Diagnostic Imaging E-Book

Andrea G. Rockall

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 627

Veröffentlichungsjahr: 2013

Beschreibung

Diagnostic Imaging will help medical students, junior doctors, residents and trainee radiologists understand the principles behind interpreting all forms of imaging. Providing a balanced account of all the imaging modalities available – including plain film, ultrasound, computed tomography, magnetic resonance imaging, radionuclide imaging and interventional radiology – it explains the techniques used and the indications for their use.

Organised by body system, it covers all anatomical regions. In each region the authors discuss the most suitable imaging technique and provide guidelines for interpretation, illustrating clinical problems with normal and abnormal images.

Diagnostic Imaging is extensively illustrated throughout, featuring high quality full-colour images and more than 600 photographs. The images are downloadable in PowerPoint format from the brand new companion website at www.wileydiagnosticimaging.com, which also has over 100 interactive MCQs, to aid learning and teaching.

When you purchase the book you also receive access to the Wiley E-Text: Powered by VitalSource. This is an interactive digital version of the book, featuring downloadable text and images, highlighting and note-taking facilities, bookmarking, cross-referencing, in-text searching, and linking to references and abbreviations. Diagnostic Imaging is also available on CourseSmart, offering extra functionality as well as an immediate way to access the book. For more details, see www.coursesmart.com or ‘The Anytime, Anywhere Textbook ’ section.

