[Pulmonary manifestations in adult rheumatic diseases]. / Lungenmanifestationen bei adulten rheumatischen Erkrankungen.

BACKGROUND: Rheumatic diseases frequently present with pulmonary involvement. All anatomic structures of the lungs can be affected. Interstitial lung diseases are characterized by a system of patterns evident in high-resolution computed tomography (HR-CT) scanning of the lungs. The HR-CT pattern can differ between rheumatic diseases. OBJECTIVE: Systematic description of all variants and patterns of pulmonary involvement in rheumatic diseases. MATERIAL AND METHODS: Narrative review based on the current literature on the topic from the perspective of rheumatology, pulmonary diseases and radiology. RESULTS: Pulmonary involvement is frequent and prognostically relevant. The summary of pulmonary involvement reveals a high variability of affected anatomical structures as well as patterns of interstitial diseases for inflammatory rheumatic diseases. A synopsis of the main diagnostic findings is provided. CONCLUSION: Every rheumatic disease presented here can be associated with pulmonary involvement. Therefore, a systematic diagnostic evaluation is mandatory at the first diagnosis as well as during follow-up. Apart from clinical findings and lung function HR-CT of the lungs is decisive for the diagnostics.

[Minimally invasive vs. open partial nephrectomy : Perioperative success and complication rates]. / Minimal-invasive vs. offene Nierenteilresektionen : Perioperative Erfolgs- und Komplikationsraten.

BACKGROUND: Solid renal masses are increasingly treated with nephron-sparing surgery. As in other uro-oncological surgical techniques, minimally invasive and robotic-assisted techniques are becoming increasingly popular. OBJECTIVES: The perioperative results from minimally invasive nephron-sparing surgery versus open surgery were retrospectively compared. MATERIALS AND METHODS: In our single center retrospective study, all patients who underwent nephron-sparing tumor excision between 2006 and 2016 were divided into two groups (group O = open approach and group M = minimally invasive approach). The (pre-)operative data, complications, and change in renal function were compared. Trifecta criteria (R0, no perioperative complications, ischemia ≤25 min) were used to determine success rates. RESULTS: Of 329 patients, 310 were included for analysis (group O 123, group M 187). Patients in group O had significantly worse ASA score but comparable Charlson Index and significantly more pT3/4 tumors but equal PADUA-score when compared with group M. Otherwise, preoperative patient and tumor characteristics were comparable. Patients in group M had significantly shorter hospital stays (p < 0.001) and lower transfusion rates (p < 0.05). Trifecta criteria were more frequently met in group M than in O (M: 66.8% vs. 0: 49.6%; p < 0.001). Both major and minor complications were lower in group M (major: 10.7% vs 17.1%; minor: 13.9% vs. 26.0%; p < 0.05). Preservation of renal function was comparable in both groups. R0 rates did not differ significantly between groups (M: 97.8% vs O: 97.5%). Surgical procedure times were significantly longer in group M (p < 0.001; mean 30 min). CONCLUSIONS: Minimally invasive, robotic assisted partial nephrectomy also proved to be successful in complex cases. In all aspects studied, the minimally invasive approach was shown to be at least equivalent to the open approach.

Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology.

Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings.

The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study.

BACKGROUND: The threshold for disease activity required to start antitumour necrosis factor (TNF) therapy has been arbitrarily set in patients with axial spondyloarthritis (axSpA) at Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4. How this relates to spinal inflammation is unknown. OBJECTIVE: To systematically compare the clinical, laboratory and imaging data of patients with axSpA with respect to their BASDAI level. METHODS: A total of 100 consecutive patients with axSpA who had never been treated with TNF blockers were included. Laboratory parameters, spinal MRI and x-rays were quantified. Data were stratified according to BASDAI ≥ 4. RESULTS: 44 patients were diagnosed as non-radiographic axSpA (nraxSpA) and 56 patients as ankylosing spondylitis (AS): median age 40.3 ± 10.4 years; 57% male, mean disease duration since diagnosis 6.4 ± 8.4 years, 88% HLA-B27+, mean modified Stokes Ankylosing Spondylitis Spinal Score 8.3 ± 16.4. 60% of patients had spinal inflammation by MRI. The stratification based on BASDAI ≥ 4 disclosed significant differences in most clinical parameters but not for inflammation: patients with nraxSpA and BASDAI < 4 versus ≥ 4 had 0.9 ± 1.4 and 0.5 ± 0.6 inflammatory lesions/patient, respectively (p=0.6), while patients with AS had 3.6 ± 3.7 and 2.7 ± 3.0 inflammatory lesions/patient, respectively (p=0.4). CONCLUSION: The burden of inflammation is quite comparable in patients with axSpA-regardless of disease activity. These data clearly challenge the concept of the recommended cut-off point of BASDAI ≥ 4.

