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Imaging in Geriatrics

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This book addresses in a structured and multidisciplinary way the medical issues related to aging, paying particular attention to the role of diagnostic imaging in the field of cardiovascular, musculoskeletal, respiratory, neurological, urogenital and gastrointestinal diseases.

The progressive increase of the average age of the population, of life expectancy and the improvement of the quality of life are common phenomena in many countries of the World.

Over the years, the management of older persons seems to have had an increasing impact both on the socio-economic and on the medical-health level. Medicine, in all its branches, has in fact focused more and more on the health conditions of the elderly patient and its protection and, in this context, due to the increasing progress in the field of technology and imaging methods, the radiologist occupies a front-line position.

Unlike the young or middle-aged patients, the elderly need special care and attention, especially because of the involutive-degenerative senile processes they have to face, which must be taken into account to avoid incurring into misdiagnosis.

Radiology, in fact, aims more and more at developing imaging techniques that are on the one hand satisfactory and comprehensive, but at the same time that do not represent any risk and/or obstacle for the elderly patient.

The aim of this book is to provide the radiologist, and not only, with an adequate and complete geriatric preparation, thus to improve the diagnostic-therapeutic management of those patients who, to date, constitute the most conspicuous part of the medical-health users.

 

Author(s): Giuseppe Guglielmi, Mario Maas
Series: Practical Issues in Geriatrics
Publisher: Springer
Year: 2023

