Diseases of the abdomen and Pelvis 2010-2013 - Diagnostic Imaging and Interventional Techniques

Title Page

Copyright Page

Preface

Table of Contents

List of Contributors

WORKSHOPS

Emergency Radiology of the Abdomen: The Acute Abdomen

Introduction

Imaging Techniques

Acute Pain in an Abdominal Quadrant

Right Upper Quadrant

Left Upper Quadrant

Right Lower Quadrant

Left Lower Quadrant

Gynecological Disorders

Acute Abdomen with Diffuse Pain

Bowel Obstruction

Ischemic Bowel Disease

Perforation of the Gastrointestinal Tract

Acute Abdomen with Flank or Epigastric Pain

Urinary Colic

Acute Pancreatitis

Leaking Abdominal Aortic Aneurysm

Conclusions

Suggested Reading

Trauma of the Abdomen and Pelvis

Introduction

Computed Tomography vs. Ultrasound

Urinary Tract

Bowel and Mesenteric Injuries

Splenic Injuries

Hepatic Injuries

Adrenal Injuries

Pancreatic and Duodenal Injuries

References

Diseases of the Esophagus and Stomach

Introduction

Gastroesophageal Reflux Disease

Infectious Esophagitis

Drug-Induced Esophagitis

Idiopathic Eosinophilic Esophagitis

Esophageal Carcinoma

Erosive Gastritis

Helicobacter Pylori Gastritis

Gastric Ulcers

Gastric Carcinoma

Gastric Lymphoma

Gastrointestinal Stromal Tumors

References

Small-Bowel Imaging: Pitfalls in Computed Tomography Enterography/Enteroclysis

Computed Tomography Enterography

Pitfalls of Computed Tomography Enterography

General

Crohn’s Disease

Obscure Gastrointestinal Bleeding

Neoplasms

Computed Tomography Enteroclysis

Pitfalls of Computed Tomography Enteroclysis

General

Crohn’s Disease

Masses

Obstruction

Summary

References

Diseases of the Small Bowel, Including the Duodenum – MRI

Introduction

The Duodenum

Neoplasms of the Duodenum

The Small Intestine

Inflammatory Bowel Disease

Crohn’s Disease: Acute Inflammatory Type

Crohn’s Disease: Fibrostenosing Type

Crohn’s Disease: Fistulizing Type

Differential Diagnosis of Crohn’s Disease

Small Bowel Neoplasms

Neuroendocrine Tumors: Carcinoid

Gastrointestinal Stromal Tumors

Other Small Bowel Pathologies

References

Imaging of the Colon and Rectum: Inflammatory and Infectious Diseases

Introduction

Ulcerative Colitis

Crohn’s Disease

Pseudomembranous Colitis

AIDS-Related Colitis

Typhlitis

Graft-Versus-Host Disease

Differential Diagnosis of the Colitides

Appendicitis

Diverticulitis

Epiploic Appendagitis

Acute Abdominal Pain

Perianal Fistulas

References

CT Colonography: Updated

References

Imaging of Diffuse and Inflammatory Liver Diseases

Introduction

Fibrous Tissue Deposition (Cirrhosis)

Background

Regenerative Nodules

Confluent Hepatic Fibrosis

Hepatic Morphology in Cirrhosis

Portal Hypertension

Ancillary Findings in Cirrhosis

Vascular Disorders

Arterial-Portal Shunts

Perfusion Abnormalities

Portal Vein Thrombosis

Budd-Chiari Syndrome

Passive Hepatic Congestion

Macro-regenerative Nodules

Hepatic Veno-occlusive Disease

Peliosis Hepatis

Hepatic Infarction

Metabolic and Storage Diseases

Steatosis

Iron Overload

Primary Hemochromatosis

Hemosiderosis

Wilson’s Disease

Amyloidosis

Neoplastic Diseases

Metastatic Disease

Lymphoma

Diffuse Infectious and Inflammatory Diseases

Fungal Infections

Candidiasis

Granulomatous Diseases

Sarcoidosis

Tuberculosis

Histoplasmosis

Parasitic Infections

Schistosomiasis

Viral Infections

Viral Hepatitis

HIV Infection

Uncommon Hepatic Infections

Cat-scratch Disease

Bacillary Angiomatosis

Focal Infections

Bacterial (Pyogenic) Abscess

Amebic Abscess

Echinococcal Disease

Suggested Reading

General

Fibrous Tissue Deposition (Cirrhosis)

