Table Of ContentMEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A.1. Baert,Leuven
K.Sartor,Heidelberg
Springer-Verlag Berlin Heidelberg GmbH
M.F. Reiser · M. Takahashi · M. Modic
c.
R. Becker (Eds.)
Multislice CT
2nd Revised Edition
With Contributionsby
T.Banno.U.Baum.W.Bautz·C.R.Becker-H.Bitterling.D.Boeing'M.Dobritz
R.Eibel- B.B.Ertl-Wagner·M.Essig'R.Fischbach·W.Flatz .D.Fleischmann·T.Flohr
N.Pujii-M.Funke-E.Grabbe·H.Grees .P.Herzog' R.-T.Hoffmann·1.Jager
K.Katada- B.Klingemann.G.Kohl-M.Lell-U.G.Mueller-Lisse.U.1.Mueller-Lisse
H.-D.Nagel .M.Nakane-Y.Nakayama-A.Nomayr-B.Ohnesorge-M.F.Reiser
W.Romer-S.Schaller- C.Scherf'-U.J.Schoepf'-M.Takahasi.M.Wintermark
B.J.Wintersperger.Y.Yamashita
Forewordby
A.1. Baert
With 259 Figures in 410 Separate Illustrations,58 in Color and38 Tables
" Springer
MAXIMILIAN F.REISER,MD
Professor,InstituteofClinical Radiology
Ludwig-Maximilians-University
Klinikum Grosshadern
Marchioninistrasse15
81377Miinchen
Germany
MUTSUMASATAKAHASHI,MD
InternationalImagingCenter
1-2-23Kuhonji
Kumamoto862-0976
Japan
MICHAELMODIC,MD
Professor,DepartmentofRadiology
Cleveland Clinic Foundation
9500EuclidAvenue
Cleveland, OH44195
USA
CHRISTOPH R.BECKER,MD
InstituteofClinical Radiology
Ludwig-Maximilians-University
KlinikumGrosshadern
Marchioninistrasse15
81377Miinchen
Germany
MEDICAL RADIOLOGY' Diagnostic Imaging and Radiation Oncology
SeriesEditors:A.1. Baert.1.W. Brady-H.-P.Heilmann· M.Molls- K.Sartor
Continuation of Handbuch der medizinischen Radiologie
EncyclopediaofMedicalRadiology
ISBN978-3-662-05381-2 ISBN978-3-662-05379-9 (eBook)
DOI 10.1007/978-3-662-05379-9
LibraryofCongress Cataloging-in-PublicationData
MultisliceCTIM.F.Reiser...letal.](eds.);with contributionsbyT.Banno;foreword by
A.L.Baert>-2nd rev.ed
p.;em.--(Medicalradiology)
Includes bibliographicalreferences and index.
I.Tomography. I.Reiser,Maximilian. II.Banno,T.(Tatuo) III.Series.
[DNLM:I.Tomography,X-RayComputed--methods. WN206M9612004]
RC78.7.T6M8552004
616.07'572--dc22 2003066714
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Foreword
This is the second, revised edition of the very successful volume on multislice CT
published only 2 years ago.A second edition became necessary so swiftly due to the
rapidtechnical developments in multi-detectorrowtechnology; ahuge amountofnew
experimental and clinical data has recently become available.
This book is the most comprehensive up-to-date work on all aspects of the clinical
applications ofthis fascinating imagingtechnique. Itcontains information on the very
latest developments in the field,aswellasnumerous superb illustrations.
I am very much indebted to the editors of this volume, M.F. Reiser,M.Takahashi,
M.Modic and C.R.Becker- allrenowned internationalexperts in computertomogra
phy - for the immense dedication and tireless effort involvedin preparing and editing
this superb volume in a record briefperiod of time.I would like to congratulate the
editors and the contributingauthors,allselected for theirexceptionalexpertise,on the
outstanding qualityofthe different chapters and the wide range of topics covered.
This work will be of great help as a daily source of reference for all radiologists
involvedin CTimagingand willprovide asolid base ofinformation for radiologists in
training.Itwillalsobeofgreat interesttothe differentmedical and surgical subspecial
istswhowanttolearnmoreaboutthe excitingwaysinwhichthisimaging techniquecan
improve the clinicalmanagementoftheirpatients.Iam confident thatthis outstanding
volume willmeet the same successwith the readership as the previousvolumes ofour
series MedicalRadiology - Diagnostic Imaging.
Leuven ALBERT1.BAERT
Preface
Five years ago, the introduction of 4-detector row CT aroused the desire to acquire
isotropic or at least near-isotropic image resolution for any application. However,the
practical accomplishment was limited at that time. In the meantime, multi-detector
rowCT(MDCT)scannerswith 8and 16detector rowsare widely available alloverthe
world.Thislast generationCTscannermade many ofthe wishes awakened by4-detec
tor-row CTpracticable in general practice.Nowadays,established clinical applications
such asMDCTangiographyassume greaterimportanceindailyroutine.Also,the scope
ofMDCTapplications expands or requires different investigation strategies.
