Bildgebung extraduraler Raumforderungen

There is a wide variety of spinal extradural tumors. In addition to real neoplasms, degenerative diseases, congenital abnormalities and inflammatory disorders can be causes of extradural masses. Due to the bony boundary of the spinal canal, both benign as well as malignant masses can cause progressive neurological deficits including paraplegia. Most of the spinal tumors are benign (hemangioma of the vertebral body, degenerative diseases). In younger patients congenital abnormalities and primary tumors of the spine have to be considered, whereas in adults the list of differential diagnoses should include secondary malignancies such as metastases and lymphomas as well as metabolic disorders such as osteoporotic vertebral compression fracture and Paget's disease. Cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine often help to make a specific diagnosis of extradural spinal lesions and represent important tools for tumor staging and preoperative evaluation.     

Histopathologie spinaler Raumforderungen

The first step in diagnosing spinal lesions is to define the anatomical location, especially via magnetic resonance tomography, which is also helpful for histopathologists. However, definite diagnosis is based on histologic and cytologic examinations especially in the case of fine-needle biopsies. In this short review the principal histopathologic diagnoses of primary and secondary tumors and tumor-like lesions of the spine itself, the epidural space, the spinal meninges and nerve roots, and the spinal cord are addressed. The significance of immunohistochemistry for differential diagnosis or, in cases of spinal metastasis, for determination of the primary is discussed.     

Klinik spinaler Raumforderungen

Zusammenfassung Schmerzen, Paresen und Sensibilitätsstörungen stellen die wesentlichen und häufigen Symptome spinaler Raumforderungen dar. Blasen- und Mastdarmstörungen sind weitere mögliche Symptome. Ausdehnungen der Raumforderungen im Querschnitt und im Hinblick auf die Längsachse des Rückenmarks bestimmen das klinische Bild. Kompletter Querschnitt, Brown-Sequard-Syndrom, zentrale Rückenmarkschädigung und Hinterstrangsyndrom sind häufige Ausprägungen entsprechend der Querschnittsläsion. Tetraparese, spastische oder schlaffe Paraparese resultieren aus Läsionen in Höhe HWS, BWS bzw. unterhalb von LWK1.     

Differenzialdiagnose renaler Raumforderungen

Through the large numbers of ultrasound studies and computed tomography (CT) and magnetic resonance imaging (MRI) scans being done, many symptomless renal tumors are detected. The radiologist has a duty to differentiate renal lesions and diagnose malignant tumours in adults. Modern imaging modalities such as CT and MRI have the capability to further differentiate renal tumours by specific attributes. In this article, the most common renal tumours are presented, and typical findings are discussed.     

Unklare retroperitoneale und intrahepatische Raumforderungen

25j?hrige Patientin mit bekannter tuber?ser Sklerose (Adenoma sebaceum, kutanen Lipomen und Fibromen, mentaler Retardierung und Epilepsie). Station?re Aufnahme wegen intermittierender Schmerzsymptomatik im linken Mittelbauch mit Ausstrahlung in die linke Flanke. Ausführliche Eigenanamnese nicht m?glich. Klinische Untersuchung: tastbare Resistenz im linken Mittelbauch und abgeschw?chte Darmger?usche über beiden linken Quadranten. Kein Peritonismus, keine Makroh?maturie. Labor: leicht erh?hte LDH (340 U/l), ansonsten unauff?llig. Sonographie: ausgedehnte, heterogen echoreiche Raumforderung im linken Mittelbauch und der linken Flanke, die nicht zweifelsfrei einem Organ zugeordnet werden konnte. Au?erdem echoarme Raumforderung im rechten Leberlappen. Daraufhin CT-Untersuchung unter Sedierung.     

Unklare retroperitoneale und intrahepatische Raumforderungen

Klinische Untersuchung: tastbare Resistenz im linken Mittelbauch und abgeschw?chte Darmger?usche über beiden linken Quadranten. Kein Peritonismus, keine Makroh?maturie.     

Multiple Raumforderungen der Leber

The case of a 73-year-old female patient with a known increase in tumor markers is described. The course of this patient shows that a definitive diagnosis can sometimes not be achieved with comprehensive laboratory and imaging investigations alone.     

