MEDICAL RADIOLOGY Diagnostic Imaging and Radiation Oncology Editorial Board Founding Editors L.W. Brady, M.W. Donner(t), H.-P. Heilmann, F.H.W. Heuck Current Editors Diagnostic Imaging A.L. Baert, Leuven F.H.W. Heuck, Stuttgart J.E. Youker, Milwaukee Radiation Oncology L.W. Brady, Philadelphia H.-P. Heilmann, Hamburg Springer-Verlag Berlin Heidelberg GmbH F. Terrier . M. Grossholz . C. D. Becker (Eds.) e l Spiral of the Abdomen With Contributions by C. Ala Edine . C. Bartolozzi . C. D. Becker . M. Bezzi . L. Bidaut . E. Biscaldi . D. A. Bluernke V. M. Bonaldi . H.-J. Brambs· L. Broglia . R. Brooke Jeffrey Jr. . J. M. Bruel . C. Catalano o. Cay· D. Cioni . L. Crocetti· J. F. Debatin· F. Donati· F. Dubrulle . J.H. D. Fasel· X. Fouillet F. Fraioli· P.C. Freeny· B.Gallix· G. Georgakopoulos . G. Granai· N. Grenier· M. Grossholz B.Hamm·P.R.Hilflker·H.-M.Hoogewoud· N. Howarth· H.Hricak· W.A. Kalender H.G. Khan· R. Kubale . A.Laghi. M. J. Lane· L. LemaÎtre· R.Lencioni· G.Marchal· J.Mareceaux B. Marincek· L. Masquillier· J.-Y. Meuwly· W. Okuno . J. Palussiere . V. Panebianco R. Passariello . P. Pavone· J.-P. Pelage· J. H. Pringot· M. Prokop . V.-D. Raptopoulos G. A. Rollandi· L. Rubbia Brandt . S. G. Riihm· P. Soyer· L. Spadola . A. Spinazzi· P. Taourel M. Taupiz· F. Terrier· H. Trillaud . H. Tschăppeler· D. Vanbeckevoort· B. E. Van Beers L. Van Hoe· G. Verswijvel· V. Vilgrain· P. Vock Series Editor's Foreword by A.L.Baert With 455 Figures in 818 Separate Illustrations, 51 in Color and 29 Tables Springer FRANC;:OIS TERRIER, MD Professor, Department of Radiology Division of Diagnostic and Interventional Radiology Geneva University Hospital 24, Rue Micheli-du-Crest CH-1211 Geneve 14 Switzerland MARIANNE GROSSHOLZ, MD Hopital de la Tour CH-1217 Meyrin Switzerland CHRISTOPH D. BECKER, MD Department of Radiology Division of Diagnostic and Interventional Radiology Geneva University Hospital 24, Rue Micheli-du-Crest CH-1211 Geneve 14 Switzerland MEDICAL RADIOLOGY . Diagnostic Imaging and Radiation Oncology Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISBN 978-3-540-42291-4 Library of Congress Cataloging-in-Publication Data. Spiral CT of tbe abdomen 1 F. Terrier, M. Grossholz, C. D. Becker, (eds.) p. cm. - (Medical radiology) Includes bibliographical references. ISBN 978-3-540-42291-4 ISBN 978-3-642-56976-0 (eBook) DOI 10.1007/978-3-642-56976-0 1. Abdomen -Tomography. 2. Spiral computed tomography. I. Terrier, F. II. Grossholz, M. (Marianne), 1952- . IV. Series. RC944.S678 1999 617.5'50757--dc21 98-52822 CIP This work is subject to copyright. AlI rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of tbe German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 200<Ro Originally published by Springer-Verlag Berlin Heidelberg New York 2000 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in tbe absence of a specific statement, tbat such names are exempt from tbe relevant protective laws and regulations and tberefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in tbis book. In every individual case the user must check such information by consulting tbe relevant literature. Typesetting: Verlagsservice Teichmann, Mauer SPIN: 10633407 2113135-543210 Foreword I am delighted to introduce a new volume in our series "Medical Radiology" devoted to the clinical applications of spiral CT for study of diseases of the abdomen. Since the introduction of Spiral CT by W. Kalender a few years ago the technique has matured rapidly and has already found widespread applications in all areas of the body. Spiral CT has now attained a high level of sophistication, which requires from radiologists appropriate knowledge and skills in order optimally to exploid the numerous diagnostic potentials of this modality. Notwithstanding the considerable progress achieved in abdominal MR due to the recent sucessful introduction of fast sequences and specific contrast media, CT still plays a major role in daily management of many abdominal conditions and many radiologists devote a considerable amount of their clinical time to this technique. I would like to congratulate the editors for their excellent efforts in producing this com prehensive and up-to-date overview of abdominal spiral CT applications. They have been very sucessfull in securing the collaboration of so many leading experts in the field, from both Europe and the USA. This splendid volume will be of benefit to all radiologists eager to remain on the cutting edge of abdominal CT as well as to gastroenterologists and to abdominal surgeons who are interested to learn more about the fascinating possibilities for better diagnostic and thera peutic management of their patients. As responsible series editor I sincerely hope that this volume - like earlier volumes - will be well received by our colleagues in the different fields