Significance of imaging techniques (roentgen, scintigraphy, MRI) in the diagnosis and therapy planning of Perthes disease]

The value of MRT, bone scintigraphy and conventional radiographs were studied for early stage diagnosis of Perthes' disease. Our experience in a series of 28 patients showed MRI to have a 100% sensitivity and specificity compared with bone scintigraphy (68.1% and 66.7%) and normal radiographs (58.3% and 100%). MRT often demonstrates changes while the conventional radiographs or bone scans appear normal. This might reflect the ability of MRT to detect the histopathologic changes before a measurable bone mineral change occurs.     

Bildgebende Diagnostik des ulnaren Handgelenkschmerzes

An exact knowledge of the value of different pictorial diagnostic techniques allows a focussed and rapid diagnosis of ulnar wrist pain. A prerequisite for the choice of the best possible method of investigation is an exact clinical examination. The basic examination involves conventional recording at both the centralised at the symptomatic levels. If there is a suspicion of occult bone lesion, finely focused, magnified graphics, CT or bone scintigraphy should be used, depending on both the problem faced and availability. For tissue or ligament lesions, stress graphics, movement studies or MRT, also with contrast media, should be used. Bone scintigraphy is a suitable method to differentiate between inflammatory tissue and/or bone changes.     

Arthroskopie ohne vorherige MRT

As a result of the widespread establishment of magnetic resonance tomography (MRT) in diagnostics, arthroscopy, as well as clinical and radiological examinations, have lost their significance as primary diagnostic modalities. However, due to the use of MRT in non-critical cases, unnecessary costs are produced, therapy is delayed and, in some cases, periods of disability are extended. Diseases of the palmar ligaments are straightforward for the practiced examiner to diagnose by means of structured clinical diagnostic steps; diagnosis with MRT is unnecessary in the presence of positive findings and prompt surgical therapy. In the case of delayed definitive treatment, concomitant injuries which are critical in terms of time need to be excluded. Accuracy in the clinical diagnosis of meniscus injury is less dependable, while on the other hand, sensitivity and specificity in MRT, when the appropriate protocols are used, reach high values. In the case of negative MRT findings, additional arthroscopy can be dispensed with. Cartilage lesions are more difficult to assess, in particular in terms of depth and extent. MRT provides helpful values in terms of specificity when sensitivity is poor, showing at the same time a tendency to overestimate degree of lesions.     

Imaging procedures in diagnosis of bone tumor]

The historical development of the various imaging procedures for diagnosis, differential diagnosis and for the effect of chemotherapy of malignant bone lesions are discussed. The present status of imaging including MRT has been defined.     

Wertigkeit bildgebender Verfahren bei ossären Metastasen

Bone metastases are common by prostate and renal carcinomas but prostate carcinomas are predominantly osteoblastic metastases and renal carcinomas often osteolytic. Apart from bone scintigraphy and conventional X-ray imaging, computed tomography (CT), magnetic resonance tomography (MRT) and positron emission tomography (PET) can also be used for primary diagnosis. X-rays and CT are less sensitive but better for evaluating the stability of metastases. Primary diagnosis of prostate carcinomas should encompass selective bone imaging and skeletal scintigraphy is also recommended. Local recurrences or lymph node metastases can be detected using PET with (11)C-choline. MRT is the method with higher sensitivity and specificity but for whole body scans is, at present, very time-consuming and, therefore, impractical and cost-intensive. However, for selective, non-invasive valency evaluation of suspect metastases, it is considered the gold standard for the tumor entities prostate and renal carcinomas where the results of FDG PET are consistently negative.     

Malignant rhabdoid tumor of the vulva: is distinction from epithelioid sarcoma possible? A pathologic and immunohistochemical study

Epithelioid sarcoma (ES) and malignant rhabdoid tumor (MRT) have heretofore been regarded as two separate clinicopathologic entities. However, they have some histologic similarities, and both represent histogenetic and phenotypic enigmas. This study reports the pathologic and immunohistochemical findings of four vulvar neoplasms occurring in young women that represented diagnostic dilemmas because of their similarity to both ES and MRT. Only one case had the classic histologic features of ES, whereas, in our opinion, the other three cases fulfilled the histologic criteria of MRT, despite the fact that two of the three cases were reported earlier as examples of ES. Neither electron microscopy nor immunohistochemistry has been found to be helpful in separating ES from MRT, mainly because they share several ultrastructural and immunophenotypic features. The behavior of these vulvar tumors--ours and the few published examples of ES--is generally aggressive, more in keeping with MRT than classic ES. We believe that some, if not most, putative ES of the vulva are in fact MRT, a neoplasm with an unfavorable prognosis.     

