Imaging Pitfalls Research Articles

Pitfalls in shoulder MRI: part 2--biceps tendon, bursae and cysts, incidental and postsurgical findings, and artifacts.

The purpose of this article is to review frequently encountered pitfalls as they pertain to the biceps tendon, bursae and cysts around the shoulder, incidental findings, postsurgical findings, and frequently encountered imaging artifacts. Imaging pitfalls in and around the shoulder are not limited to normal anatomy and anatomic variants. Radiologists must be cognizant of the vast variability of structures in the shoulder and of the incidental and postsurgical findings and artifacts affecting them.

Pitfalls of ophthalmic radiographic imaging.

Ophthalmologists are dependent on computed tomography (CT) and MRI to aid in the diagnosis and management of patients with orbital and visual conditions. Pitfalls in the imaging process can lead to inefficient care or patient harm. This review summarizes these problems and provides methods to reduce imaging errors. There has been exponential growth in the number of radiographic scans performed, resulting in increased awareness of the risks from medical radiation. Strategies to minimize radiation exposure include reducing the need for sequential scans, using appropriate technology, and substituting MRI for CT. Contrast administration can be associated with systemic reactions, renal disease, and thyroid dysfunction. Scan interpretation errors are reduced by the ophthalmologist reviewing the study and communication with the radiologist. Medical radiation exposure can be reduced by initially ordering the appropriate scan and substituting MRI for CT when possible. MRI is contraindicated in patients with certain implants and metallic foreign bodies. Noncontrast studies are adequate to evaluate many conditions and some patients should not receive contrast. Imaging errors can be reduced by the ophthalmologist personally reviewing the orbital scans and correlating the results with the clinical findings.

FDG-PET/CT pitfalls in oncological head and neck imaging.

ObjectivesPositron emission tomography-computed tomography (PET/CT) with fluorine-18-fluorodeoxy-D-glucose (FDG) has evolved from a research modality to an invaluable tool in head and neck cancer imaging. However, interpretation of FDG PET/CT studies may be difficult due to the inherently complex anatomical landmarks, certain physiological variants and unusual patterns of high FDG uptake in the head and neck. The purpose of this article is to provide a comprehensive approach to key imaging features and interpretation pitfalls of FDG-PET/CT of the head and neck and how to avoid them.MethodsWe review the pathophysiological mechanisms leading to potentially false-positive and false-negative assessments, and we discuss the complementary use of high-resolution contrast-enhanced head and neck PET/CT (HR HN PET/CT) and additional cross-sectional imaging techniques, including ultrasound (US) and magnetic resonance imaging (MRI).ResultsThe commonly encountered false-positive PET/CT interpretation pitfalls are due to high FDG uptake by physiological causes, benign thyroid nodules, unilateral cranial nerve palsy and increased FDG uptake due to inflammation, recent chemoradiotherapy and surgery. False-negative findings are caused by lesion vicinity to structures with high glucose metabolism, obscuration of FDG uptake by dental hardware, inadequate PET scanner resolution and inherent low FDG-avidity of some tumours.ConclusionsThe interpreting physician must be aware of these unusual patterns of FDG uptake, as well as limitations of PET/CT as a modality, in order to avoid overdiagnosis of benign conditions as malignancy, as well as missing out on actual pathology.Teaching points• Knowledge of key imaging features of physiological and non-physiological FDG uptake is essential for the interpretation of head and neck PET/CT studies.• Precise anatomical evaluation and correlation with contrast-enhanced CT, US or MRI avoid PET/CT misinterpretation.• Awareness of unusual FDG uptake patterns avoids overdiagnosis of benign conditions as malignancy.

Pearls and pitfalls of pediatric head trauma imaging

Pearls and pitfalls of pediatric head trauma imaging

Skull base fractures and their complications.

Basilar skull fractures are a relatively frequent occurrence in significant head trauma, and their detection is important, as even linear nondisplaced fractures can be associated with critical complications. The management of skull base fractures depends on the location and extent of these associated complications. This article reviews skull base anatomy; morphology of the common fracture patterns within the anterior, central, and posterior skull base; associated complications; imaging findings; and possible pitfalls in imaging of skull base trauma.

