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(BQ) Part 2 book “Computed body tomography with MRI correlation” has contents: The biliary tract, the pancreas, abdominal wall and peritoneal cavity, the adrenal glands, musculoskeletal system, pediatric applications,… and other contents.
5063_Lee_Ch12pp0829-0930 2/17/06 10:17 AM Page 829 12 Liver Jay P Heiken Christine O Menias Khaled Elsayes For more than 25 years, computed tomography (CT) has been widely used for evaluating both focal and diffuse hepatic diseases It has become established as the imaging method of choice for routine screening of the liver However, magnetic resonance imaging (MRI) has proved to be at least as effective as intravenous contrast-enhanced CT for detecting and characterizing most hepatic abnormalities Each method has strengths and limitations Regardless of the imaging method used, however, the technique of conducting the examination is crucial to its diagnostic performance This chapter highlights the use of CT and MRI for evaluating both focal and diffuse hepatic abnormalities Various CT and MRI techniques are discussed, and the rationale for choosing among them in different clinical situations is explained The clinically relevant anatomy of the liver and the CT and MRI appearances of important pathologic processes involving the liver are detailed ANATOMY Gross Morphology The liver is the largest organ in the abdomen, occupying most of the right upper quadrant It varies considerably among individuals in size and configuration Superiorly, laterally, and anteriorly the liver is bordered by and conforms to the undersurface of the diaphragm Prominent diaphragmatic leaves may indent the surface of the liver as they insert on the ribs, producing hypoattenuating or lowsignal-intensity defects that should not be misinterpreted as intrahepatic lesions (19) (Fig 12-1) The liver is bordered medially by the stomach, duodenum, and transverse colon, inferiorly by the hepatic flexure of the colon, and posteriorly by the right kidney The superior portion of the right adrenal gland borders the medial aspect of the posterior superior right hepatic segment (segment VII) The liver is covered by peritoneum, except for the surfaces apposed to the inferior vena cava (IVC), the gallbladder fossa, and the posterosuperior aspect of the diaphragm (the “bare area”) It is attached to the diaphragm anterosuperiorly by the falciform ligament and posteriorly by the coronary ligaments The surface of the liver between the superior and inferior coronary ligaments is devoid of peritoneum and is referred to as the “bare area.” Because of the lack of peritoneum on this hepatic surface, peritoneal fluid cannot accumulate between the liver and the diaphragm in this area Fluid identified posterior to the liver in this region is located in the pleural space (425), in the superior recess of the retroperitoneum, or beneath the liver capsule Laterally the superior and inferior coronary ligaments come together to form the left and right triangular ligaments Three hepatic fissures help define the margins of the hepatic lobes and the major hepatic segments (148) The interlobar fissure is an incomplete structure on the inferior margin of the liver that is oriented along a line passing through the gallbladder fossa inferiorly and the middle hepatic vein superiorly (727) (Figs 12-2 and 12-3) Although it is well defined in some patients, it may be difficult to identify in others The interlobar fissure forms the inferior margin of the border between the right and left hepatic lobes The left intersegmental fissure (fissure for the ligamentum teres), which forms a well-defined sagittally oriented cleft in the caudal aspect of the left hepatic lobe, divides the lobe into medial and lateral segments (Figs 12-2 and 12-3) The ligamentum teres, which is usually surrounded by a small amount of fat, runs through the fissure after entering it via the free margin of the falciform ligament A third fissure, the fissure for the ligamentum venosum, is oriented in a coronal or oblique plane between the posterior aspect of the left lateral hepatic segment and the anterior aspect of the caudate lobe (see Figs 12-2 and 829 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 830 830 Chapter 12 A B Figure 12-1 Hepatic pseudolesion Contrast-enhanced CT image A: shows a low attenuation defect in the medial segment of the left hepatic lobe (arrow) A more cephalad image B: demonstrates that the appearance is due to indentation from the adjacent diaphragm Figure 12-2 Hepatic segmental anatomy as viewed in the transaxial plane at different levels through the liver The transverse scissura, described by the left and right portal vein branches, demarcates the cranially located segments (II, VII, and VIII) from the caudally located segments (III, VI, and V, respectively) RHV, right hepatic vein; MHV, middle hepatic vein; LHV, left hepatic vein; PV, portal vein; IVC, inferior vena cava; FLT, fissure for the ligamentum teres; FLV, fissure for the ligamentum venosum; RPV, right portal vein (A, anterior branch; P, posterior branch); LPV, left portal vein; U, umbilical segment; FL, falciform ligament; ILF, interlobar fissure; GB, gallbladder 5063_Lee_Ch12pp0829-0930 2/17/06 10:17 AM Page 831 Liver 12-3) This fissure, which is in continuity with the intersegmental fissure, contains a portion of the gastrohepatic ligament (lesser omentum) It is best seen on images obtained cephalad to the fissure for the ligamentum teres 831 The caudate lobe may be considered an autonomous part of the liver from a functional viewpoint because it has separate blood supply, bile drainage, and venous drainage from the rest of the liver (148) It is a pedunculated portion A B C D E F Figure 12-3 Hepatic segmental and venous anatomy as depicted by CT A–L Transaxial images A–F: The main hepatic veins (black arrowheads, A–F) form the major vertical scissurae that divide the hepatic segments The right and left portal veins, shown in C, form the transverse scissura Open arrow, fissure for the ligamentum venosum; curved arrow, umbilical segment of left portal vein; straight arrow, fissure for the ligamentum teres; PV, portal vein; LPV, left portal vein; RPV, right portal vein; LLPV, left lateral segment portal vein branch; ARPV, anterior branch of right portal vein; PRPV, posterior branch of the right portal vein White arrow, accessory right hepatic vein Curved open arrow, interlobar fissure The hepatic segments are numbered according to the system of Couinaud as modified by Bismuth 5063_Lee_Ch12pp0829-0930 2/17/06 10:17 AM Page 832 832 Chapter 12 G H I J Figure 12-3 (continued) Coronal images (G–L) ordered from K most anterior (G) to most posterior (L): The hepatic segments are numbered according to the system of Couinaud as modified by Bismuth G: Arrow, left lateral portal vein branch to segment III Arrowheads, left hepatic vein branches draining segments II and III Curved arrow, fissure for the ligamentum teres Open arrow, interlobar fissure (gallbladder fossa) H: Arrow, umbilical segment of the left portal vein Curved arrow, left hepatic vein Arrowhead, middle hepatic vein Open arrow, interlobar fissure (gallbladder fossa) White arrow, right anterior segment portal vein branch I: Arrow, umbilical segment of the left portal vein Curved arrow, left hepatic vein Arrowhead, middle hepatic vein Open arrow, left lateral portal vein branch to segment II J: PV, main portal vein RPV, right portal vein LPV, left portal vein Curved arrow, left hepatic vein Arrowhead, middle hepatic vein K: Curved arrow, left hepatic vein Arrowhead, middle hepatic vein PV, main portal vein RPV, right portal vein 5063_Lee_Ch12pp0829-0930 2/17/06 10:17 AM Page 833 Liver L Figure 12-3 (continued) L: IVC, inferior vena cava Arrow, right hepatic vein Images prepared by Brett Gratz, MD of the liver that extends medially from the right lobe between the IVC and portal vein (see Figs 12-2 and 12-3) The isthmus, which occupies the position between the portal vein and vena cava, is referred to as the caudate process The more medial extension is called the papillary process Below the porta hepatis, the papillary process may appear separate from the rest of the liver and may be mistaken for an enlarged lymph node (18,162) Multiplanar viewing or careful analysis of consecutive CT or MRI sections is essential to avoid this potential pitfall Segmental Anatomy An understanding of the segmental anatomy of the liver is critical for localization and appropriate management of he- patic neoplasms Confusion regarding hepatic segmental anatomy relates primarily to differences between American and European nomenclature (754) The system proposed by Goldsmith and Woodburne (242) and used by most American radiologists does not provide a level of detail adequate for the surgical planning of subsegmental hepatic resections That proposed by Couinaud (139) and later modified by Bismuth (54) provides the surgically relevant information and is easily applicable to cross-sectional imaging techniques such as CT, MRI, and ultrasound (754) Table 12-1 shows the correspondence among these three nomenclatures An additional nomenclature adopted at the World Congress of the International Hepato-PancreatoBiliary Association in Brisbane, Australia in 2000 (786) also will be described The system of Goldsmith and Woodburne is the most basic and divides the liver into right and left lobes, with each lobe having two segments The right lobe consists of anterior and posterior segments, whereas the left consists of medial and lateral segments A smaller, anatomically distinct caudate lobe derives its arterial supply from both the right and left hepatic arteries, and its venous blood drains directly into the IVC The right and left lobes are divided by a vertical (cephalocaudal) plane passing from the gallbladder fossa inferiorly to the middle hepatic vein superiorly The plane is oriented obliquely from the gallbladder fundus anteriorly to the IVC posteriorly (see Fig 12-2) The anterior and posterior segments of the right lobe are divided by a vertical plane through the right hepatic vein The medial and lateral segments of the left lobe are divided by a vertical plane through the fissure for the ligamentum teres inferiorly and the left hepatic vein superiorly Thus, the main hepatic veins run between hepatic segments, and cephalocaudal planes drawn through the main hepatic veins divide the major hepatic segments (see Fig 12-2) The right hepatic vein lies between the an- TABLE 12-1 ANATOMIC SEGMENTS OF THE LIVER AND CORRESPONDING NOMENCLATURE Nomenclature Anatomic Subsegment Caudate lobe Left lateral superior subsegment Left lateral inferior subsegment Left medial subsegment Right anterior inferior subsegment Right anterior superior subsegment Right posterior inferior subsegment Right posterior superior subsegment Couinaud I II II IV V VIII VI VII 833 Bismuth I II f III IVa, IVb V f VIII VI f VII Goldsmith and Woodburne Caudate lobe Left lateral segment Left medial segment Right anterior segment Right posterior segment Reprinted with permission from Soyer P Segmental anatomy of the liver: utility of a nomenclature accepted worldwide AJR Am J Roentgenol 1993;161:572–573 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 834 834 Chapter 12 terior and posterior segments of the right lobe, the middle hepatic vein between the right and left lobes, and the left hepatic vein between the medial and lateral segments of the left lobe In contradistinction, the intrahepatic portal triads, consisting of branches of the portal vein, hepatic arteries, and bile ducts, course through the central portions of the hepatic segments In the traditional hepatic segmental nomenclature described above, no distinction is made between superior and inferior subsegments within each major segment Because surgical techniques allowing resection of such subsegments have been developed, it is important to distinguish these hepatic subdivisions for more precise lesion localization In the nomenclature of Couinaud, the hepatic segments, except for the caudate lobe and medial segment of the left lobe, are defined not only by the three vertical scissurae described by the major hepatic veins but by a transverse scissura described by the right and left portal vein branches (Fig 12-4) Thus, according to this system, eight segments are defined Segment I is the caudate lobe, and segments II through VIII are numbered in a clockwise direction when the liver is viewed from its ventral aspect (see Fig 12-4 and Table 12-1) Each segment has an independent vascular supply and biliary drainage (148) The modification by Bismuth divides segment IV into superior (IVa) and inferior (IVb) subsegments The Brisbane 2000 Terminology of Liver Anatomy (786) divides the liver into a right hemiliver (Couinaud segments V–VIII, Ϯ segment I) and left hemiliver (segments II–IV, Ϯ segment I), corresponding to the traditional right and left hepatic “lobes.” The term for the second order divisions in this nomenclature is “section,” which corresponds to the traditional “segment.” For example, the right hemiliver consists of anterior and posterior sections, whereas the left hemiliver consists of medial and lateral sections The third order divisions are termed “segments,” which correspond to the numbered Couinaud segments Vascular Anatomy The afferent vessels of the liver are the hepatic arteries and portal veins, which enter the liver at the hilum (porta hepatis) and branch in a recognizable pattern within the liver parenchyma They are accompanied by corresponding branches of the bile ducts with