Magnetic resonance imaging of the brain in patients with anosmia and hypothalamic hypogonadism (Kallmann's syndrome).

Kallmann's syndrome is characterized by hypogonadotropic hypogonadism and anosmia. Postmortem studies have revealed either hypoplasia or aplasia of the rhinencephalon, respectively, in patients with hyposmia and anosmia. This anatomical defect has now been demonstrated in vivo in four patients with Kallmann's syndrome by magnetic resonance imaging.

Cerebral MR in ophthalmoplegia plus.

PURPOSE: To evaluate MR patterns in ophthalmoplegia plus and correlate them with clinical symptoms. METHODS: MR was performed on a 1.5-T whole-body scanner with T2-weighted gradient-echo and spin-echo images. The retrospective analysis included 19 patients with clinically established diagnoses of ophthalmoplegia plus. RESULTS: Two types of cerebral MR abnormalities were found in ophthalmoplegia plus: brain atrophy and hyperintensities restricted to the white matter and basal ganglia, which appeared as either focal or diffuse areas of high signal intensity and were of strictly supratentorial location. No specific distribution was found. These findings differ markedly from infarction-like lesions found in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. CONCLUSIONS: MR is sensitive for the detection of central nervous system involvement in ophthalmoplegia plus, but findings are nonspecific. However, cerebral MR in ophthalmoplegia plus is different from other mitochondrial encephalomyopathies and underlines the clinical differentiation of mitochondrial encephalomyopathies.

Brain metastasis of an invasive thymoma.

A rare case of a thymoma metastatic to brain is reported. This tumor was localized intraoperatively with the use of transdural ultrasound imaging, and gross total resection was accomplished. Radiation therapy was administered to both brain and mediastinum. The growth characteristics, classification, and treatment of thymomas are discussed.

[Intraoperative sonographic localization of brain tumors]. / Intraoperative sonographische Lokalisation von Hirntumoren.

Twenty-six patients with mostly small intracranial space-occupying lesions were examined sonographically during surgery. In all patients, accurate localisation and complete delineation of the intra-cerebral lesion proved possible. The extent of the lesion could be determined accurately and surrounding cerebral structures were identified unequivocally. There were no significant differences in the appearances before and after opening of the dura. The significant advantage of the intra-operative use of sonography lies in the accurate localisation of the space-occupying lesion. This results in a reduction of interference with normal cerebral tissue and in a reduction of the duration of the operation.

[Intraoperative sonographic demonstration of intraspinal tumors]. / Intraoperative sonographische Darstellung intraspinaler Tumoren.

Four examples are given to demonstrate the problems, methods and advantages of intra-operative sonography for intra-spinal tumours. The value of intra-operative sonography for localising the tumours and for judging their extent is demonstrated and related to other imaging methods, such as myelography, CT and MR.

[MR tomography and computer tomography of alcohol-induced brain tissue changes]. / MR-Tomographie und Computertomographie von alkoholtoxischen Hirngewebsveränderungen.

Results of MRI in five alcoholics suffering from acute neurologic disorders such as ataxia, ophthalmoplegia and confusion are presented. The detection of focal cerebral lesions of high signal intensity in T2-weighted Spin-Echo- and Gradient-Echo-images in periventricular white matter, thalamus and pons combined with patients history and clinical presentation led to the diagnosis of Wernicke-Encephalopathia and Pontine Myelinolysis. MRI was far more sensitive compared with CT.

[MR tomography of the temporomandibular joint using T1-weighted multislice-gradient echo-sequences]. / MR-Tomographie des Kiefergelenkes unter Anwendung T1-gewichteter Multislice-Gradientenecho-Sequenzen.

31 examinations of temporo-mandibular joints, using T1-weighted multislice gradient echo sequences have been performed. The short scan time of one minute and 50 seconds ensured that there were no movement artefacts in 28 cases. The position of the disc was visible in more than 90% of examinations. Degenerative changes in the cartilage and arthroses of the joint cannot be demonstrated adequately by the rapid sequences.

[Lung parenchymatous changes following mustard gas poisoning]. / Lungenparenchymveränderungen nach Schwefellostvergiftung.

The authors present a late sequel of poisoning with dichlorodiethyl sulphide, also known as mustard gas or Ypérite, in a patient of 22 years of age--a late sequel not described in the literature to date. After the poisoning, a severe pulmonary fibrosis with pulmonary artery hypertension developed. A mediastinal emphysema that had so far been observed only during the acute intoxication phase, was evident even two years after the intoxication. Perivascular collections of air in the left lung communicating via the left hilus with the mediastinal air point to the existence of bronchus or lung parenchyma fistulas.

