•. Autoimmune pancreatitis most commonly presents with painless obstructive jaundice.•. Bile duct involvement is present in up to 90% of cases.•. Presentation and imaging mimic pancreatic and biliary malignancy.•. Serological markers, particularly IgG4, help to establish the diagnosis.•. Symptoms and radiological abnormalities are readily reversible with steroids.Autoimmune pancreatitis was, until recently, a rarely diagnosed and poorly understood condition. Recent work outlining its characteristic clinicopathological and imaging features have helped in identifying this as a cause of chronic pancreatitis and painless obstructive jaundice. At presentation it can be a close mimic of pancreatic and biliary neoplasms. This highlights the need to be fully aware of the diagnostic criteria required to prevent erroneous diagnoses, unnecessary surgery and delay in appropriate treatment. Autoimmune pancreatitis commonly involves the biliary tree. Cholangiographic appearance is characteristic and can be different fr...

•. Ovarian cancer affects mainly post-menopausal women but is not uncommon in pre-menopausal women.•. The presentation of ovarian cancer is usually delayed, and therefore early detection of disease is important.•. Imaging has an important role in the detection and characterisation of adnexal masses with the primary imaging modality being transvaginal ultrasound.•. Cross-sectional imaging is useful to assess the extent of disease prior to surgery, for monitoring treatment response and for detecting recurrence.Ovarian cancer is the fifth most common cancer affecting women in the UK and is associated with a worse prognosis than other forms of gynaecological malignancy. There are increasing numbers of women presenting with ovarian cancer over the age of 65 years. The diagnosis of ovarian cancer is often delayed, owing to the lack of symptoms and the non-specific nature of the disease, particularly in the early stages. The prognosis of advanced ovarian cancer is poor in the later stages, making early detection...

•. Acute aortic syndrome comprises three interrelated pathologies: intramural haematoma, penetrating atherosclerotic ulcer and aortic dissection. •. Multislice CT is the imaging modality of choice. •. A pre-contrast scan significantly aids the detection of intramural haematoma. •. Intramural haematoma needs repeated imaging follow-up and can progress to penetrating atherosclerotic ulcer, pseudoaneurysm or dissection. •. In aortic dissection the false lumen is usually larger and may contain aortic “cobwebs”. The term “acute aortic syndrome” (AAS) encompasses a spectrum of aortic emergencies, which include aortic dissection, intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU). Some authors have also included ruptured aneurysms and aortic transection in this group; however, we will confine our discussion to the original definition by Vilacosta, (Vilacosta I, San Roman JA. Acute aortic syndrome. Heart 2001;85:365–8) [1]. The clinical signs and symptoms of these entities are similar and have in common an acute onset of severe chest pain localised to the front or back of the chest. Anterior chest, neck and jaw pain suggests involvement of the ascending aorta, whilst back and abdominal pain more often indicates involvement of the descending aorta [1]. The pain might be migratory and can be confounded with that of acute coronary syndromes. Moderate to severe hypertension is a universal risk factor for the development of AAS. This article provides an overview of this heterogeneous group of disease entities and discusses current concepts of pathophysiology and diagnosis.

Picture quizPicture quizJ T SMITH, C P SMITH, N RABY, A A NICHOLSON and C HAMMONDJ T SMITHSt James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF Search for more papers by this author, C P SMITHPinderfields Hospital, Aberford Road, Wakefield, West Yorkshire WF1 4DG Search for more papers by this author, N RABYRadiology Department, Western Infirmary, Glasgow G11 6NT Search for more papers by this author, A A NICHOLSONRadiology Department, Leeds Teaching Hospitals, Great George Street, Leeds LS1 3EX, UK Search for more papers by this author and C HAMMONDRadiology Department, Leeds Teaching Hospitals, Great George Street, Leeds LS1 3EX, UK Search for more papers by this authorPublished Online:13 Feb 2014https://doi.org/10.1259/imaging/33478031SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About Previous article Next article FiguresReferencesRelatedDetails Volume 21, Issue 1March 2009Pages: 1-iv 2009 The British Institute of Radiology History Published onlineFebruary 13,2014 Metrics Download PDF

•. The whole spine must be imaged in suspected cases of cord compression. Clinical levels are unreliable. •. Cord compression may be the presenting feature in as many as 30% of cases. Do not rely on history of malignancy. •. Many patients with known malignancy have non-malignant cause for symptoms. •. Look for intradural and intramedullary metastases; contrast is needed in these patients. •. Consider infection and haemorrhage if no cause is apparent. •. Consider and look for any extra spinal abnormalities. Cord compression is an often overused term to cover a multitude of clinical presentations. This article considers the various possible clinical presentations and pathophysiology. Imaging techniques that can be used to diagnose cord compression are discussed, together with the interpretation of potential findings. Pitfalls are described along with alternative diagnoses. A systematic approach to evaluation is described and advocated.

