Stroke Stroke is the third leading cause of death in Western populations and is the largest single cause of adult disability. It has a tremendous medical, social and economic impact. Over 80,000 cases develop in the UK every year. The annual cost to the National Health Service (NHS), UK families, businesses and public sector exceeds £7 billion. ‘Stroke’ is an imprecise term used to describe the…
Radiological Investigations in Intracranial Tumours Brain tumours are a leading cause of death in young adults, but they occur at all ages with a variable prognosis depending on lesion type. The aim of imaging at first diagnosis is to localise the tumour, to exclude differentials and to decide whether urgent surgical intervention is required. The choice of imaging protocol will depend on the patient's symptoms, their…
Introduction Traumatic brain injury (TBI) is a major cause of mortality and morbidity. In England and Wales, approximately 1.4 million patients per year attend hospital following head injury and it is the most common cause of death under the age of 40 years. In the following chapter, the imaging techniques best placed for the initial assessment of these patients and the complications of trauma are introduced.…
Introduction Neuroradiology forms an important part of radiology training and a substantial part of many, if not most, radiologists’ daily work. The latest imaging techniques provide the radiologist with unprecedented anatomical detail. A strong working knowledge of neuroanatomy is crucial to correct image interpretation and accurate communication of these results in the radiology report. Fortunately, the normal brain, at the macroscopic level, is a largely symmetrical…
Clinical Aspects The cervical spine and thoracolumbar junction are the most common sites of spinal trauma. Specifically, the most common sites for fractures and dislocations are the lower cervical spine (C4–7), the thoracolumbar junction (T10–L2) and the craniocervical junction (C1–2). These mobile areas, particularly the cervical spine, can be injured with relatively little force. Patients with cervical trauma may present as ‘walking wounded’ to the accident…
Introduction Imaging plays an important role in the assessment of the postoperative spine. The main objectives of imaging are to evaluate the alignment of the spinal column, the position of implants and the status of fusion or fracture healing, and to demonstrate potential complications in case of persistent or new postoperative symptoms. Postsurgical appearances may be complex, and knowledge of indications for surgery, type of the…
Inflammatory Disease Multiple Sclerosis Multiple sclerosis (MS) is a progressive neurodegenerative disorder characterised by multiple inflammatory demyelinating foci called ‘plaques’. The spinal cord is commonly involved with changes on autopsy in up to 98% of the cases. One-third of MS patients will have isolated spinal cord involvement. Spinal cord abnormalities in MS include focal lesions, diffuse involvement, axonal loss and spinal cord atrophy. Focal MS lesions…
Radiological Investigations in Spinal Tumours Computed tomography (CT) and magnetic resonance (MR) imaging are complementary techniques that are needed for evaluation of both the intraosseous extent of the tumour and soft-tissue involvement. MR imaging is the best imaging technique for the evaluation of the epidural space and neural structures. Plain Radiography Plain radiography is not the primary imaging technique of choice to image patients with spinal…
Introduction The spine is a complex anatomical structure composed of vertebrae, intervertebral discs and ligaments. All of these structures may undergo degenerative, morphological and functional changes with age. The intervertebral discs are part of the connection between two adjacent intervertebral bodies and have two main functions: allowing movement and at the same time serving as shock absorbers. Movement at a single level is limited; the combined…
Anatomy Anatomically the spine is organised segmentally, consisting of 7 cervical, 12 thoracic, 5 lumbar, 5 (fused) sacral and 3 to 5 coccygeal vertebrae. Each level, except C1, consists of the following elements: a vertebral body (corpus vertebrae) anteriorly and a vertebral or neural arch (arcus posterior) posteriorly. Together these two structures enclose the spinal canal. Functionally the spine can be divided into three so-called columns.…
Introduction Infection of the musculoskeletal system is encountered in everyday clinical practice and the scope of this chapter includes both osteomyelitis and soft-tissue infection. Osteomyelitis is defined as infection of the bone marrow and adjacent osseous structures, with or without extension into the soft tissues. It is generally categorised as acute, subacute or chronic based on the clinical course and histopathological findings. Acute osteomyelitis presents with…
Introduction This chapter considers skeletal trauma with an emphasis on the importance of the conventional radiograph in establishing the diagnosis of bone injury. The role of CT and MRI in identifying occult bone injury and more accurately defining patterns of injury that modify management is detailed; soft tissue injury assessment is not considered in this chapter. Evaluation of potential bone injury ideally requires two radiographs obtained…
Imaging of Joint Disease The imaging of joint disease is complex, with the radiologist required to combine imaging findings and clinical information to accurately characterise arthritis. This chapter details the general principles of the radiographic assessment of arthritis and the key features of common arthritic conditions encountered. It will also outline where cross sectional imaging is of value and outline the most common features seen on…
Bone Physiology and Pathophysiology Bone is a composite material whose extracellular matrix mainly consists of mineral (hydroxylapatite (Ca 10 (P0 4 ) 6 (OH) 2 ), collagen (mainly type 1), and non-collagenous proteins. Though bone appears rigid and inert, it is a highly metabolically active tissue, and is constantly remodelled with osteoblasts building bone and osteoclasts resorbing bone. This dynamic cellular process allows the bone to…
Introduction Soft-tissue masses are frequently referred for imaging assessment. They may be benign, malignant, or non-neoplastic and all may present in a similar manner. The frequency of each type of mass is difficult to determine accurately: many patients do not seek medical attention for slowly-growing, unobtrusive masses; indolent masses may not biopsied or excised; formal histological assessment of superficial masses may not be obtained and many…
Introduction Bone tumours can be generally divided into two groups: benign, including tumour-like lesions (see Chapter 40 ), and malignant. The malignant category can be subclassified into primary, secondary and metastatic. In common parlance the terms secondary and metastatic are frequently used interchangeably. In the context of this chapter, however, the term secondary is reserved for those tumours arising from malignant transformation of a pre-existing benign…
General Characteristics of Bone Tumours Bone tumours are currently classified according to the World Health Organisation (WHO) classification of 2013 as being benign, intermediate or malignant; intermediate lesions are those that are either locally aggressive but do not metastasise (e.g. grade 1 chondrosarcoma) or those that are benign but can rarely metastasise (e.g. giant cell tumour [GCT] and chondroblastoma [CB]). The pre-biopsy diagnosis of a bone…
Introduction Magnetic resonance imaging (MRI) and ultrasound (US) complement conventional radiography and computed tomography (CT) in allowing the radiologist to undertake detailed examinations of the soft tissues of joints including tendons, ligaments, cartilage and fibrocartilaginous structures. These structures can be assessed in great detail, allowing assessment of prognosis for conservative management and planning for surgical decision making. Whilst there are common imaging features of tendon and…
Introduction It can be argued that imaging of the musculoskeletal system has been revolutionised by the advent of magnetic resonance imaging (MRI). Despite this, our armamentarium would be incomplete without plain radiographs, computed tomography (CT), ultrasound (US) and nuclear medicine. The aim of this chapter is to outline the basic principles, strengths and limitations of each technique, and to discuss the role of each tool in…
The Adrenal Glands With the increasing use of cross-sectional imaging, adrenal lesions are frequently identified in routine practice and are seen in up to 5% of abdominal computed tomograph (CTs). Recent lung-screening data report 2% of screening low-dose CTs demonstrate the presence of an incidental adrenal lesion. Pathognomonic imaging features have been established for many of these lesions, including myelolipomas, adenomas, haematomas and cysts. Most of…