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1.
JBR-BTR ; 92(4): 191-4, 2009.
Article in English | MEDLINE | ID: mdl-19803096

ABSTRACT

The aim of this study is to analyze the MDCT findings of juxtapapillary duodenal diverticula (JPDD) and to propose a new radiological classification. CT-examinations of 1010 consecutive patients, all examined by 16-row MDCT of the abdomen over a time period of 20 months were retrospectively analyzed. All study patients were examined by triple phase CT (native, arterial and portal venous CT scan) of the abdomen and all recieved positive oral contrast prior to the examination. Thirty-three patients showed a juxtapapillary duodenal diverticulum, which could be seen on all CT scans, but jusually was depicted most clearly on the thin collimated arterial phase CT images. Size of diverticula range from 4 mm to 4.5 cm (mean 1.7 cm). In 17 cases the diverticulum was located ventrally to the vaterian sphincter complex, extending less or more into the pancreas at the site where the dorsal and the ventral anlage of the pancreas have fused (type I). 12 diverticula were located dorsally to the sphincter complex (type II). Three patients presented with a bilobated juxtapapillary diverticulum extending to both sides, ventrally and dorsally (type III) and one patient showed a little diverticulum ventrally to the minor papilla (type IV).Three patients presented with food impaction in the diverticulum but only one of these patients with a large IPDD showed a Lemmel-syndrome, whereas the other three patients with non-calculous extrahepatic cholostasis showed larger diverticula without food impaction. MDCT allows to identify four different types of juxtapapillary duodenal diverticula and using the proposed classification may be helpful for a more exact, anatomy based radiological description of this CT finding.


Subject(s)
Diverticulum/diagnostic imaging , Duodenal Diseases/diagnostic imaging , Tomography, X-Ray Computed , Aged , Aged, 80 and over , Ampulla of Vater/diagnostic imaging , Common Bile Duct/diagnostic imaging , Diverticulum/classification , Duodenal Diseases/classification , Female , Humans , Male , Middle Aged , Pancreatic Ducts/diagnostic imaging
3.
Praxis (Bern 1994) ; 96(33): 1209-13, 2007 Aug 15.
Article in German | MEDLINE | ID: mdl-17867608

ABSTRACT

A case of a medullary osteoidosteoma of the pisiforme bone is presented that appeared as a light bulb on MR-Angiography while causing diffuse hypointensity of the pisiforme bone and of the surrounding soft tissue on T1- and diffuse hyperintensity of these regions on T2-w and T1- w postcontrast images. Although not surprising according to the typical appearance of osteoidostomas on triple phase scintigraphy, the light bulb sign of osteoidosteomas on MRA has not yet been reported and familiarity with this findings may be of value in order to avoid their confusion with vascular lesions such as aneurysms or pseudoaneurysms during MR-angiography.


Subject(s)
Bone Neoplasms/diagnosis , Osteoma, Osteoid/diagnosis , Pisiform Bone , Adult , Bone Neoplasms/blood supply , Diagnosis, Differential , Female , Humans , Image Enhancement , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Microcirculation/pathology , Osteoma, Osteoid/blood supply , Pisiform Bone/pathology
4.
Praxis (Bern 1994) ; 96(50): 2003-7, 2007 Dec 12.
Article in German | MEDLINE | ID: mdl-18179108

ABSTRACT

Two patients with ectopic pancreas, associated with pancreas divisum are presented. In one of these patients MDCT examination showed an island of pancreatic parenchyma, isolated from the pancreatic head and located within the anterior wall of the duodenal bulb, where ectopic pancreas could be confirmed by endoscopy. The other patient suffered from acute pancreatitis according to the clinical and laboratory findings. However, MDCT showed a normal pancreas. Here the only abnormality on CT was found in an area of inflamed and infiltrated fatty tissue ventrally to the descending duodenum and the pancreatic head, which was clearly separated from pancreatic head. While these CT findings alone were non-specific, MRT allowed to identify an island of ectopic pancreas within this area of inflammation. Additionally both patient showed pancreas divisum. These two cases nicely demonstrate, that ectopic pancreas may be recognized by MDCT. However, familiarity with the embryology of the pancreas and knowledge about a probable association of pancreas divisum and ectopic pancreas may be helpful for the correct interpretation of imaging findings. Furthermore, in cases of ectopic pancreatitis CT may show only nonspecific extrapancreatic soft tissue inflammation and MRT may become necessary to identify the enclosed island of ectopic pancreatic tissue.


