A Abdomen, Blunt Trauma Bowel/Mesentery Imaging, 447–448

Index

A Acute afebrile symptomatic goals of, 262 Abdomen, blunt trauma seizures imaging protocols, 268–270 bowel/mesentery imaging, incidence, 196 and IV drug users, 267 447–448 See also Seizures neruoimaging literature search, 262–263 case studies (images), 450–451 Acute aortic dissection, 371–373 MRI, 264, 266–267, 270 costs, 443 CT angiography, 371–372 radionuclide bone scintigraphy, CT, 446–450, 452 imaging cost-effectiveness, 372 264, 266–267, 269–270 doppler ultrasound, 446 imaging goals, 371 repeat imaging, 266, 267 epidemiology, 442–443 pathophysiology, 370 ultrasound, 264–265, 267, 270 future directions, 450 Acute appendicitis. See X-rays, 268–269 imaging protocol, 446 Appendicitis, acute Acute limb ischemia, 370 literature search, 443 Acute calculous cholecystitis, Adolescent idiopathic scoliosis, pathophysiology, 442 496–502 338–339 retroperitonal injuries imaging, case studies (images), 499, 502 Adrenal gland 448–450 cholescintigraphy, 496–498, blunt trauma, imaging, 450 spleen/liver imaging, 445–447 500–501 metastasis, and lung cancer, 70 types of injuries, 442 costs, 496 Alzheimer’s disease ultrasound, 446, 452 CT, 498, 501 clinical criteria, accuracy of, Abdominal aortic aneurysms epidemiology, 495 144–145 (AAA), 373–375 imaging goals, 496 costs, 143 endovascular versus surgical imaging strategy, 498, 501 epidemiology, 143 treatment, 373–375 MR cholangiopancreatography, genetic susceptibility, 151–153 imaging cost-effectiveness, 373 498 Alzheimer’s disease neuroimaging mortality and screening, 373 MRI, 498 at-risk persons, identifying, pathophysiology, 370 pathophysiology, 494–495 149–151 stent-graft endoleaks, 377–378 ultrasound, 496–497, 500 cost effectiveness, 153 Abdominal pain, acute Acute hematogenous osteomyelitis CT, 146, 156 appendicitis, 458–465 clinical signs, 263 for disease progression, 153–155 colonic diverticulitis, 458–461, costs, 262 functional imaging, 147 467–468 epidemiology, 261–262 goals of, 143–144 common causes, 458–459 long-term effects, 265 literature search, 144 costs, 460 medical therapy versus surgery, MRI, 146, 148–149, 154–156 epidemiology, 459–460 265–266 PET, 147, 154–156 imaging goals, 460 pathogens, 262, 265 PET FDG, 156 literature search, 461–462 pathophysiology, 261 proton MR spectroscopy (1H small bowel ischemia, 466–467 Acute hematogenous osteomyelitis MRS), 148 small bowel obstruction, imaging SPECT, 147, 151, 154–156 458–461, 465–466 case studies (images), 269–270 structural neuroimaging, See also speciﬁc disorders and diabetic foot, 266–267 145–146 Acute abdomen. See Abdominal diagnostic accuracy, 268 for therapeutic efﬁcacy, 153–155 pain, acute future directions, 270 Analytical studies, 4–5

571 572 Index

Aneurysms. See Abdominal aortic Bile duct obstruction, 505–506 Bowel aneurysms; Intercranial CT, 506 blunt trauma, imaging, 447–448 aneurysms endoscopic ultrasonogrphy, 506 invagination. See Intussusception Angiography epidemiology, 495 ischemia. See Small bowel pulmonary, 402–403 MR cholangiopancreatography, ischemia See also Computed tomography 506 obstruction. See Small bowel angiography (CTA); Coronary MRI, 506 obstruction angiography; Magnetic pathophysiology, 495 Brain resonance angiography ultrasound, 505–506 atropy, 248 (MRA) Bile duct stricture, 509–515 imaging. See Neuroimaging Angioplasty and stenting, carotid CT, 510 Brain cancer stenosis, 386, 392–393 endoscopic retrograde clinical signs, 106–107 Ankylosing spondylitis, 309–310 cholangiopancreatography, costs, 104–105 MRI, 310 510 epidemiology, 103–104 radionuclide bone scintigraphy, endoscopic ultrasonography, forms of, 103–104, 107 310 511–512, 514 pediatric cases, 107, 182 SPECT, 310 imaging strategy, 513–514 unique nature of, 103 X-rays, 309 Klatskin tumor, 512–513 Brain cancer neuroimaging Anterior spinal meningocele, 337 MR cholangiopancreatography, case studies (images), 114–116 Anular tears, and herniated disk, 510–511, 514–515 cost effectiveness, 113 305 percutaneous transhepatic CT, 108–110, 113 Aorta cholangiography, 510–511 decision-making flowchart, 114 abdominal aortic aneurysms ultrasonography, 509–510 diffusion-weighted imaging, (AAA), 373–375 Biliary disorders 111 acute aortic dissection, 371–373 acute calculous cholecystitis, goals of, 105 aortic rupture, 370 496–502 indications for, 106–107 See also specific disorders bile duct obstruction, 505–506 literature review, 105–106 Aortic dissection. See Acute aortic bile duct stricture, 509–515 MRI, 105, 108–111 dissection choledocholithiasis, 506–509 PET FDG, 108–109 Appendicitis, acute, 461–465 chronic calculous cholecystitis, proton MR spectroscopy, 105, case studies (images), 470 502–505 112–113 costs, 460, 463, 465 costs, 496 SPECT, 108–109 CT, 462–465 epidemiology, 495 symptomology criteria, 106–107 defined, 458 future directions, 515 tumors versus tumor-mimicking diagnostic accuracy, 469 imaging goals, 496 lesions, 111–112 future directions, 468–469 literature search, 496 Brain ischemia, imaging methods, graded compression ultrasound, pathophysiology, 494–495 165–168 464 See also specific disorders Brain metastasis imaging protocol, 472 Bladder and headache, 186–187 literature search, 461 blunt trauma, imaging, 450 from lung cancer, 70, 71 pathophysiology, 458 disorders. See Urinary tract Brain swelling, traumatic brain pediatric cases, 463–465 disorders injury imaging, 243 ultrasound, 462–464 Blinding Breast cancer Arthritis, septic. See Septic arthritis clinical studies, 5–6 at-risk persons, 30 versus not blinding, 23–24 costs, 31 B Blunt trauma epidemiology, 30 Back pain. See Low back pain aortic rupture, 370 grades, 30 Barium, negative aspects of use, thoracolumbar spine imaging, scoliosis imaging as cause, 486 329 343–344 Bayes’ theorem, 13, 15 See also Abdomen, blunt trauma; Breast cancer imaging Bias, 22–26 Chest, blunt trauma and BIRADS category 3 lesions, lead-time, 25 Bolus nonionic contrast, and 43 length-time, 25–26 intracranial hemorrhage case studies (images), 46–48 observer, 23–24 imaging, 172 future directions, 52 reference standard, 23–24 Bone metastasis goals of, 31 screening selection, 24–25 from lung cancer, 67, 70, 71 image-guided percutaneous selection, 23 from prostate cancer, 131, 136 biopsy, 29–31, 43–52 slippery linkage, 26 Bone scan. See Radionuclide bone literature review, 31–32 sticky diagnosis, 26 scintigraphy literature search, 31–32 Index 573