which they form the portal triads The hepatic veins are the efferent vessels of the liver They run separately from the afferent vessels and drain directly into the IVC The portal vein originates posterior to the neck of the pancreas at the confluence of the superior mesenteric and splenic veins It passes posterior to the bile ducts and hepatic artery within the hepatoduodenal ligament (free edge of the lesser omentum) as it proceeds toward the porta hepatis (see Fig 12-3E) At the porta hepatis the portal vein divides into right and left branches (see Fig 12-3C, Figure 12-4 Diagrammatic illustration of hepatic segmental anatomy As described by Couinaud, the liver consists of eight functional hepatic segments, which are numbered in a clockwise direction when the liver is viewed from its ventral aspect Each segment has a precise arterial supply, venous drainage, and biliary ductal drainage The main hepatic veins run between hepatic segments (Adapted from Ger R Surgical anatomy of the liver Surg Clin North Am 1989;69:179–192.) D), which course alongside the right and left hepatic arteries and bile ducts The initial portion of the right portal vein courses rightward and cranially, giving off several branches that supply the porta hepatis and caudate lobe Within the substance of the right lobe the right portal vein divides into anterior and posterior branches that supply the corresponding hepatic segments (see Fig 12-3C, D) Each of these vessels divides again into superior and inferior branches that supply the superior and inferior subdivisions of their respective hepatic segments (see Fig 12-4) The initial portion of the left portal vein (pars transversa) passes horizontally to the left, giving off branches that supply the lateral segment (segments II and III) before turning medially to join the obliterated umbilical vein within the fissure for the ligamentum teres This intrafissural portion (umbilical segment) of the left portal vein (see Fig 12-3B) extends cranially, terminating in ascending and descending branches that supply the superior and inferior divisions of segment IV The hepatic artery provides only 25% to 30% of the afferent hepatic blood flow but carries approximately 50% of available oxygen (148) The common hepatic artery usually arises as a branch of the celiac axis, coursing anteriorly and to the right to enter the lesser omentum After giving off right gastric and gastroduodenal branches, it continues 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 835 Liver within the hepatoduodenal ligament as the proper hepatic artery On images obtained at the level of the porta hepatis, the hepatic artery and bile duct can be identified anterior to the portal vein, with the artery usually occupying a more medial position than the duct Within the porta hepatis the proper hepatic artery divides into right and left branches This classic arrangement of hepatic arterial anatomy is present in only slightly more than half of subjects, with up to 45% having one or more variations (530) The two most common variations are origin of the left hepatic artery from the left gastric artery and origin of all or some right hepatic artery branches from the superior mesenteric artery Within the liver, the right and left hepatic artery branches divide in a fashion similar to that of the portal vein branches to supply their corresponding segments The hepatic veins drain into the IVC The three main hepatic veins—right, middle, and left—lie within the posterosuperior aspect of the liver and drain into the IVC just below the diaphragm (see Fig 12-2) In addition to the main venous trunks, a variable number of smaller dorsal hepatic veins drain from the posterior aspect of the right lobe and caudate lobe (segment I) directly into the IVC The right hepatic vein (see Figs 12-2 and 12-3), which lies between the right anterior and posterior hepatic segments, drains segments V, VI, and VII (148) The middle hepatic vein (see Figs 12-2 and 12-3), which lies in the interlobar plane, drains primarily segments IV, V, and VIII The left hepatic vein (see Figs 12-2 and 12-3), which courses in the sagittal plane between the medial and lateral segments of the left lobe, drains segments II and III In about 90% of cases, the middle and left hepatic veins join to form a common trunk before emptying into the IVC (569) Hepatic Parenchyma On both CT and MR images normal hepatic parenchyma has a homogeneous appearance The attenuation value of normal liver parenchyma on unenhanced CT varies considerably among individuals, but generally it is in the range of 45 to 65 HU In normal adults, the attenuation value of the liver on unenhanced images is consistently higher than that of the spleen, with a mean difference of HU (641) This hepatic-splenic attenuation difference is due to the high concentration of glycogen within the liver (173) After intravenous administration of contrast material, however, the attenuation value of the liver often becomes less than that of the spleen, with the amount of difference depending on the timing of image acquisition and the method of contrast medium administration This normal postcontrast change in the relative attenuation values of liver and spleen should not be misinterpreted as an indication of hepatic steatosis On T1-weighted MR images, the normal liver has an intermediate signal intensity, similar to that of the pancreas 835 but higher than that of the spleen The difference in signal intensity between the liver and spleen can be used as a rough measure of the degree of T1 weighting (the greater the difference, the greater the T1 weighting) (204) On T2-weighted images the liver has a lower signal intensity, higher than that of muscle but less than that of the spleen Hepatic vessels appear very low in signal intensity on T1-weighted images due to flow-related signal loss However, on T2-weighted images the vessels may have high signal intensity owing to flowrelated enhancement Anatomic Variants and Anomalies The importance of recognizing anatomic variants of liver morphology is to avoid misinterpreting them as pathology A common variant is the presence of one or more incomplete accessory hepatic fissures formed by invaginations of the diaphragm (19) These are seen most commonly in the right lobe superiorly and should not be mistaken for peripheral hepatic pathology In some patients a leftward extension of the lateral segment of the left hepatic lobe projects posteriorly to wrap around the spleen Knowledge of this variant is important to avoid mistaking pathology in this portion of the liver for diseases originating in the stomach or spleen True congenital anomalies of the liver are rare (104) They can be categorized into two types: those caused by defective development and those caused by excessive development (104) The most common anomaly, Riedel’s lobe, is due to excessive development More common in women, it represents a sessile accessory lobe that extends caudally from the inferior aspect of the right lobe and often has a bulbous configuration Anomalies caused by defective development of a hepatic lobe or segment may be characterized by absence (agenesis), small size with normal structure (hypoplasia), or small size with abnormal structure (aplasia) (104) Such anomalies generally affect an entire lobe (41,350,357,663,883), but rarely may affect just one segment (619) They must be distinguished from lobar atrophy that develops as a consequence of acquired vascular or biliary disease (143,158) Appearance After Partial Hepatectomy The appearance of the liver after partial hepatectomy depends on the segment or lobe resected, the operative technique used, and the amount of hepatic regeneration (447) Liver tissue may regenerate quite rapidly after partial hepatic resection, a process that continues for months to year, as demonstrated by progressive hepatic enlargement over this period (138) A small region of low attenuation at the surgical margin is often present, likely representing a transient accumulation of blood and bile (447) Fat attenuation at the resection margin represents the omental patch placed at surgery (447) 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 836 836 Chapter 12 COMPUTED TOMOGRAPHY IMAGE ACQUISITION CONSIDERATIONS As will be discussed in subsequent sections, liver lesion detection depends on a variety of factors, including intrinsic characteristics of the lesion, contrast enhancement techniques, and scan timing In addition to these factors, however, the technical parameters used to acquire the image data play a very important role in lesion detection Partial volume averaging and image noise may interfere with our ability to discern small lesions Partial volume averaging can be minimized by using narrow section width and reconstructing overlapping sections However, thinner sections increase image noise, which can interfere with lesion detection With single detector-row scanners, collimation should be no greater than mm, except in obese patients, and a pitch of 1.5 can be used to provide adequate volume coverage Reconstruction of sections that overlap by 25% to 50% improves detection of small liver lesions (818) For dedicated multiphase liver imaging studies, 3-mm collimation with a pitch of 1.5 to 2.0 can be used if 3D vascular reconstructions are required Reconstruction of overlapping sections improves the quality of the 3D images An important advantage of MDCT scanners is that from the same data set, thin sections can be reconstructed to minimize partial volume averaging and thicker sections can be reconstructed to decrease image noise, if necessary For detector-row scanners, a detector configuration of ϫ 2.5 mm is recommended for routine liver screening, with ϫ 1–1.25 mm detector configuration reserved for dedicated multiphase imaging in which high-quality 3D reconstructions are needed With 16 detector-row scanners, standard examinations can be performed with 16 ϫ 1.25– 1.5 mm detector configuration and staging or pre-operative evaluation studies with 16 ϫ 0.625–0.75 mm detector configuration With 64-detector-row scanners, all studies can be performed with 0.6–0.625 detector collimation and images of various section thicknesses reconstructed as needed The optimal section thickness for viewing liver images acquired with MDCT scanners remains to be determined Two studies have shown that more liver lesions can be detected with 2.5-mm slice thickness than with 5.0-mm slice thickness (257,855), although most of the additional lesions identified with the thinner slices may be benign (257) On the other hand, a phantom study has demonstrated that MDCT with less than 5-mm section thickness is less effective in depicting low-contrast objects than MDCT with 5-mm section thickness (831) Further study is needed to resolve the issue of the optimum section thickness for detecting small liver lesions with MDCT For the time being, 5-mm slice thickness appears adequate for routine liver screening, with thinner sections reconstructed from the MDCT data set as needed For dedicated multiphase liver protocols, reconstruction of thin (1- to 2-mm) sections is preferable to enable high-quality 3D and multiplanar reconstructions Thicker sections can be reconstructed from the MDCT data set for ease of review When imaging obese patients, high levels of image noise can interfere with liver lesion detection Modifications that can be used to reduce image noise in this group of patients include (a) increasing the x-ray tube current and the scan time used to acquire the images and (b) reconstructing thicker sections As will be discussed later, very large patients also require a larger dose of intravenous contrast medium PRINCIPLES OF HEPATIC CONTRAST ENHANCEMENT The primary purpose of administering an intravascular contrast agent for hepatic CT is to increase the attenuation value difference between liver lesions and normal hepatic parenchyma The diagnostic effectiveness of the resulting CT examination is dependent on the contrast medium dose, the method of contrast medium administration, and scan timing In addition, patient factors such as weight and cardiac output have important effects on the magnitude and timing of hepatic enhancement, respectively In this section, the physiologic principles of hepatic contrast enhancement are presented Normal unenhanced liver parenchyma has an attenuation value of 45 to 65 HU (641,676,778) The mean attenuation value of hepatic neoplasms varies considerably, being dependent on multiple factors including histology, vascularity, and the presence of areas of necrosis, calcification, hemorrhage, or fatty degeneration Most hepatic neoplasms have a lower attenuation value than normal hepatic parenchyma However, if diffuse fatty metamorphosis of the liver parenchyma is present, neoplasms may be isoattenuating or hyperattenuating A neoplasm may be indiscernible if its attenuation difference from the surrounding hepatic parenchyma is less than 10 HU When a contrast agent is administered intravenously, it rapidly redistributes from the vascular to the extravascular (interstitial) space, while being continuously excreted by the kidneys (85,397) In the liver this process occurs quite rapidly, and shortly after an intravenous contrast medium injection has ended, a substantial amount of the hepatic parenchymal enhancement is contributed by interstitial contrast material accumulation (210) Hepatic contrast enhancement is best understood by considering the three phases of hepatic enhancement (vascular, redistribution, and equilibrium) (210), each of which corresponds to a different portion of the aortic–hepatic