Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy.

OBJECTIVE: A prospective study to determine the value of multidetector CT (MD-CT) in assessing the course of nonresectable pancreatic carcinoma during therapy. MATERIAL AND METHODS: 26 patients with nonresectable pancreatic carcinoma underwent MD-CT before and after therapy. The examinations were evaluated with regard to tumor size and vascular invasion using an invasion score (IS) by 2 radiologists independently (kappa analysis). Diagnosis was confirmed surgically, by biopsy or clinical course. RESULTS: Sensitivity for the assessment of irresectability was 100%. Following therapy, 54% of all the tumors were smaller (14/26), 42% had increased in volume (11/26), and one tumor remained stable (1/26). The IS (veins) during follow-up changed in 26 patients (portal vein: 5 higher (mean score 10.4/16.2), 4 lower (mean score 17.5/11.5); superior mesenteric vein: 12 higher (11/14.4), 5 lower (16.2/14.6); p = 0.026). The IS (arteries) changed in 13 patients (celiac trunk: 3 higher (3.3/10); hepatic artery: 4 higher (5.7/10.2), 3 lower (11.6/10.3); superior mesenteric artery: 2 higher (4.5/9.5), 1 lower (12/11)). The kappa values were calculated between 0.56 and 0.87. CONCLUSION: MD-CT is suitable for evaluating tumor spread during therapy for nonresectable pancreatic carcinoma. The IS is useful for assessing the degree of change in vessel invasion.

A new invasion score for determining the resectability of pancreatic carcinomas with contrast-enhanced multidetector computed tomography.

OBJECTIVE: It was the aim of this study to evaluate a new infiltration score to determine the resectability of pancreatic carcinomas in preoperative planning. MATERIALS AND METHODS: Eighty patients with suspected pancreatic tumor were examined prospectively using 16-row spiral CT. The scans were evaluated for the presence of pancreatic carcinoma, peripancreatic tumor extension and vascular invasion using a standardized questionnaire. Invasion of the surgically relevant vessels was evaluated using a new invasion score. The operative and histological findings and the clinical follow-up served as the gold standard. RESULTS: Forty patients had a pancreatic carcinoma, 5 had metastasis of a different primary tumor, and in 35 patients, there was no malignant pancreatic disease. The sensitivity for tumor detection was 100%, with a specificity of 88% for differentiating between malignant and benign pancreatic tumors. Invasion of the surrounding vessels was evaluated correctly using the invasion score, with a sensitivity of 89% and a specificity of 99%. In evaluation of resectability, a sensitivity of 94% and a specificity of 89% were achieved. CONCLUSION: Using 16-row spiral CT, the invasion score is a valid tool for correctly assessing invasion in relevant vessels in cases of pancreatic carcinoma and for determining resectability.

Efficacy and safety of percutaneous transhepatic portal embolization before right liver resection using an ethibloc/lipiodol mixture: a single-center experience.

AIM: The purpose of this study was to evaluate the safety and efficacy of percutaneous transhepatic portal vein embolization of the right portal vein with an Ethibloc/Lipiodol mixture to induce hypertrophy of the left liver lobe in patients with primarily unresectable liver tumor. METHODS: 15 patients (8 primary liver tumors, 7 liver metastases) underwent portal vein embolization. Liver volumetry, duration of hospitalization, complication rates, relevant laboratory values were documented. RESULTS: In 13/15 patients (84.6%) embolization could be performed with a median of 8.8 ml (range 1.5-28 ml) Ethibloc/Lipiodol. One minor procedure-related complication (subcapsular hematoma) occurred, which did not affect the two-step liver resection. No patient developed acute liver failure after embolization or liver resection. The volume of the left liver lobe increased significantly (p = 0.0015) by 25% from a median of 750 ml (587-1,114 ml) to 967 ml (597-1,249 ml). 11/13 (81.8%) of the embolized patients underwent liver resection at a median of 49 days after embolization. Median hospitalization time was 4 days after embolization and 7 days after liver resection. Median overall survival of the 11 operated patients was 376 days. CONCLUSION: Percutaneous transhepatic portal vein embolization using an Ethibloc/Lipiodol mixture is a safe, feasible, and efficient interventional procedure.

