[Degenerative alterations of the spinal column: rational imaging]. / Degenerative Veränderungen der Wirbelsäule: Rationale Bildgebung.

Unspecific back pain is a common phenomenon. Imaging often shows no clear cause for the genesis of back pain and generally has no impact on the therapeutic procedure. In contrast specific back pain, where a morphological cause is present is more infrequent. In these cases imaging and especially magnetic resonance imaging (MRI) is indicated. The indications for imaging should be geared to the so-called red flags which suggest serious morphological changes of the spine. The article deals with often encountered degenerative changes of the spine and describes spondylodiscitis as an important differential diagnosis to erosive osteochondritis.

Acute ventricular fibrillation during primary HIV infection.

Primary HIV infection normally shows an asymptomatic presentation or symptoms resembling infectious mononucleosis. However, severe unusual presentations have been reported. We report a case of acute ventricular fibrillation during primary HIV infection. Moreover, the rapid development of symptoms, the profound pancytopaenia and the marked elevation of liver enzymes make this case rather unique. Therefore, acute ventricular fibrillation should be added to the list of complications of primary HIV infection.

Determination of flow profiles of different mechanical aortic valve prostheses using phase-contrast MRI.

AIM: After heart valve replacement in aortic position turbulences may occur in the aortic outflow tract. Valve-induced turbulences and retrograde flow represent a loss of efficiency of cardiac output in respect to antegrade kinetic energy of blood flow. Aim of this study is the evaluation of the flow profiles of monoleaflet and bileaflet valves after aortic valve replacement. METHODS: The flow profiles of three different mechanical aortic heart valve prostheses were compared using phase contrast magnetic resonance imaging (MRI) in vivo. One monoleaflet (group A, 30 patients) was compared with two bileaflet valves (group B, 20 patients, group C, 10 patients). Phase-contrast MRI measurements were taken 3 cm above the valve in the aortic outflow tract. Flow and velocity were evaluated in the aortic cross-section and in nine subregions. RESULTS: The peak-velocity of Group A was significantly higher (234.79±7.38) than of groups B and C. The right laterodorsal subregion showed significantly higher peak-velocity values in the monoleaflet valve group (group A 196.34±66.94; group B 119.22±75.92; group C 129.26±57.37). In the left lateral subregion group A revealed a significant negative peak velocity, indicating retrograde flow towards the valve. There were no significant differences in the retrograde flow volumes between the three patient groups. CONCLUSION: Bileaflet valves (groups B and C) have a more homogenous flow profile, lower flow velocities, less retrograde flow and fewer turbulences in the outflow tract of the aortic valve in comparison to the monoleaflet valve (group A).

Aneurysmal bone cyst of the cervical spine (2008:7b).

Aneurysmal bone cysts (ABC) are rare, benign, but locally destructive bone tumors. They occur in the spine in 14% of cases, but only 2% are found in the cervical spine. This case report presents a 16-year-old female with an expansive aneurysmatic bone cyst with extensive bone destruction and instability in the cervical segments C1 and C2. In CT and MRI, there was a soft-tissue tumor mass with multiple cysts and fluid-fluid levels within these cysts, as well as contrast enhancement of the cyst wall and the tissue among the cysts. The typical macroscopic and histological findings were present. The tumor was resected en bloc, after which the patient underwent adjuvant radiation therapy. The patient made a complete recovery.

[Aneurysmal bone cysts. First description of the extensive destruction of the upper cervical spine]. / Aneurysmatische Knochenzyste. Erstbeschreibung einer ausgedehnten Destruktion der oberen HWS.

Aneurysmal bone cysts are not counted among the classic malignant tumors, although they are destructive locally as blood filled reactive bone lesions. Typically, they are found in the metaphysis of the long bones, while localizations on the spine are rare. A 16-year-old female patient presented with unspecific, progressive neck pain which had been present for half a year. The initial x-ray showed no noticeable pathology whatsoever. Subsequently, the complete destruction of the first cervical vertebrae was found. The tumor had completely infiltrated and completely surrounded the spinal chord. A combined approach was used as therapy: resection of the dorsal tumor portion with occipitocervical spondylodesis (C0-C4) and postoperative radiation of the remaining ventral portions. Currently, the patient is free of complaints and recurrence. The differential diagnosis of an aneurysmal bone cyst should also be considered in cases of unspecific cervical vertebral complaints in adolescents that are not otherwise explainable.

