Erste Erfahrungen mit der Mehrzeilendetektorspiral-CT in der Diagnostik der Arteriosklerose der Koronargefäße

PURPOSE: Multi-row-detector-spiral-CT (MSCT) allows for 250 ms effective exposure time. The purpose of this study was to demonstrate the possibilities and limitations of this CT technology for non enhanced and contrast enhanced investigation of the coronary arteries. METHODS: Investigation of the coronary arteries without contrast medium for quantification of coronary calcifications was performed in an obese patient (140 kg) with MSCT and electron beam CT (EBCT). In 56 patients contrast enhanced CT angiography of the coronary arteries was performed to determine image quality depending on the heart rate. RESULTS: In the obese patient superior image quality could be achieved with MSCT allowing for reliable quantification of coronary calcifications. With MSCT angiography of the coronary arteries good image quality was achieved in patients with a heart rate of 59 +/- 8 beats per minute. CONCLUSION: Even if there are limitations in patients with higher heart rates with an effective exposure time of 250 ms MSCT has clear advantage of image quality in the assessment of non enhanced and contrast enhanced coronary arteries.     

Der Einfluß der Reduktion der Bestrahlungsdosis auf die Inzidenz der radiogenen Pneumonitis, Lungenfibrose und Perikarditis nach Mediastinalbestrahlung bei der Behandlung der Lymphogranulomatose

Background

The amount of radiation dose applied in the treatment of Hodgkin’s disease is associated with the incidence of complications including radiation-induced pneumonitis, lung fibrosis and pericarditis. Therefore, from the beginning of 1986, we have started to apply a radiation therapy approach with reduced doses in order to minimize complications while maintaining effective treatment.

Patients and Method

From 1983 through 1992 141 patients suffering from Hodgkin’s, disease were included in the present study. All of them were treated by radiation of mediastinum. In 126 cases polychemotherapy was applied before radiation. From 1986 we used a reduced radiation dose in cases that were treated by radiation alone (affected nodal regions with 40 Gy instead of 45 Gy and unaffected nodal regions with 36 Gy instead of 40 Gy) as well as after application of chemotherapy (affected nodal regions 36 Gy instead of 40 Gy and unaffected nodal regions with 30 Gy instead of 36 Gy). Ninety-five patients were treated according to the new therapy protocol. Forty-six patients had been treated with the higher dosages and served as the historical control group. Radiation therapy included Co-60, 15-MV and 9-MV photons, and 15-MeV and 9-MeV electrons. Serial thoracic X-ray controls were performed. CT scans, echocardiographic and electrocardiographic investigations were added in selected cases.

Results

During the period from 1983 to 1992, we diagnosed radiation-induced pneumonitis in 31% of the patients who underwent radiation therapy of the mediastinum. In addition, 16% demonstrated lung fibrosis and 10% pericarditis. After implementation of the reduced radiation dosages, the incidence of pneumonitis decreased from 35% to 24% (nearly significant in the 5% range), lung fibrosis from 24% to 12% (p<0.05) and pericarditis from 26% to 2% (p<0.01). The efficacy of treatment remained unaffected by the new therapy approach as has been demonstrated for cumulative survival data and recurrence-free intervals.

Conclusions

Reduction of radiation dose in patients with Hodgkin’s disease who undergo mediastinal radiation leads to a decrease in the incidence of radiation-induced complications (pneumonitis, lung fibrosis, pericarditis) whereas treatment efficacy remains unchanged.     

Über Erfahrungen mit der Bestimmungstechnik und der forensischen Brauchbarkeit der Haptoglobintypen nach Smithies

Ohne Zusammenfassung     

Behandlung der arteriosklerotischen Erkrankung der A. carotis

In order to find the most suitable therapy concept for patients with severe stenosis of the carotid bifurcation (>70%), knowledge on the currently available treatment methods is necessary. In addition to carotid endarterectomy, medication therapy and stent angioplasty are also available. The outcome after stent angioplasty must be considered under the aspects of rapid technical development and increasing experience. Results of studies are still only of limited value with respect to the development of protection systems, flexible guiding catheters, low profile and more visible stents and balloons as well as using thrombocyte aggregation.     

