Radiographics (RadioGraphics )

Publisher: Radiological Society of North America


The primary mission of RadioGraphics is to publish the best in peer-reviewed educational material, emphasizing that presented at the annual meeting of the RSNA, for radiologists, trainees, physicists, and other radiologic professionals.

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  • Website
    RadioGraphics website
  • Other titles
    Radiographics (Online), Radiographics
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  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Radiological Society of North America

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    • Can request from Publisher permission to link to article
    • RSNA will deposit final published version of NIH author's article in PubMed Central
    • RSNA requires a 12 months embargo on submission to PubMed Central
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although 3-T magnetic resonance (MR) imaging is well established in neuroradiology and musculoskeletal imaging, it is in the nascent stages in cardiovascular imaging applications, and there is limited literature on this topic. The primary advantage of 3 T over 1.5 T is a higher signal-to-noise ratio (SNR), which can be used as such or traded off to improve spatial or temporal resolution and decrease acquisition time. However, the actual gain in SNR is limited by other factors and modifications in sequences adapted for use at 3 T. Higher resonance frequencies result in improved spectral resolution, which is beneficial for fat suppression and spectroscopy. The higher T1 values of tissues at 3 T aid in myocardial tagging, angiography, and perfusion and delayed-enhancement sequences. However, there are substantial challenges with 3-T cardiac MR imaging, including higher magnetic field and radiofrequency inhomogeneities and susceptibility effects, which diminish image quality. Off-resonance artifacts are particularly challenging, especially with steady-state free precession sequences. These artifacts can be managed by using higher-order shimming, frequency scouts, or low repetition times. B1 inhomogeneities can be managed by using radiofrequency shimming, multitransmit coils, or adiabatic pulses. Chemical shifts are also increased at 3 T. The higher radiofrequency results in higher radiofrequency deposition power and a higher specific absorption rate. MR angiography, dynamic first-pass perfusion sequences, myocardial tagging, and MR spectroscopy are more effective at 3 T, whereas delayed-enhancement, flow quantification, and black-blood sequences are comparable at 1.5 T and 3 T. Knowledge of the relevant physics helps in identifying artifacts and modifying sequences to optimize image quality. Online supplemental material is available for this article. ©RSNA, 2014.
    Radiographics 10/2014; 34(6):1612-1635.
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    ABSTRACT: Recent improvements in Web and mobile technology, along with the widespread use of handheld devices in radiology education, provide unique opportunities for creating scalable, universally accessible, portable image-rich radiology case files. A cloud database and a Web-based application for radiologic images were developed to create a mobile case file with reasonable usability, download performance, and image quality for teaching purposes. A total of 75 radiology cases related to breast, thoracic, gastrointestinal, musculoskeletal, and neuroimaging subspecialties were included in the database. Breast imaging cases are the focus of this article, as they best demonstrate handheld display capabilities across a wide variety of modalities. This case subset also illustrates methods for adapting radiologic content to cloud platforms and mobile devices. Readers will gain practical knowledge about storage and retrieval of cloud-based imaging data, an awareness of techniques used to adapt scrollable and high-resolution imaging content for the Web, and an appreciation for optimizing images for handheld devices. The evaluation of this software demonstrates the feasibility of adapting images from most imaging modalities to mobile devices, even in cases of full-field digital mammograms, where high resolution is required to represent subtle pathologic features. The cloud platform allows cases to be added and modified in real time by using only a standard Web browser with no application-specific software. Challenges remain in developing efficient ways to generate, modify, and upload radiologic and supplementary teaching content to this cloud-based platform. Online supplemental material is available for this article . ©RSNA, 2014.
    Radiographics 04/2014;
  • Radiographics 03/2014; 34(2):274.
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    ABSTRACT: A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making. ©RSNA, 2014.
    Radiographics 01/2014; 34(1):179-96.
