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Book Details
Abstract
For 30 years, the highly regarded Secrets Series® has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Radiology Secrets Plus, 4th Edition, by Drs. Drew Torigian and Parvati Ramchandani, features the Secrets’ popular question-and-answer format that also includes lists, tables, and an informal tone – making reference and review quick, easy, and enjoyable.
- Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams.
- The proven Secrets® format gives you the most return for your study time – concise, easy to read, engaging, and highly effective.
- Full-color, expanded layout enhances understanding in this highly visual field.
- Thorough updates throughout by a new expert author team from the highly regarded program at University of Pennsylvania and world-renowned contributors from top radiology programs.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Radiology Secrets Plus | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xi | ||
| Acknowledgment | xii | ||
| Table Of Contents | xiii | ||
| Top 100 Radiology Secrets | xviii | ||
| I Introduction to Imaging Modalities | 1 | ||
| 1 Introduction to Radiography, Fluoroscopy, and Tomosynthesis | 3 | ||
| Radiography | 3 | ||
| 1. What is radiography? | 3 | ||
| 2. When were x-rays discovered? | 3 | ||
| 3. How do x-rays differ from other types of electromagnetic radiation? | 3 | ||
| 4. How do x-rays interact with matter? | 3 | ||
| 5. What is an x-ray tube? | 3 | ||
| 6. How are x-rays for diagnostic imaging produced? | 3 | ||
| 7. What is a focal spot? | 3 | ||
| 8. What is a collimator? | 3 | ||
| 9. What happens to most of the energy entering the x-ray tube? | 3 | ||
| 10. What key input parameters may be adjusted when generating x-rays? | 3 | ||
| 11. What are the effects of increasing kV? | 4 | ||
| 12. What are the effects of increasing mAs? | 4 | ||
| 13. What is screen film radiography? | 4 | ||
| 14. What is computed radiography (CR)? | 4 | ||
| 15. What is digital radiography (DR)? | 4 | ||
| 16. What is dual energy radiography? | 4 | ||
| 17. What is an anti-scatter grid? | 4 | ||
| 18. What is the inverse square law? | 5 | ||
| 19. What is the difference between a posteroanterior (PA) and an anteroposterior (AP) radiograph? | 5 | ||
| 20. What are the five basic densities seen on a radiograph? | 5 | ||
| 21. How does mammographic technique differ from that performed in chest and abdominal radiography? | 5 | ||
| Fluoroscopy | 5 | ||
| 22. What is fluoroscopy? | 5 | ||
| 23. What are some clinical applications of fluoroscopy? | 5 | ||
| 24. What general types of contrast agents are used in gastrointestinal fluoroscopic studies? | 5 | ||
| 25. What is digital subtraction angiography (DSA)? | 5 | ||
| Tomosynthesis | 6 | ||
| 26. What is tomosynthesis, and how does it work? | 6 | ||
| 27. What are some clinical applications of tomosynthesis? | 6 | ||
| Bibliography | 6 | ||
| 2 Introduction to Ultrasonography, CT, and MRI | 8 | ||
| Ultrasonography (US) | 8 | ||
| 1. What is ultrasonography (US), and how does it work? | 8 | ||
| 2. When was US first used for clinical diagnostic purposes? | 8 | ||
| 3. What are some common clinical applications of US? | 8 | ||
| 4. Why is gel used in US? | 8 | ||
| 5. What is a transducer, and what types are available for US? | 8 | ||
| 6. What is echogenicity? | 8 | ||
| 7. What is posterior acoustic enhancement? | 8 | ||
| 8. What is posterior acoustic shadowing? | 8 | ||
| 9. What is Doppler US? | 9 | ||
| Computed Tomography (CT) | 9 | ||
| 10. What is computed tomography (CT), and how does it work? | 9 | ||
| 11. When was CT developed? | 9 | ||
| 12. What are some common clinical applications of CT? | 9 | ||
| 13. What is multislice CT (MSCT)? | 9 | ||
| 14. What is dual-source CT (DSCT)? | 10 | ||
| 15. What is dual-energy CT (DECT)? | 10 | ||
| 16. What is the difference between sequential and helical CT acquisition? | 10 | ||
| 17. What is attenuation? | 10 | ||
| Magnetic Resonance Imaging (MRI) | 10 | ||
| 18. What is magnetic resonance imaging (MRI), and how does it work? | 10 | ||
| 19. When was MRI developed? | 11 | ||
| 20. What are some common clinical applications of MRI? | 11 | ||
| 21. What are some contraindications to the use of MRI? | 11 | ||
| 22. What is the typical field strength of magnets used in clinical MRI? | 11 | ||
| 23. What are T1 and T2? | 11 | ||
| 24. What is a pulse sequence? | 12 | ||
| 25. What is k space? | 12 | ||
| 26. What are TR and TE? | 12 | ||
| 27. What is a spin echo (SE) pulse sequence? | 12 | ||
| 28. What is a fast spin echo (FSE) pulse sequence? | 12 | ||
| 29. What is a gradient recalled echo (GRE) pulse sequence? | 12 | ||
| 30. What is signal intensity (SI)? | 12 | ||
| 31. What are T1-weighted images? | 12 | ||
| 32. What are T2-weighted images? | 12 | ||
| 33. What typically has high SI on T1-weighted images? | 12 | ||
| 34. What typically has high SI on T2-weighted images? | 12 | ||
| 35. What typically has low SI on both T1-weighted and T2-weighted images? | 13 | ||
| 36. Why is it important to acquire precontrast and postcontrast images with the same imaging parameters? | 13 | ||
| 37. What is diffusion-weighted imaging (DWI)? | 13 | ||
| 38. What is diffusion-tensor imaging (DTI)? | 13 | ||
| 39. What is magnetic resonance spectroscopy (MRS)? | 13 | ||
| Bibliography | 13 | ||
| 3 Introduction to Nuclear Medicine and Molecular Imaging | 14 | ||
| 1. What is molecular imaging? | 14 | ||
| 2. What is nuclear medicine, and how is a nuclear medicine test performed? | 14 | ||
| 3. How does molecular imaging differ from structural imaging? | 14 | ||
| 4. What is the difference between x-rays used in radiography and CT and gamma rays used in nuclear medicine techniques? | 14 | ||
| 5. What is radioactivity, and when was it discovered? | 14 | ||
| 6. When was the positron discovered? | 14 | ||
| 7. How are radioisotopes and radiotracers created? | 14 | ||
| 8. What are some commonly used radioisotopes in diagnostic nuclear medicine? | 15 | ||
| 9. What is the physical half-life of a radioisotope? | 15 | ||
| 10. What units are used to measure radioactivity? | 15 | ||
| 11. What is a dose calibrator? | 15 | ||
| 12. How are nuclear medicine imaging tests generally performed? | 15 | ||
| 13. What is planar scintigraphy? | 16 | ||
| 14. What are some examples of common clinical applications of planar scintigraphy? | 16 | ||
| 15. What is SPECT? | 16 | ||
| 16. What are some examples of common clinical applications of SPECT/CT? | 16 | ||
| 17. What is PET? | 16 | ||
| 18. What are some examples of common clinical applications of PET/CT? | 17 | ||
| 19. What is a standardized uptake value (SUV)? | 18 | ||
| 20. What is total lesional glycolysis (TLG)? | 18 | ||
| 21. What is optical imaging, and how does it work? | 18 | ||
| 22. What is the difference between fluorescence and bioluminescence? | 18 | ||
| 23. What is Cherenkov radiation? | 18 | ||
| Bibliography | 18 | ||
| 4 Introduction to Image Processing, Visualization, and Analysis | 20 | ||
| 1. What is a digital image? | 20 | ||
| 2. What is the difference between a pixel and a voxel? | 20 | ||
| 3. What is image reconstruction? | 20 | ||
| 4. What is the field of view (FOV) of an image? | 20 | ||
| 5. What is the matrix size of an image? | 20 | ||
| 6. What is signal-to-noise ratio (SNR)? | 20 | ||
| 7. What is contrast-to-noise ratio (CNR)? | 20 | ||
| 8. What is spatial resolution? | 20 | ||
| 9. What is contrast resolution? | 20 | ||
| 10. What is temporal resolution? | 20 | ||
| 11. What is a modulation transfer function (MTF)? | 20 | ||
| 12. What is quantitative radiology (QR)? | 20 | ||
| 13. What is the purpose of computer-aided visualization and analysis (CAVA)? | 20 | ||
| 14. What is image preprocessing? | 21 | ||
| 15. What is VOI restriction? | 21 | ||
| 16. What is filtering? | 21 | ||
| 17. What is interpolation? | 21 | ||
| 18. What is registration? | 21 | ||
| 19. What is segmentation? | 21 | ||
| 20. What is thresholding? | 21 | ||
| 21. What is the purpose of image visualization? | 21 | ||
| 22. What are some ways to visualize tomographic images? | 22 | ||
| 23. What is the difference between window level and window width? | 23 | ||
| 24. What is the purpose of image manipulation? | 23 | ||
| 25. What is the purpose of image analysis? | 24 | ||
| 26. What is the purpose of computer-aided diagnosis (CAD)? | 24 | ||
| 27. What is a biomarker? | 24 | ||
| 28. What is a clinical endpoint? | 24 | ||
| 29. What is a surrogate endpoint? | 24 | ||
| 30. What is radiomics? | 24 | ||
| 31. What is radiogenomics? | 24 | ||
| Bibliography | 24 | ||
| 5 Computers in Radiology | 26 | ||
| 1. What is PACS? | 26 | ||
| 2. How are PACS images stored? | 26 | ||
| 3. What is image compression? | 26 | ||
| 4. What is the difference between “lossy” and “lossless” compression? | 26 | ||
| 5. What is RIS? | 26 | ||
| 6. What is HIS? | 26 | ||
| 7. What is DICOM? | 26 | ||
| 8. What determines image storage size? | 26 | ||
| 9. How large are these studies? | 27 | ||
| 10. What is teleradiology? | 27 | ||
| 11. What is IHE? | 27 | ||
| 12. What is HL7? | 27 | ||
| 13. How are conventional radiographs integrated into an all-digital PACS? | 27 | ||
| 14. What is voice recognition (or speech recognition)? | 28 | ||
| 15. What are the advantages and disadvantages of voice or speech recognition relative to conventional dictation/transcription? | 28 | ||
| 16. What is structured reporting? | 28 | ||
| 17. What is RadLex? | 28 | ||
| 18. What is CADe? | 28 | ||
| 19. What is BI-RADS? | 28 | ||
| 20. What types of injuries can result from working at a PACS workstation, and what are some potential remedies? | 28 | ||
| 21. What is image sharing? | 29 | ||
| 22. What is XDS? | 29 | ||
| 23. What is Imaging 3.0? | 29 | ||
| 24. What factors are important to consider when choosing a mobile device for use in radiology departments? | 29 | ||
| 25. Can I interpret radiology images on a tablet device? | 29 | ||
| 26. What are the display requirements for diagnostic interpretation of radiology images? | 30 | ||
| 27. Where can I learn more about imaging informatics? Are there formal training programs and certifications available? | 30 | ||
| Bibliography | 31 | ||
| 6 Introduction to Contrast Agents | 32 | ||
| 1. What is a radiographic contrast agent? | 32 | ||
| 2. What types of contrast agents are available for intravascular use? | 32 | ||
| 3. How common are acute adverse reactions to intravascular contrast material? | 32 | ||
| 4. What are the categories of acute adverse reaction to contrast agents? | 32 | ||
| 5. What are the 5 important immediate assessments that should be made when evaluating a patient for a potential contrast reaction? | 33 | ||
| 6. What are some risk factors that predispose patients to acute adverse contrast reactions? | 33 | ||
| 7. When do adverse reactions to intravascular iodinated contrast material usually occur? | 33 | ||
| 8. What is iodine “mumps”? | 33 | ||
| 9. When is premedication indicated prior to contrast administration? | 33 | ||
| 10. What is a breakthrough reaction? | 34 | ||
| 11. Is there a specific association between presence of a shellfish allergy and an increased allergy to iodinated contrast material? | 34 | ||
| 12. Is there a specific association between presence of an allergy to iodinated contrast material and having a future reaction to gadolinium-based contrast material? | 34 | ||
| 13. How often does extravasation of intravenous contrast material occur? | 34 | ||
| 14. What is the most common severe injury that may occur following extravasation of intravenous contrast material? | 34 | ||
| 15. What is contrast-induced nephropathy (CIN)? | 34 | ||
| 16. What are the major risk factors for CIN? | 34 | ||
| 17. What is the best way to prevent CIN? | 34 | ||
| 18. Does metformin increase the risk of CIN? | 34 | ||
| 19. Which factors require assessment of patient renal function prior to administration of intravascular contrast material? | 35 | ||
| 20. What are the major contraindications to the administration of intravascular contrast material? | 35 | ||
| 21. Can intravascular iodinated contrast material be safely administered to anuric patients with end-stage renal disease who are on dialysis? | 35 | ||
| 22. What is nephrogenic systemic fibrosis (NSF), and who is at risk for developing this complication? | 35 | ||
| 23. Is intravascular iodinated contrast material contraindicated for use in pregnant women? | 35 | ||
| 24. Is intravascular gadolinium-based contrast material contraindicated for use in pregnant women? | 36 | ||
| 25. Is intravascular contrast material safe for use in women who are breast-feeding? | 36 | ||
| 26. What major types of enteric contrast agent are available? | 36 | ||
| 27. What are the major complications of barium sulfate enteric contrast material? | 36 | ||
| 28. What are the major complications of iodinated contrast material when used as an oral contrast agent? | 36 | ||
| Bibliography | 37 | ||
| 7 Radiation Dose and Safety Considerations in Imaging | 38 | ||
| 1. What is the terminology for radiation dose? | 38 | ||
| 2. In what units is radiation dose expressed? | 38 | ||
| 3. What organizations make recommendations or monitor the use of ionizing radiation in medical imaging? | 38 | ||
| 4. What are the recommended annual dose limits for radiation exposure? | 38 | ||
| 5. What is the ALARA principle? | 39 | ||
| 6. What is the inverse square law? | 39 | ||
| 7. What are stochastic and nonstochastic effects of radiation exposure? | 39 | ||
| 8. What is the BEIR VII report? | 39 | ||
| 9. What is the linear no-threshold model? | 39 | ||
| 10. What is radiation hormesis? | 40 | ||
| 11. What are the biological effects of radiation exposure? | 40 | ||
| 12. What are the typical sources and annual levels of background radiation exposure? | 40 | ||
| 13. What are the typical levels of radiation exposure caused by various imaging tests? | 40 | ||
| 14. What tools are used to measure radiation exposure in diagnostic imaging? | 41 | ||
| 15. What is CTDI? | 41 | ||
| 16. What is SSDE? | 42 | ||
| 17. What is DLP, and how is it calculated? | 42 | ||
| 18. What is effective dose, and how is it calculated? | 42 | ||
| 19. What approaches are available to reduce exposure to imaging radiation dose? | 43 | ||
| 20. What is the American College of Radiology (ACR) Dose Index Registry (DIR)? | 43 | ||
| 21. What is Image Wisely? | 43 | ||
| 22. What is Image GentlySM? | 43 | ||
| 23. What is the Mammography Quality Standards Act (MQSA)? | 43 | ||
| 24. What are the risks of radiation to the fetus? | 44 | ||
| 25. What types of imaging are permissible in the setting of pregnancy? | 45 | ||
| 26. What are the potential safety hazards of US, and how are they avoided? | 45 | ||
| 27. How is a radioactive spill managed? | 45 | ||
| 28. What are the potential safety hazards of MRI, and how are they avoided? | 45 | ||
| 29. What are some contraindications to performing MRI? | 45 | ||
| 30. What is specific absorption rate (SAR), and what are the mandated limits? | 46 | ||
| 31. What is quenching? | 46 | ||
| Bibliography | 46 | ||
| II Breast Imaging | 49 | ||
| 8 Screening Mammography | 51 | ||
| 1. What is a screening mammogram? | 51 | ||
| 2. When should an average woman start getting mammograms? | 51 | ||
| 3. Are there instances when screening should start earlier than 40? | 51 | ||
| 4. How many views are obtained for a routine mammogram? | 51 | ||
| 5. Which view visualizes the most breast tissue? | 51 | ||
| 6. Which portion of the breast is better visualized on the CC view than on the MLO view? | 51 | ||
| 7. What if there are comparison studies elsewhere? Do we need to get them? | 51 | ||
| 8. What is the incidence of screening-detected breast cancer? | 51 | ||
| 9. What is the reported sensitivity of screening mammography? | 51 | ||
| 10. What is the difference between a screening mammogram and a diagnostic mammogram? | 51 | ||
| 11. Are there other types of breast cancer screening modalities? Which modalities are used in everyday clinical practice? | 52 | ||
| 12. Is digital mammography better than film screen mammography in detecting breast cancer? | 52 | ||
| 13. Is there an age at which breast cancer screening should stop? | 53 | ||
| 14. What are some risk factors for developing breast cancer? | 53 | ||
| 15. True or false: Most breast cancers occur in women with a family history of breast cancer. | 53 | ||
| 16. True or false: The incidence of breast cancer is currently rising. | 53 | ||
| 17. It has been said that one in eight women has a risk of developing breast cancer. Does a 40-year-old woman have the same risk as an 80-year-old woman? | 53 | ||
| 18. What are BRCA1 and BRCA2 genes? | 53 | ||
| 19. How much radiation does a woman receive from a routine screening mammogram? | 53 | ||
| 20. What is the call-back rate? What should the call-back rate be for a radiologist? | 53 | ||
| 21. Is the breast a modified skin gland, fatty tissue, muscle, or lymphatic structure? | 53 | ||
| 22. How does accessory breast tissue form? Where is it most commonly located? | 53 | ||
| Bibliography | 54 | ||
| 9 Diagnostic Mammography | 55 | ||
| 1. What are the indications for a diagnostic mammogram? | 55 | ||
| 2. What views are performed for diagnostic mammography? How are patients who have undergone diagnostic mammography informed of results? | 55 | ||
| 3. What is BI-RADS? | 55 | ||
| 4. What types of mammographic changes may be seen after breast conservation? | 55 | ||
| 5. Does mammography have high sensitivity in detecting recurrent breast cancer after breast conservation? | 55 | ||
| 6. What is the incidence of recurrent breast cancer in a patient after breast conservation? | 55 | ||
| 7. True or false: In patients who develop recurrence after breast conservation, survival rates are about the same as for patients who had a mastectomy as the initial treatment. | 55 | ||
| 8. What are some contraindications to breast conservation? | 55 | ||
| 9. In a patient who is planning to have breast conservation, when is it necessary to obtain a postbiopsy mammogram shortly after a successful excisional biopsy? | 56 | ||
| 10. True or false: In a patient with a history of breast cancer, it is beneficial to get a mammogram more frequently than once a year. | 56 | ||
| 11. What is a 6-month follow-up? How long is the follow-up performed for BI-RADS category 3 lesions? | 56 | ||
| 12. How is the mastectomy bed evaluated? | 56 | ||
| 13. What types of surgical reconstruction are available after a mastectomy? | 56 | ||
| 14. True or false: After a benign breast biopsy, significant residual changes are usually visible on a mammogram. | 56 | ||
| 15. For all breast biopsies, approximately what percentage of the pathology results should be malignant? | 56 | ||
| 16. A 47-year-old woman presents with a newly palpable breast mass and has a negative mammogram. What should be done next? | 57 | ||
| 17. If US results are negative, what should be done next? What percentage of the time can a cancer be missed on US and mammography? | 57 | ||
| 18. What types of nipple discharge are considered suspicious and warrant additional imaging evaluation? What imaging workup is recommended for suspicious nipple discharge? | 57 | ||
| 19. What types of nipple discharge are associated with benign etiologies? | 57 | ||
| 20. In a patient with a suspicious type of nipple discharge, what is the likelihood that the discharge is due to cancer? | 57 | ||
| 21. What is the most common etiology for bloody nipple discharge? | 58 | ||
| 22. What are the most common histologic types of breast cancer? | 58 | ||
| 23. Is lobular carcinoma in situ (LCIS) a form of cancer? What is the significance of LCIS? | 58 | ||
| 24. What is the differential diagnosis for a red swollen breast? | 58 | ||
| 25. Is there such a thing as a mammographic emergency? | 58 | ||
| 26. How many views are obtained in a patient with breast augmentation? | 58 | ||
| 27. Where can the implants be placed in the breast? | 58 | ||
| 28. What types of implants are available? | 58 | ||
| 29. What is the most sensitive imaging evaluation for implant rupture? | 58 | ||
| 30. A man presents with a breast lump. How should the patient be imaged? What is the most common etiology for a breast lump in a man? | 59 | ||
| 31. What is the etiology of gynecomastia? | 59 | ||
| 32. Do men get breast cancer? What is the frequency? | 59 | ||
| 33. True or false: Breast cancer can manifest in the following ways: calcifications, masses, architectural distortion, and density. | 59 | ||
| 34. Classify the following terms commonly used to describe breast calcifications as indicative of benign, indeterminate, or malignant patterns. | 60 | ||
| 35. Figures 9-4 through 9-9 show images of breast calcifications. Classify them as benign or malignant patterns of calcification. | 60 | ||
| 36. What is a triple-negative breast cancer, and what is its significance? | 60 | ||
| 37. A patient presents with a palpable breast mass and a stable mammogram. The mass in Figure 9-10 is seen on US. What should be the radiologist’s recommendation? | 60 | ||
| 38. What is the difference between multifocal and multicentric breast cancer? | 61 | ||
| 39. Are radial scars associated with prior surgery? | 61 | ||
| 40. What is a fibroadenoma? | 61 | ||
| 41. What is a phylloides tumor? | 63 | ||
| 42. What is Mondor’s disease? | 63 | ||
| Bibliography | 63 | ||
| 10 Breast Ultrasonography (US) and Breast Procedures | 64 | ||
| 1. What are the labeled structures on the ultrasound image in Figure 10-1? | 64 | ||
| 2. What type of transducer should be used to perform breast US? | 64 | ||
| 3. List the indications for targeted breast US after a mammographic evaluation. | 64 | ||
| 4. When would breast US be indicated without obtaining a mammogram first? | 64 | ||
| 5. What are some suspicious lesion features for malignancy on US? | 65 | ||
| 6. What are some benign lesion features on US? | 65 | ||
| 7. What types of biopsy procedures may be performed to evaluate breast lesions? | 65 | ||
| 8. What are the relative disadvantages of FNA, core needle biopsy, and needle localization/excision? | 65 | ||
| 9. How can one be certain that the lesion of interest was actually what was sampled during core needle biopsy? | 66 | ||
| 10. What is the lesion depth, or the z axis, calculated on a stereotactic biopsy? | 66 | ||
| 11. In what circumstances would a stereotactic biopsy be difficult to perform? | 66 | ||
| 12. In what circumstances would US-guided biopsy be difficult to perform? | 66 | ||
| 13. What is a discordant pathology result? | 66 | ||
| 14. In what situations or histopathologic diagnoses should an excisional biopsy be recommended after a percutaneous breast biopsy? | 66 | ||
| Bibliography | 66 | ||
| 11 Breast MRI | 67 | ||
| 1. What are the indications for breast magnetic resonance imaging (MRI)? | 67 | ||
| 2. What are the contraindications for breast MRI? | 67 | ||
| 3. What are the risks of breast MRI? | 67 | ||
| 4. How sensitive is breast MRI at finding breast cancer? | 67 | ||
| 5. If a biopsy is performed based on an abnormal MRI finding, how likely will this be cancer? | 67 | ||
| 6. What are the typical sequences used in a breast MRI? | 67 | ||
| 7. Which is more helpful to characterize a lesion as malignant, morphology on postcontrast images or kinetic analysis features? | 67 | ||
| 8. What are the ACR recommended morphologic descriptors for abnormal enhancement on breast MRI? | 68 | ||
| 9. What kinds of enhancement kinetics are seen? | 68 | ||
| 10. What are the typical morphologic and kinetic features of a benign mass on breast MRI? | 68 | ||
| 11. What are some commonly observed benign masses? | 68 | ||
| 12. What are the typical features of a malignant mass on breast MRI? | 69 | ||
| 13. Are there associated findings that may increase the probability that a breast mass is malignant? | 69 | ||
| 14. What are the typical features of malignant nonmass enhancement? | 69 | ||
| 15. How should a breast MRI report be organized? | 69 | ||
| 16. What are the BI-RADS assessment categories used to indicate management recommendations? | 69 | ||
| 17. Does breast MRI have to be performed with contrast material? | 72 | ||
| 18. Should breast MRI generally be ordered as a unilateral or bilateral examination? | 72 | ||
| 19. What are the next steps after characterizing abnormal enhancement on breast MRI? | 73 | ||
| 20. What is MRI-directed US? | 73 | ||
| 21. How is breast MRI biopsy performed? | 73 | ||
| 22. Is there any recommended follow-up after a benign breast biopsy? | 73 | ||
| 23. What are the signs of breast implant rupture? | 73 | ||
| Bibliography | 74 | ||
| III Noninvasive Cardiac and Vascular Imaging | 75 | ||
| 12 Cardiac and Pericardiac Imaging | 77 | ||
| 1. What forms the borders of the heart on the frontal posteroanterior (PA) or anteroposterior (AP) chest radiograph? | 77 | ||
| 2. What forms the borders of the heart on the lateral chest radiograph? | 77 | ||
| 3. What are the signs of left atrial enlargement on the chest radiograph? | 77 | ||
| 4. What are the signs of right ventricular enlargement on the chest radiograph? | 77 | ||
| 5. What is Eisenmenger syndrome? | 78 | ||
| 6. What are the advantages of MRI for imaging the heart? | 79 | ||
| 7. What are the disadvantages of MRI? | 79 | ||
| 8. What are the indications for cardiac MRI? | 79 | ||
| 9. What are the contraindications to performing cardiac MRI? | 79 | ||
| 10. What are the standard planes for cross-sectional cardiac imaging? | 79 | ||
| 11. How is bright blood MRI accomplished, and why is it used? | 79 | ||
| 12. How is dark blood MRI accomplished, and why is it used? | 80 | ||
| 13. How is cine imaging accomplished, and why is it used? | 80 | ||
| 14. How are late gadolinium enhancement (LGE) images obtained, and how are they used? | 80 | ||
| 15. What are some diseases that affect valvular function, and how can they be diagnosed with imaging? | 80 | ||
| 16. How is phase contrast imaging accomplished, and why is it used? | 80 | ||
| 17. Why is Qp/Qs important, and how is it measured on MRI? | 82 | ||
| 18. What is the normal imaging appearance of the pericardium? | 82 | ||
| 19. What imaging features may be seen with congenital absence of the pericardium? | 82 | ||
| 20. What are the imaging findings of a pericardial effusion? | 82 | ||
| 21. What are the imaging findings of acute pericarditis? | 82 | ||
| 22. What are some imaging findings of chronic (constrictive) pericarditis? | 82 | ||
| 23. What portions of the heart are supplied by the right coronary, left anterior descending, and left circumflex arteries? | 83 | ||
| 24. What are noninvasive methods of coronary artery imaging? | 83 | ||
| 25. What is the most sensitive imaging technique for the detection of myocardial infarction? | 83 | ||
| 26. How long after myocardial infarction does a ventricular aneurysm develop? | 83 | ||
| 27. How long after myocardial infarction does a ventricular pseudoaneurysm develop? | 83 | ||
| 28. What is the differential diagnosis of a regional wall motion abnormality? | 84 | ||
| 29. What are some causes of dilated cardiomyopathy and restrictive cardiomyopathy? | 84 | ||
| 30. What are the findings of hypertrophic cardiomyopathy on MRI? | 85 | ||
| 31. How does a patient with myocarditis present clinically, and what are the findings on MRI? | 85 | ||
| 32. In a patient with an abnormal ECG finding and a family history of sudden death, cardiac MRI shows a dilated right ventricle with abnormal wall motion and a normal left ventricle. What is the most likely diagnosis? | 85 | ||
| 33. What is myocardial noncompaction, and how does it appear on MRI? | 85 | ||
| 34. What happens when a ventricle becomes dilated? | 85 | ||
| 35. What are common cardiac or paracardiac masses? | 85 | ||
| 36. How can you differentiate tumor from thrombus? | 85 | ||
| 37. What is the most common malignancy of the heart and pericardium? | 88 | ||
| 38. What does lipomatous hypertrophy of the interatrial septum (LHIS) look like on imaging studies? | 88 | ||
| Bibliography | 88 | ||
| 13 Aortic Imaging | 90 | ||
| 1. What is the normal imaging appearance of the aorta on computed tomography (CT) and magnetic resonance imaging (MRI)? | 90 | ||
| 2. What typical CT and MRI protocols/techniques are used to image the aorta? | 90 | ||
| 3. What are aneurysms and pseudoaneurysms, and how do they differ? | 91 | ||
| 4. What is a mycotic aneurysm? Which imaging findings help suggest the diagnosis? | 91 | ||
| 5. What is an inflammatory abdominal aortic aneurysm (AAA)? | 91 | ||
| 6. What are aortoenteric and aortocaval fistulas, and how are they diagnosed? | 91 | ||
| 7. What is an aortic dissection, and how is it different from aortic transection? | 91 | ||
| 8. In the setting of blunt trauma, where do aortic injuries most commonly occur? | 92 | ||
| 9. How are traumatic aortic injuries diagnosed? | 92 | ||
| 10. Name the chest radiographic findings that are suggestive of thoracic aortic pathology. | 92 | ||
| 11. What are the two classification schemes for aortic dissection? | 92 | ||
| 12. How are dissections that involve the ascending aorta managed differently from those that involve the descending aorta only? | 93 | ||
| 13. Which lumen is usually larger in aortic dissection—the true or false lumen? | 93 | ||
| 14. Describe other acute aortic syndromes that are often called variants of aortic dissection. | 93 | ||
| 15. What is the best imaging modality for diagnosing each of these conditions? | 93 | ||
| 16. How can these conditions be distinguished on axial CT or MR images? | 94 | ||
| 17. What is the utility of precontrast imaging when performing CTA or MRA of the aorta? | 94 | ||
| 18. How large must the thoracic and abdominal aortas be to be called aneurysmal? | 94 | ||
| 19. When is an AAA usually repaired? | 94 | ||
| 20. What is Laplace’s law, and how is it relevant to aortic aneurysms? | 94 | ||
| 21. Can the overall size of an aortic aneurysm be determined by catheter angiography? | 94 | ||
| 22. How is the size of the aorta most accurately measured on CT or MRI? | 94 | ||
| 23. Name two methods of repairing aneurysms, and compare their advantages and disadvantages. | 95 | ||
| 24. What criteria are used to determine whether an aortic aneurysm can be treated by endovascular technique? | 95 | ||
