Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘classification’ Category

Vascular Anomalies, ISSVA Classification

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2 categories: vascular tumors or vascular malformations. Distinction determines therapy.

Vascular Tumors

  • infantile hemangiomas: grow rapidly after birth, GLUT1+
  • congenital hemangiomas (RICH and NICH): fully mature at birth, GLUT1-
  • Tufted angioma
  • Kaposiform hemangioendothelioma
  • Spindle cell hemangioendotheliomas
  • Dermatologic acquired vascular tumors

Vascular malformations (slow)

  • capillary malformation (port-wine stain, telangiectasia, angiokeratoma)
  • venous malformation
  • lymphatic malformation

Vascular malformations (fast)

  • arterial malformation
  • arteriovenous fistula
  • arteriovenous malformation

PDF link

Written by lmwong

April 23, 2012 at 12:57 pm

Disc Disease Nomenclature

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Divide axial disc into 4 quadrants of 25%:

Focal Herniation = <25% [pic] (protusion type or extrusion type) [pic]

Broad based Herniation = 25-50% [pic]

Bulge = >50% normal disc circumference.

Symmetric Disc Bulging = 100% [pic]

Link

Written by lmwong

January 5, 2011 at 4:00 pm

Posted in classification, neuro, spine

Lung Cancer Staging

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New 7th Edition of for Lung Cancer Staging, Radiographics Sept 2010.

Written by lmwong

December 16, 2010 at 4:07 pm

Bankart and Bankart variant lesion

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Classification of Bankart and Bankart variant lesions. a Bankart lesion, b bony Bankart lesion, c Perthes lesion, d ALPSA (anterior labro-ligamentous periosteal sleeveavulsion) lesion, e GLAD (glenolabral articular disruption) lesion, f HAGL (humeralavulsion of glenohumeral ligaments) lesion. (LLC anteroinferior labro-ligamentous complex, P scapular periosteum, HH humeral head, AC articular cartilage of glenoid,IGHL inferior glenohumeral ligament)

Written by lmwong

December 12, 2010 at 10:33 am

Cervical Cancer Staging

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IA = confined to cervix
IB = extension to uterus
IIA = extension to upper vagina
IIB = extension to parametrium
IIIA = extension into lower vagina
IIIB = pelvic wall (hydronephrosis)
IVA = adjacent organs
IVB = distant organs.

 

Written by lmwong

December 11, 2010 at 7:27 pm

AVM Spetzler-Martin Grading System

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Size (largest diameter of nidus)

  • ❤ cm = 1
  • 3-6 cm = 2
  • >6 cm = 3

Eloquence (areas of sensorimotor, language, visual, thalamus, hypothalamus, internal capsule, brain stem, cerebellar peduncles, and deep cerebellar nuclei)

  • Noneloquent = 0
  • Eloquent = 1

Venous Drainage

  • Superficial only = 0
  • Deep component = 1

Add the 3 categories to get Spetzler-Martin Grade 1-5.

emedicine

Written by lmwong

October 20, 2010 at 7:39 am

Urethral Injury Types

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urethral injury typesPosterior urethra: from bladder neck, through prostate, to membranous urethra

Anterior urethra: bulbar and penile urethra

  • type 1: stretched, periurethral hematoma
  • type 2: rupture above urogenital diaphragm, extraperitoneal contrast
  • type 3: rupture below urogenital diaphragm, extraperitoneal and perinium contrast
  • type 4: bladder extending to urethra
  • Type 5: anterior urethral injury

Written by lmwong

March 31, 2010 at 2:53 pm

Posted in classification, GU, trauma

Bladder Rupture Classification

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  • Type 1: contusion
  • Type 2: intraperitoneal rupture
  • Type 3: interstitial bladder injury
  • Type 4: Extraperitoneal rupture; a = simple; b = complex
  • Type 5: Combined bladder injury

Written by lmwong

March 31, 2010 at 2:48 pm

Tumor Cancer Staging

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Nasophyngeal Squamous Cell Carcinoma Head and Neck

  • Tis = carcinoma in situ
  • T1 = confined to 1 site
  • T2 = 2 sites
  • T3 = extends to nasal cavity or oropharynx
  • T4 = invades skull, cranial nerve
  • N0 = no nodes
  • N1 = homolateral node ❤ cm
  • N2 = homolateral node > 3 cm
  • N3 = node > 6 cm
  • M0 = no mets
  • M1 = distant mets

Thyroid Cancer

  • T1a = nodule < 4cm
  • T1b = nodule > 4cm
  • T2 = nodule with partial fixation
  • T3 = nodule with complete fixation
  • N1 = regional nodes
  • N2 = fixed regional nodes
  • M1 = mets

Lung Cancer (TNM)

