT Colonography
MR Imaging
MR Colonography
Arteriography
Immunoscintigraphy
Positron Emission Tomography
Recent Advances
Other Malignant Tumors of Colon
CONCLUSION
CHAPTER 76:
Lymphoma of the Gastrointestinal Tract
INTRODUCTION
PATHOLOGY
STAGING
CLINICAL PRESENTATION AND INVESTIGATION
Imaging Modalities
Barium Studies and Computed Tomography
CT Enteroclysis
Magnetic Resonance Imaging
Radionuclide Imaging
Radiological Findings
Esophagus
Stomach
Small Intestine
Appendix
Colon and Rectum
Lymphoma Variants
Burkitt's Lymphoma
Mediterranean Lymphoma
Multiple Lymphomatous Polyposis
CHAPTER 77:
Imaging of Appendix
INTRODUCTION
NORMAL IMAGING APPEARANCE
ACUTE APPENDICITIS
Pathophysiology
Clinical Picture
IMAGING
Conventional Radiography
Ultrasonography
US Technique
Sonographic Findings
Doppler Imaging
Pitfalls in Sonographic Diagnosis
Computed Tomography
CT Technique
CT Findings in Acute Appendicitis
Magnetic Resonance Imaging
WHICH MODALITY AND WHEN
MUCOCELE OF APPENDIX
PRIMARY APPENDICEAL INTUSSUSCEPTION
POSTOPERATIVE APPENDICEAL DEFECTS
TUMORS OF THE APPENDIX
CHAPTER 78:
Liver Anatomy and Techniques of Imaging
INTRODUCTION
NORMAL ANATOMY
BISMUTH AND COUINAUD'S SEGMENTAL NOMENCLATURE
ULTRASONOGRAPHY
Technique
Ultrasound Contrast Agents
Sonographic Anatomy
Intraoperative Ultrasonography
Computed Tomography
CT Anatomy
Magnetic Resonance Imaging
Technique
Magnetic Resonance Imaging Contrast Agents
Magnetic Resonance Anatomy
ANGIOGRAPHY
Technique
Anatomy
POSITRON EMISSION TOMOGRAPHY
CHAPTER 79:
Benign Focal Lesions of the Liver
INTRODUCTION
CLASSIFICATION
HEPATIC CYSTS
Imaging Features
Ultrasonography
CT
Nuclear Scintigrams
Angiogram
MRI
CONGENITAL HEPATIC FIBROSIS AND POLYCYSTIC LIVER DISEASE
Imaging Features
BILIARY CYSTADENOMA
Imaging Features
USG and CT
MR Imaging
BILE DUCT HAMARTOMA
HEMANGIOMA
Pathology
Imaging Features of Cavernous Hemangiomas
Plain Film Findings
USG and CT
Microbubble-enhanced USG
Multiple Phase Imaging
MRI
MR Imaging Characteristics in Giant Hemangioma of the Liver
Red Blood Cell Scintigraphy
Angiographic Findings
HEPATOCELLULAR ADENOMA
Imaging Features
USG
CT
Triphasic Study
Radionuclide Scintigraphy
MRI
Angiograms
FOCAL NODULAR HYPERPLASIA
Pathology
Imaging Features
USG
Color Doppler
Contrast-enhanced USG
Focal Nodular Hyperplasia and Hepatic Adenoma: Differentiation with Low Index Contrast Enhanced Sonography
CT
Hemodynamic Characterization of Focal Nodular Hyperplasia
Nuclear Scintigraphy
Hepatic Adenoma and Focal Nodular Hyperplasia: MR Findings with Super-paramagnetic Iron Oxide-enhanced MRI (SPIO)
NODULAR REGENERATIVE HYPERPLASIA
ADENOMATOUS HYPERPLASTIC NODULE
LIPOMATOUS TUMORS
CT
MRI
PEDIATRIC LIVER TUMORS
Mesenchymal Hamartoma
US
CT
MRI
Infantile Hemangioendothelioma
USG
CT
MRI
Hepatic Arteriograph
FOCAL INFLAMMATORY LESIONS OF LIVER
Bacterial (Pyogenic) Liver Abscess
Pathology
Plain Film Findings
USG
ERCP
CT and MR Imaging
Amebic Abscess
Pathology
Plain Film Findings
Nuclear Scintigrams
USG
CT
MRI
Complications
Fungal Hepatic Abscesses
Imaging Features
HYDATID DISEASE
Hydatid Cyst Structure
Hepatic Hydatid Disease
Imaging Features
Plain Film Findings
Nuclear Scintigraphy
CT
MRI
Local Complications
Intrahepatic Complications
Exophytic Growth
Transdiaphragmatic Thoracic Involvement
Perforation into Hollow Viscera
Peritoneal Seeding
Biliary Communication
Portal Vein Involvement
Abdominal Wall Invasion
HEPATIC TUBERCULOSIS
Pathology
Imaging Features
Plain Film Findings
Nuclear Scintigraphy
USG
CT
HEPATIC SCHISTOSOMIASIS
Imaging Features
Plain Film Findings
USG
CT
MRI
HEPATIC PNEUMOCYSTIS CARINII INFECTION
Miscellaneous Lesions
Fatty Infiltration
Hematoma
Biloma
CHAPTER 80:
Malignant Focal Lesions of the Liver
INTRODUCTION
PRIMARY MALIGNANT FOCAL LESIONS
Hepatocellular Carcinoma
Clinical Presentation
Imaging in HCC
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Angiography
Fibrolamellar Hepatocellular Carcinoma
Interventional Techniques
Intrahepatic Cholangiocarcinoma
Imaging
Hepatoblastoma
Imaging
Epithelioid Hemangioendothelioma
Imaging
Angiosarcoma
SECONDARY MALIGNANCIES
Metastatic Disease
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Image-guided Biopsy
Lymphoma
CHAPTER 81:
Diffuse Liver Diseases
INTRODUCTION
FATTY LIVER (HEPATIC STEATOSIS)
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
HEPATITIS
Viral Hepatitis
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Alcoholic Hepatitis
Radiation Hepatitis
HEMOCHROMATOSIS AND HEMOSIDEROSIS
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
AMYLOIDOSIS
WILSON'S DISEASE
GRANULOMATOUS DISEASES
Tuberculosis
Sarcoidosis
Schistosomiasis
Liver Fluke or Fasciola Hepatica
CIRRHOSIS
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
MALIGNANT DIFFUSE LIVER DISEASES
CHAPTER 82:
Imaging of Obstructive Biliopathy
INTRODUCTION
Ultrasonography
Endoscopic Ultrasonography
Computed Tomography
Hepatobiliary Scintigraphy
Magnetic Resonance Imaging
Endoscopic Retrograde Cholangiopancreatography
BENIGN LESIONS CAUSING OBSTRUCTIVE BILIOPATHY
Choledocholithiasis
Ultrasonography
Computed Tomography
Magnetic Resonance Cholangiopancreatography
Benign Strictures
Postoperative Biliary Strictures
Postinflammatory Strictures
Bile Duct Fistula
Mirizzi Syndrome
Choledochal Cysts
Primary Sclerosing Cholangitis
Primary Biliary Cirrhosis
Recurrent Pyogenic Cholangitis
Bacterial Cholangitis and Aids-related Biliary Abnormalities
Parasitic Diseases
Rare Infections
Ampullary Stenosis
Portal Biliopathy
Hemobilia
Benign Tumors of the Bile Duct
MALIGNANT LESIONS CAUSING OBSTRUCTIVE BILIOPATHY
Carcinoma Gallbladder
Cholangiocarcinoma
Intrahepatic (Peripheral) Cholangiocarcinoma
Hilar Cholangiocarcinoma (Klatskin Tumor)
Extrahepatic Cholangiocarcinoma
Carcinoma Head of the Pancreas
Other Malignant Tumors of Biliary Tract
CHAPTER 83:
Clinical Aspects of Liver Cirrhosis: A Perspective for the Radiologists
INTRODUCTION
EPIDEMIOLOGY
PATHOLOGY
CAUSES AND RISK FACTORS OF CIRRHOSIS
NATURAL HISTORY AND PROGNOSIS
SEVERITY OF CIRRHOSIS
TYPES OF CIRRHOSIS
DIAGNOSIS OF CIRRHOSIS
Endoscopy
Liver Biopsy
Imaging in Cirrhosis
COMPLICATIONS OF CIRRHOSIS
Cirrhosis and Hepatocellular Carcinoma
Screening Tests
Surveillance Intervals
Protocol for HCC Surveillance
Cost Effectiveness
TREATMENT OF CIRRHOSIS
Treatment of Complications
CONCLUSION
CHAPTER 84:
Imaging and Interventions in Pancreatitis
INTRODUCTION
ACUTE PANCREATITIS
Classification
Assessment of Severity
Role of Imaging in Patient Management
Computed Tomography
CT Protocol
CT Findings in Acute Pancreatitis
MILD ACUTE PANCREATITIS OR EDEMATOUS PANCREATITIS
SEVERE ACUTE PANCREATITIS
Acute Fluid Collections
Acute Pseudocyst
Pancreatic Abscess
Pancreatic Necrosis
Vascular Complications
Extrapancreatic Adjacent Organ Involvement
Staging of Acute Pancreatitis
Magnetic Resonance Imaging
Ultrasound
Percutaneous Cross-sectional Image-guided Interventions
CHRONIC PANCREATITIS
Etiology and Pathophysiology
Imaging in Chronic Pancreatitis
Plain Films
Ultrasonography (US)
Endoscopic Ultrasonography
CT
Endoscopic Retrograde Pancreatography
Magnetic Resonance Imaging
MR Cholangiopancreatography
Advantages of MRP over ERP
Advantages of ERP over MRP
Positron-emission Tomography
Imaging in Special Situations and Variants
SUMMARY
CHAPTER 85:
Tumors of Pancreas
INTRODUCTION
ANATOMY
Topography
Histology
Physiology
MACROANATOMY
Ductal System
Vascular System
PATHOLOGY
Classification of Tumors (Based on Predominant Cell Type and Radiological Appearances1)
Epithelial Exocrine
Endocrine Islets Cell Tumors
Other Pancreatic Neoplasms
PANCREATIC ADENOCARCINOMA
PATHOLOGICAL ANATOMY AND BIOLOGICAL BEHAVIOR
Ultrasonography
Color Doppler Flow Imaging
Endoscopic US
Computed Tomography
Dual Phase Helical CT
Magnetic Resonance Imaging
MRCP
ERCP
PET
DSA
Tumor Markers in Pancreatic Carcinoma
Laparoscopy
Fine Needle Aspiration
STAGING OF PANCREATIC TUMORS
CYSTIC TUMORS
Mucinous Cystic Neoplasms
Microcystic Adenoma (Serous Cystadenoma)
Intraductal Papillary Mucinous Tumors/Neoplasms
Solid and Papillary Epithelial Tumors/ Neoplasms
UNCOMMON CYSTIC PANCREATIC TUMORS
Cystic Endocrine Tumors
Insulinoma
Gastrinoma
Glucagonoma
Vipoma
Somatostatinoma
Nonfunctioning ICTs
Arteriography and Venous Sampling
Arterial Stimulation and Venous Sampling
Endoscopic US
UNCOMMON SOLID PANCREATIC TUMORS
Pancreatoblastoma
Acinar Cell Carcinomas
Tumors of Neural Origin
Metastasis
Lymphoma
CHAPTER 86:
Imaging in Portal Hypertension
ANATOMY AND COLLATERAL CIRCULATION
Tributary Collaterals (Hepatofugal)
Developed Collaterals (Hepatofugal)
Bridging Collaterals (Hepatopedal)
ETIOLOGY OF PORTAL HYPERTENSION
NONINVASIVE RADIOLOGICAL EVALUATION
Barium Contrast Examinations
Sonography and CDFI
Computed Tomographic Imaging
Magnetic Resonance Imaging
MR Portography
Pitfalls22
INTRAHEPATIC PORTAL HYPERTENSION
Organ Parameters
Splenomegaly
Ascites
Vascular Evaluation
Portal Vein, Superior Mesenteric Vein and Splenic Vein Diameter
Pitfalls of Portal Flow Assessment
Portosystemic Venous Collaterals12
Assessment of Hepatic Veins
Arterial Evaluation
Extrahepatic Portal Hypertension: Prehepatic
Portal Vein Occlusion
Spleinic Vein Occlusion
SMV Occlusion
Extrahepatic Portal Hypertension: Posthepatic
Hyperkinetic Portal Hypertension6
MEDICAL TREATMENT FOLLOW-UP
Evaluation of Surgical Portosystemic Shunts and Tips
Transjugular Intrahepatic Portosystemic Shunt
CHAPTER 87:
Hepatic Venous Outflow Tract Obstruction
INTRODUCTION
DIAGNOSTIC TECHNIQUES
EVALUATION OF HEPATIC VEINS IN BCS
EVALUATION OF IVC IN BCS
Collateral Pathways
ASSESSMENT OF LIVER PARENCHYMA IN BCS
MANAGEMENT OF BCS
CHAPTER 88:
Gastrointestinal Hemorrhage
INTRODUCTION
IMAGING MODALITIES
Angiography
Technical Considerations
Angiographic Findings in GIH
Radionuclide Studies
Computed Tomography
Barium Studies
CONTROL OF GASTROINTESTINAL HEMORRHAGE
Transcatheter Embolization
SPECIFIC SITUATIONS IN GI HEMORRHAGES
Upper Gastrointestinal Hemorrhage
Hemobilia
Pancreatitis and UGIH
Lower Gastrointestinal Hemorrhage
Colonic Diverticula
Meckel's Diverticulum
Angiodysplasia
Hemangioma and Arteriovenous Malformation
Tumors
Inflammatory Bowel Diseases and Small Bowel or Colonic Ulcers
Others
CONCLUSION
CHAPTER 89:
Interventions in Obstructive Biliopathy
INTRODUCTION
INDICATIONS FOR BILIARY DRAINAGE
Percutaneous Transhepatic Cholangiography
Preprocedure Evaluation and Preparation
Technique
Percutaneous Transhepatic Biliary Drainage
Technique
Fluoroscopic Guidance
Internal and External Drainage
Complications of Biliary Drainage
Follow-up of Biliary Catheters
Biliary Stenting
Intraluminal Brachytherapy with PTBD
Dilatation of Benign Biliary Structures
Percutaneous Cholecystostomy
Technique
Complications
Gallbladder Biopsy
CHAPTER 90:
Interventional Treatment of Liver Tumors
INTRODUCTION
TREATMENT OF LIVER TUMORS
Hepatocellular Carcinoma
Chemical Ablation
Radiofrequency Ablation
Transcatheter Arterial Chemoembolization
Transcatheter Arterial Embolization
Transarterial Radionuclide Therapy
Right Portal Vein Embolization
Hepatic Vein Stenting
METASTATIC TUMORS OF LIVER
BENIGN TUMORS OF LIVER
CONCLUSION
CHAPTER 91:
Percutaneous Nonvascular Gastrointestinal Tract Interventions
INTRODUCTION
PERCUTANEOUS GASTROSTOMY
Indications
Other Indications
Contraindications
Technique
Complications
PERCUTANEOUS JEJUNOSTOMY
Indications
Technical Difficulty
Technique (Figs 1A to D)
Complications
ESOPHAGEAL STENTING
Indications
Stent Designs
Commercially Available Stents (Fig. 2)18
Stent Selection
Technique (Figs 3 and 4)
Postprocedure Care
Complications
Early Complications
Late Complications
GASTRODUODENAL STENTING
Indications
Contraindications
Available Devices
Endoscopic versus Fluoroscopic Placement
Technique (Figs 5A to D)
Postprocedure Care
Complications
COLORECTAL STENTING
Indications
Contraindications
Technical Considerations
Fluoroscopic Guidance
Postprocedure Follow-up
Complications
PERCUTANEOUS ENTEROCUTANEOUS FISTULA CLOSURE WITH N-BUTYL-2-CYANOACRYLATE
Mechanism of Action of the Glue (N-butyl-2-cyanoacrylate)
Prerequisites
Technical Consideration
Preparation
Technique (Figs 6A to D)
CHAPTER 92:
Interventional Radiology in Portal Hypertension
INTRODUCTION
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
Indications of TIPS2
Contraindications of TIPS2
Complications of TIPS2
REVISION OF OCCLUDED SURGICAL SHUNT
ARTERIOPORTAL FISTULAS
RECANALIZATION OF OCCLUDED PORTAL VEIN AND ITS TRIBUTARIES
PARTIAL SPLENIC EMBOLIZATION
PERCUTANEOUS TRANSHEPATIC VARICEAL EMBOLIZATION
Angiographic Vasopressin Infusion
BALLOON-OCCLUDED RETROGRADE TRANSVENOUS OBLITERATION OF GASTRIC VARICES
BUDD–CHIARI SYNDROME
RECENT ADVANCES
SECTION 4: GENITOURINARY IMAGING
CHAPTER 93:
Current Status of Conventional Techniques in Urogenital Imaging
BACKGROUND
CONCLUSION
CHAPTER 94:
Ultrasound of Urogenital Tract: Techniques and Normal Appearances
KIDNEYS AND URETERS
Technique
Normal Sonographic Appearance
Normal Variations
Doppler Evaluation
Technique
Normal Doppler Pattern
Indications
Ureters
URINARY BLADDER AND URETHRA
Technique
Normal Sonographic Appearance
Urethra
PROSTATE AND SEMINAL VESICLES
Technique
Normal Sonographic Appearance
Normal Variants
SCROTUM
Technique
Normal Appearances
Indications
Doppler Evaluation
Indications
PENIS
Technique and Normal Appearance
Indications
UTERUS AND ADNEXA
Technique
Normal Appearances
CERVIX AND VAGINA
ADNEXA
Indications for Evaluation of Uterus and Adnexa
Doppler Evaluation
Indications
Three-dimensional Sonography
Indications
Extended Field of View (EFOV) Imaging33
Elastography34
Contrast-enhanced Ultrasonography (CEUS)
CONCLUSION
CHAPTER 95:
Computed Tomography of Urogenital Tract: Techniques and Normal Appearances
INTRODUCTION
NORMAL RENAL STRUCTURE AND CT ANATOMY OF KIDNEYS
NORMAL CT ANATOMY OF THE PELVIS
MULTIDETECTOR CT
Advantages of Renal Multidetector Row CT
Increased Diagnostic Images
Increased Temporal Resolution
Isotropic Data Acquisition and Increased Spatial Resolution
EXAMINATION TECHNIQUE AND IMAGING PROTOCOLS OF MULTIDETECTOR ROW CT OF THE KIDNEY
Noncontrast CT
Contrast-enhanced CT Oral Contrast Medium
Administration of Intravenous Contrast Medium
PHASES OF RENAL ENHANCEMENT/ MULTIPHASIC HELICAL CT
Normal CT Nephrogram
Corticomedullary Phase (CMP)
Nephrographic Phase (NP)
Pathological CT Nephrogram
Excretory Phase (EP)
IMAGE PROCESSING AND POSTPROCESSING TECHNIQUES
Multiplanar Reformation (MPR)
Maximum Intensity Projection (MIP)
Shaded Surface Displays (SSD)
Volume Rendered Technique (VRT)
MULTIDETECTOR CT UROGRAPHY
MDCTU Protocol
Split Bolus MDCT Urography with Synchronus Nephrographic and Exceretory Phase Enhancement
Compression
Saline Infusion
Diuretic Administration
Patient Positioning
Image Interpretation
MULTIDETECTOR CT IN RENAL MASSES
MDCT IN BLUNT RENAL TRAUMA
MDCT IN EVALUATION OF FLANK PAIN AND URINARY CALCULI
MDCT IN RENAL INFECTIONS
HELICAL CT FOR LOWER URINARY TRACT AND PELVIS
CT ANGIOGRAPHY (CTA) OF RENAL ARTERIES
VIRTUAL CYSTOSCOPY/ENDOSCOPY
CHAPTER 96:
MRI of Urogenital Tract: Techniques and Normal Appearances
INTRODUCTION
KIDNEY
Techniques and Recommended Imaging Sequences
Normal Appearances
MR Urography
Renal Angiography and Venography
URINARY BLADDER
Technique and Recommended Sequences
Normal Appearance
PROSTATE GLAND
Technique and Recommended Sequences
Normal Appearance of Prostate on MRI
UTERUS AND OVARIES
Technique and Recommended Sequences
Normal MR Appearance
PELVIC LYMPH NODES
CHAPTER 97:
Current Status of Nuclear Medicine in Urinary Tract Imaging
INTRODUCTION
RADIOPHARMACEUTICALS
99mTc-MAG-3
99mTc-LLEC
99mTc-DTPA
123I-OIH
99mTc-GHA
99mTc-DMSA
IMAGING TECHNIQUES
Renal Dynamic Scintigraphy
Dynamic Renography
Normal Dynamic Renal Study
Diuretic Renography
Captopril Renography
Cortical Scintigraphy/Static Renal Scintigraphy
Imaging Techniques
Radionuclide Cystography
Clinical Applications
Measurement of Renal Function
Positron Emission Tomography—Computed Tomography (PET-CT)
Renal Cancer
Urinary Bladder Cancer
CHAPTER 98:
Current Status of Urographic Contrast Media
INTRODUCTION
DEVELOPMENT OF CONTRAST MEDIA
TYPES OF RADIOGRAPHIC CONTRAST MEDIA
PHARMACOKINETICS OF EXTRACELLULAR IODINATED CONTRAST AGENTS
PHYSICOCHEMICAL PROPERTIES OF CONTRAST MEDIA
Water Solubility, Hydrophilicity and Osmolality
Viscosity
Pharmaceutical Characteristics: The Role of Formulation
ADVERSE REACTIONS TO CONTRAST MEDIA
