Practical Differential Diagnosis for CT and MRI

363 Pages·2008·4.225 MB·English

by  Eugene C. Lin, Edward Escott, Kavita Garg, Andrew G Bleicher, David Alan Alexander

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Practical Differential Diagnosis
for CT and MRI
Eugene C. Lin, MD Edward J. Escott, MD
Clinical Assistant Professor Assistant Professor
Department of Radiology Department of Radiology,
University of Washington Division of Neuroradiology
Attending Radiologist University of Pittsburgh Medical
Virginia Mason Medical Center Center
Seattle, WA Pittsburgh, PA
Kavita D. Garg, MD
Professor
Department of Radiology
Anschutz Centers for
Advanced Medicine
University of Colorado Health
Sciences Center
Aurora, CO
Andrew G. Bleicher, MD David Alexander, MD
Assistant Professor Radiology Fellow
Department of Radiology, University of Washington
Division of Neuroradiology Seattle, WA
University of Pittsburgh
Medical Center
Pittsburgh, PA
Thieme
New York • Stuttgart
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Library of Congress Cataloging-in-Publication Data
Practical differential diagnosis for CT and MRI / Eugene Lin . . . [et al.].
p. ; cm.
Includes bibliographic references and index.
ISBN 978-1-58890-655-7 (alk. paper)
1. Diagnosis, Differential—Handbooks, manuals, etc. 2. Tomography—Handbooks, manuals, etc.
3. Magnetic resonance imaging—Handbooks, manuals, etc. I. Lin, Eugene.
[DNLM: 1. Magnetic Resonance Imaging—methods—Handbooks. 2. Tomography,
X-Ray Computed—methods—Handbooks. 3. Diagnosis, Differential—Handbooks. WN 39 P8947 2008]
RC71.5.P73 2008
616.07’57—dc22 2008014877
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To Satish, Samita and Sandip for their love, support and patience. Thank you to my residents,
fellows and clinical colleagues for a lifetime of professional joy.
— Kavita D. Garg, MD
I would like to thank Patty Smith for her help preparing references.
— Edward J. Escott, MD
I would like to thank Bonnie Marston for help in preparing the manuscript. I would also like to
thank my colleagues in the radiology department at Virginia Mason Medical Center. In particular,
Dr. Neal Conti for reviewing the manuscript and providing many helpful comments.
— Eugene Lin, MD
With gratitude to all who have helped me reach this stage, with appreciation of my family and
their continued support, with hopes for a shared future of growth and happiness.
— Andrew G. Bleicher, MD
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
BRAIN
Edward J. Escott, MD
Andrew G. Bleicher, MD
Jawad Tsay, MD
Melissa Kang, MD
Parvez Masood, MD
Sunayna Bakaya, MD
Tumor and Tumor-like Lesions
1. Peripherally Enhancing Cystic Brain Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2. Metastases versus Primary Brain Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3. Intraventricular Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
4. Tumefactive Demyelination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
5. Posterior Fossa Neoplasms in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
6. Posterior Fossa Cystic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
7. Cerebellopontine Angle Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
8. Posterior Fossa Cysts and Cerebellar Malformations . . . . . . . . . . . . . . . . . . . . . . . .23
9. Meningeal Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
10. Sellar and Parasellar Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
11. Dermoid Cysts and Lipomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
12. Pineal Region Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Vascular
13. Arterial Infarcts versus Venous Infarcts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
14. Bilateral Thalamic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
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15. Intracranial Hemorrhages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
16. Perivascular Spaces versus Lacunar Infarcts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Infection
17. Intracranial Manifestations of Human Immunodeficiency Virus . . . . . . . . . . . .50
Miscellaneous
18. Hyperdense and Calcified Lesions on Computed Tomography . . . . . . . . . . . . . .54
19. Corpus Callosum Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
20. Abnormal Basal Ganglia Signal on Magnetic Resonance Imaging . . . . . . . . . . . .59
21. Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
22. Restricted Diffusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
HEAD AND NECK
Edward J. Escott, MD
Sunayna Bakaya, MD
Andrew G. Bleicher, MD
Mohsin Rahman, MD
Melissa Kang, MD
Skull
23. Focal Calvarial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
24. Diffuse Calvarial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Skull Base
25. Skull Base Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
26. Jugular Foramen Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Sinonasal Region
27. Sinonasal Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
28. Abnormal Sinus Density and Signal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Orbit
29. Orbital Vascular Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
30. Orbital Lymphoproliferative and Inflammatory Disorders . . . . . . . . . . . . . . . . . .83
31. Optic Nerve-Sheath Complex Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
32. Lacrimal Gland Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Salivary Gland
