Computed Tomography of the Body: A Radiological and Clinical Approach

231 Pages·1981·36.867 MB·English

by  Janet E. Husband MRCP, FRCR, Ian Kelsey Fry DM, FRCP, FRCP (auth.)

Computed
Tomography
of the Body
We would like to acknowledge the pioneer work of Sir Godfrey Hounsfield, CBE, FRS, in the development of
computed tomography. He is seen here with King Carl Gustav and Queen Silvia after the award of the 1979 Nobel
Prize in Medicine
Computed
Tomography
of the Body
A RADIOLOGICAL AND
CLINICAL APPROACH
Janet E. Husband, MRCP, FRCR
Consultant Radiologist and Honorary Senior Lecturer,
Institute of Cancer Research, Royal Marsden Hospital, Sutton; and
Consultant Radiologist, BUPA Medical Centre, London
and
Ian Kelsey Fry, DM, FRCP, FRCR
Consultant Radiologist, St Bartholomew's Hospital, London; and
Director, CT Scanning Unit, BUPA Medical Centre, London
M
© Janet E. Husband and Ian Kelsey Fry 1981
All rights reserved. No reproduction, copy or transmission
of this publication may be made without written permission.
No paragraph of this publication may be reproduced, copied
or transmitted save with written permission or in accordance
with the provisions of the Copyright Act 1956 (as amended).
Any person who does any unauthorised act in relation to
this publication may be liable to criminal prosecution and
civil claims for damages.
First edition 1981
Reprinted 1983, 1985
Published by
Scientific and Medical Division
MACMILLAN PUBLISHERS LTD
London and Basingstoke
Companies and representatives throughout the world
Typeset in Great Britain by
PINTAIL STUDIOS LTD
Ringwood, Hampshire
ISBN 978-0-333-25585-8 ISBN 978-1-349-04254-8 (eBook)
DOI 10.1007/978-1-349-04254-8
To our long-suffering families
Contents
The Contributors vii Use and accuracy of computed
tomography 36
Preface IX
5 The Thorax - Lungs, Pleura and Chest
Basic Principles with R. Parker 1 Wall 40
The scanner 1 Technique of examination 40
The image 3 CT anatomy 40
Storage of data 6 Pulmonary nodules 44
Resolution 6 General lung disease 47
Slice width 6 Pleural disease 49
Partial volume effect 6 Chest wall 51
Artefacts 7 Use and accuracy of computed
Radiation 7 tomography 52
Resolution and its relationship to dose 8
6 The Abdomen-Kidney 55
2 General Considerations-Technical 9 Technique of examination 55
CTanatomy 55
Outlining the bowel 10
Renal mass lesions 58
Reducing movement artefacts 1l
Other renal and perirenal lesions 64
Bladder emptying 12
Use of computed tomography and
Scanogram or scout view 13
relationship to other techniques 68
Enhancement 14
Care of the patient 16 7 The Abdomen - Adrenals 71
Planning and supervision of the Technique of examination 71
examination 16 CTanatomy 71
Adrenal masses 73
3 General Considerations - Clinical 17
Other adrenal lesions 77
The clinical value of computed
Accuracy and relationship to other
tomography 19
techniques 77
Relationship to other techniques 20
Computed tomography and ultrasound 20 8 The Abdomen - Liver and Biliary Tract 81
How useful is computed tomography? 21 Technique of examination 81
CT anatomy 82
4 The Thorax - Mediastinum 23 Focal liver disease 85
Technique of examination 23 Diffuse liver disease 89
CT anatomy 23 Gall-bladder disease 91
Mediastinal masses 27 Use and accuracy of computed
Heart 36 tomography 93
v
vi
9 The Abdomen - Pancreas 97 CTanatomy 166
Technique of examination 97 Tumours 171
CTanatomy 98 Use of computed tomography in
Signs of pancreatic disease 102 tumours of bone and soft tissues 177
Differential diagnosis and the use of Trauma 178
computed tomography in pancreatic Congenital and developmental lesions 181
disease 108 Vertebral column and spinal cord 181
Accuracy of computed tomography
and relationship to other techniques 109 14 The Spinal Cord by P. Pullicino 184
Technique of examination 184
10 The Abdomen - Miscellaneous Topics 113 Intramedullary lesions 185
The retroperitoneal and peritoneal Intradural extramedullary lesions 185
spaces 113 Extradural lesions 187
Ascites 123 Metrizamide CT myelography 187
Aorta 123
Inferior vena cava 124 15 The Head and Neck with C. A. Parsons 189
Use of computed tomography in Paranasal sinuses 189
assessment of intra-abdominal Technique of examination 189
masses 125 CTanatomy 189
Spleen 126 Tumours 191
Gastrointestinal tract 127 Pharynx 194
Aspiration techniques guided by Technique of examination 194
computed tomography 128 CTanatomy 195
Tumours 196
II Lymph Node Disease of the Abdomen Larynx 198
and Pelvis 132 Technique of examination 198
Technique of examination 132 CTanatomy 198
CT anatomy and abnormal Tumours 199
appearances 132 Parotid gland 201
Para-aortic and retrocrural nodes 134 Technique of examination 201
Nodes in other upper abdominal sites 137 CTanatomy 201
Accuracy of computed tomography 140 Tumours 202
Use of computed tomography in lymph
node disease 142 16 The Orbits by G. A. S. Lloyd 204
Technique of examination 204
12 The Pelvis 146
Abnormalities of the orbit 205
Technique of examination 146
Use of computed tomography in
CTanatomy 148
orbital diagnosis 208
Bladder 151
Rectum 154
Female genital tract 157 17 Computed Tomography in Oncology 210
Prostate 159 Primary diagnosis 210
Miscellaneous pelvic conditions 161 Staging 211
Use of computed tomography 162 Monitoring response to treatment 213
Radiotherapy treatment planning 215
13 The Musculo-Skeletal System 165
Technique of examination 166 Index 219
The Contributors
G. A. S. Lloyd, DM, FRCR
Consultant Radiologist, Royal National Throat, Nose and Ear Hospital, London
R. Parker, PhD, MSc
Senior Lecturer in Physics, Royal Marsden Hospital, Sutton
