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Liver, biliary tract and pancreas

Methods of imaging the hepatobiliary system 1. Plain film 2. Ultrasound (US): (a) Transabdominal (b) Endoscopic (c) Intraoperative 3. CT including: (a) Routine ‘staging’ (portal venous phase) CT (b) Triple phase ‘characterization’ CT (c) CT cholangiography 4. MRI 5. Endoscopic retrograde cholangiopancreatography (ERCP) 6. Percutaneous transhepatic cholangiography (PTC) 7. Operative cholangiography 8. Postoperative (T-tube) cholangiography 9. Angiography – diagnostic and interventional 10. Radionuclide imaging: (a) Static,…

Gastrointestinal tract

Methods of imaging the gastrointestinal tract 1. Plain film 2. Barium swallow 3. Barium meal 4. Barium follow-through 5. Small bowel enema 6. Barium enema 7. Ultrasound (US): (a) Transabdominal (b) Endosonography 8. Computed tomography (CT) 9. Magnetic resonance imaging (MRI) 10. Angiography 11. Radionuclide imaging: (a) Inflammatory bowel disease (b) Gastro-oesophageal reflux (c) Gastric emptying (d) Bile reflux study (e) Meckel's scan (f) Gastrointestinal bleeding.…

Intravascular contrast media

Historical development of radiographic agents The first report of opacification of the urinary tract after intravenous (i.v.) injection of a contrast agent appeared in 1923 using an i.v. injection of 10% sodium iodide solution, which was at that time prescribed for treatment of syphilis and was excreted in the urine. In 1928 German researchers synthesized a compound with a number of pyridine rings containing iodine in…

General notes

Radiology The procedures are laid out under a number of sub-headings, which follow a standard sequence. The general order is outlined below, together with certain points that have been omitted from the discussion of each procedure in order to avoid repetition. Minor deviations from this sequence will be found in the text where this is felt to be more appropriate. Methods A description of the technique…

Alphabetical list of conditions

Achondroplasia An AD (80% new mutation rate) skeletal dysplasia due to impaired enchondral bone growth. Skull 1. Large skull. Small base. Small sella. Steep clivus. Small, funnel-shaped foramen magnum. 2. Hydrocephalus of variable severity. Thorax 1. Thick, stubby sternum. 2. Short ribs with deep concavities to the anterior ends. Axial skeleton 1. Decreasing interpedicular distance caudally in lumbar spine. 2. Short pedicles with a narrow sagittal…

Nuclear medicine

Diffuse increased uptake on whole-body bone scans (‘superscan’) Definition: diffuse increased uptake in the axial skeleton ± proximal long bones with almost no uptake in soft tissues and kidneys, though bladder activity may still be present. 1. Widespread bone metastases —most common sources include prostate and breast. Uptake is diffuse but often patchy Long bones less commonly involved. 2. Metabolic bone disorders —osteomalacia, hyperparathyroidism and renal…

Paediatrics

Retarded skeletal maturation Chronic ill-health 1. Congenital heart disease —particularly cyanotic. 2. Renal failure. 3. Inflammatory bowel disease * . 4. Malnutrition. 5. Rickets * . 6. Maternal deprivation. Endocrine disorders 1. Hypothyroidism —severe retardation (≥5 standard deviations below the mean) with granular, fragmented epiphyses. 2. Steroid therapy/Cushing's disease —see Part 2 . 3. Hypogonadism —including older patients with Turner syndrome. 4. Hypopituitarism —panhypopituitarism, growth hormone…

Skull and brain

Solitary acute intracranial haemorrhage 1. Intracerebral . (a) Hypertension —basal ganglia, pons, cerebellum. (b) Cerebral amyloid angiopathy —lobar location, peripheral microhaemorrhages (often multifocal). (c) Haemorrhagic lesions —e.g. metastases, primary tumours, infarcts. (d) Traumatic —more commonly multifocal (see Section 13.3 ). 2. Subarachnoid —see Section 13.2 . Extends into sulci ± basal cisterns. 3. Subdural —most common in elderly post trauma (which may be minor); also associated…

Head and neck

Parapharyngeal space lesions The parapharyngeal space (PPS) contains primarily fat, small vessels and small nerves. It lies between the parotid, masticator, carotid and pharyngeal mucosal spaces. Primary pathology in the PPS is rare (e.g. schwannoma, branchial cleft cyst, venolymphatic malformations and tumours arising from ectopic salivary tissue). More commonly lesions from other spaces bulge into or invade the PPS. The key to identifying the site of…

Breast disease and mammography

In UK practice, breast abnormalities are evaluated as part of a ‘triple assessment’ process: clinical examination, imaging and subsequent image-guided tissue diagnosis. All breast-imaging tests are assigned a numerical score from 1 to 5 with a prefix for each score: P for clinical examination findings, M for mammography, U for ultrasound and MRI for findings on MRI studies. Subsequent histology/cytology results are similarly described. The UK…

