Spiral and Multislice Computed Tomography of the Body E-Book

• Herausgeber: Thieme
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 2578

Veröffentlichungsjahr: 2002

Beschreibung

All you need to know to maximize the diagnostic capabilities of CT . . .

Whole body computed tomography has developed at a rapid pace in the past decade, spurred on by the introduction of spiral and multislice scanning. These new technologies have not only improved diagnostic accuracy, but also made new applications possible that were previously accessible only through more complex or invasive techniques.

This new book expertly fills a gap in the literature by combining the practically relevant technical background with the clinical information required for correctly performing and interpreting CT examinations. The book presents the state-of-the-art capabilities and requirements of CT as a key diagnostic and interventional tool, with special emphasis on the role of spiral and multi-slice CT.

You will find a thorough introduction to CT technology from scanner design to 3D image reconstruction, useful practical hints on how to optimize your examination protocols and how to keep the radiation exposure of your patients to a minimum, as well as an extensive clinical section in which symptoms, pathology and CT morphology are integrated to provide you with the basis for subtle interpretation of CT findings using the most modern CT techniques.

Highlights include:

• Full coverage of single-slice, 4-slice and 16-slice scanning techniques
• Introduction to extended CT applications including cardiac CT, CT fluoroscopy, and 3D image processing
• Organ-specific protocols for scanning and contrast administration
• Practical guidelines for maximizing image quality and minimizing radiation exposure
• Useful suggestions for image interpretation and for avoiding pitfalls and errors
• Convenient format by organ system and disease entity
• Full discussion of organ-specific pathology and CT morphology
• CT indications integrated with other imaging modalities

At a tim

Leseprobe

Spiral and MultisliceComputed Tomography of the Body

Mathias Prokop, M.D.

Associate Professor of RadiologyDepartment of Diagnostic RadiologyUniversity of ViennaVienna, Austria; andDepartment of RadiologyUniversity Medical Center UtrechtUtrecht, The Netherlands

Michael Galanski, M.D.

Professor and ChairmanDepartment of Diagnostic RadiologyHanover Medical SchoolHanover, Germany

Co-editors:

Aart J. van der Molen, M.D.

Department of RadiologyLeiden University Medical CenterLeiden, The Netherlands

Cornelia Schaefer-Prokop, M.D.

Associate Professor of RadiologyDepartment of Diagnostic RadiologyUniversity of ViennaVienna, Austria

With contributions byC. Engelke, M. Jörgensen, K.J. Lehmann, A. Leppert, U. von Smekal

1972 Illustrations 332 Tables

ThiemeStuttgart • New York

Library of Congress Cataloging-in-Publication Datais available from the publisher

Parts of this book are an authorized translation of the German edition Ganzkörper Computertomograhie, edited by M. Galanski and M. Prokop, published and copyrighted 1998 by Georg Thieme Verlag, Stuttgart, Germany

Parts translated by Terry C. Telger, Forth Worth, TX, USA

Contributors’ addresses:Christoph Engelke, M.D.Department of RadiologyKlinikum der Technischen Universität MunichMunich, Germany

Maik Jörgensen, M.D.MR and CT FleethofPrivate PracticeHamburg, Germany

Karl Juergen Lehmann, M.D.Professor and ChairmanDepartment of Diagnostic andInterventional RadiologySt. Vincentius HospitalKarlsruhe, Germany

Andreas Leppert, M.D.Department of Diagnostic RadiologyHanover Medical SchoolHanover, Germany

Ulrich von Smekal, M.D.Institute for Diagnostic Radiologyand NeuroradiologyUniversity HospitalCologne, Germany

© 2003 Georg Thieme Verlag,Rüdigerstraβe 14, D-70469 Stuttgart, Germanyhttp://www.thieme.deThieme New York, 333 Seventh Avenue,New York, N.Y. 10001 U.S.A.http://www.thieme.com

Cover design: Thieme MarketingTypesetting by: Druckhaus Götz GmbH,  D-71636, Ludwigsburg, GermanyPrinted in Germany by: Druckhaus Götz GmbH,  D-71636, Ludwigsburg, Germany

ISBN 3-13-116481-6ISBN 0-86577-870-1                                                                                                                                                                 2 3 4 5

Important Note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user's own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

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Foreword

Although in its third decade, CT scanning remains a highly dynamic field. Rapid developments in CT technology, particularly over the past 5 years, have challenged radiologists to transform organ- and disease-specific CT acquisition protocols to take full advantage of the capabilities of 4-, 8-, and 16-row CT scanners. At no time in the past 3 decades has there been a greater diversity in CT scanner capabilities amongst those currently in clinical use. Further challenging radiologists are the new applications made possible by these technologic improvements. CT angiography and cardiac CT, as well as evolving post-processing technologies are among the newest and most dynamic areas of CT practice.