time-attenuation curve (Fig 12-5) The vascular phase represents the period of intravenous contrast medium injection into the central blood compartment and is characterized by a rapid rise in aortic enhancement that reaches a peak shortly after the end of the contrast medium injection (23,24) During this 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 837 Liver 837 The concept of equilibrium as it relates to contrast enhancement (21,149,844) was much more important in the pre–helical CT era when hepatic scan durations were routinely longer than minute The short scan durations of abdominal helical CT, particularly multidetector-row CT (MDCT), have eliminated the risk of imaging the liver during the equilibrium phase and obscuring liver lesions, if proper scan timing is used Magnitude of Hepatic Enhancement Figure 12-5 Phases of hepatic contrast enhancement Simulated contrast enhancement curves of the aorta and liver for a 150-pound man receiving 150 mL of a 320 mg I/mL contrast agent at mL/ second The vascular phase (1) represents the period of intravenous contrast medium injection into the central blood compartment and is characterized by a rapid rise in aortic enhancement that reaches a peak shortly after the end of the contrast medium injection During this phase, hepatic enhancement increases slowly The redistribution phase (2) is characterized by a rapid decrease in aortic enhancement and an accompanying increase in hepatic enhancement During the equilibrium phase (3) aortic and hepatic enhancement undergo a gradual parallel decline phase hepatic parenchymal enhancement increases gradually During the redistribution phase, contrast material diffuses from the central blood compartment to the extravascular compartment of the liver This redistribution results in a rapid decrease in aortic enhancement and a concomitant increase in hepatic enhancement, indicating that most normal hepatic parenchymal enhancement is due to extravascular contrast material accumulation The plateau of peak hepatic parenchymal enhancement is commonly referred to as the portal venous phase or hepatic parenchymal phase of enhancement The equilibrium phase occurs when contrast medium slowly diffuses from the liver back into the central vascular compartment, resulting in a gradual decline in hepatic enhancement Aortic enhancement also gradually declines during this phase as contrast medium continuously exits the vascular compartment through glomerular filtration and diffusion into less wellperfused organs, such as skeletal muscle and fat Many hepatic lesions become obscured during this phase because there is no substantial difference in interstitial accumulation of contrast material between the lesions and the normal hepatic parenchyma (210,633) However, some lesions such as hepatocellular carcinoma may become more apparent during the equilibrium phase as their interstitial enhancement diminishes relative to that of the surrounding hepatic parenchyma (462,541) The magnitude of hepatic parenchymal enhancement is determined by a combination of factors The most important technique-related factors are total iodine dose, which is determined by the contrast medium volume (44,102, 155,275) and concentration (275), and the rate of injection (44,102,103,131,155,267,274,275) For a given injection rate, the magnitude of peak hepatic contrast enhancement increases linearly with the dose of iodine administered (23,27) Use of contrast medium with a higher iodine concentration improves hepatic parenchymal enhancement to the extent that it increases overall iodine dose (225) The magnitude of hepatic parenchymal enhancement also increases with faster injection rates but in a nonlinear fashion Increases in injection rate result in substantially increased peak hepatic parenchymal enhancement with rates up to approximately mL/second (24) Above mL per second, increases in injection rate result in relatively small additional hepatic parenchymal enhancement increases (230) Rapid injection rates (e.g., to mL per second) do, however, result in increased hepatic arterial enhancement and greater separation of the peaks of aortic and hepatic enhancement (24,333,384) These benefits of rapid contrast medium injection rate are helpful when multiphase helical CT is used for the detection of vascular hepatic neoplasms (541) The most important patient-related factor affecting the magnitude of hepatic contrast enhancement is body weight (275,398) Maximum hepatic enhancement decreases with increasing patient weight (275,398) Although diminished cardiac output causes delayed aortic and hepatic enhancement, it does not diminish the magnitude of hepatic enhancement (22) Timing of Hepatic Enhancement The liver receives approximately 75% of its blood supply from the portal vein and the remaining 25% from the hepatic artery (148) In contradistinction, hepatic neoplasms receive their blood supply primarily from the hepatic artery with relatively little supply from the portal vein (510) During the hepatic arterial phase of enhancement, solid hepatic neoplasms are maximally enhanced, whereas the hepatic parenchyma is only minimally enhanced because substantial extravascular redistribution of 5063_Lee_Ch12pp0829-0930 10/13/05 5:36 PM Page 838 838 Chapter 12 A B Figure 12-6 Focal nodular hyperplasia CT image acquired during the arterial phase of hepatic contrast enhancement (A) demonstrates a small subcapsular enhancing mass (arrow) During the portal venous phase of enhancement (B) the lesion is isoattenuating and can no longer be identified enhanced portal venous blood has not yet occurred Therefore, during the hepatic arterial phase “hypervascular” tumors appear as hyperattenuating masses (Fig 126) “Hypovascular” tumors may be indiscernible during the hepatic arterial phase, but they can be demonstrated during the portal venous phase of enhancement as hypoattenuating masses when substantial amounts of contrast material have diffused into the extravascular space of the hepatic parenchyma via the portal venous system In contradistinction, hypervascular tumors may become indiscernible during the portal venous phase if their interstitial accumulation of contrast material is similar to that of the normal hepatic parenchyma (see Fig 12-6) The timing of peak hepatic arterial and hepatic parenchymal contrast enhancement depends primarily on the injection duration (102,274) Rapid or low-volume (shorter duration) injections produce earlier peak hepatic enhancement, whereas slow or high-volume (longer duration) injections result in later peak hepatic enhancement (102,274) In patients with normal cardiac output, peak arterial enhancement is achieved within 10 seconds after the termination of the contrast medium injection (25), and peak hepatic parenchymal enhancement is achieved approximately 30 seconds after termination of the injection As noted earlier, diminished cardiac output delays the peaks of aortic and hepatic enhancement without significantly altering the magnitude of hepatic enhancement (22) Timing Modifications for Multidetector Computed Tomography Scanners Multidetector-row CT scanners can image the liver with very short acquisition times compared with single detector-row scanners The shorter MDCT scan durations require a longer delay from the start of the contrast medium injection to the start of data acquisition in order to image during the peak of hepatic parenchymal enhancement (271) Thus for routine hepatic screening CT examinations, it is necessary to increase the scan delay by approximately seconds when switching from a single detector-row scanner to a detectorrow scanner, from a 4-row to a 16-row scanner, and from a 16-row to a 64-row scanner The exact scan timing will depend on the injection duration of the contrast administration protocol For example, if the scan delay for a study on a single detector-row scanner performed with a particular contrast administration protocol is 60 seconds, then the appropriate scan delay for the same study performed with the same injection protocol on a 4-row scanner would be 65 seconds; for a 16-row scanner, 70 seconds; and for a 64-row scanner, 75 seconds IMAGING TECHNIQUES Computed Tomography Without Contrast Medium Administration CT scans of the liver without contrast medium administration are not routinely obtained but may be useful in selected situations These include identification of calcifications, hemorrhage and iron deposition and determination of the precontrast attenuation value of a lesion, which may be helpful in its characterization In addition, primary hepatic neoplasms or hypervascular metastases such as those from carcinoid tumor, islet cell neoplasms, renal cell carcinoma, breast carcinoma, and sarcomas may become isoattenuating or nearly isoattenuating on contrast-enhanced images (77,169) and may be more easily identified on unenhanced images Although one study has shown that the presence or absence of hypervascular hepatic tumors was correctly demonstrated on portal venous phase bolus 5063_Lee_IDX_I1-I30 11/2/05 10:17 AM Page I-16 I-16 Index Lung (continued) arteriovenous malformations of, 486–488, 1742 in asbestosis, 229, 604 aspergillosis of, 496–497, 550–551 attenuation in decreased, 526–528 mosaic, 527 biopsy of, 104–107, 433 bullae of, 526 candidiasis of, 552 cavitary lesions of, 490 in children, 1745 collapsed, 465–474 See also Atelectasis congenital anomalies of, 1741–1746 in connective tissue/collagen vascular diseases, 533 contusion of, 1423–1425 cystic adenomatoid malformations of, 490 cystic airspaces in, 526 in cytomegalovirus infection, 552–553 decreased attenuation in, 526–528 diffuse disease of See Diffuse lung disease drowned, 466 drug-related injury of, 533–534 eosinophilic disease of, 542 eosinophilic granuloma of, 540–541 focal lesions of, 485–494 extrapleural fat lateral to, 490 ground-glass opacities in, 525, 527 halo sign in, 527 hematoma of, 1424–1425 vs lung cancer, 433, 435 herniation of, 617 in histiocytosis X, 540–541 in hypersensitivity pneumonitis, 541–542 hypogenetic, 1742 infections of, 549–554 in children, 1745–1746 opportunistic, 551, 552–554 laceration of, 1424–1425 in lupus erythematosus, 533 in lymphangioleiomyomatosis, 540 in lymphangitic carcinomatosis, 543 in lymphomatoid granulomatosis, 540 metastases to in children, 1742 occult, 494–496 mosaic perfusion in, 527 necrosis of, 549 nodular lymphoid hyperplasia of, 549 nodules of See Pulmonary nodules occult lesions of, 494–497 occupational diseases of, 537–539 asbestosis, 538–539 silicosis, 537 parenchymal infiltrates in, 496 parenchymal lesions of, 479 in polymyositis/dermatomyositis, 533 pulverized, 1425 in rheumatoid arthritis, 533 in sarcoidosis, 534–537 in scleroderma, 533 in Sjögren’s syndrome, 533 transplantation of, 554–555 trauma to, 1423–1425 tree-in-bud pattern in, 478, 527 in tuberous sclerosis, 540 tumors of benign, 433 malignant, 434–460 See also Lung cancer vascular lesions of, 486–490 vs empyema, 581 in Wegener’s granulomatosis, 539–540 Lung cancer, 229, 230, 424–460 adjuvant therapy for, 459 biopsy in, 104–107, 433 bronchioloalveolar cell carcinoma, 459 cavitary lesions in, 490, 493 with coexistent pulmonary embolism, 511 diagnosis of, 431–433 CT in, 431–433, 459–460 missed lesions in, 464–465 MRI in, 433, 459 differential diagnosis of, 431–433 histiocytosis X and, 541 initial evaluation in, 433 laser photoresection surgery for, 447 mediastinotomy in, 454 metastases from, 455–459 non-small cell, 433 Pancoast tumor in, 449, 633, 641 pericardial effusion in, 447–448 pleural effusion in, 447–449 presenting as solitary nodule, 461–463, 479–485 See also Solitary pulmonary nodule radiofrequency ablation for, 130–132 screening for, 460–465 small-cell, 433, 460 staging of, 433–459 distant metastases in, 455–459 extent of primary tumor in, 443–451 mediastinal node status in, 451–455 mediastinoscopy in, 454 purpose of, 433–442 TNM system for, 442–443 superior sulcus, 449 surgery for, 433 indications for, 443–446 synchronous, 449–451 types of, 433 Lung parenchyma, 479 Lung volume reduction surgery, 546–547 Lupus erythematosus, lung involvement in, 533 Lymph nodes axillary, 637–638 bronchopulmonary, 279 cervical, 193–199 disorders of, 196–199, 200 metastases to, 198 normal anatomy of, 193–196 pathology of, 196–199 radical dissection of, 209–212 diaphragmatic, superior, 651–655 interpectoral, 271 mediastinal, 283–284 in children, 1731 metastases to, 451–455 metastases to cervical, 198 mediastinal, 451–455 retroperitoneal, 1199 MRI of, 88 in mediastinum, 352–353, 359–360 retroperitoneal disorders of, 1198–1209 See also Retroperitoneal lymphadenopathy normal anatomy of, 1197–1198 thoracic, 283–284, 286 Lymphadenopathy in cat scratch disease, 1639 cervical, 196–199, 200 hilar, 347–357 in lymphoma See Lymphoma mediastinal, 346–347, 349–357 in children, 1737 retroperitoneal, 1198–1209 retropharyngeal, 190, 191 Lymphangiectasia, congenital intestinal, 793 Lymphangiography, bipedal, 1201–1202 Lymphangioleiomyomatosis, 241 lung involvement in, 540 retroperitoneal lymphadenopathy in, 1198 Lymphangioma capillary, of neck, 204 cavernous, of neck, 204 chest wall, 628–629 in children, 1736–1737 mediastinal, 337–339 mesenteric, 1130–1132 retroperitoneal, 1219–1220, 1756 splenic, 985 Lymphangiomatous malformations, mesenteric, 1762 Lymphangitic carcinomatosis, lung involvement in, 523, 543 Lymphatic malformations of mediastinum, 337–339 of neck, 203–205 Lymphoblastic lymphoma, mediastinal, 319 Lymphocele, 1205 intraperitoneal, 1123 pelvic, 1412 retropharyngeal, 191 Lymphocytic interstitial pneumonia, 531, 549 Lymphoma adrenal, 1349–1350 