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<![CDATA[[Review] Incidental Adrenal Lesions: Principles, Techniques, and Algorithms for Imaging Characterization]]>
http://radiology.rsnajnls.org/cgi/content/short/249/3/756?rss=1
Incidental adrenal lesions are commonly detected at computed tomography, and lesion characterization is critical, particularly in the oncologic patient. Imaging tests have been developed that can accurately differentiate these lesions by using a variety of principles and techniques, and each is discussed in turn. An imaging algorithm is provided to guide radiologists toward the appropriate test to make the correct diagnosis.
]]>2008-11-14info:doi/10.1148/radiol.2493070976Radiological Society of North America32497752008-12-01756Review<![CDATA[[Review] Postoperative Surveillance of Differentiated Thyroid Carcinoma: Rationale, Techniques, and Controversies]]>
http://radiology.rsnajnls.org/cgi/content/short/249/2/429?rss=1
Although differentiated thyroid cancer (DTC) is typically an indolent disease with a high rate of cure, recurrence is common (15%–30% of patients), even in early-stage disease. These high rates of recurrence have resulted in the widespread adoption of intensive posttherapy surveillance algorithms. Currently used strategies rely primarily on serial serum thyroglobulin measurements combined with cervical ultrasonography (US): US is utilized to search for recurrences within the thyroid bed or anterior cervical lymph nodes and as a guidance system for directed fine-needle aspiration biopsy of suspicious lesions. Positron emission tomography (PET) and coregistered computed tomography/fluorine 18 fluorodeoxyglucose PET are used primarily in the setting of non–iodine-avid tumors. Intensive surveillance has improved the ability to detect small-volume tumor recurrence with a sensitivity that surpasses current understanding of the clinical implications of detecting clinically occult residual or recurrent disease. Knowledge of currently used treatment and surveillance strategies is crucial for understanding the appropriate use of imaging studies, the clinical implications of imaging findings, and the appropriate use of US-guided tissue sampling in patients with DTC. Recent advances in the understanding of DTC tumor biology hold promise for improving the ability to predict tumor behavior and aggressiveness, thereby allowing more appropriate risk stratification, imaging surveillance, and treatment.
]]>2008-10-20info:doi/10.1148/radiol.2492071313Radiological Society of North America22494442008-11-01429Review<![CDATA[[Review] Management of the Incidental Renal Mass]]>
http://radiology.rsnajnls.org/cgi/content/short/249/1/16?rss=1
Despite substantial advances in the imaging-based diagnosis of renal masses, the increased detection of incidental renal masses with cross-sectional imaging poses problems to the radiologist and referring physician. Most incidental renal masses can be diagnosed with confidence and either ignored or treated without further testing. However, some renal masses, particularly small ones, remain indeterminate and require a management strategy that is both medically appropriate and practical. In this article, the literature will be reviewed and an approach to the diagnosis and management of the incidental renal mass will be suggested. Management recommendations, derived from data regarding the probability of malignancy in cystic and solid renal masses, are provided for two types of patients, those in the general population and those with limited life expectancy or co-morbidity. The Bosniak classification is used to guide the management of cystic masses, with observation reserved for selected patients, and the presumption of benignity recommended for simple-appearing cystic masses smaller than 1 cm. Among solid renal masses, a more aggressive overall approach is taken. However, additional imaging, and in selected patients, percutaneous biopsy, is recommended to diagnose benign neoplasms. Although additional studies are needed to establish risks and benefits, observation of solid masses may be considered in selected patients. Minimally invasive treatments of renal cancer (including percutaneous ablation) show promise but at the same time challenge the radiologist to review the approach to the incidental renal mass.
]]>2008-09-16info:doi/10.1148/radiol.2491070783Radiological Society of North America1249312008-10-0116Review<![CDATA[[Review] Imaging of Skull Base Cerebrospinal Fluid Leaks in Adults]]>
http://radiology.rsnajnls.org/cgi/content/short/248/3/725?rss=1
Cerebrospinal fluid (CSF) leak occurs when there is an osseous and dural defect at the skull base, with direct communication of the subarachnoid space to the extracranial space, usually a paranasal sinus. Recognition of the leak site and source and appropriate treatment are necessary to avoid rhinorrhea or otorrhea, low-pressure headaches, and meningitis, known complications of CSF leak. The imaging evaluation has evolved over the past several decades. Description of current techniques available to direct treatment options, including multidetector thin-section computed tomography, and imaging recommendations are presented.