[A radiological case collection with interactive character as a new element in the education of medical students]. / Eine radiologische Fallsammlung mit interaktivem Charakter als neues Element in der studentischen Ausbildung.

PURPOSE: Evaluation of an interactive, multimedia case-based learning platform for the radiological education of medical students. MATERIALS AND METHODS: An interactive electronic learning platform for the education of medical students was built in HTML format independent of the operating system in the context of the Heidelberg Curriculum Medicinale (HeiCuMed). A case collection of 30 common and authentic clinical cases is used as the central theme and clinical background. The user has to work on each case by making decisions regarding a selection of diagnostic modalities and by analyzing the chosen studies. After a reasonable selection and sequence of diagnostic radiological modalities and their interpretation, a diagnosis has to be made. An extensive collection of normal findings for any modality is available for the user as a reference in correlation with the pathology at anytime within each case. The case collection consists of 2053 files with 1109 Internet pages (HTML) and 869 image files (.jpeg) with approximately 10 000 crosslinks (links). The case collection was evaluated by a questionnaire (scale 1 - 5) at the end of the radiological student course. The development of the results of the radiological course exam was analyzed to investigate any effect on the learning performance after the case collection was introduced. RESULTS: 97.6 % of the course participants would use the case collection beyond the radiological student course to learn radiology in their medical studies. The handling of the case collection was rated excellent in 36.9 %, good in 54.6 %, satisfactory in 8 % and unsatisfactory in 0.4 %. 41 % felt that the case collection was overall excellent, 49.2 % good, 7.8 % satisfactory, 1.6 % unsatisfactory and 0.4 % poor. A positive trend in the development of the results in the radiological course exam with less variance after the introduction of the case collection was found but failed statistical significance. CONCLUSION: A platform-independent, interactive, multimedia learning platform with authentic clinical cases and multiple choice elements for the user is the ideal method for supporting and expanding medical education in radiology. The usefulness and the reasonable exertion of diagnostic modalities are conveyed in a practical context as teaching goals. The high acceptance among students is based on the interactivity and use of multimedia.

[MR imaging in cardiac amyloidosis--morphology, function and late enhancement]. / Magnetresonanztomografie bei kardialer Amyloidose--Morphologie, Funktion und late enhancement.

PURPOSE: Since limited data is available using MR imaging in cardiac amyloidosis, the purpose of our study was to evaluate morphological and functional differences of the heart using cardiac MRI. MATERIALS AND METHODS: 19 consecutive patients (14 males, 5 females, mean age 59 +/- 6 years) with histologically proven cardiac amyloidosis were evaluated with MRI at 1.5 T. Results were compared with data of 10 healthy, age-matched control subjects (5 males, 5 females, mean age 60 +/- 6 years). Functional and morphological data including late enhancement (LE) was acquired. RESULTS: Compared to the control group, patients with cardiac amyloidosis had thickened atrial walls and dilated atriums. Both ventricles and the interventricular septum were thickened. The LV hypertrophy was focal in 11 / 19 (58 %) and global in 4 / 19 (21 %) of patients. A myocardial edema occurred in 2 / 19 patients with cardiac amyloidosis (11 %). An edema of the myocardium was visible in 2 / 19 (11 %) of patients. The LV ejection fraction was statistically significantly decreased. The prevalence of LE was 74 % (14 / 19 of patients). LE was detected predominantly in the LV anterior wall and in the interventricular septum. Within the segments LE was located predominantly in a subendocardial location. Between patients with and without LE no statistically significant differences of functional and morphological results were able to be established. CONCLUSION: There are three major outcomes of our assessment: 1. The LV hypertrophy is focal in the majority of patients with cardiac amyloidosis. 2. No statistically significant differences can be established in regard to the functional and morphological features between patients with and without LE. 3. Myocardial edema is a possible feature in cardiac amyloidosis.

[Clinical 3-year follow-up of uterine fibroid embolization]. / Klinische 3-Jahres-Ergebnisse nach Uterusmyomembolisation.