mammographic screening, 28–29, and stroke risk, 394–396 thoracolumbar spine imaging, 32–38 Case-control studies, 4–5 329 MRI, 50–52 Catheter angiography (CA), carotid traumatic brain injury imaging, and nipple discharge, 42 imaging, 383, 385–387, 397–398 249–251 and radial scars, 44–45 Cauda equina syndrome, 297 Cholecystitis. See Acute calculous ultrasound, 29–30, 38–43, 48 Caudal regression syndrome, 337, cholecystitis; Chronic calculous 340 cholecystitis C CBTRUS database, 106 Choledocholithiasis, 506–509 Calcification scoring, coronary Cerebral blood flow assessment, CT, 507 artery, 354–357 carotid stenosis, 393–394 endoscopic retrograde Calculous cholecystitis. See Acute Cerebral blood volume assessment, cholangiopancreatography calculous cholecystitis; Chronic carotid stenosis, 394 (ERCP), 507 calculous cholecystitis Cervical spine imaging endoscopic ultrasonography, Canadian C-spine rule, 321–324 Canadian C-spine rule, 321–324 508–509 Cancer risk, scoliosis imaging, 343 children, 327 epidemiology, 495 Cardiac imaging cost-effectiveness, 325–326 imaging strategy, 508–509 coronary angiography, 357–363 CT, 324–328 magnetic resonance cost-effectiveness, 358, 361, diagnostic accuracy, 325, 330 cholangiopancreatography 363–364 goals of, 321 (MRCP), 507–509 CT, 364–366 Harborview high-risk cervical pathophysiology, 495 CT calcium scoring, 354–357 spine criteria, 326–327 ultrasound, 506–507 future directions, 366 in high-risk patients, 324–326 Cholescintigraphy goals of, 354 indications for, 321–324 acute calculous cholecystitis, literature search, 354 literature search, 321 496–498, 500–501 MRI, 364–365 NEXUS prediction rule, 321–324 chronic calculous cholecystitis, PET, 363–365 and unconscious patient, 327–328 502–504 SPECT, 363–366 Cervical spine injury Chronic calculous cholecystitis, stress echocardiography, 363–364, costs, 320 502–505 366 epidemiology, 320 cholescintigraphy, 502–504 stress electrocardiography, 363 Chest, blunt trauma costs, 496 Carotid imaging case studies (images), 450–451 endoscopic retrograde of asymptomatic patients, chest wall imaging, 443–444 cholangiopancreatography, 504 391–392, 396, 397 costs, 443 epidemiology, 495 catheter angiography (CA), 383, CT, 443–445 imaging goals, 496 385–387, 397–398 CT angiography, 443, 445 imaging strategy, 503–504 cost-effectiveness, 386, 392, 396 diaphragm imaging, 445 magnetic resonance CT angiography, 389–390, 398 epidemology, 442–443 cholangiopancreatography doppler ultrasound (DUS), 385, future directions, 450 (MRCP), 504 386, 390–391, 398 literature search, 443 pathophysiology, 495 goals of, 384 MRI, 445 ultrasound, 502–503 literature review, 384 pathophysiology, 442 Cirrhosis MR angiography, 387–389, 398 pleura/lung imaging, 444–445 costs, 524 multiple overlapping thinslab types of injuries, 442 epidemiology, 523 acquisition (MOTSA), 389 X-rays, 445 pathophysiology, 521–522 transcranial doppler (TCD), Children See also Hepatocellular carcinoma 394–395 appendicitis, acute, 463–465 Clinical prediction rules, 13 Carotid stenosis brain cancer, 107, 182 Clinical question, formulation for angioplasty and stenting, 386, cervical spine imaging, 327 EBI, 3 392–393 gastrointestinal tract obstruction. Clinical studies, 4–6 carotid endarterectomy, See Intussusception analytical, 4–5 effectiveness, 385 headache/headache bias, 22–26 cerebral blood flow assessment, neuroimaging, 182, 187–188 case-control, 4–5 393–394 Ottowa knee rule, 278 clinical trials, 5 cerebral blood volume seizures/seizures neuroimaging, cohort, 4–5 assessment, 393 196–198, 200–201, 209 cross-sectional, 5 complete occlusion, 394–396 sinusitis imaging, 220–221 descriptive, 4 costs, 384 spinal disorders. See Occult errors, types of, 19–22 epidemiology, 384 spinal dysraphism; Scoliosis experimental, 5 pathophysiology, 383 and stroke, 175–176 prospective, 5–6 574 Index

