Multislice CT

"The fourth edition of this well-received book offers a comprehensive update on recent developments and trends in the clinical and scientific applications of multislice computed tomography. Following an initial section on the most significant current technical aspects and issues, detailed information is provided on a comprehensive range of diagnostic applications. Imaging of the head and neck, the cardiovascular system, the abdomen, and the lungs is covered in depth, describing the application of multislice CT in a variety of tumors and other pathologies. Emerging fields such as pediatric imaging and CT-guided interventions are fully addressed, and emergency CT is also covered. Radiation exposure, dual-energy imaging, contrast enhancement, image postprocessing, CT perfusion imaging, and CT angiography all receive close attention. The new edition has been comprehensively revised and complemented by contributions from highly experienced and well-known authors who offer diverse perspectives, highlighting the possibilities offered by the most modern multidetector CT systems. This book will be particularly useful for general users of CT systems who wish to upgrade and enhance not only their machines but also their knowledge." -- Prové de l'editor. In Memoriam Contents Part I: Techniques Multi-slice CT: Current Technology and Future Developments 1 Introduction 2 System Design 2.1 Gantry 2.2 X-Ray Tube and Generator 2.3 MDCT Detector Design and Slice Collimation 2.4 Dual Source CT 3 Measurement Techniques 3.1 MDCT Sequential (Axial) Scanning 3.2 MDCT Spiral (Helical) Scanning 3.2.1 Pitch 3.2.2 Collimated and Effective Slice Width 3.2.3 Image Reconstruction 3.2.4 Double z-Sampling 3.3 ECG-Synchronized Cardiovascular CT 3.3.1 ECG-Gated Spiral CT 3.3.2 ECG-Triggered Sequential (Axial) CT 3.3.3 ECG-Triggered High-Pitch Spiral CT 3.4 Dual Energy Computed Tomography 4 Radiation Dose Reduction 4.1 Anatomical Tube Current Modulation 4.2 Adaptation of the X-Ray Tube Voltage 4.3 Spectral Shaping 4.4 Iterative Reconstruction 5 Future Developments References Radiation Dose Optimization in CT 1 Introduction 2 Dose Metrics 3 Justification for CT 4 Effects of Scan Factors on Radiation Dose and Image Quality 4.1 Reconstruction Techniques 4.2 Body Size-Adapted CT Protocols 5 Image Quality and Radiation Dose 6 Dose Optimization Based on Specific Body Regions References Spectral CT/Dual-Energy CT 1 Introduction 2 Concept of Dual Energy 3 Design of Devices 3.1 Single-Source Dual-Energy CT (ssDECT) 3.1.1 Sequential Acquisition 3.1.2 Rapid kV Switching 3.1.3 Split-Filter Technology 3.1.4 Sandwich or Layer Detectors 3.1.5 Photon-Counting Detectors 3.2 Dual-Source Dual-Energy CT (dsDECT) 4 Image Post-Processing and Clinical Applications 4.1 “Morphological” Images 4.2 VME Images 4.2.1 Clinical Applications Artifact Reduction Optimizing Contrast Reducing the Intravenous Contrast Media 4.3 Material-Specific Images 4.3.1 Clinical Applications of Different Materials Water Iodine Calcium Urate Fat Radiation Dose Considerations Challenges Future Opportunities References Contrast Enhancement at CT 1 Pharmacokinetics of the Iodine Contrast Material 1.1 Distribution of Contrast Material (CM) in the Body (Fig. 1) 1.2 Phases of Contrast Enhancement 1.3 Time-Density Curve 1.4 Simulation of CM Distribution in the Body 2 Factors Influencing the Enhancement of Blood Vessels and Organs 2.1 Patient Factors 2.1.1 Body Size 2.1.2 Cardiac Function 2.1.3 Renal Function 2.1.4 Hepatic Function 2.1.5 Other Patient Factors 2.2 Contrast Material Factors 2.2.1 Iodine Dose 2.2.2 Injection Duration (Injection Rate) 2.2.3 Iodine Concentration 2.2.4 CM Osmolality and Viscosity 2.2.5 Saline Chaser 2.3 Scan Factors 3 Optimization of Scan Protocols Taking into Account CM