Imaging features of iliopsoas bursitis.

The aim of this study was firstly to describe the spectrum of imaging findings seen in iliopsoas bursitis, and secondly to compare cross-sectional imaging techniques in the demonstration of the extent, size and appearance of the iliopsoas bursitis as referenced by surgery. Imaging studies of 18 patients (13 women, 5 men; mean age 53 years) with surgically proven iliopsoas bursitis were reviewed. All patients received conventional radiographs of the pelvis and hip, US and MR imaging of the hip. The CT was performed in 5 of the 18 patients. Ultrasound, CT and MR all demonstrated enlarged iliopsoas bursae. The bursal wall was thin and well defined in 83% and thickened in 17% of all cases. The two cases with septations on US were not seen by CT and MRI. A communication between the bursa and the hip joint was seen, and surgically verified, in all 18 patients by MR imaging, whereas US and CT failed to demonstrate it in 44 and 40% of the cases, respectively. Hip joint effusion was seen and verified by surgery in 16 patients by MRI, whereas CT (4 of 5) and US ( n=12) underestimated the number. The overall size of the bursa corresponded best between MRI and surgery, whereas CT and US tended to underestimate the size. Contrast enhancement of the bursal wall was seen in all cases. The imaging characteristics of iliopsoas bursitis are a well-defined, thin-walled cystic mass with a communication to the hip joint and peripheral contrast enhancement. The most accurate way to assess iliopsoas bursitis is with MR imaging; thus, it should be used for accurate therapy planning and follow-up studies. In order to initially prove an iliopsoas bursitis, US is the most cost-effective, easy-to-perform and fast alternative.

[Molecular imaging]. / Molekulare Bildgebung.

The disclosure of the human genoma, the progress in understanding of diseases on molecular and cellular levels, the discovery of new disease-specific targets, and the development of new medications will revolutionize our understanding of the etiology and the treatment of many disease entities. Radiologists are faced with a paradigm shift from unspecific to specific molecular imaging techniques as well as with enormous speed in the development of new methods and should be enrolled actively in this field of medicine.

[Lymph node staging and diagnostic imaging--status quo and future prospects]. / Lymphknotenstaging und Bildgebung--"Status quo" und Zukunft.

Exact lymph node staging is crucial to tumor staging and outcome, as well as therapy planning. Due to the low specificity and sensitivity of current imaging methods, invasive, expansive and uncomfortable diagnostic procedures are still widely used, often in conjunction with imaging. This brief overview is intended to summarize current imaging strategies and to give an outlook on new experimental imaging strategies which may play an important role in lymph node staging.

First experience with a new dedicated ultrasound system for computer-guided large-core breast biopsy.

We describe a new dedicated ultrasound system for computer-guided large core breast biopsy (LCBB) and report our first clinical experience in 45 female patients. After an initial 30 biopsy procedures on a US breast phantom, LCBB using this new system was performed in 45 non-palpable surgically verified breast lesions. All biopsies were performed by the same radiologist using 14-gauge long-throw biopsy needles. Histological results following LCBB were compared with open surgical biopsy. Procedure time and any complication arising was registered in all procedures. Biopsies using this prototype were successful and yielded sufficient material in all 45 lesions. There were 23 benign and 22 malignant lesions with complete histological agreement between LCBB and open surgical biopsy in 44 of the 45 lesions. In one invasive ductal cancer the pathologist could only state high probability of malignancy but not give a definite diagnosis. Besides one case with early termination due to decreased visibility of the target lesion, no technical complications were noted. Slight vasovagal reactions were seen in 4 patients but did not alter the histological results. The average procedure time was 30+/-2.7 min. This new dedicated US system for computer-guided LCBB is an accurate and safe method for diagnosing breast lesions. Although this new system may have no major impact for US-guided LCBB experienced physicians, it might be a promising alternative for the non-skilled physician to currently available breast biopsy techniques.

