Circular spirit level guidance system for CT- and MR-guided punctures.

A circular spirit level guidance system was tested for control of CT- and MR-guided punctures. The device consists of a needle holder fixed to a ground plate and two protractors. This allows adjustment of the fixed needle according to the angulation of the supposed puncture path as measured on tomographic images. A circular spirit level is fixed to the needle and leveled. Now the needle can be removed from the needle holder; by leveling the circular spirit level during the puncture, the formerly adjusted angulation is achieved. The system was tested in vitro and in vivo (22 patients) under CT and MR guidance. The average needle deviation was measured to be 1.96 degrees in vitro and 2.51 degrees in vivo. This simple device allows accurate puncture under CT and MR guidance.

[A new MR-(and CT-) compatible bone biopsy system: first clinical results]. / Neues MR-(und CT-)kompatibles Knochenbiopsiesystem: Erste klinische Ergebnisse.

PURPOSE: To describe the development and clinical evaluation of a new, hand-powered or alternatively motor-driven, MRI and CT compatible percutaneous bone biopsy system. MATERIALS AND METHODS: A new coaxial drill system (Cook Europe A/S) was designed for percutaneous, MR-guided bone biopsies and powered either by hand or an optional motor (10-250 rotations/minute using 6 bar [88.2 PSI] compressed air). The system has been used in 23 patients. Fourteen procedures were performed in a 1.5 T MR scanner (Philips-Gyroscan ACS-NT) which has an attached C-arm (Philips-BV 212-Angio) in case fluoroscopy is required, and 9 procedures in a CT scanner (Siemens-Somatom Plus). RESULTS: Driven by hand or by the pneumatic motor unit, the system achieved safe and accurate MR-guided access to all of the lesions and was even able to penetrate osteosclerotic lesions. MR- or CT-guided percutaneous biopsy yielded a correct diagnosis in all but 5 cases. No procedural complications occurred. CONCLUSION: MR-guided percutaneous bone biopsy performed with the new coaxial drill system was found to be safe and reliable, and suitable for obtaining histological specimens from skeletal lesions even when covered with thick cortical or sclerotic bone.

[MR-micturating cystourethrography using radical k-space sampling]. / MR-Miktionszystourethrographie mit radialer k-Raum-Abtastung.

PURPOSE: To investigate the feasibility of micturating cystourethrography (MCU) by means of real-time MR imaging with radial k-space sampling. METHODS: The MR-MCU was performed in 7 adult male patients subsequent to a gadolinium(Gd)-DTPA-enhanced excretory MR-urography. The Gd-enhancement of the urethra was visualized by MR-fluoroscopy using a T1-weighted gradient-echo-sequence with radial k-space sampling and a slice thickness of 10 mm. RESULTS: The proposed technique allowed in all 7 patients a dynamic realtime imaging of the Gd-flow inside the urethra during micturition. The normal anatomy of the entire course of the urethra was demonstrated in each patient, while simultaneously the relation to the prostate and pelvic floor became visible. Furthermore, the urinary bladder could be assessed by interactive repositioning of the slice orientation in any preferred direction. The ureters could also be visualized due to the persisting Gd-enhancement of the upper urinary tract after the preceding MR-urography. CONCLUSIONS: MR-MCU using Gd-DTPA and radial k-space data acquisition is a novel imaging modality for a real-time visualization of the urethra during micturition without radiation exposure. This method also allows the assessment of the bladder, the pelvic floor, and the Gd-filled upper urinary tract which suggests a potential for the diagnosis of vesicoureteral reflux and urinary incontinence.

[Determining the effectiveness of percutaneous cava filters: experimental studies]. / Bestimmung der Effektivität perkutaner Kavafilter: Experimentelle Untersuchungen.

PURPOSE: In vitro clot-trapping capacity of 16 different caval filters should be evaluated under varying experimental conditions. MATERIAL AND METHODS: In a flow model simulating in vivo conditions (soft latex tube, dextran solution at 37 degrees C, pulsatile flow at a mean rate of 3 1/min) the efficiency of 16 caval filters was evaluated in horizontal and vertical position by using 640 or 1280 clots/filter (8 sizes). Non-self centering filters were tested in centric and in tilted position. RESULTS: Efficiency of optimally centered caval filters varied between 97.8 and 69.4%. The largest thrombi were captured by all optimal centered filters. A change from vertical to horizontal position of the flow model resulted in a variation of filter efficiency by about 4.8%. Efficiency of non-self centering filters decreased significantly when placed in a tilted position (mean decrease 15.5%; range 2.7%-37.7%) resulting in a deterioration of the capture rate by as much as 43.2%. CONCLUSION: Under optimal study conditions efficiency of all evaluated caval filters was high. Tilting of caval filters resulted in a significant efficiency decrease.