Geriatric Imaging $c

In the elderly, the coexistence of various diseases, the presence of involutional and degenerative changes, and the occurrence of both physical and cognitive problems represent “the norm.” It is therefore important to know how to distinguish the healthy elderly from those in need of treatment as a sound basis for avoiding overdiagnosis and overtreatment. This aspect is a central theme in Geriatric Imaging , which covers a wide range of applications of different imaging techniques and clearly explains both the potential and the limitations of diagnostic imaging in geriatric patients. Individual sections are devoted to each major region or system of the body, and a concluding section focuses specifically on interventional procedures. The book, written by recognized experts in the field, is superbly illustrated and will be an ideal resource for geriatricians, radiologists, and trainees. Geriatric Imaging Copyright Page Dedication Foreword I Foreword II Preface Contents 1: Epidemiology of Ageing (Socioeconomic Impact) 1.1 An Ageing Population 1.1.1 The Demographic Transition 1.1.2 Baby Boomers 1.1.3 The Role of Medicine 1.1.4 Age-Related Diseases: Public Health Burden and Costs 1.2 Profiles of Select Conditions 1.2.1 Heart Disease and Stroke 1.2.1.1 Disease Burden 1.2.1.2 Prevention, Diagnosis, and Treatment 1.2.1.3 Costs 1.2.2 Cancer 1.2.2.1 Disease Burden 1.2.2.2 Prevention, Diagnosis, and Treatment 1.2.2.3 Costs 1.2.3 Diabetes Mellitus 1.2.3.1 Disease Burden 1.2.3.2 Prevention, Diagnosis, and Treatment 1.2.3.3 Costs 1.2.4 Chronic Obstructive Pulmonary Disease 1.2.4.1 Disease Burden 1.2.4.2 Prevention, Diagnosis, and Treatment 1.2.4.3 Costs 1.2.5 Osteoarthritis 1.2.5.1 Disease Burden 1.2.5.2 Prevention, Diagnosis, and Treatment 1.2.5.3 Costs 1.2.6 Osteoporosis 1.2.6.1 Disease Burden 1.2.6.2 Prevention, Diagnosis, and Treatment 1.2.6.3 Costs 1.2.7 Alzheimer’s Disease 1.2.7.1 Disease Burden 1.2.7.2 Prevention, Diagnosis, and Treatment 1.2.7.3 Costs Conclusion References Part I: Musculoskeletal 2: Diagnostic Algorithm in the Elderly 2.1 Introduction 2.2 General Considerations 2.2.1 Clinical Traits 2.2.2 Technical Choices 2.2.3 Use of Contrast Media 2.3 Traumatic Diseases 2.4 Nontraumatic Diseases References 3: Metabolic 3.1 Introduction 3.2 Osteoporosis 3.2.1 Definition and Classification 3.2.2 Pathogenesis and Risk Factors 3.2.3 Clinical Aspects and Complications 3.2.4 Epidemiology and Economic Burden: Disease and Complications 3.2.5 Diagnosis 3.2.5.1 Conventional Radiography Axial Skeleton Appendicular Skeleton 3.2.5.2 Dual-Energy X-Ray Absorptiometry 3.2.5.3 Vertebral Fractures 3.2.5.4 Quantitative Computed Tomography Axial QCT Peripheral QCT 3.2.5.5 Magnetic Resonance 3.2.5.6 Quantitative Ultrasound 3.3 Osteomalacia 3.3.1 Diagnosis 3.4 Paget Disease 3.4.1 Diagnosis 3.5 Sarcopenia 3.5.1 Diagnosis References 4: Imaging of Insufficiency Fractures 4.1 Introduction 4.2 Imaging Insufficiency Fractures 4.2.1 Radiography 4.2.2 Bone Scintigraphy 4.2.3 Computed Tomography 4.2.4 Magnetic Resonance Imaging 4.3 Fracture Sites References 5: Imaging of Osteoarthritis 5.1 Introduction 5.2 Conventional Radiography and Tomosynthesis 5.2.1 Conventional Radiography 5.2.2 Summary 5.3 Magnetic Resonance Imaging 5.3.1 Methodological Aspects 5.3.2 Choice of Pulse Sequences for OA Imaging 5.3.3 Semiquantitative MRI Whole-Organ Scoring 5.3.4 Cartilage Compositional Imaging 5.3.5 Quantitative Cartilage Morphometry 5.3.6 Summary 5.4 Ultrasound 5.5 Tomosynthesis 5.6 Computed Tomography 5.7 Nuclear Medicine Conclusion References 6: Noninfectious Arthritis 6.1 Introduction 6.2 Rheumatoid Arthritis 6.3 Spondyloarthritis 6.3.1 Ankylosing Spondylitis 6.3.2 Psoriatic Arthritis 6.3.3 Undifferentiated Spondyloarthritis 6.4 Gout 6.5 Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD) References 7: Infection and Miscellaneous 7.1 Introduction 7.2 Spinal