Table Of ContentClinical
Computer Tomography
Head and ITunk
Edited by
A. Baert . L. J eanmart . A. Wackenheim
With 414 Figures
Springer-Verlag Berlin Heidelberg New York 1978
A. BAERT, Professor van Radiologie, Diensthoofd, Radiodiagnose, Universitaire
Klinieken, Capucienen voer, B-3000 Leuven '7.~ .
L. JEANMART, Professeur de Radiologie, Chef du service de Radiologie, Institut
J. Bordet, 3, rue Heger Bordet, B 1000 Bruxelles .-" J
A. WACKENHEIM, Professeur agrege de Radioiogie, Chefd u service de Neuroradiologie
et de Radiopediatrie, C.R.U. de Strasbourg, 1, place de l'Ropital, F-67005 Strasbourg-
Cedex
ISBN-13: 978-3-540-08458-7 e-ISBN-13: 978-3-642-81182-1
DOl: 10.1007/978-3-642-81182-1
Library of Congress Cataloging in Publication Data. Main entry under title: Clinical computer tomography, head
and trunk. Papers presented at a meeting organized by College d'enseignement post-universitaire de radiologie and
held in Luxembourg, March 1977. Bibliography: p. Includes index. 1. Tomography--Congresses. 1. Baert, A., 1931-
II. Jeanmart, L., 1929-, III. Wackenheim, Auguste. IV. College d'enseignement post-universitaire de radiologie.
RC78.7.T6C54. 617'. 51'07572. 77-14224.
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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 1978.
The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of specific
statement, that such names are exempt from the relevant protective laws and regulations and therefore free for
general use.
Foreword
In this book are published papers presented at the first meeting about tomodensito-
metry (Computer Tomography) which the CEPUR organized in Luxembourg in March 1977.
CEPUR (College d'enseignement post-universitaire de Radiologie) is an international
medical association having as its main aim the promotion of courses in advanced
radiology. Several sections deal with the subspecializations, one of which is Com-
puter Tomography.
Thanks to the fruitful cooperation of several University Hospitals (Ancona, Leuven,
Montpellier, Bruxelles, Strasbourg), the two-day meeting organized by Dr. Capesius
in Luxembourg covered a certain number of aspects of clinical tomodensitometry in
the brain as well as in the trunk.
We hope that this volume will be the first of a series dealing with the actual
problems in clinical radiology.
Leuven/Bruxelles/Strasbourg A. BAERT
L. JEANMART
A. WACKENHEIM
Contents
I. Introduction to the Technology of Computer Tomography
K. Ungerer. With 18 Figures ... 2
II. Head
Sellar Region: Normal and Pathologic Conditions. U. Salvolini,
F. Menichelli, and U. Pasquini. With 40 Figures ...... 14
Empty Sella and Pituitary Gland. J.L. Dietemann and A. Wackenheim.
Wi th 3 Figures . • . . • . •. •.... • . ., 38
Midline Lesions. D. Baleriaux-Waha, L.L. Mortelmans, M. Dupont,
and L. Jeanmart. With 17 Figures .......•.. 39
Ventriculocisternal Pathology in Children. D. Touitou. With 9
Figures . . . . . • . . • . . . . . . . .. ....... 47
Endocranial Calcifications. J.H. Vandresse, G. Cornelis, and A.
Rousseau. With 20 Figures • . . . . . . . . . . . . . . . . .. 53
Area of Maximal Density in Extracerebral Tumors. J.C. Dosch. With
16 Figures .........•.... , ..... 59
Tumoral Masses of the Posterior Fossa. B. Staelens, Y. Palmers,
A.L. Baert, and J.-L. Termote. With 16 Figures . . . . .. 65
Cerebellopontine Expansive Lesions. U. Salvolini, F. Menichelli,
and U. Pasquini. With 35 Figures ...... . . . . 79
The Cervical Medullar Canal and its Content. P. Mancs and W. van
Damme. With 14 Figures . . . . 104
Cerebral Ischemia. Y. 'Palmers, B. Staelens, A.L. Baert, and L.
Termote. With 19 Figures . . . . 113
Cerebral Metastases. J.C. Dosch. With 8 Figures 128
Inflammatory Diseases of the Brain. M.G. Dupont, L.L. Mortelmans,
D. Baleriaux-Waha, A. Bollaert, and L. Jeanmart. With 10 Figures 131
Epidermoid Cyst. A. Rousseau, G. Cornelis, and J.H. Vandresse.
With 2 Figures . . . • . . . . • . . 139
Meningiomas en Plaque. B. Bittighoffer. With 4 Figures 142
Neuroophthalmology. L.L. Mortelmans, D. Baleriaux-Waha, M.G.
