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Fundamentals of Body CT, 3rd ed

Emory University Atlanta, GA 30307-1805

By W. Richard Webb, William E. Brant, and Nancy M. Major. Philadelphia, PA: W. B. Saunders, 429 pp., 2005. $76.95 (soft cover). (ISBN: 1416000305)

WEB—This is a Web exclusive article.

Drs. Webb, Brant, and Major have published the third edition of their popular (and portable) Fundamentals of Body CT. This update is organized into large sections on the thorax (subdivided into seven chapters), the abdomen and pelvis (11 chapters), and the musculoskeletal system (three chapters). Most of the material has been revised and updated since the last edition and all chapters end with suggested reading lists.

The section on the thorax starts with a chapter on CT technique, including new tabular material that compares 16-MDCT with single-detector CT. This gives the reader an overview of the capabilities of MDCT without sacrificing text space by specifically listing the protocols for 4-, 8- and 64-MDCT scanners (the reader is left to extrapolate the given information). A chapter on mediastinal and cardiac anatomy follows that includes not only CT images but also line drawings. The only limitation in this chapter is the lack of coronal and sagittal images with appropriate annotation. A chapter on vascular abnormalities then follows, further divided into aortic, superior vena cava, and other venous, as well as pulmonary artery, abnormalities, including pulmonary embolism (PE). Each of these sections is well illustrated and obviously updated with images obtained from MDCT scanners. However, given the explosion in the use of MDCT for the diagnosis of PE, it would have been helpful to include more than three cases (two illustrating acute and one chronic PE). Although all three case examples show obvious abnormalities, inclusion of additional and subtler examples would have been useful.

The chapter on lymph nodes and masses completes the section on the mediastinum with a discussion of lymph node stations using CT images and line drawings as well as the implications for lymph node enlargement in these regions. A discussion of lymph node enlargement as well as various mediastinal masses based on location plus diffuse mediastinal abnormalities provides enough information for the reader to formulate an intelligent and practical differential diagnosis. The following chapter is devoted to the pulmonary hila with a long section on anatomy and node enlargement, followed by shorter sections on bronchial abnormalities, pulmonary vascular disease, and differentiation of masses from atelectasis (atelectasis and bronchial abnormalities are revisited in the chapter on lung disease). Again, as with other chapters, these are well illustrated and the images are well annotated.

The chapter on lung disease begins with anatomy, moves to congenital abnormalities, focuses on solitary/focal lesions and then multifocal processes before moving to sections on bronchial abnormalities and atelectasis and ending with high-resolution CT (HRCT). This last section is particularly well done with a focus on the top 10 processes one is likely to encounter with HRCT, enabling one to diagnose more than 90% of abnormalities on HRCT, according to the authors. This section has great CT examples and lists are used to organize disease patterns; the only limitation of the section is a lack of CT correlation for four of the 10 processes.

The final chapter in the thorax section explores diseases of the pleura, chest wall, and diaphragm. This chapter is also generally complete and well illustrated. However, given the nature of pleural, chest wall, and diaphragmatic abnormalities, inclusion of more than one 2D reformatted image would have been useful. In addition, the mention of diaphragmatic rupture was too brief to be of use as no example was provided and there was no mention of the concept that if the lung above the diaphragm and a solid organ below the diaphragm are injured by penetrating trauma, by default the diaphragm is also affected.

The section on the abdomen and pelvis starts with an overview of contrast agents (oral and IV) and includes a few paragraphs on interpretation techniques, artifacts, and radiation considerations. Unlike the section on the chest, there is no attempt to provide CT protocols, likely a wise move as there are so many different variables to consider, resulting in such a multitude of protocols that each institution should optimize imaging for their particular scanners and clinical scenarios. That is not to say that technique is ignored. On the contrary, within each chapter, ways to optimize imaging of each organ system are provided in general terms without going into too much detail about particular scan parameters. In addition, these chapters contain useful lists that describe features of the various entities included.

