Pub Date : 2024-01-15DOI: 10.1097/01.CDR.0001004620.57397.33
Adrian QingYu Xu, Ken Nakanote, Siddhi Hegde, Sarah Bastawrous, Alex Chan, Jennifer S. Weaver, Jonathan Revels, Sherry S. Wang
Acute mesenteric ischemia is frequently a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcome. The small and large bowels are supplied by the celiac trunk, superior mesenteric artery, and inferior mesenteric artery with watershed zones at the splenic flexure (Griffith's point) and rectosigmoid junction (Sudeck's point). Important bowel collateral circulation is the superior-inferior pancreaticoduodenal anastomosis, marginal artery of Drummond, and arc of Riolan. The most common cause of acute mesenteric ischemia is arterial embolism or thrombosis with less common causes being veno-occlusive and other nonocclusive causes. CT angiography evaluation is the first-line modality with high sensitivity and specificity for identifying acute mesenteric ischemia. Dual-energy CT is an emerging modality, which may be helpful in subtle cases.
{"title":"Acute Mesenteric Ischemia: Anatomy, Imaging Techniques, and Pathophysiology","authors":"Adrian QingYu Xu, Ken Nakanote, Siddhi Hegde, Sarah Bastawrous, Alex Chan, Jennifer S. Weaver, Jonathan Revels, Sherry S. Wang","doi":"10.1097/01.CDR.0001004620.57397.33","DOIUrl":"https://doi.org/10.1097/01.CDR.0001004620.57397.33","url":null,"abstract":"Acute mesenteric ischemia is frequently a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcome. The small and large bowels are supplied by the celiac trunk, superior mesenteric artery, and inferior mesenteric artery with watershed zones at the splenic flexure (Griffith's point) and rectosigmoid junction (Sudeck's point). Important bowel collateral circulation is the superior-inferior pancreaticoduodenal anastomosis, marginal artery of Drummond, and arc of Riolan. The most common cause of acute mesenteric ischemia is arterial embolism or thrombosis with less common causes being veno-occlusive and other nonocclusive causes. CT angiography evaluation is the first-line modality with high sensitivity and specificity for identifying acute mesenteric ischemia. Dual-energy CT is an emerging modality, which may be helpful in subtle cases.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"43 7","pages":"1 - 7"},"PeriodicalIF":0.1,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139437116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1097/01.CDR.0000997396.64455.48
Kellie Patterson, Sarah Byun, John Hines
Placenta accreta spectrum (PAS) refers to a range of abnormally adhesive and penetrative placental tissues in the myometrium. It is critical to diagnose PAS before delivery, as maternal morbidity/mortality can occur due to life-threatening hemorrhage. Ultrasound has traditionally been the first-line imaging modality for the diagnosis of PAS; however MRI is a useful supplemental modality in the workup and is a valuable tool in cases where ultrasound is limited or equivocal. It is also indicated in further assessment of PAS in cases with a positive ultrasound diagnosis. There are three main categories of MRI findings of PAS, all of which involve disruption of the normal anatomic appearance of the placenta/myometrium and include gross morphologic signs (placental bulge, bladder wall interruption, exophytic mass, rolled-up placental edge, and placental protrusion into the cervix), interface signs (myometrial thinning, loss of T2 hypointense interface, abnormal vascularization of the placental bed, and placental infarction), and architecture signs (T2 dark bands, abnormal intraplacental vascularity, and placental heterogeneity). It is important for radiologists to be aware of these signs, and potential MRI imaging pitfalls to avoid false diagnosis. Numerous studies are currently being conducted to improve the diagnosis of PAS on imaging, including investigations looking at dynamic contrast gadolinium enhancement and machine learning.
