Search

Der Umstand, dass eine zivilrechtliche Inanspruchnahme des Nuklearmediziners bei Schilddrusenbehandlungen eher selten ist, andert nichts an der Notwendigkeit, Haftungsrisiken zu kennen und sie zu vermeiden. Im Bereich der Befunderhebung sollte es der Mediziner, insbesondere wenn eine mogliche gefahrliche Erkrankung in Rede steht, keinesfalls auf einen Befunderhebungsfehler ankommen lassen und hier im Rahmen des medizinisch Vernunftigen eher zu breiter angelegten Untersuchungen und zu dichteren Kontrollen greifen. Er sollte v. a. aber den Patienten durch eindeutige therapeutische Hinweise mit einbinden und solche der Patientensicherheit dienende Hinweise konsequent dokumentieren. Bei der Therapie sollte sich der Nuklearmediziner seiner Verantwortung fur die umfassende Aufklarung gerade auch uber Alternativen bewusst sein und auch diese angemessen dokumentieren.

In the present paper the images produced by spheres of varying diameter (d = 4,6,8,10 mm) embedded in a homogeneous substance of varying densities (H' = 3,48,93,137 Hounsfield units) as produced by computer tomography were studied. Measurements show that for each sphere diameter there is a minimum contrast between the substance of the sphere and its surroundings which must exist in order to show this sphere by computer tomography. It was also shown that the partial volume effect is of significance for the attenuation of the spheres. The effect of the position of the spheres within the slices to be imaged was studied. The results clearly indicate that in the investigation of small tissue changes in the body, the thickness of the slice and patient displacement should be kept as small as possible.

Bei 7 Patienten (Durchschnittsalter 42 Jahre) mit Rhythmusstorungen verschiedener Form wurden mit Hilfe der Myokardszintigraphie Verteilungsstorungen der myokardialen Perfusion bei im Koronarogramm unauffalligen extramuralen Koronargefasen nachgewiesen. Die Defekte waren zum Teil umschrieben, zum Teil diffus. Bei 2 Patienten mit einem Linksschenkelblock projizierte sich die Perfusionsverteilungsstorung auf den oberen Teil des Septum interventriculare. Ein Zusammenhang zwischen der Topographie des Perfusionsdefektes und der Form der elektrophysiologischen Abnormitat erscheint bei diesen Patienten wahrscheinlich. Als Atiologie der myokardialen Perfusionsstorung kann bei einem der Patienten ein Zustand nach Myokarditis mit narbiger Ausheilung angenommen werden. Bei den anderen 6 Patienten mus die Ursache der Perfusionsstorung offen bleiben. Das Vorliegen einer „small vessel disease“ mus diskutiert werden. Die Untersuchungen weisen auf einen Zusammenhang zwischen Storungen im Bereich der Mikrozirkulation und Arrhythmien bei jungeren Patienten hin.

The incidence of complications in 2000 selective retrograde laevocardiograms is reported. Seventy-four complications were observed in 69 patients. None of these was fatal. On 39 occasions cardiac, and on three occasions cerebral complications were observed. In 20 patients there were complications at the site of puncture and in four patients sepsis or bacteraemia. Contrast sensitivity or allergy was found in eight patients. The relationship, described in the literature, between intramural contrast deposition and the type of catheter, ventricular size and ventricular wall was confirmed by our own observations, as well as the most frequent situation on the posterior wall of the left ventricle.

The doubling time (DT) was estimated quantitatively for 16 carcinomas of the breast according to the method described by Collins and co-workers in 1956. This is based on the concept of constant and exponential growth. Observation interval for these mammographically confirmed tumors was between 83 and 1,034 days. The DT was calculated to vary from 45 to 260 days; in order to reach a diameter of 1 cm. after 30 divisions would require a period of 3.7 to 21.4 years. Mammography frequently demonstrates small, clinically occult, tumours. Axillary lymph node metastases are relatively rare from small tumours; growth rate of 70% of breast carcinomas in such that an annual clinical and radiological check-up will prove to be the best means of reducing mortality from carcinoma of the breast. The risk inherent in the radiation resulting from annual mammography is acceptable in women over 35 years. This leaves the problem of rapidly growing carcinomas which would escape early diagnosis by early examinations. Half-yearly examinations of women in high risk groups (1. Previous mastectomy for carcinoma, 2. Biopsy-proven mastopathy with atypical proliferation) comprising about 30% of carcinomas with a short doubling time would appear to be reasonable.