PURPOSE: The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere). MATERIALS AND METHODS: 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals 1) 1-year follow-up MRI evaluation of the fibroid behavior and 2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE. RESULTS: Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 +/- 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 +/- 0.5 (p = 0.0001), after two years to 1.7 +/- 0.5 (p = 0.0042) and after three years to 1.3 +/- 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 +/- 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 +/- 0.3 (p = 0.0001), after two years to 1.2 +/- 0.2 and after three years to 1.2 +/- 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 +/- 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 +/- 0.3 (p = 0.0069) and remained after two years at 1.1 +/- 0.2 and after three years at 1.2 +/- 0.4 (p = 0.905). The initial overall health status was 54.7 +/- 20.1 (maximal value 100). After one year it rised to 90.5 +/- 15.4 (p = 0.0001), was 91.8 +/- 5.6 after two years and was 91.3 +/- 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2.9 +/- 0.2 after one year, 2.6 +/- 0.3 after two years and 2.7 +/- 0.5 (3 = extremely satisfied) after three years. We observed 12 minor and 3 major complications (one hysterectomy, one fibroid expulsion associated with a short bleeding episode and one transient amenorrhoea for three months). All patients benefited clinically from the procedure and a clinical benefit was achieved in all cases. CONCLUSION: Under controlled study conditions, flow-guided UAE with spherical embolization particles achieves high clinical success for all relevant clinical symptoms without negative changes during follow-up after at least 3 years. Accordingly, patient therapy satisfaction remained extraordinarily high even 3 years after UAE.

Comparison of CT during arterial portography and MR during arterial portography in the detection of liver metastases.

OBJECTIVE: This study compared MR during arterial portography (MRAP) with CT during arterial portography (CTAP) with regard to the detection and differentiation of liver metastases before surgery. MATERIALS AND METHODS: Fifteen patients with liver metastases were enrolled before surgery according to the guidelines of our institutional review board and good clinical practice. After mesentericography, unenhanced scans (Volume Zoom) were performed initially. For CTAP, the contrast medium was injected through the superior mesenteric artery. Images were acquired in portal and delayed enhancement. The MR protocol (1.5 T; Magnetom Symphony) started with T1-weighted fast low-angle shot (FLASH) T2-weighted turbo spin echo (TSE). MRAP followed with gadolinium-enhanced dynamic T1-weighted 3D FLASH. Delayed-phase T1-weighted 2D FLASH axial images were performed 2 min after IV injection of the contrast medium. Qualitative and quantitative evaluation of CTAP and MRAP was performed by three blinded radiologists regarding the number of lesions and their size, localization, and differential diagnosis. RESULTS: The overall sensitivity in detecting liver metastases was 97% with MRAP and 93% with CTAP (p > 0.05, not significant [n.s.]). The specificity was calculated to be 97% for MRAP and 82% for CTAP (p < 0.0001, statistically significant [s.s.]). The differences in sensitivity were more accentuated if only lesions 10 mm or smaller were considered (95% vs 88%, p > 0.05, n.s.), for which the respective specificities were 95% and 80% (p < 0.0014, s.s.). Improvements in sensitivity and specificity were associated with a higher lesion-to-liver contrast-to-noise ratio (59.4 +/- 51.0 for MRAP vs 10.4 +/- 7.3 for CTAP) and resulted in higher diagnostic confidence in the differential diagnosis of liver lesions (p < 0.001, s.s.) and better interobserver agreement (median kappa value, 0.88 vs 0.63). CONCLUSION: MRAP proved to be a reliable method in the preoperative detection of small liver metastases in particular, with a higher sensitivity and specificity than CTAP. If organizational difficulties of MRAP can be overcome, MRAP could be considered instead of CTAP in the preoperative invasive evaluation of metastatic liver disease.

Atypical manifestations of multiple myeloma: radiological appearance.

Diagnostic procedures performed on patients with multiple myeloma typically reveal lytic bone lesions, osteopenia or osteoporosis, bone marrow infiltration by plasma cells as well as overproduction of immunoglobulin or light chains in the serum or urine. Skeletal manifestations are extremely variable and the unusual forms have been described extensively. Extramedullary plasma-cell tumours (plasmocytoma) are found in about 5% of newly diagnosed patients with multiple myelomas. In this paper we present eight patients with atypical forms of multiple myeloma.

