Grainger & Allison's Diagnostic Radiology Essentials. Part 1

237 Pages·2016·115.13 MB·English

by  Grant L.

&
Grainger Allison's
DDiiaaggnnoossttiicc
RRaaddiioollooggyy
Essentials
Lee Alexander Grant BA (Oxon) FRCR
Consultant Radiologist
The Royal Free NHS Foundation Trust
London, UK
Nyree Griffin MD FRCR
Consultant Radiologist
Guy’s and St Thomas’ NHS Foundation Trust
London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013
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Foreword
I am delighted to be able to write the foreword to this which are needed for day-to-day radiological practice.
book prepared by two outstanding young radiologists Thus,inonesimpletextbook,mostoftheessentialinfor-
who worked with me here in Cambridge. While they mation required for practising radiology becomes
wereatmysidereporting,theypolitelypointedoutthat available.
a list-like textbook was what candidates for examina- Justtotakeoneexample,thesectiononlobarcollapse
tions required, even if there is still a need for the defini- is extremely well presented. For old-stagers like me it is
tive‘authorizedbible’.Thustheysetaboutreviewingthe excellent to see the plain CXR findings so well matched
fifth edition of Grainger & Allison’s Diagnostic Radiology, with their CT equivalents. But more importantly the
one of the largest multi-author textbooks of radiology commonest causes are listed, rather like a bookmaker’s
in the world, with a view to presenting the data in a list: but not with the odds attached! Then come the all
more examination-orientated format. To this end they important teaching pearls. Even in the legends to the
have used much of the text and several of the illustra- images there are additional teaching points, such as is
tionswithinthebook butembellishingthecrucial teach- seen in a patient with left upper lobe collapse: ‘the jux-
ing points with the minimum amount of text. Thus the taphrenic peak sign: A small triangular density (arrow)
organization of this new shortened version still adopts is seen; the sign is due to reorientation of an inferior
the same form of organization as the main textbook but accessory fissure.’
with a more graphic and more modern feel. They Theeditorsofthemaintextbookverymuchhopethat
acknowledge the help that Michael Houston and all this new single textbook will be seen as an essential
those from Elsevier have given them and they acknowl- add-on to its big brother. As Doctors Griffin and Grant
edge the work that the four editors of the fifth edition suggest,itisverymuchanticipatedthatthesmallertext-
(Professors Ronald G. Grainger, David J. Allison, Andy book will be a bench book which becomes dog-eared
Adam and myself) have put into this book. Of course close to the reporting station, whilst the definitive bible
we, in turn, all owe an enormous debt to Professors is in a more sacrosanct place within the department or
Grainger and Allison for having had the vision of start- on the bookshelf of the radiologist’s office. They should
ing the whole process all those years ago. be congratulated on their enormous energy to harness
In any event, the presentation of this single-volume such a huge amount of data on top of their very busy
textbook is much more suitably aimed at the young lives while they metamorphosed from Senior Registrar
radiologist/examination candidate. It has an attractive to Consultant status. I wish both them and this remark-
layout, easy referencing, excellent images and the mini- able book every success.
mum of text. It also includes appendices with the latest
TNM staging, new RECIST criteria for following Adrian K Dixon
response to chemotherapy and other ‘pearls’, all of Cambridge, 2013
xi
Preface
We are extremely grateful to Michael Houston for the However, our greater vision was for it to become an
opportunity to write our ‘dream’ book and the support invaluable tool for practising consultants as well. With
given to us by all four editors of the Grainger & Allison’s this in mind, we have added a new Appendices section
Diagnostic Radiology series (Profsessors Andy Adam, incorporatingthelatestTNMstaging,RECIST1.1criteria
AdrianK.Dixon,RonaldG.GraingerandDavidJ.Allison). and other important pearls in anatomy and imaging,
We would also like to single out Joannah Duncan for that we felt would be of immense value in day-to-day
special praise, as without her hard work and tireless radiological practice. These will hopefully provide
dedication this book would never have been completed. essential aide memoirs for those things that somehow
Theoverridingvisionwastosatisfyaneedthatisnot always seem impossible to commit to memory!