Staging was undertaken in 118 patients with primary lymph node neoplasms; the sensitivity of computer tomography in the paraaortic region was 80%, that of lymphography 89%. Specificity of computer tomography was 93%, of lymphography 95%. In the iliac region, sensitivity was 81% (CT) and 90% (lymphography), and specificity was 90% (CT) and 97% (Lymphography). The value of computer tomography should, however, be stressed, since it can demonstrate lymph nodes not shown by lymphography, including those in the mediastinum, as well as lesions in the spleen, liver and lungs.

Retrograde portography is carried out through a trans-jugular route. Contrary to previously available techniques of trans-juglar portography, the method does not inflict any trauma on the parenchyma or vessels. Demonstration of the portal system is achied by reserved flow through the liver sinusoids. Together with arterial hepatography and indirect splenic and mesenteric portography, the method provides additional information in various forms of pre-, intra- and post-hepatic block without submitting the patient to any additional risk.

The results of 150 examinations by computed tomography in emergency situations are described (about 5% of all CT examinations). There were 80 examinations of the skull, 65 of the abdomen and five of the mediastinum. The results are shown in two tables and include the diagnosis of bleeding, infarcts and inflammatory lesions (abscesses, encephalitis, acute pancreatitis). The morphologic and densitometric findings are compared with the literature and with other imaging procedures. Computer tomography has assumed the most important place in the emergency diagnosis of the skull; as regards the abdomen, it reaches its limitations in the presence of acute vascular occlusion and diseases of the gastro-intestinal tract. In this situation other procedures (contrast studies, angiography) and endoscopy are to be preferred since these demonstrate the tubular organs longitudinally, unlike the transverse image produced by the CT scan. Acute diseases of the lungs can be demonstrated more quickly and simply by conventional radiography. CT is a non-invasive and rapid procedure, which can demonstrate haemorrhages, abscesses and exudates in the mediastinum and abdomen directly and also show their topography. The method is therefore essential for emergency diagnosis of conditions involving the trunk.

Im Vergleich von Computertomographie und Ultraschall wird die Gefasdarstellung und der Gefasverlauf im Abdomen und Retroperitonealraum mit beiden Verfahren demonstriert. Wahrend die Abbildung zentraler Abschnitte von Organhauptgefasen mit beiden Methoden gleichermasen gut gelingt, erlaubt die Computertomographie eine bessere Differenzierung der Arterien und Venen auch in den peripheren Gefasabschnitten. Demgegenuber ermoglicht die Sonographie eine methodisch einfache Differenzierung intrahepatischer Gefasstrukturen. The value of computer tomography and ultrasound for demonstrating vessels in the abdomen and retroperitoneal space was compared. The methods were equal in their ability to demonstrate the major vessels situated centrally, but computer tomography proved better at differentiating arteries and veins situated peripherally. On the other hand, sonography proved a simple means of differentiating intrahepatic vascular structures.

During ECG-controlled cardio-computer tomography, only certain defined phases of the cardiac cycle are used for computing the image. Consequently several cycles are necessary in order to obtain the required projection. ECG-controlled cardio-computer tomography produces findings regarding dys- or akinetic portions of the myocardium which are in good agreement with the laevo-cardiogram. The septum, apex and antero-lateral wall are demonstrated most easily, since their movement lies within the appropriate plane. Demonstration of the anterior and posterior walls is more difficult, since their movement is angled to the computer tomographic plane.