appendiceal, 814 brachial plexus, 639 breast, 633–634 Burkitt, retroperitoneal lymphadenopathy in, 1199 cardiac metastases from, 700 cervical lymphadenopathy in, 199 chest wall, 630–631 in children, 1732–1733 renal involvement in, 1751 colorectal, 813 esophageal, 776 5063_Lee_IDX_I1-I30 11/2/05 10:17 AM Page I-17 Index gastric, 786 hepatic, 882–883 intestinal, in children, 1762 mediastinal, 318–319, 358–362 mesenteric, in children, 1762 pancreatic, 1057–1058 peritoneal, 1143–1146 pleural, 602–603 pulmonary, 549 renal, 1751 retroperitoneal lymphadenopathy in, 1198, 1199, 1205–1207 small intestinal, 794–795 splenic, 987–990 staging of, 1205–1206 thymic, 318–319 in children, 1732–1733 thyroid, 188 treatment of, evaluation after, 1204–1205 vertebral, 344 vs pleural calcification, 592 Lymphomatoid granulomatosis, 540 Lymphoproliferative disorders, pulmonary HIV-related, 553–554 posttransplant, 555 M M0 (excitation pulse), 35–40 Maffucci syndrome, 623 Magnetic coils, 81, 84 Magnetic field applied, 34–35, 37–40 fringe, 82 gradient See Gradient(s) homogeneity of, 82 ultrahigh, 79–80 Magnetic field distortions, 68 Magnetic moment, 30 Magnetic resonance, principles of, 32–35 Magnetic resonance angiography (MRA), 73–77 bright-blood, 73–74 limitations of, 75 maximum-intensity projection in, 77 phase-contrast, 74, 75–76 time-of-flight, 74 2D vs 3D, 74–75 Magnetic resonance cholangiopancreatography, 931, 932, 933 artifacts in, 937 contraindications to, 937–938 limitations of, 937–938 normal findings in, 936–937 technique of, 936–938 Magnetic resonance colonography, 822 Magnetic resonance imaging, 29–93 of abdominal organs, 91 advantages and disadvantages of, 149 in agitated patients, 93 artifacts in, 62–70 claustrophobia in, 149–150 clinical applications of, 87–93 computer systems for, 80–81 contrast agents for, 85–87 of coronary arteries, 679–682 data acquisition methods in, 44–45 data acquisition system in, 84 data collection methods in, 44–49, 84 energy absorption in, 32–35 saturation and, 36 energy emission in, 35–40 energy transfer in, 32, 375 fat saturation in, 59–61, 68, 92, 93 frequency encoding in, 41–42 general principles of, 87–88 goals of, 87–88 gradient system in, 82–83 See also Gradient(s) of heart and great vessels, 7–9, 89, 253 image contrast in, 56–59 image data in, 45, 46 instrumentation for, 80–84 interventional, 96 of kidney, 1237–1239 of liver, 89–91 of lymph nodes, 88 in mediastinum, 352–353, 359–360 magnetic moment and, 30 magnetic susceptibility and, 32 magnets in, 79, 81–82 measurement parameters for, 56–59, 87–88 mechanics of, 30–40 of neck, 146–150 net magnetization in, 31–32 nuclear spin and, 29–32 out-of-phase gradient echo, 92 of pelvis, 91–92 in perfusion studies, 77–78 phase encoding in, 43–44 in pregnancy, 1400–1401 principles of, 40–49 pulse sequences in, 40, 49–56, 88 See also Pulse sequences radiofrequency system in, 83–84 raw data in, 45–49 readout in, 41–42 relaxation in, 35–37 safety precautions for, 79, 82 in sedated patients, 93 sedation for, 149–150 signal amplification in, 84 slice orientation in, 40–41 slice selection in, 40–41 spin echo, 39–40, 49–51, 55, 93 cardiac, 71 spoiled gradient echo sequences in, 51–52, 92 study design and, 88 T1–weighted techniques in, 92–93 T2–weighted techniques in, 93 of thorax, 88–89 3D-multislice, 44–45 2D-multislice, 44 ultrahigh field, 79 Magnetic resonance perfusion studies, 77–78 Magnetic resonance signal See Signal Magnetic resonance spectroscopy, 148–149 marker metabolites for, 148–149 I-17 Magnetic susceptibility, 32 Magnetic susceptibility difference artifacts, 67–68 Magnetite-dextran, for liver imaging, 90–91 Magnetization transfer, 148 Magnetization-prepared sequences, 53–56 Magnets, 81–82 high-field, 81 medium-field, 81 safety precautions for, 79, 82 shielding of, 82 shimming of, 79, 82 ultrahigh-field, 79, 81 Main field inhomogeneity, 38 Malacoplakia, renal, 1279–1280 Malignant ascites, 1114, 1116 Malignant fibrous histiocytoma, 1626–1627 of chest wall, 629 retroperitoneal, 1218–1219 splenic, 991 Malignant melanoma cardiac metastases from, 700 chest wall metastases from, 631 Malignant mesothelioma, 603–608 Malignant nerve sheath tumors, retroperitoneal, 1219 Malignant otitis externa, 164 Malignant rhabdoid tumor, 1751–1752 Malignant teratoma, splenic, 991 Malrotation, intestinal, 793 MALT lymphomas, 786 Manganese-chelated contrast agents, 86 Marfan syndrome aortic aneurysm in, 363 aortic dissection in, 378 MAs, 25 effective, 21 MAST (motion artifact suppression technique), 73 Mastectomy, evaluation after, 635–636 Masticator space, imaging of, 159–160 Maximum-intensity projections, 14 in magnetic resonance angiography, 77 May-Thurner syndrome, 1196 Measurement hardware artifacts from, 68–69 calibration of, 68–69 Measurement parameters, in MRI, 87–88 image contrast and, 56–59 operator modification of, 56–59 Meckel diverticulum, 791–792 Medial cuneiform, bipartite, 1588 Median sternotomy, postoperative findings in, 643–644 Mediastinal imaging, 311–410 See also Thoracic imaging of congenital abnormalities, 297–301 MRI, 229, 230 normal anatomy in, 283–284 thymic, 311–324 Mediastinal lipomatosis, 1428 Mediastinal lymph nodes, 283–284, 286 in children, 1731 metastases to, 451–455 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-18 I-18 Index Mediastinal lymphadenopathy, 346–347, 349–353 in tuberculosis, 353–355 Mediastinal masses, in children, 1732–1738 anterior, 1732–1737 middle, 1737 posterior, 1737–1738 Mediastinal metastases, in lung cancer, 451–455 Mediastinal widening, in children, 1732 Mediastinitis acute, 345 fibrosing, 355–356, 1737 vs pulmonary embolism, 512 Mediastinoscopy anterior parasternal, 433 in lung cancer, 454 transcervical, 433 Mediastinotomy, in lung cancer, 454 Mediastinum abscess of, 330, 345–346 aorta and See Aorta biopsy of, 104–107, 454 in children, 1730–1738 disorders of, 1732–1741 normal anatomy of, 1730–1731 cystic lesions of, 324–333 differential diagnosis of, 329–333 duplication of, 1737–1738 hemangioma of, 335 hematoma of, 330–331, 1428–1429 lipomatosis of, 334 lung cancer invasion of, 443–446 lymphatic malformations in, 337–339 lymphoma of, 318–319, 358–362 metastases to, 320–321, 349, 357–358, 451–455 tumors of mesenchymal, 333–339 metastatic, 357–358 neurogenic, 339–344 paraspinal, 344–345 Melanoma cardiac metastases from, 700 chest wall metastases from, 631 small intestinal, 795 Ménétrier disease, 787 Menghini needle, 99 Meningiomas, extracranial, 159 Meningocele, 1773–1774 lateral, 1738 thoracic, 331 vs neurofibroma, 340 Meniscus synovial cyst involving, 1579 tears of, 1580 Mesenchymal hamartoma, 1759–1760 hepatic, 859 tracheal, 421 Mesenteric cysts, 1130–1132, 1762 Mesenteric edema, 1124 Mesenteric hemorrhage, 1132 Mesenteric lymphoma, in children, 1762 Mesenteric root, 741–742, 1123 Mesenteric tumors, 1135 Mesenteric vessels, 738–739, 1123 embolic metastases of, 1146, 1147 thrombosis of, 1133 Mesenteritis, sclerosing, 1127–1130 Mesoblastic nephroma, 1751 Mesocolon, 1123–1124 Mesothelioma, 603–608 chest wall metastases from, 632 cystic, 1134 peritoneal involvement in, 1134 Metal implants artifacts from, 68 MRI and, 82 Metastases to abdominal wall, 1107 to adrenal gland, 1345–1349 hemorrhage in, 1361 from lung cancer, 456–459, 1345–1349 to bile ducts, 958 to bone from lung cancer, 456 radiofrequency ablation for, 135 to bone marrow, 1776 to brain, from lung cancer, 456 to chest wall, 625, 631–632 for colon, 814 to gallbladder, 946 to heart, 700 to kidney, 1268–1269 to larynx, 183–184 to liver, 874–879 alcohol ablation for, 125–126 in children, 1758–1759 from lung cancer, 456 radiofrequency ablation of, 127–130 to lung in children, 1742 occult, 494–496 radiofrequency ablation for, 130–132 from lung cancer, 455–459 extrathoracic, 455–459 mediastinal nodal, 451–455 to lymph nodes cervical, 198 mediastinal, 451–455 retroperitoneal, 1199 to mediastinum, 320–321, 349, 357–358, 451–455 to pancreas, 1058–1062 to peritoneum, 1135, 1137–1146 to pleura, 600–602, 611 to retroperitoneum, 1199 from testicular tumors, 1198, 1207–1209 to ribs, 625 to small intestine, 795 to spine, 1680–1683 to spleen, 991–992 to stomach, 786 to trachea, 404, 421 Methyl-methyacrylate pulmonary embolization, 519 Meyenburg complexes, 844–845 Microcystic adenoma, pancreatic, 1049–1051 Microwave ablation See also Tumor ablation of liver tumors, 883 Middle colic vessels, 722 Midfoot, fracture of, 1605 Midgut volvulus, 798 Mini brain sign, 1719 Minimum-intensity projections, 14 Mirizzi syndrome, 949–950 Mitral valvular disease, 701–703 Mn-DPDP, 86, 90 Monteggia injury, 1519 Morgagni hernia, 647, 719–721 vs mediastinal lipoma, 334 vs thymolipoma, 322 Morison pouch, 725, 1110 Mosaic perfusion (oligemia), 527 Motion artifact(s), 62–63 reduction of, 70–73 in thoracic imaging, 231, 251–253 Motion artifact suppression technique (MAST), 73 Mounier-Kuhn syndrome, 408–409, 421 MRA See Magnetic resonance angiography (MRA) MRI See Magnetic resonance imaging (MRI) Mucinous carcinoma, pancreatic, 1045–1051 Mucocele colonic, 811 laryngeal, 201 Mucosa-associated lymphoid tissue (MALT) lymphoma, 786 Mucus plug vs pulmonary embolism, 512 vs tracheal tumor, 403 Mullerian ducts, anomalies of, 1380–1381 Multicystic dysplastic kidney, 1257 Multidetector row computed tomography, 5–6, 18–20 cardiac, 26–27 in lung cancer, 459 pancreatic, 1009, 1011, 1014 tracheobronchial, 421, 459 Multiecho spin echo imaging, 93 Multifocal biliary adenomas/papillomas, 958 Multifocal fibrosclerosis, 1212 Multilocular cystic nephroma, 1257, 1752–1753 Multiplanar reformation, 13–14 Multiple endocrine neoplasia syndromes pheochromocytoma in, 1332 thymic carcinoids in, 320 Multiple myeloma, 1622 chest wall involvement in, 614, 624 of spine, 1719 Multislice CT scanners, 1311 Murphy’s sign, 940 Muscles See also specific muscles arm, 1489 laryngeal, 169–171 pelvic, relaxation of, 1397–1399 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-19 Index Musculoskeletal imaging, 1481–1653 See also Bone; Soft tissue; specific structures and abnormalities CT in, technique of, 1481–1488 pediatric, 1775–1782 Musculoskeletal trauma See also Fractures and specific structures in children, 1780 spinal, 1668–1683 Myasthenia gravis, thymomas and, 311, 312–313 Mycetomas, in aspergillosis, 494 Mycobacterial infections pulmonary, 549–550, 552 retroperitoneal lymphadenopathy in, 1198 Mycotic aneurysm, aortic, 363, 1166 Myelography, intrathecal Pantopaque after, 1706 Myelolipoma adrenal, 1350–1352 hepatic, 859 Myelomeningocele, 1773–1774 Myocardial contusion, 1432 Myocardial function CT evaluation of, 682 MRI evaluation of, 683–685 Myocardial infarction, 685–686 Myocardial ischemia, dobutamine stress imaging for, 684–685 Myocardial mass, measurement of, 684 Myocardial perfusion, 685–686 Myocardial viability, 684, 685–686 Myofibroblastic tumor, peritoneal, 1134 Myopathy, inflammatory, idiopathic, 1639 Myositis, 1637 Myositis ossificans of abdominal wall, 1106 of chest wall, 629 Myxoid liposarcomas, mediastinal, 334 Myxomas, atrial, 699 N Nasopharynx, 161–164 cancer of, 161, 162 Navicular fracture, 1606 Neck, 200 See also under Cervical abscess of, 200 cystic lesions of, 200–206 lymphatic malformations of, 203–205 surgically reconstructed, 212–213 synthetic materials in, 215 Neck imaging, 145–215 See also specific structures and abnormalities anatomic aspects of, 150–151 of buccal space, 152 of carotid space, 158–159 cervical spaces in, 150–151 cervical triangles in, 150 contrast injection in, 145–146 CT in technique of, 145–146 vs MRI, 149–150 of cystic lesions, 200–206 of lymph nodes, 193–199 of masticator space, 159–160 MRI in technique of, 146–149 vs CT, 149–150 of parotid space, 152–156 of perivertebral space, 193 of pharyngeal mucosal space, 160–164 of pharyngeal space, 156–158 of posterior cervical space, 191–192 posttreatment, 207–215 of retropharyngeal space, 190–191 of sublingual space, 151 of submandibular space, 151–152 tumor markers in, 148–149 of visceral space, 164–190 Necrotizing fasciitis, 1637–1638 Necrotizing pneumonia, 549 in children, 1745–1746 Needles, biopsy, 97–100 See also Biopsy Neonate See also Pediatric patients adrenal hemorrhage in, 1358 Nephroblastosis, 1750–1751 Nephrocalcinosis, 1246 Nephroma cystic, multilocular, 1257 multilocular cystic, 1752–1753 Nephrostomy, CT-guided percutaneous, 122 Nerve sheath tumors See Neurofibromas; Schwannomas Net magnetization, 31–32 manipulation of, 32–33 production of, 31–32 Neurenteric cysts, 329 in children, 1738 Neurilemmoma brachial plexus, 639 chest wall, 627 gastric, 782–783 laryngeal, 183 mediastinal, 339–341 of neck, 205 parapharyngeal, 157–158 retroperitoneal, 1219 Neurinomas, gastric, 783 Neuroblastoma, 1737, 1754 bone marrow metastases from, 1776 chest wall, 627 mediastinal, 341–342 presacral, 1774 retroperitoneal, 1219 Neurofibroma, 1628 abdominal wall, 1107 brachial plexus, 639 chest wall, 627 in children, 1737–1738, 1778 mediastinal, 339–340 neck, 205 plexiform, 193, 339, 733 retroperitoneal, 1219, 1756 Neurofibrosarcoma, abdominal wall, 1110 Neurolysis, 124 Neuromas, gastric, 783 Neutrons, 29 Neutropenic enterocolitis, 818 Nissen fundoplication, 779 Nocardiosis, lung involvement in, 552 I-19 Nodal metastases cervical, 198 mediastinal, 451–455 retroperitoneal, 1199 Nodular hyperplasia of spleen, 985–987 Nodular lymphoid hyperplasia, of lung, 549 Nodule(s) adrenal in Cushing syndrome, 1324 in primary aldosteronism, 1325 in hepatic cirrhosis, 867–869, 895 pulmonary See Solitary pulmonary nodule Schmorl, 1684 Noise, 11–13 artifacts from, 69–70 Noncoronary ECG-gated cardiac imaging, 670 Normal anatomy of, 753 Nuclear cholescintigraphy, 