Computed Tomography and Magnetic Resonance of the Thorax

928 Pages·2007·46.261 MB·English

by  Monvadi B. Srichai, David P. Naidich, W. Richard Webb, Nestor L. Muller, Ioannis Vlahos, Glenn A. Krinsky

5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page i
Computed Tomography
and Magnetic Resonance
of the Thorax
FOURTH EDITION
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page ii
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page iii
Computed Tomography and
Magnetic Resonance
of the Thorax
FOURTH EDITION
EDITORS
DAVID P. NAIDICH, MD W. RICHARD WEBB, MD
Professor of Radiology and Medicine Professor of Radiology
NYU Medical Center University of California San Francisco
New York, New York Hideyo Minagi Professor of Radiology
San Francisco General Hospital
San Francisco, California
NESTOR L. MÜLLER, MD, PhD IOANNIS VLAHOS, MB, BS, BSC
Professor and Chairman Assistant Professor of Radiology
Department of Radiology NYU Medical Center
University of British Columbia New York, New York
Vancouver, British Columbia, Canada
CONTRIBUTING AUTHOR
GLENN A. KRINSKY, MD MONVADI B. SRICHAI, MD
Valley Hospital Assistant Professor of Radiology
Ridgewood, New Jersey NYU Medical Center
New York, New York
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page iv
Publisher:Lisa McAllister
Managing Editor:Kerry Barrett
Project Manager:Fran Gunning
Manufacturing Coordinator:Kathleen Brown
Marketing Manager:Angela Panetta
Design Coordinator:Terry Mallon
Production Services:Nesbitt Graphics, Inc.
Printer:Edwards Brothers
©2007 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business
530 Walnut Street
Philadelphia, PA 19106 USA
LWW.com
Third edition, ©1999 Lippincott-Raven Publishers
Second edition, ©1991 Raven Press
First edition, ©1984 Raven Press
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or byany means, includ-
ing photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner,
except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part
oftheir official duties as U.S. government employees are not covered by the above-mentioned copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
Computed tomography and magnetic resonance of the thorax / editors, David P. Naidich ... [et al.]; contributing author,
Monvadi B. Srichai. —4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-5765-2 (alk. paper)
ISBN-10: 0-7817-5765-7 (alk. paper)
1. Chest—Tomography. 2. Chest—Magnetic resonance imaging. I. Naidich, David P. II. Srichai, Monvadi B.
[DNLM: 1. Radiography, Thoracic. 2. Magnetic Resonance Imaging. 3. Thorax—pathology. 4. Tomography, X-Ray Computed.
WF 975 C7379 2007]
RC941.N27 2007
617.5’40757—dc22
2006038568
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.
To purchase additional copies of this book, call our customer service department at [phone] or fax orders to [phone].
International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are
available from 8:30 am to 6 pm, EST.
10 9 8 7 6 5 4 3 2 1
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page v
To my wife Jocelyn, my son Zachary, and to my father Harry
D.P.N.
To the learners and teachers:
Cole, Andy, Sonny, Jessica, Emma, Brett, and Teresa
W.R.W.
To Alison and Phillip Müller
N.L.M
To my wife Jo, my boys Emile and Sebastian, and to my parents
I.V.
To Stacie, Emma, and Reginald
G.A.K.
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page vi
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page vii
Contents
Preface to the First Edition ix
Preface to the Fourth Edition xi
Acknowledgments xiii
1 Heart 1 6 Focal Lung Disease 557
2 Aorta, Arch Vessels, and Great Veins 87 7 Lung Cancer 621
3 Pulmonary Arterial Disease 217 8 Diffuse Lung Disease 671
4 Mediastinum 289 9 Pleura, Chest Wall, and Diaphragm 769
5 Airways 453
Subject Index 885
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page viii
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page ix
Preface to the First Edition
Diagnostic imaging has undergone a profound and aston- 1981, Dr. Zerhouni moved to the East Virginia Medical
ishingly rapid transformation over the last decade, parallel- Center. Despite this separation, the team continued their
ing the rapid evolution of modern computer science. The collaborative endeavors, and in 1982 and 1983 presented
first computed tomography (CT) unit, conceived and instructional courses in chest CT at the annual meeting of
developed by Godfrey Hounsfield, underwent initial clini- the American Roentgen Ray Society. From these presenta-
cal testing at the Atkinson Morley Hospital, Wimbledon, tions, the need for a volume representing the current status
England, in 1971. This early scanner employed two of thoracic CT became apparent.
sodiumiodide crystals and produced an image based on an This textbook has been organized primarily around the
80(cid:1)80 matrix. The scan time of four and one half major anatomic subunits of the thorax. These include: the
minutes effectively limited the machine to examination of mediastinum, the airways, the hila, the pulmonary
intracranial pathology. parenchyma, the pleura, and the chest wall, the peri-
Within three years, Ledley developed a CT unit capable cardium, and the diaphragm. Additional chapters have been
of imaging the body. In 1974 and 1975, whole body scan- added specifically on the role of CT in evaluating lobar
ner prototypes were installed first at the Cleveland Clinic, collapse and the pulmonary nodule, as these represent dis-
then at the Malinckrodt Institute of Radiology and the crete topics best addressed apart. This organizational
Mayo Clinic. Initial reports from these institutions were scheme represents the authors’ view that CT is primarily an
enthusiastic about the role of CT in the evaluation of anatomic imaging modality. Specifically excluded from con-
the pancreas, liver, and retroperitoneum, but pessimistic sideration is the use of CT in evaluating the heart. It is only
about the value of CT in the thorax. appropriate to consider cardiac CT in comparison to other
Further improvements in instrumentation were neces- cardiac imaging modalities, including angiography, echocar-
sary in order to assess the clinical role of thoracic CT. The diography, and nuclear cardiology. It is the authors’ feeling
pace of technological innovation was such that by 1977, that this is outside the intended scope of the present volume
scanners capable of scan times shorter than breath-holding as initially conceived.
had been developed. Additional improvements, including Thoracic CT has become an integral part of the daily
more detectors to increase resolution and finer collimation practice of radiology. With the ever-increasing number of
allowing a reduction in slice thickness to minimize partial diagnostic modalities, the task of deciding which diagnos-
volume averaging, soon became standard. As a result, tic test is the most appropriate for a given clinical problem
initial pessimism about the role of CT in the thorax has become a significant part of medical practice. The
quickly gave way to considerable enthusiasm. This first be- authors believe that an adequate understanding of clinical
came apparent as reports of the value of CT in analyzing issues is necessary for practicing radiologists to best help
mediastinal disease were published. Thereafter, an ever- the referring physician. Consequently, throughout the text,
expanding range of uses for thoracic CT has evolved and a strong emphasis has been placed on discussing CT as it
continues to evolve. relates to clinical issues, especially as compared to other
In December 1977, a CT scanner was installed at the routine imaging modalities. It is to be anticipated that
Johns Hopkins Hospital. At that time, Drs. Naidich further technologic advances in diagnostic imaging will
and Zerhouni were residents under the tutelage of further complicate the role of radiologists. It is hoped that
Dr. Siegelman, under whose auspices the three authors this text will prove valuable in assisting this process.
of this volume enthusiastically began a series of studies
concerning the utility of thoracic CT in a wide range of David P. Naidich
clinical settings. In July 1980, Dr. Naidich joined the staff Elias A. Zerhouni
at New York University Medical Center, and in January Stanley S. Siegelman
5636_Naidich_fm_ppi-xiv 12/8/06 11:07 AM Page x