Malignant Rhabdoid Tumor of the Floor of Mouth: First Reported Case in the Oral Cavity of an Adult

Malignant rhabdoid tumors (MRTs) are exceedingly rare lesions. To our knowledge, only 2 cases have been reported in the oral cavity, with both examples occurring in infants. The current case is the third reported case of MRT of the oral cavity and the first reported case to occur in an adult at this location. The following report describes the clinical, histologic and immunohistochemical features of this tumor.     

Multiple sclerosis: Diagnostic value of computerized tomography with delayed scanning after a double-dose of contrast medium in comparison with other diagnostic tests

In 63 cases of clinical definite or suspected MS we compared the results of CSF analysis, VEP, BAEP, CT scanning without and after double dose contrast, in 17 cases also those of MRT. We found that CSF analysis had the highest rate of abnormal findings, followed by MRT. VEP and CT with double dose contrast showed similar sensitivity, while BAEP and CT without contrast had disappointing results. We think that CT with delayed scanning after double dose contrast can be a very useful investigation in early and doubtful cases of MS, until MRT will become a more widespread and less expensive investigation.     

Using magnetic-resonance tomography in differential diagnosis of the adrenal glands malignant tumors

Possibilities of application of magnet-resonance tomography (MRT) for differential diagnosis of the adrenal glands tumors were studied up. MRT was conducted to 39 patients with adrenal glands tumors, including 22 - with malignant adrenal gland tumor, 17 - with benign tumor of adrenal gland. MRT constitutes the most effective method of topic diagnosis of the adrenal glands tumor, owes multipurpose possibilities, do not deliver radiation load, permits to visualize the vessels without the contrast media usage. The tumor diameter more than 10,1 cm, irregular form, illegible edges, uneven contours, presence of lymphadenopathy, regional or remote metastases constitutes diagnostic criterions of the adrenal glands malignant tumors. The intensity of MRT signal could not be used for differential diagnosis of malignant and benign tumors of adrenal glands.     

Potentialities of high field magnetic resonance tomography in preoperative staging of gastric cancer

An analysis of results of magnetic resonance tomography (MRT) of the stomach of 80 patients has shown that a complex examination with morphological verification had diagnosed gastric cancer in 60 of them. The technique of fulfilling MRT of the stomach was optimized, the main symptoms of gastric cancer were specified. The sensitivity of preoperative assessment of spread of gastric cancer on MRT was 82%, specificity -78%. The sensitivity of detection of the lymph nodes infiltrated with the tumor in MRT was 82%, specificity--84%. The general diagnostic informative value of MRT in gastric cancer was as follows: sensitivity--93%, specificity--86.6%, accuracy--92%.     

Successful treatment of malignant rhabdoid tumor of the vulva in an older patient: a case report and review of the literature

PURPOSE: Malignant rhabdoid tumor (MRT) of the vulva is a rare and very aggressive neoplasm. Only 7 cases have been reported thus far in the English literature. This case reports the oldest patient to date with MRT. This 63 year old was successfully treated with surgery and radiation therapy. The current literature is reviewed, and different treatment modalities are considered and evaluated.     

Clinical value of extended biologic staging by bone marrow micrometastases and tumor-associated proteases in gastric cancer.

OBJECTIVE: To investigate whether extended staging, including biologic grading and aspects of an early systemic disease component, would give additional prognostic information on patients with curatively resected gastric cancer. BACKGROUND: Tumor-associated proteolytic mechanisms have been shown to be essential for invasion and metastasis. The urokinase-type plasminogen activator (uPA) system is of major biologic impact, but different interactive proteases and inhibitors with modulating effects also must be considered. The detection of early tumor cell dissemination indicates the systemic character of a primarily local gastric cancer. The confrontation of the organism with these cells determines the often unpredictable course of an individual tumor after presumed curative primary treatment. METHODS: In a prospective study of 247 consecutive patients with gastric cancer, detection of disseminated tumor cells in bone marrow aspirates was immunocytochemically performed in 180 patients. The expression of uPA, activators of uPA (cathepsin D, antithrombin III), uPA substrates (plasminogen, matrix-metalloproteinase 2 [collagenase IV, 72 kD; MMP-2]), uPA/plasmin inhibitors (plasminogen activator inhibitor type 1 and 2 [PAI-1, PAI-2], alpha1-antitrypsin, alpha2-antiplasmin), uPA receptor (uPA-R), and parameters of the uPA-R cycle (alpha2-macroglobulin, alpha1-antichymotrypsin) could be determined immunohistochemically and were scored semiquantitatively in 203 patients. Kaplan-Meier statistical techniques and multivariate Cox regression models were used for prognostic analyses. RESULTS: In multivariate analysis considering all the established risk factors, disease-free survival was independently predicted by PAI-1 (relative risk 2.21, 1.32-3.73) and cathepsin D (relative risk 2.98, 1.28-6.91) besides pT, pN, and extended resection. Tumor cell dissemination was found to be an additional prognostic factor in early tumor stages (pT1, T2) and lymphnode-negative patients. Stepwise regression analysis revealed an extended staging system with new risk groups. Node-positive, curatively resected pT1/2 patients with low expression of PAI-1 had a favorable prognosis (mean recurrence-free survival [MRT] 54.84 months), similar to that of node-negative patients (MRT 54.76 months). In node-negative, curatively resected pT1/2 patients, detection of bone marrow tumor cells and high expression of PAI-1 defined a subgroup with a steep decrease of prognosis (MRT 36.60 months), which was worse than that of node-positive patients (MRT 45.81). CONCLUSION: This new staging model gives better prognostic differentiation of subgroups, which should be considered in future adjuvant therapy protocols. In addition, it indicates that the uPA system might be a future therapeutic target.     

