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Cystic and solid renal masses can be imaged with ultrasound, CT, and MRI, with contrast enhancement needed to optimize renal mass detection and characterization. Most very small renal masses cannot be characterized due to their size. Because the overwhelming majority of these are benign, follow-up is suggested only when these masses appear heterogeneous. CT and MRI are able to predict which cystic renal masses are most likely to be malignant. CT and MRI can identify macroscopic fat in the vast majority of angiomyolipomas, allowing for differentiation from other solid renal masses. Although some solid renal masses without macroscopic fat may contain distinct combinations of imaging features, there is much overlap, and biopsy will often be required for diagnosis. CT and MRI are accurate in staging renal cancers, predicting whether partial nephrectomy can be performed successfully, and for imaging patients after treatment. Unique patterns of metastatic disease response can be encountered after treatment of metastatic renal cancer with targeted chemotherapeutic agents. Radiologists must be aware of these patterns as well as of the imaging appearance of newly emerging treatment complications.

Pelvic floor disorder (PFD) is a common condition in today’s society with its aging population. The leading symptoms may vary from urological, gynecological, intestinal, or proctologic origin and may strongly affect the patients’ quality of life. Nowadays, MRI gains more attention before planned surgical repair to identify all involved compartments in pelvic organ prolapse and to detect incidental pathologic conditions. Due to the increasing use of dynamic magnetic resonance imaging (MRI) for diagnostic purposes regarding PFD, a standardized and state-of-the-art MRI procedure as well as a systemic approach to report the MRI findings is crucial in daily routine to improve effective communication between the radiologist and the clinician.

The normal anatomy and congenital anomalies of the uterus are described using the new classification proposed by the European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESHE). Ultrasound and detailed MRI technique of the uterus are included. The classification of uterine leiomyoma is described according to the FIGO classification. Complications of leiomyoma and pathways to differentiate them from sarcomas are discussed. Adenomyosis is the uterine form of endometriosis responsible for intense dysmenorrhea and can be diffused or localized and needs to be differentiated from leiomyoma. Endometrial polyps and submucosal leiomyoma are a common cause for menometrorrhagia and can be diagnosed with ultrasound and MRI. Deep endometriosis corresponds to the presence of endometrial cells surrounded by stromal tissue outside the uterus and is responsible for chronic pelvic pain. Possible localizations in the pelvis include the retrocervical area, the posterior vaginal cuff, the uterosacral ligaments, as well as the bladder and bowel wall.

Accurate and early response assessment is essential for personalized medicine not only to optimize systemic therapy for metastasized disease but also to tailor local treatment after neoadjuvant chemoradiotherapy. Both can be a daily conundrum leading to challenging clinical questions. The assessment of the efficacy of the current treatment or the resectability after local therapy often requires multimodal imaging expertise, as well as a profound understanding of the therapeutic mechanism.

Cross-sectional imaging modalities including ultrasound (US), magnetic resonance (MR) imaging, and computed tomography (CT) play a critical role in the diagnosis of gallbladder and biliary disease.

Biliary imaging for evaluation of obstructive jaundice seeks to diagnose the level of obstruction and its cause. The identification of dilated bile ducts necessitates evaluation for strictures or filling defects, which is best performed with thin-section CT or T2-weighted MR cholangiography. Choledocholithiasis is the most common cause of biliary obstruction, and modern thin-section three-dimensional MR cholangiography is highly sensitive and specific for the detection of stones. Identification of bile duct wall thickening raises concern for cholangitis or malignancy. Primary sclerosing cholangitis and secondary sclerosing cholangitis such as recurrent pyogenic cholangitis and IgG4-related sclerosing disease can develop chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts. Familiarity with the typical clinical and radiologic appearances of various etiologies of cholangiopathies and biliary malignancies is also important for accurate image interpretation.

In order to detect and characterize diseases of the gallbladder appropriately, knowledge of congenital variants and anomalies of the gallbladder anatomy is essential.

Understanding the pathogenesis responsible for gallstone formation and resultant imaging features will be outlined.

Recognizing mechanisms leading to acute and chronic inflammatory scenarios of the gallbladder may influence the decision on appropriate treatment.

Differentiating inflammatory gallbladder disease from gallbladder neoplasms can be challenging in early stages; recognizing imaging features which raise the suspicion for potential underlying neoplasms is essential in guiding potential treatment options.

Understanding the abdominal and pelvic visceral anatomy is critical to understanding and predicting the pathways by which disease may spread throughout the abdomen and pelvis. The ligamentous attachments that interconnect the intra-abdominal organs are critically important as these are common conduits for the spread of disease. Moreover, the organs and the peritoneal ligaments that support them form the boundaries of the peritoneal cavity, and together, they guide the flow of peritoneal fluid throughout the abdomen and pelvis. Neoplastic and inflammatory processes that extend into the peritoneal cavity may spread through the ascitic fluid that flows through these peritoneal spaces.

Adnexal masses are a common clinical finding and may present symptomatically or incidentally. Most adnexal masses are benign and most can be confidently characterized on ultrasound. The common ovarian lesions, including physiological cysts, endometrioma, benign cystic teratoma, and cystadenoma, should be readily recognized. Malignant lesions are much less common, but recognition is important to ensure referral to a specialist center. MRI is advocated for problem-solving in the case of a sonographically indeterminate adnexal mass. An algorithmic approach to MRI interpretation is advocated. Risk stratification of adnexal masses, either on US or on MRI, can help the clinician to plan the most appropriate treatment for the patient.

This is an overview of adrenal imaging and an approach to evaluating incidental and suspected adrenal masses in a variety of clinical scenarios.

With the continuing increased utilization of CT, the detection of incidental, asymptomatic adrenal masses (incidentalomas) has increased, with the overwhelming majority being benign. But in the setting of a known malignancy, differentiation between a metastases and adenoma is essential to guide management.

In this chapter, we describe the imaging techniques to differentiate benign from malignant lesions and provide an algorithmic approach of workup of an adrenal mass.

Diseases of the upper gastrointestinal (GI) tract can be evaluated by a variety of imaging modalities, including barium fluoroscopy, CT, ultrasound, MR, PET-CT, PET-MR, and endoscopic ultrasound (EUS). Fluoroscopic examinations remain helpful for detecting a variety of benign conditions, especially in the esophagus, whereas cross-sectional imaging techniques are particularly useful for diagnosing and staging malignant tumors. This review therefore first considers radiologic evaluation of nonneoplastic conditions and then neoplastic conditions of the upper GI tract.