Guidelines on Prevention and Management of Acute Reactions
Guidelines on Late Adverse Reactions
Guidelines on Renal Adverse Reactions
Guidelines on Prevention and Management of Extravasation of Contrast Media
EVALUATING THE PATIENT BEFORE CONTRAST MEDIA INJECTION AND IDENTIFYING GROUPS AT INCREASED RISK FOR ADVERSE CONTRAST REACTIONS
AGGRAVATION OF DISEASES BY CONTRAST MEDIA
Guidelines on the Use of Iodinated Contrast Media in Patients with Thyroid Disease
Guidelines on the Use of Contrast Media in Patients with Catecholamine-producing Tumors (Pheochromocytomas and Paragangliomas)
Guidelines on Interaction between Contrast Media with Other Drugs and Clinical Tests
Guidelines on the Use of Iodinated Contrast Media during Pregnancy or Lactation
SELECTIVE VERSUS UNIVERSAL USE OF NONIONIC CONTRAST MATERIAL
STRATEGIES FOR CLINICAL USE: COST CONTAINMENT
CHAPTER 99:
Tubercular Infection of the Urinary Tract
INTRODUCTION
PATHOGENESIS
CLINICAL PICTURE
LABORATORY INVESTIGATIONS
CYSTOSCOPY
RADIOLOGICAL EXAMINATION
Plain Films
Intravenous Urography (IVU)
Kidney
Ureter
Urinary Bladder
Urethral TB
Retrograde Pyelography
Ultrasonography
Kidney
Ureter
Urinary Bladder
Computed Tomography
Kidney
Ureter
Urinary Bladder
MRI
COMPLICATIONS
Differential Diagnosis
Genitourinary Tuberculosis in HIV
CHAPTER 100:
Nontubercular Infections of the Urinary Tract
INTRODUCTION
ACUTE PYELONEPHRITIS
Pathology
Radiology
ACUTE FOCAL BACTERIAL NEPHRITIS
RENAL AND PERIRENAL ABSCESS
EMPHYSEMATOUS PYELONEPHRITIS
PYONEPHROSIS
CHRONIC PYELONEPHRITIS
REFLUX NEPHROPATHY
FAT PROLIFERATION IN THE KIDNEY
XANTHOGRANULOMATOUS PYELONEPHRITIS
HIV-ASSOCIATED NEPHROPATHY
RENAL PAPILLARY NECROSIS
MALACOPLAKIA
SQUAMOUS METAPLASIA
PARASITIC INFECTION
CHAPTER 101:
Pathology of Renal Tumors
INTRODUCTION
ADULT RENAL TUMORS
Renal Cell Tumors
Clear Cell (or Nonpapillary or Conventional) RCC
Multilocular Cystic Renal Cell Carcinoma
Papillary (or Chromophilic) Renal Cell Carcinoma
Chromophobe Renal Cell Carcinoma
Collecting Duct (Duct Bellini) RCC (CDC)
Renal Medullary Carcinoma
Renal Carcinomas Associated with XP11.2 Translocations/TFE3 Gene Fusions
Mucinous Tubular and Spindle Cell Carcinoma
Renal Cell Carcinoma—Unclassified
Papillary Adenoma
Renal Oncocytoma
MOLECULAR/GENETIC FEATURES OF RENAL CELL CARCINOMA
Clear Cell Renal Cell Carcinoma
Papillary Renal Adenomas and Carcinomas
Renal Oncocytoma
Chromophobe Renal Carcinomas
Collecting Duct Carcinomas
Sarcomatoid Transformation in RCC
NUCLEAR GRADING
Pathological Staging
AJCC Staging
METANEPHRIC TUMORS
MESENCHYMAL RENAL TUMORS OCCURRING IN ADULTS
Angiomyolipoma (AML)
Epithelioid Angiomyolipoma
Juxtaglomerular Cell Tumor
Renomedullary Interstitial Cell Tumor
Nephroblastoma [Wilms’ Tumor (WT)]
PEDIATRIC RENAL TUMORS
Gross Features
Microscopic Features
Anaplasia
Nephrogenic Rests
Cystic Partially Differentiated Nephroblastoma (CPDN)
Congenital Mesoblastic Nephroma (CMN)
Clear Cell Sarcoma of Kidney (CCSK)
Rhabdoid Tumor
CHAPTER 102:
Pathology of Gynecological Malignancies
INTRODUCTION
NEOPLASMS OF THE OVARY
Ovarian Surface Epithelial Tumors
Serous Tumors
Mucinous Tumors
Endometrioid Tumors
Clear Cell Adenocarcinoma of the Ovary
Brenner's Tumor
Malignant Mixed Müllerian Tumor (MMMT)
Germ Cell Tumors
Dysgerminoma
Yolk Sac Tumor (Endodermal Sinus Tumor)
Immature Teratoma
Mature Cystic Teratoma
Carcinoid Tumor and Strumal Carcinoid
Sex Cord Stromal Tumors
Granulosa Cell Tumor
Juvenile Granulosa Cell Tumor (JGCT)
Thecoma, Fibroma and Other Tumors
Sertoli-Leydig Cell Tumor
Metastatic Tumors
CARCINOMA OF THE FALLOPIAN TUBE
MALIGNANT TUMORS OF THE UTERUS
Type I: Endometrioid Adenocarcinoma
Type II: Carcinoma
Endometrial Stromal Tumors
MMMT Carcinosarcoma
Müllerian Adenosarcoma
Leiomyosarcoma
CARCINOMA OF THE UTERINE CERVIX
Invasive Cervical Carcinoma
MALIGNANT TUMORS OF THE VULVA
Squamous Cell Carcinoma
Vulvar Paget's Disease
CHAPTER 103:
Imaging in Renal Tumors
INTRODUCTION
BALLS VERSUS BEANS
Imaging Modalities
Plain Films
Intravenous Urograms
Ultrasound
CT
Magnetic Resonance Imaging
Angiography
Retrograde and Antegrade Pyelography
RENAL CELL CARCINOMA23
Staging of Renal Cell Carcinoma7-11
Follow-up
UROTHELIAL TUMOR
Transitional Cell Carcinoma
IVU
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging13-15
Staging
Squamous Cell Carcinoma
Collecting Duct Carcinoma (Bellini Duct Carcinoma/Renal Medullary Carcinoma)18,19
Renal Sarcoma3
Lymphoma
Renal Metastasis23
Oncocytoma
Renal Adenomas
MIXED EPITHELIAL AND STROMAL TUMORS (MESTs)3,26
CYSTIC NEPHROMA
ANGIOMYOLIPOMA
PNET OF THE KIDNEY
Biopsy2,3,35
Incidental Solid Renal Mass
CHAPTER 104:
Imaging of Urinary Bladder and Urethra
ANATOMY
Urinary Bladder
Urethra
Male Urethra
Female Urethra
IMAGING MODALITIES
Plain Films
Retrograde Urethrography
Voiding Cystourethrography (VCUG)
Cystography
Urodynamic Studies of the Lower Urinary Tract
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Radionuclide Imaging
SPECIFIC DISEASES OF THE URINARY BLADDER
Bladder Diverticulae
Urachal Anomalies
Exstrophy
Other Anomalies
Neurogenic Bladder
Infections
Acute Cystitis
Chronic Cystitis
Cystitis Cystica
Malakoplakia
Schistosomiasis
Extravesical Processes
Bladder Tumors
SPECIFIC DISEASES OF URETHRA
Gonococcal and Nongonococcal Urethritis
Condyloma Acuminata (Venereal Warts)
Tuberculosis
Urethral Strictures
Urethral Diverticulum
Urethral Calculi
Tumors of the Male Urethra
Tumors of the Female Urethra
Metastatic Tumors of Urethra
CHAPTER 105:
Imaging of the Prostate Gland
INTRODUCTION
ANATOMY
IMAGING MODALITIES3
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
BENIGN PROSTATIC HYPERPLASIA
Ultrasonography
Magnetic Resonance Imaging
Other Imaging Modalities
PROSTATE CANCER
Transrectal Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
EVALUATION OF THE METASTASES
PROSTATITIS AND PROSTATIC ABSCESS
PROSTATIC CYSTS
CHAPTER 106:
Renal Cystic Diseases
INTRODUCTION
EMBRYOLOGY
CLASSIFICATION
Bosniak Classification System
IMAGING MODALITIES
Conventional Radiography
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Angiography
Cyst Puncture/Cystography
SIMPLE RENAL CYST
Pathology
Clinical Features
Imaging Features
Complicated Simple Renal Cyst
Hemorrhagic Cyst
Infected Cyst
Cyst Rupture
Carcinoma in Wall of a Preexisting Cyst
ATYPICAL SIMPLE CYSTS
Calcified Cyst
Hyperdense Cyst
Septated Cysts
Multiple Simple Cysts
Localized Cystic Disease
POLYCYSTIC KIDNEY DISEASE
Autosomal Dominant Polycystic Kidney Disease (ADPKD) (Potter Type III)
Pathology
Clinical Features
Imaging Features
Autosomal Recessive Polycystic Kidney Disease (ARPKD) (Potter Type I)
Clinicopathologic Features
Imaging Features
MEDULLARY SPONGE KIDNEY
Clinicopathologic Features
Imaging Features
MEDULLARY CYSTIC DISEASE
Clinical Features
Imaging Features
MULTICYSTIC DYSPLASTIC KIDNEY (MCDK) (POTTER TYPE II)
Pathology
Imaging Features
CYSTIC DISEASE ASSOCIATED WITH RENAL NEOPLASM
Acquired Cystic Kidney Disease (ACKD)
Clinical Features
Imaging Features
von Hippel–Lindau Disease (VHL)
Pathology
Imaging Features
TUBEROUS SCLEROSIS (TSC)
CYSTS OF RENAL SINUS
MISCELLANEOUS CYSTIC DISEASE
Inflammatory
Hydatid Cysts
Imaging Features
Pyogenic Cyst
Tuberculous Cysts
Pleuricystic Kidney Disease
Glomerulocystic Disease
Microcystic Disease
CYSTIC RENAL CELL CARCINOMAS
CHAPTER 107:
Renovascular Hypertension
INTRODUCTION
PATHOPHYSIOLOGY
ETIOLOGY OF RENAL ARTERY STENOSIS
Atherosclerosis
Fibromuscular Dysplasia
Nonspecific Aortoarteritis/Takayasu's Arteritis22-24
Middle Aortic Syndrome25-27
SCREENING FOR RENOVASCULAR HYPERTENSION
Clinical
Clinical and Biochemical Tests
IMAGING MODALITIES FOR ASSESSMENT OF RAS
Radionuclide Renal Scintigraphy
Principles of Angiotensin-converting Enzyme Inhibitor (Captopril) Scintigraphy
Protocol
Results
Ultrasound
Color Doppler Flow Imaging (CDFI)
Direct Approach
Indirect Approach
CT Angiography (CTA)
Magnetic Resonance Angiography
Contrast-enhanced MRA (CE-MRA)
Noncontrast-enhanced MR Imaging of the Renal Arteries
TOF MRA
Phase-contrast (PC) MRA
Steady-state Free Precession Magnetic Resonance Angiography
Arterial Spin Labeling
Renal Angiography
Features of RAS on Arteriography
TREATMENT
Atherosclerotic Disease
Percutaneous Transluminal Renal Angioplasty (PTRA) and Stenting
Renal Artery Stenting
Future Management of RAS
Takayasu's Arteritis/Nonspecific Aortoarteritis
Surgical Therapy
Renal Artery Stenosis in Children27,90
Causes
CONCLUSION
CHAPTER 108:
Renal Parenchymal Disease and Renal Failure
INTRODUCTION
DEFINITION AND CLASSIFICATION OF RENAL FAILURE
Acute Renal Failure
Chronic Renal Failure (CRF)
ROLE OF IMAGING IN RENAL FAILURE
Radiological Approach to Renal Parenchymal Disease
Imaging Techniques
Plain Radiography and Urography
Ultrasonography
Color Doppler
Computed Tomography
Magnetic Resonance Imaging
Renal Angiography
Radionulceotide Imaging
Contrast Medium-associated Nephropathy
IMAGING IN RENAL PARENCHYMAL DISEASE
Acute Renal Parenchymal Disease
Acute Tubular Necrosis
Imaging Features
Acute Cortical Necrosis
Imaging Features
Leukemia
Imaging Features
Acute Interstitial Nephritis
Imaging Features
Amyloidosis
Imaging Features
Amyloidosis of Renal Pelvis
Multiple Myeloma
Imaging Features
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Imaging Features
Chronic Renal Parenchymal Disease
Renal Papillary Necrosis
Alport's Syndrome
Imaging Features
Benign and Malignant Nephrosclerosis
Imaging Features
Renal Osteodystrophy
CONCLUSION
CHAPTER 109:
Renal Transplant
INTRODUCTION
TECHNIQUE
COMPLICATIONS
Acute Tubular Necrosis
Rejection
Renal Artery Thrombosis
Renal Artery Stenosis
Pseudoaneurysm
Renal Vein Thrombosis
Arteriovenous Fistula
Peritransplant Fluid Collections
Urinary Complications
Malignancy
IMAGING TECHNIQUES
Radiography
Plain Radiography
Intravenous Urography
Cystography
Radionuclide Imaging
Ultrasonography (US)
Computed Tomography
Magnetic Resonance Imaging
Angiography
Percutaneous Interventional Techniques
ACKNOWLEDGMENTS
CHAPTER 110:
Imaging of Obstructive Uropathy and Diseases of Ureter
INTRODUCTION
PATHOPHYSIOLOGY
IMAGING OF ACUTE OBSTRUCTION
Plain X-ray
Intravenous Urography
Sonography
Duplex and Color Doppler Sonography
Computed Tomography
Radionuclide Renography
Magnetic Resonance Imaging
IMAGING OF CHRONIC OBSTRUCTION
Intravenous Urography
Sonography
Computed Tomography
Magnetic Resonance Imaging
INVASIVE TECHNIQUES IN URINARY OBSTRUCTION
Antegrade Pyelography
Retrograde Pyelography
CAUSES OF OBSTRUCTION AND DISEASES OF URETER
Congenital Ureteric Obstruction
Ureteropelvic Junction Obstruction
Primary Megaureter
Ureterocele
Circumcaval Ureter
Acquired Ureteric Obstruction
Intraluminal Causes
Ureteric Calculus
Intramural Causes
Ureteral Tumors
Transitional Cell Carcinoma
Benign Tumors
Nonepithelial Tumors
Secondary Tumors and Contiguous Infiltration
Inflammatory Lesions of Ureter
Inflammatory Bowel Disease
Extrinsic Causes of Ureteral Obstruction
Retroperitoneal Fibrosis
Retroperitoneal Neoplasms
Pelvic Lipomatosis
Pregnancy-related Dilatation of Ureter
Gynecological Causes
Gastrointestinal Diseases
Miscellaneous Diseases of Ureter
Ureteral Injury
Ureteral Herniation
Ureteral Fistula
CHAPTER 111:
Urinary Tract Trauma
INTRODUCTION
RENAL TRAUMA
Imaging Work-up in a Patient with Suspected Renal Trauma
Role of Radiography (Plain Radiographs)
Role of Ultrasound
Role of Intravenous Urography
Role of CT
Role of Angiography
Role of Retrograde Pyelography
Role of Radionuclide Renal Scintigraphy
Role of MRI
Radiological Findings
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Vascular Contrast Extravasation
Renal Trauma with Pre-existing Abnormality
Management of Renal Trauma
URETERAL TRAUMA
Imaging Work-up
Role of IVU
Role of CT
Role of Antegrade and Retrograde Ureterograms
Classification
Management
BLADDER TRAUMA
Cystography
Conventional Cystography
CT Cystography
Classification
Blunt Trauma
Penetrating Bladder Trauma
Iatrogenic Bladder Trauma
Management of Bladder Trauma
URETHRAL TRAUMA
Radiology
Technique of Urethrography
Blunt Urethral Trauma
Posterior Urethral Injuries Associated with Pelvic Fracture
Anterior Urethral Injury
Classification
Management of Urethral Trauma
Evaluation before Delayed Urethroplasty
Penetrating Injury
Iatrogenic Injury
Female Urethra
CHAPTER 112:
Imaging the Adrenal Gland
INTRODUCTION
ANATOMY AND PHYSIOLOGY
IMAGING MODALITIES
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Radionuclide Imaging
Positron Emission Tomography
ADRENAL DISEASES
Group I: Adrenal Hyperfunctional Diseases
Cushing's Syndrome
ACTH-independent Cushing's syndrome
Aldosteronism
Androgenital syndrome
Pheochromocytoma
Group II: Adrenal Insufficiency
Group III: Adrenal Diseases with Normal Function
Incidentaloma
Adenoma versus Metastasis
Adrenal Carcinoma
Adrenal Lymphoma
Adrenal Collision Tumor
Adrenal Cyst
Myelolipoma
Neuroblastoma
SUMMARY
CHAPTER 113:
Retroperitoneum
INTRODUCTION
NORMAL ANATOMY
IMAGING MODALITIES
RETROPERITONEAL COLLECTIONS
AORTA
Aortic Aneurysm
Aortic Dissection
INFERIOR VENA CAVA
Congenital Anomalies
Venous Thrombosis
Primary Tumors of the IVC
LYMPH NODES
Benign Lymphadenopathy
Lymphoma
HIV Lymphadenopathy
Metastatic Lymphadenopathy
PRIMARY NEOPLASMS
Malignant Neoplasms
Liposarcomas
Leiomyosarcomas
Malignant Fibrous Histiocytomas
Hemangiopericytomas
Other Malignancies
Benign Neoplasms
Paragangliomas
Neurogenic Tumors
Teratomas
Lipoma
RETROPERITONEAL FIBROSIS
Iliopsoas Muscle Compartment
CHAPTER 114:
Nonvascular Interventions in the Urinary Tract
INTRODUCTION
PERCUTANEOUS NEPHROSTOMY
Indications
Anatomy Relevant to Percutaneous Renal Entry
Technique
Postprocedure Care
Results
Complications
Systemic Complications
Local Complications
Extended Applications of Percutaneous Nephrostomy
Antegrade Ureteric Stenting
Large Bore Track Creation
SCLEROTHERAPY FOR RENAL CYSTS
PERCUTANEOUS CATHETER DRAINAGE
BIOPSIES
COMPLICATED RENAL TRANSPLANT
RADIOFREQUENCY ABLATION OF RENAL TUMORS
Ablation Process
Equipment
Patient Selection and Preprocedure Evaluation
Guidance
Procedure
Postprocedure and Follow-up
Complications
Other Applications of RFA
CHAPTER 115:
Vascular Interventions in the Genitourinary Tract
INTRODUCTION
RENAL ARTERY ANGIOPLASTY
Imaging the Renal Arteries
Technique4-6
Renal Artery Angioplasty
RENAL ARTERY STENTING
Outcome
Renal Artery Intervention in Renal Transplants
Complications
RENAL ARTERIAL EMBOLIZATION
Technique
TRANSCATHETER EMBOLIZATION OF RENAL NEOPLASMS
Transcatheter Embolization of Renal Pseudoaneurysms
Incidence
Causes
Risks Posed by the Aneurysm
Anatomic/Physiologic Considerations
Technique
Results of Embolization
Complications
Embolization of End-stage Kidney
Technique
UTERINE ARTERY EMBOLIZATION
Indications
Uterine Leiomyoma
Uterine Arteriovenous Malformations
Postsurgical and Postpartum Hemorrhage
Technique
Results
Complications
VAGINAL AVM EMBOLIZATION
SCROTAL AVM AND TESTICULAR TUMOR EMBOLIZATION
VARICOCELE EMBOLIZATION
CONCLUSION
CHAPTER 116:
Imaging in Female Infertility
INTRODUCTION
CAUSES OF INFERTILITY
Imaging Modalities
Hysterosalpingography8,9
Transvaginal Sonography
Sonohysterosalpingography
Normal Menstrual Cycle1
Cervical Factor
Endometrial–Uterine Factor
Endometrial Adhesions or Synechiae
Leiomyoma
Endometrial Polyps9
Mullerian Duct Abnormalities1,9, 21,22
Adenomyosis
Nontubercular Chronic Endometritis
Tubal Factor
Peritoneal Factor
Endometriosis
Genital Tuberculosis
Ovarian Factor
Polycystic Ovarian Syndrome
Follicular Monitoring
Spontaneous Cycles15,52
Induced Cycles2,15
Prediction of Ovulation1,15,52
Luteinized Unruptured Follicle (LUF)3,15
Ovarian Hyperstimulation Syndrome
TREATING INFERTILITY
Follicle Aspiration15,64,65
CONCLUSION
CHAPTER 117:
Benign Diseases of the Female Pelvis
INTRODUCTION
BENIGN UTERINE LESIONS
Congenital Uterine Anomalies
Classification
Class I: Müllerian Agenesis or Hypoplasia
Class II: Unicornuate Uterus
Class III: Uterus Didelphys
Class IV: Bicornuate Uterus
Class V: Septate Uterus
Class VI: Arcuate Uterus
Class VII: Diethylstilbestrol Exposed Uterus
Leiomyomas
Treatment of Uterine Leiomyomas
OTHER BENIGN MESENCHYMAL TUMORS
Adenomyosis
Endometrial Polyps
Endometrial Hyperplasia
Endometrial Synechiae
UTERINE ARTERIOVENOUS MALFORMATION
BENIGN OVARIAN MASSES
BENIGN CYSTIC MASSES OF PELVIS
FUNCTIONAL CYSTS
Follicular Cysts
Corpus Luteum Cyst
Hemorrhagic Cyst
Theca Lutein Cysts
Polycystic Ovarian Disease
Peritoneal Inclusion Cyst