Clinical studies (cont.) acute calculous cholecystitis, 498, Confounding factors, 6 randomized, blinded, 5–6 501 Congenital scoliosis. See Scoliosis retrospective, 5 Alzheimer’s disease, 146, 156 CONSORT initiative, 19 Cohort studies, 4–5 appendicitis, acute, 462–465 Coronary angiography, 357–363 Colonic diverticulitis, 458–461 bile duct obstruction, 506 cost-effectiveness, 358, 361 case studies (images), 472 bile duct stricture, 510 decision tree, 358–361 costs, 460 brain cancer, 108–110, 113 initial use, factors in, 362 CT, 467–468 calcium scoring, 354–357 Coronary artery calcification diagnostic accuracy, 470 cardiac, 364–366 scoring, 354–357 imaging protocol, 472 cervical spine, 324–328 Coronary artery disease literature search, 461–462 chest, blunt trauma, 443–445 costs, 353–354 pathophysiology, 458–459 choledocholithiasis, 507 epidemiology, 353 ultrasound, 468 colonic diverticulitis, 467–468 pathophysiology, 353 Colonoscopy, 83–84, 87–90 headache, 183–191 See also Cardiac imaging Colorectal cancer hepatocellular carcinoma, Cortical rim sign, 449 adenoma-carcinoma sequence 531–534 Cost-benefit analysis (CBA), 9 hypothesis, 79–80, 87–88 herniated disk, 299–301 Cost-effectiveness analysis (CEA), after first occurrence, 88 intracranial hemorrhage, 7, 9, 10 at-risk populations, 81, 86–90 162–163, 165–167, 171–172 Cost-minimization analysis, 9 costs, 80 knee injury, 277–278 Costs, types of, 11 epidemiology, 80, 523 liver metastases, 524–528 Cost-utility analysis familial factors, 86–87, 89–90 lung cancer, 62–72 quality-adjusted life year fecal occult blood testing (FOBT), prostate cancer, 126–127, 132, 135 (QALY), 10 82–83 seizures, 198–204 quantification of health in, and inflammatory bowel disease, sinusitis, 216–229 10 88–89 small bowel ischemia, 466–467 Crescent sign, intussusception, and liver metastases, 523, 536 small bowel obstruction, 465–466 479–480 Lynch syndrome, 90 spinal stenosis, 310 Cross-sectional studies, 5 sigmoidoscopy, 82–83 temporal lobe epilepsy, 203–204 Cryoablation, 523 Colorectal cancer imaging thoracolumbar spine, 329–331 asympotmatic patients, screening traumatic brain injury, 236–252, D protocol, 98 256 Data analysis asymptomatic patient imaging urolithiasis, 551–552 meta-analysis, 11–12 protocol, 98 Computed tomography qualitative and quantitative, colonoscopy, 83–84, 87–90 angiography (CTA) 11 comparison of methods, 84–90 intracranial hemorrhage, 174 Deep venous thrombosis, clinical computer-assisted detection subarachnoid hemorrhage, 186 signs, 411 (CAD) algorithms, 93 Computed tomography arterial Descriptive studies, 4 cost-effectiveness, 91–92 portography (CTAP) Diabetic foot, osteomyelitis in, CT colonography (CTC), 85–86 hepatocellular carcinoma, 533 266–267 double contrast barium enema liver metastases, 528 Diagnostic tests (DCBE), 81, 84, 89 Computed tomography hepatic evaluation of, 6–7 false-negative (image), 94, 97 arteriography (CTHA), receiver operating characteristics false-positive (image), 95 hepatocellular carcinoma, 531 (ROC) curve, 7 future directions, 92–93 Computed tomograpy angiography sensitivity of, 6–7 goals of, 80–81, 524 (CTA) specificity of, 6–7 literature review, 81 acute aortic dissection, 371–372 Diaphragm, blunt trauma, imaging, prepless colonography, 92–93 aneurysm, intercranial, 186 445 staging, 90–91 carotid imaging, 389–390, 398 Diastematomyelia, 337 true-positive (image), 96–97 chest, blunt trauma, 443, 445 Differential Outcome Scale (DOS), Compression fractures, 308–309 headache, 186 234 osteoporotic type, 313 peripheral vascular disease, Diffusion-tensor imaging, radionuclide bone scintigraphy, 376–377 traumatic brain injury 308 pulmonary embolism evaluation, imaging, 240 SPECT, 309 404, 415 Diffusion-weighted imaging vertebroplasty, 313 Computer-assisted detection (CAD) brain cancer, 111 X-rays, 309 algorithms, colorectal cancer traumatic brain injury imaging, Computed tomography (CT) imaging, 93 240, 246, 248 abdomen, blunt trauma, 446–450, Confidence intervals (CI), Digital rectal exam (DRE), prostate 452 construction of, 21–22 cancer, 120–121, 125 Index 575

