[Establishing a protein signature from prostate tissue biopsies]. / Erstellung eines Proteinprofils aus Gewebeproben der Prostata.

The prostate-specific antigen test (PSA) has been a major factor contributing to a better management of prostate cancer. The low specificity limits its use in diagnosis especially in early detection of prostate cancer. Multiply expressed proteins need to be identified to establish a disease-specific protein signature that distinguishes between cancerous and noncancerous tissue. The first aim of our study is to identify differentially expressed proteins in both tissues using two-dimensional gel electrophoresis and subsequent mass spectrometry. We elucidated whether prostate biopsies are useful. First results have shown a different protein expression pattern in cancerous and noncancerous tissue. PCR revealed an increasing amount of mRNA for some upregulated proteins. We conclude that biopsies are useful material to establish protein expression patterns.

Expression of annexin AI in conventional renal cell carcinoma (CRCC) correlates with tumour stage, Fuhrman grade, amount of eosinophilic cells and clinical outcome.

There is increasing evidence that Annexin AI (ANX AI) expression is dysregulated in several carcinomas and tumour cell lines. In order to gain insight into the putative role of ANX AI in tumorigenesis, clinical outcome and metastatic potential of conventional renal cell carcinomas (CRCCs) we investigated the expression of ANX AI in CRCCs and metastases. Furthermore, it was elucidated whether ANX AI overexpression affects migratory potential in Caki-1 cells. ANX AI immunohistochemistry was performed on 33 samples of CRCCs and 10 metastases. ANX AI expression was assessed in 12 samples by 2-dimensional gelelectrophoresis (2-DE), subsequent mass spectrometry and RT-PCR. Immunohistochemical data were statistically correlated with pathological parameters, amount of eosinophilic cells and clinical outcome. Furthermore, a haptotactic migration assay was done on Caki-1 cells transfected with ANX AI. Immunostaining for ANX AI was found in 18 tumours and all metastases investigated. Intensity of immunohistochemical staining correlated to Fuhrman grade, amount of eosinophilic cells and clinical outcome. 2-DE and RT-PCR confirmed the presence of ANX AI in neoplastic tissue. Overexpression of ANX AI did not significantly influence cell migration. From these findings ANX AI expression seems to be related to Fuhrman grade, clinical outcome and metastatic potential of CRCCs. Thus ANX AI could serve as a prognostic marker for tumour progression.

[Percutaneous vertebroplasty -- the role of osseous phlebography]. / Die perkutane Vertebroplastie -- Rolle der ossären Phlebographie.

PURPOSE: To evaluate the usefulness of osseous phlebography preceding percutaneous vertebroplasty. MATERIALS AND METHODS: Seventy-five patients with painful osteoporotic (57) or malignant (18) vertebral fractures were treated by percutaneous vertebroplasty under fluoroscopic control. Prior to cement injection, osseous phlebography was performed, with 247 phlebographic studies included in the retrospective correlation with radiographic and CT images. Clinical results were assessed by standardized questionnaire. RESULTS: In 69/75 (92 %) patients, pain and mobility improved and medication needed for pain control decreased significantly after vertebroplasty. Two clinically apparent complications occurred. The results of osseous phlebography prompted correction of the needle position in 34/247 (14 %) of the procedures and cancellation of the cement injection in 19/247 (8 %). No complications occurred related to osseous phlebography. CT was superior to conventional radiography in detecting extra-osseous cement leakage (106/247 by CT vs. 63/247 by conventional radiography). The cement leakage was asymptomatic in 104/106 (98 %) cases for the duration of follow-up. DISCUSSION: Osseous phlebography prior to percutaneous vertebroplasty had a significant impact on the procedure in our retrospective study and was able to predict the cement distribution in the majority of cases. However, phlebography was unable to foresee and therefore prevent 2 clinically relevant complications. Complications related to phlebography did not occur.

Combined 123I-FP-CIT and 123I-IBZM SPECT for the diagnosis of parkinsonian syndromes: study on 72 patients.