Toexploit the full potential of MDCT,fundamental knowledge about the technique
and optimal investigation strategies in terms of patient preparation,contrast medium
administration and image interpretation ismandatory.
On the occasion ofthe Second International Symposium on MultisliceCTin Starn
berg, Germanyin April 2002wewere able to gather a number ofrenowned experts to
demonstrate the new possibilities ofthe latest MDCTtechnology.With the experience
of these contributors,wewere able to collectthe expertise and knowledge of different
aspects ofwell-established applications and new clinical indications.
This current edition of "Multislice CT" is being published to coincide with the
Third International Symposium on Multislice CT in Starnberg in January 2004.This
conference has the mission to educate the participants inMDCTskillsratherthanjust
presenting the recent developments in technology and research. The book will per
fectly support this mission with its profound discussion of different applications and
investigation strategies.
Wearegrateful toProf.Albert Baertforstimulatingustoeditagainthisvolume ofthe
"Medical Radiology" series.The publisher, Springer-Verlag, enthusiasticallysupported
the idea and provideduswith invaluable assistance.Wehope this bookwillbevaluable
to allthose interested in MDCT.
Munich MAXIMILIAN F.REISER
Kumamoto MUTSUMASATAKAHASHI
Cleveland MICHAELMODIC
Munich CHRISTOPH R.BECKER
Contents
Multi-Row:TechnicalConcepts .
Design,Technique,and Future PerspectiveofMultisliceCTScanners
T.FLOHR,B.OHNESORGE,S.SCHALLER...................................... 3
2 Radiation DoseIssueswith MSCT
H.-D.NAGEL 17
3 ContrastMedium DeliveryforVascularMDCT:Principles and Rationale
D.FLEISCHMANN......................................................... 27
4 VisualizationofLargeImageDataVolumesUsingPACSand
AdvancedPostprocessingMethods
S.SCHALLER,D.BOEING,B.KLINGEMANN,C.SCHERF,G.KOHL,T.FLOHR ........ 35
Brain....................................................................... 43
5 UsefulnessofIsotropicVolumetricDatainNeuroradiologicalDiagnosis
K.KATADA,N.FUJII,T.BANNO,M.NAKANE .................................. 45
6 Imaging Pathologiesinthe PosteriorFossawith MSCT
M.EsSIG................................................................ 53
7 CervicocranialMSCTA
R.-T.HOFFMANN,B.B.ERTL-WAGNER,M.F.REISER........................... 59
8 Perfusion CTImaging ofAcuteIschemicBrainInjurywith MSCT
M.WINTERMARK......................................................... 69
Ear,NeckandThroat......................................................... 75
9 TemporalBoneImaging with MultisliceCT
L.JAGER 77
10 Morphologic and FunctionalAssessmentofHeadand NeckTumors
withMultisliceCT
M.LELL,W.ROMER,H.GREESS,A.NOMAYR,U.BAUM,W.BAUTZ................ 85
11 StagingofLaryngealand HypopharyngealCancerUsingMSCT
W.H.FLATZand L.JAGER 93
x Contents
Chest ...................................................................... 107
12 Lung CancerScreening
P.HERZOG............................................................... 109
13 MultisliceCTin Focal andDiffuseLungDiseaseswithSpecialEmphasis
on CoronalandSagittalMPRs
R.EIBEL ................................................................ 119
14 ImagingofPatientswithMucoviscidosis
H.BITTERLING........................................................... 131
15 MultisliceCTImagingofPulmonaryEmbolism
U.J.SCHOEPF............................................................ 137
16 CoronaryCalciumScreening
R.FISCHBACH........................................................... 149
17 MultisliceComputedTomographyAngiographyoftheCoronaryArteries
C.R.BECKER............................................................ 159
Abdomen.................................................................. 171
18 CTAngiographyoftheAortaandItsMajorBranchesbyMultidetectorCT
Y.NAKAYAMA,Y.YAMASHITA,M.TAKAHASHI 173
19 MSCTin theEvaluationofInflammatoryBowelDiseases
H.BITTERLING........................................................... 185
20 BiphasicContrast-EnhancedMSCToftheLiver
M.FUNKEandE.GRABBE ...................................... 195
21 CTPortographybyMultidetectorCT
Y.NAKAYAMA,Y.YAMASHITA,M.TAKAHASHI................................. 199
22 MDCT oftheKidney
