Radiologische Frühdiagnostik der rheumatoiden Arthritis

CLINICAL/METHODICAL ISSUE: For optimal therapy management of patients with rheumatoid arthritis (RA) specific and sensitive diagnostic methods are essential for assessment of disease activity. STANDARD RADIOLOGICAL METHODS: In addition to projection radiography, imaging techniques, in particular magnetic resonance imaging (MRI) and ultrasound (US) are becoming increasingly more important for the early diagnosis of RA. PRACTICAL RECOMMENDATIONS: The MRI and US techniques play a key role in the early imaging diagnostics of RA. Measurement of inflammation activity represents the basis of therapeutic decision-making and can be quantitatively and qualitatively determined with MRI and US. Synovitis and bone marrow edema are predictors of erosion.     

Radiologische Diagnose des femoroazetabulären Impingements

Femoroacetabular impingements (FAI) are due to an anatomical disproportion between the proximal femur and the acetabulum which causes premature wear of the joint surfaces. An operation is often necessary in order to relieve symptoms such as limited movement and pain as well as to prevent or slow down the degenerative process. The result is dependent on the preoperative status of the joint with poor results for advanced arthritis of the hip joint. This explains the necessity for an accurate diagnosis in order to recognize early stages of damage to the joint. The diagnosis of FAI includes clinical examination, X-ray examination and magnetic resonance imaging (MRI). The standard X-radiological examination for FAI is carried out using two X-ray images, an anterior-posterior view of the pelvis and a lateral view of the proximal femur, such as the cross-table lateral or Lauenstein projections. It is necessary that positioning criteria are adhered to in order to avoid distortion artifacts. MRI permits an examination of the pelvis on three levels and should also include radial planned sequences for improved representation of peripheral structures, such as the labrum and peripheral cartilage. The use of contrast medium for a direct MR arthrogram has proved to be advantageous particularly for representation of labrum damage. The data with respect to cartilage imaging are still unclear. Further developments in technology, such as biochemical-sensitive MRI applications, will be able to improve the diagnosis of the pelvis in the near future.     

Rechtsprobleme der stationären Rehabilitation

Ohne Zusammenfassung RID="*" ID="*"Erweiterte Fassung eines Vortrags anl?sslich des 20j?hrigen Bestehens der Fachkliniken Hohenurach in Bad Urach. Prof. Dr. iur. Hans Kamps und Dr. iur. Regine Kiesecker, Bezirks?rztekammer Südwürttemberg, Haldenhaustra?e 11, D-72770 Reutlingen     

Radiologische und nuklearmedizinische Diagnostik und Therapie der Schilddrüsenerkrankungen

Malignant thyroid diseases have increased in recent years. The distinction between differentiated and non-differentiated thyroid carcinoma is essential for therapy and follow-up. The frequently diagnosed papillary and follicular thyroid carcinomas are differentiated and have a good prognosis. Clinical symptoms are relatively unspecific, however imaging and laboratory testing can often provide evidence for diagnosis of thyroid carcinoma. Therapy typically involves surgery, ablative radioiodine therapy and subsequent suppressive hormone substitution. The pillars of follow-up are diagnostic scintigraphy, sonography and laboratory tests. Redifferentiation or a change of the tracer can make dedifferentiated tumors again susceptible to nuclide therapy. New treatment options have become available with the introduction of tyrosine kinase inhibitors.     

