MR-Angiographie peripherer Gefäße mit automatischer Verschiebetisch-Technik bei 1.0 T im Vergleich zur i. a. DSA

PURPOSE Contrast-enhanced (CE) 3D-MR angiography of peripheral arteries was performed in 8 patients with peripheral arterial occlusive disease by applying a new tracking technique on a 1.0 T system (Magnetom Harmony, Siemens). The studies were compared with intra-arterial digital angiography as gold standard. MATERIALS AND METHODS Imaging of the distal aorta, pelvis, upper and lower limb arteries was accomplished with a Flash-3D-sequence (TR/TE = 6.2/3.2 ms) within 26 s acquisition time of each region after a single bolus of 30 ml contrast agent. Individual circulation time was determined by a test bolus before each examination. RESULTS 112 vessel segments were evaluated. MR angiography ach…

Subtotal esophageal resection in motility disorders of the esophagus.

<i>Background:</i> Esophagectomy for motility disorders is performed infrequently. It is indicated after failed medical therapy, pneumatic dilation, non-resecting surgical and redo procedures. Patient selection in this group is challenging and the operative risk has to be weighted carefully against the poor quality of life with persistent or recurrent dysphagia. <i>Patients and Methods:</i> Between September 1985 and April 2004, subtotal esophageal resections for advanced esophageal motility disorders of the esophagus not responding to previous therapy were carried out in 8 patients (6 females, 2 males). The median age of these patients was 59.5 (43–78) years. Six pa…

Assessment of left ventricular function by breath-hold cine MR imaging: Comparison of different steady-state free precession sequences

Purpose To compare steady-state free precession (SSFP) sequence protocols with different acquisition times (TA) and temporal resolutions (tRes) due to the implementation of a view sharing technique called shared phases for the assessment of left ventricular (LV) function by breath-hold cine magnetic resonance (MR) imaging. Materials and Methods End-diastolic and end-systolic volumes (EDV, ESV) were measured in contiguous short-axis slices with a thickness of 8 mm acquired in 10 healthy male volunteers. The following true fast imaging with steady-state precession (TrueFISP) sequence protocols were compared: protocol A) internal standard of reference, segmented: tRes 34.5 msec, TA 18 beats pe…

Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: interim analysis of a multicentric prospective observational study.

Purpose: To study the accuracy of different cutoffs for an involved circumferential resection margin (CRM) compared with T and N categories measured by MRI as basis for selective application of neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma. Materials and Methods: In a prospective multicenter observational study involving 153 primarily operated patients, the preoperative results of MRI with pathohistological findings of resected specimens were compared. Results: For a cutoff of ≤1 mm for involvement of the CRM, the accuracy of preoperative MRI was 90.9% (139/153). The negative predictive value was 98.5% (134/136). The four participating departments did not differ significantly. Fo…

Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MRI using an integrated parallel acquisition technique

Purpose To assess the diagnostic accuracy of integrated parallel acquisition technique (iPAT) in local staging of rectal carcinoma in comparison to conventional high-resolution MRI. Materials and Methods A total of 28 patients with a neoplasm of the rectum and 15 control patients underwent MRI of the pelvis. High-resolution images were acquired conventionally and with iPAT using a modified sensitivity encoding (mSENSE). Image quality, signal-to-noise and contrast-to-noise ratios (SNR, CNR), tumor extent, nodal status, and delineation of the circumferential resection margin (CRM) were compared. In 19 patients with a carcinoma, MR findings were correlated with the histopathological diagnosis.…

CT-Angiographie an einem 16-Schicht-CT zur perioperativen Evaluation der Leberarterien im Vergleich zur MR-Angiographie

Purpose: To evaluate the efficiency of CT angiography (CTA) with 16-row MSCT compared with MR angiography (MRA) in analyzing the arterial anatomy in patients undergoing liver surgery. Materials and Methods: In 30 patients, MRA and CTA studies of the abdominal vessels were reviewed. CT parameters: slice thickness 3 mm; collimation 1.5; reconstruction interval 2 mm (Philips MX 8000 IDT); 120 ml contrast media (400 mg/ml) at a rate of 4 ml/ sec; acquisition of arterial-phase scans. The anatomy of the hepatic artery was evaluated from axial and reconstructed maximum-intensity-projection (MIP) images ("Slab-Viewer", Philips). MR parameters: contrast-enhanced coronal FLASH-3D sequences; slice thi…