Epidural Infections 7.2.1 Epidemiology 7.2.2 Routes of Contamination 7.2.3 Clinical Features 7.2.4 Imaging Findings 7.2.4.1 Radiography 7.2.4.2 Computed Tomography 7.2.4.3 Magnetic Resonance Imaging 7.2.4.4 Etiological Diagnosis 7.2.4.5 Nuclear Medicine 7.3 Peripheral Osteomyelitis 7.3.1 Imaging of Peripheral Osteomyelitis 7.4 Septic Arthritis 7.5 Peripheral Osteoarticular TB 7.5.1 Appendicular Skeleton 7.5.2 Tuberculous Arthritis 7.6 Diabetic Foot: Differentiating Osteomyelitis from Neuropathic Osteoarthropathy References 8: Bone Tumors 8.1 Introduction 8.2 Primary Tumors (Figs. 8.1 and 8.2) 8.2.1 Diagnosis 8.2.2 Staging 8.2.2.1 Localization 8.2.2.2 General Staging 8.2.3 Treatment Effectiveness and Follow-Up 8.2.4 Most Frequent Examples 8.2.4.1 Malignant 8.2.4.2 Benign Tumors 8.3 Metastases 8.3.1 Introduction 8.3.2 Imaging Techniques 8.3.2.1 Radionuclide Scintigraphy 8.3.2.2 Computed Tomography 8.3.2.3 Magnetic Resonance Imaging MR Sequences Fat and Water T1-Weighted Spin-Echo Sequences Chemical Shift Imaging Fat Suppression Techniques Bone Trabeculae Diffusion Contrast Medium Evaluation of Vertebral Monitoring Tumor Response to Treatment 8.3.2.4 PET with Fluorodeoxyglucose (18 FDG-PET) Conclusion References Part II: Cardiovascular 9: Introduction Cardiovascular Ageing References 10: Atherosclerotic Heart Disease 10.1 Normal Age-Related Changes of the Coronary Arteries 10.2 Coronary Artery Disease 10.2.1 Epidemiology and Economic Impact 10.2.2 Pathophysiology 10.2.3 Concepts of Risk Stratification 10.3 Diagnostic Imaging of the Coronary Arteries 10.3.1 Invasive Techniques 10.3.1.1 Conventional Coronary Angiography 10.3.1.2 Intravascular Ultrasound 10.3.1.3 Optical Coherence Tomography 10.3.1.4 Coronary Angioscopy 10.3.2 Noninvasive Imaging Techniques 10.3.2.1 Coronary CT Angiography 10.3.2.2 Coronary Artery Calcium Scoring 10.3.2.3 Ultrasound: Carotid Intima–Media Thickness 10.3.2.4 Magnetic Resonance Imaging 10.3.2.5 Nuclear Imaging Coronary FDG Positron Emission Tomography Other Radioactive Tracers for Plaque Imaging Conclusions References 11: Congestive Heart Failure 11.1 Clinical Overview 11.2 Echocardiography 11.2.1 Introduction 11.2.2 Left Ventricular Volumes, Ejection Fraction, and Systolic Function 11.2.3 Diastolic Function 11.2.4 Determining Etiology of Cardiomyopathy 11.2.4.1 Ischemic Cardiomyopathy 11.2.4.2 Non-ischemic Cardiomyopathy Idiopahtic Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Differentiating Restrictive Cardiomyopathy and Pericardial Constriction 11.2.5 New Uses: Cardiac Resynchronization Therapy 11.2.6 Limitations 11.3 Cardiac MRI 11.3.1 Introduction 11.3.2 Left Ventricular Volumes, Ejection Fraction, and Systolic Function 11.3.3 Diastolic Function 11.3.4 Determining Etiology of Cardiomyopathy 11.3.4.1 Ischemic and Dilated Cardiomyopathies 11.3.4.2 Non-ischemic Cardiomyopathy Myocarditis Hypertrophic Cardiomyopathy Amyloid Hemochromatosis Pericardial Constriction 11.3.5 Novel Uses in Heart Failure: Cardiac Resynchronization Therapy 11.3.6 Limitations of Cardiac Magnetic Resonance Imaging 11.4 Cardiac Multi-detector Computed Tomography 11.4.1 Clinical Use in Heart Failure 11.4.2 Limitations 11.5 Radionuclide Ventriculography 11.6 Single-Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET), and Molecular Imaging Conclusions References 12: Valvular Heart Disease 12.1 Introduction 12.2 Anatomy of the Cardiac Valves 12.3 Valvular Heart Disease 12.3.1 Pathophysiology 12.3.1.1 Mitral Stenosis 12.3.1.2 Mitral Regurgitation 12.3.1.3 Aortic Stenosis 12.3.1.4 Aortic Regurgitation 12.3.1.5 Right-Sided Valve Disease 12.3.2 Echocardiography 12.3.2.1 Mitral Stenosis 12.3.2.2 Mitral Regurgitation 12.3.2.3 Aortic Stenosis 12.3.2.4 Aortic Regurgitation 12.3.2.5 Right-Sided Valve Disease 12.4 Magnetic Resonance Imaging 12.4.1 Technique 12.4.2 Applications 12.5 Computed Tomography 12.5.1 Technique 12.5.2 Applications