Twelve years of experience with percutaneous, paravascular biopsy of pelvic lymph nodes.

Twelve years of experience with paravascular percutaneous biopsy of iliac lymph nodes is described. The technique has been performed in 150 patients with equivocal lymphographic diagnoses or with clinical symptoms of malignant disease without peripheral lymphadenopathy. The method is simple and has few complications. No diagnosis has proved to be falsee positive, while in eight per cent of the cases fals negative diagnoses were found. In nine per cent of the patients the results were unacceptable for technical reasons. The method is useful only for biopsy of external iliac lymph nodes. A further study has been initiated to compare the results of the paravascular and the transperitoneal biopsy techniques.

CT diagnosis of pedunculated liver tumours.

Liver tumours with extrahepatic location are uncommon. They show specific CT criteria with respect to blood supply. Various CT criteria have been analysed in 10 tumours, including three hepatocellular adenomas, two focal nodular hyperplasias, four cavernous haemangiomas and one hepatocellular carcinoma. Correct diagnosis was obtained only in haemangiomas with their characteristic hyperdense blood pools, and in one hepatocellular carcinoma. CT criteria of the ten pedunculated tumours are discussed, to with the aim of adding to our knowledge of the diagnostic relevance of CT.

CT guided percutaneous fine needle biopsy in the diagnosis of small adrenal tumours.

In the diagnosis of expansive lesions of the pancreas, liver, kidneys, lymph nodes and other organs, percutaneous fine needle aspiration biopsy has proved its value. For small objects computed tomography is particularly suitable as a localization aid. This article reports on the diagnostic advantages of CT and biopsy in the diagnosis of lesions of the adrenals, demonstrated by 6 selected examples of small tumours, 5 of them smaller than 2 cm., and 1 smaller than 3 cm. The cytological diagnosis of an adrenal adenoma in 5 patients and a metastasis in one provided an important contribution towards therapy and prognosis.

CT diagnosis of hepatic adenoma.

Only few publication have so far been known on case histories in the context of CT-findings of hepatic adenoma (HA). An analysis was, therefore, made of the findings of ten patients with HA. Precontrast and postcontrast scans (dynamic CT), densitometric evaluations (gamma-fit) and "profile" determination were taken into consideration. Diagnostic relevance is attributed to two types of features (with and without tumour haemorrhage) as well as to complementary findings (capsule-like structure and fat-ring around the tumour, island-like areas).

CT guided percutaneous fine-needle biopsy of the pancreas.

147 CT guided fine-needle biopsies of the pancreas were carried out on 141 patients (45 malignant tumours, 79 chronic pancreatitis and pancreas without lesions, respectively). In 23 pseudocysts a malignant lesion could be excluded. By analysing the remaining 124 biopsies (non-cystic targets) an overall accuracy of 79%, a sensitivity of 71% and a specificity of 84% in differentiating between benign and malignant lesions were obtained. By excluding 12% of biopsies with no diagnostic material, an overall accuracy of 90% might be recorded. The comparison between the number of aspirates per examination and the cytological diagnoses would indicate that a minimum of four aspirates is required for satisfactory results.

[A frequency analysis and evaluation of the criteria for dynamic CT and a test of the CT diagnosis of space-occupying lesions of the liver]. / Frequenzanalyse und Wertbestimmung von Kriterien der dynamischen CT und Test zur CT-Diagnostik von Leberraumforderungen.

In a retrospective study the findings of dynamic CT investigations in 185 patients with histologically confirmed hepatic masses were analysed and related to 47 criteria which have been described in the literature. The criteria with the highest value for making a specific diagnosis have been defined for seven different lesions (abscess, adenoma, FNH, haemangioma, adenocarcinoma metastases, metastases from other tumours, HCC). We found agreement with the literature in the following: the target phenomenon for abscesses, central scarring for FNH, spreading enhancement for haemangiomas and irregularity of the liver contour in the absence of subcapsular tumours for HCC. By combining a number of criteria it was possible to suggest the type of lesion retrospectively. The predictive value was found to range from 73% to 100%, a definite diagnosis was possible in only 64%.

[Results of the diagnosis of adrenal masses using percutaneous CT-guided fine needle biopsy]. / Ergebnisse der Diagnostik von Nebennierenraumforderungen durch perkutane CT-gestützte Feinnadelbiopsien.

This paper reports the results of 42 CT-aided fine needle biopsies of adrenal masses in 40 patients (26 were smaller than 3 cm., six smaller than 1 cm.). There were 25 adenomas, seven metastases, one primary carcinoma, one case of tuberculosis, two phaeochromocytomas and four post-inflammatory lesions. Diagnostic material was obtained in 88%. There was one incorrect diagnosis and on five occasions the result was indefinite, leading to an accuracy of 73%. Exclusion or demonstration of malignancy was, however, correct in 85%. There were no complications except for one unimportant pneumothorax.

