[Preoperative staging of bladder carcinomas with Gd-DTPA-supported dynamic magnetic resonance tomography. Comparison with plain and Gd-DTPA-supported spin-echo sequences]. / Präoperatives Staging von Blasenkarzinomen mit der Gd-DTPA-unterstützten dynamischen Magnetresonanztomographie. Vergleich mit nativen und Gd-DTPA-unterstützten Spin-Echo-Sequenzen.

PURPOSE: Evaluation of dynamic Gd-DTPA enhanced MR imaging in the staging of bladder cancer. METHODS: We studied 40 patients with histologically proven bladder cancer. All patients were examined with routine T1- and T2-weighted MRI and late Gd-DTPA enhanced T1-weighted MRI. Additionally, a dynamic study was performed with 10 subsequent short FLASH-2-D gradient echo sequences without delay immediately after bolus injection of Gd-DTPA. Signal intensities of the tumour and of the surrounding tissue as well as image contrast parameters were quantified. RESULTS: The dynamic study showed a higher accuracy in the evaluation of stage pTa to pT2 cancer compared to spin echo MRI (63% and 46%, respectively) and no difference regarding the sensitivity (87.5%). However, overstaging was a problem with both modalities. The contrast-to-noise ratio of bladder tumour and muscle was equal or significant higher with the dynamic study compared to spin echo MRI. A higher signal-to-contrast ratio of bladder tumour and bladder muscle was calculated for the dynamic study compared with the spin-echo MRI (p < 0.01; Mann-Whitney U test). CONCLUSION: Dynamic Gd-DTPA enhanced MRI is recommended to be used additionally in the preoperative staging of bladder neoplasms.

[Determining the depth of infiltration in urinary bladder carcinoma with contrast medium enhanced dynamic magnetic resonance tomography. With reference to postoperative findings and inflammation]. / Bestimmung der Infiltrationstiefe beim Harnblasenkarzinom mit der kontrastmitteldynamischen Magnetresonanztomographie. Mit Betrachtung postoperativer Befunde und Entzündungen.

OBJECTIVE: The purpose of this study was to evaluate dynamic contrast-enhanced magnetic resonance imaging for the staging of urothelial bladder carcinoma and to compare it with plain and contrast-enhanced spin-echo MRI. METHODS: Pre-operative MRI was carried out in 62 patients. Post-operative histological examination confirmed bladder carcinoma in 50/62 patients. Carcinoma was excluded in 12 patients. Beside spinecho MRI a dynamic contrast-enhanced study was performed immediately after IV application of Gd-DTPA using 10 sequential FLASH-2Dsequences, each with a duration of 15 s. Images were evaluated visually by three radiologists in a blinded fashion. RESULTS: In 41/62 patients pre-operative tumor staging with the dynamic contrast-enhanced study was confirmed by the histological examination after surgery. MRI with spinecho sequences yielded correct staging in 30/62 patients (P = 0.028). Staging of superficial bladder cancer was more accurate with dynamic contrast-enhanced MRI than with conventional MRI (P = 0.024). Overstaging was observed in some patients with stage pT1 tumors. Furthermore, postoperative changes of the bladder wall could be differentiated from cancer due to significantly earlier contrast enhancement of bladder cancer compared with postoperative and inflammatory alterations (P < 0.001). CONCLUSION: Contrast-enhanced dynamic MRI is a helpful addition in the presurgical T-staging of bladder cancer.

[Paraspinal conduction anesthesia from the viewpoint of the patient--exemplified by a selected urologic patient sample]. / Die rückenmarksnahe Leitungsanästhesie aus der Sicht des Patienten--am Beispiel eines ausgewählten urologischen Patientengutes.

Patients operated because of benign prostatic hyperplasia in spinal cord close block anesthesia were interviewed by a questionnaire. The well known and accepted medical advantages of this method are completed by the results of an examination of the psychic situation. Only 6 out of 66 patients have negative feelings of awakeness during the operation.