The decision of Harvey Cushing to leave general surgery and concentrate on the infant field of central nervous system surgery was in retrospect a landmark in the history of neurosurgery. His concentrated work, and also that of his colleague Walter Dandy, originated with the desires of both pioneers to understand surgical anatomy and neurophysiology. The fundamental knowledge and surgical techni ques that they provided became the standard of excellence for several generations of neurosurgeons; so much so that the general belief was that the surgical techniques could not be improved upon. Twenty-five to thirty years ago microtechniques began to appear in a few surgical research centers, they were then gradually applied to clinical neurosurgery and have contributed to a new level of understanding in surgical anatomy and neurophysiology. We are now fortunate to have a new standard of morbidity and mortality in the surgical treatment of intrathecal aneurysms, angiomas, and tumors. It has been said that microneurosurgery was reaching its limits, especially when treating lesions in and around the cavernous sinus and skull base; those lesions notorious for involvement of the dural and extradural compartments, with a tendency to infiltrate adjacent nerves and blood vessels. The dangers of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea appeared unsurmountable. The lateral aspects of the petro-clival region have been of interest to a few pioneering ENT surgeons and neurosurgeons but the cavernous sinus in most respects has remained the final unconquered summit."

The diagnosis of osteoporosis and the determination of fracture risk has always been a challenge for radiologists, epidemiologists, and clinicians as well as oth er researchers and health care professionals working in the field. It is bone min eral density that is closely related to bone fragility, and the advent of techniques to quantitatively assess bone density has been welcomed. It has reduced the sub jectivity inherent to conventional radiologic assessment of osteoporosis. The on going technical process has made various techJ)iques to assess bone density wide ly available. However, these measurement techniques have also incurred some crit icism because bone densitometry has sometimes been applied without specific indications and without appropriate clinical ramifications. The purpose of this text is to provide a perspective on the current status of bone densitometry and ist relevance to osteoporosis diagnosis and management. Therefore, this book will give the reader an introduction to the nature of osteo porosis, its pathophysiology and epidemiology, and the clinical consequences of performing bone densitometry. Aside from standard bone densitometry, newer technologies such as quantitative ultrasound techniques, magnetic resonance imaging and bone structure analysis are discussed in the context of diagnosing osteoporosis."

In 1932 there appeared the work of SCHMORL and JUNGHANNS, Die gesunde und kranke Wirbelsiiule im Rontgenbild, which laid the foundations of diagnostic radiology of the spine. Since that time the discipline has been extended and refined in a systematic manner and our knowledge has been greatly enriched by the large number of monographs in which leading experts have assembled additional data. An encyclopedic treatment of all that is currently known requires not only that reference be made to all work published since 1932 in order to reveal the problems that remain but also that a serious attempt be made to contribute to the solution of such problems. For this reason, Professor TONDURY and Professor THEILER of Zurich, who know more than anyone else about the ontogeny of the spine, have been invited to display their erudition in this field. Should contra dictions or divergent opinions on certain points be revealed through this confrontation with radiologically obtained findings, so much the better; the effect of this could only be to spur workers in both disciplines on to more advanced research. We have only to recall how in Goethe's time the premaxilla was still the subject of controversy, yet this great man pursuing his studies in comparative anatomy and anthropology was able to prove its existence beyond all doubt. Mainz, May 1974 L. DIETHELM Inhaltsverzeichnis - Contents A. Die normale Wirbelsliule . . . . . . . . . . . . . . . . . . . . 1 1 I. Phylogenetische Entwicklung des Achsenskelets. Von K. THEILER 1 1. Die Bogenelemente. . . . . . . . . . . . . . . 2. Die Chorda dorsalis . . . . . . . . . . . . . ."

Significant development made in the Siemens CT scanner SOMATOM PLUS have opened new possibilities for diagnostic imaging in computed tomography. Spiral CT with a continously rotating X-ray tube and synchronous table increments for up to 60 cm in less than half a minute make radiological diagnosis more accurate. Blind gaps are no longer a major problem, and all structures, especially in the lungs, can be identified and diagnosed. The practical experience of an expert groupof clinical researchers and physicists is now made available in this book.

