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1.
Am J Gastroenterol ; 95(7): 1818-20, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10925991

ABSTRACT

Two years after resection of a pancreatic glucagonoma, scintigraphy with 111indium-labeled octreotide revealed hepatic metastases in a 48-yr-old man. Hepatic metastases were also visualized by CT, whereas an additional lesion in the chest was seen only by scintigraphy. A total of 11 follow-up examinations over 46 months proved somatostatin receptor scintigraphy to monitor reliably somatostatin receptor expression, growth and dissemination of glucagonoma metastases, and to indicate therapeutic readjustment if necessary. The survival time of the patient is now >75 months, in comparison with a mean survival time of 59 months reported for metastatic glucagonoma.


Subject(s)
Glucagonoma/diagnostic imaging , Glucagonoma/secondary , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Pancreatic Neoplasms/pathology , Follow-Up Studies , Humans , Male , Middle Aged , Radionuclide Imaging , Time Factors
2.
Rofo ; 171(4): 269-78, 1999 Oct.
Article in German | MEDLINE | ID: mdl-10598161

ABSTRACT

Computed tomography (CT) and magnetic resonance (MR) imaging are first line modalities in the evaluation of patients with adrenal gland masses, and have the potential to be very accurate for the localization of adrenal gland masses in patients with diseases associated with hyperfunctioning conditions of the adrenal gland. Both CT and MR imaging allow a specific diagnosis of acute adrenal hemorrhage, adrenal myelolipoma, and adrenal cysts. CT is also helpful in the assessment of patients with Addison's disease, particularly the subacute form secondary to granulomatous diseases. Quantitative evaluation of adrenal masses on unenhanced CT scans and/or qualitative analysis on chemical-shift MR imaging have been shown to be accurate in distinguishing adrenal adenomas from non-adenomas. Attenuation of 11 HE or less on unenhanced CT scans and/or signal loss on opposed phase MR images indicate adenoma with a high specificity and acceptable sensitivity. More recently, delayed-enhanced CT has yielded higher sensitivity and specificity values in distinguishing between adrenal adenomas and non-adenomas than both unenhanced CT and chemical-shift MR imaging do. On delayed-enhanced CT scans, adrenal adenomas exhibit a greater washout of contrast material than do adrenal non-adenomas. Therefore, adrenal non-adenomas have significantly higher attenuation than adenomas on delayed-enhanced CT scans obtained at several arbitrarily chosen time points (3-60 min) after the initiation of contrast material administration.


Subject(s)
Adenoma/diagnosis , Adrenal Gland Diseases/diagnosis , Adrenal Gland Neoplasms/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Adenoma/diagnostic imaging , Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/diagnostic imaging , Adrenal Gland Diseases/diagnostic imaging , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/secondary , Adrenocortical Carcinoma/diagnosis , Adrenocortical Carcinoma/diagnostic imaging , Aged , Child , Cushing Syndrome/diagnosis , Cushing Syndrome/diagnostic imaging , Cysts/diagnosis , Cysts/diagnostic imaging , Diagnosis, Differential , Female , Ganglioneuroma/diagnosis , Ganglioneuroma/diagnostic imaging , Hemangioma/diagnosis , Hemangioma/diagnostic imaging , Hemorrhage/diagnosis , Hemorrhage/diagnostic imaging , Humans , Hyperaldosteronism/diagnosis , Hyperaldosteronism/diagnostic imaging , Lymphoma/diagnosis , Lymphoma/diagnostic imaging , Male , Middle Aged , Myelolipoma/diagnosis , Myelolipoma/diagnostic imaging , Pheochromocytoma/diagnosis , Pheochromocytoma/diagnostic imaging
3.
Acta Med Austriaca ; 26(3): 105-8, 1999.
Article in English | MEDLINE | ID: mdl-10520379