[Malignant and benign diseases of the breast in 41 male patients: mammography, sonography and pathohistological correlations]. / Maligne und benigne Erkrankungen der Brust bei 41 männlichen Patienten: Mammographie und Sonographie mit histopathologischer Korrelation.

AIM: The goal of our study was to evaluate findings in mammography and sonography in male patients with pathohistologically proven diseases of the breast. MATERIAL AND METHODS: Mammographies and sonographies, which were obtained in 41 male patients in a 6-year period, were retrospectively evaluated in accordance with the BI-RADS(R) classification. RESULTS: Histologically 13 carcinomas, 21 gynecomastias, 3 pseudogynecomastias, 2 epithelial inclusion cysts and 2 other benign lesions were diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of mammography in differentiation of benign versus malignant disease were 92 %, 89 %, 80 %, 96 % and 90 %, respectively. Additional sonography did not change these results. However, sonography increased diagnostic confidence in 18.2 % (2/11) of suspicious lesions. CONCLUSION: In our study the invasive ductal carcinoma of male patients was a predominantly lobulated, ill-defined lesion in mammography and sonography. The differentiation of carcinoma to pseudogynecomastia and diffuse or dendritic gynecomastia was securely feasible. However, we could not reliably distinguish between carcinoma and some benign mass lesions. In cases of mammographically diagnosed masses or unclear mammography, additional sonography should be performed to increase the diagnostic confidence.

Efficient radiological assessment of the internal snapping hip syndrome.

The aim of this study was to evaluate the diagnostic value/significance of various imaging techniques for demonstrating the underlying causative pathology of clinically suspected internal snapping hip syndrome. We intended to define the most efficient diagnostic imaging algorithm that leads to a specific definite therapy for this rare hip disorder. The imaging studies of 54 patients (43 women, 11 men, average age 58 years) with the clinical suspicion of internal snapping hip syndrome were compared for their diagnostic value/significance for finding the underlying pathology. Radiological workup included plain radiographs of the pelvis and hip joints (n=54), ultrasound (US) of the hip joints (n=29), computed tomography (CT) of the pelvis and proximal femur (n=17), and magnetic resonance imaging (MRI) of the pelvis/hip joint (n=21). In order to establish an efficient diagnostic algorithm we compared the diagnostic value of each imaging technique alone and in combination with the other methods. The underlying causative pathology could be established in 37% of patients (n=20) by the use of conventional radiographs alone and in 46% of the patients (n=25) by US alone, and in combination in 83% of the patients (n=45). By adding CT to the radiological workup, we established final diagnosis in 88% (in combination with X-ray; n=15/17) and 94% (together with X-ray and US; n=16/17) of the patients. Whenever MR imaging was used a causative pathology was found in all patients (100%; n=21). The most efficient radiological algorithm in the assessment of patients with internal snapping hip syndrome is the combination of plain radiography and US. MR imaging can be retained for unresolved and difficult cases.

Cardiopulmonary resuscitation performed by bystanders does not increase adverse effects as assessed by chest radiography.

UNLABELLED: Important adverse effects of bystander cardiopulmonary resuscitation (CPR) are well known. We describe the number of nonmedical professional CPR-related complications in patients surviving cardiac arrest, as assessed by chest radiograph. Within 2 yr, all consecutive patients admitted to the department of emergency medicine at a university hospital who had a witnessed, nontraumatic, normothermic cardiac arrest were studied. Radiologically evaluated adverse effects were compared with Mann-Whitney U-tests between patients who received bystander basic life support (Bystander group) and patients who did not receive bystander basic life support before advanced life support was started (ALS group). For assessment of bystander CPR-associated complications, chest radiographs were used. Of 224 patients, 173 were eligible. The median age was 58 yr (interquartile range, 51-71 yr), and 126 patients (73%) were men. The incidence of adverse effects associated with assisted-ventilation maneuvers and external chest compressions did not differ significantly between groups (severe gastric insufflation, 17% vs 18% between the Bystander group [n = 59] and the ALS group [n = 96], respectively; suspicion of aspiration, 22% vs 17%, respectively; soft tissue emphysema, 2% vs 1%, respectively; and serial rib fractures, 8% vs 8%, respectively). CPR administered by nonmedical personnel did not increase the number of life support-related adverse effects in patients surviving cardiac arrest as assessed by means of chest radiograph on admission. IMPLICATIONS: Complications related to cardiopulmonary bypass (CPR) are not increased when CPR is administered by nonmedical personnel, as assessed by chest radiograph. These data may be valuable in motivating lay people to perform basic life support.