References 13: Central and Peripheral Vessels 13.1 Introduction 13.2 Technical Considerations 13.2.1 Computed Tomography 13.2.1.1 Introduction 13.2.1.2 Principles 13.2.1.3 Image Processing 13.2.2 Magnetic Resonance 13.2.2.1 Introduction 13.2.2.2 Principles Non-contrast MRA with Time-of-Flight Sequences Contrast-Enhanced MRA with T1-Weighted 3D Gradient-Echo Sequences 13.2.3 Ultrasonography 13.2.3.1 Introduction 13.2.3.2 Principles 13.2.4 Other Techniques 13.3 Imaging of Carotid Arteries 13.3.1 Introduction 13.3.2 Imaging Diagnostic Flow Chart 13.3.3 From Stenosis Degree to Vulnerable Plaque 13.3.4 Carotid Artery Stenosis Quantification 13.3.5 Carotid Artery Plaque Characterization 13.4 Central Vessels 13.4.1 Aorta 13.4.1.1 Abdominal Aortic Aneurysm 13.4.1.2 Aortic Dissections 13.4.2 Pulmonary Arteries 13.4.2.1 Pulmonary Hypertension 13.4.2.2 Pulmonary Embolism 13.5 Peripheral Vessels 13.5.1 Lower Extremities 13.5.2 Upper Extremities Conclusions References Part III: Respiratory 14: Airway Disease 14.1 Introduction 14.2 Paraphysiologic Modifications of Elderly Airways 14.3 Classification 14.4 Imaging Modalities 14.5 Upper Airway Diseases in the Elderly 14.5.1 Nonneoplastic Tracheobronchial Disease 14.5.1.1 Focal Nonneoplastic Diseases Secretions Broncholithiasis Stenoses Tuberculosis 14.5.1.2 Diffuse Nonneoplastic Diseases Tracheobronchomegaly Tracheal and Main Bronchial Diverticula Tracheobronchomalacia Tracheobronchopathia Osteochondroplastica Tracheobronchial Amyloidosis Wegener Granulomatosis Bronchial Anthracofibrosis 14.5.2 Neoplastic Tracheobronchial Diseases 14.5.2.1 Primary Malignant Tumors 14.5.2.2 Secondary Malignant Tumors 14.5.2.3 Benign Tumors 14.6 Lower Airway Diseases in the Elderly 14.6.1 Chronic Obstructive Pulmonary Disease 14.6.1.1 Physiopathology and Diagnosis 14.6.2 Bronchiectasis 14.6.3 Asthma 14.6.3.1 Physiopathology and Diagnosis 14.6.4 Bronchiolitis 14.6.4.1 Aspiration Bronchiolitis 14.6.4.2 Infectious Bronchiolitis 14.6.5 Complications Conclusion References 15: Infectious Diseases 15.1 Incidence, Etiology, and Epidemiology 15.1.1 Pulmonary Infections 15.1.2 Tuberculosis 15.2 Clinical and Pathological Anatomy 15.2.1 Pulmonary Infections 15.2.2 Tuberculosis 15.3 Role of Diagnostic Imaging 15.4 Radiological Findings 15.4.1 Pulmonary Infections 15.4.1.1 Focal Infiltrates 15.4.1.2 Diffuse Infiltrates 15.4.1.3 Nodular Infiltrates 15.4.2 Tuberculosis 15.5 Differential Diagnosis Conclusions References 16: Diffuse Lung Diseases 16.1 Introduction to Diffuse Lung Diseases 16.2 Radiological “Tools of the Trade”: HRCT 16.2.1 The HRCT Old Era 16.2.2 The HRCT New Era 16.2.2.1 Multiplanar Reconstruction (MPR) 16.2.2.2 Maximum Intensity Projection (MIP) 16.2.2.3 Minimum Intensity Projection (minIP) 16.2.2.4 Volume Rendering (VR) 16.2.2.5 Pattern Approach to Diffuse Lung Diseases 16.3 Reticular Pattern 16.3.1 Definition 16.3.2 Reticular Pattern with Distortion (Irregular, Fibrosing) 16.3.2.1 Idiopathic Pulmonary Fibrosis (IPF) 16.3.2.2 Idiopathic Nonspecific Interstitial Pneumonia (NSIP) 16.3.2.3 Secondary NSIP (Collagen Vascular Diseases, Drug Toxicity) 16.3.3 Reticular Pattern Without Distortion (Smooth) 16.3.3.1 Hydrostatic Pulmonary Edema 16.3.4 Reticular Pattern Without Distortion (Nodular) 16.3.4.1 Lymphangitic Carcinomatosis (LC) 16.4 Nodular Pattern 16.4.1 Definition 16.4.2 Random Nodules 16.4.2.1 Hematogenous Metastases 16.4.2.2 Miliary Tuberculosis 16.4.3 Lymphatic Nodules 16.4.3.1 Silicosis and Coal Worker Pneumoconiosis (CWP) 16.4.4 Centrilobular Nodules 16.4.4.1 Hypersensitivity Pneumonitis (HP), Subacute 16.5 Alveolar Pattern 16.5.1 Acute Alveolar Pattern 16.5.1.1 Acute Exacerbation of IPF and NSIP 16.5.1.2 Acute Infections 16.5.2 Chronic Alveolar Pattern 16.5.2.1 Chronic Exogenous Lipoid Pneumonia 16.5.2.2 Chronic Infection (Atypical Mycobacteriosis) 16.5.2.3 Organizing Pneumonia: Idiopathic and Secondary 16.6 Cystic Pattern 