In the past, CT was the first choice among diagnostic measures for neurological diseases, and MRI was con- sidered to be a supplementary test. However, with the introduction of an ever increasing number of devices, MRI is being used routinely, and it is possible that eventually CT will become supplementary to MRI. This guide to the practical use of MRI has been compiled bearing these considerations in mind. Minimal working knowledge of the simple operations - that does not require details about the technical production of television images - is all that is required in order to obtain information from the views. Thus, even if a clinician is not thoroughly familiar with the theories of MRI, he can use it as efficiently as he does the CT scan. In this book, the theoretical aspects of the principles of MRI are deliberately simplified and the text can be used solely as an atlas. In the introduction, useful general features of MRI interpretation are described and itemized, and major diseases of the central nervous system are presented.

This book reflects the views of an international faculty and provides an authoritative appraisal of modern radiology. It represents the sec ond volume in a planned series of competent overviews, and is mod eled on the successful first volume, Radiology Today, which was enthu siastically received by an international readership. We were encour aged by the comments we received to continue blending the latest ad vances in radiology with comprehensive teaching material concerning modern radiological practice. The Radiology Today 1982 meeting again brought together outstanding radiologists from Europe and North America for the purpose of sharing their experiences and their viewpoints of the current position and opportunities of imaging in medicine. Updating his/her knowledge of advances in medical imaging has be come an integral part of continuing medical education for every radiol ogist. Because all imaging modalities are continuously being refined, new clinical applications develop and frequently replace more com plex or more invasive procedures. Also, the relationship of imaging procedures to each other changes constantly, and with it the configura tion of critical diagnostic pathways for investigation of clinical signs and symptoms. To recognize this trend is important, because it is ex panding the role of the radiologist: our involvement in active guidance to the point of the patient's diagnostic workup has increased signifi cantly where it has become strategic."

The anatomic structure of the vascular supply of the pelvis has long been the subject of study. Progress in angiography rendered it a valu- able diagnostic aid. Nevertheless, angiography is finding new applica- tions in combination with the technique of superselective catheteriza- tion, opening the way for interventional angiography. Remarkable as this may prove, one must not overlook the difficulties involved, most of which essentially result from insufficient knowledge of the anatomic structure concerned: the pelvic arteries are particularly pro b- lema tic owing to their complexity and multiple variations. For this reason we here attempt to chart precisely the course of each artery supplying the pelvis and to provide a synthetic study of the different vascular territories. The book is completed by some pathologic exam- ples which illustrate the sometimes very important role of embolization in therapy. VII Acknowledgements This work has been produced in close collaboration with urologists, gynecologists, orthopedic surgeons, gastroitestinal surgeons, and neu- rosurgeons. We would particularly like to thank all those who have referred their patients to us, and especially Prof. Kuss from the Depart- ment of Urology, Hopital La Pitie, whose role in the realization of this book was crucial, and his colleagues, Prof. LE GUILLOU, Prof. JARDIN, and Prof. CHATELAIN. Others to whom we owe our thanks in the above respect are Prof. STEG and Prof. BoccoN-GmoD (Depart- ment of Urology, Hopital Cochin); Prof. DUFOUR, Prof. CUKIER, and Dr. LEPAGE (Department of Urology, Hopital Necker); Prof.

In this age when we are witnessing a veritable explosion in new modalities in diagnos tic imaging we continue to have a great need for detailed studies of the vascularity of the brain in patients who have all types of cerebral vascular disease. Much of the understanding of cerebral vascular occlusive lesions which we developed in the last two decades was based on our ability to demonstrate the vessels that were affected. Much experimental work in animals had been done where major cerebral vessels were obstructed and the effects of these obstructions on the brain observed pathologically. However, it was not until cerebral angiography could be performed with the detail that became possible in the decades of the '60 's and subsequently that we could begin to understand the relationship of the obstructed vessels observed angiographically to the clinical findings. In addition, much physiologic information was obtained. For instance, the concept ofluxury perfusion which is used to describe non-nutritional flow through the tissues was observed first angiographically although the term was not used until LASSEN described it as a pathophysiological phenomenon observed during cerebral blood flow studies with radioactive isotopes. The concept of embolic occlusions of the cerebral vessels as against thrombosis was clarified and the relative frequency of thrombosis versus embolism was better understood. The concept of collateral circulation of the brain through so-called meningeal end-to end arterial anastomoses was vastly better understood when serial angiography in obstructive cerebral vascular disease was carried out with increasing frequency."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