Leseprobe

Table of Contents

Companion website

Title page

Copyright page

Preface

Acknowledgements

List of Abbreviations

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1 Technical Considerations

Use of the imaging department

Conventional radiography

Computed tomography

Contrast agents in conventional radiography and computed tomography

Ultrasound

Radionuclide imaging

Magnetic resonance imaging

Picture archiving and communication systems

Radiation hazards

2 Chest

THORACIC DISEASE

Imaging techniques

Diseases of the chest with a normal chest radiograph

Abnormal chest signs

Radiological signs of lung disease

PLEURA

Pleural effusion

Mediastinum

Hilar enlargement

Diaphragm

SPECIFIC DISORDERS

Bacterial pneumonia

Viral and mycoplasma pneumonia

Lung abscess

Pulmonary tuberculosis

Fungal and parasitic diseases

Pneumonia in the immunocompromised host

Sarcoidosis

Diffuse interstitial pulmonary fibrosis

Radiation pneumonitis

Collagen vascular diseases

Pneumoconiosis

Diseases of the airways

Cystic fibrosis

Respiratory distress in the newborn

Adult respiratory distress syndrome

Pulmonary emboli and infarction

Trauma to the chest

Carcinoma of the bronchus

Metastatic neoplasms

Lymphoma

3 Cardiac Disorders

Imaging techniques

Specific cardiac diseases

4 Breast Imaging

Mammography

Breast ultrasound

Breast magnetic resonance imaging

Breast screening

5 Plain Abdomen

Intestinal gas pattern

Dilatation of the bowel

Pneumoperitoneum

Ascites

Abdominal calcification

Liver and spleen

Abdominal and pelvic masses

6 Gastrointestinal Tract

Imaging techniques: general principles

OESOPHAGUS

Imaging techniques

Oesophageal abnormalities

STOMACH AND DUODENUM

Imaging techniques

Specific diseases of the stomach and duodenum

SMALL INTESTINE

Imaging techniques

Normal appearances of the small bowel

Imaging signs of disease of the small intestine

Specific diseases of the small intestine

LARGE INTESTINE

Imaging techniques

Normal appearance of the colon

Imaging signs of disease of the large intestine

Specific diseases of the colon

SPECIFIC USES OF IMAGING IN THE GASTROINTESTINAL TRACT

Imaging investigation of the acute abdomen

Imaging investigation of acute bleeding from the gastrointestinal tract

Imaging investigation of abdominal trauma

7 Hepatobiliary System, Spleen and Pancreas

LIVER

Imaging techniques

Liver masses

Liver abscesses

Cirrhosis of the liver and portal hypertension

Liver trauma

Fatty infiltration of the liver

BILIARY SYSTEM

Imaging techniques

Gall stones and cholecystitis

Jaundice

PANCREAS

Pancreatic masses

Acute pancreatitis

Chronic pancreatitis

Pancreatic trauma

SPLEEN

Splenic trauma

8 Urinary Tract

Imaging techniques

Urinary tract disorders

Bladder disorders

Prostate and urethra disorders

Scrotum and testes disorders

9 Female Genital Tract

Normal appearances

Gynaecological pathology

Hysterosalpingography

Obstetric ultrasound

Ectopic pregnancy

10 Peritoneal Cavity and Retroperitoneum

PERITONEAL CAVITY

Peritoneal cavity disorders

RETROPERITONEUM

Imaging techniques

Retroperitoneal disorders

11 Bones

Imaging techniques

Bone disease diagnosis

Solitary lesions

Multiple focal lesions

Generalized decrease in bone density (osteopenia)

Generalized increase in bone density

Alteration of trabecular pattern and change in shape

Changes in bone shape

12 Joints

Imaging techniques

Arthritis

Joint infections

Avascular (aseptic) necrosis

Internal derangement of the knee

Shoulder and rotator cuff disorders

Miscellaneous joint conditions

13 Spine

Imaging techniques

Radiographic signs of spinal abnormality

Spinal abnormalities

14 Skeletal Trauma

Imaging techniques

Specific injuries

15 Brain

Imaging techniques

Specific brain disorders

Head injury

16 Orbits, Head and Neck

Sinuses

Nasopharynx

Orbits

Salivary glands

Neck

17 Vascular and Interventional Radiology

Diagnostic vascular angiography

Interventional radiology

Appendix: Computed Tomography Anatomy of the Abdomen

Index

This new edition is also available as an e-book.

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Companion Website

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Interactive multiple choice questions for each chapterFigures from the book in PowerPoint format

This edition first published 2013 © 2013 by A. Rockall, A. Hatrick, P. Armstrong, M. Wastie.

Previous editions published 1981 (as X-ray Diagnosis), 1987, 1992, 1998, 2004, 2009

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Library of Congress Cataloging-in-Publication Data

Diagnostic imaging. — 7th ed. / Andrea G. Rockall ... [et al.].

p. ; cm.

Rev. ed. of: Diagnostic imaging / Peter Armstrong, Martin L. Wastie, Andrea G. Rockall. 6th ed. 2009.

Includes bibliographical references and index.

ISBN 978-0-470-65890-1 (pbk. : alk. paper)

I. Rockall, Andrea G. II. Armstrong, Peter, 1940– Diagnostic imaging.

[DNLM: 1. Diagnostic Imaging. WN 180]

616.07'54–dc23

201203

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © Andrea Rockall, Andrew Hatrick, Peter Armstrong, Martin Wastie

Cover design by Jim Smith

Preface

Medical imaging is central to many aspects of patient management. Medical students and junior doctors can be forgiven their bewilderment when faced with the daunting array of information which goes under the heading ‘Diagnostic imaging’. Plain film examinations remain the most frequently requested imaging investigations that non-radiologists may be called on to interpret and we continue to give them due emphasis. However, the use of cross-sectional imaging techniques continues to increase and, in some situations, has taken over from the plain film. The growing use of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), radionuclide imaging, including positron emission tomography (PET), and interventional radiology is reflected in the new edition.

With the widespread availability of most of the various imaging techniques, there are often several ways of investigating the same condition. We have avoided being too prescriptive as practice varies depending on the available equipment as well as the preferences of the clinicians and radiologists. It is important, however, to appreciate not only the advantages but also the limitations of modern medical imaging.

We have continued to try to meet the needs of the medical student and doctors in training by explaining the techniques used in diagnostic imaging and the indications for their use. We aim to help the reader understand the principles of interpretation of imaging investigations. New for this edition is the availability of online material, including multiple choice questions for each chapter, allowing readers to test their knowledge.