[Thoracic actinomycosis: diagnostic pitfalls and therapeutic considerations]. / Thorakale Aktinomykose: diagnostische Schwierigkeiten und therapeutische Uberlegungen.

We report two patients admitted to our hospital suspected to suffer from cancer in the lung or mediastinum, respectively. Both patients had a diagnosis of thoracic actinomycosis. A 76 year old man revealed pulmonary and endobronchial actinomycosis associated with broncholithiasis. Diagnosis was achieved by bronchoscopy. Therapy with ampicillin/sulbactam was successful. A 36 year old patient presented with bilateral pleural effusions, extended pericardial, mediastinal and pulmonary actinomycosis with pericarditis constrictiva and superior vena cava syndrome. Diagnosis was finally made by cardiac surgery with therapeutic pericardectomy. Prolonged therapy with ampicillin/sulbactam was administered with satisfactory result. Here we discuss the importance to include actinomycosis in the differential diagnosis of pulmonary affections and mediastinal masses in order to avoid diagnostic errors and to limit invasive procedures to the necessary amount. We illustrate the need of an individualized treatment approach.

[Bullectomy as emergency intervention in a mechanically ventilated patient with refractory type II respiratory failure due to chronic obstructive lung disease (COPD)]. / Erfolgreiche Notfall-Bullektomie bei einer invasiv beatmeten Patientin mit refraktärer ventilatorischer Insuffizienz im Rahmen einer akuten Exazerbation einer chronisch-obstruktiven Lungenerkrankung (COPD).

A 44-year-old female patient presented with an extensive exacerbation of severe chronic obstructive lung disease (COPD) and bullous emphysema. Because of a severe type II respiratory failure, the patient was intubated and mechanically ventilated. Respiratory failure was refractory despite appropriate ventilation regimes and pCO2 values ranged from 110 mm Hg to 180 mm Hg. Chest radiography revealed hyperinflation of two giant bullae with mediastinal shifting to the left lung. We describe a successful rescue bullectomy.

[Peripartum changes of the pelvic ring: usefulness of magnetic resonance imaging]. / Peripartale Veränderungen des Beckenringes: Wie sinnvoll ist die Magnetresonanztomografie?

PURPOSE: Postpartum pelvic pain beyond the normal level poses a problem to obstetricians. Beyond normal physiologic loosening of the pubic symphysis and sacroiliac joints (SIJs) during pregnancy, symphyseal separation and rupture must be excluded. The aim of this prospective study was to determine whether magnetic resonance imaging (MRI) allows for reliable differentiation of normal postpartum findings and pathologic lesions. MATERIAL AND METHODS: The study included a total of 77 women (mean age 30), among them 21 healthy subjects (group A), 21 asymptomatic postpartum women (group B), and 35 patients with postpartum pelvic pain (group C). The analyzed parameters comprised symphyseal and iliosacral tenderness, subjective pain assessed on a visual analog scale, and data pertaining to obstetric history. All 77 women underwent 1.5T MRI of the pelvic ring using oblique angulated coronal T 1-weighted and STIR sequences for imaging of the symphysis and SIJs in one slice package. Analysis of the MR images comprised signal intensities of pelvic bone marrow, width of the symphyseal cleft, and the symphyseal capsule. RESULTS: Subjects in group A in general had a normal bone marrow signal. The STIR sequence showed increased signal intensity of the pubic bone near the symphysis in 16 women (76 %) of group B and 31 patients of group C (86 %) (not significant). An increased periarticular bone marrow signal of the SIJs on the STIR images was seen in 13 women (62 %) of group B and 23 patients (63 %) of group C. The mean width of the symphyseal cleft differed significantly among the three groups (3.4 mm vs. 5.4 mm vs. 6.7 mm). A width >10 mm was observed in only 4 cases (11 %). Moreover, associated findings such as interpubic hematoma (n=23) or tears of the symphyseal capsule (n=7) were detected in patients of group C. CONCLUSION: The wide overlap of findings between symptomatic and asymptomatic postpartum patients does not allow reliable differentiation by MRI of normal and abnormal findings. MRI contributes to the differentiation of symphyseal contusion and rupture and provides information on severe associated changes.

