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Joint involvement occurs in most patients with systemic lupus erythematosus (SLE), and severe lupus arthritis is often refractory to conventional treatments. Anakinra is used in the treatment of rheumatoid arthritis, but its therapeutic potential has not been proved in patients with SLE.To determine the safety/tolerability and efficacy of anakinra in patients with SLE with leading joint involvement.In patients with SLE with active polyarthritis and no other uncontrolled systemic/organ manifestations, 100 mg/day anakinra was self administered subcutaneously for 3 months. Disease activity was assessed by VAS, number of swollen/tender joints, ECLAM score, and serological and immunological measures.Four patients with SLE were studied; anakinra was safe in all four patients and no drug related serious adverse events occurred. A subjective benefit was seen in all patients and a trend towards better activity measures after 4 weeks. After an initial response, one patient left the study because of an arthritic flare after 6 weeks.In this study anakinra was apparently safe and well tolerated and led to clinical and serological improvement. Anakinra might be an interesting alternative in individual patients with lupus arthritis not responding to conventional treatments.

In a 65-year-old female patient, B-mode sonography detected a single focal lesion in the right liver lobe with a diameter < 3 cm. Histopathologic examination revealed a low differentiated hepatocellular carcinoma (HCC; G3). Tumor staging was performed by CT (computed tomography) scan and Resovist MRI (magnetic resonance imaging). Both examinations found a single liver lesion without signs of additional focal hepatic lesions. In addition, phase-inversion sonography in the late phase was performed using the ultrasound contrast agent Levovist. This examination of late-phase Levovist uptake detected more than five additional focal hepatic lesions in the right liver lobe, which were invisible by CT scan and Resovist MRI. This finding of multiloculated HCC was very important to decide on the patient's correct therapy. While liver transplantation is the treatment of choice in single HCC < 3 cm, it is contraindicated in multicentric HCC. In the patient described here, hemihepatectomy of the right liver lobe was performed. The histopathologic examination of the resected liver confirmed the diagnosis of multicentric HCC, which was noninvasively diagnosed only by contrast-enhanced sonography, but not by CT scan or MRI.

KEYWORDS:CARS ¥ correlation spectroscopy ¥ diffusion ¥ microscopy ¥nonlinearopticsCorrelationtechniqueshavebeenwidelyappliedformonitoringsignalfluctuationsinadefinedobservationvolume.Thecauseofthefluctuationscaneitherbechangesinthenumberdensityofparticlesintheprobevolumeorchangesintheirspectroscopicproperties.Ingeneral,theobservationvolumeischosentobeassmallaspossibleinordertomaximizetherelativeamplitudeofthefluctuations.Forthisreason,thelastyearshaveseenafruitfulexchange of newdevelopments in microscopyand correlationspectroscopy. Many different spectroscopic techniques, whichhavefirstbeenappliedtoreducetheobservationvolumeortoprovideanewcontrastmechanisminmicroscopyapplications,weresubsequentlyusedforcorrelationspectroscopy.Themostprominent of these developments is the use of confocalmicroscopyincombinationwithfluorescencecorrelationspec-troscopy(FCS).

Background. Magnetic resonance cholangiography (MRC) is a relatively new, non-invasive imaging technique of the biliary tree that has shown good correlation with endoscopic retrograde cholangiopancreatography. The liver manifestation of autosomal recessive polycystic kidney disease (ARPKD) is congenital hepatic fibrosis (CHF). CHF may be accompanied by Caroli's disease, which is characterised by a non-obstructive dilation of the intrahepatic bile ducts. Objective. A prospective study was conducted to determine the presence and extent of Caroli's disease in children with ARPKD. Materials and methods. Seven children with ARPKD aged from 3.0 to 10.1 years were examined. CHF was confirmed in all biopsied cases (5 of 7). All children had been followed by repeated abdominal US examinations for many years. The MR examination included a morphological imaging study using a T2-weighted turbo spin-echo sequence and a heavily T2-weighted inversion-recovery turbo spin-echo sequence with three-dimensional maximum intensity projection (MIP) reconstructions for MRC. Results. The diagnosis of Caroli's disease could be made in one case by US; in two other children Caroli's disease was suspected, but the differentiation from hepatic cysts was not possible. By MRC, Caroli's disease could be diagnosed in three of seven children. Furthermore, MRC with MIP reconstructions demonstrated the extent of the disease by showing the entire biliary tree from different angles. Conclusions. MRC is a valuable method to establish the diagnosis and demonstrate the extent of Caroli's disease.

