[Calcifying tendinitis with osseous involvement : A diagnostic challenge]. / Kalzifizierende Tendinitis mit Einbruch in den Knochen : Eine diagnostische Herausforderung.

OBJECTIVE: The goal of this article is the radiological visualization of the often very difficult pathoanatomical changes associated with calcifying tendinitis, which in rare cases may erode and ultimately invade the bone. MATERIALS AND METHODS: We investigated the diagnostic reliability of radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) in 11 patients with calcifying tendinitis. Eight lesions were located in the upper (4 supraspinatus tendon, 2 deltoideus tendon, 1 pectoralis tendon, 1 biceps tendon) and 3 in the lower extremity (2 gluteus tendon, 1 adductor magnus tendon). The average age was 58 years (8 women, 3 men). CASE STUDIES AND DISCUSSION: Calcifying tendinitis is the consequence of overuse of an enthesis with consecutive necrosis and calcification. However, in rare cases, erosion of the underlying bone with bone invasion, which is associated with sudden escalation of long-term pain, is observed. The detection of the pathoanatomical changes using MRI is problematic because with this method calcifications and ossifications are only indirectly visualized and, thus, can only be interpreted with uncertainty. The method of choice is CT, which can be used to demonstrate the three key elements of calcifying tendinitis, i.e., the calcified/ossified part of the tendon in the insertion area, a defect in the cortex, and calcification in the medullary space.

[Skeletal sarcoidosis]. / Skelettsarkoidose.

OBJECTIVE: Presentation of the etiology, pathology, clinical course, radiology and differential diagnostics of skeletal sarcoidosis. PATHOANATOMICAL PRINCIPLES: Noncaseating epithelioid cell granulomas can trigger solitary, multiple or disseminated osteolysis, reactive osteosclerosis and/or granulomatous synovitis. INCIDENCE: The incidence of sarcoidosis is 10-12 per 100,000 inhabitants per year. Skeletal involvement is approximately 14 %. CLINICAL ASPECTS: Skeletal involvement occurs almost exclusively in the stage of lymph node and pulmonary manifestation. Most cases of skeletal involvement are clinically asymptomatic. In the case of synovial involvement, unspecific joint complaints (arthralgia) or less commonly arthritis can occur. Typical skin alterations can be diagnostically significant. RADIOLOGY: Punch out lesions osteolysis, coarse destruction and osteosclerosis can occur, which are best visualized with projection radiography and/or computed tomography. Pure bone marrow foci without interaction with the bone can only be detected with magnetic resonance imaging (MRI) and more recently with positron emission tomography (PET), mostly as incidental findings. There is a predeliction for the hand and trunk skeleton. DIFFERENTIAL DIAGNOSTICS: Skeletal tuberculosis, metastases, multiple myeloma, Langerhans cell histiocytosis and sarcoid-like reactions in solid tumors must be differentiated. The key factors for correct diagnosis are thorax radiography, thorax CT and dermatological manifestations.

[Ewing's sarcoma, fibrogenic tumors, giant cell tumor, hemangioma of bone : Radiology and pathology]. / Ewing-Sarkom, fibrogene Tumoren, Riesenzelltumor, Hämangiom des Skeletts : Radiologie und Pathologie.

Radiological imaging only reflects the anatomy and its pathological abnormalities. Therefore, the radiologist should be able to recognize the basic features of the pathological anatomy of bone tumors. This can only be learned working closely with a pathologist who is experienced in this field. On the other hand, the pathologist needs from the radiologist their diagnostic assessment with information on size, location, aggressiveness and the existence of a bone tumor's matrix, of the whole lesion, because he usually only receives a small part for examination in the form of a biopsy. In this article, the features and fundamentals (standards) of radiological-pathological cooperation as the mainstay for a precise diagnosis in bone tumors are outlined. The radiological appearance and the histopathological features behind it are presented for Ewing's sarcoma, fibrogenic tumors, giant cell tumor, and hemangioma of the bone.

[Tumor-like diseases of the knee joint]. / Tumorähnliche Erkrankungen im Kniegelenk.

