(BQ) Part 1 book “Computed body tomography with MRI correlation” has contents: Magnetic resonance imaging principles and applications, interventional computed tomography, interventional computed tomography; heart and pericardium,… and other contents.
5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page i 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page i Computed Body Tomography with MRI Correlation FOURTH EDITION 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page ii 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page iii Computed Body Tomography with MRI Correlation FOURTH EDITION EDITORS JOSEPH K T LEE, MD E H Wood Distinguished Professor and Chair Department of Radiology University of North Carolina School of Medicine Chapel Hill, North Carolina STUART S SAGEL, MD Professor of Radiology Director, Chest Radiology Section Mallinckrodt Institute of Radiology Washington University School of Medicine St Louis, Missouri ROBERT J STANLEY, MD, MSHA Editor-in-Chief American Journal of Roentgenology Professor and Chair Emeritus, Department of Radiology University of Alabama at Birmingham Birmingham, Alabama JAY P HEIKEN, MD Professor of Radiology Director, Abdominal Imaging Section Mallinckrodt Institute of Radiology Washington University School of Medicine St Louis, Missouri 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page iv Acquisitions Editor: Lisa McAllister Managing Editor: Kerry Barrett Project Manager: Fran Gunning Manufacturing Manager: Ben Rivera Marketing Manager: Angela Panetta Design Coordinator: Teresa Mallon Production Services: Nesbitt Graphics, Inc Printer: Maple Press © 2006 by LIPPINCOTT WILLIAMS & WILKINS 530 Walnut Street Philadelphia, PA 19106 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in the USA Library of Congress Cataloging-in-Publication Data Computed body tomography with MRI correlation / editors, Joseph K.T Lee, Stuart S Sagel.— 4th ed p ; cm Includes bibliographical references and index ISBN 0-7817-4526-8 Tomography Magnetic resonance imaging I Lee, Joseph K T II Sagel, Stuart S., 1940- III Title [DNLM: Tomography, X-Ray Computed Magnetic Resonance Imaging WN 206 C7378 2005] RC78.7.T6C6416 2005 616.07’57—dc22 2005029421 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page v To our wives, Christina, Beverlee, Sally, and Fran To our children, Alexander, Betsy, and Catherine; Scott, Darryl, and Brett; Ann, Robert, Catherine, and Sara; and Lauren And to our grandchildren 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page vi 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page vii Contents Contributing Authors ix Preface xi Acknowledgments xiii BASIC PRINCIPLES OF COMPUTED TOMOGRAPHY PHYSICS AND TECHNICAL CONSIDERATIONS Kyongtae T Bae and Bruce R Whiting MAGNETIC RESONANCE IMAGING PRINCIPLES AND APPLICATIONS 29 Mark A Brown and Richard C Semelka INTERVENTIONAL COMPUTED TOMOGRAPHY 95 Charles T Burke, Matthew A Mauro, and Paul L Molina NECK 145 Franz J Wippold II THORAX: TECHNIQUES AND NORMAL ANATOMY 225 Fernando R Gutierrez, Santiago Rossi, and Sanjeev Bhalla 12 LIVER 829 Jay P Heiken, Christine O Menias, and Khaled Elsayes 13 THE BILIARY TRACT 931 Franklin N Tessler and Mark E Lockhart 14 SPLEEN 973 David M Warshauer 15 THE PANCREAS 1007 Desiree E Morgan and Robert J Stanley 16 ABDOMINAL WALL AND PERITONEAL CAVITY 1101 Jay P Heiken, Christine O Menias, and Khaled Elsayes 17 RETROPERITONEUM 1155 David M Warshauer, Joseph K T Lee, and Harish Patel 18 THE KIDNEY AND URETER 1233 Mark E Lockhart, J Kevin Smith, and Philip J Kenney 19 THE ADRENAL GLANDS 1311 Suzan M Goldman and Philip J Kenney MEDIASTINUM 311 Alvaro Huete-Garin and Stuart S Sagel 20 PELVIS 1375 Julia R Fielding LUNG 421 Stuart S Sagel 21 COMPUTED TOMOGRAPHY OF THORACOABDOMINAL TRAUMA 1417 Paul L Molina, Michele T Quinn, Edward W Bouchard, and Joseph K T Lee PLEURA, CHEST WALL, AND DIAPHRAGM 569 David S Gierada and Richard M Slone HEART AND PERICARDIUM 667 Pamela K Woodard, Sanjeev Bhalla, Cylen Javidan-Nejad, and Paul D Stein 10 NORMAL ABDOMINAL AND PELVIC ANATOMY 707 Dennis M Balfe, Brett Gratz, and Christine Peterson 11 GASTROINTESTINAL TRACT 771 Cheri L Canon 22 MUSCULOSKELETAL SYSTEM 1481 Robert Lopez-Ben, Daniel S Moore, and D Dean Thornton 23 THE SPINE 1661 Zoran Rumboldt, Mauricio Castillo, and J Keith Smith 24 PEDIATRIC APPLICATIONS 1727 Marilyn J Siegel Index 1793 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page viii 5063_Lee_FMppi-xiv 10/20/05 12:44 PM Page ix Contributing Authors Associate Professor of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Julia R Fielding, MD Professor of Radiology, Department of Diagnostic Radiology, Washington University School of Medicine, St Louis, Missouri David S Gierada, MD Assistant Professor of Radiology, Co-Chief, CT and Emergency Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Suzan Menasce Goldman, MD, PhD Kyongtae T Bae, MD, PhD Dennis M Balfe, MD Sanjeev Bhalla, MD Radiology Resident, University of North Carolina School of Medicine, Chapel Hill, North Carolina Edward W Bouchard, MD Senior Technical Instructor, Siemens Training and Development Center, Cary, North Carolina Mark A Brown, PhD Associate Professor and Director of Abdominal Imaging, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina Associate Professor of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Affiliated Professor, Imaging Diagnosis Department, UNIFESP/EPM, São Paulo, Brazil Instructor in Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Brett Gratz, MD Professor of Radiology, Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Fernando R Gutierrez, MD Assistant Professor of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina Jay P Heiken, MD Associate Professor, Vice Chair for Education, Department of Radiology, University of Alabama at Birmingham; Chief, Gastrointestinal Radiology, Department of Radiology, UAB Health System, Birmingham, Alabama Alvaro L Huete-Garin, MD Charles T Burke, MD Cheri L Canon, MD Professor and Director of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina Mauricio Castillo, MD Khaled M Elsayes, MD Institute, Giza, Egypt Staff Radiologist, Theodore Bilhars Professor of Radiology, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Assistant Professor of Radiology, Catholic University, Santiago, Chile Assistant Professor of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri Cylen Javidan-Nejad, MD Director of Outpatient Radiology and Chief, GU Section, Professor, Abdominal Imaging Section, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama Philip J Kenney, MD 5063_Lee_Ch11pp0771-0828 10/13/05 2:59 PM Page 814 814 Chapter 11 M B A Figure 11-67 Metastatic squamous cell carcinoma with carcinomatosis 59-year-old man with base of tongue squamous cell carcinoma Patient had extensive metastatic disease involving the brain, neck, skin, abdomen, and pelvis A: CT through the upper abdomen reveals multiple large liver metastases and retrocrural adenopathy (arrow) B: Innumerable metastatic nodules are present in the omentum and mesentery Large mesenteric mass (M) has invaded the adjacent transverse colon, resulting in an annular stricture Squamous cell carcinoma can occur in the anal canal It does not have any discriminating features from adenocarcinoma Carcinoid can occur anywhere in the colon, but it is more common in the rectum These tumors have a similar appearance as carcinoid tumors in the small bowel, and they most commonly present with a metastatic mesenteric mass Carcinoids arising in the colon, rectum, and appendix have a better prognosis than those arising in the stomach, duodenum, and small bowel (248,252) Metastatic disease involving the colon can occur hematogenously (Fig 11-67), as in lung and breast cancer, but it occurs secondary to peritoneal seeding more commonly This is most frequently due to ovarian carcinoma Outside of retention and neoplastic mucoceles, tumors of the appendix are rare The most common appendiceal tumor is carcinoid It usually appears as a focal mass in the distal appendix, and it seldom metastasizes Non-Hodgkin lymphoma can also rarely involve the appendix Most patients with lymphoma of the appendix present with acute symptoms of appendicitis On CT, lymphomatous involvement appears as a diffusely enlarged appendix, typically larger than those affected by appendicitis, generally with a diameter of cm or greater (219) This is similar to the aneurysmal dilatation seen in small bowel lymphoma Inflammation and tumor extension can appear as soft-tissue strands extending into the periappendiceal fat, so this finding cannot be used as a discriminator from appendicitis Lymphadenopathy may or may not be present Malignant dilatation of the appendix can also occur in the setting of cecal colon cancer obstructing the appendiceal orifice (Fig 11-68) Paraganglioma, ganglioneuroma, and other mesenchymal tumors of the appendix are rare C * Figure 11-68 Adenocarcinoma of cecum (C) with obstructed appendix (asterisk) There is marked, asymmetric thickening of the wall in this patient with a cecal adenocarcinoma The mass has obstructed the appendix, resulting