C. A. Parsons, FRCS, FRCR
Consultant Radiologist, Royal Marsden Hospital, Sutton
P. Pullicino, MD, MRCP
Research Fellow, National Hospitalfor Nervous Diseases, London
Preface
The effective use of a diagnostic imaging technique of machine. The development of new faster scanners
depends on both radiologist and clinician has already improved picture quality and there is
understanding what the technique can do and how little doubt that the number of clinical situations in
to use it. We have, therefore, set out to provide an which CT scanning is the investigation of choice will
introduction to computed tomography of the body expand. In particular, the introduction of dynamic
describing not only the technique and interpretation scanning is likely to have important clinical implica
of scans but also the value of scanning in clinical tions. Such developments are, however, unlikely to
practice. The essentially technical aspects of scan invalidate the general principles which have already
ning have been kept to the minimum required to been established.
understand how the scans are done and how they One of us (JH) first gained experience of CT scan
are interpreted. ning with Dr Louis Kreel of Northwick Park
The resources available in a department of Hospital. We are both happy to have this
medical imaging are usually in excess of the ability opportunity of putting on record our recognition of
to use them to best advantage. When a new tech Dr Kreel's special contribution to the understanding
nique is introduced it often continues to be used just of the principles of CT scanning of the body.
because it is there. This is unlikely to happen with Between us we have experience of scanners in
computed tomography (CT) scanning of the body three other institutions - the Royal Marsden
because of the way in which its introduction has Hospital, the BUP A Medical Centre and St
coincided with a time of diminishing resources and, Bartholomew's Hospital - and we would like to
in some quarters, of increasing disenchantment with acknowledge the immense help that we have had
high-technology medicine. Very proper questions are from numerous radiological and clinical colleagues
being asked about the justification for scans in terms in these institutions. It is a pleasure to recognise the
of their effect on the management of the patient and part played by our radiological colleagues working
on the outcome of the disease. Experience is too with the scanners - Dr J. S. Macdonald, Dr Colin
limited for definitive answers to be given to such Parsons and Dr Stephen Golding at the Royal
questions at this time, but there is already con Marsden Hospital, Dr P. Travers, Dr D. G. Shaw,
siderable agreement about the main applications of Dr P. Gishen, Dr M. Kellett and Dr R. Dick at the
the method and its relation to other imaging tech BUPA Medical Centre, and Dr Adrian Dixon and
niques. Dr Elizabeth White at St Bartholomew's Hospital.
Our personal experience is limited to the use of a We have been fortunate to work with skilled and
second-generation scanner, the EMI 5005 General dedicated radiographers who have handled their
Purpose Scanner. Many of the reports in the sometimes temperamental machines with great
literature refer to studies on this or some similar type expertise and patience. The radiographers in charge
ix
X Preface
of the departments - Mrs Dorothy Mears, Mrs J ac supported research on the scanners of their institu
queline Seckel, Miss Sandy Jewell and Miss Marion tions.
Hallett - have not only managed their departments Also, we would like to thank Mrs Judy Grimes
with great competence but have also found time for and Mr John Higgins for help with producing the
the extra work involved in research and the docu illustrations and Mrs Julie Jessop and Mrs Janice
mentation of results. O'Donnell for their enthusiastic and expert
Having access to a new imaging technique secretarial help with the manuscript.
capable of examining any part of the body soon Finally, we would like to thank the following for
exposes the radiologist's ignorance of many clinical their kind permission to reproduce figures: the
conditions. Much of the content of this book is the Cancer Research Campaign, Dr Foley (Milwaukee
result of discussion with surgeons and physicians County Hospital, Milwaukee, Wisconsin), Inter
and we are grateful for their stimulus and interest. In national General Electric (New York), Pitman Press,
particular, Professor Michael Peckham and Dr Neil Dr Robinson (Leeds General Infirmary), Radiology,
Hodson at the Royal Marsden Hospital have done a Siemens AG VB Med (Erlanger, West Germany),
great deal towards helping to define the precise role Dr T. P. Naidich (The Edward Mallinckrodt
of computed tomography in the management of Institute of Radiology, St Louis, Missouri), Dr M.
malignant disease. Their advice has been inva:Juable Sage (Department of Radiology, Flinders Medical
but they should not be held responsible for any of Centre, Bedford Park, South Australia), Dr L. A.
the views that we have expressed. Gilula (The Edward Mallinckrodt Institute of
We would like to record our appreciation of the Radiology, St Louis, Missouri), Dr Haughton (Mil
contributions from the Cancer Research Campaign waukee General Hospital, Milwaukee, Wisconsin),
and the Department of Health and Social Security Dr Hoare and Dr Stanley.
who have generously financed research at the Royal
Marsden Hospital and from the Trustees of St
Bartholomew's Hospital and the Research Fund of London, 1981 J.E.H.
the BUPA Medical Centre, both of whom have I.K.F.