The findings on computer tomography after ligation of the coronary artery of a dogs heart are described. The ischaemic area can be differentiated from normal myocardium by its hypo-dense appearance. The localisation and size of the ischaemic area correlates with the scintigraphic findings. The known morphological and functional changes after intravenous oxyfedrin (positively inotropic, increased myocardial blood-flow) can also be seen on the computer tomogram (after oxyfedrin: myocardial thickening, reduction in cross-sectional area of the left ventricle, improved contraction, increased density of the ischaemic area). This confirms the possible diagnostic role of CT in the elucidation of changes in the left ventricle in the course of coronary disease.

Eighteen patients were investigated by laevocardiography, perfusion scintigraphy and with a 201thallium scan. In four patients with normal contractility of the left ventricle, normal uptake of 202thalium was found in every patient. Hypokinesia of the anterior wall or apex of the ventricle showed normal uptake on the 201thallium scintigram in four out of five patients. It follows that it is not usually possible to diagnose hypokinetic mural portions on 201thallium scintigrams without quantitative analysis. Our experience up to date with areas of akinesia has shown that it is possible to demonstrate areas of scarring (as negative contrast) in seven out of nine cases.

The use of computer tomography as a non-invasive procedure in the diagnosis of idiopathic hypertrophic subvalvular aortic stenosis is described. Seven patients were investigated in whom the diagnosis had been confirmed by echocardiography and laevocardiography with pressure measurements. Details of the method are discussed and computer tomography and echocardiography are compared. The features of greatest differential diagnostic importance relating to asymmetrical septum hypertrophy are discussed.

The present paper investigates the variations due to various parameters on the image of homogeneous materials as obtained with the Somatom CT scanner. Sugar solutions were used with concentrations equivalent to the absorption values of soft tissues. Because of quantum noise, attentuation at various points is not uniform, but is distributed in a Gaussian manner round a mean value. Using the Evaluskop it was possible to determine the degree of scatter. It was shown that, with increasing density of the material, the scatter increased and that this can be reduced by subjecting the tomogram to a smoothing process. It was further shown how the scatter depends on various parameters, such as thickness and dose. The amount of scatter in a tomogram is important in determining the density gradation which can be a achieved.

Radiographs of the thorax were evaluated in 240 patients during the acute phase following a myocardial infarct. Following the acute infarct, 53% of the patients showed some cardiac enlargement, in a quarter this was marked. Congestive lung changes were found in 53% of patient following the infarct, interstitial pulmonary oedema in 22% and intra alveolar oedema in 9%. Patients with marked cardiac enlargement and those with congestive lung changes showed a bad prognosis, particularly if the congestion did not regress rapidly. Even advanced pulmonary congestion and interstitial oedema may be missed by clinical examination. Radiography of the thorax following acute myocardial infarction is of value in treatment and prognosis.

Anatomical localisation of intramuscular haematomas can be achieved more accurately by computer tomography than by clinical examination in conjunction with conventional radiography. Computer tomography is able to demonstrate fresh haematomas before they become diagnosable clinically, and before secondary changes, such as calcification or bone erosions, make them visible on conventional radiographs. In this way the diagnosis is made more certain and the choice between conservative or surgical treatment is simplified. Ther period of treatment with clotting factors can, in some cases, be shortened as a result of serial examinations by computer tomography.

Computer tomography is a non-invasive method for demonstrating occlusion or patency of an aorto-coronary bypass. The early results of computer tomographic investigations of 77 bypasses in 51 patients are described. CT diagnosis of bypass patency is well established, but further work will be required to determine the accuracy of computer tomographic diagnosis of bypass occlusion.