Digital subtraction angiography, random, 19–22 Graded compression ultrasound, peripheral vascular disease, systematic, 19–20 appendicitis, acute, 464 376 Type I, 20–21 Gradient echo sequences, traumatic Direct costs, 11 Type II, 20, 22 brain injury, 240 Disability Score (DS), 234–235 Evidence-based imaging (EBI) Diverticulitis. See Colonic clinical question in, 3 H diverticulitis defined, 3 Harborview high-risk cervical Doppler ultrasound (DUS) evidence, application of, 12–15 spine criteria, 326–327 abdomen, blunt trauma, 446 guiding principles, 1–3 Headache carotid imaging, 385, 386, imaging effectiveness hierarchy, and children, 182 390–391, 398 12–13 epidemiology, 182 Dorsal dermal sinus, 337, 341 literature review. See Medical primary/secondary etiologies, Double contrast barium enema literature 181, 183 (DCBE), 81, 84, 89 Experimental studies, 5 Headache neuroimaging Dysraphism. See Occult spinal for brain metastases, 186–187 dysraphism F case studies (images), 190–191 False-negatives, elimination of, 22 cost effectiveness, 189–190 E False-positives, elimination of, 22 CT, 183–191 Echocardiography Febrile seizures. See Seizures CT angiography, 186 pulmonary embolism evaluation, neuroimaging goals of, 182 406–407 Fecal occult blood testing (FOBT), indications for, 183 stress, 363–364, 366 82–83 literature review, 183 Economic evaluations, 9–11 Fixed costs, 11 for migraine/chronic headache, cost-benefit analysis (CBA), 9 Fluid-attenuated inversion 185–186 cost-effectiveness analysis (CEA), recovery (FLAIR) MR angiography, 186 10 and intracranial hemorrhage, MRI, 184–189 cost-minimization analysis, 9 164 for new-onset headache, 183–185 costs, types of, 11 and temporal lobe epilepsy, 206 pediatric imaging, 187–188 cost-utility analysis, 10 traumatic brain injury, 240 sensitivity/specificity of Electron beam computed Fluoroscopy, intussusception methods, 189 tomography (EBCT), enema reduction, 484 and subarachnoid hemorrhage, pulmonary embolism Flurodeoxyglucose PET. See 186 evaluation, 405 Positron emission tomography suspected intracranial aneurysm, Embase, 461 with flurodeoxyglucose (PET 186 Embolism. See Pulmonary FDG) Head injury embolism; Pulmonary Functional endoscopic sinus types of, 235 embolism imaging evaluation surgery, before/after imaging, See also Traumatic brain injury; Endoleaks, abdominal aortic 227 Traumatic brain injury aneurysm (AAA) graft, Functional magnetic resonance imaging 377–378 imaging (fMRI) Health status, quantification of, 10 Endoscopic retrograde Alzheimer’s disease, 147 Helical CT, nephrolithiasis, cholangiopancreatography seizures, 207–209 545–546 (ERCP) traumatic brain injury, 242, 248 Hematogenous osteomyelitis. See bile duct stricture, 510 Functional Status Examination Acute hematogenous choledocholithiasis, 507 (FSE), 235 osteomyelitis chronic calculous cholecystitis, Hepatic disorders 504 G cirrhosis, 521–522 Endoscopic ultrasonography (EUS) Gadobenate dimeglumine (Gd- hepatocellular carcinoma, 522 bile duct obstruction, 506 BOPTA), 530 literature search, 521 bile duct stricture, 511–512 Gadolinium enhancement liver metastases, 521 choledocholithiasis, 508–509 herniated disk, 304 See also specific disorders -guided fine-needle aspiration, liver metastases, 530 Hepatitis, and hepatocellular 512 osteomyelitis, 308 carcinoma, 522 Endovascular repair, abdominal Gallbladder disease. See Biliary Hepatocellular carcinoma aortic aneurysms (AAA), disorders case studies (images), 537 373–375 Gastrointestinal tract obstruction. cost-effectiveness, 524, 535–536 Enema, intussusception. See See Intussusception costs, 524 Intussusception Glasgow Coma Scale, 234 CT, 531–534 Errors, 19–22 Glasgow Outcome Scale, 234 CT arterial portography (CTAP), and bias, 22–26 Gleason score, 127, 131 533 576 Index

Hepatocellular carcinoma (cont.) PET, 172–173 Knee injury CT hepatic arteriography SPECT, 173 costs, 274–275 (CTHA), 531, 533 stroke mimics, exclusion of, epidemiology, 274 diagnostic accuracy, 531–536 165–168 Ottowa knee rule, 275–278 epidemiology, 522–523 xenon gas in, 171–172 Knee injury imaging hematologic testing, 522 Intradural lipoma, 337 children, 278 imaging goals, 524 Intraoperative ultrasound (IOUS), cost effectiveness, 277–278, MRI, 533–534 liver metastases, 526 281–282 prognosis, 522 Intussusception, 475–490 CT, 277–278 ultrasound, 532 alternative treatments, 484 decision rules, 275–277 whole-body PET, 534–535 bowel necrosis, predictors of, diagnostic accuracy, 279–281 Herniated disk, 299–305 481 future directions, 289–290 and anular tears, 305 case study (images), 489 goals of, 275 bulge versus herniation, 302–303 clinical predictors of, 478–479 imaging protocols, 290 CT, 299–301 cost-effectiveness, 480–481, literature review, 275 gadolinium enhancement, 304 486–487 meniscal/ligamentous injuries, MRI, 300–303 costs, 477–478 278–281 MR myelography (MRM), 301, crescent sign, 479–480 MRI, 277–283 303–304 delayed repeat enema, 484 osteoarthritic knee, 282–283 protrusions and extrusions, diagnostic accuracy, 480 of prosthesis, 283 302–304 enema, air versus liquid, X-rays, 277–278, 283 X-rays, 299, 301 482–483, 485 Hierarchical framework, imaging enema reduction effectiveness, L effectiveness, 12–13 481–482 Laser photocoagulation, 523 enema reduction procedure, 482, Lead-time bias, 25 I 490 Length-time bias, 25–26 Image-guided biopsy. See enema rule of threes, 482, Life expectancy, cross-cultural Percutaneous image-guided 483 view, 2 breast biopsy enema therapy complications, Ligament tears. See Knee injury Indirect costs, 11 485–486 imaging Inflammatory bowel disease, and epidemiology, 477 Likelihood ratios (LR), 13–15 colorectal cancer, 88–89 fluoroscopy and enema positive and negative, 14–15 Intercranial aneurysms reduction, 484 Limb ischemia, acute, 370 CT angiography, 186 future directions, 488 Linear transducer sonography, MR angiography, 186 imaging goals, 478 intussusception, 480–481 Intracranial hemorrhage. See imaging protocol, 490 Lipomyelocele, 337 Intracranial hemorrhage linear transducer sonography, Lipomyelomeningocele, 337 imaging; Stroke 480–481 Literature review. See Medical Intracranial hemorrhage imaging literature search, 478 literature search and bolus nonionic contrast, 172 pathologic lead points, 476, 481, Liver brain ischemia, identifying, 487–488 blunt trauma, imaging, 445–447 165–168 pathophysiology, 476 See also Hepatic disorders case studies (images), 165–166, radiation dose, 483–484 Liver metastases 170 recurrent, management of, 487 case studies (images), 527, 529 CT, 162–163, 165–167, 171–172 rotavirus vaccine, relationship to, and colorectal cancer, 523, 536 CT angiography, 174 477 CT, 524–528 diffusion-weighted MRI, small bowel intussusception, CT arterial portography, 528 167–170 488 epidemiology, 523 and fluid-attenuated inversion surgical complications, 486 gadolinium enhancement, 530 recovery (FLAIR), 164 treatment setting, 485 image-guided therapies, 523 future directions, 176 ultrasound, 479–481, 490 intraoperative ultrasound, goals of, 162 X-rays, 479–480 526 literature review, 162 and lung cancer, 69–70 MR angiography, 174–175 K MRI, 524–525, 528–530 MRI, 163–165, 167–171 Kidney multirow detector helical CT, MRI spectroscopy, 171 blunt trauma, imaging, 449 528 noninvasive vascular imaging, cortical rim sign, 449 organ-specific contrast, 530, 173–175 renal artery stenosis, 370–380 531 and pediatric patients, 175 transplant donor, evaluation of, pathophysiology, 521 perfusion-weighted MRI, 378–379 PET, 525, 530, 532, 534–535 168–170 Klatskin tumor, 512–513 staging, 525 Index 577

