It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

Avascular Necrosis (AVN) is a disease resulting from temporary or permanent loss of blood supply. It frequently affects the femoral head and in this area, if left untreated, routinely causes premature joint destruction.

In the USA, 5 to 10% of cases of hip osteoarthritis requiring total hip replacement are primarily caused by AVN. In 33 to 72% of patients, the disease is bilateral. The peak incidence is between 30 and 60 years of age, and the social costs of this pathology are remarkable. There is therefore increasing interest in hip joint preserving techniques such as conservative treatment through electromagnetic fields and shockwaves as well as joint preserving surgical techniques. This volume aims to present a complete overview of the current knowledge on AVN including therapeutic options.

Owing to the anatomic complexity of the neck and the diver sity of pathologic entities affecting it, the cervical region has long been of great semiological interest. Physical examination is an easy means of evaluating the size and origin of a solitary cervical mass, yet valid interpretation can prove difficult when the normal morphology of the neck has been altered; excellent examples are patients with extensive fibrosis or scarring secondary to previous irradiation or surgery. Like wise, physical examination cannot assess the relations of a pathologic process to adjacent structures - e. g., invasion can not be distinguished from simple displacement -and it is un suitable for monitoring therapeutic efficacy, such as the re sponse of metastatic nodes to medical management. Between physical examination, which remains fundamental, and exploratory surgical procedures, which are often the only means of obtaining indispensable anatomic proof for diagno sis, lie a number of recent imaging techniques including com puted tomography and magnetic resonance imaging using surface coils that provide invaluable information for the in vestigation of cervical pathologies. Real-time ultrasonogra phy occupies a privileged position because of its noninvasive ness, rapidity, and reliability, especially when performed by a specially trained examiner."

The acute abdomen is one of the most frequent, most dangerous and most difficult problems that the diagnostic radiologist has to deal with. This comprehensive manual presents a clinico-radiologic approach to the use of diagnostic imaging techniques for acute abdominal conditions. Imaging techniques, radiologic symptoms and clinical conditions are treated separately. This lucid format, together with a detailed subject index, offer the reader a quick and reliable reference aid in daily practice. The text is clearly structured and concise in style, and provides helpful practical hints, including discussion of diagnostic pitfalls. It is supported by a wealth of illustrations covering native diagnosis, ultrasonography, computer tomography and angiography.

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."

by Dr. Jan. J. Smulewicz Ultrasound imaging has reached a stage of sophistication where by diagnostic information can be gained without discomfort to the patient and with complete absence of morbidity and mortality. The procedure is quick, safe, noninvasive and in many instances can supersede and obviate more time-consuming procedures requiring catheterization, injection of a contrast material, and radiographic imaging. In obstetrical problems the danger of ionizing radiation to the fetus is eliminated. In debilitated and very ill patients this simple and painless method becomes the procedure of choice. Unique features of ultrasound equipment allow for pinpoint local ization oflesions and direct visual guidance of percutaneous puncture techniques for aspiration and biopsy. The accuracy of ultrasound guided punctures and the absence of side effects make this modality far superior to percutaneous invasive techniques performed with other imaging systems. Renal cyst puncture and amniocentesis are but two of the procedures in which ultrasonic guidance is the method of choice. v Dr. Hassani has throughly explained and carefully explored the wide variety of exam inations available with ultrasound. The large volume of material and the clear interpre- tion makes this book of great interest to all of the medical profession. In addition to the existing methods available for diagnostic in terpretations, this method of noninvasive diagnosis should find its way into every hospital or center where good medical care is provided. JanJ. Smulewicz, M.D."

Very thorough knowledge of breast pathology is a sine qua non for interpretation of breast films ... progress in X-ray diagnosis could only be made by careful comparison of the film with the actual specimen. H.INGLEBY Multiplication of the same e"oneous diagnosis does not make that diagnosis co"ect. J.G.AzZOPARDI Paradoxically enough, our specialty considers the radiologist who mis takes a skin fibroma or the calcifications in a sponge kidney for a kid ney stone to lack basic knowledge, while the radiologist who imme diately calls for the surgeon because of a few white spots on a mammogram is thought to be acting according to the rules of medical practice. Misunderstandings and confusion with regard to breast pathology as well as the comfortable philosophy that superfluous biopsies are the price we have to pay for the early detection of carcinomas have in many places led to a loss of confidence in mammography. Yet this is a meth od with which carcinomas can be detected earlier than with any other imaging technique.

