Sarcoidosis is a complex multisystem inflammatory disease characterized by noncaseating granulomas and variable clinical manifestations, most commonly affecting the lungs, skin, heart, and nervous system. Imaging is central in its diagnosis, staging, and management, providing essential insights into organ involvement and disease activity. Pulmonary manifestations remain the hallmark, with modalities such as high-resolution chest computed tomography (CT) and chest radiography offering critical diagnostic clues. Imaging techniques, including Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and cardiac magnetic resonance imaging, are invaluable for identifying cardiac and systemic involvement, including cutaneous and musculoskeletal, while abdominal MRI and ultrasound help delineate hepatic and splenic manifestations. Neurosarcoidosis requires MRI for precise evaluation, supplemented by FDG-PET to guide biopsy and monitor treatment response. This chapter synthesizes the imaging features of sarcoidosis across organ systems, emphasizing practical approaches to diagnosis and management while identifying key areas for future research.

Although lymphoscintigraphy is most commonly used for sentinel lymph node mapping, it can also be helpful for evaluating lymphedema, lymphatic malformations, lymphatic leaks, chylous ascites, and chylothorax. Assessment for lymphedema is important because this condition poses significant clinical challenges, and early diagnosis is essential for timely intervention and prevention of complications. Lymphoscintigraphy is a valuable radiologic tool for distinguishing lymphatic causes of edema from nonlymphatic ones, with findings of lymphedema including absent, asymmetric, or delayed drainage from the injection site; dermal backflow; and reduced activity in the inguinal or axillary lymph nodes at lower extremity and upper extremity lymphoscintigraphy. Other supporting evidence of lymphedema may include collateral lymphatic channels and visualization of the deep lymphatic nodes. Additional imaging modalities, such as fluorescence lymphangiography, US, and MR lymphangiography, can also aid in lymphedema assessment. The authors provide an overview of lymphatic physiology, image acquisition, and image interpretation. ©RSNA, 2025.

Cerebrospinal fluid (CSF) is an essential component of the central nervous system, and disruption of normal CSF flow from the lateral ventricles to the subarachnoid spaces around the brain and spinal canal can have serious consequences. Nuclear imaging may be useful to help diagnose abnormalities in CSF flow; cisternograms can be used to assess for CSF leaks or normal-pressure hydrocephalus, and shuntograms can be used to evaluate for CSF shunt malfunction. The authors review normal and pathologic findings and pitfalls of cisternography and shuntogram examinations. ©RSNA, 2025.

T1-weighted (T1W) pulse sequences are an indispensable component of clinical protocols in abdominal MRI but usually require multiple breath holds (BHs) during the examination, which not all patients can sustain. Patient motion can affect the quality of T1W imaging so that key diagnostic information, such as intrinsic signal intensity and contrast enhancement image patterns, cannot be determined. Patient motion also has a negative impact on examination efficiency, as multiple acquisition attempts prolong the duration of the examination and often remain noncontributory. Techniques for mitigation of motion-related artifacts at T1W imaging include multiple arterial acquisitions within one BH; free breathing with respiratory gating or respiratory triggering; and radial imaging acquisition techniques, such as golden-angle radial k-space acquisition (stack-of-stars). While each of these techniques has inherent strengths and limitations, the selection of a specific motion-mitigation technique is based on several factors, including the clinical task under investigation, downstream technical ramifications, patient condition, and user preference. The authors review the technical principles of free-breathing motion mitigation techniques in abdominal MRI with T1W sequences, offer an overview of the established clinical applications, and outline the existing limitations of these techniques. In addition, practical guidance for abdominal MRI protocol strategies commonly encountered in clinical scenarios involving patients with limited BH abilities is rendered. Future prospects of free-breathing T1W imaging in abdominal MRI are also discussed. (c) RSNA, 2024 center dot radiographics.rsna.org

