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It is the considered opinion of the authors that meniscus sonography can largely replace arthrography. This opinion is based on their detailed examinations and studies. Sonographic visualisation of all lesions produced by a scalpel was demonstrated using knees of corpses. Even cracks having the fineness of a human hair were visualised by sonography. A comparison between sonographic and surgical findings in meniscus lesion yielded in 82 patients an agreement of 95.1%. In 47 patients it was possible to prove that sonography was more accurate than arthrography as far as diagnosis was concerned. A comparison of 94 sonographically and arthrographically established findings yielded agreement in 89% of the cases. Sonography is suitable for meniscus imaging especially on account of the good imaging reproducibility of meniscus morphology; through safe detection of a pathological process in the meniscus; through the safe presentation of lesions; through the accurate imaging of all parts of the meniscus; and, furthermore, through the invaluable advantage of noninvasiveness, freedom from pain and hazards; and, last but not least, rapid manipulation and unlimited repeatability.

PURPOSE To evaluate the role of contrast enhanced MRI in quantifying signal changes of the inferior alveolar nerve following inflammatory changes of the mandible. MATERIAL AND METHODS 30 patients with inflammatory changes of the mandible underwent MRI of the face. Both sides of the mandible, the affected as well as the unaffected healthy side were evaluated retrospectively. Regions of interest were placed at 5 defined places on both sides to assess signal intensity before and after intravenous application of paramagnetic contrast agent. The results of the measurements were compared between the healthy and the affected side (t-test, p < 0.05) and correlated with clinical findings (t-test, p < 0.05). RESULTS All patients with hypesthesia of the inferior alveolar nerve in areas of the lips or chin (n = 4) showed a marked increase in signal intensity from 35 % to 83 % distal to the inflammatory process. Patients without sensitivity disorders showed less increase in signal intensity with a maximum of 51 % distal to the inflammatory process. In nearly all patients no contrast enhancement was observed distal to the first molar on the unaffected side. CONCLUSIONS Quantitative analysis of contrast enhanced MRI of the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible, the neurovascular bundle shows a significant increase in signal intensity distal to the lesion compared to the unaffected healthy side of the mandible.

Purpose: To compare in a single-blind study the reliability of quantitative measurements and subjective evaluations of contrast enhancement of the facial nerve in patients with idiopathic facial paralysis. Materials and Methods: Magnetic resonance images with a 0.7mm slice thickness (surface coil) were obtained in patients with idiopathic facial paralysis before and after administration of Gd-DTPA, 0.1 mmol/kg. The five intratemporal segments of the facial nerve were quantitatively measured and subjectively assessed by five radiologists as to the degree of enhancement. The results were compared as to the reliability of both methods. Results: Using the quantitative measuring method, 175 measurements were calculated from a total of 350 regions of interest. At all 35 measured sites, the five quantitative measurements produced identical results. In contrast, the subjective assessment of the five radiologists arrived at a majority consensus in only 16 sites. A complete agreement was not reached for any measured site. Conclusion: The measured quantitative increase in signal intensity after administration of contrast medium is more reliable than subjective assessment. The quantitative method enables reproducible signal intensity measurements even for different window settings and can be easily and swiftly performed at the workstation.

Objective The aim of the study was to assess whether MRI has a prognostic value at an early stage of Bell's palsy. Material and methods Prospective, blinded study on 30 patients suffering from Bell's palsy, who came to hospital until the sixth day of illness, to receive high doses steroid therapy. MRI was done on the first day of inpatient treatment as a gradient-echo-sequence with a slice thickness of 0.7 mm before and after i. v. administration of 0.1 mmol GdDTPA/kg weight. The signal intensity increase was evaluated quantitatively by region on interest (ROI). The results were compared to the clinical outcome and the results of electrophysiology. Results The examinations of all patients could be evaluated. The 3 patients who developed a chronic facial paralysis were detected by MRI on the first day of inpatient treatment. The patients, who showed MR signs for an unfavorable course, had a highly significant pathologic compound muscle action potential (CMAP) as a result of the electrophysiologic measurement. Rather than using complex measurement procedures it is possible to obtain reliable prognostic information from just one measurement within the Internal auditory canal before and after i. v. administration of contrast. Conclusion MRI has a prognostic value at an early stage of the illness. In the clinical setting this measurement is easy to perform, so that it is possible to obtain prognostic information at a stage when causal treatment is still possible.