CLINICAL/METHODICAL ISSUE: Radiological diagnostics of tumor-like lesions of the knee joint. STANDARD RADIOLOGICAL METHODS: Magnetic resonance imaging (MRI), computed tomography (CT) and X-ray imaging. PERFORMANCE: Up to now there have been no studies regarding sensitivity and specificity of the various diagnostic tools (MRI, CT, X-ray) for the visualization of soft tissue tumors of the knee. PRACTICAL RECOMMENDATIONS: The method of first choice for detecting soft tissue tumors and tumor-like lesions in the knee joint is MRI.

[Bone (marrow) edema in magnetic resonance imaging - finding or only signal? A brief look behind the mirror]. / Knochen(mark)ödem in der MRT - Befund oder nur Signal? Ein kurzer Blick hinter den Spiegel.

An ill-defined area of increased signal intensity in bone marrow seen on water-sensitive magnetic resonance (MR) sequences (e. g. T2, short TI inversion recovery STIR) is usually referred to as "bone marrow edema". It may be observed with traumatic (e.g. bone bruise), inflammatory, osteoarthritic as well as neoplastic processes. Therefore, it can be confusing if the term "bone marrow edema" is used to describe a clinicoradiologic condition or diagnosis. Addressing these imaging findings as "edema equivalent" or "edema-like increased signal intensity" helps to restrict this phenomenon to a magnetic resonance sign and to avoid using it as a radiologic diagnosis. To illustrate this three case examples with corresponding MR images are presented to point out the intention of this article.

[The subchondral synovial cyst (intraosseous ganglion)]. / Die subchondrale Synovialzyste (intraossäres Ganglion).

Twelve cases of subchondral synovial cysts (intra-osseous ganglion) have been seen and their clinical features, radiological findings and differential diagnosis are described. The lesion is a benign cystic tumour-like mass in the subchondral portion of a synovial joint. Our findings in respect of age, sex and localisation are compared with those of other authors. The aetiology and pathogenesis of the lesion is not completely understood. There is an increased incidence in middle life and joints with high dynamic and static stress are favoured, particularly in the lower extremities. Chronic stress or microtrauma, causing damage to the involved joint, therefore appears to be a plausible explanation.

[The use glucagon for endoscopic and radiological examination of the gastrointestinal tract (author's transl)]. / Anwendung von Glukagon bei endoskopischen und röntgenologischen Untersuchungen des Gastrointestinaltrakts

In more than 1,000 radiological and endoscopic examinations of the smooth muscle hollow organs of the upper intestinal tract, crysalline glucagon (0.2 to 0.5 mg., average dose 1 u/kg. body weight given at a single intravenous injection) resulted in a significant relaxation and reduction of peristalsis. This effect was less marked in the colon and recto-sigmoid. In five patients with colonic diverticulosis it had no effect. In 150 patients it was found that the onset of hypotonia after injection of glucagon increases from proximal to distal, the duration of maximal reduction in peristalsis decreasing distally. Glucagon is indicated for reducing the tone of smooth muscle hollow organs in order to judge their elasticity and to distinguish between functional and organic causes of a stenosis or increased size of folds. The rapid onset of peristaltic inhibition makes various diagnostic and therapeutic endoscopic procedures simpler or even possible. Compared with the usual atropin-like antispasmodics, glucagon has the advantage of being free from side effects apart from transient hyperglycaemia. Diabetes mellitus requiring insulin is a (relative) contra-indication to the use of glucagon.

[The effect of haemodynamic factors on tomograms during angio-tomography (author's transl)]. / Die Beeinflussung des Schichtbildes durch kreislaufdynamische Faktoren bei der Angiotomographie

Haemodynamic factors may influence the appearance of the tomograms during the performance of angio-tomography. Model experiments have shown that the thickness of section able to demonstrate vessels may depend on the relationship between vessel opacification and the timing of the cut. The clinical relevance of this is illustrated by tomographic studies of the renal and cerebral circulations.

