Diseases of the abdomen and Pelvis 2010-2013 (eBook)

Title Page 2
Copyright Page 3
Preface 4
Table of Contents 5
List of Contributors 8
WORKSHOPS 9
Emergency Radiology of the Abdomen: The Acute Abdomen 10
Introduction 10
Imaging Techniques 10
Acute Pain in an Abdominal Quadrant 11
Right Upper Quadrant 11
Left Upper Quadrant 12
Right Lower Quadrant 12
Left Lower Quadrant 13
Gynecological Disorders 14
Acute Abdomen with Diffuse Pain 15
Bowel Obstruction 15
Ischemic Bowel Disease 16
Perforation of the Gastrointestinal Tract 17
Acute Abdomen with Flank or Epigastric Pain 17
Urinary Colic 17
Acute Pancreatitis 18
Leaking Abdominal Aortic Aneurysm 19
Conclusions 19
Suggested Reading 20
Trauma of the Abdomen and Pelvis 21
Introduction 21
Computed Tomography vs. Ultrasound 21
Urinary Tract 21
Bowel and Mesenteric Injuries 25
Splenic Injuries 25
Hepatic Injuries 26
Adrenal Injuries 27
Pancreatic and Duodenal Injuries 27
References 28
Diseases of the Esophagus and Stomach 29
Introduction 29
Gastroesophageal Reflux Disease 29
Infectious Esophagitis 29
Drug-Induced Esophagitis 29
Idiopathic Eosinophilic Esophagitis 30
Esophageal Carcinoma 30
Erosive Gastritis 30
Helicobacter Pylori Gastritis 30
Gastric Ulcers 31
Gastric Carcinoma 31
Gastric Lymphoma 31
Gastrointestinal Stromal Tumors 32
References 33
Small-Bowel Imaging: Pitfalls in Computed Tomography Enterography/Enteroclysis 35
Computed Tomography Enterography 35
Pitfalls of Computed Tomography Enterography 35
General 35
Crohn’s Disease 35
Obscure Gastrointestinal Bleeding 36
Neoplasms 36
Computed Tomography Enteroclysis 36
Pitfalls of Computed Tomography Enteroclysis 37
General 37
Crohn’s Disease 37
Masses 37
Obstruction 37
Summary 37
References 38
Diseases of the Small Bowel, Including the Duodenum – MRI 39
Introduction 39
The Duodenum 39
Neoplasms of the Duodenum 39
The Small Intestine 40
Inflammatory Bowel Disease 40
Crohn’s Disease: Acute Inflammatory Type 40
Crohn’s Disease: Fibrostenosing Type 40
Crohn’s Disease: Fistulizing Type 41
Differential Diagnosis of Crohn’s Disease 41
Small Bowel Neoplasms 42
Neuroendocrine Tumors: Carcinoid 42
Gastrointestinal Stromal Tumors 42
Other Small Bowel Pathologies 42
References 43
Imaging of the Colon and Rectum: Inflammatory and Infectious Diseases 44
Introduction 44
Ulcerative Colitis 44
Crohn’s Disease 45
Pseudomembranous Colitis 47
AIDS-Related Colitis 47
Typhlitis 48
Graft-Versus-Host Disease 48
Differential Diagnosis of the Colitides 48
Appendicitis 48
Diverticulitis 50
Epiploic Appendagitis 50
Acute Abdominal Pain 51
Perianal Fistulas 51
References 53
CT Colonography: Updated 55
References 56
Imaging of Diffuse and Inflammatory Liver Diseases 57
Introduction 57
Fibrous Tissue Deposition (Cirrhosis) 57
Background 57
Regenerative Nodules 57
Confluent Hepatic Fibrosis 57
Hepatic Morphology in Cirrhosis 58
Portal Hypertension 58
Ancillary Findings in Cirrhosis 59
Vascular Disorders 59
Arterial-Portal Shunts 59
Perfusion Abnormalities 59
Portal Vein Thrombosis 60
Budd-Chiari Syndrome 60
Passive Hepatic Congestion 61
Macro-regenerative Nodules 61
Hepatic Veno-occlusive Disease 62
Peliosis Hepatis 62
Hepatic Infarction 62
Metabolic and Storage Diseases 62
Steatosis 62
Iron Overload 62
