Diseases of the Abdomen and Pelvis 2023-2026: Diagnostic Imaging

Contents
1: Emergency Radiology of the Abdomen and Pelvis
1.1 Trauma Part
1.1.1 Role of Imaging to Assess Blunt Abdominal Polytrauma (BAT) Patients
1.1.1.1 Primary Survey
1.1.1.2 Secondary Survey
Imaging of Common Abdominal Traumatic Injuries
Intraperitoneal Fluid
Organ Injuries
Spleen Injuries
Liver Injuries
Urinary Tract Injuries
Bowel and Mesenteric Injuries
Diaphragmatic Injuries
Pancreatic Injuries
1.2 Non-Traumatic Abdominal Pain
1.2.1 Modalities
1.2.2 Right Upper Quadrant
1.2.2.1 Acute Cholecystitis
1.2.2.2 Duodenal Ulcers
1.2.3 Left Upper Quadrant
1.2.3.1 Acute Pancreatitis
1.2.3.2 Gastritis
1.2.4 Right Lower Quadrant Pain
1.2.4.1 Acute Appendicitis
1.2.4.2 Cecal Inflammation
1.2.4.3 Terminal Ileitis
1.2.5 Left Lower Quadrant Pain
1.2.5.1 Sigmoid Diverticulitis
1.2.5.2 Epiploic Appendagitis
1.2.5.3 Pelvic Pain: Endometriosis
1.2.5.4 Ovarian Torsion
1.2.6 Diffuse Abdominal Pain
1.2.6.1 Small Bowel Obstruction
1.2.6.2 Colonic Obstruction
1.2.6.3 Acute Mesenteric Ischemia
1.2.7 Concluding Remarks
References
2: Imaging Infectious Disease of the Abdomen (Including COVID-19)
2.1 Introduction
2.2 Risk Factors for Infections
2.2.1 Barrier Disruption
2.2.2 Anatomic Obstruction
2.2.3 Vascular Compromise
2.2.4 Pre-existing Malignancy
2.2.5 Immunosuppression
2.2.6 Prior Radiation
2.2.7 Medical Devices
2.2.8 Surgery
2.3 Imaging in Abdominal Infections
2.3.1 Gastrointestinal Tract Infections
2.3.1.1 Clostridioides Difficile Colitis
2.3.1.2 Neutropenic Enterocolitis
2.3.1.3 Gastrointestinal Tuberculosis
2.3.1.4 Viral Enterocolitis
2.3.1.5 Fungal Infections
2.3.2 Hepatobiliary Infections
2.3.2.1 Liver Abscesses
2.3.2.2 Cholangitis
2.3.2.3 Viral Infections
2.3.2.4 Parasitic Infections
2.3.3 Genitourinary Tract Infections
2.3.3.1 Obstructive Uropathy
2.3.3.2 Renal and Urinary Bladder Infections
2.3.3.3 Prostatic Infections
2.3.4 Peritoneal and Abdominal Wall Infections
2.3.4.1 Peritoneal Devices
2.3.4.2 Intra-abdominal Abscesses
2.3.4.3 Abdominal Wall Infections
2.4 Conclusion
References
3: Advances in Molecular Imaging and Therapy and Its Impact in Oncologic Imaging
3.1 Introduction
3.2 Introduction to Theranostics
3.2.1 Therapeutic Radionuclides
3.2.2 Unique Role of Dosimetry
3.2.3 Current Theranostic Agents and Agents in Development
3.2.4 Patient Selection for Internal Radiotherapy
3.3 Monitoring Disease
3.3.1 Response Based on Morphology
3.3.2 Response Based on Morphology for Immunotherapy
3.3.3 Response Based on FDG PET
3.4 Monitoring Liver Disease After SIRT
3.4.1 Monitoring SIRT with CT/MRI
3.4.2 Monitoring SIRT with PET
3.5 Monitoring Neuroendocrine Tumors
3.6 Monitoring Metastasized Prostate Cancer
3.6.1 Conventional Monitoring of Metastasized Prostate Cancer with CT and Bone Scans
3.6.2 Monitoring Metastasized Prostate Cancer with PET/CT
3.7 The Role of MRI and PET/MRI for Response Evaluation
3.8 Concluding Remarks
References
4: Benign and Malignant Diseases of the Colon and Rectum
4.1 Benign Diseases of the Colon and Rectum
4.1.1 Inflammatory Diseases of the Colon and Rectum
4.1.1.1 Chronic Inflammatory Bowel Diseases
4.1.1.2 Infectious Colitis
Pseudomembranous Colitis
4.1.1.3 Non-infectious Colitis
