A. Wackenheim – författare

In this book are published papers presented at the first meeting about tomodensito- metry (Computer Tomography) which the CEPUR organized in Luxembourg in March 1977. CEPUR (College d'enseignement post-universitaire de Radiologie) is an international medical association having as its main aim the promotion of courses in advanced radiology. Several sections deal with the subspecializations, one of which is Com- puter Tomography. Thanks to the fruitful cooperation of several University Hospitals (Ancona, Leuven, Montpellier, Bruxelles, Strasbourg), the two-day meeting organized by Dr. Capesius in Luxembourg covered a certain number of aspects of clinical tomodensitometry in the brain as well as in the trunk. We hope that this volume will be the first of a series dealing with the actual problems in clinical radiology. Leuven/Bruxelles/Strasbourg A. BAERT L. JEANMART A. WACKENHEIM Contents I. Introduction to the Technology of Computer Tomography K. Ungerer. With 18 Figures ...2 II. Head Sellar Region: Normal and Pathologic Conditions. U. Salvolini, F. Menichelli, and U. Pasquini. With 40 Figures ...14 Empty Sella and Pituitary Gland. J.L. Dietemann and A. Wackenheim. Wi th 3 Figures .* . . * . *. *...* . ., 38 Midline Lesions. D. Baleriaux-Waha, L.L. Mortelmans, M. Dupont, and L. Jeanmart. With 17 Figures ...*.. 39 Ventriculocisternal Pathology in Children. D. Touitou. With 9 Figures ...* . . * ...47 Endocranial Calcifications. J.H. Vandresse, G. Cornelis, and A.

It was with great pleasure that I accepted Professor Wackenheim's invitation to write the preface of this most interesting monograph. During the international course on neuroradiology in Obernai, organized by Professor Wackenheim in 1978, an entire day was devoted to discussions about various aspects of stenosis of the lumbar vertebral canal. As Professor Wackenheim and his group, in particular Dr. E. Babin, had thorough· ly studied this field, it was an excellent occasion for the exchange of views through personal contact. Their support of basic views such as attributing the cause of stenosis to a developmental disturbance of growth of the neural element - the vertebral arc- and spontaneous agreement about essentials in classification and nomenclature facili­ tated this exchange. Reading the present monograph made me think back to 1949 when I wrote my first publication on stenosis of the lumbar vertebral canal in a French volume that com­ memorated my teacher in neurosurgery, Professor Clovis Vincent. During the following years it was impossible to publish a more detailed paper on the subject in international journals since their editorial boards did not believe in its occurrence. My first English papers were published in the Journal of Bone and Joint Surgery (1954, 1955), but it was only during the 1970s that this form of stenosis became more universally recog­ nized.

In 1932 there appeared the work of SCHMORL and JUNGHANNS, Die gesunde und kranke Wirbelsiiule im Rontgenbild, which laid the foundations of diagnostic radiology of the spine. Since that time the discipline has been extended and refined in a systematic manner and our knowledge has been greatly enriched by the large number of monographs in which leading experts have assembled additional data. An encyclopedic treatment of all that is currently known requires not only that reference be made to all work published since 1932 in order to reveal the problems that remain but also that a serious attempt be made to contribute to the solution of such problems. For this reason, Professor TONDURY and Professor THEILER of Zurich, who know more than anyone else about the ontogeny of the spine, have been invited to display their erudition in this field. Should contra- dictions or divergent opinions on certain points be revealed through this confrontation with radiologically obtained findings, so much the better; the effect of this could only be to spur workers in both disciplines on to more advanced research.We have only to recall how in Goethe's time the premaxilla was still the subject of controversy, yet this great man pursuing his studies in comparative anatomy and anthropology was able to prove its existence beyond all doubt. Mainz, May 1974 L. DIETHELM Inhaltsverzeichnis - Contents A. Die normale Wirbelsliule ...1 1 I. Phylogenetische Entwicklung des Achsenskelets. Von K. THEILER 1 1. Die Bogenelemente...2. Die Chorda dorsalis ...

It is a privilege and pleasure to write a foreword to this work. Who, twenty years ago, would have thought that a whole book could be devoted to the veins of the posterior fossa? Even today the standard text-books of anatomy only give a paragraph to the subject. Thanks to the dedicated work of rather a few neuroradiologists our knowledge has now reached a very sophisticated level. The careful correlation of anatomical dissection with the angiographic image has achieved this, but without the aid of subtraction (discovered by a world figure in neuroradiology - Professor ZIEDSES DES PLANTES) the subject would not be as advanced as it is. The authors are to be congratulated not only for presenting the most up to date anatomical information but also for showing how wide the applications are in the clinical field by the careful analysis of displacements of veins, many of which were quite unrecognised only a very few years ago. Drs W ACKENHEIM and BRAUN are in the forefront of this discipline to which they and the French school have contributed so much. Also it was their great enthusiasm and drive which led to the birth of the European Society of Neuroradiology, the first meeting of which was held in Colmar in September 1969. The Society has flourished under their guidance and very successful annual meetings have been held for nearly a decade.

