[Diagnostic value of whole-body MRI and bone scintigraphy in the detection of osseous metastases in patients with breast cancer--A Prospective Double-Blinded Study at two Hospital Centers]. / Diagnostischer Stellenwert der Ganzkörper-MRT und der Skelettszintigrafie in der ossären Metastasendetektion bei Mammakarzinompatientinnen--eine prospektive Doppelblindstudie an zwei Klinikzentren.

PURPOSE: The purpose of this study was to compare the diagnostic accuracy of whole-body MRI (WB-MRI) and bone scintigraphy (BS) for the screening of bone metastases for the first time in a large and homogeneous patient collective with breast cancer in a systematic and controlled study. MATERIALS AND METHOD: 213 breast cancer patients were evaluated for bone metastases under randomized, double-blinded and prospective conditions at two hospitals. All participants were examined by WB-MRI and BS over an average period of four days. The examinations were performed separately at two different locations. The WB-MRI protocol included T 1-TSE and STIR sequences. WB-MRI and BS were reviewed independently by experienced radiologists and nuclear medicine specialists in a consensus reading. RESULTS: In 66 % of cases bone metastases were excluded by both procedures, and bone metastases were detected concordantly in 2 % of cases. In 7 % of cases there were discrepant results: in 7 cases BS was false-positive when WB-MRI was negative. In 5 / 7 cases BS was negative when WB-MRI identified bone metastases. In 89 % of cases BS was uncertain when WB-MRI was true-negative. In 17 % of cases WB-MRI showed important (non-) tumor-associated findings. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for WB-MRI were 90 %, 94 %, 82 %, 98 % and 99 % and for BS those were 40 %, 81 %, 36 %, 91 % and 93 %. CONCLUSION: It could be demonstrated that WB-MRI is superior to BS for detecting bone metastases in breast cancer patients. These results should be considered for the next version of the S 3 guideline "Diagnosis, Therapy and Follow-Up of Breast Cancer".

[Treatment of lumbar facet joint syndrome by CT-guided infiltration of the intervertebral joints]. / Behandlung des lumbalen Facettensyndroms durch CT-gesteuerte Infiltration der Zwischenwirbelgelenke.

INTRODUCTION: Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain. Denervation by scalpel or electrofrequency is a well-known method of treating it. An alternative method for longer lasting pain relief is CT-guided intraarticular infiltration of facet joints with local anaesthetics and cortisone. METHODS: In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but had additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. RESULTS: Results were significantly in group 2 than in group 1 (Fisher's exact test P < 0.012). In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant (Table 3). Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. CONCLUSIONS: CT-guided facet joint infiltration is a good method for treatment and diagnosis of lumbar facet joint syndrome. It can be repeated and has no severe side effects. The best results were seen in patients with spondylarthrosis of the facet joints. After lumbar disc surgery the pain relief was shorter, though it also yielded good results. For patients with unspecific low back pain, facet joint injections are a very good diagnostic method, allowing definite exclusion of lumbar facet syndrome.

[Postpartum ovarian vein thrombophlebitis--case report]. / Postpartale Ovarialvenenthrombophlebitis-Kasuistik.

Because of the low incidence and the lack of clinical symptomatology, puerperal ovarian vein thrombophlebitis has constituted a diagnostic problem now as ever, and diagnostic errors are frequent. With the help of US and CT, however, the chances of early detection have improved. On the 26-year old patient P. C. a section had to be performed in the 34th week of pregnancy because of premature rupture of the bag of waters. On the 7th postoperative day, the patient developed pyrexia inspite of antibiotic therapy. Sonographical examinated lead us to suspect a floating thrombus in the vena cava inferior. It was in the CT that the diagnosis of ovarian vein thrombosis was made for the first time. On the 13th day post partum a laparotomy and exstirpation of the v.ovarica dextra with removal of the thrombus plug from the v.cava inferior infrarenally was performed. Primarily, conservative treatment is given preference if the development is uncomplicated; operative sanitation is undertaken in case of difficulties only.

Prospective clinical study with in vitro endothelial cell lining of expanded polytetrafluoroethylene grafts in crural repeat reconstruction.