Ischemic Colitis
Drug-Induced Colitis
Neutropenic Colitis
Radiation Colitis and Proctitis
Graft-Versus-Host Disease
4.1.2 Diverticular Disease and Diverticulitis
4.1.3 Benign Mucosal Colonic Polyp
4.2 Malignant Diseases of the Colon and Rectum
4.2.1 Rectal Cancer
4.2.1.1 Elective Rectal Cancer Staging
4.2.2 Colon Cancer
4.2.2.1 Elective Colon Cancer Staging
4.2.2.2 Colon Cancer Presenting as Acute Abdomen
4.2.3 Evaluation of Response to Neoadjuvant Therapy in Rectal Cancer
4.2.3.1 Technique
4.2.3.2 Re-staging to Plan Surgery
4.2.3.3 The Prognostic Value of Re-staging MR Imaging
4.2.3.4 Re-staging to Select Patients for Non-operative Management
4.3 Concluding Remarks
References
5: Indeterminate Retroperitoneal Masses
5.1 Introduction
5.2 Retroperitoneal Space
5.3 Tissue Diagnosis
5.4 Adipocytic Tumors
5.5 Other Soft-Tissue Sarcomas
5.6 Neurogenic Tumors
5.7 Miscellaneous
5.8 Concluding Remarks
References
6: Diffuse Liver Disease
6.1 Metabolic and Storage Diseases
6.1.1 Steatosis
6.1.2 Iron Overload
6.1.3 Wilson’s Disease
6.1.4 Amyloidosis
6.1.5 Gaucher Disease
6.2 Cirrhosis
6.2.1 Imaging of Pre-stages of Cirrhosis
6.2.2 Imaging of Cirrhosis
6.3 Focal Lesions in Cirrhotic Liver
6.3.1 Regenerative Nodules
6.3.2 Dysplastic Nodules
6.3.3 Malignant Lesions
6.3.4 Confluent Focal Fibrosis
6.3.5 Standardized Reporting with LI-RADS
6.4 Diffuse Vascular Liver Disease
6.4.1 Arteriovenous Shunts
6.4.2 Budd-Chiari Syndrome
6.4.3 Sinusoidal Obstruction Syndrome
6.4.4 Passive Hepatic Congestion and Fontan-Associated Liver Disease
6.4.5 Hereditary Hemorrhagic Telangiectasia (HHT)
6.5 Diffuse Metastatic Disease
6.6 Concluding Remarks
References
7: Focal Liver Lesions
7.1 Introduction
7.2 MDCT Imaging Techniques
7.3 MR Imaging Technique
7.4 Benign Hepatic Lesions
7.4.1 Cysts
7.4.2 Hemangioma
7.4.3 Focal Nodular Hyperplasia (FNH)
7.4.4 Hepatocellular Adenoma
7.4.5 Biliary Hamartomas (von Meyenburg Complex)
7.4.6 Hepatic Abscess and Echinococcus
7.5 Malignant Primary Tumors
7.5.1 Hepatocellular Carcinoma
7.5.2 Fibrolamellar HCC
7.5.3 Cholangiocellular Carcinoma
7.6 Rare Primary Liver Tumors
7.6.1 Biliary Cystadenoma/Cystadenocarcinomas
7.6.2 Hepatic Angiosarcoma
7.6.3 Epithelioid Hemangioendothelioma
7.7 Hepatic Metastases
7.8 Differential Diagnosis of Focal Liver Lesions
7.9 Concluding Remarks
References
8: Diseases of the Gallbladder and the Biliary Tree
8.1 Biliary Tract
8.1.1 Normal Anatomy and Variants
8.1.2 Congenital Biliary Anomalies
8.1.2.1 Choledochal Cysts and Anomalous Pancreatobiliary Ductal Junction
8.1.3 Pathologic Conditions
8.1.3.1 Choledocholithiasis
8.1.3.2 Cholangitis
Suppurative Cholangitis
Pyogenic Cholangitis
Primary Sclerosing Cholangitis
8.1.3.3 IgG4 Cholangitis
8.1.3.4 Neoplasms of the Biliary System
Benign Tumors of the Bile Ducts
Hamartomas and adenomas
Biliary Intraepithelial Neoplasm and Intraductal Papillary Neoplasms of the Bile Ducts
Mucinous Cystic Neoplasms
Malignant Tumors of the Bile Ducts
Cholangiocarcinoma
Metastatic Disease
8.2 Gallbladder
8.2.1 Normal Anatomy
8.2.2 Congenital Variants and Anomalies
8.2.2.1 Agenesis of the Gallbladder
8.2.2.2 Duplication of the Gallbladder
8.2.2.3 Phrygian Cap of the Gallbladder
