Investigation of choice

INVESTIGATION OF CHOICE

• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metasta sis – MRI
• Avascular necrosis- MRI
• Bone Density/Osteoporosis- DEXA (Dual energy x ray absorptiometry)
• Aneurysm/ AV Fistula- Angiography
• Dissecting Aneurysm (Stable) - MRI (Unstable)-Trans oesophageal USG
• Pericardial Effusion- Echocardiography
• Lobulated pericardial effusion- MRI > CT
• Minimum Pericardial Effusion- Echocardiography
• Ventricular Function- Echocardiography
• Radiotherapy/Chemotherapy induced cardiotoxicity- Endomyocardial Biopsy
• Pulmonary Embolism- CECT> Pulmonary Angiography > V/Q Scan
• Interstitial lung disease(Sarcoidosis)- HRCT
• Bronchiectasis- HRCT scan
• Solitary Pulmonary Nodule- High resolution CT (HRCT)
• Posterior Mediastinal Tumor- MRI
• Pancoast Tumor (Superior Sulcus Tumor) – MRI
• Minimum Ascites/Pericardial effusion/Pleural effusion – USG
• Traumatic Paraplegia- MRI
• Posterior Cranial Fossa – MRI
• Acute Haemorrhage- CT
• Chronic Haemorrhage- MRI
• Intracranial Space Occupying Lesion- MRI
• Primary brain tumour- contrast MRI (Gold standard however remains to be biopsy)
• Metastatic brain tumor- (Gadolinium) contrast enhanced MRI
• Temporal Bone-CT
• SAH Diagnosis- unenhanced CT
• SAH aetiology- 4 vessel MR Angiography > CT Angiography > DSA
• Nasopharyngeal angiofibroma- CECT scan
• Acoustic neuroma- Gadolinium DTPA enhanced MRI
• Obstetrics- USG
• Calcifications- CT
• Blunt abdominal Trauma- CT
• Acute Pancreatitis- CT
• GERD- pH manometer > endoscopy
• Dysphagia- Endoscopy
• Congenital hypertrophic pyloric stenosis- USG
• Extrahepatic biliary atresia- perioperative cholangiogram
• Obstructive Jaundice/GB Stones- USG
• Diverticulosis – barium enema
• Diverticulitis – CT scan
• Renal TB (early) – IVP (Late)- CT
• Posterior Urethral Valve- MCU
• Ureteric stone- non contrast CT
• Renal Artery Stenosis- Percutaneous Angiography
• Extraintestinal Amoebiasis- ELISA
• Discrete swelling(solitary nodule) of thyroid- FNAC

Radiology- CVS

Radiology- CVS
________________________________________
1) egg on side appearance-- uncorrected TGA.
2) boot shaped heart--TOF.
3) BOX shaped-- ebstein anomaly
4)flask shaped-- pericardial effusion.
5) egg in cup appearance--constrictive pericarditis
6)snowman/figure of 8 / cottage loaf sign-- TAPVC.
7)Docks/figure of 3/E- sign= coarctation of aorta. jug handle appearnce = primary pulm HTN.
9) MALADIE DE ROGER DEFECT= SMALL VSD
10) Hilar dance = ASD.
11) goose neck sign= endocardial cushion defect.
12)schimitar sign= partial anamolous pulmonary vein return.
13)convex left heart border= L-TGA.
14)straight left upper cardiac border= ebstein anomaly.
15) concave main pulmonary segment & right aortic arch= persistent truncus arterious
16) calcifiction of heart= carcinoid syndrome.
17)cardiothoracic ratio should be <0.5
18)lamda sign= small ascending aorta in hypoplastic left heart syndrome.
19)severe stenosis - mitral valve diameter < 1 sq.cm
20) uhl disease= parchment right ventricle
21) IOC for aortic dissection-- MRI
22) IOC for pericardial effusion= M- mode ECHO.
23)IOC for valvular disease = 2 D -ECHO.
24) INVERTED MOUSTACHE SIGN= MITRAL STENOSIS.
25) IOC FOR RADIOTHERAPY CAUSED FIBROSIS= BIOPSY
26)small heart
*normal variant
*emphysema
*addisons disease
*dehydration/malnutrition
*constrictive pericarditis.
27) CARDIAC SHADOW
*right= superior venacava,right atrium,inf venacava
*left=aortic knuckle,pulm artery,left atrial appendage,RV,LV
28)mitral stenosis
*straightening of the left border of the cardiac silhouette
*double atrial shadow.
29) non obstructive TAPVC
*cardiomegaly with plethoric.
*snow man or figure of 8 configuration.
30)obstructive TAPVC
*normal sized heart
*ground glass appearance of lung
due to severe pulmonary HTN.
31)m.c calcification of aorta= syphilitic aortitis.
32)ascending aorta commonest site of calcification.
33)CCF
*enlarged cardiac silhouette.
*ground glass appearance
*kerley b lines
*prominence of upper lobe blood vessel.
*pleural effusion, usually bilateral.
34)even quantities as small as 20-50 ml of pericardial fluid can be diagnosed by echocardiography
35) spring water cyst also k/a pleuro- pericardial cyst or pericardial coelomic cyst.
36)SMALL VSD
*normal
*minimal cardiomegaly
*minimal increase in pulmonary vasculature
37) LARGE VSD
*gross cardiomegaly
*dilatation of both ventricles, left atrium,pulm artery.
*increased pulmonary vascular marking,pulmonary edema &pleural effusion
38)gross cardiac enlargement
*multiple valvular disease.
*pericardial effusion
*ASD
*cardiomyopathy
*ebstein anomaly

