Contents I
MEDICAL RADIOLOGY Diagnostic Imaging
Editors:
A. L. Baert, Leuven K. Sartor, Heidelberg
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Contents III
C. Catalano · R. Passariello (Eds.)
Multidetector- Row CT
Angiography
With Contributions by
H. Abe · C. Bartolozzi · C. R. Becker · L. Bertoletti · L. Bonomo · A. Caggiati · C. Catalano D. Caramella · M. D. Dake · M. Danti · R. Ferrari · D. Fleischmann · T. Flohr · F. Fraioli J. C. Hellinger · T. Hirai · M. Hohn · M. Hori · R. Iannaccone · R. Iezzi · D. S. Katz A. A. Khankan · T. Kim · Y. Korogi · M. Kuwabara · A. Laghi · J. M. Levin · D. Marin B. Merlino · T. Murakami · H. Nakamura · A. Napoli · P. Nardis · E. Neri · F. Odoguardi R. Passariello · F. Pediconi · S. Schaller · U. J. Schoepf · M. Takahashi · J-F. Uhl · P. Vagli Y. Yamashita
Foreword by
A. L. Baert
With 176 Figures in 345 Separate Illustrations, 85 in Color and 22 Tables
123
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IV Contents
Carlo Catalano, MD
Associate Professor, Department of Radiological Sciences University of Rome “La Sapienza”
Policlinico Umberto I Viale Regina Elena n. 324 00161 Rome
Italy
Roberto Passariello, MD
Professor and Chairman, Department of Radiological Sciences University of Rome “La Sapienza”
Policlinico Umberto I Viale Regina Elena n. 324 00161 Rome
Italy
Medical Radiology · Diagnostic Imaging and Radiation Oncology Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Molls · K. Sartor Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
Library of Congress Control Number: 2004110739
ISBN 3-540-40148-2 Springer Berlin Heidelberg New York
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi - cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the 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.
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Contents V
Intravenous CT angiography (CTA) was fi rst introduced more than 10 years ago follow- ing the development of spiral CT. However, considerable technical problems, related to the diffi culties in achieving satisfactory spatial resolution of large body volumes or of the extremities, prevented widespread clinical application of this interesting non-invasive diagnostic imaging modality.
The introduction of the multidetector-row technology allowed excellent volume data acquisition and improved considerably the technical quality of CTA imaging while reducing the quantities of iodinated contrast media administered to the patient.
CTA is now a mature and robust technique that increasingly is replacing catheter angiography for diagnostic purposes in daily radiological practice.
This volume covers exhaustively not only the technical and physical bases of multi- detector-row CTA but also the correct clinical execution of the study, as well as the new and fascinating applications of this method in all organs of the body as well as in the extremities. The eminently readable text is complemented by numerous superb illustra- tions.
The editors belong to the department of radiology of the University “La Sapienza”, a clinical radiological center with a long-standing interest and competence in new imag- ing modalities and specifi cally in angiography and CT. They are widely recognized as experts in the fi eld.
The authors of individual chapters, who come from both sides of the Atlantic and from the Far East, were invited to contribute because of their outstanding personal experience in a specifi c anatomic area and their major contributions to the radiological literature on the topic.
I would like to thank the editors and the authors and congratulate them sincerely for their superb efforts in writing this excellent volume, which is a much-needed compre- hensive update of the considerable diagnostic possibilities of modern CTA.
This book will be of great interest not only for general and vascular radiologists but also for all referring clinical practitioners. I am confi dent that it will meet the same suc- cess with readers as the previous volumes published in this series.
Leuven Albert L. Baert
Foreword
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Contents VII
Preface
The advent of spiral CT introduced a new era in radiology: three-dimensional acquisi- tion. The possibility to acquire volumes instead of simply bi-dimensional scans allowed to introduce the concept of multiple phases studies after a single intravenous bolus of contrast agent administration and especially to acquire a volume during the passage of the contrast agent in the arteries. The advent of computed tomography angiography (CTA) resulted in a revolution in vascular radiology with more and more pathological entities assessed non invasively, leaving catheter angiography the main and increasing role of treating mini-invasively diseases.
The clinical advantage of CTA appeared immediately clear either in emergency or selected cases. Infact since then the role of CTA is well established in the diagnosis of acute diseases of the aorta (dissection and rupture), pulmonary embolism, thoracic and abdominal aortic aneurysms.
Other applications were also successfully considered, such as the evaluation of the intracranial circulation, the carotid arteries, the renal arteries and the pelvic arteries.
The success of the technique was also related to the development of sophisticated workstations for three-dimensional evaluation and reconstructions of the acquired volume, introducing new algorithms that facilitated the diagnosis and created images analogue or at least similar to those provided by catheter angiography.
As the experience with CTA increased it became evident which were the limitations of spiral CT: the need to reach a compromise between spatial resolution along the z-axis and volume coverage and to administer quite large volumes of iodinated contrast agent. In fact if a large volume needed to be acquired a thin slice collimation could not be used; on the contrary a high resolution volume using a thin collimation was possible only for limited volume width. At the same time scan duration was long (considering a minimum gantry rotation time of 0.75 seconds, which nevertheless in most scanners was 1 second) necessitating, in order to achieve a good vascular enhancement, a large amount of contrast agent.
These limitations were then surpassed at the beginning of 1999 when the fi rst mul- tidetector row scanners were introduced and tested clinically, with excellent results. It seems immediately clear that the compromise between volume coverage and spatial resolution had no reason to exist anymore and that the volume of iodinated contrast agent could be reduced.
Since then a large number of articles have demonstrated that computed tomography has entered a new technological era with enormous impact on the routine daily practice;
real three-dimensional visualization of all body structures, non invasive assessment of vascular structures, cardiac and coronary imaging, perfusion imaging and more and more screening examinations.
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VIII Contents
Multidetector row CT technology is under continuous development and at this time we are assisting to decrease of the gantry rotation time, improvement of x-ray tubes performances and increase of number of slices acquired per second.
Computed Tomography Angiography is the application that has most benefi ted of all these technological improvements opening to non invasive assessment the evaluation of all peripheral vasculature and the coronary arteries with all relative clinical implica- tions.
The aim of this text is therefore to show the potentials and clinical applications of CTA, with its limitations and advantages, also in comparison with other imaging modali- ties.
Rome Carlo Catalano
Roberto Passariello
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Contents IX
1 Multidetector-Row CT Angiography: Evolution, Current Usage, Clinical Perspectives, and Comparison with Other Imaging Modalities
Douglas S. Katz and Man Hon . . . 1 2 Multidetector-Row CT: Technical Principles
Thomas Flohr and Stefan Schaller . . . 11 3 Multidetector-Row CT: Image Processing Techniques and Clinical Applications
Emanuele Neri, Paola Vagli, Francesco Odoguardi, Davide Caramella, and Carlo Bartolozzi . . . 25 4 Contrast Medium Administration
Dominik Fleischmann . . . 41 5 CT Angiography in the Assessment of Intracranial Vessels
Toshinori Hirai, Yukunori Korogi, Mutsumasa Takahashi,
and Yasuyuki Yamashita . . . 55 6 Carotid Arteries
Carlo Catalano, Federica Pediconi, Alessandro Napoli,
Massimiliano Danti, Piergiorgio Nardis, and Linda Bertoletti . . . 69 7 Thoracic Aorta
Michael D. Dake, Jeffrey C. Hellinger, and Jonathan M. Levin. . . 87 8 Multidetector-Row CT Angiography of the Pulmonary Circulation
U. Joseph Schoepf . . . 103 9 Multidetector-Row CT Angiography of the Coronary Arteries
Christoph R. Becker . . . 125 10 Abdominal Aorta
Lorenzo Bonomo, Roberto Iezzi, and Biagio Merlino . . . 137 11 Hepatic Vessels
Takamichi Murakami, Masatoshi Hori, Tonsok Kim, Masatomo Kuwabara, Hisashi Abe, Azzam Anwar Khankan, and Hironobu Nakamura . . . 155 12 Multislice CT Angiography of the Splanchnic Vessels
Andrea Laghi, Riccardo Iannaccone, Riccardo Ferrari,
Daniele Marin, and Roberto Passariello . . . 167
Contents
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X Contents
13 Multidetector-Row CT of Renal Arteries
Francesco Fraioli, Carlo Catalano, Linda Bertoletti,
and Piergiorgio Nardis . . . 177 14 Multidetector-Row CT Angiography of Peripheral Arteries:
Imaging Upper and Lower Extremity Vascular Disease
Dominik Fleischmann, Jeffrey C. Hellinger, and Alessandro Napoli. . . 187 15 Three Dimensional Evaluation of the Venous System in Varicose Limbs by
Multidetector Spiral CT
Jean-François Uhl and Alberto Caggiati . . . 199
Subject Index . . . 207 List of Contributors . . . 211
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