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TNM classification 8th edition

This is a summary of the 8th Edition of TNM in Lung Cancer, which is the standard of non-small cell lung cancer staging since January 1st, 2017.It is issued by the IASLC (International Association for the Study of Lung Cancer) and replaces the TNM 7th edition.

Coronary anatomy and anomalies

In this article we describe the anatomy of the coronary arteries of the heart and some of the anomalies with illustrations and CT-images. This article is an update of an article that appeared earlier in the Radiology Assistant.

MRI examination of the ankle

In this article a systematic approach is presented on how to describe a standard MRI of the ankle.The following subjects will be discussed:Anatomy of the ankleCommon pathologyVariants, accessory muscles and ossiclesMRI protocol

Renal Tumors in Children

Wilms tumor comprises the vast majority of renal neoplasms in young children and resection with neoadjuvant chemotherapy is the treatment of choice.Most other renal tumors cannot be reliably distinguished from Wilms tumor at imaging, but some features may suggest an alternative diagnosis, which in some cases can lead to the decision to adjust the...

Enhancement Patterns in CNS disease

Under normal conditions there will be no enhancement of the brain parenchyma in the central nervous system, because the brain is the only organ with a barrier for proteins, inflammatory cells and also for contrast medium.This barrier is called the Blood-Brain Barrier.The Blood-Brain Barrier can be damaged by various diseases like:Inflammation or infection...

Pulsatile and non-pulsatile tinnitus

This article is based on a review by Pegge et al. describing a systematic approach for the diagnostic work-up of tinnitus [1]. The differential diagnosis is related to findings on different imaging modalities. A flowchart for choosing the appropriate imaging modality in pulsatile tinnitus is provided.

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.

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.

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...

Fractures

Fractures of the distal radius account for one-sixth of all fractures seen in the emergency department. The radiologist must possess an understanding of the factors that alter clinical decision making and patient treatment. In this review we will discuss:Importance of standard radiography of the wristProper description of fractures with knowledge of...

Shoulder - Rotator cuff injury

The rotator cuff plays an important role in the stabilization of the glenohumeral joint during movements of the arm.Rotator cuff tears are the most common cause of shoulder pain and result in loss of strength and loss of stability of the shoulder.In this article we will discuss:The role of MRI in detection of full thickness tears. MR arthrography for...

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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...

Imaging in Acute Stroke

This review is based on a presentation given by Majda Thurnher and was adapted for the Radiology Assistant by Robin Smithuis. We will discuss the following subjects:Role of CT and MR in patients with strokeEarly CT and MR signs of infarctionHow to identify patients with tissue at risk for guidance in selecting the appropriate therapy

Meniscus special cases

In this article we will show some examples of special meniscal pathology in more detail. For the basics of meniscal pathology we advise you first to read the article 'Knee Meniscus - Part 1'. On most images you can click to get an enlarged view, but this does not work on the iPhone application.

Dementia - Role of MRI

This presentation will focus on the role of MRI in the diagnosis of dementia and related diseases. We will discuss the following subjects:Systematic assessment of MR in dementiaMR protocol for dementiaTypical findings in the most common dementia syndromes Alzheimer's disease (AD)Vascular Dementia (VaD)Frontotemporal lobe dementia (FTLD)Short overview of...

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.

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.

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...

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...

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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.

Hamstring injury

The diagnosis of a hamstring injury is a clinical one and fairly straightforward. The role of MRI is not to determine the presence or absence of injury, but to determine whether there is a partial or full thickness tear.Full thickness tears are typically injuries to the free tendons or the insertion of the tendons on the ischial tuberosity. In these...

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...

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 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...

Prostate Anatomy

MRI of the prostate has become increasingly popular with the use of multiparametric MRI and the PI-RADS classification.In this article we describe the MR anatomy of the prostate and regional lymph nodes.

Biliary duct pathology

This review is based on a presentation given by Angela Levy and adapted for the Radiology Assistant by Robin Smithuis. We will discuss: Nonobstructive biliary disorders Obstructive biliary neoplasmsby Angela D. Levy

Thoracolumbar injury

This review is based on a presentation given by Adam Flanders and adapted for the Radiology Assistant by Robin Smithuis. In this overview we will discuss the most common injuries of the thoracolumbar spine. You can click on some of the images to get an enlarged view.

