[Tumor-like lesions of bone]. / Tumorähnliche Knochenläsionen.

Historically, tumor-like lesions of bone were defined as non-neoplastic bone lesions. Today, however, some of them are considered real neoplasms. They are among the most frequent bone lesions. They usually grow slowly, but occasionally they grow rapidly. Many of them can be diagnosed by plain films alone; in others, CT and MRI yield additional features for a correct diagnosis. Some lesions do not need treatment; others should be resected, and some may even recur. Non-ossifying fibroma, juvenile and aneurysmal bone cysts, fibrous and osteofibrous dysplasia and eosinophilic granuloma are presented.

[MRI morphology of bone tumors and tumor-like lesions]. / MRT-Morphologie von Knochentumoren und tumorähnlichen Läsionen.

Spin-echo sequences are mandatory at MRI for staging and characterization of bone tumors and tumor-like lesions. MRI is of minor value in the estimation of the malignant potential of an osseous lesion. Although many bone tumors and tumor-like lesions present similar morphology at MRI, some entities can be diagnosed with good reliability. These include chondrogenic tumors, solitary and aneurysmal bone cysts, giant cell tumors, lesions containing fatty tissue and, to a certain extent, osteoid-osteomas and osteoblastomas. Practical advice is given regarding when to perform a MRI study in cases of tumor suspicion. Further advice is given for cases a tumor is found incidentally at a MRI study, how to modify the study and which kind of tumor may be present.

[Basic diagnostics of bone tumors]. / Basisdiagnostik von Knochentumoren.

Primary bone tumors and tumorlike lesions are rare. However, they are found on x-ray incidentally or during examination of a painful skeletal region. This article explains how to diagnose such a detected lesion. Primarily, the growth rate is analyzed according to the Lodwick classification to differentiate a benign from a malignant lesion. With that, the lesser experienced clinician has solved the most important task in the diagnostic process. Further steps include analysis of the tumor matrix and the location within the tumor-bearing bone to make a specific diagnosis. Finally, the patient's age is included as a further parameter. With an optimized combination of the different parameters, the expert achieves a correct specific diagnosis in about 80% of cases.

Imaging and differential diagnosis of primary bone tumors and tumor-like lesions of the spine.

Primary bone tumors and tumor-like lesions of the spine and sacrum are rare. A wide variety of benign and malignant lesions can arise in the spine and sacrum. Specific diagnosis is based on the location, matrix appearance and patient's age at time of presentation. In this location CT is often necessary for matrix characterization, particularly, detection of mineralization. MRI can be helpful for further characterization and radiological differential diagnosis. An overview of age distribution and imaging features including pattern for differential diagnosis is presented for the most frequent primary spinal bone tumors and tumor-like lesions.

[Extranodale lymphomas infradiaphragmal]. / Extranodale Lymphome infradiaphragmal.

Non-Hodgkin's lymphoma occurs in up to 30% primarily out of lymph nodes (extranodal). In the abdomen, beside spleen and liver the gastrointestinal tract is often and the kidneys are not rarely affected. However, each abdominal organ and peritoneal space, muscles and skin can be affected at various frequencies. While an exclusive manifestation within an organ without lymphadenopathy is rather unusual, often a concomitant lymphadenopathy is present. A secondary infiltration of an organ due to widespread lymphoma,hematogenous spread or relapse occurs more frequently. On the other hand, in Hodgkin's lymphoma, except spleen and liver other organs are only rarely affected. Mostly it occurs by direct invasion from adjacent pathological lymph nodes.Frequency, morphology at and problems of imaging of extranodal lymphoma are presented.

[Benign cartilaginous tumors]. / Benigne Knorpeltumoren.

Benign cartilaginous tumors are the most frequent bone tumors. At radiography they are not seldomly detected as an additional finding. Most osteochondromas and enchondromas can be diagnosed radiologically based upon their morphology. However, differentiation of a low grade chondrosarcoma from an enchondroma is difficult, and differentiation of a peripheral chondrosarcoma from an osteochondroma can be difficult. Clinics, localization, age distribution and morphology of benign cartilaginous tumors are presented and the most important differential diagnoses are given.

[Histiocytosis X of the lung after successfully treated pulmonary metastatic ovarian carcinoma]. / Histiozytosis X der Lunge nach erfolgreich therapiertem pulmonal metastasierenden Ovarialkarzinom.

We report a case of a woman who developed a pulmonary histiocytosis X after treatment of an ovarian cancer with intrapulmonary metastases. Development of histiocytosis X seems to be coincidental and not to be therapy induced. Inspired by this case radiological findings of pulmonary histiocytosis X are presented.