It is beyond the scope of a small book such as this one to describe fully the pathology responsible for the various imaging appearances and the role of imaging in clinical management. Consequently, we encourage our readers to study this book in association with the study of these other subjects.

Andrea RockallAndrew HatrickPeter ArmstrongMartin Wastie

Acknowledgements

It would not have been possible to prepare this edition without the help of the many radiologists who have given ideas, valuable comments and inspiration. We would like to thank particularly the staff of the Radiology Departments at St Bartholomew’s Hospital, London, Frimley Park NHS Trust, University Hospital, Nottingham, University of Malaya Medical Centre, Kuala Lumpur and County Hospital, Lincoln for this and past edition illustrations. Our special thanks go to those radiologists who gave us their expert assistance, including Dr Rob Barker, Dr Francesca Pugliese, Dr Sarah Vinnicombe, Dr Muaaze Ahmad, Dr Polly Richards and Dr Kasthoori Jayarani.

The following kindly provided illustrations for this and previous editions: Lorenzo Biassoni, Nishat Bharwani, John Bowe, Paul Clark, Siew Chen Chua, Peter Jackson, Jill Jacobs, Ranjit Kaur, Priya Narayanan, Steven Oscroft, Niall Power, Shaun Preston, Ian Rothwell, Peter Twining, Caroline Westerhout and Bob Wilcox.

We would like to thank Julie Jessop for her superb secretarial help and we would like to express our gratitude to the staff of Wiley-Blackwell.

List of Abbreviations

ADC

apparent diffusion coefficient

AIDS

acquired immune deficiency syndrome

ALARA

‘as low as reasonably achievable’ principle

AP

anteroposterior

ARDS

adult respiratory distress syndrome

AVM

arteriovenous malformation

BBB

blood–brain barrier

CFA

cryptogenic fibrosing alveolitis

CPPD

calcium pyrophosphate dihydrate

CSF

cerebrospinal fluid

CT KUB

non-contrast computed tomography of the kidneys, ureters and bladder

CT

computed tomography

CTR

cardiothoracic ratio

CXR

chest radiograph

3D

three-dimensional

DCE-MRI

dynamic contrast-enhanced magnetic resonance imaging

DEXA

dual-energy x-ray absorption

DMSA

dimercaptosuccinic acid

DTPA

diethylene triamine pentacetic acid

DWI

diffusion-weighted imaging

ERCP

endoscopic retrograde cholangiopancreatography

EUS

endoscopic ultrasound

EVAR

endovascular aneurysm repair

FAST

focused assessment with sonography for trauma

FDG

F-18 fluorodeoxyglucose

FDG-PET

fluorodeoxyglucose positron emission tomography

FLAIR

fluid attenuated inversion recovery

FNA

fine needle aspiration

GI

gastrointestinal

GIST

gastrointestinal stromal tumour

HCC

hepatocellular carcinoma

HMPAO

hexamethylpropyleneamine oxime

HOCM

hypertrophic obstructive cardiomyopathy

HRCT

high resolution computed tomography

123

I

iodine-123

131

I

iodine-131

IPF

idiopathic pulmonary fibrosis

IUCD

intrauterine contraceptive device

IVC

inferior vena cava

IVU

intravenous urography

81m

Kr

krypton-81m

MAG-3

mercaptoacetyl triglycine

MDCT

multidetector CT

MEN

multiple endocrine neoplasia

MIBG

meta-iodobenzylguanidine

MIP

maximum intensity projection

MRA

magnetic resonance angiography

MRCP

magnetic resonance cholangiopancreatography

MRI

magnetic resonance imaging

NHS

National Health Service

PA

posteroanterior

PEG

percutaneous endoscopic gastrostomy

PET

positron emission tomography

PTC

percutaneous transhepatic cholangiogram

PUJ

pelviureteric junction

RIG

radiologically inserted gastrostomy

SCIWORA

spinal cord injury without radiological abnormality

SPECT

single photon emission computed tomography

99m

Tc

technetium-99m

TCC

transitional cell carcinoma

TIPSS

transjugular intrahepatic portosystemic shunt

TRUS

transrectal ultrasound

UIP

interstitial pneumonia

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Interactive multiple choice questions for each chapterFigures from the book in PowerPoint format

1

Technical Considerations

Use of the Imaging Department

Good communication between clinicians and radiologists is vital because the radiology department needs to understand the clinical problem in order to carry out appropriate tests and to interpret the results in a meaningful way. Also, clinicians need to understand the strengths and limitations of the answers provided.