ultrasound, 525–526 M seizures, 198–206 whole-body PET, 530 Magnetic resonance angiography shoulder injury, 285–290 Low back pain (MRA) sinusitis, 218, 226 costs, 298 carotid imaging, 386–389, 398 small bowel ischemia, 466 differential diagnosis, 296–297 headache, 186 SPECT, 308 epidemiology, 296–297 intracranial hemorrhage, 174–175 spinal metastasis, 306–307 Low back pain imaging peripheral vascular disease, spinal stenosis, 310–311 ankylosing spondylitis, 309–310 375–376 temporal lobe epilepsy, 201–206 cauda equina syndrome, 297 pulmonary embolism evaluation, traumatic brain injury, 238, compression fractures, 308–309, 405–406 239–242, 242–248, 251–254, 256 313 Magnetic resonance arthrography Magnetic resonance myelography diagnostic accuracy, 314 (MRA), knee injury imaging, (MRM), herniated disk, 301, future directions, 315–316 285–289 303–304 goals of, 298 Magnetic resonance Magnetic resonance spectroscopy herniated disk, 299–305 cholangiopancreatography (MRS) imaging protocols, 314–315 (MRCP) intracranial hemorrhage, 171 infection, 307–308 acute calculous cholecystitis, 498 prostate cancer, 129–130 literature review, 298–299 bile duct obstruction, 506 seizures, 208 metastatic disease, 305–306 bile duct stricture, 510–511, single-voxel proton. See Single- osteoporotic vertebral 514–515 voxel spectroscopy (SVS) compression fractures, 313 choledocholithiasis, 507–509 traumatic brain injury, 241, and outcome, 311–312 chronic calculous cholecystitis, 245–246, 251, 255 patient expectations/satisfaction, 504 Mammographic screening, 28–29, 311–313 Magnetic resonance imaging (MRI) 32–38 spinal stenosis, 310–311 acute calculous cholecystitis, 498 age and beneﬁts, 35 vertebroplasty, 313 acute hematogenous age factors, 35–36 See also individual conditions osteomyelitis imaging, 264, in community setting, 34 Lung, blunt trauma, imaging, 266–267, 270 cost effectiveness, 37–38 444–445 Alzheimer’s disease, 146, effectiveness, 32–35 Lung cancer 148–149, 154–156 frequency of, 36–37 categories of, 57 ankylosing spondylitis, 310 Mangafodipir trisodium costs, 58 bile duct obstruction, 506 (MnDPDP), 530 epidemiology, 58 brain cancer, 105, 108–111 Marfan syndrome, 337 occupational causes, 58 breast cancer, 50–52 Medical literature, 4–12 radiologic follow-up, 71–72 cardiac, 364–365 clinical studies, types of, 4–6 Lung cancer imaging chest, blunt trauma, 445 cost-effectiveness analysis (CEA), for adrenal metastasis, 70 diffusion-weighted, 111, 149–150, 7, 9 for bone metastasis, 67, 70, 165, 169–170 data-analysis, 11–12 71 FLAIR, 164, 206, 252 diagnostic tests, evaluation of, for brain metastasis, 70, 71 functional. See Functional 6–7 case studies (images), 60, 66 magnetic resonance imaging National Guideline chest X-ray, 59–62 (fMRI) Clearinghouse, 236–237 cost effectiveness, 65–66 headache, 184–189 See also Clinical studies CT, 62–72 hepatocellular carcinoma, Medical literature search literature search, 58–59 533–534 CBTRUS data, 106 for liver metastasis, 69–70 herniated disk, 300–303 Embase, 461 mediastinum evaluation, 68–69 intracranial hemorrhage imaging, Medline/PubMed, 31–32, 58–59, MRI, 68–71 163–165, 167–171 81–82, 105, 120, 144, 162, 183, PET, 68–72 knee injury, 277–283 197, 236, 275, 298, 321, 339, PET FDG, 69, 71 liver metastases, 524–525, 354, 371, 401, 461, 478, 496, primary tumor evaluation, 529–530 545 67–68 lung cancer, 68–71 MESH headings, 321, 461, 478 small cell lung cancer (SCLC), magnetization transfer MRI, National Cancer Data Base 70–71 149–150 (NCDB), 106 staging, 66–67, 72 occult spinal dysraphism National Guideline video-assisted thoracotomy imaging, 342, 348 Clearinghouse, 236–237, 496 (VATS), 64 osteomyelitis, 307–308 on-line sources, 4 Lynch syndrome perfusion-weighted, 168–170 Ovid search engine, 120, 162, 183 diagnostic criteria, 90 prostate cancer, 108–111, 132, SEER program, 106 See also Colorectal cancer; 135–136 See also speciﬁc medical Colorectal cancer imaging scoliosis, 344–348 conditions 578 Index

