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MRI-Guided Interventions

Introduction The term interventional MRI is used to describe the use of magnetic resonance imaging (MRI) for rapid guidance and/or monitoring of a minimally invasive diagnosis or therapy where the entire procedure is interactively performed within an interventional MRI suite in a manner that is equivalent to standard fluoroscopic or ultrasound (US)-guided procedures. The term interventional MRI itself is relatively new as a description of a…

High-Resolution 3T Magnetic Resonance Neurography: Applications, Techniques, and Pitfalls

Dedicated magnetic resonance imaging (MRI) of peripheral nerves is referred to as magnetic resonance neurography (MRN). From the time Howe and Filler et al. originally described MRN, this technique has evolved with constant addition of newer and optimized MRI techniques, and it is being increasingly used in clinical practice. Pathophysiology of Nerve Diseases Basic nerve anatomy, pathophysiology, and injury grading should be understood to detect deviations from…

Foot and Ankle

This chapter is intended to serve as a practical approach to imaging the ankle and foot using computed tomography (CT) and magnetic resonance imaging (MRI). We include a review of the anatomic structures and common pathologic processes as well as an overview of the CT and MRI techniques used. Finally we include references for those readers who wish to explore topics in more detail. Anatomy Tarsal…

Knee

Imaging Technique Magnetic resonance imaging (MRI) is commonly used to evaluate important structures of the knee not adequately depicted on radiographs or computed tomography (CT). Radiography is the first-line imaging modality performed for most suspected abnormalities of the knee in the setting of trauma, degeneration, inflammatory arthritis, or suspected bone lesion. It will often suffice in diagnosing or excluding an abnormality. CT depicts to better advantage…

Hip and Pelvis

Introduction The uses and applications of computed tomography (CT) and magnetic resonance imaging (MRI) to image the hip and pelvis continue to expand. These imaging techniques are effectively used to diagnose and characterize pathologic conditions including congenital and developmental abnormalities in their downstream sequelae, acquired intraarticular soft tissue and bony defects, infection, arthritis, vascular compromise, as well as tumors and tumorlike conditions. As with most musculoskeletal…

Shoulder

Normal Anatomy Gross Anatomy The glenohumeral joint is relatively shallow, with the humeral head large compared with the glenoid fossa. This configuration grants mobility at the expense of stability. The labrum is a meniscus-like fibrous or fibrocartilaginous structure that increases the depth of the glenoid, providing more contact area and thus more stability for the glenohumeral joint. A synovium-lined recess may be interposed between the labrum…

Musculoskeletal Tumors

Skeletal Tumors Imaging Techniques Many imaging modalities are available for the evaluation of skeletal lesions. In most cases, standard radiographs are sufficient for detecting skeletal tumors. When evaluated together with clinical data (e.g., patient's age and sex, anatomic location of the lesion, clinical presentation), radiographs are the best predictors of the histologic condition of the lesion. To fully characterize a tumor in an anatomically complex area…

Advanced Cardiovascular CT Imaging

CT Myocardial Perfusion Imaging According to the cascade model by Nesto et al., myocardial ischemia is preceded by alterations in blood flow. Therefore stress myocardial perfusion imaging holds the potential to detect coronary artery disease at an early stage before adverse clinical events occur. Computed tomography myocardial perfusion imaging (CTMPI) provides functional information in addition to anatomic cardiovascular assessment via coronary CT angiography (cCTA) and may enhance…

Coronary Arteries, Heart, and Pericardium

The coronary arteries are vessels that course through the epicardial fat to supply the myocardium with oxygenated blood. There is a great deal of variability in the anatomy of the coronary arteries from person to person, and the size and branching pattern of each coronary artery can vary significantly. Therefore it is important to remember that anatomic variants are quite common, and it is imperative to…

Female Pelvis

Imaging Considerations of the Female Pelvis Imaging of the female pelvis plays a critical role in the diagnosis and evaluation of various gynecologic diseases. Typically ultrasonography (US) is used as first-line evaluation of the female genital organs. The lack of ionizing radiation, relative low cost, and ability to evaluate normal and pathologic findings in a wide range of gynecologic diseases makes US an attractive choice in…

Male Pelvis

Introduction Evaluation of the male pelvis can be performed with several imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US), depending on the clinical indication and anatomic region of interest. US may be the first study of choice for selected indications because of its lack of radiation exposure, benefit of real-time examination, and ability of color Doppler to investigate blood flow. However,…

Retroperitoneum

Introduction The retroperitoneum is the compartmentalized space located external to and predominantly posterior to the posterior parietal peritoneum. About half a century ago, the retroperitoneum was described as a “veritable jungle of strange things” and as a “hinterland of straggling mesenchyme, with vascular and nervous plexuses, weird embryonic rests and shadowy fascial boundaries”. Since then, a better understanding of the anatomy and pathology of the retroperitoneum…

Kidney

Computed tomography (CT) is a rapid, easily performed, and safe diagnostic imaging technique that provides valuable information about a wide spectrum of renal disorders. CT is highly accurate for determining the nature and extent of renal masses and plays a valuable role in assessing patients with renal cystic disease, renal trauma, renal infections, renal blood flow disturbances, and hydronephrosis of unknown cause. Multidetector (MD)CT (multislice CT)…

Adrenal Glands

Introduction In 1564, Bartolomeo Eustachius (1520-1574) was the first anatomist to give a detailed description of the adrenal glands, which he depicted in a series of drawings on copper plates. However, the function of the adrenal glands remained a mystery for the next 3 centuries. In 1855, Thomas Addison (1793-1860) described the clinical syndrome of adrenal insufficiency in his monograph titled, “On the Constitutional and Local…

Contrast Nephropathy and Its Management

Since the introduction of multidetector computed tomography (MDCT) technology, the number of patients undergoing contrast-enhanced CT studies has steadily increased. In addition the patient population subjected to CT is becoming progressively older with more comorbid conditions. The benefits of contrast-enhanced CT are well recognized in the diagnosis of diseases, evaluation of trauma patients, and guidance of interventional and therapeutic procedures. However, adverse reactions to contrast administration…

Rectum

Anatomy The rectum and anal canal form the terminal part of the intestine. The rectum varies in length from 10 to 15 cm and extends from the rectosigmoid junction at the level of the S3 sacral vertebra to the anorectal line. The surgical anorectal junction is at the upper edge of the anorectal muscle ring located about 4 cm from the anal verge. The anatomic anorectal junction called…

Peritoneum

Computed tomography (CT) and magnetic resonance imaging (MRI) have proven useful for the diagnosis of many peritoneal and mesenteric problems. Even in the absence of a primary peritoneal problem, many secondary signs that add valuable insights about other disorders may be observed. This chapter discusses the embryology, normal anatomy, and physiology of the peritoneum and retroperitoneum and a wide spectrum of relevant pathologic disorders. Because of…

Spleen

The spleen is well evaluated with current cross-sectional imaging modalities. The primary imaging technique continues to be computed tomography (CT), although magnetic resonance imaging (MRI) has become important for lesion characterization. Ultrasonography is also used frequently, although there may be limited visualization of the spleen owing to a subcostal location or obscuration by adjacent bowel gas. 18 Fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET) is…

Mesentery

Embryology At the end of the third week of gestation, the primitive gastrointestinal (GI) tract of an embryo consists of a straight tube suspended from the esophagus to the rectum by the dorsal mesentery, which contains the vascular supply. In the dorsal mesentery, the portion connected to the stomach is known as the dorsal mesogastrium. As the embryo lengthens, the caudal portion of the septum transversum…