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Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated.

To determine normal anatomy of metacarpophalangeal (MCP) joints at ultrasonography (US) and to compare findings with anatomic and histopathologic findings.Right hands of five cadavers (two women, three men; age range at death, 46-96 years; mean age at death, 62 years) and dominant hands of 30 volunteers (15 men, 15 women; age range, 27-74 years; mean age, 43 years) were evaluated. Nonthumb MCP joints were scanned longitudinally and transversely by two musculoskeletal radiologists working independently at US with a high-frequency linear-array transducer (frequency, 12 MHz). US appearances of intraarticular and periarticular structures were analyzed independently by these radiologists. Specimen sectioning provided anatomic and histopathologic comparisons. Interobserver precision was assessed with determination of coefficient of variation (CV).Sagittal US images enabled good visualization of the dorsal metacarpal synovial recess and the metacarpal head cartilage. In 37% of cases, a small depression (mean depth, 0.3 mm) was identified on the dorsal aspect of the metacarpal head, especially at the second MCP joint (19% of cases). Direct visualization of sagittal bands of the extensor hood was possible on dorsal transverse US scans, especially at the second and third MCP joints. In all cases, the first annular pulley was well seen on palmar transverse US scans. The radial collateral ligament of the second MCP joint was better recognized by the two observers than was the ulnar collateral ligament of the fifth MCP joint. Interobserver precision was high (CV range, 1.5%-6.5%) for intraarticular and periarticular structures.US provides detailed information about normal anatomy of nonthumb MCP joints.

To demonstrate the normal and abnormal appearance of the mamillothalamic tract (MTT) on cranial magnetic resonance (MR) images.Two formalin-fixed normal human brain specimens sectioned in axial and coronal planes were used to demonstrate the normal anatomy of the MTT. MR images were obtained in 32 volunteers. Proton-density-weighted coronal and axial pulse sequences were used. The images were evaluated for visualization quality and size and signal intensity of the MTTs in correlation with the specimens. Abnormal MTTs were identified on cranial MR images in two patients, and the imaging findings were analyzed. The clinical history of the patients was also reviewed to determine the effect of these findings on patient care.Normal MTTs were easily identified on MR studies of cadaveric brains and of the brains of the human volunteers. On MR images, normal MTTs were commonly symmetric in appearance, with signal intensity equal to that of other normal fiber tracts. The abnormal MTTs showed high signal intensity on images obtained with a long repetition time or asymmetric volume loss and were associated with atrophy of the ipsilateral mamillary body.Normal MTTs are readily visible on conventional MR images. Abnormality of the MTT is a very subtle finding but may be a marker of a limbic system abnormality.

To compare the subjective visibility of normal anatomy and pathologic structures in the chest on conventional screen-film radiographs versus selenium-based digital radiographs.Screen-film and digital standard posteroanterior (PA) and lateral chest radiographs were obtained in 49 patients (32 men, 17 women; mean age, 60 years; range, 24-91 years) undergoing chest computed tomography (CT). Conventional images were phototimed at 115 kVp with use of a wide-latitude screen-film system and an antiscatter grid. Digital images were obtained at 150 kVp with use of a commercial system with a selenium detector and an air gap alone for scatter reduction. The image sets were independently compared by four radiologists, and the relative visibility of anatomic and pathologic features (proved at CT) was graded. Statistical significance (P.0028) was evaluated with a one-tailed t test.Visibility with the digital images was statistically significantly increased for 11 of 13 normal anatomic features and for pathologic structures in the lung, soft tissue, and bone.Subjective visibility of pathologic structures and most normal anatomic features in the thorax was statistically significantly improved with selenium-based digital chest radiography compared with conventional screen-film chest radiography.

This description of pathology of joints, tendons, and bursae has been prepared as a preliminary to a discussion of irradiation therapy in certain diseases of these structures. Accordingly the subject will be treated in its broadest aspects, with special stress on pathogenesis. It should be emphasized that such an elucidation is greatly hampered by our almost complete lack of knowledge of etiology. An entirely satisfactory or accurate classification cannot be given on a pathological basis without some consideration of etiology. The criteria for diagnoses of most rheumatic diseases are primarily clinical, with secondary consideration being given to the pathological lesions. As our knowledge of this comparatively neglected group of diseases increases, it is probable that more attention will be given to this phase of the subject. In the description to follow, rheumatic fever and tuberculosis will not be considered in any detail. Normal Anatomy While it is not the purpose of this paper to discuss anatomy at an...