Vascular diagnostics traditionally rely on x-ray angiography. This approach remains even today essential in the clinical work-up of patients with vascular pathology. Recently, however, newer imaging modalities have been intro duced to assess vascular disease. Among these the color Doppler flow and magnetic resonance imaging appear the most promising. Due to their noninva sive character both methods are ideally suited for screening as well as serial follow-up of vascular patients. The emergence of color Doppler flow and magnetic resonance vascular imaging coincides with new concepts in vascular medicine. Today, vascular prevention and percutaneous interventions are becoming the leading compo nents in modern vascular care. It is in this new and exciting environment of novel vascular concepts where the demand for reliable noninvasive vascular imaging is becoming a high priority. Color Doppler flow and magnetic reso nance vascular imaging are well on the way to satisfy this demand. This textbook provides the long awaited information on vascular imaging by color Doppler flow and magnetic resonance. The text covers the essentials of vascular anatomy, physiology and noninvasive imaging technology before providing a state-of-the-art review of their current clinical applications. All chapters are written by competent scientists and clinicians in a clear, conscise and yet thorough and exhaustive manner. The coherent and didactic composi tion of the textbook allows the reader an easy access to the elementary as well as the advanced principals and clinical applications of the modern noninvasive vascular imaging.

Echocardiography has recently become one of' the most important techniques in clinical cardiology. The major advantage of this method is its noninvasive nature enabling us to apply it under a widespread variety of clinical conditions. In the late 1960s, when research and clinical application of echo cardiography were started, and during the first decade investigations were mainly focused on the morphology of the valves and the chambers of the heart. The introduction of two-dimensional echocardiography was a major breakthrough in visualizing different portions of the heart. How ever, the poor resolution of the first devices provided only little qualitative information. With the introduction of phased array 2-D-echo-devices yielding better results and the application of computer techniques for the processing of M-mode and two-dimensional echo cardiograms, a great amount of qualitative information has become available to describe not only the morphology, but also the dynamic function of the heart in a noninvasive manner. This volume summarizes the lectures held at the International Symposium on Echocardiography, Hamburg, September 1978, endeavoring to review the current state of knowledge with regard to echo cardiography in the experimental and clinical setting. We herewith thank all lecturers, who have contributed to the publication and the Pharma-Schwarz Company which enabled us to organize this meeting by a generous subsidy."

3.2 Technique ............. '. . . . . . . 123 3.3 Drainage Catheters: Materials and Selection . 139 3.4 The Loop Catheter . . . . . . . . . . 141 4 Aspiration of Pancreatic Pseudocysts 145 E. Concluding Remarks 149 151 References " Subject Index . 158 VII List of Contributors BURGER, H. R, Dr. med., Oberarzt, Institut fur Pathologie, Univer sitiit Zurich, SchmelzbergstraBe 12, CH-8091 Zurich EINIGHAMMER, H.J., Dipl. Phys., Dr. rer. nat., Neurologische Uni versitatsklinik, MoorenstraBe 5, 0-4000 Dusseldorf HAUKE, R, Dipl., Phys., Dr. rer. nat., Gesellschaft fur Medizin. Techn. Informationssysteme, MarienstraBe 2,0-7910 Neu-Ulm PEmo, G., Professor Dr. med., Leitender Arzt, Abteilung fUr Zytolo gie, Institut fur Pathologie, Universitatsspital, CH-8091 Zurich " ... so it is not good for men to fear all that is not already known and settled, and thus feel that it is bad and harmful to strive for a greater perfection than already exists." Holderlin to his mother, 16. November 1799 A. Introduction 1 General The modem cross-sectional imaging methods of sonography and computed to mography, developed in the early 1970s, have contributed greatly to noninva sive studies of the parenchymatous organs and permit the evaluation of patho logic changes in areas that were previously accessible only to invasive, indirect, or inadequate examination."