[Studies on the diagnostic accuracy of lymphography (author's transl)]. / Studie zur diagnostischen Treffsicherheit der Lymphographie.

Contradictory reports in the literature on the reliability of lymphography stimulated the authors to test the diagnostic accuracy, employing methods which are approximately analogous to practice, using carcinoma of the cervix as the model on which the study was carried out. Using 21 observers it was found that there was no correlation between their experience and on-target accuracy of the diagnosis. Good observers obtained an accuracy of 85% with good proportions between sensitivity in the recognition of detail, specificity and readiness to arrive at a decision on the basis of discriminatory ability. With the help of the concept of the ROC curves, the position taken up by the observers in respect of diagnostic decisions, and a complex manner of assessing the various characteristic factors determining diagnostic accuracy, are demonstrated. This form of test, which permits manipulation of different variants of diagnosis, is recommended, among other things, for performance control at the end of training and continuing education courses in other fields of x-ray diagnosis as well.

[Suggestibility as a factor in diagnostic decision-making, illustrated by lymphographic diagnosis (author's transl)]. / Einflussmöglichkeit auf die diagnostische Entscheidungshaltung, dargestellt am Beispiel der lymphographischen Diagnostik.

Sixteen diagnosticians were repeatedly shown a series of lymphograms. On repeated viewing, the participants were informed of their diagnostic decisions at the first reading (accuracy, sensitivity, specificity). The results show that it was possible to influence the participants in their judgement and attitude. Changes in individual attitudes are demonstrated diagnostically and the individual diagnostic parameters were subjected to a quantitative analysis. The accuracy of the results are related to the method and to the diagnostician with reference to the composition of the clinical material.

[MRT in nonpalpable testes]. / MRT bei nichttastbaren Hoden.

Magnetic resonance imaging was performed in 22 male patients for localisation of 27 nonpalpable undescended testes. The operative verification, carried out in 19 testes (15 patients) served as basis for checking on the accuracy of MRI results and for their comparison with those of sonography and laparoscopy. The impalpable testis was localised via MRI in 13 cases and its lack was correctly established in three cases. There were three false MRI diagnoses. The suspicion of two intraabdominal localised testes were not confirmed at surgery and one intracanalicular testes were not seen by MRI. The low signal intensity of the undescended testes on T2-weighted images is indicative for fibrotic changes and may be of value for more accurate planning of the operative volume. MRI offers a new promising opportunity for localisation and morphologic estimation of the undescended testis and should be performed before the invasive investigation methods.

[Computed tomographic findings in extrinsic allergic alveolitis. Comparison with conventional x-ray findings]. / Computertomographische Befundmuster bei der exogen-allergischen Alveolitis. Ein Vergleich zur konventionellen Röntgensymptomatik.

Seventeen patients with extrinsic allergic alveolitis or bird-fancier's lung were examined by standard radiological techniques and classified after Hapke's classification. In addition, the patients were examined by CT. The CT patterns have been analysed and compared with standard radiological findings. The methodological advantages of CT are discussed. Radiological investigation is of limited value in the diagnosis of extrinsic allergic alveolitis. Conventional radiography remains the standard of initial x-ray examination. In early cases, however, CT may be a valuable addition within the diagnostic strategy of a diagnostic imaging department.

[MRT in clinically unclear posttraumatic knee joint lesions]. / MRT bei klinisch unklaren posttraumatischen Kniegelenksläsionen.

An MRI examination was performed on 31 patients with clinically questionable posttraumatic knee joint lesions. A broad range of intra- und extraarticular pathological changes was found. The correlation of MRI with arthroscopy and surgery showed a correct MRI diagnosis in 78% of the meniscal lesions (n = 18) and in 89% of the anterior cruciate ligament ruptures (n = 9). An analysis of false positive and false negative MRI diagnoses was made. MRI offers the opportunity for noninvasive complex assessment of knee joint structures and is of particular value in the diagnosis of posttraumatic knee joint lesions.

[The place of computed tomography in the staging of bronchial carcinoma. A retrospective study]. / Der Stellenwert der Computertomographie beim Staging des Bronchialkarzinoms. Eine retrospektive Studie.

The conventional radiological and CT findings in 347 patients with confirmed bronchial carcinomas have been compared. In 184 patients subjected to surgery, the post-operative TNM classification was compared with the pre-operative CT staging. It was found that CT staging of the T-classification was correct in 82% and of the lymph nodes in 62.5% of cases. CT had a sensitivity of 92% and 95% for the recognition of mediastinal and bronchopulmonary lymph nodes, respectively, and a specificity of 68% and 57%. In 163 patients not subjected to surgery the reasons for avoiding operation were also studied. In more than 80% of these patients it was the CT findings which had indicated that the patient was inoperable.

