RESUMO
In order to improve pre-interventional prognosis of blood pressure normalization, in patients normalization, in patients with angiographically proven uni- (n = 75) and bilateral (n = 38) renal artery stenosis, (RAS) evaluation of renal venous and peripheral renin activity including stimulative procedures and Saralasin-infusion-test was carried out. In addition selective renal arteriographic, hemodynamic and pharmacodynamic (133 xe-washout) investigations were performed. The data were correlated with operative results concerning response of blood pressure to surgical treatment in 54 patients with uni- and 30 patients with bilateral RAS. Our results suggest that a postoperative normalization of blood pressure can only be expected if pre-interventional selective arteriograms reveal a normal vascular tree accompanied with normal cortical flow rates of both kidneys in uni- and bilateral RAS. Selective renin determinations, stimulative procedures of the renin-angiotensin system and application of angiotensin antagonists are only of value for selection of patients.
Assuntos
Obstrução da Artéria Renal/diagnóstico por imagem , Circulação Renal , Renina/metabolismo , Adolescente , Adulto , Pressão Sanguínea , Feminino , Hemodinâmica , Humanos , Hipertensão Renovascular/complicações , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Prognóstico , Radiografia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/cirurgiaRESUMO
Anomalous pulmonary venous drainage can be detected and evaluated by angiographic studies. Now that intravenous DSA is available, this method can be used to demonstrate pulmonary venous return. This study presents the results of DSA examination in three patients having anomalous pulmonary vein connection with the left innominate vein and the superior vena cava respectively. In a fourth patient, intra-pulmonary atypical venous return could be demonstrated by DSA without anomalous connection. This minimal invasive procedure is diagnostically useful in anomalies of pulmonary veins when recommended post-processing techniques are evaluated, particularly in patients with additional cardiac septal defects.
Assuntos
Angiografia/métodos , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Adulto , Veias Braquiocefálicas/anormalidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Técnica de Subtração , Veia Cava Superior/anormalidadesRESUMO
Transvenous digital subtraction angiography (DSA) of the kidneys has shown to be useful in detection of renovascular abnormalities in hypertensive patients. In this study DSA was performed in 27 patients (fibrom. dyspl. n = 12, arterioscl. n = 15) following percutaneous transluminal angioplasty (PTA) of renal artery stenosis. Concerning PTA-effect on blood pressure, patients were classified in 3 groups (normal n = 13, improved n = 10, failure n = 4). DSA images and simultaneously determined effective renal plasma flow (ERPF) were correlated with response of blood pressure to PTA. The results demonstrate the usefulness and accuracy of transvenous renal DSA-imaging in follow-up studies. Normal ERPF correlated with a completely re-opened renal artery and normal renal parenchyma in DSA in normotensive patients. In patients with persistent or recurrent hypertension (n = 14) ERPF was reduced in 10 cases and DSA demonstrated disorders such as peripheral renal infarction or reduced renal size (n = 6) and re-stenosis (n = 2).
Assuntos
Angiografia/métodos , Angioplastia com Balão , Hipertensão Renovascular/terapia , Adulto , Idoso , Pressão Sanguínea , Feminino , Seguimentos , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Circulação Renal , Técnica de Subtração , Fatores de TempoRESUMO
Forty-two patients treated surgically for tibio-fibular syndesmosis were observed radiologically and clinically for a period of five years; the lesions followed fracture-dislocations type B, type C and following intra-articular fractures. Surgery consisted, as usual, of bone reconstruction and, where necessary, of transfixation of the syndesmosis with a horizontal screw introduced 2 cm. above the syndesmosis at a 30 degree angle to the frontal plane (15 cases). A new classification of the severity of subsequent arthrosis, as seen radiologically, was introduced and its correlation with clinical findings were determined. There was good agreement between the degree of arthrosis and functional results. The earliest signs of posttraumatic arthrosis following an incompletely treated lesion can be seen within the first year following the injury. An arthrosis of severity O due to sclerosis is of no, or only little, significance; it does not share the poor prognosis of severity grades I to III which, once they have developed, always show further deterioration.
Assuntos
Traumatismos do Tornozelo , Ligamentos Articulares/lesões , Osteoartrite/diagnóstico por imagem , Pinos Ortopédicos , Seguimentos , Fixação de Fratura , Fraturas Ósseas/complicações , Humanos , Luxações Articulares/complicações , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Osteoartrite/classificação , Osteoartrite/etiologia , Osteosclerose/complicações , Osteosclerose/etiologia , Prognóstico , RadiografiaRESUMO
Periostal new bone formation can be observed as a symptom secondary to numerous diseases. In gastrointestinal disease this hypertrophic osteoarthropathy occurs very rare. The present case report demonstrates an extensive periostal proliferation involving the long bones in a 14 years old girl with longstanding ulcerative colitis.
