[Age-dependent MR imaging of the tibia in children up to 2 years old. The findings in children without bone marrow-relevant diseases or therapies]. / Altersabhängige MR-Darstellung der Tibia bei Kindern bis zu zwei Jahren. Befunde bei Kindern ohne knochenmarksrelevante Erkrankungen oder Therapien.

PURPOSE: Since the beginning of bone marrow conversion presents with substantial differences as shown by anatomical or magnetic resonance studies, the purpose of this study was to demonstrate via MRI an age-dependent bone marrow conversion of the tibia in children of up to two years of age. METHODS: We studied the bone marrows of the tibia in 24 children ranging from one month to two years by means of MRI. T1-weighted SE-sequences were used. Children who suffered from diseases affecting the bone marrow were excluded. A retrospective analysis of the MR images was performed. RESULT: A gradual increase of signal intensity could be demonstrated in the epiphyses and the diaphysis of the tibia beginning shortly after birth. During the first two years of life a further increase of signal intensity could be observed in these regions, progressing through metaphyses up to the growth plates. CONCLUSION: First signs of bone marrow conversion can be detected in the tibia shortly after birth. Bone marrow infiltration in the tibia is expected to be recognised by MRI from this time onward.

[Medullary carcinoma of the thyroid and 99mTc(V)-DMSA scintigraphy. Clinical results with a new radiopharmaceutical]. / Medulläres Schilddrüsenkarzinom und 99mTc(V)-DMSA-Szintigraphie. Klinische Ergebnisse mit einem neuen Radiopharmakon.

99mTc(V)-DMSA scintigraphy is a non-invasive diagnostic tool for diagnostic differentiation and localisation of medullary carcinoma of the thyroid. For primary tumours its sensitivity is 77%. This diagnostic means is not only helpful for the diagnosis of primary tumours, but is especially informative for recidives and metastases of the medullary carcinoma of the thyroid. Its sensitivity for recidives and metastases is 66%. The sensitivity obtained in our study, which included four patients, corresponded to that reported in the literature.

[MRI in testicular diagnosis: differentiation of seminoma, teratoma and inflammation using a statistical score]. / MRT in der Hodendiagnostik-Differenzierung von Seminomen, Teratomen und Entzündungen mit Hilfe eines statistischen Bewertungsmassstabs (Score).

PURPOSE: To differentiate scrotal pathology via MRI by means of a statistical score. METHODS: Between 1989 and 1995 MR images of 105 patients with scrotal pathology were rated retrospectively. In 69 cases linear discriminant analysis was used to differentiate seminoma, teratoma and inflammation. Six MRI attributes were found to be necessary and were weighted with a factor according to their importance. These factors were used to build a score. RESULTS: Criteria found to be important contained the distribution of the variate extensions of elements inside the pathological area and their maximal and minimal signal intensities. Furthermore, the contrast pattern of the pathological area and the visibility of healthy tissue in the pathological testicle was of importance. Seminoma was found to be homogeneous and well demarcated against healthy tissue. Teratoma was also well defined but characterised by inhomogeneous distribution of signal intensities. Inflammation showed diffuse signal increase of the pathological testicle, especially in T1-sequences. Using the score differentiation between tumors and inflammation succeeded in 94.2% between seminoma and teratoma in 89.7%. CONCLUSIONS: Compared to other studies using visual MR image analysis differentiation of scrotal diseases was improved by using a statistical score.

[Proton spin tomography of the orbit in post-traumatic motility disorders]. / Kernspintomographie der Orbitae bei posttraumatischen Motilitätsstörungen.