The computer tomographic and angiographic findings in 53 patients with intrahepatic masses were compared. The histological findings show that 17 were due to echinococcus, 12 were due to hepatic carcinoma, ten were metastases, five patients had focal nodular hyperplasia, three an alveolar echinococcus and there were three cases with an haemangioma of the liver and a further three liver abscesses. Computer tomography proved superior in peripherally situated lesions, and in those in the left lobe of the liver. Arteriography was better at demonstrating lesions below 2 cm in size, particularly vascular tumours. As a pre-operative measure, angiography is to be preferred since it is able to demonstrate anatomic anomalies and variations in the blood supply, as well as invasion of the portal vein or of the inferior vena cava.

The paper deals with the early clinical experience, using a new DSA installation with a specially programmed cardiological module. DSA provides very good contrast and special resolution and morphometric estimation of the ejection fraction and regional movement of the left ventricular myocardium derived from DSA. This is as good as the results of the left cardiogram. The significant advantage of DSA ist the ability to make a rapid and simple diagnosis. In addition, it is possible with densitometric methods to calculate ventricular volume curves and to provide phasic indications of the amplitude to contraction of the left ventricle. These investigations have so far proved valuable and provide new scope for the radiological evaluation of left ventricular function.

Ungated cardio-CT provides good morphologic information in the case of congenital heart disease, volume or pressure loading, left ventricular aneurysm, tumours, thrombi, cardiac calcifications and pericardial diseases. It allows qualitative assessments of myocardial thickness and perfusion of coronary bypass grafts. ECG-gated cardio-CT allows a quantitative assessment of systolic and diastolic myocardial thickness, volume calculation of cardiac cavities and evaluation of functional parameters. The correlation of the calculated left ventricular ejection fraction comparing laevocardiography and ECG-gated cardio-CT was poor (r = 0.7) mainly due to the comparable poor time resolution on the side of cardio-CT (approximately 0.1s). The quantitative analysis of regional wall motion based on cardio-CT showed for the diagnosis of pathologic wall motion a specificity of 80.5%, sensitivity of 73.9% and accuracy of 75.7%. Side effects must be taken into account following the injection of 200-250 ml hyperosmolar contrast medium during 5-10 minutes which causes intravascular fluid retention and cardiac volume loading. Patients prone to cardiac decompensation should be excluded from cardio-CT examinations.

The fast-field-echo (FFE) sequence provides a new rapid imaging method for MR tomography. By using gradient echoes with shorter high frequency pulse repetitions than conventional sequences with 180 degrees echo pulses, it is possible to produce single cuts in 10 to 20 s with good signal-to-noise ratio. In this way the liver can be examined while respiratory movement artifacts are reduced. The possibility of obtaining T1- and T 2-weighted FFE images with good contrast resolution and the ability to determine relaxation times suggests a wide application of this rapid imaging procedure in the diagnosis of liver disease.

One hundred patients with a variety of cardiac abnormalities were examined by digital subtraction angio-cardiography; the quality of the image was almost as good as conventional cinecardiograms. Image frequency of 25 pictures per second provides a reliable analysis of cardiac contraction and, in many situations, makes it unnecessary to perform selective angio-cardiography. Compared with selective catheter techniques, digital subtraction cardiography has various advantages. Because of its low risk and small patient stress, it is particularly suitable for follow-up examination after various therapeutic measures.

The early results in the investigation of normal and pathological hearts using fast computer tomography are presented. By means of tomographic sections of cadaver hearts, it has been shown that it is possible to distinguish the ventricular cavities and individual cardiac walls by this non-invasive method. Changes in volume of the ventricles and atria due to various forms of stress are easily distinguishable. Myocardial scars can be distinguished from other circumscribed myocardial defects. The particular advantages of this method, which is non-invasive, painless and easily repeatable, do not need to be stressed. The technique adds a significant dimension to previously available non-invasive diagnostic methods, such as ultrasound echo-cardiography.