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    ABSTRACT: Barium pharyngography remains an important diagnostic tool in the evaluation of patients with dysphagia. Pharyngography can not only help detect functional abnormalities but also help identify a wide spectrum of structural abnormalities in children and adults. These structural abnormalities may reflect malignant or nonmalignant oropharyngeal, hypopharyngeal, or laryngeal processes that deform or alter normal coated mucosal surfaces. Therefore, an understanding of the normal appearance of the pharynx at contrast material-enhanced imaging is necessary for accurate detection and interpretation of abnormal findings. Congenital malformations are more typically identified in the younger population; inflammatory and infiltrative diseases, trauma, foreign bodies, and laryngeal cysts can be seen in all age groups; and Zenker and Killian-Jamieson diverticula tend to occur in the older population. Squamous cell carcinoma is by far the most common malignant process, with contrast-enhanced imaging findings that depend on tumor location and morphology. Treatments of head and neck cancers include total laryngectomy and radiation therapy, both of which alter normal anatomy. Patients are usually evaluated immediately after laryngectomy to detect complications such as fistulas; later, pharyngography is useful for identifying and characterizing strictures. Deviation from the expected posttreatment appearance, such as irregular narrowing or mucosal nodularity, should prompt direct visualization to evaluate for recurrence. Contrast-enhanced imaging of the pharynx is commonly used in patients who present with dysphagia, and radiologists should be familiar with the barium pharyngographic appearance of the normal pharyngeal anatomy and of some of the processes that alter normal anatomy. © RSNA, 2013.
    Radiographics 11/2013; 33(7):e189-208.
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    ABSTRACT: The evolution of oncologic surgical technology has moved toward reducing patient morbidity and mortality without compromising oncologic resection or oncologic outcomes. The goals in treating head and neck cancer are to cure patients, as well as to provide quality of life by improving functional and social outcomes through organ-preservation therapies, which may include surgery, chemotherapy, and/or radiation therapy. Transoral robotic surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens and over open surgery for head and neck cancer, including reductions in operative times, blood loss, intensive care unit stays, and overall duration of patient hospitalization. Transoral robotic techniques allow wide-view, high-resolution, magnified three-dimensional optics for visualization of the mucosal surfaces of the head and neck through an endoscope, while avoiding the extensive external cervical incisions often required for open surgeries. Radiologists play an important role in the successful outcome of these procedures, both before and after TORS. Determining a cancer patient's surgical candidacy for TORS requires a thorough preoperative radiologic evaluation, coupled with clinical and intraoperative assessment. Radiologists must pay particular attention to important anatomic landmarks that are clinical blind spots for surgeons. Knowledge of the expected postoperative imaging appearances, so that they can be distinguished from recurrent disease and second primary tumors, is essential for all radiologists involved in the care of these patients.
    Radiographics 10/2013; 33(6):1759-1779.
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    ABSTRACT: Recent advances in treatment of metastatic renal cell carcinoma (RCC), such as new molecular therapies that use novel antiangiogenic agents, have led to revision of the most frequently used guideline to evaluate tumor response to therapy: Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Assessment of the response of metastatic RCC to therapy has traditionally been based on changes in target lesion size. However, the mechanism of action of newer antiangiogenic therapies is more cytostatic than cytotoxic, which leads to disease stabilization rather than to tumor regression. This change in tumor response makes RECIST 1.1-a system whose criteria are based exclusively on tumor size-inadequate to discriminate patients with early tumor progression from those with more progression-free disease and prolonged survival. New criteria such as changes in attenuation, morphology, and structure, as seen at contrast-enhanced multidetector computed tomography (CT), are being incorporated into new classifications used to assess response of metastatic RCC to antiangiogenic therapies. The new classifications provide better assessments of tumor response to the new therapies, but they have some limitations. The authors provide a practical review of these systems-the Choi, modified Choi, and Morphology, Attenuation, Size, and Structure (MASS) criteria-by explaining their differences and limitations that may influence the feasibility and reproducibility of these classifications. The authors review the use of multidetector CT in the detection of metastatic RCC and the different appearances and locations of these lesions. They also provide an overview of the new antiangiogenic therapies and their mechanisms of action and a brief introduction to functional imaging techniques. Functional imaging techniques, especially dynamic contrast-enhanced CT, seem promising for assessing response of metastatic RCC to treatment. Nonetheless, further studies are needed before functional imaging can be used in routine clinical practice. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1691-1716.