| 25. Why is follow-up imaging of stent-grafts needed? | 95 | ||
| 26. What is the expected CT and MR imaging appearance of the aorta after stent-graft repair? | 95 | ||
| 27. What are endoleaks, and what imaging technique is used to find them? | 96 | ||
| 28. What other types of aortic procedures can be performed through an endovascular approach? | 96 | ||
| 29. How do aortic coarctation and pseudocoarctation differ? | 96 | ||
| 30. What measurements are required for planning of transcatheter aortic valve replacement (TAVR)? | 96 | ||
| 31. What is a bovine aortic arch? | 98 | ||
| Bibliography | 98 | ||
| 14 Coronary Arterial Imaging | 99 | ||
| 1. What are some noninvasive methods of coronary artery imaging? | 99 | ||
| 2. What is coronary CTA, and how does it differ from routine chest CT? | 99 | ||
| 3. How long does a cardiac CT acquisition take? | 99 | ||
| 4. What is gating? | 99 | ||
| 5. Can coronary CT imaging be performed at any heart rate? | 99 | ||
| 6. What are the indications for CT coronary calcium scoring, and how is it performed? | 101 | ||
| 7. What is the diagnostic performance of CT coronary calcium scoring? | 101 | ||
| 8. What are the indications, contraindications, typical scanning protocols, advantages, and disadvantages for coronary CTA versus magnetic resonance angiography (MRA)? Which patients can benefit from coronary CTA? | 101 | ||
| 9. What is the normal CT and MR imaging appearance of the coronary arteries? | 101 | ||
| 10. What is the normal coronary arterial anatomy, and what is the frequency and significance of anatomic variants? | 102 | ||
| 11. Can I use nitroglycerin to dilate the coronary arteries and obtain better images? | 102 | ||
| 12. How much radiation exposure is there for a patient undergoing coronary CTA? | 102 | ||
| 13. What are the advantages and disadvantages of coronary CTA versus catheter angiography? | 102 | ||
| 14. Can I use coronary CTA as a single study for a patient with chest pain to exclude cardiac ischemia, aortic dissection, and pulmonary embolus? | 102 | ||
| 15. Are there uses for cardiac CT other than coronary artery evaluation? | 102 | ||
| 16. How is a coronary CTA examination reviewed? | 105 | ||
| 17. How are coronary artery stenoses reported? | 105 | ||
| 18. What are the CT and MR imaging (and relevant clinical) features of some common coronary arterial pathologies? | 105 | ||
| 19. Which congenital coronary artery anomalies can cause sudden death? | 105 | ||
| 20. What is the usefulness of CT in imaging atherosclerosis? | 106 | ||
| 21. What is myocardial bridging, and is it important? | 106 | ||
| 22. What is a coronary artery aneurysm? | 106 | ||
| 23. What are the CT and MR imaging features of coronary arterial stents and bypass grafts (including various types)? | 107 | ||
| 24. Have clinical trials shown an advantage to using coronary CTA in place of catheter angiograms or nuclear stress tests? | 107 | ||
| Bibliography | 108 | ||
| 15 Pulmonary Vascular Imaging | 109 | ||
| 1. What is the normal appearance of the pulmonary vessels on computed tomography (CT) and magnetic resonance imaging (MRI)? | 109 | ||
| 2. What are the indications for computed tomography angiography (CTA) versus magnetic resonance angiography (MRA) for pulmonary vascular imaging? | 109 | ||
| 3. What are the typical CTA and MRA pulmonary vascular imaging protocols? | 109 | ||
| 4. What is the role of chest radiography in the diagnosis of pulmonary embolism (PE)? | 109 | ||
| 5. What are advantages of CTA for assessment of PE? | 109 | ||
| 6. What are the direct CTA findings of PE? | 110 | ||
| 7. What are the indirect CTA findings of PE? | 110 | ||
| 8. How can acute PE be distinguished from chronic PE on CTA? | 110 | ||
| 9. What are other uses for CT in the setting of PE? | 110 | ||
| 10. What is pulmonary hypertension, and what CT and MRI findings are suggestive? | 110 | ||
| 11. What is a pulmonary artery aneurysm, and what is the major differential diagnosis? | 112 | ||
| 12. What is a pulmonary AVM, and what is the clinical presentation? | 112 | ||
| 13. With what hereditary disorder are pulmonary AVMs associated? | 112 | ||
| 14. You are asked to start a peripheral intravenous line in a patient with a known pulmonary AVM. What special precautions should you take? | 112 | ||
| 15. What are the imaging characteristics of a pulmonary AVM on radiography, CT, and MRI? | 112 | ||
| 16. What is partial anomalous pulmonary venous return (PAPVR)? | 112 | ||
| 17. What is scimitar syndrome, and what are its associated imaging findings? | 112 | ||
| 18. What is the most common primary neoplasm of the pulmonary artery? | 114 | ||
| Bibliography | 114 | ||
| 16 CT Angiography and MR Angiography of the Peripheral and Visceral Vasculature | 115 | ||
| 1. What are the clinical indications for computed tomography angiography (CTA) and magnetic resonance angiography (MRA) of the peripheral and visceral arteries? | 115 | ||
| 2. What is the most important principle for performing contrast-enhanced CTA and MRA? | 115 | ||
| 3. How is the image acquisition timed following contrast administration in a CTA? | 115 | ||
| 4. When should a test bolus be used? | 115 | ||
| 5. Describe a typical computed tomography (CT) protocol for assessing the arteries. | 115 | ||
| 6. Is the quality of evaluation of the arteries of the lower extremities better with a wide-detector multidetector row CT (MDCT) scanner? | 116 | ||
| 7. How can we mitigate outrunning of the contrast bolus when using a wide-detector MDCT scanner? | 116 | ||
| 8. What is the most important consideration when imaging the arteries of the upper extremities? | 116 | ||
| 9. How is MRA image acquisition timed? | 116 | ||
| 10. Describe a typical MRA protocol. | 116 | ||
| 11. What are the options if the patient cannot receive intravenous gadolinium-based or iodinated contrast material? | 116 | ||
| 12. What must you tell the MRI technologists when performing a TOF MRA? | 116 | ||
| 13. What is the advantage of TOF MRA? | 117 | ||
| 14. What are the disadvantages of TOF MRA? | 117 | ||
| 15. Is CTA or contrast-enhanced MRA better? | 117 | ||
| 16. When performing a contrast-enhanced MRA, what must you communicate to the technologists? | 117 | ||
| 17. Is CTA or MRA preferred for assessment of the renal arteries? | 117 | ||
| 18. Is CTA or MRA preferred for assessment of the iliac arteries for percutaneous access? | 117 | ||
| 19. Is CTA or MRA preferred for assessment of the calf and foot vessels? | 117 | ||
| 20. Is CTA or MRA preferred for assessment of arteriovenous malformations? | 117 | ||
| 21. Is CTA or MRA preferred for assessment of mesenteric ischemia? | 117 | ||
| 22. Is CTA or MRA preferred for assessment of arterial trauma following penetrating trauma? | 118 | ||
| 23. Is CTA or MRA preferred for assessment of endoleaks following stent graft repair of an aneurysm? | 118 | ||
| 24. Is CTA or MRA preferred for assessment of entrapment syndromes? | 118 | ||
| 25. Is CTA or MRA preferred for assessment of venous thrombosis? | 118 | ||
| 26. How are CT and MR angiographic images visualized? | 118 | ||
| 27. What is a hemodynamically significant artery stenosis? | 118 | ||
| 28. How do we measure stenosis? | 118 | ||
| 29. What are the major branches of the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA)? | 118 | ||
| 30. What is the most common variant of the celiac axis? | 118 | ||
| 31. What are the major collateral pathways in the abdomen? | 119 | ||
| 32. What is the meandering mesenteric artery? | 119 | ||
| 33. What artery is often occluded during open or endovascular repair of an AAA? | 119 | ||
| 34. Why are angiographic studies performed on potential renal donors? | 119 | ||
| 35. What is the prevalence of accessory renal arteries in the general population? | 120 | ||
| 36. What is the most common left renal vein anatomic variant? | 120 | ||
| 37. What are the major normal variants of the IVC? | 120 | ||
| 38. What segment is missing in azygos continuation of the IVC? | 120 | ||
| 39. What anatomic structure is used as a reference for the parts of the subclavian artery? | 120 | ||
| 40. At what point does the subclavian artery become the axillary artery? | 121 | ||
| 41. What are the major branches of the upper extremity arterial tree? | 121 | ||
| 42. What structures separate the superficial femoral artery (SFA) from the popliteal artery and the external iliac artery from the common femoral artery (CFA)? | 121 | ||
| 43. On an anterior projection, which thigh vessel takes a more medial course: the SFA or the deep femoral (profunda femoris) artery (DFA)? | 121 | ||
| 44. What is meant by “single-vessel,” “two-vessel,” or “three-vessel” runoff? | 121 | ||
| 45. What is the distribution of peripheral vascular disease in different age groups? | 121 | ||
| 46. What compressive disorders may involve the popliteal artery? | 122 | ||
| 47. How does one assess for popliteal entrapment syndrome? | 122 | ||
| 48. What are the causes of venous contamination? | 122 | ||
| 49. A 40-year-old heavy smoker has pain in the foot at rest. Should one be thinking about atherosclerosis as the underlying etiology? | 122 | ||
| 50. How may renal arterial steno-occlusive disease present clinically? | 123 | ||
| 51. What are the common causes of renal artery stenosis? | 123 | ||
| 52. What are the common causes of renal artery aneurysms/pseudoaneurysms? | 124 | ||
| 53. What are the common causes of renal artery dissection? | 124 | ||
| 54. How is FMD classified? | 124 | ||
| 55. How does FMD present? | 124 | ||
| 56. Does a normal CTA or MRA exclude presence of polyarteritis nodosa (PAN)? | 125 | ||
| 57. What is the median arcuate ligament, and what is its significance? | 125 | ||
| 58. Can ostial celiac artery or SMA occlusion result in mesenteric ischemia? | 125 | ||
| 59. What is SMA syndrome? | 125 | ||
| 60. What is nutcracker syndrome? | 125 | ||
| 61. Which vein is compressed in May-Thurner syndrome? | 125 | ||
| 62. Is CT or MRI the preferred imaging modality to assess for acute lower extremity deep vein thrombosis (DVT)? | 125 | ||
| 63. What is pelvic congestion syndrome? | 126 | ||
| 64. How do patients with thoracic outlet syndrome (TOS) present? | 126 | ||
| 65. List some useful tips regarding imaging assessment of patients with suspected TOS. | 127 | ||
| 66. Is CTA or MRA better to assess for subclavian steal syndrome? | 127 | ||
| 67. List some principles regarding CTA and MRA assessment of the vasculature of a transplanted kidney. | 127 | ||
| 68. What is the main clinical indication for pancreatic transplantation? | 127 | ||
| 69. What is the vascular anatomy of the pancreatic transplant? | 128 | ||
| Bibliography | 128 | ||
| IV Thoracic Imaging | 131 | ||
| 17 Imaging of Lung Nodules and Masses | 133 | ||
| 1. What is a solitary pulmonary nodule (SPN)? | 133 | ||
| 2. List some causes of pulmonary nodules. | 133 | ||
| 3. What is the general approach to the evaluation of SPN? | 133 | ||
| 4. What further diagnostic steps may be implemented in the workup of indeterminate pulmonary nodules? | 133 | ||
| 5. What are the Fleischner Society guidelines? | 133 | ||
| 6. What are some potential blind spots on chest radiography and CT when trying to detect pulmonary nodules? | 133 | ||
| 7. List some morphologic imaging features of nodules assessed on CT. | 133 | ||
| 8. Describe morphologic imaging findings that are suggestive of a benign SPN. | 134 | ||
| 9. Describe morphologic imaging findings that are suggestive of a malignant SPN. | 134 | ||
| 10. How does measurement of the doubling time of nodules aid in the determination of a benign SPN? | 136 | ||
| 11. How does the degree of enhancement of pulmonary nodules on CT aid in the determination of benignancy? | 136 | ||
| 12. How does FDG PET aid in the differentiation of benign and malignant lung nodules? | 136 | ||
| 13. Describe some clinical features that suggest whether SPN is more likely to be malignant and whether it is more likely to be due to lung cancer or a pulmonary metastasis. | 136 | ||
| 14. What minimally invasive procedures may be used to obtain tissue samples from SPN? | 137 | ||
| 15. What are the potential complications of transthoracic needle biopsy? | 137 | ||
| 16. How important is lung cancer as a public health issue? | 137 | ||
| 17. What are the major histologic types and subtypes of lung cancer? | 137 | ||
| 18. Summarize some of the different features of the various histologic types and subtypes of lung cancer. | 137 | ||
| 19. What is a superior sulcus tumor? | 137 | ||
| 20. Describe the major imaging findings related to lung cancer. | 137 | ||
| 21. Summarize the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for lung cancer. | 139 | ||
| 22. Are there any other staging systems used in patients with SCLC? | 139 | ||
| 23. When is NSCLC generally considered unresectable? | 139 | ||
| 24. Are there any reliable screening tests for lung cancer? What is the National Lung Screening Trial (NLST)? | 140 | ||
| 25. Are there any risks of LDCT screening for lung cancer? | 140 | ||
| 26. Name some treatment options for lung cancer. | 140 | ||
| 27. Describe the imaging findings of pulmonary metastases. | 140 | ||
| 28. What is lymphangitic carcinomatosis? | 140 | ||
| 29. What are pulmonary carcinoid tumors? | 140 | ||
| 30. What is a pulmonary hamartoma? | 141 | ||
| 31. What is congenital bronchial atresia? | 141 | ||
| Bibliography | 141 | ||
| 18 Imaging of Airspace Lung Disease | 143 | ||
| 1. What is the difference between a pulmonary acinus and a secondary pulmonary lobule? | 143 | ||
| 2. When a patient is suspected of having airspace lung disease, what is the first imaging method of evaluation that is utilized? | 143 | ||
| 3. When is chest CT used to assess airspace lung disease? | 143 | ||
| 4. True or false: Referring to an “opacity” on chest radiography or CT implies airspace disease. | 143 | ||
| 5. What is the definition of consolidation? | 143 | ||
| 6. What is the “silhouette” sign? | 143 | ||
| 7. What is an air bronchogram? | 143 | ||
| 8. What is the difference between an acinar opacity and an air alveologram? | 143 | ||
| 9. What is the definition of ground glass opacity? | 143 | ||
| 10. What is the crazy paving pattern? | 145 | ||
| 11. What are centrilobular nodules and tree-in-bud opacities? | 145 | ||
| 12. True or false: Consolidation and ground glass opacities indicate pneumonia. | 146 | ||
| 13. True or false: Consolidation and ground glass opacity can be seen in acute and chronic conditions. | 146 | ||
| 14. What are some causes of acute airspace disease? | 146 | ||
| 15. What are some causes of chronic airspace disease? | 146 | ||
| 16. What are some causes of diffuse airspace disease? | 146 | ||
| 17. What are some causes of multifocal or patchy airspace disease? | 146 | ||
| 18. What are some causes of focal airspace disease? | 146 | ||
| 19. What are some causes of peripheral airspace disease? | 146 | ||
| 20. What is atelectasis? | 146 | ||
| 21. What types of atelectasis may occur? | 146 | ||
| 22. What are the imaging features of atelectasis? | 147 | ||
| 23. What is rounded atelectasis, and what is the “comet tail” sign? | 147 | ||
| 24. What is the “Luftsichel” sign? | 147 | ||
| 25. What is the “juxtaphrenic peak” sign? | 147 | ||
| 26. What is the “S sign of Golden”? | 147 | ||
| 27. What is right middle lobe syndrome? | 148 | ||
| 28. What are the different types of pulmonary edema, and what are some common causes of each? | 148 | ||
| 29. True or false: A normal sized heart on a chest radiograph excludes the presence of pulmonary edema. | 149 | ||
| 30. True or false: The radiographic appearance of hydrostatic pulmonary edema correlates well with left atrial pressures. | 149 | ||
| 31. What is cephalization? | 149 | ||
| 32. What is alveolar edema? | 149 | ||
| 33. What is “bat wing” pulmonary edema, and is this the most common radiographic pattern of pulmonary edema? | 149 | ||
| 34. True or false: Pleural effusions can be unilateral in congestive heart failure. | 149 | ||
| 35. True or false: Pulmonary edema can be unilateral. | 149 | ||
| 36. How does pulmonary edema appear on CT? | 149 | ||
| 37. What are the definitions of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)? | 149 | ||
| 38. What are the pathophysiological phases of ARDS, and how do these manifest on imaging? | 150 | ||
| 39. True or false: Causes of ARDS can be intrathoracic or extrathoracic, and this distinction can be inferred on CT imaging. | 151 | ||
| 40. What are some chronic CT findings of ARDS? | 151 | ||
| 41. What is aspiration, what are some of its common underlying causes, and what is its radiographic appearance? | 151 | ||
| 42. What is pneumonia, and what are some of its associated complications? | 151 | ||
| 43. What are some clinical questions one may ask the referring physician when evaluating imaging studies in a patient with suspected pneumonia? | 151 | ||
| 44. What are the common causes and imaging appearances of: Bacterial pneumonia? Viral pneumonias? Fungal pneumonias? Mycobacterial pneumonias? Pneumocystis pneumonia? | 152 | ||
| 45. In the setting of pulmonary consolidation, what are some additional CT findings that are helpful to predict whether the underlying etiology is infectious or noninfectious? | 152 | ||
| 46. True or false: Cavitation is a nonspecific imaging feature. | 152 | ||
| 47. What are some common infections that cavitate? | 153 | ||
| 48. What are the “halo” and “air crescent” signs, and what infection is classically associated with these signs? | 153 | ||
| 49. What is a fungus ball, and if it is suspected, what imaging-based maneuver can be performed to confirm the suspicion? | 154 | ||
| 50. What is the “Monad” sign? | 155 | ||
| 51. What is allergic bronchopulmonary aspergillosis (ABPA)? | 155 | ||
| 52. What is a bronchocele, and what is the “finger-in-glove” sign? | 155 | ||
| 53. What is the radiographic appearance of primary TB? | 155 | ||
| 54. What is a Ghon complex, a Ghon focus, and a Ranke complex, and how do these appear on imaging? | 155 | ||
| 55. What are the imaging findings associated with postprimary (reactivation) TB? | 156 | ||
| 56. True or false: A miliary appearance on imaging is specific for TB. | 156 | ||
| 57. True or false: Typical (TB) and atypical mycobacterial infections are easily distinguished on imaging. | 156 | ||
| 58. What is Lady Windermere syndrome? | 156 | ||
| 59. What infectious organism(s) should you suspect in the setting of: HIV infection and perihilar ground glass opacities on CT? Heart transplantation and a solitary cavitary mass? Chest wall invasion? | 156 | ||
| 60. What are the pulmonary manifestations of drug toxicity on imaging? | 156 | ||
| 61. What drug can result in high attenuation pulmonary consolidation on CT? | 156 | ||
| 62. What drug used to treat patients with acute myelogenous leukemia can result in pulmonary hemorrhage? | 157 | ||
| 63. What is diffuse alveolar hemorrhage (DAH), and what is its imaging appearance? | 157 | ||
| 64. What disease condition should you consider to be present in a patient with renal failure, sinonasal disease, and pulmonary alveolar hemorrhage? | 157 | ||
| 65. What is the imaging appearance of pulmonary contusions and lacerations? | 157 | ||
| 66. What is pulmonary alveolar proteinosis (PAP), and what is the difference between primary and secondary PAP? | 157 | ||
| 67. What is the classic CT appearance of PAP? | 158 | ||
| 68. What entity can result in fat (or near fat) low attenuation pulmonary opacities on CT? | 158 | ||
| 69. What is organizing pneumonia, and what are some common causes? | 158 | ||
| 70. What is meant by the term cryptogenic organizing pneumonia (COP), and what are its imaging features? | 158 | ||
| 71. What is the “reversed halo” sign or “atoll” sign? | 158 | ||
| 72. How can one distinguish between chronic eosinophilic pneumonia and COP on imaging? | 158 | ||
| 73. What should one clinically suspect in a patient with persistent pulmonary consolidation and bronchorrhea? | 159 | ||
| Bibliography | 159 | ||
| 19 Radiography of Interstitial Lung Disease | 160 | ||
| 1. What radiographic features distinguish interstitial diseases from airspace diseases? | 160 | ||
| 2. What factors influence the likelihood of one interstitial disease over another interstitial disease? | 160 | ||
| 3. What is the most common interstitial abnormality identified on chest radiography? | 160 | ||
| 4. Name the most common interstitial abnormalities other than interstitial pulmonary edema. | 160 | ||
| 5. What radiographic characteristics help determine the diagnosis of interstitial disorders? | 161 | ||
| 6. What is the appearance of a nodular interstitial pattern on chest radiography? | 161 | ||
| 7. What disorders cause nodular interstitial diseases? | 161 | ||
| 8. Discuss granulomatous lung diseases that cause nodular interstitial disease. | 161 | ||
| 9. Discuss pneumoconioses and tumors that lead to nodular interstitial lung disease. | 161 | ||
| 10. Discuss the smoking-related lung diseases that cause micronodular lung disease. | 162 | ||
| 11. What is the chest radiographic staging system for sarcoidosis, and what is the clinical significance? | 162 | ||
| 12. Give some examples of hypersensitivity pneumonitis (extrinsic allergic alveolitis). | 162 | ||
| 13. Why do intravenous drug abusers get talcosis? | 162 | ||
| 14. What radiographic feature of nodular pneumoconioses is most strongly associated with respiratory deficits? | 163 | ||
| 15. What are the radiographic characteristics of the peripheral reticular pattern? | 163 | ||
| 16. Which diseases cause the peripheral reticular pattern? | 163 | ||
| 17. What demographic features can help distinguish the cause of the peripheral reticular pattern? | 163 | ||
| 18. Which connective tissue disorders can result in interstitial disease? | 164 | ||
| 19. Are there any imaging features that can help distinguish the cause of the peripheral reticular pattern? | 164 | ||
| 20. Describe the imaging characteristics of the linear pattern on chest radiography. | 165 | ||
| 21. What disorders cause the linear pattern of interstitial disease? | 165 | ||
| 22. Are there any imaging clues that may help to distinguish the cause of the linear interstitial pattern? | 166 | ||
| 23. What are the imaging characteristics of the cystic pattern of interstitial lung disease? | 167 | ||
| 24. What disorders produce the cystic interstitial pattern? | 167 | ||
| 25. What disorders cause diffuse bronchiectasis? | 167 | ||
| 26. Are there any radiographic imaging features that help to distinguish the cause of the cystic pattern? | 168 | ||
| 27. When is computed tomography (CT) scanning indicated for the evaluation of interstitial lung disease? | 168 | ||
| 28. What type of CT scan is indicated for the evaluation of interstitial lung disease? | 168 | ||
| Bibliography | 169 | ||
| 20 Imaging of Mediastinal Disease | 170 | ||
| 1. Describe the anatomy of the mediastinum. | 170 | ||
| 2. What are the three compartments of the mediastinum? | 170 | ||
| 3. List the differential diagnosis of major anterior mediastinal lesions. | 170 | ||
| 4. List the differential diagnosis of major middle mediastinal lesions. | 170 | ||
| 5. List the differential diagnosis of major posterior mediastinal lesions. | 172 | ||
| 6. List the differential diagnosis of fat-containing mediastinal lesions. | 172 | ||
| 7. List the differential diagnosis of cystic mediastinal lesions. | 172 | ||
| 8. Name different collections that may occur within the mediastinum. | 172 | ||
| 9. What clinical symptoms and signs can be associated with mediastinal lesions? | 172 | ||
| 10. What is a thymoma? | 172 | ||
| 11. Describe the clinical presentation of a thymoma. | 172 | ||
| 12. Describe the imaging findings of a thymoma. | 173 | ||
| 13. What is thymic carcinoma? | 173 | ||
| 14. What is thymic carcinoid? | 173 | ||
| 15. What is thymolipoma? | 174 | ||
| 16. What is a mediastinal germ cell tumor? | 174 | ||
| 17. What is a mediastinal teratoma? | 174 | ||
| 18. Name a rare but highly specific clinical presentation of mediastinal teratoma. | 175 | ||
| 19. What is mediastinal thyroid goiter? | 175 | ||
| 20. Define mediastinal lipoma and mediastinal lipomatosis. | 175 | ||
| 21. What is Hodgkin lymphoma (HL)? | 175 | ||
| 22. What is non-Hodgkin lymphoma (NHL)? | 176 | ||
| 23. What are the most common causes of mediastinal lymphadenopathy? | 176 | ||
| 24. Which vascular disorders can appear as mediastinal masses? | 176 | ||
| 25. Describe the congenital foregut cysts. | 176 | ||
| 26. What is a mediastinal pancreatic pseudocyst? | 177 | ||
| 27. What is pneumomediastinum? | 177 | ||
| 28. What is acute mediastinitis? | 178 | ||
| 29. Describe the imaging features of acute mediastinitis. | 178 | ||
| 30. What is a mediastinal abscess? | 178 | ||
| 31. What is fibrosing mediastinitis? | 178 | ||
| 32. What are neurogenic tumors? | 178 | ||
| 33. Describe the imaging appearance of neurogenic tumors. | 178 | ||
| 34. What is an intrathoracic meningocele? | 179 | ||
| 35. How do osseous tumors and infection within the posterior mediastinum differ on imaging? | 179 | ||
| 36. What is extramedullary hematopoiesis? | 179 | ||
| Bibliography | 179 | ||
| 21 Imaging of Pleural Disease | 181 | ||
| 1. Describe the normal pleural anatomy and physiologic features. | 181 | ||
| 2. List the major tumors that may affect the pleura. | 181 | ||
| 3. What are the major substances that may collect within the pleural space? | 181 | ||
| 4. What is the differential diagnosis of major causes of pleural effusion? | 181 | ||
| 5. List the major mechanisms of pleural effusion formation. | 182 | ||
| 6. What are the two major types of pleural effusions? | 182 | ||
| 7. What are the major imaging findings of simple nonloculated pleural effusions on upright chest radiography? | 182 | ||
| 8. Describe the major imaging findings related to simple nonloculated pleural effusions on portable supine and semi-upright chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI). | 182 | ||
| 9. What are the major imaging findings associated with complex loculated pleural effusions? | 183 | ||
| 10. List the differential diagnosis of major causes of hemothorax. | 183 | ||
| 11. What is pneumothorax? | 183 | ||
| 12. What are the radiographic imaging findings of pneumothorax? | 183 | ||
| 13. How much gas in a pneumothorax is required for radiographic visualization? | 183 | ||
| 14. What radiographic maneuvers can be performed to show a subtle pneumothorax? | 183 | ||
| 15. What is a tension pneumothorax? | 184 | ||
| 16. What is the differential diagnosis of major causes of pneumothorax? | 184 | ||
| 17. When should treatment of a patient with a pneumothorax be considered? | 184 | ||
| 18. How is the diagnosis of an empyema obtained? | 184 | ||
| 19. When is empyema usually treated? | 185 | ||
| 20. What is empyema necessitatis? | 185 | ||
| 21. List causes of pleural calcification. | 185 | ||
| 22. What are pleural plaques? | 185 | ||
| 23. What is malignant pleural mesothelioma? | 185 | ||
| 24. What are risk factors for the development of malignant pleural mesothelioma? | 185 | ||
| 25. Describe symptoms and signs of malignant pleural mesothelioma. | 185 | ||
| 26. What are the imaging findings of malignant pleural mesothelioma? | 186 | ||
| 27. What diagnostic tests may be used in the diagnosis or staging of malignant pleural mesothelioma? | 186 | ||
| 28. What is the prognosis for malignant pleural mesothelioma? | 187 | ||
| 29. Describe the general treatment approach to malignant pleural mesothelioma. | 187 | ||
| 30. What is solitary fibrous tumor of the pleura? | 187 | ||
| 31. Name clinical presentations of solitary fibrous tumor of the pleura. | 187 | ||
| 32. What are the imaging features of solitary fibrous tumor of the pleura? | 187 | ||
| 33. What is the treatment for solitary fibrous tumor of the pleura? | 188 | ||
| Bibliography | 188 | ||
| 22 Tubes, Lines, Catheters, and Other Devices | 189 | ||
| 1. What is the radiographic appearance of an endotracheal tube (ETT), and where is it optimally placed? | 189 | ||
| 2. Describe how an ETT may be malpositioned; list other potential complications of ETT placement. | 189 | ||
| 3. What is the optimal positioning of a tracheostomy tube? | 189 | ||
| 4. Name potential complications after tracheostomy tube placement. | 189 | ||
| 5. What is the radiographic appearance and ideal positioning of a nasogastric tube (NGT) or orogastric tube (OGT)? | 189 | ||
| 6. Describe the radiographic appearance and optimal location of an enteral feeding tube. | 189 | ||
| 7. Discuss ways in which an NGT, OGT, or feeding tube may be malpositioned, including other potential complications. | 190 | ||
| 8. If an NGT, OGT, or feeding tube is misplaced within the tracheobronchial tree, what should one do before removing the tube? | 192 | ||
| 9. When is a thoracostomy tube generally used? | 192 | ||
| 10. What is the radiographic appearance of a thoracostomy tube, and where should its tip be located? | 192 | ||
| 11. Discuss potential complications of thoracostomy tube placement. | 192 | ||
| 12. How can I decrease the chance of injury to an intercostal artery or vein during thoracostomy tube placement? | 192 | ||
| 13. Describe the basic normal venous anatomy of the chest. | 193 | ||
| 14. What is the radiographic appearance and optimal location of a central venous line (CVL) and a peripherally inserted central catheter (PICC)? | 193 | ||
| 15. What are potential complications of CVL or PICC placement? | 193 | ||
| 16. List locations where a CVL or PICC may be malpositioned when inserted through a vein. | 194 | ||
| 17. Name some clues of inadvertent arterial puncture with a CVL, PICC, or Swan-Ganz catheter (SGC). | 194 | ||
| 18. What should one consider in the differential diagnosis for rapid development of an ipsilateral pleural effusion or mediastinal widening after CVL, PICC, or SGC placement? | 194 | ||
| 19. If air embolism is suspected during catheter placement, what should one do to treat the patient? | 195 | ||
| 20. How do I prevent air embolism during catheter placement in the first place? | 195 | ||
| 21. Describe the radiographic appearance of an SGC and its optimal location. | 195 | ||
| 22. What are potential complications of SGC placement? | 195 | ||
