0000000000060002
AUTHOR
K. Schunk
Hydro-MRT mit schnellen Sequenzen bei Morbus Crohn: Vergleich mit der fraktionierten Magen-Darm-Passage
PURPOSE To compare the value of hydro-MRI with that of barium studies in patients with Crohn's disease. MATERIALS AND METHODS After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution, axial and coronal breath-hold sequences (T2W HASTE +/- FS, contrast-enhanced T1W FLASH FS) were acquired in 46 patients with Crohn's disease at 1.0 T. The findings of hydro-MRI were compared with those of barium studies. RESULTS In the stomach and the small bowel, hydro-MRI and barium studies demonstrated similar numbers of Crohn's involvements (39 vs. 36); in the colon, hydro-MRI showed clearly more affections (23 vs. 10). Hydro-MRI showed 12.7 cm of inflamed bowel per patient, on average (…
Verlaufskontrolle des Morbus Crohn: Kann die Hydro-MRT die fraktionierte Magen-Darm-Passage ersetzen?
PURPOSE: To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease. METHOD: 22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations. RESULTS: In the upper gastrointestinal tract, the follow-through exam…
Zur Frage der Darmkontrastierung in der abdominellen Computertomographie
In 56 patients undergoing abdominal CT the gastrointestinal tract was defined by negative contrast instead of the conventional positive contrast from an iodine containing contrast medium. The contrast material was a 2 1/2% mannitol solution and was used for filling the rectum. Filling of the gastrointestinal tract was of similar quality to that obtained with positive contrast media. The number of artifacts due to high contrast boundaries was slightly greater with the negative contrast than it would have been with positive contrast. Differentiation of the gastrointestinal tract from other abdominal organs was equally good for both methods. The negative contrast method was poor in diagnosing …
Bronchiektasen und Infekthäufigkeit bei Alpha-1-Antitrypsin-Mangel
UNLABELLED PURPOSE of this study was to determine the prevalence of bronchiectasis in patients suffering from alpha-1-antitrypsin deficiency and to compare its extent with the frequency of infections. MATERIAL AND METHODS High-resolution CT examinations (HRCT) of 23 patients with alpha-1-antitrypsin deficiency were retrospectively assessed for extent, severity and localisation of bronchiectasis, bronchial wall thickening and extent of emphysema. Chest radiographs and clinical records were available for correlation. RESULTS HRCT scans showed bronchiectasis in 14 of 23 patients, bronchial wall thickening in 3/14, and panlobular emphysema in 23/23. Chest radiographs showed bronchiectasis in 4/…
Die lokale Fibrinolyse bei Nierenarterienverschlüssen
The indications and technique of local fibrinolysis therapy of acute renal artery occlusions are discussed in relation to four patients. Because of the short period for which ischaemia is tolerated by the kidney, the result of treatment depends largely on the time interval between occlusion and the beginning of treatment. Partial perfusion of the renal artery was obtained in three patients. Since the "ischaemia time" of the kidneys had been exceeded, it was not possible to obtain complete restitution of renal function in any of these patients.
Rechte und Pflichten des Radiologen bei der Indikationsstellung und Anwendung radiologischer Verfahren
A radiological examination or an interventional procedure is a medical invasion of the patient's freedom and does not constitute an offense of causing bodily harm there is a medical indication, when the patient has given consent after being adequately informed, and the intervention is carried out in accord with the valid rules of medical conduct. During the assessment of possible contraindications, the radiologist must also evaluate the indicationy, i.e., he or she must decide if the medical question can be answered by the requested radiological examination. The indication must be viewed the more critically the greater the risk for a complication is. A radiological diagnosis with the use of…
Die dynamische 31-Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Einfluß von Geschlecht und Alter auf spektroskopische Parameter
PURPOSE 31P-MRS is used to assess the influence of sex und age on quadriceps muscle metabolism before and after exercise. MATERIALS AND METHODS 32 healthy volunteers (15 women, 17 men, mean age: 38 +/- 17 yrs.) were examined by dynamic phosphorus-31 (31P) magnetic resonance spectroscopy (MRS). In the magnet, the quadriceps muscle was stressed by an isometric und an isotonic form of exercise until exhaustion, respectively. RESULTS Resting conditions: With increasing subjects' age, the ratio beta-adenosine triphosphate/total phosphate decreased (r = -0.37; p = 0.02). With increasing subjects' age, the ratios inorganic phosphate/phosphocreatine (r = 0.79; p = 5 x 10(-8), phosphomonoester/beta-…
Die Skaphoidpseudarthrose: Häufigkeit, Pathogenese und Verlauf
Eight-three scaphoid pseudo-arthroses were found amongst 1.104 scaphoid examinations. Sixty-seven were present at the first examination and 16 pseudoarthroses developed amongst 252 scaphoid fractures. Men were affected predominantly, particularly in the 20 to 40-year old group. Fractures in the proximal third of the scaphoid and vertical oblique fractures had a particular tendency to pseudo-arthrosis formation. The operative treatment of choice is a Matti-Russe bone graft. Only one patient in seven with definite scaphoid pseudo-arthrosis showed firm fusion.