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    ABSTRACT: Hepatocellular carcinoma is a malignancy that predominantly occurs in the setting of cirrhosis. Its incidence is rising worldwide. Hepatocellular carcinoma differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The guidelines from the American Association for the Study of Liver Diseases (AASLD) are a leading statement for the diagnosis and staging of hepatocellular carcinoma, and they have recently been updated, incorporating several important changes. AASLD advocates the use of the Barcelona Clinic Liver Cancer (BCLC) staging system, which combines validated imaging and clinical predictors of survival to determine stage and which links staging with treatment options. Each stage of the BCLC system is outlined clearly, with emphasis on case examples. Focal liver lesions identified at ultrasonographic surveillance in patients with cirrhosis require further investigation. Lesions larger than 1 cm should be assessed with multiphasic computed tomography or magnetic resonance imaging. Use of proper equipment and protocols is essential. Lesions larger than 1 cm can be diagnosed as hepatocellular carcinoma from a single study if the characteristic dynamic perfusion pattern of arterial hyperenhancement and venous or delayed phase washout is demonstrated. If the imaging characteristics of hepatocellular carcinoma are not met, the alternate modality should be performed. Biopsy should be used if neither modality is diagnostic of hepatocellular carcinoma. Once the diagnosis has been made, the cancer should be assigned a BCLC stage, which will help determine suitable treatment options. Radiologists require a systematic approach to diagnose and stage hepatocellular carcinoma with appropriate accuracy and precision. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1653-1668.
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    ABSTRACT: Identifying the presence of axillary node and internal mammary node metastases in patients with invasive breast cancer is critical for determining prognosis and for deciding on appropriate treatment. Sentinel lymph node biopsy (SLNB) is the definitive method to exclude axillary metastases. Patients with positive SLNB results generally undergo axillary lymph node dissection (ALND). The benefit of preoperative identification of axillary metastases is that it allows the surgeon to proceed directly to ALND and to avoid an unnecessary SLNB and the need for a second surgical procedure involving the axillary nodes. Knowledge of the important anatomic landmarks of the axilla is important in finding and accurately reporting suspicious lymph nodes. The pathologic features of nodal metastases illuminate the imaging appearances of these nodes, as depicted with all modalities. Ultrasonography (US) is the primary imaging modality for evaluating axillary nodes. Morphologic criteria, such as cortical thickening, hilar effacement, and nonhilar cortical blood flow, are more important than size criteria in the identification of metastases. US-guided lymph node sampling, especially with core biopsy, is invaluable in confirming the presence of a metastasis in a suspicious node. Core biopsy has been shown to be equal in safety to fine needle aspiration and has a significantly lower false-negative rate. Magnetic resonance imaging is also useful, with the added benefit of providing a global view of both axillae. Computed tomography and radionuclide imaging play a lesser role in imaging the axilla. Preoperative image-based identification and sampling of abnormal lymph nodes that have a high positive predictive value for metastases is an extremely important component in the management of patients with invasive breast cancer. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1589-1612.
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    ABSTRACT: Primary pericardial tumors are rare and may be classified as benign or malignant. The most common benign lesions are pericardial cysts and lipomas. Mesothelioma is the most common primary malignant pericardial neoplasm. Other malignant tumors include a wide variety of sarcomas, lymphoma, and primitive neuroectodermal tumor. When present, signs and symptoms are generally nonspecific. Patients often present with dyspnea, chest pain, palpitations, fever, or weight loss. Although the imaging approach usually begins with plain radiography of the chest or transthoracic echocardiography, the value of these imaging modalities is limited. Cross-sectional imaging, on the other hand, plays a key role in the evaluation of these lesions. Computed tomography and magnetic resonance imaging allow further characterization and may, in some cases, provide diagnostic findings. Furthermore, the importance of cross-sectional imaging lies in assessing the exact location of the tumor in relation to neighboring structures. Both benign and malignant tumors may result in compression of vital mediastinal structures. Malignant lesions may also directly invade structures, such as the myocardium and great vessels, and result in metastatic disease. Imaging plays an important role in the detection, characterization, and staging of pericardial tumors; in their treatment planning; and in the posttreatment follow-up of affected patients. The prognosis of patients with benign tumors is good, even in the few cases in which surgical intervention is required. On the other hand, the length of survival for patients with malignant pericardial tumors is, in the majority of cases, dismal. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1613-1630.
  • Radiographics 10/2013; 33(6):1668-70.
