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How Good Does It Get?

rstanley{at}ajroffice.org

As I was assembling the table of contents for this month's issue of the AJR, I was struck by several concepts that were evident in the numerous articles. Today radiologists are looking at the human body and pathologic morphology in ways we could never imagine in the past and with considerably more precision. Noninvasive imaging of the entire vascular tree, from top to bottom, is now accomplished easily. In the articles by Togao et al. [1], Kapoor et al. [2], Lee et al. [3], Karcaaltincaba et al. [4], and Matsuki et al. [5] covering a wide range of clinical entities for which a precise knowledge of the arterial anatomy is required, the anatomic images presented are breathtaking; the valuable and highly relevant clinical information derived is even more impressive. As someone who can remember struggling to catheterize the left gastric artery off the celiac axis or working out the technique for imaging the arteries of the ankle and foot, I find the power and relative ease of MDCT angiography and MR angiography simply overwhelming.

As I attempted to place various manuscripts into traditional categories or sections, I realized that even this task is changing. We now must differentiate abdominal and pelvic imaging from gastrointestinal and genitourinary imaging. When the primary subject of evaluation is the arteries of the body, vascular imaging deserves its own section of the journal. I am happy to see that cardiac imaging regularly is represented in the table of contents. Prenatal imaging has reached a new plane of clarity with MRI, as demonstrated by the pictorial essay on cleft lip and palate (Stroustrup Smith et al. [6]). This is an area of emerging growth and may warrant its own section in the future.

Why does it hurt, Doc? Our musculoskeletal colleagues now provide answers to questions that could only be speculated on in the recent past. Recognition of bone marrow edema, subtle alterations in the metabolism of the cartilage, inflammation of soft tissues surrounding joints, and slight fractures not visible radiographically is becoming part of their daily diagnostic armamentarium. Those who know me well recall that I had a tendency to ignore bones. Now I stand in awe of the diagnostic expertise required to fully exploit our newer imaging methods.

The solidly established area of chest imaging, which was once largely limited to chest radiography and linear tomography, radionuclide imaging of the lungs, and pulmonary angiography, now is changing as fast as the other areas. Speed of acquisition of images with MDCT, precise timing of contrast enhancement, gating of images during respiration, and finer resolution at the millimeter level all contribute to a better understanding of pulmonary disease pathophysiology. Our diagnostic confidence level keeps rising.

And although not represented in this month's issue, neuroimaging leads the way in exploring innovative applications of MRI for diagnoses and deeper understanding of diseases of the central nervous system, many of which were once well out of the domain of a diagnostic radiologist.

Am I happy to be part of this explosion of diagnostic imaging advances? You bet I am. What a pleasure it is to read the new manuscripts containing the latest creative ideas in our specialty. I have the unique opportunity to watch with great interest the development of data on the accuracy, validity, economic impact, and health impact of our diagnostic and therapeutic efforts. My greatest desire is that we also grow wise in the appropriate use of all of our brilliant new tools.

References

1. Togao O, Mihara F, Yoshiura T, et al. Prevalence of stenoocclusive lesions in the renal and abdominal arteries in moyamoya disease. AJR 2004; 183:119 –122[Abstract/Free Full Text]
2. Kapoor V, Ferris JV, Fuhrman CR. Intimomedial rupture: a new CT finding to distinguish true from false lumen in aortic dissection. AJR 2004;183:109 –112[Abstract/Free Full Text]
3. Lee EY, Siegel MJ, Sierra LM, Foglia RP. Evaluation of angioarchitecture of pulmonary sequestration in pediatric patients using 3D MDCT angiography. AJR2004; 183:183 –188[Abstract/Free Full Text]
4. Karcaaltincaba M, Akata D, Leblebicioglu G, et al. MDCT angiography of the extremities in pediatric patients: initial experience. AJR 2004; 183:189 –192[Abstract/Free Full Text]
5. Matsuki M, Kani H, Tatsugami F, et al. Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy. AJR2004; 183:145 –151[Abstract/Free Full Text]
6. Stroustrup Smith A, Estroff JA, Barnewolt CE, Mulliken JB, Levine D. Prenatal diagnosis of cleft lip and cleft palate using MRI. AJR 2004;183:229 –235[Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Stanley, R. J. Search for Related Content PubMed PubMed Citation Articles by Stanley, R. J. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?