  • T0 = no tumor
  • T1 ❤ cm
  • T2 >3 cm, >2 cm from carina
  • T3 extends to chest wall, sulus, diaphragm, pleura, pericardium, <2 cm from carina
  • T4 distant mets
  • N0 = no nodes
  • N1 = ipsilateral hilar
  • N2 = ipsilateral mediastinal and subcarinal
  • N3 = contralateral, supraclavicular
  • M0 = no mets
  • M1 distant mets

Stomach Cancer

  • T1 = mucosa
  • T2 = muscle, serosa
  • T3 = penetration
  • T4 = adjacent organs

Renal Cell Carcinoma

  • Stage I = confined to kidney, <7 cm
  • Stage II = confined to kidney, >7 cm
  • Stage III = fatty infiltration, venous invasion, LN mets
  • Stage IV = through Gerota’s fascia, distant mets

Wilm’s Tumor

  • I = kidney
  • II = extend to perinephric space
  • III = LN
  • IV = mets to lung or liver
  • V = bilateral renal involvement

Colon Cancer (Dukes)

  • A = bowel wall only
  • B = serosa
  • C = LN
  • D = mets

Colon Cancer (TNM)

  • T1 = mucosa or submucosa
  • T2 = invasion or muscularis propria
  • T3 = invasion into subseroa
  • T3 = adjacent structures, fistulas
  • N1 = 1-3 LN
  • N2 = >4 LN
  • N3 =  LN along named vascular trunk
  • M = Mets

Bladder Cancer

  • T1 = mucosal and submucosal tumors
  • T2 = superficial muscle layers
  • T3a = deep muscular wall
  • T3b = perivesicular fat
  • T4 = other organs

Prostate Cancer (Jewett)

  • A = nonpalpable, found at biopsy
  • B = palpable, confined to prostate
  • C = through prostate capsule
  • D = mets

Endometrial Carcinoma

  • 1 and 2 = confined to uterus
  • 3 and 4 = extrauterine

Cervical Cancer

  • IA = confined to cervix
  • IB = extend to uterus
  • IIA = extend to upper vagina
  • IIB = parametrial involvement
  • IIIA = extend to lower vagina
  • IIIB = pelvic wall
  • IVA = adjacent organs
  • IVB = distant organs

Ovarian Cancer

  • 1 = ovary
  • 2 = both ovaries +/- ascites
  • 3 = intraperitoneal mets
  • 4 = mets outside peritoneal cavity

Breast Cancer

  • 0 = DCIS
  • 1 = <2 cm
  • 2 = 2-5 cm, axillary nodes
  • 3 = >5 cm, pectoralis involvement or matted LN
  • 4 = distant mets

Written by lmwong

March 30, 2010 at 9:56 am

Fleischner Society guidelines for pulmonary nodule follow up

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Low risk patients

  • < or = 4 mm: No follow-up needed.
  • >4 – 6: Follow-up at 12 months. If no change, no further imaging needed.
  • >6 – 8: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

High risk patients

  • < or = 4 mm: Follow-up at 12 months. If no change, no further imaging needed.
  • >4-6: Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change.
  • >6-8: Initial follow-up CT at 3 – 6 months and then at 9 -12 and 24 months if no change.
  • >8: Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy.

Fleischner Society Guidelines: Radiology 2005 Nov; 237:395-400.

Written by lmwong

February 3, 2010 at 12:08 pm

BIRADS

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0__ Incomplete: Your mammogram or ultrasound didn’t give the radiologist enough information to make a clear diagnosis; follow-up imaging is necessary

1__ Negative: There is nothing to comment on; routine screening recommended

2__ Benign: A definite benign finding; routine screening recommended

3__ Probably Benign: Findings that have a high probability of being benign (>98%); six-month short interval follow-up

4__ Suspicious Abnormality: Not characteristic of breast cancer, but reasonable probability of being malignant (3 to 94%); biopsy should be considered

5__ Highly Suspicious of Malignancy: Lesion that has a high probability of being malignant (>= 95%); take appropriate action

6__ Known Biopsy Proven Malignancy: Lesions known to be malignant that are being imaged prior to definitive treatment; assure that treatment is completed

Written by lmwong

January 28, 2010 at 4:12 pm

Germinal Matrix Hemorrhage

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  • low-birth-weight infants
  • most present in immediate postpartum period; can present up to 3-4 weeks post

Grading

  1. confined to germinal matrix
  2. …extends into ventricle (normal size)
  3. …with ventriculomegaly
  4. …extends into cerebrum

read more

Written by lmwong

January 23, 2010 at 8:30 pm

Ankle Fractures

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Pattern

Classification

Supination

LCL tear
avulsion fracture of lateral malleolus

Supination-external rotation

Stage 1 = disruption of anterior distal tibiofibular ligament
Stage 2 = +distal fibular fracture
Stage 3 = +tear of posterior distal tibiofibular ligament, fracture of posterior malleolus
Stage 4 = +fracture of medial malleolus