PURPOSE: To determine the value of supine chest radiography in comparison to orientating chest CT in the initial diagnostic evaluation of severely polytraumatised patients. MATERIAL AND METHODS: 303 patients with primary indication for a cranial CT following trauma were investigated between 1988 and 1993. After performing the cranial CT all patients underwent a chest CT with an average of 6 CT slices without changing the position of the patient and with a median scan time of 4 minutes. The results of the chest CT were correlated with the findings of the supine chest radiography in regard to therapeutically relevant pathological changes. RESULTS: The sensitivity in detection of pneumothorax in supine chest radiography was 53% versus 97% in CT, atelectasis 20% versus 94%, lung contusion 79% versus 99%, haemotothorax 62% versus 97%. More fractures were found conventionally (sensitivity 94%) than by chest CT (sensitivity 44%). CONCLUSION: Supine chest radiography of polytraumatised patients is clearly inferior to orientating chest CT in demonstrating posttraumatic lesions; obtaining therapeutically relevant information justifies the additionally needed small amount of time.

PURPOSE To find reliable data of the incidence of different variations of the spine. MATERIAL AND METHODS Standardised radiographic examinations of 10,922 young, healthy pilot aspirants of the German air force were made. Radiographic examination included the whole spine in a.p. and lateral projection, the cervical spine in oblique projection and in a subunit of 5781 men the lumbar spine in oblique projection. RESULTS The following incidences were found: mild habit scoliosis: 80.4%, structural scoliosis: 9%, severe thoracal kyphosis without severe lumbar lordosis: 5.1% and together with severe lumbar lordosis: 30.8%, mild forms of kyphosis of adolescence: 23.3%, severe forms: 2.1% and cuneiform deformation of vertebral body: 4.9%, sacralization: 7.8%, lumbarization: 5.9%, spondylolysis: 6.2%, spondylolisthesis: 4.3% and lumbar chondrosis: 2.1%. Chondrosis of the thoracal and cervical spine, osteochondrosis and coalescent vertebral bodies were found in less than 0.8% each. CONCLUSION In only 2.6% were there no pathological findings. This shows importance of radiological spine examinations especially for industrial and preventive medicine.

Purpose: Cystic processes are changing the course of the inferior alveolar nerve in the mandible. This study evaluates the possibility of demonstrating the relationship between space-occupying processes and the course of the neurovascular bundle. Materials and Methods: Thirteen patients with cystic processes in the mandible (9 keratocystic lesions, 1 eosinophilic granuloma, 1 plasmocytoma, 2 adamantinomas) were examined by MRI (1.5-T magnet, 8-cm surface coil, PD-gradient-echo-sequences in sagittal and coronal orientation, without enhancement) and the results retrospectively evaluated. Results: The entire course of the nerve could be delineated in all patients. In six patients with minor cystic processes, the nerve was identified in both sagittal and coronal orientation. In seven patients with major cystic lesions, only parts of the nerve were detected in either image orientation, but the nerve could be visualized in its entire length by evaluating coronal and sagittal images side by side. Conclusion: It is possible to delineate the inferior alveolar nerve in its entirety along pathologic mandibular lesions. For large cystic lesions, this requires the evaluation of both coronal and sagittal sections of multidirectional MRI.

The results of 230 retrograde phlebographies of the V. spermatica int., 165 percutaneous sclerotherapies and 60 follow-up phlebographies on subfertile patients are presented. In 24 patients (10%) complications occurred, yet in none of the cases clinical damage became evident. Percutaneous sclerotherapie is contraindicated, when selective probing of the V. spermatica int. is impossible or massive collaterals to other venous systems could lead to an uncontrolled spread of the sclerosing agent. Treatment of idiopathic varicocele in subfertile men by percutaneous sclerotherapy is a safe and effective method, which can be performed on an outpatient basis. In our opinion the so far used surgical treatment can be replaced by it as a method of choice.