Language: English
Pages: 459
City: Cham

Preface
Contents
1: Imaging Techniques in Geriatric Patients
1.1 Introduction: The Delicate Balance of Imaging in the Elderly
1.2 Imaging Modalities
1.2.1 Plain Radiography in Geriatric Patients
1.2.2 Dual-Energy X-Ray Absorptiometry (DXA) in Geriatric Patients
1.2.3 Ultrasound in Geriatric Patients
1.2.4 Multidetector Spiral Computed Tomography Scan in Geriatric Patients
1.2.5 Magnetic Resonance Imaging in Geriatric Patients
1.2.6 Interventional Radiology (IR) in Geriatric Patients
References
2: Neurodegenerative Diseases in Geriatric Patients
2.1 Introduction
2.2 Neuroradiology and Its Role in Primary Neurodegeneration
2.3 Structured Reporting in Primary Neurodegeneration: Good Practice
2.3.1 Brain Atrophy
2.3.2 White Matter Lesion Burden
2.3.3 Cerebral Microbleeds Burden
2.3.4 Structured Reporting Checklist
2.4 Most Common Primary Neurodegenerative Disorders in Elderly and Neuroradiological Clues for Diagnosis
2.4.1 Tauopathies
2.4.1.1 Alzheimer Disease (AD)
2.4.1.2 Corticobasal Degeneration (CBD)
2.4.1.3 Frontotemporal Lobar Degeneration (FTLD)
2.4.1.4 Progressive Supranuclear Palsy (PSP)
2.4.2 Synucleinopathies
2.4.2.1 Disease with Lewy Bodies (DLB)
2.4.2.2 Multiple Systemic Atrophy (MSA)
2.4.2.3 Parkinson Disease (PD)
2.4.3 Cerebral Amyloid Angiopathy (CAA)
2.4.4 Others
2.4.4.1 Creutzfeldt–Jakob Disease (CJD)
2.4.4.2 Huntington Disease
2.4.4.3 Sporadic Adult-Onset Degenerative Ataxia
2.4.4.4 Late-Onset Neurodegeneration with Brain Iron Accumulation (NBIA)
References
3: Neurovascular Emergencies in Geriatric Patients
3.1 Introduction
3.2 Ischemic Stroke
3.3 Nontraumatic Intracranial Hemorrhage
3.3.1 Intracerebral Hemorrhage (ICH)
3.3.2 Subarachnoid Hemorrhage (SAH)
3.4 Traumatic Intra-axial Brain Injures (TBI)
3.4.1 Posttraumatic Subarachnoid Hemorrhage (t-ESA)
3.4.2 Cerebral Contusion (PTBCs)
3.4.3 Post-traumatic Intracerebral Hematomas (t-ICH)
3.4.4 Traumatic Axonal Injury (TAI)
3.5 Extra-axial Hemorrhages
3.5.1 Epidural Hematoma
3.5.2 Subdural Hematoma (SDH)
3.6 Cerebral Venous Thrombosis
References
4: Head and Neck in Geriatric Patients
4.1 Ear
4.1.1 Chronic Suppurative Otitis Media
4.1.1.1 Extracranial Complication
Coalescent Mastoiditis
Subperiosteal Abscess
Petrositis
Labyrinthitis
Facial Nerve Involvement
Gradenigo’s Syndrome
4.1.1.2 Intracranial Complications
Otogenic Brain Abscess
Sinus Thrombophlebitis
4.1.2 Malignant Otitis Externa
4.1.3 Hearing Loss and Cognitive Decline
4.1.3.1 Osseointegrated Auditory Implants
4.1.3.2 Cochlear Implantation
4.2 Nose
4.2.1 Rhinosinusitis
4.2.2 Inverted Papilloma
4.2.3 Dacryocystitis
4.3 Skin Tumors
4.4 Tumors of the Oral Cavity
4.5 Salivary Gland Tumors
4.5.1 Pleomorphic Adenoma
4.5.2 Warthin’s Tumor
4.5.3 Mucoepidermoid Carcinoma
4.5.4 Adenoid Cystic Carcinoma
4.5.5 Squamous Cell Carcinoma
4.5.6 Pleomorphic Adenoma
4.5.7 Whartin’s Tumor
4.5.8 Mucoepidermoid Carcinoma
4.5.9 Adenoid Cystic Carcinoma
4.5.10 Squamous Cell Carcinoma
4.6 Osteonecrosis
References
5: Heart Diseases in Geriatric Patients
5.1 Introduction
5.2 Coronary Artery Disease
5.2.1 Introduction
5.2.2 CAD Pathophysiology
5.2.3 Multimodality Imaging with a Particular Focus on CT and MRI
5.2.3.1 CCTA
Calcium Scoring
Plaques and Stenosis Assessment
Bypass Graft and Stent Assessment
