work in progress - Fran/Derek
UK interpretation/system to guide investigation (2008)
Response Evaluation Criteria In Solid Tumours (RECIST) was updated to version 1.1 in 2009.
For both RECIST 1.0 and 1.1, the requirement for measurable disease at baseline depends on the endpoints of the clinical trial.
The fundamental concept common to both versions of RECIST is that measurabl...
The term retrolisthesis refers to posterior displacement (backward slip) of a vertebral body relative to one below. Causes include trauma, facet joint osteoarthritis or congenital anomalies (e.g. underdevelopment of the pedicles).
A retropulsed fragment is any vertebral fracture fragment that is displaced into the spinal canal, thereby potentially causing spinal cord injury.
They usually arise from the vertebral body with or without a portion of the pedicle, and are displaced posteriorly, hence the prefix 'retro'.
The retrotrochlear eminence is located posterior to the peroneal tubercle and the peroneal tendons.
It is one of two bony projections or protuberances may be seen from the lateral wall of the calcaneum – the other being the peroneal tubercle.
It is seen to be prominent in individuals with hype...
The Revised Atlanta classification of acute pancreatitis is an international multidisciplinary classification of the severity of acute pancreatitis, updating the 1992 Atlanta classification. It was initially revised in 2012 and then further updated in 2016 6.
The worldwide consensus aims for an...
As a part of international evidence-based guidelines adopted by a collaborative effort of the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, specific diagnostic HRCT criteria for usual interstitial pneumo...
Following months of preparation, experts in the field of vasculitis from 12 different countries proposed an update to the 1994 International Chapel Hill Consensus Conference nomenclature of vasculitides. This 2012 update at the time of writing (mid-2016) remains the most widely used system for d...
Riseborough and Radin classification of intercondylar fractures of the humerus can be used to classify this injury, which is the result of direct trauma to the olecranon as it is driven as a wedge between the humeral condyles. Four types of fractures can be identified:
type I: no displacement ...
The risk of malignancy index (RMI) in ovarian tumours is a validated clinical tool used for risk stratification of ovarian lesions, to guide further management 1-3.
The score incorporates the patient's menopausal status (M), ultrasound features of the lesion (U), and the serum C...
The Risser classification is used to grade skeletal maturity based on the level of ossification and fusion of the iliac crest apophyses. It is primarily in planning corrective surgery for scoliosis.
stage 0: no ossification center at the level of iliac crest apophysis
stage 1: ...
The Rockwood classification (1998) is the most common classification system in use for acromioclavicular joint injuries 3. This well known 6-type system is a modification of the earlier 3-class classification system described by Allman (1967) 2 and Tossy (1963).
It takes into account not only t...
One method of grading rotator cuff tears on MRI is as follows:
grade 0: normal
grade I: increased T2 signal with normal morphology
grade II: increased T2 signal with abnormal morphology (thickening, or irregularity of the tendon)
grade III: defined tear (e.g. partial or full thickness, compl...
The Rotterdam CT score of traumatic brain injury is a relatively recently described classification aimed at improving prognostic evaluation of patients admitted with acute traumatic brain injuries.
It was published in 2006 1 and is gaining in popularity. Along with the Marshall classification ...
The Roy-Camille classification of fractures of the odontoid process of C2 depends on the direction of the fracture line 1.
The level of fracture line as described by the Anderson and D’Alonzo classification, is not predictive of the degree of instability or the risk of non-union. This classific...
Sacroiliitis grading can be achieved using plain radiographs according to the New York criteria 4.
grade 0: normal
grade I: some blurring of the joint margins - suspicious
grade II: minimal sclerosis with some erosion
definite sclerosis on both sides of joint 5
severe erosions wi...
The Salter-Harris classification was proposed by Salter and Harris in 1963 1 and at the time of writing (June 2016) remains the most widely used system for describing physeal fractures.
Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.
Salter-Harris type II fractures are the most common type of physeal fractures that occur in children. There is a fracture that extends through the physis and into a portion of the metaphysis. A triangular metaphyseal fragment, otherwise known as the Thurston Holland fragment, will be left intact...
Salter-Harris type III fractures are an uncommon, intraarticular fracture physeal fractures that occur in children.