Vascular Disorders

Metabolic and Storage Diseases

Infectious Diseases

Focal Liver Lesions

Introduction

MDCT Imaging Techniques

Magnetic Resonance Imaging Technique

Benign Hepatic Lesions

Cyst

Hemangioma

Focal Nodular Hyperplasia

Hepatocellular Adenoma

Biliary Hamartomas (von Meyenburg Complex)

Hepatic Abscess and Hydatid Cyst

Malignant Primary Tumors

Hepatocellular Carcinoma

Fibrolamellar HCC

Cholangiocellular Carcinoma

Rare Primary Liver Tumors

Biliary cystadenoma/cystadenocarcinomas

Hepatic Angiosarcoma

Epithelioid Hemangioendothelioma

Hepatic Lymphoma

Hepatic Metastases

Differential Diagnosis of Focal Liver Lesions

References

Imaging Diseases of the Gallbladder and Bile Ducts

Introduction

Functional Magnetic Resonance Imaging of the Bile Ducts

Technique, Indications, Results

T2-weighted imaging

Contrast-Enhanced Functional MRC

Conclusion

Patterned Approach to the Diagnosis of Gallbladder and Bile-Duct Diseases

Gallbladder Wall Thickening

Gallbladder Polypoid Mass

Cystic Dilatation of the Extrahepatic Bile Duct

Cystic Dilatation of Intrahepatic Bile Ducts

Biliary Stricture

Conclusions

Suggested Reading

Functional MR imaging of the bile duct

Patterned Approach to the Diagnosis of Gallbladder and Bile Duct Diseases

Diseases of the Pancreas, I: Pancreatitis

Introduction

Acute Pancreatitis

Complications

Groove Pancreatitis

Autoimmune Pancreatitis

Chronic Pancreatitis

Complications

Diagnostic Challenge

Pancreatitis in Children

References

Diseases of the Pancreas, II: Tumors

Introduction

Ductal Adenocarcinoma of the Pancreas

Neuroendocrine Neoplasms of the Pancreas

Hyperfunctioning Neuroendocrine Neoplasms

Non-hyperfunctioning Neuroendocrine Neoplasms

Cystic Neoplasms of the Pancreas

Serous and Mucinous Cystic Neoplasms of the Pancreas

Intraductal Papillary Mucinous Neoplasm of the Pancreas

Solid Pseudopapillary Epithelial Neoplasm of the Pancreas

Follow-Up for Cystic Neoplasms of the Pancreas

References

Adrenal Imaging and Intervention

Introduction

Detection of Biochemically Active Adrenal Tumor

Staging Patients with Known Carcinoma

Evaluation of an Incidentally Discovered Adrenal Mass

References

Renal Tumors

Introduction

Ultrasonography

CT and MRI Techniques

Small Renal Masses

Cystic Renal Masses

Angiomyolipomas

Differentiating Non-Fat-Containing Renal Tumors

Differentiating Benign from Malignant Renal Neoplasms

Differentiating among Renal Cancer Subtypes

Pre-operative Imaging and Treatment of Renal Cancers

Imaging after Renal Mass Treatment

References

Urinary Tract Obstruction and Infection

Urinary Tract Obstruction

Urinary Tract Infection

Acute Pyelonephritis

Emphysematous Pyelonephritis

Granulomatous Renal Infections

AIDS Nephropathy

BK Virus Nephropathy

Pyonephrosis

Schistosomiasis

Post-therapeutic Changes

References

Benign Diseases of the Female Genital Tract

Introduction

Anatomy of the Female Genital Organs

Magnetic Resonance Imaging Technique

Congenital Uterine Anomalies

Benign Conditions of the Vagina, Cervix, and Uterus

Non-neoplastic Ovarian/Adnexal Masses

Neoplastic Ovarian Masses

Magnetic Resonance Imaging in Obstetrics

References

Malignant Diseases of the Female Genital Tract

Introduction

Ultrasound

Magnetic Resonance Imaging

Patient Preparation, Positioning, and Coil Selection

Choice of Sequences and Imaging Planes

Computed Tomography

Positron Emission Tomography/Computed Tomography

Endometrial Carcinoma

Cervical Carcinoma

Ovarian Carcinoma

References

Magnetic Resonance Imaging of Prostate Cancer

Introduction

Magnetic Resonance Imaging: Anatomy

Magnetic Resonance Techniques and Their Role in Detection and Localization

T2-Weighted Imaging

Diffusion-Weighted Imaging

Dynamic Contrast-Enhanced MRI

1H Magnetic Resonance Spectroscopic Imaging

MRI-Guided Biopsies

Prediction of Prostate Cancer Aggressiveness

Local (T) Staging

Metastatic Disease (NM Staging)

