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Body CT and Oncologic Imaging¹

¹ From the Department of Radiology (K.D.H., K.S.) and College of Medicine (A.F.), Penn State University, PO Box 850, Hershey, PA 17033. Received September 17, 1998; revision requested November 2; final revision received June 8, 1999; accepted August 24. Address reprint requests to K.D.H. (e-mail: khopper@psu.edu).

View larger version (171K): [in a new window]   Figure 1. Transverse spiral CT images obtained in a 46-year-old woman with a history of osteosarcoma with a hepatic lesion found on a previous screening CT scan. Arterial (top images) and portal venous (bottom images) phase scans (20- and 65-second scan delay, respectively) demonstrate this lesion (arrow) to be a hemangioma. Because the arterial phase study (5-mm section thickness) began at the inferior hepatic edge, the displayed arterial images have some portal venous enhancement. The diffuse intense arterial phase enhancement with quick return to isointensity is a less common appearance of a cavernous hemangioma and occurs in approximately 8% of such lesions (9). The left two images were photographed with soft-tissue (width, 374 HU; level, 92 HU) and the right two with higher contrast liver (width, 200 HU; level, 125 HU) settings. P = posterior, R = right.

View larger version (49K): [in a new window]   Figure 2a. Photographs of a power injector show contrast material followed by saline push. (a) After the contrast material is drawn into the injector syringe, the technologist carefully loads 50 mL of injectable saline solution, colored blue for demonstration. All air is then evacuated from the syringe, and the tubing is attached and filled. With a continuous, steady, and slow motion, the technologist then inverts the injector such that its nozzle is pointed directly at the floor. (b) During this inversion, the saline solution flows over the top of the contrast material, and their positions in the syringe are reversed. During the injection, the saline solution clears the syringe, tubing, and patient's arm of contrast material.

View larger version (42K): [in a new window]   Figure 2b. Photographs of a power injector show contrast material followed by saline push. (a) After the contrast material is drawn into the injector syringe, the technologist carefully loads 50 mL of injectable saline solution, colored blue for demonstration. All air is then evacuated from the syringe, and the tubing is attached and filled. With a continuous, steady, and slow motion, the technologist then inverts the injector such that its nozzle is pointed directly at the floor. (b) During this inversion, the saline solution flows over the top of the contrast material, and their positions in the syringe are reversed. During the injection, the saline solution clears the syringe, tubing, and patient's arm of contrast material.

View larger version (170K): [in a new window]   Figure 3. Transverse contrast-enhanced abdominal CT scan of the pelvis in a 43-year-old woman with International Federation of Gynecology and Obstetrics, or FIGO, stage IIB cervical cancer. She was not allowed to void prior to CT, which caused the bladder (B) to be distended with urine. The practice of not allowing patients to void prior to abdominal or pelvic CT not only decreases the time necessary for these examinations but also allows the pelvis to be scanned with the bladder distended during the vascular phase of contrast enhancement. The arrows indicate opacified vessels.

View larger version (162K): [in a new window]   Figure 4. Transverse follow-up CT scans show a new spiculated mass (arrow) in the left lung in a 77-year-old man with a previous right pneumonectomy for non-small cell carcinoma. The left two images demonstrate this metastatic tumor with use of the routine standard interpolator and algorithm for evaluation of the mediastinum. The spiral volume was reconstructed a second time with edge-enhancing interpolators and algorithms (right two images) and yielded a sharper display of the pulmonary parenchyma. P = posterior, R = right.

View larger version (136K): [in a new window]   Figure 5. Transverse follow-up diagnostic abdominopelvic spiral CT scans show a spinal lesion (arrows) in a 23-year-old man with a history of a previously resected pelvic Ewing sarcoma. The left two images show magnified views of this spinal-left transverse process lesion on the standard interpolator and algorithm images. The right two images, however, show the volume reconstructed a second time with edge-enhancing interpolators and algorithms. P = posterior, R = right.