16.6.1 Cysts with Thick Walls 16.6.1.1 Cystic Bronchiectasis 16.6.1.2 Cystic Metastases 16.6.2 Cysts with Tiny (or No) Walls 16.6.2.1 Emphysema References 17: Pleural Disease 17.1 Benign Pleural Disease 17.1.1 Pleural Effusion 17.1.1.1 Radiological and Sonographic Features 17.1.2 Empyema 17.1.3 Pneumothorax 17.1.3.1 Radiological Features 17.1.4 Pleural Plaques 17.1.4.1 Radiological Features 17.1.5 Fibrothorax 17.2 Malignant Pleural Disease 17.2.1 Primary Tumors 17.2.1.1 Malignant Pleural Mesothelioma Epidemiology and Etiology Clinical Features Pathological Features Radiographic Features CT Features MRI Findings Diagnostic Thoracoscopy Prognosis and Staging 17.2.1.2 Localized Fibrous Tumor Radiological Features 17.2.1.3 Pleural Sarcoma 17.2.2 Secondary Tumors 17.2.2.1 Pleural Metastases 17.2.2.2 Pleural Lymphoma 17.2.2.3 Invasive Thymoma References 18: Thromboembolic Disease and Pulmonary Hypertension 18.1 Thromboembolic Disease 18.1.1 Chest X-Ray 18.1.2 Lung Scintigraphy 18.1.3 Ultrasound of the Lower Limbs 18.1.4 Computed Tomography 18.1.5 Other Diagnostic Techniques 18.1.6 PE in Acute COPD Exacerbation 18.1.7 Tumor Embolism 18.2 Pulmonary Hypertension 18.2.1 Chest X-Ray 18.2.2 The Role of Computed Tomography 18.2.2.1 Vascular Signs: The Main Pulmonary Artery 18.2.2.2 Cardiac Signs 18.2.2.3 Lung Parenchymal Signs 18.2.3 Cardiac Magnetic Resonance Imaging (MRI) 18.2.4 PH in Connective Tissue Disease (CTD) 18.2.5 PH Due to Lung Disease or Hypoxia (COPD: Interstitial Lung Disease) 18.2.6 PH Associated with Left Heart Disease References 19: Neoplastic Disease 19.1 Introduction 19.2 Radiologic Imaging 19.2.1 Adenocarcinoma 19.2.2 Squamous Cell Carcinoma 19.2.3 Large Cell Carcinoma 19.2.4 Small Cell Lung Cancer 19.3 Percutaneous Biopsy 19.4 Follow-up of Pulmonary Nodules 19.5 Staging 19.5.1 T Descriptor (TNM VII Staging System) 19.5.1.1 Tumor Size 19.5.1.2 Additional Ipsilateral Nodules 19.5.1.3 Pleural and Pericardial Invasion 19.5.2 M Descriptor (TNM VII Staging System) 19.5.3 N Descriptor (TNM VII Staging System) 19.6 Radiofrequency Ablation (RFA), Radiotherapy, Chemotherapy, and Imaging 19.6.1 RFA 19.6.2 Radiotherapy 19.6.3 Chemotherapy 19.7 Metastasis 19.8 Benign Tumors 19.8.1 Hamartoma 19.8.2 Solitary Fibrous Tumors 19.8.3 Endobronchial Lipomas 19.8.4 Solitary Bronchial Papilloma References Part IV: Head and Neck 20: Lesions of the Skull Base 20.1 Introduction 20.2 Infection/Inflammation 20.2.1 Sinusitis 20.2.2 Necrotizing Otitis Externa 20.2.3 Chronic Otomastoiditis 20.2.4 External Auditory Canal Cholesteatoma 20.3 Trauma 20.4 Tumors 20.4.1 Anterior Skull Base 20.4.1.1 Squamous Cell Carcinoma 20.4.1.2 Olfactory Neuroblastoma 20.4.2 Central Skull Base 20.4.2.1 Nasopharyngeal Carcinoma 20.4.2.2 Plasmacytoma 20.4.2.3 Chordoma 20.4.2.4 Chondrosarcoma 20.4.2.5 Metastases 20.4.3 Posterolateral Skull Base (Temporal Bone) 20.4.3.1 Inner Ear and Cerebellopontine Angle Vestibular Schwannoma Meningioma Epidermoid Cyst 20.4.3.2 External Auditory Canal and Middle Ear Paraganglioma Adenomatous Tumors Neurogenic Tumors Hemangioma Malignant Tumors 20.4.3.3 Jugular Foramen 20.5 Otodystrophies and Fibro-Osseous Lesions 20.5.1 Paget Disease 20.5.2 Fibrous Dysplasia Conclusion References 21: Head and Neck Neoplastic Disease 21.1 Introduction 21.2 Choice of Imaging Modality and Technique 21.2.1 Computed Tomography 21.2.1.1 CT Technique 21.2.2 Magnetic Resonance Imaging 21.2.2.1 MRI Technique 21.2.3 Positron-Emission Tomography-CT 21.2.3.1 PET-CT Technique 21.2.4 Ultrasonography 21.2.5 Radiography 21.3 Anatomy and Diagnosis of Benign and Malignant Neoplasia 21.3.1 Oral and Oropharyngeal Tumors 21.3.1.1 Anatomy of the Oral and Oropharyngeal Area 21.3.1.2 Benign Lesions and Pseudomass of the Oral Cavity and Oropharynx 21.3.1.3 Malignant Lesions of the Oral Cavity and Oropharynx Cancer of the Tonsils Cancer of the Base of Tongue Cancer of the Palate 21.3.2 