Hydrosalpinx
Paraovarian Cysts
CYSTADENOMAS
COMPLEX MASSES
Tubo-ovarian Abscess
Endometriosis
Dermoid Cyst/Mature Cystic Teratoma
Ovarian Torsion
Ectopic Pregnancy
BENIGN SOLID OVARIAN MASSES
CONCLUSION
CHAPTER 118:
Imaging in Gynecological Malignancies
GYNECOLOGICAL MALIGNANCIES IN INDIA
CARCINOMA OF CERVIX
Imaging Modalities
Conventional Radiography
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Imaging Strategies in Cervical Cancer
Positron Emission Tomography
Treatment and Follow-up
CARCINOMA OF ENDOMETRIUM
Spread and Staging
Imaging Modalities
Conventional Radiography
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Imaging Strategies in Endometrial Cancer
Treatment and Follow-up
OVARIAN MALIGNANCIES
Epithelial Ovarian Carcinoma
Ultrasonography
Screening for Ovarian Cancer
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
Staging and Treatment
Imaging Strategies in Carcinoma of Ovary
Borderline Epithelial Carcinoma
Pseudomyxoma Peritonei
Primary Papillary Serous Carcinoma of the Peritoneum
Follow-up Imaging
Germ Cell Tumors of the Ovary
Stromal Sex Cord Tumors
Metastatic Ovarian Tumors
Rare Ovarian Tumors
MISCELLANEOUS GYNECOLOGICAL MALIGNANCIES
Carcinoma of Vagina and Vulva
Sarcoma of the Uterus
Fallopian Tube Carcinoma
Gestational Trophoblastic Neoplasms
Lymphoma of the Female Genital Tract
CHAPTER 119:
Imaging of Scrotum
ANATOMY
IMAGING MODALITIES
Technique of Sonography
MRI of Scrotum
CONGENITAL ANOMALIES OF THE TESTIS
Cryptorchidism
Miscellaneous Congenital Anomalies
ACUTE SCROTUM
Epididymitis and Orchitis
Torsion
Scrotal Trauma
TESTICULAR TUMORS
Germ-cell Tumors
Seminomas
Nonseminomatous Germ-cell Tumors
Nongerm Cell Testicular Tumors
Staging or Testicular Cancer
Primary Tumor (T)
Regional Lymph Nodes (N)
Distant Metastasis (M)
Imaging in Evaluation of Testicular Cancer
MRI
CT
PET
BENIGN INTRATESTICULAR LESIONS
Cysts
Adrenal Rests
Calcifications
EXTRATESTICULAR PATHOLOGIES
Fluid Collections
Epididymal Cysts
Postorchidectomy Scrotum
Extratesticular Tumors
Varicocele
CHAPTER 120:
Male Infertility and Erectile Dysfunction
MALE INFERTILITY
Etiology
Imaging Approach in Male Infertility
Varicocele
Testis
Epididymis
TRUS Evaluation of Distal Genital Ductal System
Seminal Vesicles and Vas Deferens
Ejaculatory Ducts
Prostate
MRI in Infertility
Imaging in Assisted Fertilization
ERECTILE DYSFUNCTION
Anatomy and Physiology of Penile Erection
Evaluation of Erectile Dysfunction
Pharmacopenile Duplex Ultrasonography
Peyronie's Disease
Cavernosometry
Cavernosography
Penile Angiography
Priapism
SECTION 5: PEDIATRIC IMAGING
CHAPTER 121:
Technical Considerations in Pediatric Imaging
INTRODUCTION
MINIMIZING HEAT LOSS
IMMOBILIZATION
SEDATION
NIL PER ORALLY STATUS
Pharmacological Agents
REDUCTION OF RADIATION DOSAGE
Radiography and Fluoroscopy
Radiographic Equipment Factors
Operator-dependent Techniques
Computed Tomography
USE OF CONTRAST MEDIA
High Osmolality Contrast Media
Low Osmolality Contrast Agents
Iso-osmolar Contrast Agents
MR Contrast Agents
CHAPTER 122:
Recent Advances in Pediatric Radiology
INTRODUCTION
RADIATION PROTECTION
NEURORADIOLOGY
THORACIC IMAGING
GASTROINTESTINAL IMAGING
URORADIOLOGY
MUSCULOSKELETAL IMAGING
SUMMARY
CHAPTER 123:
Interventions in Children
INTRODUCTION
SPECIAL CONSIDERATIONS FOR THE PEDIATRIC PATIENT
PATIENT PREPARATION
History and Physical Examination
Informed Consent
Coagulation
Anesthesia
Patient Immobilization
Temperature Control
Diet and Medications
Dose of Radiation and Fluids
TECHNIQUES
Access
PROCEDURES
EMBOLIZATION
Embolization Materials and Substances
Vascular Anomalies
Hemangioma
Arteriovenous Malformation
Cervicofacial AVMs
Extremity AVMs
Pulmonary AVMs
Arteriovenous Fistula
Vascular Malformation
Lymphatic Malformation
Hemorrhage
Gastrointestinal Hemorrhage
Pelvic Hemorrhage
Hemoptysis
Epistaxis
Post-traumatic Hemorrhage
Pseudoaneurysm
Malignant Tumors
Chemoembolization
Organ Ablation
ANGIOPLASTY
Complications of Angioplasty Procedures
THROMBOLYSIS
FOREIGN BODY REMOVAL
CONCLUSION
REFERENCES
PATIENT EVALUATION
SEDATION AND ANESTHESIA
BASIC PROCEDURES
Fine Needle Aspiration/Biopsy
Sampling Technique
Abscess Drainage
THORACIC INTERVENTIONS
GASTROINTESTINAL INTERVENTIONS
Salivary Gland Interventions
Esophageal Interventions
Gastric Interventions
Hepatic Interventions
Biliary Intervention
Pancreatic Interventions
GENITOURINARY INTERVENTIONS
Renal Biopsy
Percutaneous Nephrostomy
Ureteric Dilatation and Stenting
CONCLUSION
CHAPTER 124:
Imaging of Pediatric Trauma
IMAGING METHODS6
Potential Uses of the FAST Examination8
Abdominal Trauma11-13
Spleen and Liver
Pancreas
Kidney
Bowel and Mesentery
Chest Trauma
Blunt Trauma Chest9
Pleura
Penetrating Chest Trauma
Musculoskeletal Injuries7,10
Types of Pediatric Fractures
Physeal Fractures
Salter-Harris Classification
Head Trauma16
Broad Classification
According to Location of Lesions
Skull Fractures17
Extra-axial Injury
Secondary Head Injury
Traumatic Ischemia–infarction
Spinal Injuries
Thoracic and Lumbar Spine Trauma
CONCLUSION
CHAPTER 125:
Neonatal Respiratory Distress
INTRODUCTION
MEDICAL CAUSES OF NEONATAL RESPIRATORY DISTRESS
Hyaline Membrane Disease
Transient Tachypnea of Newborn
Neonatal Pneumonia
Meconium Aspiration Syndrome
Pneumothorax
SURGICAL CAUSES OF NEONATAL RESPIRATORY DISTRESS
Congenital Lobar Emphysema
Congenital Cystic Adenomatoid Malformation
Congenital Diaphragmatic Hernia
Esophageal Atresia with Tracheoesophageal Fistula
MISCELLANEOUS CAUSES
CHAPTER 126:
Childhood Pulmonary Infections
INTRODUCTION
PNEUMONIA
Epidemiology
Imaging
Viral Pneumonia
Bacterial Pneumonia
Exclusion of Other Pathologies
Nonresolving Pneumonia
EVALUATION OF ASSOCIATED COMPLICATIONS
Pleural Complications
Lung Parenchymal Complications
Purulent Pericarditis
Chronic Effects of Pneumonia
TUBERCULOSIS
Primary Pulmonary Tuberculosis
Postprimary Tuberculosis
FUNGAL INFECTIONS
Actinomyces
Aspergillosis
Histoplasmosis
Coccidioidomycosis
PARASITIC INFESTATIONS
Hydatid Disease of the Lung
Others
PULMONARY INFECTIONS IN HIV-POSITIVE CHILDREN
Bacterial Pneumonias
Mycobacterial Pneumonias
Fungal Pneumonias
Viral Pneumonias
Lymphocytic Interstitial Pneumonitis
CONCLUSION
CHAPTER 127:
Chest Masses
INTRODUCTION
LUNG MASSES
Congenital Cystic Adenomatoid Malformation
Pulmonary Sequestration
Bronchogenic Cyst
Vascular Lesions
Lung Abscess
Hydatid Cysts
Pulmonary Metastasis
Primary Lung Tumors
MEDIASTINAL MASSES
Anterior Mediastinal Masses
Germ Cell Tumors
Lymphoma
Thymic Masses
Lymphangioma
Pericardial Cysts
Middle and Posterior Mediastinal Masses
Neurogenic Tumors
Neuroblastoma and Other Ganglion Tumors
Neurofibroma and Schwannoma
Paraganglioma
Duplication Cysts
Anterior Thoracic Meningocele
Extramedullary Hematopoiesis
CHEST WALL MASSES
Chest Wall Infections
Lymphangioma
Hemangioma
Neurofibroma
Benign Osseous Masses
Primitive Neuroectodermal Tumor
Rhabdomyosarcoma
Miscellaneous Malignant Chest Wall Masses
CHAPTER 128:
Pediatric Airway
IMAGING MODALITIES
Plain Radiographs
Fluoroscopy
Barium Swallow
MDCT
MRI
UPPER AIRWAY OBSTRUCTION
Normal Anatomy (Plain Radiographs) (Figs 1A and B)
ACUTE OBSTRUCTION
Croup (Acute Laryngotracheobronchitis)
Epiglottitis
Retropharyngeal Cellulitis and Abscess
Exudative Tracheitis
Foreign Body
CHRONIC OBSTRUCTION
Obstructive Sleep Apnea (OSA)
Enlarged Tonsils/Adenoids
Glossoptosis
Hypopharyngeal Collapse
Subglottic Obstruction
Subglottic Stenosis
Postintubation Stenosis
Subglottic Hemangioma
LOWER AIRWAY OBSTRUCTION
Central Airways
Extrinsic Causes
Vascular Causes
Intrinsic Causes
Wall Abnormalities
Intraluminal Causes
Peripheral Airways
Bronchiolitis/Small Airway Disease
Lung Disease of Prematurity
Bronchiectasis
Asthma
CHAPTER 129:
Developmental Anomalies of Gastrointestinal Tract
ANATOMICAL
FUNCTIONAL
COMBINED ANATOMICAL: FUNCTIONAL
IMAGING MODALITIES
Plain Film Radiography
Contrast Studies
Ultrasonography
ESOPHAGUS
Esophageal Atresia and Tracheoesophageal Fistula
Embryology
Clinical Features
Classification
Imaging Features
Radiological Evaluation of Postoperative Complications
STOMACH
Microgastria
DEVELOPMENTAL OBSTRUCTIVE DEFECTS
Gastric Atresia
Pyloric Stenosis or Prepyloric Membrane or Antral Web
Ectopic Pancreas
Hypertrophic Pyloric Stenosis
Ultrasonography
Barium Study
Adult Idiopathic Hypertrophic Pyloric Stenosis (AIHPS)
DUODENUM
Duodenal Atresia and Stenosis
Imaging Features
Duodenal Web
Annular Pancreas
Preduodenal Portal Vein
SMALL BOWEL
Anomalies of Rotation and Fixation
Embryology
Clinical Features
Imaging Features
Jejunoileal Atresia and Stenosis
Embryology
Clinical Features
Classification
Imaging Features
Meconium Ileus
Imaging Features
Megacystis-microcolon-intestinal Hypoperistalsis Syndrome (Berdon's Syndrome)
Meckel's Diverticulum
Enteric Duplication
Clinical Features
Imaging Features
LARGE BOWEL
Colonic Obstruction
Colonic Atresia
Clinical Features
Imaging Features
Hirschsprung's Disease (Aganglionosis of the Colon)
Embryology
Clinical Features
Imaging Features
Functional Immaturity of the Colon/Neonatal Functional Colonic Obstruction
Clinical Features
Meconium Plug Syndrome
Small Left Colon Syndrome
CONCLUSION
CHAPTER 130:
Imaging of Anorectal Anomalies
EMBRYOLOGY OF THE CLOACA RELATED TO ARA
Internal Cloaca
External Cloaca
CLASSIFICATION
INFORMATION REQUIRED IN A PATIENT OF ARA
CLINICAL CLUES
Males
Females
IMAGING WORK-UP
Invertography
Contrast Studies
Contrast Studies in Males
ANORECTAL ANOMALIES IN MALES
High Anomalies
Anorectal Agenesis without Fistula
Anorectal Agenesis with Rectoprostatic Urethral Fistula
H or N Type of Rectoprostatic Urethral Fistula
Rectovesical Fistula
Rectal Atresia
Intermediate Anomalies
Anal Agenesis without Fistula
Anal Agenesis with Rectobulbar Urethral Fistula
Anorectal Stenosis
Low Anomalies
Anocutaneous Fistula
Anterior Perineal Anus
ANORECTAL ANOMALIES IN FEMALES
High Anomalies
Anorectal Agenesis without Fistula
Anorectal Agenesis with High Rectovaginal Fistula (Without a Urogenital Sinus Defect)
Cloacal Anomalies
Rectovesical Fistula
Rectal Atresia
Intermediate Anomalies
Anal Agenesis without Fistula
Rectovestibular Fistula
Low Rectovaginal Fistula
Low Anomalies
Anovestibular Fistula
Anocutaneous Fistula/Anterior Perineal Anus
Anal Stenosis
INVESTIGATIONS
OTHER INVESTIGATIONS
Ultrasound
CT Scan
MRI Scan
Relationship of Sacral Development and Levator Muscle Development
Associated Anomalies
Diagnostic Algorithm
CHAPTER 131:
Gastrointestinal Masses in Children
PLAIN RADIOGRAPHS
CONTRAST STUDIES
ULTRASONOGRAPHY
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
ESOPHAGEAL MASSES IN CHILDREN
Congenital Masses
Clinical Presentation
Imaging Features
Neoplasms
GASTRIC MASSES IN CHILDREN
Congenital
Clinical Presentation
Imaging Features
Acquired Outlet Obstruction of Stomach
Etiology
Clinical Presentation
Imaging Features
Ultrasound6-12
Technique
Findings on US
Barium Study4
Treatment
Neoplastic Masses
Benign Masses4,13
Gastric Teratoma1,4,14,15
Gastric Leiomyoma4,16-19
Malignant Gastric Tumors
Adenocarcinoma of Stomach
Gastric Lymphoma
Gastric Leiomyosarcoma
Gastrointestinal Stromal Tumors
BEZOARS4,28
SMALL BOWEL MASSES IN CHILDREN
Congenital
Enteric Duplication Cyst4,29-32
Infection
Neoplastic Masses
Benign
Malignant Small Bowel Masses
Small Bowel Lymphoma4,17,23,38
Leiomyosarcomas36
Gastrointestinal Stromal Tumor (GIST)27
Adenocarcinoma
Intussusception
Clinical Presentation
Imaging Features
MESENTERIC MASSES IN CHILDREN
Mesenteric and Omental Tumors
COLONIC MASSES IN CHILDREN
Congenital Mass
Duplication Cysts 50
Inflammatory Mass
Appendicular Lump51
Neoplastic Mass
Benign Colonic Neoplasms
Malignant Colonic Neoplasm52,53
CONCLUSION
CHAPTER 132:
Hepatic and Pancreatic Masses in Children
IMAGING
HEPATIC MASSES
Malignant Hepatic Tumors
HEPATOBLASTOMA
HEPATOCELLULAR CARCINOMA (HCC)
Fibrolamellar HCC
RHABDOMYOSARCOMA
HEPATIC METASTASES
Benign Hepatic Neoplasms
INFANTILE HEMANGIOENDOTHELIOMA
HEMANGIOMA
MESENCHYMAL HAMARTOMA
FOCAL NODULAR HYPERPLASIA (FNH) AND HEPATIC ADENOMA
PELIOSIS HEPATIS
INFLAMMATORY LESIONS
Pyogenic Hepatic Abscess
Amebic Hepatic Abscess
Fungal Abscess
Granulomatous Lesions
Echinococcal Disease (Hydatid Cyst)
SIMPLE HEPATIC CYST
POLYCYSTIC LIVER DISEASE
CAROLI'S DISEASE
PANCREATIC MASSES
Pancreatoblastoma
ISLET CELL TUMORS
SOLID AND PAPILLARY EPITHELIAL NEOPLASM (SPEN) (FRANTZ TUMOR)
MESENCHYMAL TUMORS
PANCREATIC ADENOCARCINOMA
PSEUDOCYSTS
PANCREATIC TUBERCULOSIS
SUMMARY
CHAPTER 133:
Childhood Biliopathies
DEFINITION AND PATHOPHYSIOLOGY OF CHOLESTASIS
PHYSIOLOGICAL NEONATAL JAUNDICE
ETIOLOGY OF JAUNDICE IN THE NEONATE AND INFANT
Transient Causes
Persistent Causes
Common
Uncommon
Other Causes of Cholestasis
DIAGNOSIS OF JAUNDICE IN INFANCY AND CHILDHOOD
NEONATAL HEPATITIS
Pathology
Imaging Features
BILIARY ATRESIA
Pathology
Imaging Features
Ultrasonography
Gallbladder Length and Gallbladder Contraction
Biliary Atresia Splenic Malformation Syndrome
Triangular Cord Sign
Objective Criteria of Triangular Cord Sign in Biliary Atresia on US
Color Doppler US in Biliary Atresia
Contrast Enhanced MR Cholangiography for Evaluation of Biliary Atresia
Kasai Operation
HEPATOBILIARY CYSTIC MALFORMATIONS
Choledochal Cyst
Etiopathogenesis
Anomalous Junction of the Pancreaticobiliary Duct
Imaging Features
CAROLI'S DISEASE
Pathology
Imaging Features
Congenital Hepatic Fibrosis
PRIMARY SCLEROSING CHOLANGITIS
Pathology
Imaging Features
CYSTIC FIBROSIS
Imaging Features
DESTRUCTIVE CHOLANGITIS ASSOCIATED WITH LANGERHANS’ CELL HISTIOCYTOSIS
Pathology
Imaging Features
BILE DUCT PAUCITY
Imaging Features
SPONTANEOUS PERFORATION OF CBD
Imaging Features
INSPISSATED BILE SYNDROME
JAUNDICE IN OLDER CHILDREN
Hepatocellular Causes
HEPATITIS
Imaging Features
CHRONIC ACTIVE HEPATITIS
Imaging Features
METABOLIC
CIRRHOSIS
Portal Hypertensive Biliopathy
BILIARY TRACT NEOPLASMS
Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Pathology
Imaging Features
DISEASES OF THE GALLBLADDER
Cholelithiasis
Pathogenesis of Gallstones in Infancy and Childhood
Imaging Features
Acute Acalculus Cholecystitis and Acute Hydrops of the Gallbladder
CHAPTER 134:
Congenital Anomalies of the Urinary Tract
INTRODUCTION
IMAGING MODALITIES
Antenatal Sonography
Magnetic Resonance Urography
Static MRU (Precontrast Imaging)
Dynamic MR Urography (Postcontrast Imaging)
Limitations
Voiding Urosonography
CT Angiography (CTA) and CT Urography (CTU)
Neonatal Kidney
Embryologic Development of the Urinary Tract
ABNORMALITIES OF KIDNEY
Renal Agenesis
Imaging Features
Rotational Anomalies
Anomalies of Renal Position
Ipsilateral/Uncrossed Ectopia
Imaging Features
Crossed Renal Ectopia
Imaging Features
Horseshoe Kidney
Imaging Features
Ureteropelvic Duplication (Duplex Kidney)
Imaging Features
Renal Hypoplasia
Cystic Renal Dysplasia
Autosomal Recessive Polycystic Kidney Disease
Imaging Features
Multicystic Dysplastic Kidney
Imaging Features
Autosomal Dominant (Adult Type) Polycystic Kidney Disease (ADPKD)
Imaging Features
PUJ Obstruction
Imaging Features
The Prominent Normal Extrarenal Pelvis
Postoperative Evaluation
ANOMALIES OF THE URETER
Ectopic Ureter
Imaging Features
Ureterocele
Simple Ureterocele
Imaging Features
Ectopic Ureterocele
Imaging Features
Primary Megaureter
ANOMALIES OF THE URINARY BLADDER
Agenesis
Complete Duplication
Bladder Exstrophy
Bladder Diverticulae
Neurogenic Bladder
Megacystis
Prune Belly Syndrome
Urachal Anomalies
Types of Anomalies
ABNORMALITIES OF THE URETHRA
Posterior Urethral Valve
Imaging Features
Posterior Urethral Polyp
Prostatic Utricle and Mullerian Duct Cyst
Cowper's Duct Cyst
Male Hypospadias/Epispadias
Anterior Urethral Diverticulum and Anterior Urethral Valve
Urethral Duplication
Megalourethra
Congenital Meatal Stenosis
CHAPTER 135:
Urinary Tract Infections (Including VUR and Neurogenic Bladder)
INCIDENCE
RADIOLOGICAL MODALITIES FOR IMAGING OF UTI
ROLE OF ULTRASOUND IN FIRST TIME UTI
Vesicoureteral Reflux
PATHOPHYSIOLOGY OF VUR AND PYELONEPHRITIS
IMAGING FINDINGS IN ACUTE PYELONEPHRITIS
ACUTE FOCAL BACTERIAL NEPHRITIS
Grading of VUR
Imaging of VUR
MICTURATING CYSTOURETHROGRAM
PRACTICE AND CONCEPT OF CYCLICAL VOIDING
RADIONUCLIDE CYSTOGRAPHY
ULTRASOUND IN VUR
MICTURATING CYSTOURETHROGRAM VERSUS VOIDING UROSONOGRAPHY
ROLE OF MRI IN UTI IMAGING
GUIDELINES FOR IMAGING IN UTI: FROM HISTORY TO CURRENT PERSPECTIVE
DMSA for Renal Scar: When is the Best Time to Scan?