Assuntos
Colite Ulcerativa/diagnóstico por imagem , Osteoartropatia Hipertrófica Secundária/diagnóstico por imagem , Periósteo/diagnóstico por imagem , Adolescente , Colite Ulcerativa/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Prednisolona/uso terapêutico , Radiografia , Sulfassalazina/uso terapêuticoRESUMO
The diagnostic value of i.a. DSA, compared with conventional arteriography (n = 48), was proven in patients (n = 116) with abdominal tumours including intrahepatic masses. Arteries supplying the tumour, anomalous vessels and pathological malignant vascular abnormalities were visualised reliably in i.a. DSA despite reduced spatial resolution. An improved definition of hypervascular tumours was possible during the early arterial phase and of hypovascular or avascular masses during the late parenchymal phase of i.a. DSA. The dynamic evaluation of contrast flow is simpler and more reliable using the continuous mode in i.a. DSA than with the static imaging of a conventional film sequence. The advantages of i.a. DSA in preoperative vascular mapping and in detailed diagnosis of abdominal tumours and masses result in replacing conventional arteriography with very few exceptions.
Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Angiografia/métodos , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Tumor Carcinoide/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/diagnóstico por imagem , Técnica de SubtraçãoRESUMO
Different indications of pulmonary DSA are discussed based on experiences in 122 cases. The quality and accuracy of imaging is demonstrated by representative examples. Indications of DSA and conventional pulmonary angiography are principally identical. However, our experience in DSA suggests that this minimal invasive procedure may replace conventional angiography in most cases and abolish the strict indication. Supported by further critical tests the high diagnostic quality of DSA imaging in pulmonary embolism and therapeutical control may substitute radionuclide methods (perfusion-ventilation-scintigraphy) to avoid costs of a double examination.
Assuntos
Artéria Pulmonar/diagnóstico por imagem , Técnica de Subtração , Adolescente , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Radiografia , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
The experience in venous digital subtraction angiography (DSA) of the pulmonary vessels is presented in order to evaluate the new method. The results of angiographic examinations in 30 patients could be classified as follows: embolic lung disease (n = 13), atelectatic disease of left lower lobe (n = 3), findings of arteritis in right upper lobe (n = 1), arteriographic alterations due to chronic pulmonary emphysema (n = 2), normal lung vessels (n = 10), and failure of examination (n = 1). Using this new angiographic method it was possible to analyze embolic clots in the subsegmental arteries and total occlusions of the peripheral small vessels. The advantage of DSA compared with the conventional technique is evident: No complications due to transcardial catheters, short examination period, easy handling of the technique, and small number of images.
Assuntos
Angiografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Técnica de Subtração , Adulto , Humanos , MasculinoRESUMO
Sterno-costo-clavicular hyperostosis (SCCH) is the most common manifestation of a syndrome, consisting of increased bone metabolism, mostly new bone formation and heterotopic ossification of fibrous tissue, which we have characterised as the acquired hyperostosis syndrome. In part I we discuss the terminology, radiological appearances, scintigraphy, clinical and laboratory findings, bacteriology, histology, nosology, complications, treatment and differential diagnosis of SCCH. Chronic recurrent multifocal osteomyelitis (CRMO) is regarded as a phenotype of SCCH, depending on the age. CRMO occurs in children, adolescents and young adults, SCCH predominantly in middle-aged and elderly adults.
Assuntos
Hiperostose Esternocostoclavicular , Adulto , Feminino , Humanos , Hiperostose Esternocostoclavicular/diagnóstico por imagem , Hiperostose Esternocostoclavicular/terapia , Masculino , Pessoa de Meia-Idade , Radiografia , Cintilografia , Síndrome , Terminologia como AssuntoRESUMO
The superiority of CT over conventional radiography in demonstrating intra-articular fractures of the os calcis was demonstrated in 34 patients. The advantages consist in being able to demonstrate the joint without superposition and the exact demonstration of the position, size, shape and number of fragments. Shortening or widening of the os calcis can be easily recognized, as well as fractures of the medial or lateral cortex. At the same time it is possible to evaluate soft tissues, particularly the peroneal ligament. The conventional classification of calcaneal fractures has been newly evaluated in the light of the ability to recognize involvement of the joint and the course of the main fracture lines.