Zur Frage der postmortalen Farbveränderungen der Haare

Zusammenfassung Wie die vorliegenden Versuchsergebnisse aufzeigen, dürfte es sich bei den postmortalen Veränderungen der Haarfarbe im wesentlichen um zwei verschiedene Vorgänge handeln, die getrennt für sich oder auch gleichzeitig ablaufen können. Einmal ist der Angriffspunkt das Haarpigment, welches durch Oxydationsvorgänge über die rote Stufe bis zur völligen Zerstörung abgebaut werden kann. Zum anderen können Nitrierungs- und anschließende Alkalisierungsvorgänge zu einer Umwandlung des Keratins, insbesondere seines Bausteines Tyrosin, und damit zu einer Farbänderung (graugelb bis fuchsigrot) führen.Diese Reaktionsabläufe sind nicht allein an flüssige oder feuchte Medien gebunden, sondern können auch bei Einwirkung von Gasen (NO₂ und NH₃) auftreten.Hervorgehoben werden darf nach den vorliegenden Untersuchungs-ergebnissen, daß nicht nur pigmentierte Haare, sondern auch graue (pigmentarme) und weiße, ja selbst Albino-Haare (pigmentlose) die fuchsigrote Farbe annehmen können.Von der jeweiligen Redoxlage unter dem Fäulnis- und Verwesungsprozeß wird es abhängen, ob Haare einen graugelblichen oder fuchsroten Farbton annehmen. Wenn O.Schmidt nach seinen Untersuchungen mit Farbstoffindikatoren ausführt, daß die Entfärbung des Farbstoffes ein Maß für das herrschende Potential ist, so kann nach vorliegenden Untersuchungsergebnissen ergänzend gesagt werden, daß auch die Bildung neuer Farbstoffe von der jeweiligen Redoxlage abhängt.Vortrag gelegentlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in Bonn (Oktober 1953).     

Ein Beitrag zur Prüfung der LeistungsfÄhigkeit der plastischen Rekonstruktionsmethode der Physiognomie bei der Identifizierung von SchÄdeln

Ohne Zusammenfassung     

Anwendung der optischen Kohärenztomographie (OCT) bei der Darstellung von Urothelerkrankungen der Harnblase

PURPOSE: The technique of optical coherence tomography (OCT) has significantly improved over the last few years. This new diagnostic procedure allows imaging of tissue structure of the bladder wall during cystoscopy with high resolution. MATERIALS AND METHODS: The penetration depth of OCT is limited to 2.5 mm. The resolution is approximately 15 microm. Fifty patients with different clinical conditions of the bladder were examined. Altogether 488 OCT images were generated. RESULTS: OCT of normal bladder mucosa clearly shows a differentiation between urothelium, lamina propria, and smooth muscle. Cystitis and metaplasia are characterized by blurring of the laminated structure and thickening of the epithelial layer. In malignant areas there is complete loss of the regular layered tissue structure. CONCLUSION: OCT improves the diagnosis of flat lesions of the urothelium. It has the potential for facilitating intraoperative staging of malignant areas in the bladder.     

Experimentelle Untersuchungen zur Bedeutung der vacuoligen Umwandlung der Leber für die Diagnostik der Kohlenmonoxydvergiftung

Zusammenfassung An 125 männlichen Ratten eines Inzuchtstammes wurde die Frage untersucht, welche diagnostischen Rückschlüsse sich aus der Veränderung der Leber, bezüglich der CO-Vergiftung ziehen lassen. Es wird festgestellt, daß bei der akuten Kohlenmonoxydvergiftung keine Beziehung zwischen CO-Hb-Gehalt und dem Auftreten einer vacuoligen Degeneration besteht. Demgegenüber findet sich eine ausgesprochene Zeitabhängigkeit zwischen der Kohlenmonoxydvergiftung, dem Auftreten der vacuoligen Umwandlung der Leber und dem Eintritt des Todes.     

Aus der forensisch-psychiatrischen Abteilung der Freien Universität Berlin

Ohne Zusammenfassung     

Biochemische MR-Bildgebung der Bandscheibe und Facettengelenke der Wirbelsäule

The limited specificity of standard magnetic resonance imaging (MRI) in patients with low back pain encourages the development of new imaging techniques. Quantitative MR methods have the potential to assess biochemical changes of spinal structures in vivo. Early diagnosis of intervertebral disc and facet joint changes in young to middle aged patients allows the use of a specific therapy and preventative measures. Potential techniques are T2 and T2* mapping, diffusion-weighted imaging, magnetization transfer imaging, T1ρ mapping, sodium imaging and MR spectroscopy. Well designed longitudinal therapy studies, which assess biochemical and clinical parameters, are necessary. High-field MR systems (3 Tesla) are needed for high resolution biochemical MRI and clinically reasonable scan times.     

