[Computed tomography of renal cell carcinoma]. / Computertomographie bei Nierenkarzinomen.

The value of computed tomography in the diagnosis and monitoring of renal carcinoma is reviewed on the basis of personal experience with 405 patients and a comparison with the literature. CT is of high sensitivity and specificity in the detection of small renal carcinomas as well in differential diagnosis and may remain the favored imaging method in this field. In local pretherapeutic tumor staging, CT, particularly dynamic studies, has achieved an accuracy of more than 90%. This method has its limits in precise estimation of the cranio-caudal extension of the tumor; complementary information is expected from MRI. In the monitoring of nonsurgically, treated renal tumors, CT is indicated where sonographic findings are doubtful only. In the diagnosis of small recurrent renal tumors, CT is more sensitive and should be a regular element in follow-up studies.

Computed tomography and endosonography in the preoperative staging of rectal carcinoma.

In 30 patients with rectal carcinoma the accuracy of computed tomography (CT) and endosonography (ES) was compared with the surgical specimen. Three cases were overstaged by ES and 4 cases were understaged by CT. The accuracy of ES was 84% and of CT only 76%. Both methods had advantages and limitations. An accurate staging of lymph node metastases was possible neither by ES nor by CT. - We advocate endosonography as the first imaging examination after proctoscopy. CT is recommended in endosonographic doubtful findings and in tight stenoses.

[The value of computed tomography in monitoring the preoperative chemotherapy of osteosarcoma]. / Zum Wert der Computertomographie für das Monitoring der präoperativen Chemotherapie des Osteosarkoms.

Computed tomography was performed in 45 patients with osteosarcomas before and after preoperative chemotherapy. Changes of bone alterations, intramedullary tumour spread and the size of soft tissue masses are computer tomographic criteria for tumour response after chemotherapy. The computed tomography decision of responder or non-responder was correct in 37/45 patients. In comparison with conventional x-rays CT was superior. CT is a reliable method for preoperative extension diagnosis and for the decision-marking for limb-saving operations.

[Computed tomography of recurrent rectal cancer with reference to guided fine-needle biopsy]. / Computertomographie des Rektumkarzinom-Rezidivs unter Berücksichtigung der gezielten Feinnadelbiopsie.

Computed tomography as a non-invasive imaging method is of high sensitivity and specificity for the detection and the extent diagnosis of recurrent rectal carcinomas. CT-guided fine-needle-biopsy can be necessary to prove presacral masses, before appropriate therapeutic decisions can be done. In our material CT-guided FNB showed an accuracy of 78% in 27 of 35 patients. Possibilities and limitations of the method are described.

[The value of computed tomography for the pretherapeutic staging of esophageal cancer]. / Zum Wert der Computertomographie für das prätherapeutische Staging des Osophaguskarzinoms.

CT examination was performed in 50 patients with histologically proved carcinoma of the esophagus. In 21 patients the CT findings were compared with the surgical or autopsy specimens. CT is revealed as a valuable diagnostic method for the estimation of infiltrating tumors. Limitations were seen in the precise judgement of the infiltration into the different layers of the adjacent organs and in the recognition of regional lymph node metastases. Nevertheless CT is recommended as a valuable staging procedure in carcinoma of the esophagus.

[Computed tomography in the diagnosis of isolated bone metastases and its influence in therapy planning]. / Computertomographie in der Diagnostik isolierter Knochenmetastasen und ihr Einfluss auf die Therapie-Planung.

In a collective of 70 patients with bone metastases the importance of CT for detection and extension diagnosis is shown. In 53% CT proved the scintigraphic and/or roentgenologic suspicion. In 30% CT gave more information than scintigraphy and plain radiography, but without any influence in the treatment. In 17% only CT gave such important information, that the planned treatment must be changed. The results led to the conclusion, that CT can be important for the optimization of radiological treatment.

[Malignant fibrous histiocytoma of soft tissue. Possibilities and limitations of computed tomography]. / Das maligne fibröse Histiozytom (MFH) der Weichteile. Möglichkeiten und Grenzen der Computertomographie.