Nasopharyngeal Tumors 21.3.2.1 Anatomy 21.3.2.2 Benign Lesions and Pseudomass of the Nasopharynx 21.3.2.3 Malignant Tumors of the Nasopharynx 21.3.3 Laryngeal and Hypopharyngeal Tumors 21.3.3.1 Anatomy of the Larynx and Hypopharynx 21.3.3.2 Pseudomass of the Larynx 21.3.3.3 Malignant Lesions of the Larynx and Hypopharynx Laryngeal and Hypopharyngeal Cancer 21.3.4 Sinonasal Tumors 21.3.4.1 Sinonasal Anatomy 21.3.4.2 Benign Lesions and Pseudomass of the Sinonasal Area Sinusitis 21.3.4.3 Malignant Sinonasal Lesions 21.3.5 Skull Base Tumors 21.3.5.1 Anatomy of the Skull Base 21.3.5.2 Benign Lesions and Pseudomass of the Skull Base Normal Jugular Bulb Glomus Tumor 21.3.5.3 Malignant Lesions of the Skull Base 21.3.6 Salivary Gland Tumors 21.3.6.1 Anatomy of the Salivary Glands 21.3.6.2 Benign Lesions and Pseudomass of the Salivary Glands Inflammatory Disease Benign Tumors 21.3.6.3 Malignant Lesions of the Salivary Glands 21.4 Perineural Spread 21.5 Nodal Disease 21.6 Unknown Primary 21.7 Imaging in the Posttreatment Setting 21.7.1 Post-radiotherapy 21.7.2 Post-surgery Conclusion References Part V: Neuroradiology 22: Neoplastic Diseases of the Central Nervous System 22.1 Introduction 22.2 Clinical Presentations 22.2.1 Issues Related to Management 22.3 Imaging Techniques 22.3.1 Magnetic Resonance Imaging 22.3.1.1 Conventional MRI Lesion Characterization 22.3.1.2 Post-contrast Imaging 22.3.1.3 Advanced MRI Techniques Diffusion-Weighted Imaging and Diffusion Tensor Imaging Perfusion-Weighted Imaging MR Spectroscopy 22.4 Classification 22.4.1 Primary Neoplastic Lesions 22.4.1.1 Intra-axial Neoplasms Glioblastoma Multiforme Anaplastic Astrocytoma Oligodendroglioma and Anaplastic Oligodendroglioma Primary Lymphoma 22.4.1.2 Extra-axial Tumors Meningiomas Acoustic Schwannoma Sellar and Parasellar Neoplasms Pituitary Adenomas Craniopharyngioma Neoplastic Lesions of Nonpituitary Origin 22.4.2 Metastases 22.4.2.1 Intraparenchymal Metastases 22.4.2.2 Extra-axial Metastases 22.5 Neoplastic Disease of the Spine and Spinal Cord 22.5.1 Extradural Tumors 22.5.1.1 Metastatic Disease to the Spine and Extradural Space 22.5.2 Intradural Extramedullary Tumors 22.5.2.1 Primary Intradural Extramedullary Tumors Nerve Sheath Tumor Meningioma 22.5.2.2 Secondary Intradural Extramedullary Tumors (Leptomeningeal Deposits) 22.5.3 Intramedullary Tumors 22.5.3.1 Primary Intramedullary Tumors Astrocytoma Ependymoma 22.5.3.2 Metastatic Disease to the Spinal Cord 22.6 Tumor Mimics 22.6.1 Radiation Necrosis 22.6.2 Sarcoidosis 22.6.3 Abscesses 22.6.4 Tuberculosis 22.7 Summary References 23: Cerebrovascular Disease 23.1 Introduction 23.2 Neuroimaging in Hemorrhagic Stroke 23.2.1 Hemorrhage on CT 23.2.2 Hemorrhage on MRI 23.2.2.1 Intracranial Hemorrhage on T1- and T2-Weighted Images 23.2.2.2 Hemorrhage on FLAIR and GRE Images and Role in SAH 23.2.3 Cerebrovascular Causes of Intracranial Hemorrhage 23.2.3.1 Hypertensive Hematoma 23.2.3.2 Cerebral Amyloid Angiopathy 23.2.3.3 Cerebral Microbleeds 23.2.3.4 Iatrogenic Causes of Hematoma and Bleeding Diathesis 23.2.3.5 AVM and Cavernous Angioma 23.2.3.6 Neoplasia and Other Causes of Spontaneous Intracranial Hemorrhage 23.3 Neuroimaging in Ischemic Stroke 23.3.1 Ischemic Infarction on CT 23.3.2 Ischemic Infarction on MRI 23.3.2.1 Acute Infarction on Diffusion-Weighted Images 23.3.2.2 Acute Infarction and Abnormal Vessels on Conventional MRI 23.3.2.3 Subacute and Chronic Infarction 23.3.2.4 Increased Sensitivity of DWI and the Definition of TIA 23.3.3 Hemorrhagic Transformation of Ischemic Infarction 23.3.3.1 Hemorrhagic Transformation on CT and Conventional MRI 23.3.3.2 Hemorrhagic Transformation on DWI 23.4 Vascular Imaging for Cerebrovascular Disease 23.4.1 MR Angiography in Cerebral Ischemia 23.4.2 CT Angiography in Cerebral Ischemia 23.4.3 Ultrasonography and Digital Subtraction Angiography 23.4.4 SAH and Imaging Intracranial Aneurysm 23.5 