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1.
A. Heinig S. H. Heywang-Köbrunner P. Viehweg D. Lampe J. Buchmann R. P. Spielmann 《Der Radiologe》1997,37(9):710-717
Summary
Early recognition of recurrence and work-up of clinically indeterminate lesions may be impaired after reconstruction with
silicone implants due to superimposition of the implant or to scarring. This study was undertaken to evaluate the use of contrast-enhanced
MRI in patients with silicone implant after breast cancer. Contrast-enhanded MRI was offered to 169 patients. Comparative
two- to three-view mammography was also performed in 169 patients, as well as comparative sonography in 144 patients. Conventional
imaging and clinical examination detected only 8/13 recurrences, whereas 12/13 were detected by MRI. One recurrence had been
visible as a strongly enhancing 2-mm dot in a previous examination (2 years before), but was not called. It was therefore
counted as false negative. In addition, multicentricity was detected by MRI alone in two of three cases. MRI correctly diagnosed
scar tissue in all cases with indeterminate findings. However, due to false-positive calls caused by enhancing granulomas
specificity could not be improved. Contrast-enhanded MRI allowed decisive additional information in our study group and improved
the sensitivity significantly (concerning all diagnoses). Contrast-enhanded MRI is recommended in patients with diagnostic
problems or high risk of recurrence after silicone implants.
相似文献
2.
Chronische Schmerzen des unteren Rückens
Prinzipien und prognostische Faktoren gymnastischer Übungen
S. Taimela 《Manuelle Medizin》1997,35(4):194-205
Zusammenfassung
In Konsensusvereinbarungen verschiedener L?nder wie den USA, Gro?britannien, den Niederlanden und Finnland wurde jüngst deutlich
Stellung für die Aufnahme von gymnastischen übungen in die Behandlung bei prolongierten und chronischen Beschwerden des unteren
Rückens bezogen. Diese übungen sind im 2. Abschnitt des Behandlungsplans nach zumindest teilweiser Schmerzrückbildung vorgesehen,
mit dem Ziel, die v?llige Funktionsf?higkeit wiederherzustellen. Die vorliegende Literaturübersicht befa?t sich mit dem Grundprinzip
der übungsbehandlung bei Schmerzen des unteren Rückens, bestehenden Wirkungsnachweisen und prognostischen Faktoren für eine
funktionelle Wiederherstellung. 相似文献
3.
H. Bonél A. Frick H. Sittek A. Heuck M. Steinborn R. G. H. Baumeister M. Reiser 《Der Radiologe》1997,37(10):785-793
Summary
Purpose of this study was to evaluate the diagnostic value of a low field dedicated MRI system in hand and wrist imaging.
All 308 exams of the hand and wrist, that were performed on a low-field dedicated MRI system (Artoscan, Esaote Biomedica,
Italy) in our institution in 1996, and high-field MRI exams performed in addition as part of the diagnostic work-up, were
evaluated and correlated to final operative (n = 64) and histologic (n = 12) reports. 90 % of all low-field MRI scans stated a diagnosis according to clinical suspicion. In 62 % the clinical question
was answered, and in 26 % additional pathologies were identified. An MR-diagnosis completely different from the clinical suspicion
was stated in 2 %. High field exams contributed additional information in 6 of 36 patients. In 3 patients a tumor was not
shown completely in the limited field-of-view of the dedicated low-field MRI-system. Frequency-selective fat-suppression pulse
sequences and a better spatial resolution were the reasons for the additional information obtained in the other three patients.
Low-field dedicated MR-imaging is a valuable method in the extensive work-up of the hand and wrist. Osseous, ligamentous and
tendinous pathologies are well depicted. Large or infiltrative tumors should be referred to a high-field system.
相似文献
4.
Summary
High-resolution computed tomography (HRCT) provides excellent contrast between osseous structures, air and soft tissue in
conjunction with high spatial resolution. Therefore, thin-section HRCT with bone window setting is the method of choice for
the examination of the middle ear structures. The indications are acute and chronic inflammatory changes, cholesteatoma and
tumor, the “postoperative middle ear”, and malformations. In most cases, HRCT enables differentiation between inflammatory
changes, cholesteatoma, and tumor. The excellent depiction of subtle osseous details enables the identification of erosions
of the ossicles or of the bony walls of the mastoid cells, of osseous defects of the tegmen, of the bony labyrinth, and of
the tympanic course of the facial canal. In addition, HRCT enables excellent depiction of reconstructions of the ossicles
or prosthesis of the ossicles. Although HRCT is the first method of choice, magnetic resonance imaging (MRI) may provide additional
information and lead to a more accurate diagnosis in some cases. This is explained by the excellent soft tissue contrast provided
by MRI. In addition, MRI offers the possibility of using various pulse sequences and the administration of IV contrast material.
Therefore, MRI may allow the differentiation between inflammatory changes, cholesteatoma, and tumor in those cases in which
accurate diagnosis cannot be made by HRCT. The differentiation between a meningocele or meningoencephalocele and other entities
such as tumors or cholesteatoma can be established by MRI. Furthermore, MRI can accurately depict cases of labyrinthitis or
of neuritis of the facial nerve or of intracranial disease caused by middle ear processes, while this is not always possible
by HRCT.
