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Imaging of Nontraumatic Spinal Disorders

1 What are the indications, advantages, and disadvantages of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of the spine? Radiography of the spine may be obtained to assess for vertebral alignment, fractures including compression deformities, and degenerative changes and as part of the workup for back pain. It may also be obtained to assess spinal alignment and hardware appearance after spinal…

Imaging of Spinal Trauma

1 What are the roles of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of spinal trauma? When it comes to spinal trauma evaluation, CT has largely replaced radiography given its higher sensitivity for detection of underlying injury. However, radiography is sometimes still obtained for initial evaluation and is widely used to monitor the treatment and healing of spinal injuries. MRI is…

Imaging of Extremity Trauma

1 What is the role of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of extremity trauma? Radiography remains the mainstay for the assessment of acute skeletal trauma with the exception of cervical spine trauma, which is now usually evaluated with CT. Properly positioned radiographs allow for accurate characterization of a large variety of appendicular skeletal injuries. Comparison radiographs of the asymptomatic…

Head and Neck Imaging, Part 2

1 What is the drainage pathway for the maxillary, frontal, and anterior ethmoid air cells? The ostiomeatal complex is the common drainage pathway for the paranasal sinuses. It refers to the uncinate process, a small bone, and the spaces around it through which mucus and secretions drain, including the maxillary sinus ostium, the infundibulum, the hiatus semilunaris, and the middle meatus ( Figure 44-1 ). The…

Head and Neck Imaging, Part 1

1 The hyoid bone divides the neck into what two distinct regions? The hyoid bone divides the neck into the suprahyoid neck (extending from the skull base to the hyoid bone) and the infrahyoid neck (extending from the hyoid bone to the cervicothoracic junction) ( Figure 43-1 ). The hyoid bone is a logical dividing point because its fascial attachments functionally cleave the neck into these…

Advanced Neurospinal Imaging

1 Identify parts of the spine labeled in Figure 42-1 . For the answer, see the figure legend. 2 What imaging modalities are most often used in the evaluation of spine pathology? Radiography, computed tomography (CT), magnetic resonance imaging (MRI), myelography, discography, magnetic resonance angiography (MRA), computed tomographic angiography (CTA), and conventional angiography are utilized for spinal imaging. 3 Describe the strengths, weaknesses, and most appropriate…

Brain Imaging : Inflammatory, Infectious, and Vascular Diseases

1 How is multiple sclerosis (MS) diagnosed? MS is the most common cause of acquired demyelinating disorders. The disease has a characteristic relapsing-remitting course and usually manifests between the third and fifth decades of life with a female predominance. On magnetic resonance imaging (MRI), the demyelinating lesions of MS are ovoid and hyperintense (bright) in signal intensity on T2-weighted images and occur predominantly in the white…

Brain Imaging: Anatomy, Trauma, and Tumors

1 Identify the normal parts of the brain labeled 1 through 6 in Figure 40-1 . For the answer, see the figure legend. 2 What imaging modalities can be used to evaluate the brain? The two major noninvasive cross-sectional imaging modalities used in neuroimaging are computed tomography (CT) and magnetic resonance imaging (MRI). Catheter angiography, also known as digital subtraction angiography (DSA) or conventional angiography, is…

Imaging of the Male Pelvis

Prostate Gland and Seminal Tract 1 What is the normal anatomy and imaging appearance of the prostate gland and seminal tract on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI)? The prostate gland is an extraperitoneal fibromuscular gland surrounding the prostatic urethra at the bladder base. It is separated into a peripheral zone posteriorly, and a central zone and transitional zone more anteriorly. These…

Imaging of the Female Pelvis

1 What is the first-line imaging modality of the female pelvis and why? Common indications for pelvic imaging in a female patient include pelvic pain, pelvic masses, and abnormal bleeding. Ultrasonography (US) is the imaging modality of choice for evaluating the female pelvis because it offers excellent visualization of the pelvic organs. It is also fast, inexpensive, and portable and requires no intravenous or oral contrast…