in marked dilatation of its lumen (asterisk) 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 815 Gastrointestinal Tract 815 A A B Figure 11-69 Sigmoid diverticulitis with abscess A: There is eccentric thickening of the sigmoid colon, greater along the medial wall (arrow) B: Superiorly, there is abscess (A) containing gas and fluid Note the inflammatory wall thickening of the adjacent loop of ileum (arrow) that is displaced by the intimately contiguous abscess Inflammation Diverticulitis is due to obstruction of a diverticulum with resultant inflammation, and it is most commonly seen in the sigmoid colon CT is the imaging method of choice for patients presenting with the constellation of lowerabdominal pain, fever, and leukocytosis Uncomplicated diverticulitis produces circumferential wall thickening with inflammatory changes extending into the pericolic fat (Fig 11-69) In many cases, the obstructed diverticulum and its fecalith are identifiable Contained colonic perforation is a relatively common complication, and CT can help to assess its extent, as many patients can be treated without surgical management Findings include a focal collection of extraluminal fluid and/or gas In the setting of diverticulitis, gas within the bladder is strongly suggestive of a colovesical fistula This must be interpreted with caution in patients who have been recently catheterized Other findings such as bladder wall thickening should be present Free perforation with pneumoperitoneum is uncommon It is more common in individuals on chronic steroid therapy, presumably because of the inability of their immune systems to mount a response and wall off the perforation Right-sided diverticulitis is not as common, but it has similar imaging findings (Fig 11-70) (115,117) It is more common in Asians and has a more benign course It is important to identify the appendix so as to exclude appendicitis; thin-section CT has markedly improved our ability to this CT imaging findings of uncomplicated appendicitis include dilatation of the appendix (total transverse diameter greater than mm), wall thickening with enhancement, and peri-appendiceal inflammatory changes (Fig 11-71) Multiple other secondary findings include cecal tip thickening, adenopathy, appendicolith, and phlegmon (228) Occasionally, a normal appendix may have a caliber greater than mm (16), so additional findings of periappendiceal inflammation and a thickened enhancing wall must be sought to support the diagnosis of appendicitis Specific protocols for evaluating appendicitis are variable Most agree that thin-section (4 to mm) CT imaging is needed (274), but the administration of oral, intravenous, and rectal contrast material is a topic of debate The performance of CT in the diagnosis of appendicitis is excellent (149,150,224,227,228,241,279), regardless of technique Therefore, some have suggested that no contrast of any kind is needed (16, 59,149,150) Most normal appendices are identifiable, even on unenhanced studies (16,113,226,227,241) However, it has also been shown that intravenous administration of contrast significantly improves accuracy in detection of appendicitis (113) Patients are being imaged earlier in the course of their disease, and early or mild appendicitis may not have periappendiceal inflammatory changes (230) Enhancement of the thickened wall may be the only finding (113) Also, contrast administration improves the likelihood of providing an alternative diagnosis (149,150,226,227) Appendicoliths are more readily identified when bone window settings are routinely reviewed (4) The presence of gas in the appendix is another source of controversy It has been proposed that gas is indicative of a patent, noninflamed appendix, 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 816 816 Chapter 11 A B Figure 11-70 Ascending colonic diverticulitis A: There is mural thickening of the proximal ascending colon with pericolonic inflammation B: The epicenter of the inflammation is a diverticulum (arrow) and not the appendix, seen on slightly more inferior images and it has also been suggested that gas occurs in acute appendicitis In one large study, intraluminal gas was present in both normal and inflamed appendices, so this cannot be used as a discriminator (225) On the other hand, peri-appendiceal or intramural gas is seen only in the setting of appendicitis (225) CT is very accurate in diagnosing complicated appendicitis, including perforation, as well as peri-appendiceal abscess and small bowel obstruction There are five imaging findings that suggest perforation: abscess (Fig 11-72), phlegmon, extraluminal air, extraluminal appendicolith, and focal defect in an enhancing appendiceal wall (99) A * Figure 11-71 Uncomplicated appendicitis The appendix is dilated, measuring 1.6 cm, and has a thickened wall (arrow) An appendicolith (curved arrow) is present Minimal peri-appendiceal inflammatory changes are present Note reactive ascites in right hemipelvis (asterisk) Figure 11-72 Perforated appendicitis Image through the superior pelvis reveals an abscess at the cecal tip (A) Note ileocecal valve (arrow) No appendix was identifiable, but diagnosis was presumed perforated appendicitis, which was surgically confirmed 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 817 Gastrointestinal Tract Independently, these findings are not very sensitive, 21% to 64%, although they are specific, 95% to 100% The defect in the appendiceal wall is the single most sensitive sign, 64% When all findings are present, the sensitivity increases dramatically to 95%, with a specificity of 95% (99) Several chronic inflammatory processes can affect the appendix and mimic acute appendicitis These include granulomatous appendicitis, lymphoid hyperplasia, fibrosis, and nonspecific chronic inflammation (36) The appearance on CT cannot be used to differentiate these processes from acute appendicitis (36) Regardless, appendectomy will often be symptomatically curative As described above, primary appendiceal or cecal tu- * 817 mors can present with signs, symptoms, and imaging findings mimicking appendicitis It is important to suggest tumor on the preoperative CT, as it dictates surgical planning A luminal diameter greater than 15 mm is more indicative of tumor (220) Idiopathic inflammatory bowel disease (IBD) includes Crohn colitis (granulomatous colitis) and UC Crohn colitis most commonly involves the right colon and rectum Similar findings as seen in the small bowel are seen in the colon There is mural thickening with surrounding inflammation and fibrofatty proliferation (Fig 11-73) There may be skip lesions and involvement throughout the reminder of the GI tract UC begins at the anus and extends more * * B A Figure 11-73 Multisegmental Crohn colitis A: There is symmetric mural thickening at the hepatic flexure (asterisks) and pericolonic inflammation B: Similar findings are identified in the sigmoid colon with a small amount of ascites (asterisk) and reactive lymph node (arrow) Note the irregular appearance of the serosa, a finding not typically seen in UC C: The vessels in the sigmoid mesocolon are dilated with multiple small nodes (arrow) Patient was having profuse diarrhea and abdominal pain at the time of the examination C 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 818 818 Chapter 11 Figure 11-74 Ulcerative colitis involving the rectum and sigmoid colon There is sigmoid (large arrow) and rectal (small arrow) thickening Perirectal fatty proliferation is also present proximally without skip lesions Cross-sectional imaging reveals mural thickening (Fig 11-74) The following generalities can help differentiate between Crohn colitis and UC (80) The wall thickening in Crohn disease is more pronounced and typically demonstrates homogeneous enhancement and serosal irregularities (see Fig 11-73) The wall thickening in UC is less than that in Crohn disease, has a layered appearance with increased deposition of submucosal fat, and has a smooth serosal surface Increased deposition of fat limited to the perirectal space is more typical of UC, although it does not have extraluminal or mesenteric changes, such as abscess or fibrofatty proliferation UC results in a lead pipe appearance with narrowing and shortening of the colon Crohn disease typically maintains the normal haustral pattern Patients with IBD have an increased risk of colorectal cancer, but the risk is much greater in UC MRI is used in diagnosing and evaluating Crohn disease (173) Disease activity is best correlated with bowel wall enhancement after IV gadolinium administration (222) MR enteroclysis is showing promising results (222) in the evaluation of disease activity and extramucosal extent MRI is well established as the imaging method of choice in the evaluation of perianal disease in Crohn colitis (151,210) It can accurately evaluate the location of fistulous tracts relative to the levator ani muscles, which is important in surgical planning The Parks classification of fistulae is the most widely accepted terminology and helps surgeons plan their approach (215) MRI is able to differentiate between