[Mono-contrast distension study of the small intestine. Comparison of conventional small bowel follow-through with enteroclysis]. / Monokontrast-Distensionsuntersuchung des Dünndarms. Vergleich mit der konventionellen MDP und dem Enteroklysma.

PURPOSE: Development of a new monocontrast examination of the small bowel. MATERIAL AND METHODS: The new examination was applied to 20 patients with suspected bowel obstruction or inflammatory bowel disease. A contrast mixture, containing gelatin, a water-soluble contrast medium (Peritrast) and water (GPW-mixture) was given over an intestinal tube. The viscosity of the new contrast mixture was measured by rotation and flow viscosimetry. The diagnostic value and the degree of small bowel distension were determined independently by 3 examiners. By comparison 20 randomized selected small bowel follow-through examinations (SBFT) and 20 small bowel enemas were examined. Special questionnaires were used to determine subjective compatibility and discomfort. RESULTS: Due to the viscosity of the new contrast medium and the administration over an intestinal tube, a good bowel distension was achieved with the GPW mixture. The bowel distension (p: < 0.01) and the diagnostic value (p: < 0.01) of the new examination in comparison to the SBFT was characterized as being significantly better. In comparison to the small bowel enema, distension was not significantly better (p: 0.31-1.0). The diagnostic value of the small bowel enema was characterized as significantly better by one of the three examiners in comparison to the new monocontrast-distenson examination (p-level < 0.01). CONCLUSION: The monocontrast-distension examination is a potential alternative in patients in whom a small bowel enema with barium sulfate is contraindicated.

[Early diagnosis of isthmic spondylolysis with MRI]. / Frühdiagnose einer isthmischen Spondylolyse mittels MRT.

INTRODUCTION: Early diagnosis of isthmic lumbar spondylolysis cannot always be established on plain radiographs and CT scans, only. In the case presented here, magnetic resonance imaging (MRI) showed typical bone marrow changes in T1- and T2-weighted images, even at an early stage. CASE: A 11-year old female judoka complained of deep lumbar pain with local tenderness to pressure at L3 to S1. Clinically, there was no neurologic deficit. Conventional x-ray showed no abnormalities. In contrast, MRI revealed a locally ill-defined bone marrow oedema in both pars interarticularis of the 5th lumbar vertebra. This was interpreted as the typical MR-tomographic feature of occult stress fracture, which has to be seen as early evidence of isthmic spondylolysis. Complete restitution was achieved after conservative treatment. CONCLUSION: In early spondylolysis--presented here in form of a case report--, changes of MR signal intensity in the pars interarticularis may be detected, even before fracture lines are to be seen on plain radiographs. Further studies are necessary to confirm MRI to be the method of choice for early diagnosis.