[The description of meniscopathy in the sense of German occupational disease No. 2102 : Results of an interdisciplinary working group]. / Das Krankheitsbild im Sinne der Berufskrankheit 2102 Meniskopathie : Ergebnisse einer interdisziplinären Arbeitsgruppe.

On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

[Back pain : State of the art and guidelines]. / Rückenschmerz : Aktuelle Entwicklungen und Leitlinien.

Pain in general and back pain in particular are associated with a variety of pathological, clinical, and sociocultural factors. There are numerous clinical and therapeutic treatment as well as imaging-options available and comprehensive knowledge is required to meet the individual clinical needs of those affected. This requires a high degree of interdisciplinary cooperation. In addition, back pain is covered differently by various numbers of insurance companies. Imaging methods, including the example of periradicular image-assisted interventions, are presented with regard to their indication and efficiency. The existing guidelines and evaluation recommendations with different structural and targeted approaches are discussed in addition to extensive legal aspects in the literature. In addition, the structured reports and the certificated curricula of the AG Bildgebende Verfahren des Bewegungsapparates (Working Group "Imaging Procedures of the Musculoskeletal System") of the Deutsche Röntgengesellschaft ("German Society of Radiology") are recommended for the quality assurance.

[Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton]. / Arthrose-Klassifikationen : Modifizierungsvorschlag für die Kriterien nach Kellgren und Vallotton.

BACKGROUND: In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50 years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. AIM: In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. METHODS: The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X­ray and MRI findings are compared. RESULTS: Suggestions for both a modification of the Kellgren classification as far as the criteria are concerned and a hierarchy (ranking) of X­ray and MRI findings to make clinical decisions more valuable are proposed. CONCLUSION: These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

[Clinical value of bronchoalveolar lavage]. / Uitlité clinique du lavage bronchoalvéolaire.

Bronchoalveolar lavage (BAL) is a minimally invasive procedure used to characterize the status of the alveolar space. Standardization of the procedure and the analysis of samples taken is essential for their proper interpretation. In nonresolving or ventilator-associated pneumonia, BAL contributes to the detection of resistant pathogens and noninfectious etiologies. In immunocompromised hosts with radiological infiltrates, BAL should be performed early during work-up since outcome is significantly modified in this population group. In cases of interstitial lung disease, BAL can exclude infectious or neoplastic causes. Associated with a clinical and radiological evaluation, it provides valuables additional diagnostic information.

[Bone infections]. / Knocheninfektionen.

Even in recent traumatology and orthopedic surgery infectious diseases of the bone (i.e. osteomyelitis) and it's surrounding tissues remain serious complications. The therapy is demanding and oftenly does not lead to a complete restitutio ad integrum. In order to create the optimal treatment one has to have a profound knowledge about the "state of the art" therapy of bone infections and the basic phases: Reassurance of the local infection (bone and surrounding tissues) and reconstruction of the bone and surrounding tissues. The local infection treatment is based on the consequent surgical eradication of infected tissue. In addition (as a supportive therapy) antibiotics have to be applied according to the local and systemic response of the patient to the infection. Also further supportive methods like hyperbaric oxygenation may be taken into consideration. The following paper provides an overview of diagnostic features and the different surgical procedures as well as the current literature in order to reach the above mentioned goals.

[Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)]. / Zur Definition der Diagnose Osteomyelitis - Osteomyelitis-Diagnose-Score (ODS).

AIM: The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. METHOD: For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. RESULTS: Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. CONCLUSION: The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis.

[Imaging diagnostics of osteitis, osteomyelitis and joint infections]. / Bildgebende Diagnostik bei Osteitis/Osteomyelitis und Gelenkinfekten.

Imaging diagnostics and surgical treatment of bone and joint infections are of paramount interest. The main purpose of our survey is to give a detailed overview about methods, indications, image criteria and efficiency of imaging diagnostics as a state of the art presentation. In conclusion we attempt to give some recommendations for clinical scenarios and diagnostic procedures concerning bone and joint infections. This paper has been prepared under the patronage of the AG Septische Chirurgie of the Deutsche Gesellschaft für Unfallchirurgie in Germany. It is our aim to update the paper with respect to the technical and clinical improvements and to publish it again after a number of years.

Image data compression in diagnostic imaging: international literature review and workflow recommendation.