Achalasie oder Pseudoachalasie? Fallstricke der Diagnostik und Therapieentscheidung

History Patient 1 (female, aged 55 years) had for some time complained of morning nausea. She reported symptoms of reflux with regurgitation of food for two-and-a-half years and also dysphagia with retrosternal bolus obstruction for the last eighteen months. Patient 2 (male, aged 84 years) complained of restrosternal dysphagia with each intake of food for one year, weight loss of 12 kg and occasional regurgitation of food. Investigations The general condition of patient 1 was only slightly impaired but that of patient 2 markedly reduced. Routine laboratory tests were unremarkable in both. Barium meal in patient 1 revealed fixed narrowing in the region of the esophageal hiatus. The inferior …

Radiologisch assistierte perkutane Gastro-/Enterostomie - Retrospektive Analyse von 90 Eingriffen

PURPOSE To analyse retrospectively the indications, technique and results of radiologically induced gastrostomies or enterostomies. PATIENTS AND METHOD Radiologically assisted gastrostomies or enterostomies were induced in 90 patients, mostly with high grade obstructions due to head and neck tumours or oesophageal tumours. 19/90 patients had had previous resection of the oesophagus or gastric operations. RESULTS A catheter was successfully introduced in all patients. In 11/90 patients this was followed by a two-stage procedure. In 16/90 patients puncture was performed under CT control because of some anatomical peculiarity. Serious complication occurred in 9/90 patients but in only one was …

Prospective Evaluation of Positron Emission Tomography in the Preoperative Staging of Esophageal Carcinoma

Hypothesis Positron emission tomography (PET) is a useful tool in the selection of patients with esophageal cancer who may not benefit from esophageal resection. Design Case series. Setting Tertiary care hospital. Patients Eighty-one patients with newly diagnosed esophageal cancer who underwent PET and computer tomography (CT) of the chest and abdomen (and of the neck in 45 patients) within 45 days were included. Main Outcome Measures We calculated the sensitivity and specificity in detecting metastatic sites on the basis of 31 histologically verified lesions. In addition to results obtained on CT, the information provided by PET was evaluated with a view to the choice of management strateg…

Iatrogene Ösophagusperforation bei transösophagealer Echokardiographie

History A 65-year-old patient underwent transesophageal echocardiography which caused a perforation of the upper esophagus. Three months after esophagostomy and gastrostomy the reconstruction was accomplished by a colon interposition graft. The patient postoperatively developed an ischemic necrosis of the graft, followed by a cervical fistula. Food intake and swallowing became impossible. Diagnosis X-ray examinations revealed the cervical fistula and a stenotic colon graft. Treatment and course The retrosternal colon graft was replaced by a gastric interposition graft, which was anastomosed with the cervical esophagus. The postoperative follow-up was normal at first. Increasing retention of…

Rapid Musculoskeletal Magnetic Resonance Imaging Using Integrated Parallel Acquisition Techniques (IPAT) - Initial Experiences

Purpose To investigate the feasibility of using multiple receiver coil elements for time saving integrated parallel imaging techniques (iPAT) in traumatic musculoskeletal disorders. Material and methods 6 patients with traumatic derangements of the knee, ankle and hip underwent MR imaging at 1.5 T. For signal detection of the knee and ankle, we used a 6-channel body array coil that was placed around the joints, for hip imaging two 4-channel body array coils and two elements of the spine array coil were combined for signal detection. All patients were investigated with a standard imaging protocol that mainly consisted of different turbo spin-echo sequences (PD-, T (2)-weighted TSE with and w…

Serial assessments of microvascular obstruction by contrast-enhanced magnetic resonance predict contractile recovery and clinical outcome after reperfused acute myocardial infarction.