Transarterial embolization of primary and secondary tumors of the skeletal system.

Percutaneous transcatheteral embolizations of primary and secondary bone tumors are important minimal invasive angiographic interventions of the skeletal system. In most of the cases embolization is performed for preoperative devascularization or as a palliative measure to treat tumor-associated pain or other tumor bulk symptoms. The transarterial embolization of primary and secondary tumors of the skeletal system has been developed to a safe and very effective method. Indications, techniques, results and complications of this minimal invasive interventional therapy for treatment of primary and secondary bone tumors are described and discussed and compared with the newer literature and our own results.

[Preoperative and palliative embolization of renal cell carcinomas: follow-up of 49 patients]. / Präoperative und palliative Embolisation des Nierenzellkarzinoms: Nachsorge von 49 Patienten.

PURPOSE: To evaluate the influence of preoperative and palliative embolization of renal cell carcinomas on survival, intra- and post-operative procedures, and symptom control for palliative and preoperative indications. MATERIALS AND METHODS: 56 patients who underwent renal cell carcinoma embolization from 1981 to 1999 were included in this retrospective study. RESULTS: 24 women and 32 men were included (mean age 59.4 years). Complete follow-up data was available for 49 patients. 42 patients underwent preoperative embolization at different tumor stages (pT1: 1 patient, pT2: 6, pT3 a: 4, pT3 b: 19, pT3 c: 2, pT4: 5). 14 patients underwent palliative embolization (T1: 0 patients, T2: 5, T3: 4, T4: 4). Indications for preoperative embolization were bleeding of the renal tumor in 6 cases -- non-recurrent bleeding reported, flank pain in 4 patients -- 3 of 4 patients had no further symptoms, recurrent tumor embolization in 1 patient, and 2 patients who wanted to be treated without symptoms. The mean survival time of preoperative embolized patients was 3.1 +/- 5.11 years with a 5-year survival rate of 50 %. The mean survival time of palliative embolized patients was 0.67 +/- 0.76 years with initial metastases (n = 7) and 2.33 +/- 2.40 without metastases (n = 6). CONCLUSION: Palliative embolization of renal cell carcinomas is a safe therapeutic method to treat advanced renal cell carcinomas allowing control of symptoms such as hematuria and flank pain in more than 90 % of our cases. Preoperative embolization yields a patient survival time comparable to that of patients at earlier tumor stages and is dependent on the metastases.

[Prevalence of latent and manifest hyperthyroidism in an iodine-deficient area: non-selected patient population admitted for CT studies with iodine-containing contrast agents]. / Prävalenz der latenten und manifesten Hyperthyreose in einem Jodmangelgebiet: Erhebung an einem nichtselektionierten Patientenkollektiv vor Durchführung einer Computertomographie mit jodhaltigem Kontrastmittel.

PURPOSE: To evaluate the prevalence of latent and manifest hyperthyroidism in a non-selected group of patients admitted for contrast enhanced CT studies blood samples were tested for the levels of thyroid-stimulating hormone (TSH). MATERIAL AND METHODS: TSH blood levels were obtained in 548 consecutive patients who were scheduled for contrast-enhanced (Iopromide; 300 mg iodine/ml) CT scanning. In case of TSH levels < 0.4 mU/l, blood samples were also tested for triiodothyronine (T3) and tetraiodothyronine (T4) blood levels, and treatment with Irenat (sodium perchlorate) was commenced before scanning. In case of TSH levels < 0.1 mU/l, CT scanning was not performed but further evaluation of the thyroid function was initiated. RESULTS: TSH blood levels ranged from 0.4 to 7.5 mU/l in 512 patients, and 36 patients (6.6%) had TSH blood levels < 0.4 mU/l and 9 patients blood levels < 0.1 mU/l, with 32 of those patients (5.8%) having regular T3 and T4 blood levels consistent with latent hyperthyroidism. In 4 patients (0.8%), T3 or T4 blood levels were increased consistent with manifest hyperthyroidism. CONCLUSION: In South Germany, the prevalence of latent or manifest hyperthyroidism in a non-selected patient group is high. Therefore TSH blood levels should be obtained prior to contrast-enhanced CT studies.

