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• Sella Turcica and Parasellar Region

  This review is based on a presentation given by Walter Kucharczyka and was adapted for the Radiology Assistant by Marieke Hazewinkel. In this review a systematic anatomic approach to differential diagnosis of a sellar or parasellar mass is described. By clicking on one of the subjects in the list on the left, you will go directly to this item. If...

• Traumatic Intracranial Hemorrhage

  Any type of bleeding inside the skull or brain is a medical emergency.The most common causes of hemorrhage are trauma, haemorrhagic stroke and subarachnoid haemorrhage due to a ruptured aneurysm.Complications are increased intracerebral pressure as a result of the hemorrhage itself, surrounding edema or hydrocephalus due to obstruction of CSF.In this...

• 32 cases of suspected COVID-19

  The role of CT in this COVID-19 pandemic still has to be determined.CT can help to determine the severity of the disease and is a valuable and fast tool to determine whether a patient is infected by COVID-19 or not.This can help to keep patients with a high suspicion of COVID-19 infection separate from patients with other diseases, especially when the...

• COVID-19 CO-RADS classification

  The CO-RADS classification is a standardized reporting system for patients with suspected COVID-19 infection developed for a moderate to high prevalence setting.This is a proposed classification system for radiologists in the Netherlands and still work in progress.Press ctrl+ for larger images and text on a PC or ⌘+ on a Mac.This can...

• COVID-19 Imaging findings

  COVID-19 is a viral disease also known as SARS-CoV-2 or severe acute respiratory syndrome coronavirus 2.The diagnosis is made by a positive PCR test, which is highly specific.CT has a higher sensitivity but lower specificity and can play a role in the diagnosis and treatment of the disease.In this article we will describe the role of...

• Cystic Lung Cancer

  Cystic primary lung cancer is increasingly being recognized as a unique imaging morphology.In this article we will discuss the imaging features and managementPress ctrl+ for larger images and text on a PC or ⌘+ on a Mac.Most images can be enlarged separately by clicking on them.

• Pulmonary Fibrosis

  In this article we will discuss lung diseases with a reticular pattern and provide a guidance for radiologists to evaluate the most common diseases and their patterns. A stepwise approach is presented to identify the key features in fibrotic lung disease and to make it easier to reach a differential diagnosis.Images can be enlarged by clicking on...

• Developmental Dysplasia of the Hip

  Developmental dysplasia of the hip is a common musculoskeletal disorder in newborns.In this article we will discuss the ultrasound examination technique according to Graf.

• Endometriosis - MRI detection

  Laparoscopy is the gold standard for the diagnosis of pelvic endometriosis. MRI is helpful in determining the extent of deep infiltrating endometriosis, especially when laparoscopic inspection is limited by adhesions. In this article we will focus on the diagnosis and preoperative assessment of endometriosis using MR imaging. You can enlarge images by...

• Contrast-enhanced MRA of peripheral vessels

  Contrast-enhanced MR angiography (CE-MRA) is more sensitive and specific for diagnosis and preinterventional work-up of Periferal Arterial Disease (PAD) compared to Duplex (1). CE-MRA detects more patent arteries than IA-DSA in patients with chronic critical ischemia and can modify the choice of therapeutic strategy in these patients (2). It is important...

• Arthroplasty of the Hip

  Radiography is the primary imaging method for the evaluation of Total Hip Arthroplasty. This overview focusses on the normal findings and complications of cemented versus non-cemented hip arthroplasties. Interactive cases are presented in the menubar to test your knowledge on hipprostheses.

• Transvaginal Ultrasound for Non-Gynaecological Conditions

  This is an overview of the use of Transvaginal Ultrasound (TVUS) for the diagnosis of various non-gynaecological conditions as they appear in the pelvic cavity.This pictorial essay is for gynaecologists who want to look beyond pathology of uterus and ovaries, and diagnose non-gynaecological conditions. Also included here is Deep Infiltrating Endometriosis...

• Breast Implants

  Breast augmentation surgery is the most popular cosmetic surgery procedure worldwide.The number of women who have breast implants for augmentation or reconstruction is increasing. The risk of rupture increases with the age of the implant and is seen more often in reconstruction after mastectomy for breast cancer than in implants for cosmetic...

• Cystic Abdominal Masses in Children

  Cystic masses in the abdomen of a child are common. Many of these are discovered with prenatal ultrasound. Others are detected when a child has abdominal complaints and imaging is performed. The cyst is either the cause of the complaints or an incidental finding. In this pictorial essay we will show the most common abdominal cystic masses in...