| 23. Why can pulmonary infarction occur as a complication of SGC placement? | 195 | ||
| 24. How does an intraaortic counterpulsation balloon (IACB) work? | 195 | ||
| 25. What are the major indications and contraindications for placement of IACB? | 196 | ||
| 26. Describe the radiographic appearance of an IACB and its optimal position. | 196 | ||
| 27. What are the potential complications of IACB? | 196 | ||
| 28. What is the radiographic appearance of a transvenous pacemaker or automatic implantable cardioverter defibrillator (AICD)? | 197 | ||
| 29. Where should the leads of a transvenous pacemaker or AICD be located? | 197 | ||
| 30. What are potential complications of transvenous pacemaker/AICD placement? | 197 | ||
| 31. What is twiddler’s syndrome? | 197 | ||
| 32. Name two retained foreign bodies that may be encountered in the postoperative setting. | 197 | ||
| 33. What are some procedure types and risk factors that may increase the risk of retention of a surgical foreign body? | 198 | ||
| 34. What are the potential complications of retained foreign bodies? | 199 | ||
| Bibliography | 200 | ||
| V Gastrointestinal Imaging | 201 | ||
| 23 Abdominal Radiography | 203 | ||
| 1. What is a “flat plate” of the abdomen? | 203 | ||
| 2. What structures are visible on a plain abdominal radiograph? | 203 | ||
| 3. What is an anteroposterior radiograph? | 204 | ||
| 4. What is a lateral decubitus radiograph? | 204 | ||
| 5. What is the purpose of an image obtained with the patient in a lateral decubitus or erect position? | 204 | ||
| 6. List indications for obtaining a plain radiograph of the abdomen. | 205 | ||
| 7. What are the advantages and disadvantages of a plain abdominal radiograph versus a computed tomography (CT) scan? | 205 | ||
| 8. In the era of fast CT scanners, what is the role of a plain radiograph? | 205 | ||
| 9. Why is the term free air a misnomer? | 205 | ||
| 10.\tWhat are the best patient positions to detect free intraperitoneal gas on a plain radiograph? | 205 | ||
| 11. What percentage of supine radiographs shows free intraperitoneal gas? | 205 | ||
| 12. What is the “Rigler” sign? | 205 | ||
| 13. In what abdominal quadrant is free intraperitoneal gas best detected? | 206 | ||
| 14. A coned-down image of the abdominal right upper quadrant is presented in Figure 23-7. What structure is outlined by gas, and where is the gas located? | 206 | ||
| 15. What is the most common non-iatrogenic cause of pneumobilia? | 206 | ||
| 16. What is the Rigler triad? | 207 | ||
| 17. What does the linear form of pneumatosis imply? | 207 | ||
| 18. In what portions of the GI tract is normal gas located when the patient is radiographed in supine and prone positions? | 209 | ||
| 19. What does the term ileus mean? | 209 | ||
| 20. Which study is superior in diagnosing small bowel obstruction: plain radiograph or CT? | 209 | ||
| 21. What are the pitfalls of plain radiographic diagnosis of small bowel obstruction? | 209 | ||
| 22. What imaging modality is able to diagnose a bowel obstruction complicated by ischemia? | 210 | ||
| 23. Can CT show adhesions? | 210 | ||
| 24. In what situations are barium studies most helpful for the diagnosis of small bowel obstruction? | 210 | ||
| 25. What is the most common form of colonic volvulus? | 210 | ||
| 26. What patient groups have a greater incidence of sigmoid volvulus? | 210 | ||
| 27. What is wrong with the term cecal volvulus? | 210 | ||
| 28. What percentage of gallstones is calcified? | 212 | ||
| 29. A plain radiograph of the abdomen is obtained in a patient who has a palpable abdominal mass (Figure 23-18). What is the diagnosis? | 212 | ||
| 30. A coned-down view of the upper abdomen (Figure 23-20) is obtained in a man with chronic abdominal pain. What is the diagnosis? | 214 | ||
| 31. A patient has a palpable abdominal mass (Figure 23-22). What organ is enlarged? | 214 | ||
| 32. A 45-year-old man has recently received a liver transplant. Identify the type and location of the two tubular structures below the diaphragm in Figure 23-23, A. What has the radiologist done in Figures 23-23, B and C? | 215 | ||
| 33. A 38-year-old man complains of nausea and vomiting (Figure 23-24). What type of tube has been placed in Figure 23-24, A? | 216 | ||
| Bibliography | 216 | ||
| 24 Fluoroscopy of the Upper Gastrointestinal Tract | 217 | ||
| 1. What organs are studied during an upper gastrointestinal (GI) series? | 217 | ||
| 2. What organs are studied during a pharyngoesophagogram? | 217 | ||
| 3. What organ is shown in Figure 24-1? | 217 | ||
| 4. What organs are shown in Figure 24-2? Identify the numbered parts of the organs as labeled, along with the curvatures labeled by arrows. | 217 | ||
| 5. Why does the gastric fundus appear white in Figure 24-2, whereas the gastric antrum appears gray? | 217 | ||
| 6. Two images of the esophagus are presented in Figure 24-3. What is your diagnosis? | 217 | ||
| 7. What does “single contrast” mean? | 219 | ||
| 8. What does “double contrast” mean? | 219 | ||
| 9. What are clinical indications for performing an upper GI study? | 219 | ||
| 10. What are clinical indications for performing a video/DVD pharyngoesophagogram? | 219 | ||
| 11. A 23-year-old woman complains of a lump in her throat at all times of the day (a globus sensation). An image of the lower pharynx and upper cervical esophagus is obtained (Figure 24-6). What is your diagnosis? | 220 | ||
| 12. A 74-year-old man complains of a lump in his throat and regurgitation of food into his mouth. Images of the lower pharynx and upper cervical esophagus are obtained (Figure 24-7). What is your diagnosis? | 221 | ||
| 13. Describe the preparation for an upper GI study or pharyngoesophagogram. | 221 | ||
| 14. What are contraindications to a barium study of the upper GI tract? | 222 | ||
| 15. What type of contrast agent should be requested first in patients with suspected upper GI perforation? | 222 | ||
| 16. When is a single-contrast upper GI series performed? | 222 | ||
| 17. What portion of the GI tract is shown in Figure 24-8? | 222 | ||
| 18. What portion of the GI tract is shown in Figure 24-9? | 222 | ||
| 19. What are the indications for a small bowel follow-through? | 223 | ||
| 20. Figure 24-10 is an overhead image obtained from what type of study? What organ is being imaged? | 223 | ||
| 21. What layers of the bowel wall comprise the valvulae conniventes? | 223 | ||
| 22. What are the indications for enteroclysis (small bowel enema)? | 223 | ||
| 23. What is the preparation for enteroclysis? | 224 | ||
| 24. Figure 24-11 is a spot radiograph of the terminal ileum in a young man with chronic diarrhea. What disease does this patient have? | 224 | ||
| 25. Figure 24-12 is from a double-contrast esophagogram performed in an immunocompromised patient with acute odynophagia. What is your diagnosis? | 224 | ||
| 26. Figure 24-13 is an image performed during an esophagogram while the patient lies prone and rapidly drinks thin barium. This patient had long-standing dysphagia for solids and chronic heartburn. What is your diagnosis? | 224 | ||
| 27. Figure 24-14 is an image performed during an esophagram in another patient with long-standing dysphagia. What is your diagnosis? | 225 | ||
| 28. Figure 24-15 shows two images of the lesser curvature of the stomach from a double-contrast upper GI series performed in a young patient with 1 week of abdominal pain. What is your diagnosis? | 225 | ||
| 29. Figure 24-16 is an image of the gastric antrum from a double-contrast upper GI series performed in a 52-year-old woman with anemia. What is your diagnosis? | 227 | ||
| 30. Figure 24-17 is a close-up of the distal greater curvature of the stomach obtained during a double-contrast upper GI series performed in a patient with abdominal pain and rheumatoid arthritis. What is your diagnosis? | 227 | ||
| 31. A coned-down image of the gastric fundus obtained during a double-contrast upper GI series is shown in Figure 24-18. What is your diagnosis? | 227 | ||
| 32. A coned-down image of the gastric fundus obtained during a double-contrast upper GI series is shown in Figure 24-19. What is your diagnosis? | 227 | ||
| 33. Figure 24-20 is an image of the gastric antrum from a double-contrast upper GI series performed in a 43-year-old man with anemia. What is your diagnosis? | 227 | ||
| 34. An elderly man complains of early satiety. A spot radiograph of the stomach from a double-contrast upper GI series is provided (Figure 24-21). What is your diagnosis? | 229 | ||
| 35. Figure 24-22 is a spot radiograph of the lower stomach obtained from a double-contrast upper GI series in a man who has had 4 months of abdominal discomfort. What is your differential diagnosis? | 229 | ||
| 36. A young man complains of acute right upper quadrant pain. Figure 24-23 is a spot radiograph from a double-contrast upper GI series. What is your diagnosis? | 230 | ||
| 37. Figure 24-24, A, is a coned-down image of the mid–small bowel obtained in a man with unexplained heme-positive stool. Figure 24-24, B, is an axial image from a CT scan that was performed several days later. What is your differential diagnosis? | 230 | ||
| 38. What is the best radiologic test to show small bowel tumors? | 230 | ||
| 39. A young man complains of increasing abdominal distention and subacute right lower quadrant pain. Two images from a computed tomography (CT) scan are presented (Figure 24-26). Although a specific diagnosis is not possible, describe what is happening. | 231 | ||
| 40. A young man complains of diarrhea for 4 weeks. Figure 24-27 is a spot image of the terminal ileum from a small bowel follow-through. What is your diagnosis? | 231 | ||
| 41. A patient with known Crohn’s disease comes to the emergency department with abdominal pain (Figure 24-28). What radiologic test should be performed first? | 233 | ||
| 42. A middle-aged woman has peripheral lymphadenopathy and heme-positive stool. Figure 24-29 is an image of the terminal ileum and ileocecal valve from the single-contrast phase of a small bowel enema. What are the diagnostic possibilities? | 233 | ||
| 43. A middle-aged woman has foul-smelling yellow stools. Figure 24-30 is a spot image of the proximal jejunum obtained during enteroclysis. The double arrows represent 1 inch. What is your diagnosis? | 233 | ||
| 44. A 35-year-old woman has right lower quadrant pain and diarrhea. The results of the CT scan were normal. Figure 24-31 is a spot radiograph of the distal ileum from a small bowel follow-through. What is your diagnosis? | 233 | ||
| 45. A 44-year-old man had surgery for a persistent duodenal ulcer (Figure 24-32). What operation was performed? | 233 | ||
| 46. What are the physiologic sequelae of gastric operations? | 234 | ||
| 47. A 62-year-old man complains of abdominal pain 20 years after an antrectomy with gastroduodenostomy was performed for intractable duodenal ulcer disease (Figure 24-33). What is your differential diagnosis? | 235 | ||
| 48. A 45-year-old woman complains of vomiting. She had surgery for morbid obesity 2 years previously (Figure 24-34). What operation did this patient have? Why is she vomiting? | 235 | ||
| 49. A 42-year-old woman has undergone surgery for morbid obesity (Figure 24-35). What operation was performed? | 236 | ||
| 50. A 41-year-old woman had undergone surgery for morbid obesity (Figure 24-36). What operation was performed? | 237 | ||
| 51. A 27-year-old woman underwent surgery for morbid obesity and now presents with left upper quadrant pain and regurgitation. Figure 24-37, A, is a spot radiograph from a study performed 14 months before the image shown in Figure 24-37, B. What has happened? | 237 | ||
| 52. A 29-year-old woman had a sleeve gastrectomy 6 weeks ago and now complains of vomiting after small meals. Figure 24-38 is from an upper GI series. What is your diagnosis? | 237 | ||
| Bibliography | 239 | ||
| 25 CT and MRI of the Upper Gastrointestinal Tract | 240 | ||
| 1. What are the general indications for routine computed tomography (CT) and magnetic resonance imaging (MRI) of the upper gastrointestinal (GI) tract? | 240 | ||
| 2. How are computed tomographic enterography (CTE) and magnetic resonance enterography (MRE) different from routine CT or MRI scans of the abdomen and pelvis? | 240 | ||
| 3. What are the major clinical indications for CTE and MRE? | 240 | ||
| 4. What is the normal CT and MRI appearance of the upper GI tract? | 240 | ||
| 5. What is the hallmark of GI tract pathology on cross-sectional imaging? | 240 | ||
| 6. What is the “target” sign? | 241 | ||
| 7. What is the “fat halo” sign? | 242 | ||
| 8. What is the “comb” sign? | 242 | ||
| 9. What is the “small bowel feces” sign? | 242 | ||
| 10. What does active GI bleeding look like on CTE or MRE images? | 242 | ||
| 11. What are some cross-sectional imaging features that suggest presence of bowel malrotation? | 242 | ||
| 12. What are some causes of esophagitis? | 242 | ||
| 13. What are the typical imaging features of esophagitis on CT and MRI? | 242 | ||
| 14. What is achalasia? | 243 | ||
| 15. How can one distinguish between primary achalasia and secondary achalasia based on clinical and cross-sectional imaging features? | 244 | ||
| 16. What are esophageal varices, and what is their appearance on CT and MRI? | 244 | ||
| 17. What is the difference between uphill and downhill varices of the esophagus? | 245 | ||
| 18. What types of esophageal diverticula are there? | 245 | ||
| 19. Can diverticula occur in the remainder of the upper GI tract? | 245 | ||
| 20. What is the most common benign tumor of the esophagus? | 245 | ||
| 21. What is an esophageal fibrovascular polyp? | 245 | ||
| 22. What are the two major types of esophageal cancers? | 245 | ||
| 23. What are the cross-sectional imaging features of esophageal malignancy? | 245 | ||
| 24. What is a hiatal hernia, and what types are there? | 246 | ||
| 25. What are some causes of gastric wall thickening? | 246 | ||
| 26. What are the typical imaging features of gastritis on CT and MRI? | 246 | ||
| 27. What is the major differential diagnosis for gas seen in the wall of the stomach? | 246 | ||
| 28. What are the major types of GI tract malignancies? | 247 | ||
| 29. What is linitis plastica? | 247 | ||
| 30. What are the cross-sectional imaging features of GI tract adenocarcinoma? | 247 | ||
| 31. What are the cross-sectional imaging features of GI tract lymphoma? | 248 | ||
| 32. What are the cross-sectional imaging features of gastrointestinal stromal tumor (GIST)? | 249 | ||
| 33.\tWhat are the cross-sectional imaging features of GI tract carcinoid tumor? | 249 | ||
| 34. What is carcinoid syndrome, and how often does it occur in patients with carcinoid tumor? | 250 | ||
| 35. What types of malignancies most often metastasize hematogenously to the GI tract? | 250 | ||
| 36. What are the main causes of small bowel wall thickening based on the spatial extent of bowel involvement? | 250 | ||
| 37. What is Crohn’s disease? | 251 | ||
| 38. What are the cross-sectional imaging features of Crohn’s disease in the GI tract? | 251 | ||
| 39. What are the cross-sectional imaging features of Crohn’s disease outside of the GI tract? | 251 | ||
| 40. What is an enteric duplication cyst? | 251 | ||
| 41. What is the difference between an external hernia and an internal hernia? | 251 | ||
| 42. What is the role of CT and MRI in the evaluation of patients with a hernia? | 252 | ||
| 43. What is the most common type of external hernia? | 252 | ||
| 44. What are the boundaries of Hesselbach’s triangle? | 252 | ||
| 45. How can one distinguish direct inguinal hernias from indirect inguinal hernias on cross-sectional imaging? | 252 | ||
| 46. What is a femoral hernia? | 252 | ||
| 47. What is a Richter hernia? | 252 | ||
| 48. What are the boundaries of the superior lumbar triangle? | 252 | ||
| 49. What are the boundaries of the inferior lumbar triangle? | 252 | ||
| 50. What is a lumbar hernia? | 253 | ||
| 51. What are the major potential complications of a hernia? | 253 | ||
| Bibliography | 253 | ||
| 26 Fluoroscopy of the Lower Gastrointestinal Tract | 255 | ||
| 1. Identify the parts of the colon (numbers 1 through 8) labeled in Figure 26-1. | 255 | ||
| 2. What are haustra? | 255 | ||
| 3. Figure 26-4 is from what type of examination? | 256 | ||
| 4. In what position is the patient lying on the tabletop of the fluoroscope in Figure 26-1? | 256 | ||
| 5. What type of patient is capable of undergoing a double-contrast barium enema examination? | 256 | ||
| 6. Figure 26-5 is an image from what type of examination? | 257 | ||
| 7. What are the indications for a double-contrast barium enema examination? | 257 | ||
| 8. What are the indications for a single-contrast barium enema examination? | 257 | ||
| 9. What is your hospital’s preparation for a barium enema? | 257 | ||
| 10. Which types of patients may require more than the standard barium enema preparation? | 258 | ||
| 11. List the contraindications for a barium enema examination. | 258 | ||
| 12. What are the contraindications for the use of intravenous glucagon? | 258 | ||
| 13. Which types of patients should be scheduled early in the day? | 258 | ||
| 14. What are the complications of a barium enema examination? | 258 | ||
| 15. Is antibiotic prophylaxis needed before administration of a barium enema? | 258 | ||
| 16. What is the most important radiographic predictor of malignancy arising in a polyp? | 258 | ||
| 17. What does fine lobulation of the surface of a polyp mean? | 259 | ||
| 18. What percentage of colonic cancers is out of reach of the flexible sigmoidoscope? | 259 | ||
| 19. Which of the following morphologic shapes is the most common form of symptomatic colonic carcinoma: polypoid, carpet, plaquelike, or annular? | 259 | ||
| 20. What is the most common cause of colonic intussusception in adults? | 259 | ||
| 21. Hyperplastic polyps are found most commonly in what part of the colon? | 259 | ||
| 22. What is the most common tumor arising in the submucosa of the colon? | 260 | ||
| 23. What tumors commonly spread to the intraperitoneal space? | 260 | ||
| 24. What are the differences in distribution between ulcerative colitis and Crohn’s disease? | 260 | ||
| 25. Aphthoid ulcers are characteristic of which chronic inflammatory bowel disease? | 261 | ||
| 26. What is the first radiographic study that is performed in symptomatic patients with previously diagnosed Crohn’s disease? | 262 | ||
| 27. What is the most common form of colitis in an outpatient older than 50 years? | 264 | ||
| 28. A woman with a history of cervical cancer now has rectal bleeding (Figure 26-15). What is the most likely diagnosis? | 264 | ||
| 29. What are colonic diverticula? | 264 | ||
| 30. Describe the distribution of colonic diverticula. | 264 | ||
| 31. What is the primary muscle abnormality in diverticular disease? | 265 | ||
| 32. An elderly patient presents with acute left lower abdominal pain. The clinical concern is acute diverticulitis. What examination is performed first? | 265 | ||
| 33. Figure 26-18 is an image from a CT scan in a patient with acute left lower quadrant abdominal pain. What is your diagnosis? | 265 | ||
| 34. A young woman complains of left lower quadrant pain (Figure 26-20). What is your diagnosis? | 266 | ||
| 35. What is defecography? | 267 | ||
| 36. What types of symptoms are indications for defecography? | 267 | ||
| 37. What happens to a patient during defecography? | 267 | ||
| 38. What abnormalities are detected during defecography that are not identified during endoscopy or barium enema? | 268 | ||
| 39. What are the indications for a water-soluble contrast enema? | 268 | ||
| 40. A water-soluble contrast enema is performed in a patient with a hand-sewn end-to-end colorectal anastomosis, after resection of a colonic adenocarcinoma. What is the diagnosis in Figure 26-23? | 269 | ||
| Bibliography | 269 | ||
| 27 CT and MRI of the Lower Gastrointestinal Tract | 270 | ||
| 1. What is shown in Figure 27-1? | 270 | ||
| 2. What is the adenoma-carcinoma sequence? | 270 | ||
| 3. What is the risk of malignancy in a colonic adenomatous polyp measuring <1 cm? | 270 | ||
| 4. What is the risk of malignancy in a colonic adenomatous polyp measuring 1 cm? | 270 | ||
| 5. What is the diagnostic performance of CTC compared to traditional or optical colonoscopy (OC) for adenomatous polyps? | 270 | ||
| 6. What is the protocol for CTC? | 271 | ||
| 7. Can CTC be performed without a cathartic bowel preparation? | 271 | ||
| 8. What are the three factors that should be optimized on CTC? | 271 | ||
| 9. What are the differences between a primary “2D” and a primary “3D” read on CTC? | 271 | ||
| 10. What is the “polyp” window? | 271 | ||
| 11. What is the differential diagnosis for a focal mass projecting into the colon lumen on 3D images (prior to correlation with the 2D images)? | 271 | ||
| 12. What is the major differential diagnosis for a focal polypoid soft tissue attenuation colonic lesion on CTC? | 272 | ||
| 13. How is a colonic diverticulum diagnosed on CTC? | 272 | ||
| 14. How do diverticula of the gastrointestinal tract form? | 272 | ||
| 15. What are the three methods utilized to distinguish stool from polyps on CTC? | 272 | ||
| 16. What is the definition of a “clinically significant polyp” on CTC? | 272 | ||
| 17. How frequently should CTC be performed? | 273 | ||
| 18. What are the most commonly observed indications for CTC? | 273 | ||
| 19. When is CTC not recommended? | 274 | ||
| 20. What is the role of routine computed tomography (CT) and magnetic resonance imaging (MRI) in colon cancer screening? | 274 | ||
| 21. What are the complications of CTC? | 274 | ||
| 22. What is the radiation dose for CTC? | 274 | ||
| 23. Why do patients prefer CTC to OC? | 274 | ||
| 24. What is the normal cross-sectional imaging appearance of the colon? | 274 | ||
| 25. What are the major nonneoplastic causes of colonic wall thickening? | 274 | ||
| 26. What is the “target” sign, and what is its significance? | 274 | ||
| 27. What are the CT and MR imaging features of infectious colitis? | 275 | ||
| 28. What is the etiology of pseudomembranous colitis? | 275 | ||
| 29. How is pseudomembranous colitis diagnosed? | 275 | ||
| 30. What are the cross-sectional imaging features that are helpful to distinguish pseudomembranous colitis from other forms of colitis? | 275 | ||
| 31. What is the treatment for pseudomembranous colitis? | 275 | ||
| 32. What is the role of CT in the management of pseudomembranous colitis? | 275 | ||
| 33. What is typhlitis? | 275 | ||
| 34. How is typhlitis diagnosed? | 275 | ||
| 35. What is the treatment of typhlitis? | 276 | ||
| 36. What are the causes of ischemic colitis? | 276 | ||
| 37. What is the most common cause of ischemic colitis? | 276 | ||
| 38. What is the most common finding of ischemic colitis on CT? | 276 | ||
| 39. What causes colonic wall thickening in ischemic colitis? | 278 | ||
| 40. What generally causes more severe bowel wall thickening, arterial or venous occlusion? | 278 | ||
| 41. Does the degree of bowel wall thickening correlate with the severity of ischemia? | 278 | ||
| 42. What are other ancillary findings of ischemic bowel? | 278 | ||
| 43. What is the preferred imaging modality for evaluation of bowel ischemia? | 279 | ||
| 44. What are the “watershed” regions of the colon? | 279 | ||
| 45. What is the role of CT and MRI in the detection of early inflammatory bowel disease? | 279 | ||
| 46. How are Crohn’s disease and ulcerative colitis distinguished on cross-sectional imaging? | 279 | ||
| 47. What percent of patients with Crohn’s disease present with isolated colonic involvement? | 279 | ||
| 48. What is the most common finding of inflammatory bowel disease on CT and MRI? | 279 | ||
| 49. What is the “comb” sign? | 279 | ||
| 50. What are the MRI findings of active Crohn’s disease? | 279 | ||
| 51. What is the significance of the degree of bowel wall enhancement in inflammatory bowel disease? | 280 | ||
| 52. What is the significance of the “fat halo” sign? | 281 | ||
| 53. What is the best technique for the evaluation of colovesical fistula? | 281 | ||
| 54. Is colorectal cancer common? | 282 | ||
| 55. What proportion of patients with colorectal cancer have synchronous colonic cancers? | 282 | ||
| 56. What is the frequency of metastatic disease on initial presentation of colorectal cancer? | 282 | ||
| 57. What are the most common locations of metastases in colorectal cancer? | 282 | ||
| 58. What are the CT and MRI findings of colorectal cancer? | 282 | ||
| 59. What is the most sensitive imaging study to detect colorectal cancer in the setting of a negative routine CT study and rising carcinoembryonic antigen (CEA) levels? | 283 | ||
| 60. What is the frequency of primary colonic lymphoma? | 283 | ||
| 61. What are the most common locations of colonic lymphoma? | 283 | ||
| 62. What are the cross-sectional imaging features that help to distinguish colorectal lymphoma from adenocarcinoma? | 283 | ||
| 63. What is the most common site of extrapulmonary tuberculosis? | 283 | ||
| 64. What percentage of patients with gastrointestinal tuberculosis demonstrate no evidence of pulmonary tuberculosis? | 283 | ||
| 65. What is the most common site of abdominal tuberculosis? | 283 | ||
| 66. What are the findings of abdominal tuberculosis on CT and MRI? | 283 | ||
| 67. What is familial adenomatous polyposis (FAP)? | 284 | ||
| 68. What is the most common location of the polyps in patients with FAP? | 284 | ||
| 69. What are the major variants of FAP? | 284 | ||
| 70. What is the risk of colorectal cancer among patients with untreated FAP? | 284 | ||
| 71. What is the treatment for FAP? | 284 | ||
| 72. What is an appendiceal mucocele? | 284 | ||
| 73. What do appendiceal mucoceles correspond to on pathology? | 284 | ||
| 74. What are the cross-sectional imaging findings of an appendiceal mucocele? | 284 | ||
| 75. What is pseudomyxoma peritonei? | 284 | ||
| 76. What is the treatment for an appendiceal mucocele? | 284 | ||
| Bibliography | 285 | ||
| 28 CT and MRI of the Liver, Gallbladder, and Biliary Tract | 286 | ||
| 1. What are the common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the liver, gallbladder, and biliary tree? | 286 | ||
| 2. What are the typical MRI sequences that are acquired for hepatobiliary imaging? | 286 | ||
| 3. What is magnetic resonance cholangiopancreatography (MRCP)? | 286 | ||
| 4. What are hepatobiliary MRI contrast agents? | 286 | ||
| 5. What is the normal appearance of the liver on CT and MRI? | 286 | ||
| 6. What is the normal segmental anatomy of the liver, and how are hepatic lobes and segments identified on cross-sectional imaging? | 288 | ||
| 7. What is the normal appearance of the biliary tree and gallbladder on cross-sectional imaging? | 288 | ||
| 8. What are the common MR imaging features to determine if a focal hepatic lesion is hepatocellular or extrahepatocellular in origin? | 289 | ||
| 9. What is the role of CT and MRI in hepatic transplantation? | 291 | ||
| 10. What is FNH, and what are its CT and MR imaging features? | 291 | ||
| 11. What is hepatic adenoma, and what are its CT and MR imaging features? | 291 | ||
| 12. How does one differentiate FNH from hepatic adenoma on cross-sectional imaging? | 291 | ||
| 13. How does one differentiate FNH from fibrolamellar hepatocellular carcinoma (HCC) on cross-sectional imaging? | 291 | ||
| 14. What are the two most commonly encountered benign hepatic lesions? | 292 | ||
| 15. What are the CT and MR imaging features of a hepatic cyst? | 292 | ||
| 16. What are the CT and MR imaging features of a hepatic hemangioma? | 292 | ||
| 17. What is nonalcoholic fatty liver disease (NAFLD), and what is nonalcoholic steatohepatitis (NASH)? | 294 | ||
| 18. What are the CT and MR imaging features of hepatic steatosis? | 295 | ||
| 19. What does hepatic iron deposition look like on CT and MRI, and what are its major causes? | 296 | ||
| 20. What are the hepatic and extrahepatic imaging features of cirrhosis? | 297 | ||
| 21. What is HCC, and what are its CT and MR imaging features? | 298 | ||
| 22. What are the Milan criteria? | 298 | ||
| 23. What are the CT and MR imaging features of hepatic metastatic disease? | 298 | ||
| 24. List the types of malignant tumors that most commonly lead to hyperenhancing hepatic lesions on arterial phase postcontrast CT or MR images. | 300 | ||
| 25. What are the CT and MR imaging features of a hepatic pyogenic abscess? | 300 | ||
| 26. What CT imaging findings may be encountered in hepatic trauma? | 300 | ||
| 27. What is cholelithiasis, and what is choledocholithiasis? | 301 | ||
| 28. What are the CT and MR imaging features of gallbladder and biliary tree calculi? | 301 | ||
| 29. What is primary sclerosing cholangitis (PSC), and what are its CT and MR imaging features? | 302 | ||
| 30. Describe the classification and cross-sectional imaging features of choledochal cysts. | 302 | ||
| 31. What is the cross-sectional imaging appearance and clinical significance of a gallbladder polyp? | 303 | ||
| 32. What is gallbladder carcinoma, and what are its CT and MR imaging features? | 303 | ||
| 33. What is cholangiocarcinoma, and what are its CT and MR imaging features? | 304 | ||
| Bibliography | 305 | ||
| 29 CT and MRI of the Spleen | 306 | ||
| 1. What is the normal CT and MRI appearance of the spleen? | 306 | ||
| 2. What is the normal enhancement pattern of the spleen? | 306 | ||
| 3. What is the difference between white pulp and red pulp? | 306 | ||
| 4. What is an accessory spleen? | 306 | ||
| 5. What is an upside-down spleen? | 306 | ||
| 6. What is splenosis? | 306 | ||
| 7. What is the major differential diagnosis of splenomegaly? | 306 | ||
| 8. What is the most common cause of a small spleen? | 306 | ||
| 9. What are some causes of splenic calcification? | 306 | ||
| 10. What does splenic iron deposition look like on MRI, and what are some major causes of iron deposition in the spleen? | 306 | ||
| 11. What are the CT and MRI findings of splenic infarction? | 307 | ||
| 12. What abdominal organ is most commonly injured due to blunt abdominal trauma? | 308 | ||
| 13. What are some benign cystic lesions that may involve the spleen? | 309 | ||
| 14. What are some benign solid lesions that may involve the spleen? | 309 | ||
| 15. What are some malignant lesions that may involve the spleen? | 310 | ||