fistula and fibrous scar, unlike CT Scar tissue is hypointense on T1-, T2-, and proton density–weighted sequences Fistulae are hyperintense on T2- and proton density-weighted sequences MRI is useful for evaluating the fistulae relative to the sphincter and levator muscles Contrast is not necessary for discrimination of fistulae MRI is also useful in the assessment of fistula-in-ano and pilonidal sinus disease (87,253,264) Endoluminal coils are limited in the evaluation of perianal disease compared to a stan- dard phased-array body coil because of decreased field-ofview (86) Ischemic colitis is most commonly due to small vessel disease and not occlusion of the superior mesenteric artery or vein The most common locations affected by ischemia include the splenic flexure, which is the watershed region between the superior and inferior mesenteric arteries, and the rectosigmoid colon, the watershed region at the junction of the inferior mesenteric and inferior hypogastric arteries Complications of ischemic colitis include infarction (Fig 11-75), perforation, and stricture (13) On CT, there is segmental wall thickening that may have a heterogeneous or layered appearance Pneumatosis in this setting is an ominous sign of infarction Otherwise, the initial CT findings cannot predict development of complications Pseudomembranous colitis is most commonly caused by Clostridium difficile in the setting of antibiotic therapy CT findings include marked, low-density mural thickening, a nonspecific finding of colitis (119) Pericolonic stranding and ascites can be present A nodular pattern of fold thickening with an accordion appearance of the haustral folds was originally described in pseudomembranous colitis, but it has been seen to occur in any severe colitis (175) The accordion appearance occurs because high-density contrast material insinuates between the severely thickened lowdensity edematous folds (Fig 11-76) However, this finding may not be present (25) Additionally, CT imaging may be normal in patients with pseudomembranous colitis (25) The positive predictive value of CT in the setting of suspected pseudomembranous colitis is high, 88%, and warrants initiation of medical treatment (136) Although rare, CT cannot predict when surgical intervention is needed (120) Neutropenic enterocolitis, referred to as typhlitis when limited to the cecum, occurs in neutropenic patients and has nonspecific imaging features of colitis (Fig 11-77) Its etiology is unclear but is related to a breach in the mucosal layer with subsequent bacterial invasion It has been shown to also involve the small bowel (138), and typically it is associated with pericolonic fluid CT is the study of choice in this setting because of the risk of perforation with endoscopy and barium enema (102) Neutropenic enterocolitis must be differentiated from GVHD, another abnormality that is sometimes present in patients who are immunocompromised GVHD produces luminal narrowing and mucosal enhancement but less colonic wall thickening (138) Other infectious colitidies include CMV, Salmonella, Shigella, and E coli The imaging appearance of these infections is nonspecific, but deep ulcerations in the setting of an immune-compromised patient with colitis should raise the suspicion of CMV (203) Bloody diarrhea is commonly seen in CMV colitis, whereas watery diarrhea prevails in pseudomembranous colitis Toxic megacolon is a complication that can be seen with any colitis, but it most commonly occurs in the setting of UC It presents with marked colonic distension and is a risk for 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 819 Gastrointestinal Tract 819 C * B A Figure 11-75 Colonic perforation secondary to necrosis 47-year-old woman with extensive vascular disease and multiple prior vascular bypass grafts presented with abdominal pain and vomiting A: There is a large abscess in the right flank (asterisk) It contains gas and oral contrast material and displaces the hepatic flexure medially (C) There is concentric mural thickening in the descending colon, which is dilated and fluid-filled No pneumatosis is seen B: Slightly more caudal images reveal a perforation in the ascending colon with a stream of oral contrast material (arrow) spilling into the abscess An ileocolectomy was performed for frank necrosis secondary to ischemia perforation Patients with this condition are systemically ill, but the severity of illness can be masked in patients receiving steroids There is an overlap in the imaging findings between toxic megacolon and severe colitis Both have marked wall thickening in a layered pattern, pericolonic inflammation, and ascites However, the possibility of toxic megacolon should be entertained when there is luminal distension, to 10 cm, of the entire colon and distortion of the haustral fold pattern in the setting of systemic sepsis (110) Radiation colitis can occur within a few weeks or many years after the exposure It is most commonly imaged in the chronic stage, where there is luminal narrowing and circumferential wall thickening (Fig 11-78) These findings are most commonly seen in the pelvis after radiation therapy for cervical or prostate cancer The perirectal fat is increased and may contain fibrous strands Primary epiploic appendagitis occurs with infarction of one of the colonic fatty appendages It occurs as a result of thrombosis or torsion, is self-limiting, and does not necessitate surgical intervention On CT, epiploic appendagitis appears as a round or oblong fatty mass, to cm in size, located lateral or anterior to the colon (Fig 11-79) There are variable surrounding mild inflammatory changes There may be a central band or dot This is thought to be a vein or fibrous septum (199,229) Omental fat necrosis has a similar appearance on CT, but the lesion is typically larger, less well defined, and located anterior or medial to the colon (Fig 11-80) Figure 11-76 Pseudomembranous colitis There is severe lowdensity mural thickening of the transverse colon The positive oral contrast material (arrows) is insinuating between grossly edematous colonic folds in an accordion-like fashion 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 820 820 Chapter 11 B A Figure 11-77 Neutropenic colitis of the right colon in a 54-year-old man undergoing chemotherapy for lung cancer A: There is concentric mural thickening in the hepatic flexure The wall thickening is severe (arrows) and low-density Also noted is adjacent fluid B: Image through the cecum demonstrates mural edema and pericolonic inflammation Miscellaneous CT is well suited for the evaluation of colonic obstruction It not only identifies the point of obstruction but can also determine the etiology Primary tumors appear as a mass with concentric annular narrowing Serosal implants or hematogenous metastases are more eccentric in location In cecal volvulus, the cecum is markedly dilated and lies most often in the left-upper quadrant (Fig 11-81) There is small bowel obstruction Sigmoid volvulus has a markedly enlarged sigmoid colon that usually projects in the right-upper quadrant or mid epigastrium, and there is distal colonic obstruction Both may have a whirl appearance of the mesenteric vessels S B A Figure 11-78 Radiation proctitis, colitis, and enteritis 43-year-old woman status post–external beam radiation for cervical cancer A: Multiple small-bowel loops in the central pelvis have mural thickening (arrow) with a layered, hyperenhancing appearance from the submucosal edema The sigmoid (S) is diffusely thickened and low density B: Similar changes are seen in the rectum (arrow) with layered mural edema There is also presacral edema 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 821 Gastrointestinal Tract * 821 B Figure 11-79 Epiploic appendagitis There is an oblong fatdensity mass anterolateral to the ascending colon (arrow) Also present is a thin soft-tissue ring and mild inflammatory change Figure 11-80 Omental fat necrosis A fat-density mass with a Pneumatosis cystoides intestinalis is a benign condition in which multiple cysts containing gas are seen in the wall of the colon and less commonly in the small bowel This condition can be idiopathic and is associated with pulmonary and connective tissue diseases The cysts can rupture, causing a benign pneumoperitoneum CT Colonography peripheral soft-tissue ring lies adjacent to the deformed bladder (B) This is larger than the typical epiploic appendicitis There is a large postsurgical flank hernia from prior renal transplant (asterisk) CT colonography (CTC) is a new addition to the colorectal cancer screening armamentarium and is showing great promise Patients must undergo a routine bowel cleansing Magnesium citrate or phospho-soda is preferred over polyethylene glycol, which results in too much residual C A B Figure 11-81 Cecal volvulus A: The dilated cecum with air-fluid level occupies the left abdomen There is small-bowel obstruction indicated by multiple dilated loops in the right abdomen Mesenteric vessels are congested (arrow), and (B) there is a whirled configuration of the mesenteric root (arrow) 