The implementation of deep neural networks has spurred the creation of deep learning reconstruction (DLR) CT algorithms. DLR CT techniques encompass a spectrum of deep learning-based methodologies that operate during the different steps of the image creation, prior to or after the traditional image formation process (eg, filtered backprojection [FBP] or iterative reconstruction [IR]), or alternatively by fully replacing FBP or IR techniques. DLR algorithms effectively facilitate the reduction of image noise associated with low photon counts from reduced radiation dose protocols. DLR methods have emerged as an effective solution to ameliorate limitations observed with prior CT image reconstruction algorithms, including FBP and IR algorithms, which are not able to preserve image texture and diagnostic performance at low radiation dose levels. An additional advantage of DLR algorithms is their high reconstruction speed, hence targeting the ideal triad of features for a CT image reconstruction (ie, the ability to consistently provide diagnostic-quality images and achieve radiation dose imaging levels as low as reasonably possible, with high reconstruction speed). An accumulated body of evidence supports the clinical use of DLR algorithms in abdominal imaging across multiple CT imaging tasks. The authors explore the technical aspects of DLR CT algorithms and examine various approaches to image synthesis in DLR creation. The clinical applications of DLR algorithms are highlighted across various abdominal CT imaging domains, with emphasis on the supporting evidence for diverse clinical tasks. An overview of the current limitations of and outlook for DLR algorithms for CT is provided. (c) RSNA, 2024 center dot radiographics.rsna.org

Parkinsonian syndromes are a heterogeneous group of progressive neurodegenerative disorders involving the nigrostriatal dopaminergic pathway and are characterized by a wide spectrum of motor and nonmotor symptoms. These syndromes are quite common and can profoundly impact the lives of patients and their families. In addition to classic Parkinson disease, parkinsonian syndromes include multiple additional disorders known collectively as Parkinson-plus syndromes or atypical parkinsonism. These are characterized by the classic parkinsonian motor symptoms with additional distinguishing clinical features. Dopamine transporter SPECT has been developed as a diagnostic tool to assess the levels of dopamine transporters in the striatum. This imaging assessment, which uses iodine 123 (123I) ioflupane, can be useful to differentiate parkinsonian syndromes caused by nigrostriatal degeneration from other clinical mimics such as essential tremor or psychogenic tremor. Dopamine transporter imaging plays a crucial role in diagnosing parkinsonian syndromes, particularly in patients who do not clearly fulfill the clinical criteria for diagnosis. Diagnostic clarification can allow early treatment in appropriate patients and avoid misdiagnosis. At present, only the qualitative interpretation of dopamine transporter SPECT is approved by the U.S. Food and Drug Administration, but quantitative interpretation is often used to supplement qualitative interpretation. The authors provide an overview of patient preparation, common imaging findings, and potential pitfalls that radiologists and nuclear medicine physicians should know when performing and interpreting dopamine transporter examinations. Alternatives to 123I-ioflupane imaging for the evaluation of nigrostriatal degeneration are also briefly discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Intenzo and Colarossi in this issue.

Acute mesenteric ischemia is a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcomes. Acute mesenteric ischemia can occur from arterial embolism or thrombosis, venous occlusive, or nonocclusive etiologies. Key findings for acute arterial occlusion include hypoenhancing bowel, which is usually not thickened or dilated. Venous occlusion often results in a hyperenhancing, thickened, and dilated bowel. Nonocclusive mesenteric ischemia should be considered in the appropriate clinical context, when there is no vascular occlusion on CT, and when there is involvement of watershed regions without specific vascular territory abnormalities. Venous congestion and increased vascular permeability can result in mesenteric edema and ascites; however, it is not predictive of mesenteric ischemia severity. Pneumatosis alone may not indicate presence of nonviable bowel; however, pneumatosis with portal venous gas or pneumoperitoneum has high sensitivity for nonviable bowel. Clinical history and laboratory results can often help differentiate between acute mesenteric ischemia and its mimics, such as inflammatory bowel disease, enteritis, and radiation injury.

Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review.

Acute mesenteric ischemia is frequently a rapidly life-threatening condition in which the radiologist may play a crucial role in early diagnosis and thus improve patient outcome. The small and large bowels are supplied by the celiac trunk, superior mesenteric artery, and inferior mesenteric artery with watershed zones at the splenic flexure (Griffith's point) and rectosigmoid junction (Sudeck's point). Important bowel collateral circulation is the superior-inferior pancreaticoduodenal anastomosis, marginal artery of Drummond, and arc of Riolan. The most common cause of acute mesenteric ischemia is arterial embolism or thrombosis with less common causes being veno-occlusive and other nonocclusive causes. CT angiography evaluation is the first-line modality with high sensitivity and specificity for identifying acute mesenteric ischemia. Dual-energy CT is an emerging modality, which may be helpful in subtle cases.