PURPOSE: Today healthcare policy is based on effectiveness. Diagnostic imaging became a "pacesetter" due to amazing technical developments (e. g. multislice CT), extensive data volumes, and especially the well defined workflow-orientated scenarios on a local and (inter)national level. To make centralized networks sufficient, image data compression has been regarded as the key to a simple and secure solution. In February 2008 specialized working groups of the DRG held a consensus conference. They designed recommended data compression techniques and ratios. MATERIAL AND METHOD: The purpose of our paper is an international review of the literature of compression technologies, different imaging procedures (e. g. DR, CT etc.), and targets (abdomen, etc.) and to combine recommendations for compression ratios and techniques with different workflows. The studies were assigned to 4 different levels (0 - 3) according to the evidence. 51 studies were assigned to the highest level 3. RESULTS: We recommend a compression factor of 1 : 8 (excluding cranial scans 1:5). For workflow reasons data compression should be based on the modalities (CT, etc.). PACS-based compression is currently possible but fails to maximize workflow benefits. Only the modality-based scenarios achieve all benefits. CONCLUSION: Imaging equipment manufacturers are encouraged to improve the compression technology of their imaging devices (e. g. freely selectable compression ratios in the output filter). Double compression should be strictly avoided. Lossless compression formats should be switched off.

Strategies for the analysis of osteitic bone defects at the diaphysis of long bones.

Septic diseases of the bone and the immediate surrounding soft tissue, i.e., osteitis, belong to the most alarming findings in recent traumatology and orthopedic surgery. The paramount goal of this therapy is to preserve the stable weight-bearing bones while maintaining a correct axis and proper working muscles and joints, in order to avoid permanent disability in the patient. "State-of-the-art" therapy of osteitis/osteomyelitis therapy has two priorities: eradication of the infection and reconstruction of bone and soft tissue. Surgical treatment of the affected bone segments and soft tissue, followed by reconstructive methods, continues to be the main basic therapy. It is often extremely difficult to decide whether the affected bone segment has to be resected, or whether bone continuity can be preserved. The following paper provides strategies and guidance to help guide decisions in this complex and challenging area.

[Compression of digital images in radiology - results of a consensus conference]. / Kompression digitaler Bilddaten in der Radiologie - Ergebnisse einer Konsensuskonferenz.

PURPOSE: Recommendations for lossy compression of digital radiological DICOM images in Germany by means of a consensus conference. The compression of digital radiological images was evaluated in many studies . Even though the results demonstrate full diagnostic image quality of modality-dependent compression between 1:5 and 1:200, there are only a few clinical applications. MATERIALS AND METHODS: A consensus conference with approx. 80 interested participants (radiology, industry, physics, and agencies) without individual invitation was organized by the working groups AGIT and APT of the German Roentgen Society DRG to determine compression factors without loss of diagnostic image quality for different anatomical regions for CT, CR/DR, MR, RF/XA examinations. The consent level was specified as at least 66 %. RESULTS: For individual modalities the following compression factors were recommended: CT (brain) 1:5, CT (all other applications) 1:8, CR/DR (all applications except mammography) 1:10, CR/DR (mammography) 1:15, MR (all applications) 1:7, RF/XA (fluoroscopy, DSA, cardiac angio) 1: 6. The recommended compression ratios are valid for JPEG and JPEG 2000 /Wavelet compressions. CONCLUSION: The results may be understood as recommendations and indicate limits of compression factors with no expected reduction of diagnostic image quality. They are similar to the current national recommendations for Canada and England .

Alterations of the Wnt signaling pathway during the neoplastic progression of Barrett's esophagus.

Aberrant activation of the Wnt signaling pathway has been reported during neoplastic progression in Barrett's esophagus (BE). However, mutations in APC and CTNNB1 genes were rarely observed. In this study, expression pattern of Wnt ligands, Frizzled receptors and APC, as well as the methylation status of the APC, SFRP1 and SFRP2 promoter genes were investigated in normal esophageal mucosa and in preneoplastic and neoplastic lesions of BE patients. Promoter methylation of APC was found in all BE samples and in 95% of esophageal adenocarcinomas (EAC). Full methylation of APC correlated with lack of expression. In EAC, nuclear translocation of beta-catenin was observed regardless of the expression of APC. WNT2 expression was higher in dysplasia and EAC than in BE, with 20/26 (77%) of the EAC showing high expression of WNT2. SFRP1 methylation occurred in all BE samples and in 96% of EAC, while SFRP2 was methylated in 73% of the normal squamous esophageal mucosa samples. In conclusion, (1) alterations of key regulators of the Wnt signaling are frequent in the pathogenesis of BE; (2) the APC and SFRP1 genes are inactivated by promoter methylation in BE; (3) the WNT2 gene is upregulated along the progression from low-grade dysplasia to EAC.

[Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm]. / Schockraummanagement polytraumatisierter Patienten. Ein Mehrzeilen-CT orientierter Versorgungsalgorithmus.

INTRODUCTION: In the treatment of the seriously injured patient, time is crucial. Clarke et al. showed that in the hypotensive patient with blunt abdominal trauma and bleeding a delay in the surgical treatment over 90 min increases mortality of 1 % every 3 minutes. So called trauma algorithms are used as systematic approach to the seriously injured patient that can be easily reviewed and practiced. One impact of this algorithm is to shorten time in the emergency room and may improve outcome of the patient. The patient outcome is directly related to the length of time between the injury and the beginning to proper definitive care. OBJECTIVE: Are improvements still necessary and possible in the care of the seriously injured patient? New technical developments like multislice-CT are able to shorten time until definitive care. The practicability of an multislice-CT orientated treatment algorithm was evaluated. METHODS: After integration of an multislice-CT into the emergency room the treatment of the seriously injured patient (ISS >16) was changed. Therefore an algorithm which puts the CT diagnostics in the first minutes of the clinical care was developed. RESULTS: 50 patients were treated following the new algorithm. The time in the emergency room decreased from 87 min to 36 min. CONCLUSION: This algorithm requires a differing from previous surgical standards, but it proved to be timesaving, effective and practicable. It makes the beginning of the definitive care possible within the first 40 min after patient arrival in the emergency room.

Digital image DNA cytometry: a useful tool for the evaluation of malignancy in biliary strictures.

BACKGROUND: Cytologic evaluation of the biliary tract strictures is nowadays widely used for distinguishing between benign and malignant lesions but remains a challenge for some problematic cases. Digital Image cytometry (DNA-cytometry) helps cytopathologists to resolve some unclear situations. METHODS: We have analysed 41 specimens of bile duct brushings obtained from patients during ERCP (11 benign cases, 7 suspicious for malignancy cases and 23 malignant cases) by DNA-cytometry and correlated them with the histological biopsy counterpart. RESULTS: All eleven cytological and histological benign cases were DNA-diploid and among 22 patients with malignant cytological and histological diagnosis 21 were DNA-aneuploid. One case considered malignant by the cytopathologist revealed DNA-aneuploid but malignancy could not be confirmed by histology. The analysis of the suspicious for malignancy cases revealed that all DNA-aneuploid cases were malignant and all DNA-diploid cases were benign referring to the follow-up of the patients. The comparison between cytology alone and cytology combined with DNA-cytometry related to the histological diagnosis (gold standard) resulted in a sensitivity of 100% and a specificity of 79% for cytology alone; a specificity of 94% and a sensitivity 92% for DNA-cytometry and a specificity of 93% and a sensitivity of 100% with combined analyses. The positive predictive value was 90% for cytology, 96% for DNA-cytometry and for both analyses. The negative predictive value showed 100% for cytology, 89% for DNA-cytometry and 100% for combined studies. CONCLUSIONS: Despite the limited number of patients involved in the study, the results obtained indicate an increased of specificity and of positive predictive value using DNA-cytometry. These results confirm the pertinence of these method for challenging cases, in conjunction with other available diagnostic tools.

[Comments on the standards for acceptance and consistency testing of systems for digital radiography]. / Kommentierungen zu den Normen zu Abnahme- und Konstanzprüfungen bei digitalen Radiographiesystemen (Projektionsradiographie).

Due to German regulations, acceptance and consistency tests have to be obtained by 12.31.2005 for all equipment used for computed radiography according to special standards published in DIN 6868. This article familiarizes all users with the most important aspects of these standards. In addition, explanatory and background information for establishing these regulations are provided.

Pitfalls in TRAP assay in routine detection of malignancy in effusions.

Telomerase has been found to be reactivated in a majority of cancers but is inactive in most somatic cells. Our principal goal was to determine the potential use of the telomeric repeat amplification protocol (TRAP) assay as marker for malignancy in cytological effusions. The simple selection criterion was the cytological diagnosis, and routine samples were classified into malignant (58 samples) and nonmalignant (233 samples). Of the malignant samples, 44/58 (76%) were positive by TRAP assay. Of the 14 telomerase-negative cytology-positive samples, RNA integrity was poor in 9, indicating suboptimal sample conservation for molecular analysis. In 3 of the remaining 5 samples with a negative TRAP assay, a high number of malignant cells was observed, and these cells might have been telomerase-negative. Thus, the sensitivity of TRAP assay for the presence of malignant cells was about 76%. In the cytologically nonmalignant effusions, the presence of telomerase activity was observed in 24% (55/233). Of these, 6% were highly suspicious for malignancy, 9% were doubtful, and 9% were cytologically nonmalignant effusions confirmed by a follow-up of 12 mo or more. According to these data, the specificity of the TRAP assay to detect tumor cells in effusions ranged only between 82-91%. Our results indicate that, although the TRAP assay is positive in 6-15% of putative malignant effusions, the relatively high number of TRAP false-negative and false-positive cases renders this test unsuitable for routine diagnostic purposes.

