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.
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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PE or no PE? Alternative diagnoses on CTA
Kelly W. Capel, MD, and Lynn S. Broderick, MD, FACR
Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2018   •   Expiration Date: February 28, 2020
Given that pulmonary embolism (PE) is the third-leading cause of cardiovascular death and that the signs and symptoms of PE are often nonspecific, many care providers obtain CTA in the acute-care setting to evaluate for any life-threatening or urgent pathology.
While most of these patients will likely not have an underlying PE, this article showcases several alternative potential pathologies, ranging from common intrathoracic conditions such as pneumonia, to acute aortic syndrome and intra-abdominal pathology, which may be partially captured via subtle clues on CTA examinations.
In the acute-care setting, the radiologist’s ability to recognize other potential sources of pain and shortness of breath as well as coexisting pathology in patients being evaluated for PE with CTA is critical.
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