This volume presents pedagogical content to understand theoretical and practical aspects of diagnostic imaging techniques. It provides insights to current practices, and also discusses specific practical features like radiation exposure, radiation sensitivity, signal penetration, tissue interaction, and signal confinement with reference to individual imaging techniques. It also covers relatively less common imaging methods in addition to the established ones. It serves as a reference for researchers and students working in the field of medical, biomedical science, physics, and instrumentation. Key Features * Focusses on the clinical applications while ensuring a steady understanding of the underlying science * Follows a bottom-up approach to cover the theory, calculations, and modalities to aid students and researchers in biomedical imaging, radiology and instrumentation * Covers unique concepts of nanoparticle applications along with ethical issues in medical imaging

More than 40 years ago British and German neurosurgeons met in Berlin and Breslau to exchange their experiences, to strengthen their friendly bonds, and to enjoy the attractions of both cities and their surroundings. In 1960 a joint meeting of the Dutch and German societies took place in Rotterdam by invitation of the Nederlandse Vereniging van Neurochirurgen. All who attended this meeting thankfully remember the great hospitality during these unforgettable days. In 1970, by courtesy of the Society of British Neurological Surgeons, German neurosurgeons had the pleasure to become acquainted with the great tradition of British sciences at one of the most famous places during the meeting in Cambridge. These impressions were deepened by visits to other famous sources of British scientific tradition during the European Congress in Oxford in 1975. The critical distance sometimes necessary towards our own discipline is implicit in the major themes of this meeting. Complications following shunting procedures for hydrocephalus have been discussed on the basis of the results of a cooperative study of some German neurosurgical departments. The second main topic was problems and diagnostic errors in computer tomography. The papers presented contain critical considerations about the findings obtained by this method, as well as on its possibilities and limitations. German neurosurgeons felt deeply indebted to their British and Dutch colleagues and wanted to return their kindness at this joint meeting in Berlin. We hope that all participants will retain pleasant memories of the days in this city.

Blood Supply of Bone: Scientific Aspects provides a comprehensive description of the development and physiology of blood supply to the skeleton. Investigative techniques for different types of bone in the body are discussed and the effects of disturbed circulation and the vascular control of osteogenesis is described. This highly illustrated and authoritative volume contains much revised material and many new illustrations reflecting 25 years of advances in this research field since the publication of its well-known precursor in 1971. The wealth of information will not only be invaluable to orthopaedic surgeons, rheumatologists, and radiologists but also pathologists, sports medicine specialists and bone metabolism research workers.

A thorough knowledge of normal radiological anatomy is necessary for detection and evaluation of pathological changes. In pediatric radiology, normal anatomy and normal proportions of anatomical structures may differ considerably from the adult, and may vary during growth. Therefore, in pediatric radiology there is a multitude of measurements, that in the individual patient is important, but that for the radiologist is not meaningful or even possible to keep in mind. This holds true both for the experienced pediatric radiologist, and for those who practise pediatric radiology only occasionally. This volume is written for both categories. In the literature, normal values are calculated and presented in many different ways, that are not always easy to compare, or easy to use in daily work. Therefore, we have revised and recalculated the data given by authors, in order to present the statistical upper and lower normal limits as between plus and minus two standard deviations (+/- 2SD). This means that about 2% of a normal population will be assessed as abnormally large and around 2% abnormally small with respect to the parameter assessed. In this way, the presentation throughout the book is uniform, and hopefully easy to use. All figures have been redrawn and computed in an attempt to make them as clear as possible.

In the last few years a good deal of information related to the biology and treatment of malignant lymphomas has been accumulated and published in journals and monographs. There is, however, no book that gives a concise and objective update of this information or presents a general survey of the subject. The contributors to this book are international authorities, and on the basis of their personal experience and data from the literature they have written a high-level update on malignant lymphomas which will be of interest to both specialists and nonspecialists.