How patient migration in bed affects the sacral soft tissue loading and thereby the risk for a hospital‐acquired pressure injury

Head‐of‐bed (HOB) elevation is a common clinical practice in hospitals causing the patient's body to slide down in bed because of gravity. This migration effect likely results in tissue shearing between the sacrum and the support surface, which increases the risk for pressure injuries. StayInPlace (HillRom Inc.) is a commercial migration‐reduction technology (MRT) incorporated in intensive care bedframes. Yet, the effects of migration‐reduction on tissue shear stresses during HOB elevation are unknown. We analysed relationships between migration and resulting sacral soft tissue stresses by combining motion analysis and three‐dimensional finite element modelling of the buttocks. Migration data were collected for 10 subjects, lying supine on two bedframe types with and without MRT, and at HOB elevations of 45°/65°. Migration data were used as displacement boundary conditions for the modelling to calculate tissue stress exposures. Migration values for the conventional bed were 1.75‐ and 1.6‐times greater than those for the migration‐reduction bed, for elevations of 45° and 65°, respectively (P < .001). The modelling showed that the farther the migration, the greater the tissue stress exposures. Internal stresses were 1.8‐fold greater than respective skin stresses. Our results, based on the novel integrated experimental‐computational method, point to clear biomechanical benefits in minimising migration using MRT.     

Possibilities of magnetic resonance tomography in pancreatic cancer diagnosis

There was conducted examination of 27 patients with pancreatic cancer using clinico-laboratory and instrumental methods: ultrasonic investigation, computeric tomography (CT), magnetic-resonance tomography (MRT). MRT was uninformative when pancreatic tumor was up to 3 cm in diameter. In diagnosis of cystadenocarcinoma, affection of common biliary duct and vessels and in small focal metastatic hepatic affection the results of MRT showed enhanced precision in comparison with CT. Informativity of MRT and CT in diagnosis of metastases in lymph nodes was equal.     

Comparative aspects of the methods of diagnosis of soft tissue injuries in traumas of the talocrural articulation

The authors give grounds for using effective methods of diagnosis of injuries of the talocrural articulation in clinical practice. The role of MRT, USI, thermometry are presented in a comparative aspect. The diagnostic means of traditional X-ray examinations are also shown. It was found that thermometry in complex with X ray methods of diagnosis and USI systematized the diagnostic information, allowed corrections of medical programs, determined the time of the end of restoration of injured elements of the talocrural articulation with special reference to each patient.     

Technik und Ergebnisse der autologen Knorpelzelltransplantation

Clinical results of transplanting precultivated autologous cartilage cells (ACT) for the treatment of circumscribed chondral injuries in the knee joint have been available since 1994. A definitive assessment of the quality of clinical results obtained with this method is still not possible, as it is not comparable with other methods conventionally used hitherto, such as bone drilling or the use of periostal flaps. The results obtained by the author with this method also do not allow a precise statement on their quality; they are similar to those recorded in larger trials conducted in 2000. The use of MRT cartilage sequences is helpful for pre- and postoperative comparison of large numbers of patients. The biggest problem is that the quality of precultivated cells prepared by the different companies supplying them is not uniform. Further improvements in cell cultivation, including the use of mesenchymal stem cells to restore the biological articular cartilage surface under optimized conditions are in work. Experience with ACT so far justifies its use in the treatment of large defects; in small or medium-sized defects conventional methods give equivalent clinical results, at least in the short and medium term, at lower cost.     