In January 1995, 300 participants from Asia, USA, and Europe lively discussed the "State of the Art and Future Aspects of CT" in Peking, China. The workshop was designed to cover all essential aspects of modern CT imaging including the historical development, different techniques, contrast agents, organ systems, and indications. The comparative evaluation of CT versus MRI and ultrasound was a central topic. Additionally, a special session was dedicated to "Angiography Tomorrow." This book summarizes the state of the art in both conventional and spiral CT imaging and provides some suggestions as for the future role of the method.

This is a unique book in that it brings together the two key investigative techniques in Gynaecology and Obstetrics, namely ultrasound and endoscopy. So often in the past they were regarded by their exponents as rival techniques but it is now recognised that they are complementary to each other. Consequently future trainees in endoscopy should become efficient in transvaginal sonography and vice versa. Ultrasound can be used to study the morphology of the pelvic organs such as the endometrium, myometrium and ovaries, and being non-invasive, safe and convenient can be repeated as often as is deemed necessary to monitor changes over time; for example in the investigation of the infertile woman the development of the dominant follicle, the maturation of the endometrium and the formation of the corpus luteum can be documented throughout the menstrual cycle while growth of ovarian cysts can be precisely measured to determine the need for surgery. A seldom-mentioned strength of the ultrasound examination is its interactive quality, for example by performing abdominal palpation during the scan, the mobility of the uterus and ovaries can be assessed. Also the images as they appear can be shown to the patient to aid understanding. Ultrasound can also determine function and the use of Doppler has been used for example to access endometrial receptivity, follicular maturity and the likelihood of malignancy in the endometrium or ovary.

Diagnostic ultrasound is changing dramatically because of the development of a variety of high resolution real-time scanning instruments. Until recently the standard instrument was the articulated arm contact scanner. Real-time scanners were viewed as adjunct instruments for specific and limited pur poses. The roles are reversing with real-time instruments more frequently accepted as the primary diagnostic tool and the contact scanner becoming the ancillary instrument for use mainly for viewing a large field that cannot be scanned with real-time instruments. Two recent editorials stated that real-time instruments were used as the sole diagnostic instrument for between 80% [Cooperberg (2)] and 98% [Bartrum and Crow (1)] of their abdominal examinations. This book introduces the reader to the field of real-time scanning in the abdomen. It presupposes an understanding of basic physical concepts of ultrasound, the appearance of both normal and pathologic conditions as produced by static articulated arm contact scanning, and a familiarity with the techniques of contact scanning. It is designed to acquaint the reader with the spectrum of real-time instrumentation, provide a basic understanding of the physics of ultrasound as related to these instruments, emphasize the special skills required in the use of this equipment, and describe applications of real-time scanning for various parts of the abdomen. While numerous illustrations of both normal and pathologic anatomy are shown, the book is an all-inclusive study of abdominal pathology as demonstrated by real-time imaging.

by Dr. Donald L. King The past decade has seen the ascent of ultrasonography to a preeminent position as a diagnostic imaging modality for obstetrics and gynecology. It can be stated without qualification that modern obstetrics and gynecology cannot be practiced without the use of diagnostic ultrasound, and in particular, the use of ultrasonogra phy. Ultrasonography quickly and safely provides detailed, high resolution images of the pelvic organs and gravid uterus. The quality and quantity of diagnostic information obtained by ultra sonography far exceeds anything previously available and has had a revolutionary impact on the management of patients. High resolution static images permit the intrauterine diagnosis of fetal growth retardation and fetal abnormalities. In addition to tradi tional images, newer dynamic imaging techniques allow observa tion of fetal motion, cardiac pulsation, and respiratory efforts. The use of ultrasonography for guidance has greatly augmented the safety and utility of amniocentesis. One of the great virtues of diagnostic ultrasound has been its apparent safety. At present energy levels, diagnostic ultrasound appears to be without any injurious effect. Although all the availa ble evidence suggests that it is a very safe modality and that the benefit to risk ratio is very high, the actual safety margin for its use Vll as yet remains unknown. As a consequence, practitioners are urged to limit its use only to those situations in which genuine clinical indica tions exist and real benefit to the patient is likely to result."