72 consecutive patients with suspected parkinsonian syndromes (PS) were studied by dopamine transporter (DAT) and D2 receptor SPECT in order to evaluate the accuracy of combined SPECT imaging. In the follow-up, the patients were diagnosed as having Parkinson's disease (PD, n = 25), dementia with Lewy bodies (DLB, n = 6), multiple system atrophy (MSA, n = 13), progressive supranuclear palsy (PSP, n = 8), corticobasal degeneration (CBD, n = 9), and essential tremor (ET, n = 11). Using the iteratively estimated optimal cutoffs, DAT was reduced in 57/61 PS patients, whereas all ET patients were identified as "normal". Reduced D2 receptor binding had 7/13 patients with MSA, 6/8 patients with PSP, 2/9 patients with CBD and no ET, PD or DLB patients. FP-CIT SPECT allows an accurate detection of nigrostriatal affection in neurodegenerative PS. IBZM SPECT is useful to approve the diagnosis of PSP and MSA although a normal finding cannot exclude an atypical PS. IBZM SPECT seems to be of restricted value in CBD.

[Percutaneous vertebroplasty]. / Perkutane Vertebroplastie.

PURPOSE: To describe the procedure of percutaneous vertebroplasty and to present our first clinical results of patients treated for benign or malignant painful vertebral body disease. MATERIAL AND METHODS: We performed percutaneous vertebroplasty in 31 painful lesions of the spine. Liquid bone cement was injected into the affected vertebral body using fluoroscopic guidance through a bilateral transpedicular approach. Etiology of the bone disease was assessed by biopsy. Pain intensity was assessed before and 1 week after the procedure by standardized catalogue. RESULTS: Percutaneous vertebroplasty was performed in 17 thoracic and in 14 lumbar spine bodies of benign (n = 23) or malignant (n = 8) disease; no clinically relevant complications occurred. All patients reported significant pain relief 1 week after the intervention. One week after treatment, patients were pain-free in 15/31 vertebral bodies, and reported mild residual pain not necessitating narcotic medication in 16/31 cases. CONCLUSION: In accordance with the literature, percutaneous vertebroplasty proved to be a highly effective, minimal invasive interventional procedure to treat severely painful bone lesions of benign and malignant origin.

Removal of contrast media by different extracorporeal treatments.

BACKGROUND: Although the capability of extracorporeal treatments after administration of contrast media to prevent radiocontrast-induced nephropathy is controversial, haemodialysis is performed in many institutions after radiographic procedures. There are conflicting reports on the efficacy of different dialysers and treatment modalities to remove contrast media. METHODS: We compared the contrast medium-removing ability of different extracorporeal treatments in a randomized trial. Thirty-nine patients on chronic renal-replacement therapy or with chronic renal failure were randomized to receive low-flux haemodialysis (Low-HD, n=10), high-flux haemodialysis (High-HD, n=10), online haemodiafiltration (HDF, 10 litre substitution, n=10) and online haemofiltration (HF, 18 litre substitution, n=9) after administration of contrast medium during routine radiological procedures. Plasma concentrations of contrast medium (iopromide or iomeprol) were measured by energy-dispersive X-ray fluorescence analysis. RESULTS: The extraction ratio for contrast media was 0.64+/-0.1 for Low HD (P<0.05 vs. High-HD and vs. HDF), 0.74+/-0.1 for High-HD (P<0.05 vs. HF), 0.81+/-0.1 for HDF (P<0.05 vs HF), and 0.62+/-0.1 for HF. Mean extracorporeal plasma clearances were 82+/-2 for Low-HD (P<0.05 vs. High-HD and vs HDF), 100+/-2 for High-HD, 115+/-4 for HDF (P<0.05 vs. HF), and 86+/-5 ml/min for HF. CONCLUSIONS: We conclude that HDF and High-HD remove contrast media more effectively than Low-HD and HF during the time of each treatment session. However, whether this is also true for the overall elimination of contrast media by these different procedures needs to be addressed in future studies, by a precise assessment of the drug time course after the session.

Arterial switch procedure for D-transposition of the great arteries: quantitative midterm evaluation of hemodynamic changes with cine MR imaging and phase-shift velocity mapping-initial experience.