The fracture line is often obliquely orientated through the epiphysis to the physis where it will take a horizontal orientation extending to the edge of the physis.
Salter-Thompson classification for Legg-Calve-Perthes disease simplifies the Catterall classification into 2 groups. Based on the radiographic crescent sign, we can distinguish:
group a: including Catteral groups I and II, where the crescent sign involves less than 50% of the femoral head.
The Sanders classification system is used to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. This classification is based on the number of intraarticular fracture lines and their location on semicoronal CT images. This classification is ...
Sarcopenia can be defined as significant loss of muscle function in older individuals, usually defined in terms of reduction in grip strength and low gait speed.
Specific criteria include 1:
< 26 kg for men
< 16 kg for women
low lean body mass based - appendicular lean mass in...
Schatzker classification system is one method of classifying tibial plateau fractures.
Increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. The most common fracture of the tib...
Scheuermann disease (also known as juvenile kyphosis, juvenile discogenic disease 11, or vertebral epiphysitis) is a common condition which results in kyphosis of the thoracic or thoracolumbar spine. The diagnosis is usually made on plain film.
occurs in ~5% (range 0.4-8%) of the ...
Sex cord / stromal ovarian tumours are a subtype of ovarian tumours and account for 8-10% of all ovarian tumours. They arise from two groups of cells in the ovary:
primitive sex cords: coelomic epithelium
The group of tumours includes
ovarian fibroma-thecoma spectrum
Short limb skeletal dysplasias are skeletal dysplasias which are charcaterised by limb shortening
Rhizomelic (proximal limb shortening)
particularly type II
The shunt-dependency in symptomatic aneurysmal subarachnoid haemorrhage (SDASH) score is a harmonized score for the prediction of hydrocephalus requiring shunting after subarachnoid haemorrhage. The tool is employed in the acute phase to predict which patients will require shunting, rather than ...
The Simpson grade of meningioma resection was described in 1957 and correlated the degree of surgical resection completeness with with symptomatic recurrence 1.
Although the type of resection still plays a part in the likelihood of symptomatic recurrence, other factors (such as the MIB-1 index...
The Singh index is a classification system for bone density of the femoral neck based on the visibility of the trabecular types that can be seen in the femoral neck.
Trabecular types in proximal femur
Five trabecular types can be present in the proximal part of the femur:
Situs classification can be a daunting topic, but it falls into three main groups :
situs solitus: the normal configuration of thoracic and abdominal organs
situs inversus: mirror image of normal
situs ambiguus: an intermediate configuration with duplication (isomerism)
Situs is best thought...
Situs solitus refers to the normal position of the thoracic and abdominal organs.
On plain radiograph, careful attention should be directed at the location of the aortic arch, gastric fundus, cardiac apex, pulmonary fissures and the branching pattern of ...
A small for dates fetus can result from a number of factors
structural anomalies (syndromes)
fetal Warfarin syndrome
hydantoin embryopathy (Dilantin TM)
The WHO 2002 classification of soft tissue tumours is as follows:
This, however, has been revised under the 2013 WHO tissue tumour classification system 4.
lipomatosis of nerve 8850/0
The Spetzler-Martin arteriovenous malformation (AVM) grading system allocates points for various features of intracranial arteriovenous malformations to give a grade between 1 and 5. Grade 6 is used to describe inoperable lesions. The score correlates with operative outcome.
size of ni...
Spinal arteriovenous malformations can be classified in a number of ways:
extramedullary: 80% 1
Or into four types 2:
type I: single coiled vessel (dural AV fistula)
type II: intramedullary glomus AVM
type III: juvenile
type IV: intradural perimedullary (AV fistula)
Spinal cord injury (SCI) can be traumatic or non-traumatic (i.e. neoplastic/stenosis) but the syndromes associated with spinal cord injury can be seen in all aetiologies.
Injury to the spinal cord can be incomplete or complete and depends upon the mechanism of injury. This is important as diffe...
The spinal instability neoplastic score (SINS) helps to assess tumour related instability of the vertebral column. It has been shown to useful in guiding the mobilisation or operative management of patients with neoplastic spinal disease.
Studies have reported good inter-observer agreement amon...
