Diseases of the Abdomen and Pelvis: Diagnostic Imaging and Interventional Techniques

279 Pages·1999·24.64 MB·English

by  G. M. Glazer (auth.)

Springer-V erlag Italia Srl.
SYLLABUS
DISEASES OF THE
ABDOMEN AND PELVIS
DIAGNOSTIC IMAGING AND INTERVENTIONAL
TECHNIQUES
31st International Diagnostic Course
in Davos (ID KD)
Davos, March 20-26, 1999
presented by the Foundation for the
Advancement of Education in Medical Radiology, Zurich
EDITORS:
G. K. VON SCUULTUESS
CU. L. ZOLLIKOFER
Springer
G. K. von SchuIthess Ch. L. Zollikofer
Univ ersi tă tsspi taI Kantonsspital
N ukIearmedizin Institut fUr Radiologie
8091 Zlirich, Switzerland 8401 Winterthur, Switzerland
© Springer-Verlag Italia 1999
Originally published by Springer-Verlag Italia, Milano in 1999
ISBN 978-88-470-0058-2 ISBN 978-88-470-2141-9 (eBook)
DOI 10.1007/978-88-470-2141-9
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IDKD '99
Preface
The International DiagnosticCoursein Davosoffersan unique learningexperi
ence for young radiologists in training as well as for experienced radiologists
wishing to be updated on the latest developments in the field. In this year's
course, entire body regions, namely the abdomen and pelvis, are presented in
group seminars and in plenary sessions with lectures by world-renowned ex
perts and teachers.
Accordingly, this Syllabus represents a condensed version of the 20 topics
dealing with the radiographic approach to the diagnosis of diseases of the ab
domen and pelvis. In addition, conventional diagnostic radiology and special
procedures such as ultrasound, computed tomography, magnetic resonance
imaging,nuclear medicine and interventional radiologyare discussed.
The Syllabus has beendesigned to be an aidememoirefor the course partici
pantssothat theycanfully concentrateonthe lecturesand participatein the dis
cussionswithout the need for taking notes.
Furthermore, the Syllabus provides a thorough overviewofthe radiographic
approach to diseases ofthe abdomen and pelvis, especially regarding the latest
developmentsin diagnosisand intervention.
G.K. von Schulthess
Ch.L. Zollikofer
IDKD '99
Table of Contents
Lectures
Managingan AcademicDepartmentin the PrivateSector
G.M. Glazer. . . . . . . . . . . . . . . . . . 3
Radiology ina Socialised Medicine Environment
H. Ringertz . . . . . . . . . . . . . . . . . . 4
Thoughtsofa Biologistonthe EvolutionofFreedom
H. Kummer . 8
Virtual Reality inClinical Abdominal MRImaging
l.F. Debatin . . . . . . . . . . . . . . . . . " 11
PETin Abdominal ImagingofTumorsand Infections
S.N. Reske. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Abdominal Ultrasound in the Year2005
l.A. Bonhof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Film Reading Panel
Film Reading Panel Quiz:Diseasesofthe Abdomenand Pelvis
G.M. Glazer 21
Seminars
The Acute Abdomen
B. Marincek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
The Acute Abdomen
G.P. Saba. II. . .. 40
AbdominalTrauma
N.R. Dunnik .... .................. 43
Traumaofthe Abdomen and Pelvis
S.l.A. Sclafani . . . . . . . . . . . ............. 48
Variantsand PseudotumorsSimulatingDisease
W. laschke 57
VIII
Variantsand Pseudotumors SimulatingDiseasesin the Abdomen
and Pelvis
A. Shirkhoda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Imagingofthe PediatricGastrointestinalTract
A. Oaneman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Imagingofthe UrogenitalTract:Concepts,Challengesand Controversies
U.v. Willi 74
A Rational Approach toTumorImagingin the Abdomen
1.K.T. Lee. . . . . . . . . . . . . . . . . . . . . .. . 83
A Rational Approach to TumourImaginginthe Abdomen
S.C Rankin . . . . . . . . . . . . . . . . . . . . . .. 87
Cineradiographic Examination ofImpairmentsofSwallowing
W.F. Briihlmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
SwallowingDisorders
R. Olsson . . ... 96
Diseasesofthe UpperGITract: BasicsofRadiologic-Pathologic
Correlation
1.E. Lichtenstein . . . . . . . . . . . . . . . . . . . . . . . 100
Contemporary Radiological Examination ofthe Upper
GastrointestinalTract
1.W.A.J. Reeders. S. Somers 108
