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Head and neck imaging

Introduction The region of the head and neck involves complex anatomic structures, including the skull base, temporal bone, orbit, oral cavity, paranasal sinuses, and aerodigestive tract. Various kinds of pathology, including trauma, infection, congenital disease, and benign and malignant tumors develop in this area. Among these, evaluation of malignant tumors is one of the most common and most important imaging challenges in head and neck imaging.…

Radiopharmaceuticals and contrast agents

Introduction to PET radiopharmaceuticals and radionuclides PET radiopharmaceuticals are radioactive tracers used for diagnostic purposes in PET imaging. They consist of two main components, a positron-emitting radionuclide and a tracer/carrier molecule that delivers the radioactive label to the target ( ). The most commonly utilized PET radionuclides are short-lived ( ; ; ) as shown in Table 2.1 . Table 2.1 Selected PET radionuclides. Radionuclide Half-life Fluorine-18 110…

PET/MRI: technical and methodological aspects

Introduction Multimodal information is often required for diagnostic or research purposes as each imaging technique provides complementary data, for example about anatomy, physiology, or metabolism. Positron emission tomography (PET) measures the distribution and concentration of certain molecules in the body, magnetic resonance imaging (MRI) reflects proton density and tissue relaxation times, and computerized tomography (CT) maps the electron densities of tissues. Imaging hardware has constantly evolved…

Appendix: System Controls and Their Uses

In addition to the basic choice of transducer type and frequency for the examination in hand, there are many other factors on a Doppler ultrasound system which need to be adjusted. Despite the efforts of the manufacturers to automate and simplify things, it is still necessary to adjust continually many of the scan and Doppler parameters during the course of an examination. Is the vessel superficial…

Microbubble Ultrasound Contrast Agents

Background In the past 15–20 years, the practice of contrast-enhanced ultrasound (CEUS) has moved from a technique used in a few centres to a widely employed imaging modality that is used worldwide. This change in practice has been facilitated by an appreciation of the importance of the technique in day-to-day ultrasound practice, together with the development and increased availability of both CEUS-capable equipment and the contrast…

Interventional and Intraoperative Doppler

Introduction Ultrasound is the preferred modality for performing imaging-guided interventional procedures. Advantages over other modalities such as CT include real-time guidance allowing precise needle placement, portability, relatively low cost, and lack of ionising radiation. , The addition of colour Doppler has been shown to be of great utility during interventional procedures. The primary benefit is the enhanced ability to visualise blood vessels during needle placement. Other…

Clinical Applications of Doppler Ultrasound in Obstetrics

The circulatory changes that occur during pregnancy involve modification of vascular structure within the uterus (spiral arteries), the development of a neocirculation (the placenta and the fetus), a redistribution of blood flow and alteration in circulating blood volume such that the placenta in the third trimester receives 20% of the total maternal circulation and maternal blood volume increases by a similar value. Certain disease processes and…

Doppler Ultrasound of the Female Pelvis

Introduction Ultrasound is integral to modern gynaecological practice. This has been recognised by bodies such as the Royal College of Obstetricians and Gynaecologists, who have made ultrasound part of the core requirements in their training modules. Assisted conception units have long been aware of the value of ultrasound. Monitoring of ovaries during stimulated cycles, egg retrieval and assessing the early development of the implanted gestation are…

Doppler Imaging of the Scrotum

Introduction Scrotal sonography was first introduced in the mid-1970s. It remains the imaging modality of choice because it is simple, relatively inexpensive, and quick. Continuing refinements in imaging technology with higher-frequency transducers, and increased Doppler sensitivity have greatly enhanced perception of testicular anatomy and pathology. The haemodynamic information acquired with Doppler adds to the imaging findings; frequently reinforcing and often clinching the diagnosis. In this era,…

Doppler Ultrasound of the Penis

Acknowledgements Acknowledgements are made to Reginald Bruskewitz, MD; Mike Ledwidge, RDMS, RVT; Jeanne Johnson and Mercedes Kirk. Introduction Common indications for penile imaging are for evaluation of erectile dysfunction, trauma, priapism, penile carcinoma and Peyronie’s disease. Because it is a superficial soft tissue structure, the penis is ideally suited for imaging with ultrasound. The addition of colour and spectral Doppler allows the examiner to delineate vascular…