The next chapter is on the peritoneal cavity (fluid, carcinomatosis, free air, and abscesses), vessels (anatomic variations, aortic aneurysm, and dissection), nodes, and abdominal wall. A chapter on abdominal trauma follows but includes what seems to be the highest number of older examples although the discussion is generally fine. One confusing point is the mention of use of oral contrast material in the blunt trauma patient. The author points to research suggesting that oral contrast does not help in the diagnosis of blunt trauma, causes a delay in scanning, and is not used in his institution but then suggests that it should be used when possible.

The chapter on the liver starts with hepatic vascular and surgical anatomy (Couinaud segments) and then explains the more common perfusion variations before moving on to diffuse and then focal liver diseases. Cases are all of high quality. A chapter on the biliary tree and gallbladder follows. In this chapter, some of the more uncommon disease processes are illustrated by images obtained on older generation CT scanners, but the illustrations are adequate. There is a particularly good discussion on differentiating benign from malignant biliary strictures using line drawings and actual cases. A chapter on the pancreas follows beginning with anatomy, then acute and chronic pancreatitis, and finally the more common and uncommon solid and cystic masses. A discussion of the spleen focuses on the more common entities (pseudolesions associated with arterial phase imaging, infarction, lymphoma, etc.) and a few more uncommon entities (angiosarcoma, hemangioma).

The chapter on the kidneys and ureters now includes a section on the use of unenhanced CT for the diagnosis of ureteral stones as well as mention of CT urography (no case material is provided). The bulk of the chapter is devoted to a discussion of the various masses that can affect the kidneys as well as the Bosniak classification of cystic lesions; examples of all of the Bosniak types are included. Renal infections are also covered. The chapter ends with processes affecting the ureters including duplication, stones, and transitional cell carcinoma. The chapter on the adrenals includes examples of the more common focal lesions as well as a fairly thorough discussion of what to do with the incidentally discovered adrenal mass (i.e., characterization of a lesion as an adenoma).

The chapter on the gastrointestinal tract logically starts with the esophagus, then moves to the stomach, small bowel, mesentery, and appendix and ends with the colon and rectum. Most of the common neoplastic and inflammatory processes are included as well as a brief discussion of small-bowel obstruction. As with other chapters, there is a lack of inclusion of 2D reformatted images (however, the coronal images of bowel pathology are particularly nice) but this is a minor quibble. A brief mention of virtual colonoscopy with a single example is a bonus.

The section ends with a chapter on the pelvis addressing nodal disease, the bladder (transitional cell carcinoma), uterus (leiomyomas, cervical and endometrial cancer), ovaries (physiologic changes, cancer, dermoids, and pelvic inflammatory disease), and prostate (hypertrophy and cancer). Unfortunately, although nodal disease is illustrated by line drawings, none of the examples of malignancy includes enlarged lymph nodes.

The final section is on the musculoskeletal system. The first chapter addresses trauma, including the spine (cervical and lumbar only), pelvis/hips, and extremities. A more complete discussion of pelvic fractures might have made the section seem less an afterthought (in general, the treatment of the musculoskeletal system seems more an introduction than the other sections). At the very least, reference back to the example of bladder rupture might have made the pelvic trauma section a bit more complete. A table of the mechanism of injury and the associated fractures might have made this section more useful (to alert the practitioner to what else to look for once a single pelvic fracture is found) without adding a great deal more text.

The treatment of nontraumatic musculoskeletal disorders is somewhat more complete, including disk disease, spinal stenosis, and degenerative diseases. There is also a very brief mention of the capabilities of CT in tarsal coalition before the chapter concludes with consideration of the use of CT in tumors and infection. Finally, there is a chapter on incidental bone lesions that might be encountered on routine examinations of the chest, abdomen, and/or pelvis (although inexplicably, examples include a distal radius giant cell tumor).

In summary, this is a great book for those just starting out in radiology training who desire a concise edition including just enough to whet the appetite for further study and to be able to offer an intelligent diagnosis of most common disease entities and a differential diagnosis for entities that are not as common. The book also would be useful for those in other medical specialties who do not need to spend a lot of money on radiology reference books; for medical students in radiology, surgery, or medicine rotations who want to read a bit about their patients' diagnoses; or for any established radiologist who wants a very readable and portable book for a quick and painless review.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Baumgarten, D. Search for Related Content PubMed Articles by Baumgarten, D. Social Bookmarking                      What's this?