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Current Status of Thoracic Imaging

Chest radiography and computed tomography (CT) remain the stalwarts of thoracic imaging. The basic technique of chest radiography has remained largely unchanged since its inception, but continuing developments in image receptor technology have resulted in techniques which are simultaneously efficient and radiation dose-optimised. Radiographs are now mainly produced in digital format, thus facilitating their incorporation into picture archiving and communications systems (PACS). Evolving CT technology has…

Interventional Genitourinary Radiology

In the genitourinary system as in other organ systems, radiologically guided interventional procedures have grown in usage. Interventional genitourinary radiology procedures are used widely, so familiarity and experience with these procedures are necessary in most clinical settings. Growth in the use of these procedures is due to their minimally invasive nature. Advantages of these procedures include shortened hospital stay, diminished need for anesthesia, lower cost, and…

Imaging of the Adrenal Glands

Cross-sectional imaging plays a major role in the evaluation of adrenal gland disease. In many patients not only can adrenal gland pathology be identified, but also a specific diagnosis can be made. The appropriate selection and accurate interpretation of adrenal imaging and interventional studies are the subject of this chapter, which is divided into three sections. In the first section, the embryology, physiology, anatomy, and imaging…

The Male Genital Tract

The diagnosis and management of diseases of the male genital tract have changed significantly in recent years as a direct result of technologic advances in imaging and progress in therapeutics. The purpose of this chapter is to present current imaging of the male genital tract in the context of selected clinical problems. The first part of the chapter reviews the embryology, anatomy, and physiology of the…

The Female Genital Tract

Medical imaging has assumed an increasingly important role in the diagnostic evaluation of gynecologic disease. In part this is because sonography and magnetic resonance imaging (MRI) can allow for high-resolution and multiplanar imaging of the female reproductive tract without exposing the ovaries to ionizing radiation. In this chapter, gynecologic radiology is reviewed. The first section is an overview of the embryology, anatomy, and physiology of the…

The Lower Urinary Tract

The lower urinary tract consists of the bladder and the urethra. Diseases of the lower urinary tract are prevalent and can be potentially debilitating from a medical and a social point of view. The bladder is the most common site of urinary tract infection in women of reproductive age. Symptoms referable to bladder-outlet obstruction are among the most common reasons why elderly men are examined by…

The Renal Sinus, Pelvocalyceal System, and Ureter

Embryology and Anatomy Although embryology of the urinary tract is complex and often baffling, its important features are actually rather simple. The ureteral bud arises from the mesonephric duct early in gestation and forms the ureter, pelvicalyceal system, and renal collecting tubules. A physical association between the ureteral bud and the metanephric blastema, the primordium of renal parenchyma, is necessary for development of the kidney and…

The Kidney: Diffuse Parenchymal Abnormalities

Diffuse parenchymal abnormalities of one or both kidneys are often recognized during renal imaging. A number of disease processes may result in abnormalities of renal size and renal shape, with or without associated abnormalities in the renal collecting system. Diagnosis of the causal disease process is often possible based on the recognition of the pattern of abnormalities. In this chapter various patterns are discussed, and suggestions…

Renal Masses

Detection of renal masses should be a high-priority task for radiologists examining the abdomen. Despite a great deal of research and many innovations in the treatment of renal cell carcinoma (RCC), the disease remains resistant to radiation therapy and chemotherapy. Modifiers of host biologic response, including agents such as interferon and interleukin, and newer biologic agents such as tyrosine kinase inhibitors have been studied extensively for…

The Kidney and Retroperitoneum: Anatomy and Congenital Abnormalities

Normal urinary structures develop through of a series of complex, staged embryologic processes. Because of this complexity of urinary tract development, congenital abnormalities occur commonly, in up to 10% of individuals. Because the kidneys and ureters develop simultaneously, an in utero event causing one malformation often affects other areas of the urinary tract. Therefore the presence of one urinary tract anomaly greatly increases the likelihood of…

