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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…

CT and MRI of the Lower Gastrointestinal Tract

1 What is shown in Figure 27-1 ? A topogram from a computed tomographic colonography (CTC), an examination tailored to evaluate for colorectal polyps and masses. 2 What is the adenoma-carcinoma sequence? The adenoma-carcinoma sequence refers to a series of genetic mutations whereby small adenomatous colon polyps (<5 mm) transform into large adenomatous polyps (>1 cm), noninvasive carcinomas, and then invasive carcinomas. This entire process takes, on average,…

Fluoroscopy of the Lower Gastrointestinal Tract

1 Identify the parts of the colon (numbers 1 through 8) labeled in Figure 26-1 . For the answer, see the figure legend. 2 What are haustra? The longitudinal muscle layer of the colon is divided into three thick bands, termed the taeniae coli . There is a paucity of longitudinal muscle between the three tenial bands. Haustra are sacculations of colon protruding between the three…

CT and MRI of the Upper Gastrointestinal Tract

1 What are the general indications for routine computed tomography (CT) and magnetic resonance imaging (MRI) of the upper gastrointestinal (GI) tract? General indications for routine abdominopelvic CT or MRI evaluation of the upper GI tract include: Assessment of patients with clinical symptoms or signs potentially related to GI tract pathology for detection and characterization of the underlying etiologies. Staging, pretreatment planning, response assessment, and restaging…

Fluoroscopy of the Upper Gastrointestinal Tract

1 What organs are studied during an upper gastrointestinal (GI) series? The esophagus, stomach, and duodenum are studied. The radiologist evaluates the morphology and motility of these organs. 2 What organs are studied during a pharyngoesophagogram? The radiologist evaluates the motility of the oral cavity, pharynx, and esophagus, and the morphology of the pharynx, esophagus, and gastric cardia. The radiologist records the fluoroscopic images of oral,…

Abdominal Radiography

1 What is a “flat plate” of the abdomen? Flat plate is a historical term that refers to a past method of radiography when radiographs were recorded on flat plates of glass coated with an emulsion sensitive to x-rays. This examination also has been termed a plain abdominal radiograph, plain film of the abdomen, abdominal plain film, and KUB. KUB refers to the kidney, ureters, and…

Tubes, Lines, Catheters, and Other Devices

1 What is the radiographic appearance of an endotracheal tube (ETT), and where is it optimally placed? An ETT usually appears as a faintly radiopaque tube with a thin, densely radiopaque line along its length, and its position should be determined relative to the carina, which if not seen on a chest radiograph can be approximated by following the course of the mainstem bronchi medially at…

Imaging of Pleural Disease

1 Describe the normal pleural anatomy and physiologic features. The pleural space is a potential space that contains 2 to 10 mL of pleural fluid between the visceral and parietal pleural layers that essentially represents interstitial fluid from the parietal pleura (an ultrafiltrate of plasma). The pleural space is contiguous with the interlobar fissures of the lungs. The pleura is a thin, serous layer that covers the…