Since the establishment of magnetic resonance imaging the clinical diagnostic of the head and neck has improved substantially and, therefore, in many cases this technique is used in the first place of radiological diagnosis. The feasibility of non-invasive MR angiography and 3-dimensional reconstruction has enlarged the indication field of MRI. This book presents the meaning of this imaging technique for the diagnosis of diseases in head and neck. Excellent figures show the technicaland diagnostical possibilities of this method, the advantages and limitations of which are explained as well. A comprehensive diagnostic strategy for each diagnostic region is presented. This book is disigned for the use of especially radiologists, ENT specialists and surgeins.

Radiology Today 3 presents papers and panel discussions from a multi national faculty at the biannual Salzburg Symposium, which this time covered three important topics: critical diagnostic pathways in gastro" intestinal and genitourinary radiology, interventional radiology of the abdomen, and cost containment in radiology. The choice of these topics illustrates the changing role of the radiolo gist in the practice of medicine today and in the foreseeable future. He will have to serve as a consultant more than ever before, assuming in creasing responsibility for sequencing of imaging procedures and par ticipating more and more in therapeutic intervention. In order to pro vide meaningful assistance, the imaging consultant must be aware of the efficacy and the limitations of every procedure. In this context, cost containment is a worldwide public concern, and the most appropriate procedures must be identified. Radiology Today 3 demonstrates how the radiologist functions as a member of diagnostic and management teams to provide optimal in formation and efficient, low-risk patient care at the lowest possible cost. Martin W. Donner Friedrich H. W. Heuck Contents Critical Diagnostic Pathways Abdomen 3 G. MARCHAL, A L. BAERT, K. GEBOES, E. PONETTE, 1. FEVERY The Diagnosis of Pancreatic Cancer ............ 3 W. REICHARDT Localization Techniques for Hormonally Active Pancreatic Tumors ........... . 7 AR. MARGULIS, S. MCCARTHY Hepatic Mass Lesions .... 12 M. KORMANO, K. PARTANEN, 1. KUIKKA Dynamic Liver CT and New Contrast Agents ....... . 17 W. FROMMHOLD, J. PIRSCHEL 20 Gallbladder Diseases: Imaging Sequences 1.A KIRKPATRICK, Jr."

It gives me great pleasure to have this opportunity to write a Foreword for this new book. In the past two decades we have witnessed very significant advances in the management of the very ill patient. The great success in this field of medical endeavour is largely due to the establishment of intensive care units, but a great deal of progress can also be attributed to the major developments in technology, which affect patient management and care as well as the many sophisticated techniques of diagnosis and patient monitoring. Imaging and Labelling Techniques in the Critically III covers this new important and difficult field of diagnosis and visual monitoring. By establishing the criteria and algorhythms for the choice of the different methods available for this purpose, defining the diagnostic signs on images and resolving some of the mis conceptions and pitfalls, this book will go a long way to help the reader, particularly those involved in the care of patients in the intensive care units. This book brings together many different methods of investigation and discusses the advantages and limitations of these techniques in different clinical circumstances. Some of the techniques are well established and their usefulness in the intensive care unit is in no doubt. Some of the newer techniques such as PET scanning or NMR imaging have not yet found a defined position of usage in the critically ill patient. There is, however, little doubt that in due course this situation will change.

Imaging procedures have been used for many years and are becoming increasingly important in a number of medical disciplines. This is due to recent technological advances, primarily computerization. The meth ods employed in CNS diagnostics are collectively referred to as "neu roimaging" and include procedures for investigating both cerebral morphology and cerebral function, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomogra phy (PET), and single-photon emission computed tomography (SPECT). Topographic mapping of electroencephalograms (EEG) and evoked potentials represents one of the functional procedures and per mits topographic imaging of EEG, evoked potentials, and magnetic fields. The latter application includes not only magnetic fields evoked by stimuli relating to different sensory modalities, but also endogenous and motor fields resulting from spontaneous brain magnetic activity, as recorded by magnetoencephalograms (MEG), the magnetic comple ment of the EEG. The advantage of recording electric and magnetic fields over other neuroimaging procedures is that these techniques are completely noninvasive and have extremely short analysis times (in the millisecond range). The aim of this book is to clarify the current state of this emerging technology, to assess its potential for substantive contributions to brain research, to delineate areas for further research and, over all, to envis age clinical applications in disciplines such as psychiatry, neurology, and neuropsychology."