Medicine imaging goals, 544–545 Overhead costs, 11 economic evaluations, 9–11 and pregnancy, 546–547 Ovid search engine, 120, 162, 183 literature. See Medical literature X-rays, 546 Medline/PubMed, 4, 31–32, 58–59, Neural tube defects. See Occult P 81–82, 105, 120, 144, 162, 183, spinal dysraphism Pancreas, blunt injury, imaging, 448 197, 236, 275, 298, 321, 339, Neurofibromatosis, 337 Pathologic lead points, 354, 371, 401, 461, 478, 496, 545 Neurogenic bladder intussusception, 476, 481, 488 Meningitis, and occult spinal pathophysiology, 549 Patient outcome efficacy, 13 dysraphism, 341 urologic workup, 549 Percutaneous image-guided breast Meningocele, 337 Neuroimaging. See Alzheimer’s biopsy, 29–31, 43–52 Meniscal injuries. See Knee injury disease neuroimaging; benefits of, 45, 49 imaging Headache neuroimaging; cost-effectiveness, 51–52 Mesentery, blunt trauma, imaging, Seizure neuroimaging; imaging guidance, type of, 50–51 447–448 Traumatic brain injury Percutaneous transhepatic MESH headings, 321, 461, 478 imaging cholangiography (PTC), bile Meta-analysis, 11–12 Newborn evaluation, occult spinal duct stricture, 510–511 Metastatic disease dysraphism imaging, 346 Perfect test, 7–8 adrenal, 70 NEXUS prediction rule, 321–324 Perfusion studies, traumatic brain bone, 67, 70, 71, 131, 136 Nipple discharge, imaging, 42 injury, 247–248 brain, 70, 71, 186–187 Noninvasive vascular imaging, Peripheral vascular disease liver, 69–70 intracranial hemorrhage, CT angiography, 376–377 spinal, 305–306 173–175 digital subtraction angiography, Microwave ablation, 523 376 Midline shift, traumatic brain O future directions, 380 injury imaging, 243, 246, 248 Observer bias, 23–24 imaging goals, 371 Migraine. See Headache Occult spinal dysraphism literature search, 371 neuroimaging closed spina bifida entities, 337 MR angiography, 375–376 Multidetector computed conus medullaris position issue, multidetector CT, 376, 389 tomography (MDCT) 337–338 pathophysiology, 370 peripheral vascular disease, 376, early intervention benefits, 341 Pleura, blunt trauma, imaging, 389 epidemiology, 338 444–445 pulmonary embolism evaluation, open spina bifida entities, 337 Positive likelihood ratio (PLR), 404–405 pathophysiology, 337, 341–342 13–14 Multiplanar imaging (MPI), renal spectrum of manifestations, 338 Positive predictive value (PPV), 14 artery stenosis, 379 surgical intervention, 341–342 Positron emission tomography Multiple overlapping thinslab Occult spinal dysraphism imaging (PET) acquisition (MOTSA), carotid at-risk groups, 340–341 Alzheimer’s disease, 147, imaging, 389 cost-effectiveness, 342 154–156 Multirow detector helical CT, liver diagnostic accuracy, 339–340 brain cancer, 108–109 metastases, 528 goals of, 339 cardiac imaging, 363–365 Multivoxel resonance spectroscopy, literature search, 339 hepatocellular carcinoma, traumatic brain injury, 241 MRI, 342, 348 534–535 Myelodysplasia, 337 newborn evaluation, 346 intracranial hemorrhage, 172–173 Myelomeningocele, 337 ultrasound, 341–342, 347 liver metastases, 525, 530, 532, On-line sources, medical literature. 534–535 N See Medical literature search lung cancer, 68–72 National Cancer Data Base Osteoarthritis, knee imaging, prostate cancer, 130–131, 136 (NCDB), 106 282–283 seizures, 206 National Guideline Clearinghouse, Osteomyelitis traumatic brain injury, 241 236–237, 496 in diabetic foot, 266–267 whole-body, 530 Negative likelihood ratio (NLR), MRI, 307–308 Positron emission tomography 14–15 radionuclide bone scintigraphy, with flurodeoxyglucose (PET Negative predictive value (NPV), 308 FDG), 69, 71, 108–109, 130–132, 14 SPECT, 308 156 Nephrolithiasis, 543–547 X-rays, 307 Alzheimer’s disease, 156 case studies (images), 550 See also Acute hematogenous brain cancer, 108–109 costs, 544 osteomyelitis lung cancer, 69, 71 diagnostic accuracy, 549 Osteoporotic vertebral compression prostate cancer, 130–132, 136 epidemiology, 544 fractures, 313 traumatic brain injury imaging, helical CT, 545–546 Ottowa knee rule, 275–278 242, 247–248 Index 579

Power analysis, and sample size, 22 literature review, 401–402 S Predictive values, positive and MR angiography, 405–406 Sample size negative, 14 multidetector computed confidence intervals (CI), 21–22 Pregnancy tomography (MDCT), 404–405 and power analysis, 22 and nephrolithiasis, 546–547 pulmonary angiography, Scoliosis and urinary tract infection, 547 402–403 classification of, 337 Prepless colonography, 92–93 recurrence rate, 402 epidemiology, 338–339 Prospective studies, 5–6 ultrasound, 406 pathophysiology, 337–338 Prostate cancer ventilation-perfusion imaging Scoliosis imaging at-risk persons, 120 (VQ), 403–404, 415 adverse reproductive outcome costs, 120 X-rays, 407 risk, 344 digital rectal exam (DRE), P value, 20–22 at-risk persons, 345–346 120–121, 125 Pyleonephritis, future directions, cancer risk, 343 epidemiology, 120 550 CIs, degrees of, 343 Gleason score, 127, 131 goals of, 339 prostate-specific antigen (PSA) Q literature search, 339 testing, 121–122, 127, 131 Qualitative analysis, 11 MRI, 344–348 treatment flow chart, 133 Quality-adjusted life year (QALY), severe idopathic scoliosis, Prostate cancer imaging 10 344–345 for bone metastases, 131, 135–136 Quantitative analysis, 11 X-rays, 348 case studies (images), 133–135 Screening selection bias, 24–25 CT, 126–127, 132, 135 R SEER program, 106 future directions, 136 Radial scars, breast cancer imaging, Seizures goals of, 120 44–45 categories of, 195 image-guided biopsy, 122–124, Radiofrequency ablation, 523 children, 196 129 Radionuclide bone scintigraphy costs, 196–197 imaging evaluation flowchart, acute hematogenous epidemiology, 196 133 osteomyelitis, 264, 266–267, febrile, 196 literature review, 120–121 269–270 Wada test, 208–209 MRI, 127–129, 132, 136 ankylosing spondylitis, 310 Seizures neuroimaging MR spectroscopy (MRS), 129–130 compression fractures, 308 for acute symptomatic seizures, PET-FDG, 130–132, 136 knee prosthesis, 283 198–199 post-treatment imaging, 132 metastasis from prostate cancer, children, 197–198, 200–201, 209 radionuclide bone scan, 131, 136 131, 136 CT, 198–204 staging, 124–131 osteomyelitis, 308 decision-making algorithm, 209 transrectal ultrasound (TRUS), septic arthritis, 264, 266–267, and febrile seizures, 197–198 121–126, 134–135 269–270 for first unprovoked seizures, ultrasound, 124–125 spinal metastasis, 306 199–201 Prosthesis, knee, imaging of, 283 Random error, 19–22 functional MRI, 207–209 Proton magnetic resonance Randomized controlled trial goals of, 197 spectroscopy (1H MRS) bias related to, 26 literature review, 197 Alzheimer’s disease, 148 blinded clinical trial, 5–6 MRI, 198–206 brain cancer, 105, 112–113 pros/cons of, 5–6, 22–23, 26 MR spectroscopy (MRS), 208 PubMed. See Medline/PubMed Rappaport Disability Rating Scale PET, 206 Pulmonary embolism (DRS), 234 SPECT, 206–208 costs, 401 Receiver operating characteristics for temporal lobe epilepsy, epidemiology, 401 (ROC) curve, 7 201–206 pathophysiology, 401 Recurrence rate, pulmonary Selection bias, 23 Pulmonary embolism imaging embolism, 402 Sensitivity of tests, 6–7 evaluation Reference standards, and bias, Septic arthritis case studies (images), 412–414 23–24 clinical signs, 263 CT pulmonary angiography, 404, Renal artery stenosis, 370–380 costs, 262 415 multiplanar imaging (MPI), 379 epidemiology, 262 and diagnosis, 407–408 Retroperitonal injuries, blunt future directions, 270 diagnostic accuracy, 410 trauma, imaging, 448–450 long-term effects, 265 echocardiography, 406–407 Retrospective studies, 5 medical therapy versus surgery, electron beam CT, 405 Rotator cuff tears, 285–288 265–266 future directions, 415 Rotavirus vaccine, and pathogens, 262, 265 goals of, 401 intussusception, 477 pathophysiology, 261 limitations of studies of, 402 Rule of threes, liquid enema, 483 predictors of, 263 580 Index

