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Pancreas

Whether the pancreas is adorable or not is a debatable issue; however, advanced cross-sectional imaging has permitted generation of excellent and exquisite images of the pancreas, which in turn has contributed immensely to the assessment of pancreatic diseases. Ultrasonography (US) has been used to evaluate abdominal pathologies, and its advantages include wide availability, low cost, and lack of radiation. Despite significant improvements and refinements in ultrasound…

Liver Transplantation

History Transplantation of the liver is the definitive treatment for irreversible acute and chronic liver disease. The first successful liver transplant was performed by Starlz in 1967 on a patient with hepatocellular carcinoma, who survived for more than 1 year. The development of cyclosporine in 1970, followed by other immunosuppressant agents and improved surgical techniques, has significantly improved the survival rates of liver transplant patients, leading…

Liver: Focal Hepatic Mass Lesions

Focal hepatic mass lesions can be divided into: (1) pseudolesions or pseudotumors, (2) nontumorous mass lesions, including cysts and inflammatory masses, (3) benign tumors, and (4) primary and secondary malignant tumors. Ultrasonography plays a primary role in detection of focal hepatic mass lesions; for further characterization, computed tomography (CT) and magnetic resonance imaging (MRI) provide valuable information. This chapter discusses the CT and MRI features of…

Liver : Normal Anatomy, Imaging Techniques, and Diffuse Diseases

Over more than 3 millennia the liver held a central and unsurpassed role among all human organs, manifested in coeval theogony, poetry, and fairy tales. The liver was chosen to be the seat of the soul, intelligence, and passion, equipped with particular divine protection and hoped to be indestructible, reflecting the prodigious recuperative powers of hepatic parenchyma. In Egyptian mythology, Isis's envoy Imsety (18th Dynasty, 1570-1350…

Biliary Tract and Gallbladder

Biliary Tract Normal Anatomy and Variants On high-resolution computed tomography (CT), normal intrahepatic bile ducts (IHDs) appear as linear water-density structures accompanying the portal vein branches. Normal IHDs measure less than 3 mm. They appear to be randomly scattered throughout the liver but are confluent toward the hilum. The IHDs from each lobe unite to form the right and left main hepatic ducts, which are located anterior…

Chest Imaging in the Pediatric Patient

Introduction Plain film radiography is the first-line imaging modality in the evaluation of pediatric chest disorders. However, computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly being used and are more valuable for further characterization of pediatric chest abnormalities. Multidetector CT (MDCT) is the most important imaging modality and is more sensitive than radiographs. CT has several advantages including high spatial resolution, good temporal resolution…

Airway

Normal Anatomy Trachea and Main Bronchi The trachea comprises 16 to 22 C -shaped cartilages that are linked longitudinally by annular ligaments of fibrous and connective tissue. The cartilages are connected posteriorly by the membranous wall of the trachea, which lacks cartilage and is supported by the trachealis muscle, which is composed of transverse smooth muscle fibers that narrow the tracheal lumen on contraction. During forced…

Disease of the Pleura, Chest Wall, and Diaphragm

Normal Anatomy Pleura and Chest Wall The pleura is a thin, two-layered serous membrane that lines the lungs and thoracic cavity. The visceral pleura lines the lungs and invaginates into a double layer to form the major and minor fissures, and the parietal pleura lines the chest wall, mediastinum, and diaphragmatic surface (sparing the hila). The pleural space is a potential space between the parietal and…

Mediastinal Disease

There are many excellent textbooks and articles on the mediastinum. This chapter references these articles and a review of the recent literature as the basis for a discussion of the anatomy, pathology, and radiologic manifestations of mediastinal diseases. Normal Anatomy Comprehensive knowledge of cross-sectional anatomy is required to accurately evaluate mediastinal abnormalities. Interpretation of mediastinal anatomy can be assisted by analyzing computed tomography (CT) images at…

Neoplastic Disease of the Lung

Although most primary pulmonary tumors are carcinomas, a large histologic spectrum of benign and malignant tumors of the lung exist. This chapter reviews the more common neoplasms according to the classification proposed by the World Health Organization (WHO) ( Box 37-1 ). Additionally, to address advances in oncology, molecular biology, pathology, radiology, and surgery this chapter includes the modifications in the histologic classification of lung cancer…

