Jean-Noel Bruneton – Författare

This book, edited by one of the most distinguished specialists in the field, provides a comprehensive update on the use of sonography for imaging of the cervical region. All of the new technical modalities are considered in depth, including high-definition gray scale, enhanced color Doppler, and ultrasound contrast agents. Detailed morphological descriptions of numerous pathological processes are provided, followed by thorough discussion of differential diagnostic problems. In addition to presenting the basic information indispensable for physicians dealing with this anatomic region (ENT specialists, endocrinologists, specialists in vascular disease), each chapter reviews the most recent imaging findings with which physicians using sonography should be familiar. The book is original in addressing the examination of a particular anatomic region using a first-line imaging technique. It will have wide appeal and will be of great value to readers.

Computerization of the radiological image (digitization, com­ puted tomography), the diagnostic contributions of ultra­ sonography, and the advent of magnetic resonance imaging all herald a new era in radiology. While this discipline retains its clinical nature, and continues to group together various specialities, the technical "common denominator" plays an increasingly important role, and requires a more global ap­ proach to the clinical problem. Centralization of state-of-the-art equipment in technical imaging centers - strategic points in future hospitals - will al­ low clinical radiologists to perform all of the examinations re­ quired for diagnosis and follow-up with a high degree of reli­ ability, under optimum security, and at the lowest possible cost. This is the right moment to publish this treatise, as we begin to apply this new approach to radiological studies. For purposes of clarity, the lymphomatous processes have been dealt with by anatomical location; more important, though, is the discussion of the multiple aspects of diagnosis, with particular emphasis on recent noninvasive modalities (characteristic visceral lesions ; analysis and characterization of the anatomical and tissue components of these lesions with the highest possible degree of precision; regional disease ex­ tension and anatomical features; information on concomitant regional involvement and distant sites), allowing selection of appropriate therapy and surveillance strategies.

Owing to the anatomic complexity of the neck and the diver­ sity of pathologic entities affecting it, the cervical region has long been of great semiological interest. Physical examination is an easy means of evaluating the size and origin of a solitary cervical mass, yet valid interpretation can prove difficult when the normal morphology of the neck has been altered; excellent examples are patients with extensive fibrosis or scarring secondary to previous irradiation or surgery. Like­ wise, physical examination cannot assess the relations of a pathologic process to adjacent structures - e. g., invasion can­ not be distinguished from simple displacement -and it is un­ suitable for monitoring therapeutic efficacy, such as the re­ sponse of metastatic nodes to medical management. Between physical examination, which remains fundamental, and exploratory surgical procedures, which are often the only means of obtaining indispensable anatomic proof for diagno­ sis, lie a number of recent imaging techniques including com­ puted tomography and magnetic resonance imaging using surface coils that provide invaluable information for the in­ vestigation of cervical pathologies. Real-time ultrasonogra­ phy occupies a privileged position because of its noninvasive­ ness, rapidity, and reliability, especially when performed by a specially trained examiner.

Only a few years ago, most treatises on sonography covered all the diagnostic applications of ultrasound, de- scribing organs from the brain down to the placenta. Dr. Bruneton and his associates must be thanked for pre- senting this book devoted to the spleen. It probably offers the most complete presentation of details and the richest images available in its field. This book will thus become the ultimate reference in most libraries of books on son- ography. March 1988 F. Weill The authors wish to thank Christine Rostagni, Fran~ise Fein, and Bernard Fontaine for their assistance in the preparation of this book. Contents 1 Sonographic Anatomy of the Normal Spleen, Normal Anatomic Variants, and Pitfalls B. Senecail ...1 1. 1 Anatomy of the Spleen...1 1. 1. 1 Morphology and Structure ...1 1. 1. 2 Location and Relations of the Spleen...3 1. 1. 3 Average Dimensions of the Cadaver Spleen ...5 1. 1. 4 Congenital Anomalies and Normal Variants...5 1. 1. 4. 1 Fissured Spleen...5 1. 1. 4. 2 Lobulated Spleen...5 1. 1. 4. 3 Spleen with Two Hili...5 1. 1. 4. 4 Wandering or Ectopic Spleen ...6 1. 1. 4. 5 Numeric Anomalies ...6 Ultrasonography of the Spleen ...1. 2 6 1. 2. 1 Equipment ...6 1. 2.2 Patient Examination ...7 1. 2. 3 Scanning Technique ...7 1. 3 Sonographic Features of the Normal Spleen...7 1. 3. 1 Splenic Contour ...7 1. 3. 2 Echo Pattern of the Splenic Parenchyma...