ABSTRACT

The study aimed to increase the sensitivity of somatostatin receptor (SR) specific scintigraphy for the detection of non-Hodgkin's lymphoma (NHL). Ten selected patients presenting with histologically proven NHL and with 50% to 100% bone marrow involvement were injected with 20 micrograms octreotide labeled with a mean of 254 MBq 111In. The results were recorded with a double head gamma camera by long-time SPET (60 sec per frame, 3 interval) of neck/thorax and abdomen/pelvis. To show bone marrow displacement by lymphoma cells, SPET of the same regions (15 sec per frame, 3 interval) was recorded 3 to 7 days later after i.v. administration of 0.5-1 mg monoclonal anti-granulocyte antibody (Mab 250/183) labeled with a mean of 454 MBq 99mTc. This modality showed a person related sensitivity of 70%, a lesion related sensitivity of 48% (29/60), 60% (22/37) above and 30% (7/23) below the diaphragm. The sensitivity in detecting bone marrow involvement was 10%. Only 80% bone marrow infiltration with lymphoma cells in nodular configuration was shown by In-111-octreotide scintigraphy correlating with cold lesions in the anti-granulocyte scan. There was no false positive result; the smallest lesion correctly identified by SR scintigraphy had with a diameter of 1 cm, the largest lesion missed measured 3.5 cm. In conclusion, doubling the doses of octreotide and radiolabel and extended SPET recording improved to some extent the patient related sensitivity and visualized nodular bone marrow involvement in 10% of patients. The lesion related sensitivity improved mainly above but not below the diaphragm.


Subject(s)
Indium Radioisotopes/pharmacokinetics , Indium Radioisotopes/therapeutic use , Lymphoma, Non-Hodgkin/diagnostic imaging , Octreotide/analogs & derivatives , Receptors, Somatostatin/analysis , Bone Marrow/pathology , Gamma Cameras , Humans , Lymphoma, Non-Hodgkin/pathology , Neoplasm Staging , Octreotide/pharmacokinetics , Octreotide/therapeutic use , Sensitivity and Specificity , Tomography, Emission-Computed, Single-Photon/methods
4.
Scand J Rheumatol ; 28(4): 257-9, 1999.
Article in English | MEDLINE | ID: mdl-10503565

ABSTRACT

Adult-onset Still's disease (AOSD) is an acute systemic inflammatory disorder of unknown origin. We report a patient whose AOSD presented with the commonly accepted diagnostic clinical signs and laboratory parameters. The painful joints distinctly demonstrated increased uptake of 99mTc-methylene diphosphonate in scintigraphy and areas of increased gadolinium-enhanced signal in MRI. Biopsies indicated bone marrow edema. AOSD in association with bone marrow edema had not been previously demonstrated. AOSD is often diagnosed after a considerable delay, bone scintigraphy, and magnetic resonance imaging may offer new imaging techniques for early diagnosis and successful therapy in follow-up examinations.


Subject(s)
Bone and Bones/diagnostic imaging , Bone and Bones/pathology , Magnetic Resonance Imaging , Still's Disease, Adult-Onset/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Pain , Radionuclide Imaging , Radiopharmaceuticals/pharmacokinetics , Still's Disease, Adult-Onset/diagnostic imaging , Still's Disease, Adult-Onset/physiopathology , Technetium Tc 99m Medronate/pharmacokinetics , Tissue Distribution
5.
Radiologe ; 39(7): 584-90, 1999 Jul.
Article in German | MEDLINE | ID: mdl-10472087

ABSTRACT

The routine staging work-up for renal cancer includes a contrast-enhanced multiphasic spiral CT and a chest radiograph. If there is doubt regarding the presence and extent of (supradiaphragmatic) IVC thrombus, MR imaging should be performed. Dynamic contrast-enhanced MR imaging should be used in place of CT in any patient with severe renal dysfunction, symptomatic polycystic kidney disease, or a history of allergy to iodinated contrast media. Cavography is no longer needed in the era of (adaptive array detector) spiral CT and MR venography.


