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Trauma is the third leading cause of death in the USA and the leading cause of death for those under 40 years of age. Approximately 25% of trauma deaths result from thoracic injuries. In the USA each year, more than 300,000 patients are hospitalized and more than 25,000 die as a consequence of chest trauma [1-3]. Blunt trauma accounts for 90% of chest trauma and the most common causes of blunt trauma are motor-vehicle collisions and falls [4, 5]. [ABSTRACT FROM AUTHOR]

The left aortic arch with an aberrant right subclavian artery is the most common congenital abnormality of the aortic arch vessels and occurs in about 0.5-2% of the population [1, 2] (Fig. 1). The right subclavian artery is the last of the major arteries to arise from the aortic arch; thus, the order of branching is right common carotid, left common carotid, left subclavian, and right subclavian. A diverticulum-like outpouching, referred to as a Kommerell diverticulum, may be seen at the site of origin of the aberrant vessel. Patients are usually asymptomatic, since this lesion does not represent a true vascular-ring anomaly. [ABSTRACT FROM AUTHOR]

Radiation dose is a contentious issue in pediatrics, as it is well-established that the lifetime cancer mortality risks attributable to CT examinations are considerably higher than for adults. As proposed by the ALARA principle ‘as low as reasonably achievable', the selection of appropriate scanning parameters focuses on the optimization of image quality whilst delivering the lowest possible radiation dose and shifting the risk-benefit balance towards benefit. [ABSTRACT FROM AUTHOR]

During infant respiration, not only the diameter but also the shape of the trachea may change dramatically. On expiration, the trachea often assumes a buckled configuration that deviates in an angular manner away from the side of the aortic arch at the level of the thoracic inlet. In addition, angular buckling associated with a widening of the pre-vertebral, retropharyngeal, and retrolaryngeal soft tissues may occur posteriorly and inferiorly at the thoracic inlet [1]. In fact, the width of the prevertebral soft tissues may increase to at least twice the AP width of the cervical vertebral bodies on expiration. This soft-tissue fullness may also be noted with flexion of the neck. As the infant matures, the amount of soft tissue decreases. [ABSTRACT FROM AUTHOR]

The gold standard among breast imaging techniques is mammography, which is a plain-film X-ray examination. The routine use of mammographic screening for clinically occult breast cancer is widespread, primarily due to favorable results from multiple randomized controlled trials and the development of improved methods of preoperative needle biopsy and localization. A large percentage of radiologists interpret mammograms, and daily caseloads in many practices involve 50 or more such examinations per day. Screening examinations comprise more than 75% of all mammography performed in most developed countries. As a result, the majority of detected lesions, both benign and malignant, are small and nonpalpable. In most general radiology practices, mammography accounts for at least 10% (sometimes as much as 20%) of all examinations performed. [ABSTRACT FROM AUTHOR]

Interventional radiology in the thorax is widespread. Although most people associate the practice with nonvascular interventions, such as lung biopsy, in fact, a huge variety of different nonvascular and vascular interventions are performed within thoracic structures (Tables 1, 2), and more, such as radiofrequency ablation of lung tumors, will probably come into the field. In the following, some of the most essential interventions are discussed. [ABSTRACT FROM AUTHOR]

Percutaneous lung biopsy was first described by Leyden, in 1883, and was carried out in order to establish the infectious nature of lung disease. Currently, percutaneous tissue sampling of a pulmonary, pleural, or mediastinal lesion is indicated when histological diagnosis will further influence the diagnostic strategy and therapeutic options, or modify tumor staging and the sequence of cancer treatment. Cost efficiency by shortening hospital stay has also been demonstrated [1]. [ABSTRACT FROM AUTHOR]

Recent advances in diagnostic radiology have radically altered the approach to the diagnosis of congenital heart disease (CHD). Sophisticated trans-thoracic and trans-esophageal echocardiography is perhaps the best-known example. Additionally, state of the art magnetic resonance (MR) and multidetector computed tomography (CT) scanners, each with cardiac packages, can render diagnostic angiocardiography unnecessary at times. With an accurate diagnosis, interventional angiocardiography, embolotherapy, surgical correction, or even cardiac transplantation can be accomplished for palliation or cure. [ABSTRACT FROM AUTHOR]