Twenty-seven patients in whom a diagnosis of sinus of Valsalva aneurysm had been made during life were re-examined and the results have been evaluated. The clinical symptoms are not diagnostic. Routine radiological examination may also fail to show any significant findings. Large sinus of Valsalva aneurysms may show an atypical prominence of the right upper heart border, and in leutic aneurysms there may be fine calcification of the aortic wall. A definitive diagnosis can be made only by thoracic aortography. Five patients had a congenital saccular aneurysm connected with a sinus of Valsalva. Three patients had acquired aneurysms of which two were leutic and one developed shortly after rheumatic fever. A diffuse aneurysms of the sinus of valsalva was found in fourteen patients with Marfan's syndrome. The radiological appearances are demonstrated. Indications for surgery are discussed; the indications must be considered for each situation separately.

Three patients with supravalvular aortic stenosis are described. One was a typical, sporadic-type supravalvular aortic stenosis, another a predominant aortic valve stenosis as part a complex heart lesion and the third inflammatory shrinking of the anulus fibrosus with an inflammatory aortic valve stenosis. The means of diagnosis are discussed. Angiocardiography and aortography are essential in order to demonstrate the pathology, haemodynamics, relation to the coronary arteries and the sinus of Valsalva, and in order to show other abnormalities. The aetiology and pathogenesis of various types of supravalvular aortic stenosis are discussed.

ECG-triggered cardio-MRT, using T1-weighted SE sequences, provides images of the heart showing very high anatomical resolution. So far, however, it has not been possible to demonstrate the morphology of the valves and coronary vessels. By using multiplanar sections, it is possible to obtain cuts which are perpendicular to the portion of myocardium or valve under consideration. This provides optimal imaging for morphological diagnosis and for evaluating the ventricular myocardium and its function.

Thirty patients with suspected pericardial effusions, or with cardiac enlargement of unknown cause were examined by computer tomography. In 19 cases a diagnosis of pericardial effusion or haematoma was made. All these cases were confirmed by echo cardiography or transthoracic puncture. The accuracy of computer tomography diagnosis did not depend on the aetiology, but could be increased by contrast enhancement. The computer tomographic criteria are enumerated and compared with those of echo cardiography. Examples of the most important differential diagnoses are discussed.

The paper describes the diagnosis of ten thoracic, 20 abdominal and three peripheral arterial aneurysms by computer tomography. This permits a definite diagnosis by a non-invasive method, it defines the extent of the aneurysm and the amount of thrombus in the aneurysm; it permits recognition of a leak and is painless and without risk and can be performed rapidly. Morever, computer tomography provides an accurate control of growth of the aneurysm. In some cases a dissection can be recognised. The use of adequate quantities of intravenous contrast medium prevents any possibility of an incorrect diagnosis. The extent and density of the aneurysms, their lumina, clot and wall thickness, as determined by computer tomography are described. The values are compared with the aortic diameters of patients with normal vessels. The advantages of the method, compared with other procedures, are discussed and its role in the diagnosis of aortic and peripheral arterial aneurysms is described.

In the first part of the present paper, the basic methods for quantitative angiocardiography are described. In the second part, a variety of results are tabulated and discussed, derived from selective coronary arteriography, laevocardiography, left ventricular pressure measurements and heart size as seen on conventional chest X-rays. Various correlations have been derived from these. It was not possible to find an quantitative relationship between coronary sclerosis and myocardial function. The reason for this depends on the fact that the parameters derived from laevocardiography represent integrated global function. The significance of regional contractility is stressed.

A linear array colour Doppler sonographic method was used experimentally on a vessel phantom in order to determine flow velocity, and the results were compared with DSA. Both the Doppler and the DSA method showed very good agreement with true velocities (r greater than 0.97). The Doppler method underestimated flow velocity. Early clinical results indicate that colour Doppler sonography is able, at the same time, to demonstrate morphology and function (direction flow and flow velocity) of significant vascular abnormalities by a non-invasive method.

Two hundred and thirty-six patients with coronary heart disease were examined by coronary angiography and laevo-cardiography. In 111 patients (47%) there was coronary artery calcification. Of these, 108 patients (97%) showed abnormal findings on the coronary angiogram; in 72 patients (67%) coronary stenosis was greater than or equal to 50% of the lumen. The severity of the stenoses increased with the amount of calcification. There were only three false positive findings and the presence of coronary calcification indicates coronary sclerosis with a high degree of probability. Fluoroscopy is the simplest and most sensitive method of examination and is of great value in the non-invasive investigation of coronary sclerosis.

