Table Of ContentAtlas of Pathological Computer Tomography
Volume 2
A.L. Baert A.Wackenheim L. Jeanmart
Abdominal
Computer Tomography
With Collaboration of G. Marchal and G. Wilms
With 315 Figures in 585 Separate Illustrations
Springer-Verlag Berlin Heidelberg New York 1980
ISBN-13: 978-3-642-67663-5 e-ISBN-13 :978-3-642-67661-1
DOl: 10.1007/978-3-642-67661-1
Library of Congress Cataloging in Publication Data
Baerl, A, 1931-,
Abdominal computer tomography, (Atlas of pathological computer tomography; v. 2). Bibliography:
p. Includes index. 1. Abdomen-Radiography-Atlases. 2. Tomography-Atlases. I. Jeanmart, L., 1929-
joint author. II. Wackenheim, Auguste, Joint author. III. Title. IV. Series.
RC944.B33 617'.55'07572 80·20159 ISBN 0·387·10093·8
This work is subject to copyright. All rights are reserved, whether the whole or part of the material
is concerned, specifically those of translation, reprinting, re·use of illustrations, broadcasting, reproduc·
tion by photocopying machine or similar means, and storage in data banks. Under § 54 of the German
Copyright Law where copies are made for other than prIvate use, a fee is payable to the publisher,
the amount of the fee to be determined by agreement with the publisher.
© by Springer-Verlag Berlin Heidelberg 1980
Softcover reprint of the hardcover 1s t edition 1980
The use of registered names, trademarks. etc. in this publication does not imply, even in the absence
of a specific statement, that such names are exempt from the relevant protective laws and regulations
and therefore free for general use.
Reproduction of the figures: Gustav Dreher GmbH, Stuttgart
Preface
It was our aim to place at the disposal of radiologists within a short
time an atlas of high-quality, valuable pictures of abdominal CT without
the image degradation inherent to slower scanning apparatus. We felt that,
notwithstanding rapid evolution in CT scanning apparatus and the resulting
rapid advances in our clinical knowledge about the value, limitations and
applications of this new diagnostic imaging modality, an effort should be
made to realize an atlas of reference.
From more than 7,000 patients studied with abdominal CT, we tried to
assemble images with maximal anatomical detail, which implies the use
of large window settings, being well aware that in daily routine practice
basic CT methodology includes the use of different window settings for
optimal information. It was, however, a conscious decision not to use
comparative images with large and small window settings in order to stay
within a reasonable total number of figures.
Much emphasis has been placed upon the use of contrast enhancement
by intravenous contrast media. This is based on the conviction that essen
tially new and better morphological information about normal and
pathological processes within the abdomen can be obtained because short
exposure times now allow one to capture the rapidly changing aspect and
degree of contrast enhancement of the lesions as a function of their vascu
larity.
Although the apparatus used for the redaction of this volume did not
allow the realization of "rapid sequence scanning" or "angioscan", the
methods of IV contrast enhancement, as applied here, illustrate an actual
trend in the field of CT scanning.
As this is essentially a clinically oriented work, description of physical
and technical aspects of CT scanning has been kept to a minimum. Very
valuable handbooks on these subjects are readily available.
We hope that those involved with clinical computer tomography will find
in this book the useful information and guidelines necessary for correct
interpretation and analysis of transverse CT of the abdomen in both com
mon and rare pathological conditions.
The contribution of the staff of the Department of Radiology of the Univer
sity of Leuven to the preparation of this book has been immeasurable.
v
We are especially indebted to Dr. G. Marchal and Dr. G. Wilms for
invaluable help in assembling the material and preparing the text. Their
original ideas concerning the improvement of the methodology of CT exami
nations are highly appreciated.
Prof. E. Ponette is thanked for his advice and for stimulating discussion
of problem cases.
Dr. M. Bruneel, Dr. P. De Maeyer, Dr. F. De Somer and Dr. D. Vandevelde
assisted in the compilation of the bibliography and case material.
