[Sclerotherapy of the internal spermatic vein in varicocele. Significance of normal anatomical variants]. / Sklerotherapie der Vena spermatica interna bei Varikozele. Bedeutung der anatomischen Normvarianten.

During a period of four years, 386 patients with left sided varicoceles were treated by sclerotherapy of the left internal spermatic vein. This was successful in 93.8%. The most common complication was perforation of the vein in 6.2%. Technical success and complications depended on anatomical variations. Of particular significance was Bähren type IVb (competent main vein, incompetent collaterals) which occurred in 18.9%. This accounted for 66.5% of all perforations and 54.2% of unsuccessful interventions. The recurrence rate was 3.8%.

[Cine MRI of the temporomandibular joint in comparison to static MRI and axiography]. / Cine-MRT des Kiefergelenks im Vergleich zur konventionellen MRT und Achsiographie.

PURPOSE: To evaluate Cine MRI (cMRI) of the temporomandibular joint in comparison to static MRI (sMRI) and axiography. MATERIALS AND METHODS: In a prospective study with 57 healthy volunteers as well as 33 patients after temporomandibular joint (TMJ) surgery or with severe joint dysfunction, we measured the mobility of both condyle and disc as well as the sagittal angle of condylar inclination with sMRI and cMRI. Measurements and image analysis were performed by a radiologist and a maxillofacial surgeon in consensus. The results of axiography served as standard of reference. RESULT: Concerning the assessment of the discoligamentous complex, sMRI was superior to cMRI in the patient-group (sensitivity sMRI 85 %, cMRI 76 %), while no significant difference was found in the volunteer-group (sensitivity sMRI 97.4 %, cMRI 98.3 %). The results of cMRI and sMRI showed a highly significant correlation with each other, as well as with the axiographic reference tracings (r = 0.90). The average mobility of the disc and condyle was 6 % and 10 % higher in sMRI compared to cMRI (p = 0.001) and showed a slightly higher variance (0.043 vs. 0.038). Concerning the condylar inclination angle, both MRI-procedures had the best correlation (r = 0.94) with each other and axiography. CONCLUSION: Real-time MRI of the TMJ is comparable to axiography in its accuracy and is a useful adjunct to conventional static MRI.

[MRI of the knee joint: first results of a comparison of 0,2-T specialized system and 1,5-T high field strength magnet]. / MRT des Kniegelenks: Erste Ergebnisse eines Vergleichs von 0,2-T-Spezialsystem mit 1,5-T-Hochfeldmagnet.

PURPOSE: Diagnostic accuracy and image quality of a specialised system for MR examinations of peripheral joints were evaluated. MATERIALS AND METHODS: 20 patients with acute or chronic injuries of the knee were examined using a low-field MR system (0.2 T). For comparison, all patients were also studied with a 1.5 T high field strength magnet and all diagnoses were correlated with arthroscopic findings. RESULTS: We found compatible diagnostic accuracies (cruciate ligaments 90%, menisci 75-90%) and good image quality ratings for the low field system ("good" and "excellent" image quality in 83% of cases). CONCLUSION: The low-field MR-system offers low-cost MR examinations of peripheral joints with good image quality and reliable diagnostic information.

[Differential diagnosis of bone and soft tissue tumors by MRI]. / Differentialdiagnostik von Knochen- und Weichteiltumoren in der MRT.

Musculoskeletal neoplasms are rare, and both the medical history and complaints of the patients are usually uncharacteristic and of limited information. After a clinical evaluation and biplane conventional radiography, the clinician must classify the patient as having a nonprogressive or progressive primary benign, primary malignant, or metastatic bone tumor. In the case of a probably benign, nonprogressive bone tumor, the patient has to be observed continuously or an additional biopsy should be performed. In the case of a probably malignant lesion, the patient should be referred for further staging and treatment to an orthopedic oncologist. Conventional biplane radiography, scintiscan, computed tomography scan, and magnetic resonance imaging (MRI) are indispensable in staging and treatment planning for patients with musculoskeletal tumors. For limb salvage procedures, delineation of the tumor from adjacent tissue structures is crucial. Hence, MRI of the entire anatomic structure involved, together with adjacent joints, is of the utmost importance, both in the coronal and axial planes. The significance of MRI in clinical follow-up depends on keeping the sequences and imaging planes used constant. Differentiating pseudotumors from true neoplasms still poses a challenge. The cellular pattern and matrix characteristics of a lesion cannot definitely be identified as neoplastic even with application of all imaging modalities including MRI. Information on epidemiology, clinical picture, radiology, and histology of the lesion is necessary to draw a firm conclusion. Biopsy is still the first choice in making the diagnosis.

