An axial (transverse) ultrasonographic image of the shoulder shows an intact supraspinatus tendon (*), seen as a zone of hypoechogenicity (low-signal echoes) on the scan. The chest x-ray shows a wedge-shaped opacity in the periphery of the right lung base. Since Roentgen’s time, many new imaging techniques have been developed that allow radiologists to see the muscles and other soft tissues of the musculoskeletal system as well as the bones and to evaluate the amount of metabolic activity in the bones and soft tissues. AVMs are congenital lesions consisting of a tangle of abnormal blood vessels, usually within the brain parenchyma, that are fed by enlarged cerebral arteries and drained by dilated, tortuous veins. Frontal view of a 65-year-old man shows the classic features of osteoarthritis of the knee with medial articular space narrowing, subchondral cyst formation, sclerosis, and osteophyte formation. GIST usually occurs as a single lesion and is most often found in the jejunum and ileum. Virtually any tumor may metastasize to the spine. Gore RM, Levine MS, eds. The most common causes of mechanical obstruction in the small bowel are adhesions, internal or external hernias, neoplasms, or intussusceptions. A, B. On the other hand, a patient with rib or sternal fractures as a result of blunt chest trauma is more likely to have pulmonary contusion. However, it is not always possible to differentiate clinically between patients who have disk herniations and those whose nerves are compressed by osteophytes, and MR imaging is the best test to order for these patients. This lesion has caused a “block” to the flow of contrast. C. cessation of routine mammograms at age 65. A layer of thickened dural enhancement (“dural tail”) is commonly seen extending away from the base of the meningioma. Dysphagia may be of oropharyngeal or esophageal origin; a modified examination of the oral cavity and pharynx may be required in some of these patients. 2. MR imaging is used frequently to characterize focal lesions within the liver, especially those discovered during survey techniques such as US or CT. NM and MR imaging are considered the optimal means for evaluating the liver for cavernous hemangioma, and both are highly accurate (approximately 95%) in evaluating the liver for cavernous hemangioma. 11-10. Axial CT scan of the chest of the same patient as in Figure 4-10 shows filling of the right pleural space by fluid, with compression of the right lung and displacement of the mediastinal contents into the left hemithorax. 2008;249:883-890. PA (A) and lateral (B) views show central venous catheter with tip in azygous vein (arrows). There is no visible fracture or dislocation. The exposure time selected should be short enough to stop the motion of the anatomic part being radiographed. However, because the energy carried by each photon is proportional to the frequency (the proportionality constant is called Planck’s constant), the higher frequency x-ray or gamma ray photons are much more energetic than, for example, light photons and can readily ionize the atoms in materials on which they impinge. Reticular pattern: A collection of innumerable small, linear opacities that together produce the appearance of a net. A correlated clinical examination often reveals abnormalities not detected without the guidance of mammographic findings (Statement C is false). The nephrographic phase is predominately used to evaluate the kidneys for mass lesions. (B) Direct coronal CT image through the posterior and middle subtalar joints demonstrates obliquely oriented fracture lines entering the posterior facet (arrows). E. middle hepatic vein. None B. Artifact C. Subarachnoid lesion D. Intramedullary lesion E. Syrinx B 13-27. A B MR imaging has revolutionized the imaging evaluation of almost all body areas, but particularly those of the central nervous system and musculoskeletal system. The advantages of CT are that it enables precise assessment of joint reconstitution and also identifies any intraarticular bone fragments or entrapped tendons that could interfere with proper reduction and healing (see Figure 7-4). Yet a tremendous amount of information regarding cardiac structure and function can be gleaned from careful analysis of studies, regardless of whether they are dedicated to cardiac imaging. Thoracic aortography is performed when there is suspicion of traumatic aortic injury, dissection (Figure 1-3), or atherosclerotic aneurysm, and to evaluate cerebral and upper extremity vascular disease. 