Nodes

Bone

Recurrence

Protocols

Detection, Localization, Recurrence

Staging

Nodes and Bone

Interpretation, Structured Reporting

Conclusion

Take-Home Messages

Acknowledgements

Suggested Reading

Anatomy

Prostate Cancer

References

Imaging of the Male Pelvis: The Scrotum

Introduction

Intratesticular Disorders

Neoplastic

Non-neoplastic

Extratesticular Disorders

Neoplastic

References

Spread of Metastatic Disease in the Abdomen and Pelvis

Introduction

Metastatic Spread via the Peritoneal Ligaments

Gastrohepatic Ligament

Hepatoduodenal Ligament

Gastrosplenic and Splenorenal Ligaments

Gastrocolic Ligament

Transverse Mesocolon

Metastatic Spread via the Peritoneal Spaces

Left Peritoneal Space

Right Peritoneal Space

References

Abdominal Vascular Disease: Diagnosis and Therapy

Acute Arterial Occlusion

Embolization

Dissection

Chronic Arterial Occlusive Disease

Mesenteric Artery Stenosis

Renal Artery Stenosis

Aneurysms

Abdominal Aortic Aneurysm

Indications

Stent Graft Designs

Imaging before Stent Graft Implantation

Complications

Visceral Artery Aneurysm

Renal Artery Aneurysm

Therapeutic Embolization of Gastrointestinal Bleeding

Treatment for Bleeding Complications after Surgery, Trauma, and Post-partum

Therapeutic Embolization of Tumors

Venous Interventions

TIPS

Embolization of the Portal Veins

Suggested Reading

Non-vascular Abdominal Disease: Diagnosis and Therapy

Introduction

Hepatocellular Carcinoma: Pathology

Pre-neoplastic Lesions: Regeneration

Pre-neoplastic Lesions: Dysplasia

Hepatocellular Carcinoma: Imaging Findings

Therapy and Follow-up

Conclusions

References

An Approach to Imaging the Acute Abdomen in the Pediatric Population

Introduction

Causes of Acute Abdomen

Modalities

Acute Appendicitis

Malrotation

Intussusception

Ileocolic and Ileo-ileocolic Intussusceptions

Diagnosis

Reduction

Pathological Lead Points

Postoperative Intussusception and Intussusception with Gastroenterostomy Tubes

Necrotizing Enterocolitis

Meckel Diverticulum

Congenital Bowel Obstruction in the Neonate

Suggested Reading

Imaging Uronephropathies in Children

Introduction and Techniques

Key Point

Management of In Utero Renal Pelvis Dilatation

Definition

Findings on Obstetric US

Postnatal Management of Fetal Pelvis Dilatation

Key Points

Imaging Cystic Kidneys in Children

Introduction

Cystic Kidneys in the Fetus

Renal Cystic Diseases in Children

Key Points

Renal Ectopia and Duplications

Key Points

Urinary Tract Obstruction

Key Points

Voiding Abnormalities and Secondary Vesicoureteric Reflux

Key Points

Renal Masses in Children

Key Points

Imaging Renal Failure in Children

Introduction

Sonographic Technique

Acute Renal Failure

Hemolytic Uremic Syndrome

Medullary or Cortical Necrosis, Shock Kidneys

Renal Vein Thrombosis

Obstructive Uropathies

Chronic Renal Failure

Renal Cystic Diseases (see above)

Congenital Nephrotic Syndromes

Syndromes Affecting the Tubules and Metabolic Diseases

Key Points

Urinary Tract Infection

Introduction

Imaging Acute Pyelonephritis

Proposed Work-Up

Complications of Acute Pyelonephritis

Late Complications of UT Infection

Key Points

Imaging Urolithiasis in Children

Introduction

Imaging

Treatment

Key Points

References

Integrated Imaging in Genitourinary Oncology: PET/CT Imaging

Introduction

Prostate Cancer

Testicular Cancer

Ovarian Cancer

Cervical Cancer

Endometrial Cancer

References

Integrated Imaging in Gastrointestinal Oncology: PET/CT Imaging

Introduction

Malignant Primary Liver Tumors

Hepatocellular Carcinoma

Cholangiocarcinoma

Pancreas

Exocrine Pancreatic Carcinoma

Endocrine Pancreatic Cancer

Colorectal Carcinoma

Initial Staging

Recurrent Disease

Stomach and Small Bowel

Gastric Cancer

Small Bowel

Conclusions

References

NUCLEAR MEDICINE SATELLITE COURSE “DIAMOND”