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 822 822 Chapter 11 151 findings were considered highly important, e.g., they revealed potential malignancy, aneurysm, and so on (92) They thus generated additional tests for the patients This is not only a morbidity issue for the patient, but there are cost and medical-legal implications Very early studies with MR colonography are under way Both liquid enemas and various gas agents are being evaluated for luminal distension REFERENCES Figure 11-82 15-mm sigmoid polyp (arrow) on supine axial source image from CT colonography examination This polyp was confirmed at endoscopy colonic fluid (177) A fecal tagging agent can be administered for days preceding the study; this has been shown to improve specificity and decrease interpretation time (162) The colon is insufflated with room air or CO2, and thin-section (2- to 3-mm) contiguous slices are performed through the entire colon Both prone and supine positions are used to improve distension and provide comparable views to confirm pathology (38,67,285) Initial studies indicate intravenous glucagon is probably not necessary (200,285) A meta-analysis of the first fourteen published clinical series evaluating CTC performance found a sensitivity on a per-patient basis of 86% for polyps greater than or equal to 10 mm (Fig 11-82) (252) On a per-polyp basis, sensitivity was 80% with a specificity of 81% Because CTC is still in its early stages of development and refinement, a single optimal protocol has yet to be established Techniques used in the initial CTC studies varied, as did their individual results In the largest and most recent trial that included 300 patients, sensitivities on a per-patient and per-polyp basis for polyps greater than or equal to 10 mm were 100% and 90%, respectively (283) CTC is better tolerated by patients than either barium enema or colonoscopy (79,257,265), which will hopefully improve compliance with screening recommendations Computeraided diagnosis (CAD) is currently undergoing evaluation and may have a role in polyp detection (256,287) CAD is able to offer a second opinion or a double reading It is hoped that this will improve sensitivity as well as decrease interpretation time As with all CT screening examinations, CTC commonly identifies extracolonic, incidental abnormalities The majority of these, but not all, are insignificant In a study of 264 patients undergoing CTC, 151 incidental findings in 109 patients were identified Twenty-three percent of the Abbara S, Kalan M, Lewicki A, et al Pictorial essay: inthrathoracic stomach revisited AJR Am J Roentgenol 2003;181:403–414 Abbas MA, Collins JM, Olden KW Spontaneous intramural small-bowel hematoma: imaging findings and outcome AJR Am J Roentgenol 2002;179:1389–1394 Ahmad A, Govil Y, Frank BB Gastric mucosa-associated lymphoid tissue lymphoma Radiology 2003;98(5):975–986 Alobaidi M, Shirkhoda A Value of bone window settings on CT for revealing appendicoliths in patients with appendicitis AJR Am J Roentgenol 2003;180:201–205 Ascenti G, Racchiusa S, Mazziotti S, et al Giant fibrovascular polyp of the esophagus: CT and MR findings Abdom Imaging 1999;24:109–110 Badar TR, Semelka RC, Chiu VCY, et al MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver J Magn Reson Imaging 2001;14:261–269 Balfe DM, Mauro MA, Koehler RE, et al Gastrohepatic ligament: normal and pathologic CT anatomy Radiology 1984;150:485–490 Balthazar EJ CT of small-bowel obstruction AJR Am J Roentgenol 1994;162:255–261 Balthazar EJ, Birnbaum BA, Megibow AJ, et al Closed-loop and strangulating intestinal obstruction: CT signs Radiology 1992; 185(3):769–775 10 Balthazar EJ, Liebeskind ME, Macari M Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis Radiology 1997;205(2):519–522 11 Balthazar EJ, Noordhoorn M, Megibow AJ, et al CT of smallbowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings AJR Am J Roentgenol 1997; 168(3):675–680 12 Balthazar EJ, Siegel SE, Megibow AJ, et al CT in patients with scirrhous carcinoma of the GI tract: imaging findings and value for tumor detection and staging AJR Am J Roentgenol 1995;165(4): 839–845 13 Balthazar EJ, Yen BC, Gordon RB Ischemic colitis: CT evaluation of 54 cases Radiology 1999;211:381–388 14 Ba-Ssalamah A, Prokop M, Uffmann M, et al Dedicated multidetector CT of the stomach: spectrum of diseases Radiographics 2003;23:625–644 15 Beall DP, Fortman BJ, Lawler BC, et al Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography Clin Radiol 2002;57(8):719–724 16 Benjaminov O, Atri M, Hamilton P, et al Frequency of visualization and thickness of normal appendix at nonenhanced helical CT Radiology 2002;225:400–406 17 Berkovich GY, Levine MS, Miller WT CT findings in patients with esophagitis AJR Am J Roentgenol 2000;175:1431–1434 18 Beyer KL, Marshall J, Diaz-Arias A, et al Primary small cell carcinoma of the esophagus: report of 11 cases and review of the literature J Clin Gastroenterol 1991;13:135–141 19 Blachar A, Federle M, Brancatelli G, et al Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia Radiology 2001;221:422–428 20 Blachar A, Federle M, Dodson S, et al Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria Radiology 2001;218:68–74 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 823 Gastrointestinal Tract 21 Blachar A, Federle M, Pealer K, et al Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings Radiology 2002;223:625–632 22 Blake MP, Mendelson RM The whirl sign: a non-specific finding of mesenteric rotation Australas Radiol 1996;40(2):136–139 23 Bladergroen MR, Lowe JE, Postlethwait RW Diagnosis and recommended management of esophageal perforation and rupture Ann Thorac Surg 1986;42:235–239 24 Bogaert J, Rosseel F, Verhaegen S, et al Esophageal lipomatosis: another consequence of the use of steroids Eur Radiol 2000; 10:1390–1394 25 Boland GW, Lee MJ, Cats AM, et al Clostridium difficile colitis: correlation of CT findings with severity of clinical disease Clin Radiol 1995;50(3):153–156 26 Borthne AS, Dormagen JB, Gjesdal KI, et al Bowel MR imaging with oral Gastrografin: an experimental study with healthy volunteers Eur Radiol 2003;13:100–106 27 Botet JF, Lightdale CJ, Zauber AG, et al Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT Radiology 1992;181(2):419–425 28 Boudiaf M, Soyer P, Terem, C, et al CT evaluation of small bowel obstruction Radiographics 2001;21:613–624 29 Burkill GJ, Badran M, Al-Muderis O, et al Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread Radiology 2003;226:527–532 30 Buy J, Moss A Computed tomography of gastric lymphoma AJR Am J Roentgenol 1962;138:859–865 31 Byun JH, Ha HK, Kim AY, et al CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract Radiology 2003; 227:59–67 32 Cademartiri F, Luccichenti G, Rossi A, et al Spiral hydro-CT in the evaluation of colo-sigmoideal cancer Radiol Med (Torino) 2002;104(4):295–306 33 Cai Q, Baumgarten DA, Affronti JP, et al Incidental findings of thickening luminal gastrointestinal organs on computed tomography: an absolute indication for endoscopy Am J Gastroenterol 2003;98(8):1734–1737 34 Carter M, Deckmann RC, Smith RC, et al Differentiation of achalasia from pseudoachalasia by computed tomography Radiology 1997;92(4):624–628 35 Carucci LR, Levine MS, Rubesin SE, et al Evaluation of patients with jejunostomy tubes: imaging findings Radiology 2002;223: 241–247 36 Checkoff JL, Wechsler RJ, Nazarian LN Chronic inflammatory appendiceal conditions that mimic acute appendicitis on helical CT AJR Am J Roentgenol 2002;179:731–734 37 Chen F, Ni Y, Zheng K, et al Spiral CT in gastric carcinoma: comparison with barium study, fiberoptic gastroscopy and histopathology World J Gastroenterol 2003;9(7):1404–1408 38 Chen SC, Lu DSK, Hecht JR, et al CT colonography: value of scanning in both the supine and prone positions AJR Am J Roentgenol 1999;172:595–599 39 Chiechi M, Hamrick-Turner J, Abbitt P Gastric herniation and volvulus: CT and MR appearance Gastrointest Radiol 1992;17(2): 99–101 40 Chintapalli KN, Chopra S, Ghiatas AA, et al Diverticulitis versus colon cancer: differentiation with helical CT findings Radiology 1999;210:429–435 41 Cho JS, Kim JK, Rho SM, et al Preoperative assessment of gastric carcinoma: value of two-phase dynamic CT with mechanical IV injection of contrast material AJR Am J Roentgenol 1994;163(1):69–75 42 Cho JS, Shin KS, Kwon ST, et al Heterotopic pancreas in the stomach: CT findings Radiology 2000;217:139–144 43 Choi D, Lee S, Cho Y, et al Bowel wall thickening in patients with Crohn disease: CT patterns and correlation with inflammatory activity Clin Radiol 2003;58:68–74 44 Choi D, Lim HY, Lee SJ, et al Gastric mucosa-associated lymphoid tissue lymphoma: helical CT findings and pathologic correlation AJR Am J Roentgenol 2002;178:1117–1122 45 Choong CK, Meyers BF Benign esophageal tumors: introduction, incidence, classification, and clinical features Semin Thorac Cardiovasc Surg 2003;15(1):3–8 46 Chou CK CT manifestations of bowel ischemia: pictorial essay AJR Am J Roentgenol 2002;178:87–91 823 47 Chou CK, Chang JM, Tsai TC, et al CT of the duodenojejunal junction Abdom Imaging 1995;20(5):425–430 48 Chou