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    ABSTRACT: Acute life-threatening conditions in oncology patients may develop either because of underlying malignancy or as a complication from treatment. Oncologic emergencies can be categorized as metabolic, hematologic, and structural conditions. Metabolic and hematologic emergencies are mainly diagnosed on the basis of clinical and laboratory findings. Structural pathologic conditions that result in bleeding, mechanical compression, or obstruction to the hollow organs, such as the trachea and bowel loops, may first be suspected because of clinical findings, including decreasing hematocrit levels, difficulty in breathing, and abdominal pain; however, performance of imaging studies is critical for timely diagnosis and management. Life-threatening conditions of the central nervous system (such as cerebral herniation, carcinomatous meningitis, and spinal cord compression), thoracic emergent conditions (such as central airway obstruction, esophagorespiratory fistula, massive hemoptysis, pulmonary embolism, superior vena cava syndrome, and pericardial tamponade), and abdominopelvic emergencies (such as uncontrolled intraabdominal hemorrhage, bowel obstruction, intestinal perforation, bowel ischemia, intussusception, and urinary tract obstruction) can be definitively diagnosed on the basis of projectional or cross-sectional imaging findings in appropriate clinical scenarios. Select emergent conditions in cancer patients related to chemotherapy and radiation treatment, as well as iatrogenic emergencies secondary to either surgery or placement of central venous catheters, may also demonstrate characteristic findings at imaging studies. In addition, interventional procedures are of great help in the treatment of acute superior vena cava syndrome, massive hemoptysis, and uncontrolled intraabdominal hemorrhage. Radiologists should be aware of these select, "not to be missed" imaging findings of oncologic emergencies to make an accurate, timely diagnosis and provide appropriate patient care. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1533-1553.
  • Radiographics 10/2013; 33(6):1651.
  • Radiographics 10/2013; 33(6):1738.
  • Radiographics 10/2013; 33(6):1531.
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    ABSTRACT: Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. Perineural spread is associated with decreased survival and a higher risk of local recurrence and metastasis. Radiologists play an important role in the assessment and management of head and neck cancer, and positron emission tomography/computed tomography (PET/CT) with 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) is part of the work-up and follow-up of many affected patients. Awareness of abnormal FDG uptake patterns within the head and neck is fundamental for diagnosing perineural spread. The cranial nerves most commonly affected by perineural spread are the trigeminal and facial nerves. Risk of perineural spread increases with a midface location of the tumor, male gender, increasing tumor size, recurrence after treatment, and poor histologic differentiation. Focal or linear increased FDG uptake along the V2 division of the trigeminal nerve or along the medial surface of the mandible, or asymmetric activity in the masticator space, foramen ovale, or Meckel cave should raise suspicion for perineural spread. If FDG PET/CT findings suggest perineural spread, the radiologist should look at available results of other imaging studies, especially magnetic resonance imaging, to confirm the diagnosis. Knowledge of common FDG PET/CT patterns of neoplastic involvement along the cranial nerves and potential diagnostic pitfalls is of the utmost importance for adequate staging and treatment planning. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1717-1736.
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    ABSTRACT: The incidence of ductal carcinoma in situ (DCIS) has increased over the past few decades and now accounts for over 20% of newly diagnosed cases of breast cancer. Although the detection of DCIS has increased with the advent of widespread mammography screening, it is essential to have a more accurate assessment of the extent of DCIS for successful breast conservation therapy. Recent studies evaluating the detection of DCIS with magnetic resonance (MR) imaging have used high spatial resolution techniques and have increasingly been performed to screen a high-risk population as well as to evaluate the extent of disease. This work has shown that MR imaging is the most sensitive modality currently available for identifying DCIS and is more accurate than mammography in evaluating the extent of DCIS. MR imaging is particularly sensitive for identifying high-grade and intermediate-grade DCIS. DCIS may have variable morphologic features on MR images, with non-mass enhancement morphology being the most common manifestation. Less commonly, DCIS may also manifest as a mass on MR images, in which case it is most likely to be irregular. The kinetics of DCIS are also variable, with fast uptake and a plateau curve reported as the most common kinetic pattern. Additional MR imaging tools such as diffusion-weighted imaging and quantitative kinetic analysis combined with the benefit of high field strength, such as 3 T, may increase the sensitivity and specificity of breast MR imaging in the detection of DCIS. © RSNA, 2013.
    Radiographics 10/2013; 33(6):1569-1588.