[Bowel perforation because of ingestion of a blister-wrapped tablet after post-interventional coronary perforation]. / Dünndarm-Perforation durch einen verschluckten Tabletten-Blister nach postinterventioneller Koronarperforation.

HISTORY AND ADMISSION FINDINGS: A 70-year-old woman was admitted to hospital with progressive chest pain. Coronary angiography demonstrated a significant stenosis of the left descending artery (LAD), which was treated by percutaneous coronary intervention (PCI) and stent implantation. During this intervention, a coronary perforation occurred which was remedied immediately. Five days after the intervention, the patient complained about severe atypical chest and abdominal pain with nausea and vomitting, but no fever. Physical examination revealed an acute abdomen of uncertain origin. INVESTIGATIONS: Laboratory tests revealed leukocytosis and elevated levels of C-reactive protein while cardiac enzymes were in normal range. The electrocardiogram showed no signs of acute myocardial ischemia. Abdominal x-ray was performed without any pathological findings. Further diagnostic tests, especially computed tomography of the abdomen, revealed an ingestion of a blister-wrapped tablet which had caused small bowel perforation and peritonitis. DIAGNOSIS, TREATMENT AND COURSE: An acute abdomen due to ingestion of a foreign body was diagnosed and an emergency laparotomy was performed immediately. The blister pack was removed by ileostomy. The further course was uneventful. CONCLUSION: The clinical presentation of abdominal pain is a frequent medical condition in hospital. Determining the cause requires precise assessment and examination and implicates a variety of differential diagnosis including non-cardiac and cardiac pain. Iatrogenic causes must be considered in differential diagnosis.

Digital amorphous silicon flat-panel detector radiography at different exposure doses versus mammography film: possibility of radiation dose reduction in detecting rheumatologic bone defects.

BACKGROUND: Radiographic examinations of the skeleton are the most commonly performed radiologic procedures, even outnumbering examinations of the chest. The imaging systems used in skeletal radiography must meet high standards in terms of contrast and spatial resolution to effectively visualize the high contrast between bone and soft tissue as well as fine bone structures. PURPOSE: To determine the performance of amorphous silicon flat-panel detector radiography compared to mammography film in detecting rheumatologic bone defects at different exposure doses. MATERIAL AND METHODS: The study enrolled 44 patients with known or presumed skeletal changes of the hand associated with inflammatory rheumatic diseases. Following a clinically indicated radiographic examination of the peripheral extremities using mammography film, a survey radiograph of one hand was taken in the posteroanterior (PA) view by digital radiography, at the same exposure dose and at a dose reduced to one quarter of the mammography film doses. Four independent radiologists scored the resultant images using the Sharp/van der Heijde and Ratingen scoring methods. The study received University of Cologne Ethics Committee and German Federal Radiation Protection Agency approval. RESULTS: Compared to mammography film, digital flat-panel detector radiography produced a significantly better image quality at identical uptake doses. A greater number of erosions were detected with the digital flat-panel detector than with mammography film at the same and at reduced doses. CONCLUSION: Although the spatial resolution of the digital flat-panel system used in this study was poorer than mammography film, this was compensated for by its wider dynamic range and improved contrast resolution, even at the reduced dose.

[A vascular pedicled duplicated fibula transplant for treatment of lumbar instability following tuberculous spondylodiscitis]. / Ein gefässgestieltes gedoppeltes Fibulatransplantat zur Behandlung der lumbalen Instabilität nach tuberkulöser Spondylodiszitis.

Operative treatment of tuberculous spondylodiscitis is still an important part of the treatment for lumbar spine instability. We report on a patient who suffered an extensive relapse with microbiological confirmation of tuberculous spondylodiscitis following operative spinal treatment for unspecific spondylodiscitis. X-Ray examination showed development of pronounced lumbar instability, which was first treated with the aid of an external fixateur and later by means of a doubled fibular bone graft with a vascularised stem with no dorsal instrumentation, which led to bony consolidation.

[Digital X-ray mammography: comparison of the image quality achievable with a wet laser imager, a dry infrared laser imager and a dry laser imager using direct thermography]. / Digitale Röntgenmammographie: Bildqualitativer Vergleich eines Nasslaserdruckers, eines infrarotbasierten Trockenlaserdruckers und eines thermographiebasierten Trockendruckers.

