Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR) -- results of a phase-III multicenter clinical trial.

The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis was > or = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (> or = 88%) and specificity (> or = 77%). For lymph node groups, the sensitivity was > or = 59% and specificity > or = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV) > or = 90% and a positive predictive value (PPV) > or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.

[Differential diagnosis of parapharyngeal mass]. / Zur Differentialdiagnose der parapharyngealen Raumforderung.

BACKGROUND: Parapharyngeal lesions are rare. Tumors arising in the parapharyngeal space can be silent clinically for a long period of time. Physical findings like dislocation of the pharyngeal walls or cervical swelling are often recognized by chance. MATERIAL AND METHODS: Representing three cases of parapharyngeal tumors the differential diagnosis of parapharyngeal masses and the importance of the magnetic resonance imaging will be shown. CONCLUSIONS: Mostly, parapharyngeal masses are represented by salivary gland tumors (40%-50%). The second most common tumors in the parapharyngeal space are neurogenic tumors (17%-25%). Paragangliomas are the third group of common parapharyngeal lesions (10%-15%). A mixed group of lesions like branchial cleft cysts, lymph nodes and hematogenic tumors represent the remaining part of the parapharyngeal masses (10%-33%). Most of the lesions (80%) are benign. Because of the magnetic response imaging a reliable preoperative diagnosis is possible in more than 80% of the tumors. The surgical management may also be influenced by the location of the tumor shown in the magnetic resonance imaging.

[Computer-assisted analysis of mammograms in routine clinical diagnosis]. / Computerassistierte Analyse von Mammographien in der klinischen Routinediagnostik.

PURPOSE: Computer-aided diagnosis in mammography is a topic many study groups have been concerned with since the first presentation of a system for computer-aided interpretation in 1967. Currently, there is only one system available for clinical use in mammaography, the CAD-System Image Checker (R2 Technology). The purpose of our prospective study was to evaluate whether the integration of the CAD-system into the routine of a radiological breast diagnosis unit is feasible. RESULTS: After the installation of the CAD-system, 300 patients with 1110 mammograms were included for evaluation in the present study. In 54 of these cases histological examination was indicated due to suspect criteria on conventional mammography. In 39 of 54 cases (72.2%) malignancy could be proven histologically. The CAD-system marked 82.1% of the histologically verified carcinomas correctly. 94.3% of all 1797 marks made by the CAD-system indicated normal or benign structures. Routinely performed CAD analysis prolonged patients waiting time by about 15 min because the marks of the CAD system had to be interpreted in addition to the routine diagnostic investigations. CONCLUSION: Our experience with the use of the CAD-system in daily routine showed that CAD analysis can easily be integrated into a preexisting mammography unit. However, the diagnostic benefit is not yet clearly established. Since the rate of false negative marks by the CAD-system Image Checker is still high, the results of CAD analysis must be checked and corrected by an observer well experienced in mammography reading.

[Vena cava filter. Indications, complications, clinical evaluation]. / Vena-cava-Filter. Indikationen, Komplikationen, klinische Wertigkeit.

INTRODUCTION: Pulmonary embolism is the third leading cause of death in the western countries. If anticoagulation fails or is contra-indicated, or if the risk for pulmonary embolism is increased for other reasons, the percutaneous implantation of a vena cava filter should be considered. METHODS: The available filters can be differentiated by the design (cone, basket, net-types), by the material, and by their removability. The rate of complications (caval thrombosis, fracture of filter) and the in vitro efficacy in trapping thrombotic clots is dependent on the specific filter type. RESULTS: In clinical practice there is no evidence for significant differences in trapping efficacy among the different filters. About 4% of all patients treated by caval filters still can have pulmonary embolism, and 1% will have a fatal outcome. Dependent on the filter type, the most common complication is caval thrombosis, in up to 25% of cases. CONCLUSION: The percutaneous implantation of caval filters can readily be performed by interventional radiologists. However, randomized clinical studies failed to clearly document efficacy of caval filters. Therefore, indication has to be considered carefully.

[Focal liver diseases]. / Fokale Lebererkrankungen.

INTRODUCTION: Advanced therapies are improving significantly the survival of patients with malignant focal liver disease. For efficient implementation of these surgical and interventional techniques a clear concept of the diagnostic procedure is mandatory. METHODS: Based on a review of the current literature, the different imaging modalities, including ultrasound, computed tomography, magnetic resonance tomography, nuclear medicine and angiography, are discussed and evaluated for their diagnostic efficacy in focal hepatic disease. RESULTS: Considering clinical, diagnostic, and economical appropriateness, recommendations for diagnostic strategies in different clinical scenarios regarding focal heptic disease are presented. CONCLUSION: If the power of specific imaging methods are relevant clinical information is known, problem-based diagnostic strategies help to avoid unnecessary, expensive and time-consuming studies in the work-up of focal liver lesions.

Pancreatic neoplasms: MR imaging and pathologic correlation.

Magnetic resonance (MR) imaging can aid in the detection and characterization of many pancreatic neoplasms. The MR imaging appearances of common pancreatic neoplasms such as ductal adenocarcinoma are well-known. However, MR imaging features of more unusual pancreatic neoplasms are not well understood. Such tumors include mucin-hyper-secreting carcinoma, serous microcystic neoplasm, mucinous macrocystic neoplasm, solid and papillary epithelial neoplasm, multiple cysts associated with von Hippel-Lindau disease, acinar cell carcinoma, pancreaticoblastoma, and endocrine neoplasms (eg, nonfunctioning islet cell tumors, insulinoma, and gastrinoma). In general, pancreatic neoplasms demonstrate high signal intensity on T2-weighted images; the signal intensity on T1-weighted images is more variable but is often intermediate or low. Gadolinium enhancement is often helpful in further characterizing pancreatic neoplasms. The gross and histologic features of pancreatic neoplasms are also not well-known. Correlation with the underlying pathologic features enhances understanding of the MR imaging characteristics of both common and unusual pancreatic neoplasms.