It is a privilege and pleasure to write a foreword to this work. Who, twenty years ago, would have thought that a whole book could be devoted to the veins of the posterior fossa? Even today the standard text-books of anatomy only give a paragraph to the subject. Thanks to the dedicated work of rather a few neuroradiologists our knowledge has now reached a very sophisticated level. The careful correlation of anatomical dissection with the angiographic image has achieved this, but without the aid of subtraction (discovered by a world figure in neuroradiology - Professor ZIEDSES DES PLANTES) the subject would not be as advanced as it is. The authors are to be congratulated not only for presenting the most up to date anatomical information but also for showing how wide the applications are in the clinical field by the careful analysis of displacements of veins, many of which were quite unrecognised only a very few years ago. Drs W ACKENHEIM and BRAUN are in the forefront of this discipline to which they and the French school have contributed so much. Also it was their great enthusiasm and drive which led to the birth of the European Society of Neuroradiology, the first meeting of which was held in Colmar in September 1969. The Society has flourished under their guidance and very successful annual meetings have been held for nearly a decade.

It is amazing to discover how little importance has been attached to narrow lumbar canal syndromes up to now. Though H. VERBIEST gave a very accurate description in 1949, the neurologist''s and neurosurgeon''s preoccupations were mainly focused on discal pathology, disregarding the problem of an exclusively bony origin in canalar stenosis. A. WACKENHEIM and E. BABIN have the merit of becoming aware of the impor­ tance and originality of this problem; they organized in the beautiful surround­ ings of the Bischenberg near Strasbourg, a postgraduate course, in which the most eminent European specialists in this field participated. I am very honored to have been asked to write the introduction to this mono­ graphy, which contains all the studies reported and commented on during this meeting. Before considering the problem from the various radiologic points of view, it is in my opinion indispensable to define the term "stenosis." We could not do so more accurately than by assuming the definition proposed by A. WACKENHEIM and E. BABIN and unanimously confirmed by all those who attented the session.

It is amazing to discover how little importance has been attached to narrow lumbar canal syndromes up to now. Though H. VERBIEST gave a very accurate description in 1949, the neurologist's and neurosurgeon's preoccupations were mainly focused on discal pathology, disregarding the problem of an exclusively bony origin in canalar stenosis. A. WACKENHEIM and E. BABIN have the merit of becoming aware of the impor­ tance and originality of this problem; they organized in the beautiful surround­ ings of the Bischenberg near Strasbourg, a postgraduate course, in which the most eminent European specialists in this field participated. I am very honored to have been asked to write the introduction to this mono­ graphy, which contains all the studies reported and commented on during this meeting. Before considering the problem from the various radiologic points of view, it is in my opinion indispensable to define the term "stenosis." We could not do so more accurately than by assuming the definition proposed by A. WACKENHEIM and E. BABIN and unanimously confirmed by all those who attented the session.

It was our aim to place at the disposal of radiologists within a short time an atlas of high-quality, valuable pictures of abdominal CT without We felt that, the image degradation inherent to slower scanning apparatus. notwithstanding rapid evolution in CT scanning apparatus and the resulting rapid advances in our clinical knowledge about the value, limitations and applications of this new diagnostic imaging modality, an effort should be made to realize an atlas of reference. From more than 7,000 patients studied with abdominal CT, we tried to assemble images with maximal anatomical detail, which implies the use of large window settings, being well aware that in daily routine practice basic CT methodology includes the use of different window settings for optimal information. It was, however, a conscious decision not to use comparative images with large and small window settings in order to stay within a reasonable total number of figures. Much emphasis has been placed upon the use of contrast enhancement by intravenous contrast media. This is based on the conviction that essen­ tially new and better morphological information about normal and pathological processes within the abdomen can be obtained because short exposure times now allow one to capture the rapidly changing aspect and degree of contrast enhancement of the lesions as a function of their vascu­ larity.

It was with great pleasure that I accepted Professor Wackenheim''s invitation to write the preface of this most interesting monograph. During the international course on neuroradiology in Obernai, organized by Professor Wackenheim in 1978, an entire day was devoted to discussions about various aspects of stenosis of the lumbar vertebral canal. As Professor Wackenheim and his group, in particular Dr. E. Babin, had thorough· ly studied this field, it was an excellent occasion for the exchange of views through personal contact. Their support of basic views such as attributing the cause of stenosis to a developmental disturbance of growth of the neural element - the vertebral arc- and spontaneous agreement about essentials in classification and nomenclature facili­ tated this exchange. Reading the present monograph made me think back to 1949 when I wrote my first publication on stenosis of the lumbar vertebral canal in a French volume that com­ memorated my teacher in neurosurgery, Professor Clovis Vincent. During the following years it was impossible to publish a more detailed paper on the subject in international journals since their editorial boards did not believe in its occurrence. My first English papers were published in the Journal of Bone and Joint Surgery (1954, 1955), but it was only during the 1970s that this form of stenosis became more universally recog­ nized.

The purpose of this book is to provide the radiologist with information which is "as practical as possible" for the everyday use of computerized tomography (CT) in the field of cervical, thoracic, and musculoskeletal pathology. The approach is simple. For each region the following information is pre­ sented: (1) a general schematic introduction, summarizing the main indications for CT and its specific usefulness; (2) a series of pictures of normal structures with a precise and practical identification; and (3) a selection of pictures of pathological structures, with a description and a short comment, aimed at covering the largest possible field of CT indications and interests. This approach has been applied to the following areas: cervical pathology, with one section dealing with the larynx and hypopharynx; the thorax, specifi­ cally to pulmonary diseases, pleural and parietal pathology, and the mediasti­ num, with special sections dealing with tumours, the heart, and large vessels; the spine, which is of growing importance in clinical CT; and finally the pathol­ ogy of the musculoskeletal system in general, with special attention being paid to the developing field of orthopaedic CT measuring methods.