[Limits of the diagnostic capability of pulmonary digital subtraction angiography]. / Grenzen der diagnostischen Aussagekraft der pulmonalen digitalen Subtraktionsangiographie (DSA).

Digital subtraction pulmonary angiography was performed in 70 patients suspected of having pulmonary emboli. In 35 patients this diagnosis proved to be correct. The technical quality of all ECG-gated studies was scored and was found to be satisfactory in 31 patients (44%), moderate in 23 (33%) and unsatisfactory in 16 patients (23%). This was mainly due to the lack of patient cooperation. In patients with direct injection into the pulmonary artery (27%) the motion artifacts were less disturbing. We therefore suggest that even when using ECG-gated acquisitions, the injection should be performed into the pulmonary artery to overcome technical problems in the diagnosis of pulmonary embolism.

[Incidence of bronchopulmonary dysplasia in the course of the respiratory distress syndrome in premature infants]. / Die Häufigkeit der bronchopulmonalen Dysplasie im Verlauf des Atemnotsyndroms bei Frühgeborenen.

The chest radiographs of 54 neonates with respiratory distress syndrome have been reviewed. 24% fell into stages I and II, 65% into stages III and IV and in 11% bronchopulmonary dysplasia developed. Infiltrations due to pneumonia or aspiration, persistent ductus arteriosus and pneumothorax can be differentiated radiologically. There was a strong correlation between the level of ventilatory pressure and the development of bronchopulmonary dysplasia. After reducing ventilation pressure to below 15 cm of water with a frequency of 66 per minute, bronchopulmonary dysplasia dropped from 14.4% (35 cases) to 5.3% (19 cases).

[Histopathologically verified cerebral CT findings in AIDS]. / Histopathologisch verifizierte zerebrale CT-Befunde bei AIDS.

Computer tomographic and histopathological findings in 55 patients who died of the complications of acquired immunodeficiency syndrome, were reviewed retrospectively. In 23 patients (42%) an increased space of the internal or external cerebral spinal fluid was diagnosed. 20 patients (36%) had focal lesions. We differentiated between single, multiple and ring-shaped lesions with contrast enhancement and hypodense lesions. In 12 cases (22%) no CT abnormalities were found. Focal lesions proved to be secondary to toxoplasmosis in 85%. Single lesions were never caused by toxoplasmosis.

[Magnetic resonance tomographic and sonographic imaging of the ankle in marathon runners]. / Kernspintomographische und sonographische Befunde der Knöchel von Marathonläufern.

Calcaneus tendons and ankles of 25 practising marathon runners were investigated by sonography and MR. We applied a 7.5 MHz transducer for sonography. Axial and sagittal T1-weighted, proton density-weighted, and T2-weighted SE images were performed. MR proved superior to sonography. Degenerative alterations of the calcaneus tendon, tendovaginitis of the flexor hallucis longus muscle, joint effusions and cartilage disease were diagnosed by MR but remained undetected by sonography.

[Postoperative nuclear magnetic resonance tomography of the talocrural joint after external syndesmorrhaphy]. / Postoperative kernspintomographische Untersuchung des oberen Spruggelenks nach Aussenbandnaht.

20 patients with acute traumatic rupture of the anterior talofibular ligament and ligamental suture were studied postoperatively by MRI. MR results were correlated with stress x-ray studies. We found a normal anterior talofibular ligament in eight cases. However, stress x-ray images showed normal stability of the ankle joint in eighteen cases. In six patients the anterior talofibular ligament was thickened, in another six cases it could not be separated from scar tissue. Therefore MR imaging of ankle ligaments did not allow a diagnosis of their function. Nevertheless, sequelae of the ankle trauma such as osteochondrosis, exudation into the ankle joint and tendovaginitis of the flexor muscles were sensitively visualised by MR.

[Abdominal organ-transcending tumors with special reference to peritoneal carcinosis. CT versus the surgical site]. / Abdominelle organüberschreitende Tumoren unter besonderer Berücksichtigung der Peritonealkarzionose. CT versus Operationssitus.

In 41 patients with a histologically confirmed peritoneal carcinomatosis (n = 29) or lymphangiomatosis (n = 12) the preoperative CT investigations of the abdomen were compared with intraoperative findings. CT findings were differentiated between direct or indirect signs. The sensitivity of the various CT signs of peritoneal carcinomatosis or lymphangiomatosis was between 66 and 100%. Abdominal CT studies proved to be a reliable preoperative method if the findings were examined closely. A precise review even of indirect signs is of high diagnostic value.