Pharmacokinetics References Image Processing from 2D to 3D 1 Introduction 2 Principles of Rendering Techniques 3 Surface Rendering 4 Maximum Intensity Projection 5 Volume Rendering 6 Cinematic Rendering References Perfusion CT: Technical Aspects 1 Introduction 2 Principles of Perfusion CT 2.1 Contrast Agent Kinetics 2.2 Biological Correlates of Perfusion CT Parameters 3 Acquisition Protocols 3.1 Patient Preparation 3.2 Contrast Agent Administration 3.3 Data Acquisition 3.4 Motion Correction and Image Registration 3.5 Arterial Input Function and Venous Output 4 Clinical Implementation 4.1 Quality Assurance and Quality Control 4.2 Accuracy and Precision 4.3 Radiation Dose 5 Summary References Part II: Neuro/ENT Stroke/Cerebral Perfusion CT: Technique and Clinical Applications 1 Introduction 2 Perfusion CT Technique 2.1 Image Acquisition 2.2 Image Processing 3 Clinical Applications 3.1 Stroke 3.2 Vasospasm 3.3 Moyamoya 3.4 Traumatic Brain Injury 3.5 Brain Tumors 4 Summary References CT Diagnostics in Brain Tumors 1 Introduction 2 Specific Role of CT Imaging 2.1 Diagnostic and Differential Diagnostic 2.2 Therapy Planning 2.3 Treatment Follow-Up 3 CT Characteristics of Brain Tumors 3.1 WHO Classification of Brain Tumors 3.2 Contrast Enhancement of Brain Tumors 3.2.1 Mechanisms of Contrast Enhancement in Brain Tumors 4 Primary Intraaxial Gliomatous Tumors 4.1 WHO Grade I Tumors 4.2 WHO Grade II Tumors 4.3 WHO Grade III 4.4 Glioblastoma 4.5 Gliomatosis Cerebri 4.6 Oligodendroglioma 4.7 Mixed Glioma 5 Lymphoma 6 Metastasis 7 Others Intraaxial Tumors 7.1 Ependymoma 7.2 Subependymoma 7.3 Anaplastic Ependymoma 7.4 Medulloblastoma 8 Extraaxial 8.1 Meningioma 8.2 Hemangiopericytoma 8.3 Melanocytoma 8.4 Choroid Plexus Tumors 9 Tumors of the Sellar Region 9.1 Pituitary Tumors 9.2 Craniopharyngioma 9.3 Rathke’s Cleft Cyst 10 Tumors of Peripheral Nerves that Affect the CNS 10.1 Schwannoma 11 Non-tumorous Changes 11.1 Arachnoid Cysts 11.2 Epidermoid Cysts 11.3 Dermoid Cysts 12 Extraaxial Metastasis References MDCT in Neurovascular Imaging 1 Background 2 Protocol Parameters for Neurovascular MDCT 3 Clinical Applications of Neurovascular MDCT 3.1 Comprehensive Stroke Imaging 3.2 Carotid Artery Stenosis 3.3 Basilar Artery Occlusions 3.4 Intracranial Aneurysms 3.5 Cerebral Venous Thrombosis 3.6 Cervical Artery Dissection References Anatomy and Pathology of the Temporal Bone 1 Introduction 2 Anatomy 3 Multi-slice CT Technique 4 Pathology 4.1 Inflammation 4.2 Trauma 4.3 Tumour 4.4 Malformation 4.5 Otosclerosis 4.6 Postoperative CT 5 Take-Home Points Further Reading Dental CT: Pathologic Findings in the Teeth and Jaws 1 Systematic Approach for Characterizing Pathologic Findings 1.1 Radiodensity 1.2 Transition Zone 1.3 Bone Remodeling 1.4 Location 1.5 Relation to Teeth 1.6 Clinical Symptoms and History 2 Clinical Examination and Imaging 2.1 Dental CT Examination Protocols 2.2 Anatomy 2.3 Tooth 3 Radiolucent Lesions with Well-Defined Borders 3.1 Radicular Cyst 3.2 Residual Cyst 3.3 Follicular Cyst 3.4 Keratocystic Odontogenic Tumor 3.5 Ameloblastoma 3.6 Stafne Cyst 3.7 Simple Bone Cyst 3.8 Primordial Cyst 4 Sclerotic, Tooth-Related Jaw Lesions 4.1 Cementoblastoma 4.2 Cemento-Osseous Dysplasia (COD) 4.3 Condensing Osteitis 4.4 Odontoma 4.5 Idiopathic Osteosclerosis 5 Sclerotic Not Tooth-Related Jaw Lesions 5.1 Osteoma 5.2 Tori and Exostoses 6 Mixed Lytic and Sclerotic Jaw Lesions 6.1 Osteomyelitis 6.1.1 AO and SCO 6.1.2 PCO 6.1.3 Proliferative Periostitis 6.2 Osteoradionecrosis of the Jaw 6.2.1 Osteoradionecrosis (ORN) 6.2.2 Medication-Related Osteonecrosis of the Jaw References Anatomy and Corresponding Oncological Imaging of the Head and Neck 1 Introduction 2 Paranasal Sinuses and Nasopharynx 2.1 Anatomy 2.2 Oncological Imaging of Sinonasal Masses 3 