To prospectively evaluate the signal intensity (SI), course, and diameter of elbow nerves and to identify anatomic variants that are potentially associated with nerve compression syndromes on magnetic resonance (MR) images of asymptomatic elbows.This study was approved by the institutional review board. Informed consent was obtained from each volunteer. Sixty subjects with asymptomatic elbows (age range, 22.4-51.7 years; median age, 32.8 years) underwent MR imaging. Increased SI compared with surrounding muscles on fluid-sensitive MR images, anatomic course, anatomic nerve and muscle variants potentially associated with nerve compression syndromes, and qualitative changes in nerve diameters were evaluated. Quantitative data on the shortest and longest nerve diameters were obtained.Increased SI on fluid-sensitive MR images was seen in the ulnar nerve in 60% (36 of 60) of subjects but was never observed in the median and radial nerves. An atypical intermuscular course of the median nerve between the brachialis and pronator muscles was detected in 17% (10 of 60) of subjects. Ulnar nerve subluxation at the level of the cubital tunnel was seen in 2% (one of 60) of subjects; an anconeus epitrochlearis muscle, in 23% (14 of 60); and a hypertrophic leash of Henry, in 15% (nine of 60). Median nerve dimensions were 2.4 x 4.0 mm (range, 1.0-4.0 x 3.0-7.0 mm) for the ulnar nerve, 1.0 x 1.9 mm (range, 0.8-2.0 x 0.9-5.0 mm) for the radial nerve, and 3.0 x 5.4 mm (range, 1.0-5.0 x 3.0-9.0 mm) for the median nerve.Increased SI of the ulnar nerve on fluid-sensitive images (60%), an atypical intermuscular course of the median nerve (17%), and an anconeus epitrochlearis muscle (23%) are common MR findings in asymptomatic elbows.

Ultrafast computed tomographic (CT) evaluation of the airway can be performed with either 50-msec low-resolution images (cine CT) or 100-msec high-resolution images (high-resolution CT). To determine the best imaging strategy for ultrafast CT of the pediatric airway, the authors prospectively compared ultrafast CT and endoscopy in 20 children. Both studies were performed in 11 patients; cine CT alone was performed in six and high-resolution CT alone in three. Six patients had normal anatomy. Six patients had focal tracheal stenoses, four had tracheomalacia or laryngomalacia, one had a laryngoesophageal cleft, one had irregularity and narrowing in the subglottic area, one had laryngeal papillomas, and one had focal stenosis with stoma granuloma. Cine CT results agreed with those of endoscopy in 10 of 17 cases. In five cases focal stenosis was misinterpreted with cine CT as tracheomalacia. High-resolution CT results agreed with those of endoscopy in 10 of 14 cases. The results of a technique that combined high-resolution CT for the entire airway and cine CT at selected areas agreed with those of endoscopy in 10 of 11 cases; only a tracheoesophageal cleft was missed with the combined technique. For the greatest diagnostic accuracy with ultrafast CT in evaluation of the pediatric airway, both cine and high-resolution modes should be used.

Three-dimensional (3D) surface renderings of the temporal bone were created from routine axial computed tomographic (CT) images in 15 subjects and in cadaver specimens. The displayed anatomy was correlated with these specimens, as well as with images from the routine study. Six sets of viewing angles were derived for optimal display of surgically important surface landmarks, such as the suprameatal triangle and supramastoid crest. The 3D CT images were found to be of excellent quality and permitted a global view of the temporal bone surface anatomy. Bone depletion artifacts ("pseudoforamina") posed a potentially serious problem in evaluating the tegmen and wall of the sigmoid sulcus, being present in eight of 20 cases. Three-dimensional CT may be a useful adjunct to routine temporal bone imaging.

Magnetic resonance (MR) imaging has proved beneficial in the evaluation of internal derangements of the knee. A limitation to general acceptance of MR imaging of the knee has been availability and cost. The recent introduction of low-field-strength MR imaging has shown promise in decreasing the cost and increasing the availability of this modality. High-resolution (pixel size, 0.7 mm2), three-dimensional Fourier transform (3DFT), thin-section (3.5 mm) imaging performed on a 0.064-T permanent magnet was used to evaluate 117 knees in 114 consecutive patients. The appearance of normal anatomy and internal derangements of the knee at low-field-strength imaging is described. Arthroscopic correlation was available for 28 knees. Findings from low-field-strength MR imaging and arthroscopy agreed in 79% of cases in the determination of meniscal tears. Partial-flip-angle techniques with 3DFT produced thin-section images of the knee of diagnostic quality. The authors conclude that in patients with internal derangements of the knee, low-field-strength (0.064-T) MR imaging may provide useful information.