PURPOSE: To evaluate cine magnetic resonance (MR) imaging and phase-shift velocity mapping for assessment of the hemodynamic relevance of stenotic segments or specific hemodynamic changes in the great vessels after an arterial switch procedure for correction of D-transposition of the great arteries. MATERIALS AND METHODS: Twenty consecutive patients (age range, 2-17 years) with an acoustic window that was insufficient for Doppler transthoracic echocardiography were included in the study. Flow and diameter measurements of the pulmonary arterial trunk and its primary branches were performed with phase-shift velocity mapping and cine MR imaging. RESULTS: There were good correlations between pressure gradients in the pulmonary arteries estimated with MR imaging and those measured with Doppler echocardiography (r = 0.83, n = 15) and cardiac catheterization (r = 0.90, n = 13). Cine MR imaging revealed that the diameters of the right and left pulmonary arteries decreased with the expansion of the aorta during systole, which increased the peak velocity. This temporary stenosis was more severe in the right than in the left pulmonary artery and was accompanied by a significantly (P <.05) lower volume flow in the right artery. CONCLUSION: The anatomic situation after arterial switch repair tended to produce temporary stenoses in the primary pulmonary arterial branches, with significant changes in hemodynamics. These changes may affect the long-term outcome and go undetected with other imaging modalities.

Successful recanalization of late portal vein thrombosis after liver transplantation using systemic low-dose recombinant tissue plasminogen activator.

Portal vein thrombosis (PVT) is an infrequent complication following hepatic transplantation. However, deterioration of liver function and accompanying complications may be life threatening. Several attempts of surgical or percutaneous transhepatic procedures have been described. In some cases high dose fibrinolytic regimens have been successful. We describe the case of a male liver recipient with recurrent liver fibrosis due to hepatitis B reinfection and late portal vein thrombosis 45 months after transplantation. Complete recanalization was achieved using systemic low dose recombinant tissue plasminogen activator (rt-PA).

Contribution of color and power Doppler sonography to the differential diagnosis of acute and chronic rejection, and tacrolimus nephrotoxicity in renal allografts.

The aim of the present study was to differentiate acute rejection, chronic rejection, and tacrolimus nephrotoxicity with color and power Doppler imaging of renal transplants. One hundred examinations were obtained from 45 patients. Pulsatility and resistive indices were calculated from color Doppler images. The grade of renal vascularization was quantified using computer-assisted pixel analysis in a rectangular region-of-interest. The percentage of vessel-covered renal parenchyma (POV) was calculated using a histogram that discriminated renal vessels from renal parenchyma via power Doppler images. Furthermore, the distance from the most peripherally located vessels to the renal capsule (PVD) was measured. A reduced POV < or = 55% proved to be the best discriminator when chronic rejection was suspected (sensitivity 79%, specificity 87%). Tacrolimus nephrotoxicity showed not only a moderate elevation of the Doppler signal but also an increased PVD > or = 3.9 mm and a normal POV. We conclude that the evaluation of renal vessels by power Doppler images improves diagnostic accuracy for patients with renal allografts.

D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions.

RATIONALE AND OBJECTIVES: This study sought to evaluate prospectively the diagnostic potential of unenhanced and enhanced color Doppler and power Doppler for the differentiation of tumors and tumorlike lesions of the breast. METHODS: Ninety-two patients with 110 tumors or tumorlike lesions of the breast were investigated by unenhanced and enhanced color and power Doppler ultrasound. The sonomorphologic aspects of vascularization were analyzed. In addition, maximal systolic frequency shift, resistance, and pulsatility indices were determined. RESULTS: In 15 (24%) of 63 primary carcinomas, 15 (68%) of 22 fibroadenomas, and all (100%) of 14 postoperative lesions, the sonomorphologic analysis for the differential diagnosis of breast tumors was improved after contrast enhancement in color Doppler mode. In comparing unenhanced color Doppler to power Doppler, the latter was found to be slightly superior (sensitivity, 60% vs. 67%; specificity, 39% vs. 45%, respectively); after enhancement, both modes were equivalent (sensitivity, 100% vs. 100%; specificity, 95% vs. 95%, respectively). Signal enhancement resulted in a significant improvement in sensitivity and specificity (P < 0.01). Typical signs of malignancy were irregular vessel calibers, serpiginous courses, penetration of the tumor's margin, and irregular reticular vascularization. The quantitative parameters proved not to be helpful for the differential diagnosis of breast tumors. CONCLUSIONS: By improved analysis of the vascularization pattern, d-galactose-enhanced color Doppler sonography was found to provide more reliable differential diagnostic information than unenhanced Doppler ultrasound in tumors and tumorlike lesions of the breast.