AIMS The purpose of the study was to investigate, using cardiac magnetic resonance (CMR), the presence and time course of microvascular obstruction (MO) in patients with acute myocardial infarction (AMI), and to test its relationship with cardiac remodeling and clinical outcomes. METHODS AND RESULTS 53 patients with AMI and successful percutaneous reperfusion underwent CMR examination at four separate timepoints: within the first 48 hours, at 10 days, at six and twelve months after infarction. MO was quantified immediately (early imaging) and 10 minutes (late imaging) after contrast administration in each session. The extent of MO decreased from early to late imaging at both the first and t…

Anteil des frühen systolischen Flussanstiegs am antegrad fließenden Gesamtvolumen bei Phasenkontrast-Flussmessungen in Atemanhaltetechnik

Purpose To evaluate the contribution of early systole for the assessment of antegrade aortic flow volume by breath-hold velocity-encoded magnetic resonance (MR) flow measurements. Materials and methods Expiratory breath-hold fast low-angle shot (FLASH) phase-contrast flow measurements (temporal resolution tRes 61 msec, shared phases) perpendicular to the proximal ascending aorta and short axis true fast imaging with steady-state precession (TrueFISP) cine MR ventriculometry (tRes 34.5 msec) were performed in ten healthy male volunteers on a 1.5 T MR system (Sonata, Siemens Medical Solutions). Antegrade aortic flow volume (AFV) and left ventricular stroke volume (LV-SV) were evaluated using …

Kontrastverstärkte MR-Angiographie abdomineller Gefäßean einem 1.0 T-System*

Purpose To evaluate the efficacy of breath-hold, three-dimensional, contrast-enhanced magnetic resonance angiography with a 1.0 T system for imaging the abdominal vessels in comparison to conventional arteriography (CA). Methods The abdominal aorta and visceral arteries were studied in 54 patients (60 examinations) on a 1.0 T scanner using an ultrafast gadolinium-enhanced gradient-echo sequence with the following parameters: TR/TE = 3.8/1.4 ms, flip angel 25 degrees, matrix 198 x 256, field 380-420 mm, pixel size 1.9 x 1.48 mm2, slice thickness 1.5-2.5 mm, acquisition time 22-26 sec. Individual circulation times were determined by a test bolus before each MR angiography. Conventional arteri…

Ergebnisse der kontrastverstärkten MR-Angiographie der aortoiliakalen Gefäße mit einem 1-molaren Kontrastmittel bei 1,0 T: Vergleich zur i. a. DSA

PURPOSE To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) using a 1.0 molar contrast agent at 1.0 T for the diagnosis of abdominal aortic aneurysms and stenoses of renal or iliac arteries in comparison to intraarterial digital subtraction angiography (DSA). MATERIALS AND METHODS A total of 19 patients with the suspicion of abdominal aortic aneurysm or stenosis of renal or iliac arteries were examined with CE-MRA at 1.0 T. Intra-arterial DSA served as reference in all cases. After test bolus tracking, 10 or 8 ml of the 1.0 molar contrast agent Gadobutrol corresponding to a dose of 0.1 - 0.15 mmol/kg bw were injected and imaging performed using a FLASH-3D sequen…

Positronen-Emissions-Tomographie zum präoperativen Staging des Ösophaguskarzinoms

BACKGROUND AND OBJECTIVE Exact preoperative staging is a prerequisite for the indication as well as the choice of the appropriate operative technique for patients with esophageal carcinoma. In this prospective study we assessed whether positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) increases the accuracy of staging compared to standard computer tomography (CT) and leads to a different therapeutic approach. PATIENTS AND METHODS 30 patients (25 men, 5 women, median age 63 years) with histologically identified carcinoma of the esophagus (n =29) and the cardia (n = 1), respectively, were studied. All patients underwent FDG-PET imaging of the neck, chest, and abdomen as w…

Koronare Bypassdiagnostik mit CT und MRT - eine Bestandsaufnahme

The limited lifetime and the correlation between graft occlusion and recurring symptoms underline the need for repeated imaging of coronary artery bypass grafts. CT and MRI allow for non-invasive imaging of coronary bypasses with high accuracies concerning the patency of these vessels. Multidetector CT seems to be the CT technique of choice, especially after the introduction of 16 slice CT scanners for morphologic assessment of coronary artery bypass grafts. Compared with MRI, CT is a robust technique for assessment of cardiac anastomoses, native coronary arteries, and for the detection of graft stenoses. MRI, however, is able to deliver functional information about the grafts and the recip…

Assessment of tumor microcirculation with dynamic contrast-enhanced MRI in patients with esophageal cancer: initial experience.