[Experimental investigations into dissolution of size of detail and contrast in the angiotomograms]. / Experimentelle Untersuchungen zur Auflösung von Detailgrössen und -kontrasten in Angiotomogramm

A comparative investigation on the resolution of angio-tomography and cut-film changer technique, standard views and direct geometrical radiographic magnification were carried out, using a phantom. Catheters of varying calibre and contrast were tested. The most significant result was the finding that lower concentrations of contrast were necessary to demonstrate small vessels or catheters when using angio-tomography or magnification, than with conventional techniques. It was also shown that angio-tomography and a magnification technique are able to show smaller and less contrasty vessels.

[The scope and limitations in the demonstration of vessels by angiotomography; their relationship with contrast and size and between detail and direction of cut (author's transl)]. / Möglichkeiten und Grenzen der Gefässdarstellung im Angiotomogramm in Abhängigkeit von Detailkontrast und -grösse sowie von der Lagebeziehung zwischen Detail und Schichtrichtung

Experiments with models and post mortem angiograms have shown that the supposed advantages of angiotomography, such as determination of the depth of vessels, cannot be achieved with accuracy if there is repeated change in direction of the vessels. Blurring of superimposed vessels depends not only on their contrast and calibre, but also on their alignment in relationship to the direction of blurring. Vessels running in the direction of blurring produce undesirable shadows through a considerable depth, whereas vessels running across the direction of blurring are rapidly blurred if not in the selected plane. The demonstration of vessels running at right angles to the direction of blurring may at times be very difficult with simultaneous tomography. The clinical significance of this finding is pointed out.

[Differential diagnosis of primary bone tumors and tumor-like lesions of the ribs]. / Zur Differentialdiagnose von primären Knochengeschwülsten und geschwulstähnlichen Läsionen an den Rippen.

Primary bone tumours in ribs are less common than tumour-like lesions. The most common solitary primary bone tumour in ribs is the chondrosarcoma (about 35%). This is followed with about the same frequency (10 to 14%) by Ewing's sarcoma, malignant lymphoma, chondroma and osteo-chondromas. The clinical features and radiological appearances of the more common tumours and tumour-like lesions in the ribs are described, and their differential diagnosis is discussed.

[The rare phenomenon of intraosseous gas collections (the so-called pneumatoceles]. / Zum seltenen Phänomen intraossärer Gasansammlungen (sog. Pneumatozelen).

We present two unusual cases of gas-filled cavities, the first in a 5th lumbar vertebra, the second in the subcortical area of the iliac bone close to the iliosacral joint. These accumulations of gas are evidently connected to vacuum phenomena in anatomically adjacent joints. They are characterised as pneumatoceles. Different mechanisms of these rare intraosseous gas accumulations are discussed.

[Computer-tomographic evaluation of tumors of the pelvis (author's transl)]. / Computertomographie bei Tumoren des Beckenskeletts.

Some cases selected from a group of 35 patients with bone tumors of the pelvis (16 primary, 15 secondary malignant neoplasia, 3 semimalignant tumors, and 1 benign tumor) serve to demonstrate the significant information gained by computed tomography. In bone tumors of the pelvis neither conventional radiography nor angiography render reliable information about the extent of the tumor. Computed tomography is helpful in showing the intra- and extraosseous extent of the lesion, in demonstrating the relationship of the tumor to the organs in the neighbourhood, in measuring of volume and density and discovering the recurrence of tumor.

[Magnetic resonance tomographic results in bone changes associated with sclerosis]. / Kernspintomographische Ergebnisse bei Knochenveränderungen mit Sklerose.

We have compared the value of MRI with conventional radiography and CT in 40 predominantly sclerotic skeletal lesions. We have found that sclerosis and other changes in the bone structure can be demonstrated by MRI in much the same way as with conventional radiography and CT. Using high resolution surface coils, it is possible to demonstrate small areas of new bone formation such as periosteal new bone or the calcification within the nidus of an osteoid osteoma. MRI is particularly appropriate if it is necessary to show soft tissue changes within an area of sclerosis, which may be responsible for the new bone formation and which may be masked on radiographs and CT by the surrounding sclerosis.