Stroke Subtype and Patterns of Ischemic Stroke 23.5.1 Large-Artery Atherosclerosis Stroke Subtype 23.5.2 Cardioembolic Stroke Subtype 23.5.3 Small-Vessel Occlusion Lacunar Stroke Subtype 23.5.4 Uses and Limitations of Stroke Subtype Classification 23.5.5 Other Distinct Patterns of Infarction 23.5.5.1 Watershed Infarcts 23.5.5.2 Moyamoya Pattern 23.6 Functional and Advanced Imaging Methods in Cerebral Ischemia 23.6.1 Pathophysiology of Ischemic Cerebral Perfusion 23.6.1.1 Perfusion CT 23.6.1.2 Perfusion-Weighted MRI 23.6.1.3 Arterial Spin Labeling 23.6.2 Perfusion Imaging as a Marker of Ischemic Penumbra 23.7 Neuroimaging in Cerebral Venous Thrombosis 23.7.1 Venous Infarction and CVT on CT 23.7.2 Venous Infarction and CVT on MRI 23.7.3 Other Methods of Venography 23.8 Therapeutic Neurointervention for Cerebrovascular Disease in the Elderly 23.8.1 Ruptured Intracranial Aneurysms: Endovascular Coiling 23.8.2 Ischemic Stroke: Acute Therapy 23.8.3 Ischemic Stroke: Carotid Stenting 23.9 Challenges in Imaging of the Elderly and Choice of Imaging Protocols 23.9.1 Challenges in Diagnostic Imaging in the Elderly 23.9.2 Choice Between MRI and CT Imaging Protocols 23.10 Summary and Conclusion References 24: Dementing Disorders 24.1 Introduction 24.2 Imaging Modalities and Protocols 24.2.1 Computed Tomography 24.2.2 Magnetic Resonance Imaging 24.2.3 Positron Emission Tomography and Single-Photon Emission Computed Tomography 24.3 Image Analysis of Structural Neuroimaging 24.3.1 Cortical Atrophy 24.3.2 Medial Temporal Lobe Atrophy 24.3.3 Vascular Pathology 24.3.4 Macrohemorrhage and Cerebral Microbleeds 24.3.5 Serial Imaging 24.4 Normal Aging and Neurodegenerative Diseases Presenting with Dementia 24.4.1 Normal Aging 24.4.2 Alzheimer’s Disease 24.4.3 Frontotemporal Lobe Dementia 24.4.4 Dementia Associated with Parkinsonian Syndromes 24.4.4.1 Dementia with Lewy Bodies 24.4.4.2 Multisystem Atrophy 24.4.4.3 Corticobasal Degeneration 24.4.4.4 Progressive Supranuclear Palsy 24.4.5 Vascular Dementia 24.5 Dementia Associated with Inflammation and Infection 24.5.1 Progressive Multifocal Leukoencephalopathy 24.5.2 Herpes Simplex Encephalitis 24.5.3 HIV Encephalitis 24.5.4 Creutzfeldt-Jakob Disease 24.5.5 Autoimmune Limbic Encephalitis 24.6 Toxic-Induced Dementia 24.7 Summary and Conclusion References 25: Movement Disorders 25.1 Overview 25.2 Disorders with Primarily Parkinsonism and Extrapyramidal Symptoms 25.2.1 Parkinson Disease 25.2.2 Multiple System Atrophy with Predominant Parkinsonism (MSA-P: Striatonigral Degeneration) 25.2.3 Progressive Supranuclear Palsy 25.2.4 Corticobasal Degeneration 25.3 Disorders with Involuntary Movement 25.3.1 Huntington Disease 25.3.2 Chorea Acanthocytosis 25.3.3 Gilles de la Tourette Syndrome 25.3.4 Fahr Disease 25.3.5 Non-ketotic Hyperglycemic Chorea Hemiballismus 25.4 Disorders Mainly Presenting Ataxia 25.4.1 Multiple System Atrophy 25.4.1.1 MSA with Parkinsonism (MSA-P: Striatonigral Degeneration) MSA with Cerebellar Ataxia (MSA-C: Olivopontocerebellar Degeneration) 25.4.1.2 Cortical Cerebellar Atrophy 25.4.2 Autosomal Dominant Cerebellar Atrophy 25.4.2.1 Spinocerebellar Ataxia Type 1 (SCA1) 25.4.2.2 Spinocerebellar Ataxia Type 2 (SCA2) 25.4.2.3 Spinocerebellar Ataxia Type 3 (SCA3: Machado-Joseph Disease) 25.4.2.4 Spinocerebellar Ataxia Type 6 (SCA6) 25.4.2.5 Spinocerebellar Ataxia Type 7 (SCA7) 25.4.2.6 Other Spinocerebellar Ataxias 25.4.2.7 Dentatorubral-Pallidoluysian Atrophy (DRPLA) 25.4.3 Autosomal Recessive Cerebellar Atrophy 25.4.3.1 Friedreich Ataxia 25.4.3.2 Early-Onset Ataxia with Ocular Motor Apraxia and Hypoalbuminemia (EAOH) 25.5 Disorders Mainly Associated with Motor Weakness 25.5.1 Amyotrophic Lateral Sclerosis (ALS) 25.5.2 Amyotrophic Lateral Sclerosis with Dementia (ALS-D) 25.5.3 Progressive Muscular Atrophy 25.5.4 Primary Lateral Sclerosis 25.6 Imaging for Evaluation of Diseases with Movement Disorders 25.6.1 