[Modified T2-weighted gradient echo sequence for MR tomography of the CNS]. / Modifizierte T2-gewichtete Gradientenechosequenz für die MR-Tomographie des ZNS.

We introduced a modification of T2-weighted rapid sequence imaging which combines the advantages of conventional spin echo sequences with those of gradient echo sequences. It provides a method which is suitable for clinical routine use. Using a 1.5 Tesla field, one obtains good image quality with contrast comparable to spin echo sequences, while reducing the time taken to examine the brain to one-half and that of the spine to one-third. Our experience in 54 patients is described.

[MR tomography of Kallmann's syndrome]. / MR-Tomographie beim Kallmann-Syndrom.

MR tomography is the only imaging method that can demonstrate atrophy of the olfactory lobe of the brain in olfacto-genital dysplasia (Kallmann's syndrome). The MRT findings in five patients with Kallmann's syndrome are described. The MRT criterion for the presence of Kallmann's syndrome appears to be an interruption or total absence of the olfactory sulcus.

[NMR tomography of the brain in patients on long-term dialysis]. / MRT des Gehirns bei Patienten unter Langzeitdialyse.

24 patients on long-term dialysis, aged between 20 and 78 years, were examined by brain MRT and CT. Both methods showed equally atrophic changes in the brain; in particular, cortical atrophy appears to increase with increasing duration of dialysis. MRT shows small hyperintensive areas in the white matter which cannot be seen on CT. Hypointensive areas on MRT are not due to calcification, but pathological deposition of metals, such as iron, must be considered.

[MR tomography, CT and angiography of vascular malformations of the central nervous system]. / MR-Tomographie, CT und Angiographie vaskulärer Malformationen des zentralen Nervensystems.

The findings on MR tomography in 31 vascular malformations of the central nervous system are described; 26 of these had angiography and 24 were examined by CT. There were 19 A-V angiomas, 7 cavernomas and 5 large aneurysms. MRT provided a correct diagnosis in 29 out of 31 cases, angiography succeeded in 19 out of 26 cases and CT in 20 of 24. MRT was superior to CT and angiography. Nevertheless, it cannot replace arteriography, since this is the only method for demonstrating the vascular supply of angiomas and small aneurysms can be demonstrated only by arteriography.

[Use of a homomorphic filter in combination with surface coils in MR tomography]. / Anwendung eines homomorphen Filters in Kombination mit Oberflächenspulen in der MR-Tomographie.

A new method for correcting the signal intensity from surface coil (homomorphic filters) was evaluated in 40 examinations. With this filter it is possible to compensate for signal loss when using surface coils for deep tissues and to avoid excessive signals from the surface. The method does not, however, provide any additional information. Properly used, there were no false positive findings, nor was there any loss of abnormal findings. The use of homomorphic filters is therefore safe and sensible.

[Diagnosis of lymphomas on the MR tomogram]. / Zur Diagnostik von Lymphomen im MR-Tomogramm.

MR tomography provides images equal to, or superior to, CT of lymph node involvement in the thorax or abdomen. It may be possible to achieve tissue characterisation by means of T1 and T2 images. Chronic inflammatory diseases causing lymph node enlargement, such as sarcoidosis, show characteristic T1 intervals (about 650 msecs), whereas lymphomas show intervals of 900 msecs. Enlarged lymph nodes of low malignancy show lower T2 values (78 to 94 msecs), highly malignant show higher T2 values (83 to 145 msecs). Already we believe MR to be the method of choice in evaluating lymphoma and sarcoidosis.

[Diagnosis of sarcoidosis using MR tomography]. / Zur Diagnostik der Sarkoidose im MR-Tomogramm.

One hundred and thirty-three patients with lymph node enlargement from various causes were examined by MR tomography, using 0.5 and 1.5 Tesla. Amongst these, there were 27 patients with chronically enlarged lymph nodes and histologically confirmed sarcoidosis; these showed characteristic T1 intervals. Enlarged lymph nodes due to chronic inflammatory conditions can be differentiated from lymph nodes with malignant lymphoma, or from lymph node metastases from carcinomas. Although there are problems with the determination of relaxation times on MR tomography, this may be a valuable method for the differential diagnosis of sarcoid.