Oral Cavity and Oropharynx 3.1 Anatomy of Oral Cavity 3.1.1 Anatomy of Oropharynx 3.2 Oncological Imaging of Oral Masses 4 Hypopharynx and Larynx 4.1 Anatomy of Hypopharynx 4.1.1 Anatomy of Larynx 4.2 Imaging of Hypopharyngeal and Laryngeal Masses 4.2.1 Hypopharynx 4.2.2 Larynx References Part III: Chest Interstitial Lung Diseases 1 Introduction 2 Anatomic and Technical Considerations 2.1 Normal Lung Anatomy 2.1.1 The Peribronchovascular Interstitium 2.1.2 The Secondary Pulmonary Lobule 2.1.3 Interlobular Septa 2.1.4 Centrilobular Region 2.1.5 Lobular Parenchyma 2.2 CT-Technique 2.2.1 Spaced High-Resolution CT 2.2.2 Volumetric High-Resolution CT 2.2.3 Other Parameters Influencing Radiation Dose 2.2.4 Reconstruction Kernels 2.2.5 Tube Voltage Selection and Tube Current Modulation 2.2.6 Spectral Shaping 2.2.7 Low Dose CT 2.2.8 Protocol Decision 3 HRCT Pattern 3.1 Linear and Reticular Pattern 3.2 Nodular Pattern 3.2.1 Perilymphatic Nodules 3.2.2 Centrilobular Nodules 3.2.3 Random Nodules 3.3 High Attenuation Pattern 3.4 Low Attenuation Pattern 4 Interstitial Lung Diseases That Have No Known Cause 4.1 Idiopathic Interstitial Pneumonias (IIP) 4.1.1 Idiopathic Pulmonary Fibrosis (IPF) 4.1.2 Nonspecific Interstitial Pneumonia (NSIP) 4.1.3 Cryptogenic Organizing Pneumonia (COP) 4.1.4 Respiratory Bronchiolitis-Associated Interstitial Lung Disease (RB-ILD) 4.1.5 Desquamative Interstitial Pneumonia (DIP) 4.1.6 Lymphoid Interstitial Pneumonia (LIP) 4.1.7 Acute Interstitial Pneumonia (AIP) 4.2 Sarcoidosis 4.3 Miscellaneous Rare Forms of Interstitial Lung Disease of Unknown Etiology 4.3.1 Pulmonary Langerhans Cell Histiocytosis 4.3.2 Lymphangioleiomyomatosis 4.3.3 Eosinophilic Pneumonia 4.3.4 Pulmonary Alveolar Proteinosis 4.3.5 Pulmonary Microlithiasis 5 Interstitial Lung Diseases of Known Cause 5.1 Occupational and Environmental Lung Disease 5.1.1 Hypersensitivity Pneumonitis 5.1.2 Pneumoconiosis 5.1.3 Drug-Induced Lung Disease 5.2 Radiation-Induced Lung Injury 5.3 Collagen Vascular Lung Disease 5.4 Diffuse Pulmonary Hemorrhage References Pneumonia 1 Introduction 1.1 General Recommendations for Imaging 1.2 Methods and Techniques 1.2.1 Chest X-Ray 1.2.2 Computed Tomography (CT) 1.2.3 Magnetic Resonance Imaging (MRI) 1.2.4 Positron Emission Tomography 2 Forms of Pneumonia 2.1 Bacterial Pneumonia 2.2 Mycobacterial Pneumonia 2.3 Viral Pneumonia 2.4 Pneumocystis Jirovecii Pneumonia 2.5 Fungal Pneumonia 2.6 Parasitic Lung Infection 3 Noninfectious Infiltrates 3.1 Organizing Pneumonia 3.1.1 Drug Toxicity 3.1.2 Radiation Pneumonia 3.2 Graft Versus Host Disease 3.3 Other Diseases 4 Special Forms and Complications of Pneumonia 4.1 Aspiration Pneumonia 4.2 Retention Pneumonia 4.3 Post Infarction Pneumonia 4.4 Septic Embolism 4.5 Lung Abscess 4.6 Pleural Empyema 5 Patients with Underlying Disorders 5.1 Pneumonia in Immunocompromised Patients 5.2 Pneumonia in Patients with Altered Airways References CT of the Airways 1 Introduction 1.1 Radiologic Anatomy of the Airways and Physiology 2 Technical Aspects 2.1 Scanning Protocol 2.2 Multiplanar Reformats, MIP, MinIP, and Image Processing 2.3 Virtual Bronchoscopy and 3D Views 3 Evaluation 3.1 Visual Evaluation 3.2 Quantitative Evaluation 4 Elementary CT Findings in Airway Diseases 4.1 Bronchiectasis and Bronchiolectasis 4.2 Bronchial Wall Thickening 4.3 Mucus Plugging 4.4 Tree-in-Bud Pattern 4.5 Mosaic Attenuation Pattern and Air Trapping 5 Diseases 5.1 Tracheobronchomalacia 5.2 Tracheobronchomegaly (Mounier-Kuhn Syndrome) 5.3 Tracheal Stenosis 5.4 Saber Sheath Trachea 5.5 Primary Ciliary Dyskinesia (Immotile Cilia Syndrome) 5.6 Cystic Fibrosis 5.7 Tracheobronchial Amyloidosis 5.8 Sarcoidosis of the Airways 5.9 Relapsing Polychondritis 5.10 Granulomatosis with Polyangiitis 5.11 Tracheopathia Osteoplastica 