A retrospective analysis of computed tomographic (CT) and magnetic resonance (MR) images and clinical records of 39 patients with retropharyngeal space (RPS) lesions was completed. The review was undertaken to answer the following questions: (a) what is the spectrum of lesions of the RPS? (b) what imaging features mark a lesion as originating in the RPS? and (c) is there a difference between the radiologic pattern of the suprahyoid and infrahyoid portions of the neck? Of the 39 patients in the study, nine had RPS infections, 17 had RPS malignancies, two had benign tumors, seven had RPS pseudotumors, and four had hematoma or air in the RPS after trauma. RPS lesions demonstrated two distinct radiologic patterns: a nodal pattern and a nonnodal pattern. The nodal pattern, found only in the suprahyoid neck, occurs when infection or tumor begins in the lymph nodes of the RPS. The lesions may be unilateral or bilateral, but the middle part of the RPS is spared. The nonnodal pattern, found primarily in the infrahyoid RPS, results when the infection or tumor directly invades the RPS or goes beyond the nodes of the RPS. The nonnodal lesion appears rectangular and spans the RPS from side to side.

A portable C arm was modified for cone-beam computed tomography (CT). This three-dimensional (3D) CT imaging system facilitated the acquisition of fluoroscopic images during a 190° rotation and computed a 3D data cube (matrix, 256 × 256 × 256; scanning time, 100 seconds) with multiplanar image reformation. The high-contrast resolution, 0.9 line pairs per millimeter, was comparable; the low-contrast resolution, minimal; and the radiation dose, 60%–80% lower, as compared with these parameters at spiral CT. The normal anatomy of small joints could be depicted, and the osteosynthesis screws in the talus were correctly identified. © RSNA, 2002

To demonstrate the normal anatomy of the metacarpophalangeal (MCP) joints of the fingers with magnetic resonance (MR) imaging and MR arthrography in cadavers.MR images of 20 MCP joints of the fingers of five fresh human cadaveric hands in the extended and flexed positions were obtained before and after arthrography. The MR appearances of all articular and periarticular structures were analyzed and compared with those seen on anatomic sections. Two readers independently graded the visibility of these structures. Interobserver agreement was tested by using the kappa statistic.The main collateral ligaments could be best evaluated on the transverse images of flexed fingers. The accessory bands of the collateral ligament complex were best seen on the transverse images of extended fingers. Sagittal MR images were best for evaluating the palmar plate and the capsule. MR arthrography improved the visualization of all articular and periarticular structures. The kappa values related to conventional MR imaging findings at all sequences, 0.42-0.71, indicated moderate to substantial agreement. The kappa values for the MR arthrographic sequences, 0.59-0.74, were slightly higher than those for the nonenhanced sequences.Conventional MR imaging and MR arthrography enable accurate visualization of the important anatomic structures of the MCP joints. MR arthrography enhances visualization of the intraarticular elements.

PURPOSE: To describe the pseudodefect of the distal humerus at the junction of the capitellum and lateral epicondyle, which may simulate an osteochondral lesion on axial and coronal magnetic resonance (MR) images. MATERIALS AND METHODS: MR imaging studies of the elbow in 32 patients and 22 asymptomatic volunteers were retrospectively reviewed. Thirty-two human humeri were also examined for normal anatomy of the junction of the capitellum and distal humerus. RESULTS: Twenty-two of the clinical MR examinations and 14 of the studies on volunteers revealed the presence of the pseudodefect. A groove at the junction and the overhanging lateral edges of the capitellum account for the appearance of this pseudolesion. CONCLUSION: Familiarity with the characteristic appearance and location of this pseudodefect will prevent its misinterpretation as an osteochondral fracture of the distal humerus.