The aim of this book is to expand the clinical information given by computed tomograms (CTs) of cerebral infarcts. Anatomical sections are displayed parallel to the CT correlate in the hope that the interpretation of pathogenesis will provide valuable clinical data at a time when the number of angiographies performed in cerebrovascular cases has diminished rapidly. For better understanding of pathogenesis our concepts concerning the process of infarction have been summarized on the basis of schematic draw ings. K.-J. ZULCH KOln Acknowledgments I am most grateful to Professor Hoeffk: en for permission to use computed tomograms from his institution, to Herr GOldner and Frau Miihlhover for their technical assistance, and to Frau Goldner for help during the editorial work. My particular thanks go to my friend Professor W.S. Fields, Houston, who undertook the great burden of styling the English text. My gratitude is expressed to Dr. Dr. h.c. multo Heinz Gotze and Springer Verlag for the excellent layout and quality of this book."

This book encompasses the proceedings of a very successful post graduate course entitled "Radiology Today" held in Salzburg in June 1980. It was organised by Dr. Martin W. Donner of Baltimore and Dr. F. H. W. Heuck of Stuttgart. It was attended by 230 radiologists from 17 countries. The aim was to select a certain number of subjects in diagnostic radiology and in each to have a broad spectrum overview reviewing recent advances presented by an acknowledged expert, followed by a series of rather more detailed papers on various aspects of that field, again given by acknowledged experts drawn from countries throughout Europe and also from the United States of America. This series of presentations on a theme was then followed later the same day by a "workshop" discussion at which the speakers, sometimes joined by other experts from collateral fields of interest, acted as a panel for discussion with the over-view speaker acting as moderator.

Malignant growth of cells is often characterized by disorganization of tissue structure, abnormal blood vessel development, and insuffi cient vascular supply. As a consequence, the cancer cells grow in a three-dimensional pattern in atypical microenvironments which include physical, chemical, and nutritional stresses. Necrosis often develops some distance away from the blood vessels. In association with an inherent instability in malignant cell populations, and also because of the changing micromilieu, significant cellular heteroge neity emerges with regard to various phenotypic characteristics. Both biological behavior and responses to therapeutic agents can be affected. A variety of in vitro and in vivo experimental models exist for research on properties of cancer cells during growth. The multicell spheroid model was developed as a system of intermediate complexity in which three dimensional growth of cells enhances cell-cell interactions and creates micro environments that simulate the conditions in intervascular microregions of tumors or microme tastatic foci. Spheroids may change their cellular characteristics with changing environments during growth. These can be studied under controlled conditions in vitro. Interest in details of experimental methods for this model system stimulated the organization of the First International Conference in Rochester, NY in 1980, the Proceedings of which were summarized in Cancer Research in 1981. Since then there has been a rapid increase in the use of this model system, and increased research on the significance of cell-cell and cell-microenvironment interactions in biology in general."

The development and the widespread clinical application of various di agnostic imaging modalities, such as diagnostic ultrasonography, X-ray computed tomography, single photon emission computed tomography, and magnetic resonance imaging, have been beyond all expectation. In particular, ultrasonography and X-ray computed tomography have be come major diagnostic tools for diseases of the liver, the biliary tract, and the pancreas. They often have virtually replaced other conventional imag ing modalities including invasive angiography and percutaneous trans he patic cholangiography. One modality may complement or conflict with another or other modalities. Each modality should be carefully selected with due regard for its diagnostic efficacy. In this book, the first section contains nine chapters dealing with current techniques of each diagnostic modality applicable to the liver, the biliary tract, and the pancreas. The second section deals with diseases of the liver, the biliary tract, and the pancreas and takes the form of case presentation with discussion of the significance of diagnostic imagings and diagnostic procedure. Preparation of the manuscript was made possible by the help of Dr. S. Fujita, who prepared the photographs, and Mrs. Sobajima, who typed the original manuscript. Dr. S. Miura and Miss Y. Shimizu under took the labor of translating our manuscript from Japanese into English. I would like to express my deep appreciation to all these persons, as well as to the contributors to this book, and also to the publishers, Shujunsha, Japan and Springer-Verlag.