During recent decades there has been a revolutionary change in the life expectancy and quality of life of the hemophiliac. This has been achieved by hematologic and c1inical research, and the future for the hemophiliac depends upon further medical knowledge and research. In spite of the dramatically improved life situation of hemophiliacs, hemorrhagic complications remain a threat. The hemorrhagic disorder may influence and/or aggravate the course of trauma or other diseases in these patients. Hemophiliacs suffering from hemorrhagic complications or eligible for elective surgery should be referred to Hemophilia Treatment and Training Centers, where evaluation and examination are performed by a multidisciplinary team with experience and interest in the disease. The radio10gist is an important member ofthis team. In the past diagnostic imaging has been based mainly on conventional radiography, and this is still very important for the diagnosis ofhemophilic complications, but the diagnostic imaging of today offers a wide range of modalities-conventional radiography, computed tomography, sonography, radionuc1ide imaging, and, in its infancy, magnetic resonance imaging. Thus there is a need for a thorough description of the potential and limitations ofthese modern diagnostic techniques.

The cerebello-pontine angle has always posed a challenge to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. Angle masses which are very small and difficult to detect frequently produce symptoms, but may remain silent while growing to exceptional size. The neuroradiologist must have firm knowl edge of the clinical manifestations of the diverse angle lesions in order to tailor his studies to the patients' needs. The majority of angle lesions are benign; thus successful surgery has the potential for complete cure. Angle lesions typically arise in conjunction with vital neurovascular structures, and often displace these away from their expected positions. Large lesions may attenuate the vestibulocochlear and facial nerves and thin them over their dome. Since the nerves often remain functional, the surgeon then faces the need to separate the tumor from the contiguous nerve, with preservation of neurological function. Depending on the exact location and extension of the lesion, resection may best be attempted via otologic or neurosurgical approaches. The neuroradiologist must determine - precisely -the presence, site, size, and extension( s) of the lesion and the displacement of vital neurovascular structures as a guide to selecting the line of surgical attack. Since the arteries, veins, and nerves that traverse the angle are fine structures, the neuroradiologist must perform studies of the highest quality to do his job effectively."

La radiologie digestive a ete pendant de nombreuses decennies Ie fleuron de la radiologie fran

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 therapeutic 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-induced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and com ments. As clinically used, it now pertains to the inadvertent side-effects and com plications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmental, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders-a major, although gen erally 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 condition. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

The esophagus, ostensibly a simple tubular structure whose functional role often is minimized and even ignored, is, in re- ality, a highly complex viscus. The problems associated with disorders of the esophagus are not only related to the usual en- tities which may be anticipated in any portion of the gastroin- testinal tract, but include in a major fashion the functional mechanisms indigenous to the pharyngoesophageal and eso- phagogastric junctions. A number of disorders, representative of the classical cate- gories of disease, affect the esophagus. These include the various congenital and developmental abnormalities, of which some are complex. Trauma to the esophagus is not un- common, and infective and inflammatory lesions of this struc- ture are encountered relatively frequently. The different types of neoplasms of the esophagus are relatively few in number, but are commonly observed-the most serious, from the point of view of survival, being carcinoma. The collagen disorders, particularly scleroderma and dermatomyositis, affect the eso- phagus all too often. A miscellaneous group includes such en- tities as achalasia and varices, occurring in varying degrees of frequency. Functional abnormalities of the oropharynx, hypo- pharynx and esophagus, particularly relating to swallowing and the frequently encountered instances of spasm of the pharyngoesophageal and the esophagogastric junctions, consti- tute an important and common source of difficulty in the pa- tient population at large. In this regard, anatomic, radiologic, and physiologic studies of these structures have provided through the years vital data which has proved of considerable VII ...