CK, Mak CW, Huang MC, et al Differentiation of obstructive from non-obstructive small bowel dilatation on CT Eur J Radiol 2000;35:213–220 49 Chung JJ, Semelka RC, Martin DR, et al Colon diseases: MR evaluation using combined T2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradient-echo sequences J Magn Reson Imaging 2000;12:297–305 50 Ciaccia D, Brazer SR, Baker ME, et al Acquired C1 esterase inhibitor deficiency causing intestinal angioedema: CT appearance AJR Am J Roentgenol 1993;161:1215–1216 51 De Backer AI, De Schepper AM, Vandevenne JE, et al Original report: CT of angioedema of the small bowel AJR Am J Roentgenol 2001;176:649–652 52 Delabrousse E CT of small bowel obstruction in adults Abdom Imaging 2003;28:257–266 53 Del Campo L, Arribas I, Valbuena M, et al Spiral CT findings in active and remission phases in patients with Crohn disease J Comput Assist Tomogr 2001;25(5):792–797 54 D’Elia F, Zingarelli A, Palli D, et al Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings A prospective study of 107 cases Eur Radiol 2000; 10:1877–1885 55 Dietz D, Walsh R, Grundfest-Broniatowski S, et al Intestinal malrotation: a rare but important cause of bowel obstruction in adults Dis Colon Rectum 2002;45(10):1381–1386 56 Doerfler O, Ruppert-Kohlmayr A, Reittner P, et al Helical CT of the small bowel with an alternative oral contrast material in patients with Crohn disease Abdom Imaging 2003;28: 313–318 57 Dudiak KM, Johnson CD, Stephens DH Primary tumors of the small intestine: CT evaluation AJR Am J Roentgenol 1989;152:995–998 58 Dux M, Richter GM, Hansmann J, et al Helical hydro-CT for diagnosis and staging of gastric carcinoma J Comput Assist Tomogr 1999;23(6):913–922 59 Ege G, Akman H, Sahin A, et al Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis Br J Radiol 2002;75:721–725 60 Eloubeidi M, Desmond R, Arguedas M, et al Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status Cancer 2002;95(7):1434–1443 61 Ernst O, Bulois P, Saint-Drenant S, et al Helical CT in acute lower gastrointestinal bleeding Eur Radiol 2003;13:114–117 62 Esophagus American Joint Committee on Cancer: AJCC Cancer Staging Manual 2002;6:91–98 63 Fenlon HM, O’Keane C, Carney DN, et al Imaging of small cell carcinoma of the oesophagus Clin Radiol 1995;50(9):634–638 64 Fidler JL, Saigh JA, Thompson JS, et al Demonstration of intraluminal duodenal diverticulum by computed tomography Abdom Imaging 1998;23:38–39 65 Fishman EK Spiral CT: clinical applications in the gastrointestinal tract Clin Imaging 1997;21:111–121 66 Fishman EK, Urban BA, Hruban RH CT of the stomach: spectrum of disease Radiographics 1996;16(5):1035–1054 67 Fletcher JG, Johnson CD, Welch TJ, et al Optimization of CT colonography technique: prospective trial in 180 patients Radiology 2000;216:704–711 68 Frager D, Baer J, Medwid S, et al Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT AJR Am J Roentgenol 1996; 166:67–71 69 Frager D, Baer J, Rothpearl A, et al Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings AJR Am J Roentgenol 1995;164:891–894 70 Fuchsjäger MH, Maier AG, Schima W, et al Comparison of transrectal sonography and double-contrast MR imaging when staging rectal cancer AJR Am J Roentgenol 2003;181:421–427 71 Fukuya T, Honda H, Hayashi T, et al Lymph-node metastases: efficacy for detection with helical CT in patients with gastric cancer Radiology 1995;197(3):705–711 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 824 824 Chapter 11 72 Fukuya T, Honda H, Kaneko K, et al Efficacy of helical CT in T-staging of gastric cancer J Comput Assist Tomogr 1997;21(1): 73–81 73 Fulcher AS, Turner MA Abdominal manifestations of situs anomalies in adults Radiographics 2002;22:1439–1456 74 Furukawa A, Yokoyama K, Murata K, et al Helical CT in the diagnosis of small bowel obstruction Radiographics 2001;21: 341–355 75 Gayer G, Zissin R, Apter S, et al Acute diverticulitis of the small bowel: CT findings Abdom Imaging 1999;24:452–455 76 Gazelle GS, Gaa J, Saini S, et al Staging of colon carcinoma using water enema CT J Comput Assist Tomogr 1995;19(1):87–91 77 Gibo M, Murayama S, Murata S, et al Small-bowel wall thickening related to a long intestinal tube: incidental CT finding mimicking a pathologic condition J Comput Assist Tomogr 2002;26(4): 505–509 78 Giménez A, Franquet T, Erasmus J, et al Thoracic complications of esophageal disorders Radiographics 2002;22:S247–S258 79 Gluecker TM, Johnson CD, Harmsen WS, et al Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences Radiology 2003;227:378–384 80 Gore RM, Balthazar EJ, Ghahremani GG, et al CT features of ulcerative colitis and Crohn disease AJR Am J Roentgenol 1996;167:3–15 81 Grayson DE, Abbott RM, Levy AD, et al Emphysematous infections of the abdomen and pelvis: a pictorial review Radiographics 2002;22:543–561 82 Greenberg J, Durkin M, Van Drunen M, et al Computed tomography or endoscopic ultrasonography in preoperative staging of gastric and esophageal tumors Surgery 1994;116(4):696–702 83 Ha HK, Kim JS, Lee MS, et al Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria Radiology 1997;204:507–512 84 Ha HK, Park CH, Kim SK, et al CT analysis of intestinal obstruction due to adhesions: early detection of strangulation J Comput Assist Tomogr 1993;17(3):386–389 85 Ha HK, Shin BS, Lee SI, et al Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy AJR Am J Roentgenol 1998;171(6):1587–1593 86 Halligan S, Bartram CI MR imaging of fistula in ano: are endoanal coils the gold standard? AJR Am J Roentgenol 1998;171(2):407–412 87 Halligan S, Buchanan G MR imaging of fistula-in-ano Eur J Radiol 2003;47:98–107 88 Halvorsen RA Jr, Thompson WM CT of esophageal neoplasms Radiol Clin North Am 1989;27(4):667–685 89 Halvorsen RA Jr, Yee J, McCormick VD Diagnosis and staging of gastric cancer Semin Oncol 1996;23(3):325–335 90 Hamed MM, Hamm B, Ibrahim ME Dynamic MR imaging of the abdomen with gadopentetate diglumine: normal enhancement patterns of the liver, spleen, stomach, and pancreas AJR Am J Roentgenol 1992;158(2):303–307 91 Hameeteman W, Tytgat GNJ, Houthoff HJ, et al Barrett’s esophagus: development of dysplasia and adenocarcinoma Gastroenterology 1989;96:1249–1256 92 Hara AK, Johnson CD, MacCarty RL, et al Incidental extracolonic findings at CT colonography Radiology 2000;215(2):353–357 93 Harisinghani MG, Wittenberg J, Blake MA, et al Halo sign: useful CT sign for differentiating benign from malignant colonic disease Clin Radiol 2003;58:306–310 94 Harisinghani MG, Wittenberg J, Lee W Bowel wall fat halo sign in patients without intestinal disease AJR Am J Roentgenol 2003;181:781–784 95 Hawn MT, Canon CL, Lockhart ME, et al Significance and outcome of CT diagnosis of pneumatosis of the gastrointestinal tract Am Surg, 2004;70(1):19–23 96 Heiken JP, Balfe DM, Roper CL CT evaluation after esophagogastrectomy AJR Am J Roentgenol 1984;143(3):555–560 97 Higa K, Ho T, Boone K, et al Internal hernias after laparascopic Roux-en-Y gastric bypass: incidence, treatment and prevention Obes Surg 2003;13(3):350–354 98 Holzknecht N, Helmberger T, Beuers U, et al Cross-sectional imaging findings in congenital intestinal lymphangiectasia J Comput Assist Tomogr 2002;26(4):526–528 99 Horrow MM, White DS, Horrow JC Differentiation of perforated from nonperforated appendicitis at CT Radiology 2003;227:46–51 100 Horton KM, Abrams RA, Fishman EK Spiral CT of colon cancer: imaging features and role in management Radiographics 2000;20:419–430 101 Horton KM, Corl FM, Fishman EK CT of nonneoplastic diseases of the small bowel: spectrum of disease J Comput Assist Tomogr 1999;23(3):417–428 102 Horton KM, Corl FM, Fishman EK CT evaluation of the colon: inflammatory disease Radiographics 2000;20:399–418 103 Horton KM, Eng J, Fishman EK Normal enhancement of the small bowel: evaluation with spiral CT J Comput Assist Tomogr 2000;24(1):67–71 104 Horton KM, Fishman EK Current role of CT in imaging of the stomach Radiographics 2003;23:75–87 105 Horton KM, Fishman EK Uncommon inflammatory diseases of the small bowel: CT findings AJR Am J Roentgenol 1998;170: 385–388 106 Horton KM, Fishman EK The current status of multidetector row CT and three-dimensional imaging of the small bowel Radiol Clin North Am 2003;41(2):199–212 107 Hsu RM, Horton KM, Fishman EK Diffuse cavernous hemangiomatosis of the colon: findings on three-dimensional CT colonography AJR Am J Roentgenol 2002;179:1042–1044 108 Hughes J, Hatrick A, Rankin S Case report: computed tomography findings in an inflamed Meckel diverticulum Br J Radiol 1998;71:882–883 109 Hundt W, Braunschweig R, Reiser M, et al Evaluation of spiral CT in staging of colon and rectum carcinoma Eur Radiol 1999;9:78–84 110 Imbriaco M, Balthazar EJ Toxic megacolon: role of CT in evaluation and detection of complications Clin Imaging 2001;25: 349–354 111 Insko EK, Levine MS, Birnbaum BA, et al Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation Radiology 2003;228:166–171 112 Iwasaki Y, Nakajima Y, Ishikawa T, et al CT appearance of implanted esophageal stents J Comput Assist Tomogr 2000;24(1): 19–23 113 Jacobs JE, Birnbaum BA, Macari M, et al Acute appendicitis: comparison of helical CT diagnosis—focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material Radiology 2001;220: 683–690 114 James S, Balfe DM, Lee JKT, et al Small-bowel disease: categorization by CT examination AJR Am J Roentgenol 1987;148: 863–868 115 Jang HJ, Lim HK, Lee SJ, et al Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings AJR Am J Roentgenol 1999;172(2):601–604 116 Jayaraman MV, Mayo-Smith WW, Movson JS, et al CT of the duodenum: an overlooked segment gets its due Radiographics 2001;21:S147–S160 117 Jhaveri KS, Harisinghani MG, Wittenberg J, et al Right-sided colonic diverticulitis: CT findings J Comput Assist Tomogr 2002;26(1):84–89 118 Karahan OI, Dodd GD III, Chintapalli KN, et al Gastrointestinal wall thickening in patients with cirrhosis: frequency and patterns at contrast-enhanced CT Radiology 2000;215:103–107 119 Kawamoto S, Horton KM, Fishman EK Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation Radiographics 1999;19:887–897 120 Kawamoto S, Horton KM, Fishman EK Pseudomembranous colitis: can CT predict which patients will need surgical intervention? J Comput Assist Tomogr 1999;23(1):79–85 121 Kernagis LY, Levine MS, Jacobs JE Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel AJR Am J Roentgenol 2003;180:733–736 122 Kessar P, Norton A, Rohatiner A, et al CT appearances of mucosaassociated lymphoid tissue (MALT) lymphoma Eur Radiol 1999; 9:693–696 123 Khurana B, Ledbetter S, McTavish J, et al Bowel obstruction revealed by multidetector CT AJR Am J Roentgenol 2002;178:1139–1144 124 Kienle P, Buhl K, Kuntz C, et al Prospective comparison of endoscopy, endosonography and computed tomography for staging of tumours of the esophagus and gastric cardia Digestion 2002;66:230–236 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 825 Gastrointestinal Tract 125 Killeen KL, Kathirkamanathan S, Poletti PA, et al Helical computed tomography of bowel and mesenteric injuries J Trauma 2001;51:26–36 126 Kim AY, Bennett GL, Bashist B, et al Small-bowel obstruction associated with sigmoid diverticulitis: CT evaluation in 16 patients AJR Am J Roentgenol 1998;170(5):1311–1313 127 Kim AY, Ha HK, Seo BK, et al CT of patients with right-sided colon cancer and distal ileal thickening AJR Am J Roentgenol 2000;175:1439–1444 128 Kim AY, Han JK, Seong CK, et al MRI in staging advanced gastric cancer: is it useful compared with spiral CT? J Comput Assist Tomogr 2000;24(3):389–394 129 Kim JH, Ha HK, Sohn MJ, et al CT findings of phytobezoar associated with small bowel obstruction Eur Radiol 2003;13:299–304 130 Kim JK, Ha HK, Byun JY, et al CT differentiation of mesenteric ischemia due to vasculitis and thromboembolic disease J Comput Assist Tomogr 2001;25(4):604–611 131 Kim KA, Park CM, Park SW, et al CT findings in the abdomen and pelvis after gastric carcinoma resection AJR Am J Roentgenol 2002;179(4):1037–1041 132 Kim KW, Choi BI, Han JK, et al Postoperative anatomic and pathologic findings at CT following gastrectomy Radiographics 2002;22:323–336 133 Kim SH, Cho JY, Lim HK CT findings of isolated small bowel angioedema due to iodinated radiographic contrast medium reaction Abdom Imaging 1999;24:117–119 134 Kim SH, Han JK, Lee KH, et al Computed tomography gastrography with volume-rendering technique: correlation with double-contrast barium study and conventional gastroscopy J Comput Assist Tomogr 2003;27(2):140–149 135 Kim SH, Han JK, Lee KH, et al Abdominal amyloidosis: spectrum of radiological findings Clin Radiol 2003;58(8):610–620 136 Kim YH, Lim HK, Han JK, et al Low-grade gastric mucosaassociated lymphoid tissue lymphoma: correlation of radiographic and pathologic findings Radiology 1999;212:241–248 137 Kirkpatrick IDC, Greenberg HM Evaluating the CT diagnosis of clostridium difficile colitis: should CT guide therapy? AJR Am J Roentgenol 2001;176:635–639 138 Kirkpatrick IDC, Greenberg HM Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT Radiology 2003;226:668–674 139 Klein HM, Lensing R, Klosterhalfen B, et al Diagnostic imaging of mesenteric infarction Radiology 1995;197:79–82 140 Ko GY, Ha HK, Lee HJ, et al Usefulness of CT in patients with ischemic colitis proximal to colonic cancer AJR Am J Roentgenol 1997;168(4):951–956 141 Ko SF, Lee TY, Cheng TT, et al CT findings at lupus mesenteric vasculitis Acta Radiol 1997;38(1):115–120 142 Koh D, Miao Y, Chinn R, et al MR imaging evaluation of the activity of Crohn disease AJR Am J Roentgenol 2001;177:1325–1332 143 Korst RJ, Rusch VW, Venkatraman E, et al Proposed revision of the staging classification for esophageal cancer J Thorac Cardiovasc Surg 1998;115(3):660–670 144 Kuhlman JE, Pozniak MA, Collins J, et al Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them Radiographics 1998;18(5):1085–1108 145 Kumbasar B Carcinoma of esophagus: radiologic diagnosis and staging Eur J Radiol 2002;42:170–180 146 Laghi A, Carbone I, Catalano C, et al Technical innovation: polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel AJR Am J Roentgenol 2001;177: 1333–1334 147 Laghi A, Paolantonio P, Catalano C, et al MR imaging of the small bowel using polyethylene glycol solution as an oral contrast agent in adults and children with celiac disease: preliminary observations AJR Am J Roentgenol 2003;180:191–194 148 Lane MJ, Katz DS, Mindelzun RE, et al Spontaneous intramural small bowel hemorrhage: importance of non-contrast CT Clin Radiol 1997;52(5):378–380 149 Lane MJ, Katz DS, Ross BA, et al Unenhanced helical CT for suspected acute appendicitis AJR Am J Roentgenol 1997;168(2): 405–409 150 Lane MJ, Liu DM, Huynh MD, et al Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients Radiology 1999;213:341–346 825 151 Laniado M, Makowiec F, Dammann F, et al Perianal complications of Crohn disease: MR imaging findings Eur Radiol 1997;7:1035–1042 152 Lappas JC Imaging of the postsurgical small bowel Radiol Clin North Am 2003;41(2):305–336 153 Lauenstein T, Schneemann H, Vogt F, et al Optimization of oral contrast agents for MR imaging of the small bowel Radiology 2003;228:279–283 154 Lee DH Three-dimensional imaging of the stomach by spiral CT J Comput Assist Tomogr 1998;22(1):52–58 155 Lee DH, Ko YT Advanced gastric carcinoma: the role of three-dimensional and axial imaging by spiral CT Abdom Imaging 1999;24:111–116 156 Lee DH, Ko YT Gastric lesions: evaluation with three-dimensional images using helical CT AJR Am J Roentgenol 1997;169: 787–789 157 Lee DH, Ko YT The role of 3D spiral CT in early gastric carcinoma J Comput Assist Tomogr 1998;22(5):709–713 158 Lee DH, Seo TS, Ko YT Spiral CT of the gastric carcinoma: staging and enhancement pattern Clin Imaging 2001;25:32–37 159 Lee R, Tung HKS, Tung PHM, et al CT in acute mesenteric ischemia Clin Radiol 2003;58:279–287 160 Lee SS, Ha HK, Kim AY, et al Primary extrapulmonary small cell carcinoma involving the stomach or duodenum or both: findings on CT and barium studies AJR Am J Roentgenol 2003;180: 1325–1329 161 Lee SS, Ha HK, Yang SK, et al CT of prominent pericolic or perienteric vasculature in patients with Crohn disease: correlation with clinical disease activity and findings on barium studies AJR Am J Roentgenol 2002;179:1029–1036 162 Lefere PA, Gryspeerdt SS, Dewyspelaere J, et al Dietary fecal tagging as a cleansing method before CT colonography: initial results— polyp detection and patient acceptance Radiology 2002;224: 393–403 163 Levine MS Benign tumors of the esophagus: radiologic evaluation Semin Thorac Cardiovasc Surg 2003;15(1):9–19 164 Levine MS, Buck JL, Pantongrag-Brown L, et al Esophageal leiomyomatosis Radiology 1996;199:533–536 165 Levine MS, Buck JL, Pantongrag-Brown L, et al Fibrovascular polyps of the esophagus: clinical, radiographic, and pathologic findings in 16 patients AJR Am J Roentgenol 1996;166(4):781–787 166 Levine MS, Buck JL, Pantongrag-Brown L, et al Leiomyosarcoma of the esophagus: radiographic findings in 10 patients AJR Am J Roentgenol 1996;167(1):27–32 167 Levine MS, Pantongrag-Brown L, Aguilera NS, et al NonHodgkins lymphoma of the stomach: a cause of linitis plastica Radiology 1996;201(2):375–378 168 Levy AD, Remotti HE, Thompson WM, et al Gastrointestinal stromal tumors: radiologic features with pathologic correlation Radiographics 2003;23:283–304 169 Lim HK, Lee WJ, Kim SH, et al Primary mucinous cystadenocarcinoma of the appendix: CT findings AJR Am J Roentgenol 1999;173(4):1071–1074 170 Lomas DJ Technical developments in bowel MRI Eur Radiol 2003;13:1058–1071 171 Low RN, Chen SC, Barone R Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging Radiology 2003;228:157–165 172 Low R, Francis I MR imaging of the gastrointestinal tract with IV gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT AJR Am J Roentgenol 1997;169:1051–1059 173 Low RN, Sebrechts CP, Politoske DA, et al Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadoliniumenhanced fat-suppressed spoiled gradient-echo MR imaging Radiology 2002;222:652–660 174 Lvoff N, Breiman R, Coakley F, et al Distinguishing features of self-limiting adult small-bowel intussusception identified at CT Radiology 2003;227:68–72 175 Macari M, Balthazar JE, Megibow JA The accordion sign at CT: a non-specific