Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone.

AIMS: To investigate the outcome of intravitreal bevacizumab (IVB) compared with laser photocoagulation in type I retinopathy of prematurity (ROP). METHODS: Case records of 54 consecutive very low birth weight (VLBW) infants with type I ROP (posterior ROP, n=33; peripheral zone II, n=21) who were treated either with IVB (n=37) or laser photocoagulation (n=17) between 2011 and 2015 were retrospectively evaluated. RESULTS: Patients with posterior ROP displayed significantly faster regression of active ROP within 12 days (range 9-15 days) if treated with IVB compared with laser photocoagulation, where active ROP regressed within 57 days (range 28-63 days) (p>0.001). No difference was observed in peripheral zone II.Five of seven patients (12%) who developed a recurrence in both eyes after IVB required additional laser photocoagulation within a mean of 12.7 weeks (11.3-15.6 weeks) after the previous treatment. After laser photocoagulation one patient with posterior ROP developed macular dragging and another patient developed a temporary exudative retinal detachment in both eyes. 12 months after treatment the spherical equivalent was not statistically significant different between IVB and laser photocoagulation in posterior ROP patients. However, IVB lead to a significant lower spherical equivalent in infants with posterior ROP (+0.37 dioptres, range -0.5 to +1.88 dioptres) compared with peripheral zone II (+3.0 dioptres range +2.0 to +4.0 dioptres, p<0.001). CONCLUSIONS: IVB leads to faster regression of active ROP in infants with posterior ROP compared with laser photocoagulation. Spherical equivalent after 12 months was comparable in those treated with IVB and laser photocoagulation, but it was significantly lower in posterior ROP than in peripheral zone II.

Quality of care of VLBW neonates: relationship between unit volume and outcome is different between metropolitan and rural regions.

BACKGROUND: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. AIM: It was investigated whether a systematic difference of treatment quality between smaller (1000-2000 births/year; < or =20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. METHODS: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (< or =1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. RESULTS: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominantly rural state, with different medical infrastructure than Berlin. CONCLUSION: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.

Noninvasive assessment of Crohn's disease activity: a comparison of 18F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies.

OBJECTIVES: Detection of disease activity in Crohn's disease (CD) is of crucial importance for diagnosis and management of the disease. Noninvasive methods for monitoring are desirable and comprise hydromagnetic resonance imaging (hydro-MRI) and leukocyte scintigraphy. In addition, a recent case report indicated the potential of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to assess CD activity. However, comparative prospective studies are lacking. METHODS: Between February, 1999 and August, 2000, 59 patients with CD were enrolled in a prospective study to assess disease activity by FDG-PET, hydro-MRI, and immunoscintigraphy with anti-nonspecific cross-reacting antigen 95 antigranulocyte antibodies. In 28 of these patients, colonoscopy could be performed. Twelve patients with irritable bowel syndrome and 20 tumor patients without gut inflammation served as controls. Results were compared by statistical analysis. RESULTS: FDG-PET detected 127 pathological findings (average maximum standardized uptake value = 4.4 +/- 1.1) in the terminal/neoterminal ileum (37), small bowel (24), and colon (66) of 54 patients with CD, whereas no pathological findings were seen in five patients with CD, the control patients with irritable bowel syndrome, and the tumor patients without gut inflammation. In contrast, examination with hydro-MRI or granulocyte antibodies detected less pathological findings in CD patients. Forty-five of the detected foci were accessible to endoscopic verification. The correlation of the foci with endoscopic findings showed a high specificity (>89%) of all three methods to detect inflamed areas in the terminal ileum and colon of patients with CD, although analyses by hydro-MRI and granulocyte antibody scan had strikingly lower sensitivities (40.9% and 66.7%) than FDG-PET analysis (85.4%). CONCLUSIONS: FDG-PET appears to be a reliable noninvasive tool for simultaneous detection of inflamed areas in the small and large bowel of patients with CD. FDG-PET can be used to detect disease activity in the terminal ileum and colon of CD patients with high sensitivity and specificity.

Chemoembolization for primary liver cancer.

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 tumour-size in CT-scan were observed in 14 of 20 patients (70%) and of the 19 patients with elevated AFP-serum levels 12 (63%) had an AFP reduction following treatment. The median survival time was 14 months with a 1- and 2-year survival rate of 69% and 29%, respectively. Survival was not different in radiological or AFP responders vs non-responders. CONCLUSION: While TACE with lipiodol and mitomycin C for primary liver cancer is associated with considerable antitumoural efficacy, as demonstrated by tumour marker and radiological response, an effect on patient survival is not evident. New treatment options with an impact on survival are needed for these patients.