[Evaluation of a computer-assisted diagnosis system in breast carcinoma]. / Evaluierung eines computerassistierten Diagnosesystems in der Erkennung des Mammakarzinoms.

PURPOSE: Evaluation of a computerassisted diagnosis (CAD) system (R2 linage Checker 1.2). Comparison of the results of three readers with and without knowledge of the computer results. MATERIALS AND METHODS: The mammograms of 52 patients, bilaterally in two planes each, with histologically proven carcinoma of the breast were included in the study. They were first scanned by the CAD machine and subsequently read by three readers with different degrees of experience in two sessions with and without knowledge of the computer results. RESULTS: Of the 91 views of carcinomas, the readers detected 96%, 89%, and 85%, respectively. With CAD, the values rose to 97%, 93%, and 96%. The increase of the first observer was not significant. As for the 49 areas of malignant microcalcifications, the first reader showed a significant decrease of sensitivity, the other two readers showed no significant change. The sensitivity of CAD was 74% for masses and 86% for microcalcifications at a rate of 1.8 false positive markers per image. All but two tumors were correctly marked in at least one plane. CONCLUSIONS: Use of the CAD machine led to a significant increase of sensitivity in the detection of malignant masses by two of three observers. In the case of malignant microcalcifications, and for the most experienced observer, CAD did not improve the results. The most important problem is the high rate of false positive markers.

[Experimental and clinical approaches to lymph node imaging]. / Experimentelle und klinische Ansätze zur Lymphknotenbildgebung.

Exact assessment of lymph nodes is crucial to tumor staging, choice of therapy and in predicting the outcome. Although imaging plays a central role in the evaluation of lymph nodes, current imaging methods have low sensitivity and specificity primarily because they rely on insensitive morphological criteria or because they have low special resolution. Because of this diagnostic dilemma invasive, expansive and uncomfortable diagnostic techniques and/or unnecessary aggressive therapies are still in use. This brief overview is intended to summarize current imaging strategies and to give an outlook on experimental and clinical strategies in lymph node imaging in cancer.

["Tubes and lines" in thoracic radiography: malpositioning and complications]. / "Tubes and Lines" im Thoraxröntgenbild: Fehlpositionen und Komplikationen.

Chest radiography is essential to evaluate the placement and position of tubes and lines in patients treated in intensive care units, such as central venous and arterial catheters, endotracheal and nasogastric tubes, thorax drains, cardiac pacemakers and defibrillators. Radiologic findings with respect to normal positioning, wrong positioning, and complications are described and illustrated.

Early pulmonary involvement in ankylosing spondylitis: assessment with thin-section CT.

AIM: To determine the frequency and the distribution of early pulmonary lesions in patients with ankylosing spondylitis (AS) and a normal chest X-ray on thin-section CT and to correlate the CT findings with the results of pulmonary function tests and clinical data. MATERIALS AND METHODS: Twenty-five patients with clinically proven AS and no history of smoking underwent clinical examinations, pulmonary function tests (PFT), chest radiography, and thin-section CT. Four of 25 patients (16%), who had obvious signs on plain films suggestive of pre-existing disorders unrelated to AS were excluded. RESULTS: Fifteen of 21 patients (71%) had abnormalities on thin-section CT. The most frequent abnormalities were thickening of the interlobular septa in seven of 21 patients (33%), mild bronchial wall thickening in (6/21, 29%), pleural thickening and pleuropulmonary irregularities (both 29%) and linear septal thickening (6/21, 29%). In six patients there were no signs of pleuropulmonary involvement. Eight of 15 patients (53%) with abnormal and four of six patients (67%) with normal CT findings revealed mild restrictive lung function impairment. CONCLUSION: Patients with AS but a normal chest radiograph frequently have abnormalities on thin-section CT. As these abnormalities are usually subtle and their extent does not correlate with functional and clinical data, the overall routine impact of thin-section CT in the diagnosis of AS is limited.