[The diagnosis and imaging of the a. hepatica after orthoptic liver transplantation--a comparison of frequency-modulated and amplitude-modulated color Doppler sonography]. / Diagnostik und Darstellung der A. hepatica nach orthotoper Lebertransplantation--Vergleich von frequenzmodulierter und amplitudenmodulierter Farb-Doppler-Sonographie.

PURPOSE: We examined whether amplitude-modulated color Doppler (power Doppler) sonography provides a better anatomic imaging of the vascular course of the hepatic artery after liver transplantation. PATIENTS AND METHODS: 82 patients were examined with Doppler sonography after liver transplantation. The distal section of the hepatic artery was imaged both with frequency-modulated color Doppler (color Doppler) and power Doppler and a Doppler spectrum derived from each mode for determination of the flow velocity. RESULTS: Native imaging of the hepatic artery was possible in 78/82 patients, in 2/82 patients only after administration of Levovist, and in 2/82 patients it could not be seen. In these two patients the diagnosis of hepatic artery occlusion was confirmed by angiography. The anatomic course was demonstrated more longitudinally by power Doppler than by color Doppler (p < 0.001; chi 2 test) which made the angle correction easier. A disadvantage of power Doppler was the lack of image contrast to the portal veins; thus evaluation of the vascular course in this section was better possible with color Doppler by means of a specifically generated aliasing in the flow of the hepatic artery (p < 0.001; chi 2 test). Determination of the flow velocity showed no significant differences between color and power Doppler supported duplex sonography. CONCLUSIONS: The combined use of color Doppler and power Doppler improves visualization of the hepatic artery after liver transplantation. The lack of visualization of the vessel after administration of Levovist is diagnostic for occlusion of the vessel.

[Blood flow quantification in hemodialysis shunts by phase contrast magnetic resonance angiography (PC-MRA) compared with duplex sonography]. / Flussquantifizierung in Hämodialyseshunts mittels Phasenkontrast-Magnetresonanzangiographie (PC-MRA) im Vergleich zur Duplex-sonographie.

PURPOSE: Aim of this study was to evaluate whether phase contrast MR angiography (PC-MRA) could provide additional functional information besides morphology in the assessment of haemodialysis fistulae. MATERIAL AND METHOD: Twenty-two patients (11 male, 11 female), aged 22-77 years, were examined. MR images were obtained with a 1.5 T Gyroscan ACS-NT (Philips, Best, Netherlands) using a high-resolution wrap-around coil. In addition to MRA blood-flow measurements were performed with a gradient-echo sequence (TR 14 ms, TE 5-5.5 ms, flip-angle 15 degrees, 6 mm slice thickness, retrospective gating, matrix 96:128) in the venous and arterial section of the fistulae. Doppler flow measurements were performed at the same position with a Sonoline Elegra (Siemens AG, Erlangen) using a 7.5 MHz transducer. RESULTS: Both methods of flow-volume measurements showed a good correlation (r = 0.94 in the arterial section, r = 0.90 in the venous section, p < 0.001). The average calculated blood flow was measured 11% (arterial section) and 12.8% (venous section) higher with Pulsed Waved Doppler as compared to PC-MRA. CONCLUSION: PC-MRA with a high-resolution wrap-around coil is a reliable method for measuring functional parameters like flow-volume and flow velocity in haemodialysis fistulae and a useful complement to the visualisation capabilities of MRA.

