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Bone Tumours (2): Radiological Approach, Malignant Bone Tumours

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…

Bone Tumours (1): Radiological Approach, Benign Tumours and Tumour-Like Lesions of Bone

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…

Internal Derangements of Joints: Upper and Lower Limbs

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…

Current Status of Imaging of The Musculoskeletal System

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…

Adrenal Imaging

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…

Genitourinary Tract Trauma

Introduction There has been a steady advance in the imaging and treatment of genitourinary (GU) system trauma over the past two decades. Multidetector computed tomography (MDCT) has now become the gold standard for the assessment of acute GU trauma. The use of intravenous (IV) contrast medium and multiplanar reconstruction facilitates rapid assessment of both the upper and lower urinary tracts as well as detection of concurrent…

Benign Gynaecological Disease

Imaging Techniques Ultrasound (US) Transabdominal and transvaginal ultrasound (TVUS) imaging are the primary initial imaging techniques for examining the female pelvis. Indications include evaluation of a suspected pelvic mass or uterine enlargement, acute pelvic pain, investigation of postmenopausal bleeding and characterisation of ovarian masses, as well as guiding invasive procedures such as biopsy and drainage. Ultrasound (US) has many advantages: it is relatively inexpensive, provides multiplanar…

Gynaecological Imaging in Oncology

Diagnostic imaging tests are essential in the detection and staging of many gynaecological cancers. The imaging findings frequently change treatment strategies and affect our understanding of disease processes. This chapter gives a brief review of common gynaecological malignancies and outlines the indications for each imaging technique used ( Table 34.1 ) while focusing on advances in ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and…

The Male Reproductive Structures

Methods of Examination There has been little evolution in methods of examination since the previous edition. Ultrasound (US) continues to be the method of choice for imaging the scrotal contents but magnetic resonance imaging (MRI) continues to play an increasing role for problem solving in the assessment of testicular masses, particularly in differentiating paratesticular from testicular masses and in further characterising masses as solid, cystic or…

Prostate

Introduction With approximately 1.3 million new cases worldwide predicted for 2018, prostate cancer (PCa) is the most common non-cutaneous male cancer. In Western countries, one in every nine men will be diagnosed with PCa at a certain moment in their life. Although PCa often has an indolent disease course, it remains the second leading cause of cancer-related death and can threaten long-term health. The past three…

Urothelial Cell Cancer, Upper Tract and Lower Tract

Upper Tract Urothelial Carcinoma Definition Upper tract urothelial carcinoma (UTUC) refers to malignant changes of the uroepithelial cells lining the urinary tract anywhere from the renal calyces to the ureteral orifice. Epidemiology Urothelial carcinoma is relatively common worldwide, and its incidence has a marked geographic variation. Urothelial carcinoma may be located in the lower urinary tract; the bladder or urethra, or the upper urinary tract; renal…

Renal Transplantation : Imaging

History of Transplantation Renal transplantation was first successfully performed in 1950 in the United States but was limited due to the lack of immunosuppression therapy. Further success was experienced between identical twins where immunosuppression was not required. Cadaveric transplantation became more feasible when effective immunosuppressive therapy became available years later. Live donor transplantation has gained favour—almost 50% in the United States and 30% in the UK—due…

Renal Masses: Imaging and Biopsy

Methods of Analysis Plain Abdominal Radiography The plain abdominal radiograph (KUB—kidneys, ureters, bladder) is not used to diagnose a renal mass. Loss of the psoas margin or displacement of retroperitoneal fat may occasionally suggest the presence of one, as may an opacity projected over the renal outline or a loss of the renal outline. Central calcification within a renal mass is more suggestive of malignancy than…

Benign Upper Urinary Tract Conditions: Congenital Anomalies, Cysts, Calculi, Nephrocalcinosis

Congenital Anomalies Normal Development Detailed embryological development of the kidneys and ureters will not be described in detail. The kidney precursors initially develop in the pelvis and ascend to their normal positions lateral to the proximal lumbar spine by 8 weeks’ gestation. As ascent occurs, the kidneys also rotate 90 degrees to their normal position with the renal hila pointing medially. Ectopy and Fusion Anomalies Renal…

Current Status of Imaging of the Urinary Tract : Imaging Techniques, Overview of Anatomy and Radiation Issues

Introduction This chapter describes clinically important aspects of urinary tract imaging with specific reference to anatomy, techniques and radiation. We begin with an outline of urinary tract embryology in order to place urinary tract anatomy and many anatomical variations into context. We describe long-established techniques of urinary tract imaging and the principles used to guide development of newer techniques. Imaging of the urinary tract is an…

Common Uroradiological Referrals: Haematuria, Loin Pain, Renal Failure and Infection

Haematuria Haematuria refers to the presence of red blood cells in urine. Radiological referral of selected patients is often necessary as part of clinical management for this problem; however, the optimal method of patient selection and the best imaging algorithm are subject to debate. In this chapter we will outline current opinion regarding best practices for such patients. Haematuria visible to the naked eye is said…

The Pancreas

Embryology The pancreas develops in two parts, both of which arise from the endoderm of the primitive duodenum. The dorsal part (or anlage) is the first to appear, as a diverticulum from the dorsal wall of the duodenum. This eventually forms the whole of the neck, body and tail of the gland, together with part of the head. The ventral anlage develops more caudally as a…

The Biliary System

Biliary Anatomy The intrahepatic pattern of bile duct branching is best described according to the system of Healey and Schroy, to which can be applied the Couinaud system for numbering segments. The typical pattern and its variations are shown in Figs 24.1 and 24.2 . The confluence of the bile ducts is a bifurcation in about 60% of individuals and a trifurcation in about 12% (…

The Liver and Spleen

Liver Anatomy The liver has a dome-shaped superior surface following the diaphragm contours, extending anteriorly to the inferior edge of the liver. The major surface landmark is a sagittal groove containing the ligamentum teres (formerly umbilical vein), within the falciform ligament. The main feature of the inferior or visceral surface is the porta hepatis or hilum, a central depression conveying the portal vein, hepatic artery and…

The Large Bowel

Anatomy Detailed anatomical knowledge of the large intestine is fundamental to accurate image interpretation. The large bowel comprises the colon, vermiform appendix, rectum and anus. The caecum, ascending and descending colon are covered anteriorly by visceral peritoneum, whereas approximately 50% of the posterior aspect of these segments is retroperitoneal. The retroperitoneal colon has an adventitial layer, separating muscle from peritoneal fat. The anterior peritoneum runs medially…