Bone age determination based on the study of the medial extremity of the clavicle

The development of the medial clavicular epiphysis and its fusion with the clavicular shaft have been a subject of medical research since the second decade of this century. Computed tomography provides the imaging modality of choice in analyzing the maturation process of the sternal end of the clavicle. In a retrospective study, we analyzed normal development in 380 individuals under the age of 30 years. The appearance of an epiphyseal ossification center occurred between ages 11 and 22 years. Partial union was found from age 16 until age 26 years. Complete union was first noted at age 22 years and in 100 % of the sample at age 27 years. Based on these data, age-related standardized age dis…

CT-Angiographie bei arterieller Verschlußkrankheit: Vergleich von 3 Rekonstruktionsverfahren

Purpose To evaluate different rendering techniques of CT data for the assessment of long vessel segments in peripheral vascular occlusive disease. Material and methods 40 CT angiograms (aortoiliac: n = 20, leg arteries: n = 20) were viewed using three different rendering techniques: 1, maximum intensity projection (MIP); 2, volume rendering (VR); 3, shaded surface display (SSD). CT angiograms were obtained in 6 or 8 projections. Axial cross-section images were analysed using an interactive cine mode. Intraarterial DSA was the standard in all cases. Results The sensitivities for the diagnosis of occlusive disease were 100% (cross-section images), 94% (MIP), 91% (VR) and 93% (SSD). The specif…

Sarcoma of the pulmonary artery: Report of two cases and a review of the literature

Primary tumours of the pulmonary arteries are rare neoplasms seldom diagnosed during the patient's life time. We report on two cases of pulmonary artery sarcomas diagnosed during life time of the respective patients in intra-operative frozen sections by histopathological examination. Case 1 was of a 55-year-old man with a fibrosarcoma originating from the main pulmonary trunk. Case 2 was of a 43-year-old woman with a malignant fibrous histiocytoma originating from the right pulmonary artery. In both patients a radical tumour resection under cardiopulmonary bypass was attempted. Both patients, however, had a local tumour recurrence and died 18 months (patient 1) and 6 months (patient 2) afte…

Spiral-Computertomographie der Mamma

Aim To evaluate the use of spiral CT in the diagnosis of breast lesions. Material and methods 93 female patients with suspicious or uncertain mammographic findings were examined by CT before and after contrast enhancement according to the following practical method: table movement, 6 mm/s, slice thickness 6 mm, increment 4 mm, contrast 200 ml, injection rate 3 ml/s, scan start 50 s after the beginning of the injection. Histological confirmation was present in 85 patients. Results All 44 invasive carcinomas were recognised. They were characterised by intensive focal contrast uptake. Only 2 out of 7 intraductal carcinomas were not shown by CT. 36 out of 38 benign lesions were correctly diagno…

CT angiography versus intraarterial digital subtraction angiography for assessment of aortoiliac occlusive disease.

The purpose of this study was to evaluate the accuracy of CT angiography (CTA) with a single helical acquisition for assessment of stenoses and occlusions of the iliac arteries.In our prospective study, intraarterial digital subtraction angiography and IV CTA were performed from the suprarenal aorta to below the femoral bifurcation in 30 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were also obtained. The accuracy of CTA with and without analysis of axial images was determined.Sensitivity and specificity of CTA were 100% for iliac artery occlusions with a confidence interval 85-100% and 97-100%, respectively. When axial scans were interpret…

Identification of an Unknown Corpse by Means of Computed Tomography (CT) of the Lumbar Spine

For the first time, a case is described in which an unknown corpse is identified by the comparison of antemortem and postmortem computed tomographic (CT) images. A posterolateral disc herniation at L5-S1 on the right side, Schmorl's nodes and a lucency in the ilium were found in identical locations in each case. Additionally there were characteristic morphological similarities in the vertebral bodies, spinous processes, transverse processes and neural arches. In CT identification, as in conventional radiographic identification, one must try to reproduce comparable scanning conditions and images because apparent differences in the roentgenological morphology can occur as a result of differen…

Pulmonale Manifestationen bei HIV-Patienten: Rolle von Thoraxübersicht, CT und HRCT