5.12 Asthma 5.13 Bronchiolitis 5.14 Bronchiolitis Obliterans 5.15 Swyer-James Syndrome References Lung Cancer Screening 1 Text 1.1 NLST: First Study to Demonstrate a Mortality Benefit of LDCT-Screening 1.2 Screening Programs and Reimbursement in the USA 2 European Studies and Recommendations 2.1 High False-Positive Rate 2.2 Overdiagnosis 2.3 Radiation Dose 2.4 Interval Cancers 2.5 Management of New Solid Nodules 2.6 Management of Nonsolid Nodules 2.7 Smoking Cessation 2.8 Biomarkers 2.9 Cost-Effectiveness 2.10 CT Can Do More Than Identifying Lung Nodule: Screening for “Big-Three” References Chest Neoplasias 1 Lung Cancer 1.1 CT Manifestations of Lung Cancer 1.1.1 Pulmonary Nodule or Mass 1.1.2 Hilar or Mediastinal Enlargement 1.1.3 Airway Abnormalities 1.1.4 Pulmonary Consolidation 1.1.5 Lymphangitic Tumor Spread 1.2 Lung Cancer by Cell Types 1.2.1 Adenocarcinoma 1.2.2 Squamous Cell Carcinoma 1.2.3 Large Cell Carcinoma 1.2.4 Neuroendocrine Tumors 1.3 Lung Cancer Staging 1.3.1 Primary Tumor (T Descriptor) 1.3.2 Regional Lymph Node Status (N Descriptor) 1.3.3 Distant Metastatic Disease (M Descriptor) 2 Malignant Pleural Mesothelioma (MGM) 3 Primary Neoplasms of the Mediastinum 3.1 Thymic Neoplasms 3.1.1 Thymic Epithelial Tumors 3.1.2 Rare Thymic Tumors 3.2 Germ Cell Tumor 3.2.1 Teratoma 3.2.2 Seminoma 3.2.3 NSGCT 3.3 Lymphoma 3.3.1 HL 3.3.2 NHL 3.4 Neurogenic Tumors References CT of Pulmonary Embolism: Imaging Update 1 Introduction 2 New Options in the Diagnostic Approach 2.1 Clinical Decision Support 2.2 Optimization of the Radiation Dose 2.3 Optimization of the Iodine Load 2.3.1 Low Contrast Medium Volume 2.3.2 Low-Concentrated Contrast Agents 2.4 Current Role of CAD Systems 2.5 Is There Always a High Level of Confidence in Diagnosing Acute PE? 3 New Options in the Prognostic Assessment 3.1 Clot Burden 3.2 Right Ventricular Dysfunction 3.3 Novel Approaches 4 The Radiologist’s Report: Which Information Is Particularly Relevant for Clinicians? 5 Pulmonary Embolism from Pregnancy to Young Adults 5.1 Pulmonary Embolism in Pregnancy 5.2 Pulmonary Embolism in Children 6 When Acute PE Evolves Toward Chronic PE References COPD 1 Definition and Clinical Features of COPD 2 Imaging 2.1 Identification and Phenotyping 2.1.1 Chest Radiography 2.1.2 Computed Tomography Technical Considerations CT Appearance 2.2 Quantification 2.3 Role of Quantitative Imaging in Clinical Practice: The Present and the Future 3 Exacerbation and Comorbidities References Part IV: Abdomen Focal Lesions in Non-cirrhotic Liver 1 Introduction 2 Protocols for MDCT of the Liver 3 Radiological Appearance of Different Focal Liver Lesions 3.1 Solid Benign Lesions 3.2 Metastatic Liver Lesions 3.3 Primary Liver Tumors 3.4 Other Lesions 4 Role of MDCT in Emergencies and Follow-Up After Radiological Interventions 5 Summary Literature Cirrhotic Liver 1 Introduction 2 CT Scan Protocols 2.1 Amount of Intravenous Contrast Material 2.2 Flow Rate of Contrast Material 2.3 Scan Timing 2.4 Radiation Issues 3 Cirrhosis 3.1 Epidemiology 3.2 Pathophysiology 3.3 Features of Liver Cirrhosis on CT 4 Cirrhotic Nodules 4.1 Multistep Carcinogenesis of Liver Cirrhosis 4.2 Multistep Changes in Intranodular Blood Flow 4.3 Regenerative Nodules 4.4 Dysplastic Nodules 5 CT Findings for HCC 5.1 Progressed HCC 5.2 Major Imaging Features 5.2.1 Arterial Phase Hyperenhancement 5.2.2 Washout Appearance 5.2.3 Capsular Enhancement 5.3 Other Imaging Features 5.3.1 Vascular Invasion 5.3.2 Fatty Metamorphosis 5.3.3 Mosaic Architecture 5.3.4 Nodule-In-Nodule Appearance 6 Early HCC 7 HCC Variants 7.1 Diffuse or Infiltrative HCC 7.2 Scirrhous HCC 7.3 Sarcomatous HCC 7.4 Fibrolamellar HCC 7.5 Combined HCC-Cholangiocarcinoma 8 Advanced CT Techniques for HCC 8.1 Four-Dimensional CT 8.2 Low-Kilovoltage CT 8.3 