As challenging as the incorporation of rapidly evolving CT techniques and applications is to the practicing radiologist, the process of learning the practice of body CT as a resident seems particularly challenging. When I performed my first rotation in body CT as a resident in 1990, CT was a “mature” technology. We acquired almost all body CT scans with contiguous 10-mm thick acquisitions regardless of anatomic region or disease in question. My education focused squarely on the development of a working knowledge of transverse cross-sectional anatomy, CT manifestations of disease processes, and the development of cogent differential diagnoses. While these specifics of CT education of 1990 still represent the cornerstones of CT education in 2003, there is simply far more to be learned today.

This book by Mathias Prokop, Michael Galanski, Aart van der Molen, and Cornelia Schaefer-Prokop is perfectly suited to the task of helping residents achieve the needed competencies in body CT scanning to practice CT at its highest level. The authors are CT experts, who have established their reputations by embracing the technical developments of spiral and multi-row CT and using them to refine existing and develop new CT applications. This excellent text embodies the fresh perspective that they bring to a book on body CT. It is a terrific balance of CT techniques and interpretation in a comfortably paced, richly illustrated, comprehensive, and current textbook. After seven lucid chapters encompassing all aspects of CT principles and techniques, 18 organ-focused chapters cover the body from the neck through the musculoskeletal system. The authors have included clinically relevant CT anatomy, anatomic and disease-adapted techniques using single, 4-and 16-row CT scanners, disease manifestations, and image interpretation and have put special attention to new and advanced applications such as image processing, CT angiography and cardiac CT.

In an era of increasingly subspecialty-focused CT books, it is nice to see a manageable volume that encompasses the full spectrum of body CT. Both trainees in radiology as well as practicing radiologists wishing to bring their knowledge up-to-date will benefit greatly from this outstanding textbook.

Geoffrey D. Rubin, M.D.Stanford University School of MedicineStanford, California

Preface

With the introduction of spiral scanning, and more recently, multislice technology, computed tomography has seen rapid technical advances and a growing number of new applications. The new technologies allow CT to defend its leading position as the cross-sectional imaging technique of choice for many indications. Multislice scanning, in particular, has transformed CT from a transaxial cross-sectional modality into a three-dimensional imaging tool.

The technical advances have yielded a substantial increase in diagnostic capabilities, improved accuracy and diagnostic confidence. Many indications that used to be the domain of projection radiography have been taken over by CT, among them diagnostic GI tests, skeletal tomography, and most intraarterial angiographic procedures. Improved 3 D capabilities enable better guidance of surgical or interventional procedures, and have revolutionized the way we analyze disease processes.

At the same time, examinations have become more complex and demanding. The number of variable parameters has grown, and for each organ system the examination must be carefully adapted to the clinical question to obtain optimum results. New types of artifacts arise. Radiation exposure is gaining increased attention because the new techniques harbor the possibility both for dose reduction and for substantial dose increase. Knowledge of the underlying principles of image acquisition is essential for making choices appropriate for individual patients.

Given this background, a new book on body computed tomography was needed that would pay tribute to the new opportunities and demands and that reflects the current state of spiral and multislice technology, without neglecting the foundation of decades of experience in image analysis. This book reflects the current state of knowledge at the time of print, including scanning technique with 16-slice scanners. Technical principles and image interpretation take up a large portion of this book: they are the prerequisite for taking full advantage of the technique while at the same time preventing mistakes. The suggested scan parameters form a sensible compromise between image quality, diagnostic yield, and radiation exposure.

The organ chapters are subdivided into pathologic entities, discussing the indications for CT in the context of other imaging modalities. CT anatomy is reduced to the most important features necessary for correct diagnostic evaluation of the images. Special emphasis was placed on the organ- and indication-specific choice of examination technique, interpretation criteria and organ-specific pathology. New or improved applications such as CT colonography, cardiac CT, and CT angiography are introduced; however, we elected not to enter the heated debate on CT screening, in particular whole body screening, as the body of evidence to support such practice is presently insufficient.

To optimize readability, an up-to-date section with suggestions for further reading was placed at the end of the book. This does not cover the long history of CT literature but focuses on newer literature dealing with spiral and multislice technology. A more extensive list is available on the product information page at the publisher's website (www.thieme.com; search for “Prokop”).

Since its inception, CT has been a cornerstone in radiology. We believe that the concept of this book, with its emphasis on both diagnostic and technical aspects, pays tribute to the future challenges of our discipline. We hope to have contributed to a better understanding of this intellectually stimulating and powerful technique, and that this book will become a constant companion in the daily work of radiologists worldwide.