Beurteilung der entzündlichen Aktivität des M. Crohn mit der Hydro-MRT∗
PURPOSE: To assess the value of hydro-MRI in the assessment of the activity of Crohn's disease. MATERIALS AND METHODS: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution, axial and coronal breath-hold sequences (T2W HASTE +/- FS, contrast-enhanced T1W FLASH FS) were acquired in 63 patients with Crohn's disease at 1.0 T. The enhancement of the bowel wall was correlated with other MRI findings, with the Crohn's disease activity index (CDAI), and the C-reactive protein (CRP). RESULTS: In Crohn's disease, contrast enhancement of the affected bowel wall is markedly increased in comparison with the normal bowel wall (+80 +/- 23% vs. +43 +/- 11%; p = 8 x 10(-11)). Positive…
Hydro-MRT bei entzündlichen Darmerkrankungen - Eine koloskopisch-histologische Vergleichsstudie*
PURPOSE To compare hydro-MRI with colonoscopy and biopsy specimen regarding the assessment of inflammatory activity and the differentiation of inflammatory bowel diseases. MATERIAL AND METHODS After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution and a rectal bowel opacification using 250-500 ml of a 0.9% saline solution, axial and coronal breath-hold sequences +/- Gd-DTPA (HASTE-["half-Fourier acquisition single-shot turbo spin echo"] and dynamic FLASH-["fast low angle shot"]) were acquired in 27 patients with inflammatory bowel disease. The enhancement of the bowel wall as well as morphological MRI findings were correlated with colonoscopy and biopsy specimens. By me…
Diagnostik von Erkrankungen des biliopankreatischen Systems und des Darms
Die bildgebenden Verfahren haben in den letzten 2 Jahrzehnten insbesondere mit der Computertomographie (CT) und der Magnetresonanztomographie (MRT) eine rasante Entwicklung erlebt. Nachdem die Kernspintomographie in den Anfangsjahren ihren Schwerpunkt vor allem in der Neuroradiologie hatte, werden kernspintomographische Techniken nun in nahezu allen Korperregionen etabliert. Mit Hilfe von ultraschnellen Sequenzen und speziellen Oberflachenspulen konnte die Qualitat der Bilder im Abdomen wesentlich verbessert werden. Der vorliegende Beitrag beschreibt die Moglichkeiten und Einschrankungen dieser weiterentwickelten diagnostischen Verfahren bezuglich der biliopankreatischen Erkrankungen mit Hi…
Messung der Pfannenwanderung bei zementfreien Hüftimplantaten
PURPOSE Migration measurements of acetabular components using a special computer aided method (EBRA = abbreviation for the German term "Ein-Bild-Rontgenanalyse") were performed to evaluate early results of the implants and predict aseptic loosening. METHODS Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes longitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. RESULTS 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e…
Uferzellangiom - eine seltene Differentialdiagnose von Milztumoren
UNLABELLED HISTORY AND PRE-ADMISSION FINDINGS: Routine abdominal sonography of a 51-year-old man 6 years after removal of the right testis and radiotherapy for a seminoma revealed a 3 cm mass within the spleen. INVESTIGATIONS All biochemical tests were normal. Computed tomography (CT) and magnetic resonance imaging confirmed the tumour which had not been present on the CT before the seminoma had been treated. No other space-occupying lesions were found in the thorax and abdomen. TREATMENT AND COURSE A splenectomy was performed because a metachronous metastasis of the seminoma was suspected. The operation and subsequent course were uneventful. At operation the tumour had been diagnosed as an…
Darmkontrastierung bei der abdominellen Computertomographie: Wasser oder Kontrastmittel?
The suitability of water as an oral or rectal contrast medium for abdominal CT was studied in 56 patients and compared with an iodine-containing water-soluble contrast medium (ioxital amino acid). In some cases it was impossible to differentiate gastrointestinal structures from extraluminal fluid collections (cystic tumours, ascites, abscesses) and there was poor filling of distal small bowel and colon. The routine use of water can, therefore, not be recommended. In some cases, however, water can result in improved image quality by reducing artifacts and improving the demonstration of the mucosa.
