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Purpose: To evaluate the effectiveness of direct MR arthrography of the glenohumeral joint with maximum distension of the joint capsule in patients with glenohumeral instability for preoperative diagnosis and for determining the method of surgical intervention., Materials and Methods: MR arthrography of the shoulder joint was performed on a 1.5 T system in 38 patients. All patients suffered from anterior or bidirectional instability. Using a fluoroscopically guided posterior approach, a 1 % dilution of dimeglumine gadopentetate (5 mmol Gd-DTPA/l) was injected until full capsular stretching was achieved. MR imaging protocol included fat-saturated transversal, oblique-coronal and oblique-sagittal T1-weighted spin-echo, T1-weighted 3-D and transversal T2-weighted Flash-2D., Results: MR imaging revealed significant capsule distention in 22 patients and ventral capsule defects in 9 patients. Labral lesions were depicted in 25 patients, bicipital tendon lesions in 4 patients and partial ruptures of the rotator cuff in 3 patients. 15 of the 38 patients underwent surgery. Areas of pathologic laxity of the glenohumeral capsule were correctly described in all cases. In 12 of 15 patients, the best method of intervention could be determined prospectively. In 3 of 15 patients, the necessary operation was overestimated. Regarding labral ruptures, MRI had a sensitivity of 88 %, a specificity of 86 %, and a diagnostic accuracy of 87 %., Conclusion: Direct glenohumeral MR arthrography allows accurate preoperative evaluation of labral and tendinous structures. Judging the capsular laxity allows the determination of the optimal method of surgical intervention. The maximum extent of a stabilizing operation can be predicted preoperatively.

Purpose: To present data on the MR imaging appearance of lumbar intraspinal juxtafacet cysts (JFC) and to assess the importance of additional CT arthrography., Material and Methods: Twenty-eight patients (16 women, 12 men) with a mean age of 64 years (range: 43 - 82), who underwent MR imaging because of radicular pain or spinal claudication, were found to have an intraspinal cyst associated with the facet joint. In 14 patients, additional CT-arthrography was performed to determine whether a communication exists between the cyst and the facet joint and to try to rupture the cyst., Results: In T(2)-weighted images, juxtafacet cysts show a typical pattern consisting of a hyperintense center and hypointense rim. The center is likely to be inhomogeneous because of recurrent hemorrhage in the cyst. In T1-weighted images, the cysts are hypo/isointense. Irregular hyperintensity may indicate subacute hemorrhage, which may aggravate the clinical symptoms. MR allows superior visualization of the cyst in all anatomical planes. It also enables assessment of typical accompanying changes, such as degenerative spondylolisthesis and facet hypertrophy. All patients, who had CT-arthrography, were found to have a direct communication between joint space and cyst. Transarticular rupture of the cyst was possible in five patients. Two of these five patients had good to excellent improvement, and the remaining three patients underwent surgery., Conclusion: MR imaging is the method of choice for diagnosing lumbar intraspinal juxtafacet cysts. CT-arthrography of the facet joint is helpful in cases with difficult differential diagnosis, and in the preoperative planning. Furthermore, it assists in the primary interventional treatment.

We evaluated ultrasound transmission velocity as an indicator for osteoporosis at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 74 female subjects (22 premenopausal, 29 postmenopausal non-osteoporotic and 23 postmenopausal osteoporotic). In addition dual x-ray absorptiometry (DXA) of the lumbar spine was performed in 30 women and a combined cortical thickness index (CCT-index) of os metacarpale II was calculated from hand radiographs in 29 women. Ultrasound velocity at all sites slightly decreased in premenopausal women with age and declined significantly after menopause. At the hand postmenopausal osteoporotic women had significantly lower velocities than normal postmenopausal or premenopausal women while no difference could be seen at os calcis. An only poor or moderate correlation between ultrasound velocity at all sites and DXA of the lumbar spine and a good correlation between the CCT-index and velocity at the fingers indicate that ultrasound velocity is not only affected by bone density but even more by structural properties.

