Grainger & Allison's Diagnostic Radiology Essentials

After qualifying in medicine in 1996 Dr Grant completed basic surgical training at the Queens Medical Centre in Nottingham prior to working for Pfizer Pharmaceuticals for four years until entry back into specialist training within the NHS. Upon completing his radiology training at Addenbrookes Hospital, including a specialist year at the Royal Marsden Hospital, he was appointed as a consultant radiologist at the Royal Free Hospital in 2010. His areas of sub specialisation include hepatobiliary imaging as well as urological imaging. He is a core member of the hepatobiliary and urological MDT lead radiologist for research activities within the radiology department and co-lead radiologist for cancers of the GU system. Dr Nyree Griffin graduated from the University of Bristol Medical School in 1995 as the Gold Medallist in her year. She was awarded a Doctorate of Medicine (MD) in 2006 from the University of Nottingham for research into the role of phoshodiesterase inhibitors in anal sphincter function. Nyree undertook higher specialist training in radiology at Chelsea and Westminster Hospital between 2002 and 2006. She subsequently completed a one-year cross sectional fellowship at Addenbrooke's Hospital in Cambridge. She was appointed as the lead consultant gastrointestinal radiologist at Guy's and St Thomas' in 2008. Since then she has developed a well-established and high-quality gastrointestinal radiology service.