[The demonstration and staging of bladder carcinoma. A comparative study between magnetic resonance tomography, computed tomography and radioimmunoscintigraphy]. / Nachweis und Stadieneinteilung des Harnblasenkarzinoms. Eine vergleichende Untersuchung zwischen Magnetresonanztomographie, Computertomographie und Radioimmunszintigraphie.

The purpose of the present study was to compare the effectiveness of MRI, CT and radioimmunoscintigraphy in the staging and detection of bladder cancers in 28 patients. We distinguish two groups: Group I included the tumour stages CIS-T3A and the second group the deep infiltrative tumours T3B-T4. MRI was slightly superior to CT in respect of tumour staging (75% correct results as compared to 63%). No understaging occurred with MRI, whereas in 22% of the cases the stage of the tumour was underestimated using CT diagnostics. Overstaging occurred in 25% of the MRI and 15% of the CT-diagnostics, respectively. RIS cannot distinguish the tumour groups, and hence this method is useful only for the detection of the primary tumour and metastases. In 77% of cases the tumour was detected and in 15% the tumour could be safely excluded.

[Correlation of scintigraphic and x-ray findings in Marie-Bamberger secondary hypertrophic osteoarthropathy]. / Korrelation szintigraphischer und röntgenologischer Befunde bei der sekundären Osteoarthropathia hypertrophicans Marie-Bamberger.

The radiological and scintigraphic findings in the rare condition of hypertrophic osteoarthropathy (Marie-Bamberger) were followed up for a period of two years. They are described and compared. Skeletal scintigraphy shows the abnormalities in the skeleton at an earlier stage than does radiology and also shows more extensive manifestations. The specific symmetrical distribution of abnormally increased uptake in the diaphyses and metaphyses of the long bones of the extremities, with sparing of the axial skeleton, produces highly specific appearances which can be considered as diagnostic.

[Relaxation time measurements in the differential magnetic resonance tomographic diagnosis of liver tumors]. / Relaxationszeitmessungen in der kernspintomographischen Differentialdiagnose von Lebertumoren.

T1-weighted IR sequences and T2-weighted SE sequences and combined SE/IR sequences were carried out in 62 patients with malignant and 50 patients with benign liver tumours and the T1 and T2 relaxation times were measured. IR sequences proved the most sensitive method for imaging focal liver lesions and providing good contrast between liver tissue and tumour. For lesions above 1.5 cm, quantitative MRI achieved an accuracy better than 95% in distinguishing between haemangiomas and malignant lesions. Routine quantitative measurements of relaxation times were sufficiently reproducible for clinical use.

[MR tomography following craniocerebral trauma: comparison with computed tomography, electroencephalography and neurologic status]. / MR-Tomographie nach Schädel-Hirn-Trauma: Vergleich mit Computertomographie, Elektroenzephalographie und neurologischem Status.

56 patients with head and brain trauma and in coma were studied prospectively by means of MRT, CT, EEG and neurological examination. All patients had initial CT and EEG admission. MRT showed that in our patients morphological return to normal was the exception. Patients with head and brain injuries should be examined by MRT during the course of their illness. The use of special sequences, such as gradient-echo sequences for the diagnosis of haemorrhagic contusions, is indicated. CT should be retained for evaluating bone injury and cerebral damage during the acute stage.

[The diagnosis of bone marrow lesions in the MR tomogram in children with diseases of the hematopoietic system with special reference to post-therapy changes]. / Zur Diagnostik von Knochenmarkläsionen im MR-Tomogramm bei Kindern mit Erkrankungen des hämatopoetischen Systems unter besonderer Berücksichtigung der posttherapeutischen Veränderungen.

119 MR-examinations of both tibiae, knees and the lower part of both femur were performed in 41 children suffering from bone marrow disease (27 ALL, 4 AML, 3 NHL, 1 agranulocytosis, 6 anaemia). T1- and T2-spin-echo sequences and a T2-gradient-echo sequence were used. Bone marrow changes in leukaemia were diffuse before therapy and patchy after therapy. Due to their different signal in T2-weighted images, differentiation of the post-therapeutic patchy findings into infiltrations, fibrosis, necrosis and siderosis seems to be possible. In future, MRI will be the method of choice for screening and controlling bone marrow disease if the examination time is shortened by using only a T1-spin-echo sequence and a T2-gradient-echo sequence.