ABSTRACT:99m Tc-dimercaptosuccinic acid ( 99m Tc-DMSA) scans are used to evaluate renal cortical defects typically related to parenchymal scarring or pyelonephritis, and ectopic renal parenchyma. 99m Tc-DMSA binds to metalloproteins in proximal tubular cells and typically localizes to the renal cortex, with minimal excretion. Planar and SPECT images are obtained 2 to 4 hours after IV administration of 99m Tc-DMSA. Altered 99m Tc-DMSA biodistribution has been reported in various conditions, including renal injury, technical issues, infiltrative processes, and hematologic disorders. Here, we present a case of altered biodistribution, with hepatic and splenic radiotracer uptake in the setting of hepatosplenomegaly and hematologic abnormalities concerning for a systemic hematologic disorder/lymphohistiocytosis.

Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.

MR defecating proctography (MRDP) is a noninvasive examination that can be used for evaluating posterior compartment disorders. MRDP has several advantages over conventional fluoroscopic defecography. These benefits include high-contrast resolution evaluation of the deep pelvic organs, simultaneous multicompartmental assessment that is performed statically and dynamically during defecation, and lack of ionizing radiation. MRDP also provides a highly detailed anatomic evaluation of the pelvic floor supportive structures, including direct assessment of the pelvic floor musculature and indirect assessment of the endopelvic fascia. As the breadth of knowledge regarding anatomic and functional posterior compartment disorders expands, so too does the advancement of noninvasive and surgical treatment options for these conditions. High-quality MRDP examinations, with key anatomic and functional features reported, guide treatment planning. Reporting of MRDP examination findings with use of standardized terminology that emphasizes objective measurements rather than subjective grading aids consistent communication among radiologists, clinicians, and surgeons. Familiarity with commonly encountered posterior compartment pelvic floor pathologic entities that contribute to posterior compartment disorders and awareness of the essential information needed by surgeons are key to providing an optimal multidisciplinary discussion for planning pelvic floor dysfunction treatment. The authors provide an overview of the basic concepts of the MRDP acquisition technique, the anatomic abnormalities of posterior compartment pelvic floor pathologic entities associated with defecatory disorders, and recently developed interdisciplinary MRDP reporting templates and lexicons. In addition, the associated imaging findings that are key for surgical treatment guidance are highlighted. © RSNA, 2022 Online supplemental material is available for this article.