[Hydro-MRI for abdominal diagnostics in children]. / 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 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol. CONCLUSION: Hydro-MRI is a valuable non-invasive method in the diagnosis of abdominal pain of unknown origin. In children it should be the method of choice because it further offers the advantage of the absence of ionizing radiation. Patient compliance is a prerequisite for this new examination. In our experience this requirement was met in children older than 9 years. Further studies should prove the necessity of conventional radiology following negative hydro-MRI.

[Hydro-MRI in inflammatory bowel diseases: a comparison with colonoscopy and histology]. / 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 means of the MRI findings, Crohn's disease (CD) and ulcerative colitis (UC) should be differentiated. RESULTS: In CD, a significant correlation between the contrast enhancement of the inflamed bowel wall (delta SI) and the endoscopic/histopathologic indices could be established (r = 0.52; p = 0.02 and r = 0.72; p = 0.001). In UC, no correlations between delta SI and the endoscopic/histopathologic indices could be found. The correct diagnosis of CD and UC by MRI findings was possible in 22/27 patients (81%). CONCLUSION: Hydro-MRI with dynamic studies is suitable for the assessment of disease activity in CD, but unreliable in UC. Hydro-MRI provides useful information for the differentiation of CD and UC.

Perineal excision of a large angiomyxoma in a young woman following magnetic resonance and angiographic imaging.

BACKGROUND: Aggressive angiomyxomas are rare, arise from connective tissue of the perineum or the lower pelvis, and affect predominantly young women. CASE: We describe an unusual case of aggressive angiomyxoma in which the perineal approach was possible owing to MRI scanning and selective angiography indications. CONCLUSION: In cases of large aggressive angiomyxomas these diagnostic procedures should make it possible to decide which operative route might be best for the patient.

Hydro-MRI in Crohn's disease: appraisal of disease activity.

RATIONALE AND OBJECTIVES: To appraise the value of hydro-MRI in the assessment of activity in Crohn's disease. METHODS: After bowel opacification with 1000 mL of an orally administered 2.5% mannitol solution was achieved, axial and coronal breath-hold sequences (T2-weighted half-Fourier acquisition single-shot turbo spin-echo sequences with or without fat saturation, dynamic T1-weighted fast low-angle shot sequences, and contrast-enhanced T1-weighted fast low-angle shot with fat saturation sequences) were acquired in 82 patients with proved Crohn's disease at 1.0 T. Enhancement of the bowel wall was correlated with other MRI findings, with the Crohn's disease activity index (CDAI), and with levels of C-reactive protein (CRP). RESULTS: In Crohn's disease, contrast enhancement of the affected bowel wall was markedly increased in comparison with the normal bowel wall (+80% +/- 22% versus +43% +/- 12%; P = 3 x 10(-15)). Positive correlations could be established between the increase in bowel wall enhancement and many other MRI findings. Between the increase in bowel wall enhancement and the CDAI, only a poor correlation was found (r = 0.25, P = 0.02). There was no statistical correlation between the increase in bowel wall enhancement and CRP. CONCLUSIONS: Hydro-MRI seems to be superior to the CDAI and CRP for the registration of Crohn's disease activity. In particular, differentiation between an active and an inactive (scarred) stenosis, which is crucial for the choice of therapeutic procedures, seems to be more reliable by the interpretation of several morphological and functional parameters on hydro-MRI than by the use of CDAI and CRP.

[Segmental anatomy of the liver in computed tomography: do we localize the lesion accurately?]. / 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. Evaluations were performed using an interactive cine mode as well as three-dimensional reconstructions. RESULTS: 20 of 126 (16%) liver lesions had a different segmental location if the individual anatomy of the peripheral portal branch was used instead of the conventional technique. These different locations were due to the path of the portal trunks or the path of the peripheral portal branches crossing the planes of the major hepatic veins. CONCLUSION: The segmental anatomy of the liver using the planes of hepatic veins and portal trunks according to Couinaud is not an accurate tool for the presurgical localization of liver lesions in many cases.

[Assessment of inflammatory activity in Crohn disease with hydro-MRI]. / 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 correlations could be established between the increase of bowel wall enhancement and other MRI findings. Between the increase of bowel wall enhancement and the CDAI a poor correlation was found (r = 0.25; p = 0.046). There was no statistical correlation between the increase of bowel wall enhancement and the CRP (r = 0.09; p = 0.24). CONCLUSION: Hydro-MRI allows an assessment of the activity of Crohn's disease.

[Littoral-cell angioma--a rare differential diagnosis on splenic tumors]. / 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 haemangioma because of its gross appearance, but histological and immunohistochemical examination revealed a littoral cell angioma. CONCLUSION: The littoral cell angioma is a benign vascular lesion in the red pulp of the spleen, which may be caused by different stimuli such as chronic infection or tumours. This case illustrates, that this tumour should be considered in the differential diagnosis of an unclear neoplasm in the spleen.