[Experimental testing of a new coil design for endoluminal MRI applied to the pig stomach]. / Experimentelle Erprobung eines neuen Spulendesigns zur endoluminalen MRT am Beispiel des Schweinemagens.

PURPOSE: Experimental feasibility study of a new MR-Coil concept for enhanced visualization of the gastric wall. MATERIAL AND METHODS: The newly developed single-loop receiver coil for endoluminal imaging (Fraunhofer Institute, St. Ingbert, Germany) was evaluated in 4 explanted pig stomachs in a 1.5T MR unit (Siemens Symphony, Erlangen, Germany) with T1 w and T2 w MR sequences in three planes. The new coil consists of a foldable and self-expanding single loop coil (receiver coil) of a shape memory metal (nitinol). It was covered with a biocompatible material (silicone) to prevent direct contact of the wire with stomach tissue. The coil assumes a circular configuration with a diameter of 8 cm because of its memory metal properties. The flexible characteristics of the material used allow the passage through the instrument channel (13 mm diameter) of a specially designed MR-compatible endoscope. The purpose of our study was to assess feasibility of the coil design as a first step in developing a new endoluminal MRI-concept. Additionally the number and signal intensity of visible gastric wall layers were evaluated and findings were correlated with histopathological results of a pig stomach. RESULTS: The new coil concept was a feasible system in all 4 cases and showed good image quality for analysis. On T1 w images, 3 layers were visible in all cases, and on T2 w images 4 different gastric wall layers were seen in 2 cases. Due to histopathological correlation, the different gastric wall layers were identified as follows: mucosa, submucosa and muscularis propria if three layers were depicted; in cases of 4 visible wall layers, serosa and subserosa could be detected additionally. For each gastric wall layer, a distinct signal intensity was found. CONCLUSION: The new MR coil concept for endoluminal imaging proved to be a feasible technique. Good differentiation of gastric wall layers in the pig stomach could be demonstrated. We have shown that endoscopic MR-imaging with our new coil concept is a valuable technique for the visualization of gastric wall layers. Due to this fact, follow-up studies including assessing safety aspects are necessary to finally conduct an experimental-clinical study on in-vivo human gastric specimens to detect tumor growth and morphology within the gastric wall. Endoscopic MRI may have the potential in the future to overcome today's limitations of diagnostic imaging in gastric cancer.

[The role of 3-D imaging and computer-based postprocessing for surgery of the liver and pancreas]. / Bedeutung der 3-D-Bildgebung und computerbasierten Nachverarbeitung für die Chirurgie der Leber und des Pankreas.

Cross-sectional imaging based on navigation and virtual reality planning tools are well-established in the surgical routine in orthopedic surgery and neurosurgery. In various procedures, they have achieved a significant clinical relevance and efficacy and have enhanced the discipline's resection capabilities. In abdominal surgery, however, these tools have gained little attraction so far. Even with the advantage of fast and high resolution cross-sectional liver and pancreas imaging, it remains unclear whether 3D planning and interactive planning tools might increase precision and safety of liver and pancreas surgery. The inability to simply transfer the methodology from orthopedic or neurosurgery is mainly a result of intraoperative organ movements and shifting and corresponding technical difficulties in the on-line applicability of presurgical cross sectional imaging data. For the interactive planning of liver surgery, three systems partly exist in daily routine: HepaVision2 (MeVis GmbH, Bremen), LiverLive (Navidez Ltd, Slovenia) and OrgaNicer (German Cancer Research Center, Heidelberg). All these systems have realized a half- or full-automatic liver-segmentation procedure to visualize liver segments, vessel trees, resected volumes or critical residual organ volumes, either for preoperative planning or intraoperative visualization. Acquisition of data is mainly based on computed tomography. Three-dimensional navigation for intraoperative surgical guidance with ultrasound is part of the clinical testing. There are only few reports about the transfer of the visualization of the pancreas, probably caused by the difficulties with the segmentation routine due to inflammation or organ-exceeding tumor growth. With this paper, we like to evaluate and demonstrate the present status of software planning tools and pathways for future pre- and intraoperative resection planning in liver and pancreas surgery.