Computed tomography was performed in 27 patients with confirmed malignant fibrous histiocytoma of the soft tissue. Compared with the CT results obtained in other tumours of the soft tissues. CT accuracy in malignant fibrous histiocytoma was only 74%. Non-typical attenuation values, diffuse tumour growth and non-typical contrast enhancement are discussed as reasons for the diagnostic understaging or overstaging of these soft tissue tumours. A higher accuracy was found on ultrasound examination with regard to tumour extension. Bone destruction was better visualised by CT. A base-line CT is recommended postoperatively for the earlier detection of recurrent tumours in further investigations.

[Confirmation power of computer tomography for suspected mediastinal tumors]. / Aussagekraft der Computertomographie bei Verdacht auf Mediastinaltumoren.

CT investigations of the mediastinum were compared in their diagnostic power with conventional X-ray pictures. With striking mediastinal broadening, CT always allowed to identify the origin of the tumour, its exact location and relationship with neighbouring organs and vessels. Determining its expansion proved valuable for the further therapeutic procedure. Density measurements gave indications as to the type of tumour. Fine-needle puncture permitted to narrow differential diagnostic findings. Finally, CT was used especially with systemic diseases for the search of lymph nodes in case of known tumours such as bronchial and mammary cancer. Also, pathological vascular processes, such as aneurysms, could be well visualized. This allowed to restrict the more stressing investigations, e.g. mediastinoscopy and angiography.

[Evaluation of computerized tomograms using a black and white and a color monitor: an ROC (receiver operation characteristic) comparison]. / Die Auswertung von Computertomogrammen am Schwarzweiss- und am Farbmonitor: Ein ROC-Vergleich.

Different views about the value of a colour monitor for the evaluation of computer tomograms have prompted us to carry out this ROC (Receiver Operation Characteristic) examination. The latter was based on patient computer tomograms in which lesions of the liver were simulated by image manipulation. 5 radiologists analysed the image material (a) on a black-and-white monitor, (b) on a colour monitor, and (c) simultaneously on a black-and-white and a colour monitor. The study shows that the use of a colour monitor gives no essentially different result than evaluation with a black-and-white monitor. The slightly better result of 2% more true positive findings with simultaneous representation of black-and-white and colour image relative to the sole use of black-and-white display is within error limits. The colour representation gives no advantage for the evaluation of usual computer tomograms because the window technique enables a contrast representation in black-and-white too.

CT evaluation of osseous tumors.

Computed tomography was performed on 153 patients with histologically proved bone tumors. CT has been found to be important for demonstrating the extent of the lesion, in aiding decisions about the operative approach, especially in tumors of the shoulder girdle and pelvis, and also for planning of localized surgery to maintain extremities. CT is of limited value in determining the nature of tumors. CT has proved efficacious in the detection or ruling out of tumor recurrences and in the assessment after chemotherapy or radiation therapy.

[Diagnostic imaging of peripheral soft tissue tumors with special reference to computed tomography]. / Bildgebende Diagnostik peripherer Weichteiltumoren unter besonderer Berücksichtigung der Computertomographie.

The further development of modern therapeutical procedures in the treatment of soft tissue tumors requires an improvement of radiological diagnostics. The diagnostic values of X-rays, angiography, sonography and computed tomography is estimated critically. The results of own CT examinations in 120 patients with soft tissue tumors and of 50 ultrasound examinations show the importance of these methods in the extent diagnosis of soft tissue tumors. Ultrasound or CT- guided biopsy are helpful to prove the definitive diagnosis. These methods have reduced the use of angiography.

[Use of CT in the staging and follow-up of small-cell bronchial cancer]. / Einsatz der CT beim Staging und Verlauf des kleinzelligen Bronchialkarzinoms.

