[MRI of plantar fasciitis]. / MR-Tomographie der Plantarfasciitis.

PURPOSE: The purpose of this study was to determine the type and frequency of characteristic bone and soft tissue changes on MRI of patients with a clinical diagnosis of plantar fasciitis. MATERIALS AND METHODS: 28 patients with a clinical diagnosis of plantar fasciitis underwent MR imaging. Besides T1- and T2-weighted sequences, short-tau-inversion-recovery sequences were used routinely. In 27 patients T1-weighted images after intravenous contrast injection were acquired additionally. As a control group the images of 15 patients without clinical signs for plantar fasciitis were evaluated. RESULTS: In 25 of 28 cases (89%) the clinical diagnosis of plantar fasciitis was established by MR imaging. The most common finding was a peritendinous edema at the calcaneal insertion site which was found in all 25 patients. In 19 of 25 cases (76%) a bone marrow edema of the calcaneus was present. In 14 of 25 cases (56%) an intratendinous signal intensity increase of the plantar fascia could be observed which showed contrast enhancement in 12 cases. Compared to the control group (mean thickness 3.3 mm) the plantar fascia showed significant thickening in the 25 MR positive patients (mean thickness 6.72 mm). DISCUSSION: Besides thickening of the plantar fascia and intratendinous signal intensity increase with contrast enhancement to some extent, bone marrow edema of the calcaneus and peritendinous edema close to the plantar fascia are characteristic signs of plantar fasciitis on MRI. Both signs can reliably be seen on STIR sequences only.

[Magnetic resonance tomography in plasmacytoma: ranking of various sequences in diffuse and focal infiltration patterns]. / Magnetresonanztomographie beim Plasmozytom: Wertigkeit verschiedener Sequenzen bei diffuser und fokaler Infiltrationsform.

PURPOSE: The aim of this study was to compare various pulse-sequences employing the spine array coil while considering the different infiltration patterns in multiple myeloma, in order to develop a fast and cost effective screening method. MATERIALS AND METHODS: In a prospective study, 50 patients with histologically proven multiple myeloma were examined with the following standardised sequences: T1-weighted SE, T2-weighted FSE, opposed phase GRE, FSE STIR, T1-weighted SE post gadopentate dimeglumine without and with fat saturation. The images were evaluated in a ROC analysis by three radiologists in consensus with a 5-grade scale separatively for diffuse and focal involvement. The gold standard was bone marrow histology in cases of diffuse infiltration and the combination of all sequences with the staging system according to Durie and Salmon. RESULTS: For focal bone marrow involvement the area under curve was greatest for FSE STIR sequences, in cases of diffuse infiltration the area under curve was superior for unenhanced T1-w SE-Sequenz images. The sensitivity can be increased by contrast material application and signal intensity measurements. A combined focal and diffuse infiltration and a "salt and pepper" pattern can be diagnosed with the combination of T1-w SE-Sequenz and FSE STIR sequences. CONCLUSION: With T1-weighted SE-Sequenz sequences pre- and post-contrast and FSE STIR all therapeutical relevant infiltration patterns of plasmocytoma can be identified and bone marrow screening of the spine can be carried out with an acquisition time of 5.58 minutes.

Magnetic resonance imaging of labral cysts of the hip.

OBJECTIVE: To present the magnetic resonance (MR) imaging findings in patients with labral cysts adjacent to the acetabulum and to examine their association with hip pathology. DESIGN: MR images and conventional radiographs of seven patients with paralabral cysts were retrospectively reviewed by three musculoskeletal radiologists. PATIENTS: The patients included three men and four women with hip pain, ranging in age from 29 to 82 years. Two patients had developmental dysplasia of the hip and six had a history of remote trauma/dislocation. Clinical history and follow-up were obtained in all patients. Surgery was performed on one patient. RESULTS AND CONCLUSIONS: Paralabral cysts were located in the posterosuperior aspect of the hip joint in five patients and in the anterior aspect in two patients. A tear of the adjacent acetabular labrum was confirmed surgically in one patient, and in all patients the MR features suggested the presence of an abnormal labrum. Osteoarthritis was observed in three patients and there was associated subchondral cyst formation in the acetabulum adjacent to the cyst in three patients. The paralabral cyst of the hip is well visualized on MR imaging and is seen in patients with a predisposition to labral pathology.