The variety of cervical lymphadenectomy and neck reconstructive procedures that have been developed in the past 20 years has led to confusion about nomenclature in the literature. In addition, some of these operations result in gross alteration of the normal anatomy. The authors review the present classification system for cervical lymph nodes and various lymphadenectomy and reconstructive procedures. Examples of typical postoperative images are given. A protocol for postoperative follow-up is presented, which calls for imaging for 5 years after surgery. Finally, the authors review their experience with 400 cases, 276 of which were initially classified as having no clinical evidence of disease. Recurrence developed in 68 of these (in 62 [91%] within 4-18 months of surgery). Imaging findings altered the postoperative salvage plan in 17 (25%). Clinically occult disease was found at sectional imaging in 47 (17%).

To determine the optimum foot position and imaging plane at magnetic resonance (MR) imaging of each ankle ligament, 10 cadaver ankles were dissected to visualize the orientation, precise attachment sites, and relationships of each ligament. Then eight cadaver ankles were studied with MR imaging and were cryosectioned in the optimum imaging planes. The ankles of 12 healthy volunteers were imaged to ensure consistency in identifying the normal ligaments. With the foot taped into full dorsiflexion of 10 degrees-20 degrees, axial imaging provided optimum views of the anterior, posterior, and inferior tibiofibular ligaments and of the anterior and posterior fibulotalar ligaments and provided an overview of the deltoid ligament. Coronal images provided full-length views of the tibiospring, tibiocalcaneal, and posterior tibiotalar parts of the deltoid ligament. With the foot taped into full plantar flexion of 40 degrees-50 degrees, axial imaging optimized visualization of the fibulocalcaneal ligament and of the tibionavicular and anterior tibiotalar parts of the deltoid ligament. Sagittal images provided the best full-length views of the spring ligament.

The authors describe their initial experience with a dedicated intraluminal ultrasound (US) device that was coupled to a catheter and introduced percutaneously into the gallbladder and/or bile ducts. Access was created with interventional radiologic techniques in 22 patients and at laparoscopy in four patients. Thirty-one examinations in 26 patients revealed information on normal anatomy, pathologic processes, and responses to therapy. The pathologic processes seen included bile duct and gallbladder debris, stones, ductal strictures, and tumors. Additional information provided with this technique over other diagnostic studies included differentiation of intraluminal filling defects, examination of areas inaccessible to conventional imaging, and observations about the walls of the ducts and gallbladder. Percutaneous US examination of metallic stents within the bile ducts and of filling defects in the ducts at laparoscopic cholecystectomy was of particular interest and altered subsequent therapy. The procedure is simple, straightforward, and devoid of complications. While refinements and improvements are needed, this diagnostic technique holds promise.

The utility of oblique views for augmenting standard posteroanterior and lateral double-contrast radiography of the pharynx was examined. Over an 8-month period, two oblique views were added to the standard posteroanterior and lateral views of the pharynx during routine upper gastrointestinal studies in 102 patients divided into two groups. Group 1 consisted of 81 patients without suspected pharyngeal or esophageal disease who demonstrated what was considered to be normal anatomy on all radiographic views. Group 2 consisted of 21 patients who were known or suspected to have pathologic abnormality of the pharynx. The members of this latter group each demonstrated various abnormal pharyngeal anatomy on the standard views. In just over half of these cases the oblique projection contributed significant information not obtained with conventional views. Therefore, the authors conclude that oblique images are a beneficial addition to the diagnostic evaluation of patients highly suspected of having pharyngeal disease.

Normal anatomy of the liver and biliary system technical aspects of CT MRI of the liver malignant liver disease benign masses of the liver diffuse liver disease inflammatory disease and trauma of the liver CT of the biliary tract liver disease in the infant and child interventional radiology in the liver and biliary tract case studies.

A study of the anterior attachments of the respiratory diaphragm was performed using gross anatomic specimens, plain radiography, and computed tomography with multiplanar image reformatting. The anterior portions of the diaphragm are affixed to the lower six ribs and the sternum. The line of attachment of each hemidiaphragm begins at the anterior axillary line and extends cranially and medially to meet at the xiphoid process. These structures can be visualized along with contiguous pathologic subdiaphragmatic and/or infradiaphragmatic air collections. In the semierect patient, free intraabdominal air may preferentially collect in the anterior subdiaphragmatic regions rather than below the domes of the diaphragm, providing a subtle but reliable indication of pneumoperitoneum. An understanding of the normal anatomy of the anterior diaphragmatic attachments is valuable in assessing a variety of anterior paradiaphragmatic air collections.