• Neonatal Chest X-Ray

  In this review we will discuss a systematic approach to the neonatal chest radiograph. Close collaboration between neonatologists and radiologists is the key in achieving the correct diagnosis, since the radiographic features of many lung disorders overlap and the findings on the chest film can be rather subtle.Clinical information like age of the...

• Epilepsy - Role of MRI

  In many patients with epilepsy antiepileptic drug treatment is unable to control the seizures. Using a dedicated MRI-protocol, it is possible to detect an epileptogenic lesion in 80 percent of these patients. Resection of these lesions can lead to seizure freedom in many patients. We will discuss the MRI protocol and the typical findings in the most...

• CT and MRI of the Eye

  This review is based on a presentation given by David Yousem and adapted for the Radiology Assistant by Robin Smithuis. David Yousem is currently the Director of Neuroradiology and Professor of Radiology at the Johns Hopkins Hospital. He is also the editor of the book 'Neuroradiology: the Requisites'. In this article a systematic approach to...

• Closed Loop in Small bowel obstruction

  This article is based on a presentation given by Jay Heiken in 2006 and adapted for the Radiology Assistant by Robin Smithuis. In 2012 an updated version was presented. Jay Heiken is professor of radiology at the Mallinckrodt Institute of Radiology of the Washington University School of Medicine in St. Louis. He has a special interest in...

• Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions

  In Esophagus II we will discuss:StricturesAcute esophageal syndromes.Benign and malignant neoplasms.Vascular impressions.

• Vascular territories of the Brain

  Knowledge of the vascular territories is important, because it enables you to recognize infarctions in arterial territories, in watershed regions and also venous infarctions. It also helps you to differentiate infarction from other pathology.

• Acute Aortic Syndrome

  The term Acute Aortic Syndrome (AAS) is used to describe three closely related emergency entities of the thoracic aorta: classic Aortic Dissection (AD), Intramural Hematoma (IMH) and Penetrating Atherosclerotic Ulcer (PAU). Clinically these conditions are indistinguishable. CT is the most accurate imaging modality for the initial diagnosis,...

• Ischemic and non-ischemic cardiomyopathy

  In this presentation we will discuss the MRI features of ischemic cardiomyopathy and non-ischemic cardiomyopathies and the role of late enhancement imaging in differentiating between the various types of cardiomyopathy. Images can be enlarged by clicking on them. If a video doesn't work, just click the stop button and then the play button once more. For...

• Bone tumor H-O

  In Bone Tumors - Differential diagnosis we discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. . Here we continue with the most common bone tumors and tumor-like lesions in alphabethic order.

• Bone tumor P-Z

  In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs, i.e. is it a sclerotic lesion or an osteolytic lesion with either...

• Nonvascular Mediastinal Masses

  This review is based on a presentation by Marilyn Siegel and was adapted for the Radiology Assistant by Valerie Niehe. Marilyn Siegel is specialized in pediatric and chest radiology. In this review we will discuss the most common non-vascular mediastinal masses in the chest. In Pediatric Chest CT part II we will discuss the most common vascular...

• Peritoneal Pathology

  This review is based on a presentation given by Angela Levy and adapted for the Radiology Assistant by Robin Smithuis. We will discuss the differential diagnosis of cystic and solid peritoneal and mesenteric masses. In Peritoneum and Mesentery - part I: Anatomy the normal anatomy and physiology of the peritoneum and peritoneal cavity...

• RECIST 1.1 - the basics

  RECIST 1.1 is a standard way to measure the response of a tumor to treatment.  In this article we will discuss the basics of RECIST.The criteria to determine whether a tumor disappears, shrinks, stays the same or gets bigger are complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD).More information is given...

• Incidentalomas in the liver

  This review is based on a presentation given by Maarten van Leeuwen for the Dutch Radiology Society and was adapted for the Radiology Assistant by Joost Nederend and Robin Smithuis. With the increasing use of multidetector CT small hepatic lesions are frequently depicted. In many cases the pathological nature of these incidentally found liver lesions or...

• Ultrasound in Acute Abdomen

  Multi-slice CT is increasingly replacing ultrasonography for the evaluation of patients with acute abdominal pain.Ultrasound however has specific advantages. This review will focus on:The advantages of US compared to CTUS techniqueThe use of US in patients with Acute abdomenPittfalls in the diagnosis of AppendicitisFor critical comments and additional...