Subject(s)
Choristoma/diagnosis , Duodenal Diseases/diagnosis , Magnetic Resonance Imaging , Pancreas , Pancreatitis/diagnosis , Tomography, X-Ray Computed , Acute Disease , Diagnosis, Differential , Duodenoscopy , Humans , Male , Middle Aged , Pancreas/abnormalities , Pancreas/pathology
5.
Ultraschall Med ; 27(2): 180-4, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16612727

ABSTRACT

OBJECTIVE: Focal myositis of the iliopsoas muscle is a rare condition. A case is presented, emphasizing the value of ultrasound for detection, localisation, image-guided biopsy and follow-up in correlation with CT and MRI findings. MATERIAL AND METHODS: A 58-year-old woman was referred to our clinic with strong left sided inguinal pain, which radiated to the thigh and had lasted for four days. Ultrasound, CT and MRI were performed. Ultrasound-guided biopsy with histological correlation was obtained and US-follow-ups were available. RESULTS: CT showed an enlarged iliopsoas muscle on the left side without any focal pathology or enhancement. MRI revealed a sharpely delineated lesion, which was hypointense to muscle in fat-suppressed T1 w images with circumferential enhancement and showed a hyperintense appearance in T2 w images. Ultrasound displayed a polylobulated, inhomogeneous and hypoechoic tumour within the iliopsoas muscle. Ultrasound-guided biopsy was found to be compatible with myositis. After oral therapy with steroids, improvement could be documented by serial ultrasound follow-up as the size of the tumour was definitely regressing. CONCLUSION: Focal myositis of the iliopsoas muscle is a rare entity which may mimic a tumoural lesion. Imaging findings may not be conclusive, and US-guided biopsy is recommended to rule out a malignant mass. Ultrasound seems to be the most cost-effective method for diagnosis, image guided biopsy and follow-up.


Subject(s)
Granuloma, Plasma Cell/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Myositis/diagnostic imaging , Adrenal Cortex Hormones/therapeutic use , C-Reactive Protein/metabolism , Diagnosis, Differential , Female , Granuloma, Plasma Cell/blood , Granuloma, Plasma Cell/diagnosis , Humans , Magnetic Resonance Imaging , Middle Aged , Myositis/blood , Myositis/diagnosis , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography
7.
Praxis (Bern 1994) ; 95(15): 575-80, 2006 Apr 12.
Article in German | MEDLINE | ID: mdl-16640177

ABSTRACT

According to its superficial anatomical location the thyroid gland is easily accessible by sonography. Ultrasound is a reliable examination to detect various pathologies of the thyroid gland and it should always be combined with a sonography of the surrounding soft tissues and vessels. Sonography allows an exact documentation of the size, volume and parenchymal echostructure of the thyroid gland as well as detection of various diffuse and focal abnormalities of the gland itself and of the surrounding structures. The presented article gives an overview of the sonographic diagnoses and differential diagnoses of various diffuse and focal pathologies of the thyroid gland as well as some recommendations regarding their possible further diagnostic approach.