[Comparison between current and high resolution ultrasound for diagnosis of breast lesions]. / Vergleich zwischen herkömmlicher und hochauflösender Sonographie für die Diagnostik von Mammaläsionen.

AIM: To assess the value of high-resolution ultrasound in the diagnosis of breast lesions. METHOD: Fifty women with a clinically suspicious breast mass were examined with mammography, conventional and high-resolution sonography. Ultrasound was performed with a linear-array 7.5-mHz transducer and an annular-array 13.0 MHz transducer. RESULTS: Histology showed carcinoma in 28 patients, fibrocystic changes in 20 and fibroadenoma in 2. High-resolution ultrasound characterized 18 lesions more accurately than conventional ultrasound, including 13 carcinomas, 3 fibrocystic changes and 2 fibroadenomas. The size of 8 carcinomas was measured more accurately with high-resolution ultrasound than with conventional ultrasound. CONCLUSION: High-resolution ultrasound is more valuable in the differentiation and size determination of breast lesions than conventional ultrasound.

Ganglia and cysts around joints.

Para-articular cysts frequently are seen on routine imaging examinations. They may be clinically asymptomatic or may cause pain, swelling, or impaired joint function. They often are associated with underlying joint disorders, such as trauma, degeneration, or inflammation. This article discusses the cause, symptoms, and appearance of para-articular cysts on various imaging examinations including arthrography, ultrasound, CT scan, and MR imaging. Specific attention is focused on those cystic masses appearing around the hip, knee, ankle and foot, shoulder, elbow, wrist and hand, spine, temporomandibular joints, and periosteum.

[Phased-array superficial coil and breath holding technique in MRI of the liver. Comparison of conventional spin echo sequences with rapid fat suppressing gradient echo and turbo-spin sequences]. / Array-Oberflächenspule und Atemanhaltetechnik bei der MRT der Leber. Vergleich konventioneller Spinechosequenzen mit schnellen, fettunterdrückenden Gradientenecho- und Turbospinechosequenzen.

PURPOSE: To determine the efficacy of fast MRI techniques using a tailored imaging design (breathhold and array-surface coil), conventional T1-, T2-weighted spin-echo (SE) sequences and breathhold gradient-echo (GRE) T1- and breathhold fast SE T2-weighted images were compared. METHODS: 20 patients with proven focal liver lesions were studied on a 1.5 Tesla system. Conventional SE T1- and T2-weighted imaging, as well as GRE T1- and fast SE T2-weighted imaging was performed. Fast imaging was done during breathhold using an array-surface coil. For all sequences signal-to-noise ratios (S/N) and liver-to-lesion-contrast ratios (L/L) were measured and statistically compared. In addition, two blinded readers qualitatively evaluated all images, using a score system regarding artifacts (breathing, pulsation), number of lesions, and over-all image quality. RESULTS: Regarding image quality parameters, S/N and L/L, there was no significant (p > 0.05) difference between the conventional and fast imaging techniques. However, GRE imaging was superior (84.8%) to conventional imaging for breathing and pulsation artifacts, while fast SE T2 imaging was equal regarding breathing artifacts, but superior (51.5%) regarding pulsation artifacts. The number of detected hepatic lesions was identical in all sequences. CONCLUSION: The fast MRI techniques demonstrated a superiority to conventional imaging regarding image quality and presence of artifacts. Therefore, fast imaging techniques can replace conventional techniques, at least in patients that can sufficiently sustain breathing.

Tibial shaft fractures: assessment of fracture healing with computed tomography.

