The use of ultrasound for various diagnostic techniques in medicine continues to increase in popularity and complexity. It seems possible that the prediction of the National Science Foun dation that ultrasonic techniques may be used as frequently as X-ray techniques by the end of the decade may indeed be fulfilled. The annual scientific meeting of the American Institute of Ultra sound in Medicine is the only meeting held regularly on the North American continent and devoted solely to the diagnostic use of ultrasound. Under these circumstances it is not surprising to find that both the attendance at these meetings and the number of papers submitted for presentation, are increasing markedly each year. The papers presented at these meetings probably reflect the "state-of-the-Art" reasonably accurately. The Proceedings of these annual meetings are therefore a valuable record of the current state of ultrasonic diagnostic techniques in the U.S.A. Even though it is not possible to print in extenso every paper presented at the meeting, an attempt has been made with this volume, by increasing the length of the papers printed in abstract form, to enable the reader to obtain an overall view of current developments and research on this continent in all fields of ultrasonic medical diagnostic technology. Speed of publication is essential if this volume is to contain current information.

An innovative, three-dimensional x-ray imaging technique that enhances projection radiography by adding depth resolution, Tomosynthesis Imaging explores tomosynthesis, an emerging limited-angle tomographic imaging technology that is being considered for use in a range of clinical applications, and is currently being used for breast cancer screening and diagnosis. While conventional mammography has been very successful in reducing breast cancer mortality, it is not perfect. A major limitation of mammography is that the recorded image represents the superposition of complex three-dimensional structures in the breast onto a two-dimensional plane, making detection and diagnosis of breast cancer challenging. Tomosynthesis produces quasi-three-dimensional images that can significantly enhance the visualization of important diagnostic features. This book highlights the flexibility of tomosynthesis systems for new clinical applications, and provides a detailed discussion of the tomosynthesis acquisition process and the impact of physical factors. It explores such topics as acquisition parameters, system components, modeling, image reconstruction algorithms, and system evaluation. Provides in-depth coverage of system design considerations, as well as image reconstruction strategies Describes the current state of clinical applications of tomosynthesis, including imaging of the breast and chest, as well as its use in radiotherapy Illustrates the merits of tomosynthesis imaging and its potential clinical applications in imaging of the breast and chest, as well as for radiation therapy Divided into five sections, this text delves into the history and development of tomosynthesis. It introduces tomosynthesis imaging, discusses imaging system design considerations, and reviews image reconstruction algorithms that have been developed for tomosynthesis. It also describes system evaluation methodologies, emphasizes current clinical applications, and examines the future direction for tomosynthesis.

Magnetic resonance imaging became clinical in 1981 and since that time, has spread in the United States, Europe and Japan like wild fire. The tremendous advantages of the method consisting of safety, superb soft tissue contrast resolution, the ability to study flow, the ability to image in any plane or acquire data in 3D and an almost infinite array of sequences capable of distinguishing between disease and normal tissue, normal and abnormal blood flow make it incomparable for the diagnosis and study of multiple diseases and is particularly valuable in studying the heart and major vessels. The authors of this book have understood that the secret of success of MR imaging in the study of the heart is to combine the knowledge of anatomy of the heart, the coronary vessels, the pericardium and large vessels with the intricacies of MR imaging. This is why they go deeply into the basic principles of NMR, starting from the essentials and going then into detailed techniques of acquiring images from traditional spin echo to gradient echo and ultra fast imaging approaches, such as the multi shot and EPI. The flow phenomena are also discussed in detail from flow and magnetic field gradients diastolic pseudogating.

The key contribution of the approach to x-ray mammographic image analysis developed in this monograph is a representation of the non-fatty compressed breast tissue that we show can be derived from a single mammogram. The importance of the representation, called hint, is that it removes all those changes in the image that are due only to the particular imaging conditions (for example, the film speed or exposure time), leaving just the non-fatty interesting' tissue. Normalising images in this way enables them to be enhanced and matched, and regions in them to be classified more reliably, because unnecessary, distracting variations have been eliminated. Part I of the monograph develops a model-based approach to x-ray mammography, Part II shows how it can be put to work successfully on a range of clinically-important tasks, while Part III develops a model and exploits it for contrast-enhanced MRI mammography. The final chapter points the way forward in a number of promising areas of research. Audience: This book has been written for a wide readership, including medical image analysts, medical physicists, radiologists, breast surgeons, and research students. The mathematics and algorithms have been relegated to boxes so that the book can be read and understood even if the mathematical detail is skipped. Large parts of the monograph will be of interest to clinicians generally and to patients.