| 16. How are incidentally detected splenic lesions generally managed? | 311 | ||
| 17. What is polysplenia? | 311 | ||
| 18. What is asplenia? | 311 | ||
| Bibliography | 311 | ||
| 30 CT and MRI of the Pancreas | 313 | ||
| 1. What are the general indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the pancreas? | 313 | ||
| 2. What is magnetic resonance cholangiopancreatography (MRCP), and how does it compare with endoscopic retrograde cholangiopancreatography (ERCP)? | 313 | ||
| 3. What is the normal CT and MRI appearance of the pancreas? | 314 | ||
| 4. What blood vessels are found near the pancreas? | 315 | ||
| 5. What structures may be seen in the portacaval space? | 315 | ||
| 6. What is pancreas divisum? | 315 | ||
| 7. What is an annular pancreas? | 315 | ||
| 8. What is an intrapancreatic splenule? | 315 | ||
| 9. What are some causes of pancreatic fatty replacement? | 316 | ||
| 10. What does pancreatic iron deposition look like on MRI, and what is the major cause? | 316 | ||
| 11. What is the role of CT and MRI in the assessment of patients with acute pancreatitis? | 317 | ||
| 12. What are the most common causes of acute pancreatitis? | 317 | ||
| 13. What are the two major types of acute pancreatitis, and how do they appear on cross-sectional imaging? | 317 | ||
| 14. Describe the four types of pancreatic and peripancreatic collections that may occur in the setting of acute pancreatitis. | 318 | ||
| 15. What are some other local complications of acute pancreatitis? | 319 | ||
| 16. What are the CT and MR imaging features of chronic pancreatitis? | 319 | ||
| 17. What is groove pancreatitis? | 319 | ||
| 18. Are there any CT or MR imaging features that may indicate the presence of autoimmune pancreatitis? | 319 | ||
| 19. What cross-sectional imaging findings may be encountered in pancreatic trauma? | 319 | ||
| 20. What cross-sectional imaging findings suggest presence of a pancreatic ductal injury? | 321 | ||
| 21. What is the major differential diagnosis for focal pancreatic lesions? | 321 | ||
| 22. What lesion can mimic a pancreatic cystic lesion on cross-sectional imaging? | 321 | ||
| 23. How are incidentally detected pancreatic cystic lesions generally managed? | 321 | ||
| 24. What conditions are associated with pancreatic epithelial cyst formation? | 321 | ||
| 25. What pancreatic lesions are associated with vHL syndrome? | 321 | ||
| 26. What is a pancreatic serous cystadenoma? | 321 | ||
| 27. What are the different types of pancreatic mucinous cystic neoplasms? | 321 | ||
| 28. What is pancreatic adenocarcinoma, and what are its CT and MR imaging features? | 322 | ||
| 29. What CT and MR imaging findings indicate unresectability of pancreatic adenocarcinoma? | 323 | ||
| 30. What is the “double duct” sign? | 324 | ||
| 31. What are pancreatic neuroendocrine tumors? | 324 | ||
| 32. What are the two most common types of pancreatic neuroendocrine tumor? | 324 | ||
| 33. What characteristic clinical presentations are associated with specific types of functional pancreatic neuroendocrine tumors? | 324 | ||
| 34. What genetic syndromes may be associated with pancreatic neuroendocrine tumors? | 324 | ||
| 35. What is a pancreatic solid pseudopapillary neoplasm (SPN)? | 324 | ||
| 36. What are the most common primary tumors that metastasize hematogenously to the pancreas? | 325 | ||
| Bibliography | 325 | ||
| 31 CT and MRI of the Peritoneum, Omentum, and Mesentery | 327 | ||
| 1. What is the peritoneum? | 327 | ||
| 2. What are peritoneal ligaments, small bowel mesentery, mesocolon, and omentum? | 327 | ||
| 3. What is the anatomy of the abdominal peritoneal cavity? | 327 | ||
| 4. What is the anatomy of the pelvic peritoneal cavity? | 327 | ||
| 5. What is the differential diagnosis for nonparenchymal cystic lesions in the abdomen and pelvis? | 328 | ||
| 6. List some potential complications that may occur with nonparenchymal cystic lesions. | 328 | ||
| 7. Are there any distinctive CT and MR imaging features of specific types of nonparenchymal cystic lesions? | 328 | ||
| 8. What are the major causes of transudative ascites? | 328 | ||
| 9. What are the major causes of exudative ascites? | 328 | ||
| 10. Are there CT and MR imaging features that can distinguish between transudative and exudative ascites? | 328 | ||
| 11. What specific types of fluid collection may occur? | 329 | ||
| 12. What are the major causes of pneumoperitoneum? | 329 | ||
| 13. What is pseudomyxoma peritonei, and what are its CT and MR imaging features? | 329 | ||
| 14. What is peritoneal carcinomatosis, and what are its CT and MR imaging features? | 329 | ||
| 15. What is malignant peritoneal mesothelioma, and what are its CT and MR imaging features? | 329 | ||
| 16. What is primary peritoneal carcinoma (PPC), and how can one distinguish this from peritoneal spread of ovarian cancer on CT and MR imaging? | 330 | ||
| 17. What is intraabdominal desmoplastic small round cell tumor (DSRCT), and what are its CT and MR imaging features? | 330 | ||
| 18. What is sclerosing mesenteritis? | 330 | ||
| 19. What are the CT and MR imaging features of sclerosing mesenteritis? | 330 | ||
| 20. What is pelvic lipomatosis? | 330 | ||
| 21. What are the CT and MR imaging features of pelvic lipomatosis? | 330 | ||
| 22. What is a desmoid tumor? | 332 | ||
| 23. What are the CT and MR imaging features of desmoid tumors? | 332 | ||
| 24. What are the major types of peritonitis? | 332 | ||
| 25. What are some differences between primary and secondary bacterial peritonitis? | 333 | ||
| 26. What are the CT and MR imaging features of peritonitis? | 333 | ||
| 27. What is sclerosing encapsulating peritonitis, and what are its CT and MR imaging features? | 333 | ||
| Bibliography | 334 | ||
| 32 CT and MRI of the Acute Abdomen and Pelvis | 335 | ||
| 1. Why is computed tomography (CT) commonly used initially for diagnostic purposes in patients with an acute abdomen or pelvis? | 335 | ||
| 2. When is magnetic resonance imaging (MRI) used for diagnostic purposes in patients with an acute abdomen or pelvis? | 335 | ||
| 3. When are oral and intravenous contrast materials for CT and MRI administered to patients with an acute abdomen or pelvis? | 335 | ||
| 4. What is the major differential diagnosis for acute abdominopelvic conditions that can be diagnosed on CT and MRI? | 335 | ||
| 5. What is an abscess, and what are its CT and MR imaging features? | 336 | ||
| 6. What is acute appendicitis? | 336 | ||
| 7. Describe the CT and MR imaging features of acute appendicitis. | 336 | ||
| 8. What is tip appendicitis? | 337 | ||
| 9. What is acute large bowel diverticulitis, and what are its CT and MR imaging features? | 337 | ||
| 10. Describe acute mesenteric lymphadenitis and its associated CT and MR imaging features. | 337 | ||
| 11. Describe primary epiploic appendagitis (PEA) and segmental omental infarction and their associated CT and MR imaging features. | 337 | ||
| 12. What is acute cholecystitis? | 338 | ||
| 13. List the CT and MR imaging findings of acute cholecystitis. | 338 | ||
| 14. What is gangrenous cholecystitis, and what are its CT and MR imaging features? | 339 | ||
| 15. Describe emphysematous cholecystitis and its CT and MR imaging features. | 339 | ||
| 16. What is the major complication of acute, gangrenous, and emphysematous cholecystitis? | 339 | ||
| 17. What is ascending cholangitis, and what are its CT and MR imaging features? | 339 | ||
| 18. What is acute pancreatitis? | 339 | ||
| 19. Describe the CT and MR imaging features of acute pancreatitis. | 339 | ||
| 20. What is acute pyelonephritis, and what are its CT and MR imaging features? | 340 | ||
| 21. What is emphysematous pyelonephritis, and what are its CT and MR imaging features? | 340 | ||
| 22. Describe the CT and MR imaging features of urolithiasis along with its associated complications. | 340 | ||
| 23. What is pyonephrosis, and what are its CT and MR imaging features? | 341 | ||
| 24. What is pelvic inflammatory disease (PID), and what are its CT and MR imaging features? | 341 | ||
| 25. List the major causes of bowel obstruction. | 341 | ||
| 26. Describe the CT and MR imaging features of bowel obstruction. | 342 | ||
| 27. What is a closed loop bowel obstruction, and what are its CT and MR imaging features? | 342 | ||
| 28. Describe the CT and MR imaging features of bowel ischemia/infarction. | 343 | ||
| 29. List some causes of bowel ischemia/infarction. | 343 | ||
| 30. What is toxic megacolon, and what are its CT and MR imaging features? | 343 | ||
| 31. List the major causes of bowel perforation. | 344 | ||
| 32. What are the CT and MR imaging features of bowel perforation? | 344 | ||
| 33. Describe the CT imaging features of acute hemorrhage and active arterial hemorrhage. | 344 | ||
| 34. Describe the CT imaging features of AAA rupture and impending rupture. | 345 | ||
| 35. What are the CT and MR imaging features associated with shock, and what should one do upon seeing these findings? | 345 | ||
| 36. List the major CT imaging features associated with solid organ traumatic injury. | 345 | ||
| 37. Describe the major CT imaging features related to hollow organ traumatic injury. | 345 | ||
| 38. What are the major CT and MR imaging features associated with vascular traumatic injury? | 345 | ||
| 39. What is Fournier gangrene, and what are its CT and MR imaging features? | 345 | ||
| 40. What is abdominal compartment syndrome (ACS), and what are its CT and MR imaging features? | 346 | ||
| 41. What is ectopic pregnancy, and what are its CT and MR imaging features? | 346 | ||
| 42. What is adnexal torsion, and what are its CT and MR imaging features? | 346 | ||
| Bibliography | 347 | ||
| VI Genitourinary Imaging | 349 | ||
| 33 Urography | 351 | ||
| 1. What is a urogram? | 351 | ||
| 2. What are the different ways a urogram can be performed? | 351 | ||
| 3. What is IVU? | 351 | ||
| 4. What is CTU? | 351 | ||
| 5. What is MRU? | 351 | ||
| 6. What are the pros and cons of the three different imaging techniques available for urography? | 351 | ||
| 7. What preprocedure preparation is required for the different urographic techniques? | 351 | ||
| 8. When is CTU or IVU contraindicated? | 352 | ||
| 9. When is MRU contraindicated? | 354 | ||
| 10. What is the sequence of images for an IVU? | 354 | ||
| 11. How should a patient with hematuria be evaluated? | 354 | ||
| 12. What should be done if IVU suggests the presence of a renal mass? | 354 | ||
| 13. My patient presented with diffuse lung metastases and gross hematuria. What study would be best to look for a renal malignancy? | 354 | ||
| 14. Why is urography necessary in patients with urothelial cancer of the urinary bladder? | 354 | ||
| 15. What does upper tract UC look like on urography? | 355 | ||
| 16. What is bladder cancer? | 355 | ||
| 17. What are the IVU, CT, and MR imaging features of bladder cancer? | 356 | ||
| 18. What is the appearance of urinary tract stones on imaging studies? | 356 | ||
| 19. Is a filling defect in the collecting system diagnostic of UC? | 357 | ||
| 20. How do I distinguish between these different pathologic conditions? | 357 | ||
| 21. What is the appearance of urinary tract obstruction on an IVU, CTU, and MRU? | 358 | ||
| 22. What is the role of urography in a patient with suspected urinary tract obstruction? | 358 | ||
| 23. What is a stone-protocol CT? | 358 | ||
| 24. My patient has severe flank pain. What study should I order to exclude renal colic as a cause of the flank pain? | 358 | ||
| 25. As a stone-protocol CT detects all renal stones, when is urography necessary in patients with urinary tract stones? | 358 | ||
| 26. What are calyceal diverticula? | 358 | ||
| 27. What is medullary sponge kidney? | 358 | ||
| 28. What is ureteropelvic junction (UPJ) obstruction? | 359 | ||
| 29. What is an ectopic ureter? | 360 | ||
| 30. What is meant by duplication of the collecting system, and what is its appearance on radiographic studies? | 360 | ||
| 31. What is a ureterocele? | 361 | ||
| 32. What is papillary necrosis? | 361 | ||
| 33. What is the imaging appearance of infections in the urinary tract? | 361 | ||
| 34. My patient is status post surgery for an abdominal tumor several days ago, and the surgical drains are putting out a lot of yellow fluid. What should I do? | 362 | ||
| Bibliography | 362 | ||
| 34 Genitourinary Tract Fluoroscopy | 363 | ||
| 1. What are genitourinary fluoroscopic examinations? | 363 | ||
| 2. What is a retrograde pyelogram, and how does it differ from a urogram? | 363 | ||
| 3. When is a retrograde pyelogram necessary? | 363 | ||
| 4. What is the difference between a cystogram and a voiding cystourethrogram? | 363 | ||
| 5. What are the indications for cystography and VCUG? | 363 | ||
| 6. What is a retrograde urethrogram? | 363 | ||
| 7. What are the indications for a retrograde urethrogram? | 364 | ||
| 8. How is the female urethra evaluated? | 364 | ||
| 9. What is a loopogram? | 364 | ||
| 10. What is a pouchogram? | 365 | ||
| 11. What is a hysterosalpingogram? | 366 | ||
| 12. What is the normal appearance of the upper urinary tract on a retrograde pyelogram? | 367 | ||
| 13. What are some abnormalities that may be seen on a retrograde pyelogram? | 367 | ||
| 14. What are the causes of ureteral trauma, and how is it best evaluated? | 368 | ||
| 15. Why is vesicoureteral reflux (VUR) important, and how is it demonstrated? | 369 | ||
| 16. What is the normal appearance of the bladder on fluoroscopic studies? | 369 | ||
| 17. What is a cystocele? | 369 | ||
| 18. What are some causes of incontinence? | 369 | ||
| 19. Is a cystogram sensitive in excluding a leak from the bladder? | 369 | ||
| 20. A patient is brought to the emergency department with blunt abdominal trauma and pelvic fractures. Does this patient need both an abdominopelvic CT scan and a fluoroscopic cystogram? | 369 | ||
| 21. What kinds of injuries occur in the bladder? | 369 | ||
| 22. What are the imaging findings of cystitis? | 370 | ||
| 23. What are the causes of bladder fistulae? | 370 | ||
| 24. What is a bladder diverticulum? | 370 | ||
| 25. What are some causes of urethral stricture? | 370 | ||
| 26. What is a urethral diverticulum? | 370 | ||
| 27. What kinds of traumatic injuries occur in the urethra? | 370 | ||
| 28. What is the normal appearance of the female genital tract on a hysterosalpingogram? | 370 | ||
| 29. Does pelvic magnetic resonance imaging (MRI) or ultrasonography (US) provide the same information as HSG? | 371 | ||
| 30. What are some abnormalities seen on a hysterosalpingogram? | 371 | ||
| 31. If a female patient has a pelvic mass, what study would be helpful for further evaluation? | 371 | ||
| 32. Is a hysterosalpingogram useful for evaluation of the endometrium in a postmenopausal patient with vaginal bleeding? | 371 | ||
| Bibliography | 372 | ||
| 35 CT and MRI of the Kidney | 373 | ||
| 1. What are the common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the kidneys? | 373 | ||
| 2. What is the normal appearance of the kidneys on CT and MRI? | 373 | ||
| 3. What is the role of CT and MRI in renal transplantation? | 373 | ||
| 4. What is a horseshoe kidney? | 375 | ||
| 5. What is the most common benign renal lesion? | 375 | ||
| 6. What is a cystic nephroma, and what are its CT and MR imaging features? | 375 | ||
| 7. What is the Bosniak classification system for cystic renal lesions? | 376 | ||
| 8. What is the major differential diagnosis for polycystic kidney disease? | 376 | ||
| 9. What is the major differential diagnosis for focal renal lesions? | 379 | ||
| 10. What is a renal AML, and what are its CT and MR imaging features? | 379 | ||
| 11. What is a renal oncocytoma, and what are its CT and MR imaging features? | 379 | ||
| 12. What is acute pyelonephritis, and what are its CT and MR imaging features? | 379 | ||
| 13. What are the CT and MR imaging features of a renal pyogenic abscess? | 380 | ||
| 14. What is xanthogranulomatous pyelonephritis (XGP), and what are its CT and MR imaging features? | 381 | ||
| 15. What is the difference between nephrolithiasis and nephrocalcinosis? | 381 | ||
| 16. What are the major causes of cortical nephrocalcinosis? | 381 | ||
| 17. What are the major causes of medullary nephrocalcinosis? | 382 | ||
| 18. What does renal iron deposition look like on MRI, and what are its major causes? | 382 | ||
| 19. What CT imaging findings may be encountered in renal trauma? | 382 | ||
| 20. What do renal infarcts look like on CT and MRI, and what are some causes of renal infarction? | 383 | ||
| 21. What are some risk factors for renal hemorrhage/hematoma? | 383 | ||
| 22. What is RCC, and what are its histologic subtypes? | 384 | ||
| 23. What are the CT and MR imaging features of RCC? | 384 | ||
| 24. What are some hereditary conditions and other risk factors associated with RCC? | 384 | ||
| 25. Summarize the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for renal cell carcinoma. | 385 | ||
| 26. What are the major indications for partial nephrectomy in patients with RCC? | 387 | ||
| 27. What are the CT and MR imaging features of renal lymphoma? | 387 | ||
| 28. What are the CT and MR imaging features of metastatic disease to the kidneys? | 387 | ||
| 29. What are the CT and MR imaging features of urothelial cancers of the upper urinary tract? | 387 | ||
| Bibliography | 388 | ||
| 36 CT and MRI of the Adrenal Glands | 389 | ||
| 1. What are common indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the adrenal glands? | 389 | ||
| 2. What is the normal appearance of the adrenal glands on CT and MRI? | 389 | ||
| 3. What is a pancake adrenal gland? | 389 | ||
| 4. What is the significance of hyperenhancement of the adrenal glands? | 389 | ||
| 5. What are the major causes of adrenal gland calcification? | 389 | ||
| 6. How often are incidental adrenal lesions detected on cross-sectional imaging? | 389 | ||
| 7. What is the major differential diagnosis for a focal adrenal gland lesion? | 391 | ||
| 8. What are the CT and MR imaging findings of adrenal hemorrhage/hematoma? | 391 | ||
| 9. What are some risk factors for adrenal hemorrhage/hematoma? | 391 | ||
| 10. What are the CT and MR imaging findings of adrenal cysts? | 392 | ||
| 11. What is adrenal hyperplasia, and what are its CT and MR imaging features? | 392 | ||
| 12. What is an adrenal adenoma, and what are its CT and MR imaging features? | 393 | ||
| 13. Are CT and MRI able to distinguish between hyperfunctional and nonhyperfunctional adrenal adenomas? | 393 | ||
| 14. What is an adrenal myelolipoma, and what are its CT and MR imaging features? | 393 | ||
| 15. What other types of adrenal gland nodules may contain microscopic lipid or macroscopic fat? | 393 | ||
| 16. If the CT or MR imaging features of an incidentally detected adrenal gland nodule are nondiagnostic, what are the next steps to determine its etiology? | 394 | ||
| 17. What are the causes of Conn’s syndrome? | 394 | ||
| 18. What are the causes of Cushing’s syndrome? | 395 | ||
| 19. What is an adrenal pheochromocytoma, and what are its CT and MR imaging features? | 396 | ||
| 20. What are some hereditary conditions associated with adrenal pheochromocytoma? | 396 | ||
| 21. What is adrenal cortical carcinoma (ACC), and what are its CT and MR imaging features? | 396 | ||
| 22. What are the cross-sectional imaging features of metastatic disease to the adrenal glands? | 396 | ||
| Bibliography | 398 | ||
| 37 CT and MRI of the Retroperitoneum | 399 | ||
| 1. What are the boundaries of the retroperitoneum? | 399 | ||
| 2. What are the compartments of the retroperitoneum and their contents? | 399 | ||
| 3. What are the extraperitoneal spaces of the pelvis? | 399 | ||
| 4. Are the psoas muscles located within the retroperitoneum? | 399 | ||
| 5. Which tumors most commonly occur in the retroperitoneum? | 399 | ||
| 6. What are the major types of retroperitoneal sarcoma? | 399 | ||
| 7. How are computed tomography (CT) and magnetic resonance imaging (MRI) useful in patients with retroperitoneal sarcoma? | 399 | ||
| 8. What are the CT and MR imaging features of a retroperitoneal sarcoma? | 399 | ||
| 9. What CT and MR imaging features favor a liposarcoma over a lipoma? | 401 | ||
| 10. What clinical and imaging features favor presence of a retroperitoneal leiomyosarcoma? | 401 | ||
| 11. What are some clinical, CT, and MR imaging features of schwannoma? | 401 | ||
| 12. What are some clinical, CT, and MR imaging features of neurofibroma? | 401 | ||
| 13. How often do patients with NF-1 develop neurofibromas? | 402 | ||
| 14. When should one suspect malignant transformation of a neurofibroma into an MPNST? | 402 | ||
| 15. What are some clinical, CT, and MR imaging features of paraganglioma? | 402 | ||
| 16. What are the CT and MR imaging features of retroperitoneal lymphoma? | 402 | ||
| 17. What CT and MR imaging findings can help distinguish benign from malignant lymph nodes? | 402 | ||
| 18. What is the differential diagnosis for abdominopelvic lymphadenopathy? | 403 | ||
| 19. What are the major causes of necrotic lymph nodes? | 403 | ||
| 20. What are the major causes of calcified lymph nodes? | 403 | ||
| 21. What are the major causes of fatty lymph nodes? | 403 | ||
| 22. What are some imaging manifestations of retroperitoneal metastasis? | 403 | ||
| 23. Which malignant tumors most often spread to the retroperitoneum? | 403 | ||
| 24. What is RPF? | 403 | ||
| 25. What are the CT and MR imaging features of RPF? | 403 | ||
| 26. What are the major risk factors for retroperitoneal hemorrhage? | 404 | ||
| 27. What are the CT and MR imaging features of hemorrhage? | 404 | ||
| 28. What is a urinoma, and what are its major risk factors? | 404 | ||
| 29. What are the CT and MR imaging features of a urinoma? | 404 | ||
| 30. What are the major causes of pneumoretroperitoneum? | 404 | ||
| Bibliography | 405 | ||
| 38 Imaging of the Female Pelvis | 406 | ||
| 1. What is the first-line imaging modality of the female pelvis and why? | 406 | ||
| 2. How are US, CT, and MRI of the female pelvis performed? | 406 | ||
| 3. Which imaging modality best demonstrates the anatomy of the uterus? | 406 | ||
| 4. What are the more common congenital uterine anomalies and their clinical significance? | 407 | ||
| 5. What is the normal thickness of the endometrium in a premenopausal patient? | 407 | ||
| 6. What is the normal thickness of the endometrium in postmenopausal patients, and what is the significance of thickened endometrium in these patients? | 407 | ||
| 7. What are the most common causes of vaginal bleeding in a postmenopausal woman? | 407 | ||
| 8. In a postmenopausal patient with vaginal bleeding, what is the role of imaging? | 408 | ||
| 9. What is adenomyosis, and what are its imaging characteristics? | 409 | ||
| 10. What is the most common neoplasm of the female genitourinary tract? | 410 | ||
| 11. What is Asherman’s syndrome, and what are its imaging characteristics? | 410 | ||
| 12. What is the normal size of the ovaries in premenopausal versus postmenopausal women? | 410 | ||
| 13. What are the most common benign lesions of the ovaries and their imaging characteristics? | 410 | ||
| 14. What is the recommended management of an incidentally discovered asymptomatic simple ovarian cyst seen on US in premenopausal versus postmenopausal women? | 410 | ||
| 15. What are the imaging findings of endometriosis on US and MRI? | 411 | ||
| 16. What are the major causes of hydrosalpinx and hematosalpinx, and what are their imaging features on US and MRI? | 411 | ||
| 17. What are the imaging features of a mature teratoma of the ovary? | 412 | ||
| 18. In a female patient with acute pelvic pain and suspected adnexal torsion, what is the study of choice, and what are the imaging findings of adnexal torsion? | 413 | ||
| 19. How is polycystic ovarian syndrome (PCOS) diagnosed, and what is the role for imaging? | 413 | ||
| 20. What are the most common malignancies of the female reproductive system? | 414 | ||
| 21. How is endometrial cancer diagnosed, and what imaging features are considered in staging? | 415 | ||
| 22. How is cervical cancer diagnosed, and what tumor features are considered in staging and pretreatment planning? | 415 | ||
| 23. What are the major imaging features that suggest presence of an ovarian neoplasm? | 415 | ||
| 24. What are the most common perineal cystic lesions seen in the female patient? | 416 | ||
| 25. In a patient with cervical motion tenderness and suspected pelvic inflammatory disease (PID), what is the role of imaging? | 416 | ||
| 26. In a multiparous patient with stress urinary incontinence, vaginal bulging, incomplete defecation, and suspected pelvic organ prolapse, what is the role of imaging? | 416 | ||
| 27. In a female patient with postvoid dribbling, dysuria, dyspareunia, and recurrent urinary tract infections, what is the differential diagnosis? | 417 | ||
| 28. What are the imaging features of intrauterine devices (IUDs)? | 418 | ||
| 29. What is the recommended imaging study in a pregnant patient with right lower quadrant pain? | 419 | ||
| Bibliography | 420 | ||
| 39 Imaging of the Male Pelvis | 421 | ||
| Prostate Gland and Seminal Tract | 421 | ||
| 1. What is the normal anatomy and imaging appearance of the prostate gland and seminal tract on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI)? | 421 | ||
| 2. What are the clinical indications for cross-sectional imaging of the prostate gland and seminal tract? | 421 | ||
| 3. What is the normal size of the prostate gland? | 421 | ||
| 4. What is hematospermia, and what are its major causes? | 423 | ||
| 5. What does hemorrhage in the prostate gland and seminal tract typically look like on MRI? | 423 | ||
| 6. What is the significance of calcification of the vas deferens? | 423 | ||
| 7. What kinds of cysts occur in the prostate gland and seminal tract? | 423 | ||
| 8. What is prostatitis, and what are its cross-sectional imaging features? | 424 | ||
| 9. Which patients are at risk for developing a prostatic abscess, and what are its cross-sectional imaging features? | 424 | ||
| 10. What is benign prostatic hyperplasia (BPH), and what are its cross-sectional imaging features? | 424 | ||
| 11. What is the major differential diagnosis for a focal prostatic lesion? | 424 | ||
| 12. What is prostate cancer? | 425 | ||
| 13. What is the Gleason score? | 425 | ||
| 14. What is the role of cross-sectional imaging in the evaluation of patients with prostate adenocarcinoma? | 425 | ||
| 15. What are the cross-sectional imaging features of prostate adenocarcinoma? | 425 | ||
| 16. What are the cross-sectional imaging features that suggest extracapsular spread of prostate adenocarcinoma? | 426 | ||
| 17. Summarize the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for prostate adenocarcinoma. | 426 | ||
| Testicles, Epididymides, and Scrotum | 426 | ||
| 18. What is the normal anatomy and imaging appearance of the testicles on US, CT, and MRI? | 426 | ||
| 19. What is cryptorchidism, and what are its cross-sectional imaging features? | 428 | ||
| 20. What are the potential complications of cryptorchidism? | 428 | ||
| 21. What is the most important question to clarify when imaging a palpable scrotal abnormality? | 428 | ||
| 22. What is the most common cause of a scrotal mass? | 428 | ||
| 23. What is the major differential diagnosis for a focal testicular lesion? | 429 | ||
| 24. What is the major differential diagnosis for multiple intratesticular masses? | 429 | ||
| 25. What is a testicular adrenal rest, and what are its cross-sectional imaging features? | 430 | ||
| 26. What is splenogonadal fusion, and what are its US imaging features? | 430 | ||
| 27. What is Leydig cell hyperplasia, and what are its cross-sectional imaging features? | 430 | ||
| 28. What is a testicular epidermoid inclusion cyst, and what are its cross-sectional imaging features? | 430 | ||
| 29. What is testicular microlithiasis, and what is its significance? | 430 | ||
| 30. What is the most common cancer of young men? | 431 | ||
| 31. What types of testicular malignancy may occur? | 431 | ||
| 32. Which type of testicular tumor is hormonally active? | 431 | ||
| 33. What are some risk factors for testicular cancer? | 431 | ||
| 34. What is the role of cross-sectional imaging in patients with testicular cancer? | 431 | ||
| 35. What are the cross-sectional imaging features of testicular cancer? | 431 | ||
| 36. Describe the routes of lymphatic spread of testicular cancer. | 432 | ||
| 37. Which germ cell tumor has a tendency for early hematogenous metastatic spread? | 433 | ||
| 38. List the stages of testicular cancer. | 433 | ||
| 39. Are there findings that are more suggestive of testicular lymphoma rather than testicular germ cell tumor? | 433 | ||
| 40. How often do extratesticular malignancies metastasize to the testicle? | 433 | ||
| 41. What is the most common extratesticular scrotal tumor? | 433 | ||
| 42. What is an adenomatoid tumor, and what are its cross-sectional imaging features? | 433 | ||
| 43. What is a varicocele, and what are its cross-sectional imaging features? | 433 | ||
| 44. What are the complications of a varicocele? | 433 | ||
| 45. What is the significance of asymmetric prominence and enhancement of the spermatic cord vessels? | 433 | ||
| 46. In a patient who presents with an acutely painful scrotum, what is the initial diagnostic imaging test of choice, and what is the major differential diagnosis? | 434 | ||
| 47. What is acute epididymo-orchitis, and what are its cross-sectional imaging features? | 434 | ||
| 48. What is the most common cause of isolated orchitis? | 434 | ||
| 49. What is a pyocele, and what are its cross-sectional imaging features? | 434 | ||
| 50. What is a hydrocele, and what are its cross-sectional imaging features? | 435 | ||
| 51. List some causes of a hydrocele. | 435 | ||
| 52. What is torsion of a testicular appendage, and what are its US imaging features? | 435 | ||
| 53. What is spermatic cord torsion, and what are its US imaging features? | 435 | ||
| 54. What cross-sectional imaging findings may be encountered in testicular trauma? | 435 | ||
| 55. What are the US and MR imaging findings of testicular hematomas? | 436 | ||
| 56. What are the US and MR imaging findings of segmental testicular infarction? | 436 | ||