[Dynamic 31-phosphorus magnetic resonance spectroscopy of the m. quadriceps: the effect of sex and age on the spectroscopic parameters]. / 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-adenosine triphosphate (r = 0.74; p = 10(-6) and phosphodiester/beta-adenosine triphosphate (r = 0.62; p = 10(-4) increased. The pH was the only one of the evaluated spectroscopic parameters which showed a sex-dependence: Female subjects had a significantly lower pH (7.03 +/- 0.02) than male subjects (7.05 +/- 0.03; p = 0.01). Exercise: With increasing age, the maxima of inorganic phosphate/phosphocreatine were less extreme during both of the exercises (r = -0.42; p = 0.0005). Likewise, the exercise-induced acidosis was less severe with increasing age (r = 0.53; p = 6 x 10(-6). After the end of the exercise, the times of half recovery of inorganic phosphate/phosphocreatine and the pH correlated neither with the subjects' age nor with sex or cross-sectional areas of the quadriceps muscle. CONCLUSION: Sex and age of volunteers affect spectroscopic results. This influence had to be considered in the interpretation of spectroscopic studies.

[Hydro-MRT with fast sequences in Crohn's disease: a comparison with fractionated gastrointestinal passage]. / 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 (barium studies: 10.4 cm; p = 0.004). There was a good agreement between the two methods regarding the assessment of the extent of Crohn's disease and the severity of bowel stenoses (r = 0.89 and 0.88, respectively). CONCLUSIONS: For the assessment of Crohn's disease, hydro-MRI is preferable to the barium study because of the superior imaging quality and the lack of radiation exposure.

Contributions of dynamic phosphorus-31 magnetic resonance spectroscopy to the analysis of muscle fiber distribution.

RATIONALE AND OBJECTIVES: In high-performance athletes, conclusions regarding the muscle fiber distribution were to be drawn from dynamic 31phosphorus magnetic resonance spectroscopy (31P MRS). METHODS: Eleven volleyball players (V), eight bodybuilders (B), and 22 nonathletic volunteers (N) were examined by dynamic 31P MRS. During rest, exhaustive exercise, and recovery, respectively, up to 60 consecutive phosphorus spectra of the quadriceps muscle were acquired by "time series" in 36 s each. Two main spectroscopic approaches to the spectroscopic analysis of muscle fiber distribution were applied: evaluation of the ratio Pi/PCr at rest and the computer-assisted analysis of the Pi-peak at its exercise-induced line width maximum. RESULTS: At rest, the bodybuilders showed a significant lower Pi/PCr (0.07 +/- 0.03), in comparison with the volleyball players (0.11 +/- 0.03) and the nonathletic volunteers (0.11 +/- 0.02). The computer-assisted analysis of the Pi-peak at its line width maximum revealed a significantly lower pH of both of the subpeaks in the bodybuilders [6.30 versus 6.37 (V) and 6.38 (N); 6.89 versus 6.92 (V, N)], whereas the volleyball players provided the largest proportion of oxidative muscle fibers (68%), compared to bodybuilders (64%) and nonathletic volunteers (59%). A correlation between the ratio Pi/PCr and the area of the subpeak with the high pH (representing oxidative fibers) could not be demonstrated. CONCLUSIONS: Spectroscopic results during rest and exercise may be influenced by the muscle fiber distribution of the respective volunteer. The applied spectroscopic approaches to the analysis of muscle fiber composition are not compatible with each other; depending on the applied method, the classification of a muscle fiber as type I or type II fiber may change. The influence of physiologic factors like muscle fiber distribution on spectroscopic results has to be considered in the interpretation of pathological conditions.

A new technique for oral endotracheal airway access in rabbits under fluoroscopic control: An easy way for drug administration in chronic experiments.

Endotracheal drug administration plays an important role in rabbit models of pulmonary injury and lung disease. However, anatomical features of the oral fissure and pharynx of rabbits make orotracheal intubation a difficult task with a high failure rate. We developed a new technique for airway access in rabbits under fluoroscopic control using a balloon catheter. The procedure consists of four major steps: (1) a shortened 5-french vertebralis catheter is placed into the mesopharynx just above the epiglottic valve, (2) through the catheter lumen a guidewire is carefully moved across the epiglottis and inserted into the trachea, (3) the vertebralis catheter is replaced by a balloon catheter that subsequently is introduced into the tracheal tree over the guidewire, and (4) with the balloon catheter in the right position the guidewire is removed and the balloon is inflated so that finally the drug can be delivered. This procedure was performed in 55 New Zealand White rabbits under general anesthesia with ketamine/xylazine. In all 55 cases the procedure was performed successfully without any major complications and within a reasonably short time period. Removal of the catheter and awakening of the animals were uneventful. The described technique is a simple and safe method for airway access in rabbits and can be useful in chronic experiments for endotracheal drug administration.