• Acute Abdomen in Gynaecology - Ultrasound

  This is a pictorial essay of the various gynaecological conditions that may cause acute abdominal pain, as far as they are encountered in daily radiological practice.   Conditions which present during a known pregnancy like miscarriage, early ectopic pregnancy, uterine rupture and placental abruption, as well as puerperal endometritis, are not...

• Solid Abdominal Masses in Children

  Malignant abdominal tumors in children are rare and usually present as solid masses. Treatment is done in specialized centers, but the initial diagnosis is usually made in the hospital where the child first presents.In this article we will provide tools to make the initial imaging diagnosis of the most common malignant abdominal tumors as accurate as...

• COVID-19 Differential Diagnosis

  This pictorial essay presents the differential diagnosis, mimickers and overlapping CT features of COVID-19.Performance of imaging in accurate prediction of disease depends on the likelihood of disease before the test was done. If regional COVID-19 prevalence is high, the likelihood of SARS-CoV-2 infection is substantial in a patient with fever, dyspnea...

• Abdominal wall hernias

  Abdominal hernias are usually a clinical diagnosis and have been considered a simple problem to be repaired. However, long-term follow-up of patients has shown disappointing results, both in terms of complications and recurrence (1). Due to increased complex abdominal wall surgery, pre-operative CT planning with abdominal wall mapping has gained...

• RECIST 1.1 - examples

  In this article some examples of tumor response to therapy are given.The response categories are complete response, partial response (30% decrease in sum of length diameters -SLD from baseline), stable disease and progressive disease (20% increase in sum from baseline or Nadir).Nadir is the best result during therapy with the smallest SLD.

• Bone tumor A-G

  In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. In this article, which is the first in a series of three, we will discuss the most common bone tumors and tumor-like lesions in alphabethic order. Our goal is to show many cases in order to make you...

• Osteolytic - well defined bone tumors

  In the article Bone Tumors - Differential diagnosis we discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. In this article we will discuss the differential diagnosis of well-defined osteolytic bone tumors and tumor-like lesions. Abbreviations used:ABC = Aneurysmal bone cystCMF = Chondromyxoid...

• Coronary Artery Disease-Reporting and Data System 2.0

  CAD-RADS is the Coronary Artery Disease-Reporting and Data System.CAD-RADS is developed to standardize reporting of coronary CTA, to improve communication and to guide therapy. The original article was published in 2016 by the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for...

• RECIST 1.1 - and more

  RECIST is a standard way to measure the response of a tumor to treatment.  It provides objective criteria to determine whether a tumor disappears, shrinks, stays the same or gets bigger. This is called complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD).In this article we describe the five easy...

• Acute Abdomen in Neonates

  A neonate with an acute abdomen usually presents with vomiting, constipation and distention of the belly. When the symptoms are present immediately after birth, the most common cause is a gastrointestinal obstruction.In this article we will discuss the congenital gastrointestinal obstructions and also some acquired diseases that present as an acute...

• Swallowing disorders update

  Swallowing is a complex movement. It requires the coordination of nerves and muscles in the buccolabial area, the tongue, the palate, the pharynx, the larynx and finally the esophagus. Radiographic studies of patients with swallowing disorders can help to analyse the problem. In this article a systematic approach on how to analyse these videos is...

• Osteolytic - ill defined bone tumors

  In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. In this article we will discuss the differential diagnosis of ill-defined osteolytic bone tumors in alphabetic order. You can click on an item on the left.

• Systematic Approach to Brain Tumors

  This review is based on a presentation given by Walter Montanera and was adapted for the Radiology Assistant by Robin Smithuis. In this review a systematic approach for the analysis of a possible brain tumor is described.

• Chest X-Ray - Heart Failure

  In this article we will discuss the radiographic signs of congestive heart failure on the chest X-ray.

• TI-RADS - Thyroid Imaging Reporting and Data System

  Up to 67% of the population evaluated with US will have an incidental thyroid nodule.The high prevalence of thyroid nodules combined with the generally indolent growth of thyroid cancer present a challenge for optimal patient care.The Thyroid Imaging Reporting and Data System (TI-RADS) of the American College of Radiology (ACR) was designed in 2017 with...