[The benign metastasizing leiomyoma: case collection and therapeutical options]. / Das "benigne" metastasierende leiomyom: fallsammlung und therapeutische optionen.

We report two patients with pulmonary nodules detected by chance. Histopathology of biopsies retrieved by surgical videothoracoscopy revealed benign metastasizing leiomyoma (BML). The origin of this disease as well as its dignity are not fully understood. We discuss the origin of this disease and different therapeutic options - from oophorectomy to different hormon therapies. A standardized therapeutic recommendation cannot be given.

[Nocardiosis as a differential diagnosis of a PET-positive pulmonary nodule]. / Nokardiose als Differenzialdiagnose eines PET-positiven Lungenherdes.

We describe the case of a 76-year-old immunocompetent man suspected to have lung cancer in the right upper lobe on the basis of radiographic and clinical findings. The tumour could not be confirmed histologically by transbronchial biopsy. In the fluorodeoxyglucose positron emission tomography (FDG-PET) we found a significantly elevated standard uptake value (SUV) of 13.4. The patient underwent thoracotomy with excision of the tumour, the histological diagnosis was chronic pneumonia. Tissue culture revealed Nocardia spp. Using 16-rDNA-gene sequence analysis the species was identified as Nocardia abscessus. The patient was treated with trimethoprim-sulfamethoxazol regarding the susceptibility profile and improved remarkably both clinically and radiographically.

Low-field MRI for assessing synovitis in patients with rheumatoid arthritis. Impact of Gd-DTPA dose on synovitis scoring.

OBJECTIVE: To investigate the impact of a double dose compared to a single dose of contrast material in low-field magnetic resonance imaging (MRI) on semi-quantitative scoring of synovitis in patients with rheumatoid arthritis (RA). METHODS: This prospective study included 38 RA patients (23 women and 15 men, mean age 51 years). All patients underwent low-field MRI of the hand before administration of contrast medium, after intravenous injection of 0.1 mmol/kg gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA), and after another dose of 0.1 mmol/kg Gd-DTPA. Two readers (A and B) blinded to dosage independently scored the single dose and double dose image sets for synovitis according to outcome measures in rheumatology (OMERACT) recommendations. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were also calculated for each set. RESULTS: 149 metacarpophalangeal (MCP) joints were evaluated. There was good inter-reader agreement for each of the two sets (intra-class correlation coefficient of 0.75 for the single dose set and 0.83 for the double dose). Median CNR and SNR values were 5.4 and 15.9, respectively, for the single dose set and 8.5 and 16.6, respectively, for the double dose set (p<0.0001). Single dose set mean synovitis scores were 1.7 and 1.6 for readers A and B, respectively. Double dose set scores were 1.9 and 2.0, respectively. Thus, higher synovitis scores were recorded for the double dose sets than the single dose sets (p<0.005). CONCLUSION: In low-field MRI, when evaluating RA, the dose of the contrast material influences synovitis scoring. Therefore, dosage of contrast material should be taken into consideration when using extremity dedicated low-field MRI.

[Imaging of enthesitis: a new field for the radiologist?]. / Bildgebung der Enthesitis: Ein neues Feld für den Radiologen?

Entheses are sites where tendons, ligaments, joint capsules, or fasciae attach to bone. Their function is to provide a mechanism for reducing stress at the bony interface by dissipating the biomechanical load acting on the bone. Enthesitis may occur in traumatic, endocrinologic, metabolic, degenerative, or inflammatory conditions and is a major symptom in patients with seronegative spondyloarthritis (SpA). The increasing interest in inflammation of the entheses associated with rheumatoid diseases has fundamentally changed our understanding of the clinical presentation, pathogenesis, and therapy of enthesitis. Conventional radiographs and computed tomography (CT) allow good evaluation of chronic changes of the entheses, such as soft-tissue calcification, erosions, and new bone formation. The method of first choice to evaluate acute enthesitis is magnetic resonance imaging (MRI), which depicts both soft-tissue changes and intraosseous abnormalities. The purpose of this overview is to discuss the MRI appearance of enthesitis in patients with SpA and to provide a morphologic survey of the predominantly affected entheses.

Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints.

OBJECTIVE: To perform a prospective long term follow up study comparing conventional radiography (CR), ultrasonography (US), and magnetic resonance imaging (MRI) in the detection of bone erosions and synovitis in rheumatoid arthritis (RA) finger joints. METHODS: The metacarpophalangeal and proximal interphalangeal joints II-V (128 joints) of the clinically dominant hand of 16 patients with RA were included. Follow up joint by joint comparisons for erosions and synovitis were made. RESULTS: At baseline, CR detected erosions in 5/128 (4%) of all joints, US in 12/128 (9%), and MRI in 34/128 (27%). Seven years later, an increase of joints with erosions was found with CR (26%), US (49%) (p<0.001 each), and MRI (32%, NS). In contrast, joint swelling and tenderness assessed by clinical examination were decreased at follow up (p = 0.2, p<0.001). A significant reduction in synovitis with US and MRI (p<0.001 each) was seen. In CR, 12 patients did not have any erosions at baseline, while in 10/12 patients erosions were detected in 25/96 (26%) joints after 7 years. US initially detected erosions in 9 joints, of which two of these joints with erosions were seen by CR at follow up. MRI initially found 34 erosions, of which 14 (41%) were then detected by CR. CONCLUSION: After 7 years, an increase of bone erosions was detected by all imaging modalities. In contrast, clinical improvement and regression of synovitis were seen only with US and MRI. More than one third of erosions previously detected by MRI were seen by CR 7 years later.

Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts.

Involvement of the sacroiliac joints (SIJ) is a major and characteristic feature of the spondyloarthritides (SpA). In early ankylosing spondylitis and undifferentiated SpA (uSpA) sacroiliitis is the most common early clinical finding and the presumed first manifestation of the disease. Magnetic resonance imaging has proved useful for visualising inflammation in the SIJ in adults and children. Recently, initial localisation of the inflammation in the SIJ has been described in some detail, but it has not been completely defined to date--either in imaging or in histopathological studies. This is mainly owing to the lack of data in very early disease and the lack of follow up studies. Here we present a patient with early disease, which may augment our understanding of this stage of SpA.

Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences.

OBJECTIVES: To compare the performance of two different MRI sequences-T(1) weighted, fat saturated, spin echo after application of contrast medium, and short tau inversion recovery (STIR) sequences-to detect spinal inflammation in patients with ankylosing spondylitis (AS). METHODS: Both MRI sequences were performed in 38 patients with active AS and compared using the MRI activity scoring system, ASspiMRI-a. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebral body. RESULTS: Intraclass correlation coefficients were excellent-0.91 and 0.86 for the Gd-DTPA and STIR sequences, respectively. The overall correlation of the single MRI scores for both sequences was also good (r = 0.84, p = 0.01). The intrarater variance was 6.71 and 9.41 and the interrater variance was 13.16 and 19.04 for the Gd-DTPA and STIR sequences, respectively. The smallest detectable distance was 4.7 and 5.6 for the Gd-DTPA and STIR sequences, respectively. The concordance rate for both sequences was 83.5% (range 80.5-87.7% in the three spinal segments). Inflammatory spinal lesions were found in 10.1% of the VUs in the STIR sequence but not in the T(1)/Gd-DTPA sequence, while the T(1)/Gd-DTPA sequence showed inflammatory lesions in 6.4% of the VUs that were found normal by STIR. CONCLUSIONS: Both MRI techniques can evaluate active spinal lesions in patients with AS. More spinal lesions are detected by the STIR sequence, but the reliability between readings and readers is better for the Gd-DTPA sequence. The ASspiMRI-a is a reliable instrument for evaluating acute spinal changes in AS.

Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging.