AIM: To analyse the value of MRI for the assessment of posttraumatic disturbances of eye motility. MATERIAL AND METHODS: We analysed retrospectively the results of 38 MR examinations of the orbit in 31 patients with posttraumatic motility impairment with preserved visus. 18 patients underwent MRI preoperatively. From this group 5 patients were additionally examined postoperatively. Another 5 patients who had not been examined prior to surgery were controlled postoperatively. Hence, a total of 10 patients with persisting disturbances was examined postoperatively. 8 patients who underwent MRI were not treated by surgery because of only minor disturbances. In all patients conventional radiography of the orbit was performed prior to MRI. Additional CT imaging was carried out in 12 patients. RESULTS: In 18 patients examined preoperatively we found displacement of orbital fat tissue, displacement and entrapment of orbital muscles, swelling of muscles and oedema in retrobulbar fat tissue. 10 patients from the postoperative group exhibited remaining prolapsed fat tissue, oedema in fat tissue and/or swelling of muscles. 8 patients had only small soft tissue changes which did not require surgery. CONCLUSION: Since it can image soft tissue precisely, MRI provides the decisive information in the assessment of motility impairment of the eye. In case of isolated orbital fracture with motility impairment, CT is not absolutely necessary for surgical therapy.

[Image fusion of MRI and immunoscintigraphy with MAb-170 in ovarian tumors]. / Bildfusion von KST und Immunszintigraphie mit MAb-170 bei Ovarialtumoren.

In recent years multimodality imaging achieved growing importance. It is mostly performed by means of quite expensive software and hardware solutions. In the present pilot study a simple and low-cost procedure was developed to achieve image fusion in the pelvis. The image data of immunoscintigraphy (SPECT) and MRI were transferred to a personal computer and combined by standard software for image manipulation. The results in eleven patients with space-occupying lesions in the pelvis showed that adequate anatometabolic slices could be achieved. The results show a tendency to increased specificity and precision of multimodality imaging in comparison with SPECT and MRI alone. In conclusion, the low-cost solution, as developed by us, is feasible in clinical practice. Its results are reliable in clinical decision making.

[Multi-modality therapy concept in metastatic follicular thyroid carcinoma with hyperthyroidism]. / Multimodales Therapiekonzept bei metastasiertem folliculären Schilddrüsencarcinom mit Hyperthyreose.

The coincidence of hyperthyroidism and thyroid carcinoma seldom occurs. Only few reports on functionally metastases of thyroid carcinoma have been published. We report a 59-year-old man who underwent subtotal thyroidectomy for toxic nodular goiter. Histological examination revealed a follicular thyroid carcinoma. After thyroidectomy and cervical lymphadenectomy the patient developed a strong hyperthyreosis. Scintigraphy showed strong radioiodine uptake in the sacrum. De-bulking resection of the metastasis followed by high-dose radioiodine treatment was performed. After radioiodine therapy the patient became euthyroid. Treatment of hyperthyreosis in metastatic thyroid cancer requires a multimodal therapeutic concept.

[Erdheim-Chester disease]. / Die Erdheim-Chester-Krankheit.

Erdheim-Chester disease (ECD) is characterized by lipid granuloma in the long tubular bones, which leads to pathognomonic symmetrical sclerosis of their metaphyses and diaphyses. Lipid granuloma may also be present in numerous other mesenchymal tissues, especially lung, orbit and retroperitoneal space. The clinical course and prognosis of the disease depend on these lesions. Reviewing 30 cases published since 1931 and a personal case with S100 positive cells, we present the typical radiological and clinical findings. There is striking resemblance to chronic disseminated histiocytosis X.

[Creutzfeldt-Jakob disease. What is the role of MR tomography?]. / Creutzfeldt-Jakob-Krankheit. Welche Rolle spielt die MR-Tomographie?

Creutzfeldt-Jakob disease (CJD) is a rare, but fatal and transmissible brain disease. The clinical diagnosis is based upon progressing dementia, myoclonic jerks and characteristic EEG changes, but it is difficult to diagnose and not only in the early phase of the disease. Cerebral biopsy is reserve for individual selected cases and contested because of the danger of contamination from instruments and potential transmission. We report three patients with histologically confirmed CJD and confirm that MRI is a valuable tool for the diagnosis of this disease.

[Neuroradiologic diagnosis of intracranial epidermoid tumors]. / Zur neuroradiologischen Diagnostik der intrakraniellen Epidermoide.