Musculoskeletal Radiology Signs

Musculoskeletal Radiology Signs
Absent in posterior dislocation of the
shoulder-Half Moon Sign
ACL Tear-Anterior Drawer Sign
ACL Tear-Bone Bruise Sign
ACL Tear-Deep lateral femoral notch sign
ACL Tear - Segund fractureLateral Capsular Sign
Acromegaly-Heel Pad Sign
Aneurysmal bone cyst-Blister of Bone
Aneurysmal bone cyst-Fluid Fluid Level
Ankle effusion-Teardrop Sign (ankle)
Ankylosing Spondylitis-Bamboo Spine
Ankylosing Spondylitis-Dagger Sign
Ankylosing Spondylitis-Trolley-track sign
Avascular Necrosis-Bite Sign
Avascular Necrosis-Crescent Sign
Avascular Necrosis-Intravertebral Vacuum Cleft
Blowout fracture-Tear Drop Sign (Orbits)
Bucket-handle tear of the menisci- Absent Bow Tie Sign
Bucket-handle tear of the menisci- Double PCL Sign
Bucket-handle tear of the menisci- Fragment-in-Notch Sign
Calcaneonavicular coalition-Anteater Nose
Chronic renal failure-Rugger Jersey Sign
Degenerative disk disease-Vacuum Phenomenon
Discoid Meniscus-Bow Tie Sign
Elbow effusion-Elbow Fat Pad Sign
Elbow effusion-Sail Sign
Enthesopathy-Tooth Sign
Eosinophilic granuloma-Button Sequestrum
Hemolytic anemia-Hair on End
Inferior subluxation of the shoulder- Drooping Shoulder Sign
Intraosseous lipoma-Cockade Image
Lipohemarthrosis-FBI Sign
Loosening prosthesis-Pedestal Sign
Mets, Paget, Lymphoma-Ivory - Vertebra Sign
Normal - No joint effusion-Pneumoarthrogram Sign
Normal spine-Cupid's Bow Contour
Osteopenia-Fish Vertebra
Osteopetrosis-Bone in Bone Sign
Paget's Disease-Blade of Grass Sign
Paget's Disease-Brim Sign
Paget's Disease-Cotton Wool Sign
Post traumatic bone cyst-Tumbling Bullet Sign
Posterior shoulder dislocation-Rim Sign
Posterior shoulder dislocation-Trough Line
Psoriasis-Ivory Phalanx Sign
Psoriasis-Sausage Digit
Rheumatoid arthritis-Boutonniere Deformity
Rheumatoid arthritis-Swan Neck Deformity
Rotary subluxation-Cortical Ring Sign
s/p anterior shoulder dislocation-Hill- Sachs Sign
Scapholunate dissociation-Terry- Thomas Sign
Short 4th Metacarpal\Metacarpal Sign
Sickle cell anemia-H Vertebra
Sickle cell, Gaucher's DiseaseStep-Off Vertebral Body Sign
Spondylolisthesis-Inverted Napoleon Hat Sign
Spondylolysis-Incomplete ring sign
Spondylolysis-Scotty Dog Sign
Subtalar coalition-C Sign
Unicameral bone cyst-Fallen Fragment
Volar Perilunar dislocation-Crowded Carpal Sign
Wrist Fracture-Pronator Sign

• IMP RADIOLOGICAL FEATURE

• IMP RADIOLOGICAL FEATURE
• Spider leg appearance----polycystic kidney
• Cobra head appearance---ureterocele
• Flower vase appearance of ureters---horse shoe kidney
• Sandy patches---schistosomiasis of bladder
• Soap bubble appearance---hydronephrosis
• Apple core lesion on barium ---ca colon
• Claw appearance on barium enema —intussusception
• Saw tooth appearance----diverticula of colon
• Birds beek appearance of esophagus on ba meal---achalasia
• Cork screw appearance of esophagus on barium meal---diffuse esophageal spasm
• String sign of cantor----crohn's dis
• Thumb printing sign---ischemic colitis
• EGG SHELL CALCIFICATION---- silicosis , sarcoidosis , scleroderma , histoplasmosis , amyloidosis , lymphoma following radiotherapy

ABSOLUTE CONTRAINDICATIONS FOR MRI:

ABSOLUTE CONTRAINDICATIONS FOR MRI:
1. PACEMAKER
2. IMPLANTED NEUROSTIMULATOR
3. BRAIN ANEURYSM CLIPS
4. STENTS IF THEY HAVE NOT BEEN IN PLACE FOR MORE THEN 8 WEEKS.
5. METAL SUTURES, POST SURGERY ( THEY MUST BE REMOVED BEFORE HAVING AN MRI).
6. METAL FRAGMENTS IN EYE OR NEAR MAJOR BLOOD VESSELS THAT HAVE NOT BEEN REMOVED BY A PHYSICIAN..