U.G.MUELLER-LISSEandU.1.MUELLER-LISSE .............................. 211
23 MultisliceCTin theDiagnosisofPancreaticThmors
U.BAUM,A.NoMAYR,M.LELL,W.BAUTZ 233
24 MultisliceSpiralCTin PreoperativeStagingofRectalCarcinoma
A.NOMAYR,U.BAUM,M.LELL,H.GREESS,M.DOBRITZ,W.A.BAUTZ............ 245
25 MDCTAngiographyofPeripheralArteries
B.J.WINTERSPERGER ..................................................... 255
SubjectIndex............................................................ 269
ListofContributors 275
Multi-Row: Technical Concepts
1 Design, Technique, and Future Perspective
of Multislice CT Scanners
THOMAS FLOHR,BERND OHNESORGE,STEFAN SCHALLER
CONTENTS scannerintroduced in 1993(Elscint TWIN).In 1998,
allmajorCTmanufacturersintroducedfour-slice CT
1.1 Introduction 3 systems,typicallywith rotation times of 0.5s,which
1.2 DetectorDesign,Dose,and DoseReduction 4
brought about considerable improvements of scan
1.2.1 DetectorDesign 4
1.2.2 Doseand DoseReduction 5 speed, transverse resolution and utilization of the
1.3 Image Reconstruction 6 tube output (KLINGENBECK-REGN et al. 1999;Hu et
1.3.1 Definition ofthe SpiralPitch 6 al. 2000;OHNESORGE et al. 1999). The examination
1.3.2 TheCone-Angle Problem and MultisliceSpiral
time for standard protocols could be significantly
ReconstructionApproaches 6
reduced,which is clinically important in avarietyof
1.3.3 AdaptiveMultiplePlaneReconstruction 7
1.4 ECG-SynchronizedMultisliceCT instances, such as in dealing with trauma or unco
forCardiothoracicApplications 9 operative patients. Alternatively, the scan range that
1.4.1 ECGTriggering and ECGGating 9 could be covered within a certain scan time was
1.4.2 AdaptiveCardio-volumeReconstruction 10 extendedcorrespondingly,asfor oncological screen
1.5 Future Perspectives ofMultisliceCT 12
ing or for CTangiographies of the extremities.Most
References 15
important,however,turned out to be the capacityto
scan a given volume in a given time with consider
ablysmallerslicewidth,thus toapproachthe idealof
1.1 isotropic resolution.Thorax and abdomen examina
Introduction tions could now routinelybe performed with 1mm
or 1.25mm collimatedslicewidth.Asaconsequence,
The introduction of spiral CTin the early 1990slaid volumetric viewing and diagnosis in a volumetric
thefoundationforafundamentalimprovementinCT mode have become integrated elements of the rou
imaging(KALENDERetal.1990;CRAWFORDand KING tineworkflow.Newapplicationshavebeen introduced
1990).Forthefirsttimevolumedata couldbeacquired in clinical practice, the most important application
without misregistration of anatomical details, which beingcardiacCT.With agantryrotationtimeof0.5s
initiatedthedevelopmentofthree-dimensionalimage and dedicated image reconstruction approaches, the
processingtechniques such asmulti-planarreforma temporal resolution ofan image could be reduced to
tions (MPRs),maximumintensityprojections(MIPs), 250ms and below (KACHELRIESS et al.2000a;OHNE
surface-shaded displays (SSPs)or volume-rendering SORGE et al.2000),which proved to be sufficient for
techniques (VRTs). However, as a consequence of motion-free imaging of the heart in the mid- to
increasing clinical demands single-slice spiral CT end-diastolic phase at low to moderate heart rates.
with 1s gantry rotation time soon encountered The improvedtransverse resolution with 4xl mm or
its limitations. The ideal of isotropic resolution, of 4x1.25mmcollimationincombinationwith excellent
acquiring image voxels with comparable sizes in all low-contrastdetectabilityallowedforhigh-resolution
three dimensions, could only be met by a substan CTAsofthecoronaryarteries(ACHENBACHetal.2000;
tial reduction of the scan range (KALENDER 1995). BECKER et al. 2000;KNEZ et al. 2000; Nieman et al.
The first step towards larger volume coverage and 2001).Inthe meantimefirstclinicalstudieshavedem
improved transverse resolution was a two-slice CT onstrated the potential of multislice CT to not only
detect butclassifylipid, fibrous and calcifiedplaques
inthe coronaryarteriesaccordingtotheirCTdensity
(SCHROEDER et al.2001).
T.FLOHR,PhD;B.OHNESORGE,PhD;S.SCHALLER,PhD
SiemensMedicalSolutions,ComputedTomography,Siemens Despiteallpromisingadvances,clinical challenges
strasse1,91301 Forchheim,Germany and limitations remain for four-slice CT systems.