There has been increasing interest in neonatal neurology, especially since imaging techniques were introduced in the neonatal ward. Looking at the natural history of imaging techniques, we can identify three main axes of its development. Logically, it was first essential to image the brain morphologically. For this purpose, computed tomography was initially used, followed by ultra sound. However, to improve the quality of the images, magnetic resonance imaging was introduced. Major features of ultrasound and magnetic reso nance imaging are their safety and lack of ionization. Morphological imaging techniques have proved to be insufficient to ex plain the mechanisms underlying CNS injuries. Thus, it was essential to develop functional techniques to assess cerebral hemodynamics and oxy genation. The use of Doppler ultrasound, PET scanning, SPECT scanning and, more recently, NIRS have widened our knowledge of general neurolog ical problems. Finally, to achieve our goal of attaining a better understanding of CNS injuries, it is important to assess cerebral cellular metabolism. Magnetic resonance spectroscopy was introduced to achieve this goal. We hope that this book links these different techniques in order to widen our horizon. The future is promising and bound to provide further develop ments, which however can only be understood if we grasp the present level of development.

The authors present their experience in more than seven years of dynamic computed tomography in clinical practice. Time density curves and characteristic examples in specific regions of interest enrich the presentation. Dynamic computed tomography makes an important contribu tion to the diagnosis and evaluation of a pathologic process: the demonstration of the dynamics of blood flow within the lesion and surrounding normal tissue. Since both the lesion itself and adjacent normal tissue demonstrate characteristic findings in each circulatory phase, the study provides a large amount of data on the flow of blood and contrast material which facilitate both recognition and diiferentation of a lesion. Late studies following administration of a contrast agent allow an estimate of the passage of the contrast medium to the inter stitium, which is of diagnostic importance. Chapters dealing with specific clinical entities also contain useful information on the most appropriate means of contrast agent administration (bolus injection or infusion) as well as a discussion of indications for the procedure. Dynamic computed tomography represents a significant advance over conventional computed tomography in some situations, and this signifies a major contri bution to the diagnostic capabilities of the clinical radiologist. The authors are to be commended for the fact that they have clearly defined the limits of dynamic computed tomography. I hope that the first English language edition, following the appea rance of the German version in 1983, will be well received."

The clinical acceptance of computed anatomic cross-sections. Schematic line tomography (CT) as an integral part of our drawings are also generously used to il diagnostic armamentarium was based on its lustrate particularly complex anatomic re ability to display cross-sectional anatomy gions and help the reader obtain a correct with near anatomic precision. However, perspective on these more difficult regions. the radiologist must first be knowledgeable The book successfully presents a clear per of the complexities of normal anatomy be spective on the anatomy we see daily in fore he can truly make full use of this tech using cross-sectional imaging techniques. nology. This book will prove useful as a learning Michael Farkas has truly made our task guide for the uninitiated, and as a refer as radiologists easier. As noted in the ence for the more experienced. Either preface, the book carefully correlates rep way, it is an important contribution to our resentative CT slices with corresponding literature. Elliot K. Fishman, M.D."

The Information Processing in Medical Imaging Conference is a biennial conference, held alternatively in Europe and in the United States of America. The subject of the conference is the use of computers and mathematics in medical imaging, the evaluation of new imaging techniques, image processing, image analysis, diagnostic decision making and related fields. The conference brings together the top specialists in the field (both scientists and medical doctors) and other participants doing active research on the subject of the conference. The success of a meeting primarily depends on the enthusiasm of the participants. It also greatly depends on the financial support as well as on the personal efforts of the technical staff and collaborators of the organizers. To all who made this conference a success, the members of the organizing committee want to express their sineere thanks. In particular, the organizers want to acknowledge the help received from: De Vice-Voorzitter van de Vlaamse Executieve De Minister van Onderwijs Het Nationaal Fonds voor Wetenschappelijk Onderzoek De Vrije Universiteit Brussel Adac Agfa-Gevaert Bruker Spectrospin Byk Belga Elseint Instituut voor Radioelementen, IRE Nucleobel Solco Sonotron VII TABLE OF CONTENTS Foreword. v A. VENOT, J.L. GOLMARD, J.F. LEBRUCHEC, L. PRONZATO, E. WALTER, G. FRIJA and J.C. ROUCAYROL: "Digital Methods for Change Detection in Medical lmages."

