[ECG-controlled cardio-computer tomography (author's transl)]. / EKG-gesteuerte Kardiocomputertomographie.

During ECG-controlled cardio-computer tomography, only certain defined phases of the cardiac cycle are used for computing the image. Consequently several cycles are necessary in order to obtain the required projection. ECG-controlled cardio-computer tomography produces findings regarding dys- or akinetic portions of the myocardium which are in good agreement with the laevo-cardiogram. The septum, apex and antero-lateral wall are demonstrated most easily, since their movement lies within the appropriate plane. Demonstration of the anterior and posterior walls is more difficult, since their movement is angled to the computer tomographic plane.

[Radiographs of the thorax in acute myocardial infarction]. / Die Röntgenuntersuchung des Thorax beim akuten Myokardinfarkt

Radiographs of the thorax were evaluated in 240 patients during the acute phase following a myocardial infarct. Following the acute infarct, 53% of the patients showed some cardiac enlargement, in a quarter this was marked. Congestive lung changes were found in 53% of patient following the infarct, interstitial pulmonary oedema in 22% and intra alveolar oedema in 9%. Patients with marked cardiac enlargement and those with congestive lung changes showed a bad prognosis, particularly if the congestion did not regress rapidly. Even advanced pulmonary congestion and interstitial oedema may be missed by clinical examination. Radiography of the thorax following acute myocardial infarction is of value in treatment and prognosis.

[Image properties of computer tomography. III. Measurements on homogenous materials. Relationship of attenuation and scatter to various parameters (author's transl)]. / Abbildungseigenschaften der Computertomographie. III. Messungen an homogenen Materialien. Abhängigkeit der Dichtewerte und der Dichtewertstreuung von verschiedenen Parametern.

The present paper investigates the variations due to various parameters on the image of homogeneous materials as obtained with the Somatom CT scanner. Sugar solutions were used with concentrations equivalent to the absorption values of soft tissues. Because of quantum noise, attentuation at various points is not uniform, but is distributed in a Gaussian manner round a mean value. Using the Evaluskop it was possible to determine the degree of scatter. It was shown that, with increasing density of the material, the scatter increased and that this can be reduced by subjecting the tomogram to a smoothing process. It was further shown how the scatter depends on various parameters, such as thickness and dose. The amount of scatter in a tomogram is important in determining the density gradation which can be a achieved.

[A comparison of computer tomography and ultrasound for the demonstration of vessels in the abdomen and retroperitoneal space (author's transl)]. / Vergleich der Gefässdarstellungen im Abdomen und Retroperitonealraum mit Computertomographie und Ultraschall.

The value of computer tomography and ultrasound for demonstrating vessels in the abdomen and retroperitoneal space was compared. The methods were equal in their ability to demonstrate the major vessels situated centrally, but computer tomography proved better at differentiating arteries and veins situated peripherally. On the other hand, sonography proved a simple means of differentiating intrahepatic vascular structures.

[Complications of selective retrograde laevocardiography. A survey of 2000 examinations (author's transl)]. / Komplikationen der selektiven retrograden Lävokardiographie. Bericht über 2000 Untersuchungen.

The incidence of complications in 2000 selective retrograde laevocardiograms is reported. Seventy-four complications were observed in 69 patients. None of these was fatal. On 39 occasions cardiac, and on three occasions cerebral complications were observed. In 20 patients there were complications at the site of puncture and in four patients sepsis or bacteraemia. Contrast sensitivity or allergy was found in eight patients. The relationship, described in the literature, between intramural contrast deposition and the type of catheter, ventricular size and ventricular wall was confirmed by our own observations, as well as the most frequent situation on the posterior wall of the left ventricle.