CONTENTS

Preface xi

Dedication 1

Acknowledgements 1

1 Chest

1.1 Chest wall and pleura 4

Chest wall: bony and soft tissue lesions 4

Diseases of the pleura 8

Pleural effusion 12

Pneumothorax 14

Diaphragmatic hernia/eventration 16

1.2 Mediastinum 18

Mediastinitis 18

Anterior mediastinal masses 20

Middle mediastinal masses 26

Posterior mediastinal masses 32

Miscellaneous mediastinal masses 34

Pericardial conditions 36

1.3 Pulmonary infection 38

Lobar pneumonia 38

Bronchopneumonia, anaerobic and atypical pneumonia 40

Pulmonary tuberculosis 42

Fungal infections 44

Metazoal and protozoal diseases 48

Pulmonary complications of HIV infection 50

1.4 Large airway disease 52

Tracheal disorders 52

Bronchiectasis 56

Congenital airway disorders 58

Emphysema 60

Chronic bronchitis and asthma 62

Miscellaneous airway disorders 64

1.5 Pulmonary lobar collapse 66

Mechanisms and radiographic appearances 66

Patterns of lobar collapse 68

1.6 Pulmonary neoplasms 72

Evaluation of the solitary pulmonary nodule 72

Lung cancer: radiological features 74

Lung cancer: pearls 76

Lymphoproliferative disorders 78

Benign pulmonary tumours 80

Miscellaneous pulmonary malignancies 82

1.7 High-resolution computed tomography (HRCT) 84

Hrct patterns of diffuse lung disease 84

Idiopathic interstitial pneumonias 86

Sarcoidosis 90

Connective tissue diseases 92

Systemic vasculitides 98

Drug-Induced lung disease 100

Silicosis/coal workers' pneumoconiosis 102

Asbestos-related disease 104

Miscellaneous interstitial lung diseases 106

1.8 Chest trauma 110

Chest wall and lung trauma 110

Trauma to the diaphragm 112

Mediastinal trauma 114

1.9 Airspace disease 116

Airspace disease 116

1.10 Paediatric chest 122

Congenital chest abnormalities 122

Causes of neonatal respiratory distress 128

Normal paediatric chest and problems with mechanical ventilation 132

1.11 Miscellaneous itu chest conditions 134

Lung transplantation 134

Acute respiratory distress syndrome (ARDS) 136

Itu chest imaging 138

2 Cardiovascular System 143

2.1 Congenital heart disease (introduction) Introduction 144

Cyanotic congenital heart disease 146

Acyanotic congenital heart disease 156

Anomalies of the aortic arch (vascular rings) 158

Septal defects 160

Acyanotic heart disease 162

Other anomalies 164

2.2 Non-ischaemic acquired heart disease 166

Acquired mitral valve disease 166

Acquired aortic valve disease 168

Tricuspid and pulmonary valve disease 170

Cardiomyopathies 174

Cardiac tumours 178

Cardiac trauma 180

2.3 Pulmonary circulation and Gastrointestinal stromal tumours (GISTs) and thromboembolism 182

Pulmonary thromboembolic disease 182

Pulmonary vascular patterns 186

2.4 The aorta 192

Aortic rupture 192

Aortic dissection 194

Aortic aneurysms 198

Mid-aortic syndrome and takaysu's disease of the

aorta 202

Aortic occlusive disease 204

2.5 Peripheral vascular disease 210

Gastrointestinal vascular disorders 210

Carotid artery stenosis 212

Peripheral vascular disease of the lower

extremities 214

Disorders of the venous system 216

Miscellaneous vascular disorders 218

2.6 Ischaemic heart disease 220

Conventional coronary angiography and

echocardiography 220

Ct imaging in ischaemic heart disease 222

Mr imaging in ischaemic heart disease 224

Nuclear cardiac imaging 226

Manifestations of atheromatous coronary artery

disease 230

3 Gastrointestinal 236

3.1 Oesophagus 238

Hiatus hernia and reflux 238

Oesophagitis and benign strictures 240

Benign and malignant oesophageal tumours 242

Oesophageal carcinoma 244

Oesophageal dysmotility disorders 248

Miscellaneous oesophageal conditions 250

3.2 Stomach 252

Benign gastric ulcers 252

Gastritis 254

Benign and malignant gastric tumours 258

Gastric carcinoma 260

Gastric surgery 264

Miscellaneous gastric conditions 266

3.3 Duodenum 270

Peptic ulceration, gastric heterotopia, duodenal

diverticula 270

Benign and malignant duodenal tumours 272

Miscellaneous duodenal conditions 274

3.4 Small bowel 276

Crohn's disease (CD) 276

Infections/infestations of the small bowel 278

Gastrointestinal stromal tumours (GISTs) and

carcinoid tumours 280

Benign and malignant small bowel tumours 282

Causes of small bowel obstruction 284

Miscellaneous small bowel disorders 286

3.5 Colon 292

Ulcerative colitis and toxic megacolon 292

Colitis 294

Polyps 296

Polyposis syndromes 298

Colorectal cancer 300

Diverticulosis and large bowel strictures 304

Large bowel obstruction 306

Miscellaneous disorders of the large bowel 308

3.6 Liver 312

Anatomy and imaging techniques 312