currentlyaddressedbyanyradiologytextbookpresently Inevitably due to the limitations of space, not every
onthemarket.Wewantedtocreateasinglevolumetext- detailorasmanyfigurescouldbeincludedaswewould
book based on the 5th edition of Grainger & Allison that have liked. However, we hope that we have achieved,
has all its information presented in a standardized within the space limitations, what we set out to do. At
way. We wished to avoid long descriptive sentence con- present there is no single volume, comprehensive gen-
structions that would make information retrieval ineffi- eral radiology textbook that has attempted to do this.
cient. Furthermore, images within this book have been Wehopethatthisbookiswellthumbedbyatrainee-
directlylinkedtotherelevanttextandplacedonthefac- to be then promoted to the workstation as a consultant
ing page. The use of colour was essential in making this radiologist - rather than gathering dust on a bookshelf
book more accessible to the reader and to facilitate at home!
quicker referencing.
As relatively recent trainees that have sat the FRCR Lee Grant BA FRCR
examinations, we wanted this book to provide as close Nyree Griffin MD FRCR
as is possible a ‘one-stop reference guide’ for trainees. 2013
xiii
Dedication
To Malcolm and Hilary, from both of us.
You know why.
Acknowledgements
Listed below are the sources for borrowed and adapted #32 Eisenhauer EA, Therasse P, Bogaerts J, et al. New
material. Due to space limitations within the book sym- response evaluation criteria in solid tumours: revised
bols have been used instead of full citations after figure RECIST guideline (version 1.1). European Journal of
and table legends. Below is a list of the symbols and Cancer 2009;45(2);228–247
their corresponding citations. #33 Royal College of Radiologists; Standards for intra-
#1 Edey AJ, Hansell DM. Incidentally detected small vascular contrast agent administration to adult patients,
pulmonary nodules on CT. Clinical Radiology 2009;64: 2nd edn. The Royal College of Radiologists, April 2010
872–884 #34 El-Khoury GY, Bennett DL, Stanley MD. Essentials
#2 Hansell DM, Lynch D, McAdams HP, Bankier AA. of MSK imaging, 1st edn. Churchill Livingstone, 2002
Imaging of diseases of the chest. Mosby, 2009 #35 Pope T, Morrison WB, Bloem HL, et al. Imaging of
#10 O’Connor JH, Cohen J. Dating fractures. In: the musculoskeletal system. Saunders, 2008
Kleinman PK (ed). Diagnostic imaging of child abuse. *AdamA,DixonAK,GraingerRG,AllisonDJ.Grainger
Williams & Wilkins, 1987, p.112 & Allison’s diagnostic radiology, 5th edn. Churchill
#11 Kleinman PK (ed). Diagnostic imaging of child Livingstone, 2007
abuse. Williams & Wilkins, 1998, p.179 † Sutton D. Textbook of radiology and imaging, 7th edn.
#12ChapmanS,NakielnyR.Aidstoradiologicaldiffer- Churchill Livingstone, 1998
ential diagnosis, 4th edn. Saunders, 2003 ‡ McLoud T. Thoracic radiology: The requisites. Mosby,
#13 Abrams HL, Sprio R, Goldstein N. Metstases in 1998
carcinoma. Analysis of 1000 autopsied cases. Cancer ¶
Middleton WD, Kurtz AB, Hertzberg BS. Ultrasound:
1950;3:74–85
The requisites. Mosby, 2004
#20 Gore RM, Levine MS. Textbook of gastrointestinal ¶¶ Kaufman J, Lee M. Vascular and interventional radi-
radiology. Saunders/Elsevier, 2007 ology: The requisites. Mosby, 2003
#21 Lim JS, Yun MJ, Kim MJ, et al. CT and PET in §
BlickmanJ,ParkerB,BarnesP.Pediatricradiology:The
stomach cancer: preoperative staging and monitoring
requisites. Mosby, 2009
of response therapy. RadioGraphics 2006;26(1): §§
Ziessman HA, O’Malley JP, Thrall JH. Nuclear medi-
143–156
cine: The requisites. Mosby, 2006
#24 Slovis TL. Caffey’s pediatric diagnostic imaging, (cid:1)
Zagoria R. Genitourinary radiology: The requisites.