Since the introduction of myocardial perfusion imaging and radionuclide angiography in the mid-seventies, cardiovascular nuclear medicine has undergone an explosive growth. The use of nuclear cardiology techniques has become one of the cornerstones of the noninvasive assessment of coronary artery disease. In the past 15 years major steps have been made from visual analysis to quantitative analysis, from planar imaging to tomographic imaging, from detection of disease to prognosis, and from separate evaluations of perfusion, metabolism, and function to an integrated assessment of myocardial viability. In recent years many more advances have been made in cardiovascular nuclear imaging, such as the development of new imaging agents, reevaluation of existing procedures, and new clinical applications. This book describes the most recent developments in nuclear cardiology and also addresses new contrast agents in MRI. What's New in Cardiac Imaging will assist the clinical cardiologist, the cardiology fellow, the nuclear medicine physician, and the radiologist in understanding the most recent achievements in clinical cardiovascular nuclear imaging.

The imaging aspects of radiography have undergone con many sources and was in general freely given when requested siderable change in the last few years and as a teacher of and this is gratefully acknowledged. In particular I would radiography for many years I have often noticed the lack of a like to express my sincere thanks for help and information to comprehensive reference book for students. This book is an Mr J. Day of DuPont (UK) Ltd. particularly for the infor attempt to correct that situation and I hope this text will be mation and illustrations in the chapter on automated film of value not only to student radiographers but also prac handling; Mr D. Harper and Mr R. Black of Kodak Ltd. ; tising radiographers as well. Fujimex Ltd. ; CEA of Sweden; 3M (UK) Ltd. ; Wardray Much of the information is based on personal experiment Products Ltd. ; D. A. Pitman Ltd. ; Agfa-Gevaert; PSR Ltd. and the knowledge gained of students' difficulties in studying for their help with information on silver recovery, and this subject. I have attempted to gather together in one book Radiatron Ltd. for their help with safelighting. All were most all the information required to understand the fundamentals helpful in my many requests for information. of the subject both for examination and for practice. Some To Mrs A. Dalton and Mrs P.

Das vorliegende Buch enth{lt die Beitr{ge eines internatio- nalen Symposiumszum Thema "Stimulierte Hirndurchblutung." Vorgestellt werden zun{chst neue Erkenntnisse zur Regulation der Hinrdurchblutung. Im 2. Abschnitt kommen verschiedene Methoden zur Messung der Hirndurchblutung zur Sprache, die sowohl unter experimentellen als auch unter klinischen Be- dingungengetestet wurden. Es folgt ein Abschnitt, der ver- schiedene M-glichkeiten zur Stimulation der Hirndurchblutung aufzeigt. Im letzten Abschnitt wird aufdie Bedeutung der stimulierten Hirndurchblutungsmessung zur Bestimmung der ce- rebrovascul{ren Reservekapazit{ten hingewiesen. Dieser Para- meter hat nach den vorliegenden Untersuchungen klinisch- praktische Bedeutung, beispielsweise f}r die Indikations- stellung bei cerebrovascul{ren Eingriffen zur Isch{mie-Pro- phylaxe.

This book was conceived with the object of presenting to doctors and medical students with a potential interest in the disciplines of orthopaedic surgery, diagnostic radiology and orthopaedic pathology, a volume which would contain basic and essential information concerning those disorders of the skeleton in which a common interest exists. Diagnosis in such conditions is dependent on close collaboration between specialists in these subjects. As medical knowledge has advanced, so the necessity for detailed specialisation has increased. As a result co-operation in a combined approach has become of great importance. The method of presentation, in the form of Exercises, is designed to permit readers to test their own diagnostic ability. The book consists of ninety-four problems of diagnosis which might be encountered in any orthopaedic unit. The case material has been chosen to emphasise those conditions in which appreciation and integration of the clinical, radiological and pathological features are required in order to establish the diagnosis.

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons }Vhy such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

The most meaningful reward to clinicians and researchers is the absence of recurrent malignancy in their patients. While in some patients the disease will be cured by resection alone, in other similarly staged cases the disease will recur despite adequate loco regional and systemic therapies. Hence, risk assessment is a complex issue with many related or unrelated prognostic factors determining outcome. The purpose of this volume is to review some of the most relevant prognostic factors of newly diagnosed breast cancer, focusing on fea tures determining the magnitude of risk. The ultimate value of establishing the significance of each prognostic factor in a given patient will be the resulting ability to plan individu alized therapies for patients at different risk of recurrence at the time of diagnosis. To secure the maximum benefit for high-risk patients, while avoiding undue toxicity in those with low-risk lesions, a well-integrated analysis of all known prognostic factors will be essential in the early postdiagnos tic period. In addition to well-established staging criteria such as axillary nodes, tumor size, receptors, scanning and radiographic examinations, the more sophisticated labora tory techniques, as discussed by several authors herein, will playa crucial role in risk assessment. Most of them, - ploidy determination, oncogenes, tumor markers, monoclonal anti bodies, growth factors, etc. -are presently available in only a minority of treatment centers.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

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 proce dures. Individual volumes will deal with iatrogenic complications involving (I) 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 autosug gestion, 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 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 generally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accom few decades, many are at times associated with certain side-effects plished in the past 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."