932 Nuclear spin, 29–32 Nucleus pulposus, 1667 Number of excitation pulses, 59 Number of partitions, 58 Number of signal averaging, 59 Nutcracker syndrome, 1291 Nyquist frequency, 34, 42, 59 O Obliterative hepatocavopathy, 1196 Obturator hernia, 796, 1101–1102 Obturator vessels, 749 Occupational lung disease, 537–539 asbestosis, 538–539 coal worker’s pneumoconiosis, 539 silicosis, 537 Ogilvie syndrome, cecostomy for, 122 Olecranon, osteophytes of, 1524 Oligemia, mosaic, 527 Ollier disease, 623 Omental fat necrosis, 819, 1129 Omental infarction, 1129–1130 Omentum, 1108 Oncocytoma, renal, 1270–1272 180LI method, 5–8 Opisthorchiasis, 794 Opportunistic infections See also Human immunodeficiency virus infection pulmonary, 551, 552–554 Oral cavity, 160–164 Organ of Zuckerkandl, paraganglioma in, 1333 Organizing pneumonia, 532–533 Oriental cholangiohepatitis, 951–952 Ormond disease, 1212 Oropharynx, 161–164 Orthopedic hardware, image-guided placement of, 1652–1653 Os acetabulum, vs acetabular wall fracture, 1547, 1550 Os odontoideum, fracture of, 1669 Os supranaviculare, 1588 Os trigonum syndrome, 1588 Osler-Rendu-Weber syndrome, pulmonary arteriovenous malformations in, 486–488 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-20 I-20 Index Osseous pelvis, 1538–1561 See also under Pelvis Ossification of ligamentum flavum, 1702 of posterior longitudinal ligament, 1701 Osteitis condensans ilii, 1556 Osteoarthritis developmental dysplasia of hips and, 1559 glenohumeral joint, 1510 sacroiliac joint, 1555 Osteoarticular tuberculosis, 1637 Osteoblastoma, spinal, 1716 Osteochondral bodies in ankle, 1610 in elbow, 1524 in knee, 1580 Osteochondritis dissecans, in knee, 1573 Osteochondroma, 1615 of rib, 617, 623 vs lung cancer, 433, 434 Osteochondrosis, 1696–1697 Osteoid osteoma, 1616 CT-guided ablation of, 1647–1649 radiofrequency ablation for, 133–135 spinal, 1716 Osteolysis, periprosthetic, 1560 Osteomyelitis, 1635–1636, 1706–1710 in children, 1780 vs pleural calcification, 592 Osteonecrosis lunate, 1536 posttraumatic, 1489 radiation, 213–214 pelvic, 1552 scaphoid, 1535 Osteopenia, disuse, 1740 Osteophytes bridging, 1696 olecranon, 1524 Osteoporosis, 1640 Osteosarcoma, 1622, 1776–1777 of chest wall, 625 of rib, vs lung cancer, 433, 435 Otitis externa, malignant, 164 Otitis media, serous, 161, 163–164 Out-of-phase gradient echo magnetic resonance imaging, 92 Ovarian vein See also Inferior vena cava thrombosis of, 1194 Ovary See also Pelvic imaging cancer of, 1395–1396, 1397, 1771 ascites from, 1116 mediastinal involvement in, 332 peritoneal involvement in, 1143 cystadenoma of, 1386, 1389 cysts of, 1383–1386, 1389 in children, 1770 dermoid of, 1383–1386, 1389, 1770–1771 disorders of, in children, 1770–1771 normal anatomy of, 760, 765, 1377, 1378–1379 polycystic, 1383 torsion of, 1387–1388, 1389, 1771 P Pacemakers, thoracic imaging and, 231 Pancoast tumor, 449 brachial plexus, 641 chest wall metastases from, 633 Pancreas abscess of, 1072 acute fluid collections in, 1070–1072 annular, 1022–1023 biopsy of, 108–110 congenital abnormalities of, 1022–1024 cystic fibrosis involving, 1086 cysts of, 1045 in children, 1761 disorders of, in children, 1760–1761, 1767–1768 dorsal, agenesis of, 1023–1024 in hemochromatosis, 1086 heterotopic, 781 infections of, 1088 inflammatory diseases of, 1062–1072 normal anatomy of, 738–740, 1016–1022 pseudofracture of, 1457 transplantation of, 1092–1093 trauma to, 1086–1088, 1455–1458 in children, 1763–1765 tumors of, 1024–1062 See also specific type in children, 1760–1761 Pancreas divisum, 1022 Pancreatectomy, postoperative evaluation after, 1088–1091 Pancreatic cancer, 1024–1045 mucinous, 1045–1051 cystic, 1047–1049 intraductal papillary, 1046–1047 resectability of, 1033–1045 spiral CT of, 1027–1033 Pancreatic duct normal anatomy of, 931 trauma to, 1457–1458 Pancreatic effusion, 743–745 Pancreatic hemorrhage, 1077 Pancreatic imaging, 1007–1093 of congenital abnormalities, 1022–1024 CT with contrast enhancement, 1007–1008 interventional, 1077 techniques of, 1008–1016 of inflammatory diseases, 1062–1072 MRI, 1078–1080 normal anatomy in, 1016–1019 anatomic relationships and, 1019–1022 postoperative, 1088–1091 of tumors, 1024–1062 Pancreatic necrosis, 1072–1074 infected, 1075–1076 Pancreatic pseudocyst, 331–333, 1045 acute, 1072 extension into spleen, 998–999 Pancreaticoblastoma, 1760 Pancreaticoduodenal vein, 739 Pancreaticoduodenectomy, 787 Pancreatitis acute, 1062–1065 CT severity index in, 1067–1070 mild, 1066–1067 MRI in, 1078–1080 severe, 1067 autoimmune, 1086 in children, 1768 chronic, 1080–1086 effusion in, 743–745 hemorrhagic, 1015 mesenteric involvement in, 1124–1125 renal involvement in, 736 splenic involvement in, 998–999, 999 transverse mesocolic involvement in, 742 Panniculitis, mesenteric, 1127 Pannus, in spinal rheumatoid arthritis, 1710–1713 Pantopaque, intrathecal, 1706 Papillomatosis biliary, 958 tracheal, 403, 421 Paracicatrical emphysema, 546 Paracoccidioidomycosis, adrenal involvement in, 1356–1358 Paraesophageal lymph nodes, 286 Paraganglioma, 158–159, 1330–1336 laryngeal, 183 mediastinal, 342–344 of minor salivary glands, 183 retroperitoneal, 1219 Parallel acquisition techniques, 48–49 Paralysis, hemidiaphragm, 656 Parameniscal synovial cyst, 1579 Parametrium, 754 normal anatomy of, 765 Parapneumonic pleural effusion, 578–580 See also Empyema Pararenal spaces, 736–737 fluid in, 743–745 Paraseptal emphysema, 545–546 Parasitic infections biliary, 954 peritoneal, 1127 soft tissue, 1639 Parastomal hernias, 796 Parathyroid gland CT-guided biopsy of, 113–114 cysts of, 206 mediastinal, 331 disorders of, 189–190 normal anatomy of, 189 tumors of, metastatic, 351–352 Paratracheal lymph nodes, 286 Parenchymal bands, in diffuse lung disease, 525 Parotid gland, 152–156 bilateral painful enlargement of, 156 tumors of, 153–156 benign, 153–154 malignant, 154–156 metastatic, 156 Parsonage-Turner syndrome, 642 Partial Fourier imaging, 48 Partial hepatectomy, imaging after, 835–836 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-21 Index Particle disease, 1560–1561 Patella, subluxation of, 1583 Patent ductus arteriosus, 689 Pathologic fractures, spinal, 1680–1683 Pectoralis muscles, congenital absence of, 296, 613 Pectus carinatum, 616 Pectus excavatum, 613, 616 Pediatric imaging, protocols for, 1789–1791 Pediatric imaging, 1727–1782 See also Pediatric patients abdominal, 1749–1770 of chest, 1730–1740 CT, 1728–1729 bowel opacification in, 1728 contrast material in, 1728 scan delay times in, 1728–1729 technique of, 1728–1729 MRI, 1729–1730 contrast material in, 1730 fat suppression in, 1729–1730 image quality optimization in, 1730 imaging parameters in, 1729 pulse sequences in, 1729 musculoskeletal, 1775–1782 normal anatomy in, thoracic, 1730–1749 patient preparation in, 1727–1739 pelvic, 1770–1775 sedation in, 1727 vascular, 1770, 1778–1780 Pediatric patients See also specific disorders abdominal masses in, 1762–1763 abdominal trauma in, 1763–1765 airway disease in, 1747 biliary masses in, 1760 bladder masses in, 1772 chest imaging in, 1739–1749 normal anatomy in, 1730 congenital anomalies in, fetal diagnosis of, 1401 cryptorchidism in, 1775 cystic hygroma in, 1736–1737 foregut cysts in, 1737 ganglion cell tumors in, 1737–1738 gastrointestinal masses in, 1762 germ cell tumors in, mediastinal, 1735–1736 heart disease in, 687–692, 1748–1749 hepatic disease in, 1765 hepatic masses in, 1756 intestinal disorders in, 1768–1770 lung disorders in, 1741–1746 lymphadenopathy in, mediastinal, 1737 lymphoma in, 1732–1733, 1762 mediastinal masses in anterior, 1732–1737 middle, 1737 posterior, 1737–1738 vascular, 1738–1739 musculoskeletal disorders in, 1775–1782 neurenteric cysts in, 1738 neurogenic tumors in, mediastinal, 1737–1738 ovarian masses in, 1770–1771 pancreatic masses in, 1760–1761 pelvic disorders in, 1770–1775 pelvic masses in, 1770–1774 presacral masses in, 1772–1774 prostate masses in, 1772 pulmonary vessel anomalies in, 1748 renal masses in, 1749–1753 cystic, 1752–1753 neoplastic, 1749–1752 retroperitoneal soft tissue masses in, 1756 thymic cysts in, 1736 thymic hyperplasia in, 1733–1734 thymolipoma in, 1736 thymoma in, 1734–1735 uterine anomalies in, 1774 vaginal/uterine masses in, 1771–1772 vascular disorders in, 1770, 1778–1779 Peliosis hepatic, 909–910, 996 splenic, 996–997 Pelvic abscess, 1118, 1412 Pelvic floor relaxation, 1397–1399 Pelvic imaging, 746–767, 1375–1413 See also specific organs in biopsy, 113 of bladder, 749–750, 1406–1409 See also Bladder of cervix, 765, 1376, 1378, 1391–1392, 1396–1397 See also Cervix CT, 1375 of extraperitoneal spaces, 750–751 in female of benign adnexal masses, 1383–1389 of benign gynecologic disease and infertility, 1380–1383 of gynecologic tumors, 1390–1397 normal anatomy in, 1376–1379 of pelvic floor relaxation, 1397–1399 in pregnancy, 1399–1401 of fetal anomalies, 1401 intravaginal coil in, 765 in male normal anatomy in, 1377, 1379 of tumors, 1402–1406 of undescended testis, 1406 MRI, 91–92, 1375–1376 of neurologic structures, 748 normal anatomy in, 746–767, 1376–1379 of ovary, 765, 1383–1389 See also Ovary of penis, 754 of perineum in female, 765 in male, 754 of peritoneal spaces, 749–750 of prostate, 753–754, 1377–1379 of seminal vesicles, 753–754 of treatment complications, 1411–1413 of urethra, in male, 754, 1379 of uterus, 754–760, 754–765, 1376–1377, 1378 See also Uterus of vagina, 760–765, 1377, 1378 See also Vagina of vasa deferentia, 753–754 of vascular structures, 748–749 I-21 Pelvic muscles normal anatomy of, 1377 weakness of, 1397–1399 Pelvic ring fracture of, 1538–1540 vertical shear injury of, 1540 Pelvis osseous normal anatomy of, 1538 radiation necrosis of, 1552 trauma to, 1538–1542 parathyroid, 113–114 penetrating injuries of, 1550 windswept, 1540 Penetrating atherosclerotic ulcer, of aorta, 389–393 Penis, normal anatomy of, 754, 1379 Penumbra, 17–18, 25 Percutaneous biopsy See Biopsy Percutaneous drainage See Drainage Percutaneous nephrostomy, CT-guided, 122 Percutaneous transhepatic cholangiography, 931, 932, 933 Percutaneous tumor ablation, 125–130 See also Tumor ablation Perforation colonic, 818 duodenal, 792 esophageal, 776 gastric, 787 Perfusion studies, magnetic resonance, 77–78 Periampullary tumors, 958 Perianeurysmal fibrosis, 731, 1165, 1204 Peribiliary cysts, 845 Peribronchial lymph nodes, 286 Pericardial agenesis, 697–698 Pericardial cysts, 329, 698–699 Pericardial disease, 696–699 Pericardial diverticulum, 698 Pericardial effusion, 697 Pericardial fat pads, 334 Pericardial imaging, normal anatomy in, 290–293 Pericardial trauma, 1432–1434 Pericarditis, constrictive, 696–697 Pericardium, lung cancer invasion of, 447–448 Pericholangitis, 952–953 Perihepatic space, right, 1110 Perilunate dislocation, 1535–1536 Perineum, normal anatomy of in female, 765 in male, 754 Periprosthetic osteolysis, 1560 Perirenal fat, 736 Perirenal spaces, 733–736 Peristalsis artifacts, 63 Peritoneal abscess, 1117–1121 Peritoneal cavity imaging, 1107–1146 normal anatomy in, 1107–1112 Peritoneal hemorrhage, 1121–1122 Peritoneal recesses, posterior, 727 Peritoneal spaces, 1109–1112 abdominal, 724–727 bile accumulation in, 1123 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-22 I-22 Index Peritoneal spaces (continued) lymphatic fluid in, 1123 pelvic, 749–750 urine collection in, 1123 Peritoneal tumors, 1134–1135 metastatic, 1135, 1137–1146 Peritonitis, 1126–1127 Perivertebral space, 193 Perivesical space, 751 PET-CT See Positron emission tomography Petit’s triangle, 713, 736 Petit’s triangle, 1101 Pharyngeal mucosal space, 160–164 Pharyngeal space, imaging of, 156–158 Pharynx cancer of, 161–164, 177–181 radiation therapy for, 213–214 normal anatomy of, 172 Phase cancellation artifacts, 65 Phase encoding, 43–44 Phase-contrast magnetic resonance angiography, 74, 75–76 Phenobarbital, for pediatric sedation, 1727 Pheochromocytoma, 342–343, 1330–1336 in children, 1755 retroperitoneal, 1219 Phleboliths, in rectal cavernous hemangioma, 810 Phrenic bundles, vs pleural calcification, 591 Phrenic nerve, 293 Phrenic vessels, 288–290 Phrenocolic ligament, 725 Phrygian cap, 931–932, 935 Pig bronchi, 1747 Pigmented villonodular synovitis, 1610, 1781 Pitch, 18–20 radiation dose and, 20, 25 Pixels, 40 intensity of, 40 Plasmacytoma, 614 of spine, 1719 Pleomorphic adenoma, 153–156 Pleomorphic carcinoma, pancreatic, 1057 Pleura See also Lung disorders of, in children, 1746 lung cancer invasion of, 447–449 tumors of, 595–609 benign, 597–600 malignant, 600–609 Pleural disease, 572–584 See also specific disease Pleural effusion, 573–578 attenuation of, 574–575 causes of, 574 CT of, 574–578 mesothelioma-related, 604 parapneumonic, 578–580 See also Empyema pleurodesis for, 609 traumatic, 1422–1423 types of, 574 volume of, 575–576 vs ascites, 577–578 Pleural imaging, 569–610 normal anatomy in, 284–290, 569–572 of pleural disease, 572–584 Pleural lymphoma, 602–603 Pleural space, foreign body in, 583 Pleural thickening, 584–593 asbestos-related, 589–591, 604 calcification and, 588–589 extrapleural fat and, 589 rounded atelectasis and, 591–593 Pleurodesis, 609 talc, 588 Plexiform neurofibroma, 193, 339, 733 in children, 1778 Plummer-Vinson syndrome, 178 Pneumatocele, 1745 Pneumatosis colonic, 821 gastric, 787 small intestinal, 801 Pneumatosis cystoides intestinalis, 821 Pneumobilia, 935 Pneumoconioses, 537–539 See also Occupational lung disease Pneumocystis carinii pneumonia, 521, 552–553 Pneumonectomy, space created from, 611–612 Pneumonia, 549–554 acute interstitial, 531 aspiration, 549 in children, 1745–1746 chronic interstitial, 528–531 with bronchiolitis, 530 