8.2.2.4 Diverticula of the Gallbladder, Multiseptate Gallbladder, and Ectopic Gallbladder
8.2.3 Pathologic Conditions
8.2.3.1 Gallstones
8.2.3.2 Acute Cholecystitis
8.2.3.3 Acalculous Cholecystitis
8.2.3.4 Chronic Cholecystitis
8.2.3.5 Hyperplastic Cholecystosis
8.2.3.6 Gallbladder Neoplasms
8.3 Conclusion
References
9: Diseases of the Pancreas
9.1 Developmental Anomalies of the Pancreas
9.2 Pancreatic Neoplasms
9.2.1 Pancreatic Carcinoma
9.2.2 Other Tumors of Ductal Origin
9.3 Cystic Neoplasm
9.3.1 Serous Cystadenoma
9.3.2 Mucinous Cystic Neoplasm (MCN)
9.3.3 Intraductal Papillary Mucinous Neoplasm (IPMN)
9.4 Other Neoplasm
9.4.1 Neuroendocrine Tumors
9.4.1.1 Insulinoma
9.4.1.2 Gastrinoma
9.4.2 Other Rare Pancreatic Neoplasm
9.5 Inflammatory Diseases of the Pancreas
9.5.1 Acute and Chronic Pancreatitis
9.5.2 Autoimmune Pancreatitis
References
10: Adrenal Diseases
10.1 Introduction
10.2 Incidental Adrenal Mass: No Underlying Malignancy
10.2.1 Unenhanced CT
10.2.2 CT Contrast-Washout
10.2.3 Dual Energy CT
10.2.4 MRI
10.2.5 FDG PET/CT
10.2.6 Lesion Morphology
10.2.7 Adrenal Biopsy
10.2.8 Management
10.3 Evaluation of Adrenal Mass in Patient with Known Extra-Adrenal Malignancy
10.4 Evaluation of Patient with Suspected Adrenal Hyperfunction
10.4.1 Adrenal Cortical Hyperfunction
10.4.2 Adrenal Medullary Hyperfunction
10.5 Future Directions
10.6 Concluding Remarks
References
11: Benign and Malignant Renal Disease
11.1 Introduction
11.2 Modalities for Imaging Renal Masses
11.2.1 Ultrasound (US) and Contrast-Enhanced US (CEUS)
11.2.2 Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)
11.3 Very Small Renal Masses (<1–1.5 cm)
11.4 Cystic Renal Masses
11.5 Angiomyolipoma (AML)
11.6 Other Solid Renal Masses and Cancer Mimics
11.6.1 Oncocytomas
11.6.2 Renal Cell Cancers (RCCs)
11.6.2.1 Clear Cell Renal Cell Cancer (ccRCC)
11.6.2.2 Papillary Renal Cell Cancer (pRCC)
11.6.2.3 Chromophobe Renal Cell Cancer (chRCC)
11.6.2.4 Uncommon Renal Cancer Cell Types
11.6.3 Urothelial Neoplasms and Lymphoma
11.6.4 Other Non-neoplastic and Vascular Lesions
11.7 Solid Renal Mass Growth Rates
11.8 Radiomics
11.9 Use of Imaging for Solid Renal Mass Differentiation
11.10 Renal Mass Biopsy (RMB)
11.11 Pretreatment Assessment of Renal Cancer
11.11.1 Staging and Diagnostic Workup
11.11.2 RENAL Nephrometry Score
11.12 Management of Local or Locoregional Renal Cancer
11.13 Management of (Oligo-)Metastatic Renal Cancer
11.14 Imaging after Renal Cancer Treatment
11.14.1 After Renal Mass Ablation
11.14.2 Imaging after Partial or Total Nephrectomy
11.14.3 Imaging After Treatment of Metastatic Disease
11.14.3.1 RECIST
11.14.3.2 Multikinase Inhibitors
11.14.3.3 Immunotherapy
11.14.3.4 Complications of Multikinase Inhibitor Treatment and Immunotherapy
11.15 Concluding Remarks
References
12: Imaging Features of Immunotherapy
12.1 Introduction
12.2 Mechanism of Action
12.2.1 Cancer Immunity Cycle
12.2.2 Goal of Immunotherapy
12.2.3 Anti-CTLA-4 Antibodies
12.2.4 PD-L1 and PD-1 Inhibitors
12.2.5 Combination Immunotherapy
12.2.6 CAR T-Cell Therapy
12.3 Tumor Response to Immunotherapy
12.3.1 Development of Standards for Assessing Cancer Treatment Response
12.3.2 Limitations of RECIST 1.1 in Assessing Immunotherapy Response