TREATMENT GUIDELINES FOR REFLUX
NEUROGENIC BLADDER
ACKNOWLEDGMENTS
CHAPTER 136:
Renal and Retroperitoneal Masses
IMAGING
RENAL MASSES
WILMS’ TUMOR (NEPHROBLASTOMA)
Etiopathogenesis
Clinical Features
Pathology
Staging
Imaging
Differential Diagnosis
Treatment and Prognosis
Follow-up and Screening
NEPHROBLASTOMATOSIS
Pathology
Imaging Features
MESOBLASTIC NEPHROMA (BOLANDE'S TUMOR)
Clinical Presentation
Pathology
Imaging
Differential Diagnosis
Treatment and Prognosis
CLEAR CELL SARCOMA
Pathology
Imaging
RHABDOID TUMOR
Clinical Presentation
Pathology
Imaging
Treatment and Prognosis
RENAL CELL CARCINOMA
Clinical Presentation
Pathology
Imaging
MULTILOCULAR CYSTIC RENAL TUMOR
Clinical Presentation
Pathology
Imaging
Differential Diagnosis
Treatment and Follow-up
ANGIOMYOLIPOMA
Clinical Presentation
Pathology
Imaging
Screening, Follow-up and Treatment
OSSIFYING RENAL TUMOR OF INFANCY
Imaging
METANEPHRIC ADENOMA (NEPHROGENIC ADENOFIBROMA, EMBRYONAL ADENOMA)
Imaging
Lymphoma
Clinical Presentation
Imaging
LEUKEMIA
PRIMARY NEUROGENIC TUMORS OF THE KIDNEY
Primitive Neuroectodermal Tumor
Neuroblastoma
CYSTIC DISEASES OF THE KIDNEY
ADRENAL MASSES
NEUROBLASTOMA
Site
Clinical Features
Pathology
Staging
Imaging
Differential Diagnosis
Management and Follow-up
GANGLIONEUROBLASTOMA
GANGLIONEUROMA
PHEOCHROMOCYTOMA
Clinical Presentation
Imaging
ADRENAL CORTICAL TUMORS
Clinical Features
Imaging Features
ADRENAL HEMORRHAGE
Clinical Features
Imaging Features
ADRENAL CYSTS
PRIMARY RETROPERITONEAL TUMORS
NEUROGENIC TUMORS
GERM CELL TUMORS
Imaging
MESENCHYMAL TUMORS
Lipomatous Tumors
Rhabdomyosarcoma and Undifferentiated Sarcomas
RETROPERITONEAL LYMPHANGIOMA
LYMPH NODE MASSES
RETROPERITONEAL ABSCESS AND HEMATOMA
CONCLUSION
CHAPTER 137:
Evaluation of Female Pelvis and Testicular Abnormalities
INTRODUCTION
NORMAL US ANATOMY OF GENITAL ORGANS IN INFANTS AND CHILDREN
UTERUS
OVARIES
OVARIAN CYSTS
ANOMALIES OF THE FEMALE PELVIS
Müllerian Anomalies
Obstructive Müllerian Anomalies
Nonobstructive Müllerian Anomalies
Primary Amenorrhea
Polycystic Ovary Syndrome (PCOS)
PELVIC MASSES IN CHILDREN
Benign Ovarian Neoplasms
Malignant Neoplasms
Malignant Ovarian Neoplasm
Ovarian Torsion
Color Doppler Imaging in Ovarian Torsion
Tubo-ovarian Abscess
Ectopic Pregnancy
NONGYNECOLOGIC PELVIC MASSES
Role of MRI in Imaging of Female Pelvis
Congenital Uterine Anomalies
Role of MRI in Characterization of Adnexal Lesions
CONCLUSION
IMAGING OF TESTICULAR ABNORMALITIES
Undescended Testes
Inguinal-Scrotal Hernia
Varicoceles
Hydrocele
Cystic Dysplasia of the Testis
Testicular Calcification (Microcalcification)
Acute Scrotum
Epididymo-orchitis
Torsion of the Testicular Appendages
Testicular Torsion
Acute Idiopathic Scrotal Edema
Scrotal Tumors
Testicular Tumors
Nonseminomatous Germ Cell Tumors
Other Testicular Tumors
EXTRATESTICULAR TUMORS
Paratesticular Rhabdomyosarcoma
Adenomatoid Tumor
Epididymal Cystadenoma
Lipoma
Fibrous Pseudotumor
ADRENAL RESTS
Scrotal Involvement in Systemic Diseases
Scrotal Trauma
Role of MRI in Testicular Abnormalities
CONCLUSION
CHAPTER 138:
Imaging of Intersex Disorders
INTRODUCTION
NORMAL SEXUAL DIFFERENTIATION1
IMAGING OF AN INTERSEX CHILD2-6
Genitography2,7
Other Imaging Modalities
MR Appearance of Genital Structures
CLASSIFICATION OF INTERSEX
Female Pseudohermaphroditism (FPH)1,2,7,14,15
Etiology
Types
Male Pseudohermaphroditism (MPH)1,2,7
Cause
True Hermaphroditism (TH)1,7
Mixed Gonadal Dysgenesis (MGD) and Dysgenetic Male Pseudohermaphroditism (DMP)1,2,7
CLUES TO THE DIAGNOSIS
CONCLUSION
CHAPTER 139:
Skeletal Dysplasias
INTRODUCTION
TERMINOLOGY
Newer Imaging Modalities
OSTEOCHONDRODYSPLASIAS
Defects of Growth of Tubular Bones, Spine or Both
Dysplasias Manifested at Birth
Dysplasias Manifested in Later Life
Disorganized Development of Cartilage and Fibrous Components of the Skeleton
Dysplasia Epiphysealis Hemimelica
Multiple Cartilaginous Exostoses
Enchondromatosis (Ollier's Disease)
Enchondromatosis with Hemangiomas (Maffucci's Syndrome)
Fibrous Dysplasia
Abnormalities of the Density of Cortical Diaphyseal Structure or Metaphyseal Modeling or Both
Dysplasias with Decreased Bone Density
Increased Bone Density without Modification of Bone Shape
Increased Bone Density with Diaphyseal Involvement
Increased Bone Density with Metaphyseal Involvement
DYSOSTOSES
Dysostoses with Cranial and Facial Involvement
Craniosynostosis
Craniofacial Synostosis
Dysostoses with Predominant Axial Involvement
Osteo-onychodysostosis
Dysostosis with Predominant Involvement of Extremities
IDIOPATHIC MULTICENTRIC OSTEOLYSIS
PRIMARY DISTURBANCE OF GROWTH
Cornelia de Lange Syndrome
Progeria
CONSTITUTIONAL DISEASES OF BONE WITH KNOWN PATHOGENESIS
Chromosomal Aberrations
Primary Metabolic Abnormalities
Calcium Phosphorus Metabolism (Hypophosphatasia)
Mucopolysaccharidoses and Mucolipidoses
Bone Abnormalities Secondary to Disturbances of Extraskeleton Systems
CONCLUSION
CHAPTER 140:
Skeletal Maturity Assessment
INTRODUCTION
MEASUREMENT OF MATURITY
Skeletal Maturity Assessment: Why is it Necessary?
Methods to Assess Skeletal Maturity
Appearance and Fusion of Ossification Centers
Greulich and Pyle (G–P) Method
Tanner and Whitehouse Method
Technique
Comparison of G–P and TW2 Methods
Computer-assisted Skeletal Age Scores
Ultrasound-based Bone Age Calculation
Indian Scene
CONCLUSION
CHAPTER 141:
Spinal Dysraphism
INTRODUCTION
CLASSIFICATION
EMBRYOLOGY
IMAGING MODALITIES
OPEN SPINAL DYSRAPHISM
Myelocele and Myelomeningocele
Chiari II Malformation
Hemimyelocele/Hemimyelomeningocele
CLOSED SPINAL DYSRAPHISM
CSD with Subcutaneous Mass
Lipoma with Dural Defect (Lipomyelocele and Lipomyelomeningocele)
Meningocele
Anterior Sacral Meningocele
Myelocystocele
CLOSED SPINAL DYSRAPHISM WITHOUT SUBCUTANEOUS MASS
Posterior Bony Spina Bifida
Lipoma (Intradural and Intramedullary)
Filum Terminale Lipoma
Tight Filum Terminale Syndrome
Persistent Terminal Ventricle
Neurenteric Cyst
SPLIT CORD MALFORMATION
DORSAL DERMAL SINUS
CAUDAL AGENESIS (CAUDAL REGRESSION SYNDROME, CRS)
SEGMENTAL SPINAL DYSGENESIS
CONCLUSION
CHAPTER 142:
Imaging of Pediatric Hip
INTRODUCTION
Normal Anatomy
METHODS OF INVESTIGATION
Conventional Radiography
Ultrasonography (US)
Normal Sonoanatomy of the Hip
Arthrography
Scintigraphy
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
PEDIATRIC HIP DISORDERS
DEVELOPMENTAL DYSPLASIA OF THE HIP
Natural History and Pathology
Clinical Examination
Radiological Diagnosis and Screening of DDH
IMAGING IN DEVELOPMENTAL DYSPLASIA OF THE HIP
Conventional Radiography
Ultrasonography in DDH
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE
Differential Diagnosis of DDH
The Painful Hip
Septic Arthritis
Pathology
Imaging
Tuberculosis of the Hip Joint
Pathology and Imaging
Stage I—Tubercular Synovitis
Stage II—Tubercular Arthritis with Damage to Articular Cartilage
Stage III—Advanced Arthritis
TRANSIENT SYNOVITIS OF HIP
LEGG-CALVE-PERTHES’ DISEASE
Imaging
CT and MRI in Perthes’ Disease
Proximal Femoral Focal Deficiency (PFFD)
Imaging
Slipped Capital Femoral Epiphysis
Imaging
Differential Diagnosis
Developmental Coxa Vara
Pediatric Hip Trauma
Neuromuscular Hip Dysplasia
Childhood Idiopathic Chondrolysis of the Hip
Calcification of Cartilage and Joints
Femoroacetabular Impingement
CHAPTER 143:
Benign Bone and Soft Tissue Tumors and Conditions
INTRODUCTION
CARTILAGINOUS TUMORS
Osteochondroma
Enchondroma
Chondroblastoma
Chondromyxoid Fibroma
OSSEOUS TUMORS
Osteoid Osteoma
Osteoblastoma
FIBROUS TUMORS
Nonossifying Fibroma
Fibrous Dysplasia
Osteofibrous Dysplasia
HISTIOCYTOSIS X (LANGERHANS CELL HISTIOCYTOSIS)
GIANT CELL TUMOR
TUMOR-LIKE LESIONS
Simple Bone Cyst
Aneurysmal Bone Cyst
Pseudotumor of Hemophilia
SOFT TISSUE TUMORS
Vascular Lesions
Hemangioma
Vascular Malformations
FIBROBLASTIC/MYOFIBROBLASTIC TUMORS
Nodular Fasciitis
Myositis Ossificans
Myofibroma/Myofibromatosis
Fibromatosis
Neurogenic Tumor
Adipocytic Tumor
Lipoma
Lipoblastoma
Pseudotumors
Fat Necrosis
Hematoma
Inflammatory Lesions
Periarticular Cysts
CONCLUSION
CHAPTER 144:
Pediatric Malignant Bone and Soft Tissue Tumors
INTRODUCTION
IMAGING MODALITIES
Plain Radiographs
Sonography
Computed Tomography
Magnetic Resonance Imaging
MRI Techniques for Bone and Soft Tissue Tumors
Role of Contrast-enhanced MRI
Newer MR Imaging Techniques
Staging of Malignant Bone and Soft Tissue Tumors
MALIGNANT BONE TUMORS
Osteosarcoma
Ewing's Sarcoma
Chondrosarcoma
Lymphoma
Metastases
Malignant Fibrous Histiocytoma
SOFT TISSUE TUMORS
Rhabdomyosarcoma
Synovial Sarcoma
Other Non-rhabdomyosarcomatous Tumors
CONCLUSION
CHAPTER 145:
Congenital Brain Anomalies
INTRODUCTION
DISORDERS OF ORGANIZATION
Supratentorial Malformations
Migrational Disorders
Holoprosencephaly
Septo-optic Dysplasia
Dysgenesis of Corpus Callosum
Hydranencephaly
Infratentorial Malformations
Chiari Malformations
Supra- and Infratentorial Malformations
DISORDERS OF HISTOGENESIS
Neurofibromatosis
Tuberous Sclerosis
Sturge–Weber Syndrome
CHAPTER 146:
Hypoxic–Ischemic Encephalopathy
INTRODUCTION
NEUROIMAGING IN INFANTS WITH HIE
BELOW 34 WEEKS GROUP: THE PREMATURE NEONATE
Severe, Total Hypoxia
Mild-to-moderate Hypoxia
Hemorrhage
Germinal Matrix Hemorrhage (GMH)
Intraventricular Hemorrhage (IVH)
Parenchymal Hemorrhage (Periventricular Hemorrhagic Infarction)
Grading of Intracranial Hemorrhage
Imaging of Intracranial Hemorrhage
White Matter Injury of Prematurity/Periventricular Leukomalacia
Imaging of Early PVL
Imaging of End-stage PVL
ABOVE 34 WEEKS GROUP: THE TERM NEONATE
Severe, Total Hypoxia
Prolonged Partial Hypoxia
HYPOXIC–ISCHEMIC INJURY IN POSTNATAL AGE GROUP
Severe, Total Hypoxia
Mild-to-moderate Hypoxia
IMAGING CHOICE FOR EVALUATION OF HYPOXIC–ISCHEMIC INJURY
PREDICTION OF CLINICAL OUTCOME
Ultrasound
Echogenic Thalamus
Cerebral Artery Doppler
CT
Reversal Sign
Diffuse Decreased Density
MR Imaging
Conventional Sequences
MR Spectroscopy
CONCLUSION
CHAPTER 147:
Cranial Sonography
INTRODUCTION
TECHNIQUE AND NORMAL ANATOMY
Cranial Doppler US
CONGENITAL BRAIN ANOMALIES
Failure of Neural Tube Closure
Chiari II Malformation
Sonographic Appearance
Agenesis of the Corpus Callosum
Dandy–Walker (DW) Complex
Disorders of Diverticulation
Holoprosencephaly
Pellucidal Agenesis and Dysgenesis
Schizencephaly
Lissencephaly
Tuberous Sclerosis
Sturge–Weber Syndrome
Vascular Malformations
DESTRUCTIVE BRAIN LESIONS
Porencephalic Cyst
Hydranencephaly
HYDROCEPHALUS
INTRACRANIAL HEMORRHAGE
Grade I
Grade II
Grade III
Grade IV
HYPOXIC OR ISCHEMIC ENCEPHALOPATHY
Mild-to-moderate Hypotension in the Preterm Neonate
Severe Hypotension in the Preterm Neonate
Diffuse Cerebral Edema
Extracorporeal Membrane Oxygenation (ECMO)
Post-traumatic Injury
Intracranial Infection
NEONATAL AND ACQUIRED INFECTIONS
Pyogenic Meningitis
Tubercular Meningitis
Neoplasms and Cysts
Cysts
CHAPTER 148:
Inflammatory Diseases of the Brain
INTRODUCTION
INVESTIGATIVE MODALITIES
BACTERIAL INFECTIONS
Brain Abscess
Abscesses Evolve in Four Stages
CRANIAL TUBERCULOSIS
Tuberculous Meningitis
Basal Exudates
Hydrocephalus
Infarction
Parenchymal Tuberculous Granulomas
Compound Parenchymal and Meningeal Tuberculosis
NEUROCYSTICERCOSIS
Clinical Features and Pathology
Leptomeningitic Form
Intraventricular Form
Racemose Cysts (Subarachnoid Form)
HYDATID DISEASE
VIRAL ENCEPHALITIS
Herpes Simplex Encephalitis
Japanese Encephalitis
DWI in Encephalitis
CONGENITAL INFECTIONS
Cytomegalovirus
Toxoplasmosis
Neonatal Herpes Simplex Encephalitis
Rubella
Congenital HIV Infection
FUNGAL INFECTIONS
Aspergillosis
Mucormycosis
CONCLUSION
CHAPTER 149:
Pediatric Brain Tumors
INTRODUCTION
CLASSIFICATION OF CHILDHOOD TUMORS BASED ON TOPOGRAPHY3
POSTERIOR FOSSA TUMORS
Medulloblastoma
Pathology
Imaging
Pilocytic Astrocytoma
Pathology
Imaging
Ependymoma
Pathology
Imaging
Brainstem Gliomas
Pathology
Imaging
Atypical Teratoid/Rhabdoid Tumor
Pathology
Imaging
Hemangioblastoma
Pathology
Imaging
Epidermoid and Dermoid
SUPRATENTORIAL TUMORS
Cerebral Astrocytoma
Pathology
Imaging
Subependymal Giant Cell Astrocytoma
Imaging
Ganglioglioma
Imaging
Supratentorial Ependymoma
Pathology
Imaging
Primitive Neuroectodermal Tumor
Pathology
Imaging
Oligodendroglioma
Dysembryoplastic Neuroepithelial Tumors
Desmoplastic Infantile Ganglioglioma
SELLAR AND SUPRASELLAR TUMORS
Chiasmatic/Hypothalamic Gliomas
Imaging
Craniopharyngioma
Imaging
Hypothalamic Hamartoma
Imaging
Pituitary Adenomas
Arachnoid Cyst
Imaging
PINEAL REGION MASSES
Germinomas
Imaging
Teratomas
Pathology
Imaging
Other Germ Cell Tumors
Pineal Parenchymal Tumors
Pineal Cysts
EXTRAPARENCHYMAL TUMORS
Choroid Plexus Tumors
Pathology
Imaging
Meningiomas and Related Tumors
Pathology
Imaging
Leukemia and Lymphoma
OCULAR TUMORS
Retinoblastoma
Imaging
RETROBULBAR ORBITAL TUMORS
Vascular Tumors
Orbital Varices
Neuroblastoma
Plexiform Neurofibroma
Rhabdomyosarcoma
Juvenile Angiofibroma
MR SPECTROSCOPY IN BRAIN
Tumor Imaging
Positron-emission Tomography (PET) in Neuro-oncology
Diffusion-weighted Imaging
Uses in Glioma Evaluation
NANOTECHNOLOGY
Imaging and Nanomedicine for Diagnosis and Therapy of CNS Tumors
CONCLUSION
CHAPTER 150:
Metabolic Disorders of the Brain
INTRODUCTION
Normal Myelination of the Brain
MR Imaging at 1.5 T (Tables 1A and B)
Graywhite Matter Differentiation
METABOLIC DISORDERS
Classification According to Cellular Organelle Dysfunction
Classification of Metabolic Disorders on the Basis of Organelle Disorder 9,10
Lysosomal Storage Diseases with White Matter Involvement
Peroxisomal Disorders
Mitochondrial Dysfunction with Leukoencephalopathy
Disorders of Amino Acid and Organic Acid Metabolism
White Matter Disorders with Unknown Metabolic Defect
Classification of Metabolic Disorders According to Brain Substance Involvement
Leukodystrophies
Poliodystrophies
Pandystrophies
LYSOSOMAL STORAGE DISORDERS
Metachromatic Leukodystrophy
Clinical Features
Pathologic Findings
Imaging Features
Krabbe Disease/Globoid Cell Leukodystrophy (GLD)
Clinical Features
Pathologic Findings
Imaging Features
Sphingolipidosis
Clinical Features
Imaging Features
Fabry Disease
Clinical Features
Pathologic Findings
Imaging Features
Gaucher's Disease
Clinical Features
Imaging
Mucopolysaccharidoses
PEROXISOMAL DISORDERS
X-linked Adrenoleukodystrophy