Pronation

Stage 1 = avulsion of medial malleolus
Stage 2 = +rupture of anterior and posterior distal tibiaofibular ligaments
Stage 3 = +fibular fractures

Pronation-external rotation

Stage 1 = avulsion of the medial malleolus, deltoid ligament tear
Stage 2 = +tear of anterior distal tibiofibular ligament and tibiofibular syndesmosis
Stage 3 = +fibular fracture
Stage 4 = + posterior distal tibiofibular ligament, posterior malleolar fracture
Tillaux fracture
triplane fracture
base of the 5th metatarsal fracture

Axial

Pilon Type 1 = nondisplaced
Pilon Type 2 = moderately displaced
Pilon Type 3 = severely displaced and impacted

Written by lmwong

January 20, 2010 at 2:35 am

Rotator Cuff Impingement

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  • Supraspinatous tendon most vunerable to impingement
  • Shape of acomion most important factor
  • Bigliani classification
    • Type 1 = flat
    • Type 2 = concave
    • Type 3 = anterior hook **
  • Osteophytes, calus, hypertrophy can also narrow subacromial space
  • Chronic impingement causes irregular cortex of acromion and greater tuberosity, subcondral cysts, sclerosis
  • Associated with subacromial bursitis
  • May see calcific bursitis and tendinitis
  • Rx: acromioplasty

Written by lmwong

January 16, 2010 at 9:39 am

Hinchey Classification of Diverticulitis

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Hinchey proposed a classification for acute diverticulitis, that has been variously adapted, and is useful not only in accademia but also in outlining successive stages of severity.

Stage 1a: phlegmon

Stage 1b: diverticulitis with pericolic or mesenteric abscess

Stage 2: diverticulitis with walled off pelvic abcess

Stage 3: diverticulitis with generalised purulent peritonitis

Stage 4: diverticulitis with generalised faecal peritonitis

Written by lmwong

January 16, 2010 at 9:20 am

Posted in abdomen, classification, gi

Vesicoureteral Reflux (VUR) Classification

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Grade I – reflux into non-dilated ureter
Grade II – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; papillary impressions

Written by lmwong

September 8, 2008 at 12:04 am

Uretheral Injury Classification

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The classification system of Goldman et al (6) is as follows:

Type I injury: The posterior urethra is stretched and elongated but intact. The prostate and bladder apex are displaced superiorly due to disruption of the puboprostatic ligaments and resulting hematoma.

Type II injury: Disruption of the urethra occurs above the urogenital diaphragm (UGD) in the prostatic segment. The membranous urethra is intact.

Type III injury: The membranous urethra is disrupted with extension of injury to the proximal bulbous urethra and/or disruption of the UGD.

Type IV injury: Bladder neck injury with extension into the proximal urethra.

Type IVA injury: Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury.

Type V injury: Partial or complete pure anterior urethral injury.

Source: http://radiographics.rsnajnls.org/cgi/content/full/23/4/951

Written by lmwong

September 8, 2008 at 12:00 am

Posted in classification, GU, trauma

Frykman classification

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describing Colles’ radial and ulnar fractures
Type 1 = R, extra-articular
Type 2 = R + U, extra-articular
Type 3 = R, intra-articular radiocarpal
Type 4 = R + U, intra-articular radiocarpal
Type 5 = R, intra-articular distal radioulnar joint
Type 6 = R + U, intra-articular distal radioulnar joint
Type 7 = R, intra-articular both radiocarpal and radioulnar joints
Type 8 = = R + U, intra-articular both radiocarpal and radioulnar joints

Written by lmwong

June 19, 2008 at 1:52 pm

Grades of Ureteral Reflux

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Grade Findings
I Reflux confined to ureter only
II Reflux to the level of the intrarenal collecting system without dilatation
III Grade II + mild or moderate dilatation of the ureter or renal pelvis, but no or only slight forniceal blunting
IV Grade II + calyceal dilatation and obliteration of the sharp angle of the fornices, but maintainance of the papillary impressions
V Gross dilatation and tortuosity of the ureter; gross dilatation of the renal pelvis and calices; papillary impressions are no longer visible

Grades I-III: Typically resolve as the child grows

Grades IV-V: Typically require surgery to correct

http://www.auntminnie.com/index.asp?sec=ref&sub=ncm&pag=get&itemid=54506

Written by lmwong

May 27, 2008 at 8:29 pm

Salter Harris Fractures

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By definition, fractures occur through growth plates (pediatric population)

  • Type I = transverse fracture through hypertrophic zone of physis
  • Type II = fracture through physis and metaphysis, NOT involving epiphysis (most common type)
  • Type III = fracture through physis and epiphysis, Rx = surgery
  • Type IV = fracture of all three elements, intra-articular
  • Type V = compression or crush injury

Written by lmwong

April 20, 2008 at 3:50 pm