Mr. W. Desmedt performed the photographic work. We are deeply indebted
to him for the outstanding quality of his work.
We are also very grateful to the radiographers of this department: Mr.
F. Deboer, Mr. P. Denecker, Mr. L. De Putter, Mr. E. Oosterlinck and
H. Van Houtvin for their expert care in performing the CT examinations.
Mrs. C. Dehaeseleer, Mrs. D. Janssens and Mrs. L. Vanderwegen provided
secretarial support and are thanked for their patience and the outstanding
quality of their work.
Lastly, we would like to express our gratitude to the staff of Springer-Verlag,
Heidelberg for their helpful suggestions and dedicated cooperation through
out the preparation of this atlas.
A.L. BAERT, A. W ACKENHElM, L. JEAN MART
Leuven-Strasbourg-Bruxelles
VI
Contents
Chapter 1 Introduction
1.1 Technical Data About the Scan Apparatus Used 2
1.2 Theoretical Analysis of Contrast Enhancement. 2
1.2.1 Types of Contrast Enhancement. . . . . 2
1.2.2 Types of Contrast Medium for Direct Enhancement . 3
1.2.3 Theoretical Analysis of Differential Contrast
Enhancement by Non-specific Contrast Medium 3
1.2.4 Influence of Apparatus Characteristics upon
Differential Contrast Enhancement . . . . 3
1.3 Clinical Methods of Contrast Enhancement in CT 4
1.3.1 Opacification of GI Tract . . . . . . . . 4
1.3.2 Opacification of the Renal Excretory System
and Bladder . . . . . . . . . . 4
1.3.3 Opacification of the Biliary System . . . . 5
1. 3.4 Opacification of the Vagina. . . . . . . . 5
1.3.5 Body Opacification by Bolus Injection of Contrast
Medium (Direct Contrast Enhancement) 5
1.4 Numerical Densitometry . . . 5
1.5 References. . . . . . . . . . 6
1.6 Abbreviations Used in Figures. 7
Chapter 2 Kidney
Figs. 2.1-2.14 Normal Anatomy; Congenital Variants. 10
Figs. 2.15-2.20 Various Benign Lesions 16
Figs. 2.21-2.24 Traumatic Lesions. . . . . . . 20
Figs. 2.25-2.30 Infectious Lesions . . . . . . . 22
Figs. 2.31-2.43 Renal Cysts; Polycystic Disease . 26
Figs. 2.44-2.45 Benign Tumours . . . . 32
Figs. 2.46-2.63 Renal Cell Carcinoma . . 33
Figs. 2.64-2.67 Other Malignant Tumours 43
References . . 46
VII
Chapter 3 Adrenals
Figs. 3.1-3.2 Normal Anatomy . . . . . . . . . . . . . 48
Fig. 3.3 Adrenal Hyperplasia. . . . . . . . . . . . 48
Figs. 3.4--3.7 Endocrine Active Tumours of Cortical Origin . 49
Figs. 3.8-3.11 Endocrine Active Tumours of Medullary Origin. 52
Figs. 3.12-3.13 N on-endocrine Active Benign Lesions . . . 54
Figs. 3.14-3.21 Primary and Secondary Malignant Tumours 54
References . . 57
Chapter 4 Retroperitoneum
Figs. 4.1-4.7 Pathology of the Great Vessels . . . . . . . . 60
Figs. 4.8-4.12 N on-tumoral Retroperitoneal Space-Occupying
Lesions . . . . . . . . . . . . . . . . 63
Figs. 4.13-4.16 Primary Retroperitoneal Tumours. . . . . 67
Figs. 4.17-4.32 Retroperitoneal Normal Lymph Nodes and
Adenopathies . 68
References . . 75
Chapter 5 Pelvis
Figs. 5.1-5.4 Bladder 78