[Diagnostic imaging of hemophilic osteoarthropathy]. / Bildgebende Diagnostik der hämophilen Osteoarthropathie.

Presently, the degree of the hemophilic arthropathy is estimated by the classification system of Pettersson, which is recommended by the Orthopedic Advisory Committee of the World Federation of Hemophilia. This classification system bases upon plain radiographs of the joints and analyses only those changes which represent the progression of the arthropathy. The value of this classification system has been established by inter-observer studies. However, it shows drawbacks at the exact definition of some parameters. Presently, it is more valuable for longitudinal than for transversal studies. Due to the possibilities of an adequate substitution therapy, only minor degrees of an arthropathy are observed in children. The ankle joints are more severly affected than the elbow joints and they more than the knee joints. This distribution is explained by an increasing sports activity in children. If more than 3 joint bleedings occur within a year the invent of an arthropathy must be presumed. Because the classification system of Pettersson analyses only osseous changes representing late changes, important early changes like hypertrophy of the synovialis and focal destruction of the joint cartilage are overlooked. Magnetic resonance imaging is suitable to show these early changes reliably. MRI can be recommended for the investigation of recurrently bleeding joints without evidence of major osseous changes and for decision making to perform a synovectomy.

Radiographic diagnosis of hemophilic osteoarthropathy.

Presently, the degree of the hemophilic arthropathy is estimated by the classification system of Pettersson, which is recommended by the Orthopedic Advisory Committee of the World Federation of Hemophilia. This classification system bases upon plain radiographs of the joints and analyses only those changes which represent the progression of the arthropathy. The value of this classification system has been established by interobserver studies. However, it shows drawbacks at the exact definition of some parameters. Presently, it is more valuable for longitudinal than for transversal studies. Due to the possibilities of an adequate substitution therapy, only minor degrees of an arthropathy are observed in children. The ankle joints are more severly affected than the elbow joints and they more than the knee joints. This distribution is explained by an increasing sports activity in children. If more than 3 joint bleedings occur within a year the invent of an arthropathy must be presumed. Because the classification system of Pettersson analyses only osseous changes representing late changes, important early changes like hypertrophy of the synovialis and focal destruction of the joint cartilage are overlooked. Magnetic resonance imaging is suitable to show these early changes reliably. MRI can be recommended for the investigation of recurrently bleeding joints without evidence of major osseous changes and for decision making to perform a synovectomy.

[Punch biopsy or fine needle aspiration biopsy in percutaneous lung puncture?]. / Stanzbiopsie oder Feinnadelaspirationsbiopsie bei der perkutanen Lungenpunktion?

PURPOSE: The diagnostic accuracy and rate of complications of CT-guided core biopsies (CB) from suspected tumors of the chest were compared to the accuracy a complications of fine-needle aspiration biopsies (FNAB). METHODS: The accuracy in the diagnosis of a benign or malignant lesion of 79 FNAB (19.5 G self-aspirating cutting needle) and of 83 CB (18 G automated core biopsy) and the rates of pneumothorax, pleural drainage and hemoptysis were retrospectively evaluated. RESULTS: With FNAB, the sensitivity for malignant lesions was 62.1% and the accuracy 68.4%. With CB the sensitivity amounted to 85.9% and accuracy to 86.7%. The rate of pneumothorax was 25.3% following FNAB, with a drainage rate of 5.1% compared to 19.3% and 6.0%, respectively, following CB. The rate of pneumothorax and drainage increased with increasing path length through aerated lung. In advanced emphysema, the pneumothorax rate did not increase; however, in pneumothoraces, pleural drainage was mandatory in 20% of FNAB and in 100% of CB. Hemoptysis without any therapeutic consequences occurred in 3.8% following FNAB and in 6.0% following CB. CONCLUSIONS: With CB diagnostic accuracy can be clearly increased without an obvious increase in the complication rate. However, in patients with obvious emphysema, the pleural drainage rate of pneumothorax may be higher following CB.

Radiological features of the visceral and skeletal involvement of hemochromatosis.

Hemochromatosis is a multisystem disorder produced by the excessive accumulation of iron in visceral organs and the musculoskeletal system. Clinically the disease may be silent, but characteristic radiological features may point to the diagnosis. The increased iron stores in the organs involved, especially in the liver and pancreas, result in an increased attenuation at unenhanced CT and an decreased signal intensity at MR imaging. Hemochromatosis arthropathy includes degenerative osteoarthritis and chondrocalcinosis. The distribution of the arthropathy is distinctive, but not unique, frequently affecting the second and third metacarpophalangeal joints of the hand.