Subject(s)
Thyroid Diseases/diagnostic imaging , Thyroid Gland/diagnostic imaging , Acute Disease , Adenoma/diagnostic imaging , Carcinoma/diagnostic imaging , Cysts/diagnostic imaging , Diagnosis, Differential , Goiter/diagnostic imaging , Graves Disease/diagnostic imaging , Hashimoto Disease/diagnostic imaging , Humans , Lymphoma/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/secondary , Thyroiditis/diagnostic imaging , Thyroiditis, Subacute/diagnostic imaging , Ultrasonography
9.
Acta Radiol ; 45(6): 618-21, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15587418

ABSTRACT

The purpose of this study is to demonstrate the feasibility of computer-tomography-navigated closed reduction and percutaneous fixation (CRPF) in a patient with an externally rotated left acetabular fracture. After a follow-up of 18 months the patient was pain-free and had a normal range of motion in both hip joints. Radiologically, the fracture was fully consolidated, remodelled, and there were no signs of osteoarthritis. To our knowledge, CT-navigated CRPF of a rotated acetabular fracture has not been reported before. Further studies regarding the feasibility of the method are warranted.


Subject(s)
Acetabulum/injuries , Fracture Fixation/methods , Fractures, Bone/surgery , Tomography, X-Ray Computed , Adult , Feasibility Studies , Follow-Up Studies , Fractures, Bone/diagnostic imaging , Humans , Male , Time Factors
11.
Ther Umsch ; 60(3): 137-44, 2003 Mar.
Article in German | MEDLINE | ID: mdl-12693316

ABSTRACT

The term "chronic inflammatory bowel disease" represents a spectrum of diseases out of which ulcerous colitis and Crohn's disease are the far most common. Large bowel enemas have lost their relevance compared to colonoscopy over the past years and small bowel enteroclysis has also been widely replaced by CT- and especially MR-enteroclysis meanwhile. The diagnostic value of computed tomography and MR-tomography in chronic inflammatory bowel disease is based on the excellent visualization and documentation of extent and severity of bowel wall inflammation, estimation of inflammatory activity of the disease and of detection of potential extraintestinal complications and/or additional diagnoses by these two methods. Nevertheless, conventional radiological techniques as well as sonography may still be valuable under certain conditions. Furthermore, nowadays imaging of chronic inflammatory bowel diseases includes also White Blood Cell scintigraphy as well as Positrone Emission Tomography which provide informations about extent and especially activity of the disease. The presented article provides an overview of the possibilities and limitations of the available imaging modalities in inflammatory bowel diseases and helps the reader to decide under what conditions which one of the available examinations should be regarded as the most appropriate and promising one.


Subject(s)
Inflammatory Bowel Diseases/diagnosis , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/diagnostic imaging , Crohn Disease/diagnosis , Crohn Disease/diagnostic imaging , Diagnosis, Differential , Enema , Humans , Inflammatory Bowel Diseases/diagnostic imaging , Magnetic Resonance Imaging , Radiography, Abdominal , Tomography, Emission-Computed , Tomography, X-Ray Computed , Ultrasonography, Doppler
12.
Eur Radiol ; 13(4): 897-902, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12664132

ABSTRACT

The purpose of this study was to describe CT findings of colonic involvement in acute non-necrotizing pancreatitis and to analyze the correlation between colonic wall thickening at CT and the clinical course of these patients. The CT examinations of 19 consecutive patients with acute non-necrotizing pancreatitis who were not treated with antibiotics initially were analyzed retrospectively. The severity of acute pancreatitis was categorized according to the CT severity index (CTSI) and the presence of colonic wall thickening at the initial CT was compared with the clinical course of all patients. Seven of 11 patients with a CTSI of 4 showed a colonic wall thickening, whereas the remaining patients with a CTSI of 4 (n=4), CTSI of 3 (n=5), and CTSI of 2 (n=3) showed no colonic abnormalities at CT. Patients with colonic wall thickening presented more often with fever, showed higher levels of infectious parameters, needed more often antibiotic therapy, and had more requests for additional CT examinations and CT-guided fluid aspirations as well as a longer duration of hospital stay as compared with patients without colonic wall involvement, even if the latter presented with the same CTSI initially. It is well known that translocation of the colonic flora may significantly influence the clinical course of patients with acute pancreatitis, and our results indicate that patients with acute pancreatitis who present with colonic wall thickening at CT have an increased risk for a complicated clinical course regarding systemic infection.