Diagnose der arrhythmogenen rechtsventrikulären Kardiomyopathie

In 2003 a 16-year-old boy died unexpectedly and the cause of death was determined as cardiomyopathy by the autopsy. A more precise specification of the cardiomyopathy was requested by the relatives 4 years later in particular with respect to the possible presence of an arrhythmogenic right ventricular cardiomyopathy (ARVCM) which mainly has an autosomal dominant inheritance. To diagnose an ARVCM standardized criteria have been developed based on structural, histological, electrocardigraphic and arrhythmogenic factors as well as a positive family anamnesis. At the time of the postmortem diagnostics only structural and histological criteria were available. For the histological verification an imaging analytic procedure described by Angelini et al. in 1993 was used for the quantitative evaluation of the fatty tissue and connective tissue in the myocardium. This procedure was adapted to modern technology standards so that an image analysis could be performed with a customary personal computer. Digital microphotographs of Sudan red and Elastica-van-Gieson stained slices with a 400x magnification were used. These images were processed by means of computer-aided image analysis and the respective areas of fatty tissue and connective tissue were determined. Arrhythmogenic right ventricular cardiomyopathy could be excluded by the investigations, however, an idiopathic dilated cardiomyopathy (DCM) could be diagnosed. The relatives of the deceased were recommended to undertake further physical and genetic examinations.     

Aktuelle Entwicklungen in der vaskulären Sonographie

Ultrasound plays a central role in the diagnostic imaging of venous and arterial vessels, especially for the assessment or exclusion of arteriosclerotic vessel obstructions as well as venous or arterial thrombosis. Due to its excellent patient acceptance and its broad availability, ultrasound is considered the standard method of choice for vascular imaging. New techniques and methods have greatly enhanced its diagnostic accuracy, the most notable of which are the B-flow technique, a variant of Doppler signal read-out for reduction of artifacts in duplex sonography, as well as other techniques, such as tissue harmonic imaging, the cross-beam technique and the speckle-reduction technique, which employ different echo processing methods for contrast improvement and enhanced delineation of body structures adjacent to the vessels. The introduction of contrast enhanced ultrasound represents an important advancement and has brought a substantial improvement in sensitivity. This article describes and discusses these new techniques and methods of vascular ultrasound diagnostics with respect to their diagnostic value.     

Ergebnisse der primären Strahlentherapie beim Vaginalkarzinom

Background

Cancer of the vagina is the least frequent primary malignant tumor of the female genital tract except carcinoma of the fallopian tube. Radiation therapy is the preferred treatment in most cases.

Patients and Method

Between 1965 and 1991, 39 patients (median age 66 years) with primary carcinoma of the vagina were treated with radiation therapy at our clinic. The mean observation period was 37 months. Classification according to the FIGO yielded a stage I in 43%, stage II in 24%, stage III in 22% and stage IV in 11%. Histological differentiation resulted in 35 squamous cell carcinomas and 4 adenocarcinomas. In 69%, the tumor was found on the posterior or lateral wall of the vagina, in 43% it arose from the upper third of the vagina. Standard therapy consisted of combined brachy-and teletherapy. Most of the brachytherapy applications were performed with a radium source.

Results

Median survival was 37 months, calculated according to the Kaplan-Meier method. The 5-year actuarial survival rate for all stages was 41% (stage I: 62%, stage II: 44%, stage III: 25%). Sixty-eight percent of all patients achieved a complete remission, 19% a partial response. Significant prognostic factors were stage of disease and histological grading.

Conclusion

Our results demonstrate the value of radiation therapy for the treatment of primary carcinoma of the vagina. Combined treatment with both external beam radiation and brachytherapy should be preferred.     

Prognostischer Wert der kardiovaskulären MRT bei Diabetikern

Die Radiologie - Trotz eines im Durchschnitt erhöhten kardiovaskulären Risikos sind Diabetiker eine heterogene Population mit höchst unterschiedlichen individuellen...     

Gesundheitsökonomie in der kardiovaskulären Bildgebung

New medical treatment methods and procedures usually cause high additional costs. Medical progress in cardiovascular imaging may fortunately reduce costs considerably. In Innsbruck it is calculated that about 1000 euros may be saved when replacing diagnostic coronary angiography (CAG) by CT coronary angiography (CTA). If in Austria 30% of CAGs are replaced by CTAs with a 64-slice CT system, about 13 million euros may be saved provided that CAG capacities will be reduced to the same extent as CTAs are done.     