Over the past decades, conventional coronary angiography has been the only accepted ‘gold standard' method for clinical imaging of coronary artery disease (CAD). However, coronary angiography is costly, causes patient discomfort, and is associated with a small but distinct procedure-related morbidity (1.5%) and mortality (0.15%). Moreover, the accuracy of coronary angiography is severely hampered by significant intraobserver as well as interobserver variability in defining the anatomic relevance of stenoses (up to 50%) [1, 2] — a problem that is underlined by the poor correlation with post-mortem coronary pathology findings [3, 4]. In addition, angiographic findings are unable to predict the physiologic relevance of a coronary stenosis [2, 5-8]. [ABSTRACT FROM AUTHOR]

Cardiovascular magnetic resonance (CMR) is a developing field with enormous potential because of its major attributes of high image quality and resolution combined with non-ionising radiation and versatility. With recent major technological advances, there have been great improvements in acquisition speed and quality that makes the use of CMR in a wide range of cardiac conditions robust and valuable. This article reviews the fundamentals of CMR and its current clinical applications. [ABSTRACT FROM AUTHOR]

Magnetic resonance (MR) imaging is widely recognized as providung an accurate and reliable means of assessing the function and anatomy of the heart and great vessels. Previously, the means to obtain images of the cardiovascular system were compromised by extremely long examination times and software that was available only at specialized centers. With the recent development of specialized cardiovascular MR scanners, cardiac MR applications have become more widely used on a routine basis. In this article, the technical aspects of MR scanning of the cardiovascular system are outlined, followed by a discussion of its applications to the heart and aorta. [ABSTRACT FROM AUTHOR]

A number of imaging techniques are available for evaluating the thorax. Currently, conventional and digital chest radiography, multidetector-row computed tomography (MDCT), and magnetic resonance imaging (MRI) are the most widely used. The particular focus of the chest radiologist is imaging of the lungs, mediastinum, chest wall, and large vessels, with less attention given to the interpretation of cardiac and pericardiac diseases. The purpose of this article is to draw attention to those cardiac/pericardial diseases that can be detected on MDCT and MRI of the chest. A short description of the technology will be provided, followed by a discussion of the normal cardiovascular anatomy and the presentation of case material to illustrate the most common diseases that can be diagnosed. [ABSTRACT FROM AUTHOR]

Thoracic vascular imaging is moving away from catheter angiography towards non-invasive techniques, and in particular computed tomography angiography (CTA). The three-dimensional imaging capabilities of CT and its ease of use have been the main reason for this change. However, 3D imaging is not limited to the vascular system; it also has useful but underused applications in routine chest CT, high-resolution CT (HRCT), or trauma cases. This article will present the basic rules for data acquisition for 3D imaging in chest CT and CTA, briefly discuss the various techniques for exploring a 3D data set, and finally focus on clinical applications that can improve chest imaging in daily routine as well as in situations in which it is important to gain as much information as possible about the three-dimensional extent of the anatomy and pathology of interest. [ABSTRACT FROM AUTHOR]

Modern day CT angiography (CTA) has replaced diagnostic angiography for the evaluation of thoracic aortic diseases. The development of CTA with retrospective ECG gating has been driven by coronary artery CTA, but it also provides significant benefits to imaging of the thoracic aorta. Retrospective ECG gating virtually eliminates cardiac pulsation artifacts and has therefore extended the clinical applicability of CTA to finally also include the aortic root. Moreover, ECG gating allows cardiac phase-resolved (‘timeresolved') cine imaging and visualization, adding a ‘fourth dimension' (4D) to this technique. [ABSTRACT FROM AUTHOR]

The following review focuses on pulmonary manifestations of granulomatous diseases (sarcoidosis), connective tissue diseases, vasculitis (Wegener granulomatosis and Church-Strauss), and Goodpasture syndrome. Rare pulmonary manifestations associated with other diseases, such as tuberous sclerosis and lymphangioleiomyomatosis, Erdheim-Chester disease (rare non-Langerhans cell histiocytosis), storage diseases (Gaucher, Niemann Pick), systemic amyloidosis, and relapsing polychondritis, as well as manifestations of neoplastic diseases (e.g., lymphoma) are not considered herein. Langerhans cell histiocytosis shows a pulmonary involvement that is associated with a systemic manifestation only in children and not in adults. [ABSTRACT FROM AUTHOR]

There are numerous systemic diseases, both acquired and hereditary, that affect the thorax. The many radiologic manifestations of these diseases may involve the lungs and pleura as well as cardiovascular, neurologic, hematologic and osseous structures of the thorax. What follows is a summary of the more common of these entities. [ABSTRACT FROM AUTHOR]