Subject(s)
Carcinoma, Renal Cell/pathology , Diagnostic Imaging , Kidney Neoplasms/pathology , Adult , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/therapy , Child , Humans , Kidney/pathology , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Magnetic Resonance Imaging , Neoplasm Staging , Prognosis , Tomography, X-Ray Computed
6.
Neuroradiology ; 41(7): 504-7, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10450844

ABSTRACT

Metastasising chordomas are extremely rare and only four cases with drop metastases have been reported. We report a patient with an intracranial chondroid chordoma, typically involving the clivus, treated by repeated resection, percutaneous transluminal embolisation and radiosurgery. During follow-up with MRI asymptomatic intradural drop metastases were observed throughout the spine, with transgression of the intervertebral foramen, forming a "dumbbell".


Subject(s)
Chordoma/secondary , Meningeal Neoplasms/secondary , Skull Base Neoplasms/pathology , Adult , Chordoma/diagnosis , Chordoma/therapy , Cranial Fossa, Posterior , Dura Mater/pathology , Humans , Magnetic Resonance Imaging , Male , Skull Base Neoplasms/diagnosis , Skull Base Neoplasms/therapy
7.
AJNR Am J Neuroradiol ; 20(2): 285-6, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10094355

ABSTRACT

Dirofilariasis is a helminthic zoonosis occurring in many parts of the world. We report the findings in a 61-year-old woman who had painless right exophthalmos caused by orbital dirofilariasis. A vivid worm was embedded inside an inflammatory nodule in the right orbit. On T1-weighted MR images, the parasite was visible as a discrete, low-intensity, tubular signal in the center of the nodule surrounded by contrast-enhancing inflammatory tissue.


Subject(s)
Dirofilariasis/diagnosis , Magnetic Resonance Imaging , Orbital Diseases/diagnosis , Dirofilariasis/complications , Exophthalmos/etiology , Female , Humans , Middle Aged
9.
Am J Rhinol ; 13(6): 469-72, 1999.
Article in English | MEDLINE | ID: mdl-10631404

ABSTRACT

We present the first case report of an endoscopic removal of a living worm, species Dirofilaria repens, from the orbital cavity. As of today, over 410 cases of Dirofilaria repens infections in man are recorded in world literature, six of which were localized in the orbital cavity. In Austria we know of four cases of an infection with this parasite, but none in the orbit. Dirofilaria repens is widespread only in the Old World, particularly in Southern and Eastern Europe, in Asia Minor, and in Central and Southern Asia. The highest prevalence of the disease is recorded in Italy (181 cases). In clinical practice, the infections have mostly been misdiagnosed as a neoplasia, usually benign but sometimes malignant. Under the assumption of an intraorbital tumor, the endoscopic transnasal revision of the orbital cavity was performed, as this approach promised to be least traumatic and best suited for the lesion, resulting in complete removal of the live worm. In unclear lesions in the head and neck, and infection with Dirofilaria repens should be considered as a differential diagnosis.


Subject(s)
Dirofilariasis/diagnosis , Dirofilariasis/surgery , Endoscopy/methods , Exophthalmos/etiology , Austria , Diagnosis, Differential , Dirofilariasis/complications , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Orbit/parasitology , Orbit/pathology , Orbit/surgery
11.
Clin Infect Dis ; 26(6): 1379-82, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9636867

ABSTRACT

Standard treatment of cerebral alveolar hydatid disease consists of open brain surgery and systemic albendazole. We describe a patient with inoperable cerebral alveolar hydatid cysts on whom gamma knife radiosurgery was used instead of open brain surgery. Because of the size of the multicystic lesion, the gamma knife procedure was done in two sessions. Repeated courses of albendazole were given concurrently. Magnetic resonance imaging follow-up studies showed marked shrinkage of the irradiated cystic structures and initially increased perifocal edema. At a follow-up visit 3 years after gamma knife radiosurgery, the polycystic lesion, the perifocal edema, and the neurological symptoms had all markedly decreased. The patient is now stable and has minimal neurological symptoms, and the quality of her life has improved. Gamma knife radiosurgery may be an alternative for patients with cerebral alveolar hydatid disease for whom surgery is not possible.