12.3.3 Development of Immunotherapy-Specific Response Standards
12.4 Immune-Related Adverse Events (irAEs)
12.4.1 Overview
12.4.2 Colitis
12.4.3 Pneumonitis
12.4.4 Sarcoid-Like Reaction
12.4.5 Hepatitis and Cholangitis
12.4.6 Pancreatitis
12.4.7 Endocrine Adverse Events
12.4.8 Toxicities of CAR T-Cell Therapy
12.5 Conclusion
References
13: Benign Disease of the Uterus
13.1 Introduction
13.2 Modalities for Imaging the Uterus
13.2.1 Ultrasound
13.2.2 MR/CT
13.3 Normal Anatomy
13.4 Benign Disease Processes
13.4.1 Endometriosis
13.4.2 Adenomyosis
13.4.3 Uterine Fibroids
13.4.3.1 Imaging Features on Ultrasound
13.4.3.2 Imaging Features on MRI
13.4.4 Endometrial Pathology
13.5 Mullerian Duct Anomalies of the Uterus
13.5.1 Class U0
13.5.2 Class U1
13.5.3 Class U2
13.5.4 Class U3
13.5.5 Class U
13.5.6 Class U5
13.5.7 Class U6
13.6 Concluding Remarks
References
14: Malignant Diseases of the Uterus
14.1 Part I: Cervical Cancer
14.1.1 Epidemiology
14.1.2 Presentation and Diagnosis
14.1.3 Staging
14.1.4 Management
14.1.5 Role of Imaging in Initial Staging
14.1.6 Assessment of Treatment Response During and After Treatment
14.1.7 Evaluation of CC Recurrence
14.1.8 Future Directions
14.2 Part II: Endometrial Cancer
14.2.1 Epidemiology and Diagnosis
14.2.2 Histopathological Subtypes
14.2.3 Role of Imaging
14.2.4 MRI Indications
14.2.5 MRI Features of EC
14.2.6 EC Staging with MRI
14.2.7 Evaluation of EC Recurrence
14.3 Concluding Remarks
References
15: Adnexal Diseases
15.1 Introduction
15.2 Imaging Modalities for Assessment of Adnexal Masses
15.2.1 Ultrasound
15.2.2 Magnetic Resonance Imaging (MRI)
15.2.3 O-RADS MRI Scoring System for Risk Stratification of Adnexal Masses
15.2.4 Computed Tomography (CT)
15.2.5 Positron Emission Tomography/Computed Tomography (PET/CT)
15.3 Benign Adnexal Masses
15.3.1 Benign Adnexal Masses and Ultrasound
15.3.2 Benign Adnexal Masses and MRI
15.4 Borderline Adnexal Masses
15.5 Malignant Adnexal Masses
15.6 Concluding Remarks
References
16: Magnetic Resonance Imaging of the Prostate in the PI-RADS Era
16.1 Introduction
16.2 The Prostate Imaging Reporting and Data System (PI-RADS)
16.2.1 Clinical Considerations
16.2.2 Technical Considerations
16.2.3 Assessment of Prostatic Lesions
16.2.4 Structured Reporting
16.3 Conclusion
Further Reading
17: Pathways for the Spread of Disease in the Abdomen and Pelvis
17.1 Introduction
17.2 Peritoneal Ligaments as Conduits for the Spread of Disease
17.2.1 Gastrohepatic and Hepatoduodenal Ligaments
17.2.2 Gastrosplenic and Splenorenal Ligaments
17.2.3 Gastrocolic Ligament and Transverse Mesocolon
17.3 Peritoneal Spaces as Pathways for the Spread of Disease
17.3.1 Left Peritoneal Space
17.3.2 Right Peritoneal Space
17.4 Concluding Remarks
References
18: Small Bowel: The Last Stronghold of Gastrointestinal Radiology
18.1 Imaging Techniques
18.2 Inflammatory and Infectious Diseases
18.2.1 Inflammatory Bowel Disease
18.2.2 Celiac Disease
18.2.3 Graft Versus Host Disease
18.2.4 Infections
18.3 Small Bowel Neoplasms
18.3.1 Benign Neoplasms
18.3.2 Polyposis Syndromes
18.3.3 Malignant Neoplasms
18.4 Mesenteric Ischemia
18.5 Concluding Remarks
References
19: Small Bowel Disease: An Approach to Optimise Imaging Technique and Interpretation