View larger version (62K): [in a new window]   Figure 6. A, B, Anteroposterior CT scout images show a new right hilar metastatic lymph node (arrow in A) in a 65-year-old woman with known ovarian cancer. Transverse spiral CT images are displayed in C-E, which show rectangular matrices with all text and the gray scale shown on every image, and F-H, which show square matrices with the gray scale and most of the text removed. Three different fields of view (B, arrows) were chosen for reconstruction: 1, (C, F) maximum skin-to-skin; 2, (D, G) minimum skin-to-skin; and 3, (E, H) outside rib to outside rib at the lowest level of pulmonary parenchyma. Each image was photographed onto film with the same frame size of four on one. The film images were then photographed for the illustration with exactly the same magnification for each. H, The use of the minimum field of view necessary (outside rib to outside rib) and a square matrix results in the largest image per frame.

View larger version (86K): [in a new window]   Figure 7. Transverse spiral CT scans show metastatic lung cancer, with measured tumor sites marked, in a 62-year-old woman. The careful numbering (1-6) of measured tumor sites on the film simplifies the oncologist's job in reviewing these studies and improves the accuracy and speed of the radiologist in remeasuring the same sites at subsequent examinations. P = posterior, R = right.

View larger version (38K): [in a new window]   Figure 8. Photograph shows a simple table stamped onto the patient's CT scan jacket, which allows meticulous delineation of each tumor measurement.

View larger version (46K): [in a new window]   Figure 9. Photograph shows a radiology report. Tumor measurements are easily dictated into the radiology report and actually simplify the dictation process. The organized display of new versus old measurements allows the oncologist to quickly evaluate the patient's overall tumor burden and response to treatment. This table also simplifies the job of the radiologist in evaluating follow-up studies.

View larger version (137K): [in a new window]   Figure 10. Computer-interpolated volumes, as shown here in a 25-year-old woman with primary hepatocellular carcinoma, provide the most accurate method of measuring tumor size. Orange indicates normal liver, red indicates tumor, and white indicates inferior vena cava and portal vein. The top left image is an anteroposterior view, the top right image is a view from the top of the liver, and the bottom two images are views from the bottom of the liver. INF = inferior, SUP = superior.

View larger version (114K): [in a new window]   Figure 11. Photograph shows the orthogonal localization in three planes allowed by current CT-based radiation therapy systems. (Photograph used with permission.)

View larger version (140K): [in a new window]   Figure 12a. Images obtained in a 75-year-old man with prostatic adenocarcinoma and a transplanted kidney. Purple indicates bladder, yellow indicates seminal vesicles and prostate, blue indicates transplanted kidney, and green indicates rectum. (a) Transverse CT scan shows the contoured region of the prostate and seminal vesicles (yellow), bladder (purple), and rectum (green). (b) An anteroposterior digitally reconstructed radiograph was obtained. The blue overlying the yellow prostate is a combination of prostate and rectum (green). (c) A coronal beam's eye view image was then created, areas to block were marked, and the design of the anterior field was completed. (d) Transverse CT image through the middle of the prostate shows the orientation of all four radiation therapy fields to be used in this patient. The use of these treatment fields resulted in a 70-Gy dose to the prostate and a 0-Gy dose to the transplanted kidney.

View larger version (131K): [in a new window]   Figure 12b. Images obtained in a 75-year-old man with prostatic adenocarcinoma and a transplanted kidney. Purple indicates bladder, yellow indicates seminal vesicles and prostate, blue indicates transplanted kidney, and green indicates rectum. (a) Transverse CT scan shows the contoured region of the prostate and seminal vesicles (yellow), bladder (purple), and rectum (green). (b) An anteroposterior digitally reconstructed radiograph was obtained. The blue overlying the yellow prostate is a combination of prostate and rectum (green). (c) A coronal beam's eye view image was then created, areas to block were marked, and the design of the anterior field was completed. (d) Transverse CT image through the middle of the prostate shows the orientation of all four radiation therapy fields to be used in this patient. The use of these treatment fields resulted in a 70-Gy dose to the prostate and a 0-Gy dose to the transplanted kidney.