Dupont, L. Jeanmart, and R. Potvliege. With 18 Figures .. 147
Arterial and Arteriovenous Malformations. J.C. Dosch. With 10
Figures . . . . . . . . . . . . . . . . . . . . . . . • . . . . . 156
VIII
III. Trunk
Chest. M. Osteaux, L. Jeanrnart, J. Struyven, and R. Huvenne. With
12Figures .......•...•.... . ...... 162
Liver. M. Osteaux, J. Struyven, R. Huvenne, and L. Jeanmart. With
17 Figures . • .. ....•.... • . . . • . . . 169
Liver and Pancreas. J.L. Lamarque, J.M. Bruel, R. Dondelinger, and
B. Vendrell. With 14 Figures ••..•... 185
Pancreatic Disease. Y. Coenen, G. Marchal, E. Ponette, A.L. Baert,
and J. Pringot. With 25 Figures. . . . . •. .••.. . 197
Kidneys. J. Struyven, M. Osteaux, R. Huvenne, and L. Jeanmart.
With 24 Figures . • . .• ..... . .... 213
Retroperitoneal Region. G. Marchal, Y. Coenen, and A.L. Baert.
With 25 Figures . . . . .. .•...• •... 221
Pelvis. G. Marchal, Y. Coenen, and A.L. Baert. With 27 Figures 239
Abdominal Computer Tomography and Contrast Media. R. Huvenne, A.
Grivegnee, J. Struyven, M. Osteaux, L. Jeanmart, and A. Bollaert.
With 11 Figures ..........•..•..•..•••... 253
Subject Index •......................... 259
Contributors
D. Baleriaux-Waha J.C. Dosch
Premiere assistante Attache des hopitaux
Institut Bordet Service de Neuroradiologie et de Radio-
3, rue Heger-Bordet pediatrie
1000 Bruxelles (Belgique) C.H.U. de Strasbourg
1, Place de l'Hopital
B. Bittighoffer 67005 Strasbourg Cedex (France)
Attache des Hopitaux
Service de Neuroradiologie et de M.G. Dupont
Radiopediatrie Assistant
C.H.U. de Strasbourg Service de Radiologie
1, Place de l'Hopital Hopital St Pierre
67005 Strasbourg-Cedex (France) rue Haute
1000 Bruxelles (Belgique)
A. Bollaert
Professeur de Radiologie A. Grivegnee
Hopital St Pierre Assistant
rue Haute Hopital St Pierre
1000 Bruxelles (Belgique) rue Haute
1000 Bruxelles (Belgique)
J.M. Bruel
Service de Radiologie-Cliniques St. Eloi- R. Huvenne
C.H.U. Assistant
34000 Montpellier (France) Hopital St Pierre
rue Haute
Y. Coenen 1000 Bruxelles (Belgique)
Resident
Universitaire Klinieken K.U.L. J.L. Lamarque
Capucienen voer Professeur de Radiologie
3000 Leuven (Belgie) Service de Radiologie-Cliniques St. Eloi-
C.H.U.
G. Cornelis 34000 Montpellier (France)
Professeur de Neuroradiologie
Universite Catholique de Louvain P. Mancs
Clinique St Luc Attache des hopitaux
10, avenue Hippocrate Service de Neuroradiologie et de Radio-
1200 Bruxelles (Belgique) pediatrie
C.H.U. de Strasbourg
J.L. Dietemann 1, Place de l'Hopital
Interne des hopitaux de Strasbourg 67005 Strasbourg Cedex (France)
Service de Neuroradiologie et de Radio-
pediatrie G. Marchal
C.H.U. de Strasbourg Adjunkt-Kliniek Hoofd
1, Place de l'Hopital Universitaire Klinieken K.U.L.
67005 Strasbourg-Cedex (France) Capucienen voer
3000 Leuven (Belgie)
R. Dondelinger
Attache a titre etranger F. Menichelli
Service de Radiologie-Cliniques St. Eloi- Ajusto
C.H.U. Servicio di Radiologia
34000 Montpellier (France) (neuroradiologia)
x
49, Corso Stamira B. Staelens
60100 Ancona (Italie) Resident
Universitaire Klinieken K.U.L.
L.L. Mortelmans Capucienen voer
Eerstaanwezend assistent 3000 Leuven (Belgie)
Universitaire Ziekenhuis Brugman-V.U.B.