PURPOSE Is there a loss of information when using selenium radiographic images displayed with reduced image format compared to full format? METHOD Digital selenium radiographic chest images in two planes were obtained in 35 patients for medical reasons. The digital data sets of each patient were separately displayed in full format on two different films and were printed in reduced format on one film. The format was reduced to 61% of the full format using an acquisition matrix of 2166 x 2488 pixels, an image display matrix of 4000 x 5000 pixels and a film format of 43 x 49 cm. All images were anonymously evaluated by four independent readers using a questionnaire concerning anatomic structures. RESULTS Format reduction did not result in a loss of information in diagnostically relevant anatomic details. CONCLUSIONS Displaying digital selenium radiographic data sets of thoracic view in two planes on one film presumably does not lead to a loss of diagnostic information. This procedure may help to reduce film costs.

PURPOSE Our goal was to investigate the value of T2-weighted fast SE (FSE) sequences, FSE sequences with shortened echo spacing (UFSE), combined gradient and spin echo sequences (GRASE), and segmented T1-weighted echo planar imaging (EPI) in comparison with conventional SE sequences in the detection of focal liver lesions. METHOD Thirty-five patients with malignant focal liver lesions underwent MRI at 1.0 T. RESULTS All fast T2-weighted imaging techniques (FSE, UFSE, GRASE) showed fewer artifacts and overall better image quality than the conventional SE sequence. Quantitative analysis demonstrated that UFSE imaging had the highest tumor/liver contrast/noise ratio (C/N) (13.9 +/- 5.5) followed by FSE (12.7 +/- 4.5), T2 SE (10.9 +/- 4.2), and GRASE (10.0 +/- 4.8) sequences. The differences in C/N between the UFSE and T2 SE sequences was statistically significant (p < 0.05). C/N was significantly higher (p < 0.01) for the T1 SE (-7.4 +/- 3.8) than for the EPI sequence (-0.5 +/- 5.6). CONCLUSION FSE sequences with shortened echo spacing are valuable for liver imaging at 1.0 T. In comparison with the T2 SE sequence, they yielded better image quality and comparable tumor/liver C/N.

PURPOSE: To evaluate the value of rapid T2-weighted turbo-spin sequences (TSE), turbo-spin-echo sequences with shortened echo spacing (UTSE), gradient-and-spin-echo sequences (GraSE) and T1-weighted echo-planar imaging (EPI) in comparison with conventional spin-echo sequences (SE) in the diagnosis of focal liver lesions. METHODS: 20 patients with malignant focal liver lesions underwent magnetic resonance imaging at 1.0 tesla. RESULTS: The use of fast T2-sequences (TSE, UTSE, GraSE) reduced the examination time to about 35-50%. Artifacts were reduced compared with the conventional T2-SE sequence. Quantitative analysis demonstrated that UTSE imaging had the highest tumor/liver contrast-to-noise ratio (CNR) followed by TSE, T2-SE and GraSE sequences. CNR with EPI was lower than with the T1-SE sequence (p < 0.05). CONCLUSION: Turbo-spin-echo sequences with shortened echo spacing yield a shorter imaging time and improved image quality without loss of signal intensity in tumor/liver-CNR, compared with conventional T2-pulse sequences in liver imaging at 1.OT.