Primary Hemochromatosis 63
Hemosiderosis 63
Wilson’s Disease 63
Amyloidosis 64
Neoplastic Diseases 64
Metastatic Disease 64
Lymphoma 64
Diffuse Infectious and Inflammatory Diseases 64
Fungal Infections 64
Candidiasis 64
Granulomatous Diseases 65
Sarcoidosis 65
Tuberculosis 65
Histoplasmosis 65
Parasitic Infections 65
Schistosomiasis 65
Viral Infections 66
Viral Hepatitis 66
HIV Infection 66
Uncommon Hepatic Infections 66
Cat-scratch Disease 66
Bacillary Angiomatosis 66
Focal Infections 66
Bacterial (Pyogenic) Abscess 66
Amebic Abscess 67
Echinococcal Disease 67
Suggested Reading 68
General 68
Fibrous Tissue Deposition (Cirrhosis) 68
Vascular Disorders 68
Metabolic and Storage Diseases 69
Infectious Diseases 69
Focal Liver Lesions 70
Introduction 70
MDCT Imaging Techniques 70
Magnetic Resonance Imaging Technique 70
Benign Hepatic Lesions 71
Cyst 71
Hemangioma 71
Focal Nodular Hyperplasia 72
Hepatocellular Adenoma 73
Biliary Hamartomas (von Meyenburg Complex) 73
Hepatic Abscess and Hydatid Cyst 73
Malignant Primary Tumors 75
Hepatocellular Carcinoma 75
Fibrolamellar HCC 77
Cholangiocellular Carcinoma 77
Rare Primary Liver Tumors 78
Biliary cystadenoma/cystadenocarcinomas 78
Hepatic Angiosarcoma 78
Epithelioid Hemangioendothelioma 79
Hepatic Lymphoma 79
Hepatic Metastases 79
Differential Diagnosis of Focal Liver Lesions 80
References 80
Imaging Diseases of the Gallbladder and Bile Ducts 82
Introduction 82
Functional Magnetic Resonance Imaging of the Bile Ducts 82
Technique, Indications, Results 82
T2-weighted imaging 82
Contrast-Enhanced Functional MRC 82
Conclusion 84
Patterned Approach to the Diagnosis of Gallbladder and Bile-Duct Diseases 84
Gallbladder Wall Thickening 84
Gallbladder Polypoid Mass 84
Cystic Dilatation of the Extrahepatic Bile Duct 85
Cystic Dilatation of Intrahepatic Bile Ducts 85
Biliary Stricture 86
Conclusions 86
Suggested Reading 87
Functional MR imaging of the bile duct 87
Patterned Approach to the Diagnosis of Gallbladder and Bile Duct Diseases 87
Diseases of the Pancreas, I: Pancreatitis 88
Introduction 88
Acute Pancreatitis 88
Complications 91
Groove Pancreatitis 91
Autoimmune Pancreatitis 92
Chronic Pancreatitis 92
Complications 92
Diagnostic Challenge 92
Pancreatitis in Children 94
References 94
Diseases of the Pancreas, II: Tumors 96
Introduction 96
Ductal Adenocarcinoma of the Pancreas 96
Neuroendocrine Neoplasms of the Pancreas 98
Hyperfunctioning Neuroendocrine Neoplasms 98
Non-hyperfunctioning Neuroendocrine Neoplasms 99
Cystic Neoplasms of the Pancreas 99
Serous and Mucinous Cystic Neoplasms of the Pancreas 99
Intraductal Papillary Mucinous Neoplasm of the Pancreas 100
Solid Pseudopapillary Epithelial Neoplasm of the Pancreas 100
Follow-Up for Cystic Neoplasms of the Pancreas 101
References 101
Adrenal Imaging and Intervention 103
Introduction 103
Detection of Biochemically Active Adrenal Tumor 103
Staging Patients with Known Carcinoma 104
Evaluation of an Incidentally Discovered Adrenal Mass 104
References 105
Renal Tumors 106
Introduction 106
Ultrasonography 106
CT and MRI Techniques 106
Small Renal Masses 106
Cystic Renal Masses 106
Angiomyolipomas 107
Differentiating Non-Fat-Containing Renal Tumors 107