Among 1217 percutaneous retrograde phlebographies of the left renal/testicular vein 1069 were performed for primary treatment of left-sided idiopathic varicocele. In 989 of these patients (92.5%) an insufficient testicular (internal spermatic) vein with reflux to the pampiniform plexus could be shown phlebographically, in 802 cases percutaneous sclerotherapy could be performed. This amounts 75.0% of patients with varicocele or 81.1% of the cases with a phlebographically proven testicular vein insufficiency. In this group percutaneous sclerotherapy has proven to be a safe and effective treatment of idiopathic varicocele on an outpatient basis and has replaced surgical ligation as method of choice. However, with anatomical and technical obstacles to sclerotherapy, especially in patients with varicocele but without phlebographic evidence of an insufficient testicular vein, surgery remains an essential means of therapy.

Among 4019 computed tomograms of the head performed in 2 years we found 2 epidural empyemas combined with an ipsilateral orbital phlegmon and one periorbital abscess with an incipient orbital phlegmon. In all 3 patients they turned out to be intracranial or orbital complications of an adjacent paranasal sinusitis. The CT diagnosis was a guideline for further therapy and was verified by immediate surgery. The reliable diagnosis of orbital and intracranial space-occupying lesions makes CT the radiological method of choice in case of suspicion of a complicated sinusitis.

The complex interactions of psychological, neurological, hormonal and vascular aspects of erectile dysfunctions require a standardised multidisciplinary diagnostic evaluation. The recent establishment of new noninvasive and invasive investigative procedures has led to a fundamental change in the assessment of erectile dysfunctions. Selective angiography of the internal pudendal artery and its branches represents the crucial diagnostic step before treatment can start. Indication, technique and results of 26 bilaterally performed pudendal angiographies on impotent patients are described.

The lymphatic spread in 123 patients with biopsy-proven malignant head and neck tumors was evaluated by CT in a prospective study. In 53 cases, clinical examination, CT and pathological-histological work-up of the surgical specimens were comparatively analysed. The fraction of false-negative judged lymph nodes by palpation was 21%. This high error in judgement could be diminished to 7.5% by the use of CT. 83% of squamous cell metastases showed a central decrease in density due to necrosis after intravenous infusion of contrast material.

Forty-six computed tomographic examinations on 39 patients with histologically confirmed malignant oral tumors are reported on. The value of information by CT is compared to clinical staging in 24 operated cases. In determination of the T-category, clinical examination is superior to CT. The local metastases and the outline of the tumor are better diagnosed by CT. Provided that a subtle examination technique is used, CT can be of great help to the surgeon in choosing the adequate therapy in oral malignant tumors.

Among 441 CT scans of 303 patients with a malignant tumor of the head or neck 138 scans of 83 patients were performed for evaluation of recurrent tumor. In diagnosing nodal recurrence computed tomography (CT) had a sensitivity of 92% (52 out of 56) and a specificity of 96% (55 out of 57). In diagnosing recurrence at the primary site sensitivity of 72% (56 out of 77) and specificity of 60% (30 out of 50) was lower and clearly inferior to physical examination with 92 and 88% respectively. CT was very useful in delineating advanced recurrencies, especially in regions that were not readily accessible by physical examination or were indurated by flat scarring. In addition to the complete staging of nodal involvement this makes CT the radiologic method of choice in follow-up of patients with malignant tumors of the head and neck. A post-therapeutic baseline scan obtained 6-8 weeks after surgery resp. radiotherapy is expected to further improve results, especially in differentiating scar from recurrent tumor.

The preoperative CT findings in 50 patients out of a total of 144 examined patients with suspected intrathoracal malignant processes with mediastinal involvement were compared to the results obtained by mediastinoscopy and thoracotomy. There was a high diagnostical reliability (95%, n = 40) in assessing lesions in the area, which can be reached by mediastinoscopy. This leads to the conclusion that mediastinoscopy is necessary only in such cases with histologically proven malignant intrathoracal masses, which show lymph nodes of a size from 1 to 2 cm. The evidence of invasive extension into adjacent mediastinal structures as well as the distance from tumour to carina could be assessed well by CT. For follow-up examinations after resection, radiation therapy or chemotherapy, computed tomography is of particular value to detect early mediastinal recurrence.