Purpose: The purpose of this study was to determine the ability of noninvasive imaging methods to localize focal liver lesions to specific hepatic segments. Material and Methods: In a prospective study we evaluated 24 patients with hepatic masses with ultrasonography (US), spiral CT and MR imaging. Results: The primary segmental location of the lesions was correct with US in 15 of 24 patients (63%), with CT in 21 of 24 patients (88%) and with MR imaging in 17 of 22 patients (77%). The full extent of the lesions was correctly described with US in 9 of 24 patients (38%), with CT in 16 of 24 patients (67%) and with MR in 12 of 22 patients (55%). Conclusion: Among the noninvasive imaging methods, CT provides the best information for determining the segmental location and planning the surgical approach to I hepatic resections. The major role of the radiologist in evaluating hepatic neoplasms is to assist the surgeon in determining the feasibility of hepatic resection. Although the segmental location and extent of the tumor are not the sole criteria of resectability, this knowledge is useful for preoperative planning of the type of resection. An understanding of the segmental hepatic anatomy is essential for locating hepatic masses. Delineation of the vascular anatomy defining the lobar and segmental demarcation lines has been assessed with US, CT and MR imaging (3-6, 9, 10, 12). Our study evaluated the ability of noninvasive imaging methods to localize focal liver pathology to the hepatic segments.

PURPOSE The purpose of the study was to determine the value of computed tomography (CT) in demonstrating fistulae in comparison with conventional radiographic methods. METHODS In a prospective study 25 patients were evaluated by conventional radiographic methods and CT. RESULTS The identification of the fistulous tract was possible with CT in 27 of 29 cases, whereas 2 fistulae could only be detected by indirect signs. Furthermore, CT showed a larger extent of the fistulous tract in 5 patients and revealed complications such as inflammatory mass, abscess or osteomyelitis in 11 cases. CONCLUSION CT seems to be superior in demonstrating the extent of a fistulous tract and provides valuable information on the surrounding structures.

Objective : Our goal was to optimize the efficiency of contrast material (CM) application in routine examinations of the neck by the use of spiral CT and slow power injection. Materials and Methods : Dynamic studies were performed in 14 patients to establish a set protocol for spiral CT examinations of the neck. Prospectively, 100 patients were examined either by use of the spiral technique with 100 ml CM (30 g iodine) injected in two phases or in conventional CT with 150 ml CM (45 g iodine). Vascular and parenchymal enhancement was evaluated at three distinct levels of the neck. Results : Despite the reduced CM volume in spiral CT, vascular enhancement was significantly higher at all three levels. Parenchymal enhancement was comparable in both groups. CM exploitation in vascular opacification (ratio of mean enhancement to applied CM volume) was 0.87 in spiral CT compared with 0.43 in conventional CT. Conclusion : Spiral CT significantly increases the efficiency of CM application and is well suited for routine examinations of the neck.

PURPOSE To determine the value of standard chest radiographs in the assessment of cardiac size. METHODS In 193 patients cardiac size was compared between standard chest radiographs in the posteroanterior and lateral projection and left ventricular angiograms. The following parameters were determined: transverse diameter, lateral horizontal transverse diameter, cardiothoracic ratio and end-diastolic volume index (EDVI) and ejection fraction (EF). RESULTS Subjective assessment of the left ventricular size resulted in a mean sensitivity/specificity/accuracy of 69.7%/87.4%/82.0% respectively, in comparison to EDVI. Estimation of global heart size yielded a mean sensitivity/specificity/accuracy of 48.8%/93.6%/77.8%, respectively, in comparison to EF. Cardiothoracic ratio for the detection of pathological EDVI or EF had a sensitivity of 77.3%/57.4% a specificity of 79.3%/80.8% and an accuracy of 78.9%/72.5%. CONCLUSIONS Standard chest radiographs with the determination of cardiothoracic ratio remain a clinically relevant procedure for screening and follow-up of heart disease.