Cerebral Amyloid Angiopathy Related Inflammation: Case Reports and Imaging Pitfalls (P2.105)

Cerebral Amyloid Angiopathy Related Inflammation: Case Reports and Imaging Pitfalls (P2.105)

Comprehensive Review of the Anatomy, Function, and Imaging of the Popliteus and Associated Pathologic Conditions

The popliteus is a relatively small but unique muscle of the knee. It is a component of the posterolateral corner of the knee and acts as a major stabilizer of the posterolateral knee. It is important to be aware of the normal magnetic resonance (MR) imaging appearance of the popliteus musculotendinous complex and its relation to other structures of the posterolateral corner for accurate diagnosis. It is also important to be aware of the pitfalls in imaging of the popliteus. Dysfunction of the popliteus is often underappreciated and is usually secondary to direct or indirect trauma. Injuries of the popliteus can be classified as first-, second-, or third-degree strains. Injuries of the popliteus are often associated with other posterolateral corner injuries. Pathologic conditions of the popliteus may be a clue to other injuries in the knee. The site and pattern of popliteus tear can be helpful to the orthopedic surgeon in deciding whether repair is warranted and determining the approach to surgery and has prognostic implications. Undiagnosed popliteus injuries can lead to poor functional results after knee reconstructive surgery. Inflammatory pathologic conditions of the popliteus may cause knee pain and can be diagnosed with MR imaging. The popliteus is an important component of the posterolateral corner that needs closer attention for optimal diagnosis and patient care.

Pitfalls and Variants in Brain Sonography of Pediatrics

: The application of modern imaging technology and techniques has enhanced detection of pathologic abnormalities on cranial sonography. With improvements in sonographic equipment, visualization of a variety of anatomic variants has become more common. Awareness of these variations is important to avoid pitfalls of misinterpretation. The successful application of modern sonography requires an understanding of technologic advances such as Doppler sonography, linear imaging, and the use of multiple fontanels, as well as knowledge of normal anatomy, variants, and imaging pitfalls that may simulate pathologic abnormalities. In this review article, we will focus on descriptions of important normal brain variants and pitfalls that may mimic pathologic abnormalities that may require additional imaging or clinical follow-up.

Variants and Pitfalls in MR Imaging of Foot and Ankle Injuries

Foot and ankle injuries are very common, particularly among young active athletic individuals. MR imaging has become one of the modalities of choice in the assessment of foot and ankle injuries. Accurate interpretation of MR images and diagnosis of pathology requires familiarity with normal anatomical variants and common diagnostic pitfalls. This article describes the common anatomical variants and technical pitfalls in MR imaging of the foot and ankle.

Variants and Pitfalls in MR Imaging of the Spine

MR imaging is a valuable tool in investigating the spine and is the diagnostic modality of choice in an increasing number of conditions. Advent of newer 3-T machines has taken MR imaging to a different level, with increased image resolution. Higher field strength magnets have also resulted in an increased number of artifacts. A sound knowledge of human anatomy and awareness of the common anatomical variants is an essential prerequisite in MR imaging of the spine because a variety of normal variants and benign conditions may potentially be confused with serious pathologies. This can significantly affect patient management, and it is essential to avoid such misdiagnoses. Identifying and eliminating the common artifacts on MR imaging can result in a significantly improved image quality. Awareness and knowledge of the common variants, common artifacts, and important distinguishing features among similar-appearing pathologies are important in avoiding the various potential pitfalls in spine imaging.

Pitfalls in Imaging of Musculoskeletal Infections

In musculoskeletal infections, imaging helps in the diagnosis and identification of disease extent. Musculoskeletal infections have variable clinical presentations related to host immune responses and virulence of pathogens. Occasionally, infectious process may mimic other entities such as autoimmune inflammatory diseases, tumors, or traumatic injuries, both clinically and radiologically. Identification of the disease extent is sometimes difficult, particularly when infection occurs in the damaged tissue. The key imaging feature of infection is formation of abscesses. Familiarity of the imaging patterns of the infectious process leads to correct diagnosis and appropriate treatment.

Variants and Pitfalls in MR Imaging of Shoulder Injuries

Shoulder MR imaging and MR arthrography are frequently used to evaluate shoulder pain and instability and to assess different types of shoulder injuries. We review different normal variants that can mimic pathologic conditions and some pitfalls that may be encountered in image interpretation. A proper knowledge of normal anatomy is necessary to prevent or minimize errors in diagnosing shoulder injuries.

