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Head and Neck on FDG PET/CT

Head and Neck Anatomy The head and neck has complex anatomy. Proper identification of benign and malignant lesions depends on an understanding of this anatomy and how it may be altered by surgery, chemotherapy, and radiation. The suprahyoid neck is divided by fascial planes into spaces. While the fascia is not visible on imaging studies, the spaces created by the fascia contain specific structures and the…

Brain on FDG PET/CT

Normal Brain 18F-Fluorodeoxyglucose (FDG) was initially designed to be a brain metabolism tracer and today has multiple applications in neurologic disorders, such as dementias and seizures. The demonstration of the value of FDG in metabolically active tumors has led to a vast majority of clinical FDG positron emission tomography/computed tomography (PET/CT) studies being performed for evaluation of malignancy, and this chapter will focus on FDG PET/CT…

Skeleton on FDG PET/CT

When approaching interpretation of osseous lesions on 18F-fluorodeoxyglucose positron emission topography/computed tomography (FDG PET/CT), it may be useful to use a 2 × 2 box divided into quadrants based on presence or absence of FDG avidity and malignant versus benign ( Fig. 3.1 ). Malignancy is often FDG avid, and thus FDG PET helps to identify malignancy that is otherwise difficult to appreciate. However, it is…

FDG PET/CT Performance and Reporting

Performing FDG PET/CT Patients need to be prepared for 18F-flourodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in order to optimize the distribution of FDG in the body. Patients should avoid exercise starting the day before the examination in order to prevent muscular FDG uptake. Patients should not consume food or liquids other than unflavored water for at least 4 hours prior to administration of FDG, in…

Interventional Techniques

Ultrasound-guided percutaneous procedures have several advantages, including real-time assessment and guidance, in which continuous visualization of a needle is possible throughout the procedure. With ultrasound guidance, a needle can be precisely placed in a target while avoiding important structures, such as nerves and blood vessels. This allows very high accuracy and low complication rate, especially compared with blind needle placement. In general, when compared with non-imaging…

Ankle, Foot, and Lower Leg Ultrasound

Ankle and Foot Anatomy Osseous Anatomy The ankle joint is a hinged synovial articulation between the talus and the distal tibia and fibula ( Fig. 8.1 ). Inferiorly, the talus articulates with the calcaneus through three facets, joined by the cervical and interosseous talocalcaneal ligaments located in a cone-shaped region termed the sinus tarsi, which opens laterally. The Chopart joint represents the articulations between the talus…

Knee Ultrasound

Knee Anatomy The knee is a synovial joint that consists of hyaline cartilage articulations between the femur, the tibia, and the patella ( Fig. 7.1 ). The menisci are C-shaped fibrocartilage structures between the femur and the tibia ( Fig. 7.1E ). A prominent joint recess, the suprapatellar recess or pouch, extends superiorly from the knee joint between the patella and the femur and communicates with…

Hip and Thigh Ultrasound

Hip and Thigh Anatomy The hip joint is a synovial articulation between the acetabulum of the pelvis and the proximal femur. The joint recess extends from the acetabulum over the femur to the level of the intertrochanteric line, just beyond the femoral neck. The joint capsule becomes thickened from the iliofemoral, ischiofemoral, and pubofemoral ligaments ( Fig. 6.1 ), and a reflection of the joint capsule…

Wrist and Hand Ultrasound

Wrist and Hand Anatomy The wrist consists of several synovial articulations among the distal radius, the distal ulna, the proximal carpal row (scaphoid, lunate, triquetrum, pisiform), and the distal carpal row (trapezium, trapezoid, capitate, and hamate). The radiocarpal joint between the distal radius and the proximal carpal row and the distal radioulnar joint between the radius and the ulna are separated by fibrocartilage, called the triangular…

Elbow Ultrasound

Elbow Anatomy The elbow is a synovial joint composed of three elbow joint articulations: the trochlea and ulna, the capitellum and the radial head, and the proximal ulna and radius ( Fig. 4.1 ). The elbow joint has prominent joint recesses located in the coronoid and radial fossae anteriorly and within the olecranon fossa posteriorly. Within each joint recess exists an intracapsular but extrasynovial fat pad,…

Shoulder Ultrasound

The rotator cuff is composed of four tendons ( Fig. 3.1 ). Anteriorly, the subscapularis with its tendons converges onto the lesser tuberosity. Superiorly, the supraspinatus inserts on the superior aspect of the greater tuberosity; its footprint or attachment averages 2.25 cm anterior to posterior, which covers the superior facet and the anterior portion of the middle facet of the greater tuberosity ( Fig. 3.2 ). Uncommonly,…

Basic Pathology Concepts

Muscle and Tendon Injury Muscle and tendon injuries may be categorized as acute and chronic. Acute injuries tend to take the form of direct impact injury, stretch injury during contraction (strain), or penetrating injury. Acute muscle injury can be clinically categorized as grade 1 (no appreciable fiber disruption), grade 2 (partial tear or moderate fiber disruption with compromised strength), and grade 3 (complete fiber disruption). At…

Nerve Blocks

Introduction Single-injection ultrasound-guided peripheral nerve blocks (USGNBs) are ideal for pain relief from acute injuries and adjunct analgesic for painful procedures. By injecting local anesthetic adjacent to the nerve, both motor and sensory innervation distally can be “blocked.” Depending on the efficacy of the USGNB, adjunctive therapies (such as intravenous medications) can be employed to achieve maximal patient comfort. Incorporation of USGNBs into clinical practice allows…

Venous Access

Introduction Since 2001 the Agency for Healthcare Research and Quality (AHRQ) and the American College of Emergency Physicians (ACEP) have recommended the use of ultrasound guidance for the placement of central venous catheters. The superiority of ultrasound guidance over traditional landmark-based approaches is well established in the emergency medicine literature and is a skill that all acute care practitioners should master. Ultrasound is utilized to improve…

Ultrasound-Guided Procedures

Pericardiocentesis Introduction Performing a pericardiocentesis in an unstable patient with cardiac tamponade is a lifesaving procedure. Pericardial fluid is a common finding on point-of-care echocardiography examination and can occur from many systemic disease processes or trauma. The normal pericardial space usually contains 15 to 50 mL of fluid, which acts as a lubricant between the visceral and parietal layers of the pericardium. An increase in fluid…

Musculoskeletal

Introduction Musculoskeletal ultrasound has become increasingly common over the last two decades. The possibility of a real-time, dynamic imaging modality that is both low cost and safe are among the key driving forces making this an important component of patient care for orthopedic presentations. Ultrasound-guided diagnostic and therapeutic procedures have become the cornerstone of many nonoperative sports medicine practices, as ultrasound guidance increases the efficacy and…