Peripheral neural sheath tumors (PNST)--what a radiologist should know.

Peripheral neural sheath tumors (PNST) are rare and the common goal of management focuses on eliminating pain and maximizing function of the affected nerve. Therefore preoperative assessment of the specific morphological behaviour of such tumors regarding the nerves internal architecture is of utmost importance. PNSTs may affect one or more fascicles of a peripheral nerve resulting in a significant functional loss after resection and the necessity of functional reconstruction in one step. Enhancement of preoperative information should also address the biological behaviour of the tumor regarding its dignity and the resulting implications on amount of radical resection, additional treatment and prognosis. Since high-resolution techniques promise more and more detail resolution in many fields of imaging, delineation of intra- and extraneural processes as well as biological informations shall lead towards a well prepared and foreseeable image-guided treatment of PNSTs.

[In-vitro suspension model of haemangioma vascular endothelial cells (HVECs)]. / Hemangioma Vascular Endothelial Cells (HVECs) im In-vitro-Modell.

INTRODUCTION: Haemangioma is the most common tumour of infancy. Its biological behaviour is one of a benign nature and characterised by a typical biphasic growth pattern. After an initial proliferation during the child's first year of life an involution takes place and usually lasts until the first decade. The expression of cellular and extracellular markers as well as cytokines follows its biphasic growth. In-vitro models reported so far have provided new insights in the tumour's biology and have identified possible targets for pharmacological agents. PURPOSE: Our study should enhance the functionality of current in-vitro models in establishing a suspension model of isolated proliferating haemangioma vascular endothelial cells (HVECs). MATERIAL AND METHODS: Tissue samples isolated from four haemangiomas (H1-H4) during the proliferation phase were cultivated in four different ways: H1 was cultivated in an MCDB-131 medium whereas for the H2 samples EGM2-MV medium was used. In the H3 series dispase enabled an immediate isolation of pure HVECs from the tissue sample which were cultivated under EMG2-MV medium. In the similarly cultivated H4 series an isolation of cultivated HVECs was enabled by the use of magnetic bead separation which finally led to a suspension model of isolated HVECs. RESULTS: In all four series HVECs were cultivated successfully. Depending on the selected medium different growth rates were observed. The use of dispase and the magnetic bead separation technique resulted in an isolation of cultivated HVECs which was documented in haematoxylin/eosin staining as well as under CD-31 immunohistochemistry. CONCLUSIONS: Research on tumour-specific processes as well as possible pharmacological targets necessitates a stable in-vitro model of proliferating HVECs. For our purposes, the described suspension model of HVECs fulfills the requirements of further research on antiproliferation and anti-angiogenesis.

Intraoperative imaging of the brachial plexus by high-resolution ultrasound.

The authors attempted to perform direct high resolution ultrasound imaging of the intraneural ultrastructure of the brachial plexus for intraoperative image guidance in brachial plexus surgery. The brachial plexuses of four fresh-frozen cadaver specimens were surgically exposed in a standard approach used in routine brachial plexus surgery to undergo direct ultrasound examination using a 15 MHz SonoCT scanhead. By placing the scanhead directly onto the epineurium, all components of the brachial plexus were directly visualized in an axial plane and compared with histologic findings. The internal neural structure at different levels could be visualized in high resolution, showing the specific fascicular pattern. The histologic processing revealed good correlation with the intraneural topography demonstrated on ultrasound. In the study, high resolution ultrasound examination of the brachial plexus showed substantial details of the ultrastructure of neural tissue, which may play a role in intraoperative image guidance in the surgical treatment of patients with brachial plexopathy.

The role of magnetic resonance imaging in routine decision making for meniscal surgery.

This clinical study evaluated factors affecting the decision for meniscal surgery in a patient population seen routinely at a trauma clinic. The study hypothesis was that patients who sustain a traumatic injury to the knee or have a long history of clinical symptoms are likelier to be operated on. We investigated 149 patients clinically and by magnetic resonance imaging (MRI). Group A (n = 62) underwent arthroscopic surgery and group B (n = 87) were treated conservatively. Multiple logistic regression analysis was used to examine correlations with regard to age, gender, injury pattern, period between the injury and first clinical examination, and MRI results. We found no significant difference between the two groups with regard to gender (P = 0.1), injury pattern (P = 0.44), or period between injury and first clinical examination (P = 0.5). Patients in group A were significantly older than those in group B (P = 0.044), and, as expected, MRI signal alterations were significantly higher in group A than in group B (P = 0.001). In acutely injured patients MRI helps to establish an accurate diagnosis, and in cases of positive MRI findings in a symptomatic patient, the surgeon should not wait 4-6 weeks but should immediately recommend surgery.