19.1 Introduction
19.2 Setting the Scene: Case Presentation and Patient Factors
19.2.1 Emergency Small Bowel Conditions: Common Clinical Presentations
19.2.1.1 CT Intravenous Contrast Considerations
19.2.1.2 CT Scan Phase Choices for Acquisition
19.2.1.3 CT Luminal Contrast: What Role?
19.2.1.4 What Role for MR and Ultrasound?
19.2.1.5 Relevant Diseases and Imaging Signs
Overt or Obscure GI Bleeding
Clinical Context
Recommended CT Protocol
Relevant Conditions and Imaging Signs
Suspicion of Bowel Obstruction
Clinical Context
Recommended CT Protocol
Relevant Conditions and Imaging Signs
Unexplained Acute Abdominal Pain with or Without Signs of Sepsis
Clinical Context
Recommended CT Protocol
Relevant Conditions and Imaging Signs
19.2.2 Outpatient Presentation: Common Clinical Presentations
19.2.2.1 CT Intravenous Contrast Considerations
19.2.2.2 CT Luminal Contrast: What Role?
19.2.2.3 Weight Loss, Abdominal Pain, and Altered Bowel Habit? Malignancy? Inflammatory Bowel Disease
Clinical Context
Recommended CT Protocol
Relevant Conditions and Imaging Signs
19.2.2.4 Iron Deficiency Anaemia with Occult Obscure GI Bleeding
Clinical Context
Recommended CT Protocol
Relevant Conditions and Imaging Signs
19.2.2.5 Small Bowel Intussusception
19.3 Concluding Remarks
References
20: Congenital and Acquired Pathologies of the Pediatric Gastrointestinal Tract
20.1 Introduction
20.2 Imaging Techniques
20.2.1 Conventional Radiography
20.2.2 Ultrasound
20.2.3 Fluoroscopy with Contrast Agents
20.2.4 Computed Tomography (CT)
20.2.5 Magnetic Resonance Imaging
20.3 Obstruction of the Upper Gastrointestinal Tract
20.3.1 Hypertrophic Pyloric Stenosis
20.3.2 Duodenal Atresia and Stenosis
20.3.3 Malrotation and Midgut Volvulus
20.4 Obstruction of the Lower Intestinal Tract
20.4.1 Meconium Ileus and Ileal Atresia
20.4.2 Meconium Plug Syndrome
20.4.3 Hirschsprung’s Disease
20.5 Necrotizing Enterocolitis
20.6 Duplication Cysts
20.7 Intussusception
20.8 Appendicitis
20.9 Inflammatory Bowel Disease
20.9.1 Crohn Disease
20.9.2 Ulcerative Colitis
20.10 Concluding Remarks
References
Untitled
21: Congenital and Acquired Pathologies of the Pediatric Urogenital Tract
21.1 Introduction
21.2 Imaging Modalities
21.3 Normal Variations
21.4 Antenatal Hydronephrosis and CAKUT
21.5 Urinary Tract Infection (UTI)
21.6 Incontinence/Enuresis
21.7 Renal Masses
21.8 Hematuria and Renal Calculi
21.9 Trauma
21.10 Acute Kidney Injury (AKI) and Chronic Renal Failure (CRF)
21.11 Renal Causes of Hypertension
21.12 Disorders of Sexual Differentiation
21.13 Testicular and Ovarian Pathology
21.13.1 Cryptorchidism
21.13.2 Scrotal Masses
21.13.3 Acute Scrotal Pain
21.13.4 Ovarian Neoplasms
21.14 Concluding Remarks
References