Anatomie und Normvarianten der Nasennebenhöhlen in der Schnittbildgebung

CT and MRI are the radiological methods of choice in the diagnostics of diseases of the paranasal sinuses. Detailed anatomical knowledge is mandatory for correct image interpretation. Before endonasal surgery the individually variable anatomic situation has to be known. This article describes radiologically relevant anatomical structures and summarizes normal variations.     

MR-Bildgebung der Nieren Neue Ansätze in der Diagnostik*

AIM: New diagnostic strategies for evaluation of the kidney by fast MR imaging techniques. MATERIAL AND METHODS: A comprehensive morphologic and functional evaluation of the kidney is proposed using fast MR imaging of renal morphology, multiphase 3D gadolinium MR angiography, MR urography and MR flow measurements. A single MR examination is designed to grade renovascular disease and assess the hemodynamic and functional significance, detect and characterize renal lesions and evaluate the urinary tract. RESULTS: The combined analysis of morphologic and functional data allows reliable assessment of renal artery stenosis, benign and malignant renal masses and diseases of the renal collecting system and ureters, as well as congenital abnormalities in good agreement to the results of conventional imaging modalities. The improved tissue contrast and additional functional information compensates for the disadvantage of a lower spatial resolution. CONCLUSION: Combined morphologic and functional MR examination represents a reliable, non-invasive and cost-effective alternative imaging modality for comprehensive diagnostic evaluation of renal disease.     

Optimierung der Zeitauflösung in der CT mittels retrospektivem EKG-Gating

PURPOSE: Spiral CT of the heart using the established ways of ECG synchronization is hampered by the relatively long acquisition times of 250 to 500 ms. This only allows to acquire diastolic images in patients with moderate heart rates. In this work, algorithms for time-optimized retrospective cardiac gating are presented, and their potential to improve temporal resolution is investigated. MATERIAL AND METHODS: These algorithms use data from multiple gantry rotations for image reconstruction, which is possible for multi-scans at fixed slice positions as well as for overlapping spiral scans. Temporal resolution was quantified using computer simulations and compared to experimental data from pigs. RESULTS: Using a conventional sub-second CT scanner, considerably higher temporal resolutions are possible with spiral scanning. A temporal resolution of 170 ms already provides systolic images with little motion artifacts. Higher temporal resolutions of up to 70 ms are demonstrated for multi-scans, which allows to depict ventricle wall movement over the complete cardiac cycle. DISCUSSION: The method of time-optimized retrospective cardiac gating broadens the spectrum of conventional spiral-CT for cardiac imaging. It can be directly transferred to multi-slice scanners. Here it can be used clinically because of reduced scan time. Potential applications are the determination of functional cardiac parameters like ejection fraction and the detection of disorders of ventricle wall movement.     

Radiologisch-orthopädische Anforderungsprofile bei der kindlichen Hüftdysplasie,der Koxitis und der Epiphyseolysis capitis femoris

DDH, septic coxarthritis and slipped capital epiphysis should be diagnosed as soon as possible. Hip sonography is the goal of DDH examination technique, anatomical identification and 3 landmarks check up are there most important points of the method. With the progress of ossification and loss of the 3 landmarks consecutively, x-rays become increasingly important. Septic coxarthritis is an orthopaedic emergency case, sonography is the most important tool in primary diagnosis. Slipped capital epiphysis requires an x-ray in 2 planes, MRI oder CT scans respectively makes sense in special cases to localize the area of necrosis and to plan further reconstructive procedures.     

Stellenwert der Radiochirurgie in der Primärtherapie des Glioblastoma multiforme

Aim

To describe the clinical results and the feasibility of a phase II dose escalation study of small boost target volumes with a radiosurgical technique in patients with positive early postoperative MRI scan.

Patients and Method

Since 1986, 35 patients were treated within a concept for first line therapy. Including criteria were residual tumor ≤5 cm and Karnofsky performance score ≥70. The mean age was 54.5 years. The treatment concept included an operation for reduction of tumor volume and a postoperative irradiation. The postoperative irradiation was divided in 2 parts: first, a hyperfractionated (1.8 Gy single dose twice a day, 54 Gy total dose) irradiation was performed containing the tumor and the edema with a 2 cm safety margin. Secondly, a radiosurgical boost dose was delivered. The target volume of this radiosurgery was the contrast enhancing residual tumor in early postoperative MRI scans. The median boost dose was 15 Gy. Survival curves were calculated according to the Kaplan-Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication

Results

The median survival calculated from the time of diagnosis was 10.1 months. The 1- and 2-year survival rate were 35% and 6%, respectively. Young age tended to longer survival, patients younger than 53 years had a median survival of 10.4 months whereas patients older than 53 years showed a median survival of 9.2 months. The mean value of the boost volume was 22 cm³. Patients with smaller volumes had a median survival of 10.1 months and patients with bigger volumes showed a median survival of 9.9 months. 4.5 months after therapy, 75% of the patients showed improved or stable quality of life.

Conclusion

The feasibility of a radiosurgically delivered boost dose after postoperative irradiation could be demonstrated. The observed survival rate is comparable to the survival rates reported in the literature. Whether or not the radiosur gery after postoperative irradiation is able to prolong survival can only be evaluated in a randomized phase III trial.     

Plötzlicher Tod bei Erkrankungen der Hypophyse und der Nebennieren

Circulatory lesions, inflammation and tumours of the pituitary and adrenal glands can affect the secretion of hormones and may cause lethal metabolic crises (adrenal crisis, pituitary coma, Conn’s syndrome). Even if such cases are quite rare, the primary and secondary morphological findings and symptoms of the acute disease should be known by every forensic medical examiner.     

Volumetrische Veränderungen der Mamma während der Radiotherapie

Hintergrund und Ziel: Eine Radiotherapie der Mamma induziert eine Gewebereaktion mit daraus resultierendem Ödem. Dieses Ödem führt zu einer Volumenzunahme der Mamma. Ziel der Studie war es, diese Volumenzunahme zu quantifizieren und deren Einfluss auf die Planung des Elektronenboosts zu analysieren. Patienten und Methodik: Bei 140 Patientinnen mit Mammakarzinom nach brusterhaltender Therapie erfolgte vor, während und/oder nach der Bestrahlung eine CT-Planung, um die Volumenveränderungen während der Bestrahlung zu evaluieren. Die ermittelten CT-Daten wurden unter Verwendung des HELAX-TMS-Planungssystems zur Bestimmung der Dosisverteilung ausgewertet. Die Bestimmung des Brustvolumens erfolgte mittels Interpolationsalgorithmus. Gemessen am Ausgangsvolumen wurden die Patientinnen in drei Subgruppen unterteilt: Gruppe 1 (n = 47): 670 cm³, Gruppe 2 (n = 46): 671–999 cm³ und Gruppe 3 (n = 47): 1 000 cm³ Brustvolumen. Ergebnisse: Initial zeigte sich ein mittleres Brustvolumen von 907 cm³ (100–3 073 cm³). Nach Radiotherapie kam es zu einem Anstieg des Brustvolumens um durchschnittlich 81 cm³ auf 988 cm³ (109–3 185 cm³). Signifikant messbare Volumenzunahmen traten ab einer Zielvolumendosis von 40 Gy auf. Bezogen auf die drei Subgruppen ergaben sich folgende mittlere Volumenzunahmen: Gruppe 1: 53 cm³ (3–120 cm³), Gruppe 2: 85 cm³ (20–200 cm³) und Gruppe 3: 105 cm³ (5–340 cm³). Der Zuwachs war in allen drei Gruppen mit einem p-Wert von p < 0,001 hochsignifikant. Je nach Volumenzunahme der Brust resultierte eine Änderung der Herdtiefe um bis zu 1,0 cm. Schlussfolgerung: Aufgrund der interkurrenten Volumenänderungen unter Bestrahlung erscheint eine zweite CT-Untersuchung zur Nachplanung vor Boostbestrahlung sinnvoll. Die zweite CT-Planung sollte ab 40 Gy erfolgen, um das Ödem ausreichend erfassen zu können.