Differentiating Benign from Malignant Renal Neoplasms 107
Differentiating among Renal Cancer Subtypes 108
Pre-operative Imaging and Treatment of Renal Cancers 108
Imaging after Renal Mass Treatment 109
References 109
Urinary Tract Obstruction and Infection 111
Urinary Tract Obstruction 111
Urinary Tract Infection 113
Acute Pyelonephritis 113
Emphysematous Pyelonephritis 114
Granulomatous Renal Infections 114
AIDS Nephropathy 114
BK Virus Nephropathy 114
Pyonephrosis 115
Schistosomiasis 115
Post-therapeutic Changes 115
References 115
Benign Diseases of the Female Genital Tract 117
Introduction 117
Anatomy of the Female Genital Organs 117
Magnetic Resonance Imaging Technique 118
Congenital Uterine Anomalies 118
Benign Conditions of the Vagina, Cervix, and Uterus 120
Non-neoplastic Ovarian/Adnexal Masses 122
Neoplastic Ovarian Masses 123
Magnetic Resonance Imaging in Obstetrics 124
References 124
Malignant Diseases of the Female Genital Tract 126
Introduction 126
Ultrasound 126
Magnetic Resonance Imaging 126
Patient Preparation, Positioning, and Coil Selection 126
Choice of Sequences and Imaging Planes 126
Computed Tomography 127
Positron Emission Tomography/Computed Tomography 127
Endometrial Carcinoma 127
Cervical Carcinoma 128
Ovarian Carcinoma 129
References 130
Magnetic Resonance Imaging of Prostate Cancer 132
Introduction 132
Magnetic Resonance Imaging: Anatomy 132
Magnetic Resonance Techniques and Their Role in Detection and Localization 133
T2-Weighted Imaging 133
Diffusion-Weighted Imaging 134
Dynamic Contrast-Enhanced MRI 135
1H Magnetic Resonance Spectroscopic Imaging 135
MRI-Guided Biopsies 136
Prediction of Prostate Cancer Aggressiveness 137
Local (T) Staging 137
Metastatic Disease (NM Staging) 138
Nodes 138
Bone 139
Recurrence 140
Protocols 141
Detection, Localization, Recurrence 141
Staging 141
Nodes and Bone 142
Interpretation, Structured Reporting 142
Conclusion 143
Take-Home Messages 144
Acknowledgements 144
Suggested Reading 144
Anatomy 144
Prostate Cancer 144
References 144
Imaging of the Male Pelvis: The Scrotum 149
Introduction 149
Intratesticular Disorders 149
Neoplastic 149
Non-neoplastic 151
Extratesticular Disorders 151
Neoplastic 151
References 152
Spread of Metastatic Disease in the Abdomen and Pelvis 153
Introduction 153
Metastatic Spread via the Peritoneal Ligaments 154
Gastrohepatic Ligament 154
Hepatoduodenal Ligament 155
Gastrosplenic and Splenorenal Ligaments 155
Gastrocolic Ligament 156
Transverse Mesocolon 156
Metastatic Spread via the Peritoneal Spaces 158
Left Peritoneal Space 158
Right Peritoneal Space 159
References 159
Abdominal Vascular Disease: Diagnosis and Therapy 161
Acute Arterial Occlusion 161
Embolization 161
Dissection 161
Chronic Arterial Occlusive Disease 161
Mesenteric Artery Stenosis 162
Renal Artery Stenosis 163
Aneurysms 164
Abdominal Aortic Aneurysm 164
Indications 164
Stent Graft Designs 165
Imaging before Stent Graft Implantation 165
Complications 165
Visceral Artery Aneurysm 165
Renal Artery Aneurysm 165
Therapeutic Embolization of Gastrointestinal Bleeding 166
Treatment for Bleeding Complications after Surgery, Trauma, and Post-partum 166
Therapeutic Embolization of Tumors 167
Venous Interventions 167
TIPS 167
Embolization of the Portal Veins 168