| Penis | 436 | ||
| 57. What is the normal anatomy and imaging appearance of the penis on US, CT, and MRI? | 436 | ||
| 58. What congenital abnormality of the penis is associated with bladder exstrophy? | 437 | ||
| 59. When the penile meatus is located more ventrally and proximally than expected, what is this congenital abnormality called, and what is an associated finding? | 437 | ||
| 60. What is Peyronie’s disease, and what are its cross-sectional imaging features? | 438 | ||
| 61. What is a Cowper duct syringocele, and what are its cross-sectional imaging features? | 438 | ||
| 62. What cross-sectional imaging findings may be encountered in penile trauma? | 438 | ||
| 63. If a patient presents with erectile dysfunction, what can one assess on Doppler US to evaluate for potential causes? | 438 | ||
| 64. What is the most common malignancy of the penis, and what are some of its risk factors? | 438 | ||
| 65. What is the role of cross-sectional imaging in patients with penile cancer? | 438 | ||
| 66. What are the cross-sectional imaging features of penile cancer? | 438 | ||
| 67. If a patient with known cancer presents with priapism, what diagnosis must be considered? | 439 | ||
| Bibliography | 439 | ||
| VII Neuroradiology | 441 | ||
| 40 Brain Imaging | 443 | ||
| 1. Identify the normal parts of the brain labeled 1 through 6 in Figure 40-1. | 443 | ||
| 2. What imaging modalities can be used to evaluate the brain? | 443 | ||
| 3. What are the clinical indications for obtaining CT and MRI of the brain? | 443 | ||
| 4. What are contraindications for performing MRI of the brain? | 444 | ||
| 5. Define the terms “intra-axial” and “extra-axial”, which are commonly used to localize intracranial pathologic conditions. | 444 | ||
| 6. What is the Glasgow Coma Scale (GCS), and how is it used? | 444 | ||
| 7. What is the imaging modality of choice in the setting of acute head trauma? | 444 | ||
| 8. What is the role of imaging after concussion or other minor head trauma? | 445 | ||
| 9. What are the advantages and drawbacks of MRI in assessing a trauma patient? | 445 | ||
| 10. How does one differentiate a subdural hematoma from an epidural hematoma? | 445 | ||
| 11. What is the CT appearance of subarachnoid hemorrhage (SAH)? | 446 | ||
| 12. What are the five patterns of brain herniation and herniation syndromes? | 446 | ||
| 13. What are Duret hemorrhages? | 446 | ||
| 14. What are the imaging manifestations of a brain contusion? | 447 | ||
| 15. What are the imaging manifestations of diffuse axonal injury (DAI)? | 447 | ||
| 16. What is the most common primary intra-axial brain tumor in adults? What cell line does it arise from? | 447 | ||
| 17. What is the most common extra-axial tumor in adults? | 447 | ||
| 18. What are the most common neoplasms arising in the corpus callosum? | 447 | ||
| 19. What are the most common neoplasms that metastasize to the brain? | 447 | ||
| 20. What are the most common primary brain tumors that calcify? | 447 | ||
| 21. What is the imaging appearance of leptomeningeal carcinomatosis or subarachnoid seeding? | 447 | ||
| 22. What are the most common tumors that produce subarachnoid seeding in adults? | 448 | ||
| 23. Why would a mass appear hyperattenuating on an unenhanced CT scan of the head? | 448 | ||
| 24. What is the most common tumor in the cerebellopontine angle cistern? | 448 | ||
| 25. What is the most common clinical presentation of a vestibular schwannoma? | 449 | ||
| 26. What is the most common posterior fossa/infratentorial mass in adults? | 449 | ||
| 27. What is pituitary apoplexy? | 450 | ||
| 28. What is a pituitary microadenoma? What is a pituitary macroadenoma? | 450 | ||
| 29. What visual symptoms can pituitary adenomas cause? What is the most common type of pituitary adenoma? | 450 | ||
| 30. Name advanced imaging techniques that help differentiate brain tumors from other pathologies. | 450 | ||
| 31. Pineal region masses are associated with what visual disturbance? | 450 | ||
| Bibliography | 451 | ||
| 41 Brain Imaging | 453 | ||
| 1. How is multiple sclerosis (MS) diagnosed? | 453 | ||
| 2. What is the differential diagnosis of MS based on imaging findings? | 453 | ||
| 3. What are the clinical and imaging features of acute disseminated encephalomyelitis (ADEM)? | 453 | ||
| 4. What are the causes of intracranial abscesses? | 454 | ||
| 5. What is the imaging differential diagnosis of a ring-enhancing lesion in the brain? | 454 | ||
| 6. What advanced MRI techniques may be useful in distinguishing brain abscess from neoplasm? | 454 | ||
| 7. What anatomic location in the brain is preferentially involved by herpes simplex encephalitis? | 454 | ||
| 8. What is the differential diagnosis of an intracranial mass in a patient with human immunodeficiency virus (HIV) infection? | 454 | ||
| 9. What is a stroke? | 456 | ||
| 10. What are the common causes of stroke that one must consider in children and young adults? | 456 | ||
| 11. What are the imaging manifestations of ischemic stroke in the acute stage? | 456 | ||
| 12. How can one differentiate acute from chronic stroke on imaging? | 457 | ||
| 13. What are watershed infarctions? | 457 | ||
| 14. What are lacunar infarctions? | 457 | ||
| 15. What are the risk factors for venous sinus thrombosis and venous infarction? | 457 | ||
| 16. What is the most common cause of nontraumatic subarachnoid hemorrhage (SAH)? | 457 | ||
| 17. What is the workup of a patient presenting with SAH? | 458 | ||
| 18. If multiple aneurysms are seen on catheter angiography in a patient with SAH, which one most likely bled? | 459 | ||
| 19. What are common locations for hypertensive intraparenchymal hemorrhages? | 459 | ||
| 20. What is amyloid angiopathy? | 459 | ||
| 21. Review the MRI signal intensity characteristics of intracranial hemorrhage. | 459 | ||
| 22. What are the imaging features of cerebral hypoxia/anoxia? | 459 | ||
| Bibliography | 461 | ||
| 42 Advanced Neurospinal Imaging | 462 | ||
| 1. Identify parts of the spine labeled in Figure 42-1. | 462 | ||
| 2. What imaging modalities are most often used in the evaluation of spine pathology? | 462 | ||
| 3. Describe the strengths, weaknesses, and most appropriate uses of CT in spinal imaging. | 462 | ||
| 4. Describe the strengths and drawbacks of MRI. | 462 | ||
| 5. In patients with contraindications to MRI, what imaging study can be used to assess the contents within the spinal canal? | 463 | ||
| 6. What is discography, and what are its indications? | 463 | ||
| 7. What is the primary role of catheter angiography of the spine? | 463 | ||
| 8. What is spinal dysraphia? | 464 | ||
| 9. Differentiate between open and occult forms of spinal dysraphia. | 464 | ||
| 10. What are the clinical findings and imaging features of a tethered spinal cord? | 464 | ||
| 11. List and describe caudal spinal anomalies. | 464 | ||
| 12. What are the split notochord syndromes? | 465 | ||
| 13. What are Tarlov cysts? | 465 | ||
| 14. What is arachnoiditis? | 465 | ||
| 15. What are the CT and MR imaging and clinical features of hydrosyringomyelia? | 466 | ||
| 16. Review the epidemiologic factors of spinal trauma. | 467 | ||
| 17. What are the appropriate indications for obtaining imaging of the spine in the setting of blunt trauma? | 467 | ||
| 18. What are the roles of CT and MRI in spinal trauma? | 467 | ||
| 19. Describe types of spinal cord injuries. | 468 | ||
| 20. What additional structures may be injured in association with cervical spinal trauma that may not be detected on radiographs or CT scans? | 468 | ||
| 21. Name the most common sites of infection in the spine. | 468 | ||
| 22. What patient populations are particularly prone to the development of infectious spondylodiscitis? | 470 | ||
| 23. What is the most common infectious agent responsible for spondylodiscitis? | 470 | ||
| 24. What is the typical clinical presentation of discitis? | 470 | ||
| 25. What are the typical imaging findings of spondylodiscitis? | 470 | ||
| 26. Describe the imaging appearance of spondylodiscitis caused by atypical organisms such as tuberculosis. | 470 | ||
| 27. List noninfectious disorders that can have imaging findings similar to infectious spondylodiscitis. | 470 | ||
| 28. What is the most common inflammatory disorder that affects the spinal cord? | 471 | ||
| 29. What are the classic imaging findings of multiple sclerosis affecting the spinal cord? | 471 | ||
| 30. What is the typical MRI appearance of spinal sarcoidosis? How can its appearance, combined with the clinical history, distinguish it from other inflammatory disorders? | 471 | ||
| 31. What is the typical time course for the development of radiation myelitis after irradiation for treatment of tumor? | 472 | ||
| 32. Which disorders commonly affect the dorsal spinal cord? | 472 | ||
| 33. Name the two most common vascular disorders of the spinal cord. | 472 | ||
| 34. What is the arterial vascular supply to the spinal cord? | 472 | ||
| 35. What are the typical clinical characteristics and imaging findings of spinal cord infarcts? | 472 | ||
| 36. List types of spinal vascular malformations, and describe their clinical and imaging characteristics. | 473 | ||
| 37. How are spinal lesions classified anatomically? | 475 | ||
| 38. Describe the clinical and imaging features of neural compression. | 475 | ||
| 39. What is the most common epidural spinal tumor in adults? | 475 | ||
| 40. What is the most common benign osseous lesion involving the spine? | 476 | ||
| 41. What is the differential diagnosis for an intradural-extramedullary neoplasm? | 476 | ||
| 42. What neoplasms are associated with leptomeningeal seeding of tumor? | 476 | ||
| 43. List the most common intramedullary spinal tumors. | 477 | ||
| 44. Describe the distinguishing clinical and imaging features of intramedullary spinal tumors. | 477 | ||
| Bibliography | 479 | ||
| 43 Head and Neck Imaging, Part 1 | 480 | ||
| 1. The hyoid bone divides the neck into what two distinct regions? | 480 | ||
| 2. Which imaging modalities are used to evaluate lesions in the suprahyoid and infrahyoid neck? | 480 | ||
| 3. What are the three anatomic subdivisions of the pharynx? | 480 | ||
| 4. Name the parts of the nasopharynx. | 481 | ||
| 5. Name the parts of the oropharynx. | 481 | ||
| 6. What is Waldeyer’s ring? | 481 | ||
| 7. The piriform sinuses are in what part of the aerodigestive tract? | 481 | ||
| 8. What structures are parts of the oral cavity? | 481 | ||
| 9. What are the three anatomic subsites of the larynx? | 481 | ||
| 10. What are the boundaries of the supraglottic larynx? | 481 | ||
| 11. What structures comprise the glottis? | 482 | ||
| 12. Where is the subglottis located? | 482 | ||
| 13. Name and identify the extramucosal spaces of the head and neck in Figure 43-5. | 482 | ||
| 14. Describe how displacement of the fat in the PPS helps to localize lesions or masses to their correct anatomic subsite in the extramucosal compartment. | 483 | ||
| 15. Displacement of the prevertebral muscle complex helps differentiate masses in what two extramucosal spaces? | 483 | ||
| 16. Displacement of the cervical internal carotid artery helps differentiate masses in what two extramucosal spaces? | 483 | ||
| 17. What are the imaging criteria for diagnosis of a pathologic cervical lymph node? | 483 | ||
| 18. What is the best cross-sectional imaging study to identify pathologic nodes? | 483 | ||
| 19. What is the most common cause of a calcified cervical lymph node? | 483 | ||
| 20. What is the most common cause of a cystic mass in the lateral neck of an adult? | 485 | ||
| 21. What are the most common causes of cervical lymph node metastases in an adult? | 485 | ||
| 22. In patients with head and neck cancer, how does the presence of metastatic lymphadenopathy affect prognosis? | 485 | ||
| 23. What risk factors are associated with the development of head and neck cancer? | 485 | ||
| 24. What major epidemiologic factor accounts for the increasing rate of head and neck cancer in adults younger than 40 years old? | 485 | ||
| 25. What is the role of the radiologist in the evaluation and staging of head and neck cancer? | 485 | ||
| 26. What treatment modalities are used for head and neck cancer? | 485 | ||
| 27. What are the most common neck masses in a child? | 485 | ||
| Bibliography | 486 | ||
| 44 Head and Neck Imaging, Part 2 | 487 | ||
| 1. What is the drainage pathway for the maxillary, frontal, and anterior ethmoid air cells? | 487 | ||
| 2. In which paranasal sinus does malignancy most commonly arise? | 487 | ||
| 3. On an unenhanced CT scan, what are common causes of hyperattenuating material within the paranasal sinuses? | 488 | ||
| 4. What classic imaging finding supports the diagnosis of acute sinusitis in the appropriate clinical setting (facial pain, nasal drainage, fever)? | 488 | ||
| 5. What are the three major salivary glands and the ducts that drain them? | 488 | ||
| 6. Which salivary gland has the highest incidence of calculi/stones, and why? | 488 | ||
| 7. Which salivary gland contains lymphoid tissue? What is the significance of this tissue? | 488 | ||
| 8. What is the most common benign tumor of the salivary glands? | 489 | ||
| 9. What are the most common malignancies of the salivary glands? | 489 | ||
| 10. How is the size of the salivary gland related to the likelihood of a mass in the gland being malignant? | 489 | ||
| 11. What imaging features distinguish a benign thyroid mass from a malignant thyroid mass? | 489 | ||
| 12. What is the most common cause of proptosis in an adult? | 489 | ||
| 13. Which metastatic lesion to the orbit is classically associated with enophthalmos? | 489 | ||
| 14. What is the most common primary ocular malignancy in a child and in an adult? | 489 | ||
| 15. What key clinical and imaging features distinguish an optic nerve glioma from an optic nerve meningioma? How do they differ in appearance from optic neuritis? | 490 | ||
| 16. Hearing loss is classified into what two major subtypes? | 491 | ||
| 17. What are the types of tinnitus, and how are they subcategorized? | 491 | ||
| 18. Cholesteatoma is a “pearly white” mass seen in the middle ear on otoscopic examination. What is a cholesteatoma? | 491 | ||
| 19. What neoplasms occur in the jugular foramen? | 492 | ||
| 20. Unilateral middle ear fluid in an adult should trigger the search for what lesion? | 492 | ||
| Bibliography | 493 | ||
| VIII Musculoskeletal Imaging | 495 | ||
| 45 Imaging of Extremity Trauma | 497 | ||
| 1. What is the role of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of extremity trauma? | 497 | ||
| 2. How are fractures evaluated with radiography? | 497 | ||
| 3. What are imaging features that help distinguish between acute and chronic fractures on radiography, CT, and MRI? | 497 | ||
| 4. Define the following terms: closed fracture, open fracture, avulsion fracture, comminuted fracture, intraarticular fracture, occult fracture, pathologic fracture, fracture displacement, and fracture angulation. | 497 | ||
| 5. What is a stress fracture? What two types may occur? | 498 | ||
| 6. What is the difference between dislocation and subluxation of a joint? | 498 | ||
| 7. What are some of the complications of fractures? | 498 | ||
| 8. What is an os acromiale? | 498 | ||
| 9. Describe type I, II, and III acromioclavicular (AC) separation. | 498 | ||
| 10. What are the radiographic features of anterior shoulder joint dislocation on an anteroposterior view? | 498 | ||
| 11. What are Hill-Sachs fracture and Bankart fracture? | 498 | ||
| 12. What radiographic signs are associated with posterior shoulder dislocation? | 499 | ||
| 13. What is pseudosubluxation of the humerus? | 499 | ||
| 14. What are the “posterior fat pad” sign and the “sail” sign in the elbow? | 500 | ||
| 15. Describe a Monteggia fracture and its associated finding. | 500 | ||
| 16. Describe a Galeazzi fracture and its associated finding. | 500 | ||
| 17. Which carpal bone gets fractured the most often? | 500 | ||
| 18. What is the “Terry Thomas” sign? | 500 | ||
| 19. Define dorsal intercalated segmental instability (DISI) and volar intercalated segmental instability (VISI). | 500 | ||
| 20. What are the four stages of perilunate instability? | 500 | ||
| 21. What is a Stener lesion? | 501 | ||
| 22. Match the following fractures with the radiographic images in Figure 45-5. | 501 | ||
| 23. Which is more common, anterior or posterior dislocation of the hip joint? | 501 | ||
| 24. What is a Segond fracture? | 501 | ||
| 25. What is a bipartite patella? | 501 | ||
| 26. What is a tibial plafond fracture? | 501 | ||
| 27. What is Böhler’s angle? | 501 | ||
| 28. Match the following fractures with the radiographic images in Figure 45-6. | 501 | ||
| Bibliography | 503 | ||
| 46 Imaging of Spinal Trauma | 504 | ||
| 1. What are the roles of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of spinal trauma? | 504 | ||
| 2. Describe how to interpret a lateral cervical spine radiograph. | 504 | ||
| 3. What is a swimmer’s view? | 504 | ||
| 4. What is the three column concept of the spine? | 504 | ||
| 5. What is the difference between compression and burst fractures? | 504 | ||
| 6. Name some hyperflexion and hyperextension spinal injuries. | 504 | ||
| 7. Describe a Jefferson fracture and its mechanism of injury. | 504 | ||
| 8. Describe three different types of odontoid process (also known as dens) fractures. | 504 | ||
| 9. What is an os odontoideum? | 505 | ||
| 10. What is a hangman’s fracture? | 505 | ||
| 11. What is a flexion teardrop fracture? What is its prognostic significance? | 505 | ||
| 12. What is an extension teardrop fracture, and how does it differ from the flexion teardrop fracture? | 505 | ||
| 13. What is a clay shoveler’s fracture? | 507 | ||
| 14. What is the difference between unilateral and bilateral interfacetal dislocations? | 507 | ||
| 15. What types of spinal fractures are considered to be unstable? | 507 | ||
| 16. What is the “reverse hamburger bun” sign? | 507 | ||
| 17. What is a Chance fracture? | 507 | ||
| 18. What is a “Scotty dog”? | 508 | ||
| 19. What is spondylolysis? | 508 | ||
| 20. Describe spondylolisthesis and its grading method. | 508 | ||
| Bibliography | 509 | ||
| 47 Imaging of Nontraumatic Spinal Disorders | 510 | ||
| 1. What are the indications, advantages, and disadvantages of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of the spine? | 510 | ||
| 2. Define scoliosis, lordosis, and kyphosis. | 510 | ||
| 3. What is the most common cause of scoliosis? | 510 | ||
| 4. What is the Cobb angle? | 510 | ||
| 5. What is a limbus vertebra? | 510 | ||
| 6. What is a butterfly vertebra, a hemivertebra, and a block vertebra? | 510 | ||
| 7. What is a transitional vertebra? | 510 | ||
| 8. List the imaging features of spinal degenerative disease. | 513 | ||
| 9. What is a Schmorl’s node? | 514 | ||
| 10. What are Modic changes of the vertebral endplates? | 514 | ||
| 11. What terms are used to describe the different types of disc extension beyond the vertebral body margin? | 514 | ||
| 12. Other than degenerative disc pathology, what other factors commonly contribute to neural foraminal narrowing and spinal canal stenosis? | 516 | ||
| 13. What nerve roots exit the C3-4, C7-T1, T3-4, and L5-S1 neural foramina? | 517 | ||
| 14. What nerve root may be impinged by a right paracentral disc herniation at L5-S1? | 517 | ||
| 15. What nerve root may be impinged by a left foraminal or extraforaminal disc herniation at L3-4? | 517 | ||
| 16. What is failed back syndrome? What is the best way to evaluate affected patients? | 517 | ||
| 17. What is spondylolisthesis and spondylolysis? Name the two major causes and the key imaging findings. | 518 | ||
| 18. What is the “inverted Napoleon hat” sign? | 518 | ||
| 19. What is OPLL? | 518 | ||
| 20. What is DISH? | 518 | ||
| 21. What are three radiographic criteria for the diagnosis of DISH? | 518 | ||
| 22. What is the difference between an osteophyte, a syndesmophyte, and an enthesophyte? | 520 | ||
| 23. What is Scheuermann’s disease? | 520 | ||
| 24. What is Baastrup’s disease? | 520 | ||
| 25. What is myelofibrosis? | 520 | ||
| 26. What types of nondegenerative arthritides may affect the spine? | 520 | ||
| 27. What is Kummel disease? | 522 | ||
| 28. What is Paget’s disease of bone? | 522 | ||
| Bibliography | 523 | ||
| 48 Imaging of Metabolic Bone Disease | 524 | ||
| 1. What is osteoporosis? How does it differ from osteopenia, osteomalacia, and osteosclerosis? | 524 | ||
| 2. What is a DXA scan? How is bone mineral density (BMD) calculated? | 524 | ||
| 3. What sites of the skeleton are routinely assessed on a DXA scan? | 524 | ||
| 4. What are the World Health Organization (WHO) diagnostic thresholds for normal bone mineral density, osteopenia, and osteoporosis? | 524 | ||
| 5. What is disuse osteoporosis? When can it be seen? What disease state can it potentially mimic? | 524 | ||
| 6. What are the radiographic findings of hyperparathyroidism? | 524 | ||
| 7. What is renal osteodystrophy? What is a Looser zone fracture? | 524 | ||
| 8. What is a brown tumor? | 525 | ||
| 9. What are the skeletal manifestations of acromegaly? | 525 | ||
| 10. What is the difference between metastatic calcification and dystrophic calcification? | 525 | ||
| 11. What is tumoral calcinosis? | 527 | ||
| Bibliography | 527 | ||
| 49 Imaging of Arthritis | 528 | ||
| 1. What kinds of joints exist? | 528 | ||
| 2. What are the advantages and disadvantages of the common imaging modalities used to evaluate arthritis? | 528 | ||
| 3. What are the radiographic features that are assessed in the evaluation of arthritis? | 528 | ||
| 4. What are the characteristic imaging findings of osteoarthritis (OA)? | 528 | ||
| 5. What are some differences between OA and rheumatoid arthritis (RA)? | 528 | ||
| 6. What are some common imaging features of RA? | 528 | ||
| 7. Which joints in the hand and wrist are usually affected by RA? | 529 | ||
| 8. What are subchondral cysts? | 530 | ||
| 9. Does RA affect larger joints? | 530 | ||
| 10. What is erosive (inflammatory) OA? | 530 | ||
| 11. How do the seronegative spondyloarthropathies differ from RA? | 530 | ||
| 12. What are the main crystal deposition disorders? | 530 | ||
| 13. What are the imaging findings in gout? | 531 | ||
| 14. What is chondrocalcinosis? | 531 | ||
| 15. Is chondrocalcinosis synonymous with CPPD? | 531 | ||
| 16. What is pseudogout? | 531 | ||
| Bibliography | 533 | ||
| 50 Imaging of Musculoskeletal Infection | 534 | ||
| 1. What is the role of imaging in the diagnosis of musculoskeletal infection? | 534 | ||
| 2. What imaging modalities are used in diagnosing musculoskeletal infections? | 534 | ||
| 3. What is the role of US in the diagnosis of musculoskeletal infection? | 534 | ||
| 4. What is the role of nuclear medicine techniques in the diagnosis of musculoskeletal infection? | 534 | ||
| 5. In general, what is the first-line imaging modality used to diagnose musculoskeletal infection? | 534 | ||
| 6. Define osteomyelitis, cellulitis, fasciitis, myositis, pyomyositis, phlegmon, and abscess. | 534 | ||
| 7. What is the clinical significance of an abscess? | 534 | ||
| 8. Define Brodie abscess, sequestrum, involucrum, cloaca, and sinus tract. | 534 | ||
| 9. What is the first-line modality in the diagnosis of acute osteomyelitis? | 535 | ||
| 10. What are the primary findings of acute osteomyelitis on radiographs? | 535 | ||
| 11. What is the most specific finding of acute osteomyelitis on radiographs? | 535 | ||
| 12. What differential diagnoses may simulate the appearance of acute osteomyelitis on radiographs? | 535 | ||
| 13. Is radiography sensitive for the detection of acute osteomyelitis in the early clinical setting? | 535 | ||
| 14. If radiographs are positive for acute osteomyelitis, is there a role for MRI? | 535 | ||
| 15. If radiographs are negative for acute osteomyelitis, is there a role for MRI? | 535 | ||
| 16. What are the MRI findings of osteomyelitis? | 535 | ||
| 17. Is bone marrow edema specific for the diagnosis of acute osteomyelitis? | 536 | ||
| 18. What can help establish the diagnosis of acute osteomyelitis on MRI? | 536 | ||
| 19. What are the routes of spread of infection that involve bone? | 536 | ||
| 20. How does the MRI appearance of acute osteomyelitis differ if the source of infection is hematogenous? | 536 | ||
| 21. How does the diagnosis of osteomyelitis differ in patients with Charcot arthropathy (neuropathic joint)? | 537 | ||
| 22. Is intravenous contrast material necessary for the diagnosis of acute osteomyelitis by MRI? | 537 | ||
| 23. What is the role of intravenous contrast material in the diagnosis of soft tissue infection? | 537 | ||
| 24. What imaging study is ordered in a patient with suspected septic arthritis? | 537 | ||
| 25. Are there any imaging findings that are suggestive of septic arthritis? | 538 | ||
| 26. What is necrotizing fasciitis? | 538 | ||
| 27. What is the radiographic and MRI appearance of infectious spondylitis? | 538 | ||
| 28. What is Pott’s disease? | 538 | ||
| 29. What is the significance of unilateral sacroiliitis? | 539 | ||
| Bibliography | 539 | ||
| 51 Imaging of Musculoskeletal Tumors | 540 | ||
| 1. What radiographic features are considered when evaluating a suspected bone tumor? | 540 | ||
| 2. How do cartilage tumor matrix and neoplastic bone matrix differ? | 540 | ||
| 3. Which imaging study should be ordered first for the evaluation of a suspected musculoskeletal tumor? | 540 | ||
| 4. What is the role of magnetic resonance imaging (MRI) in the evaluation of musculoskeletal tumors? | 540 | ||
| 5. What is the role of intravenous contrast material in MRI of musculoskeletal tumors? | 540 | ||
| 6. What are some musculoskeletal tumor features evaluated with MRI? Can MRI be used to distinguish between benign and malignant tumors? | 540 | ||
| 7. What is the role of computed tomography (CT), ultrasonography (US), bone scintigraphy, and positron emission tomography/computed tomography (PET/CT) in the evaluation of musculoskeletal tumors? | 540 | ||
| 8. Which classification system is used for soft tissue and bone tumors? | 542 | ||
| 9. What is the staging system adopted by the Musculoskeletal Tumor Society, and what three features form the basis of this staging system? | 542 | ||
| 10. What is the most common malignant tumor involving the skeleton? | 542 | ||
| 11. What are the most common primary neoplasms that metastasize to osseous structures? | 542 | ||
| 12. Which tumors can give rise to lytic, expansile, or “blown-out” osseous metastases? | 542 | ||
| 13. What is the most common primary malignant bone tumor in adults? | 542 | ||
| 14. If the diagnosis of multiple myeloma is suspected, what radiographic evaluation should be performed? | 542 | ||
| 15. What is the second most common primary bone tumor after multiple myeloma? | 542 | ||
| 16. Which primary bone tumors tend to involve the epiphysis most commonly? | 542 | ||
| 17. Which primary bone tumors tend to involve the diaphysis most commonly? | 544 | ||
| 18. Which type of tumor can manifest with bone pain, swelling, fever, and increased erythrocyte sedimentation rate (ESR), mimicking an infection? | 544 | ||
| 19. Which of the following has an increased incidence of skeletal malignancy: high-dose radiation therapy, bone infarction, Paget’s disease of bone, or chronic osteomyelitis? | 544 | ||
| 20. Where do sarcomas most commonly metastasize? | 544 | ||
| 21. What is the most common benign skeletal neoplasm? | 544 | ||
| 22. Which clinical and radiographic features suggest malignant degeneration of an osteochondroma? | 544 | ||
| 23. What is the most common benign bone tumor of the hand? Where else may these lesions occur, and what are the features of malignant transformation? | 544 | ||
| 24. Which primary bone tumor has the characteristic history of pain at night that is relieved by aspirin? | 545 | ||
| 25. What is fibrous dysplasia? | 545 | ||
| 26. What is a bone island? | 545 | ||
| 27. What is the most common location for a skeletal hemangioma? | 545 | ||
| Bibliography | 546 | ||
| 52 MRI of the Shoulder | 547 | ||
| 1. Describe the imaging planes used for evaluating the shoulder on a magnetic resonance imaging (MRI) examination. How should the patient be positioned in the scanner? | 547 | ||
| 2. Name the four muscles of the rotator cuff and their sites of attachment. What is the normal MRI appearance of the tendons? | 547 | ||
| 3. What are the symptoms of rotator cuff pathology? Which rotator cuff tendon is most commonly torn? | 547 | ||
| 4. Define shoulder impingement syndrome. | 547 | ||
| 5. Describe the MRI findings of rotator cuff pathology. | 547 | ||
| 6. What is an os acromiale? | 547 | ||
| 7. What is the glenoid labrum, and what are the symptoms of a labral tear? | 547 | ||
| 8. When should shoulder MR arthrography be performed? | 547 | ||
| 9. What are the MRI findings of a labral tear? | 547 | ||
| 10. What is a paralabral cyst, and what is its clinical significance? | 548 | ||
| 11. Define glenohumeral instability. | 548 | ||
| 12. Describe the MRI findings seen with anterior shoulder instability. | 548 | ||
| 13. What is a SLAP lesion? | 549 | ||
| 14. Describe the nerve entrapment syndromes that can occur around the shoulder. | 550 | ||
| 15. What is Parsonage-Turner syndrome? | 550 | ||
| 16. Describe the clinical and MRI findings of adhesive capsulitis. | 550 | ||
| Bibliography | 550 | ||
| 53 MRI of the Elbow | 551 | ||
| 3. What is the common flexor tendon, and where does it originate? | 551 | ||
| 4. What is the common extensor tendon, and where does it originate? | 551 | ||
| 5. What is the function of the ulnar collateral ligament (UCL), and what are its components? | 551 | ||
| 6. Which component of the UCL is the primary restraint to valgus stress? | 551 | ||
| 7. What are the three components of the lateral ligament complex of the elbow? | 552 | ||
| 8. What is the importance of the LUCL? | 552 | ||
| 9. What structure passes through the cubital tunnel? | 552 | ||
| 10. What are the borders of the cubital tunnel? | 552 | ||
| 11. What are common indications for MRI of the elbow? | 552 | ||
| 12. What are common indications for MR arthrography of the elbow? | 552 | ||
| 13. What other imaging modalities are utilized for evaluation of the elbow? | 553 | ||