11th edn. Elsevier, 2008
Mosby, 2004
#27 De Bruyn R. Paediatric ultrasound: how, why (cid:1)(cid:1)
Weissleder R, Wittenberg J, Harisinghani M, Chen J.
andwhen,2ndedn.Elsevier/ChurchillLivingstone,2010
Primer of diagnostic imaging, 4th edn. Mosby, 2007
#28 Bates J. Abdominal ultrasound: how, why and
(cid:129) Miller S. Cardiac imaging: The requisites. Mosby, 2004
when. Churchill Livingstone, 2011
(cid:129)(cid:129) Halpert R. Gastrointestinal imaging: The requisites,
#30TurgutAT,AltinL,TopcuS,etal.Unusualimaging
3rd edn. Mosby, 2006
characteristicsofcomplicatedhydatiddisease.European
1
Journal of Radiology 2007;63(1):84–93 Grossman R, Yousem D. Neuroradiology: The requi-
sites. Mosby, 2003
#31 Parizel PM, Makkat S, Van Miert E, et al. Intracra-
11
SotoJ,LuceyB.Emergencyradiology:Therequisites.
nial hemorrhage: principles of CT and MRI interpreta-
Mosby, 2009
tion. European Radiology 2001;11:1770–1783 xv
Dedication
To Malcolm and Hilary, from both of us.
You know why.
Acknowledgements
Listed below are the sources for borrowed and adapted #32 Eisenhauer EA, Therasse P, Bogaerts J, et al. New
material. Due to space limitations within the book sym- response evaluation criteria in solid tumours: revised
bols have been used instead of full citations after figure RECIST guideline (version 1.1). European Journal of
and table legends. Below is a list of the symbols and Cancer 2009;45(2);228–247
their corresponding citations. #33 Royal College of Radiologists; Standards for intra-
#1 Edey AJ, Hansell DM. Incidentally detected small vascular contrast agent administration to adult patients,
pulmonary nodules on CT. Clinical Radiology 2009;64: 2nd edn. The Royal College of Radiologists, April 2010
872–884 #34 El-Khoury GY, Bennett DL, Stanley MD. Essentials
#2 Hansell DM, Lynch D, McAdams HP, Bankier AA. of MSK imaging, 1st edn. Churchill Livingstone, 2002
Imaging of diseases of the chest. Mosby, 2009 #35 Pope T, Morrison WB, Bloem HL, et al. Imaging of
#10 O’Connor JH, Cohen J. Dating fractures. In: the musculoskeletal system. Saunders, 2008
Kleinman PK (ed). Diagnostic imaging of child abuse. *AdamA,DixonAK,GraingerRG,AllisonDJ.Grainger
Williams & Wilkins, 1987, p.112 & Allison’s diagnostic radiology, 5th edn. Churchill
#11 Kleinman PK (ed). Diagnostic imaging of child Livingstone, 2007
abuse. Williams & Wilkins, 1998, p.179 † Sutton D. Textbook of radiology and imaging, 7th edn.
#12ChapmanS,NakielnyR.Aidstoradiologicaldiffer- Churchill Livingstone, 1998
ential diagnosis, 4th edn. Saunders, 2003 ‡ McLoud T. Thoracic radiology: The requisites. Mosby,
#13 Abrams HL, Sprio R, Goldstein N. Metstases in 1998
carcinoma. Analysis of 1000 autopsied cases. Cancer ¶
Middleton WD, Kurtz AB, Hertzberg BS. Ultrasound:
1950;3:74–85
The requisites. Mosby, 2004
#20 Gore RM, Levine MS. Textbook of gastrointestinal ¶¶ Kaufman J, Lee M. Vascular and interventional radi-
radiology. Saunders/Elsevier, 2007 ology: The requisites. Mosby, 2003
#21 Lim JS, Yun MJ, Kim MJ, et al. CT and PET in §
BlickmanJ,ParkerB,BarnesP.Pediatricradiology:The
stomach cancer: preoperative staging and monitoring
requisites. Mosby, 2009
of response therapy. RadioGraphics 2006;26(1): §§
Ziessman HA, O’Malley JP, Thrall JH. Nuclear medi-
143–156
cine: The requisites. Mosby, 2006
#24 Slovis TL. Caffey’s pediatric diagnostic imaging, (cid:1)
Zagoria R. Genitourinary radiology: The requisites.
