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To identify advantages when using the new multislice spiral CT technology (MSCT) for the detection and demonstration of intracranial aneurysms with CT angiography (CTA)?Patients with suspected intracranial aneurysms underwent 4- and 8-slice spiral CTA. Image postprocessing included "maximum intensity projection" (MIP),"volume rendering" (VR) and additionally curved multiplanar reconstructions (MPR) for aneurysms suspected at the carotid siphon. The results were compared with those achieved with digital subtraction angiography (DSA).In 19 patients 21 out of 22 aneurysms were detected by CTA. A high resolution three-dimensional view of the aneurysm morphology in spatial relation to the surrounding structures was achieved. Further information could be gained by making a detailed examination of the inside wall of the aneurysm, using virtual vascular 3D-endoscopy and virtual 3D-craniotomy.Compared to DSA,MS-CTA is a useful additional and in selected cases alternative modality for the detection with marked advantages in the demonstration of intracranial aneurysms.

Despite new methods for treating complete stenosis of the nasolacrimal duct dacryocystorhinostomy remains the standard operation. Implanting a nasolacrimal polyurethane stent through the nasolacrimal duct to preserve the natural lacrimal pathway seems to offer alternative procedure with similar success rate and without skin incision and general anesthesia. We examined whether an anatomically correct position increases its success rates.This prospective study included 40 patients (mean age 57 years). The polyurethane stent was implanted during dacryocystography, and its position was checked at follow-up visits after 6 months. In the event of an additional canalicular stenosis a 45-mm-long stent was implanted, in the other patients a 35-mm-long stent.A dacryocystographically correct position was found in only 21 of 40 patients; in the other 19 the stent did not enter the nose under the inferior concha. However, there was no correlation between correct position under the inferior concha and success rate. In 8 of the 40 patients the stent was not patent.The postoperative success rate cannot be predicted by the radiographic position along the ductus nasolacrimalis.

The pathogenesis of Cyclosporin A (CsA) induced toxic leukoencephalopathy is unclear. CCT and CMRI reveal hypodense respectively hyperintense bilateral and symmetrical changes predominantly in the posterior white matter. We report a patient with a severe CsA induced toxic leukoencephalopathy in whom clinical symptoms (complete loss of brainstem functions, coma) and morphological changes in CCT and CMRI were completely reversible after immunosuppression with CsA has been stopped. We furthermore discuss the differential diagnoses of CCT and CMRI findings.

Klippel-Trenaunay-Syndrome is a rare congenital vascular malformation with cutaneous naevi, varicose veins and limb hypertrophy. We report a patient with a variant of this syndrome presenting with extensive varicose veins and arteriovenous shunts within the left arm, bony hypotrophy of the left hand, mucocutaneous melanin spots in the face and thrombocytopenia. Imaging techniques play a major role in making a diagnosis in angiophakomatoses.

To compare a T2-weighted half-fourier acquired single-shot turbo spin-echo (HF-TSE) sequence (HA-STE-sequence) for cerebral MRI with a standard T2-weighted fast spin-echo (TSE) sequence.Signal-to-noise (SNR) and contrast-to-noise ratios (CNR) for different cerebral structures, and intracerebral lesions as well as the detectability of intracerebral lesions depending on size and relaxation properties were evaluated on cranial MR examinations of 46 patients with both a TSE and a HF-TSE sequence.SNR and CNR were found to be significantly higher with the TSE sequence for all normal structures and lesions except CSF, and lesions with short relaxation time T2 (p0.001). The number of detected lesions larger than 10 mm was similar with both sequences. Thirty-six (TSE) and 34 (HF-TSE) hyperintense, and 7 (TSE) and 2 (HF-TSE) hypointense lesions of at least 5 mm but less than 10 mm in size were detected. Thirty-three (TSE) and 10 (HF-TSE) hyperintense, and 2 (TSE) and no (HF-TSE) hypointense lesions smaller than 5 mm were detected.Due to its short acquisition time, the HF-TSE sequence is an alternative for MR examinations of non-compliant or claustrophobic patients. The low SNR and CNR relative to the TSE-technique are limiting factors as to the detectability of small lesions or lesions with low contrast to surrounding structures, with the risk of an increasing number of false negative results in lesions with short T2 relaxation time smaller than 10 mm.

The pathogenesis of cortical blindness as a rare complication in severe preeclampsia is still unclear. The case of a women with postpartum blindness is reported in which CT and MRI initially showed cortical and subcortical edema in the parieto-occipital lobes. At this time cerebral angiography and transcranial color-coded sonography (TCCS) revealed widespread cerebral vasospasm. Mean blood flow velocities in the middle and posterior cerebral artery and carotid syphon initially reached 380 cm/s and normalized within 2 weeks. While the patient's vision improved rapidly, follow-up MRI disclosed ischemic lesions and petechial hemorrhage in the occipital cortex. This case provides rare documentation that transient blindness in patients with preeclampsia may result from parieto-occipital ischemia due to cerebral vasospasm. In such patients TCCS may be useful to detect vasospasm associated with preeclampsia/eclampsia.