Any book with the words percutaneous and interventional is immediately identified as one that brings to its readers a distillation of a number of new and exciting techniques. Percutaneous is not exactly a new word but it has come to take on an entirely new meaning in recent years. Interventional is a recent acquisition to medical language indicating an entirely new approach to many aspects of medical management. Exactly when is the right time to make a distillation of new thoughts and expertise requires something of the art of a master brewer. First the ingredients must be prepared, the recipe must be just right, there must be excellent quality control as well as the master brewer's touch to produce the product when the time is right. Dr. Lang has assembled just the right ingredients in the form of a very impressive team of experts in these new fields of uroradiology and urological management. Ventures into percutaneous urology may date back 30 years but the main growth in the range of procedures and the development of the technology has occurred only in the last 10 years. Relieving upper tract obstruction seemed a natural sequel to renal biopsy but the imagination to develop an effective treatment for stones was an impressive extension of the concept of minimally invasive surgery.

For the fourth English edition, this highly popular book has been thoroughly revised and updated to include such new sections as endoscopic digestive US and abnormalities related to AIDS. It is the only work available covering the diagnostic US of the whole abdomen, and its superb treatment of elementary symptoms enables beginners to become familiar with more complicated features. After an extensive technical introduction, the book covers the sonoanatomy and ultrasonic symptomatology of the diseases of the digestive system and the abdominal vessels. Numerous tips on avoiding pitfalls, as well as indications for other procedures, and backed by some 1000 illustrations, this is well on its way to becoming a standard text for practitioners and clinicians in the field.

Sonography is an ideal real-time imaging technique for the evaluation of muscles and tendons of the extremities, and this book is a useful reference for both the technique of examination and normal ultrasound anatomy. The first part considers technical aspects of the examination such as sonographic equipment, water-path systems, and dynamic maneuvers. The basic sonographic patterns of normal muscles, tendons, and other components of the extremities are then presented. Emphasis has been placed on pitfalls and artifacts. The other available imaging techniques for muscles and tendons are also discussed. The second part comprises an atlas of normal ultrasound scans of shoulder, arm, elbow, forearm, wrist, hand, thigh, knee, leg, ankle, and foot, with accompanying explanatory line drawings.

Intrauterine Growth Restriction: Aetiology and Management will be the first book to focus exclusively on this extremely important and common complication of pregnancy. There have been many recent developments in our understanding of the aetiology and pathogenesis of the condition as well as in screening, monitoring and therapy. This book is unique in that it covers both the aetiology and pathogenesis as well as clinical management and also includes sections on definitions and potential future advances. Every aspect is covered by an international expert which will provide the reader with a valuable insight into this condition.

Cardiac ultrasound has rapidly developed into one of the most important clinical methods for diagnosis and follow-up of patients with heart disease and has changed the practice of cardiology permanently. In addition to improving image quality, most of the progress relies on digital image acquisition, storage, and quantitative analysis equipment. Automatic endocardial detection and three- dimensional reconstruction are now being developed. The progress with contrast echocardiography for myocardial perfusion imaging and results with tissue characterization is slow, but ever increasing, illustrating that the full potential of the method has not yet been explored. All of these digital techniques are extensively dealt with in this volume. Computerized tools will help the clinical cardiologists in their daily practice and stimulate further development to gen- uinely improve patient care in the coming years. We wish to thank the authors to this volume for their excellent contribution and Mrs. T. van der Kolk for secretarial assistance. IX Contributors F. J. ten Cate Thorax Center, Erasmus University, P. O. Box 1738, 3000 DR Rotterdam, The Netherlands R. Erbel II Medical Clinic, Johannes Gutenberg University, Langenbeckstr. 1, P. O. Box 3960, D-6500 Mainz, FRG Co-authors: R. Zotz, B. Henkel, G. Schreiner, C. Steuernagel, R. Zahn, H. Kopp, W. Clas, R. Brennecke, P. Schweizer, J. Meyer S. B. Feinstein Division of Cardiology, Box 44, University of Chicago, 950 East 59th Street, Chicago, IL 60637, USA D. G. Gibson Department of Cardiology, Brompton Hospital, Fulham Road, London SW3 6HP, UK Co-author: R. B. Logan Sinclair E.