of medicine involved. Leuven ALBERT L. BAERT Preface Until the mid-1990s, the impressive, relentless progress of MRI had led many of us to believe that the days of abdominal CT were numbered. This feeling was made even stronger by the emerging concept of "interventional MRI", which gave the impression that one of the major achievements of CT, namely the guidance of diagnostic and therapeutic interventions, could soon be challenged. Such pessimism about CT was a big mistake! Indeed, the future of CT now appears brighter than ever. The advent of the slip-ring tech nology and the accelerating progress of information technology have laid the foundations for spiral data acquisition, which has allowed the move from slow, step-by-step scanning to fast, volumetric scanning. Highly optimised CT imaging protocols, based on a better under standing of the pharmacodynamics of iodinated contrast media, have resulted in greatly improved imaging of organs such as the liver, kidney and pancreas. For the study of the aorta and its branches, the inferior vena cava and the portal circula tion, powerful workstations can now calculate within a short time two- and three-dimen sional reformatted images of exquisite quality from data acquired in the phase of maximal vessel enhancement and during a single breath-hold, a guarantee for high contrast and absence of respiratory misregistration artefacts. In many applications CT angiography has the advantage over MR angiography, and the respective roles of the two techniques still need to be clarified. Virtual endoscopy provides completely new perspectives for imaging of tubular struc tures, including the gastrointestinal tract, and could have a major socio-economic impact if its potential in the secondary prevention of colonic carcinoma can be established by clini cal studies. Despite strong competition from US and MRI, CT remains the most informative and com prehensive modality for abdominal imaging in many clinical situations, especially in acute ly ill patients and trauma victims and in perioperative situations. Most probably, the privi leged role of CT will remain unchanged in the future and will even be strengthened by the breakthrough of multi-array detectors and perhaps also the introduction of tissue-specific contrast media in clinical practice. All the new achievements in CT technology have led to a revival of CT as a field of excit ing research and academic interest, besides its task as the workhorse in daily radiological practice. This is reflected in the large number of highly original publications on spiral CT in the recent literature. It takes a highly competent team of radiologists and technologists to master state-of-the art CT. Being in charge of a CT examination no longer just involves deciding whether or not to inject intravenous contrast material. The imaging protocol has to be tailored very pre cisely to the clinical question one has to answer and to the patient's condition, by adequate selection of scanning and contrast injection parameters. Furthermore, the sophisticated techniques of image reformatting require both familiarity with dedicated workstations and profound knowledge of the clinicians' requirements. The daily work of the CT team is in no way less complex or challenging than that of the MRI team and requires constant adaptation to the rapidly changing computer environment, very close contact with the referring clinicians and, last but not least, hard work. VIII Preface In this book, contributions from many leading radiologists and scientists in Europe and the United States have been collected to give a clinically oriented overview of state-of-the-art spiral CT of the abdomen. We would like to thank all of them for their enthusiasm and excellent work. This book will be a great help to radiologists and technicians involved in the daily use of spiral CT as the prime imaging modality for the abdomen. For clinicians who are interested in abdominal imaging it may serve as a reference work on the capabilities of state-of-the-art CT in this field. A final word of gratitude to the series editors of Medical Radiology, and to Professor A.L. Baert in particular, for their trust and patience, and to Ursula N. Davis, Janet Dodsworth, and Kurt Teichmann for their great help and professional spirit. Geneva FRAN<;:OIS TERRIER CHRISTOPH D. BECKER M. GROSSHOLZ Contents Technique .............................................................. . Principles P. VOCK and W.A. KALENDER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 Data/Image Processing L. BIDAUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13 3 Reconstruction Techniques for CT Angiography M. PROKOP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 41 Liver .................................................................... 