PURPOSE: To investigate the feasibility and impact of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on tumor characterization and response to radiochemotherapy (RCT) in patients with esophageal cancer. MATERIALS AND METHODS: A total of 48 patients underwent DCE-MRI to assess tumor microcirculation based on a two-compartment model function. Effects of RCT on kinetic parameters were studied in 12 patients with squamous cell carcinoma. RESULTS: Tumor microcirculation differs with respect to histological subtype: squamous cell carcinomas showed lower values of amplitude A (leakage space, P = 0.015) and higher contrast agent exchange rates (k(21), P = 0.225) compared with adenoc…

Multi-Slice CT (MSCT) in Cardiac Function Imaging: Threshold-Value-Supported 3D Volume Reconstructions to Determine the Left Ventricular Ejection Fraction in Comparison to MRI

Kontrastmittelgestützte 3D-MR-Angiographie der Becken- und Beinarterien mit automatischer Tischverschiebung bei 1,0 Tesla

PURPOSE Assessment of the value of contrast-enhanced MR angiography (ceMRA) using an automatic tracking technique at 1.0 Tesla in comparison with digital subtraction angiography (DSA) of the pelvic and lower limb arteries. MATERIALS AND METHODS In 15 patients with peripheral arterial occlusive disease a ceMRA (3D FLASH, TR/TE = 6.2/2.3 ms, Flip angle alpha = 30 degrees, Matrix 170 x 256) using a new automatic tracking technique was accomplished. The reference method was DSA. Twenty-one vessel segments of each patient were graded as normal, stenosed (> 50%) or occluded. Image material was evaluated independently by two radiologists. RESULTS In comparison, the interobserver agreement showed a…

Diagnostik der primär sklerosierenden Cholangitis: prospektiver Vergleich von MR-Cholangiographie mit endoskopisch retrograder Cholangiographie

PURPOSE To assess the accuracy of MR cholangiography (MRC) in the diagnosis of primary sclerosing cholangitis (PSC) in comparison to endoscopic retrograde cholangiography (ERC). METHOD 20 patients with PSC were examined by ERC and MRC (1.0 T, HASTE sequence). Visualization and pathologic changes of the extra- and intrahepatic bile ducts were evaluated with both methods. RESULTS Mural irregularities of the common bile duct were seen with MRC in 6/7 cases, stenoses and dilatation of the common bile duct were detected correctly in all patients. Diffuse, multifocal strictures of the intrahepatic bile ducts were the most common intrahepatic findings and correctly diagnosed in almost all patients…

Möglichkeiten der 16-Schicht-CT bei der linksventrikulären Funktionsbestimmung: Beurteilung zweier unterschiedlicher Software-Tools zur quantitativen Funktionsanalyse sowie qualitative Bewertung von Wandbewegungsstörungen im Vergleich zur Magnetresonanztomographie

PURPOSE To determine global and regional left ventricular (LV) function from retrospectively gated multidetector row computed tomography (CT) by using two different semiautomated analysis tools and to correlate the results with those of magnetic resonance imaging (MRI). MATERIALS AND METHODS Nineteen patients (5 females, 14 males, mean age 69 years) underwent 16-slice spiral-CT (MS-CT) with standard technique without administration of beta-blockers for a decrease in the cardiac rate. Ten series of images were reconstructed at every 10 % of the RR-interval. With commercially available software capable of semiautomated contour detection, end-diastolic and end-systolic LV volumes (EDV and ESV)…

Positron Emission Tomography for Staging Esophageal Cancer: Does It Lead to a Different Therapeutic Approach?

Accurate preoperative staging is essential for the indication and selection of the appropriate surgical procedure in patients with esophageal cancer. The present prospective study was designed to determine if the preoperative use of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) increases the accuracy of staging esophageal cancer compared with computed tomography (CT) and if it thereby leads to a different therapeutic approach. A total of 58 patients, 46 men and 12 women (mean age 61 years), with histologic proof of esophageal carcinoma underwent FDG-PET of the neck, chest, and abdomen, as well as CT of the chest and abdomen, to determine tumor stage. FDG-PET and CT data we…

Permanent Stoma After Low Anterior Resection for Rectal Cancer

BACKGROUND AND OBJECTIVES: A low anterior resection procedure for removing a rectal tumor aims to preserve the sphincter and avoid a permanent stoma. Permanent stomas are primarily necessary in cases of poor anorectal function and local recurrence. The aim of this study was to clarify whether anastomosis-related complications and local recurrence influenced the rate of permanent stomas in a long-term follow-up. METHODS: Of 1032 consecutive patients with rectal cancer, 397 were treated by low anterior resection (R0 and R1 resections) between 1985 and 2007 at the Department of General and Abdominal Surgery of the University Hospital, Mainz (Germany). All patient data were collected prospectiv…

A multicenter, site-independent, blinded study to compare the diagnostic accuracy of contrast-enhanced magnetic resonance angiography using 1.0M gadobutrol (Gadovist) to intraarterial digital subtraction angiography in body arteries.