Aim To determine the prevalence of pulmonary changes on chest radiographs and computed tomography (CT/HRCT) in HIV patients and their relation to pulmonary symptoms. Material and method 64 HIV patients were examined prospectively. 15 had no respiratory symptoms (group I), 30 had non-specific respiratory symptoms (group II), 19 complained of dyspnoea (group III). Chest radiographs and CT were performed within a week. In patients with positive findings, bronchoscopy was carried out with bacteriological and histological examinations. Results In group 1, 13% of chest radiographs and 40% of CTs showed infiltrative changes. In group II, the figures were 27% and 57% respectively. In group III, abn…

CT-Angiographie versus intraarterielle DSA bei Bauchaortenaneurysmen

PURPOSE To evaluate if CT angiography is able to image all features necessary for the preoperative planning of abdominal aortic aneurysms (accessory renal arteries, stenoses or occlusions of renal and iliac arteries, patency of inferior mesenteric artery). METHODS CT angiography and DSA were performed on 27 patients with abdominal aortic aneurysms. CT angiography was performed using a protocol that covered the abdominal aorta and the pelvic arteries with a single spiral acquisition (contrast dose: 150 ml, collimation: 5 mm, table feed: 7.5 mm/s, increment of reconstruction: 2 mm). Maximum intensity projections (MIP) and axial scans were compared with the results of intraarterial DSA. RESULT…

Computertomographie der Nieren nach Tumorenukleation

Two weeks to 120 months after enucleation of renal tumours the postoperative defects were correctly localized by renal computed tomography in 34 patients. Typical defect morphology was either wedge-shaped or concave. No dependence on tumour localization, tumour size, operative technique or a certain surgeon was observed. The cortical defects were smaller (mean 2.0 cm) than the original, prominent tumours (mean 3.4 cm). In small defects without tension suture of the capsule is sufficient, leading to minor defects. Larger defects were closed with a retroperitoneal or free peritoneal fat flap resulting in larger residual defects. In case of intra- or postoperative bleeding, CT could demonstrat…

Leber-CT mit portal-venöser Kontrastmittelgabe

Contrast administration through the superior mesenteric or splenic arteries provided additional information in 22 out of 31 patients, when compared with intravenous contrast bolus for CT of the liver. In 11 patients, the demonstration of a tumour lead to a change in treatment. False positive findings occurred in four of the 31 patients. In 2 patients intrahepatic lesions were overlooked, but were found during angiography carried out at the same examination. The diagnosis of intrahepatic space-occupying lesions is discussed as well as the CT appearances of portal-venous liver perfusion.

Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS.

The aim of the study was to improve the objectivity of X-ray image comparison for the identification of unknown dead individuals. CT-data were collected for 30 macerated skulls. An already presented computer program which uses CT data to establish virtual X-ray images was used to obtain X-rays with different beam angulations simulating rotation, dorsal flexion, and ventral flexion. Specific parameters were measured on the simulated images. The frontal sinus reveals the highest variability not only between the individual skulls but also within an individual skull in different positions. The most consistent parameters with respect to different positions were the skull breadth, the biorbital b…

Spiral CT of bronchial arteries in chronic thromboembolism.

OBJECTIVE: Computed tomography study of bronchial artery anatomy and evaluation of dilatation and tortuousity as indicators for pulmonary hypertension and surgical risk in patients with chronic thromboembolism were performed. MATERIALS AND METHODS: We retrospectively reviewed contrast-enhanced, thin section spiral CT scans of 39 patients undergoing pulmonary thromboendarterectomy. Findings were compared with mean pulmonary artery (PA) pressure in all, postoperative mortality in 33, and postoperative CT in 5 patients. Twenty patients without pulmonary hypertension served as controls. RESULTS: In the pulmonary hypertension group, 50 bronchial arteries were observed in 30 of 39 patients. Their…

Computertomographie nach extrakorporaler Stoßwellenlithotripsie (ESWL) der Nieren

In 105 patients CT studies were done prospectively after renal ESWL with a second generation lithotripter. 33 (31%) of the patients had renal oedema (n = 8), renal (n = 20) or extrarenal (n = 31) bleeding. Three of the 23 patients who had a three year follow-up had chronic renal changes, 10 had renal stones. As blunt renal trauma can be the cause of renal hypertension a longterm follow-up is necessary in ESWL patients, particularly if there was renal bleeding after treatment. Further studies are needed to determine the exact risk of renal hypertension after ESWL.