[Aneurysms of the sinus of Valsalva (author's transl)]. / Die Aneurysmen der Sinus Valsalvae

Twenty-seven patients in whom a diagnosis of sinus of Valsalva aneurysm had been made during life were re-examined and the results have been evaluated. The clinical symptoms are not diagnostic. Routine radiological examination may also fail to show any significant findings. Large sinus of Valsalva aneurysms may show an atypical prominence of the right upper heart border, and in leutic aneurysms there may be fine calcification of the aortic wall. A definitive diagnosis can be made only by thoracic aortography. Five patients had a congenital saccular aneurysm connected with a sinus of Valsalva. Three patients had acquired aneurysms of which two were leutic and one developed shortly after rheumatic fever. A diffuse aneurysms of the sinus of valsalva was found in fourteen patients with Marfan's syndrome. The radiological appearances are demonstrated. Indications for surgery are discussed; the indications must be considered for each situation separately.

[Computer tomography in the diagnosis of aortic aneurysms (author's transl)]. / Das Aortenaneurysma im Computertomogramm.

The paper describes the diagnosis of ten thoracic, 20 abdominal and three peripheral arterial aneurysms by computer tomography. This permits a definite diagnosis by a non-invasive method, it defines the extent of the aneurysm and the amount of thrombus in the aneurysm; it permits recognition of a leak and is painless and without risk and can be performed rapidly. Morever, computer tomography provides an accurate control of growth of the aneurysm. In some cases a dissection can be recognised. The use of adequate quantities of intravenous contrast medium prevents any possibility of an incorrect diagnosis. The extent and density of the aneurysms, their lumina, clot and wall thickness, as determined by computer tomography are described. The values are compared with the aortic diameters of patients with normal vessels. The advantages of the method, compared with other procedures, are discussed and its role in the diagnosis of aortic and peripheral arterial aneurysms is described.

[Computer tomography in emergency diagnosis (author's transl)]. / Die Computertomographie in der Notfalldiagnostik.

The results of 150 examinations by computed tomography in emergency situations are described (about 5% of all CT examinations). There were 80 examinations of the skull, 65 of the abdomen and five of the mediastinum. The results are shown in two tables and include the diagnosis of bleeding, infarcts and inflammatory lesions (abscesses, encephalitis, acute pancreatitis). The morphologic and densitometric findings are compared with the literature and with other imaging procedures. Computer tomography has assumed the most important place in the emergency diagnosis of the skull; as regards the abdomen, it reaches its limitations in the presence of acute vascular occlusion and diseases of the gastro-intestinal tract. In this situation other procedures (contrast studies, angiography) and endoscopy are to be preferred since these demonstrate the tubular organs longitudinally, unlike the transverse image produced by the CT scan. Acute diseases of the lungs can be demonstrated more quickly and simply by conventional radiography. CT is a non-invasive and rapid procedure, which can demonstrate haemorrhages, abscesses and exudates in the mediastinum and abdomen directly and also show their topography. The method is therefore essential for emergency diagnosis of conditions involving the trunk.

[Supravalvular aortic stenosis: Congenital and acquired changes in the ascending aorta near the valve (author's transl)]. / Zur supravalvulären Aortenstenose--angeborene und entzündliche Veränderungen der klappennahen Aorta ascendens.

Three patients with supravalvular aortic stenosis are described. One was a typical, sporadic-type supravalvular aortic stenosis, another a predominant aortic valve stenosis as part a complex heart lesion and the third inflammatory shrinking of the anulus fibrosus with an inflammatory aortic valve stenosis. The means of diagnosis are discussed. Angiocardiography and aortography are essential in order to demonstrate the pathology, haemodynamics, relation to the coronary arteries and the sinus of Valsalva, and in order to show other abnormalities. The aetiology and pathogenesis of various types of supravalvular aortic stenosis are discussed.

[The diagnostic value of kymography in aortic isthmus stenosis (author's transl)]. / Der diagnostische Wert der Flächenkymographie bei der Aortenisthmusstenose.