Subject(s)
Albendazole/therapeutic use , Anthelmintics/therapeutic use , Brain Diseases/parasitology , Echinococcosis/therapy , Radiosurgery , Adult , Brain Diseases/drug therapy , Brain Diseases/surgery , Combined Modality Therapy , Echinococcosis/drug therapy , Echinococcosis/surgery , Female , Humans
12.
Neuroradiology ; 40(4): 261-3, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9592801

ABSTRACT

We present the CT and MRI findings of a histologically proven synovial sarcoma arising in the left parapharyngeal space of a 21-year-old man. CT was useful for confirming the presence of calcification within the tumour, which may be a favourable prognostic sign, and in excluding involvement of cortical bone. The CT and MRI findings were, however, nonspecific. MRI was superior to CT for assessing the topographical relationships of the tumour to the vessels and the invasion of neighbouring structures.


Subject(s)
Magnetic Resonance Imaging , Pharyngeal Neoplasms/diagnosis , Sarcoma, Synovial/diagnosis , Tomography, X-Ray Computed , Adult , Calcinosis/diagnosis , Calcinosis/pathology , Diagnosis, Differential , Humans , Male , Pharyngeal Neoplasms/pathology , Pharynx/pathology , Sarcoma, Synovial/pathology
14.
Skeletal Radiol ; 26(10): 615-8, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9361359

ABSTRACT

This case report describes an ossifying tumor in the left musculus erector spinae in a 32-year-old man. Radiologically it showed irregular lamellar bone formation in the periphery, demonstrating as juxtacortical and macroscopically sarcoma-like features. Histologic it was diagnosed as an ossifying fibromyxoid tumor of soft parts (OFTSP). The CT features of this tumor have never previously been reported. This is the first time pulmonary metastases, malignant pleural effusion, and death of the patient directly related with an OFTSP have been described.


Subject(s)
Fibroma/diagnostic imaging , Ossification, Heterotopic/pathology , Soft Tissue Neoplasms/diagnostic imaging , Abdominal Muscles , Adult , Fibroma/pathology , Fibroma/surgery , Humans , Lung Neoplasms/secondary , Male , Neoplasm Recurrence, Local , Ossification, Heterotopic/surgery , Pleural Effusion, Malignant/etiology , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgery , Tomography, X-Ray Computed
15.
Z Gastroenterol ; 35(8): 603-8, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9297775

ABSTRACT

OBJECTIVES: Fistulas in Crohn's disease remain a difficult clinical challenge. Rapid improvement with cyclosporine followed by deterioration after discontinuation of this drug has been reported. This study aimed to determine whether fast remission and long-term improvement could be achieved when cyclosporine was administered concurrently with azathioprine and low-dose prednisolone and then be discontinued. METHODS: Nine patients with fistulas were enrolled in this open study. For the first two weeks cyclosporine was administered intravenously at a dose of 5 mg/kg/day. Azathioprine and low-dose prednisolone were also given during this period. After two weeks cyclosporine was administered orally for a further ten weeks while azathioprine and a tapered dose of prednisolone were continued. Effectiveness was evaluated clinically, by a scoring system and by magnetic resonance imaging. RESULTS: With intravenous cyclosporine as part of this regimen, all nine patients went into remission within days. There were no recurrences after changing from intravenous to oral cyclosporine. Cyclosporine was terminated after three months while azathioprine and low-dose prednisolone were continued. Thereafter, four patients did not deteriorate, three deteriorated slightly, and two patients had a recurrence. The CDAI (Crohn's Disease Activity Index) improved from 200 (range 85-350) to 136 (range 26-200) by the end of the third month. Serological markers remained stable after discontinuation of cyclosporine. There were no serious side effects during this triple drug regimen. CONCLUSIONS: The combination of cyclosporine, azathioprine and low-dose prednisolone leads to marked improvement of perianal fistulas in Crohn's disease. Remission occurs quickly under cyclosporine. These remissions can be maintained with azathioprine in a majority of patients.