[Imaging tumor extension of renal cell carcinomas with magnetic resonance tomography. Improved tumor-tissue contrast with Gd-DTPA-assisted spin-echo sequences and simultaneous fat suppression]. / Darstellung der Tumorausdehnung von Nierenzellkarzinomen mit der Magnetresonanztomographie. Verbesserung des Tumor-Gewebekontrastes mittels Gd-DTPA unterstützter Spin-Echo-Sequenzen und gleichzeitiger Fettsättigung.

PURPOSE: To evaluate the use of contrast-enhanced T1-weighted images with fat suppression (T1FS) to improve the contrast-to-noise ratio of renal cancer and renal parenchyma as well as perirenal fat. METHODS: 25 patients with histologically proven unilateral renal cancer after nephrectomy were examined before surgery. In addition to plane and contrast-enhanced T1-weighted as well as T2-weighted spin-echo images, all patients had T1 FS immediately after administration of Gd-DTPA in two planes. The contrast-to-noise ratio was calculated using circular regions-of-interest which outlined the tumor, the renal parenchyma, pyelon, and the perirenal fat. RESULTS: T1 FS significantly improved the contrast-to-noise ratio of renal cancer and renal parenchyma compared to all conventional spinecho sequences (p < 0.001; Wilcoxon-Test). Compared to contrast-enhanced T1-weighted images without fat-suppression T1 FS yielded a higher CNR of the tumor, the perirenal fat and the pyelon. Another advantage was the absence of the chemical-shift artifact which is mostly pronounced in T2-weighted images and a reduced number of observed artifacts due to breathing. CONCLUSION: T1 FS should replace conventional contrast-enhanced T1-weighted spin-echo images in the work-up of renal cancer using MRI.

[Color-coded signal-enhanced duplex ultrasonography of space-occupying intramammary processes]. / Farbkodierte signalverstärkte Duplexsonographie raumfordernder intramammärer Prozesse.

PURPOSE: Prospective comparison of plain and signal-enhanced frequency and amplitude-modulated colour Doppler ultrasound of intramammary tumours to evaluate new criteria for diagnostic analysis. METHODS: Frequency and amplitude-modulated colour Doppler examination with qualitative and quantitative analysis of 80 potentially malignant intramammary lesions were performed before and after application of d-galactose. RESULTS: Signal-enhanced sonography revealed a typical vessel morphology of primary and recurrent breast cancer facilitating differential diagnosis. In 18 (frequency modulated US) or 16 (amplitude modulated US) of 51 carcinomas, the typical malignant vascularisation structure was sufficiently visible only after application of the signal enhancing agent. In 50% of the fibroadenomas, Doppler analysis of the vessels was possible only after application of d-galactose. CONCLUSION: The application of d-galactose provides additional criteria for the differential diagnosis of breast lesions due to improved visualisation of the vascularisation structure.

Loss of dopamine-D2 receptor binding sites in Parkinsonian plus syndromes.

UNLABELLED: This study analyzed temporal changes of striatal dopamine-D2 receptor binding during the course of different extrapyramidal movement disorders using 123I-iodobenzamide (IBZM) SPECT. METHODS: Eighteen patients (9 with Parkinson's disease, 9 with parkinsonian plus syndrome) were followed for 11-53 mo. Dopamine-D2 receptor binding was assessed using 123I-IBZM SPECT at the beginning and at the end of the follow-up period. SPECT data were acquired 120 min postinjection of 3-5 mCi 123I-IBZM. A semiautomated algorithm was applied to the raw data for semiquantitative evaluation of regional cerebral receptor binding. RESULTS: Intraobserver (r = 0.992) and interobserver (r = 0.930) variance was low for the semiautomated interpretation of the SPECT examination of the dopaminergic D2 receptor binding, reflecting a highly reproducible SPECT algorithm. Mean specific dopamine-D2 receptor binding was lower in patients with parkinsonian plus syndrome compared to patients with Parkinson's disease on the initial (p < 0.001) as well as the follow-up study (p < 0.001). In patients with Parkinson's disease, we observed an unaffected receptor binding compared to a reduced binding of radiotracer in patients with parkinsonian plus syndrome during the course of the disease (p < 0.001). CONCLUSION: During the follow-up, patients with Parkinson's disease showed a constant dopamine-D2 receptor binding. In contrast, patients with parkinsonian plus syndrome revealed a decline of the binding of dopamine-D2 receptor. These findings are in agreement with histopathological data that demonstrated a preserved dopamine-D2 receptor status in patients with Parkinson's disease and a decline of the dopamine-D2 receptors in patients with parkinsonian plus syndrome. SPECT examinations using 123I-IBZM are useful for assessing dynamic changes of dopamine-D2 receptors in extrapyramidal movement disorders. Semiquantitative SPECT evaluations may provide valuable information for clinical management and prognosis of the patient with extrapyramidal movement disorders.

