Radiology Key Points
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| 1. Radiology Principles and Indications | show 🗑
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| show | Plain radiography images: produced by x-rays and radiographic film. CT images: x-rays, detectors, and computers. MR images: magnetic fields, radio-frequency waves, and computers. Ultrasound images: high-frequency sound waves, transducers, and computers.
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| 1. Radiology Principles and Indications | show 🗑
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| 1. Radiology Principles and Indications | show 🗑
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| show | T1 MR images: excellent resolution -> best to obtain anatomic information. T2 MR images: better contrast than T1 images and cause water to light up -> best when looking for pathologies (they tend to contain a lot of water).
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| show | The high resolution of CT makes it effective for imaging anatomy. MRI has high soft tissue contrast that makes it especially useful for soft tissue imaging.
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| show | Type of contrast agents: barium sulfate, high and low osmolar iodinated compounds, ionic iodinated and nonionic (low osmolar) contrast media, air, gadolinium. Barium sulfate is better than water-soluble iodinated agents 2/2 less dense -> poorer contrast
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| show | PA and lateral views are the routine standard chest radiographs.
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| 2. Chest | show 🗑
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| show | If thoracic bone imaging is necessary, it is best to order the specific radiographs such as ribs, shoulders, or dorsal spine.
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| show | Position chest radiographs on the viewbox with the patient’s labeled right side opposite the viewer’s left hand, and this generally applies to almost all other images.
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| show | Develop a simple systematic approach for viewing chest radiographs to avoid errors of omission.
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| 2. Chest | show 🗑
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| 2. Chest | show 🗑
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| 2. Chest | show 🗑
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| show | The right atrium forms the convex right cardiac border, and the left ventricle forms the cardiac apex on AP or PA radiographs.
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| 2. Chest | show 🗑
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| 2. Chest | show 🗑
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| show | When two similar densities abut each other, it is virtually impossible to differentiate their borders on a radiograph. This is called the silhouette sign.
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| show | Imaging evaluation of the abdomen usually begins with an AP supine abdominal radiograph. This is particularly helpful in evaluating the gas pattern.
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| 3. Abdomen | show 🗑
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| 3. Abdomen | show 🗑
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| 3. Abdomen | show 🗑
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| show | Contrast studies of the gut remain a valuable method to detect intraluminal and mural diseases such as tumors, mucosal disease, and ulcerations. They are particularly useful in the small bowel, where endoscopy is technically difficult.
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| show | Ultrasound is the primary imaging modality for obstetrics and useful for detecting gallstones, renal and gynecologic disease, and abdominal aortic abnormalities.
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| show | Abdominal CT is the method of choice for detection, localization, and characterization of tumors.
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| 3. Abdomen | show 🗑
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| 3. Abdomen | show 🗑
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| show | CT is the study of choice in evaluating the trauma patient.
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| 3. Abdomen | show 🗑
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| show | In some babies, in utero lung fluid takes more than a few minutes to clear, resulting in transient tachypnea of the newborn. This appears on radiographs as pleural effusions and streaky densities. TTN should resolve within the first 24 hours after birth.
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| 4. Pediatric Imaging, Chest | show 🗑
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| show | Best clue to diagnosing congestive heart failure in babies is a radiograph displaying a streaky density pattern in the lungs and cardiomegaly. Heart protrudes significantly beyond the visible airway on a lateral radiograph = enlarged of the heart
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| 4. Pediatric Imaging, Chest | show 🗑
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| show | Generally, surgical conditions are unilateral amd will displace the mediastinum away from the more abnormal side.
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| show | Radiographic features of cystic fibrosis include hyperexpanded lungs, mucoid impactions, very prominent hili, and peribronchial cuffing.
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| show | In summary, the rules for evaluating an infant’s abdomen are different from those used for adults.
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| show | The younger the child, the more discrepant the rules.
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| show | Babies have a lot of air, and it is difficult to differentiate large from small bowel by plain film.
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| 4. Pediatric Imaging, Abdomen | show 🗑
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| 4. Pediatric Imaging, Abdomen | show 🗑
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| 4. Pediatric Imaging, Abdomen | show 🗑
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| 4. Pediatric Imaging, Abdomen | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| show | MRI is useful for injuries to the shoulder rotator cuff, knee ligaments and menisci, ankle ligaments, and Achilles tendon. CT is good for bone detail, fracture diagnosis, locating fracture fragments, and evaluating matrix formation in bone tumors.
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| 5. Musculoskeletal System | show 🗑
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| show | Metastatic cancer is the most common malignant bone tumor. The majority of metastatic lesions are osteolytic or radiolucent. Osteoblastic metastatic lesions most commonly are secondary to prostate and breast neoplasms.
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| show | Multiple myeloma is the most common primary malignant bone tumor, and it originates in the bone marrow.