Subject(s)
Azathioprine/therapeutic use , Crohn Disease/drug therapy , Cyclosporine/therapeutic use , Immunosuppressive Agents/therapeutic use , Prednisolone/therapeutic use , Rectal Fistula/drug therapy , Adult , Azathioprine/adverse effects , Crohn Disease/diagnosis , Cyclosporine/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Immunosuppressive Agents/adverse effects , Magnetic Resonance Imaging , Male , Prednisolone/adverse effects , Rectal Fistula/diagnosis , Rectum/pathology , Recurrence , Substance Withdrawal Syndrome/diagnosis , Treatment Outcome
16.
Ultraschall Med ; 18(4): 165-8, 1997 Aug.
Article in German | MEDLINE | ID: mdl-9381124

ABSTRACT

A 29 year-old woman presented with continuous metrorrhagia and a positive pregnancy test 3 1/2 months after vaginal birth. Transvaginal sonography showed a 3.5 x 4 x 4 cm mostly echogenic uterine mass with diffuse myometrial invasion in the right fundal region. Colour Doppler sonography revealed extensive low impedance flow in the periphery of the mass suggestive of a trophoblastic tumor. Histological examination of curettage specimens revealed a chorionic carcinoma. The tumor size as measured by magnetic resonance imaging correlated well with that by sonography. Trophoblastic disease after a normal pregnancy is rare. Early diagnosis can be facilitated by transvaginal colour Doppler sonography.


Subject(s)
Choriocarcinoma/diagnostic imaging , Endosonography , Puerperal Disorders/diagnostic imaging , Ultrasonography, Doppler, Color , Uterine Neoplasms/diagnostic imaging , Adult , Blood Flow Velocity/physiology , Choriocarcinoma/blood supply , Diagnosis, Differential , Female , Humans , Neoplasm Invasiveness , Pregnancy , Uterine Neoplasms/blood supply
18.
Magn Reson Imaging ; 15(7): 727-35, 1997.
Article in English | MEDLINE | ID: mdl-9309603

ABSTRACT

Graft dysfunction is a common occurrence during the first weeks following renal transplantation. The current study was designed to evaluate the potential of renal magnetic resonance (MR) perfusion imaging to differentiate acute allograft rejection (AAR) from acute tubular necrosis (ATN) during the post-transplant period. Twenty-three consecutive patients with clinically suspected ATN and/or AAR and eight consecutive control patients (asymptomatic, serum creatinine concentration < 1.5 mg/dL) underwent MR perfusion imaging of the renal allograft within 64 days after transplantation. Histopathology was obtained in all cases with clinical suspicion of ATN or AAR. Sixty sequential fast gradient-recalled-echo MR images were acquired in each patient after intravenous administration of gadolinium-DTPA (0.1 mmol/kg). Histopathology revealed 6 patients with pure AAR, 4 patients with a combination of AAR and ATN, 12 patients with ATN and 1 patient with normal findings. Kidney graft recipients with normal renal function showed a moderate increase in signal intensity (SI) of the renal cortex and medulla after administration of contrast agent followed by an immediate and short decrease in SI of the medulla (biphasic medullary enhancement pattern). The increase in cortical SI of patients with AAR was significantly smaller (61 +/- 4% increase above baseline) than that measured in normal allografts (136 +/- 9% increase above baseline) (p < 0.05) and patients with ATN (129 +/- 3% increase above baseline) (p < .05). Patients with ATN had a slightly delayed and diminished cortical enhancement and an uniphasic and lesser medullary enhancement pattern compared to that observed in normal allografts (p < 0.05). A close correlation (r = 0.72) was found between serum creatinine concentration levels and changes in SI. Thus, MR imaging results and histopathology were in agreement in 22 of 23 patients (96%). MR perfusion imaging of renal allografts can be used to noninvasively differentiate ATN from AAR during the post-transplant period, and may also be helpful in cases were covert AAR is superimposing ATN during a phase of anuria. Patients with ATN can be separated from normals in the majority of cases as reflected by an uniphasic medullary enhancement pattern.