Meniscal pathology

This article is based on a presentation by David Rubin and adapted for the Radiology Assistant by Robin Smithuis. Interactive cases are presented in the menu bar to test your knowledge.by David Rubin and Robin Smithuis

Ultrasound of the Neonatal spine

Ultrasound is the preferred modality in neonates with suspected occult spinal dysraphism (OSD).OSD implies the presence of one or more spinal cord anomalies, which can cause tethering of the spinal cord and possible neurological and bladder or bowel function deficits. Ultrasound is easy to perform, since the posterior arch of the vertebra is not yet...

Ankle fractures - Weber and Lauge-Hansen Classification

Classification of ankle fractures is important in order to estimate the extent of the injury and the stability of the joint. The Weber classification focuses on the integrity of the fibula and the syndesmosis, which holds the ankle mortise together. The Lauge-Hansen system focuses on the trauma mechanism. Adding the stages of Lauge-Hansen to the Weber...

CT contrast injection and protocols

Optimal contrast enhancement is important for a succesful diagnostic CT-scan.In this article we will discuss:Basics of contrast enhancementAmount of contrast and injection rateTiming of CT-seriesDiscuss a few protocols

Cervical Lymph Node Map

This article is based on the nomenclature proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery.10 node groups are defined with a concise description of their main anatomic boundaries, the normal structures juxtaposed to these nodes, and the main tumor sites at risk for harboring metastases in...

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,...

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.

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...

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Mediastinal Lymph Node Map

This is an update of the 2007 article, which used the Mountain-Dresler regional lymph node classification for lung cancer staging (MD-ATS maps)(1). In 2009 a new Lung cancer lymph node map was proposed by the International Association for the Study of Lung Cancer (IASLC) in order to reconcile the differences between the Naruke and the MD-ATS maps and...

Craniosynostosis

In this review we will discuss imaging in craniosynostosis. Craniosynostosis refers to the premature closure of sutures of the skull and results in an abnormal head shape. It is a rare disorder with a prevalence of around 1 in 1500. Most cases occur already prenatally and will be diagnosed in the first few months of life.It may also be diagnosed...

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...

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.

Algoritm for Ankle Fractures 2.0

In this lecture we present a simple algoritm that helps you to find:All ankle fractures, even the ones that are not visible on the X-raysPredict rupture of ligaments even if you can’t see them on the imagesDetermine whether the ankle is stable or unstable, just by looking at the radiographs The algoritm is based on the Weber-classification, because...

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

MRI traumatic changes

This article is based on a presentation given by Mini Pathria and was adapted for the Radiology Assistant by Jennifer Bradshaw. In part I we will discuss MR features of various muscle injuries. In part II we will discuss non-traumatic muscle changes.

Shoulder Anatomy and Variants on MRI

The glenohumeral joint has a greater range of motion than any other joint in the body. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. MR is the best imaging modality to examen patients with shoulder pain and instability. In Shoulder MR-Part I...

Ankle Fracture Mechanism and Radiography

The ankle is the most frequently injured joint. Management decisions are based on the interpretation of the AP and lateral X-rays. In this article we will focus on: Trauma mechanism of ankle injuries Ottawa ankle rules Proper positioning of the ankle for radiography

Liver - Segmental Anatomy

The anatomy of the liver can be described using two different aspects: morphological anatomy and functional anatomy. The traditional morphological anatomy is based on the external appearance of the liver and does not show the internal features of vessels and biliary ducts branching, which are of obvious importance in hepatic surgery. The French surgeon...

Perianal Fistulas

Perianal fistula is a common disorder that often recurs because of infection that was missed at surgery. Preoperative MR can help to prevent recurrence. In this review we will address the anatomy, pathogenesis, classification and scanning protocol of perianal fistulas.by Susanne Tonino and Robin Smithuis

Chest X-Ray - Heart Failure

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

Multiple Sclerosis 2.0

This article is an updated version of the 2013 article and focusses on the role of MRI in the diagnosis of Multiple Sclerosis. We will discuss the following subjects:Typical findings in MSRole of MR in the McDonald criteria of MSHow to differentiate MS lesions from other white matter diseasesThe importance of the a priori chance for the...

Head Neck tumors - When to think of malignancy

Benign head neck tumors are common, while malignant tumors are rare. The question is, when do we need to think of a malignant tumor, since many radiologists will not frequently be confronted with a malignant tumor. In this article we provide you with some red flags, that may help you to recognize the occasional malignant lesion in daily practice.