Anatomic variants of the spermatic vein: importance for percutaneous sclerotherapy of idiopathic varicocele.

PURPOSE: To evaluate percutaneous sclerotherapy of idiopathic varicocele in left internal spermatic vein variants. MATERIALS AND METHODS: The left spermatic vein was embolized with a liquid sclerosing agent in 386 patients (mean age, 29.5 years) with idiopathic varicocele. Success and complication rates were assessed and correlated with spermatic vein variant. Doppler ultrasound was performed 3 and 6 months after therapy in 263 patients. RESULTS: The success rate was 93.8% (n = 362). Perforation of the vein was the most common complication (n = 24). The recurrence rate was 3.8% (10 of 263 patients). Success and complication rates were associated with spermatic vein variant. Type IVb (intact valve of the main trunk, insufficient collateral vessels; n = 73) was of special importance: 67% (16 of 24) of all perforations occurred and 54% (13 of 24) of all unsuccessful interventional procedures were performed in patients with this variant. CONCLUSION: Sclerotherapy is a safe and effective alternative treatment of idiopathic varicocele. It can be performed on an outpatient basis. Success depends on the anatomic variant.

MRI of peripheral joints with a low-field dedicated system: a reliable and cost-effective alternative to high-field units?

In the age of health care cost containment new imaging technology has to meet diagnostic requirements as well as economic limitations. In the MR sector new dedicated systems promise reliable diagnostic information at considerably lower costs than whole-body imagers. Within the past 18 months we have examined 2200 patients with acute and chronic lesions of peripheral joints (knee, ankle, foot, elbow, wrist, hand) in a 0.2T dedicated MR system (ARTOSCAN, Esaote Biomedica, Genoa, Italy). We report our experience with this system focusing on its special features, cost-effectiveness and on diagnostic accuracy of low-field MR studies of the knee in correlation with arthroscopy and in comparison with high-field whole-body imagers.

0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint: a prospective arthroscopically controlled clinical study.

The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 244 patients. A dedicated system for MRI of limbs and peripheral joints--the 0.2-T Artoscan (Esaote, Italy)--was used for imaging knee joint lesions. T1-weighted spin-echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of the femoropatellar joint were acquired. Paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments and medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 h after imaging, the sensitivity, specificity, and accuracy were respectively 93%, 97%, and 95% for tears of the medial meniscus; 82%, 96%, and 93% for tears of the lateral meniscus; 100%, 100%, and 100% for tears of the posterior cruciate ligament; 98%, 98%, and 97% for tears of the anterior cruciate ligament; and 72%, 100%, and 92% for full-thickness articular cartilage lesions. The examination can be performed within 30-45 min at lower cost than diagnostic arthroscopy. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.

[Prospective comparison of ARTOSCAN-MRI and arthroscopy in knee injuries]. / Prospektiver Vergleich von ARTOSCAN-MRT und Arthroskopie bei Kniegelenkverletzungen.

The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 276 patients. A "dedicated system" for MRI of limbs and peripheral joints--the 0,2 Tesla ARTOSCAN (ESAOTE, Italy)--was used for imaging knee joint lesions. T1-weighted spin echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of bone and the femoropatellar joint were acquired. If necessary paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments, medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 hours after imaging, the sensitivity, specificity, and accuracy were respectively, 91, 92 and 91 per cent for tears of the medial meniscus; 80, 96, and 92 per cent for tears of the posterior meniscus; 100, 100, and 100 per cent for tears of the posterior cruciate ligament; 93, 98, and 99 per cent for tears of the anterior cruciate ligament; and 73, 100, and 92 per cent for full-thickness articular cartilage lesions. The examination can be performed within 30 to 45 minutes at a cost that is lower than that of diagnostic arthroscopy. ARTOSCAN imaging is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.

[Ambulatory diagnosis and therapy of gonarthrosis]. / Ambulante Diagnostik und Therapie der Gonarthrose.

AIM OF STUDY: To develop recommendations for appropriate diagnostic procedures and conservative treatment of knee osteoarthritis in outpatients. MATERIAL AND METHODS: Following a consensus conference and expert reviews basic recommendations were developed. RESULTS: While standardized radiographic assessment is mandatory, MRI investigation should be restricted to problems apart from osteoarthritis. Indications for physical therapy, bracing and pharmaco-treatment depend on the severity of the disease. Guidelines for intraarticular injections are presented. CONCLUSION: Effective treatment of knee osteoarthritis must be based on available recommendations and guidelines.