CT Tissue Characterization: Perfusion and Scar
5.2.3.2 MR Imaging
5.3 Heart Failure
5.3.1 Introduction
5.3.2 Aetiology and Pathophysiology of Heart Failure
5.3.3 Multimodality Imaging with a Particular Focus on CT and MRI
5.3.3.1 CT Imaging
5.3.3.2 MR Imaging
5.3.3.3 Indications and Planning for ICD and ICD-CRT
5.3.4 Amyloidosis
5.4 Valvular Heart Diseases
5.4.1 Aortic Stenosis
5.4.1.1 Aetiology and Pathology
5.4.1.2 Pathophysiology
5.4.1.3 Multimodality Imaging
CT Imaging
CMR Imaging
5.4.2 Mitral Regurgitation
5.4.2.1 Introduction
5.4.2.2 Aetiology and Pathophysiology
5.4.2.3 Multimodality Imaging
CT Imaging
MR Imaging
5.5 Conclusion
References
6: Vascular Diseases in Geriatric Patients
6.1 Introduction
6.2 Physiological Vascular Changes in Geriatric Population
6.2.1 Peripheral Artery Disease
6.3 Clinical Features
6.4 Clinical Diagnosis
6.5 Imaging
6.5.1 Doppler Ultrasonography
6.5.2 Computed Tomography Angiography
6.5.3 Magnetic Resonance Angiography
6.5.4 Digital Subtraction Angiography
6.6 Features of Vulnerability of the Atherosclerotic Plaque
6.7 Treatment
6.7.1 Aneurysms
6.8 Diagnosis
6.8.1 Ultrasound
6.8.2 Computed Tomography
6.8.3 Magnetic Resonance
6.8.4 Functional Imaging and Molecular Imaging
6.9 Treatment
References
7: Airway Diseases in Geriatric Patients
7.1 Introduction
7.2 Imaging Techniques
7.2.1 Chest Radiography (CXR)
7.2.2 High-Resolution Computed Tomography (HRCT)
7.3 Normal Aging
7.3.1 Trachea and Main Bronchi
7.3.2 Airway Wall Thickness
7.3.3 Bronchial Caliber
7.3.4 Small Airways
7.4 Pathological Conditions
7.4.1 Chronic Obstructive Pulmonary Disease (COPD)
7.4.2 Bronchiectasis
7.4.3 Large Airway Collapse (LAC)
7.4.4 Broncholithiasis
7.4.5 Tracheal Diverticula
7.4.6 Bronchial Anthracofibrosis
7.5 Conclusions
References
8: Neoplastic Diseases of the Respiratory System in Geriatric Patients
8.1 Epidemiology
8.1.1 The Role of Aging
8.1.2 Risk Factors
8.1.2.1 Smoke as the Main Risk Factor
8.1.3 Clinical Symptoms of Lung Cancer
8.1.4 Lung Cancer Diagnosis: General Features
8.1.4.1 Chest X-Ray
8.1.4.2 Computed Tomography
Nuclear Medicine
8.2 Lung Cancer: Role of the Chest X-Ray
8.2.1 Chest X-Ray: Role in Screening and Diagnosis of Lung Cancer
8.2.2 Radiological Characteristics Based on Cellular Type
8.2.2.1 Adenocarcinoma
8.2.2.2 Adenosquamous Carcinoma
8.2.2.3 Squamous Cell Carcinoma
8.2.2.4 Small-Cell Lung Cancer
8.2.2.5 Carcinoid Tumor
8.2.2.6 Large-Cell Lung Cancer
8.2.3 Pulmonary Nodules and Masses
8.2.3.1 Velocity of Growth
8.2.3.2 Margins
8.2.3.3 Dimensions and Cavitation
8.2.3.4 Differential Diagnosis
8.2.4 Atelectasis
8.2.4.1 Types of Atelectasis
Compressive Atelectasis
Obstructive Atelectasis
8.2.5 Pleural Effusion
8.3 Role of CT in the Diagnosis of Lung Cancer in Older Patients
8.3.1 Pulmonary Nodules
8.3.2 Pulmonary Masses
8.3.2.1 Non-Small-Cell Lung Carcinoma (NSCLC)
8.3.2.2 Small-Cell Lung Carcinoma (SCLC)
8.3.3 Lung Cancer Staging
8.3.3.1 TNM Classification
T Component
N Component
M Component
8.3.3.2 Lung Cancer Stages
8.4 Chest Characteristics in the Elderly Patient: Possible Difficulties and Overlapping of Diagnoses
8.4.1 Age-Related Rib Cage Deformation
8.4.2 Mediastinum Deformation: Cardiomegaly, Aortic Ectasia
8.4.3 COPD, Pneumonia
8.4.4 Pneumonia
8.4.5 Conclusion