Place· Van Gehuchten J. Struyven
1020 Brussel (Belgie) Adjoint
Hopital Brugmann
M. Osteaux Place Van Gehuchten
Premier assistant 1020 Bruxelles (Belgique)
Institut Bordet
3, rue Heger-Bordet L. Termote
1000 Bruxelles (Belgique) Resident
Universitaire Klinieken K.U.L.
Y. Palmers Capucienen voer
Resident 3000 Leuven (Belgie)
Universitaire Klinieken K.U.L.
Capucienen voer D. Touitou
3000 Leuven (Belgie) Chef de Clinique Assistant
Service de Neuroradiologie et de Radio-
U. Pasquini pediatrie
Ajusto C.H.U. de Strasbourg
Servicio di Radiologia 1, Place de l'Hopital
(neuroradiologia) 67005 Strasbourg Cedex (France)
49, Corso Stamira
60100 Ancona (Italie) K. Ungerer
Siemens
E. Ponette D8520 Erlangen (Deutschland)
Adjunkt-Kliniek Hoofd-Docent
Universitaire Klinieken K.U.L. W. Van Danune
Capucienen voer Attache des Hopitaux
3000 Leuven (Belgie) Service de Neuroradiologie et de Radio-
pediatrie
R. Potvliege C.H.U. de Strasbourg
Professeur de Radiologie 1, Place de l'Hopital
Hopital Brugmann 67005 Strasbourg Cedex (France)
Place Van Gehuchten
1020 Bruxelles (Belgique) B. Vandrell
Attache des hopitaux
J. Pringot Service de Radiologie-Cliniques St.
Charge de cours Eloi-C.H.U.
Universite Catholique de Louvain 34000 Montpellier (France)
Clinique St Luc
10, avenue Hippocrate J.H. Vandresse
1200 Bruxelles (Belgique) Resident
Service de Neuroradiologie
A. Rousseau Universite Catholique de Louvain
Assistant Clinique St Luc
Service de Neuroradiologie 10, avenue Hippocrate
Universite Catholique de Louvain 1200 Bruxelles (Belgique)
Clinique St Luc
10, avenue Hippocrate
1200 Bruxelles (Belgique)
U. Salvolini
Ajusto
Servicio di Radiologia (neuroradiologia)
49, Corso Stamira
60100 Ancona (Italie)
I. Introduction to the Technology of Computer
Tomography
Introduction to the Technology of Computer Tomography
K. Ungerer
Why is computer Tomography Needed?
Conventional radiology encompasses the skeleton and, with the help
of contrast medium, the intestinal tract and the vascular system,
with some exceptions. In these areas, radiology today has attained a
high degree of reliability and information quality.
However, human beings are composed predominantly of tissue, i.e.,
muscles, glands and organs, so-called soft tissue. The absorption of
X-radiation by this soft tissue is approximately the same as that for
water but does not vary so much, and therefore conventional radiology
is not very successful in representing it. A visible contour on an
X-ray film requires a certain absorption difference, which is not the
case with soft tissues. To determine the soft tissue structures, one
must abandon the relatively insensitive pictorial display for a pure
measurement method which distinguishes between the various types of
tissue by measuring their absorption of X-rays.
Since, however, the radiologist is accustomed to a pictorial display,
he readily combines the measured values again into a picture. If one
considers that a picture composed of only 100 vertical and 100 horizon-
tal lines already contains 10,000 individual points, it is obvious
that only a computer can carry out the image calculation. We are there-
fore dealing with a device measuring X-ray absorption, which, with the
help of a computer, produces an image from the gathered measurement data.
The Principle of Computer Tomography
A measuring device consisting of X-ray tube and scintillation detector
(Fig.1) supplies only one discrete absorption value, which represents
the sum of all the absorbers positioned in the radiation beam. However,
if one moves the device and guides the measuring beam over the object,
then one obtains a so-called measurement profile, which, with appropriate
collimation is the profile of a section of the object. To produce a
complete image, we need as many as possible of these profiles. By turn-
ing the measuring device by a definite angle aftgr every transverse
movement until a complete half revolution of 180 has been carried out,
sufficient measured values are obtained to produce an image. The na-
ture of the tomographic procedure along with the data processing of a
computer have also given the method its name: Computer Axial Tomography,
also abbreviated CAT, or for particular brevity it is named CT in the
Anglo-American world.
Both X-ray tube and detector system turn about the object by a pre-
cision drive, and according to the type of movement, translational,
rotational or both, the various so-called generations of equipment
are distinguished. The first CT-equipments (Fig.2) were mainly head
units with a simple radiation geometry, the X-ray tube standing op-
posite one detector, consisting of a scintillation crystal with photo-
multiplier. The scanning was linear from different directions, each