Ultrasound transmission velocity at the appendicular skeleton is determined by elastic properties of the bone as mass density. We evaluated ultrasound transmission velocity at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 51 male subjects. 28 of them were professional soccer players of the 1st German division, 11 subjects performed non-professional exercise in various athletic organisations regularly and 12 did not exercise at all. A significant difference in the speed of sound could be seen at os calcis, where the soccer players had higher velocities than the other groups. The differences between the groups at the upper and lower extremities suggest that changes in ultrasound transmission velocity are not only affected by structural changes in the aging skeleton, as it might be suggested by age differences, but by exercise. Physical exercise can change the properties (structure and/or density) of weightbearing bone and this can be detected by measuring ultrasound velocity.

The radiation dose to the ocular lens and thyroid gland during high resolution CT of the jaw was measured in a head phantom and in 9 patients. The dose for the lens and thyroid gland resulting from 10 cuts was 0.7 and 0.9 mGy, respectively. By shielding the thyroid gland against scatter a reduction of 20% is possible. Radiation exposure is considerably higher than during conventional dental x-ray examinations. Compared with CT examinations of the head and neck region, radiation exposure of both organs is about the same.

Fourteen patients with carcinomas of the gallbladder and eight patients with biliary duct carcinomas were examined by CT, sonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiography (ERC) and angiography. The results were compared retrospectively. Sonography proved suitable as a screening method. For accurate demonstration, this should be supplemented by CT. PTC and ERC demonstrate intraductal extension of biliary carcinomas and of gallbladder carcinomas infiltrating the bile ducts. The value of angiography consists merely in the preoperative demonstration of the vascular anatomy.

The results of CT in 104 patients with traumatic lesions of the orbits have been analysed retrospectively. Eighty-four fractures of the orbital skeleton were diagnosed in 58 patients; in 18 cases there was peri-orbital, retrobulbar or intrabulbar bleeding and two patients had a ruptured globe. A foreign body was demonstrated in 20 cases. Additional fractures of neighbouring paranasal sinuses were present in 22 cases. Mucosal swelling or bleeding in the sinus was found in 59 cases and orbital emphysema in 22 patients. The particular value of CT in the diagnosis of orbital trauma lies in the certainty with which bony injury of the orbit and peri-orbital structures can be demonstrated.

High-resolution CT of the petrous bone was carried out in 259 patients with clinically diagnosed abnormalities of the inner ear; in some the lesions were bilateral. In 62 patients (approximately 20%), the scans showed findings which related to the signs and symptoms. Patients with hearing loss and vestibular neuronitis showed no abnormalities. Amongst the remaining patients, the most common findings were acoustic neuromas (17 cases), cochlear otospongiosis (14 cases), malformations (13 cases) and tumours or cholesteatomas of the labyrinth (13 cases) as well as single rare isolated lesions.

The CT and conventional radiological findings in 30 patients with space-occupying lesions of the pelvic bones were compared. 73% of the tumours diagnosed by CT were shown by conventional means and in 71% their extent was correctly estimated. Lesions at the ilio-sacral junction are not demonstrated as well by conventional methods as those near the hip joint. The lesions most frequently missed by conventional radiography lie in the dorsal part of the ilium and in the lateral mass of the sacrum.

CT portography was performed in 32 patients with liver tumours and in four patients with cirrhosis of the liver, but without evidence of tumour, after angiographic injection of contrast into the superior mesenteric or splenic arteries. Compared with CT using no contrast, or contrast by intravenous injection, CT portography has the following advantages: better tumour detection, better detection of tumour size, better demarcation and localisation of tumours, better demonstration of the portal system, more inhomogeneity of the parenchyma. Of 12 patients with a number of tumours shown on CT, CT portography demonstrated tumours in four cases, which could not be shown by any other imaging method. Problems concerning CT portography in patients with cirrhosis of the liver are discussed.

The computer tomographic appearances of very rare sarcomas of the liver have been demonstrated in five cases (four haemangiosarcomas, one spindle-cell sarcoma). On the plain scan, all the tumours appeared less dense than the liver parenchyma, but in haemangiosarcomas there was a marked increase in density after the infection of contrast up to an isodense level. During angio-CT, densities equal to intrahepatic vessels were observed. There was only a slight increase in density of the spindle cell sarcoma after contrast injection. The CT appearances have been compared with the pathological and anatomical structure of the tumour.