PURPOSE: To compare the image quality of digital X-ray mammographies obtained with wet imagers with that of standard dry imaging technology. MATERIAL AND METHODS: Beginning 03/08/2003, 200 X-ray mammographies with a digital fullfield mammography system (Lorad Selenia, Lorad/Hologic) were prospectively and consecutively documented with a wet laser imager (Scopix LR 5200, Agfa), a dry infrared laser imager (DryView 8610, Kodak) and a dry imager using the principle of direct thermography (Drystar 4500M, Agfa, N = 166). One X-ray exposure was systematically chosen from each examination and was presented in an anonymous and randomized form to three radiologists who evaluated the films using a structured questionnaire. RESULTS: The visualization of normal anatomic structures was considered being good to excellent for all imagers with the mean assessments 1.0 - 2.4 for the Drystar 4500M, 1.0 - 2.1 for the DryView 8610 and 1.1 - 2.0 for the Scopix LR 5200. The mean assessments were 0.1 - 0.6 points lower in dense than in normal parenchyma, thus, the parenchymal density is the predominant factor for image quality. CONCLUSION: In view of the comparable image quality obtained with the different imagers used in the study, individual decisions to purchase a specific imager will be based on economics rather than on diagnostic points of view.

[Magnetic resonance tomogography after cryotherapy of long bones in an animal model]. / Magnetresonanztomographie nach Kryoablation langer Röhrenknochen im Tiermodell.

PURPOSE: To describe the MR findings following cryoablation of long bones. MATERIALS AND METHOD: Cryoablation was performed in femoral and tibial bones of 24 sheep under general anesthesia. MRI of the treated and untreated contralateral bones was performed immediately thereafter and at 2, 4 and 6 months after the cryosurgical procedure. RESULTS: On the MRI performed immediately after cryotherapy, the lesions showed low signal intensities relative to the normal bone marrow on unenhanced T1- and T2-weighted images. At 2, 4 and 6 months after cryoablation, the lesions showed high signal intensities on STIR images, low signal intensities on T1-weighted and heterogeneous enhancement on contrast-enhanced T1-weighted MR images. The femoral lesions decreased in size from 31 +/- 3 mm immediately after the cryotherapy to 13 +/- 4 mm 6 month later and the tibial lesions from 29 +/- 7 mm to 19 +/- 4 mm. CONCLUSION: MRI shows bone marrow lesions immediately after cryotherapy and can easily monitor healing lesions. MR imaging is suitable for following cryotherapy.

[Diagnostic value of preoperative contrast-enhanced MR imaging of the breast]. / Diagnostischer Stellenwert der präoperativen MR-Mammographie (MRM).

PURPOSE: To evaluate preoperative contrast enhanced MR imaging in clinically, mammographically and/or ultrasonographically established breast cancer. MATERIALS AND METHOD: From September 1998 to August 1999, preoperative contrast-enhanced MR imaging of the breast was performed in 91 patients with lesions highly suggestive of malignancy (BIRADS IV and V) by clinical, mammographic, and/or ultrasonographic criteria. MR imaging findings were postsurgically correlated with other imaging, intraoperative and histopathologic results. RESULTS: Histopathologic analysis revealed 61 (66 %) malignant and 31 (34 %) benign lesions. In 63 (69 %) of the 91 investigated patients, MR mammographies were classified as tumor suspect and in the remaining 28 (31 %) cases as benign. The sensitivity, specificity and accuracy were 90 %, 67 % and 81 % for contrast-enhanced MR imaging. Additional tumor manifestations (multifocal or multicentric disease, contralateral carcinoma) were found by MR imaging alone in 10 patients (11 %). CONCLUSION: Contrast-enhanced MR imaging may reveal unsuspected multifocal, multicentric or contralateral breast carcinoma that changes the surgical therapy if the intention is total tumor removal. The prognostic role of a potentially more radical surgical therapy on the basis of these findings is not clear.

[Quality control of outpatient imaging examinations in North Rhine-Westphalia, part I]. / Qualitätskontrolle der ambulanten bildgebenden Diagnostik in Nordrhein-Westfalen, Teil I.