Zur Bedeutung der MRT-Diagnose „bone bruise“ bei kindlichen Wirbelsäulenverletzungen

ZusammenfassungHintergrund Die MRT stellt ein sensitives, nicht strahlenbelastendes bildgebendes Verfahren dar und bietet sich daher für die Diagnostik kindlicher Wirbelsäulenverletzungen an. Als ein indirektes Verletzungszeichen lässt sich hierbei u. U. ein sog. bone bruise nachweisen, ohne dass weitere Verletzungen sichtbar werden. Ziel der vorliegenden Arbeit war es, die klinische Bedeutung dieser Diagnose bei kindlichen Wirbelsäulenverletzungen zu untersuchen.Patienten und Methoden Zwischen 1998 und 2003 wurden in unserer Klinik insgesamt 66 Kinder mit Wirbelsäulenverletzungen konservativ behandelt. 34 dieser Kinder erhielten während der Primärdiagnostik eine MRT. Im Rahmen einer retrospektiven Studie wurden 20 Kinder, bei welchen die Diagnose einer Wirbelkörperverletzung vorwiegend durch den Nachweis eines bone bruise im initialen MRT geführt worden war, sowohl klinisch als auch mittels MRT nachuntersucht.Ergebnisse Alle 20 Kinder gaben bei der Nachuntersuchung subjektiv weitgehende Beschwerdefreiheit an. Bei der objektiven Untersuchung fanden sich keine klinischen Auffälligkeiten. Bei keinem der Kinder war im Rahmen der Nachuntersuchung MR-tomographisch eine Persistenz des bone bruise feststellbar. Eine sekundäre Sinterung der betroffenen Wirbelkörper war in keinem Fall aufgetreten.Schlussfolgerung Kindliche Wirbelsäulenverletzungen, die mit einem mittels MRT nachgewiesenen bone bruise ohne weitere bildmorphologische knöcherne oder diskoligamentäre Läsionen einhergehen, sind in der Regel als prognostisch günstig einzustufen. Bei entsprechender Therapie, die in einer kurzfristigen, schmerzadaptierten Bettruhe und einer anschließenden frühfunktionellen Behandlung besteht, wurden bei unseren Patienten keine sekundären Sinterungen beobachtet.* Beide Autoren haben gleichen Anteil an dieser Arbeit und teilen sich die Erstautorenschaft.     

The many faces of chondrosarcoma of bone, own cases and review of the literature with an emphasis on radiology, pathology and treatment

Chondrosarcoma is the third most frequent primary malignant tumor of bone, constituting up to 16% of the malignant osseous neoplasms. Up to date several genetic alterations and markers were described concerning the pathogenesis and the progression of the chondrosarcoma, which represents actually a heterogeneous group of different types including conventional intramedullary, clear cell, myxoid, mesenchymal, and dedifferentiated chondrosarcoma. The pathologic appearance varies, however, in general they grow with a lobulated pattern. Histologically the hyaline cartilage demonstrates high water content and typically enchondral ossification is apparent. Imaging reflect this while radiographic findings suggest the diagnosis when the typical "ring-and-arc" chondroid matrix mineralization, endosteal scalloping and soft-tissue extension were apparent. The CT is used for detecting the mineralization of the matrix, especially when it is subtle or when the lesion is located in complex areas. MRT is the method of choice to detect the high water content of these lesions with a high signal intensity with T2-weighting and its bone marrow extend. Surgical resection is the primary and preferred treatment modality for most individuals with localized disease. In selected cases of the Grad I conventional chondrosarcoma curettage should be discussed. Systemic chemotherapy may be considered in variant forms such as mesenchymal or dedifferentiated chondrosarcomas. In knowledge of the "many faces" of the primary chondrosarcoma individualized patient assessment and optimal clinical management is possible.     

Recurrent spinal ependymoma showing partial remission under Imatimib

Summary. Background. There are few treatment options for recurrent spinal ependymoma after surgery and radiation therapy.Clinical presentation. We present a patient with recurrent spinal ependymoma who received radiation therapy after laminectomy and partial tumor resection. Months later, the patient developed gait paresis. MRT showed tumor recurrence and partial resection was again performed. Oral cytotoxic chemotherapy with Temozolomide was initiated. After a short relief, there was clinical worsening and MRT showed progressive disease. As the tumor had stained positively for platelet derived growth factor (PDGF) receptor, treatment with Imatimib was initiated.Findings. The patient experienced improvement in neurological symptoms and the following MRT revealed slight tumor regression. She remained stable for a total of 11 months.Conclusion. Imatimib should be considered a potential therapeutic option in recurrent ependymomas expressing PDGF receptor.     

Magnetic-resonance tomography in diagnosis of hepatopancreatoduodenal tumors

Results of magnetic-resonance tomography (MRT) in 112 patients with diseases of hepatopancreatoduodenal zone were analyzed, 24 of them had tumors of bile ducts and pancreas. New noninvasive diagnostic method--magnetic-resonance cholangiopancreatography (MRCPG)--performed in addition to routine MRT was evaluated. The technique of MRCPG, analysis of results, manetic-resonance semiotics are presented. This method is compared with endoscopic retrograde cholangiopancreatography. It is concluded that combination of consentional MRT with MRCPG increases possibilities in diagnosis of hepatopancreatoduodenal cancers, complicated by obstructive jaundice, as a rule.