BACKGROUND: Magnetic resonance imaging (MRI) is increasingly used to detect inflammation in the spine of patients with ankylosing spondylitis (AS). OBJECTIVES: To detect differentially the presence and extent of inflammation in the three spinal segments of patients with AS by MRI. METHODS: In 38 patients with active AS, acute spinal lesions were assessed by T(1) weighted, gadolinium enhanced, spin echo MRI (T(1)/Gd-DTPA) and short tau inversion recovery (STIR) sequences. MRI was quantified by the validated scoring system ASspiMRI-a. Acute spinal lesions were detected in the whole spine and in each spinal segment. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebral body. RESULTS: A greater number of inflammatory spinal lesions were found by the STIR sequence than by Gd-DTPA: inflammation was present in 30.6% of the VUs as assessed by STIR, compared with 26.8% of the same VUs assessed by T(1)/Gd-DTPA. Inflammation was found more commonly in the thoracic spine (TS) than in the cervical (CS) or the lumbar spine (LS) with both techniques. When STIR was used, spinal inflammation in the CS, the TS, and LS was detected in 10/38 (26%), 28/38 (74%), and 9/38 (24%) patients, respectively. The VU T7/8 was found to be the VU most often affected by both techniques (27.8% by T(1)/Gd-DTPA and 34.5% by STIR). CONCLUSIONS: Spinal inflammation is a common manifestation in patients with AS, and appears more frequently in the TS. The scoring system ASspiMRI-a can be used for evaluation of acute spinal changes in AS.

[Magnetic resonance tomography of sacroiliitis: anatomy, histological pathology, MR-morphology, and grading]. / Magnetresonanztomographie der Sakroiliitis: Anatomie, Pathohistologie, MR-Morphologie und Graduierung.

The diagnosis of spondyloarthropathy is based on radiography of the sacroiliac joints, beside the patient's history and clinical examination. In cases where the clinical examination and radiography yield discrepant findings, contrast-enhanced magnetic resonance imaging (MRI) is a sensitive modality for the diagnosis of early sacroiliitis. Knowledge of the morphologic anatomy of the sacroiliac joints and of their abnormal micro- and macroanatomy in sacroiliitis and enthesitis are helpful for interpreting MR images. Arthritis of the sacroiliac joints is characterized by subchondral sclerosis, erosions, transarticular bone bridges, accumulation of periarticular fat, juxta-articular osteitis, synovtis, capsulitis, and enthesitis. The major histologic finding in active sacroiliitis is the presence of proliferative, pannus-like connective tissue destroying cartilage and bone. This tissue contains fibroblasts and fibrocytes as well as T cells and macrophages with a shift of the CD4/CD8 ratio toward the CD4 T helper cell population. The well-established grading of MRI findings by means of a chronicity and activity index, which are determined quantitatively from dynamic MR images, is supplemented by an alternative, semi-quantitative grading of activity. The following grades were defined for the short tau inversion recovery (STIR) sequence or the T1-weighted, fatsaturated spin-echo sequence for each quadrant (iliac anterior, iliac posterior, sacral anterior, sacral posterior): 0: no signal increase, 1: local increase in the joint cavity or within erosions, 2: small areas of increased juxta-articular signal, 3: moderate sized areas of increased juxta-articular signal, 4: large areas of increased juxta-articular signal. Values of the 4 quadrants are summed to an activity score (range 0-16). The new grading system is proposed to facilitate the examination and shorten image interpretation time.

Evaluation of a wavelet-based computer-assisted detection system for identifying microcalcifications in digital full-field mammography.

PURPOSE: To evaluate a new wavelet-based computer-assisted detection (CAD) system for detecting and enhancing microcalcifications. MATERIAL AND METHODS: A total of 280 mammograms acquired by full-field digital mammography (Senographe 2000D; G.E. Medical Systems Milwaukee, Wisc., USA) were analyzed with and without a new wavelet-based CAD system for detecting and enhancing microcalcifications. The mammograms comprised roughly equal numbers of cases from each of the BIRADS (Breast Imaging, Reporting and Data System, according to the American College of Roentgenology) categories 1-5. Histologic confirmation was available for all of the 180 cases assigned BIRADS categories 3-5. Four readers interpreted all 280 images for suspicious microcalcifications using a scale of 1-5. The readers alternately assessed 5 images with and 5 without CAD. In a second reading immediately following the first, the readers had to reassess the 280 mammograms. The images that had already been interpreted without CAD were now presented with CAD and vice versa. The images were interpreted as soft copies on a diagnostic mammography workstation (Image Diagnost GmbH, Neufahrn/Munich, Germany). All images interpreted with CAD were presented with enhancement of microcalcifications by wavelet algorithms and prompting of microcalcifications. ROC (receiver operating characteristic) analyses were performed, and image interpretation time with and without CAD was measured. RESULTS: The overall time for interpretation required by all 4 readers together was 483 min with CAD compared to 580 min without CAD. ROC analysis revealed no significant advantage of CAD for the individual readers. Readers 3 (0.811/0.817) and 4 (0.799/0.843) had a slightly improved AUC (area under the curve) with CAD. Readers 1 and 2 had a slightly lower AUC with CAD (0.832 versus 0.861 and 0.818 versus 0.849). CONCLUSION: The CAD system significantly (P<0.05, t test) speeded up image interpretation with respect to the identification of microcalcifications, while the diagnostic quality remained almost identical under the study conditions.

Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional x rays with magnetic resonance imaging using established and new scoring systems.

OBJECTIVES: To compare conventional radiography and magnetic resonance imaging (MRI) for detection of chronic changes in the spine of patients with ankylosing spondylitis (AS). METHODS: Assessment of chronic lesions in conventional x rays and T1 weighted MRI turbo spin echo sequences was performed with the established x ray scores BASRI and SASSS, the new Berlin score, and the MRI scoring system ASspiMRI-c All images were read twice and "blindly" by two readers. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebra. Definite involvement was defined as a score > or =2 in a spinal segment. RESULTS: Thirty nine patients with AS were examined (25 (64%) male, mean age 40.9 years, 33/36 (92%) HLA-B27 positive). The Berlin score correlated with the BASRI (r = 0.73, p = 0.01). The ASspiMRI-c correlated well with the BASRI and the Berlin score (r = 0.66 and r = 0.51, respectively, p = 0.01). The Berlin x ray score showed that 12/35 (34.3%), 13/35 (37.1%), and 12/28 (31.6%) patients had definite involvement of the cervical spine (CS), thoracic spine (TS), and lumbar spine (LS), respectively. The ASspiMRI-c showed that 10/36 (27.8%), 21/36 (58.3%), and 9/35 (25.7%) patients had definite involvement of the CS, TS, and LS, respectively. Syndesmophytes were found in 14.4% of all VUs with 90% agreement between the SASSS and Berlin score. CONCLUSIONS: T1 weighted MRI can detect chronic lesions in AS. The two new scoring systems proved valid in comparison with established scoring systems and based on aspects of the OMERACT filter. The thoracic spine is most commonly affected in AS. This part of the spine is best assessed by MRI.

[Use of state-of-the-art ultrasound techniques in diagnosing sarcoidosis of the salivary glands (Heerfordt's syndrome)]. / Einsatz moderner Ultraschallverfahren in der Diagnostik der Speicheldrüsensarkoidose (Heerfordt-Syndrom).

AIM: The parotid gland is a rare site of sarcoidosis (6% of all cases). The role of state-of-the-art ultrasound techniques in the diagnostic assessment of parotid sarcoidosis (Heerfordt's syndrome) is presented. PATIENTS AND METHODS: Four patients (three male, one female; aged 31-42 years) with inconclusive parotid swelling associated with fever and uveitis were referred for diagnostic assessment by the ENT outpatient service over a 1 year period. High-resolution ultrasound (US) was performed using the SONOLINE Elegra system with a 7.5-MHz wide-band transducer and various, special US techniques (tissue harmonic imaging, photopic imaging, color-coded duplex US, and power Doppler). Diagnoses were confirmed in all cases by puncture and histology. RESULTS: Two patients with typical lung findings (stage I and II sarcoidosis) and two patients without known sarcoidosis showed an inhomogeneous nodular appearance of the clinically enlarged salivary glands at US. Duplex US demonstrated hypervascularization in three cases and moderate, inhomogeneous vascularization in one. In comparison to plain B-mode scanning, optimal visualization of the hypodense, nodular, structural changes was achieved using contrast-enhancing techniques. All patients underwent US-guided puncture for determining the etiology of parotitis. Histology demonstrated granulomatous epitheloid cell inflammation. CONCLUSION: An inhomogeneous nodular appearance of the parenchyma of enlarged parotid glands with areas of hypervascularization, which is optimally depicted by state-of-the-art US techniques, should suggest Heerfordt's syndrome as a possible differential diagnosis.