PURPOSE: In the state of North-Rhine Westphalia (NRW), Germany, a survey was conducted on radiologic examinations ordered by general practitioners (GPs). Part I of this study aims to collect characteristic epidemiological data and to assess structural quality. MATERIALS AND METHODS: All GPs in NRW were asked to cooperate. Participating GPs filled out a questionnaire for each patient. The patients recorded the symptoms prompting the imaging examinations. The radiologists or other physicians performing the examinations were asked to provide the images and written reports and to complete a questionnaire. Two university radiologists documented the pertinent test data from the submitted images and written records. Independently of each other, five university radiologists anonymously reviewed the image quality of each examination using structured questionnaires. RESULTS: A total of 920 patients gave their informed consent and participated. Questionnaires from 787 patients, 852 GPs and 611 radiologists or other interpreting physicians as well as the complete survey data from 530 examinations were available. Of 1503 examinations, conventional radiography made up 52 %, sonography 17 %, computed tomography (CT) 13 % and magnetic resonance imaging (MRI) 5 %. Most indications involved the musculoskeletal (37 %) and respiratory systems (24 %). Physicians without board certification in radiology interpreted 1 % of the CT examinations, 26 % of the radiographic examinations and 71 % of the sonographic examinations. Of the 174 self-referrals, 1 % involved CT, 33 % conventional radiography and 66 % sonography. Written reports were available for 95 % of all 469 examinations performed by radiologists and 74 % of all 127 examinations conducted by non-radiologists. Only 44 % of the 23 sonographic studies were self-referrals by the patient's GP. On average, the radiographic techniques were acceptable in terms of diagnostic information and radiation hygiene. Conventional radiographs were better exposed when obtained by radiologists than by non-radiologists (p = 0.038). The delineation of anatomical structures was rated as good to acceptable for MRI, CT and conventional radiography, while the image quality was rated as diagnostically insufficient for sonography (p < 0.0001). The image quality of radiographic and sonographic examinations performed by radiologists was superior in comparison to examinations performed by physicians without board certification in radiology (p < 0.0001). CONCLUSION: Examination technique and imaging quality of MRI, CT and conventional radiography performed on outpatients were in an acceptable diagnostic range, whereas the quality of sonography was inadequate.

[Comparison of flat-panel radiography and computed radiography in urography]. / Vergleich der digitalen Flachdetektorradiographie mit der digitalen Lumineszenzradiographie bei Urogrammen.

PURPOSE: To evaluate the diagnostic value of digital flat-panel radiography in uroradiology the i. v. urograms of patients who had been examined with computed radiography and digital flat-panel radiography were compared regarding image quality. METHODS: 50 patients who underwent clinically indicated i. v. urography were examined with digital flat-panel radiography and computed radiography. In order to avoid unnecessary double exposure to X-rays, patients were examined either by flat-panel or computed radiography before injection of contrast media. Each further clinically indicated exposure after administration of contrast media was done by alternating the other examination technique. The digital images were compared by 4 radiologists regarding image quality for the detection of defined anatomic structures. RESULTS: Digital flat-panel radiography showed an image quality of the liver, spleen and both kidneys that was similar to computed radiography. The urinary tract, lumbar spine, pelvis and psoas muscle were significantly better visible on flat-panel radiography images. CONCLUSIONS: Compared to computed radiography there is no loss of image information by using digital flat-panel radiography in uroradiology. On the contrary, some anatomic structures on abdominal survey images show better image quality. In conclusion, digital flat-panel radiography has the potential to replace computed radiography in uroradiologic examinations.

Image quality of digital chest X-rays: wet versus dry laser printers.

The aim of this study was to compare the image quality of digital chest x-rays (Thoravision) obtained with 2 "wet" laser imagers of different matrix sizes and a "dry" system. Fifty chest x-rays in 2 planes were printed out in normal (100%) and reduced (61%) format using 3 different systems: 2 "wet" laser imagers (Agfa Matrix LR 3300, 4256 x 5174 pixels, 315 dpi; Agfa Scopix LR 5200, 8512 x 10348 pixels, 630 dpi), and one "dry" system (Agfa Drystar 3000,4352 x 5295 pixels, 330 dpi). All tests yielded normal findings. Anonymous images were evaluated by 4 independent reviewers on record forms rating the detectability of predefined anatomic structures. When the image quality of diagnosis-relevant, anatomic structures was evaluated on digital chest x-rays reproduced in normal and reduced format, the wet laser imagers did not show significant advantages over the dry system, Agfa Drystar 3000. The Agfa Drystar 3000 system is a feasible alternative for reproducing digital images, particularly for decentralized archives.