Suggested Reading 168
Non-vascular Abdominal Disease: Diagnosis and Therapy 169
Introduction 169
Hepatocellular Carcinoma: Pathology 169
Pre-neoplastic Lesions: Regeneration 169
Pre-neoplastic Lesions: Dysplasia 170
Hepatocellular Carcinoma: Imaging Findings 171
Therapy and Follow-up 172
Conclusions 172
References 173
An Approach to Imaging the Acute Abdomen in the Pediatric Population 174
Introduction 174
Causes of Acute Abdomen 174
Modalities 174
Acute Appendicitis 175
Malrotation 176
Intussusception 176
Ileocolic and Ileo-ileocolic Intussusceptions 176
Diagnosis 176
Reduction 177
Pathological Lead Points 177
Postoperative Intussusception and Intussusception with Gastroenterostomy Tubes 177
Necrotizing Enterocolitis 177
Meckel Diverticulum 178
Congenital Bowel Obstruction in the Neonate 178
Suggested Reading 179
Imaging Uronephropathies in Children 181
Introduction and Techniques 181
Key Point 181
Management of In Utero Renal Pelvis Dilatation 181
Definition 181
Findings on Obstetric US 181
Postnatal Management of Fetal Pelvis Dilatation 182
Key Points 182
Imaging Cystic Kidneys in Children 182
Introduction 182
Cystic Kidneys in the Fetus 183
Renal Cystic Diseases in Children 183
Key Points 183
Renal Ectopia and Duplications 183
Key Points 184
Urinary Tract Obstruction 184
Key Points 184
Voiding Abnormalities and Secondary Vesicoureteric Reflux 184
Key Points 185
Renal Masses in Children 185
Key Points 185
Imaging Renal Failure in Children 185
Introduction 185
Sonographic Technique 185
Acute Renal Failure 186
Hemolytic Uremic Syndrome 186
Medullary or Cortical Necrosis, Shock Kidneys 186
Renal Vein Thrombosis 186
Obstructive Uropathies 186
Chronic Renal Failure 186
Renal Cystic Diseases (see above) 186
Congenital Nephrotic Syndromes 186
Syndromes Affecting the Tubules and Metabolic Diseases 186
Key Points 186
Urinary Tract Infection 186
Introduction 186
Imaging Acute Pyelonephritis 186
Proposed Work-Up 187
Complications of Acute Pyelonephritis 187
Late Complications of UT Infection 187
Key Points 187
Imaging Urolithiasis in Children 187
Introduction 187
Imaging 187
Treatment 188
Key Points 188
References 188
Integrated Imaging in Genitourinary Oncology: PET/CT Imaging 190
Introduction 190
Prostate Cancer 190
Testicular Cancer 192
Ovarian Cancer 194
Cervical Cancer 194
Endometrial Cancer 195
References 195
Integrated Imaging in Gastrointestinal Oncology: PET/CT Imaging 197
Introduction 197
Malignant Primary Liver Tumors 197
Hepatocellular Carcinoma 197
Cholangiocarcinoma 197
Pancreas 198
Exocrine Pancreatic Carcinoma 198
Endocrine Pancreatic Cancer 199
Colorectal Carcinoma 199
Initial Staging 199
Recurrent Disease 200
Stomach and Small Bowel 201
Gastric Cancer 201
Small Bowel 201
Conclusions 201
References 201
NUCLEAR MEDICINE SATELLITE COURSE “DIAMOND” 203
Lymphoma: Diagnostic and Therapeutic Applications of Radiopharmaceuticals 204
Introduction 204
Particularities of Abdominal Lymphoma 204
Indications of FDG-PET/CT 205
Response Assessment 205
IHP Criteria of Visual FDG-PET Interpretation 206
Pitfalls in Interpretation 207
Radioimmunotherapy of Lymphomas 207
Conclusions 208
References 208
Conventional Nuclear Medicine in the Evaluation of Gastrointestinal and Genitourinary Tract Disorders 210