| 14. What is the MRI appearance of tendinopathy? | 553 | ||
| 15. What is the MRI appearance of a tendon tear? | 553 | ||
| 16. What is “tennis elbow,” and what are its causes? | 553 | ||
| 17. What is “golfer’s elbow,” and what are its causes? | 553 | ||
| 18. What is the most frequent cause of a distal biceps tendon tear? | 553 | ||
| 19. What is a ganglion cyst? Where do they occur at in the elbow? | 554 | ||
| 20. What are the causes and MRI appearance of olecranon bursitis? | 554 | ||
| 21. What is cubital tunnel syndrome, and what are its causes? | 554 | ||
| 22. What ligament is the most commonly injured by the throwing athlete? | 554 | ||
| Bibliography | 555 | ||
| 54 MRI of the Hand and Wrist | 556 | ||
| 1. What are some common indications for performing magnetic resonance imaging (MRI) of the hand and wrist? | 556 | ||
| 2. What is the anatomy of the hand and wrist? | 556 | ||
| 3. What is meant by the term “intercalated segment”? | 556 | ||
| 4. What is ulnar variance? | 556 | ||
| 5. What is the normal MRI appearance of the wrist? | 556 | ||
| 6. What are the boundaries and contents of the carpal tunnel? | 557 | ||
| 7. What are the boundaries and contents of the ulnar tunnel (Guyon’s canal)? | 557 | ||
| 8. What is carpal tunnel syndrome (CTS)? | 557 | ||
| 9. What is the MRI appearance of CTS? | 558 | ||
| 10. What is ulnar tunnel syndrome (UTS)? | 558 | ||
| 11. What is the MRI appearance of traumatic injuries to the TFCC? | 558 | ||
| 12. What is the MRI appearance of degenerative injuries to the TFCC? | 558 | ||
| 13. What is the MRI appearance of tendon degeneration, tendon tear, and tenosynovitis? | 558 | ||
| 14. What is de Quervain’s disease? | 559 | ||
| 15. What is intersection syndrome? | 559 | ||
| 16. What is wrist instability? | 559 | ||
| 17. What is the MRI appearance of tears of the scapholunate and lunotriquetral ligaments? | 559 | ||
| 18. What is the role of MR arthrography for evaluation of wrist ligamentous injuries? | 559 | ||
| 19. What are the MRI findings of fractures? | 560 | ||
| 20. What is the role of MRI in the evaluation of scaphoid fractures? | 560 | ||
| 21. What is Kienböck’s disease? | 560 | ||
| 22. What is a ganglion cyst? | 560 | ||
| 23. What is a fibrolipomatous hamartoma (FLH)? | 561 | ||
| 24. What is “gamekeeper’s thumb”? | 561 | ||
| 25. What is a Stener lesion? | 561 | ||
| Bibliography | 562 | ||
| 55 MRI of the Hip | 563 | ||
| 1. What is the basic normal anatomy of the hip? | 563 | ||
| 2. What are the indications for magnetic resonance imaging (MRI) of the hip? | 563 | ||
| 3. What is the proper MRI technique used for the evaluation of hip pain? | 563 | ||
| 4. When should intravenous contrast material be administered for hip MRI? | 563 | ||
| 5. What is the significance of the bone marrow edema pattern in the proximal femur? | 563 | ||
| 6. What is AVN of the hip? | 563 | ||
| 7. What is the role of MRI in the diagnosis of the femoral head AVN? | 563 | ||
| 8. What is the MRI appearance of hip osteonecrosis? | 564 | ||
| 9. What is ITOH? | 564 | ||
| 10. What are the imaging features of ITOH? | 564 | ||
| 11. What are the most common types of radiographically occult hip fractures? | 564 | ||
| 12. Why is MRI important in the early diagnosis of occult proximal femoral fractures? | 564 | ||
| 13. How are stress and insufficiency fractures diagnosed on MRI? | 565 | ||
| 14. What is the differential diagnosis of cystic lesions around the hip joint? | 566 | ||
| 15. What causes a paralabral cyst, and how can MRI help determine if a juxtaarticular cyst is paralabral? | 567 | ||
| 16. What is femoroacetabular impingement (FAI), and why is it important to recognize? | 567 | ||
| 17. How does MRI help in evaluation of patients with FAI? | 567 | ||
| 18. What are the causes of greater trochanteric pain syndrome? | 567 | ||
| Bibliography | 568 | ||
| 56 MRI of the Knee | 570 | ||
| 1. What sequences are typically included in a routine magnetic resonance imaging (MRI) examination of the knee? | 570 | ||
| 2. Describe the clinical presentation of meniscal injury. What part of the meniscus is most commonly torn? | 570 | ||
| 3. What is the appearance of the normal menisci on MRI? | 570 | ||
| 4. What are the criteria for diagnosing a meniscal tear on MRI? | 570 | ||
| 5. Describe the common types of meniscal tears. | 570 | ||
| 6. What is a parameniscal cyst, and what is its significance? | 570 | ||
| 7. What is a discoid meniscus, and what is its significance? | 573 | ||
| 8. Describe the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) attachment sites. | 573 | ||
| 9. Describe the MRI appearance of ACL rupture (i.e., tear). | 573 | ||
| 10. What are some secondary MRI findings of ACL rupture? | 573 | ||
| 11. What comprises the medial collateral ligament (MCL)? | 573 | ||
| 12. What comprises the lateral collateral ligament (LCL) complex? | 573 | ||
| 13. How is ligamentous injury graded on MRI? | 573 | ||
| 14. What structures are present at the posterolateral corner of the knee, and why are they important? | 573 | ||
| 15. What is O’Donoghue’s “unhappy triad”? | 573 | ||
| 16. Describe findings of transient lateral patellar dislocation. | 573 | ||
| 17. Describe the MRI findings of patellar tendinitis. | 574 | ||
| 18. What is osteochondritis dissecans (OCD)? | 574 | ||
| 19. What are the MRI features of an unstable OCD fragment? | 574 | ||
| 20. What is subchondral insufficiency fracture of the knee? Describe its MRI appearance. | 574 | ||
| 21. What is pes anserinus? | 574 | ||
| 22. Where is a popliteal (Baker) cyst located, and what is its significance? | 574 | ||
| Bibliography | 576 | ||
| 57 MRI of the Foot and Ankle | 577 | ||
| 1. What are the compartments of the ankle joint, and what structures do they contain? | 577 | ||
| 2. Which bones form the hindfoot, midfoot, and forefoot? | 577 | ||
| 3. What is the MRI appearance of tendon abnormalities? | 577 | ||
| 4. What is the MRI appearance of Achilles tendon rupture? | 578 | ||
| 5. Which ligaments are injured during ankle inversion? | 578 | ||
| 6. Which ligaments are injured during ankle eversion? | 578 | ||
| 7. How does an osteochondral lesion occur? | 578 | ||
| 8. What are the most common sites of avascular necrosis in the ankle? | 579 | ||
| 9. What is tarsal coalition, and where does it occur? | 579 | ||
| 10. Describe the MRI appearance of plantar fasciitis. | 579 | ||
| 11. What is plantar fibromatosis? | 579 | ||
| 12. What is a Morton’s neuroma, and where does it occur? | 580 | ||
| 13. What is the tarsal tunnel, and what does it contain? | 580 | ||
| 14. What is tarsal tunnel syndrome? | 580 | ||
| 15. What is the MRI appearance of stress fractures in the foot? | 580 | ||
| 16. What is sinus tarsi syndrome? | 580 | ||
| Bibliography | 581 | ||
| IX Ultrasonography | 583 | ||
| 58 Obstetric Ultrasonography in the First Trimester | 585 | ||
| 1. What are the indications for ultrasonography (US) in the first trimester? | 585 | ||
| 2. What is typically evaluated during obstetric US in the first trimester? | 585 | ||
| 3. Describe the US features of a normal gestational sac. | 585 | ||
| 4. Describe the US features and significance of an abnormal gestational sac. | 585 | ||
| 5. When should a yolk sac and an embryo be visible by US? | 585 | ||
| 6. What are the US findings of an abnormal yolk sac? | 585 | ||
| 7. At what point should embryonic cardiac activity be detected on US? | 586 | ||
| 8. What is the first trimester nuchal translucency (NT) measurement? | 586 | ||
| 9. Describe the first trimester US features of twin gestations. | 587 | ||
| 10. List seven causes of vaginal bleeding in the first trimester. | 587 | ||
| 11. Name three possible causes of a positive serum β-HCG level and an empty uterus on US. | 587 | ||
| 12. Name six types of early pregnancy complications, and describe their US appearances. | 587 | ||
| 13. What is an ectopic pregnancy? | 587 | ||
| 14. Who is at increased risk for an ectopic pregnancy? | 589 | ||
| 15. What is the classic clinical presentation of an ectopic pregnancy? | 589 | ||
| 16. List four possible US findings associated with an ectopic pregnancy. | 589 | ||
| 17. What is a pseudogestational sac? | 589 | ||
| 18. What is a heterotopic pregnancy? | 589 | ||
| 19. What is a molar pregnancy? | 589 | ||
| 20. What is the US appearance of a molar pregnancy? | 589 | ||
| Bibliography | 591 | ||
| 59 Obstetric Ultrasonography in the Second Trimester | 592 | ||
| 1. What are the indications for obstetric ultrasonography (US) in the second (and third) trimester? | 592 | ||
| 2. List the basic components of a standard (level 1) second trimester US examination. | 592 | ||
| 3. How is gestational age determined in the second trimester? | 592 | ||
| 4. How is the amniotic fluid volume measured? | 592 | ||
| 5. What is oligohydramnios? | 592 | ||
| 6. What is polyhydramnios? | 592 | ||
| 7. How is cervical incompetence evaluated sonographically? | 593 | ||
| 8. Describe the various types of placenta previa. | 593 | ||
| 9. Differentiate the various types of placenta accreta. | 594 | ||
| 10. Does US have a role in assessing second (and third) trimester maternal pain and bleeding? | 594 | ||
| 11. How many vessels are in the umbilical cord? | 595 | ||
| 12. Why is the diameter of the fetal lateral ventricle measured during routine second trimester US? | 595 | ||
| 13. What is the importance of the fetal cisterna magna measurement during routine second trimester US? | 595 | ||
| 14. Describe the US features of anencephaly. | 595 | ||
| 15. What is the purpose of evaluating the fetal lips on US? | 595 | ||
| 16. Can US differentiate spina bifida in utero? | 595 | ||
| 17. Are there secondary intracranial signs of open spina bifida on US? | 596 | ||
| 18. How many anomalies can be detected on the second trimester US four-chamber heart view? | 596 | ||
| 19. How is fetal pulmonary hypoplasia assessed on US? | 596 | ||
| 20. What is the most common intrathoracic/extracardiac fetal anomaly? | 596 | ||
| 21. Describe the US features of an omphalocele versus gastroschisis. | 596 | ||
| 22. When should the urinary bladder be visible on US? | 598 | ||
| 23. What is the significance of finding dilated bilateral renal pelves on routine second trimester US? | 598 | ||
| 24. How is IUGR diagnosed sonographically? | 599 | ||
| 25. The estimated fetal weight (EFW) for a fetus at 34 weeks gestation on US is greater than the ninetieth percentile. What are the potential complications at delivery? | 599 | ||
| 26. When should the umbilical artery systolic to diastolic (S/D) ratio be measured? | 599 | ||
| 27. Describe the ultrasound features of fetal hydrops. | 599 | ||
| 28. List the complications that can be associated with a twin gestation. | 599 | ||
| 29. What are the ultrasound features of a monochorionic diamniotic twin-to-twin transfusion syndrome (TTTS)? | 599 | ||
| 30. Name seven “soft” ultrasound markers of potential fetal aneuploidy. | 601 | ||
| Bibliography | 601 | ||
| 60 Advanced Fetal Ultrasonography and Therapy | 602 | ||
| 1. What is a “level II” obstetric ultrasound examination, and what elements of fetal anatomy are included? | 602 | ||
| 2. What is a “detailed extended” obstetric ultrasound examination? | 602 | ||
| 3. What are the common nonemergent indications to perform a detailed extended obstetric ultrasound study? | 603 | ||
| 4. What is the significance of an elevated maternal serum AFP level? | 604 | ||
| 5. What is the significance of size-date discrepancies? | 604 | ||
| 6. A detailed extended obstetric ultrasound examination can take considerably longer than a level II study. What are the safety elements of obstetric US? | 604 | ||
| 7. Why does the TI have a letter after it? | 605 | ||
| 8. What values of TI and MI are recommended for fetal US studies? | 605 | ||
| 9. What constitutes fetal therapy? | 605 | ||
| 10. What are the major fetal anomalies for which diagnostic and therapeutic techniques are available? | 605 | ||
| 11. How are fetuses with open spina bifida and myelomeningocele (MMC) evaluated? | 606 | ||
| 12. What is the therapeutic approach to treatment of fetuses with spina bifida and MMC? | 608 | ||
| 13. What are the imaging requirements for thoracic and lung abnormalities? | 609 | ||
| 14. What specific imaging is performed for fetal pleural effusions? | 609 | ||
| 15. What are the therapeutic strategies for fetal pleural effusions? | 609 | ||
| 16. How are fetal lung masses evaluated sonographically? | 610 | ||
| 17. What are the therapeutic strategies for treatment of lung masses? | 612 | ||
| 18. What is CHAOS, and how is it diagnosed and treated? | 612 | ||
| 19. How is the diagnosis of a congenital diaphragmatic hernia (CDH) made sonographically, and what features and measurements are important? | 613 | ||
| 20. How is CDH treated? | 614 | ||
| 21. How are fetuses with neck masses diagnosed and treated? | 614 | ||
| 22. What is involved in the evaluation of sacrococcygeal teratoma (SCT), and how is it treated? | 615 | ||
| 23. What is lower urinary tract obstruction (LUTO) in a fetus, and how is it diagnosed and treated? | 616 | ||
| 24. What are the important ultrasound findings in evaluation of abnormalities in twins, and what are the treatment methods? | 616 | ||
| 25. What is the role of US for conjoined twins? | 621 | ||
| Acknowledgment | 622 | ||
| Bibliography | 622 | ||
| 61 Neck Ultrasonography | 624 | ||
| 1. What is the basic normal anatomy and sonographic imaging appearance of the thyroid gland? | 624 | ||
| 2. What is the basic normal anatomy and sonographic imaging appearance of the parathyroid glands? | 624 | ||
| 3. What is the basic normal anatomy and US imaging appearance of cervical lymph nodes? | 624 | ||
| 4. What are the indications for US of the thyroid gland, parathyroid glands, and neck lymph nodes? | 625 | ||
| 5. What is a thyroid goiter? | 626 | ||
| 6. What is chronic lymphocytic (Hashimoto’s) thyroiditis? | 626 | ||
| 7. What is Graves’ disease? | 627 | ||
| 8. How good is US for detecting thyroid abnormalities? | 627 | ||
| 9. What proportion of focal thyroid nodules are neoplastic? | 628 | ||
| 10. What types of thyroid cancer are there? | 628 | ||
| 11. How is US useful to determine which thyroid nodules warrant FNA? | 628 | ||
| 12. What is the most common congenital anomaly of the neck? | 631 | ||
| 13. What are some parathyroid gland pathologies that may occur? | 632 | ||
| 14. What are some causes of cervical lymphadenopathy? | 634 | ||
| 15. What imaging features may be useful to distinguish benign from malignant lymph nodes? | 634 | ||
| Bibliography | 637 | ||
| 62 Abdominal Ultrasonography | 638 | ||
| 1. List some of the most common indications for abdominal ultrasonography (US). | 638 | ||
| 2. What is the sonographic appearance of the liver? | 638 | ||
| 3. How are the hepatic veins and portal veins differentiated on US? | 638 | ||
| 4. What is the most common cause of increased hepatic echogenicity? | 638 | ||
| 5. Describe the US appearance of acute hepatitis. | 638 | ||
| 6. Name and describe the US appearance of common benign and malignant focal hepatic lesions. | 638 | ||
| 7. Describe the US appearance of a target lesion in the liver and its significance. | 638 | ||
| 8. What are the sonographic features of cirrhosis? | 638 | ||
| 9. What is the appearance of gallstones on US? | 638 | ||
| 10. What is the “wall-echo-shadow” sign? | 641 | ||
| 11. Can tumefactive sludge and gallbladder polyps be differentiated from gallstones sonographically? | 641 | ||
| 12. Name possible causes of gallbladder wall thickening. | 641 | ||
| 13. Describe the US appearance of adenomyomatosis. | 641 | ||
| 14. What is the significance of gallbladder wall calcification? | 641 | ||
| 15. How does acute cholecystitis manifest on US? | 641 | ||
| 16. Name four complications of cholecystitis and their appearance on US. | 642 | ||
| 17. Can US differentiate between benign and malignant gallbladder polypoid lesions (polyps)? | 642 | ||
| 18. Describe the US appearances of gallbladder carcinoma. | 643 | ||
| 19. What is the normal caliber of the extrahepatic bile duct? | 643 | ||
| 20. List four possible causes of biliary obstruction. | 643 | ||
| 21. What is the normal sonographic appearance of the pancreas? | 643 | ||
| 22. Does US have a role in evaluating acute pancreatitis? | 643 | ||
| 23. What are the sonographic features of pancreatic adenocarcinoma? | 643 | ||
| 24. Can the two main cystic neoplasms of the pancreas be differentiated sonographically? | 643 | ||
| 25. What is the normal sonographic appearance of the kidney? | 644 | ||
| 26. Does US have a role in evaluating pyelonephritis? | 644 | ||
| 27. What are the US findings of urinary obstruction? | 644 | ||
| 28. What is the US appearance of renal calculi? | 644 | ||
| 29. Describe the various appearances and management of renal cysts detected sonographically. | 644 | ||
| 30. Name four diseases associated with renal cysts and their extrarenal manifestations. | 645 | ||
| 31. Renal US detects a 3-cm hypoechoic solid mass in the right kidney of a 57-year-old man with hematuria. What is the most likely diagnosis? | 645 | ||
| 32. Is it possible to differentiate AMLs and RCCs sonographically? | 645 | ||
| 33. What is the significance of increased renal echogenicity on US? | 645 | ||
| Bibliography | 646 | ||
| 63 Musculoskeletal Ultrasonography | 647 | ||
| 1. What are some benefits of ultrasonography (US) for musculoskeletal applications? | 647 | ||
| 2. What are the common indications for musculoskeletal US? | 647 | ||
| 3. When is musculoskeletal US not utilized? | 647 | ||
| 4. How are images oriented in musculoskeletal US? | 647 | ||
| 5. What are the commonly used transducers in musculoskeletal US? | 647 | ||
| 6. What is anisotropy, and how can this be used to differentiate among soft tissue structures? | 647 | ||
| 7. What is the normal sonographic appearance of various soft tissues (skin, subcutaneous fat, fascia, cortical bone, hyaline cartilage, fibrocartilage, and muscle)? | 648 | ||
| 8. What is the normal echotexture of tendons and ligaments? | 649 | ||
| 9. What is the normal echotexture of peripheral nerves? | 649 | ||
| 10. Which soft tissue masses can be diagnosed on US? | 650 | ||
| 11. How can US differentiate between a ganglion cyst and a bursa? | 650 | ||
| 12. How can a ganglion cyst be differentiated from a parameniscal cyst on US? | 651 | ||
| 13. What is the sonographic appearance of a lipoma? | 651 | ||
| 14. What is an angiolipoma? | 651 | ||
| 15. What is fat necrosis? | 651 | ||
| 16. What are the sonographic characteristics of a PNST? | 652 | ||
| 17. What is the sonographic appearance of a GCTTS? | 652 | ||
| 18. When should a soft tissue mass detected on US be referred for MRI? | 652 | ||
| 19. What is the appearance of a hematoma on US? How should hematomas be followed up? | 652 | ||
| 20. Describe the sonographic appearance of rotator cuff tendon pathology on US. | 652 | ||
| 21. What is the accuracy of US in the diagnosis of rotator cuff tears? | 653 | ||
| 22. How is dynamic imaging useful in US? | 653 | ||
| 23. What is the sonographic appearance of calcific tendinosis? | 654 | ||
| 24. What is the sonographic appearance of ligament pathology? | 655 | ||
| 25. What is the sonographic appearance of musculoskeletal infection? | 655 | ||
| 26. What are some common artifacts seen in musculoskeletal US? | 656 | ||
| 27. How is carpal tunnel syndrome diagnosed on US? | 657 | ||
| Bibliography | 657 | ||
| 64 Vascular Ultrasonography | 658 | ||
| 1. List some of the most common indications for vascular ultrasonography (US). | 658 | ||
| 2. How is vascular flow assessed with US? | 658 | ||
| 3. What information can be obtained from the spectral Doppler waveform of a vessel? | 658 | ||
| 4. How does spectral Doppler US detect vascular stenosis? | 658 | ||
| 5. Describe the normal spectral Doppler waveform in a low-resistance artery. | 658 | ||
| 6. Describe the normal spectral Doppler waveform in a high-resistance artery. | 658 | ||
| 7. Describe the normal spectral Doppler waveform in a vein. | 659 | ||
| 8. How is extremity deep vein thrombosis diagnosed sonographically? | 659 | ||
| 9. Can US differentiate between acute and chronic deep vein thrombosis? | 659 | ||
| 10. How is venous insufficiency evaluated sonographically? | 660 | ||
| 11. Name the common indications for carotid artery US. | 660 | ||
| 12. How are the extracranial carotid arteries evaluated sonographically? | 661 | ||
| 13. What are the sonographic criteria for diagnosing extracranial carotid artery stenosis? | 661 | ||
| 14. Define the carotid artery “string” sign. | 662 | ||
| 15. Can US detect subclavian steal syndrome? | 662 | ||
| 16. Is there a role for US in evaluating abdominal aortic aneurysms (AAAs)? | 662 | ||
| 17. What is the role of US in diagnosing renovascular hypertension? | 662 | ||
| 18. What is the role of vascular US in evaluating renal transplants? | 662 | ||
| 19. Describe the normal hepatic spectral Doppler waveforms. | 662 | ||
| 20. What various vascular complications can be detected with color spectral Doppler imaging of the liver? | 662 | ||
| 21. When and how should US be used to evaluate a transjugular intrahepatic portosystemic shunt (TIPS)? | 663 | ||
| 22. What are the ultrasound features of an arteriovenous fistula (AVF)? | 664 | ||
| 23. How is a pseudoaneurysm diagnosed sonographically? | 665 | ||
| 24. Can US be used to treat pseudoaneurysms? | 666 | ||
| Bibliography | 667 | ||
| X Interventional Radiology | 669 | ||
| 65 Patient Sedation and Pain Management | 671 | ||
| 1. What is the purpose of sedation and pain management during an interventional radiology procedure? | 671 | ||
| 2. What is the difference between analgesia and anesthesia? | 671 | ||
| 3. What is the difference between anxiolysis and amnesia? | 671 | ||
| 4. What capabilities should the patient maintain during conscious sedation? | 671 | ||
| 5. Describe the levels of patient sedation. | 671 | ||
| 6. List the details that should be included in the presedation evaluation of a patient. | 671 | ||
| 7. How long should a patient typically fast before undergoing conscious sedation? | 671 | ||
| 8. The physical status of a patient is often measured on a 6-point scale, known as the American Society of Anesthesiologists (ASA) Physical Status (PS) classification. Describe this scale. | 671 | ||
| 9. Commonly, conscious sedation is administered by the provider (e.g., interventional radiologist) with patient monitoring provided by a qualified nurse. What patient factors should influence a provider to consider consulting an anesthesiologist to administer conscious sedation? | 671 | ||
| 10. What patient factors must be monitored during conscious sedation? | 672 | ||
| 11. What equipment must be present when administering conscious sedation to a patient? | 672 | ||
| 12. What pharmacologic agents are commonly used for patients undergoing conscious sedation? What is their reversal agent? | 672 | ||
| 13. What are the usual effects of benzodiazepines? | 672 | ||
| 14. What pharmacologic agents are commonly used for pain control? What is their reversal agent? | 672 | ||
| 15. What are the typical effects of opiates? | 672 | ||
| 16. What pharmacologic agent used for pain control is contraindicated in patients taking a monoamine oxidase (MAO) inhibitor? | 672 | ||
| 17. What are the strategies to manage a patient who has a known hypersensitivity to iodinated contrast material? | 672 | ||
| 18. List possible options for the management of an acute vasovagal reaction. | 672 | ||
| 19. What is the basic life support sequence of steps for patient resuscitation? | 672 | ||
| 20. Describe the management of acute hypotension. | 672 | ||
| 21. List possible options for the management of an acute hypertensive crisis. | 673 | ||
| 22. How is acute pulmonary edema managed? | 673 | ||
| 23. Describe the immediate options for management of an anaphylactic reaction. | 673 | ||
| 24. Describe the immediate options for management of acute laryngeal edema. | 673 | ||
| 25. Describe the immediate options for management of bronchospasm. | 673 | ||
| 26. What are possible options for the management of generalized urticaria? | 673 | ||
| Bibliography | 673 | ||
| 66 Equipment, Terms, and Techniques in Interventional Radiology | 674 | ||
| 1. What are the characteristics of a diagnostic catheter? | 674 | ||
| 2. What is the difference between Cobra 1, Cobra 2, and Cobra 3 catheters? | 675 | ||
| 3. What is a French? What is a gauge? | 675 | ||
| 4. What are the two general categories of stents? How do they differ? | 675 | ||
| 5. How is a balloon-expandable stent deployed? | 675 | ||
| 6. What two materials are used to make self-expandable stents? | 675 | ||
| 7. How do woven Elgiloy and nitinol self-expandable stents differ? | 675 | ||
| 8. What is nitinol? | 676 | ||
| 9. What do the terms hoop strength, chronic outward force, and radial resistive force mean? | 676 | ||
| 10. What is a sheath? | 676 | ||
| 11. What is a guiding catheter? | 676 | ||
| 12. What is an up-and-over sheath? | 676 | ||
| 13. Explain the Trojan horse technique. | 676 | ||
| 14. What are the defining characteristics of guidewires? | 676 | ||
| 15. What is an exchange-length wire? How long does it have to be? | 677 | ||
| 16. What is a Cope loop? | 677 | ||
| 17. What is the origin of the term “stent”? | 677 | ||
| 18. What does it mean to “Dotter” a lesion? | 678 | ||
| 19. What is a micropuncture set? | 678 | ||
| 20. What is the difference between the single-wall and the double-wall technique? | 678 | ||
| 21. What are the advantages and disadvantages of a single-wall puncture? | 678 | ||
| 22. What is a snare? | 678 | ||
| 23. What is a reverse curve catheter? | 678 | ||
| 24. What are the different ways to form a Simmons catheter? | 679 | ||
| 25. What is a Waltman loop? | 679 | ||
| 26. What is “road mapping”? | 679 | ||
| 27. How do you select the proper injection rate for an arteriogram? | 679 | ||
| 28. What is meant by an injection of “20 for 40”? | 679 | ||
| 29. What is a rate rise? | 679 | ||
| 30. What is a Hickman catheter? | 679 | ||
| 31. What is a PermaCath? | 679 | ||
| 32. What is a Medcomp? | 679 | ||
| Bibliography | 679 | ||
| 67 Inferior Vena Cava Filters | 680 | ||
| 1. What is an inferior vena cava (IVC) filter? | 680 | ||
| 2. What are some common indications for IVC filter placement? | 680 | ||
| 3. List relative indications for IVC filter placement. | 680 | ||
| 4. What is a prophylactic IVC filter? | 680 | ||
| 5. What is Virchow’s triad? | 680 | ||
| 6. What are absolute contraindications to IVC filter placement? | 680 | ||
| 7. What are relative contraindications to IVC filter placement? | 680 | ||
| 8. How many PE originate from the lower extremities? | 680 | ||
| 9. When would a superior vena cava (SVC) filter be placed? | 680 | ||
| 10. Why is a vena cavogram performed before IVC filter placement? | 680 | ||
| 11. How is a vena cavogram performed before IVC filter placement? | 681 | ||
| 12. What do the renal veins look like on a cavogram? | 681 | ||
| 13. Can a cavogram be performed if the patient is allergic to iodinated contrast material or has an elevated creatinine level? | 681 | ||
| 14. What common venous anomalies are seen on a cavogram? | 681 | ||
| 15. How common is IVC duplication? What does it look like on a cavogram? | 681 | ||
| 16. What should be done in a patient with duplicated IVC who needs an IVC filter? | 681 | ||
| 17. What are the characteristics of a left-sided IVC? | 681 | ||
| 18. What are the characteristics of a circumaortic left renal vein? How common is this anatomic variant? | 681 | ||
| 19. Where should a filter be placed in a patient with a circumaortic left renal vein? | 681 | ||
| 20. What is a retrievable IVC filter? | 681 | ||
| 21. What patients could benefit from a retrievable IVC filter? | 681 | ||
| 22. Can patients with an IVC filter still get PE? | 682 | ||
| 23. Where in the IVC should the filter be placed, and why? | 682 | ||
| 24. What complications are related to IVC filter placement? | 682 | ||
| 25. How often does IVC occlusion occur after IVC filter placement? | 682 | ||
| Bibliography | 682 | ||
| 68 Image-Guided Percutaneous Needle Biopsy | 684 | ||
| 1. What are the major indications for image-guided percutaneous needle biopsy? | 684 | ||
| 2. What are the available imaging modalities for IPNB? | 684 | ||
| 3. What are the contraindications for percutaneous biopsy? | 684 | ||
| 4. What criteria are used to determine whether or not a lesion is amenable to IPNB? | 684 | ||
| 5. How effective is percutaneous needle biopsy? | 686 | ||
| 6. What patient preparation is necessary prior to percutaneous biopsy? | 686 | ||
| 7. What type of anesthesia is used for IPNB? | 687 | ||
| 8. What is the difference between fine-needle aspiration (FNA) and core biopsy? | 687 | ||
| 9. What is the difference between the single-needle technique and the coaxial needle technique of percutaneous biopsy? | 687 | ||
| 10. How does one decide whether to use a percutaneous approach or a bronchoscopic approach to biopsy a lung nodule? | 687 | ||
| 11. What are the indications for liver biopsy, and what is the best way to biopsy the liver? | 687 | ||
| 12. What are the indications for renal biopsy, and what is the best way to biopsy the kidney? | 687 | ||
| 13. What are the complications of percutaneous biopsy? | 687 | ||
| 14. What are some factors that increase the risk of pneumothorax following percutaneous biopsy? | 689 | ||
| 15. How does one manage an air embolus encountered after percutaneous biopsy? | 689 | ||
| 16. How are patients managed after percutaneous biopsy? | 690 | ||
| 17. How are biopsy specimens handled? | 690 | ||
| Bibliography | 691 | ||
| 69 Advanced Procedures in Interventional Radiology | 692 | ||
| Endovascular Aneurysm Repair (EVAR) | 692 | ||
| 1. What is the basic composition of a stent graft? | 692 | ||
| 2. Who is at risk for abdominal aortic aneurysm (AAA), and what are the major complications of AAA? | 692 | ||
| 3. What is the natural history of AAA, and when is intervention indicated? | 692 | ||
| 4. How are most AAAs detected, and what is the role of screening? | 692 | ||
| 5. In general, when is endovascular aneurysm repair (EVAR) favored over open surgical repair? | 692 | ||