In contrast to the visceral organs (lung, mediastinum), the symmetry of the chest wall allows radiographic detection of tiny changes overlaying the deeper structures. Except in skeletal disease, calcification, and emphysema, chest radiography will often only reveal nonspecific signs, whereas sectional methods, i.e., ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), permit the identification, characterization, and assessment of many diseases. [ABSTRACT FROM AUTHOR]

High-resolution computed tomography (HRCT) is rightly considered by radiologists and physicians to be an important technique in the investigation of patients with suspected diffuse lung disease. In those cases in which biopsy would previously have been mandatory, the diagnostic process has been revolutionized by HRCT. For example, in patients with the entity of usual interstitial pneumonia, the appearance of the disease on HRCT is characteristic enough for an accurate radiological diagnosis to be made, rendering biopsy unnecessary [1-3]. A similar scenario is the patient with suspected sarcoidosis; in such cases the HRCT images will allow a radiological diagnosis to be made with greater confidence, again obviating the need for more invasive procedures. [ABSTRACT FROM AUTHOR]

Imaging in the intensive care unit (ICU) has to deal with several disorders affecting the critically ill patient. In such patients, one or more organs are so compromised that management requires continuous monitoring of vital functions and their support through external devices, either mechanical or pharmacological. Above all, two functions of exceeding importance are often impaired and require external support: respiration and circulation. The task frequently involves the use of mechanical instruments and the administration of fluids and drugs, in turn, may interfere with, or even damage thoracic organs and structures. [ABSTRACT FROM AUTHOR]

Radiology has always been involved with the analysis of the pulmonary vasculature. A chest radiograph is a unique piece of information since it is the only radiographic examination that can depict veins and arteries without the need to inject a contrast agent. Instead, the natural contrast between the density of air and water permits excellent analysis of the vessels in the lungs. [ABSTRACT FROM AUTHOR]

Pulmonary infections are one of the most frequent causes of morbidity and mortality throughout the world. In the immune-competent population, pneumonia is a major infectious disease, either in the more prevalent community-acquired form or as a nosocomial complication. [ABSTRACT FROM AUTHOR]

This paper reviews the common spectrum of disorders of the neonatal chest. Emphasis is on radiographic changes that have been produced by the introduction of new therapeutic maneuvers, particularly the use of artificial surfactant in treating hyaline membrane disease and the survival of profoundly premature newborns (less than 650 grams). A discussion of meconium aspiration syndrome, neonatal pneumonia, transient tachypnea of the newborn, congenital lymphangiectasia and congenital heart disease is also included. The effect on the neonatal chest radiograph of extracorporeal membrane oxygenation and high frequency ventilation are also mentioned [1]. A review of' surgical' lesions is also included [2]. [ABSTRACT FROM AUTHOR]

This article reviews the applications of CT in the evaluation of common chest problems in children, in particular mediastinal masses and congenital lung anomalies. Normal anatomy and anatomic variants and CT techniques are also discussed. [ABSTRACT FROM AUTHOR]

Imaging of the airways with 2D and 3D reconstructions has significantly improved with the advent of multidetector-row computed tomography (MDCT) scanners. These scanners allow for volumetric acquisition of isotropic datasets. As a result, the scanning time is significantly reduced, and large anatomic regions are covered within seconds with optimal intravenous contrast material enhancement. MDCT scanners have significantly improved the image quality by dramatically reducing artifacts resulting from partial volume averaging and motion. Additionally, fast and user-friendly scanner workstations allow for post-processing of impressive multiplanar 2D and 3D reconstructions, which are desirable to clinicians for comprehensive pre-surgical planning purposes [1, 2]. [ABSTRACT FROM AUTHOR]

Multidetector computed tomography (MDCT) using thin collimation during a single breath hold has become the best imaging technique for assessing airway diseases. Volumetric high-resolution data sets provide a precise morphologic evaluation of both proximal and distal airways. The term ‘airway diseases' covers acute and chronic inflammatory disorders as well as the fibrotic sequelae involving proximal and/or distal airways. Large-airway diseases include tracheal disorders, bronchiectasis, and broncholithiasis. Small-airway diseases include all infectious or inflammatory diseases involving the bronchioles. MDCT can also play a role in assessing obstructive lung diseases, a group of diffuse conditions associated with chronic airflow obstruction that includes chronic obstructive pulmonary disease (COPD), asthma, and obliterative bronchiolitis. [ABSTRACT FROM AUTHOR]