A nonrandomized prospective clinical study was undertaken to evaluate the technique and efficacy of in vitro endothelial cell lining of synthetic grafts. Twenty-six patients (10 men and 16 women with a mean age of 68.4 years; range, 49 to 80 years) with end stage chronic peripheral vascular disease requiring reoperation were entered into the study. In 13 patients venous endothelial cells were harvested 4 to 7 weeks before operation, grown to confluency in culture flasks, and seeded onto the inner surface of expanded polytetrafluoroethylene grafts. Thirteen patients received untreated expanded polytetrafluoroethylene grafts and served as a control. A scoring system with use of intraarterial angiography was used to assess disease severity. No statistically significant differences in angiographic score were seen between the two groups, indicating comparable severity of disease. Early secondary graft patency (0 to 30 days) was 92% for the in vitro endothelial cell lining group and 53% for control patients. The amputation rate after 18 months for the in vitro endothelial cell lining group was 15%, with a 31% rate in the control group. The functional performance of the in vitro endothelial cell lining bypasses was superior to that of untreated bypass grafts during the observed follow-up period. These early results suggest that in vitro endothelial cell lining is a method that can reduce the early occlusion rate now seen after repeat reconstruction of crural vessels.

Dislocation and fracture-dislocation of the hip.

Of 54 patients with posterior dislocations of the hip of type I and type II (Stewart and Milford 1954), 47 were followed for a mean period of 6.7 years (2 to 11). Of these, 23 had dislocation with minimal lesions of the acetabulum (type I) and 24 had an avulsed dorsocranial fragment (type II). All were reduced by closed methods within six hours. The subsequent treatment of type I dislocations was conservative. At the beginning of the period type II injuries were treated conservatively, but surgery was increasingly chosen for later cases. Type I dislocations had significantly better results (p < 0.05) than type II fracture-dislocations, regardless of the method of treatment. There were no essential differences between the results of surgical and conservative treatment in type II dislocations.

[The value of different clinical and imaging procedures for the postoperative follow-up of extra-anatomical bypasses]. / Wertigkeit unterschiedlicher klinischer und bildgebender Verfahren für die postoperative Verlaufskontrolle extraanatomischer Bypasses.

In order to judge the patency of extra-anatomical by-passes in the lower extremities, 24 patients with 29 by-passes were examined clinically (palpation of the by-pass pulse, Fontaine staging, Doppler index) and by imaging methods (i-v DSA, Duplex sonography, colour-coded Doppler sonography). The value of these methods was compared. Sonography was found to be the ideal method for follow-up. Palpation was unreliable, particularly for femoro-femoral by-passes. The Doppler index and the Fontaine method provided no information about the actual state of the bypass. Angiography is indicated only if further vascular reconstruction is planned.

Blood rheology after cardiac valve replacement with mechanical prostheses or bioprostheses.

Arterial thromboembolism is a serious complication in patients after heart valve replacement. Abnormalities in blood rheology may contribute to this complication. Therefore, the aim of this study was to compare various determinants of blood rheology in patients with substitute heart valves with those in healthy controls; furthermore, differences between patients with mechanical valves and those with bioprostheses should be investigated. The hemorrheologic determinants--fibrinogen, plasma viscosity, red cell aggregation, hematocrit and platelet aggregation--were studied in 92 patients with mechanical bileaflet valves, in 28 patients with bioprostheses and in 29 control subjects; the time since valve replacement was greater than or equal to 9 months. Fibrinogen, plasma viscosity, red cell and spontaneous platelet aggregation were found to be increased in all patients after heart valve replacement compared with normal subjects (fibrinogen: 348 +/- 87 vs 267 +/- 66 mg/dl, p less than 0.01; plasma viscosity: 1.71 +/- 0.1 vs 1.66 +/- 0.1 mPas, p less than 0.05; red cell aggregation: 9.9 +/- 2 vs 7.8 +/- 2 U, p less than 0.01; platelet aggregation: 22 +/- 15 vs 13 +/- 13%, p less than 0.01); among patients, fibrinogen, plasma viscosity and spontaneous platelet aggregation were higher in mechanical valves than in bioprostheses (fibrinogen: 359 +/- 95 vs 314 +/- 41 mg/dl, p less than 0.01; plasma viscosity: 1.72 +/- 0.1 vs 1.68 +/- 0.1 mPas, p less than 0.1; platelet aggregation: 23 +/- 15 vs 16 +/- 11%; p less than 0.05), whereas no difference could be found for red cell aggregation (9.7 +/- 2 vs 10.5 +/- 2%, p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acetabular fractures--surgical versus conservative treatment]. / Azetabulumfrakturen--operative versus konservative Behandlung.

