How to Think Like a Radiologist: Ordering Imaging Studies PDF
Preview How to Think Like a Radiologist: Ordering Imaging Studies
How to Think Like a Radiologist ORDERING IMAGING STUDIES Tara Marie Catanzano CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521715232 © Cambridge University Press 2009 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2008 ISBN-13 978-0-511-46365-5 eBook (EBL) ISBN-13 978-0-521-71523-2 paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to- date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in hi Inlovingmemoryofmygrandparents.Thankyouforbeing myguidinglight,myinspiration,myhope,andmyfuture. Withoutyourloveandsupport,noneofmyachievements wouldhavebeenpossible.Thisbookisarepresentationof yourdedicationtome...thusIdedicateittoyou. Foreverlove. How to Think Like a Radiologist Radiologic investigations can be confusing to clinicians and radiol- ogists alike. Questions invariably arise as to which type of imaging study best answers the clinical question posed. Once a modality is determined, decisions must be made regarding the technical manner inwhichthestudyisperformedandifIVcontrastisrequired.Patient factors,risks,benefits,andothervariablesmustalsobeconsidered. This pocket guide is written for anyone who needs to understand enough about radiology to know which study to order in a patient workup.Thebookaddressesimagingstudiesbymodality,bodyregion, and type of study in bulleted outline format for easy reference. Gen- eralconsiderationsforeachmodality–includingadvantagesanddis- advantages–arepresented,followedbyinformationonpatientprepa- rationandrequirementsforeachtypeofexamination.Dr.TaraMarie Catanzanoexplainshowspecificstudiesareperformed,whatinforma- tioncanbeobtained,studyindications,contraindications,andlimita- tions.Thebookalsoincludestwoappendixes. Educated at the Royal College of Surgeons in Ireland, Dr. Tara Marie Catanzano learned the value of appropriate medical indications for imaging.Duringherinternship,residency,andfellowshipindiagnos- ticradiologyatYale-NewHavenHospital,sheperformedavarietyof research projects and was awarded the title of Fellow of the Year as well as the RSNA Resident/Fellow Research Award. Dr. Catanzano is formerly Assistant Professor of Diagnostic Radiology and Chief of CardiacImagingatYaleUniversitySchoolofMedicine. Contents Preface pagexv 1 RadiationandContrastConcerns. . . . . . . . . . . . . . . . . . . 1 GeneralConsiderations 1 RadiationRisks 1 ContrastAgentsandAdministration 3 PremedicationforIntravascularContrast 5 NephrogenicSystemicFibrosis 7 2 ChestImaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ConventionalRadiographs 8 DecubitusRadiographs 9 Inspiration/ExpirationRadiography 10 ApicalLordoticImaging 10 ShallowObliqueRadiographs 11 NippleMarkers 11 RibFilms 11 IndicationsforRepeatChestX-Ray 12 CToftheThorax 12 CTAngiographyforPulmonaryEmbolism 14 “TripleRuleOut”:Contrast-EnhancedCT AngiographyoftheThorax 17 3 MusculoskeletalImaging . . . . . . . . . . . . . . . . . . . . . . . . 19 ConventionalRadiographs 19 Arthrography 21 CT 23 MusculoskeletalContrast-EnhancedCT 24 CTArthrography 24 vii viii Contents MusculoskeletalMRI 25 Non-ContrastMusculoskeletalMRI 26 IVContrast-EnhancedMusculoskeletalMRI 27 MRArthrography 28 4 GenitourinaryImaging. . . . . . . . . . . . . . . . . . . . . . . . . . 30 ConventionalRadiographs 30 IVUrogram/Pyelogram 31 CTUrography 33 Nephrostogram 35 Loopogram 35 Cystogram/VoidingCystourethrogram 36 RetrogradeUrethrogram 38 Hysterosalpingography 38 5 Gastrointestinal(Barium)Imaging . . . . . . . . . . . . . . . . . 41 ConventionalRadiographs 41 Esophagography 42 ModifiedBariumSwallow 45 UpperGISeries 45 SmallBowellFollow-Through 46 Enteroclysis 48 SingleConstrastBarium/HypaqueEnemas 49 DoubleContrastBariumEnema 51 Fistulograms 52 OstomyStudies 53 6 ComputedTomography . . . . . . . . . . . . . . . . . . . . . . . . . 