Abstract Purpose Prospective evaluation of diagnostic accuracy of single field-of-view contrast-enhanced MR Angiography (ceMRA) with 1.0 M gadobutrol compared to intraarterial DSA in body arteries. Materials and methods In an European multicenter study 179 patients underwent ceMRA and DSA. For each indication five prospectively defined vessel segments were evaluated by local investigators onsite and by three site-independent blinded readers (BR) independently. Results The agreement between ceMRA and DSA diagnosis was statistically significant in the onsite (96.6%) and blinded reader (86.6–90.2%) evaluation. Sensitivity, specificity, accuracy, positive (PPV) and negative predictive values (N…

Pneumomediastinum and pneumopericardium due to malignant subcarinal lymphadenopathy: CT demonstration

A 52-year-old man had been treated for oral cancer T3 N0 M0 by radical surgery, neck dissection on the right and cervical irradiation (60 Gy). Two months after therapy he presented with dysphagia and hemoptysis. Admission chest X-ray revealed a pneumopericardium. It was caused by a bronchomediastinal fistula due to necrotic metastatic lymph nodes as shown by CT, which also revealed a concomitant pneumomediastinum. The patient died 10 days later from pneumonia. The CT findings were confirmed at autopsy. We conclude that malignant mediastinal lymphadenopathy is a potential cause of pneumopericardium and pneumomediastinum.

Anthrazyklin-induzierte Kardiotoxizität: MRT des Herzens bei Kindern und Jugendlichen mit malignen Erkrankungen

Purpose: Quantification of left and right ventricular function using MRI in young cancer patients treated with cardiotoxic anthracyclines. Materials and Methods: Twenty-eight patients (mean age 16.4 years) underwent cardiac MRI at 1.5 T. The study protocol consisted of morphologic T2-weighted images with fat suppression and cine steady-state free precession sequences (SSFP) for functional analysis. Seven patients were examined at the end of chemotherapy, two of them also repeatedly during therapy, and 21 patients following an average period of three years after finishing chemotherapy (range one month - 20 years) Results: The end-systolic volume index increased and the ejection fraction of t…

Experimentelle In-vitro-Studie zur Evaluierung eines elektronischen Detektors für die digitale Radiographie

Purpose: To evaluate the contrast-detail performance of a flat-panel detector system, we performed a comparative study of this flat-panel system versus storage phosphor and conventional screen-film systems. Materials and Methods: Bone models made of human humeri were prepared with foreign bodies, fracture lines and drilled holes to create artificial fractures, osteolyses or metastases. Immersed in a water bath, hard copy images of these models were acquired with the same exposure dose (55 kV; 3.2 mAs) on the flat-panel detector, two state-of-the-art storage phosphor systems (PCR®, ADC®) and two conventional screen-film systems (Insight®, T-Mat®). Using a standardized protocol with a 4-point…

Kontrastverstärkte dreidimensionale MR-Angiographie der A. carotis bei 1,0 Tesla im Vergleich zuri.a. DSA - ist die Methode für die Diagnostik von Karotisstenosen geeignet?

Artery Disease? Purpose: To evaluate the efficacy of three-dimensional, contrast-enhanced magnetic resonance angiography (CE-MRA) of the carotid artery with a 1.0 system in comparison to intra-arterial conventional angiography (i.a.CA) for the assessment of carotid artery disease. Method: 55 patients with suspected stenosis of the carotid artery were examined with a 3D-CE gradient-echo sequence on a 1.0 T scanner (TR/TE = 6.2/2.2 ms) and a selective DSA i.a. angiography. Image quality was evaluated by estimating the arterial contrast and venous enhancement. Morphological pathologies were registered for all arteries, stenoses of the internal carotid artery were graded by applying the NASCET …

Die Positronenemissionstomographie zur pr�operativen Lymphknotendiagnostik bei �sophaguskarzinom

