Applied Radiology
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Applied Radiology is pleased to offer you a selection of free SA-CME accredited courses to choose from, as part of your free subscription to AR.
SA-CME
Accreditation/Designation Statement
The Institute for Advanced Medical Education (IAME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Institute for Advanced Medical Education (IAME) designates these Journal-based activities for a maximum of 1 AMA PRA Category 1 Credit™ each. Physicians should only claim credit commensurate with the extent of their participation in the activity.
These credits qualify as SA-CME credits.
Imaging Acute Face and Neck Infections
Blair A Winegar, MD; Ethan A Neufeld, MD; Wayne S Kubal, M
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2020   •   Expiration Date: February 28, 2022
Many acute infectious conditions of the face and neck resulting from common sources, such as pharyngitis, dental infection, and penetrating trauma, are evaluated in the emergency department. The clinical features of these conditions overlap, and clinical evaluation is often insufficient to localize or determine the extent of infection within the deep spaces of the neck.
This article showcases the classic imaging features and locations of a variety of acute face and neck infections encountered in the emergency department. In addition, the imaging findings of potentially life-threatening complications, such as mediastinitis resulting from retropharyngeal abscess and septic pulmonary emboli resulting from Lemierre syndrome, are described.
In the emergency setting, the radiologist’s ability to correctly identify and categorize acute face and neck infections and their complications is paramount to direct appropriate surgical and medical management.
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A Multimodality Approach to Imaging the Mediastinum and Pleura: Pearls and Pitfalls
Leonid Roshkovan, MD; Sharyn I. Katz, MD, MTR
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2020   •   Expiration Date: February 28, 2022
Diagnostic interpretation of cross-sectional imaging of the mediastinum and pleura presents unique and significant challenges even to the experienced radiologist. The mediastinum is anatomically complex, comprising numerous structures ar-ranged into multiple anatomic compartments that can give rise to a wide range of pathologies. The pleural space is thin and multi-planar, which can confound evaluation and quantification of pleural abnormalities.
In this article, we will review imaging approaches to the mediastinum and pleura and present imaging pearls and pitfalls that can assist radiologic interpretation. This will include common masses that present in routine imaging of the chest and key imaging features that help to distinguish them using CT, MRI and FDG-PET/CT.
The knowledge of common mediastinal and pleural pa-thologies present on cross-sectional imaging will enable the radiologist to make informed diagnostic radiologic interpreta-tions and guide appropriate intervention and surveillance.
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Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review
Matthew Schwenke, MD; Manu Singh, MD; and Bernard Chow, MD
Estimated time for completion: 1 hour   •   Date of release and review: January 1, 2020   •   Expiration Date: December 31, 2022
Injuries to the anterior cruciate ligament (ACL) are increasing over time, with younger women at elevated risk. Meniscal tears are also a significant source of morbidity in both the younger and older populations. Surgical repair of both conditions may alleviate symptoms and allow resumption of athletic activities. Understanding of the pathogenesis, associated findings, and appearance of these injuries on all imaging modalities is critical to their accurate diagnosis and timely treatment. Radiographs may show indirect signs of ACL and meniscal injuries. Ultrasonography is being utilized more often in the workup of these conditions as an adjunct to physical exam and as an initial screening tool. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions, though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography. ACL and meniscal tears can also be graded and classified according to their appearance on imaging which helps guide the surgeon during arthroscopy.
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Imaging Brachial Plexus Pathology
James Thomas Patrick Decourcy Hallinan, MBChB; Mini N. Pathria, MD; and Brady K. Huang, MD
Estimated time for completion: 1 hour   •   Date of release and review: November 1, 2019   •   Expiration Date: October 31, 2021
Brachial plexus disorders are a diagnostic challenge due to the complex anatomy and nonspecific symptomatology. MRI remains the best modality for assessing the brachial plexus (BP), due to its superior soft-tissue contrast compared to CT or ultrasound. Traumatic lesions are the most common cause of BP dysfunction, closely followed by neoplastic infiltration. Infection, inflammation and iatrogenic causes are less common
This review article will provide an overview of anatomy and practical, up-to-date BP imaging techniques for general radiologists, followed by a step-wise discussion of common pathology. Clinically relevant advances such as dynamic tho-racic outlet MRI will also be discussed.
