Computed Tomography of the Gastrointestinal Tract: Including the Peritoneal Cavity and Mesentery

287 Pages·1986·19.22 MB·English

by  C. D. Becker, W. A. Fuchs (auth.), Morton A. Meyers M.D. (eds.)

Computed Tomography
of the Gastrointestinal Tract
Computed Tomography
of the
Gastrointestinal Tract
Including the Peritoneal Cavity
and Mesentery
Edited by Morton A. Meyers
With Contributions by C.D. Becker
A.S. Berne R. Churchill M.A.M. Feldberg
W. Frik W.A. Fuchs M.J. Hendriks
K.-C. Klose S. Komaki A.J. Megibow
M.A. Meyers M. Oliphant M. Persigehl
P.F.G.M. van Waes N.O. Whitley
With 250 Illustrations in 466 Parts
Springer-Verlag
New York Berlin Heidelberg Tokyo
Morton A. Meyers, M.D.
Professor and Chairman, Department of Radiology, School of Medicine,
State University of New York at Stony Brook, Stony Brook, NY 11794,
U.S.A.
Library of Congress Cataloging in Publication Data
Main entry under title:
Computed tomography of the gastrointestinal tract.
Includes bibliographies and index.
1. Gastrointestinal system-Diseases-Diagnosis.
2. Gastrointestinal system-Radiography. 3. Tomography.
I. Meyers, Morton A. II. Becker, C. D. (Christoph D.)
[DNLM: 1. Gastrointestinal Neoplasms-radiography.
2. Gastrointestinal System-radiography. 3. Tomography,
X-Ray Computed. WI 141 C738]
RC804.T65T66 1986 616.3/307572 85-27915
© 1986 by Springer-Verlag New York Inc.
Sofcover reprint of the hardcover 1st edition 1986
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with respect to material contained herein.
Typeset by Kingsport Press, Kingsport, Tennessee.
9 8 7 6 5 4 3 2 1
ISBN-13:978-1-4612-9345-3 e-ISBN-13:978-1-4612-4882-8
001: 10.1007/978-1-4612-4882-8
To
Bea, Richard and Amy
Preface
This book is designed as a comprehensive, useful, up-to-date presenta-
tion of computed tomography (CT) of the major disease states involving
the gastrointestinal tract, mesentery and peritoneal cavity. Rather than
representing one institution's sole experience, the coverage reflects
masterful contributions from international centers with the most exten-
sive experience.
Plain £lm identification of intraperitoneal structures is generally lim-
ited to those aspects outlined by contrasting extraperitoneal fat or
naturally occurring intraluminal gas. Routine contrast studies of the
intestinal tract permit visualization of its internal mucosal contour
alone. An outstanding limitation has been the inability to accurately
evaluate the thickness of the bowel wall. In these circumstances, only
indirect signs are relied upon for the radiologic diagnosis of mural
or serosal disease. Approaches to visualize the bowel wall and perito-
neal reflections by the introduction of intraperitoneal contrast medium
have been of only limited success (1-3). Computed tomography, by
virtue of its superior density discrimination and excellent spatial resolu-
tion, permits exquisite imaging of the gastrointestinal tract, mesenter-
ies and peritoneal cavity.
In the presentation of normal and pathologic anatomy and the discus-
sion of clinical efficacy, efforts have been made to keep the text as
precise as possible.
In the elaboration of CT's capability to detect and to determine
the extent of disease, particularly as the findings relate to staging,
insights and responsible conclusions are drawn for the accuracy, relia-
bility, limitations and sources of error for the study.
Unavoidable, albeit minimal, overlap in the inclusion of disorders
is briefly encountered. Since the gastrointestinal tract, mesenteries and
peritoneal cavity are not separate finite entities but rather structures
in anatomic continuity and intimate relationships, a particular abnor-
mality may occasionally be mentioned in one chapter and more fully
detailed in another section. The reader will also understand that
whereas the CT image in an occasional illustration may not be derived
from the most recent generation of scanners, the cases have neverthe-
less been highly selected from an impressive range of clinical experi-
viii Preface
ence to demonstrate the abnormality discussed. Captions are printed
for ease of ready reference to the figures, and tables and graphics
further serve for clearer understanding.
References
1. Frimann-Dahl J, Traetteberg K: Parietography of stomach. Br J Radiol
35:249-254, 1962
2. Meyers MA: Peritoneography; Normal and pathologic anatomy. AJR
117:353-365, 1973
3. Meyers MA, Young SW, Hakkal HG: Peritoneography: Demonstration of
normal and abnormal mural thickness. AJR 122:281-287, 1974
Morton A. Meyers, M.D.
Contents
1 Carcinoma of the Esophagus and Gastroesophageal Junction
C.D. Becker and W.A. Fuchs ............................ 1
Technique of Examination .............................. 1
Normal Anatomy ....................................... 2
Morphology and Staging ................................ 7
Posttherapeutic Evaluation .............................. 18
References ............................................ 20