The spectrum of diseases that affect the airways is immense, ranging from disorders of the trachea to diseases of the respiratory bronchioles. Moreover, the investigation of airway diseases is challenging to both physiologists and physicians, especially when dealing with small-airway diseases. [ABSTRACT FROM AUTHOR]

Knowledge of the normal mediastinal anatomy and its variants is indispensable for proper interpretation of chest radiology. Mediastinal masses may be found incidentally in asymptomatic individuals, but they can also be symptomatic, depending on their size and location. Cross-sectional imaging with computed tomography (CT) and magnetic resonance (MR) imaging plays an important role in the nonsurgical evaluation of mediastinal lesions. [ABSTRACT FROM AUTHOR]

The possible diagnoses of a solitary pulmonary nodule are numerous (Table 1), but over 95% fall into one of three groups: 1.Malignant neoplasm, either primary or metastatic2.Infectious granulomas, either tuberculous or fungal3.Benign tumors, notably hamartomas. [ABSTRACT FROM AUTHOR]

Thoracic imaging has an important role in the evaluation of patients with lung cancer: it is used in the detection, diagnosis, and staging of the disease as well as in assessing the response to therapy and monitoring for tumor recurrence after treatment. This article reviews the diagnosis and staging of non-small-cell lung cancer (NSCLC), emphasizing the appropriate use of computer tomography (CT), magnetic resonance (MR), and positron emission tomography (PET) imaging in patient management. [ABSTRACT FROM AUTHOR]

The suspicion or diagnosis, even if it is nonspecific, of an abdominal mass in a child raises concern and anxiety. The pediatric radiologist may be the first person either to suspect or to diagnose a mass, quite commonly by ultrasonography (US). Therefore, adequate psychological interaction with the patient and the parent(s) is part of his or her professional competence. The findings should generally not be discussed while the examination is underway. Specific diagnostic statements should be avoided, even by the experienced examiner. Caution should be exercised before giving preliminary histological and prognostic hypotheses. The involved clinician, possibly the oncologist, should be informed promptly about the morphological findings and the information exchanged between the examiner and the patient and/or accompanying parent(s). This regards the situation of a suspicious mass that has been demonstrated and where a malignant process might exist or be likely. If the mass turns out to be a hydronephrosis or a similar obviously benign process, such concerns are less relevant. [ABSTRACT FROM AUTHOR]

Intussusception is not an uncommon phenomenon in children and is one of the commoner causes of the acute abdomen between six months and five years of age. The vast majority of intussusceptions arise in the ileum and are either ileocolic or ileo-ileocolic. They are thought to occur because of hyperplasia of the lymphoid tissue in the ileum, possibly as a result of a viral infection [1, 2]. [ABSTRACT FROM AUTHOR]

Sonography is usually the first imaging modality applied and is a powerful tool for the evaluation of infants and children suspected of having genitourinary tract anomalies. The intention of this lecture is to provide a broad overview of common genitourinary anomalies and to highlight the strength of ultrasound for the evaluation of these conditions. [ABSTRACT FROM AUTHOR]

Thanks to improving technology and experience, sonographic surveying of fetal development is now more accurate and precise. Further, more anomalies are detected, allowing the adaptation of postnatal management, if necessary. [ABSTRACT FROM AUTHOR]

Percutaneous biopsies and drainages of abdominal fluid collections are standard procedures that are mainly performed under ultrasound (US) and computed tomography (CT) guidance. [ABSTRACT FROM AUTHOR]

Abdominal vascular imaging is moving away from catheter angiography towards computed tomographic angiography (CTA), and to a lesser degree, magnetic resonance angiography (MRA) or ultrasound. Ultrasound used to be performed mainly in young patients and in acute settings, but computed tomography (CT) is starting to take over most of the work in patients with acute abdomen. MRA remains a good technique for follow-up of stented aortic aneurysms and for the detection of renal artery stenoses. Its ease and speed has led to CT becoming the technique of choice for the vast majority of indications in abdominal vascular imaging. [ABSTRACT FROM AUTHOR]

Following the development of breath-hold, contrast-enhanced techniques, magnetic resonance angiography (MRA) has become an important tool for the evaluation of patients with abdominal vascular pathology. Specifically, the lack of ionizing radiation, lack of nephrotoxic contrast media and the non-invasive nature of MRA make it a useful modality for abdominal vascular pathology. The objective of this work is to describe the acquisition techniques, relevant anatomy, and pathologic conditions for accurate application of MRA in the abdomen. [ABSTRACT FROM AUTHOR]