55 AbdominopelvicImaging 55 GeneralConsiderationsinCTImaging 55 PremedicationforPatientswithIVContrast Allergies 57 HepaticCTImaging 58 BiliaryImaging 59 SplenicImaging 61 PancreaticImaging 63 AdrenalImaging 64 RenalImaging 66 ImagingofSuspectedRenalMasses(RenalMass ProtocolCT) 69 CTUrogram 71 Contents ix CTCystogram 73 CTImagingofGynecologicDisease 75 CTImagingofBowelPathology 76 VascularCTImaging 79 AorticImaging 79 RenalVascularCTImaging 81 VenousCTImaging 83 7 BodyMRI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 GeneralConsiderations 84 ContraindicationstoMRI 85 MRoftheChest 86 MRoftheHeart 86 MRoftheAbdomen 87 MRofthePelvis 88 MRoftheLiver 88 MagneticResonanceCholangiopancreatography 91 MRofthePancreas 92 MRoftheAdrenalGlands 94 MRoftheKidneys 95 MRAngiogramoftheRenalArteries 96 MRofCardiacAbnormalities 97 MRofVascularStructures 101 MRofthePelvis(forGynecology/Obstetrics) 102 MRoftheBreast 104 MRoftheProstate 105 8 Neuroradiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 ConventionalRadiographs 107 Non-ContrastCToftheBrain 108 Contrast-EnhancedCToftheBrain 109 CTAngiographyoftheNeckandCircleofWillis 111 CToftheSinus 113 CToftheFacialBones 114 CToftheOrbits 114 CTofthePetrous/TemporalBone 115 CToftheNeck 116 CToftheCervicalSpine 117 CToftheThoracic/LumbarSpine 119 MRIoftheCentralNervousSystem 121 Contrast-EnhancedMRoftheBrain 124 x Contents MRoftheNasopharynx 125 MRoftheOrbits 126 MRofthePituitary 127 MRoftheNeck 128 MRAngiography/MRVenography 129 MRSpectroscopy 130 MRoftheSpine 130 Non-ContrastMRoftheSpine 131 Contrast-EnhancedMRoftheSpine 131 9 CardiacImaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 GeneralConsiderations 133 ChestRadiography 134 Echocardiography 136 ExerciseStressTesting 139 PreparationforNuclearStressTests 140 NuclearStress/RestPerfusionImaging (201-Thallium,99mTcSestamibi/ Tetrofosmin/Teburoxime) 141 NuclearViabilityImaging(FDGPET) 143 NuclearMedicinePETCTStress/RestImaging 144 CoronaryArteryCalciumScoring 146 CTCoronaryAngiography 148 CardiacMRI 150 ConventionalCatheterAngiography 153 10 Ultrasound. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 GeneralConsiderations 156 VascularUltrasound 157 CarotidUltrasound 158 AbdominalAortaUltrasound 159 SplanchnicVasculature(CeliacAxis/Superiorand InferiorMesentericArteries)Ultrasound 160 RenalArteryStenosisUltrasound 161 UltrasoundDopplerEvaluationoftheHepatic Vasculature/EvaluationofTIPS 161 VascularGraftUltrasound 162 ArteriovenousGraft/FistulaUltrasound 163 UltrasoundEvaluationofPseudoaneurysmor ArteriovenousFistulaFollowingArterial Puncture 164 Contents xi DVT(UpperorLowerExtremity)Ultrasound 165 NeckUltrasound(Nonvascular) 166 BreastUltrasound 168 ChestUltrasound 169 AbdomenUltrasound 170 Retroperitoneal(Renal)Ultrasound 174 RenalTransplantUltrasound 174 PancreaticTransplantUltrasound 175 PelvicUltrasound(Females) 176 11 NuclearMedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 GeneralConsiderations 178 CNSImaging 180 Technetium-99mHexamethylpropyleneamine OximeCNSImaging 180 F-18FluorodeoxyglucoseCNSImaging 181 CerebrospinalFluidLeak 182 ObstructiveHydrocephalus 182 Vascular/Lymphatic 183 LymphaticStasis 184 Lymphoscintigraphy/SentinelNode Sampling 185 BoneScan 185 Endocrine 188 Iodine-131ThyroidImaging 190 RadioactiveThyroidAblation 191 ParathyroidImaging 192 MetaiodobenzylguanidineImaging 193 GalliumImaging 193 WhiteBloodCellImaging 195 TaggedRedBloodCellStudy 196 Meckel’sScan 198 SulfurColloidImaging 199 HIDAStudy 200 GastricEmptyingStudy 202 RenalImaging 203 CaptoprilStudies 204 DiureticRenogram(LasixStudy) 204 RadionuclideCystography 205 Ventilation/PerfusionImaging 206 PETCT(forAttenuationCorrection) 207
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