OBJECTIVE: To assess the capability of CT in assessing stability of tibial shaft fractures with planimetry. MATERIALS AND METHODS: Eighteen patients with fracture of the tibial shaft were treated by external fixator. All patients underwent CT 1, 6, 12, and 18 weeks postoperatively to assess the fracture healing. The callus formation and compacta were determined with planimetry. Fractometry, a noninvasive method to measure stability, was used as the gold standard to determine the stability of the fracture. RESULTS: The patients were divided into three groups according to different periods of time for removal of external fixation. Twelve patients with stable fractures showed a steady increase of callus, which was 50% higher after 12 weeks. Three patients with delayed fracture healing demonstrated an increase of callus of > 50% after 18 weeks. Three patients with unstable fractures obtained only callus formation of < 20% after 15-18 weeks. The external fixator was removed and endomedullary nails were used for stabilization. CONCLUSION: The CT data allow quantification of callus and compacta formation and are able to determine the stability of tibial shaft fractures.

Liver transplantation: significance of the periportal collar on MRI.

OBJECTIVE: Liver transplantation is performed with increasing success and frequency all over the world. Experience with MRI of the liver allograft is, however, limited. This study was designed to correlate MRI to clinical-laboratory findings, CT, and biopsy and to evaluate the significance of the periportal collar on MRI. MATERIALS AND METHODS: Fourteen patients who had undergone orthotopic liver transplantation were studied by CT and MRI [T1-weighted imaging: gradient-echo, repetition time/echo time (TR/TE) 306/14 ms, theta 90 degrees; proton density and T2-weighted imaging: spin-echo, TR/TE 1,600/30-120 ms]. Three patients also had follow-up MR examinations 43 days, 89 days, and 5 months after transplantation. RESULTS: Magnetic resonance imaging demonstrated a perivascular collar around central portal venous branches in all 14 patients and around peripheral portal branches in 10 of the 14 patients on the initial MRI study. The perivascular collar showed low signal intensity on T1-weighted imaging and an increase in signal intensity on T2-weighted multiecho imaging. The distribution and prevalence of central and peripheral periportal collars were identical on MR and CT. Peripheral periportal collars were seen in 9 patients who had no clinical-laboratory signs of rejection. In 3 patients with biopsy-proved rejection, the periportal collar was less prominent on MR at the time of rejection when compared with MR performed when the patient had no signs of transplant rejection. CONCLUSION: A perivascular collar in a patient with liver transplantation is likely to be related to impaired lymph drainage after surgical interruption of the draining lymph vessels and lymphedema. In contrast to previous CT reports, however, a perivascular collar around peripheral portal branches does not appear to correlate to rejection, since it is frequently observed in the normal liver allograft.

Meniscal ossicle: radiographic and MR imaging findings.

PURPOSE: To determine the magnetic resonance (MR) imaging appearance of meniscal ossicles and correlate that with the radiographic and clinical features. MATERIALS AND METHODS: Radiographs and MR images were studied retrospectively in six patients with meniscal ossicles; all patients had intermittent discomfort in the knee, and five patients had experienced knee trauma. Imaging findings were correlated with the clinical history. Four patients underwent arthroscopy. RESULTS: All patients had a visible ossicle on conventional radiographs initially interpreted as a loose joint body. MR imaging features included a corticated marrow-containing structure within the substance of the medial meniscus near the tibial attachment that appeared as a rounded focus of increased signal intensity on T1-weighted images that decreased in signal intensity on T2-weighted images. CONCLUSION: Meniscal ossicles have a characteristic MR appearance that may help distinguish them from loose bodies. They should be considered diagnostically when a circumscribed ossification is identified near the posterior horn of the medial meniscus on radiographs.

[Radiological diagnosis before and after laparoscopic cholecystectomies]. / Radiologische Diagnostik vor und nach laparoskopischen Cholezystektomien.

PURPOSE: To study the diagnostic value of radiological imaging modalities in patients undergoing endoscopic cholecystectomy. PATIENTS AND METHODS: In 286 patients with endoscopic cholecystectomy ultrasound and intravenous cholecystography was performed for preoperative work-up. Postoperatively all patients were examined with ultrasound. RESULTS: ERCP showed a stone in the common bile duct in 12 patients with suspected stones on ultrasound, cholecystography or laboratory values. All 12 patients were treated with papillotomy. Postoperative ultrasound detected increasing fluid in the peritoneal cavity in three patients. Laparotomy of one patient showed bleeding from the cystic artery, in the second patient, injury of the right bile duct. One patient showed an accessory hepatic duct, another patient demonstrated pancreatitis. CONCLUSION: Ultrasound and intravenous cholecystography are suitable for preoperative imaging. Postoperative ultrasound is useful in detecting complications.

