Mariam Moshiri

Certain embryologic and anatomic features of the placenta and umbilical cord seen at US and MRI represent key diagnostic findings in early detection of disease and complications, and prenatal identification of conditions such as placenta previa and velamentous cord insertion has significant implications for clinical management.

Trauma in pregnancy is complicated by the need for simultaneous care of the mother and fetus as well as prompt diagnosis and treatment, requiring radiologists to have specific knowledge of appropriate imaging methods and findings.

Three-dimensional US has potential to improve the diagnostic accuracy of gynecologic US, offering valuable solutions to diagnostic dilemmas with multiplanar data reconstruction and advanced quantitative analysis techniques.

Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review. ^©RSNA, 2024 See the invited commentary by Maurer and Parkman in this issue.

Since the first application of contrast-enhanced US (CEUS) in the late 1960s, the use of US contrast agents has grown tremendously, and this examination has proved to be a valuable adjunct to diagnostic US for detection and characterization of disease. Also, CEUS has emerged as an excellent option for evaluation of indeterminate lesions that require additional imaging, given its excellent safety profile, including that in patients with end-stage renal disease or allergies to contrast material who are unable to undergo contrast-enhanced CT or MRI. US traditionally has been considered the imaging modality of choice for evaluation of the female pelvis, followed by MRI and rarely fluoroscopy, CT, PET, or angiography. CEUS has the potential to add significant value in imaging gynecologic disease, and indications for its use in the female pelvis are expected to continue evolving. It can aid in evaluation of nonvascular structures, such as assessment of tubal patency, uterine cavity morphology, and pelvic fistulas. CEUS can help characterize poorly vascularized gynecologic tumors or tissues with slow flow by using qualitative and quantitative parameters and aid in image-guided interventions or biopsies by facilitating visualization of lesions that are difficult to see with other imaging modalities. The authors provide an overview of current applications of US contrast agents in the female pelvis and discuss associated factors such as technique, interpretation, and image optimization. They also discuss the limitations of CEUS and describe its utility in the evaluation of female pelvic disease by using an organ system case-based approach. ^© RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Pancreatic surgery is considered one of the most technically challenging surgical procedures, despite the evolution of modern techniques. Neoplasms remain the most common indication for pancreatic surgery, although inflammatory conditions may also prompt surgical evaluation. The choice of surgical procedure depends on the type and location of the pathologic finding because different parts of the pancreas have separate vascular supplies that may be shared by adjacent organs. The surgical approach could be conventional or minimally invasive (laparoscopic, endoscopic, or robotic assisted). Because of the anatomic complexity of the pancreatic bed, perioperative complications may be frequently encountered and commonly involve the pancreatic-biliary, vascular, lymphatic, or bowel systems, irrespective of the surgical technique used. Imaging plays an important role in the assessment of suspected postoperative complications, with CT considered the primary imaging modality, while MRI, digital subtraction angiography, and molecular imaging are considered ancillary diagnostic tools. Accurate diagnosis of postoperative complications requires a solid understanding of pancreatic anatomy, surgical indications, normal postoperative appearance, and expected postsurgical changes. The practicing radiologist should be familiar with the most common perioperative complications, such as anastomotic leak, abscess, and hemorrhage, and be able to differentiate these entities from normal anticipated postoperative changes such as seroma, edema and fat stranding at the surgical site, and perivascular soft-tissue thickening. In addition to evaluation of the primary operative fossa, imaging plays a fundamental role in assessment of the adjacent organ systems secondarily affected after pancreatic surgery, such as vascular, biliary, and enteric complications. Published under a CC BY 4.0 license. Test Your Knowledge questions are available in the supplemental material. See the invited commentary by Winslow in this issue.

Lymphoma-related malignancies can be categorized as Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL) based on histologic characteristics

The fluoroscopic upper gastrointestinal examination can be tailored for different clinical scenarios and remains a valuable and versatile examination in contemporary radiology.

The workup of cancer in pregnancy, while balancing both maternal prognosis and fetal well-being, is dependent on diagnostic imaging findings to guide complex multidisciplinary management. Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (~1:1000 pregnancies), PAC is increasing owing to postponed child...

Sickle cell disorder (SCD) refers to a spectrum of hematologic disorders that cause a characteristic clinical syndrome affecting the entire body. It is the most prevalent monogenetic hemoglobinopathy worldwide, with a wide range of focal and systemic expressions. Hemoglobin gene mutation leads to the formation of abnormal sickle-shaped red blood cells, which cause vascular occlusion and result in tissue and organ ischemia and infarction. Recurrent episodes of acute illness lead to progressive multisystem organ damage and dysfunction. Vaso-occlusion, hemolysis, and infection as a result of functional asplenia are at the core of the disease manifestations. Imaging plays an essential role in the diagnosis and management of SCD-related complications in the abdomen and pelvis. A thorough understanding of the key imaging findings of SCD complications involving hepatobiliary, gastrointestinal, genitourinary, and musculoskeletal systems is crucial to timely recognition and accurate diagnosis. The authors aim to familiarize the radiologist with the SCD spectrum, focusing on the detection and evaluation of manifestations that may appear at imaging of the abdomen and pelvis. The topics the authors address include (a) the pathophysiology of the disease, (b) the placement of SCD among hemoglobinopathies, (c) the clinical presentation of SCD, (d) the role of imaging in the evaluation and diagnosis of patients with SCD who present with abdominal and pelvic manifestations in addition to extraperitoneal manifestations detectable at abdominal or pelvic imaging, (e) imaging features associated with common and uncommon sequelae of SCD in abdominal and pelvic imaging studies, and (f) a brief overview of management and treatment of patients with SCD. Online supplemental material is available for this article. ^©RSNA, 2022 Download as PowerPoint