Assuntos
Calcâneo/lesões , Fraturas Ósseas/diagnóstico por imagem , Articulações Tarsianas/lesões , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Calcâneo/diagnóstico por imagem , Feminino , Fraturas Ósseas/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Articulações Tarsianas/diagnóstico por imagemRESUMO
In the second part of this publication, we describe some additional findings in cases of sternocostoclavicular hyperostosis. These include focal hyperostosis of the spine, in the pelvis and in the extremities and psoriatic skin lesions and severe forms of acne (acne conglobata, acne fulminans). Other features, which are not diagnostic, include erosive or non-erosive peripheral arthritis and unilateral or bilateral sacro-iliitis. An analysis of our 13 patients and of the relevant literature indicates that the hyperostosis is due to increased bone metabolism and heterotopic ossification of fibrous tissue and that these are the pathogenic bases of the changes in the axial skeleton, the pelvis and the bones of the extremities. We have suggested a scheme which would categorize the syndrome into complete, incomplete and possibly acquired forms.
Assuntos
Hiperostose Esternocostoclavicular/diagnóstico por imagem , Adulto , Feminino , Humanos , Hiperostose Esternocostoclavicular/classificação , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Bolus injections of gadolinium-DTPA result in high contrast concentration in the distal vessels within the brain and cause a local disturbance of the magnetic field with a shortening of T2 relaxation time. Pulse frequencies were designed to demonstrate inhomogeneities in the magnetic field. The resultant reduction in T2-weighted gradient echo signals was used in order to examine changes in regional perfusion caused by pathological conditions. Cerebral tumours showed variable perfusion patterns but were always better perfused than surrounding brain tissue; oedema surrounding the tumour resulted in reduced perfusion. Ischaemic infarcts showed significant underperfusion compared with control areas. In both groups the areas involved were larger on the perfusion scans than on T2-weighted images.
Assuntos
Encéfalo/patologia , Circulação Cerebrovascular , Imageamento por Ressonância Magnética , Isquemia Encefálica/diagnóstico , Neoplasias Encefálicas/diagnóstico , Infarto Cerebral/diagnóstico , Meios de Contraste/administração & dosagem , Gadolínio/administração & dosagem , Gadolínio DTPA , Humanos , Injeções Intravenosas/métodos , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Compostos Organometálicos/administração & dosagem , Ácido Pentético/administração & dosagemRESUMO
MR angiography with selective pre-saturation was applied in 5 normal volunteers, 22 patients with cerebrovascular disease, 3 patients with arteriovenous malformations (AVM) and one patient with thrombosis of the superior sagittal sinus. The results were compared with Doppler ultrasound and conventional angiography. MR angiography reliably demonstrated the direction of blood flow and the presence or absence of collateral flow in the circle of Willis. Collateral flow via leptomeningeal vessels and the ophthalmic artery could not be demonstrated. In the patient with superior sagittal sinus thrombosis, the absence of flow was well seen. MR angiography was able to demonstrate the major supplying arteries in the patients with AVMs. MR angiography is a valid noninvasive means to demonstrate direction of flow and blood supply of the major intracranial arteries.
Assuntos
Circulação Cerebrovascular/fisiologia , Transtornos Cerebrovasculares/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Angiografia Cerebral , Transtornos Cerebrovasculares/fisiopatologia , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/fisiopatologia , Masculino , UltrassonografiaRESUMO
In lung tumours histological findings, exclusion of metastatic disease and different diagnostic procedures such as bronchoscopy, mediastinoscopy and thoracic CT play an important role for tumour staging to plan the correct therapeutic approach. Selection of patients for thoracotomy depends on results of these examinations. This study was carried out to assess the value of an additionally applied pulmonary DSA in 17 patients with lung tumours (bronchogenic carcinoma n = 14). Our results demonstrate that in 4 cases angiography could prove inoperability of tumours (compression of sup. v. cava, occlusion of a main pulmonary artery): one patient had a negative mediastinoscopy, one patient had a small cell bronchogenic carcinoma; in two patients an additional mediastinoscopy could be omitted. In two other patients with bronchogenic carcinoma who appeared operable in mediastinoscopy and DSA, explorative thoracotomy only could ensure inoperability due to an infiltration of the thoracic wall. As a minimal invasive method applicable in outpatients pulmonary DSA seems to be useful in giving additional important diagnostic information particularly in central bronchogenic carcinomas.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Técnica de Subtração , Idoso , Angiografia/métodos , Broncoscopia , Carcinoma Broncogênico/irrigação sanguínea , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/cirurgia , Feminino , Humanos , Pulmão/irrigação sanguínea , Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/cirurgia , Masculino , Mediastinoscopia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios XRESUMO
A retrospective study of plain radiographic findings in 11 patients with traumatic rupture of the aorta was conducted, and the results compared with the incidence of numerous chest x-rays signs previously described in 294 cases of angiographically proven thoracic aorta dissection. It is concluded that positive plain radiographic signs obtained from patients with blunt chest trauma reveal high sensitivity and may thus be used as an indication for emergency aortography. However, since this procedure lacks 100% specificity even those patients with normal x-ray findings but clinically and/or anamnestically adequate thoracic trauma should be submitted to aortography.