Subject(s)
Colonic Diseases/diagnostic imaging , Colonic Diseases/etiology , Pancreatitis/complications , Tomography, X-Ray Computed , Acute Disease , Colon/diagnostic imaging , Female , Humans , Male , Middle Aged , Severity of Illness Index
14.
Eur Radiol ; 12(4): 789-92, 2002 Apr.
Article in English | MEDLINE | ID: mdl-11960227

ABSTRACT

The purpose of this study was to evaluate if subjective symptoms indicating an impaired deglutition correlate with videofluoroscopic findings in patients with multiple sclerosis (MS). Videofluoroscopic examinations of 18 MS patients were analyzed by a radiologist and a logopedist and compared with the symptoms of these patients. Four patients complained about permanent dysphagia. Six patients reported mild and intermittent difficulties in swallowing, but were asymptomatic at the time of videofluoroscopy. Eight patients had no symptoms regarding their deglutition. All patients ( n=4) who complained of permanent dysphagia showed aspiration. All patients ( n=6) with mild and intermittent difficulties in swallowing showed undercoating of the epiglottis and/or laryngeal penetration. Of those 8 patients without any swallowing symptoms, only 2 had a normal videofluoroscopy. Swallowing abnormalities seem to be much more frequent in patients with MS than generally believed and they may easily be missed clinically as long as the patients do not aspirate.


Subject(s)
Deglutition Disorders/diagnostic imaging , Deglutition Disorders/etiology , Multiple Sclerosis/complications , Adult , Deglutition/physiology , Deglutition Disorders/physiopathology , Female , Fluoroscopy , Humans , Male , Middle Aged , Video Recording
15.
Unfallchirurg ; 104(10): 1025-30, 2001 Oct.
Article in German | MEDLINE | ID: mdl-11699300

ABSTRACT

Modern imaging and computer technology gain more and more importance in surgery. This is true for elective and emergency diagnosis and treatment. However integration of technology and optimization of process management is severely behind. A new diagnostic-therapeutic platform should balance this deficit. The platform is composed of a fully equipped operation room environment with integrated high end computer-tomography with navigation, a digital subtraction angiography and an OR- and imaging-table particularly developed for this set-up. The platform may be used for elective diagnosis, for diagnosis and therapy in polytraumatized patients in one and the same location (one stop shop) and for computer assisted surgery (CAS). Bringing the technology to the patient and not the patient to the technology can save time consuming and potentially dangerous transports and expensive personnel can be reduced. Navigation-technology and high quality intra-operative imaging expand the spectrum of minimally invasive surgery.


Subject(s)
Diagnostic Imaging/instrumentation , Multiple Trauma/surgery , Operating Rooms , Surgery, Computer-Assisted/instrumentation , Humans , Multiple Trauma/diagnosis , Surgical Equipment , Switzerland , Time and Motion Studies
16.
Dig Surg ; 18(5): 418-21, 2001.
Article in English | MEDLINE | ID: mdl-11721119

ABSTRACT

A 68-year-old male presented with abdominal pain and obstructive jaundice. CT revealed a large mass in the pancreatic head that was initially interpreted as pancreatic carcinoma. Needle biopsy revealed only fibrous tissue with signs of chronic inflammation. Together with typical findings of an idiopathic retroperitoneal fibrosis, the final diagnosis of multifocal idiopathic fibrosclerosis with focal pseudotumorous pancreatic head fibrosis could be made.


Subject(s)
Carcinoma/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Retroperitoneal Fibrosis/diagnostic imaging , Aged , Carcinoma/therapy , Diagnosis, Differential , Humans , Male , Pancreatic Neoplasms/therapy , Retroperitoneal Fibrosis/therapy , Tomography, X-Ray Computed
18.
Eur Radiol ; 10(11): 1713-5, 2000.
Article in English | MEDLINE | ID: mdl-11097394

ABSTRACT

Two cases of hepatic fascioliasis with characteristic features in US examinations and CT scans are presented. In both modalities they show tunnel-like branching and clustered areas of low echogenicity/density, which reach subcapsular regions. These cases are presented to recall the imaging features in hepatic fascioliasis especially outside endemic regions. Not only CT but also US is able to detect these characteristic lesions, which may help to make the diagnosis of hepatic fascioliasis in patients with clinical symptoms suggestive of parasitic disease.