Figs. 5.5-5.8 Prostate 79
Figs. 5.9-5.12 Rectum 81
Figs. 5.13-5.17 Ovaries 82
Figs. 5.18-5.23 Cervix. 84
Figs. 5.24-5.27 Uterus. 86
Figs. 5.28-5.31 Varia 88
References . . 90
Chapter 6 Abdominal Cavity and Abdominal Wall
Figs. 6.1-6.7 Abdominal Cavity. 92
Figs. 6.8-6.11 Stomach .... 94
Figs. 6.12-6.24 Abdominal Wall 96
References . . · 101
Chapter 7 Liver
Figs. 7.1-7.7 Normal Anatomy; Anatomical Variants · 104
Figs. 7.8-7.12 Parenchymatous Disease · 106
Figs. 7.13-7.15 Portal Hypertension . · 108
Figs. 7.16---7.23 Vascular Lesions . . . · 110
Figs. 7.24-7.27 Hepatic Haematoma. . · 113
Figs. 7.28-7.33 Hepatic Abscess; Parasitic Hepatic Disease . · 114
Figs. 7.34-7.41 Cysts and Primary Tumours · 117
Figs. 7.42-7.63 Secondary Tumours · 122
References · 136
VIII
Chapter 8 Gall Bladder and Biliary Tract
Fig. 8.1 Normal Anatomy . . · 138
Figs. 8.2-8.6 Acute Cholecystitis . · 138
Figs. 8.7-8.8 Chronic Cholecystitis · 141
Fig. 8.9 Cholecystolithiasis. . · 141
Figs. 8.10-8.12 Gall Bladder Carcinoma · 142
Figs. 8.13-8.17 Biliary Tract · 143
References . . · 146
Chapter 9 Pancreas
Figs. 9.1-9.9 Normal Anatomy · 148
Figs. 9.10-9.16 Acute Pancreatitis. . · 152
Figs. 9.17-9.21 Chronic Pancreatitis . · 156
Figs. 9.22-9.32 Pancreatic Pseudocysts . · 158
Figs. 9.33-9.34 Benign Tumours · 164
Figs. 9.35-9.44 Malignant Tumours · 164
References . . · 170
Chapter 10 Spleen
Figs. 10.1-10.6 Normal Anatomy; Congenital Variants. · 172
Figs. 10.7-10.13 Benign Lesions .. · 175
Figs. 10.14-10.16 Malignant Lesions. · 178
References . . . . . . . . . . . . · 179
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . 181
IX
Authors and Collaborators
Baert, Albert L.
Professor and Chairman of Department of Diagnostic Radiology,
Vniversitaire Ziekenhuizen, Capucijnenvoer 35, B-3000 Leuven
Wackenheim, Auguste
Professor and Chairman of Department of Diagnostic Radiology,
CHV Strasbourg, 1, Place de l'Hopital, F-67005 Strasbourg Cedex
J eanmart, Louis
Professor and Chairman of Department of Diagnostic Radiology,
Institut Jules Bordet, 1, Rue Heger-Bordet, B-I000 Bruxelles
Bodart, P.
Professor and Chairman of Department of Radiology,
Cliniques Vniversitaires St. Luc, V.C., B-I000 Bruxelles
Colette, J.
Chairman of Department of Radiology, Hopital Civil,
B-6000 Charleroi
Marchal, G.
Senior Staff Member of Department of Radiology,
u.,
Akademische Ziekenhuizen, K. B-3000 Leuven
Osteaux, M.
Professeur Agrege, Department of Radiology, Institut Jules Bordet,
Vniversite Libre, 1, Rue Heger-Bordet, B-I000 Bruxelles
Ponette, E.
Professor of Radiology, Department of Radiology,
Akademische Ziekenhuizen, K. V., B-3000 Leuven
Pringot, J.
Professor of Radiology, Department of Radiology,
Cliniques Vniversitaires St. Luc, V.c., B-IOOO Bruxelles
Wilms, G.
Resident of Department of Radiology,
Akademische Ziekenhuizen, K.U., B-3000 Leuven
Photographs:
W. Desmedt, B-3000 Leuven
XI
CHAPTER 1
Introduction