Radiology High Yield

Must Know Points Before Exams

•William Roentgen discovered X-rays
•Father of Interventional Radiology : Charlies Dotter
•Father of medical USG : John Wild
•Father of Obstetric USG : Sir Ian Donald
•Attenuation of x ray depend on Absorption Coefficient
•Radiation exposure is measured by Dosi Meter
•GRID used in X ray to reduce scattered radiation
•Contrast in x ray depend on Kv
•Radioactivity was discovered by Curie (1896)
•Pantomography : is a special radiographic technique used for CURVED SURFACES
•GAMMA RAYS : Discovered by Henry Becquerel , high energy ionizing radiation , maximum penetrating power . radiation sickness is mostly due to gamma rays
•Cesium -137, cobalt and Radium predominantly emit gamma rays , natural soure : Phosphorus 40.
•Most ionizing radiation are Alpha rays .
•Infra Red Rays are used in Placental localization , Thermography , Orbital pneumotography , intra cerebral infract diagnosis
•USG is sound with frequency > 20,000 cycles/sec , MC used frequency 1MHz to 20 MHz , principle : PIEZO ELECTRIC CRYSTAL ACTIVATION
•USG is non mutagenic , contrast used is sonavist
•Echocardiography uses high frequency sound waves .
•Transesophageal echocardiography is used to evaluate patients with suspected aortic dissection
•CT scan was invented by Hounsfield
•Spiral CT uses Slip ring technology , in routine spiral CT splice thickness is 10mm , Routine spiral CT : 1rotation/1section/1sec
•Multi Detector CT scan : IOC for Pulmonary Embolism , Aortic aneurysm, Aortic dissection
•Most accurate investigation for Aortic Dissection : MRI
•CEREBRAL ANEURYSM IOC : Angiography
•CARDIC CT SCAN : Coronary calcium scoring or AGATSON scoring is done for patients with asymptomatic CAD
•HRCT is specialized technique used to evaluate lung parenchyma which uses Bone Algorithm
•HRCT IOC : ILD , Miliary TB, Bronchectasis
•Box car ventricles or Butter fly ventricles : on MRI is seen in HUNTINGTONS CHOREA
•Eye of tiger appearance on MRI : HALLEVORDEN SPATZ DISEASE
•Brain infract earliest detected by dw- MRI
•IOC Acute brain hemorrhage : CT SCAN
•IOC Acute head injury : CT-SCAN
•IOC stroke : CT-SCAN
•Pop corn calcification on chest x ray : Hamartoma
•Pop corn calcification on mammography : Fibroadenoma
•Cancer missed on mammography : LCIS
•MRI discovered by SIR PETER MANSFIELD & PAUL LATENBEUR
•MRI works on principle of Gyro Magnetic Property of Proton
•MC contrast agent used in MRI Gadolinium DTPA, magnetic field strength : 0.2-7 tesla , routine MRI : 1.5 tesla
•Time of flight technique : MRI
•Salt and pepper skull : Hyperthyroidism
•Salt and pepper appearance on MRI : Glomus Tumor
•Carotid body tumor : LYRE sign on angiography
•Corpus callosum agenesis on MRI : Racing car appearance
•Corpus callosum Lipoma on X ray : Bracket shaped calcification
•Elevated NAA levels on MR Spectroscopy : CANAVANS DISEASE
•MRCP is initial investigation for : Biliary stricture, Carolis disease, Choledochal cyst
•SCIWORA : spinal cord injury with out obvious radiological abnormality
•MRI IOC for stress fracture , Bone Bruise, occult bony injury
•CT SCAN IOC : ankle , temporal bone, acetabular fractures
•Minimum amount of pleural fluid identified in lateral decubitus postion : 25 ml
•Right heart border : RA,SVC,IVC
•Left heart border : LV, Auricle, PA , Aortic Knuckle
•Left atrial enlargement : BED FORD SIGN
•LV enlargement : HOFFMAN RIGLER SIGN
•CT finding of Endo-Bronchial spread of TB : TREE IN BUD SIGN
•Scadding criteria : grading criteria for Sarcoidosis
•FACE OF GAINT PANDA ON MRI of Brain : Wilsons disease
•Aspergillus : air cresent sign / Mondas sign
•ABPA : Gloved Finger of Simon app
•HALO sign on CT scan : invasive Aspergillosis
•Reverse Halo Sign : Cryptogenic organizing pneumonia
•Hydatid Cyst : USG – Cart wheel app , CXR – water lily sign , Cumbo sign
•Dropping lily sign on IVP : Duplication with non functional upper pole
•Polo Mint sign on CT scan : Portal vein thrombosis
•Safe and accurate for fetal viability at 6 wks : USG
•Doppler- pregnancy for IUGR
•MOYA MOYA disease PUFF OF SMOKE app
•IOC for Blunt abdominal trauma : CECT
•FAST : focused assessment & sonography in trauma
•PACS : picture archiving & communication system
•Minimum Blood detected by FAST 200ml
•USG – Pneumothorax :STRATOSPHERE SIGN
•MCU IOC for VUR , PUV , posterior urethral evaluation
•IOC for renal and splenic injury : CECT
•IOC urinary stones : NCCT , Stones detected only on Ureteroscopy : INDINAVIR stones
•RENAL TB : IOC – CECT
•Renal TB on IVP : moth eaten calyces , thimble bladder , Putty /cement kidney / Auto –nephrectomy
•Egg in a cup app on IVP : Papillary Necrosis
•AR – PCKD – sun ray appearance / Striated Nephrogram
•AD-PCKD- Swiss cheese Nephrogram
•ADPCKD on IVP : Spider leg app
•Multi cystic dysplastic kidney on IVP : is not visualized , on USG : Soap Bubble app
•Horse Shoe kidney on IVP : Flower Vase app , Hand-shake sign
•Bouquet of flowers on IVP : Medullary Spongy Kidney
•Multiple sclerosis MRI : Dawson’s Fingers
•On MRI Metachromatic Leuko-dystrophy shows : TIGROID PATTERN LEOPARD SKIN APP
•Parkinsons disease –MRI – Absene of swallow tail app
•Progressive Supranucler Palsy – MRI – HUMMIMG BIRD App
•Medulloblastoma has CSF drop metastasis , MRI : Sugar Coating App
•Ring Enhancing Lesion of brain : Toxoplasmosis , brain abscess, tuberculoma, metastasis, Neurocysticercosis
•Solid Homogenous Enhancing Lesion in Brain : Lymphoma (AIDS)
•Meningioma : MRI : Dural tail sign , X ray – shows calcification and hyperosteosis of skull bone
•Vestibular schwannoma MRI : ICE CREAM CONE app
•Spinal Neurofibroma : MRI – DUMBELL SHAPED NEUROFIBROMA
•Osteosarcoma : Codman triangle , Sun Ray app on x ray
•Chondroblastoma HPE : chicken wire calcification
•Enchondroma : x ray – O’Ring sign
•Fibrous Dysplasia : x ray- Ground Glass app
•Vertebral Haemangioma : X ray : corduroy app , vertical striations are present . CT scan POLKA DOT sign
•Simple bone cyst : fallen leaf sign on x ray
•Beveled Edges of skull on x ray : Histocytosis
•Punched out lytic lesions of skull : Multiple Myeloma
•Earliest X ray finding of TB spine : Rarefaction of end plate -> disc space narrowing
•Spool shaped vertebrae is feature of – Pyknodysostosis
•Molten candle wax appearance seen in- Melorheostosis