desquamative, 530 lymphocytic, 531, 549 nonspecific, 529–530 usual, 528–529 empyema and, 578 fungal, HIV-related, 553 HIV-related, 551, 552–554 hypersensitivity, 541–542 lipoid, 242, 485 mycobacterial, 549–550 necrotizing, 549 in children, 1745–1746 organizing, 532–533 Pneumocystis carinii, 521, 522–523 Pneumonitis See also Pneumonia hypersensitivity, 541–542 radiation, 497–499 Pneumopericardium, traumatic, 1434 Pneumoperitoneum, traumatic, 1460–1461 Pneumothorax, 594–595, 698, 1421–1422 traumatic, 1435 Poland syndrome, 614 Polyarteritis nodosa, intestinal involvement in, 801–802 Polychondritis, relapsing tracheal, 405–406, 421 Polycystic kidney disease autosomal dominant, 1252–1253 autosomal recessive, 1255 in children, 1753 Polycystic liver disease, 843–844 Polycystic ovary, 1383 Polymyositis/dermatomyositis, lung involvement in, 533 Polyps colonic, 822 esophageal, 773 gallbladder, 943 gastric, 783 vocal cord, 182 Polysplenia, 981–982 Popcorn calcifications, in hamartomas, 483, 485 Porcelain gallbladder, 943, 944–945 Portacaval shunt, congenital, 1190 Portacaval space, 730 Portal vein, 834–835 cavernous transformation of, 903 malignant invasion of, 860–861, 863–864 Portal vein thrombosis, 903–904 in hepatocellular carcinoma, 864 posttransplant, 911 Portosystemic collateral veins, in hepatic cirrhosis, 895–898 Positron emission tomography, 27–28, 214 See also FDG PET of adrenal gland, 1367–1368 of lung cancer, 454–455, 459–460 of retroperitoneal lymphadenopathy, 1202–1204 of solitary pulmonary nodule, 483–484 Posterior cervical masses, 191–192 Posterior cruciate ligament, 1562 Posterior junction line, thoracic, 293 Posterior longitudinal ligament, 1666–1667 ossification of, 1701 Posterior pararenal space, 736 Postpatient collimators, 17–18 Postpneumonectomy space, 611–612 Postpneumonectomy syndrome, 611 Potter’s syndrome, 1401 Potts’ shunt, 690 Pouch of Douglas, 750 Pouchitis, 808 Precession, 39 frequency of, 30 Pregnancy CT in, 1399–1400 MRI in, 1400–1401 Preparatory pulses, 37 Prepatient collimators, 17 Presacral neuroblastoma, 1774 Prevesical space, 751 Primary aldosteronism, 1324–1326 Primary epiploic appendicitis, 819 Primary hepatic angiosarcoma, 881–882 Primary sclerosing cholangitis, 952–954 cholangiocarcinoma in, 954–955, 956 Proctitis, radiation, 819 Projection x-ray imaging, Prostate, 1404 See also Pelvic imaging abscess of, 1404 cancer of, 1402–1405 retroperitoneal lymphadenopathy in, 1200 disorders of, in children, 1772 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-23 Index normal anatomy of, 753–754, 1377, 1379 Protocol-related artifacts, 63–68 Protons, 29 dephasing of, 37–40, 41 energy absorption by, 32–35 saturation and, 36 energy emission by, 35–40 precession of, 30, 39 periodicity of, 43 saturation of, 36 spin vectors of, 30–31 Pseudoaneurysm aortic, 245, 1169–1171 traumatic, 1430 hepatic artery, 1453 mediastinal venous, 400 pulmonary artery, 486 Pseudochylous pleural effusion, 575 Pseudocoarctation, 304, 394–395 Pseudocyst, pancreatic, 331–333, 1045 acute, 1072 extension into spleen, 998–999 Pseudofracture, pancreatic, 1457 Pseudomembranous colitis, 818 Pseudomyxoma peritonei, 1112 Pseudonodule, pulmonary, 270 Pseudopapillary tumor, pancreatic, solid, 1056–1057 Pseudotumor adrenal, 1315–1317 diaphragmatic, 645 peritoneal, 1134 pleural, calcifying fibrous, 600 Pseudotumoral lipomatosis, of mesentery, 1132 Psoas muscles, 731–733 abscess of, 1222–1225 atrophy of, 1225 hematoma of, 1225 inflammatory lesions of, 1222–1225 normal anatomy of, 1220–1221 tumors of, 1221–1222, 1225 Psoas spaces, 731–733 Pulmonary alveolar proteinosis, 542–543 in children, 1745 Pulmonary artery, 262, 275–278 anomalous, 304 congenital anomalies of, 486 pseudoaneurysm of, 486 Pulmonary atelectasis, pleural effusion and, 574 Pulmonary candidiasis, 552 Pulmonary carcinoids, 431 Pulmonary collapse, 465–474 See also Atelectasis Pulmonary contusion, 1423–1425 Pulmonary edema, 528 Pulmonary embolism, 232, 237, 251, 499–519 acute, 501–503 calcification of, 503 chronic, 503 with coexistent lung cancer, 511 CT imaging of accuracy of, 514–517 interpretation of, 501–514 pitfalls in, 516 role of, 514–519 technique of, 501 with venography of pelvis and thighs, 514 deep venous thrombosis and, 514 differential diagnosis of, 511–514 massive, 511 overview of, 499–501 sources of, 514 V/Q scintigraphy of, 517–519 vs aortic dissection, 512 vs fibrosing mediastinitis, 513 vs mucus plug, 512 Pulmonary embolization, methylmethyacrylate, 519 Pulmonary emphysema See Emphysema Pulmonary eosinophilia, 542 Pulmonary fibrosis, 231, 232, 238 in children, 1745 idiopathic, 528–531 in occupational lung diseases, 537–539 in systemic disease, 531–537 vs lung cancer, 433, 435 Pulmonary fissures, 284–286 Pulmonary hamartomas, 228 Pulmonary hematoma, 1424–1425 vs lung cancer, 433, 435 Pulmonary hila, 272 Pulmonary imaging, normal anatomy in, 275–278 Pulmonary laceration, 1424–1425 Pulmonary ligament(s), 286–288 inferior, 571–572 Pulmonary ligament nodes, 286 Pulmonary lymphoid disorders, 549 Pulmonary nodule(s), 227, 228, 241–245, 527–528 in diffuse lung disease, 527–528 as occult metastases, 494–496 secondary, in diffuse lung disease, 523 solitary, 479–485 air bronchograms in, 483 calcification in, 482–483 densitometry for, 482 evaluation of in screening, 461–463 fat in, 483 management of, 484–485 Pulmonary parenchyma, 227–229, 271–272 Pulmonary pseudonodule, 270 Pulmonary sequestration, 488–490, 1741–1742 Pulmonary sling, 1748 Pulmonary valvular disease, 701–703 Pulmonary vasculitis, 548–549 Pulmonary vein, 275–277 anomalous, 299–301, 302, 692 congenital anomalies of, 486, 692 imaging of, 670 mapping of, 692–694 Pulse(s) artifacts from, 67 in thoracic MRI, 254 composite, 61–62 power produced by, 79 I-23 radiofrequency, 41, 61–62 spatial presaturation, 59 Pulse angle, 37, 58, 61 Pulse sequences, 40, 49–56 combination of, 49 comparison of, 49 composite, 61–62 definition of, 49 echo planar imaging, 52–53 ETSE, 50–51, 53 gradient echo, 51–52, 54–56 magnetic field distortion and, 68 in magnetic resonance angiography, 51–52, 54–56 magnetization-prepared sequences, 53–56 measurement parameters for, 49, 56–59 radiofrequency, 59 selection of, 49, 56–57 spin echo, 49–51 timing diagrams for, 49 varieties of, 49, 56–57 Pulverized kidney, 1467 Pulverized lung, 1425 Pyelonephritis acute, 1274–1277 in children, 1766 chronic, 1277–1278 Pyogenic hepatitis, recurrent, 951–952 Pyomyositis, 1637 Pyriform sinuses cancer of, 177, 181 normal anatomy of, 172 Q Quadratus lumborum muscles, 731–733 Query/Retrieve, 81 R Radial head fracture of, 1516–1519 fracture-dislocation of, 1519 Radiation colitis, 819 Radiation dose in cardiac CT, 670 definition of, 23 measurement of, 23–24 in PET-CT, 27–28 pitch and, 20, 25 reduction of, 25–26 regulation of, 24–25 scan parameters affecting, 24–25 in thoracic CT, 234–235 tube voltage/current and, 20–21, 24–26 Radiation dosimetry, 23–24 Radiation enteritis, 802, 820 Radiation esophagitis, 776 Radiation exposure, 23–26 Radiation injury hepatic, 900–901 intestinal, 820 osseous, 213–214 pelvic, 1552 pulmonary, 497–499 Radiation penumbra, 17–18, 25 Radiation pneumonitis, 497–499 Radiation proctitis, 819 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-24 I-24 Index Radiation therapy brachial plexopathy from, 640–642 complications of See Radiation injury for head and neck cancer, 213–214 for lung cancer, 459–460 pelvic, 1411–1412 Radical neck dissection, 209–212 Radiculomeningeal vascular malformations, 1719 Radiofrequency ablation, 126–135 for bone tumors, 133–135 for kidney tumors, 132–133, 1297–1299 for liver tumors, 128–130, 883 biliary complications of, 964 contraindications to, 128–129 imaging follow-up for, 129–130 indications for, 128 patient selection for, 128 results of, 129–130 technique of, 129 for lung tumors, 130–132 for osseous lesions, 1647–1649 Radiofrequency (rf) energy, 32 absorption of, 32–35 saturation and, 32–35, 36 emission of, 35–40 pulsed, 41, 61–62 artifacts from, 67 Radiofrequency pulses, 59 Radiofrequency spoiling, 67 Radiofrequency transmitter system, 83–84 Radiographic contrast agents See Contrast agents Radioisotope scanning adrenal, 1367 in lymphoma, 361–362 renal, 1465–1466 Radioulnar joint, distal, trauma to, 1530–1532 Radius, fracture of, distal, 1529–1530 Ranula, 202–203 Raw data, 44 collection of, 46–49 Raw data matrix, 46–49 Readout, 41–42 Rebound thymic hyperplasia, 324 Receiver bandwidth, 42, 59 Reconstruction kernel, 21 Rectouterine pouch, 750 Rectum See also under Colon; Intestinal congenital malformations of, 1768 Rectus abdominis muscles, 707–708 Recurrent pyogenic hepatitis, 951–952 Reference frequency, 35 Refocused gradient echo sequences, 51 Reidel’s lobe, 835 Reidel’s thyroiditis, 186 Relapsing polychondritis, tracheal, 405–406, 421 Relaxation, 35–40 T1, 35–37 T2, 37–40 Renal abscess, 1277–1278 Renal artery, trauma to, 1467 Renal artery aneurysm, 1288–1289 Renal artery dissection, 1290 Renal artery occlusion, in children, 1767 Renal artery stenosis, 1288 Renal artery stents, 1288 Renal artery thrombosis, posttraumatic, 1467 Renal biopsy, 111–112, 1293–1295 Renal cell carcinoma, 1258–1263 calcified, 1246 in children, 1752 cystic, 1263–1264 pulmonary nodule in, 227, 228 radiofrequency ablation for, 132–133 retroperitoneal lymphadenopathy in, 1199 sarcomatoid, 1270 staging of, 1260–1263 treatment of, 1263 vs pheochromocytoma, 1338 Renal clear cell sarcoma, 1751–1752 Renal cortex, abnormal appearance of, 1241–1242 Renal cysts, in children, 1752–1753 Renal disease, in children, 1766–1767 Renal ectopia, 1239 Renal failure, 1281 Renal imaging, 1233–1299 of abscess, 1277–1278 of congenital abnormalities, 1239–1242 CT in, 1234–1237 of cystic disease, 1247–1258 of infections acute, 1274–1277 chronic, 1277–1278 MRI in, 1237–1239 normal anatomy in, 1233–1234 radionuclide, 1465–1466 of trauma, 1282–1287 of tumors benign, 1270–1274 calcified, 1246 malignant, 1258–1270 ultrasonography in, 1465–1466 of vascular disease, 1287–1292 Renal infarction, in children, 1767 Renal infections, 1274–1277 chronic, 1278–1280 Renal laceration, 1466 Renal lymphoma, 1751 in children, 1751 Renal medullary carcinoma, 1752 Renal perfusion, 1288 Renal replacement lipomatosis, 1280 Renal stones, 1242–1245 Renal transplant, 1292, 1295–1297 Renal trauma, 1282–1287, 1463–1468 in children, 1763–1765 Renal tuberculosis, 1279 Renal tumors See also Renal cancer benign, 1270–1274 calcified, 1246 in children, 1749–1752 malignant, 1258–1270 See also Renal cell carcinoma radiofrequency ablation of, 1297–1299 Renal vascular disease, in children, 1767 Renal vein See also Inferior vena cava left circumaortic, 1185 retroaortic, 1185 normal anatomy of, 1182, 1183 thrombosis of, 1194 trauma to, 1467 Renal vein thrombosis, 1290–1291 Rendering techniques, 13–16 Reordered data collection, 46 Repetition time (TR), 37 image contrast and, 57 Resolution, 9–11 contrast, 10 definition of, in phase-encoding direction, 43–44 spatial, 9–10 Resonance absorption, 33 Resonant frequency, 33–35 of fat vs water, 35 Respiratory bronchiolitis-interstitial lung disease, 530 Respiratory distress syndrome, adult, 528 Respiratory gating, 251–252 Respiratory motion artifacts, 63, 231, 251–252 Retention cysts, esophageal, 773 Retractile mesenteritis, 1127 Retroaortic left brachiocephalic vein, 299 Retrocrural space, 267–268, 719 Retroperitoneal biopsy, 112–113 Retroperitoneal fibrosis, 731, 1204–1205, 1212–1213 malignant, 1212–1213 perianeurysmal, 1165, 1204 posttreatment, 1204–1205 Retroperitoneal fluid, 735–736 Retroperitoneal hemorrhage, 1209–1211 Retroperitoneal imaging anatomic aspects of, 1155 of aorta, 1156–1181 CT, technique of, 1155–1156 of inferior vena cava, 1181–1197 of lymph nodes, 1197–1209 See also Retroperitoneal lymphadenopathy MRI, technique of, 1156–1159 Retroperitoneal lymphadenopathy, 1198–1209 in Burkitt lymphoma, 1199 in Castleman disease, 1199 differential diagnosis of, 1204 hemorrhagic, 1197 hypodense, 1198 imaging of, 1198–1204 bipedal lymphangiography in, 1201–1202 CT in, 1198–1201 MR lymphangiography in, 1202 MRI in, 1198–1201 PET in, 1202–1204 ultrasonography in, 1204 in Kawasaki disease, 1198 in lymphoma, 1198, 1205–1207 metastatic, 1199 in mycobacterial infections, 1198 posttherapy evaluation of, 1204–1205 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-25 Index in prostate cancer, 1200 in renal cell carcinoma, 1199 in sarcoidosis, 1198 testicular tumors and, 1198 in Whipple disease, 1198 Retroperitoneal planes, fluid in, 743–745 Retroperitoneal spaces pararenal, 1155 perirenal, 1155 Retroperitoneal tumors, 1196–1197, 1213–1220 in children, 1756 cystic, 1219–1220 leiomyosarcoma, 1196–1197, 1218 lipomatous, 1216–1218 lymphangioma, 1756 malignant fibrous histiocytoma, 1218–1219 neurofibroma, 1756 neurogenic, 1219 primary germ cell, 1219 rhabdomyosarcoma, 1756 teratoma, 1756 Retropharyngeal masses, 190–191 Retrospective gating, 73 Retrotracheal recess, 293 Reverse Bankhart lesions, 1504 Reverse Barton fracture, 1529 Reverse halo sign, 532 Reverse Hill-Sachs fracture, 1504 Rf See under Radiofrequency Rhabdoid tumor, 1751–1752 Rhabdomyosarcoma, 1756 biliary, 1760 bladder, 1772 in masticator space, 160 pharyngeal, 162 soft tissue, 1777–1778 uterine, 1772 vaginal, 1772 Rheumatoid arthritis of foot, 1610 of hips, 1558 juvenile, 1781 lung involvement in, 533 of spine, 1710–1713 Rib(s), 270, 616–618 See also Chest wall bone island of, vs lung cancer, 433, 434 fracture of, 616–617, 1419–1420 lung cancer invasion of, 448 multiple myeloma involving, 614 osteochondroma of, 617, 623 vs lung cancer, 433, 434 osteosarcoma of, vs lung cancer, 433, 435 Richter