Diseasesofthe Small Bowel
N. Gourtsoyiannis. . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Diseasesofthe Small Bowel
OJ. Nolan . . .... 119
Diseasesofthe Colon and DisturbancesofRectal Evacuation
R. Goei . 124
Defaecography:A RadiologicalInvestigationfor Defaecation Disorders
P. Mahieu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
The Peritoneal Cavityand Reflections
Y.H. Auh . . 134
Pathways ofIntraabdominalSpread ofDisease
1.A. Brink 142
ImagingofDiseasesofthe Liver
P.R. Ros . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Diseasesofthe Liver
E.l. Rummeny . . . ........ 156
ImagingofDiseasesofthe Pancreasand BiliarySystem
CD. Becker. . . . . . . . . . . . . . . . . . . . . . . .... 162
Differential DiagnosisofPancreaticand Biliary Duct Diseases
CA. Rohrmann. lr. . . . . . . . . . . . . . . . . . . . . . . . . . . 170
IX
VascularInterventional Proceduresin the Abdomen
R.F. Dondelinger . . . . . . . . . . . . . . . . . · .. 175
Diagnosisand Intervention in Vascular Diseasesofthe Abdomen
D. Hunter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Renal and AdrenalTumors
Al. Davidson. D.S. Hartmann. · .. 192
Radiographic ImagingofUrinaryTract Infectionand Obstruction
R.A Older . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Obstructionand Infection ofthe Kidneysand Ureters
R.l. Zagoria 202
MRI and CTofthe Uterus
B. Hamm. . . . . . . .. . 206
Diseasesofthe Female Pelvis
C.M.C. Tempany . . . .. 211
Diseasesofthe Male Pelvis
1.0. Barentsz . . . . . . . . 217
ImagingDisordersofthe Male Pelvis
P.l. Woodward . . . . . . . . .. 227
GastrointestinalTract Intervention
W.R. Castaneda-Zuniga. . . . .. 231
Non-Vascular Abdominal Interventions
P. Rossi. G. Marcelli. D. Pepino. S. Perotti .......... 244
Interventionsin the Genito-UrinaryTractand Pelvis
E.K. Lang . · .. 254
Interventional Radiology in the LowerUrinaryand GenitalTracts
D. Rickards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
OcclusiveVascular Diseasesofthe Abdomen
1. Lammer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Occlusive Vascular Diseasesofthe Abdomen
T.A Sos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
LECTURES
IDKD '99
Managing an Academic Department in the Private Sector
G.M. Glazer
DepartmentofRadiology,Stanford UniversitySchoolofMedicine.LucasCenter.Stanford.CA. USA
Introduction - Government fiscal surpluses
- Service linesdifficult to implement
Academic medicine and Departments of Radiology in
America are in the midst of unprecedented changes in Advisory Board projections concerning future health
the underlying financing of the delivery of clinical care. carerevenuesin America:
The economic challenge has arisen because of the high - Hospitals will be healthy
costs of providing care coupled with high demand for Inpatient revenues are critical
health care services. The problem is exacerbated in Inpatient revenues will be fairly stable because of
Americaas wellas in manyothercountriesbythe demo acuity increase despite diminished utilization
graphics of an aging population. I will review general Outpatient facility revenues will be rapidly increasing
trends, implications, and challenges from the vantage Outpatient revenues will soon surpass inpatient rev
point ofa private sector, research-intensive Department enues in America
ofRadiology. Decreased inpatient utilization will soon be reversed
because ofaging population.
"Megatrends" in Health Care:
- The eraofthe purchaser The net impact of these megatrends to date has been
Health care as acommodity likened to a "deflationary boom" with increased activity
Growth ofmanaged care in America and diminished unit revenues. I will present information
Reduction in reimbursement/unit service for clinical aboutStanford Radiologywhichshowsthe impactsofthis
care "deflationary boom" as well as the protections derived
Excessinpatientcapacity from the diversified revenue streams ofa majoracademic
Increased acuityofinpatientcare department. Majoropportunitiesexisttocreateaddedrev
Growth in outpatientservices enueandIwillgiveexamplesofpossible"topline" growth.