Ultrasound (US) prenatal screening has been proposed as the most effective technique for Trisomy 21 early assessment. Assessment of Nuchal Translucency (NT) offers promising non-invasive method for fetal abnormalities detection up to 75%. Nevertheless, current clinician practice of NT examination by locating the sonogram calipers on 2D US image requires highly trained and competent operators by adhering to a standard tedious protocol; therefore it is prone to errors and hence it decreases the reliability in intra- and inter-observer repeatability. This Brief provides the basic knowledge regarding Trisomy 21 diseases and its existing detection methods. The restrictions and disadvantages of each method are discussed accordingly. Therefore, a non-invasive early detection method using 3D ultrasound reconstruction of Nuchal Translucency is introduced. This new method for 3D NT assessments has an edge over the previous 2D methods, and entails the composite function in visualizing the explicit internal marker structure. Further, image processing techniques covered from data acquisition, pre-processing, speckle noise reduction and 3D segmentation are also discussed. This should be especially useful for students and professional researchers in the Biomedical and image processing fields.

New developments in the field of high resolution imaging focus on functional parameters pertaining to disease-specific medical imaging. Such new diagnostic strategies are possible using scintigraphic techniques and, more recently, by MRI and US. In addition, new therapeutic concepts, including gene therapy, require specific tracers or contrast media for therapy monitoring, for example, enzyme activity and changes in receptor expression. For this purpose scientists conducting basic research, expecially molecular biologists, and clinicians must collaborate in order to exploit the available interdisciplinary knowledge in the development of new imaging technologies so as to incorporate the molecular signals of diseases.

"Diagnostic Ultrasound Imaging" provides a unified description of the physical principles of ultrasound imaging, signal processing, systems and measurements. This comprehensive reference is a core resource for both graduate students and engineers in medical ultrasound research and design. With continuing rapid technological development of ultrasound in medical diagnosis, it is a critical subject for biomedical engineers, clinical and healthcare engineers and practitioners, medical physicists, and related professionals in the fields of signal and image processing.

The book contains 17 new and updated chapters covering the fundamentals and latest advances in the area, and includes four appendices, 450 figures (60 available in color), and almost 1,500 references. In addition to the continual influx of readers entering the field of ultrasound worldwide who need the broad grounding in the core technologies of ultrasound, this book provides those already working in these areas with clear and comprehensive expositions of these key new topics as well as introductions to state-of-the-art innovations in this field.
Enables practicing engineers, students and clinical professionals to understand the essential physics and signal processing techniques behind modern imaging systems as well as introducing the latest developments that will shape medical ultrasound in the futureSuitable for both newcomers and experienced readers, the practical, progressively organized applied approach is supported by hands-on MATLAB(r) code and worked examples that enable readers to understand the principles underlying diagnostic and therapeutic ultrasoundCovers the new important developments in the use of medical ultrasound: elastography and high-intensity therapeutic ultrasound. Many new developments are comprehensively reviewed and explained, including aberration correction, acoustic measurements, acoustic radiation force imaging, alternate imaging architectures, bioeffects: diagnostic to therapeutic, Fourier transform imaging, multimode imaging, plane wave compounding, research platforms, synthetic aperture, vector Doppler, transient shear wave elastography, ultrafast imaging and Doppler, functional ultrasound and viscoelastic models

The aim of this work was not an exhaustive review of all pediatric echo graphic problems but a presentation of our daily experience with ultrasonography in pediatric practice. Several teams of pediatric radiologists from France and Belgium have combined their experiences to produce a practical book. The different authors have been chosen for their specific experience and their special area of work. The different chapters express therefore personal opinions. Unresolved questions are posed and ultrasonographic examinations are used in the diagnosis of different diseases, while the discoveries and ideas of the individual authors are described. Some fields are not included, such as echocardiography. Gabriel Kalifa Contents Chapter 1. Antenatal Diagnosis by Ultrasonography . . . . . . . . . . . . . . 1 . . . Introduction ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Ultrasonography of a Normal Pregnancy ...................... 1 2.1 Timing of Successive Examinations. . . . . . . . . . . . . . . . . . . . . . . 1 2.2 Normal Fetal Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2.1 Central Nervous System .......................... 3 2.2.2 Chest........................................... 3 2.2.3 Abdomen....................................... 3 2.2.4 Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . .