A Multinational Series

Radiology Today 1 Edited by M. W. Donner and F. H. W. Heuck 1981. 290 figures, 61 tables. XIX,431. ISBN 3- 540-10099-7

Radiology Today 2 Edited by F. H. W. Heuck and M. W. Donner 1983. 306 figures, 44 tables. XII,362. ISBN 3-540-11754-7 Contents: Gastrointestinal Radiology, Swallowing Disorders, Liver Disease and Function, Renal Transplant, Obstructive Uropathy, Direct Coronal CT, Embolization, Digital Angiography, Lymphatic System, CT of Lung and Mediastinum, Bone Mineral Analysis, Soft Tissue Tumors, Interventional Neuroradiology, Nuclear Magnetic Resonance

Radiology Today 3 Edited by

M.W. Donner and F.H.W. Heuck

With 196 Figures and 45 Tables

Springer-Verlag Berlin Heidelberg New York Tokyo

Proceedings of the Multinational Postgraduate Course, held in Salzburg, June 21-24, 1984. Editors

Professor Dr. Martin W. Donner Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, MA 21205, USA Professor Dr. Friedrich H. W. Heuck Radiologisches Institut im Zentrum Radiologie des Katharinenhospitals der Stadt Stuttgart 7000 Stuttgart 1, FRG

ISBN-13: 978-3-642-69739-5 e-ISBN-13: 978-3-642-69737-1 DOl: 10.1007/978-3-642-69737-1

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use a fee is payable to 'Verwertungsgesellschaft Wort', Munich. © Springer-Verlag Berlin, Heidelberg 1985 Softcover reprint of the hardcover 1st edition 1985 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceuticalliterature. 2121/3140-543210

Preface

Radiology Today 3 presents papers and panel discussions from a multinational faculty at the biannual Salzburg Symposium, which this time covered three important topics: critical diagnostic pathways in gastro" intestinal and genitourinary radiology, interventional radiology of the abdomen, and cost containment in radiology. The choice of these topics illustrates the changing role of the radiologist in the practice of medicine today and in the foreseeable future. He will have to serve as a consultant more than ever before, assuming increasing responsibility for sequencing of imaging procedures and participating more and more in therapeutic intervention. In order to provide meaningful assistance, the imaging consultant must be aware of the efficacy and the limitations of every procedure. In this context, cost containment is a worldwide public concern, and the most appropriate procedures must be identified. Radiology Today 3 demonstrates how the radiologist functions as a member of diagnostic and management teams to provide optimal information and efficient, low-risk patient care at the lowest possible cost.

Martin W. Donner Friedrich H. W. Heuck

Contents

Critical Diagnostic Pathways

3

Abdomen G. MARCHAL, A L. BAERT, K. GEBOES, E. PONETTE, 1. FEVERY

The Diagnosis of Pancreatic Cancer

............

3

W. REICHARDT

Localization Techniques for Hormonally Active ........... . Pancreatic Tumors

7

AR. MARGULIS, S. MCCARTHY

Hepatic Mass Lesions

....

12

M. KORMANO, K. PARTANEN, 1. KUIKKA

Dynamic Liver CT and New Contrast Agents

....... .

W. FROMMHOLD, J. PIRSCHEL

Gallbladder Diseases: Imaging Sequences 1.A KIRKPATRICK, Jr.

Abdominal Masses in Children: Selection of Imaging Techniques

17

20 26

1. T. FERRUCCI, AL. BAERT, W. REICHARDT, AR. MARGULIS, W. FROMMHOLD, J.A KIRKPATRICK, Jr.

Consensus on Imaging Pathways: Liver, Gallbladder, and Pancreas . . . . . . . . . . . . . . . . . . . . . .

30

H. PO KIESER, H. CZEMBIREK, W. FRANK, P. HAJEK, H. IMHOF, W. KUMPAN, G. LECHNER, E. SALOMONOWITZ

Septic Lesions of the Abdomen

. . . . . . . ... . . . . .

36

1. T. FERRUCCI, Jf.

Percutaneous Drainage of Abdominal Abscesses and Fluid Collections . . . . . . . . . . .

41

P.E. PETERS

Radiologic Investigation of the Postoperative Patient

46

1. LAUFER

Diagnostic Pitfalls of Double-Contrast Gastrointestinal Studies and How to A void Them . . . . . . . . . . . . . . . .

53

Genitourinary Tract

59

H. HRICAK

Radiology of Renal Masses

. . . . . . . .