Benign diffuse liver disease 314

Cirrhosis 316

Benign solid liver lesions 318

Malignant solid liver lesions 326

Hepatic vascular lesions 332

Miscellaneous liver conditions 338

Liver transplantation and interventional

techniques 344

Diffusion-weighted mr imaging of the liver 346

Mr contrast agents and the liver 348

3.7 Biliary 350

Methods of investigation 350

Cholelithiasis and choledocholithiasis 352

Cholecystitis 354

Miscellaneous gallbladder conditions 356

Benign biliary strictures 358

Malignant biliary tumours 360

Biliary atresia and hypoplasia 362

Miscellaneous bile duct disorders 364

3.8 Pancreas 366

Congenital abnormalities 366

Pancreatitis 368

Pancreatic ductal adenocarcinoma 372

Cystic pancreatic tumours 374

Endocrine and islet cell pancreatic tumours 376

Pancreatic trauma, transplant and intervention 378

3.9 Spleen 380

Miscellaneous splenic conditions 380

3.10 Peritoneum, mesentery and omentum 382

Benign diseases 382

Developmental anomalies of the mesentery 384

Infective/inflammatory conditions of the

mesentery 386

Neoplastic peritoneal/omental disorders 388

Neoplastic mesenteric disorders 390

3.11 Plain abdominal radiograph 392

Abnormal gas distribution 392

3.12 Paediatric gastrointestinal disorders 394

Abdominal wall defects 394

Gastrointestinal causes of neonatal vomiting 396

Oesophageal atresia (OA) and tracheo-oesophageal

fistula (TOF) 398

Malrotation 400

Delayed passage of meconium 402

Abdominal manifestations of cystic fibrosis 404

Necrotizing enterocolitis (NEC) 406

Anorectal malformations 408

Neuroblastoma (NB) 410

Miscellaneous paediatric gastrointestinal

disorders 412

4 Genitourinary 415

4.1 Kidneys 416

Renal parenchymal disease 416

Renal tract infection/inflammation 418

Renal artery stenosis (RAS) 424

Renal vascular abnormalities 426

Benign renal masses 430

Renal parenchymal malignancies 432

Other malignancies 434

Transitional cell carcinoma of the upper urinary

tract 436

Renal failure 438

Renal transplantation: assessment 440

Renal transplantation: postoperative

complications 442

Urolithiasis 444

Methods of imaging in obstruction 446

Dilatation of the urinary tract 448

Upper urinary tract trauma 450

4.2 Bladder 454

Miscellaneous bladder conditions 454

Bladder tumours 456

Lower urinary tract trauma 458

4.3 Prostate 460

Prostate: benign disorders 460

Carcinoma of the prostate 462

Prostate anatomy and imaging 464

4.4 Urethra 466

Urethra: benign disorders 466

Tumours of the urethra 468

4.5 Male reproductive system 470

Cryptorchidism and testicular torsion 470

Primary testicular malignancies 472

Miscellaneous scrotal lesions 474

Miscellaneous penile conditions 476

4.6 Paediatric genitourinary disorders 478

Duplex kidney 478

Congenital renal anomalies 480

Congenital renal cystic disease 484

Childhood renal malignancies 488

Paediatric pelvic and scrotal malignancies 492

5 Musculoskeletal System 494

5.1 Skeletal trauma 496

Introduction 496

Assessment of cervical spine injuries 498

Spinal injuries 500

Shoulder injuries 506

Upper extremity injuries 512

Carpal bone injuries 514

Wrist and hand injuries 518

Pelvic injuries 520

Hip injuries 522

Avascular necrosis of the hip 526

Knee and lower leg fractures 528

Knee soft tissue injuries 532

Ankle injuries 536

Foot injuries 538

5.2 Paediatric fractures 540

Specific paediatric fractures 540

Radiology of non-accidental injury 542

Skeletal and brain injuries in non-accidental

injury 544

5.3 Soft tissue imaging 550

Localized calcification and ossification 550

Generalized soft tissue calcification 552

Soft tissue masses 554

5.4 General characteristics of bone tumours 558

General characteristics of bone tumours 558

5.5 Benign bone tumours 560

Chondroid origin 560

Osteoid origin 564

Osteoid origin/tumours of neural tissue 566

Cystic lesions 568

Giant cell tumour/lipomatous bone lesions 570

Fibrous origin 572

Vascular origin 574

Miscellaneous bone lesions 576

5.6 Malignant bone tumours 580

Chondroid origin 580

Osteosarcoma 582

Other varieties of osteosarcoma 584

Fibrous origin 586

Medullary origin 588

Miscellaneous malignant bone tumours 590

Bone metastases 592

5.7 Metabolic and endocrine skeletal disease 594

Osteoporosis 594

Vitamin D deficiency 596

Endocrine bone disorders 598

Metabolic bone disorders 602

5.8 Joint disease 610

Introduction 610

Osteoarthritis 612

Haemophilic and neuropathic arthropathies 614

Juvenile idiopathic arthritis and dish 616

Rheumatoid arthritis 618

Seronegative spondyloarthropathy 620