Prostate cancer continues to be the leading cancer among American men, with 184,500 new cases annually [1]. It has been estimated that 39,200 men died of prostate cancer in the U.S.A. in 1998. This makes prostate cancer the second cause of cancer-related death in men [2, 3]. Furthermore, the probability of developing prostate cancer from birth to death is 20% [3]. Treatment selection is dependent on patient age and health, cancer stage and grade, morbidity and mortality of treatment, as well as patient and physician preference. The mainstay for organ-confined disease is either radical surgery or curative radiotherapy [4, 5]. This is only considered an option in the absence of seminal vesicle infiltration (SVI), extension through the prostatic capsule (extracapsular extension, ECE) or metastatic disease. Therefore, the purpose of staging is the possible detection of extraprostatic disease. Clinical staging by digital rectal examination (DRE) and prostate specific antigen (PSA) remains as yet inaccurate. Imaging modalities such as transrectal ultrasound (TRUS) and magnetic resonance (MR) imaging can be used to increase staging accuracy. [ABSTRACT FROM AUTHOR]

Neoplastic disease may spread within the abdomen by embolic metastasis, lymphatic extension, direct invasion, and intraperitoneal seeding. Direct invasion may occur from contiguous primary tumors and usually implies that a locally aggressive tumor has broken through fascial planes. Direct invasion from non-contiguous primary tumors typically occurs via spread along the peritoneal ligaments and mesenteries. Intraperitoneal spread of malignancy occurs initially through seeding of the peritoneal cavity with metastatic cells. Tumor spread occurs via the natural flow of ascitic fluid within the peritoneal spaces, which, in turn, are defined by the peritoneal ligaments and mesenteries. [ABSTRACT FROM AUTHOR]

While transabdominal or transvaginal ultrasound remain the imaging modalities of first choice for the initial evaluation of any suspected pathologic condition of the female genital tract, technical advances in cross-sectional imaging have opened up many diagnostic applications in female pelvic pathology. Computed tomography (CT) is usually employed in an emergency situation, such as in an acute abdomen caused by ovarian torsion, as well as for the diagnosis of metastatic spread in oncologic patients. Compared to CT, magnetic resonance imaging (MRI) provides improved soft tissue contrast and is thus better suited to evaluate female genital organs. Further advantages of MRI over CT include that it does not employ ionizing radiation and has no teratogenic effects. MRI is thus well suited for imaging women of reproductive age and especially during pregnancy, e.g., for MR pelvimetry and, more recently, as an adjunct to sonography for fetal imaging. [ABSTRACT FROM AUTHOR]

In most patients, ureteral obstruction results from an acute process with associated symptoms. Some controversy exists as to which imaging studies are best for investigating suspected ureteral obstruction. In most hospitals in the United States, non-contrast helical computed tomography (CT) is preferred because it is safe and extremely rapid, and the accuracy rate for detecting ureteral stones, the most common cause of ureteral obstruction, exceeds that of other imaging studies. Other causes of acute abdominal pain, such as appendicitis, leaking aortic aneurysm, and diverticulitis, can also be readily diagnosed and occur in 13-19% of cases. Non-contrast helical CT has an overall accuracy of 97% for diagnosing ureteral stone disease [1]-[8]. This far exceeds the accuracy of intravenous urography (IVU) or ultrasonography (US) (See Table 1). Regardless of composition, virtually all ureteral stones have high attenuation values, making them readily detectable with CT. Nonmineralized matrix stones and some drug-related stones (due, for example, to protease inhibitors) may not be visible on CT images, but are rarely encountered. [ABSTRACT FROM AUTHOR]

Renal mass-like lesions are ubiquitous. Fortunately, most are benign. The most common renal mass is a benign cyst. In fact, pathologic investigations have shown that approximately one-half of the population over the age of 50 has one or more renal cysts [1]. Computed tomography (CT) investigations show that one-quarter to one-third of patients over 50 years of age has at least one cyst [2]. Renal cell carcinoma (RCC) is most commonly identified because of the widespread use of cross-sectional imaging in the abdomen, either by CT or ultrasound (US), usually performed for a non-renal complaint [3]. With advances in CT and US technology, radiologists are detecting more masses and characterizing cysts as small as 5 mm [4]. Similarly, small solid masses may be also characterized with confidence. [ABSTRACT FROM AUTHOR]