59

Diagnostic Approach to the Dysplastic Kidney

63

H. TREUGUT, M. ZIEGER

VIII

Contents

M. A~ BOSNIAK

Diagnostic Workup of Ureteral Obstruction in the CT Era

67

H. SCHMOLLER, R. KLOSS, T. IRNBERGER

Radiologic Management of Adult Traumatic Renal and Pelvic Hemorrhage . . . . . . . . . . . . . . . .

76

G. EGENDER, H. FROMMHOLD, A. FURTSCHEGGER

Examinations of the Female Lower Urinary Tract and Ureter

79

P. REINDL, P. CARL

Evaluation of the Male Lower Urinary Tract

86

H.M.SAXTON

Low-Osmolality Contrast in Urography

90

Retroperitoneal and Pelvic Masses

96

H. SCHREYER, G. H. SCHNEIDER, E. TOLLY

...... .

96

Imaging of Adrenal Masses . . . . . . .

104

Retroperitoneal Masses L.EKELUND E. GRABBE, E. BOCHELER

Diagnostic Approach to ParapeIvic Masses

110

H. HOTZINGER

Transrectal and Intrauterine Sonography of Gynecologic Neoplasms . . . . . . . . . .. . . . . . . 116

Interventional Radiology

121

Gastrointestinal Tract

123

S.L. KAUFMAN

Acute and Chronic Gastrointestinal Bleeding: Role of Angiographic Diagnosis and Management

. . . . . . 123

K.H.BARTH

Hepatic Artery Infusion and Embolization in the Management of Hepatic Tumors . . . . . . . . . . . . . . . . . . . 131 H. J. BURHENNE

Update on Percutaneous Gallstone Extraction and Stricture Dilatation . . . . . . . . .

135

N. RUPP, S. FEUERBACH, M. REISER, A. SCHEKATZ, K. BECKER

Percutaneous Tissue Core Biopsy with the Tru-Cut Needle

141

Genitourinary Tract

146

. . . . . . . . . . . . . . . . . . .

K.AMPLATZ

New Developments in Caval Filters

146

E.LOHR

Present Workup of Renal Hypertension

.......

148

Percutaneous Transluminal Angioplasty in Renal Arteries

153

F. OLBERT, N. MUZIKA, A. SCHLEGL

Contents

IX

E.K. LANG

Transcatheter Embolization of Renal Cell Carcinoma with 1-125 Particles . . . . . . . . . . . . . .

. . . 156

F. EISENBERGER, G. FUCHS, K. MILLER, 1. RASSWEILER

Noninvasive Renal Stone Therapy with Extracorporal Shock-Wave Lithotripsy . . . . . . . . .

161

K.AMPLATZ

Percutaneous Stone Removal

168

R. GUNTHER, P. ALKEN

Percutaneous Stone Litholapaxy and Extraction

172

Miscellaneous

175

K.N. VIZY

The Effects of Digitization and Processing on Diagnostic Images

175

U. SPECK, R. FELIX

Paramagnetic Contrast Media of the Present and the Future

180

Problems of Progress in Radiology: Supplementary Informations

184

W. P. COCKSHOTT

Variations and Cost Containment in Radiology

184

H. SCHREYER, E. TOLLY

Cost Development in Uroradiology and Neuroradiology

187

A.R. MARGULIS

The Development of Algorithms for Radiologic Procedures: Avoidance of Duplication Through Education of Physicians . . 189 J. LISSNER, G. FENZL

New Advances in Diagnostic Imaging and Their Influence on the Practice of Radiology . . . . . . . . . . .

190

W.A. FUCHS

Promotion of Radiology in Nonindustrialized Countries

197

Subject Index . . . . . . . . . . . . . . . . . .

201

List of Contributors

P. AIken Institut fUr Klinische Strahlenkunde, Urologische Klinik, Universitat Mainz, Langenbeckstrasse 1,6500 Mainz, FRG K. Amplatz Department of Radiology, University of Minnesota, Box 292, 420 Delaware Street, Minneapolis, MN 55455, USA A. L. Baert Department of Radiology, University Hospitals K.u.L., 3000 Leuven, Belgium K. H. Barth Department of Radiology, Georgetown University Hospital, 3800 Reservoir Road, N.W. Washington, DC 20007, USA K. Becker Institut fUr Allgemeine Pathologie und Pathologische Anatomie, Klinikum Rechts der Isar, Technische Universitat Miinchen, Ismaninger Strasse 22, 8000 Miinchen 80, FRG M. A. Bosniak Department of Radiology, New York University Medical Center, 550-560 First Avenue, New York, NY 10016, USA E. Biicheler Radiologische Klinik, Universitatskrankenhaus Eppendorf, Martinistrasse 52, 2000 Hamburg 20, FRG H. J. Burhenne Department of Radiology, University of British Columbia, Vancouver General Hospital, 855 West, 12th Avenue, Vancouver, British Columbia, V5Z IM9, Canada P.Carl Hauptkrankenhaus, Perlasberger Strasse 41,8360 Deggendorf, FRG W. P. Cockshott Harward Medical School, Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, 25 Shattuck Street, Boston, MA 02115, USA H. C~embirek Rontgenstation, I. Medizinische Universitatsklinik, 1090 Wien, Austria G. Egender Universitatskliniken, Ordinariat fUr Strahlentherapie, Anichstrasse 35, 6020 Innsbruck, Austria