Clinical Features
Pathologic Findings
Imaging Features
Adrenomyeloneuropathy
Zellweger Syndrome
Refsum Disease
Cerebrotendinous Xanthomatosis
Rhizomelic Chondrodysplasia Calcificans Punctata
UNCLASSIFIED LEUKODYSTROPHIES
Canavan Disease
Clinical Features
Pathologic Findings
Imaging Features
Alexander Disease
Pathologic Findings
Clinical Features
Imaging Features
Van der Knaap Disease/Megaloencephalic Leukodystrophy with Subcortical Cysts
Vanishing White Matter Disease/Childhood Ataxia with CNS Hypomyelination
Aicardi–Goutieres Syndrome
Pelizaeus–Merzbacher Disease
Pathologic Findings
Clinical Features
Imaging Features
Cockayne Syndrome
MR Spectroscopy
MITOCHONDRIAL DISORDERS/ DEFECTS OF THE RESPIRATORY CHAIN
Mitochondrial Encephalomyopathy: Lactic Acidosis and Stroke-like Symptoms
Clinical Features
Pathologic Findings
Imaging Features
Myoclonic Epilepsy with Ragged Red Fibers (MERRF)
Pathologic Findings
Imaging Features
Kearns–Sayre Syndrome
Clinical Features
Imaging Features
Subacute Necrotizing Encephalomyopathy (Leigh Disease)
Pathologic Features
Imaging Features
LEBER'S HEREDITARY OPTIC NEUROPATHY
DISORDERS OF AMINO ACID METABOLISM/AMINOACIDOPATHIES
Urea Cycle Defects
Phenylketonuria
Clinical Features
Imaging Findings
Malignant Form of Phenylketonuria
Maple Syrup Urine Disease
Imaging Findings
Classic Homocystinuria
Clinical Features
Imaging
Nonketotic Hyperglycinemia
Imaging
5, 10 Methylene-tetrahydrofolate Reductase Deficiency
ORGANIC ACIDEMIAS
Methylmalonic Acidemia
Imaging Findings during Metabolic Crisis
Imaging Findings after Metabolic Crisis
Propionic Acidemia
Imaging Findings
Ethylmalonic Acidemia
Methylglutaconic Aciduria
Imaging Finding
3-Hydroxy-3-methylglutaryl (HMG)- Coenzyme a Lyase Deficiency
Glutaric Aciduria Type 1
METABOLIC DISORDERS PRIMARILY AFFECTING GRAY MATTER
Hallervorden–Spatz Disease
Neuronal Ceroid Lipofuscinosis (NCL)
Imaging Findings
Rett Syndrome
DISORDERS OF METAL METABOLISM
Wilson's Disease (Hepatolenticular Degeneration)
Clinical Features
Imaging
Menkes’ Disease
CONCLUSION
SECTION 6: CHEST AND CARDIOVASCULAR IMAGING
CHAPTER 151:
Chest X-ray: Techniques and Anatomy
INTRODUCTION
CONVENTIONAL CHEST RADIOGRAPHY
TECHNICAL ADVANCES
High kV Technique
New Screen Film Combinations
Beam Equalization Radiography
Digital Radiography
Digital Radiography and Chest
RADIOGRAPHIC PROJECTIONS
Posteroanterior View
Patient Positioning
Patient Respiration
Film Exposure
Kilovoltage
Grids and Filters
Lateral View
Anteroposterior View
Decubitus View
Lordotic View
Oblique View
SPECIAL RADIOGRAPHIC TECHNIQUES
Inspiratory–Expiratory Radiography
Valsalva and Müller Maneuvers
Bedside/Portable Radiography
NORMAL ANATOMY ON CHEST X-RAY
Trachea
Tracheobronchial Divisions
Lungs
Bronchopulmonary Segments
Hilum and Pulmonary Vasculature
Pleura
Mediastinum
Mediastinal Lines and Interfaces
Heart
Diaphragm
CONCLUSION
CHAPTER 152:
Multidetector Computed Tomography of Chest: Techniques and Anatomy
INTRODUCTION
COMPUTED TOMOGRAPHY
Indications for CT of the Chest
Definition of Spiral Pitch
Dose Considerations
Intravenous Contrast Medium Enhancement
Window Settings
HIGH-RESOLUTION COMPUTED TOMOGRAPHY
Sequential HRCT Protocol
Volumetric HRCT Protocol
Volumetric Standard CT Protocol
Volumetric Low-dose CT Protocol
Pediatric MDCT Chest
ANATOMY
Tracheobronchial Tree
Lungs
Mediastinum
Esophagus
Lymph Nodes
Mediastinal Spaces
CHAPTER 153:
Basic Patterns of Lung Diseases
PATTERN RECOGNITION
High-resolution CT Patterns of Disease
LUNG DISEASES THAT INCREASE RADIOGRAPHIC DENSITY
Predominantly Airspace Disease
Parenchymal Consolidation
Radiographic Criteria of Airspace Disease
Airspace Nodule
Coalescence
Distribution Characteristics
Margination
Air Bronchogram
Time Factor
Parenchymal Atelectasis
Maintenance of Lung Volume
Resorption Atelectasis
Passive Atelectasis
Adhesive Atelectasis
RADIOGRAPHIC SIGNS OF ATELECTASIS
Direct Signs
Indirect Signs
Local Increase in Density
Elevation of the Hemidiaphragm
Mediastinal Displacement
Compensatory Overinflation
Displacement of the Hila
Changes in the Chest Wall
Predominantly Interstitial Disease
Radiographic Patterns of Diffuse Interstitial Disease
Reticular Pattern
Nodular Pattern
Reticulonodular Pattern
Linear Pattern
Combined Airspace and Interstitial Disease
General Signs in Diseases that Increase Radiographic Density
Characteristics of the Border of a Pulmonary Lesion
Changes in Position of Interlobar Fissures
Cavitation
Calcification and Ossification
Bullae and Cysts
Distribution of Disease within the Lungs (Anatomic Basis)
Radiologic Localization of Pulmonary Disease (The Silhouette's Sign)
Line Shadows
Tubular Shadows (Bronchial Wall Shadows)
Parenchymal Scarring
Line Shadow of Pleural Origin
Horizontal or Obliquely Oriented Linear Opacities of Unknown Nature
HIGH-RESOLUTION CT SCAN FINDINGS MANIFESTING AS INCREASED LUNG OPACITY
Nodules
Linear Abnormalities
Interlobular Septal Thickening
Parenchymal Bands
Subpleural Lines
Reticular Abnormalities
Ground-glass Opacity
Consolidation
LUNG DISEASES THAT DECREASE RADIOGRAPHIC DENSITY
Increased Air with Unchanged Blood and Tissue
Increased Air with Decreased Blood and Tissue
Normal Amount of Air but Decreased Blood and Tissue
Reduction in All Three Components
RADIOGRAPHIC SIGNS
Alteration in Lung Volume
General Excess of Air in the Lungs
Local Excess of Air
Static Signs
Dynamic Signs
Alteration in Vasculature
General Reduction in Vasculature
Local Reduction in Vasculature
Pulmonary Air Cysts
HIGH-RESOLUTION CT SCAN FINDINGS MANIFESTING AS DECREASED OPACITY
Areas of Decreased Attenuation with Walls
Bronchiectasis
Honeycomb Pattern
Cystic Pattern
Areas of Decreased Attenuation without Walls
Emphysema
Mosaic Perfusion and Inhomogeneous Lung Opacity
Normal Inspiratory Scans with Air Trapping on Expiratory Imaging
Multidetector CT in Assessment of Diffuse Lung Disease
CONCLUSION
CHAPTER 154:
Radiographic Manifestations of Pulmonary Tuberculosis
INTRODUCTION
NEW CONCEPT OF RADIOLOGIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS
RADIOLOGICAL PATTERNS OF PULMONARY TUBERCULOSIS
Typical Radiological Patterns of Primary Tuberculosis
Postprimary TB or Phthisis
Radiological Patterns Encountered in Both Primary and/or Postprimary TB
Miliary TB
Exudative Pleuritis
Tracheobronchial TB
Tuberculoma
Complications and Sequelae of Pulmonary TB
Atypical Patterns
PET/CT IN TUBERCULOSIS
CHAPTER 155:
Nontubercular Pulmonary Infections
INTRODUCTION
IMAGING MODALITIES
RADIOGRAPHIC PATTERN
ETIOPATHOGENESIS OF PULMONARY INFECTIONS
SPECIFIC PNEUMONIAS
Bacterial Pneumonias
Pneumococcal Pneumonia
Staphylococcal Pneumonia
Gram-negative Pneumonias
Chlamydia pneumoniae
Anaerobic Pneumonias
Actinomycosis
Mycoplasma Pneumonia
Viral Pneumonia
Influenza Virus
Respiratory Syncytial Virus
Varicella
Adenovirus
FUNGAL INFECTIONS
Opportunistic Invaders
Aspergillosis
Cryptococcosis
Primary Pathogens
Histoplasmosis
Coccidioidomycosis
PARASITIC INFECTIONS
Protozoal Infections
Metazoal Infestations
Roundworm, Hookworm and Strongyloides Infections
Filariasis
Echinococcus Infection/Hydatid Disease
COMPLICATIONS OF PNEUMONIA
Pleural Effusion and Empyema
Hydropneumothorax
Pneumatoceles
Abscess
Bronchiectasis
Miscellaneous Complications
Delayed Resolution of Pneumonia
INTERVENTIONAL PROCEDURES IN THE PATIENTS WITH PNEUMONIA
CONCLUSION
CHAPTER 156:
Imaging of the Tracheobronchial Tree
INTRODUCTION
IMAGING MODALITIES
Chest Radiograph
Computed Tomography
Acquisition
Axial CT Images
Advanced Reconstruction Techniques
NORMAL AIRWAY ANATOMY
Anatomic Variants
TRACHEOBRONCHIAL LESIONS
Central Airways
Tracheobronchomalacia
Strictures
Inflammatory Tracheal Stenosis due to Tuberculosis
Fungal Infections
Postintubation Stenosis
Neoplasms of Tracheobronchial Tree
Malignant Tumors
Benign Tumors
Miscellaneous
Mucous Plug/Mucoid Pseudotumor
Broncholithiasis
Tracheopathia Osteoplastica
Tracheoesophageal Fistulas
Diffuse Diseases Involving Tracheobronchial Tree
Amyloidosis
Relapsing Polychondritis
Sarcoidosis
Wegener Granulomatosis
Saber Sheath Trachea
Peripheral Airways
Bronchiectasis
Congenital Airway Wall Abnormality
Tracheobronchomegaly (Mounier–Kuhn Disease)
Williams–Campbell Syndrome
Congenital Bronchial Atresia
Acquired Wall Abnormalities
Mucociliary Clearance Abnormalities
Hyperimmune Response
Small Airway Disease/Bronchiolitis
Cellular Bronchiolitis
Bronchiolitis Obliterans with Intraluminal Polyps
Obliterative or Constrictive Bronchiolitis
Asthma
Chronic Obstructive Pulmonary Disease
CONCLUSION
CHAPTER 157:
Imaging of Interstitial Lung Disease
INTRODUCTION
PLAIN RADIOGRAPHY
High-resolution CT
Anatomy of the Secondary Pulmonary Lobule
SARCOIDOSIS
Imaging Features
CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE
RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE
Imaging Features
PROGRESSIVE SYSTEMIC SCLEROSIS
Imaging Features
SYSTEMIC LUPUS ERYTHEMATOSUS
Imaging Features
HYPERSENSITIVITY PNEUMONITIS
Imaging Features
SILICOSIS AND COAL-WORKER PNEUMOCONIOSIS
Imaging Features
ASBESTOSIS
LYMPHANGIOLEIOMYOMATOSIS
Imaging Features
LANGERHANS CELL HISTIOCYTOSIS
Imaging Features
PULMONARY ALVEOLAR PROTEINOSIS
Imaging Features
IDIOPATHIC INTERSTITIAL PNEUMONIAS
IDIOPATHIC PULMONARY FIBROSIS
Imaging Features
NONSPECIFIC INTERSTITIAL PNEUMONITIS
Imaging Features
CRYPTOGENIC ORGANIZING PNEUMONIA
Imaging Features
RESPIRATORY BRONCHIOLITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE
Imaging Features
DESQUAMATIVE INTERSTITIAL PNEUMONIA
Imaging Features
LYMPHOID INTERSTITIAL PNEUMONIA
Imaging Features
ACUTE INTERSTITIAL PNEUMONIA
Imaging Features
CHAPTER 158:
Pulmonary Manifestations in Immunocompromised Host (HIV and Solid Organ Transplant Patients)
INTRODUCTION
HIV/AIDS
Systematic Approach to Imaging Diagnosis
Imaging Methods
Radiological Pattern Approach to Diagnosis
Normal Chest Radiograph
Ground-Glass Opacities
Consolidation
Multiple Pulmonary Nodules
Lymphadenopathy
Pleural Effusion
NON-HIV IMMUNOCOMPROMISED HOSTS
Imaging Approach
BACTERIAL INFECTIONS
PNEUMOCYSTIS JIROVECI PNEUMONIA
MYCOBACTERIAL INFECTIONS
HIV/AIDS Patients
HIV Negative Immunocompromised Patients
VIRAL INFECTIONS
FUNGAL INFECTIONS
NONINFECTIOUS MANIFESTATIONS OF AIDS
Kaposi's Sarcoma
Lymphoma
Lymphocystic Interstitial Pneumonitis
Post-transplant Lymphoproliferative Disorder
CONCLUSION
CHAPTER 159:
Chest in Immunocompromised Host (Hematological Infections and Bone Marrow Transplant)
INTRODUCTION
COMPLICATIONS NOT SPECIFIC TO HSCT
Infections
Bacterial Pneumonia
Pneumocystis jirovecii Pneumonia
Fungal Infections
Tuberculosis
Drug Toxicity
Pulmonary Hemorrhage
COMPLICATIONS SPECIFIC TO HSCT
Infections
Cytomegalovirus Pneumonia
Pulmonary Edema
Idiopathic Pneumonia Syndrome
Bronchiolitis Obliterans
Bronchiolitis Obliterans Organizing Pneumonia
Radiation Injury
Spontaneous Pneumothorax
CHAPTER 160:
Imaging the Mediastinum
INTRODUCTION
IMAGING MODALITIES
Chest Radiograph
Computed Tomography
Magnetic Resonance Imaging
DIFFERENTIAL DIAGNOSIS OF MEDIASTINAL MASSES
ANTERIOR MEDIASTINUM
Lesions of Thymus
Thymic Rebound
Thymic Hyperplasia
Thymoma
Germ Cell Tumors
Thyroid Mass
Parathyroid Adenoma
Lymphangioma (Cystic Hygroma)
Other Vascular Tumors
Pericardial Cyst
MIDDLE MEDIASTINUM
Bronchogenic Cyst
Esophageal Duplication Cyst
Neurenteric Cyst
Esophageal Lesions
POSTERIOR MEDIASTINUM
Neurogenic Tumors
Peripheral Nerve Tumors
Tumors from Sympathetic Ganglia
Paraganglioma
Lateral Thoracic Meningocele
Paraspinal Infection
Extramedullary Hemopoiesis
Mediastinal Varices
MULTICOMPARTMENT MEDIASTINAL MASSES/LESIONS
Mediastinal Lymphadenopathy
Tuberculosis
Sarcoidosis
Lymphoma
Metastasis
Vascular Lesions
Aortic Aneurysm
Aortic Dissection
Superior Vena Cava Obstruction
Abnormalities of the Mediastinal Fat
Mediastinal Lipomatosis
Lipoma
Herniation of Abdominal Fat
MISCELLANEOUS LESIONS OF THE MEDIASTINUM
Mediastinal Hemorrhage
Pneumomediastinum
Acute Mediastinitis
Fibrosing Mediastinitis
CONCLUSION
CHAPTER 161:
Imaging of Solitary and Multiple Pulmonary Nodules
INTRODUCTION
MORPHOLOGICAL CHARACTERISTICS OF SPN
Size
Shape
Location
Edge Characteristics
INTERNAL CHARACTERISTICS OF SPN
Calcification
Calcification in a Benign Nodule
Indeterminate Calcification
Calcification in Tumor
Fat
Nodule Attenuation
Cavitation
Air Bronchograms and Pseudocavitation
Air Crescent Sign
AIR FLUID LEVEL
Satellite Nodules
Feeding Vessel Sign
Positive Bronchus Sign
INDETERMINATE SOLITARY PULMONARY NODULE
Contrast-enhancement/Hemodynamic Characteristics on Dynamic Helical CT
For Benign Nodules
Growth Rate Assessment
VOLUME QUANTIFICATION ON CT/THREE– DIMENSIONAL EVALUATION
COMPUTER-AIDED DIAGNOSIS
IMAGE REGISTRATION
Bayesian Analysis
Decision Analysis
FDG Positron Emission Tomography
Biopsy
Transthoracic Needle Aspiration Biopsy (TNAB)
Fiberoptic Bronchoscopy (FOB)
Video Assisted Thoracic Surgery
NEWER TECHNIQUES FOR THE EVALUATION OF SPN
Dynamic MR Imgaing
Diffusion Weighted MRI Imaging
Dual Energy CT in the Evaluation of SPN
DIFFERENTIAL DIAGNOSIS OF SOLITARY PULMONARY NODULE72
Malignant Neoplasm
Benign Neoplasm and Neoplasm Like Condition
Infective Causes
Inflammatory (Noninfectious)
Airway and Inhalational Disease
Vascular Lesions
Congenital Lesions
Idiopathic/Miscellaneous
MORPHOLOGICAL CHARACTERISTICS IN SPECIFIC LESIONS
Malignant Lesions
Lung Malignancies
Lymphoma
Metastatic Neoplasm
Carcinoid Tumor
Benign Neoplasms
Pulmonary Hamartoma
Other Benign Tumors
Infective Causes
Granuloma
Mycetoma
Hydatid Cyst
Round Pneumonia
Lung Abscess
Inflammatory (Noninfectious)
Rheumatoid Nodules
Airway or Inhalational Disease
Lipoid Pneumonia
Vascular Lesions
Pulmonary Artery Aneurysm
Pulmonary Vein Varix
Arteriovenous Malformation (AVM)
Pulmonary Infarction
Congenital Lesions
Pulmonary Bronchogenic Cyst
Sequestration
Miscellaneous
Round Atelectasis
MULTIPLE PULMONARY NODULES
MORPHOLOGICAL CHARACTERISTICS IN SPECIFIC CAUSES
Metastatic Lung Nodules
Kaposi's Sarcoma
Sarcoidosis
Rheumatoid Nodules and Caplan Syndrome
Progressive Massive Fibrosis
Wegener's Granulomatosis
Septic Emboli with Infarction
Arteriovenous Malformation
Amyloidosis
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
CONCLUSION
CHAPTER 162:
Lung Malignancies
INTRODUCTION