Reduction in reimbursementfor medical education
The accelerating rapidity of change poses particular
What haschangedin thepastyear? strains for academic faculty who have historically been
- Publicdissatisfaction with managedcare plans shielded from the economics ofmedical care in Ameri
- Diminished public demand for primary care "gate- ca. The tensions between the missions of patient care,
keepers" research. and education have been intensified in nearly
- Specialists exerting more control on health care de all Americandepartments. Iwill highlightsome ofthese
livery tensionsandsuggestways the academicdepartmentcan
- Increasingfederal budgetfor medical research prosper in the future.
IDKD '99
Radiology in a Socialised Medicine Environment
H. Ringertz
DepartmentofRadiology,KarolinskaHospital,Stockholm.Sweden
Introduction below. There are mainly three different scenarios that
will be described and they can be graphicallyillustrated
The medical speciality ofdiagnostic radiology is repre on a curve demonstrating the approximate statistics of
sentedin mostcountriesin theworldindependentofpo the numberofradiologyexaminationsinSwedenduring
litical system and political ideologies. There are howev the years 1960-1996as seen in Fig. 1:
er differences in the health care systems depending on a) The first scenario is going from a fee-for-service sys
political ideologies that effect the way radiology func tem to a socialised medicine environment overnight
tions and interacts. An analysis ofthis situation in a so as occurred in Sweden on 1January 1970.
cialisedhealthcaresystemwill bemade basedontheex b)The second is the practice ofradiology during a peri
periences in Europe, but specifically in Sweden. od ofsocialised medicine with relativelygood econo
MostEuropeancountrieshavesome type ofcompre my as in the 1980s.
hensive health care system. However, lack ofpublished c) Finally,the presentsituationwith modifiedsocialised
information about the detailed situation in many coun medicine and bad economy will be discussed.
tries makes a well structured analysis ofthe total situa
tiondifficult. Reportsonradiology in theformer eastern
countriesare rare butindicate poorconditionsinfor ex Background
ample Ukraine and Belarusse. A number of countries
like France, Germany, the Scandinavian countries. and Up to 1970,Sweden had a system where a doctor had a
the United Kingdom with different health systems and fixed salary,and in addition, most outpatientandemer
backgrounds can be used for comparison when dis gency visits were privatelypaid.This fee-for-service for
cussing how radiology can function in a socialised envi eachoutpatient examinationwasoften accumulated in
ronment. to a pool that was divided in uneven proportions be
Based on personal experience, the Scandinavian and tween individual doctors. The system applied to nearly
specifically the Swedish development will be discussed all health care activities including radiology depart
ments. In radiology, part of the pool was paid to the
6 hospital for equipment,personnel,film, contrastmater
Radiology Examinations
Milli ns ial. etc. Radiology as a whole did well in this system,
Sweden 1960·96
5 and positionsingeneral radiology departmentswere at
tractive. In smaller departments, all of the fee-for-ser
E vice part ofthe income wascollected bythe headofthe
4
.co, department and distributed to the co-workers. Acade
)(
mic departments and subspecialised radiology units
'0 3-t------:.."...----------------
! with relatively few private and/or outpatient examina
E::s tions did less well.
z 2
Goodeconomy Bad In 1970, all of Swedish medicine was socialised with
4 ~ .4---------- ...~ fixed salaries for each type of position in hospital de
Feeforservice Socializedmedicine
partments. All fee-for-service disappeared and an aver
age number of5000 radiological examinations read per
1965 1970 1975 1980 1985 1990 1995
O++-+-+-+++-+-+-+-t-I-H-t-t-+-t-+-+-+-++-+-+-++-++--+-+-H-H-t- radiologist per year was recommended. In this system,
radiology could be limited and the indications for each
Fig.1.The numberofradiologyexaminationsinSweden (popu
examinationwerequestioned. A lowand fairly constant
lation8-9million).Changeduringtheyears1960-1996according
todifferentavailablestatistics number of just below 0.5 examinations per inhabitant