6-11. Differentiation of liver disease into diffuse or focal disease is an artificial but convenient way to analyze liver disorders radiographically. Case 9-8. Practical tables and appendixes contain a wealth of valuable data, reflecting the bookÆs usefulness as a reference for nuclear medicine professionals, including physicians, residents, and technologists. (A) Ultrasonographic image of a portion of normal breast. Note normal perineural fat (arrowheads) in the left neural foramen. It may be palpable as a soft mass. (A) Axial postmyelographic CT demonstrates enlargement of the spinal cord (asterisk), representing tumor, with narrowing of the subarachnoid/contrast space surrounding the cord. The patient now needs breast ultrasonography. (B) Lateral view of normal chest. NCRP Report No. TCC of the bladder spreads by local invasion and by lymphatic and hematogenous spread. Case 10-17. Abnormality in the cord ranges from one to multiple lesions, although diffuse involvement of the cord can also be seen. Fibrocystic change, although very common, is an unlikely diagnosis. This positioning results in a lack of normal pacing function. MR imaging may have a role in the evaluation of islet-cell tumors, because these tumors have a characteristic appearance on MR studies. Case 3-6: 68-year-old man with a long history of elevated blood pressure and systolic murmur. MR imaging may detect evidence of a small joint effusion, inflamed synovium, and subtle erosions that could suggest the diagnosis of an inflammatory arthropathy or a septic joint. AP (A) and PA (B) radiographs of the chest in same patient on same day. A 57-year-old man presents with history of hepatitis. Hemorrhagic contusions are demonstrated in the inferior bifrontal lobes (large black arrows), subarachnoid hemorrhages in the interpeduncular cistern (white arrow) and Sylvian fissure (double white arrows), subdural hemorrhage along the tentorial incisura (double black arrows), and epidural hemorrhage crossing the right tentorium (black arrowhead), as well as a large scalp hematoma (white arrowhead). A Chiari I malformation is associated with a relatively small posterior fossa and a normal-sized cerebellum. Case 6-4. The radiographic examination of the patient in Case 7-14 (Figure 7-36) provides general anatomic information, helps to determine whether further imaging is necessary, and aids in deciding whether further intervention is appropriate. The cause of AS is not known, but most of the spondyloarthritides share a common genetic marker called the HLA-B27 antigen. ACS recommends annual screening MRI in women at high risk for breast cancer. CHEST 5. Patients with a strong history of allergic reaction to iodinated contrast media should not routinely undergo contrast-enhanced CT scanning, unless they are pretreated with anti-inflammatory agents (ie, steroids). In addition, MR imaging can be useful if abscesses are suspected in the adjacent soft tissues. A lesion of the C7 spinous process B. The major fissure is displaced posteriorly, as well as rotated into a more sagittal orientation than the normal coronal orientation (D is the correct answer to Question 4-5). An oblique view of right foot in a 60-year-old man who presented to the emergency department with intense foot pain. 302 PART 4 ABDOMEN Figure 11-28. The nodules are less well defined on their periphery, and there is a lesser tendency to develop progressive massive fibrosis. A 44-year-old woman presents with occult blood in her stools, and postprandial epigastric pain that is relieved with meals. The heart is normal in size and shape. Image-Guided Needle Aspiration and Biopsy The indications for needle aspiration and biopsy of breast lesions are varied and are variably interpreted by radiologists and referring physicians. In both methods, large and small compression images of all segments of the colon are obtained. 7-9. a, aorta; bi, bronchus intermedius; cpa, costophrenic angle; d, diaphragm; e, esophagus; ivc, inferior vena cava; lpa, left pulmonary artery; lul, left upper lobe bronchus; lv, left ventricle; m, manubrium; mf, minor fissure; MF, major fissure; rpa, right pulmonary artery; rul, right upper lobe bronchus; rv, right ventricle; st, sternum; svc, superior vena cava; t, trachea; v, vertebral body. Importantly, imaging techniques are not necessarily exclusive and in some circumstances are complementary— taken alone, they may not provide enough information, but together they allow a correct clinical diagnosis. Calcification within the thrombus also confirms the chronic nature of the thrombus. It had been present for a year and was painless. MAGNETIC RESONANCE IMAGING In 1952, Felix Bloch and Edward Purcell were awarded the Nobel Prize for their independent discovery of the magnetic resonance phenomenon in 1946. The diagnosis is usually made by demonstrating thin linear bands of calcification at the extreme periphery of the kidney that may extend into the columns of Bertin but should not involve the renal medulla. CT in diffuse tumor showing diffuse, coarse inhomogeneity of the liver parenchyma, with a nodular border (arrowheads). St. Louis, Mo: Mosby; 2002. Cardiac aneurysms, as shown in the patient in Case 3-8 (Figure 3-34), are almost always the sequelae of myocardial CHAPTER 3 49 A Table 3-5.

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