PATHOLOGY
CLINICAL FEATURES
IMAGING FEATURES
Peripheral Tumors
Central Tumors
Methods to Establish Tissue Diagnosis
STAGING OF NSCLC
Imaging Work-up for the Staging of NSCLC
Mediastinal Invasion
CHEST WALL INVASION
Pancoast Tumor
Lymph Node Staging
Additional Lung Nodules
Pleural Effusion
Distant Metastases
PET in Management of Lung Cancer
Bronchoalveolar Carcinoma
TREATMENT OF NSCLC
Follow-up Imaging
Recurrent Lung Cancer
SCREENING FOR LUNG CANCER
NEUROENDOCRINE TUMORS OF THE LUNG
Bronchial Carcinoid
Small-cell Lung Cancer
Treatment of Neuroendocrine Tumors
RARE LUNG MALIGNANCIES
LUNG METASTASES
Detection of Lung Metastases
Lymphangitis Carcinomatois
Treatment of Lung Metastases
LYMPHOMA OF THE LUNG
CHAPTER 163:
Intensive Care Chest Radiology
INTRODUCTION
CHEST X-RAY IN IMAGING OF ICU PATIENTS
Atelectasis
Aspiration Pneumonitis
Pneumonia
Hydrostatic Pulmonary Edema
CT in Hydrostatic Pulmonary Edema
Noncardiogenic Pulmonary Edema
Pulmonary Embolism
Barotrauma
Pulmonary Interstitial Emphysema
Pneumomediastinum
Pneumothorax
Subcutaneous Emphysema
Support and Monitoring Apparatus
Respiratory Support
Endotracheal and Tracheostomy Tube
Intravascular Catheters
Central Venous Line
Swan-Ganz Catheter
ULTRASOUND IN IMAGING OF ICU PATIENTS
CT SCAN IN IMAGING OF ICU PATIENTS
CHAPTER 164:
Imaging in Pulmonary Thromboembolism
INTRODUCTION
PLAIN RADIOGRAPHS
PULMONARY ANGIOGRAPHY
Echocardiography
D-dimer
Scintigraphy
Duplex Ultrasound and Compression Ultrasound of Lower Limbs
COMPUTED TOMOGRAPHY
Spiral CT
Technique
VASCULAR FINDINGS
PARENCHYMAL FINDINGS
Acute Thromboembolism
Chronic Thromboembolism
Acute Versus Chronic Thromboembolism
PITFALLS IN DIAGNOSIS OF PULMONARY EMBOLISM
EFFICACY AND ACCURACY OF MULTIDECTOR COMPUTED TOMOGRAPHY
ISOLATED SUBSEGMENTAL PULMONARY EMBOLISM
COMPUTED TOMOGRAPHY VENOGRAPHY
MAGNETIC RESONANCE IMAGING
MR Venography
IMAGING-GUIDED INTERVENTION IN THE MANAGEMENT OF PULMONARY THROMBOEMBOLISM
Pulmonary Embolism in Pregnancy
ACKNOWLEDGMENTS
CHAPTER 165:
Imaging in Thoracic Trauma
INTRODUCTION
PULMONARY PARENCHYMAL INJURIES
Pulmonary Contusion
Pulmonary Laceration
Aspiration Pneumonitis
Atelectasis
Traumatic Lung Herniation
PLEURAL INJURIES
Pneumothorax
Hemothorax
INJURIES OF THE MEDIASTINUM
Tracheobronchial Injury
Esophageal Injury
Pneumomediastinum
Vascular Injury
Cardiac and Pericardial Injury
INJURY OF DIAPHRAGM
Injury of Chest Wall
CONCLUSION
CHAPTER 166:
Imaging of Pleura
INTRODUCTION
IMAGING MODALITIES
Layers of Pleura
PLEURAL EFFUSION
Types of Effusion: Exudates and Transudates
Exudates
Transudate
Fibrin Body
IMAGING IN PLEURAL EFFUSION
Plain Radiographs
ULTRASONOGRAPHY OF PLEURAL EFFUSION
COMPUTED TOMOGRAPHY
PLEURAL EFFUSION OR ASCITIS
Loculated Pleural Fluid (Encysted/ Encapsulated)
MAGNETIC RESONANCE IMAGING OF PLEURAL EFFUSION
Specific Causes of Pleural Effusion
Parapneumonic Effusion with Empyema9-14
Organization Stage (Pleural Peel)
Empyema Necessitans
Tube Drainage of Empyema
BRONCHOPLEURAL FISTULA
Postsurgical BPF
Infective BPF
PLEURAL THICKENING
Visceral Pleural Thickening
Pleural Apical Cap and Fibrous Thickening
Pleural Thickening
Mimics
PLEURA AND ASBESTOSIS18-19
ASBESTOSIS PSEUDOTUMOR (ROUND ATELECTASIS)
PLEURAL CALCIFICATION
PNEUMOTHORAX
Spontaneous Pneumothorax
Primary Spontaneous Pneumothorax
Secondary Spontaneous Pneumothorax
Pneumothorax Ex Vacuo
Traumatic Pneumothorax
Catamenial Pneumothorax
IMAGING FINDINGS
X-ray
Upright Patient
Supine Patients
Ultrasonography
Computed Tomography
Tension Pneumothorax
SIZE OF PNEUMOTHORAX21
PLEURAL NEOPLASM
Pleural or Extrapleural Masses
Pleural Effusion
Pleural Thickening
MESOTHELIOMA (MALIGNANT PLEURAL MESOTHELIOMA)23-24
Radiographic Findings
Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
Localized Fibrous Tumor
Pleural Metastasis
Pleural Lymphoma
CHAPTER 167:
Imaging of the Diaphragm and Chest Wall
DIAPHRAGM
Anatomy
Imaging Modalities
Plain Radiograph
Ultrasonography (USG)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Radionuclide Scan
Normal Variants
Accessory Diaphragm
Elevated Hemidiaphragm
Unilateral Elevation
Bilateral Elevation
Low Lying Diaphragm
Inversion of the Diaphragm
Peridiaphragmatic Collections
DIAPHRAGMATIC MOVEMENTS
Diaphragmatic Hernias
Bochdalek Hernia
Morgagni Hernia
Intrapericardial Hernia
Diaphragmatic Injury
Tumors of the Diaphragm
CHEST WALL
Congenital and Developmental Anomalies
Inflammatory and Infectious Diseases
Tumors of the Chest Wall
Malignant Chest Wall Tumors
CHAPTER 168:
Bronchial Artery Embolization
INTRODUCTION
PATHOPHYSIOLOGY AND ETIOLOGY
Causes of Hemoptysis (Figs 1A to D)
DIAGNOSTIC WORK-UP
Conventional Radiography (Figs 2A to C)
Fiberoptic Bronchoscopy (FB)
Computed Tomography (CT) (Figs 1 and 3)
BRONCHIAL ARTERY ANATOMY
NONBRONCHIAL SYSTEMIC ARTERY ANATOMY
TECHNIQUE OF BRONCHIAL ARTERY EMBOLIZATION
RESULTS
COMPLICATIONS
CONCLUSION
CHAPTER 169:
Diagnostic and Therapeutic Interventions in Chest
INTRODUCTION
IMAGE GUIDANCE MODALITIES
Nonvascular Interventions
Transthoracic Needle Biopsy of Pulmonary Lesions
Indications
Patient Evaluation
Contraindications
Image Guidance
Biopsy Technique
Complications
Results
Transthoracic Needle Biopsy from Other Sites
Percutaneous Needle Biopsy of the Pleura
Localization of a Nodule for Thoracoscopic Resection
Diagnostic Thoracocentesis
PERCUTANEOUS DRAINAGE OF PLEURAL SPACE FLUID COLLECTIONS
Pleural Sclerotherapy or Pleurodesis
Pneumothorax Drainage
Lung Abscess Drainage
Mediastinal Abscess Drainage
Pericardial Effusion Drainage
Pneumatocele and Bulla Drainage
SECONDARY PULMONARY ASPERGILLOMA
Endoluminal Tracheobronchial Stenting
RADIOFREQUENCY ABLATION OF LUNG LESIONS
VASCULAR INTERVENTIONS
Pulmonary Artery Embolization
Endovascular Therapy of SVC Obstruction
Percutaneous Vascular Foreign Body Retrieval
CONCLUSION
CHAPTER 170:
Chest X-ray Evaluation in Cardiac Disease
INTRODUCTION
CARDIAC SILHOUETTE
Cardiac Shape
Cardiac Contour
Posteroanterior (PA) View
Right Anterior Oblique View
Left Anterior Oblique View
Lateral View
Cardiac Size
Cardiac Volume
Assessment of Chamber Enlargement
Right Atrium
Left Atrium
Left Ventricle
Right Ventricle
Aorta
PULMONARY VASCULATURE
Normal Radiographic Anatomy
Increased Pulmonary Blood Flow (Pulmonary Plethora)
Radiological Signs of Plethora (Fig. 6)
Decreased Pulmonary Blood Flow (Pulmonary Oligemia)
Radiological Signs (Fig. 7)
Pulmonary Arterial Hypertension (Fig. 8)
Pulmonary Venous Hypertension
Stage 1: Redistribution/Cephalization of the Blood Flow (Fig. 9)
Stage 2: Interstitial Edema (Fig. 10)
Stage 3: Alveolar Edema (Fig. 11)
Asymmetrical Pulmonary Blood Flow (Fig. 12)
Orientation of Pulmonary Outflow Tract
CHAPTER 171:
Imaging in Ischemic Heart Disease
INTRODUCTION
PATHOPHYSIOLOGY OF ISCHEMIC HEART DISEASE
Myocardial Ischemia
Myocardial Viability and Myocardial Infarction (MI)
Rationale for Ischemia and Viability Imaging
Imaging Modalities
Echocardiography
Nuclear Imaging
Cardiac Magnetic Resonance
Imaging Sequences
Stress Cardiac Magnetic Resonance
Cardiac Magnetic Resonance for Viability
CMR for Myocardial Mass and Function
Other Useful Sequences
Multidetector Computed Tomography
Limitations of MDCT
Evaluation of Various Components of IHD
Coronary Artery Imaging
Plaque Imaging
Detection of Myocardial Ischemia
Myocardial Viability
Myocardial Function
FUTURE DIRECTIONS
Appropriateness Criteria for use of Cardiac MDCT and CMR in the Investigation of IHD
CONCLUSION
CHAPTER 172:
Imaging Approach in Children with Congenital Heart Disease
INTRODUCTION
PHYSICAL EXAMINATION
RADIOLOGICAL APPROACH
Chest Radiograph
Left-to-Right (L–R) Shunt
Large Aorta
Normal Aorta
Pretricuspid Shunt
Post-tricuspid L–R Shunt
Right-to-Left (R–L) Shunt
Large Aorta with Decreased Lung Vascularity
Small Aorta with Increased Vascularity
Large Pedicle with Increased Vascularity
Normal Aorta with Decreased Lung Vascularity
Other Conditions
MULTISLICE CARDIAC CT
CARDIAC MRI
Analyzing CT or MRI Images
Anatomy
Normal Connections
Cardiac Tumors
Follow-up after Surgery or after Endovascular Intervention
CARDIAC CATHETERIZATION
CHAPTER 173:
Imaging in Cardiomyopathies
INTRODUCTION
CLASSIFICATION
DIAGNOSTIC TECHNIQUES
DILATED CARDIOMYOPATHY
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Amyloidosis
Sarcoidosis
Siderotic (or Iron Overload) Cardiomyopathy
Endomyocardial Fibrosis
Anderson–Fabry Disease
Tuberculosis
Miscellaneous Myocardial Diseases
CONCLUSION
CHAPTER 174:
Imaging Evaluation of Cardiac Masses
INTRODUCTION
CLINICAL FEATURES
Imaging Techniques
Angiocardiography
ECHO
MDCT
MRI
MR Imaging Sequences for Evaluation of Cardiac Masses
Spin Echo (SE) Sequences
Gradient Echo (GRE) and Steady-state Free Precession Sequences
Contrast-enhanced Imaging
Other Techniques
Classification (Table 1)
NEOPLASTIC LESIONS OF THE HEART
Primary
Benign Tumors
Malignant Tumors
Sarcoma
Secondary Neoplasms
Paracardiac and Extracardiac Tumors
NON-NEOPLASTIC LESIONS
Thrombus
Aneurysm of Sinus of Valsalva (SOV)
Atrial Septal Aneurysm
Pleuropericardial Cyst
Infective Lesions
Valvular Vegetation
Hydatid Cyst
Tuberculoma
VARIANT AND NORMAL ANATOMICAL STRUCTURES SIMULATING A CARDIAC MASS
Pericardium
Left Atrium
Left Ventricle
Right Atrium
Right Ventricle
CONCLUSION
CHAPTER 175:
Imaging Diagnosis of Valvular Heart Disease
INTRODUCTION
AORTIC VALVULAR DISEASE
MITRAL VALVULAR DISEASE
TRICUSPID VALVULAR DISEASE
HEMODYNAMIC EFFECTS ON PULMONARY VASCULATURE
Associated Pulmonary Pathologies
Effects of Treatment during Follow-up
Heart Size
Left Atrial Size
Other Changes
ECHOCARDIOGRAPHY
Valvular Stenosis
Valvular Regurgitation
Infective Endocarditis
Prosthetic Valves
CARDIAC MAGNETIC RESONANCE IMAGING
Valve Leaflet Morphology
Valvular Stenosis
Valvular Regurgitation
Valve Endocarditis and Tumors
Prosthetic Valve
COMPUTED TOMOGRAPHY
ANGIOCARDIOGRAPHY
CONCLUSION
CHAPTER 176:
Imaging of the Pericardium
INTRODUCTION
ANATOMY
Transverse Sinus
Superior Aortic Recess
Inferior Aortic Recess
Right and Left Pulmonic Recesses
Oblique Sinus
Recesses of the Pericardial Cavity Proper
Right and Left Pulmonary Venous Recesses
Postcaval Recess
PHYSIOLOGY
CONGENITAL PERICARDIAL ANOMALIES
Pericardial Cysts
CONGENITAL ABSENCE OF THE PERICARDIUM
PERICARDIAL EFFUSION
Cardiac Tamponade
Pericarditis
Nonconstrictive Pericarditis
Constrictive Pericarditis
Pneumopericardium
PERICARDIAL TUMORS
Metastases
Primary Pericardial Tumors
CONCLUSION
CHAPTER 177:
Nuclear Medicine in CVS and Chest
INTRODUCTION
MYOCARDIAL PERFUSION IMAGING
Radiopharmaceuticals
Rationale of Myocardial Perfusion Imaging
Study Protocol for Stress MPI
Clinical Indications of Myocardial Perfusion Imaging
Detection of Coronary Artery Disease
Assessment of Prognosis and Risk Stratification
Evaluation of Myocardial Perfusion after Revascularization
Detection of Myocardial Viability
RADIONUCLIDE VENTRICULOGRAPHY
Patient Preparation
Data Acquisition
Interpretation
Clinical Application
Chemotherapy Toxicity
Coronary Artery Disease
Cardiomyopathy
CARDIAC POSITRON EMISSION TOMOGRAPHY
Clinical Application of Cardiac PET
Diagnosis of CAD
Assessment of Myocardial Viability
NEW DIRECTIONS IN NUCLEAR CARDIOLOGY
LUNG VENTILATION: PERFUSION IMAGING
Lung Perfusion Scan
Ventilation Scan
Interpretation of V-Q Scan for Pulmonary Embolism
Current Status and Future Developments in V-Q Imaging
POSITRON EMISSION TOMOGRAPHY IN LUNG CANCER
Patient Preparation for F-18 FDG Study
PET-CT in Solitary Pulmonary Nodules (SPN)
PET-CT in Staging Lung Cancer
Restaging and Assessment of Response to Therapy
PET in Radiotherapy Planning
CHAPTER 178:
Imaging of Aorta
INTRODUCTION
ANGIOGRAPHIC ANATOMY
Measurement (Diameter) of Aorta
Normal Anatomic Variations
Indications for Imaging the Aorta
IMAGING MODALITIES
Ultrasound (US)
Transesophageal Echocardiography (TEE)
Intravascular Ultrasound (IV US)
Computed Tomography (CT)
Conventional Technique
Spiral/Helical Technique
Limitations
Magnetic Resonance Imaging (MRI) and MR Angiography
Black-blood Imaging
White-Blood Imaging
Contrast MR Angiography
Catheter Angiography
Technique
Complications of Angiography
CONGENITAL AORTIC ANOMALIES
Aortic Arch Anomalies
Coarctation of Aorta
Associated Anomalies
Hemodynamics in Adults
Radiological Findings
Conventional X-ray Chest
Noninvasive Imaging
ACQUIRED AORTIC DISEASES
Aortic Aneurysms
Incidence
Classification
Growth Rates of Aneurysm and Risk of Rupture
Objectives of Imaging
Plain Radiography
Ultrasound (US)
Computed Tomography and Magnetic Resonance Imaging
Catheter Angiography
AORTIC DISSECTION
Classification
Imaging
Aortography
Computed Tomography
Precontrast Images
Postcontrast Images
Magnetic Resonance Imaging
TAKAYASU'S ARTERITIS
Types31
Imaging Findings
AORTIC TRAUMA
Grading of Aortic Injuries37
Imaging
Computed Tomography
Magnetic Resonance Imaging
ATHEROSCLEROSIS
Pathology
Imaging
Postoperative Aorta
CONCLUSION
CHAPTER 179:
Imaging of Peripheral Vascular Disease
INTRODUCTION
EVALUATION OF THE PERIPHERAL ARTERIAL SYSTEM
Imaging Modalities
Ultrasound and Doppler Scanning
Arterial Flow Patterns on Spectral Doppler
CT Angiography
MR Angiography
Conventional Angiography/DSA9,10
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
Clinical Features
Radiological Evaluation
Angiography
LOWER LIMB ARTERIOGRAPHY9
Arteritis9,10
Upper Extremities20,21
Treatment
Evaluation of Bypass Grafts10,22-24
Acute Limb Ischemia9,10,20,25
Etiology
Clinical Features
Imaging
Angiography
Thoracic Outlet Syndrome20,22,24
Clinical Features
Imaging
Aneurysms
Pseudoaneurysms
Vascular Malformations9,20,26,29
Capillary Malformations
Venous Malformations
Arteriovenous Malformations
Arteriovenous Fistulae23,24
Dialysis Fistulae
Trauma9,10,20,21
EVALUATION OF THE PERIPHERAL VEINS
Lower Extremity
Acute Deep Venous Thrombosis
Sonography and Color Doppler Flow Imaging
Color Doppler Flow Imaging
Upper Extremity DVT20,24,32,33
Acute Versus Chronic DVT
CT Venography33,34
MR and MR Venography33-36
Venography30,31,35
Chronic Venous Disease30,37,38
Imaging
Sonography
Perforating Veins
Venography
Venous Mapping
OTHER DISORDERS
Venous Aneurysms30,31
CONCLUSION
SECTION 7: MUSCULOSKELETAL AND BREAST IMAGING
CHAPTER 180:
Diagnostic Approach to Focal Bone Lesions: Conventional Radiography, Computed Tomography and Magnetic Resonance Imaging