Conventional MRI 25.6.2 MR Spectroscopy 25.6.3 Diffusion/Diffusion Tensor Imaging 25.6.4 Susceptibility-Weighted Images References Part VI: Gastrointestinal 26: Dysfunctional Disorders of the Pharynx and the Esophagus: VFSS and VFMSS 26.1 Introduction 26.2 VFSS: Technique 26.3 VFSS: Normal and Pathological Aspects 26.3.1 Primary Presbyphagia 26.3.2 Secondary Presbyphagia 26.4 VFMSS: Technique 26.5 VFMSS: Normal and Pathological Aspect 26.6 VFMSS: Compensatory Postures References 27: Peritonitis 27.1 Introduction 27.2 Physiology of the Peritoneum 27.3 Classification 27.4 Pathophysiologic Intra-abdominal Changes in the Older Adult 27.5 Diagnosis 27.6 Challenges to Diagnosis in the Older Adult 27.7 Imaging Techniques 27.8 Common Causes of Acute Peritonitis in the Elderly Patients 27.9 Uncommon Causes of Acute Peritonitis in the Elderly Patients References 28: Ischemic Bowel Disease 28.1 Introduction 28.2 Acute Mesenteric Ischemia 28.2.1 Etiology 28.2.2 Presentation 28.2.3 Diagnosis 28.2.3.1 Arterial AMI 28.2.3.2 Venous AMI 28.2.3.3 Failed Perfusion Without Reperfusion (NOMI) and Failed Perfusion with Reperfusion 28.3 Chronic Mesenteric Ischemia 28.3.1 Presentation 28.3.2 Diagnosis 28.4 Ischemic Colitis or IC 28.4.1 Etiology 28.4.2 Presentation 28.4.3 Diagnosis References 29: Bowel Obstruction 29.1 Small Bowel Obstruction 29.1.1 Terminology and Clinical Issues 29.1.1.1 Simple SBO 29.1.1.2 Decompensated SBO 29.1.1.3 Complicated SBO 29.1.1.4 Vascular Changes due to Reaction 29.1.1.5 Vascular Changes due to Strangulation 29.1.1.6 Volvulus 29.1.1.7 Closed Loop 29.1.1.8 Intussusception 29.1.2 Imaging 29.1.2.1 Radiographic and Ultrasound Findings of Simple SBO 29.1.2.2 CT Findings of Simple SBO 29.1.2.3 Decompensated SBO Imaging Findings 29.1.2.4 CT Findings of Decompensated SBO 29.1.2.5 Strangulation of the Small Intestine 29.1.2.6 Imaging Findings of Volvulus, Closed-Loop Obstruction, and Intussusception 29.1.3 Differentials 29.2 Large Bowel Obstruction 29.2.1 Terminology and Clinical Issues 29.2.2 Imaging 29.2.3 Differentials 29.2.4 Acute Pseudo-obstruction of the Large Bowel 29.3 Current Role of Plain Film in the Study of the Acute Intestinal Behaviors 29.3.1 Acute Intestinal Behaviors 29.3.1.1 Reflex Spastic Ileus 29.3.1.2 Reflex Hypotonic Ileus 29.3.1.3 Paralytic Ileus 29.3.1.4 Mechanical Ileus References 30: Inflammatory Bowel Disease 30.1 Introduction 30.2 Inflammatory Bowel Disease 30.2.1 Epidemiology 30.3 Clinical Manifestations and Prognosis 30.3.1 Crohn Disease 30.3.2 Ulcerative Colitis 30.4 Imaging Technique and Findings 30.4.1 Crohn Disease 30.4.1.1 Barium Contrast Examinations 30.4.1.2 Ultrasound 30.4.1.3 CT and MRI 30.4.2 Ulcerative Colitis 30.4.2.1 Barium Studies 30.4.2.2 Ultrasound 30.4.2.3 CT and MRI 30.5 Differential Diagnosis 30.6 Comparison of Diagnostic Modalities in IBD References 31: Gastrointestinal Tumors 31.1 Introduction 31.2 Esophageal Tumors 31.2.1 Benign Tumors 31.2.2 Malignant Tumors 31.3 Gastric Tumors 31.3.1 Benign Tumors 31.3.2 Malignant Tumors 31.4 Small Bowel Tumors 31.4.1 Benign Tumors and Tumor-Like Lesions 31.4.2 Primary Malignant Diseases 31.4.3 Secondary Malignant Tumors 31.5 Large Bowel Tumors 31.5.1 Benign Tumors 31.5.2 Malignant Tumors 31.6 The Gastrointestinal Stromal Tumors References Part VII: Urogenital 32: Benign Prostate Hyperplasia and Prostatic Tumor 32.1 Introduction 32.2 Benign Prostatic Hyperplasia 32.2.1 Imaging 32.2.1.1 Ultrasound of the Prostate and of the Bladder Wall 32.2.1.2 Magnetic Resonance Imaging 32.2.2 Evaluation of the Efficacy of Medical Treatment 32.2.3 Arterial Embolization 32.2.4 Minimally Invasive Procedures 32.3 Prostate Tumor 32.3.1 Imaging 32.3.1.1 Ultrasound 32.3.1.2 Contrast-Enhanced Ultrasound 32.3.1.3 Elastography 32.3.1.4 Magnetic Resonance Imaging 32.3.1.5 Nuclear Medicine Localization of Prostate Cancer Staging Prostate Cancer Evaluation of Lymph Node Metastases