The diagnostic scope of CT has been demonstrated for malignant tumours of the oesophagus (41 patients) and tumours of the stomach (18 patients). Of importance is the demonstration of circumferential spread of tumours of the oesophagus, the early demonstration of mediastinal lymph node metastases and the demonstration of infradiaphragmatic lymph node involvement from tumours of the middle and lower thirds of the oesophagus. In the presence of tumours of the stomach, it is possible to demonstrate infiltration of neighbouring organs (pancreas, spleen, hilum of liver) and haematogenous or lymphatic spread.

Three hundred and thirty-seven patients with portal hypertension and recurrent bleeding from oesophageal varices were examined by sonography. The situation was correctly elucidated in 17 out of 21 patients (81%) with pre-hepatic blocks, in 275 out of 313 cases (88%) with intra-hepatic blocks and in two out of three cases with post-hepatic blocks. The relevant findings consisted of stenoses and occlusions of the portal venous system and collaterals in pre-hepatic blocks, dilatation of the portal venous system and hepato-fugal collaterals in intra-hepatic blocks and occlusion of the hepatic veins in post-hepatic blocks. Sonography is recommended in cases of portal hypertension because of its non-invasive nature and high accuracy as the primary form of investigation. Spleno-portography should be used only if surgery is indicated.

Digital subtraction angiography, using a time interval difference mode in relation to a suitable mask, provides a means of showing the myocardium in every phase of the cardiac cycle. The endo- and peri-cardial contours and the thickness of the myocardium in both ventricles can be demonstrated accurately. Artifacts are usually due to displacements of the heart or to tachycardia.

Beside demonstrating morphological changes, CT enables one to make quantitative measurements of the spinal canal (sagittal diameter, transverse diameter, area of the spinal canal, width of the lateral recess and symmetry of the articular joints). A reduction of the transverse diameter of the spinal canal or asymmetry of the articular joints is associated with an increased and earlier incidence of back pain. In addition, patients with asymmetrical vertebral joints showed more frequent and earlier development of disc prolapse.

The findings of conventional radiography were compared with the results of computer tomography in 91 patients with histologically confirmed lesions of the thoracic wall. In 22 (24%) CT gave no additional information. In 67 (74%), CT supplied additional information or narrowed the differential diagnosis. Particularly important on computer tomography was the enhancement brought about by intravenous contrast medium in malignant tumours of the thorax or thoracic wall. CT should be used in preference to conventional tomography in the investigation of lesions of the thoracic wall.

High resolution computer tomographic examinations of the petrous bones were performed on 19 patients with confirmed peripheral facial nerve paralysis. High resolution CT provides accurate information regarding the extent, and usually regarding the type, of pathological process; this can be accurately localised with a view to possible surgical treatment. The examination also differentiates this from idiopathic paresis, which showed no radiological changes. Destruction of the petrous bone, without facial nerve symptoms, makes early suitable treatment mandatory.

The diagnostic value of sonography and CT was studied in 259 patients. In the diagnosis of solid tumours, CT is superior to sonography, whereas ultrasound is more useful in the investigation of cystic lesions. In estimating the extent of intrahepatic tumours, the falciform ligament is more useful than a line from the cava to the gall bladder, both for CT and ultrasound, although in this case CT shows the extent of tumours more accurately. 3.7% of the ultrasound and 2.3% of the CT examinations were of limited value because of unavoidable technical problems.

The CT findings in 34 patients with histologically confirmed tumours at a lung apex are described. CT, compared with conventional methods, provides more comprehensive information regarding the localisation and extent of the tumour and of local metastases. On the basis of CT examinations, 28 patients were treated by radiotherapy and in six patients surgery could be carried out.

The clinical and computer tomographic findings in 142 patients with carcinoma of the body of the uterus have been compared. The CT findings at the first examination were then compared with the clinical results. The likelihood of a recurrence was related to infiltration of the parametrium. There was strong positive correlation between the CT findings during treatment and the probability of recurrences. The wealth of information provided by computed tomography makes any other form of investigation during tumour staging and during follow-up unnecessary.