INTRODUCTION
AGE OF THE PATIENT
LOCATION OF LESION (FIG. 1)
PATTERN OF BONE DESTRUCTION
Geographic Bone Destruction
Geographic Lesion with Sclerotic Margin
Geographic Lesion with No Marginal Sclerosis
Geographic Lesion with Ill-defined Margins
Moth-eaten Bone Destruction
Permeative Bone Destruction
Combination and Changing Pattern
MARGIN OF THE LESION AND RATE OF GROWTH
CORTICAL RESPONSE
MATRIX MINERALIZATION
Osseous Matrix
Cartilage Matrix
PERIOSTEAL REACTION
Continuous Periosteal Reaction
Interrupted Periosteal Reaction
Codman Angles
Buttresses
Truncated Lamellae
Complex Periosteal Reaction
SOFT TISSUE EXTENSION
MULTIPLICITY
MISCELLANEOUS
Septations (Table 2)
Saucerization
Floating Fragment Sign
BENIGN VERSUS MALIGNANT
COMPUTED TOMOGRAPHY ANALYSIS OF BONE LESIONS
MAGNETIC RESONANCE IMAGING OF BONE LESIONS11,12
CONCLUSION
CHAPTER 181:
Basic Principles and Current Concepts of Musculoskeletal Magnetic Resonance Imaging
INTRODUCTION
HARDWARE ISSUES
3T IMAGING
SEQUENCES
Fast Spin-echo Sequences
Gradient-recalled Echo Sequences
Fat Suppressed Sequences
Role of Contrast
Reduction of Metallic Artifact from Orthopedic Hardware
NORMAL APPEARANCE OF MUSCULOSKELETAL TISSUES
IMAGING OF ARTICULAR CARTILAGE
MORPHOLOGICAL ASSESSMENT OF CARTILAGE
COMPOSITIONAL ANALYSIS OF CARTILAGE
T2 Mapping
d-GEMRIC
T1ρ Mapping
MUSCULOSKELETAL TUMORS
USE OF ADVANCED MR TECHNIQUES IN TUMOR EVALUATION
Dynamic Perfusion Imaging
Proton Spectroscopy
Diffusion-weighted Imaging
MARROW IMAGING
MUSCULOSKELETAL INFECTIONS
INFLAMMATORY ARTHRITIS
INTERVENTIONAL MR IMAGING
CONCLUSION
CHAPTER 182:
Nuclear Medicine Imaging for Musculoskeletal Disorders
INTRODUCTION
BONE SCINTIGRAPHY
SPECT AND SPECT-CT
PET AND PET-CT
MUSCULOSKELETAL TUMOR IMAGING
Metastasis
Primary Malignant Tumors
Benign Tumors
INFECTION IMAGING
Acute and Chronic Osteomyelitis
Diabetic Foot
Prosthetic Infection
FDG PET-CT for Musculoskeletal Infection
MUSCULOSKELETAL TRAUMA
Stress Fractures
Shin Splints
Fractures in Childhood
Sport Injuries
METABOLIC BONE DISEASE IMAGING
Paget's Disease
Hyperparathyroidism
Renal Osteodystrophy
Osteoporosis and Osteomalacia
Bone Dysplasias
Avascular Necrosis
Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
JOINT IMAGING
FUTURE DIRECTION
CONCLUSION
CHAPTER 183:
Angiography and Interventions in Musculoskeletal Lesions
INTRODUCTION
TECHNIQUE
Diagnostic Angiography
Angioembolization
ANGIOGRAPHY IN BONE TUMORS
Osteochondroma
Osteoid Osteoma
Osteosarcoma
Giant Cell Tumor
Aneurysmal Bone Cyst
ANGIOGRAPHY IN BONE AND SOFT TISSUE LESIONS OF VASCULAR ORIGIN
Hemangioma
Hemangiopericytoma
Angiosarcoma
ANGIOGRAPHY IN METASTATIC TUMORS IN BONE AND SOFT TISSUES
ANGIOGRAPHY IN PERIPHERAL TRAUMA
IMAGE-GUIDED INTERVENTIONS IN BONE AND SOFT TISSUE LESIONS
Aspiration Cytology and Biopsy
Embolization
Preprocedural Preparations
Indications
Embolizing Materials
Complications
Contraindications
Intra-arterial Chemotherapy
Percutaneous Vertebroplasty
Technique
Results
Complications
Future Directions
Percutaneous Treatment of Disk Herniation
PERCUTANEOUS ABLATION OF BONE TUMORS
CHAPTER 184:
Tuberculosis of Bones and Joints
INTRODUCTION
ETIOPATHOGENESIS
Clinical Features
Radiological Features
TUBERCULOSIS OF JOINTS
Tubercular Arthritis
Hip
Knee
Ankle and Foot
Shoulder
Elbow
Wrist and Carpus
Sacroiliac Joints
TUBERCULOSIS OF LONG AND FLAT BONES
Tubercular Osteomyelitis
Pathology
Tuberculosis of Long Bones
Flat Bones
Ribs
Scapula
Sternum
Skull
Pelvis
Sternoclavicular Joint
Acromioclavicular Joint
TUBERCULOSIS OF SHORT BONES
Tuberculosis of Tendon Sheaths and Bursae
Atypical Mycobacterial Infection
Tubercular Infection of Prosthetic Joint
CONCLUSION
CHAPTER 185:
Nontubercular Bone and Joint Infections
INTRODUCTION
IMAGING MODALITIES
ACUTE OSTEOMYELITIS
Clinical Features
Radiologic Features
LOCALIZED OSTEOMYELITIS (BRODIE'S ABSCESS)
CHRONIC OSTEOMYELITIS
SCLEROSING OSTEOMYELITIS OF GARRE
SYPHILIS OF BONE
Congenital (Infantile) Syphilis
Late Congenital Syphilis
Acquired Syphilis
RUBELLA OSTEOMYELITIS
ACTINOMYCOSIS OF BONE
MADURAMYCOSIS
LEPROSY OF BONE
DIABETIC FOOT
HYDATID DISEASE
SEPTIC ARTHRITIS
CHAPTER 186:
Tuberculosis of the Spine
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
LABORATORY INVESTIGATIONS21-24
IMAGING MODALITIES
Conventional Radiographs
Nuclear Medicine Scintigraphy
Computed Tomography
Magnetic Resonance Imaging
IMAGING APPEARANCES
CONVENTIONAL RADIOGRAPHS
Paradiskal
Central
Anterior Subperiosteal
Appendiceal or Neural Arch Tuberculosis
Computed Tomography
Magnetic Resonance Imaging
Cord Changes
ATYPICAL SPINAL TUBERCULOSIS21
Post-treatment Follow-up
Conventional Radiographs
PET/CT65
Computed Tomography
Magnetic Resonance Imaging40,48,57
DIFFERENTIAL DIAGNOSIS
CHAPTER 187:
Noninfective Inflammatory Arthritis
INTRODUCTION
RHEUMATOID ARTHRITIS
Pathophysiology
Imaging
Radiographic Features
Late Changes
Axial Skeleton Involvement
OTHER IMAGING MODALITIES
Ultrasonography
Computed Tomography
Radionuclide Scanning
Magnetic Resonance Imaging
Synovial Imaging
Bone Marrow Edema
Erosions
Tendons and Ligaments
Large Joints
SCORING SYSTEMS FOR RA
JUVENILE IDIOPATHIC ARTHRITIDES
Juvenile-onset Adult Type (Seropositive) Rheumatoid Arthritis
Seronegative Chronic Arthritis
Radiologic Features
SERONEGATIVE SPONDYLOARTHROPATHIES
ANKYLOSING SPONDYLITIS
Pathophysiology
Radiologic Features
Sacroiliac Joints
Spine
Peripheral Joints
PSORIATIC ARTHROPATHY
Radiologic Features
REITER'S SYNDROME
ENTEROPATHIC SPONDYLOARTHROPATHY
CRYSTAL DEPOSITION ARTHROPATHY
Gout
Imaging
CALCIUM PYROPHOSPHATE DIHYDRATE CRYSTAL DEPOSITION DISEASE
CHAPTER 188:
Nontubercular Infections of the Spine
INTRODUCTION
PATHOGENESIS OF SPINAL INFECTIONS
IMAGING OF SPINAL INFECTIONS
Plain Radiography
Radioisotope Scanning
Computed Tomography
Myelography/CT Myelography
Magnetic Resonance Imaging
TYPES OF INFECTIONS
Pyogenic Bacterial Infections
Pyogenic Disc Space Infections
Spinal Infections in Children
Childhood Disc Infection or Discitis
Differential Diagnosis of Spinal Infection
Postoperative Spondylodiscitis
Epidural Space Infections
Nonpyogenic Bacterial Infections
Brucellosis
Actinomycosis
Nocardiosis
Viral Infections
Spinal Infections in AIDS
Fungal Infections
Aspergillosis
Coccidioidomycosis
Cryptococcosis (Torulosis)
Blastomycosis
Candidiasis (Moniliasis)
Parasitic Infections
Echinococcosis or Hydatid
Cysticercosis
CONCLUSION
CHAPTER 189:
Degenerative Disease of the Spine and Joints
INTRODUCTION
DEGENERATIVE DISORDERS OF THE SPINE
Imaging Modalities
Pathophysiology
Anatomy of Intervertebral Disk
Degenerative Disk Changes
Disk Herniation
Endplate Changes
Disease of Facets, Uncovertebral Joints and Ligaments
Spondylosis Deformans and Intervertebral Osteochondrosis
Complications of Degenerative Spinal Disease
Spinal and Foraminal Stenosis
Scoliosis and Kyphosis
Segmental Instability
Clinical Implications
DEGENERATIVE DISEASE OF JOINTS
Prevalence and Incidence of Osteoarthritis
Imaging Modalities
Pathogenesis
Systemic Risk Factors
Local Joint Vulnerabilities
Extrinsic Factors Acting on the Joint
Joint Overuse from Occupations and Athletics
Radiographic–Pathologic Correlation
HIP OSTEOARTHRITIS
Radiographic Views
Radiographic Appearance
Superior Migration Pattern
Medial Migration Pattern
Axial Migration Pattern
Rapid Destructive Osteoarthritis
KNEE OSTEOARTHRITIS
Radiographic Views
Radiographic Findings
Cartilage Space
Osteophytes
Subchondral Sclerosis
Malalignment
Differential Diagnosis
Radiographic Grading of Osteoarthritis
SHOULDER OSTEOARTHRITIS
ROTATOR CUFF TEAR ARTHROPATHY
HAND AND WRIST OSTEOARTHRITIS
Interphalangeal Joints
Thumb Base
Metacarpophalangeal Joints
Erosive (Inflammatory) Osteoarthritis
FOOT AND ANKLE OSTEOARTHRITIS
SECONDARY OSTEOARTHRITIS
CONCLUSION
CHAPTER 190:
Skeletal Disorders of Metabolic and Endocrine Origin
DISORDERS OF METABOLIC ORIGIN
RICKETS AND OSTEOMALACIA
Causes
Clinical Features
Biochemical Findings
Pathology of Rickets and Osteomalacia
Radiological Features
RICKETS
Signs of Healing Rickets
Sequelae
Etiologic Considerations of Rickets
ABNORMALITIES OF VITAMIN D METABOLISM
Renal Osteodystrophy
Hereditary Vitamin D-dependent Rickets
Type I VDDR
Type II VDDR
RICKETS AND OSTEOMALACIA SECONDARY TO PHOSPHATE LOSS
X-linked Hypophosphatemia
Clinical Features
Biochemical Findings
Radiological Features
Renal Tubular Acidosis
Type I (Distal) RTA
Type II (Proximal) RTA
Tumor-associated Rickets and Osteomalacia
Chemotherapeutic Drug-induced Rickets
SYNDROMES WITH THE RADIOGRAPHIC APPEARANCE OF RICKETS OR OSTEOMALACIA BUT WITHOUT ABNORMALITIES OF VITAMIN D METABOLISM OR RENAL TUBULAR DYSFUNCTION (PHOSPHATE LOSS)
Hypophosphatasia
Metaphyseal Chondrodysplasia (Schmid Type)
Atypical Axial Osteomalacia
OSTEOMALACIA
Radiological Changes
HYPERPARATHYROIDISM
Primary HPT
Secondary HPT
Tertiary HPT
Pathophysiology
Clinical Features
Biochemical Findings
Radiological Approach
Radiological Findings
BONE RESORPTION
Subperiosteal Resorption
Intracortical Bone Resorption
Endosteal Bone Resorption
Subchondral Bone Resorption
Subphyseal Bone Resorption
Subligamentous and Subtendinous Bone Resorption
Trabecular Bone Resorption
BROWN TUMORS
JOINT DISORDERS
OSTEOSCLEROSIS
RENAL OSTEODYSTROPHY
RENAL LESIONS
NEPHROCALCINOSIS
PARATHYROID LOCALIZATION
PREOPERATIVE LOCALIZATION TECHNIQUES
ANATOMICAL AND PATHOLOGICAL CONSIDERATION IMPORTANT FOR LOCALIZATION
Embryology and Anatomy
Surgical Treatment
Parathyroid Imaging
Sonographic Evaluation
Pitfalls in Interpretation
Percutaneous Aspiration/Biopsy
Contrast-enhanced Computed Tomography
Magnetic Resonance Imaging
Parathyroid Scintigraphy
Single Photon Emission Computed Tomography
HYPOPARATHYROIDISM
Clinical Presentation
Biochemical Findings
RADIOLOGICAL FINDINGS
PSEUDOHYPOPARATHYROIDISM
Clinical Findings
Biochemical Findings
Radiological Findings
PSEUDOPSEUDOHYPOPARATHYROIDISM
DISORDERS OF ENDOCRINE ORIGIN
HYPERCORTISOLISM
Radiological Findings
HYPOPITUITARISM
Radiological Findings
HYPOTHYROIDISM
Clinical Findings
Radiological Findings
HYPERTHYROIDISM
Clinical Findings
Biochemical Findings
Radiological Findings
HYPERGONADISM
HYPOGONADISM
Radiological Findings
Turner's Syndrome
GROWTH HORMONE DISORDERS
ACROMEGALY
Clinical Findings
Definitive Diagnosis
Radiological Findings
GIGANTISM
SCURVY
Clinical Findings
Biochemical Findings
Pathophysiology
Radiological Findings
FLUOROSIS
Clinical Findings
Radiographical Findings
CHAPTER 191:
Osteoporosis
DEFINITION
PATHOGENESIS
CLASSIFICATION
Primary Osteoporosis
Juvenile Osteoporosis
Endocrine Causes
Malignant Diseases
Immobilization
Drugs
Genetic Abnormalities in Bone Collagen Synthesis
Gastrointestinal Diseases
Organ Transplantation
CLINICAL FEATURES
INVESTIGATIONS
Bone Mineral Analysis
Standard Radiography
Radiogrammetry
Photodensitometry
Neutron Activation Analysis
Compton Scattering
Single Energy Photon Absorptiometry
Dual Energy Photon Absorptiometry
Dual Energy X-ray Absorptiometry
Quantitative Computed Tomography
Quantitative Ultrasound
High-resolution Bone Imaging
Magnetic Resonance Imaging
Trabecular Bone Assessment Using
Cortical Bone Assessment Using MRI
Clinical Applications
High-resolution Peripheral Quantitative Computed Tomography (HR-pQCT)
Multidetector CT (MDCT)
MANAGEMENT OF OSTEOPOROTIC COMPRESSION FRACTURES: PERCUTANEOUS VERTEBROPLASTY
Indications
Procedure
Postprocedure Care
Complications
CHAPTER 192:
Benign Bone Tumors and Tumor-like Conditions
INTRODUCTION
IMAGING MODALITIES
Radiography
Computed Tomography
Magnetic Resonance Imaging
BONE-FORMING TUMORS
Enostosis
Osteoma
Osteoid Osteoma
Osteoblastoma
CARTILAGE-FORMING TUMORS
Osteochondroma
Enchondroma
Chondroblastoma
Chondromyxoid Fibroma
FIBROUS TUMORS/LESIONS
Fibrous Cortical Defects and Nonossifying Fibroma
Fibrous Dysplasia
Osteofibrous Dysplasia
Desmoplastic Fibroma
VASCULAR AND CONNECTIVE TISSUE TUMORS
Hemangioma
Lipoma
OTHER TUMORS
Giant Cell Tumor
TUMOR-LIKE LESIONS
Simple Bone Cyst
Aneurysmal Bone Cyst
Eosinophilic Granuloma
Pseudotumor of Hemophilia
Brown Tumor of Hyperparathyroidism
CONCLUSION
CHAPTER 193:
Malignant Bone Tumors
INTRODUCTION
CLASSIFICATION OF PRIMARY MALIGNANT BONE TUMORS
General Principles of Diagnosis
Staging of Bone Tumors
IMAGING MODALITIES
Conventional Radiography
Magnetic Resonance Imaging
Computed Tomography
Nuclear Medicine
Angiography
Ultrasonography
OSTEOSARCOMA
Intraosseous Osteosarcoma
Clinical Presentation
Imaging Features
Surface Osteosarcomas
Periosteal Osteosarcoma20
Juxtacortical/Parosteal Osteosarcoma
High-grade Surface Osteosarcoma
Extraosseous Osteosarcoma
Primary Multifocal Osteosarcoma24
Secondary Osteosarcoma
CHONDROSARCOMA
Clinical Presentation
Imaging Features27, 28
Other Varieties of Chondrosarcoma
FIBROSARCOMA
Clinical Presentation
Imaging Features32
MALIGNANT FIBROUS HISTIOCYTOMA12
Clinical Presentation
Imaging Features32
MALIGNANT ROUND CELL TUMORS (MRCT)
EWING'S SARCOMA33
Clinical Presentation
Imaging Features34
Primitive Neuroectodermal Tumor of Bone (PNET)12
Non-Hodgkin's Lymphoma of Bone38 (Lymphosarcoma, Reticulum Cell Sarcoma)
Clinical Presentation
Imaging Features
Hodgkin's Lymphoma of Bone
Imaging Features
CHORDOMA
Clinical Presentation
Imaging Features
LIPOSARCOMA
VASCULAR TUMORS OF THE BONE
Angiosarcoma
Hemangioendothelioma
MALIGNANT GIANT CELL TUMOR
ADAMANTINOMA OF LONG BONES41
Clinical Presentation
Imaging Features
MULTIPLE MYELOMA
Clinical Presentation
Imaging Features
PLASMACYTOMA (SOLITARY MYELOMA)
Clinical Presentation
Imaging Features
POEMS Syndrome
METASTATIC BONE DISEASE
Clinical Presentation
Imaging Features
Differential Diagnosis
CONCLUSION
CHAPTER 194:
Magnetic Resonance Imaging of the Knee
INTRODUCTION
IMAGING PROTOCOLS/TECHNICAL FACTORS
Patient Positioning
Slice Thickness
Imaging Planes and Pulse Sequences
MENISCI
Normal Anatomy
Microanatomy of the Menisci
Macroanatomy and MRI Appearance
Medial Meniscus
Lateral Meniscus
Anatomic Variants
Discoid Meniscus
Meniscus Flounce (Buckled Meniscus)
Meniscal Ossicle
ABNORMAL MENISCUS
Meniscal Degenerations and Tears
MR Grading of Meniscal Tears
Abnormal Morphology
CLASSIFICATION OF MENISCAL TEARS
Horizontal Tears
Radial/Free Edge Tears
Longitudinal Tears
Peripheral Tear
Meniscocapsular Separation