Pulmonary nodule - Benign versus Malignant

A solitary pulmonary nodule is defined as a discrete, well-marginated, rounded opacity less than or equal to 3 cm in diameter that is completely surrounded by lung parenchyma, does not touch the hilum or mediastinum, and is not associated with adenopathy, atelectasis, or pleural effusion. Lesions larger than 3 cm are considered masses and are treated as...

Vascular Anomalies of Aorta, Pulmonary and Systemic vessels

This review is based on a presentation by Marilyn Siegel and was adapted and illustrated for the Radiology Assistant by Robin Smithuis. Marilyn Siegel is specialized in pediatric and chest radiology. The second edition of her book entitled Pediatric Body CT will be out next week. In this review we will discuss the most common vascular anomalies...

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...

MRI of the Breast

This review is based on a presentation given by Leonard Glassman and adapted for the Radiology Assistant by Marieke Hazewinkel. MRI is a powerful tool: it is able to detect cancer not visible on conventional imaging, it can be used as a problem-solving instrument, and it can be applied to screen high-risk patients. Breast MRI is also better at...

Stress fractures

One of the most common injuries in sports is the stress fracture. In this review we will discuss:Clinical and imaging features of stress fracturesCommon locations of stress fractures.

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.

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...

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...

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...

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...

Appendicitis - Pitfalls in US and CT diagnosis

In this chapter we will deal with the optimal diagnostic strategy in patients with suspected appendicitis, and the pitfalls leading to a false-positive or false-negative diagnosis. Special attention will be given to: Abnormal location of the appendixDifferential diagnosis of appendicitisComplications. For critical comments and additional...

Neck Masses in Children

A mass in the neck is a common finding in children.In this article we present a pictorial essay of neck masses in children and provide a diagnostic approach based on the location of the lesion and whether it is cystic or solid.Ultrasound is the imaging method of choice and in many cases a definite diagnosis is possible, especially if the lesion is...

Anatomy and Pathology of the Infrahyoid Neck

In this article we will focus on:a 3-step approach on how to analyze pathology of the infrahyoid neck on cross-sectional imaging..the 5 anatomical spaces of the infrahyoid neck.

Bi-RADS for Mammography and Ultrasound 2013

This article is a summary of the BI-RADS Atlas 2013 for mammography and ultrasound. It is an updated version of the 2005 article.Since 2000 BI-RADS is required in the Netherlands, as described in the updated Guideline breast cancer 2012 (6). The application of BI-RADS is part of the national quality assessment program.We encourage anyone who is involved...

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...

Sclerotic 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. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. In this article we will discuss the differential diagnosis of sclerotic bone tumors...

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...

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...

Acute Scrotum in Children

This article is based on a presentation given by Gael Lonergan at the 'Teaching in Holland' course and adapted for the Radiology Assistant by Robin Smithuis. In this overview we will discuss the following subjects: Torsion of testis and appendage Infection: epididymitis, epididymoorchitis, orchitisTraumaHerniaIdiopathic scrotal edemaby Gael J....

Neck Masses in Children.

A mass in the neck is a common finding in children.In this article we present a pictorial essay of neck masses in children and provide a diagnostic approach based on the location of the lesion and whether it is cystic or solid.Ultrasound is the imaging method of choice and in many cases a definite diagnosis is possible, especially if the lesion is...

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...

Prostate Cancer - PI-RADS v2.1

The introduction of the PI-RADS classification for prostate MRI in 2012 lead to a more standardized acquisition, interpretation and reporting of prostate MRI.The PI-RADS Steering Committee has recommended several modifications to the PI-RADS version 2.0. Because the overall framework of the system is maintained, the updated version is termed PI-RADS...

Arthritis

In this article we provide an overview of the different imaging findings of common joint diseases as a useful tool in daily musculoskeletal radiology.Arthritis is a challenging topic. A long list of diagnoses has to be considered when looking at X rays of the hand and feet, each with its own extensive set of findings. Sometimes the abnormalities are...

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...

Ovarian cystic lesions.

In this review the imaging features of normal ovaries and the most common ovarian cystic masses are presented. In Ovarian Cystic Masses Part I a roadmap for the diagnostic workup and management of ovarian cystic masses is presented based on the findings of ultrasound and MRI. Images can be enlarged by clicking on them. On the iPhone application...

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...