Doppler Imaging of the Prostate

Indications The most important use of colour Doppler imaging of the prostate remains as an aid in cancer detection. This is particularly relevant in patients in whom cancer is suspected based on prostate specific antigen (PSA) elevation without obvious tumour on grey scale imaging. Other uses for Doppler imaging are largely confined to detection of prostatitis and inflammatory conditions. Controversy continues surrounding diagnosis and treatment of…

Solid Organ Transplantation

Acknowledgements Thanks to Dr Luis Fernandez, Department of Surgery, University of Wisconsin for manuscript review, Mercedes Kirk and Jeanne Johnson for manuscript preparation and Mike Ledwidge, RT, RDMS, for image preparation. Introduction The number of transplant candidates on waiting lists for organs continues to increase each year. The shortage of organs remains a major problem for patients with end-stage liver, renal failure and diabetes mellitus. Graft…

The Kidneys

Renal Vascular Doppler Ultrasound Ultrasound is the imaging modality of choice for evaluation of the kidneys, especially in patients with borderline renal function, the incidence of which is increasing. In comparison with other modalities, ultrasound has the distinct advantage of providing clinically diagnostic information without the need for ionising radiation or contrast agents. The combination of spectral, colour, and/or power Doppler is extremely helpful in renal…

The Liver

Introduction There have been impressive advances recently in the application of ultrasound contrast medium to liver imaging; but these agents are not universally available. Researchers have shown the benefits of microbubble-enhanced lesion detection and characterisation. Unfortunately governing agencies across the world have not uniformly endorsed these agents and there is limited ability and/or interest to apply them in many centres. This chapter is, therefore, written for…

Haemodialysis Access

Arteriovenous Fistulas and Synthetic Arteriovenous Grafts At the end of 2009, there were 571,414 patients being treated for end-stage renal disease in the United States with 116,395 new cases in that year ; approximately 65% of these patients received haemodialysis. Complications associated with vascular access procedures are a major cause of morbidity and increasing healthcare costs in patients undergoing haemodialysis. For patients with end-stage real disease…

The Aorta and Inferior Vena Cava

Doppler examination in the abdomen is associated with specific problems which are not encountered in peripheral vascular examinations and these are particularly relevant to examinations of the aorta, inferior vena cava and their associated vessels. Respiratory motion and cardiac pulsation impair the examination, but getting the patient to suspend respiration for any length of time results in relative hypoxia and subsequently increased respiratory movement. It is…

The Peripheral Veins

The peripheral veins may be affected by a variety of disorders which can be assessed by ultrasound. Deep vein thrombosis (DVT) and thromboembolic disease are the most common indications for investigation of the peripheral veins but venous insufficiency and vein mapping are also reasons for examining the veins. Anderson et al. found an average annual incidence of 48 initial cases, 36 recurrent cases of DVT and…

The Peripheral Arteries

Atheroma occurs to different degrees in different parts of an individual’s cardiovascular system and the lower limb arteries are particularly prone to the development of atherosclerosis. Approximately 2% of adults in late middle age in Western countries have intermittent claudication and each year in England and Wales around 50 000 patients are admitted to hospital with a diagnosis of peripheral arterial disease; 15 000 of these…

The Carotid and Vertebral Arteries; Transcranial Colour Doppler

The Carotid and Vertebral Arteries CAROTID DISEASE AND STROKE Stroke is a major cause of morbidity and mortality. In the United Kingdom, there are approximately 150 000 first strokes each year and some 53 000 deaths a year as a result of stroke; in the United States the equivalent figures are 795 000 strokes and 137 000 deaths each year. There are significant direct and indirect…

Haemodynamics and Blood Flow

Principles of Blood Flow This section describes the simple principles of blood flow which are of value in understanding the role of Doppler and for performing vascular ultrasound examinations. The underlying principles of fluid mechanics applied to the flow of blood are complex, and discussed in detail in a number of texts including those by McDonald, Caro et al., Strackee & Westerhof and chapters in the…