IMAGING CHALLENGES
Potential Pitfalls
Transverse Intrameniscal Ligament
Meniscofemoral Ligaments
Popliteus Tendon
Magic Angle Effect
Pulsation Artifact from the Popliteal Artery
Surgical Considerations in Meniscal Tear
Tear Location
Tear Morphology and Length
Accuracy of MR in the Diagnosis of Meniscal Tears
LIGAMENTS AND TENDONS OF THE KNEE
CENTRAL STRUCTURES OF THE KNEE
Anatomy of Anterior Cruciate Ligament
MR Appearance of ACL
ACL Tears
Indirect Signs of ACL Tear
Accuracy of MR in ACL Tears
Posterior Cruciate Ligament
Anatomy of the PCL
MR Appearance of PCL
MEDIAL STRUCTURES OF THE KNEE
Anatomy
Magnetic Resonance Imaging
MCL Injury
POSTEROMEDIAL STRUCTURES OF THE KNEE
Anatomy
Magnetic Resonance Imaging
POSTEROLATERAL CORNER OF THE KNEE
Anatomy
Magnetic Resonance Imaging
POSTERIOR STRUCTURES OF THE KNEE
Anatomy
Magnetic Resonance Imaging
KNEE DISLOCATIONS
Magnetic Resonance Imaging
ANTEROLATERAL CORNER OF THE KNEE
Normal Anatomy
Iliotibial Band Injury
Segond Fracture
Iliotibial Band Friction Syndrome
ANTERIOR STRUCTURES OF THE KNEE OR THE EXTENSOR MECHANISM OF THE KNEE
Anatomy
Patellar Tendinosis (Jumper's Knee)
Acute Patellar Tendon Disruption
Patellar Tendon–Lateral Femoral Condyle Friction Syndrome
PATELLOFEMORAL JOINT
Patellofemoral Joint Anatomy
Femoral Trochlear Groove
Patella Alta and Patella Baja
KINEMATIC MR IMAGING
Techniques
Incremental, Passive Positioning Technique
Active Movement or Dynamic Technique
Motion Triggered Cine Technique
Active Movement, Loaded Technique
MR IMAGING OF THE ARTICULAR CARTILAGE
Articular Cartilage Structure and Damage
MRI of Articular Cartilage
MRI Assessment of Articular Cartilage Injury
QUANTITATIVE CARTILAGE MR IMAGING
Chondromalacia Patellae
Osteoarthritis
EVALUATION OF THE SYNOVIUM
Rheumatoid Arthritis
Tuberculosis of the Knee
Juvenile Rheumatoid Arthritis
Pigmented Villonodular Synovitis
Hemophilia
Synovial Chondromatosis of the Knee
Deferiprone-induced Arthropathy
MR IMAGING OF BONE MARROW ABNORMALITIES OF THE KNEE
Trauma
Acute and Chronic Avulsive Injuries
Fatigue and Insufficiency Fractures
Stress Fractures
Spontaneous Osteonecrosis
Medullary Infarction
Osteochondritis Dissecans
Transient Bone Marrow Edema Syndrome (Transient Osteoporosis)
Reflex Sympathetic Dystrophy
Infection
Bone Neoplasms
MR ARTHROGRAPHY
Technique
Meniscal Lesions
Cartilage Lesions
Osteochondritis Dissecans
Intra-articular Bodies
Plica Synovialis
POSTOPERATIVE EVALUATION OF THE KNEE
Imaging of the ACL Graft
Graft Rupture
Graft Impingement
Arthrofibrosis
Postoperative Meniscus
Postoperative Articular Cartilage
CONCLUSION
CHAPTER 195:
Magnetic Resonance Imaging of Hip and Pelvis
INTRODUCTION
NORMAL ANATOMY
TECHNIQUE
HIP AND PELVIS: EVALUATION OF STRUCTURES
Coronal (Figs 7A and B)
Osseous Structures
Nonosseous Structures
Axial (Figs 8A to C)
Osseous Structures
Nonosseous Structures
Sagittal
AVASCULAR NECROSIS
Cause and Pathogenesis
Presentation
MRI OF AVN
Magnetic Resonance Imaging and Prognostic Indicators
Pitfalls in Diagnosis20
Staging
Study Choice and Work-up
Prognosis
MONITORING OF TREATMENT
MINIMAL AVN
BONE MARROW EDEMA SYNDROME
Insufficiency or Stress Fractures of the Femoral Head
Femoral Head Osteonecrosis and BMEs
FEMOROACETABULAR IMPINGEMENT
Cam Impingement
Pincer Impingement
HERNIATION PITS
FRACTURE
Magnetic Resonance Imaging
STRESS FRACTURES
OSTEOCHONDRAL INJURY41,42
TRAUMATIC MUSCULOTENDINOUS INJURIES43,44
Avulsion Injury
Muscle Contusions
Muscle Strain—Myotendinous Strain
Gluteus Medius Tendon Tear—Greater Trochanteric Pain Syndrome
LABRUM
BURSAE
PIRIFORMIS SYNDROME
MAGNETIC RESONANCE IN POSTARTHROPLASTY
ARTHRITIS
Pigmented Villonodular Synovitis (PVNS)
Magnetic Resonance Imaging
Primary Synovial Chondromatosis
Magnetic Resonance Imaging
Amyloid Arthropathy
INFECTION
Magnetic Resonance Imaging
NERVES
MARROW REPLACEMENT PROCESSES
TUMORS
Osteoid Osteoma
Magnetic Resonance Imaging
Chondroblastoma
Magnetic Resonance Imaging
Chondrosarcoma
Magnetic Resonance Imaging
Chordomas
Magnetic Resonance Imaging
CONCLUSION
CHAPTER 196:
Magnetic Resonance Imaging of Shoulder and Temporomandibular Joints
SHOULDER JOINT
MR IMAGING PROTOCOLS
MR ARTHROGRAPHY
NORMAL ANATOMY
OSSEOUS STRUCTURES
LIGAMENTS
MUSCULOTENDINOUS ANATOMY
BURSAE
NORMAL MR APPEARANCE
Axial Sections (Figs 1 and 4)
Coronal Sections (Figs 2 and 4)
Sagittal Sections (Figs 3 and 4)
SHOULDER IMPINGEMENT SYNDROME
Primary Extrinsic Impingement
Secondary Extrinsic Impingement
Internal Impingement
ROTATOR CUFF TENDINOPATHY AND TEARS
MR Appearance
INSTABILITY
Imaging Techniques for Labral Tears
MR Findings in Patients with Instability
Pitfalls
ABNORMALITIES OF BICEPS TENDON
Bicipital Tendinopathy/Rupture
Bicipital Tendon Dislocations
NERVE ENTRAPMENT SYNDROMES
Quadrilateral Space Compression Syndrome
Suprascapular Nerve Entrapment
ADHESIVE CAPSULITIS
CALCIFIC TENDINITIS
ARTHRITIS
OSTEOARTHRITIS
INFECTIVE ARTHRITIS
RHEUMATOID ARTHRITIS
AVASCULAR NECROSIS
NEOPLASMS
TEMPOROMANDIBULAR JOINT
MR Imaging Technique
NORMAL ANATOMY AND MR APPEARANCE (FIGS 34 TO 37)
Normal MR Appearance
Movements
DISEASES OF TEMPOROMANDIBULAR JOINT
INTERNAL DERANGEMENT
DISK DISPLACEMENTS
DISK DEFORMITY AND OSTEOARTHRITIS
STUCK DISK
OPEN LOCK JAW
OSTEONECROSIS AND OSTEOCHONDRITIS DISSECANS
POSTOPERATIVE IMAGING
EVALUATION OF MANDIBULAR ASYMMETRY
INFECTIONS AND ARTHRITIDES
TUMORS AND TUMOR-LIKE CONDITIONS
CHAPTER 197:
Magnetic Resonance Imaging in Bone Marrow Disorders
INTRODUCTION
DISTRIBUTION OF NORMAL BONE MARROW AND NORMAL CONVERSION
MR IMAGING TECHNIQUES FOR EVALUATION OF NORMAL BONE MARROW
RECENT ADVANCES IN MR IMAGING OF BONE MARROW
Dynamic Contrast-enhanced MR Imaging and Bone Marrow Perfusion
CONTRAST-ENHANCED MR IMAGING OF THE BONE MARROW USING IRON OXIDE PARTICLES
MR SPECTROSCOPY
WHOLE BODY MRI
3T MRI
COMBINED PET AND MR IMAGING
NORMAL MR APPEARANCES OF BONE MARROW
IMAGING OF BONE MARROW DISORDERS
Reconversion of Fatty Marrow to Hematopoietic Marrow
Marrow Replacement or Infiltration
Myeloid Depletion
Depletion of Myeloid Elements with Fibrosis
Differential Diagnosis of Gaucher's Disease and Hemosiderosis
Deposition of Metabolic Products
MR IMAGING OF THERAPY-INDUCED CHANGES OF BONE MARROW
CHANGES IN MARROW SIGNAL DUE TO CHEMOTHERAPY
NEW THERAPY REGIMENS
BONE MARROW TRANSPLANTATION
FOCAL DISORDERS OF THE BONE MARROW
CONCLUSION
CHAPTER 198:
Radiological Evaluation of Appendicular Trauma
INTRODUCTION
CLINICAL EVALUATION
RADIOLOGICAL EVALUATION
Definitions and Classification
Osseous Evaluation
Presence or Absence of Bony Injury
Anatomic Location and Extent of the Fracture
Types of Fracture
Direction of Fracture Line
Spatial Relationship of the Fragments
Presence of Special Features
Presence of Associated Abnormalities of the Adjacent Joints
Presence of Special Types of Fractures
Involvement of Growth Plate/Physis: Seen in Children
Soft-tissue Evaluation
FRACTURE HEALING
COMPLICATIONS OF FRACTURE
Immediate Complications
Intermediate Complications
Delayed Complications
Imaging Modalities
UPPER LIMB TRAUMA
Dislocation of the Shoulder
Fracture of Neck of Humerus
Fracture of Shaft of Humerus
Fracture of Distal Humerus
Dislocation of the Elbow
Fracture of the Head and Neck of Radius
Fracture of Upper End of Ulna
Fractures of the Shaft of the Radius and Ulna
Fractures of Distal End of Radius
Fractures of the Carpal Bones
Dislocation of the Wrist
Single Carpal Dislocations
Multiple Carpal Dislocations
Fractures and Dislocations of the Hand
LOWER LIMB TRAUMA
Dislocations of the Hip
Posterior Dislocation
Anterior Dislocation
Fractures of the Proximal Femur
Intracapsular Fractures
Extracapsular Fractures
Fractures of the Shaft of Femur
Fractures of the Patella
Dislocation of the Patella
Fractures of the Proximal Tibia
Fractures of Shaft of Tibia and Fibula
Fractures of the Distal Tibia and Fibula
Fractures of the Talus
Fractures of the Calcaneum
Dislocations of the Foot
CONCLUSION
CHAPTER 199:
Imaging of Soft Tissue Lesions
INTRODUCTION
IMAGING MODALITIES
Plain Radiography
Ultrasonography
Magnetic Resonance Imaging
MR Spectroscopy
Staging
Location
Computed Tomography
PET-CT
SOFT TISSUE LESIONS
ARTIFACTS
CALCIFICATION AND OSSIFICATION IN SOFT TISSUES
Metastatic Calcification
Dystrophic Calcification
Metabolic Diseases
Collagen Vascular Diseases
Dermatomyositis
Parasitic Infestations
Vascular Calcification
Idiopathic Calcification
Idiopathic Calcinosis Universalis
Calcinosis Circumscripta
Tumoral Calcinosis
OSSIFICATION
Myositis Ossificans
Myositis Ossificans Progressiva (Fibrodysplasia Ossificans Progressiva)
Soft Tissue Masses with Calcification/Ossification
AREAS OF DECREASED DENSITY
Air in the Soft Tissues
Air Leaks (Surgical Emphysema)
Air Formed within the Soft Tissues
Air Introduced from Outside
FAT IN THE SOFT TISSUES
SOFT TISSUE MASSES
Cystic Soft Tissue Lesions
Bursae
Cystic Masses around the Knee
Inflammatory Lesions
Soft Tissue Tumors
Adipocytic Tumors
Vascular Lesions
Hemangioma
Soft Tissue Angiosarcoma
Vascular Malformations
High-flow Vascular Malformations
Low-flow Vascular Malformations
Fibroblastic/Myofibroblastic Tumors
Fibrohistiocytic Tumors
Dermatofibrosarcoma Protuberans
Malignant Fibrous Histiocytoma
Smooth Muscle Tumors
Leiomyoma
Leiomyosarcoma
Skeletal Muscle Tumors
Rhabdomyosarcoma
Pericytic Tumors
Chondro-osseous Tumors
Mesenchymal Chondrosarcoma
Extraskeletal Osteosarcoma
Tumors of Uncertain Origin
Synovial Sarcoma
Miscellaneous
Neurogenic Tumors
EXTRASKELETAL EWING'S SARCOMA AND PRIMITIVE NEUROECTODERMAL TUMOR
SUMMARY
ACKNOWLEDGMENT
CHAPTER 200:
A Systematic Approach to Imaging of Breast Lesions
INTRODUCTION
IMAGING TECHNIQUES
Mammography (Basic Physics, Equipment and Technique)
RADIATION DOSE
Mammography Projections
Supplementary Views
NORMAL MAMMOGRAPHIC ANATOMY
Interpretation and Reporting of Mammograms
Mass
Calcification
ARCHITECTURAL DISTORTION
FOCAL ASYMMETRY
BREAST EDEMA
Abnormal Axillary Lymph Nodes
AMERICAN COLLEGE OF RADIOLOGY BI-RADS ASSESSMENT CATEGORIES
Mammographic Assessment is Incomplete
Category 0
Mammographic Assessment is Complete: Final Categories
Category 1
Category 2
Category 3
Management of Probably Benign Lesions
Category 4
Category 5
Category 6
Indications for Mammography
DIGITAL MAMMOGRAPHY
FULL FIELD DIGITAL IMAGING
Advantages and Applications of the Digital Mammography
Computer-aided Detection
Digital Breast Tomosynthesis
CONTRAST-ENHANCED DIGITAL MAMMOGRAPHY
BREAST ULTRASOUND
Technique
Normal Anatomy
Indications for Breast Ultrasound
ACR BI-RADS Ultrasound Lexicon Descriptors
Challenges in Assigning Final Assessment Categories and the Influence of Clinical Factors
Contrast-enhanced Ultrasound
Ultrasound Elastography
DYNAMIC CONTRAST-ENHANCED BREAST MRI
Basic MR Technique for Breast Cancer Imaging
Coils and Patient Positioning
MR Field Strength
Imaging Protocols
Plane of Imaging
Fat Suppression
Nongadolinium-enhanced Sequences
Kinetic Analysis
Normal MRI Appearances
Interpretation of Breast MRI
Mass
Nonmass like Enhancement
Distribution
Internal Enhancement Pattern
FOCUS
ASSOCIATED FINDINGS
Kinetic Curve Assessment
Sensitivity and Specificity of MRI
Indications for MRI
PROTON MR SPECTROSCOPY
DIFFUSION-WEIGHTED IMAGING
NUCLEAR MEDICINE IN BREAST IMAGING
Breast-specific Gamma Imaging
Positron Emission Tomography
Limitations
Positron Emission Mammography
CHAPTER 201:
Benign and Malignant Lesions of the Breast
INTRODUCTION
PROLIFERATIVE BENIGN LESIONS OF THE BREAST
Fibrocystic Disease
Adenosis
Fibroadenoma
Cysts
Intraductal Papilloma
Duct Ectasia
Ductal Epithelial Hyperplasia
MISCELLANEOUS BENIGN BREAST CONDITIONS
Lipoma
Fat Necrosis
Galactocele
Radial Scar
Hamartoma
Pseudoangiomatous Stromal Hyperplasia
Desmoid Tumor
Diabetic Mastopathy
Superficial Thrombophlebitis (Mondor's Disease)
Breast Infections
Breast Tuberculosis
Breast Implants
MALIGNANT LESIONS OF THE BREAST
Risk Factors for Breast Cancer
Diagnosis of the Breast Cancer
BREAST CANCER SCREENING
Mammography Screening
MRI Screening
Ultrasound Screening
Breast Cancer Screening in Developing Countries
IMAGING FEATURES OF BREAST CANCER
Preinvasive Breast Lesions
Ductal Carcinoma in Situ
Lobular Carcinoma in Situ
Invasive Breast Cancer
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Medullary Carcinoma
Mucinous Carcinoma
Tubular Carcinoma
Papillary Carcinoma
Triple Negative Breast Cancer
STAGING AND TREATMENT OF BREAST CANCER
Preoperative Breast Imaging
Breast Conservation Therapy
Mastectomy
Management of Axilla
Perioperative Breast Imaging
Adjuvant Treatment
ADVANCED BREAST CANCER
Locally Advanced Breast Cancer
Inflammatory Breast Cancer
Neoadjuvant Chemotherapy
Metastatic Breast Cancer
Occult Primary Breast Cancer
POST-TREATMENT BREAST IMAGING AND FOLLOW-UP
MISCELLANEOUS MALIGNANT LESIONS OF THE BREAST
Paget's Disease
Phyllodes Tumor
Sarcoma
Metastases to Breast
Male Breast Cancer
CHAPTER 202:
Breast Interventions
INTRODUCTION
BREAST BIOPSY
BREAST BIOPSY TECHNIQUES
Surgical Biopsy
Fine Needle Aspiration Cytology
Core Needle Biopsy
Vacuum-assisted Biopsy
Advantages of VAB
Marker Clip Placement with VAB
Disadvantages of VAB
Complete Lesion Removal with VAB
Lesion Selection for Breast Biopsy
Selection of Guiding Modality
Prebiopsy Assessment
Ultrasound-guided Breast Biopsy
Technique
Stereotactic Breast Biopsy
Equipment
Technique
Specimen Radiography
Postbiopsy Care
COMPLICATIONS OF BREAST BIOPSY
MRI-guided Breast Biopsy
Histopathological Correlation
PREOPERATIVE HOOKWIRE LOCALIZATION
Equipment
Technique
Specimen Radiography
Complications
Special Techniques of Localization
MISCELLANEOUS BREAST INTERVENTIONS
Ductography
Cyst Aspiration
Ultrasound-guided Axillary Lymph Node FNAC
ABLATIVE PROCEDURES FOR BREAST CANCER
CHAPTER 203:
PET-CT in Management of Breast Cancer
INTRODUCTION
PRIMARY MALIGNANCY
POSITRON EMISSION MAMMOGRAPHY
LOCOREGIONAL STAGING
FDG-PET-CT for Axillary Disease
FDG-PET-CT for Other Regional Lymph Nodes
SYSTEMIC STAGING
Distant Metastasis
Bone Metastasis
18 F-Fluoride PET-CT for Bone Metastasis
RESPONSE TO CHEMOTHERAPY
Neoadjuvant Chemotherapy
Adjuvant Chemotherapy in Metastatic Disease
RESTAGING
Prognostication
RECEPTOR IMAGING
FUTURE DIRECTIONS
CONCLUSION
INDEX
TOC
Index
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