Paget’s disease:

oCotton wool skull
oIvory vertebra (also seen in – metastasis)

Ankylosing spondylitis:

oBamboo spine
oRomanus sign/ Dagger sign
oSquaring of vertebrae (picture frame vertebra)
oIntervertebral disc calcification.

•Bare orbit sign seen in – Neurofibromatosis
•Earliest seen in rickets – Loss of provisional zone of calcification
•Looser’s zones or pseudo fractures is the hallmark feature of – Osteomalacia.
•Rugger jersey spine seen in Renal osteo-dystrophy, Osteopetrosis.
•Achalasia cardia : Bird beak app , Pencil tip app
•Ca Esophagus : Rat tail app
•IOC for swallowing disorder : Videoscopy
•Duodenal ulcer : Trifolate Duodenum
•IOC CHPS : USG
•Bening Gastric Ulcer : spoke wheel app
•Malignant Gastric Ulcer : Carmen’s meniscus sign / Carmen kirkliv complex
•Acute Pancreatitis –IOC CECT
•Chronic Pancreatitis –IOC : MRCP ( chain of lake app)
•Periampullary ca of pancreas : Frost Berg Reverse 3 Sign
•Bowel TB : string sign , Inverted Umbrella sign / fleschner’s sign , conical ceacum , goose neck ileum .
•Ulcerative Colitis : Earliest barium finding : Mucosal granularity , collar button ulcer , lead pipe app colon
•Crohn’s disease : Earliest barium finding : Apthous Ulcer , rose thorn app, string sign of kantor
•IOC Meckel’s Diverticulum : Tc 99 Per technetate scan
•Ischemic Colitis : Ba Enema : thumb print sign
•Thumb sign on neck X ray : Epiglottis
•Sigmoid volvus : X ray : coffee bean sign , bird of prey sign on Ba enema

Radiation and Radiotherapy:

o1Particulate/corpuscular: alpha, beta ,proton , neutron
o2Electro magnetic: X-rays’s , gamma rays , cosmic rays .
oMost common cause of outdoor radiation – cosmic.
oMost common cause of indoor radiation – radon.
oMost common cause of endogenous (human body)– potassium