HomeRadioGraphicsVol. 43, No. 12 PreviousNext Gastrointestinal ImagingRadioGraphics FundamentalsMesenteric Pathologic Conditions: Interactive Case-based ApproachAmelia L. Kernizan , Jonathan Revels, Cristina Hajdu, Maria Manning, Myles T. TaffelAmelia L. Kernizan , Jonathan Revels, Cristina Hajdu, Maria Manning, Myles T. TaffelAuthor AffiliationsFrom the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.).Address correspondence to A.L.K. (email: [email protected]).Amelia L. Kernizan Jonathan RevelsCristina HajduMaria ManningMyles T. TaffelPublished Online:Nov 2 2023https://doi.org/10.1148/rg.230077MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractPathologic conditions of the mesentery can present a diagnostic challenge for radiologists because many benign and malignant entities have overlapping imaging findings, but approaching these cases in a systematic manner can help determine the most likely diagnosis and appropriate follow-up recommendations.Suggested ReadingsBurrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. RadioGraphics 2007;27(5):1255–1273. Link, Google ScholarCamacho JC, Moreno CC, Harri PA, Aguirre DA, Torres WE, Mittal PK. Posttransplantation lymphoproliferative disease: proposed imaging classification. RadioGraphics 2014;34(7):2025–2038. Link, Google ScholarCorwin MT, Smith AJ, Karam AR, Sheiman RG. Incidentally detected misty mesentery on CT: risk of malignancy correlates with mesenteric lymph node size. J Comput Assist Tomogr 2012;36(1):26–29. Crossref, Medline, Google ScholarGezer NS, Başara I, Altay C, et al. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol 2015;21(2):111–117. Crossref, Medline, Google ScholarHubbard R, Kotecha J, Nash T, Lee YJ, Khan N, Kazmi F. Radiology examination as a diagnostic aid in presentations with wide differential diagnoses: Case report of new Hodgkin’s lymphoma on a background of poorly controlled HIV. SA J Radiol 2017;21(2):1239. Medline, Google ScholarRuuska T, Ramírez Escalante Y, Vaittinen S, et al. Somatostatin receptor expression in lymphomas: a source of false diagnosis of neuroendocrine tumor at 68Ga-DOTANOC PET/CT imaging. Acta Oncol 2018;57(2):283–289. Crossref, Medline, Google ScholarSato M, Hiyama T, Kaito K, Hayashi Y, Okumura T. Usefulness of F-18 FDG PET/CT in the assessment of disseminated Mycobacterium avium complex infection. Ann Nucl Med 2009;23(8):757–762. Crossref, Medline, Google ScholarShinagare AB, Ramaiya NH, Jagannathan JP, et al. A to Z of desmoid tumors. AJR Am J Roentgenol 2011;197(6):W1008–W1014. Crossref, Medline, Google ScholarTaffel MT, Khati NJ, Hai N, Yaghmai V, Nikolaidis P. De-misty-fying the mesentery: an algorithmic approach to neoplastic and non-neoplastic mesenteric abnormalities. Abdom Imaging 2014;39(4):892–907. Crossref, Medline, Google ScholarYu RS, Zhang WM, Liu YQ. CT diagnosis of 52 patients with lymphoma in abdominal lymph nodes. World J Gastroenterol 2006;12(48):7869–7873. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 4 2023Revision requested: May 25 2023Revision received: June 22 2023Accepted: June 28 2023Published online: Nov 02 2023 FiguresReferencesRelatedDetailsRecommended Articles Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and PelvisRadioGraphics2020Volume: 40Issue: 3pp. 731-753Mimics of Malignancy in Abdominal Imaging: Multisystem RadiologyRadioGraphics2017Volume: 37Issue: 7pp. 2202-2203Multimodality Imaging Findings in Carcinoid Tumors: A Head-to-Toe SpectrumRadioGraphics2017Volume: 37Issue: 2pp. 516-536Case 307: Heterotopic Pancreas in Jejunal MesenteryRadiology2022Volume: 305Issue: 2pp. 490-494Case 244: Systemic Amyloidosis—A Complication of Waldenström MacroglobulinemiaRadiology2017Volume: 284Issue: 2pp. 597-602See More RSNA Education Exhibits Seeing Through the Mist: An Interactive Tour of Mesenteric PathologyDigital Posters2022Demistifying the Mesentery: A Differential-Based Approach to Mesenteric PathologyDigital Posters2022The Mysterious Mesentery: An Imaging ReviewDigital Posters2019 RSNA Case Collection Midgut carcinoid tumor RSNA Case Collection2021Carcinoid of the Ileal NeobladderRSNA Case Collection2022Small Bowel Carcinoid Tumor RSNA Case Collection2022 Vol. 43, No. 12 Slide Presentation Metrics Altmetric Score PDF download

Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered. (c) 2022 Elsevier Inc. All rights reserved.

Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.

The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-threatening emergencies such as malrotation, leading to midgut volvulus. Many infectious processes affect the duodenum, including duodenal ulcers and opportunistic infection in patients with HIV/AIDS or Crohn disease. Small bowel malignancies are uncommon but important to recognize, because the duodenum can be involved in polyposis syndromes or the development of primary adenocarcinoma, neuroendocrine tumors, lymphoma, and metastasis. Although endoscopy is currently the most used diagnostic method to assess the lumen of the upper gastrointestinal tract, fluoroscopy is a valuable adjunct technique and the study of choice for many diseases, specifically those for which anatomic and functional information is required. Fluoroscopy is also commonly used postoperatively to assess for complications such as obstruction and extraluminal leaks. Compared with endoscopy, fluoroscopy is an inexpensive and noninvasive technique that provides salient anatomic information and allows delineation of the duodenal mucosa and assessment of real-time duodenal motility. The authors examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy. Online supplemental material is available for this article.©RSNA, 2022.