Pitfalls in MR Imaging of Musculoskeletal Tumors

A wide range of musculoskeletal tumors and tumor-like conditions may be encountered when patients undergo radiologic examinations. Although MR imaging is a powerful medical imaging method that has been used extensively in the evaluation of musculoskeletal tumors, nontumoral or tumorlike lesions may have similar imaging findings. The imaging features of certain normal, reactive, benign neoplastic, inflammatory, traumatic, or degenerative processes in the musculoskeletal system may mimic malignant tumors. Misinterpretation of the imaging findings can lead to inappropriate clinical management of the patient. We review and describe the MR imaging characteristics of nontumoral bone lesions that are located in the marrow cavity, cortical bone, or in both, and soft tissue lesions that may be misinterpreted as sarcoma.

Variants and Pitfalls in MR Imaging of Knee Injuries

MR imaging is an established tool for the detection and diagnosis of various injuries and internal derangements of the knee, enabling excellent anatomical visualization and producing good soft tissue contrast and characterization. However, numerous normal variants and potential pitfalls may lead to diagnostic errors. Understanding the basic MR imaging principles, applying the correct technique, knowing the normal anatomy and variants, recognizing artifacts, and assuring good clinical and radiographic correlation helps avoid these potential pitfalls.

Pitfalls in diagnostic imaging: A case report

The new millennium has witnessed a sea change in diagnostic imaging sciences and the unfortunate 'tilt' toward 'over imaging' and 'over relying' on modern imaging needs to be relooked. This case report emphasizes the need to strengthen conventional diagnostic skills/acumen and the importance of case history taking in all its grandeur as a part of comprehensive patient work up. In this case report of a 7-year-old child, the entire prognosis and treatment outcome was fortuitous since the imaging findings and suspected diagnosis on magnetic resonance imaging were relegated to the findings of history and clinical examination.

2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography/computed tomography imaging in paediatric oncology

Positron emission tomography (PET) is a minimally invasive technique which has been well validated for the diagnosis, staging, monitoring of response to therapy, and disease surveillance of adult oncology patients. Traditionally the value of PET and PET/computed tomography (CT) hybrid imaging has been less clearly defined for paediatric oncology. However recent evidence has emerged regarding the diagnostic utility of these modalities, and they are becoming increasingly important tools in the evaluation and monitoring of children with known or suspected malignant disease. Important indications for 2-deoxy-2-((18)F)fluoro-D-glucose (FDG) PET in paediatric oncology include lymphoma, brain tumours, sarcoma, neuroblastoma, Langerhans cell histiocytosis, urogenital tumours and neurofibromatosis type I. This article aims to review current evidence for the use of FDG PET and PET/CT in these indications. Attention will also be given to technical and logistical issues, the description of common imaging pitfalls, and dosimetric concerns as they relate to paediatric oncology.

Multislice CT Scans in Patients on Extracorporeal Membrane Oxygenation: Emphasis on Hemodynamic Changes and Imaging Pitfalls

This pictorial review provides the principles of extracorporeal membrane oxygenation (ECMO) support and associated CT imaging features with emphasis on the hemodynamic changes and possible imaging pitfalls encountered. It is important that radiologists in ECMO centers apply well-designed imaging protocols and familiarize themselves with post-contrast CT imaging findings in patients on ECMO.

Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers.

The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.

Post-treatment appearances, pitfalls, and patterns of failure in head and neck cancer on FDG PET/CT imaging.

Majority of patients with head and neck cancer are treated with combined treatment regimes such as surgery, radiation therapy, and chemotherapy. The loss of structural symmetry and imaging landmarks as a result of therapy makes post-treatment imaging a daunting task on conventional modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) as well as on 18 Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET/CT). Combined multimodality treatment approach causes various tissue changes that give rise to a spectrum of findings on FDG PET/CT imaging, which are depicted in this atlas along with a few commonly encountered imaging pitfalls. The incremental value of FDG PET/CT in detecting locoregional recurrences in the neck as well as distant failures has also been demonstrated.

Adrenal Venous Sampling in Primary Hyperaldosteronism

Adrenal venous sampling (AVS) is used to distinguish unilateral from bilateral aldosterone hypersecretion as a cause of primary hyperaldosteronism (PHA). This distinction is critical because unilateral disease is treated, and often cured, by adrenalectomy, whereas bilateral hypersecretion should be managed medically. In this article, we review the epidemiology and etiologies of PHA, present screening guidelines for hypertensive patients with suspected PHA, assess the utility and pitfalls of cross-sectional imaging, and discuss the indications for and interpretation of AVS.