CT and MRI of the Retroperitoneum

1 What are the boundaries of the retroperitoneum? The retroperitoneum is bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia and extends from the diaphragm to the pelvic brim. 2 What are the compartments of the retroperitoneum and their contents? The anterior pararenal space, perirenal space, and posterior pararenal space are the main retroperitoneal compartments, which are separated from each other by…

CT and MRI of the Adrenal Glands

1 What are common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the adrenal glands? The most common clinical indications include: Characterization of indeterminate adrenal lesions incidentally detected on prior cross-sectional imaging. The main goal in this situation is to determine whether an adrenal lesion represents a benign lesion, such as an adenoma, or a malignant lesion. Detection and characterization of culprit adrenal…

CT and MRI of the Kidney

1 What are the common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the kidneys? The most common clinical indications include: Characterization of indeterminate renal lesions detected on prior cross-sectional imaging. This is done most frequently to distinguish a benign lesion such as a renal cyst from a malignant primary or metastatic neoplasm. Surveillance of patients with genetic syndromes who are at increased…

Genitourinary Tract Fluoroscopy

1 What are genitourinary fluoroscopic examinations? Genitourinary fluoroscopic examinations are studies that require “real-time” observation using fluoroscopy so that maximal information is obtained about the anatomy and function of the structure being studied. A radiographic iodinated contrast agent is injected into the various portions of the genitourinary tract for these examinations. Examples include retrograde pyelography to evaluate the upper urinary tract, cystography or voiding cystourethrography (VCUG)…

Urography

1 What is a urogram? A urogram is an imaging study that is used to evaluate both the anatomy and physiology of the urinary tract. The major indications for urography are to evaluate patients with gross or microscopic hematuria, history of urothelial carcinoma, urinary tract stones, and suspected post-surgical or post-traumatic ureteral leaks. 2 What are the different ways a urogram can be performed? There are…

CT and MRI of the Acute Abdomen and Pelvis

1 Why is computed tomography (CT) commonly used initially for diagnostic purposes in patients with an acute abdomen or pelvis? Accurate and timely diagnosis of life-threatening disease involving the abdomen and pelvis is essential to decrease potential morbidity and mortality. Clinical evaluation is sometimes difficult, and laboratory analysis and radiographic findings are not always useful in diagnosing the condition at hand. CT imaging of the abdomen…

CT and MRI of the Peritoneum, Omentum, and Mesentery

1 What is the peritoneum? The peritoneum is the largest and most complexly arranged serous membrane in the body. It is closed in men and open to the ends of the fallopian tubes in women. The parietal layer lines the abdominal wall, whereas the visceral layer lines the visceral organs. It contains a potential space, the peritoneal space, which normally contains a small amount of fluid.…

CT and MRI of the Pancreas

1 What are the general indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the pancreas? CT and MRI are commonly used to assess the extent and severity of disease in patients suspected of having pancreatitis, to evaluate for associated complications of pancreatitis, and to provide guidance for percutaneous drainage of peripancreatic fluid collections or percutaneous biopsy of pancreatic lesions. They are also useful…

CT and MRI of the Spleen

1 What is the normal CT and MRI appearance of the spleen? The normal spleen has homogeneous soft tissue attenuation on unenhanced CT, usually 5 to 10 HU less than liver, and appears slightly hypointense on T1-weighted images and hyperintense on T2-weighted images relative to liver ( Figure 29-1 ). It is typically less than 13 cm in craniocaudal dimension and has an average volume of ≈225 ml in…

CT and MRI of the Liver, Gallbladder, and Biliary Tract

1 What are the common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the liver, gallbladder, and biliary tree? The most common clinical indications include: Characterization of indeterminate hepatic lesions detected on prior cross-sectional imaging. Surveillance of cirrhotic patients for hepatocellular carcinoma (HCC). Surveillance of patients with primary sclerosing cholangitis (PSC) for cholangiocarcinoma. Staging and response assessment of patients with hepatobiliary malignancies. Pretreatment…