XII

List of Contributors

F. Eisenberger Urologische Klinik, Katharinenhospital, Kriegsbergstrasse 60, 7000 Stuttgart I, FRG L. Ekelund Department of Diagnostic Radiology, University of Lund, 22185 Lund, Sweden R. Felix Abteilung Radiologie mit Poliklinik, Strahlenklinik und Poliklinik (WE 07), Universitatsklinikum Charlottenburg, Freie UniversiHit Berlin, Spandauer Damm 130, 1000 Berlin 19, FRG G. Fenzl Radiologische Klinik und Poliklinik, Klinikum Grosshadern, L ud wig -Maximilians-U ni versi tat M iinch en, Marchioninistrasse 15, 8000 Miinchen 70, FRG J. T. Ferrucci, Jr. Department of Radiology, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, USA S. Feuerbach Institut flir Rontgendiagnostik, Klinikum rechts der Isar, Technische Universitat Miinchen, Ismaninger Strasse 22, 8000 Miinchen 80, FRG J. Fevery Department ofInternal Medicine, University Hospitals K.UL., 3000 Leuven, Belgium W. Frank Rontgenstation,1. Chirurgische Universitatsklinik Wien, Alser Strasse 4, 1090 Wien, Austria

H. Frommhold Universitatskliniken, Ordinariat flir Strahlentherapie, Anichstrasse 35, 6020 Innsbruck, Austria W. Frommhold Medizinisches Strahleninstitut, Eberhard-Karls-Universitat Tiibingen, Rontgenweg 11,7400 Tiibingen, FRG G. Fuchs Division of Urology UCLA, School of Medicine, Center for Health Sciences, 18033 Le Conte Avenue, Los Angeles, CA 90024, USA W. A. Fuchs Institut flir Diagnostische Radiologie, Inselspital, 3010 Bern, Switzerland A. Furtschegger Universitatskliniken, Ordinariat flir Strahlentherapie, Anichstrasse 35, 6020 Innsbruck, Austria K. Geboes Department of Pathology, University Hospitals K UL., 3000 Leuven, Belgium . E. Grabbe Radiologische Klinik, Universitatskrankenhaus Eppendorf, Martinistrasse 52, 2000 Hamburg 20, FRG

List of Contributors

XIII

R. Gunther

Abteilung Radiologische Diagnostik, Neuklinikum, Pauwelsstrasse, 5100 Aachen, FRG P. Hajek Zentrales Institut fUr Radiodiagnostik, Universitat Wien, Aiser Strasse 4, 1090 Wien, Austria H. Hotzinger Abteilung fUr Radiologie, Sta.dtisches Krankenhaus Pass au, Bischof-Pilgrim-Strasse 1,8390 Passau, FRG H. Hricak Department of Radiology, School of Medicine, University of California, San Francisco, CA 94143, USA H. Imhof Zentraies Institut fUr Radiodiagnostik, Universitat Wien, Alser Strasse 4, 1090 Wien, Austria T. Irnberger Rontgendiagnostisches Zentralinstitut der Landeskrankenanstalten, Mullner Hauptstrasse 48, 5020 Salzburg, Austria S. L. Kaufman Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD 21205, USA J. A. Kirkpatrick, Jr.

Department of Radiology, The Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA R. Kloss Rontgendiagnostisches Zentralinstitut der Landeskrankenanstalten, Mullner Hauptstrasse 48,5020 Salzburg, Austria M. Kormano Department of Diagnostic Radiology, University Central Hospital, 20520 Turku, Finland J. Kuikka Department of Clinical Physiology, University Central Hospital, Kuopio, Finland W. Kumpan Zentrales Institut fUr Radiodiagnostik, Universitat Wien, Aiser Strasse 4, 1090 Wien, Austria E. K. Lang Department of Radiology, School of Medicine, Louisiana State University, Medical Center, 1542 Tulane Avenue, New Orleans, LA, USA I. Laufer Hospital of the University of Pennsylvania, 3400 Spruce Street/G 1, Philadelphia, PA 19104, USA G. Lechner Rontgenstation, I. Chirurgische Universitatsklinik Wien, Aiser Strasse 4, 1090 Wien, Austria J. Lissner Radiologische Klinik und Poliklinik, Klinikum Grosshadern, L udwig-Maximilians-U ni versi Hit Munchen, Marchioninistrasse 15, 8000 Munchen 70, FRG