In the last two decades imaging of the brain, or neuroimaging, has become an integral part of clinical and research psychiatry. This is due to recent advances in computer technology, which has made it relatively easy to generate brain images representing structure and function of the central nervous system. Currently used clinical diagnostic imaging modalities, such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI) , provide predominantly anatomic information. CT images reflect X-ray attenuation distribution within the brain, whereas MRI signals depend primarily on proton sensitivity and tissue relaxivity. The chapter "Structural Imaging Methods" reviews CT and MRI studies on schizophrenic and affective disorders and degenera tive central nervous system diseases. The impact of fast three dimensional (3-0) imaging and the automatic transfer from 3-D elements in the brain to artificial diagrams based on this information is considered. Since the original report of the findings of Ingvar and Franzen in 1974 and the introduction of regional cerebral blood flow (rCBF) measurements, single photon emission computed tomography (SPECT) has been gaining acceptance as one of the major imaging techniques, and it is available in most nuclear medicine depart ments. The section "Functional Imaging Methods (Cerebral Blood Flow - CBF, Single Photon Emission Computerized Tomography - SPECT)" describes rCBF studies with the 133Xe inhalation method utilizing a 254 detector system and rCBF images measured by SPECT using the tracer 99mTc-HMPAO.

Neurosurgery o/the Future: Computers and Robots in Clinical Neurosurgical Practice and in Training - a Philosophical Journey into the Future Many present day neurosurgeons believe that they already obtain good results in operative surgery with the benefit of the operating microscope and other aids which have become available in the last three decades and that the introduction of computers and robots to the operating theatre is superfluous. However, it is clear from analogy with the function of the airline pilot, another profession where there are great demands on manual skill and on spatial awareness, that these devices do have much to offer neurosurgery. Classical neurosurgery, in the time of Cushing, Dandy and Scarff, was based on a three dimensional picture of the patient's brain formed in the surgeon's mind and often illustrated in elegant drawings. Such pictures were based on neuroradiological studies by pneumoencephalography, ventriculography or by angiography. Generally these stud ies showed the presence and position of a lesion by displacement of normal brain structures and the picture was built up by interference. This was then converted by the experienced neurosurgeon into a plan for the craniotomy site and the trajectory of the surgical approach. Once the brain was exposed further pre-operative information was obtained by visual inspection and by palpation with the brain needle. These classical forms ofneuroradiology have largely been superseded by computerised tomography and by magnetic resonance imaging."

Cervical Spine Research Society European Branch "The Cervical Spine Research Society is an organization of individuals interested in clinical and research problems of the cervical spine. Its purpose is for the exchange and development of ideas and philosophy regarding the diagnosis and treatment of cervical spine injury and disease. The com position of the membership should reflect the varying specialities and disciplines dealing with the cervical spine; biochemical, engineering, neurology, neurosurgery, radiology, orthopedic surgery and others," wrote J. William Fielding, New York City, one of the Society'S founding members. In 1984 the membership list contained 118 names. The overwhelming majority of members came from the United States, four from Canada and 9 Europeans, amongst them Mario Boni. He was the organizer, in con junction with the members of the Cervical Spine Research Society, of a splendid "International Meeting for the updating on pathology and surgery Preface VI of the cervical spine" held in Pavia (Italy) in May 1982. It was from this meeting that the idea of a European branch of the Society first originated, with the purpose of establishing multi-disciplinary meetings in Europe. The first meeting of the European branch was organized by A. Weidner in September 1984 in Osnabriick (Federal Republic of Germany). Mario Boni was elected president. He was not only the initiator but also the drivinglorce who tirelessly promoted the development of the European branch. Mario Boni's death in 1986 at the age of 64 was a great loss to us."

Recent years have witnessed major developments in diagnostic imaging methods. The facilities for these new methods are sometimes expensive. and not always accessible. yet they continue to improve and to change. It is essential that those concerned with orthopaedic imaging should appreciate not only recent developments but also the changes likely to occur during the next few years. It is also important that the indications. contraindications. uses and complications for each individual imaging technique should be understood. This book is an attempt to provide such information for orthopaedic surgeons. diagnostic radiologists. and other clinicians. par ticularly those in training or those who are involved in management of patients with disorders of the musculoskeletal system. In the first part of the book the different imaging techniques are discussed. with emphasis on advantages and disadvantages. indications and contraindica tions. In the second part. authors have been asked to discuss ways in which specific groups of disorders might be investigated. It is hoped that the reader will obtain from this section a balanced view of the different diagnostic imaging methods. the indications for their use. and the sequence in which they might be carried out. The Editors are grateful to aU authors for the time and work they have put into their individual chapters. They are also grateful to the publishers. in particular Michael Jackson. for help given in the preparation of this book. Manchester C. S. B. Galasko I.

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.

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.

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.

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."

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."