Radiation exposure limits:

oNatural radiation / anum: 0.1 rad / anum
oFatal dose – single exposure – 500 REM
oMinimum dose required for systemic effect: 100 Rem
oMaximum permissible dose for normal population – 5 rads / anum
oMaximum permissible dose for a pregnant female who is occupationally exposed: 0.5 rads /anum .
oMinimum dose required for teratogenicity: 5 rads

Sensitivity and resistance:

oMost radio sensitive tissue: bone marrow
oLeast radio sensitive tissue: brain / nervous tissue
oMost radio sensitive cell: lymphocyte
oMost radio resistant: platelets / RBC
oMost radio sensitive stage of cell cycle – G2 M > M
oMost radio resistant stage of cell cycle – late S phase

MRI T1

5 things hyperintense on T1 MRI

1. Fat (hyperintense both on T1 & T2)
2. Blood products
3. Gadolinium
4. Melanin
5. proteinicious substance

Artery

Completely occluded artery – T1M1 0

Marked occluded artery – T1M1 1

Mild occluded artery – T1M1 2

Normal coronary flow – T1 M1 3

Hyperintrnse T weighed MRI

3 F
Fat
Flow
Fluid

4M
Melanin
Magnavist
Mineralisation
Methemoglobin

IOC

INVESTIGATION OF CHOICE:
• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metastasis – MRI
• Avascular necrosis- MRI
• Bone Density/Osteoporosis- DEXA (Dual energy x ray absorptiometry)
• Aneurysm/ AV Fistula- Angiography
• Dissecting Aneurysm (Stable) - MRI (Unstable)-Trans oesophageal USG
• Pericardial Effusion- Echocardiography
• Lobulated pericardial effusion- MRI > CT
• Minimum Pericardial Effusion- Echocardiography 
• Ventricular Function- Echocardiography
• Radiotherapy/Chemotherapy induced cardiotoxicity- Endomyocardial Biopsy
• Pulmonary Embolism- CECT> Pulmonary Angiography > V/Q Scan
• Interstitial lung disease(Sarcoidosis)- HRCT
• Bronchiectasis- HRCT scan
• Solitary Pulmonary Nodule- High resolution CT (HRCT)
• Posterior Mediastinal Tumor- MRI
• Pancoast Tumor (Superior Sulcus Tumor) – MRI
• Minimum Ascites/Pericardial effusion/Pleural effusion – USG
• Traumatic Paraplegia- MRI
• Posterior Cranial Fossa – MRI
• Acute Haemorrhage- CT
• Chronic Haemorrhage- MRI
• Intracranial Space Occupying Lesion- MRI
• Primary brain tumour- contrast MRI (Gold standard however remains to be biopsy)
• Metastatic brain tumor- (Gadolinium) contrast enhanced MRI
• Temporal Bone-CT
• SAH Diagnosis- unenhanced CT
• SAH aetiology- 4 vessel MR Angiography > CT Angiography > DSA
• Nasopharyngeal angiofibroma- CECT scan
• Acoustic neuroma- Gadolinium DTPA enhanced MRI
• Obstetrics- USG
• Calcifications- CT
• Blunt abdominal Trauma- CT
• Acute Pancreatitis- CT
• GERD- pH manometer > endoscopy
• Dysphagia- Endoscopy
• Congenital hypertrophic pyloric stenosis- USG
• Extrahepatic biliary atresia- perioperative cholangiogram
• Obstructive Jaundice/GB Stones- USG
• Diverticulosis – barium enema
• Diverticulitis – CT scan
• Renal TB (early) – IVP (Late)- CT
• Posterior Urethral Valve- MCU
• Ureteric stone- non contrast CT
• Renal Artery Stenosis- Percutaneous Angiography
• Extraintestinal Amoebiasis- ELISA
• Discrete swelling(solitary nodule) of thyroid- FNAC

Investigation of choice

“Investigation of choice for early renal tb is IVP”
“Inv of choice in advanced renal tb is CT”
“Inv of choice for blunt abd trauma is CT”
“Inv of choice for avascular necrosis is MRI”
“Inv of choice for cholecystitis n gall stones is ultrasound”
“Investigation of choice for bone density and osteoporosiiis DEXA bone test”
“Inv of choice for GERD is 24 hour ph metry”
“Inv of choice for VUR and posterior valves is MCU”
“Inv of choice for cytotoxic drug induced cardiotoxicity Is endomyocardial biopsy”
“Inv of choice for obstetric probs is USG”
“Inv of choice for PE is CECT>angiography>v/Q scan”
“Inv of choice for acute cerebral hemorrhage CT”
“Inv of choice for chronic cerebral hemorrhage is MRi”
“Inv of choice for posterior med tumor,pancoasts tumor,posterior cranial fossa is MRI”
“Inv of choice for subarachnoid hemmorhage diagnosis unenhanced CT”
“Inv of choice for subarachnoid hemorrhage etiology is 4vessel MR angiography”
“Inv of choice for interstitial lung disease and bronchectasis is HRCT”“
“Inv of choice for stable dissecting aneurysm is MRI”
“Inv of choice for dissecting aneurysm unstable is transoesophagal usg”
“Inv of choice for traumatic paraplegia is MRI”