Septic arthritis (cont.) Sinusitis imaging Stenting. and angioplasty, carotid ultrasound, 264–265, 267, before/after functional stenosis, 386, 392–393 270 endoscopic sinus surgery, Sticky diagnosis bias, 26 X-rays, 268–269 227 Stress echocardiography, 363–364, Septic arthritis imaging case studies (images), 225 366 and diabetic foot, 266–267 children, 220–221 Stress electrocardiography, 363 diagnostic accuracy, 268 chronic, diagnosis of, 222–226 Stroke future directions, 270 cost-effectiveness, 228–229 and carotid stenosis, 394–396 imaging protocols, 268–270 CT, 216–229 classification of, 161 and IV drug users, 267 diagnostic accuracy, 216–224 costs, 161–162, 384 MRI, 264, 266–267, 270 goals of, 215 defined, 161 radionuclide bone scintigraphy, imaging findings, 224–226 epidemiology, 161 264, 266–267, 269–270 indications for, 226 pediatric, 175–176 repeat imaging, 266, 267 MRI, 218, 226 treatment, 161 Shoulder injury to predict clinical outcome, 227 See also Carotid imaging; Carotid costs, 274–275 and treatment decision-making, stenosis; Intracranial differential diagnosis, 286 228 hemorrhage imaging epidemiology, 274 Slippery linkage bias, 26 Structural neuroimaging, Shoulder injury imaging Small bowel ischemia, 466–467 Alzheimer’s disease, 145–146 dislocations, 284–285 CT, 466–467 Subarachnoid hemorrhage, CT future directions, 289–290 future directions, 469 angiography, 186 goals of, 275 MRI, 466 Superparamagnetic iron oxide high-risk patients, 285 Small bowel obstruction, 458–461, (SPIO), 530, 531 imaging protocols, 290 465–466 Supervision Rating Scale (SRS), 235 indications for, 284–285 case studies (images), 471 Susceptibility-weighted imaging literature review, 275 costs, 460 (SWI), traumatic brain injury, MR arthrography (MRA), CT, 465–466 240 285–289 diagnostic accuracy, 469 Systematic error, 19–20 MRI, 285–290 imaging protocol, 472 See also Bias rotator cuff tears, 285–288 literature search, 461 soft tissue diagnosis, 285–289 pathophysiology, 458 T ultrasound, 287 ultrasound, 465–466 Temporal lobe epilepsy Sickle cell anemia, stroke Small cell lung cancer (SCLC) CT, 203–204 prevention, 175 metastatic disease, 71 and fluid-attenuated inversion Sigmoidoscopy, 82–83 staging, 70–71 recovery (FLAIR), 206 Single photon emission computed whole-body MRI, 71 magnetic resonance imaging tomography (SPECT) Sonography, intussusception, (MRI), 201–206 Alzheimer’s disease, 147, 151, 480–481 Therapeutic efficacy, 13 154–156 Specificity of tests, 6–7 Thoracolumbar spine imaging ankylosing spondylitis, 310 Spina bifida. See Occult spinal blunt trauma patients, 329 brain cancer, 108–109 dysraphism children, 329 cardiac imaging, 363–366 Spinal metastasis, 305–306 clinical prediction rules, 328–329 compression fractures, 309 MRI, 306–307 CT, 329–331 intracranial hemorrhage, 173 radionuclide bone scintigraphy, diagnostic accuracy, 330 osteomyelitis, 308 306 future directions, 330 seizures, 206–208 SPECT, 306 imaging protocols, 331 spinal metastasis, 306 X-rays, 305–306 indications for, 323, 328–329 thallium, 108 Spinal stenosis, 310–311 Thoracolumbar spine injury traumatic brain injury, 241, CT, 310 costs, 320 247–248 MRI, 310–311 epidemiology, 320 Single-voxel spectroscopy (SVS) X-rays, 310 goals of, 321 seizures, 241 Spinal trauma. See Cervical spine literature review, 321 traumatic brain injury, 241 imaging; Thoracolumbar spine Transcranial doppler (TCD), carotid Sinusitis imaging imaging, 394–395 antibiotic treatment, 216 Spine disorders, children. See Transient ischemic attacks (TIA). at-risk persons, 214 Occult spinal dysraphism; See Carotid imaging; Carotid costs, 214–215 Scoliosis stenosis defined, 213, 218 Spleen, blunt trauma, imaging, Transrectal ultrasound (TRUS) epidemiology, 213–214 445–447 color Doppler imaging, 122 subtupes, 213 STARD initiative, 19 prostate cancer, 121–126, 134–135 Index 581