18F-FDG-PET/CT is becoming the imaging modality of choice in staging Hodgkin's and high-grade non-Hodgkin's lymphoma, particularly in defining extranodal disease.Assessment of early response after chemotherapy using 18FDG-PET/CT can provide prognostic information, identifying patients who may relapse within 2 years.Residual mass assessment with 18F-FDG-PET/CT has led to the development of more tailor-made treatment strategies.At present, it is unclear if the additional information provided by 18F-FDG-PET/CT translates into better outcomes. The introduction of metabolic imaging with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has had a major impact on the management of lymphoma. In Hodgkin's and high-grade non-Hodgkin's lymphomas in particular, 18F-FDG-PET/CT has been shown to be more accurate than conventional CT in radiological staging. It can define malignant lesions in structures that appear normal upon anatomical imaging. 18F-FDG-PET/CT is far superior to o...

Plain films are useful as an initial screen test for diffuse ankle and foot pain. MRI is the most suitable technique for global assessment of bone and soft tissues for persistent pain following injury. Ultrasound should be reserved for specific focal soft-tissue conditions and when dynamic information is required. Ultrasound is an excellent technique for guiding injections. This article covers all of the common and important conditions of the ankle and foot that may present to the radiologist for imaging, with the exception of acute bony trauma. For a variety of clinical scenarios, the possible imaging strategies are explored and examples of the various pathologies are described and illustrated. Plain films are usually requested but many cases also require MRI or ultrasound. In general, MRI is best for diffuse symptoms and ultrasound for focal soft-tissue problems, particularly if dynamic imaging or guided injection is required.

Plain films continue to be central to the diagnosis and monitoring of rheumatological diseases. Imaging has a particular role to play in identifying disease in its earliest stages. Ultrasound and MRI permit the detection of subclinical joint inflammation. Ultrasound is helpful in guiding diagnostic and therapeutic interventions. Despite the increasing availability of modern imaging techniques such as ultrasound and MRI, conventional radiographs (CRs) remain fundamental to rheumatological imaging, playing an important role in the diagnosis and monitoring of the arthritides. Evaluation of plain films includes an assessment of the soft tissues for swelling and calcification. The joint space on CRs reflects the thickness of articular cartilage and is typically lost as a result of arthropathy. Evaluation of the periarticular bone will reveal the presence of erosions, osteophytes, subchondral bone changes, such as cysts and sclerosis, and changes in bone density. Finally, plain films allow an assessment of joint alignment and, in the case of hand and foot films, give an indication as to the distribution of disease. Despite the wide use of the CR in the evaluation of the arthritides, it has the disadvantage that it is relatively insensitive to the early changes of disease and changes occur relatively slowly. In the early stages of arthritis, when therapy may have the greatest impact and where structural abnormalities may be reversible, radiographically defined joint damage is not a prominent feature. MRI and ultrasound have the ability to diagnose arthritis earlier, detect changes in disease status more rapidly and increase the clinical understanding of the disease.

The incidence of sub-clinical thyroid nodules inthe general population is high. Thyroid carcinoma is rare and has a good prognosis. Clinical assessment can reduce the number of ultrasounds requested. Ultrasound and FNAc can detect the majority of neoplasms requiring treatment. Management strategies should minimize the risks, cost and anxiety of unnecessary surgery. Benign nodular thyroid disease is common, and biologically significant thyroid cancers (10 mm in size, or associated with lymphadenopathy) are rare. By comparison, papillary microcarcinomas (<10 mm) are quite common but the majority are thought to be clinically insignificant . The investigation and management of thyroid nodules is controversial; the ideal diagnostic pathway is a balance between missing carcinomas of potential clinical aggressiveness and reducing the number of unnecessary operations whilst keeping an eye on the cost. This article reviews some of the ultrasonographic features of thyroid nodular disease, and discusses the role of ultrasound and fine-needle aspiration in the assessment of thyroid nodules.