Dacryocystorhinostomy is still the standard procedure complete stenosis of the nasolacrimal duct. New methods try to preserve the natural lacrimal pathway. Song implanted in 1995 a nasolacrimal polyurethane stent through the nasolacrimal duct. The results and complications of this new method are described in this prospective study.Thirty consecutive patients with complete obstruction of the nasolacrimal duct or lacrimal sac were included in the study. The stenosis was localized by dacryocystography. The ages ranged from 22 to 87 years (mean, 58.9 +/- 16 years). Dacryocystography was performed immediately, 4 weeks and 8 months after the procedure to verify the position and patency of the stent.Twenty-five short (35 mm) and 5 long (45 mm) stents were implanted. Twenty-four of 30 patients after 4 weeks and 9 of 10 patients after 8 months had reduced or no complaints. In 1 patient the stent was obstructed. Forceful irrigation with saline solution permitted recanalization. In 1 patient the stent had moved into the upper canaliculus. Because of irritation of the canaliculus it had to be pulled out after 2 months.The follow-up is still too short to recommend stent implantation as a real alternative to dacryocystorhinostomy. The main advantages are that the procedure is faster, no incision is necessary, and the local anesthesia is easier. The disadvantage is the need for X-ray examination.

The effectiveness of radiosynovirothesis in the local treatment of chronically inflammatory joint diseases, especially rheumatoid arthritis, was evaluated.Follow-up examinations of 415 joints in 115 patients up to 4.5 years after intraarticular application of beta-emitting yttrium-90, rhenium-186, and erbium-169 were evaluated. The examination protocol included estimation of joint circumference, range of active joint moving capability, fist-bending power, and radiological assessment of joint destruction. Subjective assessment of pain, swelling, and joint function by the patients was evaluated by means of a score with three levels.The mean range of active joint moving capability increased in all joint subgroups, compared with the initial examination, with exception of ankle joints examined more than 30 months after therapy. The mean joint circumference decreased in all joint subgroups. Good to excellent results were achieved in up to 66% of joints, satisfying results in up to 21%, and no improvement or further deterioration was noted in 13% according to subjective assessment by patients themselves. Treatment proved most effective in joints with poor or no alteration in X-ray examinations.In the local treatment of chronically inflammatory joint diseases--especially beyond systemic drug therapy and local corticoid therapy--, radiosynoviorthesis is a low-invasive method, which may provide long-term relief of pain and swelling as well as improvement of joint function.

Both dacryocystography and dacryoscintigraphy are well established in the evaluation of stenoses of the lacrimal drainage system. They provide limited information about the ductal anatomy itself and about periductal structures. MR imaging was evaluated for its capability to directly visualize the lacrimal drainage system in detail and simultaneously provide functional characterization of dacryostenosis.Twenty-seven lacrimal drainage systems of 23 patients suffering from epiphora were examined in an MR unit before and after conjunctival and intravenous application of Gd-DTPA using a surface coil.Dacryostenosis was found in 23 of 27 lacrimal systems. Stenoses were localized to the canalicular (n = 3), saccular (n = 8), and ductal (n = 12) level, and were classified as stenosis or occlusion.MR imaging with conjunctival contrast application allows within one examination both detailed morphological and functional assessment of the lacrimal drainage system with depiction of surrounding structures. Limitations arise mainly from demands on technical and patient-related preconditions.

To evaluate in which parts of the gastrointestinal tract and in what clinical situations the diagnostic quality of MR examination may be improved by a positive enteral contrast agent.MR examinations of 37 patients performed before and after application of a Gadolinium-DTPA preparation suitable for oral and rectal application were evaluated. Exams were evaluated by two independent observers. Neoplastic disease of the gastrointestinal tract constituted the majority of indications followed by inflammatory changes and extraenteral space-occupying lesions.The majority of examinations (62%) were improved by the application of enteral contrast agent. No effect was observed in 35%; in two patients image quality was poorer after contrast application. The benefit of enteral contrast agents was highest in MR examinations of the sigma and rectum. The enteral contrast agent was most valuable in the detection of lymphoma if an evaluation according to indication was performed.In selected cases, the diagnostic quality of abdominal MRI can be improved by the application of an enteral contrast agent. Apart from the effect of greater signal intensity, the contrast agent does complement MR imaging by a functional aspect.