Spinal metastases is a vague term which can be variably taken to refer to metastatic disease to any of the following:
vertebral metastases (94%)
may have epidural extension
intradural extramedullary metastases (5%)
intramedually metastases (1%)
Each of these are discussed separately. Below ...
Spondylolisthesis denotes the slippage of one vertebra relative to the one below. Spondylolisthesis can occur anywhere but is most frequent, particularly when due to spondylolysis, at L5/S1 and to a lesser degree L4/L5.
Although etymologically it is directionless (see below) and c...
A commonly adopted method of grading the severity of spondylolisthesis is the Meyerding classification. It divides the superior endplate of the vertebra below into 4 quarters. The grade depends on the location of the posteroinferior corner of the vertebra above.
grade I: 0-25%
grade II: 26-50...
Spondylolisthesis can be classified according to broad aetiology as described by Wiltse in 1981 1. Typically when reporting studies with spondylolisthesis the Wiltse type is merely stated without referring to it's number, whereas the grade of spondylolisthesis is explicitly stated: e.g. "Grade 1...
Squamous cell carcinomas (SCC) of the head and neck are common, being the sixth most common cancer. They can have a cutaneous or mucosal origin. As such there is a wide array of clinical and radiographic manifestations, and are separated into:
squamous cell carcinoma of the skin of the head and...
The Stahl classification of Kienbock disease, modified by Lichtman, is the most commonly used staging system and is useful in the treatment of Kienbock disease (avascular necrosis of the lunate). This system divides the disease into four stages:
stage I: normal radiograph
stage II: increased ...
Along with the DeBakey classification, the Stanford classification is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:
type A: A aff...
The St. Anne-Mayo grading system, also known as the Daumas-Duport grading system, introduced in 1988 was for a time a popular system for grading diffuse astrocytomas but has now largely been replaced by the WHO grading system which is, however, derived from the St Anne-Mayo system and thus share...
Steinberg staging of avascular necrosis of hip is a commonly used system (at the time of writing, mid-2016) similar to the Ficat and Arlet staging.
History and etymology
It is based on the radiographic appearance and location of lesion. It primarily differs from the other systems by quantifyi...
The Stewart classification for proximal fifth metatarsal fractures is based upon fracture location and morphology. It is divided into five types.
extra-articular transverse or oblique fracture between base of 5th metatarsal and diaphysis (jones fracture)
Grading of SUFE (slipped upper femoral epiphysis) can be made on both AP and true lateral projections.
On a AP radiograph a line along the superior margin of the femoral neck (line of Klein) should intersect the lateral corner of the epiphysis.
As the epiphysis slips, the metaphysis can be di...
SVC obstruction can cause SVC syndrome which is the most common condition affecting this vessel. It can be secondary to an extrinsic compression or intraluminal thrombosis/stenosis. Collateral pathways, with the azygos vein being the most important collateral vessel, form in response to severe n...
Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic paediatric injury which require vigilance as imaging findings can be subtle.
Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults; 90% a...
The staging system for moyamoya disease first described by Suzuki and Takaku in their seminal 1969 article1 is still in use today. Formally, the staging refers to findings on conventional angiography, although there are efforts to apply similar systems to MR angiography.2
Suzuki stage appears t...
There are specific terms used when describing a syrinx or other cystic lesions within the spinal cord 1:
hydromyelia: fluid accumulation/dilatation within the central canal, therefore, lined by ependyma
syringomyelia: cavitary lesion within cord parenchyma, of any cause (there are many); locat...
The Tabar 5-tier grading system is used to classify mammographic lesions. This should not be confused with the Tabar classification of parenchymal patterns in breast imaging. It is a separate but translatable system to the BI-RADS classification system (please note that Tabar grade 3 ≠ BI-RADS 3...
Talar neck fractures extend through the thinnest cross-sectional portion of the talus, just proximal to the talar head. They represent one of the most common types of talus fracture (~30-50%), along with chip and avulsion fractures of the talus (~40-49%). These fractures are commonly associated ...
Temporal bone fracture is usually a sequela of significant blunt head injury. In addition to potentially damage to hearing and the facial nerve, associated intracranial injuries, such as extra-axial haemorrhage, diffuse axonal injury and cerebral contusions are common. Early identification of te...