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.

We present a novel experimental method for studying photochemical reactions that involve permanent products. The accumulation of photoproducts facilitates the measurement of extremely small product yields. A calibration of the setup accounts for diffusion effects, and the experimental results can be expressed in terms of single-pulse photochemical efficiencies. A demonstration experiment on indocyanine green (ICG) is presented. The general method is suited both for femtosecond spectroscopy and quantum control experiments.

Objective: In our multicenter trial we compared the potentials of biphasic contrast-enhanced computed tomography (CT) and a novel tissue-specific magnetic resonance imaging (MRI) contrast agent gadoxetic acid disodium in liver lesion characterization. Methods: A total of 176 patients with 252 liver lesions were analyzed. There were 104 malignant and 148 benign lesions. High-field strength (1.0 T or 1.5 T) MR systems with Tl-and T2-weighted sequences were used with and without fat suppression. After gadoxetic acid disodium injection, dynamic imaging and hepatocyte phase MR imaging were performed. Biphasic with 150 mg I/kg of body weight (100-200 mL) spiral CT was also performed. Image reading consisted of on-site (by study investigators) and fully blinded off-site (by E.S.P; C.R; and A.S) evaluations. The classification (benign or malignant) and characterization (lesion type) outcomes of both techniques were assessed. All imaging results were verified against a standard of reference. Results: Both on-site and off-site evaluations demonstrated increases in the lesion classification accuracy with gadoxetic acid disodium-enhanced MRI when compared with spiral CT. This improvement was also shown for characterization. Gadoxetic acid disodium was well tolerated. Conclusions: Gadoxetic acid disodium offers a safe and diagnostically powerful tool for the evaluation of patients with focal liver lesions with a reliable assessment of lesion classification and characterization.

Purpose: To evaluate the ability of contrast-enhanced magnetic resonance imaging (MRI) with Gd-EOB-DTPA in comparison with non-enhanced imaging and spiral computed tomography (CT) to provide additional information for classification and characterization of hepatocellular carcinoma. Material and Methods: Forty patients with histopathology-proven hepatocellular carcinoma were selected for this subgroup analysis from a phase-III multicenter study in 235 patients with known or suspected liver lesions. The primary analysis was comparison of the proportion of hepatocellular carcinoma correctly classified and characterized by combined pre-/post-contrast MRI compared with pre-contrast MRI alone or with spiral CT. All images were evaluated on site, and in a blinded reading by three independent readers off site. Results: In the on-site evaluation, the lesions were correctly classified as a malignant tumor with combined MRI in 90.3%, with pre-contrast imaging alone in 82.9% and with spiral CT in 87.8% (n.s.). The proportion of correct characterization (lesion type diagnosis) with combined MRI was 85.4%, 75.6% for pre-contrast imaging, and 77.5% for spiral CT (n.s.), respectively. In the blinded reading, one reader showed a significant increase in the proportion of correctly characterized lesions by 27% ( P Conclusion: With regard to lesion classification, no difference was found between combined pre-/post-contrast MRI and spiral CT. A non-significant trend in favor of Gd-EOB-DTPA-enhanced MRI with regard to characterization of hepatocellular carcinoma was found, although the CT scans were not optimized as the MRI scans.

The authors report on the occurrence of a focal demyelination showing a mass effect around a developmental venous anomaly in the cerebellum. Because the latter presented as a single lesion, the differentiation from intraparenchymal neoplasms or infarction was difficult. Follow-up magnetic resonance imaging and histology from a biopsy specimen give useful information to find the appropriate diagnosis.