finding in patients with colonic edema Radiology 1999;743–746 176 Macari M, Chandarana H, Balthazar E, et al Intestinal ischemia versus intramural hemorrhage: CT evaluation AJR Am J Roentgenol 2003;180:177–184 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 826 826 Chapter 11 177 Macari M, Lavelle M, Pedrosa I, et al Effect of different bowel preparations on residual fluid at CT colonography Radiology 2001;218(1):274–277 178 Macari M, Lazarus D, Israel G, et al Duodenal diverticula mimicking cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients AJR Am J Roentgenol 2003;180:195–199 179 Maccioni F Current status of gastrointestinal MRI Abdom Imaging 2002;27(4):358–360 180 Maccioni F, Viscido A, Broglia L, et al Evaluation of Crohn disease activity with magnetic resonance imaging Abdom Imaging 2000;25:219–228 181 Maglinte DD, Bender GN, Heitkamp DE, et al Multidetector-row helical CT enteroclysis Radiol Clin North Am 2003;41(2):249–262 182 Makita O, Ikushima I, Matsumoto N, et al CT differentiation between necrotic and nonnecrotic small bowel in closed loop and strangulating obstruction Abdom Imaging 1999;24:120–124 183 Makó E, Mester Á, Tarján Z, et al Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn disease Eur J Radiol 2000;35:168–175 184 Mani NBS, Suri S, Gupta S, et al Two-phase dynamic contrastenhanced computed tomography with water-filling method for staging of gastric carcinoma Clin Imaging 2001;25:38–43 185 Maniatis V, Chryssikopoulos H, Roussakis A, et al Perforation of the alimentary tract: evaluation with computed tomography Abdom Imaging 2000;25:373–379 186 Marcos HB, Semelka RC, Noone TC, et al MRI of normal and abnormal duodenum using half-fourier single-shot RARE and gadolinium-enhanced spoiled gradient-echo Magn Reson Imaging 1999;17(6):869–880 187 Marks WM, Callen PW, Moss AA Gastroesophageal region: source of confusion on CT AJR Am J Roentgenol 1981;136:359–362 188 Marom EM, Goodman PC Double-ring esophageal sign: pathognomonic for esophageal lipomatosis J Comput Assist Tomogr 2002;26(4):584–586 189 Matsuo M, Kanematsu M, Kim T, et al Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage AJR Am J Roentgenol 2003;180: 461–466 190 Matsuoka Y, Masumoto T, Koga H, et al Positive and negative oral contrast agents for combined abdominal and pelvic helical CT: first iodinated agent and second water Radiat Med 2000;18(3):213–216 191 Mayo-Smith WW, Wittenberg J, Bennett GL, et al The CT small bowel feces sign: description and clinical relevance Clin Radiol 1995;50:765–767 192 Mazzeo S, Caramella D, Battolla L, et al Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution J Comput Assist Tomogr 2001;25(4): 612–616 193 McDermott VG, Low VH, Keogan MT, et al Malignant melanoma metastatic to the gastrointestinal tract AJR Am J Roentgenol 1996;166(4):809–813 194 Megibow AJ Gastrointestinal lymphoma: the role of CT in diagnosis and management Semin Ultrasound CT MR 1986;7: 43–45 195 Merino S, Saiz A, Moreno M, et al CT evaluation of gastric wall pathology Br J Radiol 1999;72:1124–1131 196 Meyers MA, McGuire PV Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign.” Abdom Imaging 1995;20(4)327–332 197 Miettinen M, Sarlomo-Rikala M, Sobin LH, et al Esophageal stromal tumors: a clinicopatholigic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas Am J Surg Pathol 2000;24:211–222 198 Miller PA, Mezwa DG, Feczko PJ, et al Imaging of abdominal hernias Radiographics 1995;15:333–347 199 Mollà E, Ripollés T, Martínez MJ, et al Primary epiploic appendagitis: US and CT findings Eur Radiol 1998;8:435–438 200 Morrin MM, Farrell RJ, Keogan MT, et al CT colonography: colonic distention improved by dual positioning but not intravenous glucagon Eur Radiol 2002;12(3):525–530 201 Murakami R, Sugizaki K, Kobayashi Y, et al Strangulation of small bowel due to Meckel diverticulum: CT findings Clin Imaging 1999;23:181–183 202 Murata Y, Ohta M, Hayashi K, et al Preoperative evaluation of lymph node metastasis in esophageal cancer Ann Thorac Cardiovasc Surg 2003;9(2):88–92 203 Murray JG, Evans SJ, Jeffrey PB, et al Cytomegalovirus colitis in AIDS: CT features AJR Am J Roentgenol 1995;165(1):67–71 204 Nino-Murcia M, Stark P, Triadafilopoulos G Esophageal wall thickening: a CT finding in diffuse esophageal spasm J Comput Assist Tomogr 1997;21(2):318–321 205 Nishida T, Kumano S, Sugiura T, et al Multidetector CT of highrisk patients with occult gastrointestinal stromal tumors AJR Am J Roentgenol 2003;180:185–189 206 Nishimaki T, Tanaka O, Nobutoshi A, et al Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer Ann Thorac Surg 1999;68:2059–2064 207 Noda Y, Ogawa Y, Nishioka A, et al New barium paste mixture for helical (slip-ring) CT evaluation of the esophagus J Comput Assist Tomogr 1996;20(5):773–776 208 Noh HM, Fishman EK, Forastiere AA, et al CT of the esophagus: spectrum of disease with emphasis on esophageal carcinoma Radiographics 1995;15(5):1113–1134 209 O’Connor JB, Falk GW, Richter JE The incidence of adenocarcinoma and dysplasia in Barrett’s esophagus: report on the Cleveland Clinic Barrett’s Esophagus Registry Am J Gastroenterol 1999;94(8):2037–2042 210 O’Donovan AN, Somers S, Farrow R, et al MR imaging of anorectal Crohn disease Radiographics 1997;17(1):101–107 211 Ogata I, Komohara Y, Yamashita Y, et al CT evaluation of gastric lesions with three-dimensional display and interactive virtual endoscopy: comparison with conventional barium study and endoscopy AJR Am J Roentgenol 1999;172(5):1263–1270 212 Oguzkurt L, Karabulut N, Cakmakci E, et al Primary nonHodgkin’s lymphoma of the esophagus Abdom Imaging 1997;22:8–10 213 Oudit G, Girgah N, Allard J ACE inhibitor-induced angioedema of the intestine: case report, incidence, pathophysiology, diagnosis and management Can J Gastroenterol 2001;15(12):827–832 214 Padidar AM, Jeffrey RB Jr, Mindelzun RE, et al Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis AJR Am J Roentgenol 1994;163:81–83 215 Paley MR, Ros PR MRI of the gastrointestinal tract Eur Radiol 1997;7:1387–1397 216 Parks AG, Gordon PH, Hardcastle JD A classification of fistulain-ano Br J Surg 63:1–12 217 Park MS, Kim KW, Yu JS, et al Radiographic findings of primary B-cell lymphoma of the stomach: low-grade versus high-grade malignancy in relation to the mucosa-associated lymphoid tissue concept AJR Am J Roentgenol 2002;179:1297–1304 218 Pavone P, Laghi A, Catalano C, et al CT of Nissen’s fundoplication Abdom Imaging 1997;22:457–460 219 Pickhardt PJ, Levy AD, Rohrmann CA Jr, et al Non-Hodgkin’s lymphoma of the appendix: clinical and CT findings with pathologic correlation AJR Am J Roentgenol 2002;178:1123–1127 220 Pickhardt PJ, Levy AD, Rohrmann CA Jr, et al Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison Radiology 2002;224:775–781 221 Picus D, Balfe DM, Koehler RE, et al Computed tomography in the staging of esophageal carcinoma Radiology 1983;146: 433–438 222 Prassopoulos P, Papanikolaou N, Grammatikakis J, et al MR enteroclysis imaging of Crohn disease Radiographics 2001;21: S161–S172 223 Rabushka LS, Fishman EK, Kuhlman JE CT evaluation of achalasia J Comput Assist Tomogr 1991;15(3):434–439 224 Raman SS, Lu DS, Kadell BM, et al Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review AJR Am J Roentgenol 2002;178:1319–1325 225 Rao PM, Rhea JT, Novelline RA Appendiceal and peri-appendiceal air at CT: prevalence, appearance and clinical significance Clin Radiol 1997;52(10):750–754 226 Rao PM, Rhea JT, Novelline RA, et al Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis AJR Am J Roentgenol 1997;169(5): 1275–1280 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 827 Gastrointestinal Tract 227 Rao PM, Rhea JT, Novelline RA, et al Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination Radiology 1997;202:139–144 228 Rao PM, Rhea JT, Novelline RA Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations J Comput Assist Tomogr 1997;21(5): 686–692 229 Rao PM, Wittenberg J, Lawrason JN Primary epiploic appendagitis: evolutionary changes in CT appearance Radiology 1997;204(3):713–717 230 Raptopoulos V, Katsou G, Rosen MP, et al Acute appendicitis: effect of increased use of CT on selecting patients earlier Radiology 2003;226:521–526 231 Raptopoulos V, Schwartz R, McNicholas M, et al Multiplanar helical CT enterography in patients with Crohn disease AJR Am J Roentgenol 1997;169(6):1545–1550 232 Raymond MH, Horton KM, Fishman EK Diffuse cavernous hemangiomatosis of the colon: findings on three-dimensional CT colonography AJR Am J Roentgenol 2002;179:1042–1044 233 Regan F, Beall D, Bohlman M, et al Fast MR imaging and the detection of small-bowel obstruction AJR Am J Roentgenol 1998; 170:1465–1469 234 Reittner P, Goritschnig T, Petritsch W, et al Multiplanar spiral CT enterography in patients with Crohn disease using a negative oral contrast material: initial results of a noninvasive imaging approach Eur Radiol 2002;12:2253–2257 235 Rha SE, Ha HK, Lee SH, et al CT and MR imaging findings of bowel ischemia from various primary causes Radiographics 2000;20:29–42 236 Rollandi G, Curone P, Biscaldi E, et al Spiral CT of the abdomen after distention of