Stereological measures of trabecular bone structure: comparison of 3D micro computed tomography with 2D histological sections in human proximal tibial bone biopsies.

Stereology applied on histological sections is the 'gold standard' for obtaining quantitative information on cancellous bone structure. Recent advances in micro computed tomography (microCT) have made it possible to acquire three-dimensional (3D) data non-destructively. However, before the 3D methods can be used as a substitute for the current 'gold standard' they have to be verified against the existing standard. The aim of this study was to compare bone structural measures obtained from 3D microCT data sets with those obtained by stereology performed on conventional histological sections using human tibial bone biopsies. Furthermore, this study forms the first step in introducing the proximal tibia as a potential bone examination location by peripheral quantitative CT and CT. Twenty-nine trabecular bone biopsies were obtained from autopsy material at the medial side of the proximal tibial metaphysis. The biopsies were embedded in methylmetacrylate before microCT scanning in a Scanco microCT 40 scanner at a resolution of 20 x 20 x 20 microm3, and the 3D data sets were analysed with a computer program. After microCT scanning, 16 sections were cut from the central 2 mm of each biopsy and analysed with a computerized method. Trabecular bone volume (BV/TV) and connectivity density (CD) were estimated in both modalities, whereas trabecular bone pattern factor (TBPf) was estimated on the histological sections only. Trabecular thickness (Tb.Th), number (Tb.N) and separation (Tb.Sp), and structure model index (SMI) were estimated with the microCT method only. Excellent correlations were found between the two techniques for BV/TV (r = 0.95) and CD (r = 0.95). Additionally, an excellent relationship (r = 0.95) was ascertained between TBPf and SMI. The study revealed high correlations between measures of bone structure obtained from conventional 2D sections and 3D microCT data. This indicates that 3D microCT data sets can be used as a substitute for conventional histological sections for bone structural evaluations.

Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS).

The aim of this analysis was to determine the influence of lifestyle, anthropometric and reproductive factors on the subsequent risk of incident vertebral fracture in men and women aged 50-79 years. Subjects were recruited from population registers from 28 centers across Europe. At baseline, they completed an interviewer-administered questionnaire and had lateral thoraco-lumbar spine radiographs performed. Repeat spinal radiographs were performed a mean of 3.8 years later. Incident vertebral fractures were defined morphometrically and also qualitatively by an experienced radiologist. Poisson regression was used to determine the influence of the baseline risk factor variables on the occurrence of incident vertebral fracture. A total of 3173 men (mean age 63.1 years) and 3402 women (mean age 62.2 years) contributed data to the analysis. In total there were 193 incident morphometric and 224 qualitative fractures. In women, an age at menarche 16 years or older was associated with an increased risk of vertebral fracture (RR = 1.80; 95%CI 1.24, 2.63), whilst use of hormonal replacement was protective (RR = 0.58; 95%CI 0.34, 0.99). None of the lifestyle factors studied including smoking, alcohol intake, physical activity or milk consumption showed any consistent associations with incident vertebral fracture. In men and women, increasing body weight and body mass index were associated with a reduced risk of vertebral fracture though, apart from body mass index in men, the confidence intervals embraced unity. For most variables the strengths of the associations observed were similar using the qualitative and morphometric approaches to fracture definition. In conclusion our data suggest that modification of other lifestyle risk factors is unlikely to have a major impact on the population occurrence of vertebral fractures. The important biological mechanisms underlying vertebral fracture risk need to be explored using new investigational strategies.

[Prognostic significance of lacunar lesions in magnetic resonance tomography in multiple sclerosis]. / Die prognostische Bedeutung von lakunären Herden im Magnetischen Resonanztomogramm bei Multipler Sklerose.

175 patients with definite multiple sclerosis underwent nuclear magnetic resonance imaging. T1-weighted images showed in 59 patients (34%) periventricular lesions with a central area of decreased signal intensity. They appear as lacunar defects in the walls of the lateral ventricle system. In accordance with neuropathological findings we suggest that in these plaques a cystic degeneration has replaced gliosis. Patients with cystic defects are characterized by a high activity of the disease (e.d. increased annual production of plaques) and a poor prognosis. Lacunae are found in the early stages of the disease and provide a prognostic sign in multiple sclerosis.

[Diagnostic value of magnetic resonance tomography in disseminated encephalomyelitis]. / Zur diagnostischen Wertigkeit der magnetischen Resonanztomographie bei Encephalomyelitis disseminata.

In 83 of 86 patients with multiple sclerosis (MS) cranial magnetic resonance imaging (MRT) demonstrated lesions consistent with the clinical diagnosis. All the patients had either clinically typical MS oralaboratory-confirmed diagnosis of MS. The sensitivity of MRI is compared to those of computed tomographic (CT) scanning, evoked potential testing and cerebrospinal fluid analysis. The features of MS revealed by MRI are interpreted in terms of the macroscopic pathology and correlated with the clinical findings. The importance of particular findings (cystic appearance of lesions, spread of periventricular patches into the centrum semiovale) for the patients prognosis in stressed.

[Differential diagnosis of the clinical picture of multiple sclerosis in MR tomography]. / Differentialdiagnosen zum Erscheinungsbild der multiplen Sklerose im MR-Tomogramm.

Magnetic resonance imaging (MRI) has the advantage of high sensitivity compared to other diagnostic imaging techniques in focal pathological lesions of the brain in multiple sclerosis patients. However, the specificity of this examination method is limited. Diseases of the central nervous system due to other, different causes could produce a similar magnetic resonance image. Clinically examined cases of malignant and toxic affections of the brain caused by inflammatory, degenerative, traumatic and vascular diseases are presented and compared with the changes occurring in multiple sclerosis.

[Pericaval intravasation of contrast media in the changed indication for hysterosalpingography]. / Der perikavale Kontrastmittelübertritt bei veränderter Indikationsstellung zur Hysterosalpingographie.

Today the indication of hysterosalpingography is supplied via radiography in the diagnosis of female infertility patients. Hence, a different group of patients is now selected in contrast to the previous indications. The venous intravasation in uterine and adnexal vessels among infertility patients was observed in only 0.4% of our cases. The relationship between the changed indication, the technique of HSG, the changed permeability of the vessels after surgery, and the rare occurrence of intravasation is discussed.

[Significance of the venous system of the spine in the formation of metastases]. / Die Bedeutung des Wirbelsäulenvenensystems bei der Metastasenbildung.

The vertebral veins and their anastomoses to the other venous vascular regions are represented in their anatomy, physiological and pathophysiological function, with a special reference to the spreading of tumor cells through the veins of the vertebral column. The causes of the accumulation of metastases in the trunk skeleton and brain is pointed out by malignant tumors of the prostata, of the ren, of the lung, of the mamma, of the genital organs and the thyroid gland. The signification of the vertebral venous system as a spread of metastases is emphasized under consideration of the tumor cell kinetics in the blood-flow and the different forms of the metastatic formations, and is verifying by experienced clinical cases and reviews of the literature.

[The post-traumatic intrapulmonary haematoma (author's transl)]. / Das posttraumatische intrapulmonale Hämatom.

The case of a 29-year-old female patient is presented as an example of formation and resorption of a post-traumatic intrapulmonary hematoma. This case is compared with the findings in the literature and discussed. The importance of diagnostic differentiation from malignant coin lesions is pointed out.