Wegener granulomatosis of the eustachian tube and skull base mimicking a malignant tumor.

Wegener granulomatosis is a well-studied yet sometimes difficult-to-diagnose systemic vasculitis. Early treatment with immunosuppressants is the therapy of choice and usually controls the disease. Two cases of Wegener granulomatosis are presented, both with symptoms and imaging findings suggestive of a malignant tumor of the nasopharynx or skull base. The focus of upper respiratory involvement in each case was the eustachian tube.

Leiomyosarcoma of the larynx presenting as a laryngopyocele.

An 87-year-old man had an 8-month history of hoarseness, respiratory distress, and dysphagia. Physical examination, including direct laryngoscopy, revealed a mass on the right anterolateral side of the neck and a submucosal mass of the supraglottic larynx. A contrast-enhanced CT scan showed a more superior cystic mass, a laryngopyocele resulting from a more inferior, solid-appearing and obstructing mass at the level of the true vocal cord. The obstructing mass was also entirely submucosal at direct laryngoscopy; however, a biopsy specimen revealed a malignant tumor. Subsequent total laryngectomy and pathologic review showed it to be a leiomyosarcoma.

Rhabdomyoma of the pharyngeal musculature extending into the prestyloid parapharyngeal space.

A 66-year-old woman reported fullness in the right ear for 6 months before admission. A submucosal mass shown by MR imaging and CT to arise in the prestyloid parapharyngeal space was the cause of her symptoms. Histologically, the mass proved to be a rhabdomyoma, a rare benign neoplasm, that arose from the muscular wall of the pharynx.

[Computerized tomography of malignancies of the oral cavity, the oropharynx and hypopharynx and invasiveness]. / Computertomographie von Malignomen des Cavum oris, des Oro- und Hypopharynx und deren Ausbreitungswege.

Carcinomas of the oral cavity, oropharynx and hypopharynx represents 5% of all malignant neoplasms. The vast majority, over 90%, are squamous cell carcinomas; less common are lymphomas and tumors of the minor salivary glands. In general, the clinical findings already suggest the presence of a tumor. Therefore, the role of imaging is precise tumor localisation and staging of the malignancy. CT is still the gold standard, although MRI is gaining more importance. We present the CT appearance of most frequent malignancies of the oral cavity, oro- and hypopharynx, discussing briefly the pertinent anatomy.

[Donor site morbidity following radial forearm flap]. / Hebemorbidität nach radialem Unterarmlappen.

The results concerning morbidity of the fasciocutaneous radial forearm flap donor site of 20 patients are presented. The review was carried out with an average time of 4.4 years after raising the flaps, ranging from ten months to eleven years. Range of motion of the wrist joint was limited in extension in two patients with 15 degrees and in one patient with 30 degrees. Pinch and grip strength was found normal in 13 patients and was limited in five cases to 88% of the strength of the opposite limb. Dysesthetic areas were found in three patients on the radial border of the donor site and reduced sensation of the radial nerve was present in four patients.

[Value of plate osteosynthesis in treatment of radius fractures at a typical site]. / Stellenwert der Plattenosteosynthese in der Behandlung von Radiusfrakturen an typischer Stelle.

In the past, distal radius fractures tended to be treated conservatively. Recently, however, unsatisfactory anatomical and functional results have led to an increase in their surgical treatment. Our preferred method of treatment has been percutaneous pin fixation after closed reduction. In our opinion, open reduction and internal fixation with an A0-plate is indicated for Smith fractures (B3 A0-classification), and for any fractures which cannot be ideally reduced (usually C1 to C3 fractures). From 1972 until 1989, 84 patients with distal radius fractures underwent surgical treatment in the Unfallkrankenhaus Salzburg. The procedure was usually performed under brachial plexus or Bier block, and we preferred a palmarly positioned plate for internal fixation. Follow-up of 42 patients showed good results, the functional and subjective results earning higher marks than the X-ray findings.

[Therapy of lunate necrosis]. / Therapie der Mondbeinnekrose.

Out of the multiple methods for treating Lunatum-malacia the following were used in our hospital: shortening of the radius, pisiform-transposition, cancellous bone graft, tendon interposition arthroplasty, intercarpal arthrodesis, prothetic replacement, wrist arthrodesis and denervation of the wrist. Because of non satisfactory results the conservative treatment was abandoned. The indication for one of the different operative methods depended on the radiological Decoulx-Stage, the profession and the age of the patient and his willingness to cooperate. From 1972-1988 36 patients with Kienböck's disease were treated in the Unfallkrankenhaus Salzburg. 20 were seen with an average follow up of 8.7 years. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius otherwise with the pisiform transposition. The same results could be achieved in intermediate stages although with reservation for the pisiform transposition. Although the other operative methods gave pain relief and an improvement of grip strengths, they showed radiologically a progression of the necrosis. Denervation and wrist arthrodesis are reserved for stage IV. Despite some good results, new operative methods like revascularisation operations of the lunate bone seem promising.