Detection of porcine bone lesions and fissures: comparing digital selenium, digital luminescence, and analog film-screen radiography.

OBJECTIVE: The purpose of our study was to compare the diagnostic performance of a digital selenium detector (Thoravision) with that of analog film-screen systems and digital luminescence radiography in skeletal radiography for the detection of fissures and lesions in porcine bones. MATERIALS AND METHODS: One hundred bones taken from domestic pigs (50 ribs and 50 femurs) were divided into two equal groups. Fissures and bone lesions were created in 50 bones and 50 served as controls. The bones were examined using film-screen systems, digital luminescence radiography, and digital selenium radiography at various doses. Digital selenium radiography exposure values were adapted to the image geometry differing from the reference methods with a detector focus distance of 2.15 m. Four radiologists independently evaluated image quality and detectability of fissures and lesions on a five-point scale of confidence. Statistical evaluation was based on receiver operating characteristic curve analysis. RESULTS: Fissures and bone lesions were detected most reliably using the mammography film-screen system, but the difference in the results of the analog and digital reference images did not achieve statistical significance. CONCLUSION: Compared with analog film-screen systems, the lower spatial resolution of the digital selenium and digital luminescence radiography systems does not affect detectability of fissures and bone lesions in porcine bone. Selenium is effective in skeletal radiography for detecting fissures and bone lesions. With digital selenium and digital luminescence radiography, the surface dose can be cut to half that required for 200-speed film-screen systems without losing any diagnostically relevant information.

[Comparison of digital selenium radiography with an analog screen-film system in the diagnostic process of pneumoconiosis according to ILO classification]. / Vergleich der digitalen Selenradiographie mit einem analogen Film-Folien-System in der Diagnostik von Staublungenerkrankungen anhand der ILO-Klassifikation.

UNLABELLED: Comparison of digital selenium radiography with an analog screen-film system in the diagnostic process of pneumoconiosis according to ILO classification. PURPOSE: The aim of the study was to determine the diagnostic value of digital selenium radiography in patients with pneumoconiosis. For this purpose chest x-rays by digital selenium radiography and analog screen-film system were compared according to the ILO classification of pneumoconiosis. METHOD: After approval of the study by the local ethic commission and the Federal German Office for Radiation Protection 50 patients were subjected to x-rays by digital selenium radiography (Thoravision; Philips Medical Systems, Hamburg, Germany) and analog screen-film system of the same day within the scope of an industrial medicine preventive checkup. Four investigators rated the chest x-rays according to the ILO classification of pneumoconiosis. RESULTS: The findings demonstrated by chest x-rays according to ILO classification were rated similar by digital selenium radiography and analog screen film systems. Image quality of the digital pictures was rated significantly better. CONCLUSION: The use of digital selenium radiography in evaluating chest x-rays according to the ILO classification does not result in over- or underestimation of pulmonary pathologies. Hence, in the diagnosis of pneumoconiosis, digital selenium radiography can replace the tested analog screen-film system.

[Indications and rate of repeat studies in the color duplex department of a radiology university clinic]. / Zuweiser und Rate der Doppeluntersuchungen in der farbduplexsonographischen Abteilung einer radiologischen Universitätsklinik.