[MR functional diagnosis of the cervical spine after strain injury]. / MR-Funktionsdiagnostik der Halswirbelsäule nach Schleudertrauma.

50 patients with a history of distortion injury of the cervical spine were examined with static and functional MRI. Functional MRI consisted of different patient's positions from maximal extension to maximal flexion (30 degrees, 0 degrees, 25 degrees, 40 degrees, 50 degrees). T2*-weighted gradient echo sequences were performed in a sagittal view for the different positions. Ligamentous instabilities and disc protrusions were seen only in functional MRI in 17 patients. These findings correlated with the neurological symptoms. Two patients were treated by operative fusion because of these findings.

[Diagnosis of the site and extent of breast carcinoma]. / Lokalisations- und Ausdehnungsdiagnostik beim Mammakarzinom.

The value of X-ray-mammography, ultrasound, and MRI are compared with regard to their results in localization, differential diagnosis, and staging of carcinomas of the breast. For microcalcifications that are only imaged by mammography, X-ray is superior to the other imaging modalities and remains method of choice. Ultrasound is the most useful to differentiate cystic and solid lesions. The value of MRI is not yet proved sufficiently except in conservative and plastic surgery of breast carcinoma.

[Color-coded duplex sonography in postoperative evaluation of aortic aneurysms]. / Die farbkodierte Duplexsonographie in der postoperativen Beurteilung von Aortenaneurysmen.

One hundred patients with infrarenal abdominal aortic aneurysms were treated by surgery. Fifteen deaths occurred postoperatively. Eleven patients died during the follow-up of a medium period of 13 months. Three patients with a ruptured aneurysm died intraoperatively before the graft was implanted. Three patients were lost to follow-up. Sixty-four patients were examined with colour-coded Duplex sonography after surgical repair. Colour-coded Duplex sonography was able to image the aortic prostheses with the adjacent major vessels. Fifty-eight patients showed a normal prosthesis, 3 dilatation proximal of the prosthesis, 1 dilatation distal of the prosthesis, 1 mild stenosis, 1 haematoma. Colour-coded Duplex sonography imaged the intraluminal space of the prosthesis more easily than ultrasound. Colour-coded Duplex sonography was able to differentiate between intraluminal and extraluminal lesions.

Tuberculosis of the breast: US, mammographic, and CT findings.

A case of tuberculosis of the breast is presented. The mammographic, ultrasound, and CT appearances are described.

[The early recognition of infected fluid collections in acute pancreatitis in computed tomography]. / Zur Früherkennung infizierter Flüssigkeitsansammlungen bei akuter Pankreatitis in der Computertomographie.

UNLABELLED: Infected accumulations of abdominal fluid are a severe complication and the major cause of death (mortality rate between 20 and 60%) in patients suffering from acute pancreatitis. In 93 patients with confirmed acute pancreatitis including 28 with surgically confirmed pancreatic abscess CT findings (volume of pancreatic and extrapancreatic necrosis, capsular enhancement, gas bubble formation and contact between fluid collection and intestinum) were retrospectively correlated with clinical and operative data to assess abscess formation. This revealed a sensitivity of 0.57 in respect of pancreatic necrosis; for extrapancreatic necrosis the sensitivity was 0.39, for capsular enhancement 0.5, for gas bubble formation 0.46 and for intestinal contact 0.93. The specificity was high for gas bubbles (1.0) and intestinal contact (0.91) and low for the other criteria. IN CONCLUSION: There is a strong relationship between fluid accumulations in direct contact with intestinal structures and the occurrence of abscess. This parameter enhances the reliability of CT in the early detection of extrapancreatic infection.