[New intensifying screens in clinical radiology. II. Examinations in clinical practice]. / Neue Verstärkerfolien in der klinischen Radiologie. II. Praktisch-klinische Untersuchungen

A clinically applicable procedure for testing new intensifying rare earth screens, as well as the special Siemens' screen is described. The results are related to universal screens. The film-screen combination alpha 4XD (gadolinium oxysulphide with normal, green sensitive film) results in a reduction of radiation dose to half with detail comparable with universal screens. The Siemens' special screen has similar advantages. Screens with a higher intensification factor and reduction of the mAs to one sixth results in loss of detail. This does not necessarily reduce their clinical use if they are used for appropriate purposes. The results of this clinically orientated technique agreed well with physically objective methods using lead grids. The advantages of the new screens are discussed in terms of their practical application.

[Multicentric reticulohistiocytosis as a cause of an erosive, destructive arthropathy (author's transl)]. / Multizentrische Retikulohistiozytose als Ursache einer "erosiv-destruktiven Arthropathie".

Multicentric reticulohistiocytosis is a special form of an erosive, destructive arthropathy. It can be distinguished from other forms of erosive polyarthropathies by the characteristic x-ray appearances, although the final proof of the diagnosis is histological in association with the clinical features and the presence of nodular skin lesions. A case of multicentric reticulohistiocytosis is described. The typical radiological appearances are discussed and the differential diagnosis from other forms of chronic polyarthritis, such as gout, psoariatic arthropathy, Reiter's disease and erosive osteoarthritis is considered.

[Radiological changes in the skeleton due to anticonvulsant therapy in childhood (author's transl)]. / Röntgenologische Skelettveränderungen bei antiepileptischer Therapie im Kindesalter.

Anticonvulsant therapy can lead to severe rachitic changes in the skeleton which closely resemble renal osteopathy. In addition to apparent widening of the epiphyseal plate, there are changes in the cortex of the long bones. Within four to six weeks of the commencement of vitamin D therapy, recalcification of the poorly recognised. Since the changes are best seen in the hand, further examinations of the skeleton are only indicated if there are positive findings in the hand.

[Fibrous metaphyseal defect (fibrous cortical defect, non-ossifying fibroma) (author's transl)]. / Der fibröse metaphysäre Defekt (fibröser Kortikalisdefekt, nicht ossifizierendes Knochenfibrom).

Fibrous cortical defect and non-ossifying fibromas can be classified together as fibrous metaphyseal defects (FMD) since they have the same pathological substrate, with a tendency to the same localisation around the knee, and occurring at the same age. They have a tendency to spontaneous healing, are clinically silent and are usually discovered accidentally during radiological examination. A radiological survey of 5.674 metaphyseal regions in the upper and lower extremities of 2.065 unselected patients aged one to 20 years revealed an incidence of 1.8%; exclusive examination of the distal femur showed an incidence of 2.7%. 96% of all lesions were in the lower extremities and only 4% in the upper. The marked discrepancy in the incidence rate between American and German publications is discussed.

[Fibrous metaphyseal defect (fibrous cortical defect, non-ossifying fibroma). Paper II: differential diagnosis (author's transl)]. / Der fibröse metaphysäre Defekt (fibröser Kortikalisdefekt, nicht-ossifizierendes Knochenfibrom).

FMD, whether in the stage of a fibrous cortical defect or a non-ossifying fibroma, possesses very characteristic radiological appearances which rarely make it necessary to resort to biopsy. In order to avoid mistakes, it is necessary to observe strictly the known radiological features: metaphyseal position, clearcut relationships to the cortex, well defined margins, maximal size 6 to 7 cm., presence during growth, rarely observed in the upper extremity. The differential diagnosis, which needs to be considered only rarely, is discussed.

[Tumor-like bone lesions in sternocostoclavicular hyperostosis and palmoplantaris pustulosis]. / Tumorsimulierende Knochenläsionen bei sternokostoklavikulärer Hyperostose und Pustulosis palmoplantaris.

We present two unusual cases of sternocostoclavicular hyperostosis (SCCH) in conjunction with palmoplantar pustulosis (PPP) and additional tumour like manifestations in a scapula and a femur respectively. The association of SCCH with complexes of signs and symptoms such as chronic multifocal osteomyelitis (CRMO), or other nosological entities such as seronegative spondylarthropathies, is discussed.