33. Salivary Gland Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Thyroid Lesions and Calcifications
34. Thyroid Diseases and Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94
Carotid Space
35. Carotid Space Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Congenital Cystic Neck Masses
36. Congenital Cystic Neck Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
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Lymph Nodes
37. Lymph Node Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Ear and Temporal Bone
38. Ear and Temporal Bone Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Larynx
39. Vocal Cord Lesions and Paralysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Carcinomas and Neoplasms
40. Head and Neck Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
41. Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
42. Radiation Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
CHEST
Kavita Garg, MD
Patterns and Signs
43. The Mosaic Pattern of Lung Attenuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
44. The Tree-in-Bud Pattern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
45. Ground-Glass Opacity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
46. The Halo Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
47. The Crazy-Paving Pattern. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
48. The Angiogram Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
49. The Feeding Vessel Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Airways
50. Bronchiectasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
51. Tracheobronchomalacia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
52. Asthma and Associated Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
53. Emphysema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Mediastinum
54. Differential Diagnosis of Mediastinal Masses
Based on Common Sites of Origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Pulmonary Parenchyma
55. High-Resolution Computed Tomography of Chronic
Diffuse Infiltrative Lung Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
56. Idiopathic Interstitial Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
57. Cystic Lung Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
58. Pneumoconiosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
59. Radiation and Drug-Induced Lung Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
60. The Solitary Pulmonary Nodule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
61. Lung Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
62. Pleural Effusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
63. Pericardial Effusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
64. Pulmonary Embolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
65. Aortic Dissection (by Eugene Lin, MD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
66. Cardiac Aneurysms and Abnormalities (by Eugene Lin, MD). . . . . . . . . . . . . . . 167
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ABDOMEN
Eugene Lin, MD
David Alexander, MD
Liver
67. Overview of Liver Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
68. Hypervascular Liver Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
69. Liver Lesions with Delayed/Prolonged Enhancement . . . . . . . . . . . . . . . . . . . . . 181
70. Liver Lesions with Central Scar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
71. Cystic Liver Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
72. Calcified Liver Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
73. Hemorrhagic Liver Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
74. Liver Lesions with Macroscopic Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
75. Liver Lesions with Microscopic Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
76. Liver Lesions with Hyperintensity on T1-Weighted
Magnetic Resonance Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
77. Liver Lesions with Hypointensity on T2-Weighted
Magnetic Resonance Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
78. Transient Hepatic Attenuation Difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
79. Hepatic Capsular Retraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
80. Periportal Halo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
81. Liver Lesions with Supraparamagnetic Iron Oxide Uptake. . . . . . . . . . . . . . . . . 202
82. Diffuse Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
83. Cirrhosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
84. Mimics of Cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Bile ducts
85. Magnetic Resonance Cholangiopancreatography Pitfalls. . . . . . . . . . . . . . . . . . 207
Pancreas
86. Cystic Pancreatic Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
87. Hypervascular Pancreatic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
88. Focal Chronic Pancreatitis versus Pancreatic Cancer. . . . . . . . . . . . . . . . . . . . . . 212
89. Pancreatic Lymphoma versus Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Spleen
90. Splenic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Adrenals
91. Adrenal Adenoma versus Metastasis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
92. Adrenal Lesions with Macroscopic Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
93. Cushing Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
94. Hyperaldosteronism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Kidneys