Vorraussetzung fur Indikation und Wahl des geeigneten operativen Verfahrens bei Patienten mit Osophaguskarzinom ist ein genaues praoperatives Staging. Ziel der prospektiven Studie war es, zu klaren, ob eine Positronenemissionstomographie mit 18F-Fluoro-Deoxyglukose (FDG-PET) die Genauigkeit des praoperativen Lymphknotendiagnostik gegenuber der Computertomographie (CT) erhoht und die Wahl des operativen Zugangs zur Osophagusresektion beeinflusst. 58 Patienten, 46 Manner und 12 Frauen (Alter 61 Jahre im Mittel), erhielten bei histologisch gesichertem Osophaguskarzinom im Rahmen des Stagings ein FDG-PET von Hals, Thorax und Abdomen sowie ein CT von Thorax und Abdomen. Sensitivitat, Spezifitat …

Rectal cancer: Dynamic contrast-enhanced MRI correlates with lymph node status and epidermal growth factor receptor expression

Purpose To evaluate correlations between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and clinicopathologic data as well as immunostaining of the markers of angiogenesis epidermal growth factor receptor (EGFR) and CXC-motif chemokine receptor 4 (CXCR4) in patients with rectal cancer. Materials and Methods Presurgical DCE-MRI was performed in 41 patients according to a standardized protocol. Two quantitative parameters (k21, A) were derived from a pharmacokinetic two-compartment model, and one semiquantitative parameter (TTP) was assessed. Standardized surgery and histopathologic examinations were performed in all patients. Immunostaining for EGFR and CXCR4 was performed an…

Kontrastmittelverstärkte 3D-MRA der Pulmonalarterien mit integrierter paralleler Akquisitionstechnik (iPAT) bei Patienten mit CTEPH - sagittale oder koronare Datenaufnahme?

PURPOSE Comparison of two different types of contrast-enhanced 3D-MR angiography (CE-MRA) with integrated parallel acquisition technique (iPAT) in patients with chronic-thromboembolic pulmonary hypertension (CTEPH) and evaluation whether sagittal acquisition with higher resolution and minimized acquisition time is superior to common coronal orientation. MATERIALS AND METHODS CE-MRA was performed on 15 patients with CTEPH preoperatively and on 10 patients also postoperatively, while 5 other patients received only a postoperative MRA. All 30 MR studies with one coronal and two sagittal acquisitions were blindly evaluated and compared. The resolution of coronal and sagittal MRA was 1.3 x 0.6 x…

Diagnose von Intraduktal papillär-muzinöse Neoplasien (IPMN) – Bestandsaufnahme der Versorgungsrealität an einem deutschen Zentrum

Die Diagnostik des hilären Cholangiokarzinoms: Wertigkeit von präoperativer ERC, MRC und PTC im Vergleich zur Histopathologie

PURPOSE To compare the results of the preoperative workup consisting of endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), and percutaneous resonance cholangiography (PTC) with the tumor extent of the surgical specimen in patients with hilar cholangiocarcinoma (hilCC). MATERIALS AND METHODS Between 9/1997 and 12/2002, 59 patients with hilCC tumor underwent surgical resection. Preoperative ERC, MRC, and PTC were analyzed, blinded for the identity of the patient, and compared with the surgical specimen. For this retrospective analysis, 55 of the initial 59 ERCs, 39 of the initial 40 MRCs and 32 of the initial 38 PTCs were available. Most of the ERCs and MRC…

Assessment of chronic aortic dissection: contribution of different ECG-gated breath-hold MRI techniques.

Our objective was to evaluate the impact of different rapid MRI techniques for the assessment and follow-up of chronic aortic dissections.Fifty-three patients (41 postoperative Stanford type A, 12 type B dissections) were scanned at 1.5 T during a 3-year period. The study reviewed ECG-gated breath-hold black blood sequences and 3D contrast-enhanced MR angiography of the thoracic aorta supplemented by segmented cine and phase-contrast imaging as well as abdominal contrast-enhanced MR angiography. A retrospective separate analysis of black blood acquisitions and contrast-enhanced MR angiograms from a total of 72 examinations was performed by two radiologists to evaluate detection of intimal f…

MRT des Herzens bei Verdacht auf Myokarditis

Purpose To evaluate the potential of ECG-gated breath-hold MRI in diagnosing acute myocarditis. Material and methods Cardiac MRI was performed on 21 consecutive patients with suspected myocarditis. ECG-gated breath-hold T2-weighted images with fat suppression were acquired in 3 standard views. T1-weighted imaging (FLASH) was performed 10 min after IV administration of Gd-DTPA. Laboratory data included creatine kinase, troponin T and serological tests, ECG findings and echocardiography. Imaging findings were retrospectively compared to the discharge diagnoses. Signal alterations were semiquantitatively classified. Results Acute myocarditis was diagnosed in 9 patients and cardiac sarcoidosis …