Stellenwert der Galaktographie zur Abklärung pathologischer Sekretion in der komplementären Mammadiagnostik

Purpose

Galactography has been used in cases of pathological discharge for decades. Meanwhile other methods, such as high-resolution ultrasound (US) and magnetic resonance mammography (MRM) have been established for modern multimodal breast imaging. A survey among certified German breast care centers aimed to investigate to what extent galactography is currently used and whether newer techniques in multimodal imaging are preferred.

Materials and methods

An anonymous online survey was carried out nationwide and open to 342 radiology units in certified German breast care centers.

Results

A total of 177 units (52?%) participated in the survey of which 13?% generally do not provide galactography, 33?% conduct a maximum of 5 galactographies per year, 24?% conduct 6–10, 18?% 11–20, 8?% 21–50 and 5?% 51–100. Of the participants 53?% give first priority to US and prefer galactography to MRM in stepwise diagnosis and 32?% prefer MRM to galactography. Only 4?% use galactography initially.

Conclusion

Currently galactography is no longer a mandatory standard and newer methods are preferred. The evidential value of galactography in comparison to other techniques should be established on the basis of the literature. The second part of this paper will deal with this question.     

Quantitative Analyse der linksventrikulären Wandbewegung mit MR-tagging

ZusammenfassungZielsetzung Ziel dieser Studie war es, verschiedene Parameter der linksventrikulären Wandbewegung aus MR-tagging-Aufnahmen quantitativ zu analysieren. Die Auswertemethode sollte angewendet werden, um den physiologischen Kontraktionsablauf zu charakterisieren und pathophysiologische Veränderungen zu erfassen.Material und Methoden Die Tagginguntersuchung wurde in einer basisnahen, mittventrikulären und einer apikalen Schicht des linken Ventrikels durchgeführt. Für die automatische Quantifizierung von Rotation, Kontraktion und Umfangverkürzung wurde eine geeignete Software erstellt. Die Methode wurde bei 8 gesunden Probanden, 13 Patienten mit Aortenstenose vor und ein Jahr nach Klappenersatz und 10 Patienten mit Myokardinfarkt vor und nach Revaskularisation angewendet.Ergebnisse Die von uns entwickelte Software gestattet die Quantifizierung der linksventrikulären Wandfunktion über die Bestimmung von Rotation, Kontraktion und Umfangsverkürzung. Bei den Probanden zeigte sich eine Wringbewegung mit gegenläufiger Rotation der Herzbasis zur Herzspitze. Vor Klappenersatz zeigten die Patienten mit Aortenstenose eine signifikant verstärkte apikale Rotation und Torsion. Ein Jahr postoperativ hatte sich die Torsion normalisiert. Bei den Patienten mit Myokardinfarkt zeigte sich nach Revaskularisierung eine Zunahme der Umfangverkürzung im Infarktareal.Schlussfolgerungen Die Quantifizierung der linksventrikulären Wandbewegung mit MR-tagging-Aufnahmen ermöglicht die Charakterisierung und Verlaufsbeobachtungen von Veränderungen der linksventrikulären Wandfunktion bei verschiedenen Herzerkrankungen.     

Stellenwert der Galaktographie zur Abklärung pathologischer Sekretion in der komplementären Mammadiagnostik

Background

The survey results of a previous study showed that galactography is now rarely used in Germany and newer methods are applied. The evidential value of galactography should be established and opposed to the evidential value of ultrasound (US) and magnetic resonance mammography (MRM).

Materials and methods

A search was carried out in PubMed and Cochrane involving studies written in English or German. The level of evidence was measured according to the Oxford Centre for Evidence-based Medicine.

Results

A total of 19 studies were included, 14 with results on galactography, 10 on US and 5 on MRM. Almost all studies were retrospective with an evidence assigned to level 3b or lower. The results on the diagnostic values showed a very wide range. Because of very variable numbers of cases and consideration of various pathologies, the studies are only comparable to a limited extent.

Conclusion

Galactography, US and MRM all show a weak level of evidence and no superiority of a particular method can be derived. Therefore, galactography can no longer be considered as a mandatory standard in modern multimodal imaging of the breast. Recommendations for the diagnostic work-up of pathological nipple discharge have to be included in current guidelines and must consider these facts.