Ovarian cystic lesions

In this review the imaging features of normal ovaries and the most common ovarian cystic masses are presented. In Ovarian Cystic Masses Part I a roadmap for the diagnostic workup and management of ovarian cystic masses is presented based on the findings of ultrasound and MRI. Images can be enlarged by clicking on them. On the iPhone application...

Chest X-Ray - Lung disease

On a chest x-ray lung abnormalities will either present as areas of increased density or as areas of decreased density.Lung abnormalities with an increased density - also called opacities - are the most common. A practical approach is to divide these into four patterns:
ConsolidationInterstitialNodules or massesAtelectasis
In this article we will...

Cardiac Anatomy

This review is based on a presentation given by Tineke Willems and was adapted for the Radiology Assistant by Marieke Hazewinkel. We will discuss:The different cardiac axesThe cardiac anatomy in the order of normal blood flow: from the right to the left.

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...

Cardiovascular devices

The number of implanted cardiovascular devices has dramatically increased in recent years. With the advent of implantable cardioverterdefibrillators and cardiac resynchronization therapy, devices have become more complex. There is also an increase of minimally invasive procedures to replace heart valves.An overview is presented of common cardiovascular...

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...

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...

Practical approach to Acute Abdomen

The 'acute abdomen' is a clinical condition characterized by severe abdominal pain, requiring the clinician to make an urgent therapeutic decision. This may be challenging, because the differential diagnosis of an acute abdomen includes a wide spectrum of disorders, ranging from life-threatening diseases to benign self-limiting conditions (Table...

Appendicitis and Mimics

Introduction In this overview we focus on nonsurgical appendicitis-mimicking diseases. A correct imaging diagnosis prevents an unnecessary operation or costful in-hospital observation.For critical comments and additional remarks: j.puylaert@gmail.com

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.

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...

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...

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

Radiology Assistant 2.0 app

by Wouter Veldhuis

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...

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...

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...

Rectal Cancer MR staging 3.0

This is the third version describing the role of MRI for the staging and restaging of rectal cancer.The two major advancements in the treatment of rectal cancer are total mesorectal excision (TME) and neoadjuvant radiotherapy with or without chemotherapy.Both have dramatically changed the local recurrence and survival rates.MRI is the most accurate tool...

Chest X-Ray - Basic Interpretation

The chest x-ray is the most frequently requested radiologic examination. In fact every radiologst should be an expert in chest film reading. The interpretation of a chest film requires the understanding of basic principles.In this article we will focus on:Normal anatomy and variants.Systematic approach to the chest film using an inside-out...

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

Elbow fractures in Children.

Elbow fractures are the most common fractures in children. The assessment of the elbow can be difficult because of the changing anatomy of the growing skeleton and the subtility of some of these fractures. In this review important signs of fractures and dislocations of the elbow will be discussed. Before reading this article you can try one of the cases...

Elbow fractures in Children

Elbow fractures are the most common fractures in children. The assessment of the elbow can be difficult because of the changing anatomy of the growing skeleton and the subtility of some of these fractures. In this review important signs of fractures and dislocations of the elbow will be discussed. Before reading this article you can try one of the cases...

BTS guideline of pulmonary nodules

This article presents the 2015 guidelines of the British Thoracic Society (BTS) for the management of pulmonary nodules [1].Important issues in these guidelines are:Higher nodule size threshold for follow up ⩾ 5mm or ⩾ 80mm3Reduction of the follow-up period to one year for solid nodules.Use of two malignancy risk prediction models to better characterize...

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...

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...

Carpal instability

This article is based on a presentation given by Louis Gilula and adapted for the Radiology Assistant by Ileana Chesaru. First a systematic analysis of the wrist is presented to look for carpal instability and fracture dislocation. Secondly cases are presented as examples in the chapter systematic review and diagnosis.

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...

MRI of the Paranasal Sinuses

This article is based on a presentation given by Laurie Loevner and adapted for the Radiology Assistant by Jennifer Bradshaw. This review focusses on the complimentary roles that CT and MR play in the assessment of:Complicated sino-nasal infectionsSino-nasal and skull base lesionsFibro-osseous lesions

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...

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...

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...

Dynamic Rectal examination

Dynamic rectal examination (DRE) is also known as defecography or proctography. DRE provides a dynamic assessment of the act of defecation by recording the rectal expulsion of a barium paste that approximates the consistency of feces. DRE provides qualitative and quantitative information on the function of anorectal and pelvic floor function, and the...