Perfusion CT 8.4 Dual-Energy CT References Pancreatic Tumors 1 Introduction 2 Standard CT for Pancreatic Tumor Evaluation 3 Pancreatic Ductal Adenocarcinoma (PDAC) 3.1 Morphologic Evaluation of Main Tumor and Secondary Signs 3.2 Vascular Evaluation 3.3 Extrapancreatic Evaluation 3.4 Performance of CT for Staging and Resectability of Pancreatic Cancer 4 Pancreatic Neuroendocrine Tumors 4.1 Nonfunctioning Pancreatic Neuroendocrine Tumors 4.2 Insulinoma 4.3 Gastrinoma 5 Cystic Neoplasms 5.1 Serous Cystadenoma (SCA) 5.2 Mucinous Cystic Neoplasm (MCN) 5.3 Intraductal Papillary Mucinous Neoplasm (IPMN) 5.4 Solid Pseudopapillary Epithelial Neoplasm (SPEN) 5.5 Cystic Change of Solid Tumors 6 Secondary Pancreatic Neoplasms 7 Nonneoplastic Solid Lesions Mimicking Pancreatic Solid Tumors 7.1 Focal Pancreatitis 7.2 Fatty Infiltration-Replacement 7.3 Intrapancreatic Accessory Spleen References Acute and Chronic Pancreatitis 1 Acute Pancreatitis 1.1 Introduction 1.2 Diagnostic Criteria 1.3 Phases of Acute Pancreatitis 1.4 Severity of Acute Pancreatitis 1.5 Imaging 1.6 Morphological Classification 1.7 Pancreatic and Peripancreatic Collections 1.8 Acute Peripancreatic Fluid Collection and Pseudocyst 1.9 Acute Necrotic Collection and Walled-Off Necrosis 1.10 Infection 1.11 Vascular Complications 1.12 Treatment 2 Chronic Pancreatitis 2.1 Introduction 2.2 Imaging 2.3 Treatment 2.4 Other Forms of Chronic Pancreatitis 2.4.1 Paraduodenal Pancreatitis 2.4.2 Autoimmune Pancreatitis 2.4.3 Hereditary Chronic Pancreatitis References Spleen 1 Imaging Anatomy and Function of the Spleen 2 Trauma 2.1 Introduction 2.2 Classification 2.3 Imaging Characteristics 2.4 Image Examples (Figs. 6–10) 2.5 Treatment Options 3 Benign Lesions 3.1 General Principles 3.2 Cysts 3.3 Epidermoid Cyst 3.4 Hemangioma 3.5 Lymphangioma 3.6 Hamartoma 3.7 Sclerosing Angiomatoid Nodular Transformation 3.8 Angiomyolipoma 4 Semi-malignant Lesions 4.1 Littoral Cell Angioma 4.2 Hemangioendothelioma 5 Malignant Lesions 5.1 Lymphoma 5.2 Splenic Metastases 5.3 Angiosarcoma 5.4 Hemangiopericytoma 6 Infection 6.1 Abscess 6.2 Hydatid Infection 6.3 Tuberculosis 6.4 Malaria 7 Miscellaneous 7.1 Splenic Infarction 7.2 Extramedullary Hematopoiesis 7.3 Splenic Sarcoidosis 7.4 Splenic Amyloidosis 8 Differential Diagnosis Based on Imaging Finding 8.1 Splenomegaly 8.2 Splenic Infarction 8.3 Splenic Rupture References Imaging of the Stomach and Esophagus Using CT and PET/CT Techniques 1 Introduction 2 CT and PET-CT Technique 2.1 CT Technique 2.2 PET-CT Technique 3 Esophageal Cancer 3.1 CT, PET-CT Imaging of the Esophagus 3.2 Tumor Detection and Classification 3.2.1 N Staging 3.2.2 M Staging 3.3 Follow-Up After Esophagectomy 3.3.1 CT Findings 3.3.2 CT and PET-CT for Predicting Survival 4 Other Esophageal Malignancies 4.1 Esophageal Lymphoma 4.1.1 CT and PET/CT Findings 4.2 Leiomyoma and GIST 4.2.1 CT Findings 4.3 Fibrovascular Polyps 4.3.1 CT Findings 4.4 Esophageal Fistula 4.4.1 CT Findings 4.5 Achalasia 4.5.1 CT Findings 4.6 Dysphagia Lusoria 4.6.1 CT Findings 5 Gastroesophageal Diseases 5.1 Gastro- and Esophageal Perforation 5.1.1 CT Findings 5.2 Diverticula 5.2.1 CT Findings 5.3 Duplication Cyst 5.3.1 CT Findings 5.4 Hiatal Hernia 5.4.1 CT Findings 5.5 Esophagitis, Gastritis, and Ulcer 5.5.1 CT Findings 5.6 Gastroesophageal Varices 5.6.1 CT Findings 6 Gastric Adenocarcinoma 6.1 Tumor Detection and Classification 6.2 T Staging 6.3 N Staging 6.4 M Staging 6.5 Follow-Up After Partial Gastrectomy 7 Other Gastric Malignancies 7.1 Gastric Lymphoma 7.1.1 CT Findings 7.2 Gastro-Entero-Pancreatic Neuroendocrine Tumors (GEPNETs) 7.2.1 CT Findings 7.3 Gastrointestinal Stromal Tumors (GISTs) 7.4 Neural Tumors 7.5 Gastric Outlet Obstruction References Small Bowel MDCT 1 Introduction 2 General Recommendations for