[A NMR tomographic follow-up assessment of the replacement plastic repair of the anterior cruciate ligament with an autologous ligamentum patellae transplant]. / Kernspintomographische Verlaufsbeurteilung der vorderen Kreuzbandersatzplastik mit einem autologen Ligamentum-patellae-Transplantat.

Reconstruction of the anterior crucial ligament can be performed by using an autogenous transplant from the patellar ligament. Employing postoperative MR investigation, reaction of the non-vascularised tendon was studied. In 16 patients 20 knees were investigated by applying a 1.5 tesla magnet with T1-weighted (TR 500 ms, TE 15 ms) and a T2*-weighted (FISP 3D: TR 30 ms, TE 10 ms, flip angle 40 degrees). Postoperative MR follow-up showed an increase in signal intensity and diameter in T1-weighted images. This represents revascularisation of the transplant.

[MRI of the cervical spine using T1-weighted multislice FLASH sequences]. / MRT der Halswirbelsäule mit T1-gewichteten mehrschichtfähigen FLASH-Sequenzen.

A study has been carried out to evaluate contrast and image quality of cervical structures using multislice 2D-flash sequences with long repetition times (TR = 400 ms.) and short echo delay times (TE = 5.8 ms.). The examinations were carried out using ten normals with an MRI of 1.5 Tesla and flip angles of 10, 20, 30, 50, 70 and 90 degrees. The best contrast between intervertebral disc and surrounding tissue was obtained between 50 and 70 degrees, best contrast between compact bone and CSF with 10 degrees. In order to demonstrate degenerative changes of the cervical spine, it appears sensible to use a combination of these angles. The described sequences produce good images of the cervical structures with little image degradation. Compared to T1-weighted spin-echo sequences, the method has a number of significant advantages, such as variations in image contrast, higher maximal number of slices, contiguous imaging and less imaging time.

["Surgical projection" in the gadolinium-DTPA (Gd-DTPA)-supported NMR tomographic diagnosis of lateral lumbar disk prolapse]. / Die "chirurgische Projektion" in der Gadolinium-DTPA(Gd-DTPA)-unterstützten kernspintomographischen Diagnostik des lateralen lumbalen Bandscheibenvorfalls.

In a group of 25 patients the coronal views of plain and Gd-DTPA-enhanced MRI studies were correlated with CT and operative findings. All series included sagittal, transverse and coronal FLASH sequences (GE 500/6, flip angle 70 degrees), sagittal proton density-(SE 2500/15) and T2-(SE 2500/70) weighted images. MR diagnosis proved to be correct in all cases. Compared to CT and axial MRI herniated disk material in the lateral intravertebral space and its relationship to nerve roots was demonstrated more clearly on coronal views.

[Angiographically confirmed vasospasm following aneurysmal subarachnoid hemorrhage: does the quantity of the primary diagnostic contrast medium modify the incidence of vasospasm?]. / Angiographisch gesicherter Vasospasmus (VSP) nach aneurysmatischer Subarachnoidalblutung (SAB): Beeinflusst die primärdiagnostische Kontrastmittelmenge die Vasospasmusinzidenz?

Prognosis after subarachnoid haemorrhage secondary to a ruptured intracranial aneurysm is greatly influenced by arterial vasospasm. In 50 patients the influence of the amount of subarachnoid blood detected by CT and the amount of the nonionic contrast medium on the postoperative vasospasm and the outcome of the patient were investigated. For angiographically proven vasospasm, a grading system is suggested. There was a good correlation between the extent of the haemorrhage and the development of cerebral vasospasm. If used within limits, the volume of the contrast medium does not seem to exercise any influence on the development of vasospasm and on the results after treatment. Therefore, a complete investigation of the cerebral vascular system should be performed before surgical management of the ruptured cerebral aneurysm is initiated.

[More rapid MRT with T2-weighted spin-echo sequences through variation of the flip angle]. / Schnellere MRT mit T2-gewichteten Spinecho-Sequenzen durch Variation des Anregungswinkels.

