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The aims of this study were to measure the size of Lister’s Tubercle, the extent of the extensor pollicis longus (EPL) groove and the dihedral angle of the distal dorsal radius. Computer tomography scans of 30 forearms were performed by using a 64-slice Siemens SOMATOM Sensation®CT system (Resolution 0.6 mm). DICOM raw data were calculated to 3D by MIMICS®software (Materialise, Leuven, Belgium). The size of Lister’s Tubercle varied from 1.4 to 6.6 mm (average 3.3 mm) in height radial to the tubercle, and from 5.6 to 18.6 mm (average 13.2 mm) in length. The depth of the EPL groove varied from 0.6 to 3.2 mm (average 1.6 mm). The height on the ulnar side, between the depth of the groove and the tip of the tubercle, varied from 2.2 to 5.8 mm (average 3.4 mm). The dihedral angle of the distal dorsal radius varied from 110° to 135° (average 123°). The variations in height of Lister’s Tubercle and in depth of the EPL groove are considerable. This needs to be taken into account when performing volar plating of distal radius fractures otherwise screws may inadvertently penetrate the dorsal cortex of the radius potentially leading to EPL rupture.

The diagnosis and therapy of pericardial diseases are still a physician's challenge. Advanced CT and MR imaging technologies can display the complete morphology of the heart and the pericardium and of the adjacent thoracic structures with a spatial and contrast resolution below 1 mm. All the macromorphologic determinants of pericardial constriction and their functional sequels may be identified by these remarkable technologies. A careful systematic image analysis defines not only a precise diagnosis but also determines the optimal surgical or conservative therapy for the individual patient and minimizes the risk of perisurgical mortality.

In accidents resulting in severe injuries, a clinical forensic examination is generally abandoned in the initial phase due to high-priority clinical needs. However, in many cases, data from clinical computed tomography (CT) examinations are available. The goals of this prospective study were (a) to evaluate clinical CT data as a basis for forensic reconstruction of the sequence of events, (b) to assess if forensic radiological follow-up reading improves the forensic diagnostic benefit compared to the written clinical radiological reports, and (c) to evaluate if full data storage including additional reconstructed 0.6-mm slices enhances forensic analysis. Clinical CT data of 15 living individuals with imaging of at least the head, thorax, and abdomen following polytrauma were examined regarding the forensic evaluation of the sequence of events. Additionally, 0.6-mm slices and 3D images were reconstructed for forensic purposes and used for the evaluation. At the forensic radiological readings, additional traumatic findings were observed in ten of the 15 patients. The main weakness of the clinical reports was that they were not detailed enough, particularly regarding the localization of injuries and description of wound morphology. In seven cases, however, forensic conclusions were possible on the basis of the written clinical reports, whereas in five cases forensic reconstruction required specific follow-up reading. The additional 0.6-mm slices were easily available and with improved 3D image quality and forensic diagnostics. In conclusion, the use of clinical CT data can considerably support forensic expertise regarding reconstruction issues. Forensic follow-up reading as well as the use of additional thin slices for 3D analysis can further improve its benefit for forensic reconstruction purposes.

To determine the value of digital storage-phosphor radiography (SR) on the detection and identification of subtle lung nodules, postero-anterior (PA) and lateral (LAT) film-screen (FR) chest radiographs were compared with isodose SR images of 45 patients with metastatic malignancies. The SR postprocessing was done with a particular mode previously optimized for routine chest radiography. Pulmonary metastases were found in 34 patients and were proved or excluded by CT (n = 28) or longterm follow-up FR (n = 17). Chest images were divided into four regions for evaluation of image quality, number of lung nodules per region and marked pulmonary structures by receiver-operating characteristics (ROC) analysis (45 patients; 125 nodules; 2810 observations; five readers). Of the nodules selected for an ROC study 82 % were 0.5–1.0 cm in diameter. Overall image quality was rated better for FR concerning lung fields (PA) and mediastinum/hilum (LAT). More lung-field nodules were detected on FR than on SR chest images (P < 0.05). Use of FR was superior to SR in the general identification of nodules (PA chest), especially concerning intermediate (P < 0.01) and subtle abnormalities (P < 0.05), whereas there was no significant difference for LAT chest images. Our results show, that currently FR still has advantages over SR in the detection and identification of subtle lung nodules in routine clinical radiography.