View larger version (134K): [in a new window]   Figure 12c. Images obtained in a 75-year-old man with prostatic adenocarcinoma and a transplanted kidney. Purple indicates bladder, yellow indicates seminal vesicles and prostate, blue indicates transplanted kidney, and green indicates rectum. (a) Transverse CT scan shows the contoured region of the prostate and seminal vesicles (yellow), bladder (purple), and rectum (green). (b) An anteroposterior digitally reconstructed radiograph was obtained. The blue overlying the yellow prostate is a combination of prostate and rectum (green). (c) A coronal beam's eye view image was then created, areas to block were marked, and the design of the anterior field was completed. (d) Transverse CT image through the middle of the prostate shows the orientation of all four radiation therapy fields to be used in this patient. The use of these treatment fields resulted in a 70-Gy dose to the prostate and a 0-Gy dose to the transplanted kidney.

View larger version (149K): [in a new window]   Figure 12d. Images obtained in a 75-year-old man with prostatic adenocarcinoma and a transplanted kidney. Purple indicates bladder, yellow indicates seminal vesicles and prostate, blue indicates transplanted kidney, and green indicates rectum. (a) Transverse CT scan shows the contoured region of the prostate and seminal vesicles (yellow), bladder (purple), and rectum (green). (b) An anteroposterior digitally reconstructed radiograph was obtained. The blue overlying the yellow prostate is a combination of prostate and rectum (green). (c) A coronal beam's eye view image was then created, areas to block were marked, and the design of the anterior field was completed. (d) Transverse CT image through the middle of the prostate shows the orientation of all four radiation therapy fields to be used in this patient. The use of these treatment fields resulted in a 70-Gy dose to the prostate and a 0-Gy dose to the transplanted kidney.

View larger version (83K): [in a new window]   Figure 13. Photograph shows a coaxial needle form fitted for a current automated biopsy device.

View larger version (72K): [in a new window]   Figure 14. Transverse spiral CT scans show a large abdominal mass (*) in a 57-year-old woman who was subsequently shown, with results from this percutaneous biopsy, to have B-cell lymphoma. During needle localization, several transverse spiral CT sections were obtained consecutively through the needle and demonstrate its tip (arrow). P = posterior, R = right.

View larger version (55K): [in a new window]   Figure 15. Transverse spiral CT scans obtained in a 55-year-old man with non-small cell primary lung carcinoma and two failed attempts at transbronchial biopsy. With the patient in a right lateral decubitus position that limited motion of the right lung, a single 19-gauge coaxial needle was placed into the mass (*) by using spiral CT guidance. Two 22-gauge aspirates and two 20-gauge cores were obtained subsequently and yielded the final diagnosis. A = anterior.

View larger version (78K): [in a new window]   Figure 16a. (a) Transverse CT scan shows non-small cell lung carcinoma in a 57-year-old woman. Arrows indicate a mass. (b) Transverse CT scan shows biopsy was much easier to perform with CT when the patient was rolled toward her left. Biopsy was then accomplished with no complications.

View larger version (94K): [in a new window]   Figure 16b. (a) Transverse CT scan shows non-small cell lung carcinoma in a 57-year-old woman. Arrows indicate a mass. (b) Transverse CT scan shows biopsy was much easier to perform with CT when the patient was rolled toward her left. Biopsy was then accomplished with no complications.

View larger version (158K): [in a new window]   Figure 17. Transverse CT scan shows CT-guided adrenal biopsy in a 63-year-old man with primary lung cancer. The kidney was adjacent to the vertebral body, but by injecting 20 mL of saline solution a safe path was created and the needle passed into the left adrenal gland (arrows). L = left.