Adnexa ACR
Adrenal ACR
Bosniak
Gallbladder Polyp
Liver ACR
Pancreas Cyst ACR
Renal ACR
Thyroid ACR

Patel MD, Ascher SM, Horrow MM, Pickhardt PJ, Poder L, Goldman M, et al. Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol [Internet]. 2020 Feb 1 [cited 2023 Feb 11];17(2):248–54. Available from: http://www.jacr.org/article/S1546144019311998/fulltext

Mayo-Smith WW, Song JH, Boland GL, Francis IR, Israel GM, Mazzaglia PJ, et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol [Internet]. 2017 [cited 2023 Feb 13];14:1038–44. Available from: http://dx.doi.org/10.1016/j.jacr.2017.05.001

Radiology Tools | Radshare.net

Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, et al. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol [Internet]. 2017 [cited 2023 Feb 13];14:1429–37. Available from: http://dx.doi.org/10.1016/j.jacr.2017.07.018

Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani D V., Newman E, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol [Internet]. 2017 Jul 1 [cited 2023 Feb 11];14(7):911–23. Available from: http://www.jacr.org/article/S1546144017303186/fulltext

Non-contrast CT

Contrast-enhanced CT

Incidental Cystic

Too Small to Characterize

Containing Fat

Bosniak

Herts BR, Silverman SG, Hindman NM, Uzzo RG, Hartman RP, Israel GM, et al. Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol [Internet]. 2018 [cited 2023 Feb 13];15:264–73. Available from: http://dx.doi.org/10.1016/j.jacr.2017.04.028

Hoang JK, Langer JE, Middleton WD, Wu CC, Hammers LW, Cronan JJ, et al. Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee. J Am Coll Radiol [Internet]. 2015 [cited 2023 Feb 11];12:143–50. Available from: http://dx.doi.org/10.1016/j.jacr.2014.09.038

DWI and T2 Timing
Vascular Territories

When we compare the findings on T2WI and DWI in time we will notice the following:

In the acute phase T2WI will be normal, but in time the infarcted area will become hyperintense.
The hyperintensity on T2WI reaches its maximum between 7 and 30 days. After this it starts to fade.
DWI is already positive in the acute phase and then becomes more bright with a maximum at 7 days.
DWI in brain infarction will be positive for approximately for 3 weeks after onset (in spinal cord infarction DWI is only positive for one week!).
ADC will be of low signal intensity with a maximum at 24 hours and then will increase in signal intensity and finally becomes bright in the chronic stage.

Liver Resistive Index
Liver Tx Anatomy
Renal Transplant Complications

Multimodality Imaging after Liver Transplant: Top 10 Important Complications

Kidney AAST
Liver AAST
Spleen AAST

Kidney Injury Scale (2018 revision)
AAST Grade	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma and/or parenchymal contusion without laceration	Nonexpanding subcapsular hematoma	Subcapsular hematoma or parenchymal contusion without parenchymal laceration
			Parenchymal contusion without laceration

II	2	Perirenal hematoma confined to Gerota fascia	Nonexpanding perirenal hematoma confined to Gerota fascia	Perirenal hematoma confined to Gerota fascia
		Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Renal parenchymal laceration ≤1 cm depth without urinary extravasation

III	3	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation
		Any injury in the presence of a kidney vascular injury or active bleeding contained within Gerota fascia

IV	4	Parenchymal laceration extending into urinary collecting system with urinary extravasation	Parenchymal laceration extending into urinary collecting system with urinary extravasation	Parenchymal laceration extending into urinary collecting system
		Renal pelvis laceration and/or complete ureteropelvic disruption	Renal pelvis laceration and/or complete ureteropelvic disruption	Renal pelvis laceration and/or complete ureteropelvic disruption
		Segmental renal vein or artery injury	Segmental renal vein or artery injury	Segmental renal vein or artery injury
		Active bleeding beyond Gerota fascia into the retroperitoneum or peritoneum	Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding	Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
		Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
V	5	Main renal artery or vein laceration or avulsion of hilum	Main renal artery or vein laceration or avulsion of hilum	Main renal artery or vein laceration or avulsion of hilum
		Devascularized kidney with active bleeding	Devascularized kidney with active bleeding	Devascularized kidney
		Shattered kidney with loss of identifiable parenchymal renal anatomy	Shattered kidney with loss of identifiable parenchymal renal anatomy	Shattered kidney with loss of identifiable parenchymal renal anatomy
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of kidney injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III.