Functional evaluation of swallowing disorders requires rapid imaging modalities. Videofluorography and cinematography are the gold standard, but they have their limitations: no transverse plane imaging is achieved and structural resolution for exact topographic analysis is limited. Three cases preselected by videofluorography were studied to evaluate whether electron beam tomography (EBT) permits more detailed dynamic imaging of swallowing disorders focusing on the mesonasopharyngeal segment, the hypopharynx and the upper esophageal sphincter (UES). Immediately after videofluorographic examination of the oropharyngeal deglutition, EBT is performed. The patient is in a supine position and while the patient swallows a 20 ml bolus of water or diluted iodine containing contrast agent, a sequence of 20 images per level is scanned. The levels, which are determined by using the scout view, are oriented parallel to the hard palate either at the level of the hard palate to image the mesonasopharyngeal segment or just above the hyoid bone to focus on the hypopharynx or at the location of the UES. The scan technique is a single-slice cinemode with a slice thickness of 3 mm (exposure time 100 ms, interscan delay 16 ms, 130 kV, 620 mA). The following structural interactions that we have so far been unable to image can be clearly demonstrated with EBT: (1) during normal swallowing, the mesonasopharyngeal segment is completely and symmetrically closed by the soft palate and Passavant's cushion; (2) lateral hypopharyngeal pouches can be located more precisely; and (3) disorders of the UES can be differentiated into functional or morphologically caused disorders (e.g., goiter or cervical osetophytes). Videofluorography and cinematography are still the gold standard in functional evaluation of swallowing disorders. However, EBT permits dynamic imaging of pharyngeal deglutition in a preselected transverse plane and can give useful additional information concerning functional anatomical changes in the pharynx during swallowing. Further clinical evaluation is needed.

Although echocardiography is mostly applied for the diagnosis of heart tumors there are restrictions concerning the representation of the mediastinal and cardial topography in spite of the usage of transoesophageal echocardiography. Computed tomography (CT) and magnetic resonance imaging (MR) are able to give a full representation of the heart and also the thorax with mediastinum, pleura, and lungs. Not only for the diagnosis of various kinds of heart tumors but also for decisions concerning the therapy, the detection of postoperative complications and development are CT and MR very valuable procedures. The ability to deliver a complete cross-section of all cardial, mediastinal, pulmonal and thoracic structures--in contrast to angiocardiography--and without any anatomic restrictions in contrast to echocardiography--is another advantage of CT and MR. Because of the fullness of information CT and MR supply these procedures are especially used for the detailed planning of operative procedures. They are also a big help in determining whether surgery might have to be excluded because a complete tumor resection is not possible anymore.

The following is based on an experimental animal study of Javanese macaques examined by high resolution CT at the end of 27 months exposure to defined amount of quartz and/or high atmospheric pressure [1].

Video-densitograms of the heart of 46 patients were obtained in three projections; these patients had clinically and angiocardiographically confirmed coronary disease of varying severity, or suffered from cardiomyopathy or were normal. The results were compared with levocardiography. The purpose of the investigation was to determine to what extent abnormalities of movement, seen on levocardiography, can also be demonstrated by video-densitometry. Our results show that video-densitometry, compared with levocardiography, has a sensitivity of 97%, a specificity of 44% and an accuracy of 86%. Video-densitometry provides definite proof of abnormal cardiac movement. The differentiation of hypokinesia from akinesia by the two methods is discussed.

150 patients were examined by the double contrast-technique in drug-induced hypotonia of the stomach. They were examined gastroscopically and at the same time biopsies were taken. Comparison of histological and radiological results was performed. There was found an agreement of 82% in the performance of areae gastricae and the histological diagnosis of chronic gastritis.

In the bovine, the uterus shows prominent circular folds during early pregnancy. These folds protrude into the lumen nearly at right angles to the uterine wall and, reaching a height of about 2-3 cm in some cases, often reach the center of the uterine lumen. Thus the uterus becomes apparently divided into a number of pocket-like chambers. Endometrial folds are usually found in the pregnant as well as the contralateral uterine horn. Intra-uterine features can be well demonstrated on exenterated bovine uteri without injuring the organ by means of nuclear magnetic resonance imaging with a high resolution performance. This technique was used to examine the uteri of 4 heifers on day 26, 28, 32 and 55 of pregnancy, respectively. The 3-dimensional imaging of these uteri demonstrated the presence of crescent-shaped folds usually at right angles to the long axis of the uterine horn. These endometrial folds explain why the allantochorionic vesicle cannot be demonstrated in toto by transrectal sonography during early pregnancy, apparently being subdivided by the protrusions from the uterine wall. It has been found that the uterus is characterized by 2-3 echo-weak compartments around day 25 of pregnancy and by about 4-6 by day 30. The number may yet increase with progressing pregnancy. Histological sections out of the wall of the pregnant and the contralateral uterine horn have revealed that the folds are composed mainly of the endometrium (Tunica mucosa) and the circular muscle (Stratum circulare).

The aim of the present study was to compare left ventricular myocardial changes due to infarcts, as seen by computed tomography (CT), with the clinically well recognised methods, such as electrocardiography and angiocardiography. Our first group consisted of 57 patients with a clinical diagnosis of coronary heart disease, the second group comprised 19 patients with various cardiac abnormalities. The two groups were included in 530 CT examinations of the heart. The sensitivity of CT, compared with the other methods, was 77-100%, its specificity 50-100% in the first group, which had an infarct frequency of 71-82%. In this group a positive predictive value was found in 80-100%. The second group of patients had an infarct prevalence of 13-18% and a positive predictive value of 50-100%. Sensitivity in this group rose to 100% and specificity to 86-100%.