A 48-year-old woman presented with chronic intermittent abdominal pain and moderate weight loss. She had a history of fibromyalgia syndrome and vaginal hysterectomy. A 6-month-old computed tomography scan showed a cystic mass 5 cm in diameter with no relation to any solid organ in the left middle abdomen (Figure A). A second CT scan performed after admission showed a mass of 7 cm in diameter now in the right middle abdomen (Figure B). Mobility of the mass was confirmed by sonography because its location was dependent on the position of the patient. Physical examination and standard laboratory tests revealed no abnormalities. Laparotomy revealed a cystic mass adherent to the mesentery of the jejunum (Figure C), which was enucleated without complications. Histology revealed the diagnosis of a benign mesenteric pseudocyst. Mesenteric pseudocysts are a subgroup of the mesenteric cysts, rare intraabdominal tumors subdivided into several groups of distinct etiology.1 The differential diagnosis includes gastrointestinal stromal tumors, teratomas, cystic mesotheliomas, abscesses, and parasitic cysts. Of the symptoms associated with mesenteric cysts,2 our patient exhibited intermittent abdominal pain and moderate weight loss, but no nausea and vomiting. On imaging studies, intraabdominal mobility, a rather thick wall, and sedimentation of the cyst contents, as found in this case, are frequent features of mesenteric pseudocysts.1 Complications include rupture, torsion, infection, and, rarely, malignant transformation.3 Surgical excision by open laparotomy or laparoscopy is generally recommended.2

Fluorescence correlation spectroscopy (FCS) has turned out to be a useful tool for investigations of the population of dark states of the GFP. Using common FCS techniques, it is however not possible to reveal the nature of the dark state. We developed a simultaneous two-color excitation scheme which allows us to collect information about the dark state absorption spectra. Apart from the identification of dark states, two-color FCS opens up ways for the detailed investigation of the photodynamics of molecules with multiple dark states. It will be shown how the increase in fluorescence signal obtained by double resonance excitation can be exploited for obtaining brighter images in live cell and single molecule microscopy. The experimental setup employed for the two-color excitation can easily be extended to generate non-linear vibrational contrast. First examples of this new Coherent Anti-Stokes Raman Scattering (CARS) correlation spectroscopy will be presented.© (2002) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Purpose To evaluate the diagnostic value of MR imaging in abdominal lymphoma staging, in comparison with that of the established spiral CT, within the context of a prospective study. Methods 50 patients with non-Hodgkin (n = 27) and Hodgkin lymphoma (n = 23) were examined with a plain T2-weighted TSE sequence (parameters: TE 90 ms, TR >2.500 ms, slice thickness 8 mm, slice interval 0.8 mm, ETL 20, NEX 4), and with spiral CT following oral and intravenous administration of contrast agent. Results Both CT and MR imaging agreed in showing abdominal lymphomas in 34/50 cases. The size of the detected lymphomas was between 1.5-9 cm (mean: 4.3 +/-2.2 cm). In the analysis of the individual lymph node sites, CT showed involvement of the paraaortic lymph nodes in 29/50 patients, compared with 28/50 in MRI, and involvement of the portal lymph nodes in 15/50, compared with 12/50. Both techniques showed the iliac lymph nodes in 21/50 patients, the inguinal lymph nodes in 10/50, and the mesenteric lymph nodes in 11/50. Both techniques also showed focal organ lesions in 12/50 cases. Conclusions In the staging of abdominal lymphomas, MR imaging with a T2-weighted TSE sequence can be regarded as equal to spiral CT in the detection of lymph adenopathy and the demonstration of focal organ lesions. In addition to the absence of ionizing radiation, the advantage of MR imaging is that there is no necessity for oral or intravenous administration of contrast agent.