Sensible selection of imaging investigations is of great importance. There are two opposing philosophies. One approach is to request a battery of investigations, aimed in the direction of the patient’s symptoms, in the hope that something will turn up. The other approach is ‘trial and error’: decide one or two likely diagnoses and carry out the appropriate test to support or refute these possibilities. We favour the selective approach as there is little doubt that the answers are usually obtained less expensively and with less distress to the patient. This approach depends on critical clinical evaluation; the more experienced the doctor, the more accurate he or she becomes in choosing appropriate tests.

Laying down precise guidelines for requesting imaging examinations is difficult because patients are managed differently in different centres. Box 1.1 provides important points when requesting imaging investigations.

Box 1.1 Best Practice When Requesting Imaging Investigations

Only request an examination if it is likely to affect patient managementThe time interval between follow-up examinations should be appropriate and depends on the natural history of diseaseLocalize the clinical problem as specifically as possible prior to imaging in order to reduce over-investigation and excess radiation exposureCareful consideration should be given to which imaging procedure is likely to give the relevant diagnostic information most easilyAny investigations that have been requested but become unnecessary should be cancelledExaminations that minimize or avoid ionizing radiation should be chosen when possibleGood communication with the radiologists is key to ensuring appropriate investigation pathways

Conventional Radiography

X-rays are absorbed to a variable extent as they pass through the body. The visibility of both normal structures and disease depends on this differential absorption. With conventional radiography there are four basic densities – gas, fat, all other soft tissues and calcified structures. X-rays that pass through air are least absorbed and, therefore, cause the most blackening of the radiograph, whereas calcium absorbs the most and so the bones and other calcified structures appear virtually white. The soft tissues, with the exception of fat, e.g. the solid viscera, muscle, blood, a variety of fluids, bowel wall, etc., all have similar absorptive capacity and appear the same shade of grey on conventional radiographs. Fat absorbs slightly fewer x-rays and, therefore, appears a little blacker than the other soft tissues. Traditionally, images were produced using a silver-based photographic emulsion but now they are recorded digitally and viewed on computer screens in most centres.

Projections are usually described by the path of the x-ray beam. Thus, the term PA (posteroanterior) view designates that the beam passes from the back to the front, the standard projection for a routine chest film. An AP (anteroposterior) view is taken from the front. The term ‘frontal’ refers to either PA or AP projection. The image on an x-ray film is two-dimensional. All the structures along the path of the beam are projected on to the same portion of the film. Therefore, it is often necessary to take at least two views to gain information about the third dimension. These two views are usually at right angles to one another, e.g. the PA and lateral chest film. Sometimes two views at right angles are not appropriate and oblique views are substituted.

Portable x-ray machines can be used to take films of patients on the ward or in the operating theatre. Such machines have limitations on the exposures they can achieve. This usually means longer exposure times and poorer quality films. The positioning and radiation protection of patients in bed is often inferior to that which can be achieved within the x-ray department. Consequently, portable films should only be requested when the patient cannot be moved safely to the x-ray department.

Computed Tomography

Computed tomography (CT) also relies on x-rays transmitted through the body. It differs from conventional radiography in that a more sensitive x-ray detection system is used, the images consist of sections (slices) through the body, and the data are manipulated by a computer. The x-ray tube and detectors rotate around the patient (). The outstanding feature of CT is that very small differences in x-ray absorption values can be visualized. Compared with conventional radiography, the range of densities recorded is increased approximately ten-fold. Not only can fat be distinguished from other soft tissues, but also gradations of density within soft tissues can be recognized, e.g. brain substance from cerebrospinal fluid, or tumour from surrounding normal tissues.