HomeRadioGraphicsRecently Published PreviousNext Gastrointestinal ImagingFree AccessRadioGraphics FundamentalsUpper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st CenturyJonathan W. Revels , Shamus K. Moran, Ryan O’Malley, Bahar Mansoori, Margarita Revzin, Douglas S. Katz, Mariam Moshiri1, David J. DiSantisJonathan W. Revels , Shamus K. Moran, Ryan O’Malley, Bahar Mansoori, Margarita Revzin, Douglas S. Katz, Mariam Moshiri1, David J. DiSantisAuthor AffiliationsFrom the Department of Radiology, University of New Mexico, Albuquerque, NM, 87131 (J.W.R.); Department of Radiology, University of Washington, Seattle, Wash (S.K.M., R.O., B.M., M.M.); Department of Radiology, Yale University School of Medicine, New Haven, Conn (M.R.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (D.J.D.).Address correspondence to J.W.R., Department of Radiology, New York University, Long Island Division, 560 1st Ave, 2nd floor, New York, NY (e-mail: [email protected]).Jonathan W. Revels Shamus K. MoranRyan O’MalleyBahar MansooriMargarita RevzinDouglas S. KatzMariam Moshiri1David J. DiSantisPublished Online:Aug 19 2022https://doi.org/10.1148/rg.210069MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.TEACHING POINTS■ The UGI will be a part of standard radiology practice for the foreseeable future.■ The UGI should be tailored to answer the clinical question and suit individual clinical scenarios.■ The UGI can be complementary to cross-sectional imaging, particularly when assessment of both structure and function is warranted.The fluoroscopic upper gastrointestinal examination (UGI) is among the oldest radiologic imaging examinations. Its persistence attests to its noninvasive ability to provide detailed anatomic and functional information related to the esophagus, stomach, and duodenum in a cost-conscious noninvasive manner. These examinations require hands-on time and some technical expertise, yet they come with relatively low reimbursement. While endoscopy has become the first-line imaging examination for evaluation of many gastrointestinal inflammatory and neoplastic processes, not all patients are candidates. Consequently, radiologists still perform UGIs to guide clinical decision making. As recently as 2019, more than 578 800 UGIs were performed in the United States alone (data from the Centers for Medicare and Medicaid Services; Jennifer Hemingway, Harvey L. Neiman Health Policy Institute, American College of Radiology, written communication, April 28, 2021).Recent decades have seen breakneck-speed advances in imaging technology, yet the essentials of fluoroscopic technique are little changed from a century ago. As would be anticipated, a review of contemporary radiology journal content reveals few articles about fluoroscopy. Among radiology faculty, those with advanced fluoroscopy skills typically are the most senior. The time to teach the preservation of fluoroscopy skills is now.The ability to tailor a fluoroscopic examination to answer the clinical question is a key attribute of the UGI. Consequently, familiarity with the patient’s history and the purpose of the examination is fundamental. The UGI in a patient with possible bowel perforation will be quite different from one performed for gastroesophageal reflux disease. Fluoroscopists need in-depth knowledge of the options available and which option is likely to be both safe and diagnostic. This allows adaptation of the examination to fit the clinical situation, such as when a patient has limited mobility or dementia. Understanding the reasoning behind each patient position used during a UGI permits the fluoroscopist not only to recognize pitfalls such as anatomic variants, but also to know how to modify the procedure when the patient is unable to perform the standard maneuvers (Fig 1). While there are some historically agreed-on tenets, variation in UGI techniques occurs among and within institutions. There is no single “recipe” for an excellent-quality examination, and going beyond the basics sometimes can be pivotal in reaching a diagnosis. (Fig 2). The online presentation on the UGI reviews current indications, techniques, and approaches, followed by examples of normal anatomy and the types of pathologic conditions that the examination can reveal.Figure 1. Upright left posterior oblique double-contrast UGI image obtained during the initial swallow in a 65-year-old man with dysphagia. There is a right-sided aortic arch (black arrow), as well as an abnormal impression on the posterior aspect of the esophagus. The findings are strongly suggestive of an aberrant left subclavian artery (white arrow), which was subsequently confirmed with CT (not shown).