New approaches for imaging in gene therapy.

Gene therapy is increasingly used experimentally and clinically to replace defective genes and/or impart new functions to cells and tissues. With the recent advances in vector design, improvements in transgene and prodrug activation strategies, gene therapy has been applied to a wide variety of diseases, tissues and organ systems. It is now clear that our specialty will play a critical role in gene therapy research and its clinical applications. Three aspects of gene therapy are of particular interest to imaging. The first is in delivering genes and vector products by minimally invasive interventional techniques. The second is in quantitating gene and DNA deliveries, for example, by nuclear imaging. Finally, imaging can be used to monitor the levels of transgene expression in vivo. A variety of imaging techniques including PET imaging, nuclear imaging, MR imaging and optical imaging can potentially be used to achieve the latter. This brief introductory overview is intended to summarize current strategies and illustrate the role that radiology will play in this field.

Preoperative fast MRI of brain tumors using three-dimensional segmented echo planar imaging compared to three-dimensional gradient echo technique.

The purpose of this study was to compare the diagnostic efficacy of a newly developed T(1)-weighted three-dimensional segmented echo planar imaging (3D EPI) sequence versus a conventional T(1)-weighted three dimensional spoiled gradient echo (3D GRE) sequence in the evaluation of brain tumors. Forty-four patients with cerebral tumors and infections were examined on a 1.0 T MR unit with 23 mT/m gradient strength. The total scan time for the T(1) 3D EPI sequence was 2 min 12 s, and for a conventional 3D GRE sequence it was 4 min 59 s. Both sequences were performed after administration of a contrast agent. The images were analyzed by three radiologists. Image assessment criteria included lesion conspicuity, contrast between different types of normal tissue, and image artifacts. In addition, signal-to-noise and contrast-to-noise-ratio (C/N) were calculated. The gray-white differentiation and C/N ratio of 3D EPI were found to be inferior to conventional 3D GRE images, but the difference was not statistically significant. In the qualitative comparison, lesion detection and conspicuity of 3D EPI images and conventional 3D GRE images were similar, but a tow-fold reduction of the scanning time was obtained. With the 3D EPI technique, a 50% scan time reduction could be achieved with acceptable image quality compared to conventional 3D GRE. Thus, the 3D EPI technique could replace conventional 3D GRE in the preoperative imaging of brain.

CT and MR imaging of generalized cystic lymphangiomatosis in pediatric patients.

OBJECTIVE: The aim of this study was to describe the spectrum of abnormalities seen in generalized cystic lymphangiomatosis as shown by CT and MR imaging and to correlate these findings to gross pathology. CONCLUSION: MR imaging and CT may substantially broaden visualization of the spectrum of abnormalities seen in generalized cystic lymphangiomatosis by revealing the complete extent of disease and, thus, may contribute to clinical management of the disease by preventing initial misdiagnosis.

Acute pulmonary trunk dissection in a patient with primary pulmonary hypertension.

Spiral CT imaging findings including multiplanar reconstructions of an acute dissection of the pulmonary trunk in a 22-year-old female patient with primary pulmonary hypertension (PPH) are presented and discussed.

Mechanic intestinal obstruction--a possible presentation of perforated appendicitis.