[Immobilization in external rotation after primary shoulder dislocation]. / Ruhigstellung in Aussenrotation bei primärer Schulterluxation.

INTRODUCTION: The standard method of treating acute primary dislocation of the glenohumeral joint is immobilization of the arm in adduction and internal rotation with a sling. The recurrence rate for anterior instability after nonoperative treatment in young active patients is extremely high (up to 90%) and well reported. A new method of immobilization with the arm in external rotation improves the position of the displaced labrum on the glenoid rim. With the use of control MRI before and after immobilization in external rotation, a study on this new repositioning of the labrum is evaluated. METHODS: Ten patients (mean age 30.4 years) with primary anterior dislocation of the shoulder and Bankart lesion as shown on MRI but with no hyperlaxity of the contralateral side were immobilized in 10-20 degrees of external rotation for 3 weeks. Scans with MRI were taken in internal and external shoulder rotation post trauma and in internal rotation after 6 weeks. All patients were reevaluated after 6 and 12 months. RESULTS: Dislocation and separation of the labrum were both significantly less with the arm in external rotation due to the tension of the anterior capsule and the tendon of the subscapularis muscle. In the MRI taken in internal rotation 6 weeks post trauma, all Bankart lesions were fixed in reposition after three weeks of immobilization in external rotation. At 12-month follow-up, the average Constant Score was 96.1 points (range 63-100), and the Rowe Score was 91.5 points (range 25-100). One patient had traumatic redislocation after 8 months. CONCLUSION: After primary shoulder dislocation, immobilizing the arm in 10-20 degrees external rotation provided stable fixation of the Bankart lesion in an anatomic position. First long-term indications from an ongoing prospective study of recurrence rates after immobilization in external rotation are promising.

[Initial results of shoulder MRI in external rotation after primary shoulder dislocation and after immobilization in external rotation]. / Initiale Ergebnisse der Schulter-MRT in Aussenrotation bei primärer Schulterluxation und nach Ruhigstellung in Aussenrotation.

PURPOSE: A change in the strategy for treating primary anterior traumatic dislocation of the shoulder has occurred. To date, brief fixation of internal rotation via a Gilchrist bandage has been used. Depending on the patient's age, a redislocation is seen in up to 90 % of cases. This is due to healing of the internally rotated labrum-ligament tear in an incorrect position. In the case of external rotation of the humerus, better repositioning of the labrum ligament complex is achieved. Using MRI of the shoulder in external rotation, the extent of the improved labrum-ligament adjustment can be documented, and the indication of immobilization of the shoulder in external rotation can be derived. The aim of this investigation is to describe the degree of position changing of the labrum-ligament tear in internal und external rotation. MATERIALS AND METHODS: 10 patients (9 male, 1 female, mean age 30.4 years, range 15 - 43 years) with a primary anterior dislocation of the shoulder without hyper laxity of the contra lateral side and labrum-ligament lesion substantiated by MRI were investigated using a standard shoulder MRI protocol (PD-TSE axial fs, PD-TSE coronar fs, T2-TSE sagittal, T1-TSE coronar) by an axial PD-TSE sequence in internal and external rotation. The dislocation and separation of the anterior labrum-ligament complex were measured. The shoulders were immobilized in 10 degrees external rotation for 3 weeks. After 6 weeks a shoulder MRI in internal rotation was performed. RESULTS: In all patients there was a significantly better position of the labrum-ligament complex of the inferior rim in external rotation, because of the tension of the ventral capsule and the subscapular muscle. In the initial investigation, the separation of the labrum-ligament complex in internal rotation was 0.44 +/- 0.27 mm and the dislocation was 0.45 +/- 0.33 mm. In external rotation the separation was 0.01 +/- 0.19 mm and the dislocation was - 0.08 +/- 0.28 mm. After 6 weeks of immobilization in 10 degrees external rotation, the separation of the labrum was - 0.10 +/- 0.14 mm and the dislocation was - 0.23 +/- 0.21 mm. CONCLUSION: In anterior labrum-ligament tears, the axial MRI of the shoulder in external rotation demonstrates a more physiologic position of the glenoid. This may indicate an immobilization of the shoulder in external rotation, which results in a more anatomical healing of the glenoidal tear. Thus, in the case of labrum-ligament tears, MRI in external rotation is becoming indispensable.