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Supine anterior-posterior portable abdominal radiograph obtained 1 hour after a water-soluble single-contrast UGI in a 49-year-old man after gastric perforation repair. Enteric contrast agent is demonstrated within the surgical drain tubing (white arrow) and bulb (black arrow), indicating a leak.Figure 2.Download as PowerPointOpen in Image Viewer Our goal is to reaffirm that the UGI remains a valuable and versatile examination in contemporary radiology practice. The online presentation serves as a how-to guide for performance of fluoroscopic UGIs, detailing the basic procedure and modifications to address particular clinical scenarios.Disclosures of conflicts of interest.—R.O. Research support from GE Healthcare. M.R. Former deputy editor of RSNA Case Collection; royalties from Elsevier. M.M. Editor of RSNA Case Collection.AcknowledgmentsThe authors thank Alana Brown, OD, and Kendra Chatfield.1 Current address: Department of Radiology, Vanderbilt University Medical Center, Nashville, TN.Recipient of a Certificate of Merit award for an education exhibit at the 2020 RSNA Annual Meeting.R.O., M.R., and M.M. have provided disclosures (see end of article); all other authors have disclosed no relevant relationships.Suggested ReadingsCarucci LR, Turner MA. Dysphagia revisited: common and unusual causes. RadioGraphics 2015;35(1):105–122. Link, Google ScholarDiSantis DJ, Lewis JI, Menias CO, Balfe DM, Morgan DE, Cernigliaro JG. Imaging tips for performing a perfect barium swallow. RadioGraphics 2019;39(5):1325–1326. Link, Google ScholarGosangi B, Rocha TC, Duran-Mendicuti A. Imaging spectrum of duodenal emergencies. RadioGraphics 2020;40(5):1441–1457. Link, Google ScholarLevine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology 2005;237(2):414–427. Link, Google ScholarRubesin SE, Levine MS, Laufer I. Double-contrast upper gastrointestinal radiography: a pattern approach for diseases of the stomach. Radiology 2008;246(1):33–48. Link, Google ScholarArticle HistoryReceived: Mar 18 2021Revision requested: July 27 2021Revision received: Aug 26 2021Accepted: Sept 1 2021Published online: Aug 19 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleUpper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century19 Aug 2022Default Digital Object SeriesRecommended Articles Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential ComplicationsRadioGraphics2016Volume: 36Issue: 1pp. 107-121Congenital Variants and Anomalies of the Aortic ArchRadioGraphics2016Volume: 37Issue: 1pp. 32-51CT Esophagography for Evaluation of Esophageal PerforationRadioGraphics2021Volume: 41Issue: 2pp. 447-461Clinical, Imaging, and Pathologic Features of Conditions with Combined Esophageal and Cutaneous ManifestationsRadioGraphics2019Volume: 39Issue: 5pp. 1411-1434Extrapancreatic Advanced Endoscopic InterventionsRadioGraphics2022Volume: 42Issue: 2pp. 379-396See More RSNA Education Exhibits Catch the Move: Esophageal Disease in Barium SwallowDigital Posters2019Cleaning Up Leak Studies: Reviewing Fluoroscopy Techniques to Optimize Detection of Leaks and Tears in the Esophagus and StomachDigital Posters2019Resident Primer in Fluoroscopic Imaging of the Upper Gastrointestinal Tract: Overview of Technique, Pearls and PitfallsDigital Posters2020 RSNA Case Collection Aberrant left subclavian artery from right-sided aortic archRSNA Case Collection2020Right aortic arch with aberrant left subclavian arteryRSNA Case Collection2020Esophageal Pseudodiverticulosis RSNA Case Collection2021 Recently Published Slide PresentationAbbreviations Abbreviation: UGI upper gastrointestinal examination Metrics Downloaded 1,977 times Altmetric Score PDF download

Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating granulomas. The article focuses on the typical imaging manifestations of sarcoid and the common differentials that need to be included when appropriate. Mistaking a sarcoid-mimicking disease for sarcoid can result in increased patient morbidity and mortality. The pulmonary system is the most common system involved and is typically the best understood by the radiologist, however a deeper knowledge of the pulmonary findings and features of sarcoid in other organ systems is critical. There is a myriad of sarcoid imaging manifestations that can involve every organ system. Often a confidant diagnosis of sarcoid can be made, however a broad differential may need to be considered- differential diagnoses include primary neoplasm, metastatic disease, infectious, and inflammatory etiologies. Radiologist familiarity with the multimodality multisystem imaging findings of sarcoid can help guide clinical management and optimize patient care.