Lymphoma: Diagnostic and Therapeutic Applications of Radiopharmaceuticals

Introduction

Particularities of Abdominal Lymphoma

Indications of FDG-PET/CT

Response Assessment

IHP Criteria of Visual FDG-PET Interpretation

Pitfalls in Interpretation

Radioimmunotherapy of Lymphomas

Conclusions

References

Conventional Nuclear Medicine in the Evaluation of Gastrointestinal and Genitourinary Tract Disorders

Introduction

Gastrointestinal Tract

Salivary Glands

Esophageal Transit

Gastroesophageal Reflux Disease

Gastric Emptying Scintigraphy

Gastrointestinal Bleeding

Meckel’s Diverticulum and Heterotopic Gastric Mucosa

Protein-Losing Enteropathy

Hepatobiliary Scintigraphy

Urinary Tract

Urinary Tract Dilation

Urinary Tract Infection and Vesicoureteric Reflux

Acute Renal Failure

Renovascular Hypertension

Renal Transplantation

Live Kidney Donor

Evaluation of the Renal Graft

References

PET in Hepatobiliary-Pancreatic Tumors

Overview

Current Role of Imaging

Positron Emission Tomography

Role of FDG-PET in Liver Cancer

Role of Acetate PET in Liver Cancer

Role of PET with Other Tracers in Liver Cancer

Role of FDG-PET in Pancreatic Cancer

Suggested Reading

PET in Tumors of the Digestive Tract

Introduction

Esophagus, Stomach, and Small Bowel

Esophagus

Stomach: Malignant Disease

Small Bowel: Malignant Disease

Gastrointestinal Stromal Tumors

Colorectal Carcinoma

Initial Staging

Recurrent Disease

Therapy Response Assessment

Conclusions

References

Tumors of the Adrenergic System: Imaging and Therapy

Targeting of Neuroendocrine Tumors

Techniques

Diagnostic Imaging

Pheochromocytoma

Neuroblastoma

Carcinoid Tumors

Other Neuroendocrine Tumors

Rationale for Using MIBG and Somatostatin-Receptor Imaging Procedures

Radionuclide Therapy

Indications/Contraindications for Therapy

Malignant Pheochromocytoma and Paraganglioma

Neuroblastoma

Medullary Thyroid Carcinoma

Carcinoid Tumors

References

Neuroendocrine Tumors of the Abdomen: Imaging and Therapy

Introduction

Somatostatin-Receptor-Based Radionuclide Imaging

[111In-DTPA0]Octreotide Scintigraphy: Normal Scintigraphic Findings and Artifacts

Imaging Results of [111In-DTPA0]Octreotide Scintigraphy in Neuroendocrine and Other Tumors

Newer Ligands for Somatostatin Receptor Imaging

Somatostatin-Receptor-Based Radionuclide Therapy

Comparison of Survival Data

Timing of Treatment

Conclusions

References

PEDIATRIC SATELLITE COURSE “KANGAROO”

Imaging Cystic Kidneys in Children

Introduction

Cystic Renal Diseases in the Fetus and in the Perinatal Period

Hyperechoic Kidneys in the Perinatal Period

Sonographic Criteria

Differential Diagnosis

Renal Cyst(s) Discovered in the Perinatal Period

Cystic Renal Diseases in Childhood

Conclusions

References

Understanding Duplication Anomalies of the Kidney

Introduction

Embryology

Conclusions

References

Malrotation: Techniques, Spectrum of Appearances, Pitfalls, and Management

Introduction

Embryology

Causes of Symptoms

Imaging Modalities

Conclusions

References

Pediatric Intestinal Ultrasonography

Introduction

Gastroesophageal Junction

Stomach

Small Bowel

Large Bowel

Rectum

Anus

Cystic Intestinal Masses

Solid Intestinal Masses

Neonatal Bowel Obstruction

Conclusions

References