XIV

List of Contributors

E. L6hr R6ntgendiagnostisches Zentralinstitut, Universitatsklinikum der Gesamthochschule Essen, Hufelandstrasse 55, 4300 Essen, FRG G. Marchal Department of Radiology, University Hospitals K u.L., 3000 Leuven, Belgium

A. R. Margulis Department of Radiology, University of California, School of Medicine, San Francisco, CA 94143, USA S. McCarthy Department of Radiology, University of California, San Francisco, CA 94143, USA K. Miller Urologische Klinik, Katharinenhospital, Kriegsbergstrasse 60, 7000 Stuttgart 1, FRG

N. Muzika R6ntgenstation, 1. Chirurgische Abteilung, Krankenhaus der Stadt Wien-Lainz, Wolkersbergenstrasse 1, 1130 Wi en, Austria F.Olbert R6ntgenstation, 1. Chirurgische Abteilung, Krankenhaus der Stadt Wien-Lainz, Wolkersbergenstrasse 1, 1130 Wien, Austria K. Partanen Department of Diagnostic Radiology, University Central Hospital, Kuopio, Finland P. E. Peters Institut fUr Klinische Radiologie, Westfalische-Wilhelms-Universitat Munster, Albert Schweitzer-Strasse 33, 4400 Munster, FRG

J. Pirschel Medizinisches Strahleninstitut, Eberhard-Karls-Universitat Tubingen, R6ntgenweg 11, 7400 Tubingen, FRG H. Pokieser Zentrales Institut fUr Radiodiagnostik, Universitat Wien, Alser Strasse 4, 1090 Wien, Austria E.Ponette Department of Radiology, University Hospitals K u.L., 3000 Leuven, Belgium J. Rassweiler Urologische Klinik, Katharinenhospital, Kriegsbergstrasse 60, 7000 Stuttgart I, FRG W. Reichardt Seelbergstrasse 9, 7000 Stuttgart 50, FRG P. Reindl Hauptkrankenhaus, Perlasberger Strasse 41, 8360 Deggendorf, FRG M. Reiser Institut fUr R6ntgendiagnostik, Klinikum rechts der Isar, Technische Universitat Munchen, Ismaninger Strasse 22, 8000 Munchen 80, FRG

List of Contributors

XV

N. Rupp lnstitut fUr Rontgendiagnostik, Klinikum rechts der lsar, Technische Universitat Miinchen, lsmaninger Strasse 22,8000 Miinchen 80, FRG E. Salomonowitz Rontgenstation,1. Medizinische Universitatsklinik Wien, Lazarettgasse 14, 1090 Wien, Austria

H. M. Saxton Department of Diagnostic Radiology, Guy's Hospital, St. Thomas Street, London SEI 9RT, Great Britain A. Schekatz lnstitut fUr Rontgendiagnostik, Klinikum rechts der lsar, Technische Universitat Miinchen, lsmaninger Strasse 22, 8000 Miinchen 80, FRG A. SchIegl Rontgenstation, 1. Chirurgische Abteilung, Krankenhaus der Stadt Wien-Lainz, Wolkersbergenstrasse 1, 1130 Wien, Austria

H. Schmoller Rontgendiagnostisches Zentralinstitut der Landeskrankenanstalten, Miillner Hauptstrasse 48, 5020 Salzburg, Austria G. H. Schneider Universitatsklinik fUr Radiologie, Landeskrankenhaus, 8036 Graz, Austria H. Schreyer Abteilung fUr spezielle Rontgendiagnostik, Universitatsklinik fUr Radiologie, Landeskrankenhaus, 8036 Graz, Austria U. Speck Schering Aktiengesellschaft, Postfach 65 03 11, 1000 Berlin 65, FRG E. Tolly Universitatsklinik fUr Radiologie, Landeskrankenhaus, 8036 Graz, Austria

H. Treugut Radiologisches lnstitut, KatharinenhospitaI, Kriegsbergstrasse 60, 7000 Stuttgart I, FRG K. N. Vizy Eastman Kodak Company, Health Sciences Markets Division, 343 State Street, Rochester, NY 14650, USA

M. Zieger Olgahospital, Padiatrisches Zentrum, Radiologisches lnstitut, Bismarckstrasse 8, 7000 Stuttgart 1, FRG