Multidetector Computed Tomography: Principles, Techniques, and Clinical Applications

974 Pages·2003·98.698 MB·English

by  Elliot K. Fishman MD, R. Brooke Jeffrey Jr. MD

Multidetector Computed
Tomography

Principles, Techniques, and Clinical Applications

1st Edition
2004
Lippincott Williams & Wilkins
Philadelphia
530 Walnut Street, Philadelphia, PA 19106 USA
978-0781740876
0781740878
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© 2004 by LIPPINCOTT WILLIAMS & WILKINS
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Library of Congress Cataloging-in-Publication Data
Multidetector CT: principles, techniques, and clinical applications / editors, Elliot K.
Fishman, R. Brooke Jeffrey Jr.
p.; cm.
Includes bibliographical references and index.
ISBN 0-7817-4087-8
1. Tomography. I. Fishman, Elliot K. II. Jeffrey, R. Brooke
[DNLM: 1. Tomography, X-Ray Computed—methods. 2. Tomography Scanners, X-Ray
Computed. WN 206 M9603 2003]
RC78.7.T62M85 2003
616.07′572—dc22
2003060191
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no warranty, expressed or implied, with
respect to the currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in
this text are in accordance with current recommendations and practice at the time of publication. However, in
view of ongoing research, changes in government regulations, and the constant flow of information relating to drug
therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in
indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance
for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the
FDA status of each drug or device planned for use in their clinical practice.
10 9 8 7 6 5 4 3 2 1
Dedication
To my grandparents,
William and Sadie Fishman, who taught me that life is more than a spectator sport.
E. K. F.
To my teachers of Radiology, Hideyo Minagi, Faye Lang, Alphonse Palubinskas, and Roy Filly, who instilled in me a
love for my specialty.
R. B. J.
Editors
Elliot K. Fishman M.D.
Professor
Departments of Radiology and Oncology
The Johns Hopkins University School of Medicine
Baltimore, Maryland
R. Brooke Jeffrey Jr. M.D.
Professor
Department of Radiology
Stanford University School of Medicine
Stanford, California
P.ix

Contributing Authors
Norman J. Beauchamp Jr. M.D. M.H.S.
Professor and Chair, Department of Radiology, University of Washington, Seattle, Washington
Christopher F. Beaulieu M.D., Ph.D.
Associate Professor, Department of Radiology, Chief of Musculoskeletal Imaging, Stanford University School of
Medicine, Stanford, California
Paul D. Campbell Jr. M.D.
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Frandics P. Chan M.D.
Assistant Professor, Department of Radiology, Stanford University School of Medicine, Stanford, California
Lawrence C. Chow M.D.
Assistant Professor, Department of Radiology, Stanford University School of Medicine, Stanford, California
Marta Davila M.D.
P.x

Department of Medicine, Division of Gastroenterology, Stanford University School of Medicine, Stanford,
California
Elliot K. Fishman M.D.
Professor, Departments of Radiology and Oncology, The Johns Hopkins University School of Medicine, Baltimore,
Maryland
Karen M. Horton M.D.
Associate Professor, Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
R. Brooke Jeffrey Jr. M.D.
Professor, Department of Radiology, Stanford University School of Medicine, Stanford, California
Ihab R. Kamel M.D., Ph.D.
Assistant Professor, Department of Radiology, The Johns Hopkins Outpatient Center, Baltimore, Maryland
Satomi Kawamoto M.D.
Assistant Professor, Department of Radiology, The Johns Hopkins Outpatient Center, Baltimore, Maryland
Ella A. Kazerooni M.D.
P.xi

Assistant Professor, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
Leo P. Lawler M.D., F.R.C.R.
Assistant Professor, Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore,
Maryland
Ann N. Leung M.D.
Associate Chair of Clinical Affairs, Section Chief, Thoracic Imaging, Associate Professor, Stanford University
School of Medicine, Stanford, California
Sandy Napel Ph.D.
Associate Professor, Department of Radiology, Stanford University School of Medicine, Stanford, California
Harpreet K. Pannu M.D.
Assistant Profesor, Department of Radiology, The Johns Hopkins Outpatient Center, Baltimore, Maryland
Geoffrey D. Rubin M.D.
Chief of Cardiovascular Imaging, Associate Professor, Department of Radiology, Stanford University School of
Medicine, Stanford, California
John Paul Schreiber II
Resident, Department of Radiology, Stanford University School of Medicine, Stanford, California
Marilyn J. Siegel M.D.
Professor, Departments of Radiology and Pediatrics, Mallinckrodt Institute of Radiology, St. Louis, Missouri
F. Graham Sommer M.D.
Professor, Department of Radiology, Stanford University School of Medicine, Stanford, California
Preface
In the five years since the publication of the second edition of Spiral CT: Principles Techniques, and Clinical
Applications, the imaging world has once again changed dramatically, with the introduction and rapid clinical
dissemination of multidetector CT. A new era of “volumetric” imaging has been made possible through the
development of 16-slice scanners and the ability to generate near-isotropic datasets. With single slice spiral
scanners, we could only peer over the horizon and anticipate this future, which has now been rendered
commonplace with the clinical implementation of multidetector CT. What was once thought to be an exciting
possibility has become the clinical reality, as workstations closely integrated into the clinical environment enable
3D volumetric imaging, CT angiography, and cardiac imaging to be performed with a degree of anatomic
resolution that is truly breathtaking. What is remarkable is that CT has not only proven to be a vital
P.xvii

field for technological innovation, but has also maintained its crucial role for routine imaging studies, particularly
in acutely ill and traumatized patients.
There are challenges posed by this technological revolution, such as an explosion in data and the greater
complexity of managing image acquisition and transfer throughout a clinical enterprise. The clinical utility of
using CT to screen asymptomatic patients in high-risk categories for such diseases as lung cancer or colon cancer
will no doubt be debated for years to come, until there are definitive prospective studies documenting improved
survival. The entire new field of computer-assisted diagnosis is poised to become a clinical reality for many of
these applications, as there is a parallel revolution in the CT software in conjunction with the hardware
revolution of the multidetector CT scanner.
The challenge in writing a book like this is that there is an ever increasing and expanding array of clinical
applications for CT. A typical example is the fact that, within the past few years, CT has become the technique of
choice to evaluate patients with suspected pulmonary embolism, replacing nuclear medicine studies and
pulmonary angiography. The whole realm of cardiac CT is poised for rapid development as scan acquisition times
get faster and faster, and there is no doubt that this will be a critical area for technological development to rival
that of cardiac MRI. As the clinical applications and use of CT expand, we must be ever mindful of the need to
reduce radiation, particularly in pediatric patients and in young adults. This has not received sufficient attention
in years past, but it is clearly becoming a priority. Thus, far greater emphasis will be placed on reducing radiation
dosage than has been in the past.