Do ultrasonic contrast agents artificially increase maximum Doppler shift? In vivo study of human common carotid arteries.

The aim of this study was to establish whether an increase of maximum Doppler shift occurs in the human common carotid artery after the administration of Levovist, an ultrasonographic echo enhancer. Twenty common carotid arteries of 10 patients were examined. Spectral Doppler waveform examinations were performed before and after administration of Levovist using an Acuson 128 XP 10 and a 7.0 MHz transducer probe. Time averaged mean velocity, peak velocity, maximum Doppler shift, and spectral Doppler indices (pulsatility index, resistive index, systolic-diastolic ratio) were assessed. No significant changes in any of the measured parameters, including maximum Doppler shifts, peak velocity (P = 0.35, Wilcoxon rank sum test), pulsatility indices (P = 0.70), resistive indices (P = 0.98), or other spectral indices, were found. We conclude that an increase in Doppler shift does not inevitably occur after the administration of a signal enhancer when examining the human common carotid artery.

Quantitative estimation of I-123-Iomazenil receptor binding in temporal lobe epilepsies using two SPECT acquisitions--comparison with the regional cerebral blood flow and a compartment model.

AIM: To compare published fractional rate constants of I-123-Iomazenil (IMZ) and C-11-Flumazenil (three-compartment/four-parameter model) with a I-123-Iomazenil receptor index calculated from two SPECT acquisitions and to compare the receptor index of the epileptogenic area with the contralateral side in patients with unilateral temporal lobe epilepsies. METHODS: 28 patients were studied. 13/28 patients had a drug-resistant unilateral temporal lobe epilepsy with a successful focus localisation performed by an extensive video/EEG monitoring. 15 other patients with clinically suspected focal epilepsy and a normal MRI and IMZ SPECT scanning were used as controls. SPECT scanning was performed in all patients 15 and 100 min after intravenous injection of 111 MBq IMZ and 10 min after application of 740 MBq Tc-99m-HMPAO. Quantification of the regional uptake was performed using ROI-technique and the specific and non-specific binding of IMZ was calculated. The receptor index was calculated by the difference of the specific binding from 15 to 100 min p.i. divided by the time interval. RESULTS: The receptor index showed a linear correlation with recently published fractional rate constants k3 (r = 0.69 and 0.67; p = 0.15) and a moderate correlation with the k4 constant (-0.53 and -0.43; p = 0.28) by the means of C-11-Flumazenil PET and I-123-Iomazenil SPECT studies, respectively. However, statistical significance was not reached due to the few data points available from the published reports. Furthermore, the IMZ receptor index was lower in the epileptogenic area of patients with unilateral temporal lobe epilepsies compared with their contralateral side (p = 0.02; Wilcoxon-test). The IMZ receptor index showed a weak correlation with the regional cerebral blood flow independent of the evaluated region (r < 0.4; p < 0.05). CONCLUSION: The IMZ receptor index indicated to be a simple routine approach to estimate the fractional rate constant k3 (r = 0.67). The lower value of the receptor index within the epileptogenic area might be due to a lower receptor density. However in further studies, IMZ might be a helpful tool to find out subtle changes of the receptor affinity due to its approximately 30-fold higher ligand-receptor affinity compared to C-11-Flumazenil.