8.5 Early Detection of Lung Cancer and Mortality Reduction with Low-Dose CT (LDCT)
8.6 Therapy Response Evaluation in Lung Cancer Imaging
8.6.1 Post Surgery Imaging
8.6.1.1 Introduction
8.6.1.2 Imaging Findings After Lung Resection
8.6.1.3 Chest X-Ray
8.6.1.4 Chest CT
8.6.1.5 Common Early Complications After Lung Cancer Resection
8.6.2 Response to Therapy Assessment: RECIST and iRECIST
8.6.2.1 Medical Therapy in Lung Cancer
8.6.2.2 RECIST 1.1
8.6.2.3 iRECIST
References
9: The Gastrointestinal System in Geriatric Patients
9.1 Introduction
9.2 Esophagus
9.2.1 Achalasia
9.2.1.1 Imaging Findings
9.2.2 Hiatal Hernia
9.2.2.1 Imaging Findings
9.2.3 Ulcers
9.2.3.1 Imaging Findings
9.2.4 Esophageal Cancer
9.2.4.1 Imaging Findings
9.3 Stomach and Duodenum
9.3.1 Peptic Ulcers
9.3.1.1 Imaging Findings
9.3.2 Duodenal Diverticulum
9.3.2.1 Imaging Findings
9.3.3 Gastric and Duodenal Cancer
9.3.3.1 Imaging Findings
9.4 Small Bowel
9.4.1 Small Bowel Cancer
9.4.1.1 Imaging Findings
9.5 Large Bowel
9.5.1 Colonic Diverticulosis
9.5.1.1 Imaging Findings
9.5.2 Polyps
9.5.2.1 Imaging Findings
9.5.3 Colorectal Cancer
9.5.3.1 Imaging Findings
9.6 Abdominal Emergencies in Geriatric Patients
9.6.1 Acute Cholecystitis
9.6.1.1 Imaging Findings
9.6.2 Acute Appendicitis
9.6.2.1 Imaging Findings
9.6.3 Bowel Obstruction
9.6.3.1 Imaging Findings
9.6.4 Acute Pancreatitis
9.6.4.1 Imaging Findings
9.6.5 Acute Mesenteric Ischemia
9.6.5.1 Imaging Findings
References
10: The Male Urogenital System in Geriatric Patients
10.1 Morphologic Alterations in the Kidney of an Elderly Patient
10.2 Nephrosclerosis
10.3 Renovascular Disease
10.4 Renal Infarction
10.5 Atheroembolic Renal Disease
10.6 Renal Vein Thrombosis
10.7 Renal Failure
10.7.1 Acute Renal Failure
10.7.2 Chronic Renal Failure
10.8 Obstructive Uropathy
10.9 Renal Infections
10.10 Neoplastic Pathologies
10.11 Prostate
10.11.1 Benign Prostatic Hyperplasia (BPH)
10.11.2 Prostatic Cancer
10.11.3 Prostatitis
References
11: The Female Urogenital System in Geriatric Patients
11.1 Techniques of Imaging and Normal Anatomy
11.1.1 Ultrasound
11.1.2 Magnetic Resonance Imaging
11.1.3 Computed Tomography
11.2 Ovaries
11.2.1 Endometriosis
11.2.1.1 Imaging Findings
US Findings
MRI Findings
11.2.2 Ovarian Masses
11.2.2.1 Imaging Approach to Adnexal Masses
11.2.2.2 Ovarian Tumors
Epithelial Tumors
Serous and Mucinous Tumors
Non-Serous Non-Mucinous Epithelial Ovarian Tumors
Germ Cell Tumors
Sex-Cord Stromal Tumors
11.2.3 Adnexal Torsion
11.2.4 Inflammatory Conditions of the Ovary
11.2.4.1 Tubo-Ovarian Abscess
11.3 Uterus and Cervix
11.3.1 Nabothian Cysts
11.3.2 Adenomyosis
11.3.3 Polyps
11.3.4 Leiomyomas
11.3.5 Endometrial Carcinoma
11.3.6 Squamous Cell Carcinoma of the Uterine Cervix
11.4 Vagina and Vulva
11.4.1 Malignant Tumors of the Vagina
11.4.1.1 Primary Tumors
Imaging Findings of Vaginal Squamous Cell Carcinoma
11.4.1.2 Secondary Tumors
11.5 Vulva
11.5.1 Malignant Tumors of the Vulva
11.5.1.1 Imaging Findings of Vulvar Squamous Cell Carcinoma
11.6 Pelvic Organ Prolapse
References
12: Osteoarthritis in Axial Skeleton in Geriatric Patients
12.1 Degenerative Pathology
12.2 Functional Spinal Unit
12.2.1 Intervertebral Disc
12.2.1.1 Anatomy and Pathophysiology
12.2.1.2 Imaging
12.2.1.3 Disc Displacement
12.2.1.4 Symptoms and Complications
12.2.2 Endplate Changes