In 54 patients with small-cell bronchial carcinoma, investigated with conventional X-ray technique and computer tomography, CT afforded a considerable extension of findings in regard to mediastinal tumor and metastatic spread, as well as in the detection of supraclavicular and pleural metastases. Also, the process of remission and renewed tumor growth could be observed better. Thus, CT constitutes quite an acquisition to therapy planning. The investigations carried out simultaneously in the brain region did not appreciably add to the findings in comparison to scintigraphy. In contrast, in the abdominal region, we have discovered liver metastases, subrenal metastases and lymph-node metastases both at first investigations and at controls. At post-mortem, however, we found kidney metastases that were not described in the CT but which may possibly have arisen prefinally. Altogether, thoracal and abdominal investigations with CT prior to onset of therapy and subsequent control are a valuable addition to therapy planning.

[ROC (receiver operating characteristic) study for the recognition of liver lesions on the computer tomogram]. / ROC-Untersuchung zur Erkennbarkeit von Leberläsionen in Computertomogrammen.

ROC examination was based on patient computer tomograms, in which lesions of the liver were simulated by image manipulation. The window width for optimal recognition of the lesions was found to be 128 Hounsfield units (HU). Evaluation of Receiver Operating Characteristics (ROC) by diameters and contrasts of the lesions yielded a contrast detail diagram largely reflecting conditions in clinical practice. The detectability--measured via the smallest visible diameter of the lesions--is inferior by the factor 3 to 60 to the results obtained with hole pattern phantoms. For example, in computer tomograms lesions of the liver of 24 mm and 4 HU or also 11 mm and 10 HU yield 70% true positive and 10% false positive findings.

[The role of computerized tomography in the diagnosis and treatment planning of prostatic cancer]. / Die Rolle der Computertomographie in der Diagnostik und für die Therapieplanung des Prostatakarzinoms.

The influence of computerized tomography on planning the therapy of 58 patients with histologically confirmed carcinoma of the prostate gland was examined. In classifying the early tumour stages there were differences from the clinical findings. With more advanced stages CT in some cases gave much more detail for diagnosing the extension. In 11.5% of the cases this led to the irradiation field being either enlarged or reduced. CT also proved to be useful for follow-up, especially as regards decisions on increasing the irradiation dose.

[Tumors of the renal pelvis--diagnostic possibilities using CT]. / Tumoren des Nierenbeckens--Diagnostische Möglichkeiten mit CT.

The urographic results obtained in 14 patients with tumors of the renal pelvis are compared with those of computer tomography (CT), and the diagnostic possibilities emerging from CT are described. CT is superior to urography and angiography not only in the discovery of renal pelvic tumors but also in their further differentiation. In addition, CT gives information in case if bilateral processes and lymph node metastases. Nonetheless, intravenous pyelography continues to hold the first place in the diagnosis of pathological processes of the renal pelvis. This holds both for tumor detection and suspicion and for indirect signs, namely the "mute" kidney or hydronephrosis. Angiography is less information with renal pelvic tumors, and with ultrasonic diagnostics there is no sufficient experience up to now.

[Value of computerized tomography for the staging of bronchial cancer]. / Zum Wert der Computertomographie für das Staging des Bronchialkarzinoms.

We obtained important informations in respect of tumor extent according to the TNM-classification by computed tomography in 99 patients with bronchogenic carcinomas. This method shows high accuracy in assessment of tumor extent and of mediastinal lymphatic metastases. The detection of metastases in the upper abdomen is possible too. In spite of some limitations computed tomography is definitely superior to all roentgenological methods in assessing the stage of bronchogenic carcinoma. It is of value in exploration of local operability and in planning radiation therapy.

[Importance of computed tomography in metastatic kidney tumors]. / Bedeutung der Computertomographie bei bereits metastasierenden Nierenkarzinomen.

The value of computed tomography for discovery and assessment of primary tumors has been investigated in 54 malignant kidney tumors with already existing distant metastases. The method is compared to the diagnostic data obtained by urography. Computer tomography proved to be the most informative method to examine the state of tumor spreading and, therefore, determines the further diagnostic procedure.