[Oropharyngeal pathologies]. / Oropharynxpathologie.

The oropharynx is an interface between the airway and the digestive tract. Clinical evaluation and endoscopy suffice for the diagnosis of a variety of lesions, but tumors require cross-sectional imaging to assess local infiltration depth and lymphatic spread. This article discusses different lesions of the oropharynx with respect to imaging characteristics of CT and MRI, with a focus on resectability issues and decision-making.

[Tolerance of magnetic resonance imaging in children and adolescents performed in a 1.5 Tesla MR scanner with an open design]. / Untersuchungstoleranz von Kindern und Adoleszenten in einem 1,5 Tesla MR-Tomografen mit offenem Magnetdesign.

PURPOSE: To investigate the tolerance of MR examinations in children and adolescents performed in a 1.5 Tesla MR scanner with an expanded bore diameter. METHOD AND MATERIALS: 163 patients, ages 4 to 25, underwent MR examinations in a 1.5 Tesla MR scanner with an open design (MAGNETOM Espree, Siemens, Erlangen, Germany), characterized by a compact length of 125 cm and an expanded 70 cm bore diameter. MR imaging of the brain was carried out in most cases (78.5 %), followed by examinations of the spinal canal (9.8 %), the extremities (9.2 %) and the neck (2.5 %). The patients were divided into four age groups and the success rate, motion artifacts and diagnostic quality of the MR examinations were assessed using a 3-grade scale. RESULTS: In 119 of 163 patients (73.0 %), MR examination was possible without any motion artifacts. With respect to the different age groups, 41.7 % of the 4 - 7-year-old children, 67.6 % of the 8 - 10-year-old children, 84.1 % of the 11 - 16-year-old children and 95.8 % of the patients older than 17 showed tolerance grade I without motion artifacts and excellent diagnostic image quality. In 39 of 163 children (23.9 %), the MR images showed moderate motion artifacts but had sufficient diagnostic quality. With regard to the different age groups, 52.8 % of the 4 - 7-year-old children, 26.5 % of the 8 - 10-year-old children, 15.9 % of the 11 - 16-year-old children and none of the patients older than 17 showed tolerance grade II with moderate motion artifacts and sufficient diagnostic image quality. In only 4 of 124 children < 10 years old and 1 child > 10 years old, the MR examination was not feasible and had to be repeated under sedation. CONCLUSION: Pediatric MR imaging using a 1.5 Tesla MR scanner with an open design can be conducted in children and adolescents with excellent acceptance. The failure rate of 3.0 % of cases for pediatric MR imaging is comparable to that of a conventional low-field open MR scanner.

Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study.

BACKGROUND: To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room. METHODS: Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed-digital radiographs of the cervical spine (anterior-posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3-point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed-effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group-specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model. RESULTS: Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78). CONCLUSION: Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.

Angiogenesis and dendritic cell density are not correlated with metachronous distant metastasis in curatively operated rectal cancer.

BACKGROUND AND AIMS: Apart from surgery, treatment of rectal cancer increasingly involves the use of (neo-)adjuvant strategies. To optimize the selection process for these therapy regimens, especially in the field of cellular and molecular biology, new prognostic factors additional to the established TNM system are being investigated. PATIENTS AND METHODS: Two groups of patients ( n=2x85) with rectal carcinoma curatively treated by surgery alone were studied retrospectively (median follow-up 6.1 years). To exclude the effect of the surgeon only patients free of locally recurrent disease were selected. Patient groups were matched for age, gender, UICC stage, and year of operation (1982-1991) and differed only in subsequent metachronous distant metastatic spread, i.e., the criterion to be studied. The factors investigated in uni- and multivariate analysis were angiogenesis, density of dendritic cells, grading, venous invasion, and lymphatic invasion. RESULTS: Grading invariably proved to be the only significant prognostic factor. In univariate analysis the absence of venous invasion was also correlated significantly with increased disease-free survival. CONCLUSION: Angiogenesis and dendritic cell density are not prognostic factors for metachronous distant metastasis in rectal cancer and therefore cannot serve as selection parameters for adjuvant therapy.

[VIBE with parallel acquisition technique - a novel approach to dynamic contrast-enhanced MR imaging of the liver]. / VIBE mit paralleler Akquisitionstechnik - eine neue Möglichkeit der dynamischen kontrastverstärkten MRT der Leber.

PURPOSE: The VIBE (volume interpolated breath-hold examination) sequence in combination with parallel acquisition technique (iPAT: integrated parallel acquisition technique) allows dynamic contrast-enhanced MRI of the liver with high temporal and spatial resolution. The aim of this study was to obtain first clinical experience with this technique for the detection and characterization of focal liver lesions. MATERIALS AND METHODS: We examined 10 consecutive patients using a 1.5 T MR system (gradient field strength 30 mT/m) with a phased-array coil combination. Following sequences were acquired: T 2 -w TSE and T 1 -w FLASH, after administration of gadolinium, 6 VIBE sequences with iPAT (TR/TE/matrix/partition thickness/time of acquisition: 6.2 ms/ 3.2 ms/256 x 192/4 mm/13 s), as well as T 1 -weighted FLASH with fat saturation. Two observers evaluated the different sequences concerning the number of lesions and their dignity. Following lesions were found: hepatocellular carcinoma (5 patients), hemangioma (2), metastasis (1), cyst (1), adenoma (1). RESULTS: The VIBE sequences were superior for the detection of lesions with arterial hyperperfusion with a total of 33 focal lesions. 21 lesions were found with T 2 -w TSE and 20 with plain T 1 -weighted FLASH. Diagnostic accuracy increased with the VIBE sequence in comparison to the other sequences. CONCLUSION: VIBE with iPAT allows MR imaging of the liver with high spatial and temporal resolution providing dynamic contrast-enhanced information about the whole liver. This may lead to improved detection of liver lesions, especially hepatocellular carcinoma.

[Angiogenesis and density of dendritic cells do not correlate with metachronous distant metastases after curative surgery of rectal carcinoma]. / Angiogenese und Dichte dendritischer Zellen korrelieren nicht mit der metachronen Fernmetastasierung beim kurativ operierten Rectumcarcinom.

INTRODUCTION: Besides surgery, treatment of rectal cancer increasingly comprises (neo-)adjuvant strategies. To optimise the selection process for these therapy regimens especially in the field of cellular and molecular biology, new prognostic factors besides the established TNM system are being investigated. METHODS: Retrospectively, two groups of patients (n = 2 x 85) with rectal carcinoma curatively treated by surgery alone were studied (median follow-up: 6.1 years). The patients were selected to be free of local disease, in order to exclude surgical influence. Patient groups were matched for age, gender, UICC stage and year of operation (1982-1991) and differed only in subsequent metachronous distant metastatic spread, the criterion to be studied. The factors to be investigated in uni- and multivariate analysis were angiogenesis, density of dendritic cells, grading, venous and lymphatic invasion. RESULTS: Grading always proved to be the only significant prognostic factor (P < 0.0001). In univariate analysis, absent venous invasion also correlated significantly with increased disease-free survival (P = 0.0170). CONCLUSIONS: Angiogenesis and density of dendritic cells in rectal cancer are not prognostic factors for metachronous distant metastasis and, therefore, cannot serve as selection parameters for adjuvant therapy.