Kidney Injury Scale (2018 revision)
AAST Grade	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma and/or parenchymal contusion without laceration	Nonexpanding subcapsular hematoma	Subcapsular hematoma or parenchymal contusion without parenchymal laceration
			Parenchymal contusion without laceration

II	2	Perirenal hematoma confined to Gerota fascia	Nonexpanding perirenal hematoma confined to Gerota fascia	Perirenal hematoma confined to Gerota fascia
		Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Renal parenchymal laceration ≤1 cm depth without urinary extravasation	Renal parenchymal laceration ≤1 cm depth without urinary extravasation

III	3	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation	Renal parenchymal laceration >1 cm depth without collecting system rupture or urinary extravasation
		Any injury in the presence of a kidney vascular injury or active bleeding contained within Gerota fascia

IV	4	Parenchymal laceration extending into urinary collecting system with urinary extravasation	Parenchymal laceration extending into urinary collecting system with urinary extravasation	Parenchymal laceration extending into urinary collecting system
		Renal pelvis laceration and/or complete ureteropelvic disruption	Renal pelvis laceration and/or complete ureteropelvic disruption	Renal pelvis laceration and/or complete ureteropelvic disruption
		Segmental renal vein or artery injury	Segmental renal vein or artery injury	Segmental renal vein or artery injury
		Active bleeding beyond Gerota fascia into the retroperitoneum or peritoneum	Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding	Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
		Segmental or complete kidney infarction(s) due to vessel thrombosis without active bleeding
V	5	Main renal artery or vein laceration or avulsion of hilum	Main renal artery or vein laceration or avulsion of hilum	Main renal artery or vein laceration or avulsion of hilum
		Devascularized kidney with active bleeding	Devascularized kidney with active bleeding	Devascularized kidney
		Shattered kidney with loss of identifiable parenchymal renal anatomy	Shattered kidney with loss of identifiable parenchymal renal anatomy	Shattered kidney with loss of identifiable parenchymal renal anatomy
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of kidney injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III.

Liver Injury Scale (2018 revision)
AAST Grade	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area
		Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth
			Capsular tear	Capsular tear

II	2	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter
		Laceration 1-3 cm in depth and ≤10 cm length	Laceration 1-3 cm in depth and ≤10 cm length	Laceration 1-3 cm in depth and ≤10 cm length

III	3	Subcapsular hematoma >50% surface area; ruptured subcapsular or parenchymal hematoma	Subcapsular hematoma >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma
		Intrparenchymal laceration >10 cm	Intraparenchymal hematoma >10 cm	Intraparenchymal hematoma >10 cm
		Laceration >3 cm depth	Laceration >3 cm depth	Laceration >3 cm depth
		Any injury in the presence of a liver vascular injury or active bleeding contained within liver parenchyma

IV	4	Parenchymal disruption involving 25-75% of a hepatic lobe	Parenchymal disruption involving 25-75% of a hepatic lobe	Parenchymal disruption involving 25-75% of a hepatic lobe
		Active bleeding extending beyond the liver parenchyma into the peritoneum

V	5	Parenchymal disruption >75% of hepatic lobe	Parenchymal disruption >75% of hepatic lobe	Parenchymal disruption >75% of hepatic lobe
		Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins	Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins	Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of liver injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III.