A 61-year-old man presented with diffuse abdominal pain, diarrhea, vomiting and fever. On the initial diagnosis of gastroenteritis the patient received the antibiotic ofloxacine for one week. On admission plain abdominal radiograph suggested a mechanic intestinal obstruction. In computed tomography a conglomerate tumor in the ileocecal region was seen and the patient underwent laparotomy. The conglomerate tumor was mobilized and an abscess opened, which was caused by a perforated appendicitis. After the operation the patient improved immediately and had an uneventful postoperative course. He was released and did not suffer from gastrointestinal symptoms the following 16 months of follow-up. The present case shall set forth that perforated appendicitis can clinically present as intestinal obstruction. Although a rare complication, perforated appendicitis should therefore even be considered in cases of mechanic intestinal obstruction of unknown cause.

Cystic fibrosis: CT assessment of lung involvement in children and adults.

PURPOSE: To compare a computed tomographic (CT)-based scoring system with nonimaging indexes of pulmonary status in patients with cystic fibrosis. MATERIALS AND METHODS: Pulmonary CT findings were assessed in 117 patients with cystic fibrosis, with cases classified according to three groups by age; 0-5 years, 6-16 years, and 17 years and older. Images were examined for specific abnormalities, and the severity and anatomic extent of each sign were used to generate a score. Scores in each category and the global score for each patient were correlated with pulmonary function test results, clinical status, serum immunoglobulin levels, and genotype, all obtained within 2 weeks of CT. RESULTS: The most frequent individual CT abnormalities were bronchiectasis in 94 (80.3%), peribronchial wall thickening in 89 (76.1%), mosaic perfusion in 71 (63.9%), and mucous plugging in 56 (51.3%) patients. The percentage of patients with specific CT findings and the overall CT scores increased significantly (P < .05) with progressively increasing age groups. All CT findings and the overall CT scores correlated significantly (P < .05) with the pulmonary function test results, serum immunoglobulin levels, and clinical scores. No relationship was observed between genotype and CT scores. CONCLUSION: Scoring of CT studies in patients with cystic fibrosis seems to offer a reliable way to monitor disease status and progression and may provide a reasonable tool to assess treatment interventions.

Thoracic venous anatomy delineated by malpositioned central venous catheters on plain chest films.

The aim of this essay was to demonstrate the thoracic venous anatomy as delineated by malpositioned central venous catheters on plain chest radiographs. We therefore used the didactic advantage of clinically inadvertent catheter positions. This approach was chosen to illustrate venous anatomy with plain chest radiographs, and, thereby, to recognize malpositions promptly on the modality with which positions of central venous catheters is routinely performed.

[Staging of bronchial carcinoma]. / Staging des Bronchialkarzinoms.

Staging of any tumor, i.e. determination of the extent of the disease, serves to select the patients who might profit from curative surgical intervention or to define those patients with inoperable carcinomas who should be referred for other therapies, such as chemotherapy or irradiation. Furthermore, accurate staging is necessary for assessment of prognosis, for radiation therapy planning, and for differentiation of those with small-cell lung cancer or for follow-up examinations of small-cell lung cancer patients after during and after chemotherapy. The primary radiological staging and diagnostic modalities for assessment of bronchial carcinomas are computed tomography (CT) of the thorax including liver and adrenal glands, abdominal sonography, and bone scintigraphy. Magnetic resonance imaging (MRI) should be reserved for specific indications, e.g. infiltration of the chest wall or staging of patients with intolerance/allergy to intravenous contrast medium. The clinical value of nuclear medicine techniques, such as [18F]2-fluoride-2-desoxy-D-glucose positron emission tomography (FDG-PET) for evaluation of lymph nodes and distant metastases, In-111 octreotide/somatostatin receptor scans for staging of small-cell lung cancer, and thallium-201 SPECT are currently being assessed in numerous studies, although these techniques are already in routine use. In future these or nuclear medicine techniques, as well as techniques using molecular-based contrast material, especially for MR imaging, currently in experimental status, may yield serious potential for staging purposes.