In this paper the results of operative and conservative intervention of acetabulum fractures are analysed. It was possible to re-examine 80 of 146 Patients after a period of 5.46 years in mean. 23 patients were treated by osteosynthesis. Time from accident to operation was 13 days in mean. Posterior wall fractures seemed to be the most frequent (classified by Letournel). Results were evaluated according to the following criteria: clinical status (classified by the scheme of Merle d'Aubigne), X-ray, and subjective well-being. In the surgically treated group total hip prosthesis had to be implanted in five patients because of aseptic necrosis of the femoral head, 52.9% of the patients in this group had good results. In the conservative treated cases no total hip prosthesis had to be implanted. 77.8% of the patients had good results. A main aspect is that the average age of the patients who underwent a treatment by osteosynthesis is lower although the fractures were more severe.

[Perfusion scintigraphy using 99mTc-labeled microspheres in the functional evaluation of an implanted portsystem for intraarterial cytostatic treatment of liver metastases]. / Perfusionsszintigraphie mit 99mTc-markierten Mikrosphären zur Funktionsbeurteilung implantierter Portsysteme vor intraarterieller Zytostase bei Lebermetastasen.

Perfusion scintigraphy with 99mTc-labeled microspheres was used to assess the integrity of catheter systems implanted in patients with liver metastases for intraarterial regional chemotherapy, and to document the distribution of cytostatic drugs. 33 examinations in 12 patients were performed after implantation as well as prior to each cytostatic cycle. Recurrent stenosis with (3) and without (9) reflux into the adjacent upper abdominal organs was found in each patient with long-term implantation of the port system. In 50% of all cases, the stenosis was successfully treated using urokinase as a thrombolytic agent.

Indications for the use of Gd-DTPA in MRI of the central nervous system. Experiences in patients with cerebral and spinal diseases.

A total of 209 intracranial and spinal diseases were evaluated before and after administration of the paramagnetic contrast agent Gd-DTPA. The results justify the use of Gd-DTPA in intracranial and spinal tumors for better visualization of location and extent of a lesion and for better tissue differentiation. In inflammatory diseases Gd-DTPA allows the differentiation between active and chronic lesions.

[Nuclear magnetic resonance tomography using gadolinium-DTPA in the diagnosis of spinal lesions]. / Die Kernspintomographie mit Gadolinium-DTPA in der Diagnostik spinaler Läsionen.

In spinal lesions GD-DTPA has led to a better diagnosis of tumors concerning the extent and differential diagnosis. Important indications for the application of GD-DTPA are intramedullary tumors: excellent information with respect to extent and differentiation cyst from tumor. At extramedullary intradural tumors we got distinction of extramedullary from intramedullary tumors and more information in the differential diagnosis for example in cases of neurinomas and meningiomas. Additional information is also obtained by means of GD-DTPA in extradural tumors: better delineation from the myelon, better possibilities to differentiate between meningiomas, neurinomas and scar and tumor.

MRI of the breast--histopathologic correlation.

132 solid breast masses have been examined at our institution by MR and have consequently been histopathologically correlated. T1- and T2-weighted SE and multi-echo sequences have been evaluated visually. It was found that signal intensities of tissues on T2-weighted images correlated with the contents of fibrosis, cells or water. Thus in some lesions (which consisted of different tissue components), a characteristic internal structure was visible on T2-weighted images, reflecting their histopathologic structure. Corresponding to their different composition, differences of signal intensity have also been noted between those fibroadenomas with a high contents of fibrosis and all other well-circumscribed breast lesions (fibroadenomas, carcinomas). However, for the majority of lesions with irregular contours a discrimination based on signal intensities or calculated T1- and T2-values did not seem possible. This overlap can also be explained by the macroscopically similar composition (amount of fibrosis, water or cells) of benign and malignant irregular lesions.