11th edn. Elsevier, 2008
Mosby, 2004
#27 De Bruyn R. Paediatric ultrasound: how, why (cid:1)(cid:1)
Weissleder R, Wittenberg J, Harisinghani M, Chen J.
andwhen,2ndedn.Elsevier/ChurchillLivingstone,2010
Primer of diagnostic imaging, 4th edn. Mosby, 2007
#28 Bates J. Abdominal ultrasound: how, why and
(cid:129) Miller S. Cardiac imaging: The requisites. Mosby, 2004
when. Churchill Livingstone, 2011
(cid:129)(cid:129) Halpert R. Gastrointestinal imaging: The requisites,
#30TurgutAT,AltinL,TopcuS,etal.Unusualimaging
3rd edn. Mosby, 2006
characteristicsofcomplicatedhydatiddisease.European
1
Journal of Radiology 2007;63(1):84–93 Grossman R, Yousem D. Neuroradiology: The requi-
sites. Mosby, 2003
#31 Parizel PM, Makkat S, Van Miert E, et al. Intracra-
11
SotoJ,LuceyB.Emergencyradiology:Therequisites.
nial hemorrhage: principles of CT and MRI interpreta-
Mosby, 2009
tion. European Radiology 2001;11:1770–1783 xv
1.1 CHEST WALL AND PLEURA
RIB LESIONS
Benign Otherbenignriblesions Fibrousdysplasia▶histiocyto-
sis X ▶ haemangioma ▶ aneurysmal bone cyst
Congenitalabnormalities Theupperribsarecommonly
bifid,splayed,fused,orhypoplastic▶theyareoccasion-
Aggressive
ally associated with syndromes (e.g. basal cell naevus
syndrome) or other anomalies (e.g. Sprengel’s Destructive rib lesions These are most commonly an
deformity) osteomyelitis or a neoplastic disease
(cid:129) Cervicalrib:thisarisesfromC7(affecting1–2%ofthe (cid:129) Malignant rib tumours: these are commonly
population) and consists of an initially downward metastatic deposits or myeloma ▶ primary malignant
sloping rib just lateral to the spine (cf. an initially tumours are rare (but usually a chondrosarcoma)
upward sloping normal rib) ▶ it can cause a thoracic (cid:129) Osteomyelitis: this is uncommon ▶ it may be due to
outlet syndrome and is often bilateral and haematogenous spread (e.g. staphylococcal or
asymmetrical tuberculous), or it may be caused by direct spread
Callus Post fracture this can mimic an intrapulmonary from the lung or pleural space (e.g. actinomycosis)
opacity Bronchial carcinoma (includingpancoast’s
Rib notching This is due to external pressure on a tumours) These can spread from the lung to a rib ▶
rib (e.g. coarctation of the aorta, neurofibromatosis MRI can determine the extent of a Pancoast’s tumour
type I [NF2]) (and assess the relationship between the tumour and
Benign primary tumours These are infrequent ▶ they the plexus brachialis)
are most commonly cartilaginous tumours (e.g. a chon-
droma or osteochondroma) ▶ they are predominantly
foundinananteriorlocationandmayshowcharacteristic
cartilaginous calcification
DIFFERENTIAL OF RIB NOTCHING
Inferior ribnotching Arterial: Coarctationoftheaorta,aorticthrombosis, subclavianobstruction, anycauseof
pulmonary oligaemia
Venous:Superiorvenacavaobstruction
Arteriovenous: Pulmonaryarteriovenous malformation, chestwallarterialmalformation
Neurogenic:Neurofibromatosis (ribbonribs)
Superiorribnotching Connectivetissue diseases:Rheumatoidarthritis,SLE,Sjo¨gren’s,scleroderma
Metabolic: Hyperparathyroidism
Miscellaneous: Neurofibromatosis,restrictive lungdisease, poliomyelitis,Marfan’ssyndrome,
osteogenesis imperfecta,progeria
#12
4
CHEST WALL: BONY AND SOFT TISSUE LESIONS
Cervicalribs.Bilateraldownslopingcervicalribs AxialCT.Chondrosarcoma ofan anteriorleftrib Fibrous dysplasiainarib.