There are numerous terms used in radiology that are worth knowing and this is list of some of them.
The thoracolumbar injury classification and severity score (TLICS), also sometimes known as the thoracolumbar injury severity score (TISS), was developed by the Spine Trauma Group in 2005 to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture clas...
The two most commonly currently used thoracolumbar spinal fracture classification systems are the AO classification and the TLICS although a number of other classification systems have been proposed over the years 1. Each has benefits and drawbacks and each incorporates various features in an at...
The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.
While initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as...
The thrombolysis in cerebral infarction (TICI) grading system was described in 2003 by Higashida et al. 1 as a tool for determining the response of thrombolytic therapy for ischaemic stroke. In neurointerventional radiology it is commonly used for patients post endovascular revascularisation. Li...
The thrombolysis in myocardial infarction (TIMI) risk score is a prognostic risk stratification system that categorises the risk of death and ischemic events in patients with unstable angina / NSTEMI and provides a basis for therapeutic decision making. It is thought to have potential to improve...
TI-RADS is a risk stratification system for classifying thyroid lesions and was recently recognized in an American College of Radiology (ACR) white paper1. Its use is being advocated similar to BI-RADS category for breast lesions.
In 2017, a white paper2 was released by the ACR committee on th...
Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.
It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.
The TOAST (trial of ORG 10172 in acute stroke treatment) classification denotes five sub types of ischaemic stroke.
large-artery atherosclerosis (embolus / thrombosis)*
cardioembolism (high-risk / medium-risk)*
small-vessel occlusion (lacune)*
stroke of other determined aetiology *
The Todani classification of bile duct cysts divides choledochal cysts into five groups.
See: type I choledochal cyst
account for 80-90% of all bile duct cysts
characterised by fusiform dilation of the extrahepatic bile duct
a subclassification has been proposed
Torg's classification of proximal fifth metatarsal fractures is based on the degree of sclerosis adjacent to the fracture on imaging at the time of presentation to determine the fracture age.
narrow fracture line with sharp margins and no widening
minimal cortical hyper...
Transitional cell carcinomas of the urothelium are graded histologically as follows:
transitional cell papilloma
benign tumour, not a carcinoma but sometimes included in classification systems
carcinoma in situ
do not penetrate the basement membrane
cells resemble those of grade II or III ...
Triplane or triplanar fractures are of the distal tibia only occurring in adolescents. As the physiological closure of the physeal plate begins medially, the lateral (open) physis is prone to this type of fracture. The name is due to the fact of the fracture expanding both in frontal and lateral...
Trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.
Fractures in these regions can be classified as:
pertrochanteric: intertrochanteric, involving both trochanters
greater trochanteric avulsion f...
There are a number of tumours of muscular origin, which overall are relatively uncommon, representing only 1.7% of benign soft tissue tumours, and 10.3% of malignant soft tissue tumours1.
The tumours can be divided according to the type of muscle fibre:
Skeletal muscle origin
Tumours of the male urethra are uncommon. They can be categorised both on the grounds of histology and location.
squamous cell carcinoma of the urethra: 80%
urothelial/transitional cell carcinoma of the urethra: 15% (predominantly posterior urethra)
adenocarcinoma of the urethra: 5...
Tumours of the meninges are a heterogeneous group of lesions which usually occur as extra-axial masses. Although a large number of lesions that can involve meninges are scattered throughout the WHO classification of CNS tumours, the main entities to be considered include:
meningioma and nume...
Ultrasound assessment of carotid arterial atherosclerotic disease has become the first choice for carotid artery stenosis screening, permitting the evaluation of both the macroscopic appearance of plaques as well as flow characteristics in the carotid artery.
This article focus on internal caro...
The ultrasound "U" classification of thyroid nodules has been developed by the British Thyroid Association (BTA) as part of their 2014 guidelines on the management of thyroid cancer 1.
It allows for stratifying thyroid nodules as benign, suspicious or malignant based on ultrasound appearances t...
Uterine biophysical profile refers to assessment of uterus to produce a successful conception and implantation environment.
Uterine scoring system for reproduction (USS)
The uterine scoring system for reproduction comprises the following parameters, taken in mid-cycle:
1. endometrial thickne...