Imaging 2.1 Patient Preparation 2.2 Acquisition Protocol 2.3 Enteral Contrast Medium 3 Small Bowel Diseases 3.1 Tumours 3.1.1 CT Findings of Benign Tumours 3.1.2 CT Findings of Malignant Tumours 3.2 Crohn’s Disease 3.2.1 CT Findings 3.3 Intestinal Ischemia and Infarction 3.3.1 CT Findings 3.4 Obstructions and Perforations 3.4.1 CT Findings 3.5 Other Entities 3.5.1 Graft-Versus-Host Disease (GVHD) 3.5.2 Coeliac Disease References Imaging of Large Bowel with Multidetector Row CT 1 Colorectal Cancer 1.1 Colorectal Cancer Pathophysiology 1.2 Colorectal Staging 1.3 Colorectal Screening 1.4 CT Colonography 1.5 CTC Technique 1.6 CTC: Polyps and Cancer 1.7 CTC Reporting 1.8 CTC Screening 1.9 CT Colonography Indications/Contraindications 2 Colonic Lymphoma 3 Colitis 3.1 Inflammatory Bowel Disease: Ulcerative Colitis and Crohn’s Disease 3.2 Infectious Colitis 3.3 Pseudomembranous Colitis 3.4 Ischemic Colitis 3.5 Typhlitis 3.6 Stercoral Colitis 4 Acute Diverticulitis 5 Appendix 5.1 Appendicitis 5.2 Primary Neoplasms of the Appendix 5.2.1 Mucinous Epithelial Neoplasm: Mucocele of the Appendix 5.2.2 Nonmucinous Epithelial Neoplasm 5.2.3 Carcinoid Tumor 5.2.4 Other Neoplasms of the Appendix 6 Epiploic Appendagitis 7 Colonic Volvulus 7.1 Cecal Volvulus 7.2 Sigmoid Volvulus 8 Lower Gastrointestinal Bleeding: Role of CTA References Peritoneal Surface Malignancy 1 Introduction 2 Definition and Clinical Features of PC 3 CT Imaging 3.1 Technical Consideration 3.2 CT Appearance with Pathological Correlation 3.3 Quantification 4 Role of Laparoscopy, US, MR, and PET References Multislice PET/CT in Neuroendocrine Tumors 1 Introduction 2 Diagnostic Algorithm in NET 3 Somatostatin Receptor Imaging with PET 3.1 Somatostatin Receptor Agonists 3.1.1 Detection of Primary 3.1.2 Suspicion of Tumor Recurrence 3.1.3 Theranostics 3.1.4 Response Prediction to PRRT 3.1.5 Therapy Monitoring 3.2 Somatostatin Receptor Antagonists 4 PET Using Fluorodeoxyglucose (FDG) 5 PET Using Fluorodihydroxyphenylalanine (FDOPA) 6 Glucagon-like Peptide-1 Receptor (GLP-1R) Imaging References Adrenals 1 Introduction 2 Morphology 3 CT Densitometry 4 Contrast Media Kinetics 5 Multi-energy CT References Kidneys, Ureters, and Bladder 1 Kidneys 1.1 Anatomy 1.2 Renal Imaging 1.3 Incidental Renal Lesions 1.4 Multi-energy Imaging of Incidental Renal Lesions 1.5 Cystic Renal Masses 1.6 Solid Renal Masses 1.7 Renal Cell Carcinoma 1.8 Pseudotumor 1.9 Renal Infections 1.10 Traumatic Renal Injury 2 Ureters 3 Bladder References Part V: Cardiovascular Technical Innovations and Concepts in Coronary CT 1 Introduction 2 Coronary CT Angiography: Current Status 2.1 Technical Principle 2.2 Acquisition Techniques 3 Tube Voltage 3.1 Technical Background 3.2 Impact on Image Luminal Contrast 3.3 Impact on Radiation Exposure 4 Iterative Reconstruction 4.1 Technical Principles 4.2 Technical Evolution 4.3 Impact on Image Appearance/Quality 4.4 Impact on Radiation Exposure 4.5 Limitations 5 New Concepts in Cardiac CT 5.1 Assessment of Cardiac Function 5.2 Techniques for the Evaluation of Hemodynamic Significance 5.2.1 Cardiac Perfusion 5.2.2 Transluminal Attenuation Gradient (TAG) 5.2.3 CT Fractional Flow Reserve (CT-FFR) References Noninvasive Coronary Artery Imaging 1 Introduction 2 Technical Issues 2.1 Radiation Dose 2.1.1 ECG Gating 2.1.2 ECG Pulsing 2.1.3 Tube Current Modulation and Tube Voltage Adaptation 2.2 Image Reconstruction 2.2.1 Data Reconstruction 2.3 Reconstruction Phases 2.3.1 Filtered Back Projection 2.3.2 Iterative Reconstruction 2.3.3 Post-processing 3 Accuracy 4 Prognosis 5 Indications 5.1 Coronary Artery Disease 5.2 Coronary Artery Anomalies 5.3 Coronary Stents and Bypass Grafts 6 Summary References Pre- and Postinterventional/Surgical Evaluation by CT 1 Preprocedural Imaging 2 CCTA After