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Head and Neck Radiology

Introduction The anatomy of the head and neck is complex. The continued advances in imaging with ever faster imaging times and higher resolution studies have resulted in more anatomical detail revealing itself, especially in the head and neck where identifying subtle changes in the normal anatomy, such as middle ear ossicular erosion in cholesteatoma, widening of the cranial nerve foramina in perineural/intracranial extension of disease and…

The Orbit

Introduction The orbit is an often-overlooked anatomical structure but is obviously crucial in vision and therefore orbital pathology can have a debilitating impact on quality of life. The orbit can be affected by specific ocular diseases but is also affected by systemic disease processes, and when considering disorders of vision, it is also important to consider the retro-orbital visual pathway, described in the final section of…

Neurodegenerative Diseases and Epilepsy

Ageing and Dementia—Introduction and Clinical Overview With the rising age of the population, both normal ageing phenomena in the brain and neurodegenerative disorders become more prevalent. While exceptionally the brain may not be affected by age (successful ageing), the more typical or unusual ageing involves general involutionary alterations, which may mimic or herald neurodegenerative disease. Clinically, mild memory loss and reduced processing speed are considered normal…

Inflammatory and Metabolic Disease

Inflammatory-Demyelinating Disorders of the Central Nervous System Inflammatory-demyelinating diseases (IDDs) represent a broad spectrum of central nervous system (CNS) disorders that can be differentiated on the basis of severity, clinical course and lesion distribution, as well as imaging, laboratory and pathological findings. The spectrum includes monophasic, multiphasic and progressive disorders, ranging from highly localised forms to multifocal or diffuse variants. Relapsing-remitting (RR) and secondary progressive (SP)…

Intracranial Infections

Bacterial Infections Bacterial Meningitis The causes of bacterial meningitis are age-dependent; in adults the most common causes are Streptococcus pneumoniae and Neisseria meningitidis . Bacteria can reach the meninges by haematogenous dissemination, spread from an adjacent focus of infection (such as sinusitis or otomastoiditis) or through congenital or acquired structural defects in the skull. Clinical manifestations include fever, headache, photophobia, lethargy and confusion. Imaging is frequently…

Neurovascular Diseases

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…

Benign and Malignant Intracranial Tumours in Adults

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…

Imaging of Head Trauma

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.…

Current Status of Imaging of the Brain and Anatomical Features

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…

Spinal Trauma

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…

Postoperative Spine

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…

Non-Tumoural Spinal Cord Lesions

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…

Spinal Tumours

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…

Degenerative Disease of the Spine

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…

Current Status of Imaging of the Spine and Anatomical Features

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.…

Bone, Joint and Spinal Infections

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…

Appendicular and Pelvic Trauma

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…

Arthritis

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…

Metabolic and Endocrine Skeletal Disease

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…

Soft-Tissue Tumours

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…