hernias, 796 Right coronary artery, anomalous, 703 Right ventricular dysplasia, 694–695 Right ventricular hypertrophy, in tetralogy of Fallot, 689–692 Right ventricular obstruction, in tetralogy of Fallot, 689–692 Rise time, 83 Rokitansky-Aschoff sinuses, 943–944 Rotating frame, 32 Rotator cuff tear, 1510 Rotex needle, 98–99 Rotter’s nodes, 271 Round ligaments, 760, 1377 Rounded atelectasis, 471–474, 591–593 Roux-en-Y gastrojejunostomy, 788 Roux-en-Y pancreaticoduodenectomy, 787 S Saber-sheath trachea, 279, 405 Sacrococcygeal fracture, 1540, 1679–1680 Sacrococcygeal teratoma, 1772–1773 Sacroiliac joints, 1552–1556 Sacrum, 1538 fractures of, 1540, 1679–1680 normal anatomy of, 1663 Safety precautions, for MRI, 79, 82 Salivary glands cystic lesions of, 200–203 minor, tumors of, 162, 183–184 parapharyngeal space, 156–158 parotid, 152–156 See also Parotid gland pharyngeal, 162 schwannomas of, 157–158 tumors of, 153–156 radiation therapy for, 213–214 Sample-induced inhomogeneity, 38–39 Saphenous vein graft, aneurysm of, 400 SAR See Specific absorption rate (SAR) Sarcoidosis cardiac, 694 gastric, 786 hepatosplenic, 901–902 mediastinal lymphadenopathy in, 348, 349, 356–357 pulmonary, 523, 534–537 renal, 1274 retroperitoneal lymphadenopathy in, 1198 splenic, 997 Sarcoma See specific sites and types Sarcomatoid renal cell carcinoma, 1270 Saturation, 36 Scan parameters, 16–23 collimation, 16–18 pitch, 18–20 reconstruction kernel, 21 section thickness, 21–23 in sequential scanning, 21 in spiral scanning, 21 table travel speed, 18 tube voltage and current, 20–21 Scan room, shielding of, 84 Scan time, 56–57 total, 44–45 Scanners detector configuration in, 5–8 geometric efficiency of, 25 multislice CT, 1311 Scaphoid fracture of, 1532–1535 humpback deformity of, 1535 Scapholunate ligament, tears of, 1536 Scapular fractures, 1420 of body, 1494–1496 of neck, 1496 Scapulothoracic dissociation, 1496 Scar, epidural, 1705–1706 I-25 Scar emphysema, 546 Schatzker classification, for tibial plateau fractures, 1567–1571 Schistosomiasis, liver abscess in, 891 Schmorl nodule, 1684 Schwachman-Diamond syndrome, 1086, 1767 Schwannoma brachial plexus, 639 chest wall, 627 gastric, 782–783 gastrointestinal, 782–783 laryngeal, 183 mediastinal, 339–341 of neck, 205 parapharyngeal, 157–158 retroperitoneal, 1219 Scimitar syndrome, 302, 1742 Scintigraphy adrenal, 1367 gallium-67, in lymphoma, 361–362 renal, 1465–1466 Scleroderma intestinal involvement in, 807 lung involvement in, 240, 533 Sclerosing encapsulating peritonitis, 1127 Sclerosing mesenteritis, 793, 1127–1130 Screening for colorectal cancer, 821–822 for lung cancer, 460–465 Scrofula, 639 Seatbelt injuries abdominal, 1458 spinal, 1679 Sebaceous cysts, of chest wall, 629 Secondary pulmonary nodule, in diffuse lung disease, 523 Section thickness, 21–23 Sedation for MRI, 149–150 in pediatric imaging, 1727 Segmental hepatectomy, 959–961 Segmented data collection, 46 Seminal vesicle, normal anatomy of, 753, 1377 Seminoma, mediastinal, 316, 317 Sensitivity encoding (SENSE), 49 Sentinel clot sign, in abdominal trauma, 1443–1444 Septate uterus, 1380–1381, 1775 Septic arthritis, 1636–1637 sternoclavicular, 614 Septic emboli, HIV-related, 552 Sequence kernel time, 44 Sequence-related artifacts, 63–68 Sequential filling, 46 Sequential scanning, 21 Sequential slice technique, 45 Sequestration disc, 1693 pulmonary, 1741–1742 Seromas, 1412 Serous otitis media, 161, 163–164 Sesamoids, 1588–1590 arthritis of, 1610 fracture of, 1607 Shaded surface display, 14–15 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-26 I-26 Index Shattered kidney, 1468 Shepherd fracture, 1603 vs os trigonum, 1588 Shielding of magnets, 82 of scan room, 84 Shimming, 79, 82 Short T1 inversion recovery (STIR), 54, 59, 92–93 Shoulder dislocation of anterior, 1499 Bankhart lesion from, 1499–1500 Hills-Sachs fracture from, 1500–1501 posterior, 1501, 1504 normal anatomy of, 1488–1493 soft tissue abnormalities of, 1504–1514 trauma to, 1493–1504 Shunts arterioportal in cirrhosis, 904 in liver cancer, 860–861, 863–864 transient hepatic attenuation difference and, 904 intracardiac, 689 portacaval, congenital, 1190 surgical, in tetralogy of Fallot, 689–692 Sickle cell anemia, splenic involvement in, 997–998 Siderosis, 539 Sigmoid volvulus, 820 Signal, 9, 33–35 digitized, 34 frequency of, 33–35 magnitude of, 32, 33 mapping of, 33–34 phase of, 33 spatial localization of, 40–44 Signal amplitude, 56 Signal averaging, 59 Signal-to-noise ratio, 11–13 Silicosis, 349, 537 Simultaneous acquisition of spatial harmonics (SMASH), 49 Single-detector computed tomography, 5–6, 18–20 pancreatic, 1011, 1014 Sinuses, pyriform cancer of, 177 normal anatomy of, 172 Sinuses of valsalva, 263 Situs anomalies, 781–782 Situs inversus totalis, 296 Sjögren’s syndrome, lung involvement in, 533 Skin effect, 79 Slew rate, 83 Slice gap, 58 Slice orientation, 40–41 Slice selection, 40–41 Slice sensitivity profile, 10 Slice thickness, 58 Small airways disease, 547–548 Small cell carcinoma gastric, 786 pulmonary, 229, 230 Small intestinal mesentery, 1132–1133 abnormalities of, 1124 in Crohn’s disease, 1125 cyst of, 1130–1132 hemorrhage of, 1132 normal anatomy of, 1123 in pancreatitis, 1124–1125 pseudotumoral lipomatosis of, 1132 root of, 741–742 tumors of, 1135 Small intestine See also under Duodenum; Intestinal congenital abnormalities of, 791–793 disorders of, in children, 1769 duplication cysts of, 792 edema of, 806 imaging of, 789–808 in children, 1769 normal anatomy in, 789 pathologic findings on, 791–808 inflammation of, 803–806 intussusception of, 796–797 ischemia of, 799–800 obstruction of, 795–802 from obturator hernia, 1104 surgery of, 807–808 trauma to, 806–807, 1458–1463 tumors of benign, 793 malignant, 793–795 obstruction from, 797–802 vasculitis of, 801 SMASH (simultaneous acquisition of spatial harmonics), 49 Smith fracture, 1529 S/N ratio, 59 Snapshot ETSE, 51 Soft tissue, 1638 abscess of, 1638 osteomyelitis and, 1635 biopsy of, 1643–1647 in osteomyelitis, 1635 tumors of See also specific sites or types in children, 1777–1780 Solitary pulmonary nodule See Pulmonary nodule(s), solitary Somatostatinoma, 1052 South American blastomycosis, adrenal involvement in, 1356–1358 Space of Retzius, 751 Spatial presaturation pulses, 59 Spatial resolution, 9–10, 56–57 See also Resolution high-contrast, in-plane, 9–10 longitudinal, 10 in phase-encoding direction, 43–44 Specific absorption rate (SAR), 59 Spermatic cord, normal anatomy of, 1379 Spigelian hernia, 713, 796, 1101 Spikes, 70 Spin, nuclear, 29–32 Spin down, 31 Spin echo imaging, 39–40, 49–51, 55, 93 cardiac, 71 Spin up, 31 Spin vectors, 30–31 Spinal cord compression, 1668 Spinal dural arteriovenous fistula, 1719 Spinal imaging in degenerative disease, 1683–1704 diffusion-weighted images in, 1668, 1721–1724 in failed back syndrome, 1704–1706 future trends in, 1721–1724 in infectious disorders, 1706–1710 in inflammatory disorders, 1710–1713 normal anatomy in, 1661–1667 of spinal cord compression, 1668 technique selection in, 1668–1669 in trauma, 1669–1683 of tumors, 1713 in vascular disorders, 1719–1724 vertebral bodies in, 1661–1663 Spinal stenosis, 1699–1702 Spindle cell carcinoma esophageal, 776 pleural, 610 Spine aneurysmal bone cyst of, 1713–1716 brucellosis of, 1706–1709 cervical facet dislocation in, 1672–1673, 1677 fractures of, 1669–1677 hyperextension injuries of, 1669–1672 hyperflexion injuries of, 1672–1676 imaging of, 1667 normal anatomy of, 1661–1662 vertical compression injuries of, 1677 chordoma of, 1717 degenerative disease of, 1683 disc herniation, 1692–1696 facet joint, 1697–1699 imaging of, 1687–1692 ligamentum flavum ossification, 1702 pathology of, 1684–1687 posterior longitudinal ligament ossification, 1701 spinal stenosis, 1699–1702 spondylolisthesis, 1702–1704 spondylolysis, 1696, 1702–1704 eosinophilic granuloma of, 1716–1717 epidural abscess of, 1710 epidural hematoma of, 1719–1721 in failed back syndrome, 1704–1706 fractures of in ankylosing spondyloarthritis, 1713 cervical, 1669–1677 compression, 1677, 1679, 1683 hangman’s, 1669 Jefferson, 1669 lumbar, 1677–1679 pathologic, 1680–1683 sacral, 1679–1680 thoracic, 1420, 1669 giant cell tumor of, 1716–1717 hemangioma of, 1713 infections of, 1706–1710 Langerhans cell histiocytosis of, 1717–1719 lumbar fractures of, 1677–1679 imaging of, 1668 normal anatomy of, 1663 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-27 Index lung cancer invasion of, 448, 449 metastases to, 1680–1683 multiple myeloma of, 1719 osteoblastoma of, 1716 osteoid osteoma of, 1716 plasmacytoma of, 1719 postoperative, 1704–1706 primary bone tumors of, 1713–1719 rheumatoid arthritis of, 1710–1713 sacral See Sacrum seatbelt injury of, 1679 synovial cysts of, 1697–1699 thoracic fractures of, 1677 imaging of, 1667–1668 normal anatomy of, 1662–1663 trauma to, 1420–1421 tuberculosis of, 1706–1709, 1710 vascular malformations of, 1719 Spin-lattice relaxation time, 35 Spin-spin relaxation, 37–40 SPIO contrast agents, 86–87 Spiral computed tomography, 5, 1311 image generation in, radiation dose in, 25 section thickness, 21 as standard method, 21 Spiral magnetic resonance imaging, 47 Spleen abscess of, 993 in children, 993 absence of, 981, 982 accessory, 978–980 in amyloidosis, 994–995 angiomyolipoma of, 987 angiosarcoma of, 990–991 aspiration of, 1000 biopsy of, 1000 candidiasis of, 993 clefts of, vs lacerations, 1446 congenital abnormalities of, 977–982, 983, 1446 cysts of, 982–984 in children, 983, 1761 congenital, 983, 1761 echinococcal, 982–983 posttraumatic, 984 delayed rupture of, 1448–1449 disorders of, in children, 1761 embryology of, 721–722, 723 enlarged, 976, 999 in extramedullary hematopoiesis, 987 fibroma of, 987 Gamna-Gandy bodies in, 995 in Gaucher disease, 995–996 hamartoma of, 985–987 hemangioendothelioma of, 990–991 hemangioma of, 984–985 hematoma of, 984, 1445 in children, 1764 in hemochromatosis, 996 imaging of See Splenic imaging infarction of, 1445, 1449 infection of, 992–993 inflammatory pseudotumor of, 987 lacerations of, 1445–1446, 1449 lipoma of, 987 littoral cell angioma of, 985 lymphangioma of, 985 lymphoma of, 987–990 metastases to, 991–992 mobility of, in children, 1761 multiple masses in, 999 nodular hyperplasia of, 985–987 in pancreatitis, 999 in polysplenia, 981 in sarcoidosis, 901–902, 997 solitary mass in, 999 spontaneous rupture of, 1000 trauma to, 1444–1449 in children, 1763–1765 tumors of benign, 984–987 in children, 1761 malignant, 987–992 wandering, 978 Splenic artery anatomy of, 973 aneurysm of, 998 Splenic imaging, 973–1000 artifacts in, 1446 of congenital abnormalities, 977–982 contrast material in, 973–974 CT, 973–974 MRI, 974–976 normal anatomy and variants in, 976–982 of pathologic conditions, 982–1000 size calculation in, 976 in trauma, 1444–1449 of tumors benign, 984–987 malignant, 987–992 Splenic index, 976 Splenic infarction, 999–1000 traumatic, 1445 Splenic lobulation, 977–978 Splenic peliosis, 996–997 Splenic vessels, 973 Splenic volume, assessment of, 976 Splenic-gonadal fusion, 982 Splenomas, 985–987 Splenomegaly, 976, 999 Splenorenal fusion, 982 Splenorenal ligament, 723 Splenosis, thoracic, 600 Split pleura sign, 579 Spoiled gradient echo imaging, 51–52, 92 Spoiling gradient, 67 radiofrequency, 67 Spondylitis, infectious, 344 Spondylolisthesis, 1702–1704 Spondylolysis, 1696–1697, 1702–1704 traumatic C2, 1669 Spondylolysis deformans, 1702–1704 Sprain, cervical hyperflexion, 1672 Squamous cell carcinoma See also Cancer colorectal, 814 esophageal, 773 tracheal, 403–404 Stab wounds, renal, 1464–1465 Staghorn calculi, 1247 Standard multiecho spin echo imaging, 93 I-27 Steady-state gradient echo sequences, 51 Stenosis aortic, 1161–1163 biliary after cholecystectomy, 962 after liver transplant, 964 biliary dilation and, 964 laryngeal, 184, 215 spinal, 1699–1702 tracheal, 184, 421 Stents biliary, evaluation of, 964–965 esophageal, 779 laryngeal, 215 Sternoclavicular dislocation, 616 Sternoclavicular hyperostosis, 614–615 Sternoclavicular joint, 1488 Sternoclavicular junction, normal anatomy of, 257–259 Sternoclavicular septic arthritis, 614 Sternocostoclavicular hyperostosis, 1508 Sternomanubrial dislocation, 1493 Sternotomy, median, postoperative findings in, 643–644 Sternum, 269–270, 613–616 fractures of, 615, 1420, 1421 multiple myeloma involving, 614 STIR technique, 54, 59, 60, 92–93 Stomach See under Gastric; Gastrointestinal Strangulation, intestinal, 797–798 Stress fracture calcaneal, 1607 femoral, 1552 pelvic, 1552 sacral, 1552 tibial, 1607–1608 Stress imaging adenosine, 701–703 dobutamine, 684–685 Stromal tumors, gastrointestinal, 782–783 Subcarinal lymph nodes, 286 Subclavian artery, 258–259 anomalous, 303–304 lung cancer invasion of, 448, 449 Subclavian vein, 258 Subcutaneous emphysema, in thoracic trauma, 1419 Subglottic stenosis, idiopathic, 403 Sublingual space, imaging of, 151 Submandibular space, imaging of, 151–152 Subperitoneal space, 1108 Subphrenic spaces, 1109 abscess of, 1115 Subpleural bulla, 582 Subpleural lines, in diffuse lung disease, 525–526 Subtalar joint, trauma to, 1599 Subtotal gastrectomy, 787–788 Superior diaphragmatic lymph nodes, 286 Superior lumbar triangle, 1101 Superior mesenteric artery, 738–739, 742 Superior mesenteric artery syndrome, 785, 807 Superior mesenteric vein, 739, 742 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-28 I-28 Index Superior sulcus tumors, 449 See also Lung cancer Superior vena cava azygos fissure and, 297 obstruction of, 398–399 persistent left, 297–299, 1739 Superior vena cava syndrome, 399 Supermagnetic iron oxide contrast agents, 86–87 Supraclavicular