Percutaneous Coronary Intervention 3 CT Imaging of Coronary Artery Stents 4 CT Imaging Features Affecting Image Quality 4.1 Temporal Resolution 4.2 Contrast Enhancement 4.3 Image Reconstruction and Scan Parameters 4.4 Display Techniques and Window Settings 4.5 Stent Properties Affecting Image Quality 4.6 Stent Location and Size 5 Results of Stent Imaging with Different CT Scanners 6 CT-Imaging of Coronary Bypass Grafts 7 CT Imaging Features Affecting Image Quality 8 Results of Graft Imaging with CT References Computed Tomography in the Management of Electrophysiology Procedures 1 Atrial Fibrillation 1.1 Atrial Fibrillation and Pulmonary Vein Isolation 1.2 Technical Considerations for Computed Tomography Prior to Pulmonary Vein Isolation 1.2.1 Radiation Dose Concerns 1.3 Pulmonary Vein and Left Atrial Imaging in Atrial Fibrillation Ablation 1.3.1 Pulmonary Vein Anatomy 1.3.2 Left Atrial Anatomy 1.4 Electro-anatomic Mapping System Fusion with Computed Tomography Imaging 1.5 Pulmonary Vein Stenosis 1.6 Left Atrial Appendage Thrombus 1.7 Left Atrial Appendage Morphology Assessment 1.8 Left Atrial Appendage Occlusion Devices 1.8.1 LARIAT 1.8.2 WATCHMAN 2 Cardiac Resynchronization Therapy 2.1 Cardiac Resynchronization Therapy and Coronary Venous Imaging 2.2 Technical Considerations for Computed Tomography Coronary Venous Imaging 2.3 Noninvasive Coronary Venous Mapping Prior to Cardiac Resynchronization Therapy 2.4 Coronary Venous Imaging for Cardiac Resynchronization Therapy Nonresponders 3 Ventricular Tachycardia 3.1 Ventricular Tachycardia and Myocardial Scar 3.2 Technical Considerations for Late-Enhancement Computed Tomography for Scar Evaluation 3.3 Late-Enhancement Computed Tomography for Myocardial Scar Assessment 3.4 Computed Tomography Integration into Electro-anatomic Mapping Prior to Ventricular Tachycardia Ablation 4 Conclusions References Functional Cardiac CT Angiography 1 Introduction 2 CT Myocardial Perfusion Imaging 2.1 General Consideration 2.2 Static CTMPI: Single Energy Technique 2.2.1 Acquisition Technique and Image Analysis 2.2.2 Clinical Results 2.3 Static CTMPI: Dual-Energy Technique 2.3.1 Acquisition Technique and Image Analysis 2.3.2 Clinical Results 2.3.3 Limitations 2.4 Dynamic CTMPI 2.4.1 Acquisition Technique and Image Analysis 2.4.2 Clinical Results 2.4.3 Limitations 2.5 Pharmacological Stress Agents 3 Radiation Dose Considerations 4 Computed Tomography-Derived FFR 4.1 CT-FFR Basics 4.2 Clinical Results 4.3 Limitations 5 Summary References CT Angiography of the Peripheral Arteries 1 Introduction 1.1 Extremity CTA Technique 1.2 Patient Preparation 1.3 Image Acquisition 1.3.1 Protocol Series 1.4 Contrast Medium Administration 1.5 Strategies for Contrast Medium Administration 1.5.1 Synchronization 1.5.2 Scan Duration 1.5.3 Injection Parameters 1.5.4 Saline Flush 1.6 Image Display 1.6.1 Source Images 1.6.2 Visualization Techniques 1.6.3 Overview of Relevant Anatomy 1.6.4 Vessel Analysis 1.7 Clinical Applications 1.7.1 Peripheral Arterial Disease Acute Ischemia 1.7.2 Aneurysms 1.7.3 Vasculitis 1.7.4 Trauma 1.7.5 Compression and Entrapment Syndromes 1.7.6 Arteriovenous Fistulae, Vascular Malformations, and Vascular Masses 1.7.7 Reconstruction Surgery References Acute Aortic Syndromes 1 Introduction 2 Aortic Imaging Technique 2.1 Selection of Modality 2.2 CTA: Scan Range and Phases 2.3 Scan Parameters 2.4 Contrast Material 2.5 Radiation Dose 2.6 Reconstruction 3 Role of Other Imaging Modalities 4 Aortic Dissection and Subtypes 4.1 Definition and Clinical Background 4.2 Classification 4.3 Classical Aortic Dissection 4.3.1 CT Morphology 4.4 Intramural Hematoma (IMH) 4.4.1 CT Morphology 4.5 Penetrating Atherosclerotic Ulcer (PAU) 4.5.1 CT Morphology 5 Symptomatic Aortic Aneurysms 5.1 CT Morphology References CT