There are two important reasons for commencing this new series of publi cations entitled "Advances and Technical Standards in Neurosurgery": 1. the lack of any organized common European postgraduate training system for young neurosurgeons and 2. the language barriers, which impede the exchange of neuro surgical findings in Europe more than in other parts of the world. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore the Editors have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions will be written by specialists in the given fields and will constitute the first part of each volume."

There are two important reasons for publishing this new series entitled "Advances and Technical Standards in Neurosurgery": 1. the lack of any organized common European postgraduate training system for young neurosurgeons and 2. the language barriers, which impede the exchange of neurosurgical findings in Europe more than in other parts of the world. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore the Editors have decided to publish all contributions III English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their postgraduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons.

Benefits: - Leblancs new investigative technique allows the rapid visualisation of the most vulnerable points of the cranial nerves - the course of each nerve is studied radiologically and anatomically, using dissections, injections, serial macroscopic sections, and x-rays - each cranial nerve is depicted from its origin to the muscle with its intracranial, extracranial, and intracranial pathways - the start of each chapter features an illustration of the cranial nerve as a whole, allowing the reader to quickly memorize the cranial anatomy - unique full-colour illustrations make the atlas a reference of outstanding value to clinicians, researchers and students

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for on-line use in the catheterization room, quantitative coronary angiography is now available to all interventionalists. This book is a timely guide for the impending QCA user, providing practical as well as theoretical and scientific information. A comprehensive evaluation of the clinical usefulness of QCA is covered, from the fundamental principles through experimental validation studies, application to clinical trials of a wide range of pharmacological and interventional therapies in the full spectrum of clinical presentation of coronary disease syndromes, evaluation of the therapeutic efficacy of various new devices for coronary intervention, together with extensive presentation of its physiological, functional and anatomical correlations, by comparison with other intracoronary measurement and imaging techniques. In addition, evolving theories and concepts in the ever topical restenosis phenomenon' after percutaneous intervention, based on serial QCA studies, are presented and discussed and a potentially unifying methodological approach to further study of this ubiquitous problem is offered. This book, thanks to the collaboration of many experts in the field of intracoronary imaging and measurement, provides stimulating, interesting and practical information, both for the academic scientist and practising clinician.

This book contains a selection of communications presented at the Third International Meeting on Fully Three-Dimensional Image Reconstruction in Radiology and Nuclear Medicine, held 4-6 July 1995 at Domaine d' Aix-Marlioz, Aix-Ies-Bains, France. This nice resort provided an inspiring environment to hold discussions and presentations on new and developing issues. Roentgen discovered X-ray radiation in 1895 and Becquerel found natural radioactivity in 1896 : a hundred years later, this conference was focused on the applications of such radiations to explore the human body. If the physics is now fully understood, 3D imaging techniques based on ionising radiations are still progressing. These techniques include 3D Radiology, 3D X-ray Computed Tomography (3D-CT), Single Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET). Radiology is dedicated to morphological imaging, using transmitted radiations from an external X-ray source, and nuclear medicine to functional imaging, using radiations emitted from an internal radioactive tracer. In both cases, new 3D tomographic systems will tend to use 2D detectors in order to improve the radiation detection efficiency. Taking a set of 2D acquisitions around the patient, 3D acquisitions are obtained. Then, fully 3D image reconstruction algorithms are required to recover the 3D image of the body from these projection measurements.

Solid-State Imaging with Charge-Coupled Devices covers the complete imaging chain: from the CCD's fundamentals to the applications. The book is divided into four main parts: the first deals with the basics of the charge-coupled devices in general. The second explains the imaging concepts in close relation to the classical television application. Part three goes into detail on new developments in the solid-state imaging world (light sensitivity, noise, device architectures), and part four rounds off the discussion with a variety of applications and the imager technology. The book is a reference work intended for all who deal with one or more aspects of solid- state imaging: the educational, scientific and industrial world. Graduates, undergraduates, engineers and technicians interested in the physics of solid-state imagers will find the answers to their imaging questions. Since each chapter concludes with a short section Worth Memorizing', reading this short summary allows readers to continue their reading without missing the main message from the previous section.