The value of kymography was studied in 133 patients in whom a coarctation had been demonstrated angiographically, operatively or pathologically; its value was compared with conventional radiographic examinations. The difference in pulsation between the pib notching, dilatation of the ascending aorta and increased size of the left ventricle on plain films make it possible to diagnose an haemodynamically significant coarctation without any invasive methods. In 124 haemodynamically significant coarctations (93%), the kymogram showed increased pulsation of the dilated left subclavian artery. In nine haemodynamically insignificant or mild coarctations (7%), this sign was absent. Since the radiographic signs are to some extent reversible, it is possible to evaluate the results of surgery by plain chest films and the kymogram.

[The diagnosis of carcinoma of the breast in relation to growth rate (author's transl)]. / Die Diagnose des Mammakarzinoms unter dem Aspekt der Wachstumsrate

The doubling time (DT) was estimated quantitatively for 16 carcinomas of the breast according to the method described by Collins and co-workers in 1956. This is based on the concept of constant and exponential growth. Observation interval for these mammographically confirmed tumors was between 83 and 1,034 days. The DT was calculated to vary from 45 to 260 days; in order to reach a diameter of 1 cm. after 30 divisions would require a period of 3.7 to 21.4 years. Mammography frequently demonstrates small, clinically occult, tumours. Axillary lymph node metastases are relatively rare from small tumours; growth rate of 70% of breast carcinomas in such that an annual clinical and radiological check-up will prove to be the best means of reducing mortality from carcinoma of the breast. The risk inherent in the radiation resulting from annual mammography is acceptable in women over 35 years. This leaves the problem of rapidly growing carcinomas which would escape early diagnosis by early examinations. Half-yearly examinations of women in high risk groups (1. Previous mastectomy for carcinoma, 2. Biopsy-proven mastopathy with atypical proliferation) comprising about 30% of carcinomas with a short doubling time would appear to be reasonable.

[Morphometric and densitometric assessment of left ventricular function in the digital subtraction angiocardiogram]. / Zur morphometrischen und densitometrischen Beurteilung der Funktion des linken Ventrikels im digitalen Subtraktionsangiokardiogramm.

The paper deals with the early clinical experience, using a new DSA installation with a specially programmed cardiological module. DSA provides very good contrast and special resolution and morphometric estimation of the ejection fraction and regional movement of the left ventricular myocardium derived from DSA. This is as good as the results of the left cardiogram. The significant advantage of DSA ist the ability to make a rapid and simple diagnosis. In addition, it is possible with densitometric methods to calculate ventricular volume curves and to provide phasic indications of the amplitude to contraction of the left ventricle. These investigations have so far proved valuable and provide new scope for the radiological evaluation of left ventricular function.

[Coronary artery aneurysms (author's transl)]. / Das Koronararterienaneurysma.

Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

[Computer cardio-tomography for tumours of the left atrium (author's transl)]. / Computerkardiotomographie bei Tumoren des linken Vorhofes.

The role of computer tomography in the diagnosis of cardiac tumours was demonstrated by three patients with myxomas of the left atrium. After intravenous contrast administration these tumours appeared as relatively translucent space-occupying lesions on the computer tomograph. The invasive method of angio-cardiography is unlikely to provide any additional information concerning tumour size or localisation when compared with non-invasive computer tomography or echo cardiography.

[Mitral stenosis on conventional radiographs. II. The relationship between pulmonary venous and arterial hypertension, their haemodynamic parameters and calcified mitral valves (author's transl)]. / Die Mitralstenose im konventionellen Röntgenbild. II. Mitteilung: Beziehungen zwischen pulmonal-venöser und -arterieller Hypertonie und hämodynamischen Parametern und die verkalkte Mitrlklappe.

In the second paper, the relationship between pulmonary venous and arterial hypertension and calcification in the mitral valve is analysed statistically and its patho-physiological significance discussed. In one hundred cases of mitral stenosis the left atrium, as seen on the lateral projection, was always enlarged, but its size was independant of atrial pressure or the pressure gradient across the mitral valve. Apart from pulmonary fibrosis and haemosiderosis, the abnormal findings increased with increasing mean atrial pressure. Pulmonary-arterial mean pressure of more than 30 mmHg was found particularly in the presence of mitral valve calcification (94%). Calcification of the valve is the most important and reliable indicator for evaluating the severity of the stenosis.