Liver Injury Scale (2018 revision)
AAST Grade	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area
		Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth
			Capsular tear	Capsular tear

II	2	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <10 cm in diameter
		Laceration 1-3 cm in depth and ≤10 cm length	Laceration 1-3 cm in depth and ≤10 cm length	Laceration 1-3 cm in depth and ≤10 cm length

III	3	Subcapsular hematoma >50% surface area; ruptured subcapsular or parenchymal hematoma	Subcapsular hematoma >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma
		Intrparenchymal laceration >10 cm	Intraparenchymal hematoma >10 cm	Intraparenchymal hematoma >10 cm
		Laceration >3 cm depth	Laceration >3 cm depth	Laceration >3 cm depth
		Any injury in the presence of a liver vascular injury or active bleeding contained within liver parenchyma

IV	4	Parenchymal disruption involving 25-75% of a hepatic lobe	Parenchymal disruption involving 25-75% of a hepatic lobe	Parenchymal disruption involving 25-75% of a hepatic lobe
		Active bleeding extending beyond the liver parenchyma into the peritoneum

V	5	Parenchymal disruption >75% of hepatic lobe	Parenchymal disruption >75% of hepatic lobe	Parenchymal disruption >75% of hepatic lobe
		Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins	Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins	Juxtahepatic venous injury to include retrohepatic vena cava and central major hepatic veins
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of liver injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III.

Spleen Injury Scale (2018 revision)
Grade*	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area
		Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth
		Capsular tear	Capsular tear	Capsular tear

II	2	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm
		Parenchymal laceration 1-3 cm	Parenchymal laceration 1-3 cm	Parenchymal laceration 1-3 cm

III	3	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma ≥5 cm	Subcapsular hematoma >50% surface area or expanding; ruptured subcapsular or intraparenchymal hematoma ≥5 cm	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma ≥5 cm
		Parenchymal laceration >3 cm depth	Parenchymal laceration >3 cm depth	Parenchymal laceration >3 cm depth

IV	4	Any injury in the presence of a splenic vascular injury or active bleeding confined within splenic capsule	Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization	Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization
		Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization

V	5	Any injury in the presence of a splenic vascular injury with active bleeding extended beyond the spleen into the peritoneum	Hilar vascular injury with devascularizes the spleen	Hilar vascular injury with devascularizes the spleen
		Shattered spleen	Shattered spleen	Shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of splenic injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III. From Kozar et al.; with permission

Spleen Injury Scale (2018 revision)
Grade*	AIS Severity	Imaging Criteria (CT Findings)	Operative Criteria	Pathologic Criteria
I	2	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area	Subcapsular hematoma <10% surface area
		Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth	Parenchymal laceration <1 cm depth
		Capsular tear	Capsular tear	Capsular tear

II	2	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm	Subcapsular hematoma 10-50% surface area; intraparenchymal hematoma <5 cm
		Parenchymal laceration 1-3 cm	Parenchymal laceration 1-3 cm	Parenchymal laceration 1-3 cm

III	3	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma ≥5 cm	Subcapsular hematoma >50% surface area or expanding; ruptured subcapsular or intraparenchymal hematoma ≥5 cm	Subcapsular hematoma >50% surface area; ruptured subcapsular or intraparenchymal hematoma ≥5 cm
		Parenchymal laceration >3 cm depth	Parenchymal laceration >3 cm depth	Parenchymal laceration >3 cm depth

IV	4	Any injury in the presence of a splenic vascular injury or active bleeding confined within splenic capsule	Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization	Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization
		Parenchymal laceration involving segmental or hilar vessels producing >25% devascularization

V	5	Any injury in the presence of a splenic vascular injury with active bleeding extended beyond the spleen into the peritoneum	Hilar vascular injury with devascularizes the spleen	Hilar vascular injury with devascularizes the spleen
		Shattered spleen	Shattered spleen	Shattered spleen
Vascular injury is defined as a pseudoaneurysm or arteriovenous fistula and appears as a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Active bleeding from a vascular injury presents as vascular contrast, focal or diffuse, that increases in size or attenuation in delayed phase. Vascular thrombosis can lead to organ infarction. Grade based on highest grade assessment made on imaging, at operation or on pathologic specimen. More than one grade of splenic injury may be present and should be classified by the higher grade of injury. Advance one grade for multiple injuries up to grade III. From Kozar et al.; with permission