30 patients with myocardial infarction older than three weeks were examined by MRI prior and following intravenous injection of 0.1-0.2 mmol/kg Gd-DTPA, 201TL-SPECT and cineventriculography. Gd-DTPA did not cause any significant change (p less than 0.05) of T2-values for infarcted or non-infarcted myocardium. Compared with this, signal intensity for T1-weighted images increased after the application of the contrast agent both for normal (26 +/- 14%) and infarcted myocardium (33 +/- 16%). The intraindividual signal intensity ratio for infarcted and normal myocardium increased from 1.06 +/- 0.07 to 1.12 +/- 0.09 after the injection of Gd-DTPA. The diagnosis of myocardial infarction by visual analysis of signal intensity was not possible in individual cases. Myocardial infarction could only be visualized indirectly by morphological changes such as wall thinning and aneurysm.

Infection, hemorrhage and adult respiratory distress syndrome (ARDS) are pulmonary complications occurring after remission induction therapy for acute leukemia. The aim of this study was to analyze the incidence of these causes by serial roentgenogram, clinical, microbiological and laboratory tests in 21 patients (pts) with relapsed acute leukemia (18 x myeloid, 3 x lymphoblastic), an AML-pt (acute myeloid leukemia) suffering from secondary leukemia, and three pts with primary refractory leukemia following treatment with intermediate (IM) and high-dose cytosine arabinoside (HD-Ara C), in combination with amsacrine (AMSA) (n = 19), etoposide (VP 16) (n = 5) or Mitoxantrone (n = 1). Eleven out of 25 pts developed pulmonary complications, one of them with massive hemoptysis and roentgenographic signs of pulmonary bleecling, one suffering from protracted shock after a tumor lysis syndrome, two pts showing symptoms of a cardiogenic pulmonary edema complicating severeCandida pneumonia in one case and legionnaires’ disease in the other. Seven of the eleven pts had a noncardiogenic pulmonary edema with respiratory failure 1–14 days after cessation of induction or consolidation therapy. In six of the seven, there were no signs of cardiogenic, infectious or metabolic reasons, inclucling fluid overload, for the pulmonary edema, one had as a contributing factor aCandida infection of the lung. Three of the seven patients recovered, four died (two following IM and two after HD-Ara C). Other adverse side effects, clearly attributable to HD-Ara C, included delirious state (n = 3), generalized erythema (n = 3), acute pancreatitis (n = 2), acute abdomen (n = 1) and conjunctivitis in almost all patients. In conclusion, the most frequent (7/25) and serious complication following HD-Ara C treatment in our series was a toxic, non-cardiogenic edema of the lung. In our opinion, the clinical evidence for this type of toxicity might have been misinterpreted in many instances in the past, and it should draw close attention in the future.

With the introduction of the third generation of CT-Scanners with scanning times of 1 to 6 seconds, CT became a well accepted method in the diagnostics of thoracic and mediastinal diseases. The CT changed and partly replaced some of the well established diagnostic procedures of the mediastinum [8, 10, 17]. To differentiate vascular from nonvascular structures in the mediastinum by CT it is mostly necessary to enhance the blood density by means of an intravenously applied contrast agent. By this means cardiac structures [5] like the interventricular septum, the myocardium, the heart chambers, the coronary arteries, the coronary sinus, the peri-epicardium and the subepicardial space will also become visible.

A primary malignant fibrous histiocytoma of the left atrium was diagnosed in a 27 year old woman. After surgical excision the tumour recurred together with enlargement of the right hilar lymph nodes. The patient was then treated with nine courses of chemotherapy using a combined drug regimen. During the first course the tumour regressed, and after nine courses almost complete remission was achieved. Subsequently, the residual tumour was removed by resection of the right lung, the right hilar, paratracheal, and paraeosophageal lymph nodes and by cardiotomy with partial resection of the right and left atria and atrial septum followed by a reconstruction of the atrias. To date, more than two years after initial presentation, the patient is alive and well.

Computed tomography (CT) is considered an upcoming technology for the quantitative estimation of myocardial perfusion (MPF). Based on previous results that affirm the feasibility of estimating global MPF using a CT scanner in an animal model, this work evaluates the computation of MPF in patients by comparing two different mathematical approaches based on the indicator dilution method. The first, the so called upslope method, was already used in the previous study, the second uses a deconvolution model which possibly is more suitable in the evaluation of regional MPF measurements. A good correlation between both methods could be found and the quantitative results of both methods correspond well to myocardial perfusion values as described in the literature.