• Gallbladder obstruction

  Most gallstones that we find with ultrasound are asymptomatic and should be left untreated.However when gallstones obstruct the gallbladder or the common bile duct they become symptomatic. In part 2 we will discuss stones that obstruct the biliary ducts.In part 1 we will discuss gallstones that obstruct the gallbladder.We will focus on:How to determine...

• Non-traumatic Intracranial Hemorrhage

  Any type of bleeding inside the skull or brain is a medical emergency.The most common causes of hemorrhage are trauma, haemorrhagic stroke and subarachnoid haemorrhage due to a ruptured aneurysm.Complications are increased intracerebral pressure as a result of the hemorrhage itself, surrounding edema or hydrocephalus due to obstruction of CSF.In this...

• Ultrasound of the Breast

  This article provides a basic understanding of breast-ultrasound.We will focus on how mobile ultrasound can be used by health workers in regions where other modalities like mammography or MRI are not readily available.However this article is also a nice introduction for those who do mammography and MRI of the breast.The videos in the introduction cover...

• Esophagus I: anatomy, rings, inflammation

  In Esophagus part I we will discuss:Basic anatomy and function.Rings, webs and diverticula.Hiatus hernia.Inflammation and infection.StricturesAcute esophageal syndromes.Benign and malignant neoplasms.Vascular impressions.

• US of the GI tract - Technique

  The GI tract is the most challenging part of the abdomen to examine by US. Although technically demanding, its results have great clinical implications in early triage of bowel diseases and in the acute abdomen. This is the first of a series on US of the GI tract. Press ctrl+ for larger images and text on a PC or ⌘+ on a Mac.This can...

• Solid Renal Masses

  Most renal masses are incidental findings. Many of these masses are renal cell carcinomas. The goal of imaging is to differentiate these renal cell carcinomas from benign disease, although in many cases it may not be possible.There are certain imaging findings, however, which are in favor of benign disease or low grade malignancy. These imaging findings...

• Pancreatic cystic Lesions

  Cystic pancreatic lesions are increasingly identified due to the widespread use of CT and MRI.Certain pancreatic cysts represent premalignant lesions and may transform into mucin-producing adenocarcinoma. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and...

• CT in Abdominal Trauma

  This review is based on a presentation given by Stephen Ledbetter and was adapted for the Radiology Assistant by Robin Smithuis. Stephen Ledbetter is director of the emergency radiology department of the Brigham and Women's Hospital in Boston, which is a teaching affiliate of the Harvard Medical School. This review will focus on the role of CT in...

• US of the GI tract - Normal Anatomy

  Press ctrl+ for larger images and text on a PC or ⌘+ on a Mac.Most images can be enlarged by clicking on them.For critical comments and additional remarks:  j.puylaert@gmail.com

• Sharp foreign bodies in GI tract

  This is an overview of the widely variable US and CT  presentation of sharp foreign bodies perforating the wall of stomach or bowel. This pictorial essay is based on a literature search and our personal experience with 49 cases and will enable you to make the correct diagnosis, to understand the natural course and also to help the clinician to choose...

• Characterization of Adrenal lesions

  Adrenal lesions are very common. Many of these lesions are incidentally discovered and called incidentalomas. An adrenal incidentaloma is defined as a mass > 1 cm that is detected on imaging exams not performed for suspected adrenal disease.Most of these incidentalomas are benign non-functioning adenomas even in patients with a known malignancy.In this...

• Esophagus I: anatomy, rings, inflammation

  In Esophagus part I we will discuss:Basic anatomy and function.Rings, webs and diverticula.Hiatus hernia.Inflammation and infection.StricturesAcute esophageal syndromes.Benign and malignant neoplasms.Vascular impressions.

• LI-RADS

  The Liver Imaging Reporting and Data System (LI-RADS) is a classification system for liver lesions which is used in patients with liver cirrhosis and chronic HBV without cirrhosis, because these patients have an increased risk of hepatocellular carcinoma (HCC).The LI-RADS category reflects the probability of HCC and...

• CT-pattern of Bowel wall thickening

  This article is based on a presentation given by Richad Gore and adapted for the Radiology Assistant by Robin Smithuis.Richard Gore is editor of the Textbook of Gastrointestinal Radiology, 3rd Edition and High Yield Imaging: Gastrointestinal.We will discuss a pattern approach to patients with bowel wall thickening with special attention to the...