Die dynamische31Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Therapiebedingte Veränderungen bei arterieller Verschlußkrankheit
PURPOSE: The present investigation aimed at examining changes in muscle metabolism caused by treatment of arterial occlusive disease, using dynamic 31-phosphorus methods. METHOD: 32 patients with arterial occlusive disease were examined in a 1.5 T apparatus with a 6 cm surface coil before and after treatment. The metabolic changes in the quadriceps muscles were visualised during a 36 s phosphorus spectrum during rest, exercise (isometric and isotonic) and during a period of recovery. RESULTS: Vascular therapy resulted in a significant increase in the duration of both types of exercise during dynamic phosphorus spectroscopy (isometric exercise: 282 s against 199 s: p = 0.002, isotonic exerci…
Der Sicherheitsgurt: Auswirkungen auf das Verletzungsmuster von Autoinsassen
Since 1984 the law concerning safety belts has been implemented; this paper deals with the findings in 386 victims of motor accidents who were x-rayed between 1981 and 1989. Minor injuries have been ignored. The number of passengers wearing belts increased by 30% after 1984. The number of passenger injuries did not decrease. Injuries directly caused by the belts included a small number of fractures of clavicles, the sternum and ribs and one pelvic fracture, one serious abdominal injury with tearing of the mesenteric artery and one ruptured spleen. An indirect result of wearing seat belts was a marked increase in cervical whiplash injuries and some increase in thoracic vertebral fractures. N…
Messung des Gefäßdurchmessers zur Bestimmung von Stent- und Ballongröße bei perkutanen Eingriffen an der Beckenstrombahn
AIM Should the sizes of balloons and stents used in the pelvic circulation be determined by the size of the ipsilateral or contralateral vessel? STUDY DESIGN The angiographic findings in 31 patients were analysed; in 10 an occlusion and in 21 a high grade stenosis (greater than 75%) of the common iliac artery had been treated by stenting (26) or simple PTA (5). RESULTS In 26 of the 31 patients there was marked reduction in the lumen distal to the lesion up to 40%. In 17 patients this was reversed immediately after the procedure and in five others the lumen increased but a difference between the two sides remained. The changes on the two sides following treatment were statistically significa…
Die dynamische31Phosphor-Magnetresonanz-Spektroskopie des M. quadriceps: Metabolische Veränderungen unter zwei verschiedenen Belastungsformen
PURPOSE The aim of the present investigation was to examine the metabolism of the quadriceps muscles of normal young individuals using dynamic 31phosphorus magnetic resonance spectroscopy. METHODS 22 normal individuals were examined in a 1.5T-MRT using a 6 cm surface coil. The metabolic changes in the quadriceps muscle as shown by the phosphorus spectrum were evaluated during rest, exercise (isometric and isotonic exercise) and during a 36-second period of recovery. RESULTS The Pi/PCr quotient rose from its resting value of 0.11 +/- 0.02 following exercise to a maximum of 0.83 +/- 0.47 (isometric) or 1.40 +/- 0.59 (isotonic) (difference p = 0.0001). Half-time recovery of Pi/PCr was 35 +/- 1…
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…
Segmentanatomie der Leber in der Computertomographie: Lokalisieren wir die Läsionen richtig?*
Purpose: To evaluate if Couinaud's model using the planes of the major veins is an adequate tool for the presurgical localization of focal liver lesions. Methods: Biphasic helical CT scans were performed on patients evaluated for liver resection using an increased IV bolus of contrast medium (180 ml lopamidol) and 2 mm image reconstruction increments. During the first evaluation, all liver lesions were localized in the conventional way using the planes of the 3 major hepatic veins and the portal trunks as segmental boundaries. In a second review, all lesions were attributed to the nearest peripheral portal branches. The path and the segmental attribution of the portal branches were analysed…
Chemoembolization for primary liver cancer
Abstract Aims: For most patients with primary liver cancer surgical treatment is not feasible and prognosis without treatment is poor. We aimed to assess the morbidity and efficacy of transarterial chemoembolization (TACE) with lipiodol and mitomycin C in these patients in a prospective case-control study. Methods: From August 1996 to May 2000 22 patients with non-resectable hepatocellular carcinoma were treated with TACE. In case of radiological or tumour-marker response, treatment was repeated after 4–6 weeks, up to seven times per patient. Results: Morbidity was 23% and usually minor, no patient died within 30 days of treatment. A decrease in size of the reference tumour or constant tumo…
Eine Mannitollösung als orales Kontrastmittel in der pelvinen MRT
PURPOSE Improvement of pelvic MRI using peroral administration of an aqueous mannitol solution. METHODS We retrospectively evaluated magnetic resonance examinations of 72 patients with suspected or proven pelvic abnormalities: In 36 patients, no bowel marking was carried out. In further 36 patients, we performed a contrast enhancement of the bowel by oral application of 1000 ml of an aqueous mannitol solution. RESULTS 8/36 (22%) patients suffered from diarrhoea, nausea or meteorism as a result of mannitol application. In group 2, an excellent bowel marking of the small intestine could be obtained in 36/36 (100%) patients. Contrast enhancement of the bowel significantly improved delineation …
Der Supinatorfettkörper bei Frakturen des Ellbogengelenkes
The position of the supinator fat pad is regarded as a valuable sign in fractures of the elbow. In our patients the pad was visible in 277 out of 337 cases (82%). The sign was positive in only 27 out of 55 proximal fractures of the radius (sensitivity 0.49). There was no correlation between the severity of the fracture and the sign. There was marked variation in the distance between the pad and the radius, depending on age, build and projection. Our results indicate that the sign is not suitable for the diagnosis of fracture of the elbow.