PURPOSE: Who refers patients for a color duplex ultrasonography (CDUS) in the routine work of a radiological university department and how frequent are repeat examinations? MATERIAL AND METHODS: 1110 patients had at least one CDUS examination between 5/97 and 5/98. The specialities of the referring physicians/primary examiners and the inpatient or outpatient status of the patients were documented at the first consultation. Additionally the patients were asked by the medical staff, whether, how often, and by whom ultrasonographic, CT, or MR examinations of the same organ system had been carried out during the last 4 weeks without evidence of any clinical changes. RESULTS: 97% of the 1118 patients were referred by one of the university departments. The arterial system was exclusively investigated in 58% and the venous system in 29% of the cases. 81% of the 651 arterial examinations were requested by the Departments of Vascular/Cardiac Surgery and Radiology. 75 repeated ultrasonographic examinations were documented in 67 (6%) of the 1118 consultations. Repetitions were documented in 8% of the arterial and in 3% of the venous examinations. X-ray angiographies were already done or planned in 105 of the 625 arterial CDUS (16%). Ultrasonographic referrals with parallel phlebographies (1% of 320 venous indications) as well as parallel CT and MR examinations (1% of the 1118 consultations, respectively) were the exception. CONCLUSIONS: In the described setting, CDUS was mainly used to assess the arterial vascular system prior to vascular surgery and radiological interventions. Repeat ultrasonographies alone (6%) and parallel examinations altogether (14%) were observed less frequently than expected.

[Frequency of repeated examinations in the ultrasonographic section of a radiological university department]. / Häufigkeit von Doppeluntersuchungen in der B-Bild-sonographischen Abteilung einer radiologischen Universitätsklinik.

PURPOSE: What is the percentage of repeat examinations in the ultrasonographic section of a radiological university department? METHODS: All 4116 patients, who were first examined in the sonographic section of the Radiologic Department of the University of Cologne from 5/97 to 5/98, were asked by the medical staff, whether, how often and by whom ultrasonographic, CT or MR examinations of the same organ system had been carried out during the last 4 weeks without evidence of clinical changes. The data were documented using a structured questionnaire. RESULTS: Sonographic repeated examinations documented in 443 (10.8%) of the 4116 consultations. The proportion of in- to outpatients with repeat examinations was 26.0% to 74.0%. Contrarily, the repeated ultrasonographies were done by practitioners in 62.3% and by the university staff in 33.2% (radiology 48.2%). With regard to the 4116 consultations, the abdomen (81.1%) was the organ system most often examined repeatedly. Computed tomographies were already done or planned in 305 of 4116 patients (7.4%) and MR-tomographies were already done or planned in 57 patients (1.4%). CONCLUSION: The rate of repeated ultrasonographic examinations in a radiological university hospital was 19.6%.

[Subperiostal hematoma of the orbit and epidural hematoma in patients with skull-brain trauma]. / Subperiostales Orbitahämatom und epidurales Hämatom bei Patienten mit Schädel-Hirn-Trauma.

Subperiostal hematomas (SPOH) of the orbit are mostly of traumatic origin, but may occur spontaneously. In patients with frontal and temporal extradural hematomas, concomitant SPOH of the ipsilateral orbit have sporadically been observed. We report clinical and radiological findings of a patient and a review of the literature and discuss the development of SPOH.

Influence of UVA and UVB irradiation on hepatic and cutaneous P450 isoenzymes.

The influence of UVA and UVB irradiation of the skin for 1, 2 and 4 weeks on the activities of the hepatic and cutaneous P450 isoenzymes was investigated in female Wistar rats before and after systemic administration of hexachlorobenzene (HCB), a well-known porphyrogenic agent, which additionally induces P450 1A1 and P450 1A2 isoenzymes. UVA and UVB irradiation of the skin of controls and HCB-treated animals did not influence porphyrin metabolism. In the nonporphyric rats hepatic EROD (P450 1A1) activity was induced by UVB, but the activity of ADM (P450 2B) and EMDM (P450 3A) was either minimally or not affected. In the HCB-treated (porphyric) rats UVA and UVB irradiation resulted in a significant depression of HCB-induced EROD in the liver and in the skin. In both the nonporphyric and the porphyric rats UVA and UVB irradiation had no effect on hepatic ADM activity. In the liver of the nonporphyric animals EMDM activity remained unchanged after UVA and UVB irradiation, whereas in the HCB-treated animals the activity of this enzyme was increased. Finally, after UVA and UVB irradiation cutaneous EMDM activity was increased in the controls, whereas the HCB-induced increase of this enzyme in porphyric animals was decreased. In addition long-term (28 days) UVB irradiation decreased hepatic GSH content significantly in normal and porphyric rats. These experimental findings cannot be directly extrapolated to humans; however, they suggest that exposure of human skin to UV radiation may result in alterations in the activity of cutaneous hepatic and other extracutaneous P450 isoenzymes.