95. Hyperdense Renal Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
96. Renal Lesions with Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
97. Angiomyolipomas with Minimal Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
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98. Renal Parenchyma with Hypointensity on T2-Weighted
Magnetic Resonance Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
99. Renal Infarction versus Pyelonephritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Bowel
100. Imaging Signs of the Bowel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231
101. Diverticulitis versus Colon Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
102. Perforated Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
103. Epiploic Appendagitis versus Omental Infarction . . . . . . . . . . . . . . . . . . . . . . . . .236
Peritoneum/Retroperitoneum
104. Solid Peritoneal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237
105. Cystic Peritoneal and Retroperitoneal Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
106. Peritoneal Calcification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
107. Retroperitoneal Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
PELVIS
Eugene Lin, MD
Uterus
108. The Differential Diagnosis of Leiomyomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
109. Uterine Sarcomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249
110. Endometrial Carcinoma versus Polyp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
111. Septate versus Bicornuate Uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252
Ovaries
112. Ovarian versus Uterine Origin of a Pelvic Mass . . . . . . . . . . . . . . . . . . . . . . . . . . .253
113. Benign versus Malignant Ovarian Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
114. Ovarian Lesions with Hyperintensity on T1-Weighted
Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
115. Ovarian Lesions with Hypointensity on T2-Weighted
Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256
Perineum
116. Periurethral and Vaginal Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
Prostate
117. Prostatic Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .259
MUSCULOSKELETAL
Eugene Lin, MD
Bone lesions
118. Bone Lesions with Low Hypointensity on T2-Weighted
Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
119. Benign Bone Lesions with Surrounding Edema . . . . . . . . . . . . . . . . . . . . . . . . . . .264
120. Bone Lesions with Fluid-Fluid Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265
121. Enchondroma versus Chondrosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266
122. Osteochondroma versus Chondrosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .267
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Soft tissue lesions
123. Malignant versus Benign Soft Tissue Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . .268
124. Cystic-Appearing Soft Tissue Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
125. Soft Tissue Lesions with Fluid-Fluid Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270
126. Lipoma versus Liposarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271
127. Nerve Sheath Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
Bone marrow
128. Osteomyelitis versus Neuropathic Arthropathy in the Diabetic Foot . . . . . . . .273
129. Subchondral Bone Marrow Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .274
Joints
130. Synovial Chondromatosis versus Rice Bodies . . . . . . . . . . . . . . . . . . . . . . . . . . . .276
131. Hypointense Synovium on T2-Weighted Magnetic Resonance Imaging . . . . . .277
Knee
132. Increased Meniscal Signal Not Related to Tear . . . . . . . . . . . . . . . . . . . . . . . . . . .279
133. Meniscal Tear without Signal Extending to the Articular Surface . . . . . . . . . . .281
134. Absent Bow-Tie Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .282
135. Meniscal Extrusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283
136. Medial Fluid Collections around the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .284
137. Fluid Collections around the Posterior Cruciate Ligament . . . . . . . . . . . . . . . . . .286
Shoulder
138. Increased Signal in the Rotator Cuff Not Related to Full-Thickness Tear . . . . .287
139. Superior Labral Anterior-Posterior Tear versus Sublabral Recess . . . . . . . . . . .288
140. Abnormal Signal in the Rotator Cuff Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . .290
SPINE
Edward J. Escott, MD
Andrew G. Bleicher, MD
Vertebrae
141. Focal Vertebral Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295
142. Diffusely Abnormal Marrow Signal on Magnetic Resonance Imaging . . . . . . .297
143. Benign versus Pathologic (Neoplastic) Fracture . . . . . . . . . . . . . . . . . . . . . . . . . .299
144. Posterior Element Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301
145. Posterior Vertebral Body Scalloping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Spinal Canal Lesions
146. Lesions within the Spinal Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
147. Intradural Extramedullary Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
148. Intramedullary Spinal Cord Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310
Infectious and Degenerative Processes
149. Diskitis/Osteomyelitis, Degenerative Disease, and Scar . . . . . . . . . . . . . . . . . . . .312
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .315