Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes.

OBJECTIVE: The goal of this study was to compare the capabilities of conventional radiography, CT, and MR imaging in revealing ligamentous and bony changes in patients after hyperflexion injuries. SUBJECTS AND METHODS: Forty-nine patients with hyperflexion injuries of the foot were included in our study. Conventional radiography, weight-bearing radiography, CT, and MR imaging were performed. All images were reviewed with respect to ligamentous and bony abnormalities and alignment alterations. Eleven patients with joint malalignment underwent surgery, which is considered the gold standard in these patients. Five patients with joint malalignment refused surgery. RESULTS: For all 49 patients, conventional radiographs revealed 33 metatarsal and 20 tarsal fractures. Eight patients presented with tarsometatarsal joint (Lisfranc's joint) malalignment. Weight-bearing radiographs showed joint malalignment in the same eight patients only. CT showed 41 tarsal fractures and 53 metatarsal fractures. Joint malalignment was evident in 16 patients. MR imaging revealed 41 metatarsal fractures and 18 metatarsal bone bruises. Tarsal bones were fractured at 39 sites and there were nine tarsal bone bruises. Metatarsal fractures were mostly localized in the second metatarsal bone; tarsal fractures, in the cuboid. Joint malalignment was evident in 16 patients; in 11 of these 16 patients, Lisfranc's ligament was disrupted. Surgery confirmed bony and ligamentous changes and joint malalignment in 11 patients. CONCLUSION: Conventional radiographs including weight-bearing images are not sufficient for routine diagnostic workup of patients with acute hyperflexion injuries of the foot. CT should serve as the primary imaging technique for such patients.

[Detection of perfusion of kidney transplants. Comparison between color-coded and amplitude-coded Doppler ultrasound]. / Nachweis der Perfusion in Nierentransplantaten. Vergleich zwischen farbkodierter und amplitudenkodierter Dopplersonographie.

OBJECTIVE: To evaluate the efficiency of colour Doppler energy (CDE) in comparison to conventional colour Doppler sonography (CDI) in the detection of renal blood flow signals in asymptomatic patients after renal transplantation. SUBJECTS AND METHODS: Fifteen asymptomatic volunteer patients after renal transplantation were examined with CDI and CDE. The examination parameters were kept constant; only the Doppler-receiver gain was varied. Assessment and comparison of blood flow signals were obtained with a self defined score system. RESULTS: CDI showed Doppler signals in the main stem vessels, segmental and interlobar vessels in all patients; in the arcuate arteries blood flow signals were detected in only 11 of 15 patients. There was no Doppler signal in peripherally located medullary and cortical vessels. CDE showed blood flow signals in the main stem, segmental and interlobar vessels and additionally in the arcuate, interlobular and medullary as well as in the cortical vessels in all patients. CONCLUSION: CDE is more sensitive than CDI and improves the detection of blood flow signals in peripheral medullary and cortical vessels of renal transplants.

Magnetic resonance imaging in patients with gestational trophoblastic disease.

RATIONALE AND OBJECTIVES: The authors describe the magnetic resonance (MR) imaging characteristics in patients with gestational trophoblastic disease (GTD) before and after therapy and to correlate these findings with human gonadotropin levels and the specific histology of GTD. METHODS: Thirteen women (mean age, 30.1 years) with elevated human chorionic gonadotropin (HCG) levels and histologically proven GTD underwent MR examinations of the pelvis. Magnetic resonance imaging was performed on a 1.5-tesla unit. Axial and sagittal proton density-weighted and T2-weighted and sagittal T1-weighted sequences were obtained. Four patients underwent follow-up studies after 4 and 8 weeks to monitor the response to therapy. Gestational trophoblastic disease was histologically proven with curettage in 11 patients and with hysterectomy in two cases. RESULTS: Nine patients had a diffusely enlarged uterus with pathologic signal intensities. In four patients, a focal tumor mass was observed. All patients showed loss of the zonal anatomy of the uterus in at least one local area. In 11 patients, no uterus zones could be identified throughout the entire uterus. Pathologic dilated tumor vessels were evident in all patients. In all four cases in which follow-up imaging studies were obtained, uterus size, signal intensities, identification of uterus zones, and uterus vessels returned to normal. CONCLUSION: Magnetic resonance imaging shows trophoblastic tumor infiltration as diffuse uterus enlargement, focal tumor masses, loss of zonal anatomy of the uterus, and pathologic uterine vasculature; this seems to be the most reliable MR imaging finding in patients with GTD. No correlation was found between MR imaging changes and HCG levels or specific histologic types of GTD.

Staging of cervical carcinomas. Comparison of body-coil magnetic resonance imaging and endorectal surface coil magnetic resonance imaging with histopathologic correlation.

RATIONALE AND OBJECTIVES: The authors evaluate the accuracy of magnetic resonance (MR) imaging with body coil and endorectal surface coil techniques in the staging of cervical carcinomas and compare these results with those obtained with clinical staging (International Federation of Gynecology and Obstetrics [FIGO] classification) and postsurgical histopathology. METHODS: Fifteen patients (average age, 48.6 years) with biopsy-proved cervical cancer were included in the study. After clinical staging (FIGO classification), MR imaging with body coil (BCMR) and subsequently with endorectal surface coil (ECMR) was performed. Using a 1.5-Tesla unit, axial and sagittal proton density weighted and spin echo T2-weighted and fast spin echo T2-weighted sequences were obtained with body and endorectal surface coil. During imaging analysis, special attention was paid to the uterine zones, the vaginal fornix, and the parametrial tissue. Ten patients were treated surgically (postsurgical histopathology was considered the gold standard), five patients, all clinically staged IIIb, underwent primary radiation therapy. RESULTS: Clinical staging with FIGO classification was accurate in 12 of 15 patients, and understaged in 2 and overstaged in 1 patient. Body coil MR showed accurate staging in 13 of 15 patients. Using this technique, understaging of 2 patients, both with only minimal tumor infiltration depth (< 8 mm), was performed. Endorectal surface coil MR was accurate in 14 of 15 patients missing minimal parametrial tumor infiltration in 1 patient. Histopathology (n = 10) revealed 3 patients with tumor stage T1b, 2 with stage T2a, and 5 patients with stage T2b. CONCLUSIONS: Although suggested by only a small number of patients, ECMR appears to be the most accurate modality for staging cervical carcinomas but seems to be unreliable in the detection of minimal tumor infiltration.

Distribution pattern of computed tomography findings in patients with bronchiolitis obliterans organizing pneumonia.

RATIONALE AND OBJECTIVES: The authors evaluated high-resolution computed tomography (HRCT) findings in 15 patients with biopsy-proven bronchiolitis obliterans organizing pneumonia (BOOP). Special attention was paid to lobar distribution to establish a predominant distribution pattern for this disease. SUBJECTS AND METHODS: Fifteen patients (average age, 61.8 years) with BOOP underwent computed tomography examinations. The examination technique included a slice thickness of 4 mm with a 4-mm interval; matrix size was 256 x 256 pixels. In all patients, additional HRCT images with a 2-mm slice thickness and a 10-mm interval (matrix, 512 x 512 pixels) were obtained. Interpretation included assessment of pulmonary, pleural, and mediastinal involvement. Special attention was paid to the distribution pattern of pulmonary abnormalities. RESULTS: High-resolution computed tomography in all patients demonstrated areas of air space consolidation in a multifocal but peripheral distribution. The right lower lobe was involved in 60% of the patients, the left lower lobe in 53%, the middle and right upper lobes in 20%, and left upper lobe in 23%. Five patients had ground-glass opacities in addition to the areas of air space consolidation, with the incidence in these patients being 100% in the right lower lobe. 80% in the left lower and middle lobes, 60% in the right upper lobe, and 20% in the left upper lobe. Nodules were found in two patients, and the left lower and middle lobes were affected in both. In one patient, the right lower lobe was affected. The interstitium was thickened in 66%, with axial involvement in 20%, septal thickening in 30%, and peripheral regions affected in 50%. Bronchiectasis was present in 60% of all patients studied, predominantly located in the lower lobes. CONCLUSION: Bronchiolitis obliterans organizing pneumonia presents a predominant peripheral, bilateral, and nonsegmental distribution, with the lower and middle lobes affected more than the upper lobes.

Technical note: comparison of colour Doppler energy sonography with conventional colour Doppler sonography in detection of flow signal in peripheral renal transplant vessels.

The technical advantage of colour Doppler energy sonography (CDE) results in a higher sensitivity for blood flow detection than in conventional colour Doppler sonography (CDI). We compared the efficiency of CDE versus CDI in the detection of blood flow signals in asymptomatic patients after renal transplantation. 10 asymptomatic voluntary patients after renal transplantation were evaluated with CDI and subsequently with CDE by two examiners. Filter, scale and gate setting were kept constant, the Doppler gain was increased individually in every patient until background noise just did not derange the image. The assessment of blood flow signal was done using a self defined score system. CDI showed Doppler signal in the interlobar vessels in all 10 patients and blood flow signal in arcuate arteries and adjacent portions of interlobular vessels in nine of 10 patients. We were not able to detect blood flow related signal in the more peripheral medullary and cortical vessels. CDE obtained blood flow signal in interlobar and interlobular vessels in all patients. In addition, Doppler signal was observed in all patients in small medullary and cortical vessels. CDE increases detection of blood flow related signal in peripherally located small medullary and cortical vessels. There was no improvement in the evaluation of blood flow in interlobar vessels but marked improvement in blood flow detection in small peripherally located vessels. CDE cannot completely replace CDI in the sonographic evaluation of vascular complications in renal transplants, but should be used as an additional measure to rule out pathology in small peripheral renal vessels.