Bildgebung des Lungenemphysems

Emphysema is defined as a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole accompanied by destruction of the alveolar walls and without obvious fibrosis. It is a very common disease with high morbidity and mortality. Histopathologically, there are two types of emphysema: panlobular emphysema, typically occurring in alpha1-antitrypsin deficiency, and centrilobular emphysema, which is strongly associated with cigarette smoking. Computed tomography (CT) allows detection of emphysema with higher sensitivity than conventional chest radiography and pulmonary function tests. CT also allows quantification of emphysema and depicts associated changes and complications. The differential diagnosis of emphysema, which is characterized by the absence of clearly definable walls on CT, includes cystic lung disease, bullae, lung laceration, Langerhans cell histiocytosis, and lymphangioleiomyomatosis -which are all characterized by visible walls on CT.     

Bildgebung nach Klappenersatz

Patients who undergo heart valve replacement require lifelong cardiac follow-up care. Although the primary pathology of the patient is treated by valve replacement, the risk of postoperative complications and structural failure of the implanted device requires regular check-ups where imaging plays an important role. Immediately after surgery reference values regarding prosthetic and cardiac function for further check-ups are obtained. Transthoracic and transesophageal echocardiography are the imaging modalities of choice for standard examination and follow-up due to their availability and low costs. However, when it comes to identification of complications they are often insufficient. Magnetic resonance imaging (MRI) and computed tomography (CT) play an increasingly important role as complementary modalities for the detection and monitoring of complications after valve replacement. The following article gives an overview of the current non-invasive examination methods and the use in the investigation of postoperative complications.     

Bildgebung von Angiogenese

Angiogenesis of tumors has gained tremendous attention in the research community over the last years. Novel anti-angiogenic treatment protocols are currently in various phases of clinical testing. Thus, the major challenge for Radiological diagnostics is to develop imaging methods which reliably measure the angiogenic tumor burden as well as tumor response to anti-angiogenic treatment in vivo. This article intends to provide a brief overview of imaging strategies for angiogenesis and anti-angiogenic treatment.     

Bildgebung der Kopf-Hals-Region

Tumors of the head and neck are predominantly squamous cell carcinomas and those of the salivary glands are predominantly adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas. In 2011 the incidence of tumors of the oral cavity and pharynx in Germany was 6839 (5026 male and 1813 female) and of the larynx 1878 (1642 male and 236 female). The incidence of tumors of the nose and paranasal sinuses (467) and salivary glands (470) were much lower (www.krebsdaten.de/abfrage). The primary aim of imaging in head and neck cancer is staging of the disease and a precise assessment of tumor invasion. This information is essential for therapy decision-making (i. e. surgery or radiochemotherapy), planning of the extent of resection and subsequent reconstructive measures and also estimation of functional deficits after therapy. Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice but both have specific advantages and disadvantages. In certain cases both CT and MRI need to be performed for accurate treatment planning.     

Kontrastmittel-Untersuchungen und Computer-Tomographie bei intrakraniellen Raumforderungen

Summary In 1977, more than 2000 patients were examined in our department of neuroradiology by means of angiography, computed tomography, and in some cases also by pneumoencephalography. The value of the various neuroradiological examinations is discussed taking as an example two patients suffering from intracranial space-occupying processes of different etiologies. Consequently, the differential diagnostic problems occurring are discussed casuistically. It is demonstrated that correct diagnosis can often be achieved only by use of all the results of the different neuroradiological methods, together with precise knowledge of the course and the clinical symptoms.     

Bildgebung zerebraler Vaskulitiden

Cerebral vasculitis can have a variety of origins. Furthermore, there are no vasculitis-specific symptoms or imaging signs and vasculitis of the CNS can mimic many other neurological diseases, which require different treatment approaches. Thus, the clinical and radiological diagnosis of cerebral vasculitis is challenging. Magnetic resonance imaging (MRI) and MR angiography (MRA) should be the radiological imaging methods of choice to assess the degree of parenchymal damage and to detect vessel wall changes. If the results are unclear digital subtraction angiography (DSA) should be pursued in order to also detect changes in medium sized vessels. Vasculitis of small vessels cannot be detected by vascular imaging and requires brain or leptomeningeal biopsy. In this review we present the current diagnostic approach and a variety of imaging findings in cerebral vasculitis and discuss the main radiological differential diagnoses.