Angiomorphometry in malignant tumors and inflammatory disease.

Angiographic differentiation of malignant and inflammatory lesions is occasionally impossible, since certain criteria for malignancy also apply to benign lesions. The authors analyzed samples of microangiographic specimens of kidneys with inflammation, tumor, and normal control organs to define mathematically the frequency of such angiographic parameters as caliber fluctuation, vascular avulsion, change of direction and diameter, and change in predominant vascular structure. The described method is transferred to clinical angiograms, and results of both groups are compared. In this preliminary analysis, caliber fluctuation appears to be the single most important criterion for differentiation of malignant and benign angiographic alterations.

Experimental study of the effectiveness of capillary embolization using contrast-enhanced Ethibloc.

In experimental and clinical use, Ethibloc in combination with 40% glucose preinjection has proven to be of major advantage in tumor embolization. However, its low radiographic contrast is a limiting factor in monitoring its vascular distribution and venous propagation. Various contrast media were tested in order to enhance this contrast in laboratory and animal experiments. Normal rat kidneys (N = 96) and renal tumors, induced by Dimethylnitrosamine (N = 66) were tested as in previous studies. Ethibloc-N was produced by substituting Lipiodol for poppy seed oil which is an ingredient of the original Ethibloc. This proved to be the only embolization medium that combined the excellent properties of the original Ethibloc with increased contrast. All other embolization media tested resulted in new complications such as under-or overembolization and pulmonary embolism.

Interventional radiological treatment of malignant biliary obstruction.

Percutaneous transhepatic procedures have gained a strong position in the diagnosis and treatment of malignant biliary obstruction. Diagnostic cholangiography can easily be converted into therapeutic drainage, which is often the first step towards further diagnostic work-up (biopsy, percutaneous cholangioscopy) and tumour ablation and/or intraductal irradiation. Plastic endoprostheses and balloon- or self-expandable metallic stents are the therapeutic alternatives to achieve permanent internal drainage of bile.

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses.

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.

Degree of carotid artery stenosis. Comparison of selective and non-selective angiographic findings with surgical specimens.

OBJECTIVE: To compare the degree of vessel narrowing seen on selective and non-selective carotid artery catheter angiograms using criteria set by NASCET and ECST with the results obtained from corresponding surgical specimens. SUBJECTS: In 40 preoperative angiograms (20 non-selective, 20 selective) the 'distal' degree of internal carotid artery (ICA) stenosis according to NASCET criteria and the 'local' degree of stenosis according to ECST criteria was assessed. These data were compared with the 'distal' and 'local' degree of ICA stenosis obtained by measuring the specimens and the diameter of the distal ICA intraoperatively. RESULTS: The median 'local' degree of stenosis was 86.5% in the specimen and 83.5% in the selective angiograms (difference not significant). In non-selective angiography the median 'local' degree of stenosis was 77.5% compared to 84% in the corresponding specimens (P < 0.01). The median 'distal' degree of stenosis in selective angiography was 76.5 versus 75.5% in the specimens (n.s.). The median 'distal' degree of non-selective angiography was 67% compared to 77.5% in the corresponding specimens (P = 0.02). The trend to underestimate high grade stenosis (above 90%) was more pronounced in non-selective than in selective angiography. Medium grade stenosis (60-80%) was slightly overestimated in selective angiography. CONCLUSION: Selective angiography is more accurate in determining the 'true' degree of stenosis in internal carotid artery disease, taking into account a slight overestimation of medium grade stenosis. High grade stenosis is underestimated in both selective and non-selective angiography. These observations extend to both the ECST and NASCET criteria of measuring the degree of stenosis, which differ by about 10%.

[Roentgenmorphologic findings in scleroderma]. / Röntgenmorphologische Befunde bei Sklerodermie.

In 28 patients with progressive systemic sclerosis clinical symptoms are correlated with roentgen findings. The systemic disease of connective tissue shows typical roentgenological signs, such as soft tissue calcifications, generalized or localized osteoporosis, arthritis, dysfunction of oesophagus, small and large bowel, pulmonary fibrosis and cardiomegaly. A limited prognostic statement according to a clinical and radiological classification seems possible.