| 6. Describe briefly the traditional open surgical repair of AAA. | 692 | ||
| 7. Name some findings on preprocedure imaging of AAA that may preclude a patient from undergoing EVAR. | 693 | ||
| 8. What is an endoleak? What are the different types of endoleaks, and how are they treated? | 693 | ||
| 9. What follow-up imaging tests do patients treated with EVAR undergo? | 693 | ||
| 10. What are some of the complications related to EVAR? | 693 | ||
| 11. What are the major studies that have looked at the outcomes of EVAR? | 693 | ||
| 12. What are the results of the major EVAR studies? | 693 | ||
| 13. What devices are currently commercially available in the United States for EVAR, and how do they differ? | 694 | ||
| 14. What advantages will future generations of stent grafts have over ones that are currently available? | 694 | ||
| 15. What are advantages of EVAR over traditional open surgical repair? | 694 | ||
| Transarterial Chemoembolization (TACE) | 694 | ||
| 16. What is meant by transarterial chemoembolization (TACE)? | 694 | ||
| 17. What types of hepatic malignancies can be treated with TACE? | 694 | ||
| 18. What is a typical mixture used to perform TACE? | 694 | ||
| 19. What is the purpose of ethiodized oil (Ethiodol) in the TACE mixture? | 694 | ||
| 20. What types of patients should be considered candidates for TACE? | 694 | ||
| 21. How are patients followed after TACE, and when is retreatment indicated? | 694 | ||
| 22. What is the typical imaging and clinical workup prior to TACE? | 694 | ||
| 23. What is postembolization syndrome? | 695 | ||
| 24. What medications are patients typically treated with after TACE? | 695 | ||
| 25. What is the major risk factor for hepatic abscess formation secondary to TACE? | 695 | ||
| 26. What tumor markers are used to follow HCC? What about metastatic colon cancer? | 695 | ||
| 27. What laboratory values are checked when determining candidacy for TACE? | 695 | ||
| 28. How can the liver tolerate embolization of the hepatic artery without undergoing infarction? | 695 | ||
| 29. What does one look for on follow-up imaging to evaluate the success of a TACE procedure? | 695 | ||
| Radiofrequency Ablation (RFA) | 695 | ||
| 30. What is radiofrequency ablation (RFA), and how does it work? | 695 | ||
| 31. What characteristics of hepatic lesions are considered treatable by RFA? What are the characteristics of renal lesions treatable by RFA? | 695 | ||
| 32. What is the major CT and MR imaging characteristic of a lesion successfully treated with RFA? | 695 | ||
| 33. How are patients followed after RFA procedures? | 695 | ||
| 34. What subset of patients with renal lesions is best treated with RFA? | 695 | ||
| 35. What are complications of RFA? | 696 | ||
| Uterine Fibroid Embolization (UFE) | 696 | ||
| 36. What are typical symptoms of uterine fibroids? | 696 | ||
| 37. What clinical workup is required before undergoing uterine fibroid embolization (UFE)? | 696 | ||
| 38. What imaging is required before UFE? | 696 | ||
| 39. How is a patient followed after undergoing UFE? | 696 | ||
| 40. What are the risks associated with UFE? | 696 | ||
| 41. What are the alternatives to UFE? | 696 | ||
| 42. How do symptoms typically respond to UFE? | 696 | ||
| 43. Are there any other indications for UFE other than fibroids? | 696 | ||
| 44. What type of embolic agent is typically used? | 696 | ||
| 45. Is there a correlation between postprocedure pain and clinical outcomes? | 696 | ||
| 46. What is a typical analgesia protocol for patients undergoing UFE? | 696 | ||
| 47. What are the indications for discharge from the hospital after UFE? | 696 | ||
| 48. Describe the vascular anatomy relevant to UFE. | 697 | ||
| 49. What is the risk of premature menopause related to UFE? | 697 | ||
| 50. Is pregnancy possible after UFE? | 697 | ||
| Bibliography | 697 | ||
| 70 Peripheral Arterial Disease Diagnosis and Intervention | 699 | ||
| 1. What is the appropriate landmark for a femoral artery puncture? | 699 | ||
| 2. If the femoral artery cannot be accessed, what are other options to obtain access for an arteriogram? | 699 | ||
| 3. If a brachial approach must be used, is the right or left arm used? | 700 | ||
| 4. What are some complications unique to brachial access? | 700 | ||
| 5. What is claudication? | 700 | ||
| 6. What are the risk factors for PAD and claudication? | 700 | ||
| 7. Does the location of leg pain suggest the location of arterial stenosis? | 700 | ||
| 8. Why is it important to identify patients with claudication? | 700 | ||
| 9. What is the Fontaine classification? | 700 | ||
| 10. What is the Rutherford-Becker classification system? | 700 | ||
| 11. What are the clinical categories of acute limb ischemia? | 700 | ||
| 12. What is the ankle-brachial index (ABI)? | 700 | ||
| 13. How is the ABI interpreted? | 700 | ||
| 14. What can cause a falsely elevated ABI? | 700 | ||
| 15. What is meant by the terms inflow and outflow? | 701 | ||
| 16. What are the basic steps in performing an angioplasty procedure? | 702 | ||
| 17. What constitutes a technically successful angioplasty? | 702 | ||
| 18. What are the complications of angioplasty? | 702 | ||
| 19. What are the indications for stenting? | 702 | ||
| 20. What constitutes a hemodynamically significant arterial stenosis? | 702 | ||
| 21. What is the kissing balloon technique? | 702 | ||
| 22. If a wire cannot be passed through the lumen of a vessel because of chronic total occlusion, what techniques may be used to allow for endovascular treatment? | 703 | ||
| 23. What is an atherectomy device, and what types of lesions might it be useful for? | 703 | ||
| 24. What are the basic principles in performing a thrombolysis procedure? | 703 | ||
| 25. In general, how is a thrombolysis procedure performed? | 704 | ||
| 26. What is the guidewire traversal test? | 704 | ||
| 27. List the contraindications to thrombolysis. | 704 | ||
| 28. What is a PVR examination? | 704 | ||
| 29. What is Leriche syndrome? | 704 | ||
| 30. What is an ACT measurement? | 704 | ||
| 31. How are groin pseudoaneurysms managed? | 704 | ||
| 32. What are the major pathways of collateral circulation to supply the lower extremities in a patient with known aortic occlusion? | 704 | ||
| Bibliography | 705 | ||
| 71 Embolization Techniques and Applications | 706 | ||
| 1. Describe embolotherapy and some of its indications. | 706 | ||
| 2. What materials are most commonly used for embolization? | 706 | ||
| 3. What is Gelfoam, and how is it prepared and delivered? | 706 | ||
| 4. How does Gelfoam work, and when is it used? | 706 | ||
| 5. What are metallic coils? | 706 | ||
| 6. When are coils preferred? | 706 | ||
| 7. What happens when coils are the wrong size? | 706 | ||
| 8. When are PVA particles used? | 706 | ||
| 9. When performing an embolization procedure, why is it always recommended to place a vascular sheath at the access site? | 707 | ||
| 10. What is postembolization syndrome? | 707 | ||
| 11. How can nontarget embolization be minimized? | 707 | ||
| 12. When performing an embolization procedure for an upper GI bleed, what information from the endoscopy report is essential? | 707 | ||
| 13. Can a lower GI bleed be treated with empiric embolization? | 707 | ||
| 14. In the setting of pelvic trauma or peripartum hemorrhage in a patient with an unstable condition, is superselective embolization always indicated? | 707 | ||
| 15. Name some clinical indications for arteriography in patients with pelvic trauma. | 707 | ||
| 16. Is empiric embolization indicated in pelvic trauma? | 707 | ||
| 17. In bronchial artery embolization for hemoptysis, vigilance for which vessels is imperative? | 707 | ||
| 18. Why should coils not be used in the bronchial arteries? | 708 | ||
| 19. Why is it necessary to embolize both sides of a pseudoaneurysm, aneurysm, or AVF? | 708 | ||
| 20. What should always be placed when absolute ethanol is being used for renal artery sclerosis? | 708 | ||
| 21. How is chemoembolization theorized to work? | 708 | ||
| 22. What happens when the cystic artery is embolized during hepatic lesion embolization/chemoembolization? | 708 | ||
| 23. What happens if the left or right gastric artery is embolized during hepatic chemoembolization? | 708 | ||
| 24. What is the significance of gas in the target organ post embolization? | 708 | ||
| 25. What findings suggest that postembolization gas is due to infection? | 708 | ||
| 26. When is uterine artery embolization (UAE) used in a nonemergent setting? | 709 | ||
| Bibliography | 709 | ||
| 72 Biliary and Portal Venous Interventions | 710 | ||
| 1. What are the indications for percutaneous transhepatic biliary drainage? | 710 | ||
| 2. List the causes of benign and malignant biliary obstruction. | 710 | ||
| 3. What is the most commonly encountered biliary ductal anatomy? | 710 | ||
| 4. What are some important normal biliary ductal anatomic variants? | 710 | ||
| 5. Describe the basic steps required to perform diagnostic percutaneous transhepatic cholangiography. | 711 | ||
| 6. Describe the basic steps required to perform percutaneous transhepatic biliary drainage. | 712 | ||
| 7. What is the difference between an external biliary drainage catheter and an internal/external biliary drainage catheter? | 712 | ||
| 8. When should an internal/external drain be capped? When should this drain be uncapped? | 712 | ||
| 9. A patient begins to leak bile around an indwelling biliary drain. Why does this happen, and what can be done to remedy this? | 713 | ||
| 10. What are the potential complications associated with percutaneous transhepatic biliary drainage? | 713 | ||
| 11. After an initial drainage procedure, what additional management measures may be performed to treat benign biliary obstruction? | 713 | ||
| 12. What can be done to manage the treatment of malignant biliary obstruction after initial drainage? | 713 | ||
| 13. What does the term isolated ducts mean? What is its significance? | 713 | ||
| 14. How does stricture morphology help to differentiate between benign and malignant disease? | 713 | ||
| 15. If a histologic diagnosis is required, what methods may be used to obtain a biopsy specimen of the bile ducts? | 714 | ||
| 16. When is percutaneous cholecystostomy indicated? | 714 | ||
| 17. Name the basic steps involved in performing percutaneous cholecystostomy. | 714 | ||
| 18. What are the potential complications associated with percutaneous cholecystostomy? | 714 | ||
| 19. How long must a percutaneous cholecystostomy catheter remain within the gallbladder before it can be removed? | 714 | ||
| 20. Should a cholecystostomy catheter be placed to external drainage indefinitely? | 714 | ||
| 21. When is transjugular liver biopsy indicated and preferred over percutaneous liver biopsy? | 714 | ||
| 22. How is transjugular liver biopsy performed? | 714 | ||
| 23. What are some clinical signs and symptoms associated with portal hypertension? | 714 | ||
| 24. How can one indirectly estimate portal venous pressure to confirm the diagnosis of portal hypertension? | 715 | ||
| 25. What are the indications for creating a transjugular intrahepatic portosystemic shunt (TIPS)? | 715 | ||
| 26. What are the contraindications to TIPS creation? | 715 | ||
| 27. Describe the steps of the TIPS procedure. | 715 | ||
| 28. What are the potential complications of TIPS creation? | 716 | ||
| 29. What are the short-term and long-term goals of TIPS creation? | 716 | ||
| Bibliography | 716 | ||
| 73 Genitourinary and Gastrointestinal Interventional Radiology | 717 | ||
| 1. List the indications for percutaneous nephrostomy (PCN) (Figure 73-1). | 717 | ||
| 2. What is the indication for emergent PCN? | 717 | ||
| 3. What are the important technical factors to consider when performing PCN? | 717 | ||
| 4. What is the most common method of visualizing the collecting system for PCN? | 717 | ||
| 5. What are the alternative means other than fluoroscopy for visualizing the collection system for PCN? | 718 | ||
| 6. Should access for PCN be obtained through the renal parenchyma or directly into the renal pelvis? | 718 | ||
| 7. From what approach should PCN be performed? | 718 | ||
| 8. Aside from decreasing the chance of bleeding, what are the other benefits of performing PCN through Brödel’s line? | 719 | ||
| 9. What imaging modalities can be used to perform a percutaneous drainage of renal or perinephric abscesses? | 719 | ||
| 10. What are the possible complications resulting from percutaneous drainage of renal or perinephric abscesses? | 719 | ||
| 11. When is percutaneous management of urinary tract calculi preferred over extracorporeal shock wave lithotripsy (ESWL)? | 719 | ||
| 12. What is the role of PCN in percutaneous treatment of urinary tract calculi? | 719 | ||
| 13. How are calculi removed during percutaneous treatment of the urinary tract? | 719 | ||
| 14. What are the indications for ureteral stenting? | 719 | ||
| 15. Describe the difference between a double-J ureteral stent and a nephroureteral stent. | 719 | ||
| 16. How does a ureteral stent work? | 719 | ||
| 17. What are the indications for esophageal stenting? | 719 | ||
| 18. What technical complications are associated with esophageal stenting? | 719 | ||
| 19. What factors should be considered when selecting the puncture site for percutaneous gastrostomy? | 721 | ||
| 20. What is the difference between a G tube, G-J tube, and J tube? | 721 | ||
| 21. When are feeding G tubes not the tubes of choice? | 722 | ||
| 22. When are small bowel feeding tubes indicated? | 722 | ||
| Bibliography | 722 | ||
| 74 Neurointerventional Radiology | 724 | ||
| 1. What is the basic normal vascular anatomy of the brain? | 724 | ||
| 2. What is the basic normal arterial anatomy of the spinal cord? | 724 | ||
| 3. What are the indications and contraindications for cerebral and spinal catheter angiography? | 725 | ||
| 4. What types of vascular neurointerventional procedures are available? | 726 | ||
| 5. What types of nonvascular neurointerventional procedures are available? | 732 | ||
| 6. What are the potential complications of neurointerventional procedures? | 732 | ||
| Bibliography | 735 | ||
| 75 Musculoskeletal Interventional Radiology | 736 | ||
| 1. What are some common image-guided musculoskeletal interventional procedures? | 736 | ||
| 2. What is MR arthrography, and what are its indications? | 736 | ||
| 3. What concentration of gadolinium-based contrast material is used when performing MR arthrography? What are the components of the MR arthrogram injectate? | 736 | ||
| 4. What will occur if the concentration of gadolinium in the injectate is too high? | 737 | ||
| 5. What are the indications for a CT arthrography? What contrast material is used? | 737 | ||
| 6. What are the commonly used approaches for injecting the glenohumeral joint? What are the pros and cons of each? | 737 | ||
| 7. What imaging modalities can be used to guide joint injections, aspirations, or arthrography? | 738 | ||
| 8. What are some benefits of using US to guide musculoskeletal procedures? | 738 | ||
| 9. What are some commonly used corticosteroids in musculoskeletal interventions? | 738 | ||
| 10. What are some important contraindications to corticosteroid joint injections? | 738 | ||
| 11. What are the complications of corticosteroid use in musculoskeletal procedures? | 738 | ||
| 12. How is septic arthritis contracted? | 738 | ||
| 13. What are the indications for joint aspiration? | 738 | ||
| 14. What laboratory tests are ordered when sending aspirated joint fluid for analysis? | 738 | ||
| 15. What can you do if you are unable to aspirate any joint fluid? | 738 | ||
| 16. What are the most common pathogens in septic arthritis? | 739 | ||
| 17. What are some uncommon pathogens seen in septic arthritis? | 739 | ||
| 18. What are the indications for a tendon sheath injection, and what are the potential complications? | 739 | ||
| 19. What are the indications for an SASD bursal injection? | 739 | ||
| 20. What are the potential complications of Baker cyst aspiration? | 739 | ||
| 21. Describe the “in plane” and “out of plane” needle approaches in US-guided interventions. | 740 | ||
| 22. What techniques can help to increase the conspicuity of a needle during a US-guided procedure? | 740 | ||
| 23. What is tendon fenestration, and how is it performed? | 741 | ||
| 24. What is platelet-rich plasma (PRP) injection, and why is it used? | 741 | ||
| 25. What is calcific tendinosis lavage? | 741 | ||
| 26. What is the difference between vertebroplasty and kyphoplasty? | 742 | ||
| 27. What are some complications of vertebroplasty or kyphoplasty? | 742 | ||
| 28. What is a CT-guided bone biopsy? | 742 | ||
| 29. How should a CT-guided bone biopsy be planned? | 742 | ||
| 30. What is the most important principle of US-guided soft tissue biopsy? | 743 | ||
| 31. When should conscious sedation be used or considered when planning a musculoskeletal intervention? | 743 | ||
| Bibliography | 744 | ||
| XI Nuclear Radiology | 745 | ||
| 76 Pet of Oncological Disorders | 747 | ||
| 1. What is 18F-fluoro-2-deoxy-2-D-glucose (FDG)? | 747 | ||
| 2. What instructions do patients need to prepare for FDG PET imaging? | 747 | ||
| 3. What is dual time point (DTP) PET, and what is its potential utility? | 747 | ||
| 4. What is the normal pattern of FDG uptake in the body? | 747 | ||
| 5. What is the significance of increased FDG uptake in the thyroid gland? | 747 | ||
| 6. What is the significance of increased FDG uptake in the bowel? | 747 | ||
| 7. What is the significance of increased FDG uptake in the endometrium or adnexa? | 748 | ||
| 8. How does hybrid PET combined with structural imaging such as CT or MRI improve diagnostic performance in cancer patients? | 748 | ||
| 9. What are the main applications of FDG PET/CT in the oncological setting? | 748 | ||
| 10. What is the potential role of FDG PET/MRI in the oncological setting? | 748 | ||
| 11. What is the utility of FDG PET to characterize indeterminate lung nodules? | 749 | ||
| 12. What are the major causes for false-negative FDG PET findings in cancer patients? | 749 | ||
| 13. What are the major causes for false-positive FDG PET findings in cancer patients? | 749 | ||
| 14. Is there a specific standardized uptake value (SUV) threshold on FDG PET that can reliably distinguish malignant from benign disease processes? | 749 | ||
| 15. What is the utility of FDG PET for disease staging and pretreatment planning of cancer patients? | 749 | ||
| 16. Is the lung cancer patient in Figure 76-4 a good surgical candidate? | 750 | ||
| 17. What is the role of FDG PET in radiotherapy pretreatment planning? | 750 | ||
| 18. How useful is FDG PET for the evaluation of primary and metastatic brain tumors? | 750 | ||
| 19. How useful is FDG PET for evaluation of peritoneal spread of tumor? | 750 | ||
| 20. What is the utility of FDG PET for response assessment in cancer patients? | 750 | ||
| 21. What is the utility of FDG PET for disease restaging of cancer patients? | 751 | ||
| 22. What other non-FDG PET radiotracers are available for use in the oncological setting? | 751 | ||
| Bibliography | 752 | ||
| 77 Pet of Nononcological Disorders | 753 | ||
| 1. What are some applications of 18F-fluoro-2-deoxy-2-D-glucose positron emission tomography/computed tomography (FDG PET/CT) in the nononcological setting? | 753 | ||
| 2. What is the role of FDG PET/magnetic resonance imaging (MRI) in the nononcological setting? | 753 | ||
| 3. What is the utility of FDG PET in patients with suspected infection? | 753 | ||
| 4. What is the utility of FDG PET in patients with nonneoplastic vascular disease? | 754 | ||
| 5. What is the utility of FDG PET in patients with nonneoplastic thoracic disorders? | 755 | ||
| 6. What is the utility of FDG PET in patients with inflammatory bowel disease (IBD)? | 755 | ||
| 7. What is the utility of FDG PET in patients with psoriasis? | 755 | ||
| 8. What is the utility of FDG PET in patients with joint disease? | 756 | ||
| 9. Is FDG PET useful to evaluate muscle metabolism? | 756 | ||
| 10. Is FDG PET useful to evaluate brown fat? | 756 | ||
| Bibliography | 756 | ||
| 78 Bone Scintigraphy | 758 | ||
| 1. What should patients know about a bone scan? | 758 | ||
| 2. What should patients know about an 18F-sodium fluoride (NaF) positron emission tomography (PET) scan? | 758 | ||
| 3. What are the normal structures observed on a bone scan? Describe some typical nonmalignant findings in asymptomatic patients. | 758 | ||
| 4. Why is a “superscan” associated with a negative prognosis in the patient with prostate cancer shown in Figure 78-2? | 758 | ||
| 5. Is there a way to successfully treat a patient with bone pain associated with multiple osteoblastic metastases? | 758 | ||
| 6. Figure 78-3 shows a bone scan of a patient complaining of swelling and pain in the distal arm after a recent traumatic event. What is the diagnosis? | 759 | ||
| 7. What causes a bone scan that does not show the bones clearly? | 759 | ||
| 8. Is a bone scan an appropriate study for a 65-year-old patient with multiple myeloma? | 760 | ||
| 9. Does a bone scan that shows a worsened appearance after chemotherapy portend a bad prognosis? | 760 | ||
| 10. What are the most common findings on a bone scan that suggest metastatic disease? | 761 | ||
| 11. What are the causes of “cold,” or photopenic, defects on bone scans? | 762 | ||
| 12. Are three-phase bone scans alone useful for the diagnosis of osteomyelitis? | 762 | ||
| 13. What other scans can be used to improve diagnostic accuracy for detecting osteomyelitis? | 762 | ||
| 14. Is radiotracer uptake in the lungs normal on a bone scan? | 763 | ||
| 15. Can Paget’s disease be distinguished from cancer in the bones on nuclear medicine studies? | 763 | ||
| 16. What is the “Mickey Mouse” sign? What is the “Honda” sign? | 763 | ||
| 17. Intense radiotracer uptake on a bone scan in multiple joints can be the result of which disorders? | 764 | ||
| 18. Can shin splints be differentiated from stress fractures on a bone scan? | 764 | ||
| 19. What is the significance of a single rib lesion in a patient undergoing evaluation for metastatic disease from a known primary cancer? | 764 | ||
| 20. Which benign bone tumors have increased radiotracer uptake on a bone scan? | 764 | ||
| 21. Do bone scans have a role in the evaluation of child abuse? | 764 | ||
| 22. Is increased radiotracer uptake in the kidneys a clinically relevant finding on a bone scan? | 764 | ||
| 23. What are the causes of liver radiotracer uptake on a bone scan? | 764 | ||
| 24. What can cause radiotracer uptake in the muscles as seen on the bone scan in Figure 78-8? | 764 | ||
| 25. How does 18F-NaF PET as shown in Figure 78-9 compare to FDG PET and conventional bone scintigraphy for the detection of osseous metastases? | 764 | ||
| Bibliography | 765 | ||
| 79 Pulmonary Scintigraphy | 767 | ||
| 1. How would you describe and prepare a patient for a ventilation-perfusion (V/Q) scan? | 767 | ||
| 2. In what order are imaging studies obtained in the workup of patients with suspected acute pulmonary embolism? | 767 | ||
| 3. How do aerosols compare to xenon-133 (133Xe) for use in a ventilation scan? | 767 | ||
| 4. What are the normal findings on a V/Q scan? | 767 | ||
| 5. What findings are necessary to classify the results of the V/Q scan in Figure 79-2 as “PE present”? | 767 | ||
| 6. What are the possible causes of gas trapping on the V/Q scan in Figure 79-3? | 769 | ||
| 7. How does a quantitative V/Q scan assist in preparing patients for lung surgery? | 769 | ||
| 8. What is the significance of a “triple match” on a V/Q scan and chest radiograph? | 769 | ||
| 9. What can cause radiotracer uptake in the liver on the 133Xe ventilation scan in Figure 79-4? | 769 | ||
| 10. What are the causes of mismatched perfusion defects on a V/Q scan? | 770 | ||
| 11. How can V/Q scans be utilized in the evaluation of chronic PE? | 770 | ||
| 12. Why is alpha-1 antitrypsin deficiency the most likely cause of the perfusion scan findings in Figure 79-5? | 770 | ||
| 13. Can idiopathic pulmonary fibrosis (IPF) be distinguished from PE on the V/Q scan shown in Figure 79-6? | 770 | ||
| 14. Can V/Q scans be performed in pregnant women? | 770 | ||
| 15. What does activity in the brain or kidneys imply on a perfusion scan? | 770 | ||
| 16. How quickly do perfusion defects associated with pulmonary emboli resolve? | 771 | ||
| 17. How are V/Q scans utilized in patients who have had lung transplantation? | 772 | ||
| 18. What is a “stripe” sign, and what does it signify on a V/Q scan? | 772 | ||
| 19. What are the causes of matched ventilation and perfusion defects on a V/Q scan? | 772 | ||
| 20. What are possible causes of unilateral decreases in lung perfusion with relatively preserved lung ventilation on a V/Q scan? | 772 | ||
| Bibliography | 773 | ||
| 80 Thyroid, Parathyroid, and Salivary Gland Scintigraphy | 774 | ||
| 1. What patient preparation is required before thyroid scintigraphy? | 774 | ||
| 2. Which radioisotopes can be used for nuclear medicine imaging of the thyroid gland, and how do they compare physiologically? | 774 | ||
| 3. What are normal thyroid scan and iodine uptake results? | 774 | ||
| 4. Can a patient with normal thyroid gland 123I uptake still have Graves’ disease? | 774 | ||
| 5. What are possible outcomes after 131I therapy for Graves’ disease? | 774 | ||
| 6. How is a patient with a hot nodule on thyroid scintigraphy as seen in Figure 80-2 treated for hyperthyroidism? | 775 | ||
| 7. Why is a patient with a hot nodule in the thyroid gland more likely to end up euthyroid? | 775 | ||
| 8. What are the typical radiation safety precautions that patients must follow after 131I therapy? | 776 | ||
| 9. Should the patient with the thyroid scan in Figure 80-3 be treated with 131I? | 776 | ||
| 10. What factors affect the likelihood that the thyroid nodule in Figure 80-4 represents thyroid cancer? | 776 | ||
| 11. Why can 131I be used to treat thyroid cancer if it appears as a cold nodule on thyroid scintigraphy? | 776 | ||
| 12. What foods should be avoided as part of a low-iodine diet? | 777 | ||
| 13. What is the general management plan for patients diagnosed with thyroid cancer? | 777 | ||
| 14. What does “stunning” mean with regard to 131I scintigraphy? | 777 | ||
| 15. What range of doses of 131I is typically recommended for treatment of thyroid cancer in patients with the whole body scans seen in Figures 80-6 and 80-7? | 777 | ||
| 16. How do a recombinant human thyrotropin (Thyrogen) scan and treatment work? | 778 | ||
| 17. What are some possible causes of a thyroid scan in which there is no uptake or minimal uptake of radiotracer by the thyroid gland? | 778 | ||
| 18. Is 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) useful in the management of patients with thyroid cancer? | 778 | ||
| 19. What is parathyroid gland scintigraphy used for, and how is it performed? | 780 | ||
| 20. What is salivary gland scintigraphy used for, and how is it performed? | 780 | ||
| 21. What is the primary finding in the salivary gland study shown in Figure 80-12? | 780 | ||
| Bibliography | 782 | ||
| 81 Gastrointestinal and Genitourinary Scintigraphy | 783 | ||
| 1. What should patients know about renal scintigraphy, and what preparation should they be given? | 783 | ||
| 2. What are the normal findings in renal scintigraphy? | 783 | ||
| 3. What are causes of focal areas of decreased flow within a kidney? | 783 | ||
| 4. An increase in size of one or both kidneys may be associated with what processes? | 783 | ||
| 5. List some causes of a unilaterally small kidney seen on renal scintigraphy. | 783 | ||
| 6. Describe potential causes of nonvisualization of a kidney on renal scintigraphy. | 783 | ||
| 7. How do processes that decrease the radiotracer activity in both kidneys differ from processes that affect a single kidney? | 785 | ||
| 8. How is captopril renal scintigraphy used to evaluate for renal artery stenosis? | 785 | ||
| 9. Why are renal scans obtained 1 day after renal transplantation? | 785 | ||
| 10. How is ATN differentiated from rejection in renal transplant patients? | 785 | ||
| 11. What type of renal scan is used to evaluate for cortical scarring related to pyelonephritis or vesicoureteral reflux? How does it work? | 786 | ||
| 12. What are the current uses of liver/spleen scintigraphy? | 786 | ||
| 13. What conditions result in a hot quadrate lobe and a hot caudate lobe on a liver/spleen scintigraphy? | 786 | ||
| 14. What is the diagnostic pattern of radiotracer activity on a 99mTc red blood cell (RBC) scan in a patient with a hemangioma in the liver? | 786 | ||
| 15. What is the best scintigraphic test for the detection of splenic tissue? | 787 | ||
| 16. What functions of the hepatobiliary system can be evaluated using iminodiacetic acid (IDA) radiotracers? | 787 | ||
| 17. When should cholecystokinin (CCK) or morphine sulfate be used in relation to a hepatobiliary scan? | 789 | ||
| 18. What can a gallbladder ejection fraction study show? | 789 | ||
| 19. What are the causes of nonvisualization of the gallbladder on a hepatobiliary scan? | 789 | ||
| 20. Discuss some causes of false-negative hepatobiliary scan results in the setting of acute cholecystitis. | 789 | ||
| 21. What is the “rim” sign, and what does it imply? | 790 | ||
| 22. When a biliary leak occurs, where are the possible sites to observe the leak? | 790 | ||
| 23. How is biliary atresia differentiated from neonatal hepatitis on hepatobiliary scintigraphy? | 791 | ||
| 24. What are the typical findings of a positive gastrointestinal (GI) bleeding scan? | 791 | ||
| 25. Contrast the differences between the sulfur colloid scan and the tagged RBC scan for detecting GI bleeding. | 791 | ||
| 26. How does a gastric emptying study work? | 791 | ||
| 27. What are the normal rates for gastric emptying? | 791 | ||
| 28. What physiologic factors normally affect gastric emptying? | 792 | ||
| 29. What is a pentetreotide scan and what is it used for? | 792 | ||
| 30. What are some available nuclear medicine scans that can be used to detect a pheochromocytoma? | 792 | ||
| Bibliography | 794 | ||
| 82 Cardiac Scintigraphy | 795 | ||
| 1. How do you prepare a patient for stress myocardial perfusion imaging (SMPI)? | 795 | ||
| 2. What are the different types of radiotracers available for stress testing? | 795 | ||