Depositional arthropathy 624

Polyarthritis associated with other diseases 630

5.9 Bone and soft tissue infection 636

Acute osteomyelitis 636

Chronic osteomyelitis 638

Miscellaneous bone and soft tissue infections 642

5.10 Congenital skeletal anomalies 646

Developmental skeletal anomalies 646

Selected osteochondrodysplasias 648

Localized disorders of the skeleton 658

Haemoglobinopathies 662

5.11 Myeloproliferative disorders 666

Reticuloendothelial disorders 666

White cell disorders 668

Plasma cell dyscrasias 670

6 Women's Imaging 675

6.1 Breast 676

Introduction 676

Benign mass lesions 678

Microcalcifications 682

Invasive breast carcinoma 684

Contrast-enhanced MRI in breast cancer 688

6.2 Gynaecology 690

Imaging techniques in gynaecology 690

Congenital anomalies of the female genital tract 692

Benign uterine conditions 694

Endometrial carcinoma 698

Carcinoma of the cervix 700

Benign ovarian tumours 702

Endometriosis, polycystic ovaries and physiological

ovarian cysts 704

Ovarian carcinoma 706

Miscellaneous gynaecological conditions 710

7 Neuroradiology 714

7.1 Intracranial tumours 716

Imaging techniques and general features 716

Classification of intracranial tumours 718

Gliomas 720

Infratentorial tumours 724

Supratentorial tumours 730

Extra-axial tumours 732

Meningioma and skull base tumours 734

Cerebral and meningeal metastases 736

Intraventricular tumours 738

Pituitary region tumours 740

Pineal region tumours 744

7.2 Cerebrovascular disease and non-traumatic

haemorrhage 746

Cerebral ischaemia 746

Other patterns of cerebrovascular disease 750

Carotid and vertebral artery dissection 754

Non-traumatic intracranial haemorrhage 756

Cerebral artery aneurysms 758

Arteriovenous malformations 760

7.3 Brain infection, aids and demyelinating

diseases 762

Intracranial infection 762

Hiv infection and aids 768

Demyelinating and inflammatory disorders 772

7.4 Brain trauma, degenerative disorders and

epilepsy 776

Head injury 776

Primary and secondary cerebral injury 778

Dementias and epilepsy 780

Skull bone disease 782

Hydrocephalus 784

7.5 Paediatric neuroradiology 786

Cerebellar malformations 786

Chiari malformations 788

Cerebral malformations 790

Malformations of neuronal migration and cortical

organization 792

Neurofibromatosis type 1 (NF-1) 794

Neurocutaneous syndromes 796

Inborn metabolic brain disorders 798

Congenital skull anomalies 800

Congenital intracranial infections 802

Paediatric meningitis 804

Hypoxic-Ischaemic injury in the developing brain 806

7.6 The spine 808

Spinal dysraphism 808

Congenital spinal anomalies 810

Skeletal abnormalities 816

Vascular spinal lesions 818

Spinal tumours 820

Spinal infection 830

Infective/inflammatory disorders of the spine 832

Spinal cord trauma and the postoperative spine 834

Degenerative spinal disease 836

7.7 The orbit 842

The orbit 842

Conal and extraconal disorders 846

Intraconal disorders 848

7.8 Ear, nose and throat radiology 856

Selected disorders of the ear 856

Nose and paranasal sinuses 858

The nasopharynx 860

Disorders of the oropharynx, larynx and soft tissues of

the neck 862

7.9 Dental radiology 864

Mandibular/maxillary cystic lesions 864

Tumours of bone 866

Facial trauma 868

Salivary glands 870

Salivary gland disorders 872

8 Endocrine System 875

8.1 Thyroid disorders 876

Thyroid cancer 876

Miscellaneous thyroid disorders 880

8.2 Adrenal disorders 882

Non-functional adrenal disorders 882

Adrenal hyperfunction 888

9 Lymphoma 893

9 Lymphoma 894

Lymphoma 894

Lymph node disease in lymphoma 898

Cns lymphoma 900

Pulmonary lymphoma 902

Lymphoma of the gastrointestinal tract 904

Musculoskeletal lymphoma 906

Extranodal manifestations of lymphoma 908

Extranodal manifestations of lymphoma 910

Monitoring the response to therapy in lymphoma 912

10 Functional Imaging 915

10.1 Diffusion weighted imaging (DWI) 917

10.2 Functional imaging 918

11 Interventional Radiology 925

11.1 Interventional vascular radiology

techniques 926

11.2 Cross-sectional vascular imaging 930

11.3 Specific drainage techniques 931

11.4 Principles of tumour ablation 932

11.5 Hepatobiliary intervention 936

11.6 Genitourinary interventional radiology 940

11.7 Woman's imaging - interventional

radiology 944

Obstetric haemorrhage 946

12 Appendices 949

12.1 General pearls 950

12.2 Anatomy pearls 958

12.3 Pearls in musculoskeletal imaging and

pathology 962

Pearls in pathology 962

Pearls in musculoskeletal imaging 964

12.4 Patterns of tumour spread 968

12.5 Tnm staging of common cancers 974

Index 991