Assuntos
Ruptura Aórtica/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Aorta Torácica/lesões , Ruptura Aórtica/etiologia , Aortografia , Humanos , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicaçõesRESUMO
Two patients treated for acute leukaemia with BCNU, cyclophosphamide and cytosin-arabinoside are reported, in whom pulmonary fibrosis developed and progressed during therapy. The development of lung fibrosis during combined treatment, together with serological exclusion of other diseases known to be associated with pulmonary fibrosis, make a causal connection between the treatment and the fibrosis very probable.
Assuntos
Carmustina/uso terapêutico , Ciclofosfamida/uso terapêutico , Citarabina/uso terapêutico , Fibrose Pulmonar/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Fibrose Pulmonar/diagnóstico por imagem , Radiografia , Testes de Função RespiratóriaRESUMO
Sonography of the ankle joint is a simple method of exploring articular soft tissue. 100 patients with acute injury of the lateral ligaments were examined with a 7.5 MHz linear array transducer. Diagnostic criteria were haematoma and capsular deformation. Sonographic findings were assessed by stress films (n = 94), arthrography (n = 29) and operative evaluation (n = 28). In 94 of 100 joints, acute injury could be demonstrated with sonography. In most cases sonography was able to differentiate the site of the lesion: anterior talofibular or fibulocalcaneal ligament. The positive predictive value in relation to the operative findings is 100% for talofibular ligament and 96% for fibulocalcaneal ligament.
Assuntos
Articulação do Tornozelo/patologia , Ligamentos Articulares/patologia , Ultrassonografia/métodos , Adulto , Traumatismos do Tornozelo , Artrografia , Diagnóstico Diferencial , Estudos de Avaliação como Assunto , Humanos , Ligamentos Articulares/lesões , Ruptura/diagnóstico , Ultrassonografia/instrumentaçãoRESUMO
During a period of 24 months, 211 patients were investigated in our radiological clinic by emergency CT of the spine on the day of the injury. In 128 (61%) a traumatic lesion could be demonstrated. Most frequently involved were the transitional zones of the spine (occipito-atlanto-axial segment, cervico-thoracic and thoracolumbar segments). In 68% of these patients, conventional radiographs of the spine of these critical zones proved to be inadequate. 20% of the lesions demonstrated by CT could not be seen on conventional radiographs and 41% were shown incompletely. In 61% of cases CT provided additional information when compared with conventional radiography.
Assuntos
Mielografia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Emergências , Humanos , Luxações Articulares/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagemRESUMO
We used MR angiography to assess the thoracic inlet veins in 5 normal volunteers and 14 patients with thrombosis of these veins. The results were compared with conventional venography and contrast-enhanced computed tomography (CT). The normal anatomy was readily depicted by MR angiography in all normal volunteers. Pathology was assessed correctly by MR angiography in all patients. Thrombosis of the internal jugular vein was seen on MR angiography in all cases whereas conventional venography failed to demonstrate this region adequately in 3 cases. The best overview of the thoracic inlet veins was achieved in the coronal plane; however, for detailed demonstration of pathology, imaging in additional planes was necessary. We conclude that MR angiography is a promising method for non-invasive assessment of thoracic veins.
Assuntos
Imageamento por Ressonância Magnética/métodos , Tórax/irrigação sanguínea , Trombose/diagnóstico , Estudos de Avaliação como Assunto , Humanos , Imageamento por Ressonância Magnética/instrumentação , Flebografia , Tomografia Computadorizada por Raios X , Veias/patologiaRESUMO
Segmental aplasias of the inferior vena cava, thrombosis of the vena cava, tumour infiltration (e.g. renal neoplasms via the renal vein) and external compression (e.g. large hepatic metastases) may produce similar radiomorphologic changes in chest x-ray DSA and CT. These radiomorphological changes are described by case reports. DSA clearly demonstrates the course of the vessels and the collaterals involved. CT may elucidate the paracaval vascular changes. It is only a synopsis of cavography (DSA) and CT with reference to embryogenesis that will lead to a reliable diagnosis and enable a definite decision on therapy and prognosis.