In the second paper, the relationship between pulmonary venous and arterial hypertension and calcification in the mitral valve is analysed statistically and its patho-physiological significance discussed. In one hundred cases of mitral stenosis the left atrium, as seen on the lateral projection, was always enlarged, but its size was independant of atrial pressure or the pressure gradient across the mitral valve. Apart from pulmonary fibrosis and haemosiderosis, the abnormal findings increased with increasing mean atrial pressure. Pulmonary-arterial mean pressure of more than 30 mmHg was found particularly in the presence of mitral valve calcification (94%). Calcification of the valve is the most important and reliable indicator for evaluating the severity of the stenosis.

Es wird uber 2 Patienten mit leistungsfahiger, spontaner splenorenaler Anastomose bei portalem Hochdruck berichtet. Diese seltene Kurzschlusverbindung kann in vivo durch die Splenoportographie bei richtiger Nadellage im Bereich des Milzhilus und genugender Kontrastmittelmenge nachgewiesen werden. Wesentlich fur die anatomische und funktioneile Beurteilung der splenorenalen Anastomose und der portalen Strombahn sind Serienbilder in Grosformat. Pathogenese, hamodynamische Bedeutung und chirurgische Fragestellung bei spontaner splenorenaler Kurzschlusverbindung werden im einzelnen diskutiert. Two patients with functional spontaneous spleno-renal anastomoses suffering from portal hypertension are described. This rare type of shunt can be demonstrated in vivo by accurate needle position at the hilum of the spleen with the use of sufficient contrast medium. It is essential to use large serial films in order to evaluate the anatomy and functional effect of these anastomoses. The pathogenesis, haemodynamics and the surgical problems which arise as a result of spontaneous spleno-renal shunts are discussed in detail. Communication de deux cas de malades avec une anastomose spleno-renale spontanee et fonctionnant dans un cas d'hypertension portale. Cette anastomose rare en court-circuit put etre demontree par la splenoportographie sur le malade en introduisant l'aiguille exactement dans le hile de la rate et en injectant une quantite suffisante de substance de contraste. Il est important pour l'etude anatomique et fonctionnelle de l'anastomose spleno-renale et de la circulation porte d'effectuer des radiographies de grand format en series. La pathogenese, l'importance hemodynamique et l'indication operatoire de l'anastomose spleno-renale spontanee font l'objet d'un expose detaille. Se informa sobre dos pacientes con anastomosis esplenorrenal espontanea, de buen rendimiento, con hipertension portal. Esta conexion de cortocircuito, poco frecuente, puede ser demostrada in vivo por medio de la espleno-portografia si se cuenta con una situacion adecuada de la aguja en el territorio del hilio esplenico y con una cantidad suficiente de medio de contraste. Para el enjuiciamiento anatomico y funcional de la anastomosis esplenorrenal y de la via portal son de una gran importancia las imagenes seriadas en gran formato. Se discuten, por separado, la patogenesis, la transcendencia hemodinamica y las consideraciones quirurgicas en la conexion de cortocircuito esplenorrenal espontanea.

Die rontgenologische Diagnose und Differentialdiagnose der verschiedenen Typen der Mediastinalhernie werden besprochen. Diesc ist bei Verlagerung eines hernierten Lungenabschnittes bis an die kontralaterale Thoraxwand mit gewohnlichen Methoden tomographisch am Gefasverlauf nachweisbar. Mediastinal kreuzende Lungengefase sind auch dann ein sicheres Zeichen einer Mediastinalhernie, wenn die verlagerte Pleura mediastinalis nicht sichtbar ist. Als differentialdiagnostisches Beispiel wird eine einseitige idiopathische Lungenhypoplasie angefuhrt.