Diseases of the Abdomen and Pelvis 2018-2021

262 Pages·2018·25.02 MB·English

by  Juerg Hodler

IDKD Springer Series
Series Editors: Juerg Hodler · Rahel A. Kubik-Huch · Gustav K. von Schulthess
Juerg Hodler
Rahel A. Kubik-Huch
Gustav K. von Schulthess
Editors
Diseases of the
Abdomen and Pelvis
2018–2021
Diagnostic Imaging
IDKD Springer Series
Series Editors
Juerg Hodler
Zurich, Switzerland
Rahel A. Kubik-Huch
Baden, Switzerland
Gustav K. von Schulthess
Zurich, Switzerland
The world-renowned International Diagnostic Course in Davos (IDKD) represents a unique
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renewed update on the current state of the art and the latest developments in the field of organ-
based imaging (chest, neuro, MSK, and abdominal).
More information about this series at http://www.springer.com/series/15856
Juerg Hodler · Rahel A. Kubik-Huch
Gustav K. von Schulthess
Editors
Diseases of the Abdomen
and Pelvis 2018–2021
Diagnostic Imaging - IDKD Book
Editors
Juerg Hodler Rahel A. Kubik-Huch
Department of Radiology Department of Radiology
University Hospital of Zurich Kantonsspital Baden
Zurich, Switzerland Baden, Switzerland
Gustav K. von Schulthess
Nuclear Medicine
University Hospital of Zurich
Zurich, Switzerland
ISSN 2523-7829 ISSN 2523-7837 (electronic)
IDKD Springer Series
ISBN 978-3-319-75018-7 ISBN 978-3-319-75019-4 (eBook)
https://doi.org/10.1007/978-3-319-75019-4
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IDKD Advisor Abdominal imaging
Contents
1 Renal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Lejla Aganovic and Richard H. Cohan
2 MRI of the Pelvic Floor and MR Defecography . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Francesca Maccioni and Celine D. Alt
3 Benign Disease of the Uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Karen Kinkel, Susan M. Ascher, and Caroline Reinhold
4 Therapy Monitoring of Oncologic Disease in the
Abdomen (Including PET/CT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Irene A. Burger and Regina G. H. Beets-Tan
5 Disease of the Gallbladder and Biliary Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Jeong Min Lee and Daniel T. Boll
6 Pathways for the Spread of Disease in the Abdomen and Pelvis . . . . . . . . . . . . . 57
James A. Brink and Brent J. Wagner
7 Urogenital Pathologies in Children Revisited . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Jeanne S. Chow and Annemieke S. Littooij
8 Adnexal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Andrea Rockall and Rosemarie Forstner
9 Adrenal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Isaac R. Francis and William W. Mayo-Smith
10 Diseases of the Upper GI Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Richard M. Gore and Marc S. Levine
11 Magnetic Resonance Imaging of the Prostate
in the PI-RADS Era . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Bernd Hamm and Patrick Asbach
vii
viii Contents
12 Small Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Andrea Laghi and Amy K. Hara
13 Emergency Radiology of the Abdomen and Pelvis:
Imaging of the Non- traumatic and Traumatic Acute Abdomen . . . . . . . . . . . . . 123
Jay P. Heiken, Douglas S. Katz, and Yves Menu
14 Diseases of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Thomas K. Helmberger and Riccardo Manfredi
15 The Pediatric Gastrointestinal Tract:
What Every Radiologist Needs to Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Emily A. Dunn, Øystein E. Olsen, and Thierry A. G. M. Huisman
16 Diseases of the Colon and Rectum: CT Colonography . . . . . . . . . . . . . . . . . . . . . 167
C. Dan Johnson and Perry J. Pickhardt
17 Focal Liver Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Wolfgang Schima, Dow-Mu Koh, and Richard Baron†
18 Malignant Diseases of the Uterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Yulia Lakhman and Caroline Reinhold
19 Benign Diseases of the Colon and Rectum (incl. CT colonography) . . . . . . . . . . 207
Thomas Mang and Philippe Lefere
20 Urinary Obstruction, Stone Disease, and Infection . . . . . . . . . . . . . . . . . . . . . . . . 223
Refky Nicola and Christine O. Menias
21 Diffuse Liver Disease: Cirrhosis, Focal Lesions in Cirrhosis,
and Vascular Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Khoschy Schawkat and Caecilia S. Reiner
22 Imaging of Diffuse and Inflammatory Liver Disease . . . . . . . . . . . . . . . . . . . . . . 237
Pablo R. Ros
23 Urinary Obstruction, Stone Disease, and Infection . . . . . . . . . . . . . . . . . . . . . . . . 247
S. O. Schönberg, J. Budjan, and D. Hausmann
24 Imaging of Testicular and Scrotal Masses: The Essentials . . . . . . . . . . . . . . . . . . 257
Andreas G. Wibmer and Hebert Alberto Vargas
Renal Tumors 1
Lejla Aganovic and Richard H. Cohan
1.2 Modalities for Imaging Renal Masses
Learning Objectives
• To be familiar with the Bosniak cystic renal mass
1.2.1 Ultrasound
classification system
• To learn when very small renal masses can be
Although noncontrast ultrasound evaluates the internal mor-
ignored and when they should be followed
phology of cystic lesions with more detail than CT, it is not
• To be aware of ultrasound, CT, and MRI appear-
as sensitive in detecting or accurate in characterizing renal
ance of angiomyolipomas
masses as CT or MRI. Most consider ultrasound to be diag-
• To learn about imaging features of non-macroscopic
nostically definitive only when it identifies a renal mass as a
fat containing renal masses
simple cyst.
• To be familiar with renal cancer staging and use of
RENAL nephrometry
• To be knowledgeable of the normal imaging appear-
1.2.2 CT and MRI
ance of patients after treatment of renal cancer and
the appearance of treated and untreated metastatic
Renal tumors may be detected incidentally on CT or MRI
disease