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and thera peutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-in duced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and comments. As clinically used, it now pertains to the inadvertent side effects and complications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmen tal, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders a major, although generally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condi tion. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

Over the past few years, a wealth of new insights have been gained and put to use in basic gastrointestinal tumor research, including tumor suppressor genes, oncogenes, cell-cycle con- trol, apoptosis, adhesion receptors, signal transduction, and gene therapy. Similarly, progress has been made in preven- tion, molecular diagnosis, laparoscopic staging, and antibody- based immunotherapy, and new drugs such as thyrnidylate and topoisomerase I inhibitors have been developed espe- cially for the treatment of colorectal carcinoma. Despite this burgeoning of knowledge in both basic and clinical research, however, we have just begun to put these results into clinical practice. Therefore, the key goal of this volume is to bring together basic and clinical research findings so as to facilitate the translation of these advances into the clinical manage- ment of gastrointestinal tumors. We hope that this volume, which covers a broad spectrum of research and clinical medicine, will impart new insights and greater understanding to all those interested in the therapy of gastrointestinal tumors and will stimulate further scientific research. Berlin, January 1996 E. D. Kreuser P. M. Schlag Contents 1 I. Basic Research S. J. Meltzer The Molecular Biology of Esophageal Carcinoma 1 E. R. Greenberg Preventing Colorectal Cancer...9 M. Streit, R. Schmidt, R. U. Hi/genfeld, E. Thiel, and E. -D. Kreuser Adhesion Receptors in Malignant Transformation and Dissemination of Gastrointestinal Tumors...19 R. Kaiser, E. Thiel, and E. -D. Kreuser Human Gene Therapy in Gastrointestinal Diseases: In Vivo and In Vitro Approaches ...

The aim of this volume is to provide an illustrated overview of basic knowledge relevant to neurosurgery for students specializing in neurosurgery, operating room personnel, and neurologists seeking to inform themselves about surgical principles and applications. The major aspects of neurosurgery are presented in a clear, easy-to-follow outline form. Summaries are included of: neuroanatomy; neurologic syndromes, functional diseases, and traumas treatable through neurosurgery; physiologic and pathologic events occurring during neurosurgery. The principles of neurologic examination and diagnosis as well as supplementary diagnostic modalities are discussed from a neurosurgical perspective. The book can thus be used as an aid for quick bedside diagnosis and patient management and as a handy reference companion.

The practice of medicine changes continually, as science guides the physician to the accomplishment of his objective, the cure of the patient. Study of the history of medicine shows that often a remedy of a disease was discovered before the cause of the disease was known. Often the remedy was unnecessarily complicated, but when the cause of the trouble was discovered, the cure became simple and safe. It is with the better under standing of the true nature of thyroid disease that this book is concerned. Those who read it will be able to make their treatments of patients with diseases of the thyroid more simple and more safe. Dr. MASAYOSHI AKISADA and Dr. YOSHIHIDE FUJIMOTO have given to thyroidologists a new way of recognizing cancers of the thyroid. Taking advantage of the fact that many cancers of the thyroid contain minute areas of calcification known as psammoma bodies, they have developed a technique of roentgenographic examination of the thyroid that is sensitive enough to show these tiny opacities and to warn the internist and the surgeon that cancer is probably present. There is no question that this sensitive diagnostic test will prove to be of value comparable to that of mammography.