胎盘早剥谱（PAS）是指子宫肌层中一系列异常粘连和穿透的胎盘组织。在分娩前诊断出 PAS 至关重要，因为产妇可能因大出血而发病或死亡，危及生命。传统上，超声波是诊断 PAS 的一线影像学检查方式；然而，核磁共振成像是一种有用的辅助检查方式，在超声波检查受限或不明确的情况下是一种有价值的工具。在超声诊断阳性的病例中，磁共振成像也可用于进一步评估 PAS。PAS 的核磁共振检查结果主要有三类，均涉及胎盘/子宫肌层正常解剖外观的破坏，包括大体形态学征象（胎盘隆起、膀胱壁中断、外生性肿块、胎盘边缘卷起、和胎盘突入宫颈）、界面征象（子宫肌层变薄、T2 低密度界面消失、胎盘床血管异常和胎盘梗死）和结构征象（T2 暗带、胎盘内血管异常和胎盘异质性）。放射科医生必须了解这些征象以及潜在的磁共振成像陷阱，以避免误诊。目前正在进行大量研究，以改进影像学对 PAS 的诊断，包括研究动态对比钆增强和机器学习。
{"title":"Placenta Accreta Spectrum on MRI","authors":"Kellie Patterson, Sarah Byun, John Hines","doi":"10.1097/01.CDR.0000997396.64455.48","DOIUrl":"https://doi.org/10.1097/01.CDR.0000997396.64455.48","url":null,"abstract":"Placenta accreta spectrum (PAS) refers to a range of abnormally adhesive and penetrative placental tissues in the myometrium. It is critical to diagnose PAS before delivery, as maternal morbidity/mortality can occur due to life-threatening hemorrhage. Ultrasound has traditionally been the first-line imaging modality for the diagnosis of PAS; however MRI is a useful supplemental modality in the workup and is a valuable tool in cases where ultrasound is limited or equivocal. It is also indicated in further assessment of PAS in cases with a positive ultrasound diagnosis. There are three main categories of MRI findings of PAS, all of which involve disruption of the normal anatomic appearance of the placenta/myometrium and include gross morphologic signs (placental bulge, bladder wall interruption, exophytic mass, rolled-up placental edge, and placental protrusion into the cervix), interface signs (myometrial thinning, loss of T2 hypointense interface, abnormal vascularization of the placental bed, and placental infarction), and architecture signs (T2 dark bands, abnormal intraplacental vascularity, and placental heterogeneity). It is important for radiologists to be aware of these signs, and potential MRI imaging pitfalls to avoid false diagnosis. Numerous studies are currently being conducted to improve the diagnosis of PAS on imaging, including investigations looking at dynamic contrast gadolinium enhancement and machine learning.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"35 27","pages":"1 - 5"},"PeriodicalIF":0.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139125703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.1097/01.CDR.0000996984.01005.41
Nicholaus Monsma, Rebecca Le, Robert Brooks, Evan Basha, Garrett Schneider
Sacral insufficiency fractures are an overlooked etiology of back pain that can also be difficult to diagnose radiographically. Advanced imaging, including MR and scintigraphy, are useful modalities for diagnosis, as these fractures are frequently missed on plain films. Management is often conservative to avoid surgical fixation, a rarely performed surgery due to its high morbidity. Radiologists are also able to provide symptomatic relief via sacroplasty, a minimally invasive, percutaneous, image-guided procedure first described in 2002. The most common sites of pelvic insufficiency fractures include the sacral ala and parasymphyseal region of the os pubis. The butterfly or “H-shaped” pattern is a classic sign of this fracture on scintigraphy, best appreciated posteriorly. MR is considered the gold standard in diagnosing insufficiency fractures and is characterized by low T1 band-like signal intensity with corresponding high T2/T2 short-tau inversion recovery (STIR) signal intensity. Such fractures can be treated via sacroplasty by carefully injecting polymethylmethacrylate bone cement via one or more trocar needles. Knowledge of sacral anatomy is critical during the procedure to not violate specific sacral zones or traverse any of the neural foramina.