Radiology Signs

square patella- hemophilic arthiritis

square vertebrae- ankylosing spondylitis

fish vertebrae- osteomalacia

cupola sign - pneumoperitonium

flower vase - horseshoe kidney

dropping flower- ectopic ureter

honey comb- adamantioma

fallen fragment sign - aneurysmal bone cyst

central stellate scar on CT - renal oncocytoma

Radiology Signs

bulb sign - post dislocation of shoulder

rice grain calcification of brain - neurocysticercosis

fox sign - acute pancreatitis

square root sign - constrictive pericarditis

CVS radiology

RADIOLOGY CVS 

1) egg on side appearance-- uncorrected TGA. 
2) boot shaped heart--TOF. 
3) BOX shaped-- ebstein anomaly 
4)flask shaped-- pericardial effusion. 
5) egg in cup appearance-- constrictive pericarditis 

6)snowman/figure of 8 / cottage loaf sign-- TAPVC. 
7)Docks/figure of 3/E- sign= coarctation of aorta. 
8) jug handle appearnce = primary pulm HTN. 
9) MALADIE DE ROGER DEFECT= SMALL VSD 
10) Hilar dance = ASD. 

11) goose neck sign= endocardial cushion defect. 
12)schimitar sign= partial anamolous pulmonary vein return. 
13)convex left heart border= L-TGA. 
14)straight left upper cardiac border= ebstein anomaly.
15) concave main pulmonary segment & right aortic arch= persistent truncus arterious 

16) calcifiction of heart= carcinoid syndrome. 
17)cardiothoracic ratio should be < 0.5 
18)lamda sign= small ascending aorta in hypoplastic left heart syndrome. 
19)severe stenosis - mitral valve diameter < 1 sq.cm 
20) uhl disease= parchment right ventricle 

21) IOC for aortic dissection-- MRI 
22) IOC for pericardial effusion= M- mode ECHO. 
23)IOC for valvular disease = 2 D - ECHO. 
24) INVERTED MOUSTACHE SIGN= MITRAL STENOSIS.
25) IOC FOR RADIOTHERAPY CAUSED FIBROSIS= BIOPSY

26)small heart 
*normal variant 
*emphysema 
*addisons disease 
*dehydration/malnutrition 
*constrictive pericarditis. 

27) CARDIAC SHADOW 
*right= superior venacava,right atrium,inf venacava 
*left=aortic knuckle,pulm artery,left atrial appendage,RV,LV 

28)mitral stenosis 
*straightening of the left border of the cardiac silhouette 
*double atrial shadow. 
*prominence of the main pulm artery 
*dilatation of the upperlobe pulm veins. 
*backward displacement of esophagus 
*kerley b lines 

29) non obstructive TAPVC 
*cardiomegaly with plethoric. 
*snow man or figure of 8 configuration. 

30)obstructive TAPVC 
*normal sized heart 
*ground glass appearance of lung due to severe pulmonary HTN. 

31)m.c calcification of aorta= syphilitic aortitis. 
32)ascending aorta commonest site of calcification. 

33)CCF 
*enlarged cardiac silhouette. 
*ground glass appearance 
*kerley b lines 
*prominence of upper lobe blood vessel. 
*pleural effusion, usually bilateral. 

34)even quantities as small as 20-50 ml of pericardial fluid can be diagnosed by echocardiography 

35) spring water cyst also k/a pleuro-pericardial cyst or pericardial coelomic cyst. 

36)SMALL VSD 
*normal 
*minimal cardiomegaly 
*minimal increase in pulmonary vasculature 

37) LARGE VSD 
*gross cardiomegaly 
*dilatation of both ventricles, left atrium,pulm artery. 
*increased pulmonary vascular marking,pulmonary edema &pleural effusion 

38)gross cardiac enlargement 
*multiple valvular disease. 
*pericardial effusion 
*ASD 
*cardiomyopathy 
*ebstein anomaly