2 Gastric Carcinoma
S. Komaki ............................................. 23
Pathologic Considerations ............................... 24
Spread of Gastric Cancer and Its Staging ................. 26
CT Diagnosis .......................................... 31
Conclusions Regarding CT Assessment of Surgical
Resectability ......................................... 50
References ............................................ 52
3 Gastrointestinal Lymphoma, Leiomyoma, and Leiomyosarcoma
A.J. Megibow .......................................... 55
Gastrointestinal Lymphoma ............................. 55
Leiomyomas and Leiomyosarcomas ...................... 66
References ............................................ 76
4 Inflammatory Bowel Disease and Related Conditions
W. Frik, M. Persigehl, and K.-C Klose .................... 79
Thickening of the Bowel Wall ........................... 79
Small Bowel ........................................... 80
Colon ................................................. 83
Differential Diagnosis of Crohn's Disease and Ulcerative
Colitis ............................................... 90
References ............................................ 93
x Contents
5 Subperitoneal Spread of Intra-Abdominal Disease
M. Oliphant, A.S. Berne, and M.A. Meyers ............... 95
CT Demonstration of Normal Anatomy .................. 99
CT Demonstration of Pathology ......................... 108
Conclusion ............................................ 135
References ............................................ 136
6 Mesenteric Disease
N. O. Whitley .......................................... 139
Anatomy .............................................. 139
Scanning Techniques ................................... 142
Benign Conditions ..................................... 142
Malignant Conditions ................................... 163
Acquired Immune Deficiency Syndrome (AIDS) .......... 176
References ............................................ 178
7 Intraperitoneal Fluid Collections
R. Churchill and M.A. Meyers ........................... 183
Anatomic Considerations ............................... 183
Ascites ................................................ 191
Intra-Abdominal Abscess ................................ 196
Intraperitoneal Hemorrhage ............................ 203
Pseudomyxoma Peritonei ............................... 208
Miscellaneous Fluid Collections .......................... 212
References ............................................ 217
8 Acute Appendicitis
M.A.M. Feldberg, M.J. Hendriks, and P.F.G.M. van Waes 221
Anatomic Considerations ............................... 222
Computed Tomography Findings ........................ 223
References ............................................ 233
9 Diverticulitis
A.J. Megibow 235
Radiologic Diagnosis .................................. . 236
CT Findings: Colonic and Pericolic Changes ............. . 237
Abscess and Peritonitis ................................ . 239
Fistula Formation ..................................... . 242
Correlation of CT Findings and Contrast Enema ......... . 244
Differential Diagnosis .................................. . 247
Clinical Utility ........................................ . 249
References ........................................... . 250
10 Colorectal Carcinoma
C.D. Becker and W.A. Fuchs 253
Technique of Examination .............................. 253
Normal Anatomy ....................................... 254
Primary Diagnosis ...................................... 256
Staging ................................................ 262
Contents xi
Recurrent Carcinoma ................................... 266
Radiotherapy .......................................... 270
References ............................................ 270
Index ................................................. 273
List of Contributors
Dr. Christoph D. Becker
Department of Diagnostic Radiology, University of Bern, Inselspital,
3010 Bern, Switzerland
Alfred S. Berne, M.D.
Department of Medical Imaging, Crouse-Irving Memorial Hospital,
Syracuse, NY 13210, U.S.A.
Robert Churchill, M.D.
Department of Radiology, Loyola University School of Medicine,
Maywood, IL 60153, U.S.A.
Michiel A.M. Feldberg, M.D., Ph.D.
University Hospital, Department of Roentgendiagnosis, 3511 GV
Utrecht, The Netherlands
Professor Dr. Wolfgang Frik
Emeritus Professor of Radiology, Mittelstr. 45, 5100 Aachen, Federal
Republic of Germany
Professor Dr. Walter A. Fuchs
Department of Diagnostic Radiology, University of Bern, Inselspital,
3010 Bern, Switzerland
Martin J. Hendriks, M.D.
University Hospital, Department of Roentgendiagnosis, 3511 GV
Utrecht, The Netherlands
Dr. Klaus-Christian Klose
Department of Diagnostic Radiology, University of Aachen, 5100
Aachen, Federal Republic of Germany
Dr. Senichiro Komaki
Department of Radiology, Toyoshima Hospital, Kagoshima City, Japan