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MRI of Endometriosis: A Comprehensive Review
Naziya Samreen, MD; Candice A. Bookwalter, MD, PhD; Tatnai L. Burnett, MD; Myra Feldman, MD; Shannon P. Sheedy, MD; Christine Menias, MD; and Wendaline M. VanBuren, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2019   •   Expiration Date: August 31, 2021
Endometriosis affects a significant number of reproductive age women and can continue to be present after menopause. The disease is much more complex than ovarian endometriomas, and understanding histology, disease location, and the limitations and benefits of imaging can aid in the diagnosis and management of these patients.
A dedicated MRI protocol and key imaging features are used to optimize disease detection. Comprehensive cases will broaden the capacity for pattern recognition of pelvic morphologic changes, secondary associations, and features of malignant degeneration
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Biliary Tract Emergencies: What the Radiologist Should Know
Sarah D. Fenerty, MD; Sudhir Kunchala, MD; and Matthew A. Morgan, MD
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2019   •   Expiration Date: June 30, 2021
Acute biliary conditions are a common occurrence in the emergency department, but may be underappreciated on diagnostic imaging, particularly since these injuries may occur in complex patients or be a secondary injury in a patient presenting with a more obvious primary injury. The potential for delayed diagnosis could result in significant morbidity.
Since findings may be subtle, radiologists need to be comfortable with common presentations of acute biliary disease to maintain an adequate level of suspicion and detect early signs of injury. The radiologist should also be familiar with other imaging modalities that may be useful in confirming biliary injury and tailor effective follow up imaging to a patient’s clinical situation.
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Hand Masses: An Essential MRI Review
Nicholas Hardin, DO; Shaked Laks, MD; Carola Mullins, MD; Osvaldo Padilla, MD; Lisa Kafchinski, MD; and Crysela Smith, MD
Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2019   •   Expiration Date: April 30, 2021
Hand masses are commonly encountered entities that often cause clinical and diagnostic dilemmas due to their nonspecific clinical presentation and overlapping imaging findings. This article systematically reviews the most commonly encountered hand masses in clinical practice in order to help the radiologist gain a structured diagnostic approach and familiarity with typical clinical presentations. Furthermore, this review will strengthen the radiologist’s ability to recognize pertinent MR imaging findings and gain knowledge of the underlying pathology on a cellular level.
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Musculoskeletal Imaging In Children: What The General Radiologist Should Know
Jennifer Shaffer Ngo, MD, and Gary R. Schooler, MD
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2019   •   Expiration Date: February 28, 2021
Pediatric musculoskeletal injuries often manifest differently from adult injuries and similar mechanisms may present differently depending on the degree of skeletal maturity. This article outlines many of the common pediatric injuries that the general radiologist may encounter in practice. Select topics include physeal injuries, elbow fractures, developmental dysplasia of the hip, slipped capital femoral epiphysis, and Blount disease. Knowledge of these unique pathologies and anatomic variants will help the radiologist recognize these entities sooner, ultimately helping facilitate the most expeditious and appropriate care.
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Magnetic Resonance Enterography In Inlammatory Bowel Disease
Hina Arif-Tiwari, MBBS, MD, DNB; Philip Taylor, DO; Bobby T. Kalb, MD; and Diego R. Martin MD, PhD, FRCPC
Estimated time for completion: 1 hour   •   Date of release and review: February 1, 2019   •   Expiration Date: January 30, 2021
Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic debilitating inflammatory disease that currently lacks a single gold standard diagnostic test. Magnetic resonance enterography (MRE) is an excellent modality for assessing IBD because it demonstrates a greater ability to depict submucosal pathology in comparison to other diagnostic modalities.
Although patient preparation for MRE often involves ingestion of various osmotic agents, recent research suggests that this may be unnecessary, as the high level of bowel wall contrast is sufficient even without bowel distention.
The ability to distinguish between acute forms of IBD and non-acute forms of IBD is an important role for MRI imaging. Acute flares will demonstrate mural increased T2 signal, best appreciated on fat saturation T2-weighted sequences. MRE also plays a role in the diagnosis of extra-enteric complications of IBD such as perirectal abscess or sclerosing cholangitis.