| 3. What are the three types of stress tests? | 795 | ||
| 4. What are contraindications for an exercise stress test? | 795 | ||
| 5. What are the contraindications for pharmacologic vasodilatory and adrenergic agonist stress tests? | 796 | ||
| 6. Should patients taking medications that can affect the heart be given stress tests? | 796 | ||
| 7. List the conditions under which an exercise stress test should be stopped. | 796 | ||
| 8. Which territories are supplied by which coronary arteries? | 796 | ||
| 9. What is the implication of a nonreversible (or fixed) defect on SMPI? | 796 | ||
| 10. What methods are available to correct for attenuation artifact? | 796 | ||
| 11. How do SMPI studies compare with routine stress ECG studies in the evaluation of patients with coronary artery disease (CAD)? | 797 | ||
| 12. What is the implication of a reversible (or transient) defect on SMPI? | 797 | ||
| 13. Why is transient left ventricular cavity dilation on SMPI a poor prognostic sign? | 797 | ||
| 14. How might a left bundle branch block (LBBB) on ECG affect SMPI findings? | 798 | ||
| 15. How is a 201Tl resting-redistribution scan performed, and how are the results of a resting-redistribution scan used clinically? | 798 | ||
| 16. What is the difference between hibernating and stunned myocardium? | 798 | ||
| 17. How is a multiple-gated acquisition (MUGA) scan performed? | 799 | ||
| 18. How is a MUGA scan used clinically? | 799 | ||
| 19. How does an FDG PET scan of the heart help to evaluate for myocardial viability? | 800 | ||
| 20. How does FDG PET scan help with the diagnosis of myocardial sarcoidosis? | 800 | ||
| Bibliography | 802 | ||
| 83 Brain Scintigraphy | 803 | ||
| 1. What radiotracers are available for functional brain scintigraphy? | 803 | ||
| 2. How would you prepare a patient for a brain scan to assess general brain function? | 803 | ||
| 3. What are the normal patterns of radiotracer uptake for CBF-SPECT and FDG PET scans? | 803 | ||
| 4. What does the FDG PET brain scan pattern in Figure 83-2 represent? | 803 | ||
| 5. What does the FDG PET brain scan pattern in Figure 83-3 represent? | 803 | ||
| 6. How does an acetazolamide SPECT scan work to determine cerebrovascular disease? | 805 | ||
| 7. What is the finding in the FDG PET brain scan shown in Figure 83-4 of a patient with a history of seizures? | 805 | ||
| 8. What are the findings in these interictal and ictal CBF-SPECT scans shown in Figure 83-5 of a patient with a history of seizures and prior surgery for a benign brain tumor in the right parieto-occipital region? | 805 | ||
| 9. How can one differentiate tumor recurrence from radiation necrosis in the brain using an FDG PET scan? | 805 | ||
| 10. What does this brain perfusion scan in Figure 83-7 demonstrate in this patient who was involved in a motor vehicle accident with significant head trauma? | 807 | ||
| 11. How is a cerebrospinal fluid (CSF) scintigraphy study performed, and what is it used for? | 808 | ||
| 12. What does the CSF scintigraphy study shown in Figure 83-8 demonstrate? | 808 | ||
| 13. What does the CSF scintigraphy study shown in Figure 83-9 reveal? | 808 | ||
| 14. How is an 123I ioflupane (DaTscan) performed, and what is it used for? | 808 | ||
| 15. What is amyloid imaging used for? | 808 | ||
| Bibliography | 810 | ||
| 84 Radiopharmaceutical Therapeutic Intervention | 811 | ||
| 1. What is the purpose of radiopharmaceutical therapy? | 811 | ||
| 2. What is the therapeutic ratio? | 811 | ||
| 3. What are the different therapeutic radionuclide emissions? | 811 | ||
| 4. Why is radiopharmaceutical therapy useful in thyroid disease? | 811 | ||
| 5. What are the potential adverse effects of radiopharmaceutical therapy? | 812 | ||
| 6. What are radiation safety precautions? | 812 | ||
| 7. How are radiopharmaceutical doses determined? | 814 | ||
| 8. What are some commonly used radiopharmaceutical therapies? | 814 | ||
| Bibliography | 814 | ||
| XII Pediatric Radiology | 815 | ||
| 85 Pediatric Thoracic Radiology | 817 | ||
| 1. What is the embryologic relationship between the lungs and the gastrointestinal tract? | 817 | ||
| 2. Describe the histologic stages of lung development. | 817 | ||
| 3. Describe the pertinent findings on a normal neonatal chest radiograph. | 817 | ||
| 4. What is the correct location of umbilical arterial and venous catheters on radiographs? | 817 | ||
| 5. What is surfactant, and why is it important? | 817 | ||
| 6. What is the difference between RDS and a surfactant dysfunction? | 817 | ||
| 7. How does RDS appear radiographically? | 817 | ||
| 8. How is RDS treated, and what are the potential complications? | 817 | ||
| 9. In addition to RDS, what are some other neonatal diffuse lung diseases? | 818 | ||
| 10. How might other neonatal diffuse lung diseases be differentiated clinically? | 818 | ||
| 11. What is the mechanism behind meconium aspiration, and how does it appear radiographically? | 818 | ||
| 12. What is the mechanism behind TTN, and how does it appear radiographically? | 818 | ||
| 13. What is neuroendocrine cell hyperplasia of infancy (NEHI), and how does it present clinically and radiographically? | 818 | ||
| 14. What are alveolar growth disorders, and what is their CT appearance? | 818 | ||
| 15. What are the major (prenatally diagnosed) surgical diseases of the neonatal chest? | 818 | ||
| 16. What is the most common cause of a neonatal pleural effusion? | 819 | ||
| 17. Describe how chlamydial pneumonia manifests clinically and radiographically. | 819 | ||
| 18. What are the pulmonary and extrapulmonary manifestations of cystic fibrosis? | 819 | ||
| 19. What are the findings of primary tuberculosis of the lungs in a pediatric patient? | 819 | ||
| 20. What is acute chest syndrome? | 819 | ||
| 21. What is lymphocytic interstitial pneumonia (LIP)? | 819 | ||
| 22. How is a suspected aspirated foreign body evaluated? | 820 | ||
| 23. What is Swyer-James syndrome? | 820 | ||
| 24. What are the most common causes of metastasis to the lung in the pediatric patient? | 820 | ||
| 25. What are some mediastinal masses one might see in the pediatric patient? | 820 | ||
| 26. What are important structures to identify on a lateral radiograph of the pediatric neck? | 820 | ||
| 27. What is congenital high airway obstruction syndrome (CHAOS), and why is it important to diagnose prenatally? | 820 | ||
| Bibliography | 821 | ||
| 86 Pediatric Cardiovascular Radiology | 822 | ||
| 1. What are some of the most common types of congenital heart disease (CHD) in order of frequency (most common to least common)? | 822 | ||
| 2. How does assessment of pulmonary blood flow aid in the diagnosis of cyanotic disease? | 822 | ||
| 3. Which types of CHD appear with cyanosis and increased pulmonary blood flow? | 822 | ||
| 4. How is HLHS corrected surgically? | 822 | ||
| 5. What is congenitally corrected transposition of the great vessels, and why is it a problem? | 822 | ||
| 6. What are the most common acyanotic types of CHD? | 822 | ||
| 7. What is the role of the radiologist in assessing suspected CHD? | 822 | ||
| 8. What are some classic patterns of CHD seen on radiographs? | 822 | ||
| 9. Name the major causes of CHF in a newborn. | 823 | ||
| 10. Define the concept of situs. | 823 | ||
| 11. What is segmental classification of CHD? | 823 | ||
| 12. What are the most common benign pediatric cardiac/pericardial tumors? | 823 | ||
| 13. What are the most common malignant pediatric cardiac/pericardial tumors? | 823 | ||
| 14. What is a vascular ring? | 823 | ||
| 15. What is the importance of a right-sided aortic arch? | 823 | ||
| 16. What is a pulmonary artery sling? | 823 | ||
| 17. What are MAPCAs? | 824 | ||
| 18. What is the difference between TAPVR and scimitar syndrome? | 824 | ||
| 19. What is meant by a malignant course of an anomalous coronary artery? | 824 | ||
| 20. What are the two main types of coarctation of the aorta? | 824 | ||
| 21. What is a bicuspid aortic valve (BAV)? | 826 | ||
| 22. What are some of the major causes of pediatric pulmonary hypertension, and what are the major associated CT features? | 826 | ||
| 23. What is Eisenmenger syndrome? | 826 | ||
| Bibliography | 827 | ||
| 87 Pediatric Gastrointestinal Radiology | 828 | ||
| 1. What are the most common causes of small bowel obstruction in a child? | 828 | ||
| 2. What is intussusception? | 828 | ||
| 3. What causes intussusception? | 828 | ||
| 4. Describe the clinical signs of intussusception. | 828 | ||
| 5. How is intussusception diagnosed with imaging? | 828 | ||
| 6. How is an intussusception treated? | 828 | ||
| 7. How can one tell that an intussusception has been successfully reduced? | 828 | ||
| 8. Describe the “double bubble” sign, and name the conditions in which it is found. | 829 | ||
| 9. What is malrotation of the intestines? | 829 | ||
| 10. What are Ladd’s bands? | 830 | ||
| 11. How does a midgut volvulus occur, and why is this a surgical emergency? | 830 | ||
| 12. Does a patient with bowel malrotation always present with clinical symptoms? | 830 | ||
| 13. What is the clinical presentation of bowel malrotation? | 830 | ||
| 14. Which imaging study is the standard for diagnosing bowel malrotation? | 830 | ||
| 15. List other anomalies that are associated with bowel malrotation. | 831 | ||
| 16. Describe the clinical presentation of hypertrophic pyloric stenosis (HPS). | 831 | ||
| 17. If the “olive” cannot be palpated, how can HPS be diagnosed with imaging studies? | 831 | ||
| 18. What is a Meckel’s diverticulum? | 831 | ||
| 19. How is Meckel’s diverticulum diagnosed? | 832 | ||
| 20. What are the most common causes of GI bleeding in children? | 832 | ||
| 21. What causes necrotizing enterocolitis (NEC)? | 832 | ||
| 22. Who develops NEC? | 832 | ||
| 23. What findings of NEC can be seen on radiographs, and what is the role of the radiologist? | 832 | ||
| 24. What are other causes of pneumoperitoneum in infants and children? | 832 | ||
| 25. What is Hirschsprung’s disease? | 832 | ||
| 26. What are the radiographic findings of Hirschsprung’s disease? | 832 | ||
| 27. Is Hirschsprung’s disease diagnosed definitively by imaging? | 834 | ||
| 28. Name the types of tracheoesophageal fistulas (TEF). How common is each type? | 834 | ||
| 29. What are the radiographic findings of TEF? | 834 | ||
| 30. How can a radiograph help to differentiate an ingested coin in the esophagus from an aspirated coin in the trachea? | 834 | ||
| Bibliography | 835 | ||
| 88 Pediatric Genitourinary Radiology | 836 | ||
| 1. What is the role of the radiologist in pediatric urinary tract infection (UTI)? | 836 | ||
| 2. What conditions can be detected radiologically that impair normal urinary flow? | 836 | ||
| 3. Which imaging tests are used to diagnose these conditions? | 836 | ||
| 4. In a child with history of UTI, what are the indications for renal and bladder US? | 836 | ||
| 5. When is renal and bladder US performed? | 836 | ||
| 6. How is VCUG performed? | 836 | ||
| 7. How is VCUG modified in infants? | 837 | ||
| 8. When should VCUG be performed? | 837 | ||
| 9. What is voiding urosonography? | 837 | ||
| 10. What are the pros and cons of a radionuclide cystography or voiding urosonography compared with fluoroscopic VCUG? | 837 | ||
| 11. What is primary VUR? | 837 | ||
| 12. What is secondary VUR? | 837 | ||
| 13. How is primary VUR graded? | 837 | ||
| 14. What is dysfunctional voiding? | 837 | ||
| 15. What diagnostic tests are useful for the detection of acute and chronic pyelonephritis in children? | 838 | ||
| 16. What are the findings on a renal cortical scintigraphic study in acute and chronic infection? | 838 | ||
| 17. What are the CT findings associated with pyelonephritis? | 838 | ||
| 18. What is the “top-down approach” in the evaluation of the child with a history of UTI? | 838 | ||
| 19. How useful is renal US in the workup of suspected pyelonephritis? | 838 | ||
| 20. What is the role of magnetic resonance imaging (MRI) in a child with UTI? | 838 | ||
| 21. List the most common forms of congenital hydronephrosis. | 838 | ||
| 22. When should a postnatal renal and bladder US examination be obtained in a patient with congenital hydronephrosis? | 839 | ||
| 23. What are the roles of renal scintigraphy, VCUG, intravenous urography (IVU), and magnetic resonance urography (MRU) in congenital hydronephrosis? | 839 | ||
| 24. What are posterior urethral valves? | 839 | ||
| 25. How are posterior urethral valves detected? | 839 | ||
| 26. What is primary megaureter? | 839 | ||
| 27. What are common forms of a duplex kidney? | 840 | ||
| 28. What is the Weigert-Meyer rule? | 840 | ||
| 29. Are the collecting systems and ureters dilated in a duplicated system? | 840 | ||
| 30. What is the most common cause of a scrotal mass? | 840 | ||
| 31. What are the main differential diagnostic considerations of a painful scrotum? | 840 | ||
| 32. If epididymitis is present in an infant, what should be suspected as the etiologic factor? | 841 | ||
| 33. What is the most common testicular tumor in children? | 842 | ||
| 34. What are the most common testicular tumors in adolescents? | 842 | ||
| 35. What urinary problems occur in children with spina bifida? | 842 | ||
| 36. Name the specific problems in spina bifida that are related to neurogenic bladder. | 842 | ||
| 37. Discuss the goals of therapy for urinary tract dysfunction in a patient with spina bifida. | 842 | ||
| 38. What is the triad of prune-belly syndrome? | 843 | ||
| 39. What urinary tract abnormalities are associated with prune-belly syndrome? | 843 | ||
| 40. What is a basic classification for cystic renal diseases affecting infants, children, and adolescents? | 843 | ||
| 41. What is the most common US appearance of MCDK? | 843 | ||
| 42. List the other forms of nongenetic cystic renal disease. | 843 | ||
| 43. Name the genetic forms of cystic renal disease. | 843 | ||
| 44. Does “adult-type” ADPCKD occur in infants and young children? | 844 | ||
| 45. What imaging findings may help distinguish ADPCKD from ARPCKD in an infant or young child? | 844 | ||
| 46. Name five hereditary syndromes associated with renal cysts. | 844 | ||
| 47. What is the normal sonographic appearance of the neonatal kidney? | 844 | ||
| 48. What conditions cause echogenic renal pyramids in infants? | 844 | ||
| 49. List the common causes of urolithiasis in children. | 845 | ||
| 50. What is the “twinkling” artifact? | 845 | ||
| 51. What is the most common solid renal mass in infants? | 845 | ||
| 52. What is the role of imaging in infants with ambiguous genitalia? | 845 | ||
| 53. What is nephroblastomatosis? | 846 | ||
| 54. What are the two major types of nephroblastomatosis? | 846 | ||
| 55. How can nephroblastomatosis be distinguished from Wilms tumor? | 846 | ||
| 56. What is Mayer-Rokitansky-Küster-Hauser syndrome? | 847 | ||
| 57. How is pelvic US used in the evaluation of a child with precocious puberty? | 847 | ||
| 58. What is the sonographic appearance of adrenal hemorrhage in the neonate, and how can adrenal hemorrhage be differentiated from adrenal neuroblastoma? | 847 | ||
| Bibliography | 848 | ||
| 89 Pediatric Neuroradiology | 849 | ||
| 1. How does myelinated brain differ from nonmyelinated brain on an infant magnetic resonance imaging (MRI) examination? Where does one expect to see myelinization occur first? | 849 | ||
| 2. What are migrational anomalies of the central nervous system (CNS)? | 849 | ||
| 3. Name the four kinds of holoprosencephalies. | 850 | ||
| 4. What is the differential diagnosis for what appears to be massively dilated ventricles on a prenatal ultrasonography (US) or MRI examination? | 850 | ||
| 5. Describe the classification of germinal matrix hemorrhage. | 850 | ||
| 6. How does the premature brain respond to ischemic injury? | 850 | ||
| 7. Describe the three main types of Chiari malformations. | 850 | ||
| 8. How does the corpus callosum develop, and why is this important? | 851 | ||
| 9. What entity does not follow the normal rule of corpus callosum development? | 851 | ||
| 10. What are TORCH infections? | 851 | ||
| 11. How do TORCH infections appear radiographically? | 851 | ||
| 12. Discuss the CNS manifestations of neurofibromatosis type 1 (NF-1). | 851 | ||
| 13. How is neurofibromatosis type 2 (NF-2) different from NF-1? | 851 | ||
| 14. What is tuberous sclerosis (TS)? | 851 | ||
| 15. Describe the manifestations of Sturge-Weber syndrome. | 851 | ||
| 16. What are the most common brain tumors in infants? | 851 | ||
| 17. Name the major posterior fossa tumors in children. | 852 | ||
| 18. Describe the typical tumors that occur in the suprasellar region of a child. | 852 | ||
| 19. Why is thickening of the pituitary stalk an important finding? | 852 | ||
| 20. What is the differential diagnosis for a pediatric cystic neck mass? | 852 | ||
| 21. What is the differential diagnosis for causes of leukocoria? | 852 | ||
| 22. What is meant by trilateral retinoblastoma? | 853 | ||
| 23. What is fibromatosis colli? Describe its imaging characteristics. | 853 | ||
| 24. Where do cholesteatomas typically arise, and what is the role of the radiologist in their evaluation? | 853 | ||
| 25. What is the role of the radiologist in the evaluation of sacrococcygeal teratoma? | 853 | ||
| Bibliography | 854 | ||
| 90 Pediatric Musculoskeletal Radiology | 855 | ||
| 1. How does growing bone respond to trauma, and how is this different from mature bone? | 855 | ||
| 2. What is the significance of fractures of the physis? | 855 | ||
| 3. How are fractures of the physis classified? | 855 | ||
| 4. What are secondary ossification centers? | 855 | ||
| 5. Why are secondary ossification centers particularly important to understand in the setting of elbow trauma? | 855 | ||
| 6. What are the most common fractures of the wrist/forearm in children? | 856 | ||
| 7. What is gymnast wrist? | 856 | ||
| 8. What is the equivalent of gymnast wrist in the shoulder? | 856 | ||
| 9. How may subtle supracondylar fractures of the elbow be diagnosed? | 856 | ||
| 10. Describe nursemaid’s elbow. | 856 | ||
| 11. List risk factors for developmental dysplasia of the hip (DDH). | 856 | ||
| 12. When is DDH suspected clinically? | 856 | ||
| 13. Name the potential complications of untreated DDH. | 856 | ||
| 14. How is DDH diagnosed radiographically? | 856 | ||
| 15. How is DDH diagnosed on ultrasonography (US)? | 856 | ||
| 16. What is Legg-Calvé-Perthes disease? | 856 | ||
| 17. Describe slipped capital femoral epiphysis (SCFE). | 856 | ||
| 18. How is SCFE treated? | 857 | ||
| 19. What are coxa vara and coxa valga? | 857 | ||
| 20. Describe Blount disease. | 857 | ||
| 21. What is Osgood-Schlatter disease? | 857 | ||
| 22. What are two other common processes involving the extensor mechanism of the knee only in the pediatric patient? | 857 | ||
| 23. What is the difference between a triplane fracture and a juvenile Tillaux fracture of the ankle? | 857 | ||
| 24. What is Freiberg infraction? | 858 | ||
| 25. What is a craniosynostosis? | 858 | ||
| 26. Give the differential diagnosis for vertebra plana. | 858 | ||
| 27. When and where do pediatric primary tumors of bone occur? | 858 | ||
| 28. What are the most common pediatric primary tumors that metastasize to the osseous structures? | 858 | ||
| 29. What are the benign pediatric primary bone tumors? | 858 | ||
| 30. How should a suspected osteoid osteoma be evaluated? | 858 | ||
| 31. If a pediatric patient presents with a palpable soft tissue mass, what are some possible underlying etiologies? | 859 | ||
| 32. What is rickets? | 859 | ||
| 33. How does rickets appear radiographically? | 859 | ||
| 34. Describe the bony changes of sickle cell anemia. | 859 | ||
| 35. What is the most common type of dwarfism, and what are its manifestations? | 859 | ||
| 36. What is the differential diagnosis for dense metaphyseal bands, and how does one know when they are abnormally dense? | 860 | ||
| Bibliography | 860 | ||
| 91 Imaging of Child Abuse | 862 | ||
| 1. What are key history and physical examination findings that may raise suspicion of the possibility of nonaccidental trauma (NAT)? | 862 | ||
| 2. What diagnostic algorithm might the clinician and radiologist apply if skeletal injury from child abuse is suspected? | 862 | ||
| 3. Describe shaken infant syndrome. | 862 | ||
| 4. What are metaphyseal corner fractures? | 863 | ||
| 5. Name other pediatric fractures with high specificity for child abuse. | 863 | ||
| 6. Which common fractures have low specificity for child abuse? | 863 | ||
| 7. What features of skull fractures increase the likelihood of NAT? | 863 | ||
| 8. What features of a fracture are useful in estimating its age? | 863 | ||
| 9. Summarize common findings of head trauma in shaken infant syndrome. | 864 | ||
| 10. What is the most common cause of death in a patient who has sustained NAT? | 865 | ||
| 11. How should imaging of the brain be applied in the setting of suspected abuse? | 865 | ||
| 12. How is the age of intracranial blood determined on MRI examinations? | 865 | ||
| 13. Describe possible bowel findings in cases of abuse. | 865 | ||
| 14. What is the most common cause of pediatric pancreatitis? | 865 | ||
| 15. Describe the CT imaging features of pediatric acute pancreatitis and pancreatic lacerations. | 865 | ||
| 16. Are multiple bruises and skeletal injuries always diagnostic of child abuse? | 865 | ||
| 17. How does congenital syphilis mimic child abuse? | 865 | ||
| 18. What is the differential diagnosis of periosteal reaction in a newborn? | 865 | ||
| 19. When does physiologic periosteal new bone formation occur? | 865 | ||
| 20. Can a metaphyseal corner fracture look like a metaphyseal lucent band? | 865 | ||
| 21. What is the legal responsibility of any U.S. physician who suspects child abuse? | 866 | ||
| Bibliography | 866 | ||
| XIII Diagnostic Radiology as a Profession | 867 | ||
| 92 Training Pathways in Diagnostic Imaging | 869 | ||
| 1. Why choose radiology? | 869 | ||
| 2. What are some common myths about radiology? | 869 | ||
| 3. What is the usual training pathway to become a radiologist in the United States? | 869 | ||
| 4. Do I have to match for a separate preliminary year? | 869 | ||
| 5. Is it difficult to get a residency position in diagnostic radiology? | 869 | ||
| 6. What can I do to help my chances of matching in radiology? | 869 | ||
| 7. What information should my personal statement contain? | 870 | ||
| 8. Who should write my letters of recommendation? | 870 | ||
| 9. Are radiology positions offered outside of the National Resident Matching Program match? | 870 | ||
| 10. To how many residency programs should I apply? | 870 | ||
| 11. To what kind of residency programs should I apply? | 870 | ||
| 12. What is a research track residency position? | 870 | ||
| 13. I am an international medical graduate. What must I do to apply for a diagnostic radiology residency position in the United States? | 870 | ||
| 14. Do I have to complete a fellowship after residency? | 870 | ||
| 15. In what subspecialties is fellowship training offered? | 870 | ||
| 16. What is the training pathway for nuclear medicine? | 871 | ||
| 17. What is the training pathway for interventional radiology? | 871 | ||
| 18. How do I become board-certified in diagnostic radiology? | 871 | ||
| Bibliography | 871 | ||
| 93 Medicolegal Issues in Diagnostic Imaging | 872 | ||
| 1. Define medical negligence. | 872 | ||
| 2. What must be proven for a physician to be found liable for malpractice? | 872 | ||
| 3. Outline the history of malpractice law. | 872 | ||
| 4. List factors responsible for high medical litigation in the United States. | 872 | ||
| 5. There can be no malpractice without established practice. Who sets the established practice, and who determines whether the established practice has been breached? | 872 | ||
| 6. Would a general radiologist who misses a lesion on a brain magnetic resonance imaging (MRI) study be held to the standard of a neuroradiologist? | 872 | ||
| 7. The average plaintiff award in the United States is $3.5 million. What is the aim of the award, and what are the types of damage awarded by the jury? | 872 | ||
| 8. Can an exculpatory waiver signed by a patient shield the physician of a certain degree of liability? | 873 | ||
| 9. A radiologist in an outpatient facility reads radiographs without ever meeting the patients. Does he or she still form a physician-patient relationship? | 873 | ||
| 10. It is estimated that in any given year a lawsuit may be brought against 1 in 10 radiologists. What are the most common reasons radiologists get sued? | 873 | ||
| 11. What are the groundbreaking findings of the Institute of Medicine’s report To Err is Human: Building a Safer Health System? | 873 | ||
| 12. Radiology has unique errors. How common are perceptual errors? | 873 | ||
| 13. What is hindsight bias, and why is it important medicolegally? | 873 | ||
| 14. How can perceptual errors be reduced? | 873 | ||
| 15. In 1997, the Wisconsin Court of Appeals issued a decision that has had a positive effect for radiologists sued for perceptual errors. Outline the decision. | 873 | ||
| 16. What is the “Aunt Minnie” approach to image interpretation, and how may this approach lead to errors in judgment? | 874 | ||
| 17. How may errors in judgment be minimized? | 874 | ||
| 18. Explain the following terms: proximate cause, law of intervening cause, and joint and several liabilities. | 874 | ||
| 19. Explain the following terms in the medicolegal context: vicarious liability and respondeat superior. | 874 | ||
| 20. Who is responsible for the negligent action of a technologist? | 874 | ||
| 21. What is meant by the term res ipsa loquitur? Give some examples. | 874 | ||
| 22. A radiologist renders a report on an intensive care unit portable chest x-ray that reads, “Endotracheal tube in the right main bronchus should be withdrawn by 2 inches to lie within distal trachea; left lower lobe atelectasis; otherwise normal.” What additional step should the radiologist take? | 874 | ||
| 23. A radiologist renders a report on a posteroanterior chest x-ray of a 60-year-old man with dyspnea that reads, “Opacity in the right lower lobe, likely pneumonia, clinical correlation is advised.” Is this report adequate? | 875 | ||
| 24. A radiologist renders a report on a barium enema that reads, “Filling defect in the splenic flexure with abrupt shelf-like margins, cannot rule out malignancy; colonoscopy may be of help if clinically indicated.” What is wrong with this report? | 875 | ||
| 25. A patient develops anaphylactic shock from iodinated contrast material for intravenous urography performed to exclude presence of renal calculi. This examination (rather than the current standard (a noncontrast abdominal computed tomography [CT] scan) was performed at the insistence of the referring urologist. Who is to blame, the radiologist or the urologist? | 875 | ||
| 26. A radiologist reports that a lateral cervical spine radiograph is “normal except for straightening, which could be positional” in a patient who sustained acute trauma. Subsequently, the patient developed weakness in the legs, and a follow-up CT scan shows a “fracture-dislocation” at C7-T1, which is an area not covered by the original radiograph. How was the original reading substandard? | 875 | ||
| 27. A radiologist reports an upper gastrointestinal study as follows: “Findings are highly suggestive of a scirrhous carcinoma of the stomach; endoscopy with biopsy is advised.” Biopsy results are negative. What should the radiologist do next? | 875 | ||
| 28. Failure to diagnose breast cancer is the number one cause for litigation in radiology. Summarize how to practice safe mammography. | 875 | ||
| 29. Only 2% of medical negligence injuries result in claims, and only 17% of claims apparently involve negligent injuries. About 60 cents of every malpractice dollar is taken by administrative and legal costs. The current tort system is inefficient. What are some reforms that have been suggested? | 875 | ||
| 30. A 45-year-old man with uncontrollable hypertension is referred for “magnetic resonance angiography with contrast” to exclude renal artery stenosis by his cardiologist. His glomerular filtration rate is 25 mL/min/1.73 m2. He is not on dialysis. What should be your course of action? | 876 | ||
| 31. A report states “History—suspected pulmonary embolus. … Technique—CT scan of the chest was performed.…” If all reports in this radiology practice were of similar disposition, why would this practice expect to hemorrhage money? | 876 | ||
| 32. How does the Breast Density Law affect reporting of mammograms? | 876 | ||
| 33. What is involved in the California Dose Reporting Regulation? | 876 | ||
| 34. In approving screening low-dose CT scans to detect early lung cancers in smokers, the Centers for Medicaid and Medicare (CMS) oblige specific communication with the patient. What does this communication entail? | 876 | ||
| 35. Briefly explain root cause analysis. | 877 | ||
| Bibliography | 877 | ||
| 94 Radiology and Other Imaging-Related Organizations | 878 | ||
| 1. What is the Radiological Society of North America (RSNA)? | 878 | ||
| 2. What is the American Roentgen Ray Society (ARRS)? | 878 | ||
| 3. What is the Association of University Radiologists (AUR)? | 878 | ||
| 4. What is the Society of Nuclear Medicine and Molecular Imaging (SNMMI)? | 878 | ||
| 5. What is the American Board of Radiology (ABR)? | 878 | ||
| 6. What is the American College of Radiology (ACR)? | 878 | ||
| 7. What is the Accreditation Council for Graduate Medical Education (ACGME)? | 878 | ||
| 8. What are the major organizations and societies in radiology? | 878 | ||
| 9. What are the leading academic journals in radiology? | 880 | ||
| 10. What is the National Institute of Biomedical Imaging and Bioengineering (NIBIB)? | 880 | ||
| Index | 881 | ||
| A | 881 | ||
| B | 883 | ||
| C | 885 | ||
| D | 888 | ||
| E | 889 | ||
| F | 890 | ||
| G | 891 | ||
| H | 892 | ||
| I | 894 | ||
| J | 895 | ||
| K | 895 | ||
| L | 895 | ||
| M | 896 | ||
| N | 899 | ||
| O | 899 | ||
| P | 900 | ||
| Q | 903 | ||
| R | 903 | ||
| S | 905 | ||
| T | 907 | ||
| U | 909 | ||
| V | 910 | ||
| W | 910 | ||
| X | 911 | ||
| Y | 911 | ||
| Z | 911 | ||
| IBC-Clinical Key Ad | IBC1 | ||
| IFC- Expert consult pin page | IFC2 |