Contents I
MEDICAL RADIOLOGY Diagnostic Imaging
Softcover Edition
Editors:
A. L. Baert, Leuven K. Sartor, Heidelberg
Contents III
U. J. Schoepf (Ed.)
Multidetector- Row CT
of the Thorax
With Contributions by
J. Aldrich · C. R. Becker · C. Beigelmann-Aubry · P. M. Boiselle · P. Costello · M. Das R. Drosten · C. Fetita · R. Fischbach · E. K. Fishman · D. Fleischmann · T. Flohr L. Gattinoni · B. Ghaye · L. R. Goodman · P. A. Grenier · C. I. Henschke · C. J. Herold P. Herzog · A. R. Hunsacker · F. L. Jacobson · M. Kachelriess · W. A. Kalender
H.-U. Kauczor · J. P. Ko · W. Kostis · L. P. Lawler · A. N. Leung · R. Loose · J. M. Martensen Y. Martin-Bouyer · J. R. Mayo · D. P. Naidich · A. Nchimi · M. U. Niethammer
B. Ohnesorge · M. Oldendorf · B. L. Partik · E. J. Potchen · M. F. Reiser · G. D. Rubin S. Schaller · P. Schnyder · U. J. Schoepf · D. Shaham · S. Shankar · M. J. Siegel
H. C. Steinert · E. vanSonnenberg · M. Vazquez · J. Verschakelen · G. K. von Schulthess J. E. Wildberger · M. Wintermark · S. A. Wood · D. F. Yankelevitz
Series Editor’s Foreword by
A. L. Baert
Foreword by
M. F. Reiser
With 349 Figures in 641 Separate Illustrations, 100 in Color and 37 Tables
123
IV Contents
U. Joseph Schoepf, MD Department of Radiology Brigham and Women’s Hospital Harvard Medical School 75 Francis Street Boston, MA 02115 USA
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
ISBN 3-540-26247-4 Springer-Verlag Berlin Heidelberg New York ISBN 978 3-540-26247-3 Springer-Verlag Berlin Heidelberg New York
Library of Congress Cataloging-in-Publication Data
Multidtector-row CT of the thorax / U. J. Schoepf (ed.) ; with contributions by C. R.
Becker ... [et al.] ; foreword by A. L. Baert.
p. ; cm. -- (Medical radiology)
Includes bibliographical references and index.
ISBN 3540437746 (hardcover; alk. paper) ISBN 3540262474 (softcover; alk. paper) 1. Chest--Tomography. I. Schoepf, U. J. (U. Jeseph), 1969- II. Becker, C. R. (Christoph R.) III Series.
[DNLM: 1. Radiography, Thoracic--methods. 2. Tomography, X-Ray Computed--mehods. WF 975 M691 2004]
RC941.M76 2004
617.5’407572--dc21 2003052905
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Contents V
Für meine Eltern, Ursula und Josef Schoepf
Contents VII
Almost 30 years after the clinical introduction of computed tomography revolutionised the practice of radiology, the development of multidetector-row CT (MDCT) marked another important step forward in this cross-sectional modality.
The correct application of MDCT for optimal clinical results requires from the radi- ologist a keen insight in the technical principles of this technique as well as specifi c knowledge and skills concerning the appropriate use of i.v. contrast media, workfl ow design and radiation dose.
This superb volume covers exhaustively all aspects of the clinical application of MDCT in the study of the lung, heart and great vessels The collaboration of many inter- nationally renowned experts has resulted in top-quality up-to-date, well written and comprehensive chapters on all main topics. I would like to congratulate Dr. Schoepf and the authors most sincerely for producing this standard reference work on a very topical theme.
This outstanding book will certainly meet with great interest from general, chest and vascular radiologists but also from surgeons and medical specialists, whose manage- ment of patients with diseases of the chest will greatly benefi t from its contents. I am confi dent that it will encounter the same success with readers as previous volumes pub- lished in this series.
Leuven Albert L. Baert
Series Editor’s Foreword
Contents IX
Foreword
The introduction of computed tomography revolutionized diagnostic imaging in the thorax. Soon after the introduction of this technology fi rst reports appeared showing for example that pulmonary metastases, especially those in a subpleural location, could be detected with greater sensitivity than with chest radiography. In addition, tumors of the lung and the mediastinum could be detected more easily and staged more precisely.
It was also not long before reports began describing previously unknown diagnostic applications, especially pertaining to the use of CT for determining the nature of focal lung disease and its ability to differentiate between benign and malignant pulmonary lesions, based on measurements of density, calcium and contrast medium uptake. Early generation CT scanners with incremental image acquisition were, however, limited in their diagnostic capabilities by partial volume effects and motion artifacts, originating from the pulsation of the heart and great vessels.
High-resolution CT (HR-CT) enabled a very detailed assessment of normal and diseased lung, so that HR-CT justifi ably became established as the method of choice for in-vivo assessment of the pulmonary parenchyma. Nevertheless, non-representa- tive sections were often sampled due to the incremental nature of this scan technique, resulting in misdiagnosis.