{"title":"Is Nothing Sacrum? Identification and Treatment of Sacral Insufficiency Fractures","authors":"Nicholaus Monsma, Rebecca Le, Robert Brooks, Evan Basha, Garrett Schneider","doi":"10.1097/01.CDR.0000996984.01005.41","DOIUrl":"https://doi.org/10.1097/01.CDR.0000996984.01005.41","url":null,"abstract":"Sacral insufficiency fractures are an overlooked etiology of back pain that can also be difficult to diagnose radiographically. Advanced imaging, including MR and scintigraphy, are useful modalities for diagnosis, as these fractures are frequently missed on plain films. Management is often conservative to avoid surgical fixation, a rarely performed surgery due to its high morbidity. Radiologists are also able to provide symptomatic relief via sacroplasty, a minimally invasive, percutaneous, image-guided procedure first described in 2002. The most common sites of pelvic insufficiency fractures include the sacral ala and parasymphyseal region of the os pubis. The butterfly or “H-shaped” pattern is a classic sign of this fracture on scintigraphy, best appreciated posteriorly. MR is considered the gold standard in diagnosing insufficiency fractures and is characterized by low T1 band-like signal intensity with corresponding high T2/T2 short-tau inversion recovery (STIR) signal intensity. Such fractures can be treated via sacroplasty by carefully injecting polymethylmethacrylate bone cement via one or more trocar needles. Knowledge of sacral anatomy is critical during the procedure to not violate specific sacral zones or traverse any of the neural foramina.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"117 10","pages":"1 - 5"},"PeriodicalIF":0.1,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1097/01.CDR.0000992912.08184.35
Valerie George, Mohammed Ismail, Luke Tilmans, Amna Ajam, Xuan Nguyen
Magnetic resonance neurography (MRN) is increasingly used for the evaluation of lumbosacral plexopathy and peripheral neuropathy.1 Although clinical evaluation and electroclinical studies are helpful in evaluating function, they are limited in their ability to characterize the underlying pathology. Electromyography is very sensitive for nerve injury but lacks specificity and cannot depict the level of anatomic detail often needed to localize the nerve lesion and for treatment planning.1 Furthermore, conventional imaging studies, such as MRI or CT, have a role in evaluating extrinsic structural abnormalities that may compress the nerves, such as retroperitoneal hematomas or pelvic abscesses, but are unable to adequately depict the lumbosacral plexus and peripheral nerves due to limited imaging contrast between neural tissue and adjacent soft tissues.2 With advances in MR technology and acquisition technique, MRN has become a frequently requested advanced imaging modality for the detection of lumbosacral plexopathy and muscles and nonneural structures in the lumbar spine and pelvis.1,3
{"title":"Review of Lumbosacral MR Neurography","authors":"Valerie George, Mohammed Ismail, Luke Tilmans, Amna Ajam, Xuan Nguyen","doi":"10.1097/01.CDR.0000992912.08184.35","DOIUrl":"https://doi.org/10.1097/01.CDR.0000992912.08184.35","url":null,"abstract":"Magnetic resonance neurography (MRN) is increasingly used for the evaluation of lumbosacral plexopathy and peripheral neuropathy.1 Although clinical evaluation and electroclinical studies are helpful in evaluating function, they are limited in their ability to characterize the underlying pathology. Electromyography is very sensitive for nerve injury but lacks specificity and cannot depict the level of anatomic detail often needed to localize the nerve lesion and for treatment planning.1 Furthermore, conventional imaging studies, such as MRI or CT, have a role in evaluating extrinsic structural abnormalities that may compress the nerves, such as retroperitoneal hematomas or pelvic abscesses, but are unable to adequately depict the lumbosacral plexus and peripheral nerves due to limited imaging contrast between neural tissue and adjacent soft tissues.2 With advances in MR technology and acquisition technique, MRN has become a frequently requested advanced imaging modality for the detection of lumbosacral plexopathy and muscles and nonneural structures in the lumbar spine and pelvis.1,3","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"39 3","pages":"1 - 8"},"PeriodicalIF":0.1,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-15DOI: 10.1097/01.cdr.0000991720.49719.0e
Aby Thomas
Many renal lesions in the pediatric age group might mimic a renal neoplasm on imaging but may be proven on biopsy to be a wrong radiologic diagnosis. This describes the pseudotumors that a pediatric radiologist needs to remember and lesions with similar imaging characteristics.