Subject(s)
Graft Rejection/diagnosis , Kidney Transplantation/pathology , Kidney Tubular Necrosis, Acute/diagnosis , Kidney/pathology , Magnetic Resonance Imaging , Adult , Aged , Contrast Media/administration & dosage , Diagnosis, Differential , Female , Follow-Up Studies , Gadolinium DTPA/administration & dosage , Graft Rejection/etiology , Humans , Infusions, Intravenous , Kidney/surgery , Kidney Transplantation/adverse effects , Kidney Tubular Necrosis, Acute/etiology , Male , Middle Aged , Postoperative Period , Transplantation, Homologous/pathology
19.
AJNR Am J Neuroradiol ; 17(8): 1598-600, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8883665

ABSTRACT

After returning from Africa, a 54-year-old man began to have episodes of headache and nausea, then a cerebral convulsion. Clinical and laboratory findings and response to chemotherapy indicated the diagnosis of cerebral schistosomiasis. Three lesions were seen on CT and MR studies: two appeared to be subacute intracerebral hematomas, one in the right parietal lobe and one in the frontal lobe; the third lesion, in the cortex of the left occipital lobe, appeared to be a cyst. These lesions could represent small granulomatous tissue reactions with secondary hemorrhages.


Subject(s)
Brain Diseases/parasitology , Magnetic Resonance Imaging , Schistosomiasis/diagnosis , Tomography, X-Ray Computed , Brain Diseases/diagnosis , Brain Diseases/diagnostic imaging , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/diagnostic imaging , Frontal Lobe/diagnostic imaging , Frontal Lobe/pathology , Granuloma/diagnosis , Granuloma/diagnostic imaging , Headache/diagnosis , Hematoma/diagnosis , Hematoma/diagnostic imaging , Humans , Male , Middle Aged , Nausea/diagnosis , Occipital Lobe/diagnostic imaging , Occipital Lobe/pathology , Parietal Lobe/diagnostic imaging , Parietal Lobe/pathology , Schistosomiasis/diagnostic imaging , Seizures/diagnosis
20.
J Nucl Med ; 37(9): 1524-5, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8790208

ABSTRACT

Scintigraphy with 67Ga-citrate indicated the transition of an orbital pseudotumor into a lymphoma by a distinct increase in 67Ga avidity. The patient initially presented with a pseudotumor in the right orbit that was verified by CT and MRI. It was caused by a chronic reactive lymphocytic inflammation extending from the lacrimal gland. At that time, scintigraphy was negative. Six and a half weeks later, the tumor had not responded to therapy and scintigraphy then showed a striking increase in gallium avidity. Consequently the tumor was excised and histology ultimately revealed a high-grade non-Hodgkin's T-cell lymphoma.


Subject(s)
Citrates , Gallium Radioisotopes , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, T-Cell/diagnostic imaging , Orbital Neoplasms/diagnostic imaging , Adult , Cell Transformation, Neoplastic , Citric Acid , Humans , Lymphoma, Non-Hodgkin/pathology , Lymphoma, T-Cell/pathology , Male , Orbital Neoplasms/pathology , Orbital Pseudotumor/diagnostic imaging , Orbital Pseudotumor/pathology , Radionuclide Imaging , Time Factors
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