small bowel loops with transparent enema in patients with Crohn disease Abdom Imaging 1999;24: 544–549 237 Rossi M, Broglia L, Graziano P, et al Local invasion of gastric cancer: CT findings and pathologic correlation using 5-mm incremental scanning, hypotonia, and water filling AJR Am J Roentgenol 1999;172(2):383–388 238 Rotondo A, Scialpi M, Pellegrino G, et al Duodenal duplication cyst: MR imaging appearance Eur Radiol 1999;9(5):890–893 239 Sabaté JM, Franquet T, Palmer J, et al AIDS-related primary esophageal lymphoma Abdom Imaging 1997;22:11–13 240 Sahani DV, Jhaveri KS, D’souza RV, et al Evaluation of simethicone-coated cellulose as a negative oral contrast agent for abdominal CT Acad Radiol 2003;10(5):491–496 241 Scatarige JC, DiSantis DJ, Allen HA III, et al CT demonstration of the appendix in asymptomatic adults Gastrointest Radiol 1989;14: 271–273 242 Schmidt S, Lepori D, Meuwly J, et al Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of “sign-by-sign” correlation Eur Radiol 2003;13:1303–1311 243 Schmidt TD, McGrath KM Angiotensin-converting enzyme inhibitor angioedema of the intestine: a case report and review of the literature Am J Med Sci 2002;324(2):106–108 244 Sebastià C, Quiroga S, Espin E, et al Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis Radiographics 2000;20:1213–1224 245 Seggerman RE, Chen MY, Waters GS, et al Radiology of Ileal pouch-anal anastomosis surgery AJR Am J Roentgenol 2003;180: 999–1002 246 Semelka RC, Lawrence PH, Shoenut JP, et al Primary malignant ovarian disease: prospective comparison of contrast enhanced CT and pre- and post intravenous Gd-DPTA enhanced fat-suppressed and breath hold MRI with histological correlation J Magn Reson Imaging 1993;3:99–106 247 Shaffer HA, Jr, Valenzuela G, Mittal RK Esophageal perforation: a reassessment of the criteria for choosing medical or surgical therapy Arch Intern Med 1992;152:757–761 248 Shabani KO, Souba WW, Finkelstein DM, et al Prognosis and survival in patients with gastrointestinal tract carcinoid tumors Ann Surg 1999;229(6):815–823 249 Shimizu T, Namba R, Matsuoka T, et al Esophageal varices before and after endoscopic variceal ligitation: evaluation using helical CT Eur Radiol 1999;9(8):1546–1549 827 250 Silverman PM Gastric diverticulum mimicking adrenal mass: CT demonstration J Comput Assist Tomogr 1986;10:709–710 251 Sohn KM, Lee JM, Lee SY, et al Comparing MR imaging and CT in the staging of gastric carcinoma AJR Am J Roentgenol 2000;174:1551–1557 252 Söreide JA, van Heerden JA, Thompson GB, et al Gastrointestinal carcinoid tumors: long-term prognosis for surgically treated patients World J Surg 2000;24:1431–1436 253 Sosna J, Kruskal JB, Rosen MP, et al CT colonography for detecting colonic polyps: a meta-analysis AJR Am J Roentgenol 2003;181(6):1593–1598 254 Spencer JA, Chapple K, Wilson D, et al Outcome after surgery for perianal fistula: predictive value of MR imaging AJR Am J Roentgenol 1998;171(2):403–406 255 Stoane JM, Torrisi JM, Haller JO, et al Fibrovascular polyps of the esophagus: MRI findings J Comput Assist Tomogr 1995;19(1): 157–159 256 Summers RM, Jerebko AK, Franaszek M, et al Colonic polyps: complementary role of computer-aided detection in CT colonography Radiology 2002;225:391–399 257 Svensson MH, Svensson E, Lasson A, et al Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease Radiology 2002;222:337–345 258 Takao M, Fukuda T, Iwanaga S, et al Gastric cancer: evaluation of triphasic spiral CT and radiologic-pathologic correlation J Comput Assist Tomogr 1998;22(2):288–294 259 Takashima S, Takeuchi N, Shiozaki H, et al Carcinoma of the esophagus: CT vs MR imaging in determining resectability AJR Am J Roentgenol 1991;156:297–302 260 Tamm EP, Fishman EK CT appearance of acute abdomen as initial presentation in lymphoma of the large and small bowel Clin Imaging 1996;20:21–25 261 Taourel PG, Fabre J, Pradel JA Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction AJR Am J Roentgenol 1995;165:1187–1192 262 Tarhan NC, Coskun M, Kayahan EM, et al Regression of abdominal visceral anerysms in polyarteritis nodosa: CT findings AJR Am J Roentgenol 2003;180:1617–1619 263 Taurel PG, Deneuville M, Pradel JA, et al Acute mesenteric ischemia: diagnosis with contrast-enhanced CT Radiology 1996;199: 632–636 264 Taylor SA, Halligan S, Bartram CI Pilonidal sinus disease: MR imaging distinction from fistula in ano Radiology 2003;226:662–667 265 Thomeer M, Bielen D, Vanbeckevoort D, et al Patient acceptance for CT colonography: what is the real issue? Eur Radiol 2002;12(6):1410–1415 266 Tsuda K, Hori S, Murakami T, et al Intramural invasion of gastric cancer: evaluation by CT with water-filling method J Comput Assist Tomogr 1995;19(6):941–947 267 Umschaden H, Szolar D, Gasser J, et al Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings Radiology 2000;215: 717–725 268 Verbeeck N, Mazy V, Hoebeke Y Duodenal diverticulitis CT diagnosis and conservative management JBR-BTR 1999; 82(3): 99–100 269 Volpin E, Sauvanet A, Couvelard A, et al Primary malignant melanoma of the esophagus: a case report and review of the literature Dis Esophagus 2002;15:244–249 270 Wakelin S, Deans C, Crofts T, et al A comparison of computerized tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of oesophago-gastric carcinoma Eur J Radiol 2002;41:161–167 271 Wallace MB, Nietert PJ, Earle C, et al An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoroscopy/laparoscopy Ann Thorac Surg 2002;74(4):1026–1032 272 Warshauer DM, Lee JKT Adult intussusception detected at CT or MR imaging: clinical-imaging correlation Radiology 1999;212: 853–860 273 Weishaupt D, Pfammatter T, Hilfiker PR, et al Detecting bleeding duodenal varices with multislice helical CT AJR Am J Roentgenol 2002;178:399–401 5063_Lee_Ch11pp0771-0828 10/13/05 3:00 PM Page 828 828 Chapter 11 274 Weltman DI, Yu J, Krumenacker J Jr, et al Diagnosis of acute appendicitis: comparison of 5- and 10-mm CT sections in the same patient Radiology 2000;216:172–177 275 White CS, Templeton PA, Attar S Esophageal perforation: CT findings AJR Am J Roentgenol 1993;160(4):767–770 276 Wiesner W, Khurana B, Ji H, et al CT of acute bowel ischemia Radiology 2003;226:635–650 277 Wiesner W, Mortelé KJ, Glickman JN, et al Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome AJR Am J Roentgenol 2001;177:1319–1323 278 Willmann JK, Weishaupt D, Böhm T, et al Detection of submucosal gastric fundal varices with multidetector row CT angiography Gut 2003;52:886–892 279 Wong SK, Chan LP, Yeo A Helical CT imaging of clinically suspected appendicitis: correlation of CT and histological findings Clin Radiol 2002;57:741–745 280 Wootton-Gorges SL, Eckel GM, Poulos ND, et al Duplication of the cervical esophagus: a case report and review of the literature Pediatr Radiol 2002;32:533–535 281 Wu LF, Wang BZ, Feng JL, et al Preoperative TN staging of esophageal cancer: comparison of miniprobe ultrasonography, spiral CT and MRI World J Gastroenterol 2003;9(2):219–224 282 Yamada K, Saeki M, Yamaguchi T, et al Acute mesenteric ischemia: CT and plain radiographic analysis of 26 cases Clin Imaging 1998;22:34–41 283 Yee J, Akerkar GA, Hung RK, et al Colorectal neoplasia: performance characteristics of CT colonography for detection in 300 patients Radiology 2001;219:685–692 284 Yee J, Hung RK, Akerkar GA, et al The usefulness of glucagon hydrochloride for colonic distention in CT colonography AJR Am J Roentgenol 1999;173(1):169–172 285 Yee J, Kumar NN, Hung RK, et al Comparison of supine and prone scanning separately and in combination at CT colonography Radiology 2003;226:653–661 286 Yoon YC, Lee KS, Shim YM, et al Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection—prospective study Radiology 2003;227:764–770 287 Yoshida H, Näppi J, MacEneaney P, et al Computer-aided diagnosis scheme for detection of polyps at CT colonography Radiographics 2002;22:963–979 288 Yuen EHY, Yang WT, Lam WWM Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances Australas Radiol 1998;42:139–142 289 Zalcman M, Van Gansbeke D, Lalmand B, et al Delayed enhancement of the bowel wall: a new CT sign of small bowel strangulation J Comput Assist Tomogr 1996;20(3):379–381 290 Zalcman M, Sy M, Donckier V Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction AJR Am J Roentgenol 2000;175:1601–1607 291 Ziegler K, Sanft C, Zimmer T, et al Comparison of computed tomography, endosonography, and intraoperative assessment in TN staging of gastric carcinoma Gut 1993;34(5):604–610 292 Zissin R, Gayer G, Kots E, et al Imaging of mucocele of the appendix with emphasis on the CT findings: a report of 10 cases Clin Radiol 1999;54(12):826–832 ... 5063_Lee_Ch01pp00 01- 0028 10 /13 /05 12 : 01 PM Page 13 Basic Principles of Computed Tomography Physics and Technical Considerations 13 1. 5 0.5 −50 50 10 0 15 0 50 10 0 15 0 200 1. 5 0.5 0 0.5 Figure 1- 10 Slice...5063_Lee_FMppi-xiv 10 /20/05 12 :44 PM Page i Computed Body Tomography with MRI Correlation FOURTH EDITION 5063_Lee_FMppi-xiv 10 /20/05 12 :44 PM Page ii 5063_Lee_FMppi-xiv 10 /20/05 12 :44 PM Page iii Computed Body. .. 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