The introduction of spiral CT made it possible for the fi rst time to generate large- volume data sets during a single breath-hold. The scan range in z-direction, however, was still limited, and the slice thickness was too large to acquire isotropic data. A fundamen- tal change came with the introduction of multidetector-row CT (MDCT), initially with 4, later 8, 10, and most recently 16 detector rows. This technology allows the entire thorax to be scanned with thin sections during a single breath-hold, making possible high-resolu- tion, three-dimensional, artifact-free imaging. Even the structures of the heart can now be analyzed by CT, so that the “holy grail of imaging”, namely non-invasive coronary arteriography, is within reach. These advantages have rendered CT a particularly useful and robust technique for diagnosing thoracic disease. This holds true for the accurate non-invasive display of the pulmonary vasculature and for the non-invasive assessment of the mediastinum including the heart. Three-dimensional imaging and other post- processing methods have added greatly to diagnosis and quantifi cation.
Despite the breathtaking aesthetic beauty and clarity that can be achieved with current modalities, not all technical and diagnostic problems have been solved. With regard to radiation exposure, a suitable compromise between image quality, diagnostic accuracy and patient radiation dose still has to be found. Intelligent modifi cations of the scan technique already allow a signifi cant reduction of radiation exposure to the patient. Contrast medium administration has to be optimized and individualized, if the
X Contents
best possible contrast enhancement of the vasculature and the cardiac cavities is to be obtained. Thus, it remains inevitable that a portrayal of the current state of technology and knowledge only captures a brief moment in time while technology continues to advance. This development, therefore, should be considered in relative terms as further progress of medical applications and technical improvements occurs.
Nevertheless, it is a great achievement of Dr. Schoepf to have summarized the cur- rent state of knowledge of CT in this highly interesting, cutting-edge contribution. In the preparation of this book he was able to secure the contributions of renowned inter- national experts. The chapters are well written, comprehensive and up to date. Current techniques and future developments pertaining to diagnostic imaging of the airways, diffuse and focal lung disease, tumors of the lung and mediastinum, pulmonary embo- lism, and MDCT of the heart are all comprehensively discussed. Important topics that have emerged only recently with the introduction of novel imaging modalities, such as data management, computer aided diagnosis and medico-legal aspects, are also included. The selection of the contributing authors and the structure of each individual chapter and of the overall volume as an entity are compelling. The bibliography is exten- sive, yet relevant. The text is eminently readable and conveys modern CT applications in an interesting and enjoyable style.
Dr. Schoepf has succeeded in composing an important, timely contribution to the standard literature on a topic of exceeding clinical importance in concurrent imaging, which will be received with the greatest of interest by radiologists and those in other disciplines involved in the diagnosis and treatment of diseases of the chest. I wish this book, the publisher, and the authors the success that they deserve, and I have no doubt that “Multidetector-Row CT of the Thorax” will become a well-distributed, successful and widely read addition to the standard radiology literature.
Munich Maximilian F. Reiser
Contents XI
Preface
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Heraclitus
Change is a constant of medical imaging, more so than of any other medical specialty.
Change, innovation and adaptation are the very essence of our profession, which ever since its sweeping entrance into the realm of medicine has constantly reinvented itself.
Today more than ever, medical imaging is a thriving, exciting and expanding enterprise and is setting the pace for progress and innovation in medicine.
The subject matter of “Multidetector-Row CT of the Thorax” is the epitome of this paradigm. With the introduction of multidetector-row technology at the eve of the new millennium CT was reawakened from its dormant state as a mundane commodity and has since been transformed into a fascinating tool of exploration.
The chest is the site of the diseases of the greatest socioeconomic importance. Yet the organs of the chest have traditionally been most challenging to image because of their continuous motion and the need to acquire images in apnea. The unprecedented combi- nation of speed and spatial resolution that suddenly became available with multidetec- tor-row CT proved to be ideally suited for visualizing the minute but cardinal anatomy and pathology of the organs of the thorax.
So fundamental were the advantages of the new imaging modality that it was almost instantaneously embraced by the whole medical imaging community. Our new technical capabilities have since been used to enhance clarity, reduce diagnostic doubt and routinely render anatomy and pathology in almost breathtaking aesthetic appeal. More importantly, however, in sync with the very nature of our specialty we have instinctively availed our- selves of the new opportunities to successfully overcome vexing traditional limitations and to venture into uncharted territory in the exploration of the human body.
Our endeavors have come to great fruition, as expertly testifi ed by the contributing authors for each of their respective fi elds. Equally in accordance with the nature of our profession, we did not succumb to the temptations of our newfound technical prowess but embraced new opportunities critically and responsibly and adequately addressed new challenges.
It lies in the ever-changing nature of our fi eld, too, that the act of condensing expert knowledge and experience in the format of a book can only result in a snapshot of the status quo at a certain point in time. Novel iterations of existing technology and pro- foundly new concepts of medical imaging are already on the horizon.
What is timeless, though, is the diligence and ingenuity that so decisively hallmarked the introduction of this novel technology. The embrace and benefi cial application of multidetector-row CT may thus serve as a blueprint for future change and development within our specialty.
This book is the work of many. I am grateful and indebted to Professor Albert L. Baert for entrusting me with the role as editor for “Multidetector-Row CT of the Thorax” and
XII Contents
for his valuable guidance throughout this project. I feel very, very honored by all the kindness that my many friends in the cardiothoracic imaging community have shown me by volunteering their time, their knowledge, their experience and vision that went into their respective contributions. All authors are highly respected experts in their fi eld and this book would never have come to pass without their incredible support, for which I am so grateful. Finally I would like to thank Ursula Davis and Kurt Teichmann of Springer for so effi ciently and expertly steering the production of “Multidetector-Row CT of the Thorax”.
Boston U. Joseph Schoepf
Contents XIII
MDCT – Technical Background . . . 1
1 Technical Bases of Multi-Slice CT
T. Flohr, B. Ohnesorge, S. Schaller . . . 3 2 Radiation Exposure in Thoracic CT
J. R. Mayo and J. Aldrich . . . 25 3 Strategies for Dose Reduction and Improved Image Quality in MSCT
M. Kachelriess, S. Schaller, W. A. Kalender . . . 35 4 Contrast Medium Injection Technique
D. Fleischmann. . . 47
Airways / Diffuse Lung Disease . . . 61
5 Multi-Detector-Row CT of the Airways
P. A. Grenier, C. Beigelman-Aubry, C. Fetita, Y. Martin-Bouyer. . . 63 6 MDCT in Diffuse Lung Disease
H.-U. Kauczor . . . 81 7 Pulmonary Infections: Imaging with MDCT
B. L. Partik, A. N. Leung, C. J. Herold . . . 107 8 Multidetector CT Evaluation of Acute Respiratory Distress Syndrome
L. R. Goodman and L. Gattinoni . . . 121
Focal Lung Disease / Lung Cancer . . . 131
9 CT Screening for Lung Cancer
C. I. Henschke, D. F. Yankelevitz, W. Kostis . . . 133 10 MDCT Screening for Lung Cancer: Current Controversies
F. L. Jacobson . . . 145 11 MDCT Imaging of Focal Lung Disease
D. P. Naidich and J. P. Ko . . . 155
Contents
XIV Contents
12 MDCT Strategies for the Non-Invasive Work-Up of the Indeterminate Pulmonary Nodule
P. Herzog, M. Das, M. F. Reiser. . . 175 13 Transthoracic Needle Biopsy of Lung Nodules
D. F. Yankelevitz, D. Shaham, M. Vazquez, C. I. Henschke. . . 185 14 Staging of Lung Cancer with MDCT
P. M. Boiselle. . . 205 15 MDCT in Mediastinal Imaging
A. R. Hunsaker. . . 215 16 PET/CT of the Thorax
H. C. Steinert and G. K. von Schulthess . . . 225
Pulmonary Embolism / Thoracic Vessels . . . 237 17 Multidetector-Row CT Angiography of the Pulmonary Circulation
U. J. Schoepf, J. M. Martensen, P. Costello . . . 239 18 Thromboembolic Disease: Perfusion-Weighted Imaging of the Lung
J. E. Wildberger and M. U. Niethammer. . . 259 19 Multiple-Detector CT Venography
A. Nchimi and B. Ghaye . . . 269 20 CT Angiography of the Thoracic Aorta
G. D. Rubin. . . 287
MDCT of the Heart . . . 307 21 Detection and Quantifi cation of Coronary Calcium with MDCT
R. Fischbach. . . 309 22 MDCT Angiography of the Coronary Arteries
C. R. Becker . . . 327
Data Management. . . 339 23 Workfl ow Design for MDCT of the Thorax
R. Loose, S. Schaller, M. Oldendorf . . . 341 24 2D and 3D Visualization of Thoracic MDCT Data
L. P. Lawler and E. K. Fishman . . . 347 25 Computer-Aided Diagnosis
S. A. Wood . . . 363
Contents XV
Miscellaneous . . . 373 26 Pediatric Multislice Computed Tomography of the Chest
M. J. Siegel . . . 375 27 Diaphragm, Chest Wall, Pleura
J. Verschakelen. . . 395 28 MDCT of Chest Trauma
M. Wintermark and P. Schnyder . . . 409 29 CT Guided Thoracic Interventions
R. Drosten and E. vanSonnenberg . . . 423 30 Medical Legal Aspects of Multidetector CT
E. J. Potchen. . . 453 31 Future Technical Developments for CT of the Thorax
W. A. Kalender . . . 461
Subject Index . . . 469 List of Contributors. . . 477
Technical Bases of Multi-Slice CT 1
MDCT - Technical Background
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