[Feasibilities and bounds of diagnostic radiology in case of back pain]. / Möglichkeiten und Grenzen der diagnostischen Radiologie am Beispiel des Rückenschmerzes.

Chronic monotone back pain is no pressing indication for radiographic procedures, but chronic progressive or symptomatic back pain should be investigated by radiographic means. Beneath conventional radiology and computed tomography (CT) magnetic resonance imaging (MRI) has become a more method of standard in these cases. The radiographic investigation of back pain is shown in cases of discal and vertebral degeneration and spondylitis. Typical signs and differential diagnosis are demonstrated. After demonstration of radiological means. After introduction and valuation of radiological means, as conventional radiography, CT, MRI, myelography and scintigraphy, it is entered into degenerative changes and degenerative diseases of vertebra endplates and vertebra bodies as a reason of pain. Reasons of spinal stenosis are discussed. In case of inflammatory changes, bacterial inflammation of vertebrae and intervertebral joints are represented. Changes of spondylodiscitis/spondylitis are opposed to inflammatory changes of Morbus Bechterew and Morbus Scheuermann.

[Lumbar intraspinal juxtafacet cysts: MR imaging and CT-arthrography]. / Lumbale intraspinale Juxta-Facettenzysten: Kernspintomographie und CT-Arthrographie.

PURPOSE: To present data on the MR imaging appearance of lumbar intraspinal juxtafacet cysts (JFC) and to assess the importance of additional CT arthrography. MATERIAL AND METHODS: Twenty-eight patients (16 women, 12 men) with a mean age of 64 years (range: 43 - 82), who underwent MR imaging because of radicular pain or spinal claudication, were found to have an intraspinal cyst associated with the facet joint. In 14 patients, additional CT-arthrography was performed to determine whether a communication exists between the cyst and the facet joint and to try to rupture the cyst. RESULTS: In T(2)-weighted images, juxtafacet cysts show a typical pattern consisting of a hyperintense center and hypointense rim. The center is likely to be inhomogeneous because of recurrent hemorrhage in the cyst. In T1-weighted images, the cysts are hypo/isointense. Irregular hyperintensity may indicate subacute hemorrhage, which may aggravate the clinical symptoms. MR allows superior visualization of the cyst in all anatomical planes. It also enables assessment of typical accompanying changes, such as degenerative spondylolisthesis and facet hypertrophy. All patients, who had CT-arthrography, were found to have a direct communication between joint space and cyst. Transarticular rupture of the cyst was possible in five patients. Two of these five patients had good to excellent improvement, and the remaining three patients underwent surgery. CONCLUSION: MR imaging is the method of choice for diagnosing lumbar intraspinal juxtafacet cysts. CT-arthrography of the facet joint is helpful in cases with difficult differential diagnosis, and in the preoperative planning. Furthermore, it assists in the primary interventional treatment.

[Intrafascial hematoma of the rectus abdominis muscle as a complication after laparoscopic operations]. / Intrafasziale Hämatome des Musculus rectus abdominis als Komplikation nach laparoskopischen Operationen.

We report on two patients with intrafascial hematoma of the musculus rectus abdominis following laparoscopic operations. One patient was operated on a stenosis of the common iliac artery for an aortofemoral bypass. The other patient was operated on an inguinal hernia. Only a CT scan of the abdomen led to the correct diagnosis, because the use of ultrasound was limited by pneumoperitoneum and bandages, and retroperitoneal bleeding could not be recognized. Computed tomography is a valid method for detecting this complication of laparoscopic surgery.