Trauma Coma Databank (TCDB), SPECT, 241, 247–248 epidemiology, 544 242–243 susceptibility-weighted imaging imaging goals, 544–545 Traumatic brain injury (SWI), 240 and men, 547–548 causes of, 235–236 Type I error, 20–21 pathophysiology, 543 costs, 236 Type II error, 20, 22 and pregnancy, 547 epidemiology, 235–236 treatment, 547 Glasgow Coma Scale, 234 U Urolithiasis Glasgow Outcome Scale, 234 Ultrasound CT, 551–552 outcome scales, 234–235, abdomen, blunt trauma, 446, 452 pathophysiology, 543 248–249 acute calculous cholecystitis, types of stones, 543 Traumatic brain injury imaging 496–497, 500 See also Nephrolithiasis in acute care setting, 237–238, acute hematogenous 256 osteomyelitis imaging, V atrophy, quantification of, 248 264–265, 267, 270 Variable costs, 11 brain swelling, 243, 246 bile duct obstruction, 505–506 Ventilation-perfusion imaging case studies (images), 254–255 bile duct stricture, 509–510 (VQ), pulmonary embolism children, 249–251 choledocholithiasis, 506–507 evaluation, 403–404 CT, 236–252, 256 chronic calculous cholecystitis, Vertebroplasty, 313 diffuse axonal injury, 244–246 502–503 Video-assisted thoracotomy diffusion-tensor imaging, 240 colonic diverticulitis, 468 (VATS), lung cancer, 64 diffusion-weighted imaging, 240, endoscopic. See Endoscopic 246 ultrasonography W FLAIR, 240 hepatocellular carcinoma, 532 Wada test, 208–209 functional MRI, 242, 248, 249 intussusception, 479–481, 490 Whole-body MRI, small cell lung future directions, 256 liver metastases, 525–526 cancer (SCLC), 71 goals of, 236 occult spinal dysraphism Whole-body PET gradient echo sequences, 240 imaging, 341–342, 347 hepatocellular carcinoma, hemorrhage, 243–244, 246 prostate cancer, 124–125 534–535 image classification, 242–243 pulmonary embolism evaluation, liver metastases, 530 and immediate 406 William’s criteria, 216 treatment/surgery, 239 septic arthritis, 264–265, 267, 270 lesions, number/size/depth, shoulder injury, 287 X 244 small bowel obstruction, 465–466 Xenon gas, and intracranial literature review, 236–237 See also Doppler ultrasound hemorrhage imaging, 171–172 methods, summary of, 252–253 Ultrasound, breast cancer, 29–30, X-rays midline shift, 243, 246 38–43 acute hematogenous MRI, 238, 239–242, 244–246, case study (images), 48 osteomyelitis imaging, 268–269 251–254, 256 diagnostic accuracy, 40–43 ankylosing spondylitis, 309 MR spectroscopy, 241, 245–246, interpretation issue, 40 chest, blunt trauma, 445 251, 255 local extent, detection of, 42–43 compression fractures, 309 multivoxel resonance as supplemental screening, 38–40 herniated disk, 299, 301 spectroscopy, 241 Unconscious patient, cervical spine intussusception, 479–480 normal scans, 243 imaging, 327–328 knee injury, 277–278, 283 and outcome prediction, Urinary tract disorders lung cancer screening, 59–62 242–249 literature search, 545 nephrolithiasis, 546 perfusion studies, 247–248 nephrolithiasis, 543–547 osteomyelitis, 307 PET, 241 neurogenic bladder, 549 pulmonary embolism evaluation, PET FDG, 242, 247 urinary tract infection, 547–549 407 sensitivity/specificity of, urolithiasis, 543 scoliosis, 348 239–242 Urinary tract infection, 547–549 septic arthritis, 268–269 single-voxel spectroscopy (SVS), case studies (images), 550 spinal metastasis, 305–306 241 costs, 544 spinal stenosis, 310 Figure 3.2E. Stereotactic biopsy of microcalcifications. Biopsy probe positioned within breast for retrieval of tissues samples from microcalcifications that were targeted with computer assistance from stereotactic images acquired digitally.

B C

Figure 5.1. False negative CTC. B and C: 3D reconstruction does not reveal a signiﬁcant lesion. D: Endo- scopic view of the transverse colon in the same region reveals a 20 mm sessile lesion. Biopsy conﬁrmed a tubular adenoma. D C D

Figure 5.2. False positive CTC. C and D: 3D reconstruction of region in Figure 5-2A and 5-2B support the presence of a polypoid mass in the splenic ﬂexure. Subsequent colonoscopy was normal.

D B

Figure 5.3. True-positive CTC. B: Digitally subtracted 3D image of the ascending colon provides a lesion pro- jection similar to DCBE. D: Endoscopy reveals a 15 mm polyp. Biopsy conﬁrmed a tubulo-villous adenoma. D C

Figure 5.4. True positive CTC and false negative colonoscopy. C: 3D endoluminal reconstruction supports the ﬁndings on axial imaging. D: Colonoscopy performed on the same day as the CTC in a trial protocol was negative. Repeat sigmoidoscopy was advised based on the CTC ﬁndings. This revealed a 10 mm invasive carcinoma in the sigmoid colon.

Figure 18.1. Photograph of the lower back reveals skin discoloration, hairy patch, and dorsal lipoma. Figure 30.2. Ovarian cancer. Large multiloculated cyst with internal echogenicity and a mural nodule (solid arrow) with vascular ﬂow demonstrated on power Doppler (open arrow).

Figure 30.3. Benign ovarian mass. Complex adnexal mass with solid and cystic components. The solid component demonstrates vascular ﬂow with a low resistive index (0.49). Mass was interpreted as an ovarian carcinoma, proved to be a ﬁbroadenoma on resection.