One liners in Radiology

Pnemothorax is best demonstrated during expiration
Dye used in bronchography Dianosil
Solitary nodule lung lung cannot be NF
B/L calcification of lungs not found in Friendlanders pneumonia
Perihilar fluffy opacity on chest X-ray seen in pulmonary venous HTN
Rt. Lung is seen to best advantage on Rt. Anterior oblique
In Hamartoma no cavitating lesion in CXR
Best CXR are performed at 60-90 Kvp
Golden S sign seen in Rt. Upper lobe collapse
Preferred modality for Dx of pulmonary embolism is Ventilation perfusion >angiography
Well defined rounded opacity in the lung with coarse irregular calcification ---- Hamartoma
MC cause of spontaneous pneumothorax – rupture of subpleural blebs
Apex of lungs is best asses by AP view
Bulging fissure in lungs is seen in --- Klebsiella pneumonia
Tracheal bifurcation at T4-T5 level
Floating water lily sign --- Hydatid Lung
Hampton hump --- pulmonary embolism
U/L hyperlucent lung on CXR --- Poland syndrome
Mediastinal Lymph node calcification seen in Sarcoidosis
Lt. atrial enlargement(ALSO MITRAL VALVE) is seen with Barium swallow Rt. Anterior oblique view
Echocardiography can detect pericardial effusion min fluid – 15ml
Hilar dance -- ASD,VSD,TGV
Dx of acute MI hot spot seen with Tc 99
Best Dx for dissecting aorta ---- MRI
Flask shaped heart – Ebstein anomaly, TOF
Square root sign --- Constrictive pericarditis
Splenic calcification --- Brucellosis
Pancreatic scanning isotope MC used -- Selenium -75
In colitis cystic profunda whole colon can involved
No hapatomegaly in Coeliac Ds
Scalloping of the edge of sigmoid colon on barium enema seen in --- pnematosis intesinalis
Barium meal in trendelenberg position used best in Hiatal disorder
Invertogram to be done in newborn after 6 hrs
Hepatic adenoma can be Dx with high accuracy by using Nuclear imaging
Fox sign --- Acute pancreatitis
Adenolymphoma - Tc-99 scan show hot spot
Bird of prey sign ---- Sigmoid volvulus
Gold standard IOC for GIST – PETCT
Bead cystogram used in Dx of Stress incontinence
Placenta localization by Tc99
In nephrogram one see Collecting duct
Renal scan should be done in Supine postion
Rim sign – Massive hydronephrosis
Neonate has mass in kidney which on USG is seen as hypoechoic shadow ---- Mesonephroblastic tumour
Uereterocoele (IVP) --- Adder head appearance
Central stellate scar on CT --- renal oncocytoma
A tumour Trouser leg appearance on an ascending myelogram –intramedullary
Stipple sign in transitional CC of the renal collecting system best seen in retrograde pyeloureterography
ACUTE SAH < 48 Hrs - NON CONTRAST CT
CHRONIC SAH >48Hrs - MRI
DENSITY OF HEMORRHAGE DECREASES WITH TIME AND GRADUALLY APPROACHES THAT OF CSF
Basal ganlia calcification seen in Wilson ds
MC intracranial calcification is peneal calcification
Tram-line calcification --- Sturge weber syndrome
Commonest cause of intracerebral calcified shadow --- Oligodendroglioma
Most serious complication of myelogram – Allergey
Calcification in basal ganglia --- hypothyroidism, hypoparathyroidism
In fluorescein angiography dye is injected in ante cubital vein
Bracket calcification in skull X-ray – copus callosum lipoma
Periventricular calcification --- CMV
In meningioma no erosion occur
Extramedullary intradural tumour – Neurofibroma
Multiple sclerosis lesion in white matter
Banana sign --- Spina bifida
X-ray of Skull n phalanges is diagnostic in hyperparathyroidism
Dead bone on X-ray look more radio opaque
Intraosseous skeletal tumour is best Dx by CT scan
Stryker’s view is used in shoulder joint to visualize --- Recurrent subluxation
Normal metacarpal index is 5.4 – 7.9
Stenver View(Towne view) --- internal auditory meatus ,mastoid air cell(MALIS see mnemonics page)
Champagne Glass pelvis --- Achondroplasia
Umbau Zones -- osteogenesis imperfect
Caldwell view – Superior orbital fissure
H – shaped vertebra --- Sickle cell anemia
Schober ‘s sign --- Flexion of lumber spine
Vertebra plana --- EG,Malignancy
5 –FU not given in Mycosis fungoides
Karnofsky scale --- measurement of size of tumour
Sunburst calcification on X-ray -- insulinoma
Calcific hepatic metastases --- Adenocarcinoma of colon
S/E of USG in small organism --- cavitation
Isotope selectively concentrated in abscess --- Gallium
X-Ray film are least sensitive to which coloured light – red
Photoelectric interaction Primarily in K shell
Thesaurosis -- Resins in hairspray
Grid – used for reducing scattered radiation
Best Dx of nasopharyngeal angiofibroma – CECT
Medusa head in X-Ray – ascariasis
Spring water cyst – pleura pericardial cyst
USG of umbilical artery done for to know heart beat
USG frequency used in obs is 1-20 MHz
Sestamibi Scan --- parathyroid adenoma
UV A – 320-400 nm
Active ingredient in Xray film – silver bromide
“Time of Flight “ technique used in MRI
Target angle in tele therapy --- 300
T ½ of Co60 = 5.2 yrs
Radioactive gold is used in malignant ascitis
Radioactive phosphorus used in polycythemia
Isotope which replacing radium – Cs
Tc99 T ½ = 6hrs
Latest source of neutrons for radiotherapy --- Californium -256
A single whole body dose can cause death – 300 rad
In teletherapy distance is 100 cm
1st sign after Radiation is Erythema
T ½ of Rn-222 =3-6 days
1 gray(unit for absorbed)= 100 gray
Benign condition treated by radiotherapy is pituitary adenoma
Dose for total body irradiation in bone marrow transplantation – 1000 cgy – 1200 cgy
Hyperfractionation Rx (Radiotherapy) used in Lung cancer
Naturally occurring radioactive substance in the body – K40
Radioactive isotope used in gamma knife for t/t of AV malformation—Co
Not used in brachytherapy – I131
RAIU – I 123 (AI 07)
Max permissible dose of radiation for radiation worker 50 MSV per year
1Curie = 3.7 Gbq
Point B t/t of Ca of cervix by radiotherapy --- Obturator node
Commonly used in intra operative Rx – Electron

