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We evaluated the performance of LOINC® and RadLex standard terminologies for covering CT test names from three sites in a health information exchange (HIE) with the eventual goal of building an HIE-based clinical decision support system to alert providers of prior duplicate CTs. Given the goal, the most important parameter to assess was coverage for high frequency exams that were most likely to be repeated. We showed that both LOINC® and RadLex provided sufficient coverage for our use case through calculations of (a) high coverage of 90% and 94%, respectively for the subset of CTs accounting for 99% of exams performed and (b) high concept token coverage (total percentage of exams performed that map to terminologies) of 92% and 95%, respectively. With trends toward greater interoperability, this work may provide a framework for those wishing to map radiology site codes to a standard nomenclature for purposes of tracking resource utilization.

Evaluation of the sella and surrounding structures in pediatric endocrinopathies is best performed with high-resolution magnetic resonance imaging. Adequate assessment relies not only on determining the size and shape of the gland but also on confirming normal signal characteristics and homogeneous parenchymal enhancement. Surrounding structures, including the hypothalamus-infundibulum-stalk and the skull base and midline structures about the cerebral hemispheres, warrant careful attention to identify any associated abnormalities. Tumors, whether they arise in the gland or affect gland function through mass effect, are usually well resolved on today's scanners and imaging provides accurate characterization of these lesions.

As has happened in all facets of neuroimaging, cross-sectional imaging has dramatically changed our approach and understanding of the anatomy and pathology of paranasal sinuses. We have moved away from plain film radiographs to modern high-resolution sinus computerized tomography (CT) and magnetic resonance imaging (MRI) that helps us better depict underlying normal anatomy and evaluate pathology. Recent advances in PET/CT imaging have introduced a physiologic aspect to anatomical imaging and holds promise to better stage and restage head and neck tumors. In this article, we describe the various imaging techniques, concerns, advantages and disadvantages of the individual techniques, and provide an overview of the various pathologies involving the paranasal sinuses., (Copyright 2008 Wiley-Liss, Inc.)

Imaging of the sella and surrounding structures has become essential in the evaluation of pituitary dysfunction and its causes. This article begins with a review of the normal anatomy of the sella and the imaging patterns in and about the normal pituitary gland. There exists considerable variability in the size and configuration of the normal gland in all age groups, and absolute determination of a 'large' or 'small' gland can prove difficult and problematic. Absence of the posterior bright-spot may indicate disruption of the normal stalk transport mechanisms. Microadenomas are well-resolved by magnetic resonance imaging as areas with reduced or delayed enhancement relative to the normal gland. Among hormonally active tumors, adrenocorticotropic hormone-releasing adenomas are most common in the first 11 years of life, while prolactinomas become more common into the teenage years. Macroadenomas tend to present clinically because of mass-effect on adjacent structures, such as the bitemporal hemianopsia seen with optic chiasm compression. Cystic lesions such as Rathke's cleft cysts are commonly seen in the gland, even in healthy children, and their presence need not correlate with any functional abnormality; however, such cysts can cause mass effect on the remaining gland, reflect hemorrhage into adenoma, or actually comprise the central portion of a more worrisome tumor such as craniopharyngioma. Solid tumors of the suprasellar region include optic pathway gliomas, hamartomas, and germinomas. Among inflammatory conditions, granulomatous diseases such as sarcoidosis have predilection for involvement of the suprasellar regions and can spread along perivascular spaces deep within the parenchyma. Because of the association of pituitary endocrinopathies with midline anomalies, one should pay careful attention to midline structures included on a sellar survey.

Background and Purpose: The insula is important for gustatory sensation, motor speech control, vestibular function, and sympathetic control of cardiovascular tone. The purpose of this study was to test two hypotheses: 1) gross anatomic study of the insula will disclose reproducible patterns of insular structure, and 2) analysis of MR appearance will enable physicians to recognize these patterns on imaging studies., Methods: Gross insular anatomy was determined in 16 normal human cadaveric hemispheres. The 1.5-T MR images of 300 insulae were analyzed to determine the gyral and sulcal patterns displayed; their relationship to the Heschl gyrus, to the overlying opercula, and to the vertical planes perpendicular to the Talairach-Tournoux baseline at the anterior commissure (VAC) and posterior commissure (VPC); their continuity into the orbitofrontal cortex; and appropriate landmarks for the anterior border, apex, and posterior border of the insula., Results: MR images displayed the central sulcus of the insula (97%); the anterior (99%), middle (78%), and posterior (98%) short insular gyri that converge to the apex (100%) anteriorly; and the anterior (99%) and posterior (58%) long insular gyri posteriorly. The middle short gyrus was often hypoplastic (33%). The anterior intersections of the internal and external capsules typically delimit the anterior insular border (87%). VAC intersects the anterior insula (99%), usually at the precentral sulcus. The Heschl gyrus circumscribes the posteroinferior insula (100%). VPC demarcates the posterior insular border (94%)., Conclusion: The two hypotheses were proved correct. The insula shows reproducible patterns of gross anatomy that are demonstrable on routine clinical MR images obtained at 1.5 T.

Background and Purpose: The laminar patterns displayed by MR microscopy (MRM) form one basis for the classification of the cytoarchitectonic areas (Brodmann areas). It is plausible that in the future MRM may depict Brodmann areas directly, and not only by inference from gross anatomic location. Our purpose was to depict the laminar cytoarchitecture of excised, formalin-fixed specimens of human cerebral cortex by use of 9.4-T MR and to correlate MR images with histologic stains of the same sections., Methods: Formalin-fixed samples of human sensory isocortex (calcarine, Heschl's, and somatosensory cortices), motor isocortex (hand motor area of M1), polar isocortex (frontal pole), allocortex (hippocampal formation), and transitional periallocortex (retrosplenial cortex) were studied by MRM at 9.4 T with intermediate-weighted pulse sequences for a total overnight acquisition time of 14 hours 17 minutes for each specimen. The same samples were then histologically analyzed to confirm the MR identification of the cortical layers. Curves representing the change in MR signal intensity across the cortex were generated to display the signal intensity profiles for each type of cortex., Results: High-field-strength MR imaging at a spatial resolution of 78 x 78 x 500 micro m resolves the horizontal lamination of isocortex, allocortex, and periallocortex and displays specific intracortical structures such as the external band of Baillarger. The signal intensity profiles demonstrate the greatest hypointensity at the sites of maximum myelin concentration and maximum cell density and show gradations of signal intensity inversely proportional to varying cell density., Conclusion: MRM at 9.4 T depicts important aspects of the cytoarchitecture of normal formalin-fixed human cortex.