In 146 adults (88 men, 58 women) with groin pain of uncertain origin and normal physical examinations, herniography disclosed inguinal hernias in 40 (45%) men and in 19 (33%) women. There were no false-positive or false-negative herniographic diagnoses among 20 patients who were operated upon subsequently. These results indicate that herniography is a useful examination in the evaluation of adults with groin pain of obscure origin.

Improved scanning techniques, positioning, and adjustments in instrumentation have been developed on the basis of more than 1,500 ultrasound examinations of the upper abdomen and high retroperitoneum. The latest instrumentation was employed, including gray-scale signal processing and focused transducers. These methods have resulted in improved visualization of normal anatomical structures, including the aorta, inferior vena cava, portal venous system, and major branches of these vessels as well as the common bile duct. Aspects of these techniques are illustrated and their applications and limitations in the differential diagnosis of upper abdominal disease are discussed.

The normal gross and computed tomographic (CT) anatomy of the infrahyoid neck is reviewed. Special emphasis is given to the location of major lymph node chains. Key anatomical levels in the neck are identified, enabling the interpreter of CT scans to place any lesion accurately in space.

Thirty asymptomatic ankles were studied with high-resolution surface coil magnetic resonance (MR) imaging to identify normal structures. Several normal variants were demonstrated, including (a) Cortical irregularity of the posterior tibiotalar joint (should not be mistaken for osteonecrosis) in 27 of 30 cases; (b) normal posterior talofibular ligament with irregular and frayed superior edge simulating a tear in 13 of 30 cases; (c) normal navicular insertion of the posterior tibial tendon with heterogeneous signal intensity in 14 of 30 cases; (d) deltoid ligament inhomogeneity in seven of ten cases; and (e) fluid in the shared peroneal tendons sheath (may be confused with a longitudinal tendon tear) in three of 30 cases. Ankle imaging with the use of MR is still a relatively new procedure. Further investigation is needed to better define normal anatomy and normal variants.

High-resolution magnetic resonance (MR) images of the hands and wrists of six healthy volunteers were obtained at 1.5 T with a surface coil. Additionally, the hands and wrists of two fresh cadavers were imaged and were subsequently sectioned for anatomic correlation. High contrast when depicting soft-tissue, coupled with impressive spatial resolution and multiplanar capabilities, enabled delineation of fine structures including nerves, tendons, and blood vessels. Osseous and cartilaginous structures were also well depicted. MR imaging gives anatomic definition of the hand and wrist unmatched by other diagnostic imaging methods.

High-resolution magnetic resonance (MR) imaging with a surface coil was utilized to evaluate the normal scrotum. Scrotal contents, spermatic canal, and inguinal regions were visualized within the same field of view. Differences in signal intensity in the testis, epididymis, tunica albuginea, fluid, fat, and spermatic cord allowed for clear delineation of these structures in detail. The high contrast and spatial resolution of MR imaging, coupled with the wide field of view and absence of ionizing radiation, make MR imaging well suited for evaluation of the scrotum.

Computed tomography (CT) was used to obtain images of the vertebrae and spinal canal. The normal CT anatomy of the lower spinal canal is demonstrated. Examples of spinal stenosis caused by degenerative spondylosis, post-fusion hypertrophy, and pseudospondylolisthesis are presented.

To enhance the efficacy of magnetic resonance (MR) imaging in evaluating articular soft-tissue structures, arthrography was performed before imaging 45 fresh cadaveric specimens. Contrast agents used were gadolinium-DTPA, 0.9% saline, diatrizoate, and air. MR imaging was performed with and without intraarticular contrast material, and specimens were subsequently sectioned in the same plane. Gd-DTPA was the most effective agent. Saline and diatrizoate exhibited equivalent signal behavior and necessitated T2-weighted sequences, while air was not useful. Depiction of normal anatomy was enhanced with MR arthrography. After surgical creation of lesions in selected specimens, subtle tears were delineated exclusively with MR arthrography, and major tears were diagnosed more confidently. Intraarticular contrast material may enhance the diagnostic capabilities of MR imaging in the setting of joint disease.

A model of the normal anatomy of the capsular attachments of the posterior horn of the lateral meniscus is developed based upon anatomic dissections. The term "fascicles" is applied to the delicate bands of connective tissue which join the posterior lateral meniscus to the joint capsule around the popliteal synovial sheath. The normal anatomic arrangement is illustrated with double contrast arthrograms. Abnormalities of the posterior horn of the lateral meniscus are then demonstrated, emphasizing disturbances of attachment around the popliteal sheath.

