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MRI of the Elbow

1. Name the labeled structures of the elbow shown on magnetic resonance imaging (MRI) in Figures 53-1 and 53-2 . 2. What are the three articulations of the elbow? The radiocapitellar, ulnotrochlear, and proximal radioulnar joints. The three articulations are within a common joint capsule and work together as a hinge, allowing flexion/extension at the elbow and supination/pronation of the forearm. 3 What is the common…

MRI of the Shoulder

1 Describe the imaging planes used for evaluating the shoulder on a magnetic resonance imaging (MRI) examination. How should the patient be positioned in the scanner? Oblique coronal, oblique sagittal, and axial planes are routinely used ( Figure 52-1 ). Oblique coronal and sagittal sequences are obtained perpendicular and parallel to the glenoid articular surface, respectively. While the patient is supine on the scanner table, the…

Imaging of Musculoskeletal Tumors

1 What radiographic features are considered when evaluating a suspected bone tumor? When evaluating a suspected bone tumor, morphologic features, location in a bone (epiphysis, metaphysis, diaphysis), distribution within the skeleton (axial vs. appendicular), presence of tumor matrix, periosteal reaction, and/or presence of a soft tissue mass are considered. Morphologic features to consider are the pattern of bone destruction and the size, shape, margins, and zone…

Imaging of Musculoskeletal Infection

1 What is the role of imaging in the diagnosis of musculoskeletal infection? Imaging examinations can help to diagnose the presence of and delineate the extent of infection involving the soft tissues or bone. However, radiologists rely on correlative clinical findings including history and physical examination findings and laboratory testing results to help establish the diagnosis of infection. The diagnosis of musculoskeletal infection is a collaborative…

Imaging of Arthritis

1 What kinds of joints exist? Joints can be categorized based upon their structure and function. Fibrous joints such as the skull sutures (synarthrosis) demonstrate minimal to no mobility. Cartilaginous joints such as the intervertebral discs (amphiarthrosis) are slightly more mobile. Synovial joints (diarthrosis) are freely mobile. 2 What are the advantages and disadvantages of the common imaging modalities used to evaluate arthritis? Conventional radiography is…

Imaging of Metabolic Bone Disease

1 What is osteoporosis? How does it differ from osteopenia, osteomalacia, and osteosclerosis? Osteoporosis is characterized by diminished bone density with otherwise normal bone architecture. The main radiographic finding is cortical thinning. Loss of bony trabeculae may also be seen. Osteomalacia is characterized by normal bone density in the setting of abnormal quality of the bone, leading to excess non-mineralized osteoid. In a growing child, this…

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)…