Subject(s)
Fascioliasis/diagnostic imaging , Acute Disease , Chronic Disease , Female , Humans , Liver/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray Computed , Ultrasonography
19.
Eur Radiol ; 10(11): 1763-9, 2000.
Article in English | MEDLINE | ID: mdl-11097404

ABSTRACT

With few exceptions the interventional rooms of the present are either imaging suites or sterile operating rooms. Their users are restricted to either percutaneous procedures or to two-staged image-guided surgery without intra-operative imaging control. Since interventional therapy of the future will be minimally invasive and since minimally invasive therapy is essentially image-guided therapy, a new physical place for these activities has to be devised: the multifunctional therapy room of the future integrates sophisticated imaging and image guidance modalities together with advanced surgical and life-support equipment in a sterile environment [1, 2, 3]. Even given a high degree of integration, this will be a complex and costly piece of medical technology. These two factors--complexity and cost-- require interdisciplinary technological and medical collaboration to bring it into existence, distribute its cost and maximize usage and medical benefit. Yet another dimension of multifunctionality will be introduced and a significant impact on the care of vitally threatened patients will be exerted by using this room not only for elective image-guided therapy but also for emergent one-stop diagnosis and treatment. Motivation, technology, implementation strategies and funding of this image-guided, integrated and interdisciplinary therapy room, as well as a comprehensive approach combining emergency care and elective computer-assisted therapy (CAT), are discussed in this paper.


Subject(s)
Hospital Design and Construction/trends , Hospital Units , Radiology, Interventional , Critical Pathways , Diagnostic Imaging , Hospital Units/trends , Humans , Operating Rooms , Radiology Department, Hospital , Radiology, Interventional/trends
20.
Eur Radiol ; 10(11): 1815-23, 2000.
Article in English | MEDLINE | ID: mdl-11097413

ABSTRACT

The aim of this study was to evaluate pitfalls and technical limitations of MR imaging in diagnosing relapse of chronic posttraumatic osteomyelitis of the lower extremities. Retrospective analysis of MR examinations in 15 patients (17 body areas) with suspected relapse of chronic posttraumatic osteomyelitis (at least 1.5 years duration/mean number of surgical procedures per patient: 5.8). The MRI findings were compared with postoperative bacteriology (n = 11) and clinical follow-up (n = 4). Five patients had additional CT examination. Magnetic resonance imaging identified all infected areas correctly, but five uninfected regions were diagnosed false positive due to postoperative scarring/oedema in bone defects (n = 4) and soft tissue (n = 1). Specificity of MRI in diagnosing active bone infection was 63% and sensitivity 100%. Additional CT was preoperatively necessary in 5 patients (33%) to further examine osteomyelitic and reparative bone remodeling. Metal artefacts were present in 11 patients, rendering complete evaluation impossible (n = 2) or considerably more difficult (n = 4). Scarring/oedema in postoperative bone defects occurs up to 13 months postoperatively and represents a major pitfall leading to low specificity. Definitive evaluation of suspected fistula, bony fragments and mineralization by MRI may be limited in this special patient group and requires additional CT in one third of patients. Metal artefacts occur in most patients and may impair or even prevent correct film evaluation in 23 and 11%, respectively.


Subject(s)
Magnetic Resonance Imaging , Osteomyelitis/diagnosis , Adult , Artifacts , Chronic Disease , Female , Follow-Up Studies , Humans , Leg Bones/pathology , Male , Osteomyelitis/etiology , Postoperative Complications/diagnosis , Predictive Value of Tests , Recurrence , Retrospective Studies , Sensitivity and Specificity , Soft Tissue Infections/diagnosis , Time Factors , Tomography, X-Ray Computed
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