Over a mere 5 years, neonatal cranial sonography has evolved from an obscure and largely experimental imaging possibility to the modality of preference in the examination of the young brain. The almost immediate acceptance of the ultrasound examination of the neonatal brain was based on a number of coinci dent factors, the most important of which was the emergence of a burgeoning population of premature neonates who were, for the first time, surviving be yond infancy. These delicate patients were beginning to withstand the rigors of extrauterine life when not fully prepared for it; pulmonary, cardiac, and infec tious diseases no longer claimed most of them. With survival, a new specter reared its head: Would the eventual mental and neurologic status of these same children be worth the expense and time needed to bring them through their first months? This issue became increasingly pressing as evidence mounted through the 1970s that very premature neonates were at a high risk for intracranial hemor rhage and posthemorrhagic complications. An imaging modality that could evaluate the premature brain was sorely needed. The CT scanner with its proven ability to diagnose intracranial hemorrhage was of little value in this regard. So too were static gray-scale or waterpath ultrasound units. These modalities all had the same limitation, lack of portability. As neonatal intensive care units proliferated, so did the technology that would soon allow cribside neonatal neuroimaging, the real-time sector scanner."

Contents Abdominal and Thoracic Magnetic Resonance Angiography: Challenges, Technical Approaches and First Clinical Applications. H.U. Kauczor, R. Hausmann, W. Semmler Magnetic Resonance Spectroscopy of Skeletal Muscle. F. Tr{ber, W.A. Kaiser, G. Layer, C. Kuhl, M. Reiser Hepatic Tumors: Relaxometry and Quantitative Tissue Characterization with Magnetic Resonance Imaging. A. Steudel, F. Tr{ber, M. Reiser Liver-Specific Particulate Contrast Agents: An Overview I. Ivancev, A. Lunderquist Contrast Medium Induced Nephropathy: Animal Experiments H.S. Thomsen et al. Rheological Properties of Blood after Diagnostic Cardiac Catheterisation with Iopromide. R. Bach et al. Color Coded Doppler Sonography of the Male Urethra During Voiding: New Observations of Flow in an Aqueous Medium and Their Physical Foundations. P. H}bsch, F. Hager, E. Benes Development of a Model of Arterial Stenosis Analysis Using Digital Subtraction Angiography: A Parametric Study of Image Quality. C. Renaudin, I. Magnin, A. Amiel Arterial Calcifications in Thoracoabdominal Computer Tomography: Frequency and Correlation with Risk Factors and Cardiovascular Diseases. J. G-rich et al.

In Videofluorscopic Studies of Speech in Patients with Cleft Palate, Drs. M.L. Skolnick and E.R. Cohn present multiview videofluoroscopy as a technique for the radiological evaluation of speech defects in patients with cleft palate. Dr. Skolnick's invaluable contributions as both the originator and leading authority on the subject are discussed in a concise, clinical fashion. Topics examined include the anatomy and imaging of the velopharyngeal portal; the equipment and techniques of multiview videofluoroscopy; the interpretation of results and various patterns of velopharyngeal closure; Passavant's Ridge and patterns of velopharyngeal closure; normal and abnormal speech production; and the evaluation of test results. This book is the only source which concisely and completely describes the technique and its interpretations for those who need a description of the clinical procedure.

The contributions in this book were originally presented at the workshop "Research and Clinical Application of Isolated Liver Perfusion for Hepatic Tumors" held on 28 February to 1 March 1997 in Hanover, Germany. The workshop was planned to bring together groups working with isolated liver perfusion techniques worldwide. Experts from various countries were invited to pre sent and discuss their experimental data and clinical results. USA par Groups from Japan, The Netherlands, Sweden and the ticipated. At the beginning, oncologists, surgeons and patholo gists presented possible indications and the oncological back ground for therapeutic isolated liver perfusion from their points of view. Based on data from previous studies about loco regional chemotherapy and based on the pathology of metastasis, it could be concluded that there is a place for isolated liver perfusion in the therapy of liver cancer. Second, different surgical techniques of isolated liver perfusion were presented. These techniques var ied from a percutaneous approach with extracorporeal chemofil tration to extended open abdominal surgery. Perfusion of the liv er without a considerable amount of drug reaching the systemic circulation proved to be possible. The complex procedure with complicated extracorporeal perfusion technique represented a disadvantage of the methods presented. Further studies should simplify the technical and surgical aspects. Intraoperative and postoperative management of . patients undergoing isolated liver perfusion were also discussed. Coagulopathy was one important aspect which can occur during isolated liver perfusion. The per centage of leakage determined systemic side effects."