[Results of computed tomographic diagnosis in the grading of acute pancreatitis]. / Ergebnisse der computertomographischen Diagnostik zur Differenzierung des Schweregrades der akuten Pankreatitis.

By means of computed tomography, it is possible to classify cases of acute pancreatitis into four grades of severity with reasonable accuracy: oedematous, sero-exudative, haemorrhagic-necrotic and abscess formation. Necrotic pancreatic tissue can be differentiated from normal tissue by means of dynamic computed tomography with a high degree of accuracy and the organ can be demarcated more clearly. Of 230 patients with acute pancreatitis, 89 were treated surgically. Correlation between the CT classification and surgical findings was achieved in 83% of the cases in the three serious grades. In 86 patients (96.6%, necrosis was correctly diagnosed. The problems that arise when trying to differentiate between the haemorrhagic-necrotic form and abscess formation are discussed, particularly when there is an absence of gas in the latter type.

[CT diagnosis of focal nodular hyperplasia]. / CT-Diagnostik der fokalen nodulären Hyperplasie.

The paper analyses the findings of a CT study of 21 lesions of focal nodular hyperplasia in 17 patients. In addition to subjective valuatin of the dynamic studies, densitometric measurements on a time basis were carried out (gamma-fit curves) and a density profile was obtained. These tumour-like lesions show typical density changes with rapid enhancement in the arterial phase and rapid fall in density after one or two minutes. Various patterns of the hyperdense lesions (non-homogeneous, those resembling vessels or homogeneous lesions) may be of significance in differential diagnosis. Atypical density patterns were found particularly in foci projecting from the liver.

[Dynamic MRT after Gd-DTPA administration in kidney transplants: the susceptibility and T2 effects]. / Dynamische MRT nach Gd-DTPA-Applikation bei Nierentransplantaten: Suszeptibilitäts- und T2-Effekte.

35 kidney transplanted patients (15 without pathological findings and 20 with histologically proven chronic rejection) were investigated with a combination of dynamic MR and bolus application of Gd-DTPA. The occurrence of susceptibility artifacts and T2 effects at the junction between papilla and renal calix were analysed. There are two groups of patients. The first one shows only artifacts due to susceptibility. The second group indicates the so-called "dark ring pattern" (susceptibility artifacts and T2 effects). These effects are discussed in terms of their dependence on concentration and their dependence on the degree of transplant malfunction. The appearance of "dark-ring patterns" and of susceptibility artifacts indicate the functional status of the glomerular filters.

[Analysis of the results of 96 CT-guided fine needle biopsies of liver masses]. / Ergebnisanalyse 96 CT-gestützter Feinnadelbiopsien bei Raumforderungen der Leber.

A prospective study of 96 CT-guided fine needle biopsies in 93 patients showed 47 malignant and 46 benign lesions in the liver. Overall accuracy was 97%, with a sensitivity of 92% as specificity of 96%. At least four punctures per biopsy were necessary for a reliable diagnosis. In order to save time, fine needle biopsy is recommended to be carried out immediately after the initial CT.

[The accuracy of the imaging procedures (sonography, MRT, CT, angio-CT,nuclear medicine) in characterizing liver tumors]. / Treffsicherheit bildgebender Verfahren (Sonographie, MRT, CT, Angio-CT, Nuklearmedizin) bei der Charakterisierung von Lebertumoren.

In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).

Electron microscopic and 31-P NMR studies of ischemic injured rat livers during preservation and reflow.

Ischemic injury induced during preservation and reperfusion contributes to post-operative failure in liver transplantation. Hepatic injury and recovery from preservation was studied in an isolated rat liver model reperfused with oxygenated erythrocytes. In order to correlate morphological and functional findings, 31-P nuclear magnetic resonance spectroscopy and electron microscopy were used to investigate metabolic and ultrastructural changes during 6 hours of reperfusion. Following cold preservation, EM's showed a primary sinusoidal cell injury, whereas the hepatocytes were well maintained. During reperfusion, hepatocytes displayed further damage. The simultaneous presence of vacuolarly degenerated mitochondria and mitochondria of increased activity was noted. 31-P NMP spectra demonstrated initially a partial ATP-recovery. The maximum level of 60% of the control ATP-value could not be further increased. EM and 31-P NMR indicate that the progressive injury to the liver is due to microcirculatory malfunction induced by an endothelial cell damage, followed by injured hepatocytes themselves, and the consequent intracellular energy crisis that is produced.