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Advanced Fetal Ultrasonography and Therapy

1 What is a “level II” obstetric ultrasound examination, and what elements of fetal anatomy are included? A level II obstetric ultrasound examination is a comprehensive real-time ultrasonography (US) evaluation of fetal anatomy to detect fetal anomalies, whereas a level I obstetric ultrasound is a more general evaluation to detect obstetric problems. For the elements of fetal anatomy that are included in a level II obstetric…

Obstetric Ultrasonography in the Second Trimester

1 What are the indications for obstetric ultrasonography (US) in the second (and third) trimester? There are numerous indications for US imaging in the second (and third) trimester, the most common ones including screening evaluation of fetal anatomy; screening for fetal anomalies; estimation of gestational age; and evaluation of fetal growth, fetal well-being, fetal presentation, cervical insufficiency, amniotic fluid status, placental location, and vaginal bleeding. In…

Obstetric Ultrasonography in the First Trimester

1 What are the indications for ultrasonography (US) in the first trimester? First-trimester US is commonly performed for both symptomatic and asymptomatic pregnant patients for a variety of reasons, including: Confirmation, dating, and assessing viability of an intrauterine pregnancy, especially when the last menstrual date is uncertain. Evaluating the etiology of vaginal bleeding, pelvic pain, or a pelvic mass. Measuring embryonic nuchal translucency (NT) as part…

MRI of the Foot and Ankle

1 What are the compartments of the ankle joint, and what structures do they contain? The ankle joint contains four compartments: Anterior, medial, lateral, and posterior. Anterior compartment: From medial to lateral, the anterior compartment contains the anterior t ibialis tendon, extensor h allucis longus tendon, peroneal nerve, dorsalis pedis artery, and extensor d igitorum longus tendon. The tendons in the anterior compartment can be remembered…

MRI of the Knee

1 What sequences are typically included in a routine magnetic resonance imaging (MRI) examination of the knee? Routine knee MRI typically includes: Sagittal fat-suppressed proton density (PD)-weighted and fat-suppressed T2-weighted images. Coronal T1-weighted and fat-suppressed T2-weighted images. Axial fat-suppressed T2-weighted images. Please see Figure 56-1 for some normal knee anatomy on MRI. 2 Describe the clinical presentation of meniscal injury. What part of the meniscus is…

MRI of the Hip

1 What is the basic normal anatomy of the hip? The hip is a ball-and-socket joint formed by the femoral head and the acetabulum, providing a large range of multidirectional motion. The acetabulum is tilted anteriorly, allowing a greater degree of flexion than extension. It covers 40% of the femoral head, and its depth is increased by the acetabular labrum, a horseshoe-shaped fibrocartilagenous structure covering the…

MRI of the Hand and Wrist

1 What are some common indications for performing magnetic resonance imaging (MRI) of the hand and wrist? MRI of the wrist is routinely used to assess a wide variety of osseous and soft tissues abnormalities, including radiographically occult fractures; tendon, ligament, or cartilage injuries; tunnel syndromes; palpable abnormalities; and wrist pain. This chapter will concentrate predominantly on MRI of the wrist. MRI of the hand is…

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…