Medical imaging has been transformed over the past 30 years by the advent of computerized tomography (CT), magnetic resonance imaging (MRI), and various advances in x-ray and ultrasonic techniques. An enabling force behind this progress has been the (so far) exponentially increasing power of computers, which has made it practical to explore fundamentally new approaches. In particular, what our group terms "model-based" modalities-which produce tissue property images from data using nonlinear, iterative numerical modeling techniques-have become increasingly feasible.

Alternative Breast Imaging: Four Model-Based Approaches explores our research on four such modalities, particularly with regard to imaging of the breast: (1) MR elastography (MRE), (2) electrical impedance spectroscopy (EIS), (3) microwave imaging spectroscopy (MIS), and (4) near infrared spectroscopic imaging (NIS). Chapter 1 introduces the present state of breast imaging and discusses how our alternative modalities can contribute to the field. Chapter 2 looks at the computational common ground shared by all four modalities. Chapters 2 through 10 are devoted to the four modalities, with each modality being discussed first in a theory chapter and then in an implementation-and-results chapter. The eleventh and final chapter discusses statistical methods for image analysis in the context of these four alternative imaging modalities.

Imaging for the detection of breast cancer is a particularly interesting and relevant application of the four imaging modalities discussed in this book. Breast cancer is an extremely common health problem for women; the National Cancer Institute estimates that one in eight US women will develop breast cancer at least once in her lifetime. Yet the efficacy of the standard (and notoriously uncomfortable) early-detection test, the x-ray mammogram, has been disputed of late, especially for younger women. Conditions are thus ripe for the development of affordable techniques that replace or complement mammography. The breast is both anatomically accessible and small enough that the computing power required to model it, is affordable.

At the end of the 20th century, a tremendous progress was made in biotechnology in its widest sense. This progress was largely possible as a result of joint efforts of top academic researchers in both pure fundamental sciences and applied research. The surplus value of such interdisciplinary approaches was clearly highlighted during the 9th European Congress on Biotechnology that was held in Brussels, Belgium (11-15 July, 1999). The present volume in the 'Focus on Biotechnology' series, entiteld 'Physics and Chemistry Basis for Biotechnology' contains selected presentations from this meeting, A collection of experts has made serious efforts to present some of the latest developments in various scientific fields and to unveil prospective evolutions on the threshold of the new millenium. In all contributions the emphasis is on emerging new areas of research in which physicochemical principles form the foundation. In reading the different chapters, it appears that more than ever significant advances in biotechnology very often depend on breakthroughs in the biotechnology itself (e.g.

As noted in the Foreword, this report is one of several volumes resulting from this study of future health care technology. The purpose of the study, as formulated by the STG, was to analyze future health care technology. Part of the task was to develop an 'early warning system' for health care technology. The primary goal of the project was to develop a list or description of a number of possible and probable future health care technologies, as well as information on their importance. Within the limits of time and money, this has been done. However, given the vast number of possible future health care technologies, complete information on the importance of each area could not be developed in any depth for all technology. Therefore, four specific technologies were chosen and were prospectively assessed. These future technologies were examined in more depth, looking particularly at their future health and policy implications. Subsequently, the project was extended to September 1986, and two additional technologies were chosen for assessment.

Gaussian scale-space is one of the best understood multi-resolution techniques available to the computer vision and image analysis community. It is the purpose of this book to guide the reader through some of its main aspects. During an intensive weekend in May 1996 a workshop on Gaussian scale-space theory was held in Copenhagen, which was attended by many of the leading experts in the field. The bulk of this book originates from this workshop. Presently there exist only two books on the subject. In contrast to Lindeberg's monograph (Lindeberg, 1994e) this book collects contributions from several scale space researchers, whereas it complements the book edited by ter Haar Romeny (Haar Romeny, 1994) on non-linear techniques by focusing on linear diffusion. This book is divided into four parts. The reader not so familiar with scale-space will find it instructive to first consider some potential applications described in Part 1. Parts II and III both address fundamental aspects of scale-space. Whereas scale is treated as an essentially arbitrary constant in the former, the latter em phasizes the deep structure, i.e. the structure that is revealed by varying scale. Finally, Part IV is devoted to non-linear extensions, notably non-linear diffusion techniques and morphological scale-spaces, and their relation to the linear case. The Danish National Science Research Council is gratefully acknowledged for providing financial support for the workshop under grant no. 9502164."