Detection of malignant effusions: comparison of a telomerase assay and cytologic examination.

Telomerase is inactive in most somatic cells, but has been found to be reactivated in a majority of cancers. Our principal goal was to test whether the presence of telomerase activity concurred with positive cytology, and was thus of potential use in detecting cancer cells in effusions. The telomeric repeat amplification protocol (TRAP) assay and cytological examination were performed in a blinded fashion on 91 unselected effusions, for which laboratory processing was done according to standard procedures. In our series, 30% (27/91) of samples were found to be malignant by cytology. Of these, 19 (70%) were also positive in the TRAP assay. Of the 8 telomerase-negative cytology-positive samples, RNA integrity was generally poor, indicating suboptimal sample conservation for molecular analysis. Negative cytology in the presence of telomerase activity was observed in 17 effusions. Of these, 11 were from patients with advanced cancer, and thus a diagnosis of malignant effusion should be suspected. The TRAP assay for telomerase activity holds promise in the analysis of effusions, but its routine use as an adjunct to cytology awaits further confirmation of its positive predictive value.

[Kidney spiral CT. Indication, method, results]. / Nieren-Spiral-CT. Indikationen, Durchführung, Ergebnisse.

The introduction on spiral computed tomography (spiral CT) has vastly enriched the methodological diversity of computer-tomographic scans. It allows for the recording of different perfusion or excretion stages of the kidney parenchyma of the urine draining paths by carrying out long-distance, phase-identical multiple examinations of the retroperitoneum. The description of the findings which are characterized by their local and contrasts behavior is possible. The following report describes the indications and technological process of kidney spiral CT using kidney-typical intravenous contrast media. Special emphasis is put on the advantages and limits of multiple phase spiral CT. Decisive preconditions are: 1. specific clinical query, 2. selection of the corresponding phase contrasts of the kidneys and uretra or bladder, 3. exact technical and temporal adjustment of the acquisition parameters. Scanning times are in the range of seconds. The overall examination can be carried out quick and without any major strain on the part of the patient. A sound proof and a general differentiation of focal kidney lesions can be derived from the acquired data. This is also true for kidneys and ureters findings. Bladder findings can be localized and differentiated according to stage. More than two "spiral acquisitions" should be carried out with re-straint taking exposure to radiation into account. Due to the sound registration of focal lesions, its capability of reproduction and its short-time examination, the spiral CT of the kidneys can be said to be the most effective current scanning method of the retroperitoneum following clinical examinations and sonography.

Diffuse metastatic infiltration of a carcinoma into skeletal muscle.

Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report a patient with rapidly progressive contractures due to metastatic infiltration of a carcinoma of unknown origin into the skeletal muscle. This 61-year-old man presented with a 1-month history of rapidly evolving, painful restriction of mobility of his right arm and his legs. Computed tomography showed diffuse metastatic nodules in all muscles, particularly in the hip abductors. Muscle biopsy revealed extensive infiltration of the muscle with carcinoma cells.

Assessment of gastric cancer: value of breathhold technique and two-phase spiral CT.

The purpose of this study was to evaluate the capabilities of subsecond spiral CT in detecting and staging of gastric cancer. Our study included 40 patients with endoscopically detected gastric carcinomas. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of scopolamine and drinking of 500 ml water. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase. Gastric tumour extention and lymph node involvement was assessed. Gastric cancer was detected in 39 of 40 cases (sensitivity 97.5%). Location of the tumour was correctly assessed in all cases. In 31 of the 39 cases (79.4%) CT staging was accordant with pathological staging. One hundred two (70%) of 145 nodes infiltrated by tumour tissue were detected and 144 (42.8%) of 336 nodes free of metastatic involvement were found. The predictive values of positive and negative results for the detection of lymph node metastases were 67.1 and 75%, respectively. Spiral CT is recommended for staging of gastric cancer.