3D-CT von Frakturen: Vergleich von Volumen- und Oberflächen-Rekonstruktionen

Purpose The comparison of volume rendering (VR) and surface rendering (SSD) for demonstrating fractures from spiral-CT data. Materials and methods Standardized VR and SSD projections were produced from 50 spiral CT scans of 50 consecutive patients with fractures. Appropriate multiplanar reformattings (MPR) were used as the standard. Results SSD provided sufficient information in 31/50 cases. Results of VR were not significantly different (33/50). VR was superior in demonstrating 6/7 craniofacial fractures and 3/3 calcaneal fractures. SSD was superior for visualizing 2/3 shoulder fractures and 2/2 elbow fractures. Conclusion VR is a flexible technique for the depiction of fractures and the a…

Dreidimensionale Rekonstruktionen von computertomographischen Untersuchungen des knöchernen Schädels bei kraniofazialen Dysplasien und Frakturen

Eine Routineuntersuchung am CT gilt in der Regel nach Anfertigen der zweidimensionalen Querschnittbilder als beendet. Nahezu alle Computertomographen sind heute jedoch technisch dazu in der Lage, aus den Daten zweidimensionaler CT-Bilder ein dreidimensionales Oberflachenbild zu berechnen. Ein diagnostischer Nutzen dieser Sekundarrekonstruktionen wird oft angezweifelt, da im Vergleich zu den Querschnittbildern keine zusatzliche Information gewonnen werden kann [1, 3, 6, 15]. Unabhangig von dieser Tatsache zeigen jedoch diejenigen Chirurgen ein zunehmendes Interesse fur 3-D-Darstellungen, die in komplexen anatomischen Gebieten arbeiten und sich praoperativ eine optimale raumliche Vorstellung …

Bolus-enhanced renal spiral CT: technique, diagnostic value and drawbacks

Abstract In addition to pre- and postcontrast renal CT scans, early bolus-enhanced spiral scans during demarcation of the corticomedullary junction were acquired in 85 patients. The diagnostic value and drawbacks of the three imaging series in the evaluation of renal disease were assessed. Renal calcifications and calculus disease detected at precontrast scans (18%) were obscured after contrast administration and excretion in most cases. In the detection of renal lesions bolus-enhanced spiral CT and delayed postcontrast scans had an identical diagnostic yield (94%). Bolus-enhanced spiral CT was superior in the assessment of lesion vascularity and vascular anatomy as well as opacification of…

Ganzkörper-Spiral-CT zur Primärdiagnostik polytraumatisierter Patienten unter Notfallbedingungen

PURPOSE The aim of this study was to evaluate the role of a fast whole body helical CT scanner for primary diagnosis in trauma patients. METHODS 27 severely injured patients (9 women, 18 men; mean age 43 years) were first examined with a helical CT scanner allowing for digital radiograms up to a length of 1024 mm and continuous helical scans of up to 70 seconds (slice thickness 3 to 10 mm, pitch factor up to 2). The primary CT diagnosis was verified either by x-ray after the CT examination or during the subsequent days, by abdominal ultrasound, by additional CT scans in the following days, and by clinical follow-up. RESULTS CT showed all clinically relevant injuries of the head, spine, ches…

Identifizierung unbekannter Leichen durch Röntgenbildvergleich

Between 1987 and 1993, 30 unknown bodies were identified by means of pre- and postmortem radiographs at the Forensic Institute in Mainz. Our experience indicates that radiological identification comprises a useful, rapid and cheap method, at least as valuable as dactyloscopy or odontological comparisons. The ages of available radiographs were up to 25 years; the most suitable regions are the skull (11), pelvis and lumbar spine (6), lower femur and knee (5) and distal leg with the ankle joint (5). In respect of the problem of objectifying the probability of identity, possibilities for solutions are shown.