Our purpose was to analyze and compare the image quality and contrast-to-noise ratio (CNR) of different fast T1- and T2-weighted sequences with conventional spin-echo sequences in renal MRI. Twenty-three patients with focal renal lesions were examined with a T2-weighted ultrafast turbo spin-echo (UTSE) sequence with and without frequency selective fat suppression (SPIR), a combined gradient-and-spin-echo sequence (GraSE), and a conventional spin-echo sequence (SE). In addition, T1-weighted images were obtained pre- and postcontrast, using a fast spin-echo sequence (TSE) with and without SPIR and the conventional SE sequence. Among the T2-weighted images, the highest CNR and the best image quality were obtained with the UTSE sequence, followed by the fat-suppressed UTSE sequence. GraSE and conventional SE sequences showed a significantly lower CNR and image quality (p < 0.05). The T1-weighted sequences did not show significant differences, in either precontrast or postcontrast measurements. T2-weighted UTSE with and without fat suppression combined excellent image quality and high CNR for imaging and detection of renal lesions. The T1-weighted fast sequences provided no alternative to the gradient-echo or to the conventional SE sequences. The results of this systematic study suggest the use of T2-weighted fast techniques for improved diagnostic accuracy of renal MRI.

To assess the influence of Mangafodipir Trisodium on the imaging properties of abdominal organs when using T1-weighted gradient-echo (GE) and T2-weighted turbo spin-echo (TSE) sequences, thirty patients with focal lesions in the liver were examined at a field strength of 1.5 T before and after intravenous administration of Mangafodipir Trisodium (dose: 5 micromol/kg of body weight). Administration of Mangafodipir Trisodium led to a significant increase in the signal intensity of the liver tissue (p < 0.001), the spleen (p < 0.01), the pancreas (p < 0.001), and the kidneys (p < 0.001) in the T1-weighted GE sequence, while there was no relevant enhancement in fatty tissue and the musculature. In the T2-weighted turbo spin-echo sequence, there was no relevant change in the signal following administration of a contrast agent. The contrast-to-noise ratio (C/N) between the lesions and the liver tissue increased significantly in the post-contrast T1-weighted GE sequence (p < 0.001), while there was no change in the contrast-to-noise ratio in the post-contrast T2-weighted turbo spin-echo sequence. The contrast-to-noise ratio of the plain T2-weighted TSE sequence was significantly higher than that in the post-contrast T1-weighted GE sequence (p < 0.001). Although Mangafodipir Trisodium was primarily developed as a hepatobiliary contrast agent for demonstration and differentiation of liver lesions, it also affects the signal levels in the pancreas, spleen, and kidneys in the T1-weighted image. Awareness of this effect on the extrahepatic tissue makes it easier to interpret pathological findings in magnetic resonance imaging (MRI) of the abdomen.

Dermatomyositis (DM) is an inflammatory microangiopathy, affecting particularly the skin and muscles. The incidence ranges from 0.2 to 1.0/100 000; an overlap with other connective tissue diseases such as systemic sclerosis has been described, as has an association with cancer. Clinically DM is identified by a characteristic rash and a varying muscle weakness. The clinical diagnosis is confirmed by typical muscle histology.1 A 60 year old man was admitted to our department with a 2 week history of muscle weakness, myalgias, dysphagia, a heliotrope rash on the eye lids, and bilateral acral finger ulcers. Creatine kinase (3879 U/ml, normal

The purpose of our work was to provide data on the recurrence of resected benign hepatic lesions and to evaluate the value of follow-up examinations in this group of patients. From August to October 1993, 75 patients who had been admitted for liver surgery for benign tumors between 1975 and 1993 were controlled by physical examinations, serological tests, US, and, in the case of equivocal US findings, by CT. The histological diagnoses of the operative specimen included hydatidosis in 43 patients, focal nodular hyperplasia (FNH) in 12 patients, liver cell adenoma in 8 patients, cavernous hemangioma in 8 patients, and congenital cyst in 4 patients. Hepatic scars were observed in 36 of the 75 patients. Four cases of intrahepatic recurrence and 1 case of intraperitoneal spread were observed in the 42 patients with recent hydatosis. Long-term postoperative controls (specific serological tests, US) are necessary in the management of patients with hydatid disease. Follow-up examinations are not indicated in asymptomatic patients who have been operated on for FNH, hemangioma, or congenital cysts.