The CT findings in 80 patients with confirmed portal hypertension due to intrahepatic block were analysed retrospectively. The findings included ascites, hypo-dense areas in the liver, nodular or irregular liver contour, the inability to define intrahepatic portal vessels with narrow window settings, the so-called "kissing" sign and evidence of hepato-fugal collaterals and thickening of the wall of the oesophagus. Electronic measurements of various organs (liver, spleen) and vessel diameters (portal vein, superior mesenteric vein) provide parameters which permit classification of patients into the cirrhotic group, as compared with a control group. The statistical significance of this classification was checked by the Kolmogoroff-Smirnoff test.

The results of 242 percutaneous nephropyelostomies in 215 patients were analysed retrospectively. No consideration was given to the experience of the individual operators. There was a total complication rate of 36.4% (mild complications 32.2%, serious complications 34.1%, fatality 0.4%). Rapid reduction in serum creatinine could be demonstrated following drainage in patients in whom renal function had been damaged by obstruction.

MR tomography of the liver using 1.5 T has been carried out in 63 patients with focal lesions in order to demonstrate haemangiomas and to differentiate these from primary and secondary malignant liver tumours. This differentiation was possible in all patients, using conventional spin echo and inversion recovery sequences in combination with sonography. Accuracy was much less good when using gradient echo sequences. With sufficiently large tumours, measurement of relaxation time made possible diagnosis of all the 22 haemangiomas.

Twenty-three patients complaining of impotence were examined angiographically as part of their investigation. In all patients, DSA as well as conventional angiography was carried out. The purpose of this investigation was to compare the two methods with regard to their diagnostic value. By means of sequential analysis it was shown that, with an error level of 10%, DSA was superior to conventional angiography.

The report deals with 66 digital subtraction angiograms of the hand performed on 61 patients; 60 were carried out by direct puncture of the brachial artery and six by trans-femoral catheterisation. In 39 patients a peripheral organic vascular abnormality was demonstrated (usually arterial sclerosis, thromboangiitis obliterans or collagenosis). Purely functional flow abnormalities were found in 17 patients. In 15 patients an organic abnormality was demonstrated, but its type could not be identified. Intra-arterial DSA is able to differentiate between functional abnormalities of blood flow and peripheral organic vascular abnormalities.

The place of MRT, using surface coils, has been evaluated retrospectively in 27 patients with clinically confirmed malignant tumours of the mouth and pharynx. The extent of the tumour and its relationship to neighbouring structures is well demonstrated. The resolution obtainable by using surface coils is almost as good as that of CT. Soft tissue contrast is better in showing the spread and size of the tumour. A disadvantage of MRT is the inability in most cases to demonstrate bone destruction. Differentiation between residual tumour, recurrence and scarring is possible only occasionally. Quantitative MRT may be expected to lead to improved diagnosis during the course of following up.

Eleven patients with known malignant tumours of the outer ear and three patients with otitis externa maligna were examined by high resolution CT. CT provided accurate information concerning soft tissue infiltration into the parotid or subtemporal tissues, and of the bony destruction in the mastoid, meatus and tympanic cavity. Absolute differentiation between a malignant tumour and otitis cisterna maligna is not possible, not even by high resolution CT.

In thirty patients with cholesteatomas of the middle ear, high resolution CT of the petrous bone was performed in conjunction with the clinical examination. The extent of the soft tissue process can be demonstrated by CT, but differentiation of the cholesteatoma from the accompanying inflammatory changes is not possible. Typical complications such as destruction of the auditory ossicles, the bony labyrinth, the facial canal, the lateral wall of the attic and the superior and inferior walls of the tympanic cavity are clearly demonstrated. Changes in the mastoids are better demonstrated than by conventional radiography. Using the high contrast and special resolution of modern high resolution CT, this has become the method of choice in the investigation of cholesteatomas of the middle ear.

Contrast injection for angio-CT shows kinetic changes in patients with portal hypertension due to cirrhosis of the liver when compared with normals. Contrast-duration diagrams show a higher aortic peak, low contrast and delayed contrast maximum in the liver and portal vein in patients with liver cirrhosis and portal hypertension. On these criteria it is possible to distinguish patients with cirrhosis (n = 18) from normals (n = 16).