Chronische thromboembolische pulmonale Hypertonie: Diagnostische Wertigkeit von Mehrschicht-CT und selektiver Pulmonalis-DSA

Purpose To evaluate the diagnostic impact of multislice-CT and selective pulmonary DSA in chronic thromboembolic pulmonary hypertension (CTEPH). Methods 994 vessel segments of 14 consecutive patients with CTEPH were investigated with multislice-CT (slice thickness 3 mm, collimation 2.5 mm, reconstruction intervall 2 mm) and selective pulmonary DSA (posterior-anterior, 45 degrees oblique, and lateral projection. Analysis was performed by 2 investigators independently for CT and DSA. Diagnostic criteria were occlusions and non-occlusive changes like webs and bands, irregularities of the vessel wall, diameter reduction and thromboembolic depositions at different levels from central pulmonary a…

Möglichkeiten und Grenzen der Spiral-CT bei der Untersuchung von Nierenbeckenkarzinomen

PURPOSE To assess the value of spiral CT in comparison to conventional CT in the staging of renal pelvic carcinoma. PATIENTS AND METHODS 35 patients with renal pelvic carcinoma underwent preoperative CT; conventional technique (n = 21) and spiral CT (n = 14) with the reconstruction of thin sections were compared. RESULTS Non-invasive or minimal invasive tumours (TA, T1, T2) could not be differentiated with either technique. Small, flat tumours (TA) or multicentric tumours may be missed, even if spiral scanning is applied. The separation of local tumour growth from infiltration is significantly improved by spiral CT (12 of 12 patients instead of 18 out of 21 patients with the conventional te…

Pulmonary artery sarcoma mimicking chronic thromboembolic disease: computed tomography and magnetic resonance imaging findings.

The diagnosis of the rare primary malignant tumors of the pulmonary arteries is often delayed as symptoms are nonspecific.Computed tomography (CT) and magnetic resonance imaging (MRI) of three patients with occlusion of the right pulmonary artery, two with sarcoma and one with chronic thromboembolic disease were analyzed for discriminating diagnostic criteria.Criteria suggesting pulmonary artery sarcoma are inhomogeneous high or low attenuation (hemorrhage, necrosis), soft-tissue density in pulmonary arteries, vascular distension, enhancement after administration of gadopentetate dimeglumine. Criteria for chronic thromboembolic disease are homogeneous soft-tissue lesions, abrupt vascular na…

Das Onkozytom der Niere

The angiographic findings in ten patients with renal oncocytoma are described. Characteristic features include: absence of encasement, vascular occlusions, arterio-venous shunts and contrast lakes (8/10). Spoke-wheel arrangement of tumor vessels (8/10). Homogeneous tumour contrast during the capillary phase (7/10). Sharp demarcation from the kidney and surroundings (9/10) and a peritumoral halo (4/10). If the suspicion of an oncocytoma is raised by CT examination of a space-occupying lesion (part I), angiography should be performed to confirm the diagnosis and help in planning surgical treatment.

Erratum to “Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS” [Forensic Sci. Int. 117 (2001) 89–98]

MR-Tomographie versus CT-Arthrographie bei glenohumeralen Instabilitäten

In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superi…

Hochauflösende Dünnschicht-CT zum präoperativen Staging beim Rektumtumor: Vergleich mit der endo-luminalen Sonographie und der Histologie

Rectal carcinomas are amongst the most common malignant tumours. The aim of this work was to determine whether high resolution CT with thin sections (1 mm) can provide satisfactory delineation of perirectal tumour infiltration. Correct determination of local tumour spread was possible in four out of nine patients and distinction between those tumours confined to the rectal wall and those infiltrating the perirectal tissues was possible in four out of eight patients.

Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography.

The aim of this study was to determine the accuracy of CT angiography (CTA) with a single spiral acquisition for the diagnosis of arterial stenoses and occlusion in patients with peripheral vascular occlusive disease.In a prospective study, intraarterial digital subtraction angiography and i.v. CTA from the groin to the lower calves were performed on 50 patients with vascular occlusive disease. Maximum-intensity-projection images in multiple views were produced. The accuracy of CTA with and without analysis of the axial scans was determined with digital subtraction angiography as the standard.The sensitivities of CTA were 100% for the diagnosis of femoral artery occlusion, 100% for the dete…