[Computer tomographic demonstration of an intramuscular haematoma in haemophilia (author's transl)]. / Computertomographischer Nachweis von Muskelhämatomen bei Hämophilie.

Anatomical localisation of intramuscular haematomas can be achieved more accurately by computer tomography than by clinical examination in conjunction with conventional radiography. Computer tomography is able to demonstrate fresh haematomas before they become diagnosable clinically, and before secondary changes, such as calcification or bone erosions, make them visible on conventional radiographs. In this way the diagnosis is made more certain and the choice between conservative or surgical treatment is simplified. Ther period of treatment with clotting factors can, in some cases, be shortened as a result of serial examinations by computer tomography.

[Coronary calcification and luminal diameter in coronary disease (author's transl)]. / Koronarverkalkung und Gefässquerschnitt bei der koronaren Herzekrankung.

Two hundred and thirty-six patients with coronary heart disease were examined by coronary angiography and laevo-cardiography. In 111 patients (47%) there was coronary artery calcification. Of these, 108 patients (97%) showed abnormal findings on the coronary angiogram; in 72 patients (67%) coronary stenosis was greater than or equal to 50% of the lumen. The severity of the stenoses increased with the amount of calcification. There were only three false positive findings and the presence of coronary calcification indicates coronary sclerosis with a high degree of probability. Fluoroscopy is the simplest and most sensitive method of examination and is of great value in the non-invasive investigation of coronary sclerosis.

[Image characteristics of the computer tomograph (author's transl)]. / Abbildungseigenschaften der Computertomographie. II. Räumliches Auflösungsvermögen, Dichteauflösung und Partial-Volume-Effekt bei kugelförmigen Objekten verschiedenen Durchmessers.

In the present paper the images produced by spheres of varying diameter (d = 4,6,8,10 mm) embedded in a homogeneous substance of varying densities (H' = 3,48,93,137 Hounsfield units) as produced by computer tomography were studied. Measurements show that for each sphere diameter there is a minimum contrast between the substance of the sphere and its surroundings which must exist in order to show this sphere by computer tomography. It was also shown that the partial volume effect is of significance for the attenuation of the spheres. The effect of the position of the spheres within the slices to be imaged was studied. The results clearly indicate that in the investigation of small tissue changes in the body, the thickness of the slice and patient displacement should be kept as small as possible.

[Computer-cardio-tomography in idiopathic hypertrophic subvalvular aortic stenosis--a new contribution to non-invasive diagnosis (author's transl)]. / Computerkardiotomographie der idiopathischen hypertrophen subvalvulären Aortenstenose (IHSS)--ein neuartiger Beitrag zur nicht-invasiven Diagnostik.

The use of computer tomography as a non-invasive procedure in the diagnosis of idiopathic hypertrophic subvalvular aortic stenosis is described. Seven patients were investigated in whom the diagnosis had been confirmed by echocardiography and laevocardiography with pressure measurements. Details of the method are discussed and computer tomography and echocardiography are compared. The features of greatest differential diagnostic importance relating to asymmetrical septum hypertrophy are discussed.

[Computer tomographic diagnosis of pericardial effusions (author's transl)]. / Computertomographische Diagnostik des Perikardergusses.

Thirty patients with suspected pericardial effusions, or with cardiac enlargement of unknown cause were examined by computer tomography. In 19 cases a diagnosis of pericardial effusion or haematoma was made. All these cases were confirmed by echo cardiography or transthoracic puncture. The accuracy of computer tomography diagnosis did not depend on the aetiology, but could be increased by contrast enhancement. The computer tomographic criteria are enumerated and compared with those of echo cardiography. Examples of the most important differential diagnoses are discussed.