Half life

Iodine 132 2 to 3 hours

Technitium 6 hours

Iodine 123 13 hours

Gold 2.7 days

Thallium chloride 3.1 days

Gallium 3.2 days

Radon 3.8 days

Xenon gas 5.2 days

Iodine 131 8 days

Phosporous 32 14.3 days

Iridium 74.5 days

Tantalum 115 days

Cobalt 69 5 years

Strontium 28 years

Caesium 30 years

Ra 1622 years

Ring Enhancing Lesions

Ring Enhancing Lesions : "DR MAGICAL"

D - demyelinating disease.
R - radiation necrosis or resolving haematoma.
M - metastasis.
A - abscess e.g toxoplasmosis / Aspergilloma
G - glioblastoma multiforme.
I - infarct (subacute phase).
A- Aspergilloma / Cryptococcoma
C - contusion.
L - lymphoma.

IOC

INVESTIGATION OF CHOICE:
• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metasta sis – MRI
• Avascular necrosis- MRI
• Bone Density/Osteoporosis- DEXA (Dual energy x ray absorptiometry)
• Aneurysm/ AV Fistula- Angiography
• Dissecting Aneurysm (Stable) - MRI (Unstable)-Trans oesophageal USG
• Pericardial Effusion- Echocardiography
• Lobulated pericardial effusion- MRI > CT
• Minimum Pericardial Effusion- Echocardiography
• Ventricular Function- Echocardiography
• Radiotherapy/Chemotherapy induced cardiotoxicity- Endomyocardial Biopsy
• Pulmonary Embolism- CECT> Pulmonary Angiography > V/Q Scan
• Interstitial lung disease(Sarcoidosis)- HRCT
• Bronchiectasis- HRCT scan
• Solitary Pulmonary Nodule- High resolution CT (HRCT)
• Posterior Mediastinal Tumor- MRI
• Pancoast Tumor (Superior Sulcus Tumor) – MRI
• Minimum Ascites/Pericardial effusion/Pleural effusion – USG
• Traumatic Paraplegia- MRI
• Posterior Cranial Fossa – MRI
• Acute Haemorrhage- CT
• Chronic Haemorrhage- MRI
• Intracranial Space Occupying Lesion- MRI
• Primary brain tumour- contrast MRI (Gold standard however remains to be biopsy)
• Metastatic brain tumor- (Gadolinium) contrast enhanced MRI
• Temporal Bone-CT
• SAH Diagnosis- unenhanced CT
• SAH aetiology- 4 vessel MR Angiography > CT Angiography > DSA
• Nasopharyngeal angiofibroma- CECT scan
• Acoustic neuroma- Gadolinium DTPA enhanced MRI
• Obstetrics- USG
• Calcifications- CT
• Blunt abdominal Trauma- CT
• Acute Pancreatitis- CT
• GERD- pH manometer > endoscopy
• Dysphagia- Endoscopy
• Congenital hypertrophic pyloric stenosis- USG
• Extrahepatic biliary atresia- perioperative cholangiogram
• Obstructive Jaundice/GB Stones- USG
• Diverticulosis – barium enema
• Diverticulitis – CT scan
• Renal TB (early) – IVP (Late)- CT
• Posterior Urethral Valve- MCU
• Ureteric stone- non contrast CT
• Renal Artery Stenosis- Percutaneous Angiography
• Extraintestinal Amoebiasis- ELISA
• Discrete swelling(solitary nodule) of thyroid- FNAC

Radiological appearances in vertebrae-

*Vertebra plana-Eosinophilic granuloma

*Picture frame vertebra-Osteopetrosis and Paget's

*Calcified disc-Alkaptonuria, Flurosis,Ankylosing sponylitis, Gout,Hemochromatosis.

*Fish mouth vertebrae-SCA

*Cod fish-Osteomalacia

*Rugger jersey- Renal Osteodystrophy (Alternate bands of osteoporosis and osteosclerosis)
*Ivory Phalanx-Paget'Disease and Lymphoma

Ring enhancing

Causes of Cerebral Ring Enhancing lesions
"MAGIC DR"

M-Metastasis
A-Abscess(including tuberculoma)
G-Glioblastoma multiformae
I-infarct(Subacute phase)
C-contusion
D-Demyelinating disease (eg:tumefactive MS)
R-Radiation necrosis