In 30 to 50% erectile dysfunctions are due to vascular disorders. Roughly a third of these vasculogenic disturbances is based on venous disorders. These venous-induced erectile failures may be objectivated and radiologically located via dynamic cavernosography, combined with a simultaneous recording of a cavernous pressure profile. Based on over 130 examinations it was possible to provide both an exact description of the normal venous drainage in normal potent men and to give a good idea of the different venous leakages in patients complaining of erectile dysfunctions. Congenital and acquired penile deviations along with Peyronie's disease may also be appropriate for dynamic cavernosography.

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.

T1-weighted IR sequences and T2-weighted SE sequences and combined SE/IR sequences were carried out in 62 patients with malignant and 50 patients with benign liver tumours and the T1 and T2 relaxation times were measured. IR sequences proved the most sensitive method for imaging focal liver lesions and providing good contrast between liver tissue and tumour. For lesions above 1.5 cm, quantitative MRI achieved an accuracy better than 95% in distinguishing between haemangiomas and malignant lesions. Routine quantitative measurements of relaxation times were sufficiently reproducible for clinical use.

The conventional radiographs and CT examinations of 112 patients with primary and secondary bone tumours of the spine have been compared. Two hundred and sixty-eight vertebrae were shown to be involved, using CT; conventional radiographs showed correctly in 88% an involvement of the vertebral bone and in 66% of the different parts of the vertebrae. Of the intraspinal and paravertebral tumour extensions shown by CT, only 23% and 33% respectively were correctly diagnosed by plain radiography. Only 51% of the vertebrae showing a reduction in height on conventional radiographs could be diagnosed on horizontal CT cuts. The type of lesion could be diagnosed in only very few cases by either method.

The results of 300 digital subtraction angiographies of the thoracic and abdominal aorta are analysed. Following intraarterial injection of contrast, all examinations were of good quality. Following I-V DSA, two thoracic (1.8%) and two abdominal (1.2%) aortograms were non-diagnostic. Anomalies in the position of the aorta, dilatation (aneurysm) or stenoses (coarctations, arteriosclerosis, occlusions) could be diagnosed by I-V DSA. One I-A DSA was performed for aneurysm of the ascending aorta in order to evaluate function of the aortic valve and for demonstrating the coronary artery origins, and pre-operatively for an aortic dissection.

Thrombosis of a large vein can be demonstrated by CT. The thrombosed vein has a hypodense lumen, with a somewhat increased diameter which does not opacify after intravenous contrast injection, but which shows a narrow hyperdense margin. Collateral vessels in the pelvic or paravertebral plexus and dilated veins in the abdominal skin are indirect evidence of ileo-caval thrombosis. CT can also demonstrate the cranial extent of a caval thrombosis. Venous thrombosis demonstrated by CT is an important additional finding in the pre-operative examination of the abdomen.

The pre-operative laryngoscopic and CT findings in the larynx in 50 patients with malignant laryngeal tumours were compared. Laryngoscopy showed an accuracy for T-staging of 78.6% and CT an accuracy of 80%. In addition, CT complemented the endoscopic findings by demonstrating the depth of tumour invasion. The changes in individual anatomical portions of the larynx were compared, using both methods. CT and palpation showed equal specificity for lymph node staging, but CT is markedly superior in sensitivity.

The frequency and type of side effects from high-dose renographic contrast media correspond with those quoted in the literature for injections of small doses of contrast. In addition to the usual contra-indications against injection of renographic contrast, one should also consider the effect of short-lived increase in circulating volume in patients with left heart insufficiency.

Twenty-one patients with congenital deformities of the petrous bones were examined by high resolution computed tomography. This allows an accurate description of the extent of the malformation in all parts of the cochlear and vestibular organs; only localised changes in the auditory ossicles, such as fixation of the stapes and changes in the soft tissue portions of the labyrinth, cannot be shown. Improved demonstration of soft tissues while using less radiation makes high resolution CT preferable to conventional polytomography. It is also easier to perform and provides axial projections which are essential for the elucidation of malformations of the middle and inner ear.