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| show | Ewing’s sarcoma usually occurs in children and young adults. They may have a permeative type of lesion and an onion-skin-like periosteal reaction.
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| 5. Musculoskeletal System | show 🗑
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| 6. Spine and Pelvis | show 🗑
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| show | An absent pedicle is abnormal and should make you suspicious of a destructive process such as primary and secondary bone neoplasms.
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| 6. Spine and Pelvis | show 🗑
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| show | Spine MRI is good for imaging disease processes that involve the bone marrow fat such as tumor and infection. MRI is also valuable for diagnosis and staging of herniated intervertebral disc disease and evaluating the spinal cord.
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| 6. Spine and Pelvis | show 🗑
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| show | Hyperflexion injuries include teardrop fractures, posterior ligament injury, and facet locking. Locked facets commonly have associated spinal cord injury.
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| show | Odontoid process fractures are frequent in the elderly and result from both hyperflexion and hyperextension injuries.
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| 6. Spine and Pelvis | show 🗑
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| 6. Spine and Pelvis | show 🗑
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| 6. Spine and Pelvis | show 🗑
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| show | Following an acetabular fracture, subsequent studies should closely evaluate for the presence of avascular necrosis in the femoral head.
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| 7. Brain | show 🗑
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| show | When assessing a CT scan for potential trauma, begin by looking for blood in the head outside the vascular system. Blood appears on CT initially as a white blob.
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| 7. Brain | show 🗑
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| show | Obliteration of the distinction between gray and white matter in the brain represents profound edema. Edema profound -> “bad black brain” -> poor outcome and is almost always caused by a limitation of oxygen in the brain.
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| show | CT: acute strokes = dark edematous blotch obliterating the normal tissue density. MRI with inversion recovery or T2 weighting: damaged tissues = white (due to leakage of water from ischemic cells). Diffusion MRI = most sensitive imaging for acute stroke
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| 7. Brain | show 🗑
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| show | Complex anatomy in developmental brain anomalies is best shown with MRI.
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| 7. Brain | show 🗑
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| show | CT is the imaging modality of choice in the evaluation of sinusitis and facial bone fractures.
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| 8. Head and Neck | show 🗑
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| show | Tripod fractures involve the (a) lateral orbital wall, (b) maxillozygomatic suture and (c) zygomatic arch.
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| show | In Le Fort fractures, the facial bones are detached from the cranium by the fracture of the pterygoid plates.
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| show | In orbital blowout fractures, the inferior rectus muscle may be trapped by the fracture fragments of the orbital floor, requiring surgical release.
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| 8. Head and Neck | show 🗑
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| show | In adults, malignant mass lesions are common. In children, benign masses are more common.
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| 9. Nuclear Imaging | show 🗑
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| show | Ventilation-perfusion lung imaging plays an important role in the workup of patients with suspected PTE.
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| 9. Nuclear Imaging | show 🗑
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| 9. Nuclear Imaging | show 🗑
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| 9. Nuclear Imaging | show 🗑
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| show | Bone scintigraphy is a sensitive test for detecting skeletal metastases, osteomyelitis, and fractures.
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| show | Captopril renal imaging accurately detects hemodynamically significant renal artery stenosis in patients with renovascular hypertension.
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| show | Myocardial stress perfusion imaging is an accurate technique for detecting coronary artery disease.
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| show | PET imaging with FDG can detect many types of malignant tumors.
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| show | Approximately one in eight females in the United States will develop carcinoma of the breast at some time.
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| 10. Mammography | show 🗑
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| 10. Mammography | show 🗑
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| show | Screening mammography, monthly breast self-examination, and annual breast examinations by a physician can improve the survival rate of breast cancer.
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| show | Mammographic findings suspect for malignancy include an irregularly outlined mass, skin retraction or thickening, architectural distortion (asymmetric compared to opposite breast), and/or a hypoechoic mass on ultrasonography.
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| show | Calcifications that are suspicious for malignancy include new calcifications, irregular punctate calcifications, pleomorphic calcifications, and small branching calcifications.
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| show | Ultrasonography is often useful in differentiating solid from cystic breast masses.
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| show | Interventional radiology is a specialty of medicine that provides patients diagnostic and therapeutic minimally invasive procedures using imaging guidance.
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| show | Written informed consent is necessary for most angiographic and interventional procedures. The benefits, risks, and possible complications must be discussed with the patient.
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| 11. Interventional Radiology | show 🗑
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| 11. Interventional Radiology | show 🗑
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| 11. Interventional Radiology | show 🗑
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| 11. Interventional Radiology | show 🗑
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| 11. Interventional Radiology | show 🗑
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| 11. Interventional Radiology | show 🗑
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| show | Arterial embolization is an important therapy for traumatic vascular injury, gastrointestinal bleeding, uterine fibroids, and certain oncology tumors.
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