In the present study the influence of the flip angle on image contrast in spin echo imaging was investigated. It was evaluated, whether variation of the flip angle allows for shorter repetition and imaging times in T2-weighted spin echo sequences. 10 patients with cerebral white matter lesions were investigated with an 1.5 Tesla whole body tomograph using a conventional double-spin echo sequence (TR = 2500 ms, TE = 15 and 70 ms) and time-optimized double-spin echo sequences (TR = 1900 ms, TE 15 and 70 ms) at flip angles of 90, 80, 70, 60 and 50 degrees. A reduction of the flip angles resulted in a decrease of T1-weighting and a relative increase of T2-weighting of the images. Despite the reduced repetition time at a flip angle of 70 degrees visually and quantitatively assessed contrast between lesions and brain as well as image artifacts of the time-optimized sequence were comparable to the conventional spin echo sequence; however, imaging time was shortened about 25%.

[Results of radioiodine treatment of autonomous thyroid adenomas taking into consideration regional iodine kinetics and paranodular uptake]. / Ergebnisse der Radiojod-Behandlung autonomer Schilddrüsen-Adenome unter Berücksichtigung regionaler Jodkinetik und paranodulärer Speicherung.

In 110 patients with autonomous adenoma of the thyroid, the success rate of therapy with radioiodine using different local dosages (300 and 400 Gy) was monitored. Furthermore the relative paranodular uptake before and after radiotherapy was compared in dependence on the duration of therapy. In a short period of therapy (5-8 d) the paranodular uptake decreases as compared to a long duration (9-20 d) where it increases. This explains the higher rate of hypothyroidism found in the group of patients with a longer period of therapy. The success rate was 93.6% after applying a dosage of 300 Gy and 95% after 400 Gy. However we found a slightly smaller incidence of hypothyroidism (3.2%) after 300 Gy as compared to 400 Gy (8.8%). Nevertheless the higher dosage should be chosen to reduce the failure rate. Because of the increased rate of hypothyroidism with increasing paranodular uptake it is recommended in cases with uptake ratios between 10 and 20% (so-called transitional type) to induce exogenic suppression of the paranodular tissue by means of thyroid hormone.

[Magnetic resonance tomography of new rupture of the anterior talofibular ligament]. / Die kernspintomographische Diagnostik der frischen Ruptur des Ligamentum fibulotalare anterius.

Twenty acutely traumatised patients with a rupture of the anterior talofibular ligament were studied by MRI. The results of 3D-studies were correlated with conventional stress x-ray studies. The ruptured ligament was directly visualised in all cases as a thickened structure of high signal intensity. In case of complete ruptured ligaments free flowing ligamentous structures were seen in the signal intense exudation in the ankle joint. MRI can help to decide between surgery or conservative therapy.

[Magnetic resonance tomography diagnosis of the posterior chamber lens]. / Die kernspintomographische Diagnostik der Hinterkammerlinse.

Intraocular lenses were investigated by MRI to obtain information about the quality of this method. In experimental studies, seven lenses of between 0 and 30 diopters were visualized. By MRI it was possible to differentiate the various diameters of lenses. It was not possible to discriminate the material of the intraocular lenses. After these first studies the eyes of two corpses and eight patients were investigated. Because of the resolution of MRI it was possible to tell the diopter of implanted lenses. However, by use of MRI in the regular position, a tilting or decentration of the intraocular lens was demonstrated.

[Simultaneous radio- and chemotherapy of squamous cell carcinoma of the esophagus]. / Simultane Radio-Chemotherapie beim Plattenepithelkarzinom des Osophagus.

Between 1983 and 1986, 41 patients with a squamous cell carcinoma of the oesophagus without hematogenic metastases were treated with a combination of radio- and chemotherapy preoperatively. Treatment consisted of mitomycin C (10 mg/sqm/day 1) and continuous infusion of 5 fluorouracil (1000 mg/sqm/day-day 1 to 4) with a maximum of 1500 mg per day. On day 2 radiotherapy was started. After the administration of 36 Gy all patients were restaged. Nine patients were referred to surgery. In 13 cases surgery was refused, because of inoperability, due to local or distant metastases. In these patients radiotherapy was continued up to 50 to 60 Gy for palliation. Although the disease was confined to the oesophagus no surgery was performed in 19 patients, because of age, enhanced risk of anaesthesia or refusal by the patient. These patients were treated with radiotherapy alone (60 Gy) with curative intention. 32 patients treated without surgery were followed up. For the patients treated with curative intent, the one year survival rate was 62%, the two year survival rate was 42%. Compared to a group treated in 1970 bis 1982 with the same dosage of irradiation without the combination of chemotherapy the median survival could be raized from nine to 24 months, the two year survival rate improved from 18% to 42%. Patients treated for palliation only did not survive the first year after therapy.