(arrows). demonstrating alargesoft tissuecomponent with CXRdetailof theleftlung.
internalpunctuatecalcification(arrow). Comparedwiththeotherribs
the9thribshowsanincrease
indensityandisslightly
broadened.*
Neurofibromatosis type1(NF-1): skeletalfindings.Pressure
erosionofa ribdue toa neurofibroma.(Mostribdeformitiesin
NF-1aredue totheskeletaldysplasia, notpressureerosion.)
Chestradiographinapatientwithcoarctation.Thereisribnotching
andenlargementoftheleftsubclavianartery,causinga‘3’sign.
5
1.1 ¡ CHEST WALL AND PLEURA
SOFT TISSUE LESIONS
POLAND’S SYNDROME CT LowerdensitythanmusclebeforeandafterIVcon-
trast medium
Definition An autosomal condition where there is uni- MRI T1WI:lowtointermediateSI▶T2WI:highSI▶T1WI
lateral absence or hypoplasia of the pectoralis major þGad:markedcontrastenhancement
muscle ▶ it is accompanied by ipsilateral hand and
Haemangiomas An uncommon anterior mediastinal
arm anomalies (particularly syndactyly) lesion ((cid:3) phleboliths)
CXR Unilateral lung transradiancy and an abnormal
CT A smooth, sharp, lobulated mass with central het-
anterior axillary fold erogeneousenhancement▶theremaybeboneremodel-
ling and hypertrophy
SOFT TISSUE TUMOURS
MRI The best investigation for delineating its extent ▶
there are signal inhomogeneities generated by vessels,
Benign (rib separation or notch-like remodelling
soft tissue and haemorrhage
from pressure erosion)
(cid:129) T1WI: intermediate SI ▶ T2WI: high SI
Lipoma The most common benign chest wall tumour
CT Alow-densitywell-demarcatedhomogeneousmass Malignant (bony destruction)
((cid:1)90 to (cid:1)150HU) ▶ soft tissue components suggest a
liposarcoma (cid:129) Malignant primary chest wall tumours are rare ▶ the
MRI T1WI: high SI ▶ T2WI: intermediate SI (and low most common are lipo- or fibrosarcomas
(cid:129) Secondary tumours of the chest wall are common,
SI with fat suppression)
particularly if there is local tumour spread (e.g.
Neurofibroma Rib splaying and pressure erosion ▶
carcinoma of the breast and lung)
widened intervertebral foramina
STERNAL LESIONS
PECTUS EXCAVATUM Pearl Pigeon chest (pectus carinatum): the reverse defor-
mity, which may be congenital or acquired
Definition A depressed sternum resulting in the ante-
rior ribs projecting more anteriorly than the sternum STERNAL NEOPLASMS
(funnel chest) ▶ it may be an isolated abnormality or
associated with other disorders such as Marfan’s syn- Definition These are usually malignant: myeloma ▶
drome or congenital heart disease (particularly an ASD) chondrosarcoma ▶ lymphoma ▶ metastatic carcinoma
CXR The condition is best assessed on a lateral (cid:129) The most common benign tumour is a chondroma
CXR ▶ PA CXR: leftward shift of the heart ▶ an indis- (cid:129) Relevant non-neoplastic processes: osteomyelitis ▶
tinct right heart border simulating middle lobe disease histiocytosis X ▶ Paget’s disease ▶ fibrous dysplasia
(thesternumreplacesaeratedlungattherightheartbor- CT This is the recommended investigation: it elimi-
der)▶asteepinferiorslopeoftheanteriorribs▶undue nates any overlapping structures, detects bony destruc-
clarity of the lower dorsal spine seen through the heart tion, and allows imaging of the adjacent soft tissues
6