The Kock continent ileal urinary reservoir (Kock pouch) is a new urinary bypass system that can overcome some of the principal complications associated with other forms of urinary diversion. It is important to understand the anatomy and radiology of this new technique since radiologists play an important role in evaluating the function of the Kock pouch as well as assessing its complications. The authors review the clinical and radiographic findings in 193 patients who had undergone Kock pouch urinary diversion. Patients are evaluated radiographically in the immediate postoperative period and at regular postoperative intervals for as long as 3 years. Routine evaluation consists of Kock pouch cystography followed by intravenous urography. When indicated, computed tomography, ultrasound, and interventional radiologic procedures are used. The normal anatomy as well as the radiographic appearance of the Kock pouch is presented. In addition, the radiographic appearance of pouch complications and their frequency are reviewed.

The appearance of the vagina was evaluated on magnetic resonance (MR) images of 65 subjects who were healthy or had disease unrelated to the vagina and 24 patients with suspected congenital anomalies of the vagina. MR imaging accurately demonstrated the presence of (n = 78) or complete (n = 7) or partial (n = 4) absence of the vagina in each case. Partial (n = 2) or complete (n = 2) duplication of the vagina was also correctly diagnosed. Regardless of field strength, T2-predominant images were essential for evaluation. The transverse plane was optimal, and a 5-mm section thickness was preferable. Estrogen stimulation affected the appearance of the vagina: The contrast between the vaginal wall and the central mucus-containing area was greatest during the early proliferative and late secretory phases. MR imaging offers unique depiction of congenital anomalies and should be used when results of physical examination or other radiologic studies, such as ultrasound, are inconclusive.

The authors developed new techniques for three-dimensional display of magnetic resonance (MR) images that preserve soft-tissue definition, are fully automatic, and work with routinely used section thicknesses. MR images are segmented, selectively enhanced, and displayed by means of a volumetric rendering algorithm. These techniques were used to illustrate normal anatomy of the brain, knee, and liver. Three-dimensional rendering of balanced spin-echo images shows the ventricles and extracerebral veins and of T1-weighted images, the sulci and gyri. The large hepatic and portal vessels can be seen with these enhancement techniques. Three-dimensional views of the knee reveal articular surfaces of the tibia and clearly depict menisci and posterior and anterior cruciate ligaments. These techniques make it possible to image multiple soft tissues simultaneously while preserving the detail contained in the original images. Three-dimensional presentation of complex, overlapping anatomic regions is helpful in surgical planning and should lead to improved diagnosis.

DETAILED examination of the hepatic arterial tree can often demonstrate diseases of the liver not readily diagnosed by other means. In many cases, selective arterial catheterization may be the most important study leading to a definitive diagnosis. If hepatic surgery or chemotherapy is contemplated, it is most desirable to outline the normal vascular anatomy and variations of the hepatic arterial tree. This presentation will illustrate various catheterization technics for selective celiac and hepatic arteriography. In a series of cases the normal anatomy and anatomic variations will be dearly demonstrated, as well as a variety of pathological conditions with emphasis on primary and secondary neoplastic processes. Diagnostic criteria of these lesions will be discussed. Methods Arterial catheterization may be performed by either the needle replacement technic or a cut-down technic (1, 2). A polyethylene, nylon, or Teflon catheter with a preformed tip is inserted via the femoral, axillary, or brachial artery...

THE literature contains a vast number of articles on the extra-hepatic biliary system and suggestions have been made in many of the more recent references indicating the existence of definite functional disorders of this system.2 The present paper is a brief review of the investigations published to date on these abnormal physiologic states. First, it will be necessary, however, to summarize the available material relating to the normal anatomy and physiology of this system as directly related to the subject under discussion. Anatomy The extra-hepatic biliary system is composed of gall bladder, ducts, and sphincter. The gall bladder is not a diverticulum, but a hollow viscus with a mean capacity of 40 c.c. There is considerable variability of the size, shape, and position of the gall bladder which is dependent upon the general bodily habitus, and the physiological status, that is, state of filling. In the hypersthenic individual the gall bladder is apt to be globular, while in the asthenic person it is us...