Gallbladder wall thickening

Thickening of the gallbladder wall is a relatively frequent finding at diagnostic imaging studies. Historically, a thick-walled gallbladder has been regarded as proof of primary gallbladder disease, and it is a well-known hallmark feature of acute cholecystitis. The finding itself, however, is non-specific and can be found in a wide range of gallbladder...

Müllerian duct anomalies

Variant anatomy and true anomalies of the female internal genitalia are very common. Diagnosis is important, not only to understand future risk of complications, but also because some anomalies may benefit from treatment. Attempting to master this topic by simply memorizing different variants is a suboptimal approach: Müllerian duct anomalies (MDAs)...

Shoulder instability - MRI

A Bankart lesion is an injury of the anterior glenoid labrum due to anterior shoulder dislocation. These labral tears make the shoulder unstable and susceptible to repeated dislocations. In this article we will focus on:Shouder dislocationsBankart tears and variants

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.

Temporal Bone Pathology

The aim of this presentation is to demonstrate imaging findings of common diseases of the temporal bone. CT is the imaging modality of choice for most of the pathologic conditions of the temporal bone, especially for those of the middle ear. MRI is more useful for diseases of the inner ear. Disease processes in the pontine angle and in the internal...

Large airway disease

Pathology of the trachea and central bronchi is infrequently encountered, and therefore most radiologists find it challenging. Although there is a relatively limited differential diagnosis, pathology nevertheless varies between congenital, benign, primary malignant and metastatic disease. This article summarizes the typical imaging...

Pathology of the Male Breast

This review is based on a presentation given by Leonard Glassman and adapted for the Radiology Assistant by Robin Smithuis. We will discuss: Normal male mammogram Classic features of gynecomastia Lesions that require a biopsyby Leonard M. Glassman

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...

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...

Myelopathy

In this article we will focus on spinal cord diseases that are characterised by high signal within the cord on T2WI. The most common causes are inflammatory and demyelinating disorders like Multiple Sclerosis, Neuromyelitis Optica, Acute Disseminating Encephalomyelitis and Transverse myelitis. We will discuss the differential diagnosis including tumors,...

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...

Non-Meniscal pathology

This article is based on a presentation given by David Rubin and adapted for the Radiology Assistant by Robin Smithuis. This review focusses on all the non-meniscal pathology of the knee. See the article entitled Knee MRI - meniscal pathology for the pathology of the meniscus. Interactive cases are presented in the menubar. by David Rubin...

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...

How to Differentiate Carotid Obstructions

In patients with an acute stroke and an intracranial large vessel occlusion, we need to know if there is carotid pathology and if so what kind of pathology we are dealing with. This is important for procedural planning and the technical execution of endovascular treatment. Furthermore, carotid artery pathology determines secondary profylaxis with either...

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

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.

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...

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...

Bosniak Classification 2019

In this article we describe the 2019 Bosniak classification of renal cystic lesions.The goals of the new 2019 Bosniak classification are to reduce interobserver variability, improve the precision rate of malignancy within each category and to increase specificity and thereby reducing the rate of unnecessary treatment of benign lesions.

US-guided injection of joints

This article describes the application of Ultrasound guidance for diagnostic and therapeutic joint injections.Ultrasound is a valuable alternative to procedures performed either blind or under fluoroscopic or CT guidance.

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...

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...

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

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

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...

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...

Non-traumatic changes

This article is based on a presentation given by Mini Pathria and was adapted for the Radiology Assistant by Jennifer Bradshaw. In part I we discussed the MR features of various muscle injuries. In part II we will discuss non-traumatic muscle changes.

MRI examination of the Elbow

This review is dased on a presentation given by Mark Anderson and adapted for the Radiology Assistant by Robin Smithuis.We will discuss:Basic MR techniques and MR arthrography.Appearance of normal anatomic structures.Common types of pathology.

Normal Values in Pediatric Ultrasound

This is an overview of normal values of ultrasound examinations in neonates and children.Click on one of the items on the left.

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...

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...

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...

Hip pathology in Children

In this review we will discuss the most common imaging findings in children with hip pain.

Crohn's disease - role of MRI

In this article we will discuss the MRI-features used to evaluate Crohn's disease of the small bowel and the colon.A systematic approach is presented to grade disease activity resulting in a simple classification of mild, moderate and severe disease. This is sufficient for most therapeutic decisions.

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.