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Imaging of Postoperative Internal Hernias
Douglas H. Sheafor, MD, FSAR
Estimated time for completion: .75 hour   •   Date of release and review: November 1, 2018   •   Expiration Date: October 31, 2020
In postoperative bariatric patients, internal hernias are one of the most common, and dreaded postoperative complications; unfortunately, these hernias are also challenging to diagnosis clinically and radiographically. This article highlights several keys to correct diagnosis of the postoperative internal hernia, including understanding the common postoperative anatomy, optimizing CT imaging using oral contrast and multiplanar reformats, and combining findings such as swirling of the mesentery, bowel obstruction and other CT abnormalities to increase the specificity of diagnosis. In the acute-care setting, radiologists should have a high index of suspicion for internal hernias in the setting of prior RYGB surgery and signs of obstruction, particularly given their association with closed loop obstruction and bowel ischemia mandating prompt surgical intervention.
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Adrenal imaging: Using A Three-category Approach To Managing The Adrenal “Incidentaloma”
Lisa M. Ho, MDD
Estimated time for completion: .75 hour   •   Date of release and review: October 1, 2018   •   Expiration Date: September 30, 2020
Imaging plays a critical role in the work-up and clinical management of adrenal disease. Because masses in the adrenal glands are one of the most commonly encountered incidentalomas, the American College of Radiology (ACR) has developed specific recommendations on how to manage incidentally discovered adrenal masses in the adult population. The purpose of this article is to review the imaging appearance of common adrenal diseases and provide a diagnostic imaging algorithm for work-up of the “adrenal incidentalomas.”
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Vascular Anomalies: Description, Classification and Nomenclature
Deborah R. Shatzkes, MD
Estimated time for completion: 1 hour   •   Date of release and review: September 1, 2018   •   Expiration Date: August 31, 2020
“Nomenclature has been the major obstacle to our understanding and management of vascular anomalies.” These words were written by John Mulliken over 30 years after publishing his seminal paper on the biologic basis of vascular anomalies in 1982. The intervening decades have brought tremendous progress in classification, diagnosis and therapy of this diverse group of lesions. Still, much confusion exists in the medical community, in no small part because of inaccurate and inconsistent use of nomenclature both in the literature and in clinical practice.
The multidisciplinary International Society for the Study of Vascular Anomalies (ISSVA) was formed in 1992 to promote research in the field of vascular anomalies and to create a uniform nomenclature that would facilitate research and clinical practice. ISSVA created a comprehensive classification scheme based on Mulliken’s work on the biologic basis of disease, updated most recently in 2014 and available at issva.org/classification. The ISSVA classification and its associated nomenclature are widely accepted as the gold standard by the numerous medical specialties involved in clinical care and research related to vascular anomalies.
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A Multimodality Review Of Solid and Cystic Pancreatic Masses
Samir Mehta, MD, and Jonathan Dorff, MD
Estimated time for completion: 1 hour   •   Date of release and review: August 1, 2018   •   Expiration Date: July 31, 2020
The discovery of incidental asymptomatic pancreatic masses has gone up dramatically with the advent and increasing accessibility of CT and MRI.
It is imperative to understand the different imaging features and behaviors of these masses on CT and MRI to construct an appropriate differential diagnosis, as recommendations based on these masses are very different. Knowledge of the relevant clinical history and patient populations affected is also important to formulate an accurate diagnosis. It is also important to recognized pitfalls in diagnosing the masses, as there are both typical and atypical appearances.
There are also mimics of pancreatic masses that lead to unnecessary follow-up and workup, for which the radiologist should be aware. A multimodality approach is frequently needed to narrow the differential diagnosis, though tissue sampling is usually required for a definitive diagnosis.
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Pediatric Bone Imaging: Differentiating Benign Lesions From Malignant
Alysha Vartevan, DO; Crystal May, DO; and Craig E. Barnes, MD
Estimated time for completion: 1 hour   •   Date of release and review: July 1, 2018   •   Expiration Date: June 30, 2020
Bone tumors are one of the most common lesions encoun-tered by radiologists. Fortunately, most pediatric bone tumors are benign. Although cross-sectional imaging such as CT or MRI can be useful, the most important imaging modality in the initial workup of a bone tumor is the plain radiograph.
Differentiating between benign and malignant bone tu-mors is not always straightforward; however, it is possible to distinguish between them by carefully evaluating charac-teristics such as the lesion’s type of margin, pattern of bone destruction, type of periosteal reaction and presence of an as-sociated soft tissue mass. In addition, matrix type and tumor location can help narrow the differential diagnosis.
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