Introduction 210
Gastrointestinal Tract 210
Salivary Glands 210
Esophageal Transit 210
Gastroesophageal Reflux Disease 211
Gastric Emptying Scintigraphy 211
Gastrointestinal Bleeding 211
Meckel’s Diverticulum and Heterotopic Gastric Mucosa 212
Protein-Losing Enteropathy 213
Hepatobiliary Scintigraphy 213
Urinary Tract 215
Urinary Tract Dilation 215
Urinary Tract Infection and Vesicoureteric Reflux 216
Acute Renal Failure 216
Renovascular Hypertension 217
Renal Transplantation 217
Live Kidney Donor 217
Evaluation of the Renal Graft 217
References 219
PET in Hepatobiliary-Pancreatic Tumors 220
Overview 220
Current Role of Imaging 220
Positron Emission Tomography 220
Role of FDG-PET in Liver Cancer 221
Role of Acetate PET in Liver Cancer 221
Role of PET with Other Tracers in Liver Cancer 221
Role of FDG-PET in Pancreatic Cancer 221
Suggested Reading 223
PET in Tumors of the Digestive Tract 224
Introduction 224
Esophagus, Stomach, and Small Bowel 224
Esophagus 224
Stomach: Malignant Disease 225
Small Bowel: Malignant Disease 226
Gastrointestinal Stromal Tumors 226
Colorectal Carcinoma 226
Initial Staging 226
Recurrent Disease 227
Therapy Response Assessment 228
Conclusions 229
References 229
Tumors of the Adrenergic System: Imaging and Therapy 231
Targeting of Neuroendocrine Tumors 231
Techniques 231
Diagnostic Imaging 232
Pheochromocytoma 232
Neuroblastoma 232
Carcinoid Tumors 232
Other Neuroendocrine Tumors 232
Rationale for Using MIBG and Somatostatin-Receptor Imaging Procedures 233
Radionuclide Therapy 233
Indications/Contraindications for Therapy 233
Malignant Pheochromocytoma and Paraganglioma 233
Neuroblastoma 234
Medullary Thyroid Carcinoma 234
Carcinoid Tumors 234
References 235
Neuroendocrine Tumors of the Abdomen: Imaging and Therapy 236
Introduction 236
Somatostatin-Receptor-Based Radionuclide Imaging 236
[111In-DTPA0]Octreotide Scintigraphy: Normal Scintigraphic Findings and Artifacts 236
Imaging Results of [111In-DTPA0]Octreotide Scintigraphy in Neuroendocrine and Other Tumors 237
Newer Ligands for Somatostatin Receptor Imaging 237
Somatostatin-Receptor-Based Radionuclide Therapy 238
Comparison of Survival Data 240
Timing of Treatment 240
Conclusions 240
References 240
PEDIATRIC SATELLITE COURSE “KANGAROO” 242
Imaging Cystic Kidneys in Children 243
Introduction 243
Cystic Renal Diseases in the Fetus and in the Perinatal Period 243
Hyperechoic Kidneys in the Perinatal Period 243
Sonographic Criteria 243
Differential Diagnosis 244
Renal Cyst(s) Discovered in the Perinatal Period 244
Cystic Renal Diseases in Childhood 245
Conclusions 245
References 245
Understanding Duplication Anomalies of the Kidney 247
Introduction 247
Embryology 247
Conclusions 250
References 250
Malrotation: Techniques, Spectrum of Appearances, Pitfalls, and Management 251
Introduction 251
Embryology 251
Causes of Symptoms 251
Imaging Modalities 252
Conclusions 255
References 255
Pediatric Intestinal Ultrasonography 256
Introduction 256
Gastroesophageal Junction 257
Stomach 257
Small Bowel 258
Large Bowel 259
Rectum 259
Anus 259
Cystic Intestinal Masses 260
Solid Intestinal Masses 262
Neonatal Bowel Obstruction 263
Conclusions 264
References 264