In summary, HRCT of the middle ear is the method of choice, but MRI may provide supplementary information in those cases in
which accurate diagnosis cannot be established by HRCT.
相似文献
5.
Summary
To show the possibilities of imaging diagnostic procedures using high and extremely high resolution ultrasonic probes we investigated
the anatomic structures of the foot. We examinated 10 cadaver foots of the anatomic institute and in a clinical trial 20 healthy
patients with 10 to 20-MHz-probes and could identify correctly single tendons and ligaments even in the toe region. Especially
the possibility of dynamic examination had to be mentioned beside the other advantages of ultrasound diagnostic (saving of
expenses, lack of radiation, side-to-side comparison).
相似文献
6.
G. F. Hamann 《Der Radiologe》1997,37(11):843-852
Summary
This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of
the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization
is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy
failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation
of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity,
edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and
reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple
concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately
6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently
introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different
agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including
stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke
patients.
相似文献
7.
Summary
In the last decades back pain has reached dramatic proportions in industrialized countries. Disorders of the back are nowadays
the leading cause of direct and indirect health care costs. Accurate prevalence estimates are needed to serve as a basis for
health care evaluations. A review of epidemiologic studies in the general population reveals that back pain has reached a
prevalence of 40 % for current pain. 7 to 18 % are “frequently”, “often”, “daily” or “constantly” affected. 75 % of the adult
population suffers from back pain during the last year. 80 to 90 % of the adult population in industrialized countries experience
back pain ever. Gender specific differences are only present in severe, chronic forms which are more often experienced by
women. Back pain has a prevalence maximum at 50 to 64 years. Older persons display lower prevalence estimates. The prevalence
maximum in men is one decade earlier than in women. There are several potential explanations for this prevalence pattern that
are discussed in the article. Back pain can be classified by location, temporal characteristics, pain intensity and pain history.
Currently, for none of these dimensions generally accepted, uniformly employed and validated definitions are available. In
most of the industrialized countries back pain is one of the most expensive symptoms. 75–90 % of the direct and indirect health
care costs were caused by those 5–10 % of patients who are disabled. As predictors of back pain a history of back pain and
job satisfaction play by far a more important role than the extensively studied mechanical factors. For a first episode of
back pain the prognosis is favorable. If the pain persist for more than three months the prognosis is unfavorable. After six
months of absenteeism because of back pain more than half of the afflicted never return to work. Rarely back pain is present
as a single symptom. In more than 80 % back pain is associated with pain in at least one joint. It remains to be studied if
back pain may be viewed as an entity or as part of a more complex pain syndrome.
相似文献
8.
Summary
Forty-one patients demonstrating clinical symptoms for cerebral infarction were investigated by magnetic resonance imaging
with diffusion-weighted echo-planar imaging (DWI) and T2-weighted imaging (T2WI). In 8 patients only DWI showed the cerebral
lesions clearly. One patient with positive DWI and T2WI suffered from HSV encephalitis. DWI is superior to T2WI in assessment
of small cortical infarcts and cerebral infarction in patients with preexisting vascular lesions. DWI is not specific, so
other causes like cerebral hematoma and encephalitis have to be considered.
相似文献
9.
Summary
The introduction of fast gradient systems allows a reliable visualization of the extracranial carotid vessels by the magnetic
resonance angiography (MRA) which meanwhile is implemented into clinical routine. By the mainly applied time-of-flight (TOF)
technique, vessels can be imaged without contrast agent (CA). Due to the application of ultra-fast gradient-echo-sequences,
the first-pass evaluation of an intravenous bolus-injection of Gadolinium in the carotids from the aortic arch up to the skull
base can be performed in less than 30 s. In this study, advantages and disadvantages of both techniques are discussed. For
a qualitatively optimal contrast enhanced MRA (CE-MRA) timing parameters like injection delay, flow rate and the adjustment
of sequence parameters have to be considered in relation to the fast venous return from the sinus to the jugular veins. First,
the optimal time point of the data acquisition have been determined at a model and with a computer simulation in reference
to the presence of CA in the arteries. As a result, 90 % of the contrast contribution is defined by 16 % of the symmetrically
acquired central k-space lines. A measuring protocol for clinical use was obtained by a gradual variation of spacial resolution,
measuring time and CA-injection parameters and was proved in normal volunteers and patients. An exact determination of the
bolus-arrival-time by means of a test-bolus injection was acquired. The best qualitative results were achieved by a double-dose
injection at 2 ml/s injection rate. The temporal reserves of ultra-fast sequences should be invested in the improvement of
the spatial resolution. To date, further investigations related to the problem of optimal CA-application may improve the potentials
of CE-MRA procedures.
相似文献
10.
Summary
Extracorporeal shock wave lithotripsy (ESWL) is standard therapy for urolithiasis. With comparable technical principles, various
lithotripters have been developed and are in routine use. Renal pelvic stones, calyceal stones, ureteral stones, and other
special forms can be treated with varying results. Currently, the so-called clinically insignificant residual fragments and
the recurrence of calculi are under discussion. Whereas the side effects of ESWL are well known, studies comparing ESWL with
other endourological procedures are still lacking.
相似文献