Venography 1 Introduction 2 Technical Considerations 3 CT Venography: Lower Extremity, Thromboembolic Disease 3.1 Indications 3.2 Technique 3.3 Imaging Findings 3.4 Advantages and Limitations 4 CT Venography: Lower Extremity, Other 4.1 Indications 4.2 Technique 4.3 Imaging Findings 4.4 Advantages and Limitations 5 CT Venography: Upper Extremity 5.1 Indications 5.2 Technique 5.3 Imaging Findings 5.4 Advantages and Limitations 6 CT Venography: Pulmonary 6.1 Indications 6.2 Technique 6.3 Imaging Findings 6.4 Advantages and Limitations 7 CT Venography: Portomesenteric 7.1 Indications 7.2 Technique 7.3 Imaging Findings 7.4 Advantages and Limitations 8 CT Venography: Iliocaval and Pelvic Veins 8.1 Indications 8.2 Technique 8.3 Imaging Findings 8.4 Advantages and Limitations References Aortic Aneurysm and Stent Graft Assessment 1 Aortic Aneurysm 1.1 Thoracic Aortic Aneurysm 1.2 Abdominal Aortic Aneurysm 2 Technical Considerations in CT Evaluation 2.1 Data Acquisition and Contrast Administration 2.2 Postprocessing Reconstruction 2.3 Technical Advances 3 Preoperative Evaluation for Abdominal Endovascular Aortic Repair (EVAR) 3.1 Vascular Access 4 Postoperative Evaluation of Abdominal Endovascular Aortic Repair (EVAR) 4.1 Other Complications 5 Pre- and Postoperative Evaluation of Thoracic Aortic Aneurysm by Stent Graft (TEVAR) References Part VI: Interventions CT-Guided Biopsy and Drainage 1 CT-Guided Biopsy 1.1 Introduction 1.2 Patient Preparation and Aftercare 1.3 Sequential and CTF Guidance 1.4 CT-Guided Aspiration Biopsy 1.4.1 Indications 1.4.2 Materials 1.4.3 Technique General Considerations Special Considerations 1.4.4 Results 1.4.5 Complications 1.4.6 Key Points 1.5 CT-Guided Punch Biopsy 1.5.1 Indications 1.5.2 Materials 1.5.3 Technique 1.5.4 Results 1.5.5 Complications 1.5.6 Key Points 1.6 CT-Guided Drill Biopsy 1.6.1 Indications 1.6.2 Materials 1.6.3 Technique 1.6.4 Results 1.6.5 Complications 1.6.6 Key Points 2 CT-Guided Drainage 2.1 Introduction 2.2 Indications 2.3 Patient Preparation and Aftercare 2.4 Materials 2.5 Technique 2.5.1 Special Considerations Abdomen Chest 2.6 Results 2.6.1 Abdomen 2.6.2 Chest 2.7 Complications 2.8 Key Points References CT-Guided Spinal Interventions: Vertebroplasty/Kyphoplasty 1 Introduction 1.1 Osteoporotic Vertebral Body Fracture 1.2 Tumoral Osteolysis 2 Patient Selection 2.1 Osteoporotic Vertebral Body Fracture 2.2 Tumoral Osteolysis 3 Indications and Contraindications 3.1 Indications 3.2 Contraindications 4 Bone Cement 5 Preprocedural Evaluation 6 Technique 6.1 Biplane Fluoroscopy Guidance 6.2 Dual Guidance 6.3 CT-Fluoroscopy Guidance 7 Cement Application 8 Complications 9 Post-procedural Care 10 Results 10.1 Osteoporotic Vertebral Fractures 10.1.1 Benefits of Vertebroplasty Versus Sham Procedure (Placebo) 10.1.2 Benefits of Vertebroplasty Versus Optimal Medical Management 10.1.3 Vertebroplasty Versus Kyphoplasty 10.2 Harms of Vertebroplasty/Kyphoplasty 10.2.1 New Apparent Vertebral Fractures 10.3 Tumoral Osteolysis 10.3.1 Benefits for Analgesic Effects 10.3.2 Biomechanical Stabilization References CT-Guided Tumor Ablation 1 Introduction 2 Technique 2.1 Radiofrequency Ablation 2.2 Microwave Ablation (MWA) 2.3 Irreversible Electroporation 2.4 Laser 2.5 Kryoablation 3 Clinical Applications 3.1 Primary and Secondary Liver Tumors 3.1.1 Indications and Contraindications 3.1.2 Results in Liver Metastases 3.1.3 Results in HCC 3.1.4 Complications and Side Effects 3.2 Renal Cell Carcinoma 3.3 Lung Tumors 3.4 Bone and Soft Tissue Tumors References Functional CT for Image-Guided Personalized Tumor Interventions 1 Transarterial Embolization (TAE) and Transarterial Chemoembolisation (TACE) 2 Radiofrequency Ablation (RFA), Microwave- and Cryoablation 3 Intraarterial Radioembolization (Selective Internal