The Vancouver classification of periprosthetic hip fractures proposed by Duncan and Masri is the most widely used classification system. It takes into account the fracture site, the status of the femoral implant, and the quality of surrounding femoral bone stock.
type A: fractures involve the t...
The VASARI (Visually AcceSAble Rembrandt Images) MRI feature set is a system designed to enable consistent description of gliomas using a set of defined visual features and controlled vocabulary. It is the result of work by The Cancer Imaging Archive (TCIA) who publish relevant guides to use, an...
Vesicoureteric reflux (VUR) grading divides vesicoureteric reflux according to the height of reflux up the ureters and degree of dilatation of the ureters:
grade 1: reflux limited to the ureter
grade 2: reflux up to the renal pelvis
grade 3: mild dilatation of ureter and pelvicalyceal system
The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint. It has a role in determining treatment.
below the level of...
The Weiss classification is one of the classification systems used for lateral humeral condyle fractures and is based on the degree of displacement measured on an internal oblique view of the elbow:
type 1: <2 mm displacement
type 2: 2-4 mm displacement
type 3: >4 mm displacement
The degree ...
The WFNS (World Federation of Neurosurgical Societies) grading system uses the Glasgow Coma Scale and presence of focal neurological deficits to grade the severity of subarachnoid haemorrhage. This grading system was proposed in 1988, and this is one of the accepted systems (although not conside...
The World Health Organisation classifies anal canal neoplasms into intraepithelial neoplasms and invasive neoplasms which are further divided to epithelial and non-epithelial tumours and secondary lesions:
squamous cell carcinoma of anal canal
adenocarcinoma of anal canal
The WHO classification of anal margin tumours or perianal skin tumours is:
Bowen disease (precursor of squamous cell carcinoma)
Paget's disease (precursor of adenocarcinoma)
squamous cell carcinoma
basal cell carcinoma
The WHO classification of CNS tumours is the most widely accepted system for classifying CNS tumours and was based on the histological characteristics of the tumour. Although the most recent version of the 'blue book' is the 4th edition from 2007, an update has been released in 2016 3, which sho...
The WHO classification scheme for thymic epithelial tumours is one of many classifications systems for thymoma and related tumours, and classifies them according to histology:
spindle cell thymoma
type ab: mixed thymoma
type b1: lymphocyte rich
WHO (World Health Organisation) grading of CNS tumours is based on histological characteristics such as cellularity, mitotic activity, pleomorphism, necrosis, and endothelial proliferation (neoangiogenesis). It is used in the WHO classification of CNS tumours.
It should be noted that at the ti...
The WHO grading system is the most widely used system for grading diffuse astrocytomas (at the time of writing i.e. mid-2016) and is an adaptation of the now superseded St Anne-Mayo grading system (also known as the Daumas-Duport grading system).
Grade I is reserved for localised astrocytomas...
Benign renal tumours were histologically classified according to the WHO in 2004 as follows 1:
Renal cell tumours
renal papillary adenoma - renal adenoma
metanephric adenoma of kidney
metanephric adenofibroma of kidney
metanephric stromal tumour of kid...
The WHO histological classification is a detailed classification of tumours of the uterine cervix.
squamous tumours and precursors
squamous cell carcinoma, not otherwise specified - 8070/3
keratinizing - 8071/3
non-keratinizing - 8072/3
basaloid - 8083/3
verrucous - 805...
Wiberg classification is a system used to describe the shape of the patella based mainly on the asymmetry between the patellar medial and lateral facets on axial views of the patella. Increasing number type indicates a larger degree of asymmetry.
Wiberg type 1 or a
The Winquist classification of femoral shaft fractures is based on fracture comminution and was proposed by Winquist in 1980. This classification is used with regards to management decision making, in determining whether a fracture requires an intramedullary nail or open reduction.
Type 0: no ...
The Yasargil classification is one of the two common systems for classifying vein of Galen malformations that is currently in use at the time of writing (mid 2016).
type I: small pure cisternal fistula between the vein of Galen (voG) and either the pericallosal arteries (anteri...
The Young and Burgess classification is a modification of the Tile classification 1. It is the recommended 5 and most widely used classification system for pelvic ring fractures.
It takes into account force type, severity, and direction, as well as injury instability.