55 4 Tailoring the Imaging Protocol P.R. HILFIKER and B. MARINCEK ......................................... 57 5 Segmental Anatomy of the Liver in Spiral CT J.H.D. FASEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 65 6 Spiral CT of Hepatic Metastases P. SOYER, D.A. BLUEMKE, and J.-P. PELAGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 73 7 Hemangioma F. TERRIER, L. RUBBIA-BRANDT, L. SPADOLA, and N. HOWARTH. . . . . . . . . . . . . . . .. 85 8 Adenoma and Focal Nodular Hyperplasia V. VILG RAIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 99 9 Hepatocellular Carcinoma. R. LENCIONI, D. CIONI, and C. BARTOLOZZI ................................. III 10 Perfusion Disorders G. VERSWIJVEL, L. VAN HOE, and G. MARCHAL .............................. 133 Focal Liver Lesions: Role of Spiral CT and Controversies ........................ 149 11 The Case for Ultrasonography R. LENCIONI, D. CION!, L. CROCETTI, and C. BARTOLOZZI ..................... 151 12 The Case for Spiral CT B. MARINCEK .......................................................... 157 x Contents 13 Liver: Role of Helical CT and Controversies: the Case for MRI M. TAUPITZ AND B. HAMM ............................................... 161 14 Synthesis F. TERRIER ............................................................ 165 Pancreas and Biliary Ducts ................................................. 167 15 Tailoring the Imaging Protocol V.M. BONALDI ......................................................... 169 16 Benign and Malignant Biliary Stenoses M. BEZZI, L. BROGLIA ................................................... 177 17 Choledocholithiasis and CT Cholangiography B.E. VAN BEERS and J.H. PRINGOT ......................................... 187 18 Spiral CT for the Diagnosis and Staging of Pancreatic Adenocarcinoma O. CAY and V. RAPTOPOULOS ............................................ 197 19 CT of Endocrine and Cystic Tumors of the Pancreas D.A. BLUEMKE and P. SOYER ............................................. 215 20 Helical CT of Acute and Chronic Pancreatitis P.C. FREENY ........................................................... 227 Biliary and Pancreatic Diseases: Role of Spiral CT and Controversies .............. 241 21 The Case for Ultrasonography R. LENCIONI, F. DONATI, G. GRANAI, and C. BARTOLOZZI ..................... 243 22 The Case for Spiral CT V. RAPTOPOULOS ....................................................... 247 23 The case for MRI P. PAVONE,A. LAGH!, V. PANEBIANCO, C. CATALANO, F. FRAIOLI, and R. PASSARIELLO .................................................... 251 24 Synthesis C. D. BECKER .......................................................... 255 Urinary Tract ............................................................ 259 25 Tailoring the Imaging Protocol H.G. KHAN and F. TERRIER .............................................. 261 26 Spiral CT of Renal Perfusion Abnormalities M.J. LANE and R. BROOKE JEFFREY JR ...................................... 269 Contents XI 27 Retroperitoneum and Ureters R. LEMAITRE, C. ALA EDINE, F. DUBRULLE, L. MASQUILLIER, and J. MARECAUX .. 277 28 Adrenals H.-M. HOOGEWOUD .................................................... 319 29 Detection and Staging of Renal Neoplasms H. TRILLAUD, J. PALUSSIERE, and N. GRENIER ............................... 335 Renal Tumors: The Role of Spiral CT and Controversies ......................... 347 30 The Case for Ultrasonography J.-Y. MEUWLY .......................................................... 349 31 The Case for Spiral CT H. TRILLAUD, J. PALUSSIERE, and N. GRENIER ............................... 359 32 The Case for MRI W. OKUNO and H. HRICAK ............................................... 361 33 Synthesis F. TERRIER .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 365 Gastro-intestinal Tract ..................................................... 367 34 CT Enteroclysis G.A. ROLLANDI and E. BISCALDI ......................................... 369 35 Virtual Colonoscopy H.-J. BRAMBS .......................................................... 385 36 Mesenteric Ischemia P. TAOUREL, B. GALLI X, AND J.M. BRUEL .................................... 393 37 Synthesis: Impact of Spiral CT on Imaging of the GI Tract and Comparison with Other Imaging Modalities D. VANBECKEVOORT, L. VAN HOE, and G. VERSWIJVEL ......................... 407 Abdominal Aorta and its Branches ........................................... 417 38 Aorta and Visceral Arteries M. PROKOP ............................................................ 419 Abdominal Vessels: Role of CT Angiography and Controversies .................. 441 39 The Case for Doppler Sonography R. KUBALE ............................................................ 443 40 The Case for CT Angiography M. PROKOP ............................................................ 451