Evaluation of Bone Metastases Detection of Disease Recurrence 32.4 Conclusions and Recommendations References 33: Renal Tumors in the Elderly 33.1 Introduction 33.2 Imaging Features 33.3 Clinical and Pathological Features Conclusions References Part VIII: Hematologic/Lymphatic 34: Age-Related Physiological Changes of the Bone Marrow and Immune System 34.1 Bone Marrow 34.2 Bone Marrow Fat 34.2.1 MR Spectroscopy 34.2.2 Other Methods of Quantifying Marrow Fat 34.2.3 Imaging of Age-Related Physiological Changes in Bone Marrow Fat 34.3 Bone Marrow Perfusion 34.3.1 Bone Perfusion Assessed by MRI 34.3.2 Bone Perfusion Assessed by PET Imaging 34.3.3 Imaging of Age-Related Physiological Changes in Bone Marrow Perfusion 34.4 Bone Marrow Diffusion 34.4.1 Imaging of Age-Related Physiological Changes in Bone Marrow Diffusion 34.5 Bone Marrow Metabolism 34.5.1 Imaging of Age-Related Physiological Changes in Bone Marrow Metabolism 34.6 Immune System 34.6.1 Imaging of Age-Related Physiological Changes in the Immune System Conclusion References 35: Age-Related Pathological Changes of the Bone Marrow and Immune System 35.1 Introduction 35.2 Aplastic Anemia 35.3 Multiple Myeloma and Plasmacytoma 35.4 Amyloidosis 35.5 Leukemia 35.6 Lymphoma 35.7 Myelofibrosis 35.8 Bone Marrow Transplantation References Part IX: Breast 36: Benign Breast Diseases 36.1 Introduction 36.2 Types of Benign Breast Diseases Seen in the Elderly 36.2.1 Sebaceous Cyst 36.2.1.1 Clinical Presentation 36.2.1.2 Imaging 36.2.1.3 Management 36.2.2 Lipoma 36.2.2.1 Clinical Presentation 36.2.2.2 Imaging 36.2.2.3 Management 36.2.3 Hamartoma 36.2.3.1 Clinical Presentation 36.2.3.2 Imaging 36.2.3.3 Management 36.2.4 Mammary Duct Ectasia 36.2.4.1 Clinical Presentation 36.2.4.2 Imaging 36.2.4.3 Management 36.2.5 Cysts 36.2.5.1 Clinical Presentation 36.2.5.2 Imaging 36.2.5.3 Management 36.2.6 Intraductal Papilloma 36.2.6.1 Clinical Presentation 36.2.6.2 Imaging 36.2.6.3 Management 36.2.7 Fat Necrosis 36.2.7.1 Clinical Presentation 36.2.7.2 Imaging 36.2.7.3 Management 36.2.8 Postsurgical Scar 36.2.8.1 Clinical Presentation 36.2.8.2 Imaging 36.2.8.3 Management 36.2.9 Adenomyoepithelial Tumor 36.2.9.1 Clinical Presentation 36.2.9.2 Imaging 36.2.9.3 Management 36.2.10 Gynecomastia 36.2.10.1 Clinical Presentation 36.2.10.2 Imaging 36.2.10.3 Management Conclusion References 37: Malignant Breast Tumors 37.1 Introduction 37.2 Types of Breast Cancer Seen in the Elderly 37.2.1 Invasive Ductal Carcinoma 37.2.2 Invasive Lobular Carcinoma 37.2.3 Ductal Carcinoma In Situ 37.2.4 Papillary Carcinoma 37.2.5 Mucinous Breast Carcinoma 37.2.6 Male Breast Carcinoma 37.3 Staging of Breast Cancer 37.4 Treatment of Breast Cancer 37.4.1 Local Control of Breast Cancer with Surgery and Radiation Therapy 37.4.2 Endocrine or Hormonal Therapy 37.4.3 Chemotherapy 37.4.4 Targeted Treatments Conclusion References 38: Artifacts and Pitfalls in Breast Imaging 38.1 Introduction 38.2 Classification of Artifacts 38.2.1 Artifacts in Analog and Digital Mammography In the elderly, the coexistence of various diseases, the presence of involutional and degenerative changes, and the occurrence of both physical and cognitive problems represent “the norm.” It is therefore important to know how to distinguish the healthy elderly from those in need of treatment as a sound basis for avoiding overdiagnosis and overtreatment. This aspect is a central theme in __Geriatric Imaging__, which covers a wide range of applications of different imaging techniques and clearly explains both the potential and the limitations of diagnostic imaging in geriatric patients. Individual sections are devoted to each major region or system of the body, and a concluding section focuses specifically on interventional procedures. The book, written by recognized experts in the field, is superbly illustrated and will be an ideal resource for geriatricians, radiologists, and trainees.