lymph nodes, 286 Supraclavicular metastases, in lung cancer, 453 Supraglottic laryngectomy, 208 Supramesocolic compartment, 1109 Susceptibility artifact, 254–255 Synovial chondromatosis, 1628 Synovial cyst parameniscal, 1579 spinal, 1697–1699 Synovitis, pigmented villonodular, 1610, 1781 Syphilitic vasculitis, aortic aneurysm and, 363 Systemic lupus erythematosus, lung involvement in, 533 T T1 relaxation, 35–37 T1 relaxation contrast agents, 85–86 T1 weighted techniques, 92–93 T2 relaxation, 37–40 T2 relaxation contrast agents, 86–87 T2 weighted techniques, 93 Table travel speed, 18 Takayasu arteritis aortic aneurysm and, 364 aortic stenosis and, 395–397 Talar dome, osteochondral defect of, 1610 Talc pleurodesis, 588 Talocalcaneal coalition, 1591 Talus, fracture of, 1601–1605 vs congenital variant, 1588 Tamponade, cardiac, 697 Tandem-needle biopsy, 102–103 Tarsal coalition, 1590–1591, 1781–1782 TE See Echo time (TE) Teardrop fracture, vertebral hyperextension, 1669 hyperflexion, 1676 Teflon injection, in vocal cords, 215 Temporal resolution, 10–11 Tendinopathy, in ankle, 1609 Tenosynovitis, in ankle, 1609 Teratocarcinoma, mediastinal, 1736 Teratoma mediastinal, 316–317, 1735 ovarian, 1383–1386, 1389, 1770–1771 retroperitoneal, 1219, 1756 sacrococcygeal, 1772–1773 splenic, 991 thymic, 1733 vs lipoma, 334 vs thymolipoma, 321–322 Testis cancer of, 1405–1406 retroperitoneal lymphadenopathy and, 1198, 1207–1209 MRI of, 1379 undescended, 1406, 1775 Tetralogy of Fallot, 689–692, 1749 Thermal ablation, 126–130 See also Radiofrequency ablation Thoracic duct cysts, 331 Thoracic imaging, 225–304 See also Mediastinal imaging central veins in, 397–400 of congenital abnormalities, 297–304 CT, 225–227, 229–250 artifacts in, 255 high-resolution, 237–241 spiral, 231, 248–250 techniques of, 231–235 thin-section, 241–248 viewing parameters in, 235–237 MRI, 227–229, 251–256 artifacts in, 253–255 normal anatomy in, 228, 256–296 variants of, 296–304 Thoracic inlet, normal anatomy of, 257–259 Thoracic lymph nodes, 283–284, 286 Thoracic meningocele, 331 Thoracic outlet syndrome, 255 Thoracic spine See Spine, thoracic Thoracic splenosis, 600 Thoracic trauma, 1418–1439 cardiac/pericardial, 1432–1434 chest wall, 1419–1421 clavicular dislocation in, 1421 diaphragmatic, 1437–1439 esophageal, 1435–1437 flail chest in, 1420 hemothorax in, 1422–1423 imaging in CT in, 1418–1419 indications for, 1418 MRI in, 88–89, 1418 technique of, 1418–1419 mechanisms of injury in, 1418 mediastinal hemorrhage in, 1428–1429 pleural space, 1421–1423 pneumatocele in, 1424–1425 pneumothorax in, 1421–1422, 1422–1423, 1435 pulmonary contusion in, 1423–1425 pulmonary hematoma in, 1424–1425 pulmonary laceration in, 1424–1425 rib fractures in, 1419–1420 scapular fractures in, 1420 spinal fractures in, 1420 sternal fractures in, 1420, 1421 subcutaneous emphysema in, 1419 tracheobronchial, 1434–1435 Thoracostomy tube, placement of, in empyema, 582–583 Thoracotomy, postoperative findings in, 643 Thorax See also Chest biopsy of, 104–107 imaging of CT in, 1419–1420 MRI in, 88–89, 1418 pediatric, 1730–1749 Thorium dioxide, hepatic parenchymal attenuation and, 903 Thorotrast, splenic angiosarcoma due to, 991 3D-multislice imaging, 44–45 3D-volume acquisition, 45, 46–47 360LI method, 5–8 Thrombosis brachiocephalic vein, 398 deep venous, pulmonary embolism and, 514 hepatic artery, posttransplant, 911 jugular vein, 206 mesenteric vein, 1133 portal vein, 903–904 in hepatocellular carcinoma, 864 posttransplant, 911 renal artery, posttraumatic, 1467 renal vein, 1290–1291 Thrombus aortic, 362–363 left ventricular, 256 small intestinal, 799–800 Thymic cancer, 320–321 Thymic cysts, in children, 1736 Thymic hyperplasia, 314 rebound, 324 Thymic imaging, 311–324 Thymic lymphoma, 318–319 Thymolipoma, 321–322 in children, 1736 vs mediastinal lipoma, 334 Thymoma, 311–315 in children, 1734–1735 pleural metastases from, 606 vs lymphoma, 319 vs thymic cyst, 323 Thymus, 280–282 cysts of, 206, 322–324 hyperplasia of, in children, 1733–1734 normal anatomy of, in children, 1730–1731 tumors of, 311–322 Thyroglossal duct cyst, 185, 201 Thyroid, 184–189 adenoma of, 187 cancer of, 187–189 tracheal involvement in, 404 cysts of, 206 lingual, 185 solitary nodule of, 186–187 Thyroid cartilage normal anatomy of, 165 tumor invasion of, 178–181 Thyroiditis Hashimoto, 186 Reidel, 186 TI See Inversion time (TI) Tibial plateau fracture, 1565–1571 Tibial stress fracture, 1607–1608 Tietze syndrome, 617 Time-of-flight magnetic resonance angiography, 74, 75 Timing diagrams, 49 Tongue, 164 Tornwaldt cyst, 206–207 Total gastrectomy, 787–788 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-29 Index Total hip arthroplasty, complications of, 1560–1561 Total knee arthroplasty, assessment of, 1583–1587 Total laryngectomy, 209 Total scan time, 44–45 Toupet fundoplication, 779 Toxic megacolon, 818–819 TR See Recovery time (TR) Trachea, 400–410 amyloidosis involving, 406 benign stricture of, 402–403 cancer of, 403–404 congenital anomalies of, 1747 imaging of, 421 in children, 1747 normal anatomy in, 279 papillomas of, 403 in relapsing polychondritis, 421 relapsing polychondritis involving, 405–406 saber-sheath, 279, 405 stenosis of, 250, 421 postintubation, 402 trauma to, 1434–1435 tumors of, 403–404, 421 Wegener granulomatosis involving, 407–408 Tracheal bronchi, 1747 Tracheobronchial anatomy, 272–275 Tracheobronchomalacia, 421 Tracheobronchomegaly, 408–409, 421 Tracheobronchopathia osteochondroplastica, 244, 421 Tracheoesophageal cyst, 202 Tracheoesophageal fistula, 776 Tracheomalacia, 405, 1747 Tracheomegaly, acquired, 409–410 Tracheopathia osteochondroplastica, 406–407 Tracheostomy, tracheal stenosis after, 421 Tracheostomy tubes, 215 Traction bronchiectasis, 478, 525 Transcatheter arterial chemoembolization, of liver tumors, 884–886 Transcervical mediastinoscopy, 433 Transesophageal echocardiography, in intramural hematoma, 389 Transitional cell carcinoma, 1406–1409 renal, 1264–1268 Transplantation graft-versus-host disease in in children, 1770 intestinal involvement in, 805–806 kidney, 1292, 1295–1297 liver, 910–912, 958–964 lung, 554–555 pancreas, 1092–1093 Transposition of great arteries, 689 Transverse mesocolon, 722, 1123–1124 Transverse relaxation, 37–40 Transversus abdominis muscle, 709, 713 Trauma abdominal, 1439–1471 See also specific sites and types aortic, aneurysm and, 364–365 diaphragmatic, hernia and, 647–651 elbow, 1515–1523 foot and ankle, 1591–1607 knee, 1565–1573 osteonecrosis from, 1489 scaphoid, 1535 pancreatic, 1086–1088 pelvic, 1538–1542 in pregnancy, 1399–1401 renal, 1282–1287 shoulder, 1493–1504 small intestinal, 806–807 spinal, 1668–1683 thoracic, 1418–1439 See also Thoracic trauma thoracoabdominal, 1417–1471 wrist, 1529–1536 Tree-in-bud pattern, 478, 527 Trichinosis, soft tissue involvement in, 1639 Triggering, for motion artifacts, 71–73 Triplane fracture, 1595 Triticeus cartilage, 167 TruCut needle, 99 Truncation artifacts, 66–67 Tube current, 20–21 radiation dose and, 20–21, 24–26 Tube voltage, 20–21 radiation dose and, 20–21, 24–26 Tuber omentale, 740 Tuberculosis, 455, 548, 549–550 adrenal involvement in, 1355–1358 cervical lymphadenitis in, 199 empyema in, pleural calcification from, 588 hepatic, 891 HIV-related, 553 laryngeal, 182 mediastinal lymphadenopathy in, 349, 353–355 osteoarticular, 1637 pancreatic, 1088 peritonitis in, 1127 psoas abscess in, 1222–1225 renal, 1279 retroperitoneal lymphadenopathy in, 1198 spinal, 1706–1709, 1710 Tuberous sclerosis angiomyolipoma in, 1272–1274 lung involvement in, 540 renal cysts in, 1255 Tuboovarian abscess, 1386–1387, 1389, 1771 Tumor(s) See also Cancer and specific sites and types MR perfusion studies of, 78 necrotic, drainage of, 124 Tumor ablation, 125–135, 126–135 for bone tumors, 133–135, 1647–1649 chemical, 125–126 for kidney tumors, 132–133, 1297–1299 for liver tumors See Hepatocellular carcinoma, percutaneous ablation of for lung tumors, 130–132 pulmonary vein mapping for, 692–694 I-29 thermal, 126–135 See also Cryosurgery; Radiofrequency ablation Tumor emboli, from pulmonary metastases, 495 Turner needle, 98 2D-multislice imaging, 44 Typhlitis, 818 U Ulcer, penetrating atherosclerotic, aortic, 389–393, 1161 Ulcerative colitis, 817–818 Ulna, distal, fracture of, 1530 Ulnar collateral ligament, trauma to, 1521 Ultrafast ETSE, 51 Ultrahigh field imaging, 79 Ultrasonography adrenal, 1365–1366 of aortic aneurysm, 366, 1164–1165 endoscopic biliary, 931 hepatic, in children, 1765 interventional, 95 renal, 1465–1466 in retroperitoneal lymphadenopathy, 1204 Umbilical endometriosis, 1107 Umbilical hernia, 796 Umbilicovesical fascia, 751 Uncinate process, aplasia/hypoplasia of, 1024 Undescended testis, 1406, 1775 Unicameral bone cysts, 1615–1616 Unicornuate uterus, 1380, 1774 Uniform array detectors, Upper extremity, 1488–1538 See also specific structures or abnormalities Ureter circumcaval, 1188–1190 trauma to, 1468 Ureteropelvic junction, obstruction of, 1292 Urethra, normal anatomy of, 1377, 1379 in female, 765 in male, 754 Urinary incontinence, pelvic floor relaxation and, 1398–1399 Urinary obstruction, 1280–1281 Urinary tract infections, in children, 1766 Urinoma, 1412 intraperitoneal, 1123 Usual interstitial pneumonia, 528–529 Uterosacral ligaments, 760, 1377 Uterus See also Pelvic imaging agenesis of, 1380, 1774 arcuate, 1380 bicornuate, 1380, 1775 cancer of, 1392–1395, 1397 congenital anomalies of, 1380–1381, 1774–1775 disorders of, in children, 1771–1772 duplication of, 1774–1775 fibroids of, 1381–1382 hypoplasia of, 1380, 1774 normal anatomy of, 754–760, 1376–1377, 1378 5063_Lee_IDX_I1-I30 11/2/05 10:18 AM Page I-30 I-30 Index Uterus (continued) septate, 1380–1381, 1775 unicornuate, 1380, 1774 Uterus didelphys, 1380, 1775 V Vagina See Gastrointestinal stromal tumors (GISTs); Pelvic imaging cancer of, 1772 congenital anomalies of, 1381 disorders of, in children, 1771–1772 fascial tears of, 1399 fistulas of, 1411–1412 normal anatomy of, 760–765, 1377, 1378 rhabdomyosarcoma of, 1772 Vagus nerve, tumors of, 159 Valsalva, sinuses of, 263 Varices esophageal, 345, 778 gastric, 787 Vasa deferentia, normal anatomy of, 753 Vascular anomalies in children, 1778–1779 pulmonary, 486–490 Vasculitis pulmonary, 548–549 small intestinal, 801 syphilitic, aortic aneurysm and, 363 Vasculolymphatic malformations, of neck, 204 Vena cava inferior See Inferior vena cava superior, persistent left, 1739 Venography, 516 Veno-occlusive disease, hepatic, 907–908 Venous aneurysm, mediastinal, 399–400 Venous malformations, 1778 Venous thrombosis in children, 1770 deep venous, 514 gonadal vein, 1194 inferior vena cava, 1191–1196 filter for, 1195–1196 ovarian vein, 1194 pulmonary embolism and, 499–519 See also Pulmonary embolism renal vein, 1194 Ventral hernia, 1101 Ventricular septal defect, 689 in tetralogy of Fallot, 689–692 Vertebrae See also under Spinal; Spine cervical See also Cervical spine imaging of, 1668 normal anatomy of, 1661–1662 lumbar fractures of, 1677–1679 imaging of, 1668 normal anatomy of, 1663 lung cancer invasion of, 448, 449 thoracic fractures of, 1420–1421, 1677 imaging of, 1667–1668, 1668 normal anatomy of, 1662–1663 trauma to, 1420–1421 Vertebrae planae, 1717 Vertebral body hemangioma, 1713 Vertebral lymphoma, 344 Vertical compression injuries, spinal, 1677 Vertical hemilaryngectomy, 208–209 Vesicouterine space, 750 VIPoma, 1052 Virtual bronchoscopy, 421, 424–428 Vocal cords, 165–167 paralysis of, 184 polyps of, 182 Teflon injection in, 215 Voltage, radiation dose and, 20–21, 24–26 Volume-rendering display, 14–15 Volvulus gastric, 786 midgut, 798 sigmoid, 820 Von Gierke disease, hepatic adenoma in, 902 Von Hippel-Lindau disease, 1767 pheochromocytoma in, 1332 renal cysts in, 1255–1257 Von Meyerburg complex of liver, 958 Voxels, 40 size of, 42, 44 V/Q scintigraphy, of pulmonary embolism, 517–519 Warthin tumors, 154 Water, resonant frequency of, 35, 59–60 Water excitation, 62 Water-only images fat saturation, 59–61, 68, 92, 93 fat saturation for, 59–60, 92, 93 STIR technique for, 54, 59, 60, 92–93 Waterson shunt, 690–692 Wedge fractures cervical, 1672 lumbar, 1679 thoracic, 1677 Wegener granulomatosis, 539–540 tracheal involvement in, 407–408, 421 Welders, lung disease in, 539 Wescott needle, 99 Whipple disease, 805 mediastinal involvement in, 335 mesenteric involvement in, 1133 retroperitoneal lymphadenopathy in, 1198 Whipple procedure, 787 postoperative assessment after, 966–967 Wilms tumor, 1270, 1749–1750 metastatic, 1743 Wilson’s disease, liver involvement in, 902–903 Windswept pelvis, 1540 Winslow, foramen of, 1111 Wraparound artifact, 255 Wrist arthropathy of, 1536–1538 normal anatomy of, 1528–1529 trauma to, 1529–1536 X Xanthogranulomatous cholecystitis, 941 Xanthogranulomatous pyelonephritis, 1277–1278 X-ray(s) detection of, 4–5 early experiments with, generation of, 3–4 X-ray signals, 6–7 W Z Waldeyer’s ring, 161 Wallstents, esophageal, 779 Wandering spleen, 978 Z-filtering, Z-interpolation, Zollinger-Ellison syndrome, 787 ... and are usually asymptomatic ( 32, 322 ) Peribiliary cysts occur significantly more commonly in patients with cirrhosis than in those without cirrhosis ( 32, 290, 322 ,805) On CT examinations the lesions... low-density tubular structures paralleling the central portal veins (Fig 12- 12) ( 32, 290, 322 ,805) With MRI the lesions are best seen on T2-weighted or gadolinium-enhanced T1-weighted gradient echo images... slightly hypoattenuating mass (Figs 12- 20 and 12- 21) In approximately one third of 5063_Lee_Ch12pp0 829 -0930 10/13/05 5:36 PM Page 851 Liver 851 A B Figure 12- 20 Focal nodular hyperplasia Precontrast