The Systems Approach adopted by the University of Southern California School of Medicine involves the integration of a number of disciplines. For the radiologist this creates the challenge of teaching first-year medical students anatomy from radiographs. Units of material are presented in three parts. an anatomical lecture using diagrams, a laboratory session using prosected material, and a presentation of the material on slides of radiographs. Normal anatomy is taught by showing it in conjunction with pathological material. The student response to this approach has been enthusiastic.

Myelography is not entirely satisfactory for the preoperative diagnosis of spinal cord vascular malformations. The linear, serpiginous filling defects first described by Guillain and Alajouanine (1) are by no means constant or pathognomonic findings. Lombardi and Migliavacca (2) reported positive myelographic findings in 15 out of 18 spinal angiomas, Teng and Papatheodorou (3) in 6 out of 12 cases, and Verbiest and Calliauw (4) in only 3 of their 12 cases. Iodophendylate (Pantopaque) myelography may also lead to false-positive diagnoses, e.g., vascular malformations in cases of tumor or other lesions with dilated vessels. Nor is gas myelography of any use in the diagnosis of these malformations (5). Prior Investigatioks The diagnostic inadequacies in handling the spinal cord vascular malformations spurred this investigation. We believe, however, that some knowledge of the normal anatomy of the spinal cord vascularization is indispensable for a better understanding of the pathologic anatomy of the lesions....

Soft-tissue study of the colon and paracolonic gutters is at times a fruitful source of information for the radiologist. Good roentgenograms are a necessity; these can be produced most consistently by properly planned, functioning, and utilized phototiming. It is precisely those cases with a disturbed ratio of abdominal gas to fluid which make the greatest demands on radiographic technic and best illustrate the virtues of phototiming. Normal Anatomy The wall of the colon is often visualized on the plain roentgenogram or the barium enema examination, especially the evacuation study (Fig. 1, A). The wall of the distended bowel should not exceed 1 or 2 mm. in thickness. When contracted, however, as in the evacuation study following a tannic acid-barium enema, it may reach 7 mm. Small, spotty amounts of intraluminal gas prove an unreliable contrast medium for estimating the thickness of the colonic wall in any of its segments. In the ascending and transverse portions, not even abundant gas is dependable, thou...

Although the posterior pituitary is rarely identifiable in the frontal projection, the gland may occasionally be visualized on the lateral view of carotid arteriograms, generally under conditions of clinical stress; otherwise, the posterior pituitary generally appears as a homogeneous stain which is not always distinguishable from parasellar sinuses. The authors believe this to be the first report of visualization of the posterior pituitary at ordinary angiography. The normal anatomy of the posterior pituitary is described, including a comparison between functional physiology and static postmortem descriptions.

Blow-out fracture of the floor of the orbit occurs when a blow directed against the eyeball is transmitted with sufficient force to the orbital floor to rupture its weaker portions. Internal orbital fractures of this type tend to be overlooked because of the severity of other injuries, or because they are masked by the associated swelling of the surrounding tissues. Early detection of fracture of the orbital floor depends upon thorough roent- genographic examination and familiarity with the roentgen findings. Serious ocular dysfunction and cosmetic deformity frequently follow unless the normal anatomy of the orbit is promptly restored. In 1889, Lang (5) called attention to the association of post-traumatic enophthalmos and fracture of the floor of the orbit. In 1943, Pfeiffer (9) reported a series of 120 cases of orbital fracture, in 53 of which enophthalmos developed. In 24 of these, the fracture involved only the floor of the orbit with the rim remaining intact. Converse and Smith (1, 2) have made notab...

Magnetic resonance (MR) imaging of the head and neck is becoming an important aid in evaluating pathologic conditions of the brain, midface, and pharynx. Certain dental materials cause artifacts during MR imaging of the lower midface. These artifacts can obscure the normal anatomy. This study describes the degree of artifact production caused by various materials commonly used in dental restorations. Of the materials tested, those causing artifacts were made of stainless steel, such as orthodontic bands used for braces, and pins or posts that are commonly drilled into teeth to provide structure or stability before filling. Materials used as temporary or permanent fillings or crowns--such as amalgam, gold alloy, aluminum, microfilled resin, and polyvinyl acrylics--did not cause artifacts in the images.