Intracranial epidermoids are primarily extracerebral congenital cysts. Intra- and extradural types are differentiated: intradural lesions originate in the intracranial CSF spaces, and extradural lesions in the bony skull. Epidermoids increase in size passively as the result of an increase in the cyst volume and not because of active growth. Clinically epidermoids behave like benign, slow-growing cerebral tumours. Differential diagnosis includes other cysts and cystic tumours. Neuroradiologically epidermoids present as polycystic lesions showing extensive growth in the extracerebral CSF spaces and secondary invagination of the brain. On CT and MR, despite the high cholesterol content, epidermoids show the characteristics of liquor and not those of fat. It can be shown that the typical CT and MR appearance of an epidermoid is due to the different proportions of CSF in the cyst content, which results from diffusion or dehiscence of the cyst capsule. The present study was based on analysis of 6 cases selected from a total of 29 patients with CNS epidermoids.

[Familial association of hypothalamic hamartoma and polysyndactyly]. / Familiäre Assoziation von Hypothalamushamartom und Polysyndaktylie.

Hypothalamic hamartomas are congenital malformations. The association between hypothalamic hamartomas and other dysplasias, including polydactyly, is known to be a neonatal lethal syndrome. We report on two patients (mother and son) with asymptomatic large hypothalamic hamartomas and polysyndactyly. The relationship of the patients suggests an autosomal dominant transmission.

[Rare intracranial plasmacytoma manifestations. Case reports and review of the literature in diffuse plasmocytoma, in primary solitary extramedullary plasmacytoma in in primary solitary osseous plasmacytoma]. / Seltene intrakranielle Plasmozytommanifestationen. Fallberichte und Literaturübersicht bei diffusem Plasmozytom, bei primär solitär extramedullärem Plasmozytom und bei primär solitär ossärem Plasmozytom.

Plasmacytomas can be divided into multiple, solitary osseous and solitary extraosseous/extramedullary plasmacytomas. Intracranial plasmacytomas of the dura, leptomeninx and cerebrum are well known from the literature. They are manifestations of multiple myeloma, intracranial extramedullary plasmacytoma or metastatic disease of extramedullary plasmacytoma in distant locations. We describe a cerebellar manifestation of a solitary plasmacytoma of the bone, and a leptomeningeal carcinomatosis of a multiple plasmacytoma. A summary of the literature concerning intracranial plasmacytomas is given. Dural manifestations of plasmacytoma have the same features as meningiomas in CT or MRI. Cerebral or cerebellar manifestations cannot be differentiated from brain tumors by means of CT or MRI. In CT, plasmacytomas show high-density lesions. T2w-MRI reveals a low-intensity lesion. In T1w-MRI, intense homogeneous contrast enhancement can be demonstrated.

[Single photon emission tomography (SPECT). Cerebral function diagnosis for the clinical routine. Indications and radiotracers]. / "Single photon emission tomography" (SPECT): Hirnfunktionsdiagnostik für die klinische Routine. Indikationen und Radiotracer.

Nuclear medicine techniques have been powerful tools in neurology since their introduction. Computed tomography, magnetic resonance imaging and newer techniques, i.e. MR spectroscopy and angiography, sonography, Doppler sonography and EEG mapping with squid elements have overtaken most earlier nuclear medicine techniques for neurological diagnosis. Positron emission tomography is the gold standard for in vivo research in neurophysiology and pathology. The introduction of SPECT and the development of such tracers as 99mTc-HMPAO (99mTc-d,l-hexamethylpropylenaminoxim) and, more recently, 123I-iomazenil and 123I-IBZM (123I-3-iodo-6-methoxybenzamide) allowed closer examination of the perfusion of the brain and neuroreceptor density mapping in more than the few institutions that can afford PET and the production of special tracers marked with a positron emitting nucleus. Nuclear medicine's future will be based on neuroreceptor density mapping, as further tracers will become commercially available and no other technique can probably show such low concentrations of the receptors. Probably MR techniques will be used for brain's perfusion measurement in future. For examination of a limited cerebral region xenon-enhanced CT is an alternative to perfusion measurements with HMPAO, or a very interesting supplement. Of the old techniques in nuclear medicine, examination of the liquor dynamics is still feasible and well supplemented by SPECT.