An Introduction to Radiologic Methods

Optimal radiologic investigation of the genitourinary system requires a combination of diverse but complementary examinations that evaluate form and function. This chapter presents an overview of diagnostic tests that are commonly used to evaluate genitourinary disease. First, the pharmacology of iodinated contrast media is reviewed. Adverse effects and an approach to the management of common adverse reactions are also discussed. The chapter then turns to the…

Peritoneum, Retroperitoneum, and Mesentery

Anatomy The abdominal cavity is divided into both intraperitoneal and retroperitoneal spaces. The peritoneal cavity is lined by visceral and parietal peritoneum (a thin mesothelial membrane) and lies within the abdominal cavity, with two potential spaces, the greater and lesser sacs. The lesser sac communicates with the greater sac via the epiploic ∗ ∗ From epipluo (Greek root) “to float upon” as in the omentum that…

Pancreas

The pancreas is an obliquely positioned retroperitoneal organ containing a tail, body, neck, head, and uncinate. It has a main duct (normal measurements, 2 to 3 mm in diameter) running the length of the pancreas from the tail proximally to the ampulla of Vater ∗ ∗ Abraham Vater (1684-1751), German anatomist. distally. It has both endocrine and exocrine functions. As an endocrine organ, islets of Langerhans…

Gallbladder

The biliary tree develops embryologically along the course of the portal venous anatomy and is defined proximally by right and left intrahepatic biliary ducts, which join to form the common hepatic duct. A side appendage, the gallbladder, is attached to the common hepatic duct by the cystic duct to form the common bile duct (CBD), which traverses the pancreas to join the main pancreatic duct and…

Spleen

The spleen is part of the mononuclear phagocytic system (formally known as reticuloendothelial) and the largest lymphatic organ. Its red pulp is responsible for red blood cell and platelet metabolism and acts as a monocyte reservation. Its white pulp is critical to the immune response, producing antibodies and removing antibody-laden bacteria (humoral immune response), as well as producing macrophages and lymphocytes (cell-mediated immune response). Therefore splenic…

Liver

The liver, as the largest and most complex organ in the abdomen, can present with diverse abnormalities. The most common clinical conundrum is the characterization of single or multiple hepatic lesions, primarily into benign or malignant disease, but there are many diffuse infiltrative diseases, some of which are difficult to evaluate with imaging, particularly in their early phases. However, modern imaging techniques offer the ability to…

Colon and Appendix

Colon Anatomy The colon starts at the ileocecal valve and is made up anatomically of the cecum; appendix (which is discussed separately below); ascending, transverse, descending, and sigmoid colon; and rectum. The ascending and transverse colon develops along with the small bowel as part of the embryologic midgut. As such, its vascular supply is from the superior mesenteric artery (right and middle colic branches), ending approximately…

Small Bowel

Anatomy The embryological development of the small bowel (midgut) is complicated, involving herniation into the umbilical cord and a 270-degree counterclockwise rotation before returning to the abdominal cavity. As a result, it is not surprising that there are several congenital rotation anomalies that can result in malrotation and volvulus and that emerge in the neonatal period, infancy, or even adulthood. The small bowel is defined by…

Duodenum

Normal Anatomy The duodenum is classified into four parts. The first is the duodenal bulb, which is intraperitoneal before it passes posteriorly into the second part, or C-sweep, which is retroperitoneal and fixed. This second part starts at the superior duodenal flexure and ends at the inferior duodenal flexure. The third part, also retroperitoneal, extends transversely from the inferior duodenal flexure to a point where it…

Stomach

Normal Anatomy The stomach begins at the gastric cardia (the portion that envelops the lower esophagus) and ends after the pylorus. It consists of a fundus, body, lesser and greater curvature, antrum, and pylorus. It has three layers of smooth muscle (outer longitudinal, middle circular, and inner oblique), with gastric rugae (or folds) within. The mucosa is lined by columnar epithelium, within which are numerous mucus-…