• Crohn's disease - role of Ultrasound

  In this section we will discuss the sonographic features used to evaluate Crohn’s disease. After reading this section, you will be able to:Recognize normal bowel wall appearance and morphological changes of the bowel wall in Crohn’s disease, using ultrasound.Identify the classic US  features of Crohn’s disease. Sonographically...

• Common Liver Tumors

  This article is based on a presentation given by Richard Baron and adapted for the Radiology Assistant by Robin Smithuis. Richard Baron is Chair of Radiology at the University of Chicago and well known for his work on hepatobiliary diseases. He has been president of the Society of Computed Body Tomography and Magnetic Resonance. In Part...

• Bone tumors - Differential diagnosis

  In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. Abbreviations used:ABC = Aneurysmal bone cystCMF = Chondromyxoid fibromaEG = Eosinophilic GranulomaGCT = Giant cell...

• Lines and tubes in Neonates

  In this review we will discuss the normal and abnormal position of tubes and lines on a neonatal chest x-ray.

• Acute Pancreatitis

  The 2012 Revised Atlanta Classification of acute pancreatitis enables standardized reporting which is helpful for communication between clinicians and for research.A standardized template for reporting CT images is given to describe the local complications of acute pancreatitis.

• Pancreatic Cancer - CT staging 2.0

  This is the second version of the role of CT in staging pancreatic cancer.Pancreatic cancer is the fourth largest cause of cancer death in the United States and Europe with over 100,000 deaths per year in Europe alone.The overall 5-year survival ranges from 2–7 % and has hardly improved over the last two decades.Approximately 15 % of all patients have...

• HRCT - Common diagnoses

  In this review we present the key findings in the most common interstitial lung diseases. There are numerous interstitial lung diseases, but in clinical practice only about ten diseases account for approximately 90% of cases. Knowledge of both radiological and clinical appearances of these more common interstitial lung diseases is therefore important for...

• Differential of Breast Calcifications

  Ductal carcinoma-in-situ (DCIS) represents 25-30% of all reported breast cancers. Approximately 95% of all DCIS is diagnosed because of mammographically detected microcalcifications. In this review we will focus on:Description of breast calcifications Differential diagnosis BIRADS classification

• Staging and Treatment of Breast Cancer

  Imaging plays a major role in the detection and staging of breast cancer and monitoring treatment.In this era of rapidly changing management of breast cancer, it is important to be familiar with the staging classification and be aware of the available surgical, radiotherapeutic and oncological management options in order to provide relevant information...

• Neonatal Brain US

  Cranial sonography (US) is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.by Erik Beek and Floris Groenendaal

• Cervical injury

  This review is based on a presentation given by Adam Flanders and adapted for the Radiology Assistant by Robin Smithuis. Approximately 3 % of patients who present to the emergency department as the result of a motor vehicle accident or fall have a major injury to the cervical spine. 10-20% patients with head injury also have a cervical spine...

• How to make videos in Quicktime Player

  In this video we will show you how to make videos by using Quicktime Player on the Mac computer.

• HRCT - Basic Interpretation

  In this article a practical approach is given for the interpretation of HRCT examinations. We will discuss the following subjects:Anatomy of the secondary lobuleBasic HRCT patternsDistribution of abnormalitiesDifferential diagnosis of interstitial lung diseases

• Small Bowel Tumors

  Small bowel tumours are rare, accounting for 3-6% of gastrointestinal tumors. The clinical presentation is non-specific. Symptoms include anemia, gastro-intestinal bleeding, abdominal pain or small bowel obstruction.In this article we will focus on the four most common small bowel malignancies:AdenocarcinomaLymphomaCarcinoidGISTThe differential diagnosis...

• How to make illustrations in Keynote

  In this video we will show you how to make professional looking illustrations by using Keynote on the Mac computer.

• Anatomy of Peritoneum and Mesentery

  This review is based on a presentation given by Angela Levy and adapted for the Radiology Assistant by Robin Smithuis. We will discuss the normal anatomy and physiology of the peritoneum and peritoneal cavity. In part II we will discuss peritoneal tumors. The illustrations are by Heike Blum Images can be enlarged by clicking on them.by...

• Appendicitis - US findings

  In this article we will discuss the role of US in appendicitis and the additional role of CT scan. The variable US features in the different stages of appendicitis will be dealt with, as well as the problem of spontaneously resolving appendicitis and the appendiceal abscess. Pitfalls and differential diagnosis are discussed here. For...