[2-dimensional CT arthrotomography in the postoperative follow-up of a new anterior cruciate ligament plasty]. / Zweidimensionale (2-D) CT-Arthrotomographie zur postoperativen Kontrolle einer neuen vorderen Kreuzbandplastik.

Fifty-eight patients underwent intraarticular reconstruction of the anterior cruciate ligament. This was performed by using an autogenous transplant from the mid portion of the patellar ligament with a proximal and distal bone block, as described by Hertel. For comparison with the conventional X-ray examination, HRCT was performed to study the early postoperative results. In four patients (7%) dislocation of the bone block in the femoral condyle was seen. Two-dimensional reconstruction proved to be a satisfactory method for demonstration of the exact position of the autogenous transplant in both coronary and sagittal planes.

[Extravasation of contrast media in the excretory urogram]. / Kontrastmittelextravasate im Ausscheidungsurogramm.

Aetiology and diagnostic procedure of calyceal fornix rupture during intravenous urography are discussed. In the literature the fornix rupture is described as a spontaneous event--not so in the four cases presented. In two cases a sudden increase in intrapelvic pressure was due to an ureteric calculus, in the other cases an obstruction of the ureter was secondary to neoplasm. It is recommended to perform a CT as soon as a contrast medium extravasation in intravenous urography is diagnosed.

[Comparison of computerized tomography and pathologic-anatomic findings of the abdomen in HIV infection]. / Vergleich computertomographischer und pathologisch-anatomischer Befunde des Abdomens bei HIV-Infektion.

In a retrospective study the results of abdominal computed tomography (CT) from 48 patients, who died of the complications of HIV infection, were compared with those obtained at autopsy. The CT diagnosis was confirmed at autopsy in 39 cases (81.3%). In nine patients CT results did not correlate with the postmortal findings. This was caused by lack of cooperation, cachexia and the time between the last CT study and the death of the patients. Nevertheless, CT with its standardised imaging planes is an important method for diagnosing and monitoring HIV-related diseases of the abdomen.

[Anterior cruciate ligament rupture: MT versus arthroscopy]. / Vordere Kreuzbandruptur: MRT versus Arthroskopie.

Because of suspected rupture of the anterior cruciate ligament sixteen acute traumatised patients were investigated by MR and arthroscopy. The MR diagnosis of a lesion of the anterior cruciate ligament proved to be correct by arthroscopy in fifteen of sixteen cases. Diagnostic criteria for lesions of the anterior cruciate ligament were: Increased signal intensity in T1- and T2 weighted images, increased volume and discontinuity of ligamentous structures. Additional MR findings of meniscal tears were correct in three of four cases laterally and in four of four cases medially. Femoral cartilage lesion were correctly identified by MR in three cases. MR normal findings proved to be correct by arthroscopy in another five cases.

[Results of follow-up after surgical treatment of Perthes disease: comparison of roentgenologic and and magnetic resonance tomography examination]. / Spätergebnisse nach operativer Behandlung des Morbus Perthes: Vergleich der röntgenologischen und kernspintomographischen Untersuchung.

Twenty patients treated by surgery for Perthes' disease were studied between 4 and 9 years postoperatively. In the clinical investigation eight patients complained of persistent stress-induced pain. In nine patients flexion, extension, ab- and adduction of the hip joint was limited. In the MRI-study of ten hip joints a reduction of fatty marrow was seen in the femoral head. In 11 hip joints of patients complaining of persistent pain, a deformation of the femoral head (n = 2), a dysplasia of the femoral metaphysis (n = 2), and diaphysis (n = 4) or both (n = 2) were seen. In another five patients an additional dysplasia of the acetabulum was visualized. All these findings were diagnosed by X-ray studies as well. However, only by MRI were the extents of the postoperative defects of femoral spongiosa diagnosed in fifteen hip joints.