Nonneoplastic Parenchymal Lung Disease

Although many lung disorders can be diagnosed from the plain chest radiograph, its limitations in providing a definitive diagnosis are widely understood. Complicated chest radiographs, the lack of radiographic abnormalities in symptomatic patients, and the limitations of portable chest studies make evaluation of conventional chest films sometimes difficult. Imaging evaluation of parenchymal lung disease is essentially confined to chest radiography, high-resolution computed tomography (HRCT), spiral CT,…

Congenital Abnormalities

Introduction Development of the spine and spinal cord is a complex process determined by an intricate chain of embryologic stages under precise genetic control. Although congenital abnormalities of spine development are frequently classified according to the specific derangement responsible for the anomaly, the pathogenesis of some abnormalities is not well understood. We review these anomalies while classifying them from clinical and imaging perspectives. These include three…

Systemic Diseases Affecting the Spine

A variety of systemic diseases affect the osseous skeleton and therefore the spine. Detection of bone abnormalities with imaging can be challenging with plain film, given that demineralization, a common element of many conditions, requires a 50% decrease in bone mass before it can be detected. Computed tomography (CT) has improved the detection of demineralization, and magnetic resonance imaging (MRI) can enhance the sensitivity and specificity…

Spinal Vascular Diseases

Introduction Spinal vascular diseases consist of spinal vascular malformations, spinal aneurysms, and spinal cord arterial ischemia. They are relatively rare but should be kept in the differential diagnosis for spinal tumors, demyelinations, or compressive myelopathies. As for spinal vascular malformations, there have been various nomenclatures or classifi­cations. Spetzler proposed a classification based on anatomic and pathophysiologic characteristics, and he subdifferentiated extradural arteriovenous fistulae (AVF), intradural dorsal/ventral…

Cystic Lesions

A broad spectrum of cystic lesions can be identified on spine imaging. Multiple etiologies and different imaging characteristics of these lesions make the differential diagnosis a challenging issue for radiologists. Cysts may develop within the spinal canal and may be grouped according to their location as intramedullary, intradural extramedullary, or extradural lesions. This classification is useful in planning treatment, but it is less useful for narrowing…

Spinal Infection

Introduction Spinal infection is a common disease worldwide and is being recognized more often, especially since the introduction of more sophisticated imaging techniques. It may be a primary disease, starting locally as a spinal infection, or secondary to a systemic infection or an infection of the central nervous system. Most patients usually present with subtle and nonspecific clinical symptoms that are difficult to diagnose. Because many…

Spinal Tumors

Introduction Spinal neoplasms are divided into three groups based on their anatomic locations: extradural, extramedullary-intradural, and intramedullary tumors ( Fig. 30-1 ). Extradural tumors include masses in the bones, disks, and paraspinal soft tissues. The majority of spinal tumors (60%) in adults are extradural tumors and are most commonly (90%) metastases of systemic cancer. Extramedullary-intradural tumors include masses originating from the dura/arachnoid and nerves. They are…

Degenerative Disease

Introduction Acute and chronic low back pain is a ubiquitous complaint encountered by primary care physicians throughout the United States, accounting for the second most common symptomatic reason for office visits. Low back pain is the leading cause of disability for patients younger than age 45, resulting in lost time from work and decreased work productivity, with increasing cost expenditures for evaluation and treatment of back…

Spinal Trauma

Imaging studies play a central role in the diagnosis of spinal trauma. The biomechanics, natural history, and treatment methods differ significantly in cervical and thoracolumbar injuries and are therefore addressed separately in this chapter. Multiple classification systems have been developed and continue to evolve. We will focus on the analyses of injury characteristics and will discuss the classification systems that have been evaluated for validity and…

Noninfectious Inflammatory Diseases Affecting the Spinal Cord

Introduction Most noninfectious inflammatory diseases of the spinal cord are autoimmune in nature. Although the number of autoimmune diseases affecting the spinal cord is large, their clinical imaging manifestations are limited, and with few exceptions the most common presentation is transverse myelitis (TM). The typical magnetic resonance imaging (MRI) features of TM ( Fig. 27-1 ) are abnormal high signal on T2-weighted images, often accompanied by…