M. Prokop                                M. Galanski

C. Schaefer-Prokop                  A. J. van der Molen

Contents

1 Principles of CT, Spiral CT, and Multislice CT

2 Image Processing and Display Techniques

3 Patient Preparation and Contrast Media

4 Optimization of Scanning Technique

5 Radiation Dose and Image Quality

6 CT-Guided Interventional Procedures

7 Image Analysis

8 Neck

9 Lungs and Tracheobronchial System

10 Mediastinum, Pleura, and Chest Wall

11 Liver

12 Biliary Tract

13 Spleen

14 Pancreas

15 Gastrointestinal Tract

16 Peritoneal Cavity and Retroperitoneum

17 Adrenal Glands

18 Kidneys

19 Urinary Bladder

20 Female Pelvis

21 Male Pelvis

22 Lymphatic System

23 Heart

24 Vascular System

25 Musculosceletal System

References

Index

Acknowledgements

We would like to gratefully acknowledge all who have made this book project possible.

Several friends and colleagues have been so kind as to review one or more of the chapters of this book. In particular, we thank Cynthia McCullough (Rochester, MN) for revising the chapter on radiation exposure, and Koos Geleijns (Leiden, The Netherlands) and Peter Homolka (Vienna, Austria) for providing critical comments and up-to-date numbers within this chapter. We are gratefully indebted to Frans Zonneveld (Utrecht, The Netherlands), who has meticulously checked the first five chapters on technical aspects. We thank Stanley Fox from GE, Leon de Vries from Philips, Thomas Flohr and Stefan Schaller from Siemens, as well as Arie Munne and Luc Bouwman from Toshiba for their willingness to share the newest information about their equipment and critically reviewing the vendor-specific sections in the chapters on Principles of CT and Scanning Technique. Jonas Castelijns (Amsterdam, The Netherlands) and Suresh Mukherji (Ann Arbor, MI) have reviewed the Neck chapter and Maarten van Leeuwen (Utrecht, The Netherlands) has given his critical remarks on the Liver chapter. We are grateful for their efforts.

We would like to acknowledge the excellent technical staff at our institutions, in particular Michaela Kinze and Frank Socko from Hanover Medical School, who have introduced many new and complex techniques into clinical practice at a time when spiral scanning was still in its infancy. Dominique Sandner-Porkristl and her dedicated team have facilitated implementing and standardizing advanced multi-slice techniques and helped establish a successful 3 D lab in Vienna, without which many of our images would not have been possible. The dedication of Maria Zeidabadi, Uschi Brehmer, Christine Jaeger-Radkofsky and Susanne Huber has ensured constantly high image quality and a high level of patient care.

The authors are deeply indebted to those colleagues who opened their image archives and helped provide particularly instructive or rare cases for this book. We cordially thank Ahmet Ba-Ssalamah (Vienna), Patrick Brouwer (Leiden), Benedikt Czermak (Zürich), Christian Czerny (Vienna), Rainer Erlemann (Duisburg), Ulrich Fink (Villingen-Schwenningen), Dominik Fleischmann (Vienna), Thomas Flohr (Forchheim), Tomas Franquet (Barcelona), Andrea Guidotti (Chieti), Gertraud Heinz (Vienna), Christian Herold (Vienna), Martin Hofmann (Ulm), Willi Kalender (Erlangen), Matthias König (Bochum), Rainer Köster (Neuss), Soeren Kreuzer (Vienna), Gerhard Lechner (Vienna), Wolfgang Lemmen (Wuppertal), Thomas Mang (Vienna), Ulrich Mödder (Düsseldorf), Milan Pijl (Groningen), Andreas Neuhold (Vienna), Lino Ramos (Utrecht), Martine Remy-Jardin (Lille), Götz Richter (Heidelberg), Patrik Rogalla (Berlin), Herbert Rosenthal (Hanover), Stefan Schaller (Forchheim), Wolfgang Schima (Vienna), Pierre Schnyder (Lausanne), Ewald Schober (Vienna), Martin Uffmann (Vienna), and Joachim-Ernst Wildberger (Aachen), Dag Wormanns (Münster), and Patrick Wunderbaldinger (Vienna).

The Publisher, Thieme, and in particular Clifford Bergman deserve great credit for their continuing support and willingness to expand the project from a mere translation of a German text to a totally new book that included not only single slice CT but also the newest developments in multislice scanning. Finally, we cordially thank Gert Krüger from Thieme for his patience, dedication and flexibility in assembling the material and allowing us to keep critical sections up-to-date until shortly before going to print. Without his expertise, producing the book in this form and quality would not have been possible.