{"title":"Pediatric Renal Pseudotumors: A Pictorial Review","authors":"Aby Thomas","doi":"10.1097/01.cdr.0000991720.49719.0e","DOIUrl":"https://doi.org/10.1097/01.cdr.0000991720.49719.0e","url":null,"abstract":"Many renal lesions in the pediatric age group might mimic a renal neoplasm on imaging but may be proven on biopsy to be a wrong radiologic diagnosis. This describes the pseudotumors that a pediatric radiologist needs to remember and lesions with similar imaging characteristics.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"16 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136227108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-31DOI: 10.1097/01.cdr.0000990064.84915.68
Samar Naamo, Katherine Chung, Sahil Rawal, Mutshipay Mpoy, Pablo R. Ros
The imaging features of focal pancreatic lesions have been extensively investigated in medical literature. However, given the range of pancreatic solid and cystic masses, determining the appropriate course of management can be challenging. Our purpose is to describe classic imaging findings of solid and cystic pancreatic lesions, review their clinical features, discuss the latest management recommendations, and avoid pitfalls considering lesion mimickers.
{"title":"Marbles and Bubbles of the Pancreas: Imaging and Management of Pancreatic Solid and Cystic Lesions","authors":"Samar Naamo, Katherine Chung, Sahil Rawal, Mutshipay Mpoy, Pablo R. Ros","doi":"10.1097/01.cdr.0000990064.84915.68","DOIUrl":"https://doi.org/10.1097/01.cdr.0000990064.84915.68","url":null,"abstract":"The imaging features of focal pancreatic lesions have been extensively investigated in medical literature. However, given the range of pancreatic solid and cystic masses, determining the appropriate course of management can be challenging. Our purpose is to describe classic imaging findings of solid and cystic pancreatic lesions, review their clinical features, discuss the latest management recommendations, and avoid pitfalls considering lesion mimickers.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"364 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135765194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Marbles and Bubbles of the Pancreas: Imaging and Management of Pancreatic Solid and Cystic Lesions","authors":"","doi":"10.1097/01.cdr.0000990068.88603.e4","DOIUrl":"https://doi.org/10.1097/01.cdr.0000990068.88603.e4","url":null,"abstract":"Contemporary Diagnostic Radiology 46(22):p 8, October 31, 2023. | DOI: 10.1097/01.CDR.0000990068.88603.e4","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"364 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135765195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-15DOI: 10.1097/01.cdr.0000978784.77050.63
Kenneth N. Huynh, Min Kong, Harris Liou, Ba D. Nguyen
Prostate cancer imaging has evolved significantly with the introduction of 18 F DCFPyL positron emission tomography/computed tomography (PET/CT), a novel radiotracer targeting the prostate-specific membrane antigen (PSMA). This promising imaging modality has demonstrated superior sensitivity and specificity for detecting local, regional, and distant recurrences compared with conventional imaging modalities. This article aims to provide a comprehensive overview of the practical interpretation of 18 F DCFPyL PET/CT in the management of prostate cancer, including its advantages, potential pitfalls, and comparison to other imaging techniques. Through a better understanding of 18 F DCFPyL PET/CT, clinicians can more effectively incorporate this advanced imaging tool into routine clinical practice, ultimately optimizing prostate cancer diagnosis, staging, and management.
{"title":"Practical Interpretation of 18F PSMA PET/CT: Spectrum of Findings","authors":"Kenneth N. Huynh, Min Kong, Harris Liou, Ba D. Nguyen","doi":"10.1097/01.cdr.0000978784.77050.63","DOIUrl":"https://doi.org/10.1097/01.cdr.0000978784.77050.63","url":null,"abstract":"Prostate cancer imaging has evolved significantly with the introduction of 18 F DCFPyL positron emission tomography/computed tomography (PET/CT), a novel radiotracer targeting the prostate-specific membrane antigen (PSMA). This promising imaging modality has demonstrated superior sensitivity and specificity for detecting local, regional, and distant recurrences compared with conventional imaging modalities. This article aims to provide a comprehensive overview of the practical interpretation of 18 F DCFPyL PET/CT in the management of prostate cancer, including its advantages, potential pitfalls, and comparison to other imaging techniques. Through a better understanding of 18 F DCFPyL PET/CT, clinicians can more effectively incorporate this advanced imaging tool into routine clinical practice, ultimately optimizing prostate cancer diagnosis, staging, and management.","PeriodicalId":29694,"journal":{"name":"Contemporary Diagnostic Radiology","volume":"173 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136183149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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