examinations. On CT, it is quite common for only contrast-
• To be aware of unique features related to treatment
enhanced images to have been obtained, in which case
of metastatic renal cancer with targeted chemother-
assessment of mass enhancement is limited. When only
apeutic agents, including immunotherapy
contrast- enhanced CT images are available, it may be diffi-
cult to distinguish hyperdense cysts from solid hypoenhanc-
ing renal lesions. Renal cancers are unlikely to measure
>70 HU on unenhanced CT and <40 HU on contrast-
1.1 Introduction enhanced CT [1].
In recent years, there have been dramatic developments in
imaging assessment of renal tumors and their treatment,
Key Point
some of which will be provided in the paragraphs that
• Patients referred to CT or MRI with known or sus-
follow.
pected renal masses should be evaluated with unen-
hanced and at least one contrast-enhanced series
(with the unenhanced MRI sequences including
T1-weighted, fat-suppressed, T2-weighted, in- and
out-of-phase gradient-echo, diffusion-weighted
images).
L. Aganovic, M.D. (*)
Department of Radiology, University of California, San Diego,
Medical Center, San Diego, CA, USA
R. H. Cohan, M.D.
Department of Radiology, University of Michigan Hospital,
Ann Arbor, MI, USA
e-mail: [email protected]
© The Author(s) 2018 1
J. Hodler et al. (eds.), Diseases of the Abdomen and Pelvis 2018–2021, IDKD Springer Series,
https://doi.org/10.1007/978-3-319-75019-4_1
2 L. Aganovic and R. H. Cohan
Key Point Key Point
• Renal mass detection and characterization are max- • Most benign and malignant very small renal masses
imized when delayed rather than early contrast- grow at comparable slow rates, with many of these
enhanced images are obtained (either in the masses enlarging at a rate of no more than 3–5 mm
nephrographic phase [NP], which begins 90–100 s in maximal diameter per year [6]. As a result, inter-
after initiation of a contrast injection, or the excre- val enlargement of a renal mass cannot be used to
tory phase [EP], which begins when excreted con- predict that the mass being followed is malignant.
trast material is first detected in the renal collecting Instead, masses should be assessed for changes in
system, usually 120 s or more after initiation of morphology. These changes include increasing het-
contrast injection) [2]. erogeneity or the progression of the other afore-
mentioned complicating features [5].
1.3 Very Small Renal Masses (<1–1.5 cm) 1.4 Cystic Renal Masses
Very small renal masses (<1.0–1.5 cm in maximal diameter) Many radiologists and urologists classify cystic renal lesions
are detected on nearly half of all adult patients undergoing CT using the Bosniak classification system, which was first pro-
scans [3]. Many such renal masses detected with CT and MRI posed in 1986 [7] and revised several times, including in
cannot be characterized due to their size. Accurate attenua- 2005 [8]. This system classifies renal cystic masses into five
tion measurements in these lesions are problematic, due to categories, based upon their likelihood of being malignant. It
volume averaging and pseudoenhancement. Fortunately, the is important to emphasize that the Bosniak system was
likelihood of any one of these lesions being malignant is designed for use with dedicated renal mass CT and not for
exceedingly low [3]. The overwhelming majority of these ultrasound or MRI.
lesions will be benign renal cysts. Category I lesions, which constitute the overwhelming
Because very small renal masses are so common, further majority of cystic renal masses, are simple renal cysts. They
assessment of all of these lesions is not feasible, even though are homogeneous masses. They are anechoic on ultrasound
a few will be cancers. and of water attenuation on CT or water signal intensity on
MRI. They have imperceptible walls and do not contain nod-
ules or calcifications. They do not enhance when contrast
material is administered. Category I lesions are always
Key Point
benign and no follow-up is needed. Category II lesions are
• Follow-up imaging of tiny renal masses should be
minimally complex. They may contain one to three septa-
performed only when they subjectively appear to be
tions or thin peripheral calcifications. Hyperdense renal cysts
complex with evidence of heterogeneity, internal
<3 cm in diameter are also Category II lesions. Category II
septations, mural nodules, wall thickening, or
lesions are essentially always benign and no follow-up is
heterogeneity.
needed. Category IIF lesions contain multiple or thickened
septa, thickened walls, or coarse calcifications. Hyperdense
cysts measuring >3 cm in diameter are also Category IIF
Some homogeneous low attenuation lesions can be con- lesions.
sidered suspicious if they appear in high-risk patients, such as
those with known or suspected hereditary cancer syndromes
(such as von Hippel-Lindau, hereditary papillary renal cell Key Point
cancer, Birt-Hogg-Dubé, or hereditary leiomyomatosis-r enal • Category IIF cysts have been found to represent
cancer syndrome) [4]. When a very small renal mass is cancers or progress to become cancers about 11%
deemed suspicious, further evaluation should be performed of the time [9] and, for this reason, must be fol-
within 6–12 months. Suspicious masses should be followed lowed, with repeat imaging studies performed at
for at least 5 years. While follow-up can be obtained with CT 6 months and then annually for at least 5 years.
or MRI, MRI is more accurate. Even tiny cysts have charac- Cancer should be suspected, not when these lesions
teristic high T2 signal intensity. MRI is also much more sen- grow over time, but instead if they become increas-
sitive to contrast enhancement than is CT, and it is not ingly complex.
compromised by pseudoenhancement [5].