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Seminars in Ultrasound, CT, and MR

John Michael Hazenfield, Mary F Gaskill-Shipley
Neoplasia of the spinal cord, including both primary and metastatic tumors, is relatively rare, representing 4%-10% of all central nervous system tumors, and can present a diagnostic challenge to the radiologist. More than 90% of primary spinal cord neoplasms are derived from the glial cell lineage, including the 2 most common tumors ependymoma and astrocytoma. However, less common spinal cord tumors, including metastatic disease, as well as nonneoplastic and paraneoplastic processes should be considered in the diagnosis of intramedullary spinal cord lesions...
October 2016: Seminars in Ultrasound, CT, and MR
Shawn M Vuong, William J Jeong, Humberto Morales, Todd A Abruzzo
Vascular pathologies of the spinal cord are rare and often overlooked. This article presents clinical and imaging approaches to the diagnosis and management of spinal vascular conditions most commonly encountered in clinical practice. Ischemia, infarction, hemorrhage, aneurysms, and vascular malformations of the spine and spinal cord are discussed. Pathophysiologic mechanisms, clinical classification schemes, clinical presentations, imaging findings, and treatment modalities are considered. Recent advances in genetic and syndromic vascular pathologies of the spinal cord are also discussed...
October 2016: Seminars in Ultrasound, CT, and MR
Joana Ramalho, Renato Hoffmann Nunes, Antonio José da Rocha, Mauricio Castillo
Myelopathy describes any neurologic deficit related to the spinal cord. It is most commonly caused by its compression by neoplasms, degenerative disc disease, trauma, or infection. Less common causes of myelopathy include spinal cord tumors, infection, inflammatory, neurodegenerative, vascular, toxic, and metabolic disorders. Conditions affecting the spinal cord must be recognized as early as possible to prevent progression that may lead to permanent disability. Biopsy is rarely performed, thus the diagnosis and management rely on patient׳s history, physical examination, laboratory results, and imaging findings...
October 2016: Seminars in Ultrasound, CT, and MR
Kiran Talekar, Michael Poplawski, Rahul Hegde, Mougnyan Cox, Adam Flanders
We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers...
October 2016: Seminars in Ultrasound, CT, and MR
Jason F Talbott, Jared Narvid, J Levi Chazen, Cynthia T Chin, Vinil Shah
Infections of the spinal cord, nerve roots, and surrounding meninges are uncommon, but highly significant given their potential for severe morbidity and even mortality. Prompt diagnosis can be lifesaving, as many spinal infections are treatable. Advances in imaging technology have now firmly established magnetic resonance imaging (MRI) as the gold standard for spinal cord imaging evaluation, enabling the depiction of infectious myelopathies with exquisite detail and contrast. In this article, we aim to provide an overview of MRI findings for spinal cord infections with special focus on imaging patterns of infection that are primarily confined to the spinal cord, spinal meninges, and spinal nerve roots...
October 2016: Seminars in Ultrasound, CT, and MR
Alex Rovira, Cristina Auger
Multiple sclerosis (MS) is an idiopathic inflammatory disorder of the central nervous system that affects not only the brain but also the spinal cord. In the diagnostic and monitoring process of MS, spinal cord magnetic resonance imaging (MRI) is not performed as commonly as brain MRI, mainly because of certain technical difficulties and the increase in total acquisition time. Nonetheless, spinal cord MRI findings are important to establish a prompt accurate diagnosis of MS, impart prognostic information, and provide valuable data for monitoring the disease course in certain cases...
October 2016: Seminars in Ultrasound, CT, and MR
Victoria Young, Gerardine Quaghebeur
Transverse myelitis is defined as inflammation of the spinal cord, named because of its typical clinical presentation with bandlike symptoms of altered sensation or pain in a horizontal fashion-at a specific dermatome level. Radiographic patterns might vary but the idiopathic form is more frequent to present as involvement of 3-4 vertebral segments and both sides of the cord. It is now recognized that there are numerous other causes as well as the idiopathic type, with often atypical features and geographic variation...
October 2016: Seminars in Ultrasound, CT, and MR
Humberto Morales, Aaron Betts
T2-hyperintense signal abnormalities within the spinal cord on magnetic resonance imaging can evoke a broad differential diagnosis and can present a diagnostic dilemma. Here, we review and provide a succinct and relevant differential diagnosis based on imaging patterns and anatomical or physiopathologic correlation. Clues and imaging pearls are provided focusing on inflammatory, infectious, demyelinating, vascular, and metabolic involvement of the spinal cord.
October 2016: Seminars in Ultrasound, CT, and MR
Eric Diaz, Humberto Morales
We review the anatomy of the spinal cord, providing correlation with key functional and clinically relevant neural pathways, as well as magnetic resonance imaging. Peripherally, the main descending (corticospinal tract) and ascending (gracilis or cuneatus fasciculi and spinothalamic tracts) pathways compose the white matter. Centrally, the gray matter can be divided into multiple laminae. Laminae 1-5 carry sensitive neuron information in the posterior horn, and lamina 9 carries most lower motor neuron information in the anterior horn...
October 2016: Seminars in Ultrasound, CT, and MR
Humberto Morales
No abstract text is available yet for this article.
October 2016: Seminars in Ultrasound, CT, and MR
Vicky Goh, Davide Prezzi, Andrew Mallia, Usman Bashir, J James Stirling, Joemon John, Geoff Charles-Edwards, Jane MacKewn, Gary Cook
As an integrated system, hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) is able to provide simultaneously complementary high-resolution anatomic, molecular, and functional information, allowing comprehensive cancer phenotyping in a single imaging examination. In addition to an improved patient experience by combining 2 separate imaging examinations and streamlining the patient pathway, the superior soft tissue contrast resolution of MRI and the ability to acquire multiparametric MRI data is advantageous over computed tomography...
August 2016: Seminars in Ultrasound, CT, and MR
Yvette Griffin
Advances in the early detection and treatment of esophageal cancer have meant improved survival rates for patients with esophageal cancer. Accurate pretreatment and post-neoadjuvant treatment staging of esophageal cancer is essential for assessing operability and determining the optimum treatment plan. This article reviews the multimodality imaging approach in the diagnosis, staging, and assessment of treatment response in esophageal cancer.
August 2016: Seminars in Ultrasound, CT, and MR
Lorna Woodbridge, Peter Wylie
Computed tomography colonography has evolved over the past 2 decades to become the primary alternative to optical colonoscopy for detection of colonic neoplasia. With good technique in performance and reporting, accuracy is comparable to optical colonoscopy for cancers and larger polyps. This article discusses the current components of a high-quality examination including contemporary methods of bowel preparation and distension. Also described is the main trial data that have validated the examination. Finally, the use of the technique for nonneoplastic colonic pathology is discussed, and future directions are described including magnetic resonance colonography and wireless capsule colonic imaging...
August 2016: Seminars in Ultrasound, CT, and MR
Sofia Gourtsoyianni, Nickolas Papanikolaou
New-generation magnetic resonance imaging (MRI) scanners with optimal phased-array body coils have contributed to obtainment of high-resolution T2-weighted turbo spin echo images in which visualization of anatomical details such as the mesorectal fascia and the bowel wall layers is feasible. Preoperative, locoregional staging of rectal cancer with MRI, considered standard of care nowadays, relies on these images for stratification of high-risk patients for local recurrence, patients most likely to benefit from neoadjuvant therapy, as well as patients who exhibit imaging features indicative of a high risk of metastatic disease...
August 2016: Seminars in Ultrasound, CT, and MR
Damian J M Tolan
Perianal fistulas and other inflammatory diseases of the anus and perianal soft tissues are a cause of substantial morbidity, and are a major part of the practice of any colorectal surgeon. Magnetic resonance imaging (MRI) has a key role in the assessment of patients for the extent of fistulizing Crohn disease, complications related to fistulas, and to assist in confirming the diagnosis or proposing an alternative. Technique is critical and in particular, the selection of sequences for diagnosis and characterization of abnormalities with the main choices being between standard anatomical sequences (T1 or T2), assessing for edema (FS T2 or STIR), assessing abnormal contrast enhancement (FS T1), and assessing for abnormal diffusion or a combination of these...
August 2016: Seminars in Ultrasound, CT, and MR
Anita Wale, James Pilcher
Bowel ultrasound is cheap, relatively quick, allows dynamic evaluation of the bowel, has no radiation burden, is well tolerated by patients, and allows repeat imaging. Bowel ultrasound requires a systematic assessment of the entire bowel using high-frequency probes. In addition, hydrosonography and contrast-enhanced ultrasound may be performed. We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohn's disease, celiac disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischemia, and malignant tumors...
August 2016: Seminars in Ultrasound, CT, and MR
Nyree Griffin, Olwen Westerland
In the young patient population, magnetic resonance enterography is fast becoming a preferred imaging tool for the investigation of patients with non-Crohn׳s small bowel and mesenteric pathologies. Its advantages include lack of ionizing radiation and high-contrast resolution. This review discusses the range of small bowel and mesenteric pathologies that can be easily demonstrated with this technique.
August 2016: Seminars in Ultrasound, CT, and MR
Olwen Westerland, Nyree Griffin
Over the past decade, magnetic resonance (MR) enterography has become established as the first-line imaging test for patients with Crohn׳s disease. This article reviews the role of MR enterography in assessing the extent and activity of Crohn׳s disease at baseline and on treatment follow-up. It discusses the role of diffusion-weighted imaging, and the recent introduction of MR scoring systems to facilitate noninvasive objective assessment of disease activity and cumulative bowel damage.
August 2016: Seminars in Ultrasound, CT, and MR
Nyree Griffin
No abstract text is available yet for this article.
August 2016: Seminars in Ultrasound, CT, and MR
Marcelo F Benveniste, Daniel Gomez, Brett W Carter, Sonia L Betancourt Cuellar, Patricia M De Groot, Edith M Marom
Radiotherapy is one of the cornerstones for treatment of patients with cancer. Although advances in radiotherapy technology have considerably improved radiation delivery, potential adverse effects are still common. Postradiation changes to the mediastinum can include different structures such as the heart, great vessels, and esophagus. The purpose of the article was to illustrate the expected variety of changes to the mediastinum and adjacent lung resulting from external beam radiotherapy and radiotherapy-induced complications to the mediastinum and to discuss different radiotherapy delivery techniques...
June 2016: Seminars in Ultrasound, CT, and MR
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