[Rights and responsibilities of the radiologist in determining indications and applying radiologic procedures]. / 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 X-rays may only be employed when it will furnish information with therapeutic consequences. The more urgent the indication, the less strict are the requirements for informed consent and agreement, and vice versa. Thus, the information need for a purely diagnostic procedure without any direct therapeutic value is particularly high. The consent of the patient is only legally binding when he has been informed in advance of the objectives, extent, necessity and urgency, type, procedures, and alternatives of a medical investigation or therapeutic intervention and also of the accompanying risks. All risks on the basis of which a responsible patient can make the decision to consent or to reject a specific medical intervention are to be considered as relevant and must be explained appropriately.

Dynamic phosphorus-31 magnetic resonance spectroscopy of the quadriceps muscle: effects of age and sex on spectroscopic results.

RATIONALE AND OBJECTIVES: Phosphorus-31 (31p) magnetic resonance spectroscopy (MRS) is used to assess the influence of sex and age on quadriceps muscle metabolism before and after exercise. METHODS: Fifty-four healthy volunteers and 56 patients with an arterial occlusive disease were examined by dynamic 31p MRS. In the magnet, the quadriceps muscle was stressed by an isometric and an isotonic form of exercise until exhaustion. RESULTS: Older subjects showed a significantly larger ratio of inorganic phosphate (P(i)) to phosphocreatine (PCr) than younger subjects (r = 0.52, P = 8 x 10(-9)). With subjects' increasing age, the ratio of adenosine triphosphate (beta-ATP) to total phosphate decreased (r = -0.36, P = 5 x 10(-5)). The ratio of phosphomonoester to beta-ATP and phosphodiester (PDE) to beta-ATP showed a strong age dependence (r = 0.71 and 0.69, P = 3 x 10(-17) and 4 x 10(-15), respectively). The pH was the only one of the evaluated spectroscopic parameters that showed a sex dependence. Female subjects had a significantly lower pH (7.03+/-0.02) than male subjects (7.05+/-0.03) (P = 6 x 10(-4)). With increasing age, the maxima of P(i) to PCr were less extreme during both of the exercises (r = -0.51, P = 3 x 10(-16)). Likewise, the exercise-induced acidosis was less severe with increasing age (r = -0.51, P = 7 x 10(-16)). After the exercises ended, the times of half recovery of P(i) to PCr and the pH neither correlated with the subjects' age nor with sex or the cross-sectional area of the quadriceps muscle. CONCLUSIONS: The sex and age of volunteers or patients may affect spectroscopic results in a significant way. This influence has to be considered in the interpretation of spectroscopic studies. According to the recovery rates of P(i) to PCr and the pH, an age-related deterioration of muscular metabolism seems to be avoidable by appropriate physical activity.

Differentiation of alveolitis and pulmonary fibrosis in rabbits with magnetic resonance imaging after intrabronchial administration of bleomycin.

RATIONALE AND OBJECTIVES: The authors investigate the ability of magnetic resonance imaging to differentiate alveolitis and pulmonary fibrosis by correlating magnetic resonance and pathologic findings. METHODS: Lung damage was induced in 52 rabbits by instillation of 5 mL bleomycin sulfate (10 mg/kg) into a lower-lobe bronchus using a balloon catheter. Magnetic resonance examinations were performed in a group of 7 animals 3 hours after the initial damage, and in groups of 8 animals 24 hours and 8, 14, 30, and 80 days after the initial damage. Control animals were examined 3 hours (n = 5), 24 hours, and 8 days (n = 3 for each), respectively, after the instillation of 5 mL 0.9% sodium chloride. Magnetic resonance imaging at 1.5 T included conventional T1-weighted sequences before and after injection of gadolinium-DTPA (0.1 mmol/kg), and T2-weighted fast spin echo sequences. The signal intensity and contrast enhancement of injured lung were evaluated and compared with the contralateral healthy lung and with the lungs of control animals. All animals were killed immediately after the magnetic resonance examination, and the lungs were removed and fixed before sectioning and staining. RESULTS: There was good correlation between signal intensity and contrast enhancement with magnetic resonance imaging and histologic examination. The early phase of acute alveolitis showed lesions with high signal intensity on both T1- and T2-weighted images and marked contrast enhancement after gadolinium-DTPA administration, whereas in the late fibrotic stage the lesions displayed significantly lower signal intensity and contrast enhancement. CONCLUSION: Magnetic resonance imaging can differentiate between alveolitis and fibrosis by means of signal intensity and contrast enhancement after gadolinium-DTPA administration.