Topography of the sciatic nerve's fibres in regard of clinical use.

72 sciatic nerves were investigated from the level of the sciatic tuberosity to the branching off of the nerves for the posterior thigh muscles. The area of the cross section has a mean value of about 72 mm2. Almost 1/3 of it belongs to the peroneal component. The bundles for the hamstring muscles occupy about 13% of the tibial component; mostly they are situated slightly anterior to the medial margin of the nerve. The bundles for the short head of the biceps muscle of the femur occupy about 11% of the peroneal component; they are situated slightly anterior to the lateral margin of the nerve. The bundles for the hamstring muscles exchange fibres with other fascicles in more than 60% of the specimens, whereas the bundles for the short biceps head do so in less than 25%.

[The value of imaging procedures in myology]. / Wertigkeit bildgebender Verfahren in der Myologie.

Muscular imaging (sonography, computed tomography, magnetic resonance imaging) has proved to be worthwhile for myologic diagnostic purposes during the past few years. In 319 patients suffering from generalized neuromuscular diseases, muscle atrophies or hypertrophies and the degree and distribution of mesenchymal alterations in skeletal muscles were documented. The various imaging techniques were of assistance defining the optimal biopsy site, and the preparation of electro-myographic examinations. Real time sonography proved to be the method of choice for screening purposes and for documentation of fasciculations. Because of higher sensitivity and superior depiction of soft tissue pathology, magnetic resonance imaging supported the further diagnostic work-up in certain cases. Because of irradiating side effects, computed tomography was applied just for evaluation of muscle involvement in advanced stages of neuromuscular diseases in adults.

[Use of Gd-DTPA in the nuclear magnetic resonance study of the breast]. / Anwendung von Gd-DTPA bei der kernspintomographischen Untersuchung der Mamma.

55 patients with altogether 60 breast masses have been examined postoperatively by plain MR, MR with Gd-DTPA and mammography at our institution. All breast carcinomas and fibroadenomas did enhance significantly. Non-proliferative dysplasia, normal breast tissue and scar tissue did not enhance significantly. Borderline enhancement has been found in cases of proliferative dysplasia. The diagnostic accuracy has been improved by MR with Gd-DTPA. Advantages have been an improved visualization of tumors in dense breasts, an improved differentiation between irregular dysplasia and carcinoma and an improved differentiation between post-therapeutic changes (after radiation, surgery or silicon implants) and carcinoma. Nevertheless both technical improvements and further clinical experience is necessary.

MR imaging of the breast: comparison with mammography and ultrasound.

Fifty-seven biopsy proven breast masses have been examined at our institution by magnetic resonance (MR), mammography, and ultrasound. The three techniques have been evaluated concerning their capability to visualize the lesion and the diagnostic information obtained. Magnetic resonance proved comparable to mammography and superior to sonography in the fatty to medium dysplastic breasts but inferior to the combined examination by mammography and sonography in the dense breasts. In some selected cases, however, special advantages of MR have been found.

[Nuclear magnetic resonance tomography of the spine and spinal cord compared with computed tomography and myelography]. / Die Kernspintomographie der Wirbelsäule und des Rückenmarks im Vergleich zu Computertomographie und Myelographie.

In cases of syringomyelia MR is superior to CT and myelography in visualisation and delineation of the extent of the process. In diagnosing spinal tumours MR is a more sensitive method than CT and myelography. MR provides additional information on sagittal and frontal planes regarding the extent of the tumour. In diagnosis of disc prolapse MR seems to be as accurate as CT or myelography. We obtained additional information in diagnosis of degenerated disc tissue. Spinal stenosis is easily recognisable. CT was superior in differentiation of bony and disc protrusion. The results show that MR has opened up new possibilities in the diagnosis of spinal diseases and will result in a reorientation of the diagnostic approach.