Gynaecology and obstetrics

Gynaecological imaging 10.1 common indications for gynaecological ultrasound Primary amenorrhoea 1. Constitutional delay. 2. Polycystic ovarian syndrome (PCOS). 3. Congenital genitourinary malformation—broad range of anomalies, see Fig. 10.2 . 4. Gartner duct cyst. 5. Complete androgen insensitivity syndrome (CAIS)—Y chromosome present but external genitalia are of female phenotype due to complete insensitivity of cells to androgens. 6. Hyperprolactinaemia secondary to a pituitary tumour. 7. Androgen-secreting ovarian…

Adrenals, urinary tract, testes and prostate

Incidental adrenal mass (unilateral) Common incidental finding on CT. A mass <3 cm in diameter is likely to be benign and a mass >5 cm in diameter is probably malignant. On unenhanced CT, 98% of homogeneous adrenal masses with an attenuation of ≤10 HU will be benign (typically lipid-rich adenomas). Approximately 30% of adenomas will have an attenuation >10 HU (lipid-poor). For indeterminate lesions, i.e. those >10 HU,…

Hepatobiliary, pancreas and spleen

Intraluminal gallbladder lesions 1. Gallstones —single or multiple, small or large. ~80% are radiolucent on plain film, but ~80% are visible on CT. Often calcified, may contain central fat or gas. Typically mobile, but can be adherent to the GB wall. Typically show posterior acoustic shadowing, but calculi <5 mm may be nonshadowing and mimic a cholesterol polyp. Microlithiasis = multiple 1–3 mm calculi. A GB packed with…

Abdomen and gastrointestinal tract

Pneumoperitoneum Plain film signs include: Erect CXR —free gas under diaphragm or liver. Can detect 10 ml of gas. Takes 10 minutes for all gas to rise. Supine AXR —most sensitive signs are often in the right upper quadrant. Gas outlines both sides of bowel wall, which appears as a white line (Rigler sign). The liver may appear hyperlucent or have an overlying oval gas shadow. The…

Cardiovascular system

Gross cardiomegaly on CXR 1. Ischaemic heart disease —and other cardiomyopathies. 2. Pericardial effusion —globular (supine radiograph) or flask-shaped heart (erect radiograph), crisp cardiac outline (as the effusion masks ventricular wall motion). 3. Multivalve disease —particularly regurgitation. 4. Congenital heart disease —ASD is the most common to present in adults. Eisenmenger's syndrome may develop in longstanding untreated ASD, resulting in chronic pulmonary hypertension, shunt reversal and…

Chest

Tracheal/bronchial narrowing, mass or occlusion Airway narrowing may occur at any site from below the level of the vocal cords down to the segmental/subsegmental airways. In the lumen 1. Mucous plug —e.g. asthma, cystic fibrosis, ABPA. Low density, usually contains gas bubbles. 2. Foreign body —air trapping is more common than atelectasis. Most frequently affects the lower lobes. The foreign body may be opaque. The column…

Soft tissues

Linear and curvilinear soft tissue calcification Common causes 1. Arterial —i.e. atherosclerosis. If seen in the hands or feet, this suggests underlying diabetes or hyperparathyroidism (secondary > primary). Calcification can also be seen in aneurysms (e.g. popliteal). 2. Cartilage —i.e. chondrocalcinosis; suggests CPPD. 3. Ligament/tendon . (a) Calcific tendonitis —i.e. hydroxyapatite deposition disease (HADD). Commonly involves supraspinatus and gluteus medius tendons. (b) Seronegative spondyloarthropathy —entheseal calcification.…

Joints

Monoarthritis Common 1. Septic arthritis —including tuberculosis. Marked juxtaarticular osteopenia with loss of definition of subchondral bone plate. 2. Trauma —evidence of fracture or lipohaemarthrosis. 3. Osteoarthritis (OA) —marginal osteophytes, subchondral sclerosis and/or cysts, joint space narrowing. Commonly involves weight-bearing joints. 4. Calcium pyrophosphate deposition disease (CPPD) —chondrocalcinosis is characteristic; most commonly seen in knee, wrist, symphysis pubis and intervertebral discs. Arthropathy mimics OA but has…

Spine

Scoliosis Scoliosis is a lateral spinal curve on a PA radiograph with a Cobb angle >10 degrees. If <10 degrees then it should be described as spinal asymmetry. Idiopathic (80%) 1. Congenital —0–3 years, M>F. Left side convex. Usually regresses. 2. Juvenile —4–9 years, females. Right side convex. Usually progresses. 3. Adolescent —females. Right-sided thoracic convexity. Progressive if the Cobb angle at skeletal maturity is >30…