12.2.3 Facet Joints
12.2.4 Ligamentum Flavum
12.2.5 Interspinous Processes
12.2.6 Instability, Spondylolisthesis, Spinal Canal, and Nerve Foramina Stenosis
12.3 A Focus on Imaging Techniques and Their Role in the Assessment of the Degenerative Spine
References
13: Osteoarthritis in Appendicular Skeleton in Geriatric Patients
13.1 Introduction
13.2 Shoulder Osteoarthritis
13.2.1 Conventional Radiography (CR)
13.2.2 Computed Tomography (CT)
13.2.3 Magnetic Resonance Imaging (MRI)
13.3 Acromioclavicular Osteoarthritis
13.4 Hand Osteoarthritis
13.4.1 Conventional Radiography (CR)
13.4.2 Ultrasonography (US)
13.4.3 Magnetic Resonance Imaging (MRI)
13.5 Knee Osteoarthritis
13.5.1 Conventional Radiography (CR)
13.5.2 Magnetic Resonance Imaging (MRI)
13.6 Hip Osteoarthritis
13.6.1 Conventional Radiography (CR)
13.6.2 Computed Tomography (CT)
13.6.3 Magnetic Resonance Imaging (MRI)
13.7 Foot and Ankle Osteoarthritis
13.8 Interventional Radiology in Osteoarthritis
References
14: Metabolic Bone Disease in Geriatric Patients
14.1 Introduction
14.2 Changes in Bone with Aging
14.2.1 Menopause
14.2.2 Calcitriol
14.3 Interaction Among Bone, Muscle, and Fat
14.4 Bone as Endocrine Organ
14.5 Consequences of the Changes in Bone with Aging
14.5.1 Fragility Fractures
14.5.2 Frailty
14.6 Diagnosis of Metabolic Bone Disease Applied to the Elderly
14.6.1 Radiography
14.6.2 Dual Energy X-ray Absorptiometry (DXA)
14.6.3 Quantitative Ultrasound (QUS)
14.6.4 Computed Tomography (CT)
14.6.5 Magnetic Resonance Imaging (MRI)
14.7 Conclusion
References
15: Body Composition in Geriatric Patients
15.1 Introduction
15.2 Changes in Body Composition with Aging
15.3 Analysis of Body Composition Changes
15.3.1 Fat
15.3.1.1 Causes for the Increase of Intraabdominal Fat with Aging
15.3.1.2 The Metabolic Consequences of the Intraabdominal Accumulation of Fat
15.3.1.3 Fat as an Endocrine Organ
15.3.1.4 Fat Mass and Its Effects on Mobility and Mortality
15.3.2 Skeletal Muscle
15.3.2.1 Causes for the Decrease of Muscle Mass with Aging
Vitamin D
15.3.2.2 The Metabolic Consequences of the Decrease of Muscle Mass
15.3.2.3 Skeletal Muscle as an Endocrine Organ
15.3.2.4 Lean Mass and Its Effects on Mobility and Mortality
15.4 Imaging of Body Composition in the Elderly
15.4.1 Dual-Energy X-ray Absorptiometry (DXA)
15.4.2 Ultrasound
15.4.3 Computed Tomography (CT)
15.4.4 Magnetic Resonance (MR)
15.5 Conclusion
References
16: Myeloid and Lymphoid Disorders in Geriatric Patients
16.1 Introduction
16.2 Myeloid Disorders
16.2.1 Myeloproliferative Neoplasms (MPNs)
16.2.2 Imaging Findings
16.2.2.1 Skeletal Findings
16.2.2.2 Solid Lesions
16.2.2.3 Thrombosis
16.3 Lymphoid Disorders
16.3.1 Lymphomas
16.3.1.1 Chest X-Ray (CXR)
16.3.1.2 CT
16.3.2 Lymphoma Staging: Lugano Classification
16.3.2.1 Whole-Body Magnetic Resonance Imaging (WB-MRI)
16.3.3 Multiple Myeloma
16.3.3.1 Conventional Radiography
16.3.3.2 CT
16.3.3.3 PET/CT
16.3.3.4 MRI
16.4 Conclusions
References
17: The Role of Artificial Intelligence (AI) in the Management of Geriatric Patients
17.1 Introduction
17.2 Application of Artificial Intelligence in Geriatric Patients
17.2.1 Neurological Disorders
17.2.2 Lung and Cardiovascular Diseases
17.2.3 Abdomen
17.2.4 Prostate
17.2.5 Musculoskeletal
17.3 Conclusion
References