Gegenwärtiger Stellenwert der perkutanentranshepatischen Cholangiodrainage

Percutaneous transhepatic biliary drainage (PTBD) is a well established method in the treatment of obstructive jaundice. Major indications are malignant diseases. PTBD may be necessary preoperatively in cases with severe jaundice or cholangitis or as part of palliative treatment concepts. In the past, it has been proposed that a period of preoperative PTBD may improve the morbidity rates of surgery. Various studies could not prove this theory. The significance of preoperative PTBD has changed, as observed during a 15 years period in our own institution, the indications for preoperative PTBD have decreased by half. At present, the majority of treatments with PTBD are palliative (almost 70 % …

Klinische Relevanz der NNH-CT vor Knochenmarktransplantation

PURPOSE To investigate the clinical necessity of CT of the paranasal sinuses before bone marrow or peripheral blood stem cell transplantation. PATIENTS AND METHODS 80 patients with malignant disease underwent coronal CT of the paranasal sinuses prior to transplantation to exclude sinusitis. RESULTS CT revealed sinusitis requesting therapy in 17/80 patients (21%). Patients with leukaemia and non-Hodgkin lymphoma were significantly more affected. Chronic sinusitis was found in two patients, mucosal swelling not requesting therapy in 22, and normal findings in 39. CONCLUSION CT of the paranasal sinuses is advised in patients suffering haemoblastoses with an increased risk of infectious complic…

Influence of contrast agent dose and image acquisition timing on the quantitative determination of nonviable myocardial tissue using delayed contrast-enhanced magnetic resonance imaging.

BACKGROUND: Delayed contrast-enhanced magnetic resonance imaging (ceMRI) has been shown to identify areas of irreversible myocardial injury due to infarction (MI) with high spatial resolution, allowing precise quantification of nonviable (hyperenhanced) myocardium. The aim of our study was to investigate the size of nonviable myocardium quantitatively as a function of time post-contrast when inversion time is held constant in patients post-myocardial infarction using two contrast agent (CA) doses. METHODS: Nine patients with chronic MI underwent two MR scans on a 1.5 Tesla system. Contrast-enhanced MRI data in two short-axis (SA) slices were continuously acquired until 40 minutes after CA i…

Hydro-MRT in der Darmdiagnostik bei Kindern

Purpose A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented. Patients and methods 20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5 % mannitol solution with a 1.0 T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed. Results In 21/24 examinations the small bowel was completely visualized, in 1…

Rectal cancer: mucinous carcinoma on magnetic resonance imaging indicates poor response to neoadjuvant chemoradiation.

Purpose To assess response of locally advanced rectal carcinoma to chemoradiation with regard to mucinous status and local tumor invasion found at pretherapeutic magnetic resonance imaging (MRI). Methods and Materials A total of 88 patients were included in this prospective study of patients with advanced mrT3 and mrT4 carcinomas. Carcinomas were categorized by MRI as mucinous (mucin proportion >50% within the tumor volume), and as nonmucinous. Patients received neoadjuvant chemoradiation consisting of 50.4 Gy (1.8 Gy/fraction) and 5-fluorouracil on Days 1 to 5 and Days 29 to 33. Therapy response was assessed by comparing pretherapeutic MRI with histopathology of surgical specimens (minimum…

Rectal cancer: Assessment of response to neoadjuvant chemoradiation by dynamic contrast-enhanced MRI

Purpose To assess pretreatment functional and morphological tumor characteristics with magnetic resonance imaging (MRI) in advanced rectal carcinoma and to identify factors predicting response to neoadjuvant chemoradiation. Materials and Methods In a prospective study, 95 patients with rectal carcinoma underwent dynamic contrast-enhanced MRI before and after chemoradiation. Quantitative parameters were derived from a pharmacokinetic two-compartment model. Tumors were also characterized with regard to mucinous status at pretreatment high-resolution MRI as nonmucinous or mucinous. Response to treatment was defined as a downshift in the local tumor stage. Results The parameter k21 (contrast me…

Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation

The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recur…