The normal anatomy of the larynx and base of the tongue as seen on nuclear magnetic resonance (NMR) images was studied. Scans of normal volunteers were obtained using a 3.5 kilogauss (0.35 T) superconductive magnet and a 3.0 kilogauss (0.3 T) permanent magnet. The NMR images were compared with images obtained by CT and with anatomical sections of these regions. Although resolution is not comparable to that seen on scans obtained with modern CT equipment, there are some advantages to NMR imaging. These include availability of multiple projections, ease of identifying blood vessels and differentiating them from lymph nodes, and the possibility of improved tissue specificity.

THE use of the microscope in the study of the structures of the human body and in the diagnosis of disease has become so universal that training in microscopy is now a matter of routine in premedical and medical studies. The use of the roentgen ray in the study of normal anatomy and physiology is fast assuming a place of equal importance with the microscope. The roentgen ray in the diagnosis of pathologic conditions has already assumed a position of co-equal importance with the microscope. Years ago in medical colleges microscopy was classed as an elective study, a condition which gradually changed, until now the study of minute lesions and their consequences is a matter of daily routine. As roentgenologists we must face the problem of advancing the study of roentgenology in our under-graduate course, otherwise students will be graduated with a serious handicap. The roentgenogram and fluoroscope furnish as important methods of studying anatomy, physiology, and gross pathology, both living and dead, as the...

Radiological diagnosis of exceptionally large gastric ulcers has been a source of confusion and embarrassment for the radiologist over the years. We have recently had 5 cases of large peptic ulcers which were associated with prominent central filling defects. Frequently there is so much distortion of normal anatomy that it is difficult to recognize the ulcer crater. The barium, in most of the cases, appeared segmented into three parts, and the middle segment contained the filling defect. This was so prominent, in some of the cases, as to lead to the diagnosis of a polypoid growth. Knowledge of the surgical findings in 2 instances led to a correct interpretation of 2 others. Case History Case I: M. P. was a 41-year-old female who had several nonspecific complaints with only intermittent epigastric pain sometimes relieved by milk or alkali. She vomited a large amount of blood in the doctor's office and was taken to the hospital in shock. Transfusions were given, and three days later an upper gastrointestina...

Thin (1.5- and 5.0-mm) section contiguous computed tomographic (CT) scans obtained through the basilar segmental bronchi in 31 patients were reviewed in order to delineate normal anatomy and common variations of lower lobe airways. In each case, the frequency with which individual segmental and subsegmental bronchi were seen was established, as were variations in branching patterns. All basilar segmental bronchi were identified except in one case in which images of the left lung were obscured due to respiratory and cardiac motion. In the right lung, a division into subsegmental bronchi was identified in 84 of 150 (56%) visualized segmental bronchi. Six separate patterns of basilar segmental subdivision were found. In the left lung, subsegmental bronchi were identified arising from 51 of 145 (35%) visualized segmental bronchi. Five separate patterns of bronchial subdivision were found in the left lung. It is concluded that thin-section CT allows precise identification of all basilar segmental bronchi and, consequently, can play a significant role in the cross-sectional evaluation of lower lobe bronchial and parenchymal abnormalities.

The ultrasonographic (US) appearance of the normal small bowel mesenteric leaves was evaluated in two in vitro studies and in 30 patients. Such structures had an elongated shape, echogenic surfaces, and small vessels in their center and could be recognized in 28 of the 30 patients. They did not show active movements, and at their distal end, the small bowel loops could be seen and peristalsis detected. Doppler signals were obtained from the small vascular structures in their center in three additional cases. On the basis of these anatomic findings, pathologic changes such as lymphoma, desmoid tumor, metastatic lesions, dilated vessels, and edema could be detected in 15 patients. When examining with US patients with diseases prone to involve the mesentery, careful attention should be given to this structure, since useful information about the abdominal spread of the disease can be obtained.

Magnetic resonance (MR) images of the brainstem region from 100 normal or asymptomatic individuals were reviewed in addition to those of 17 patients with intra-axial brainstem lesions and 15 patients with extra-axial masses around the brainstem. MR was able to demonstrate consistently the normal anatomy of the brainstem and adjacent cisterns, though the distinction between gray and white matter was seldom possible with the present technology. Masses in and around the brainstem were all accurately identified on MR and its sensitivity was superior to that of x-ray computed tomography (CT). These study results show that despite its technical limitations, MR is presently the examination of choice for the evaluation of brainstem abnormalities and eventually it will undoubtedly replace metrizamide CT cisternography.