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This was a controlled cross-sectional study to investigate the prevalence of dysbaric osteonecrosis (DON) in military divers. MRI examinations of the large joints and adjacent bones were performed in a cross-sectional group of 32 highly experienced military divers and 28 non-divers matched for age and anthropometric data. Additional plain radiographs and follow-up controls were performed in all persons with signs certain or suspicious of DON. In two subject groups (one of divers and one of non-divers), lesions characteristic of DON were detected. From this controlled study, it may be concluded that MRI is a highly sensitive method to detect signs of osteonecrosis. It could be shown that the prevalence of bone lesions characteristic of osteonecrosis in highly experienced military divers is not higher than in non-diving subjects of comparable age. The outcome of this comparably small study group fits to the results of previous extensive studies performed with radiographs. The detected low incidence of DON in this collective may be due to the fact that military divers follow stricter selection criteria, decompression schemes and medical surveillance than commercial divers.

Background: To investigate incidence and number of abnormal cerebral hyperintensities (ACFs) in Magnet Resonance Imaging (MRI) and its relation to a patent foramen ovale (PFO) in divers with no history of decompression illness., Methods: Cohort study on 50 divers (21-5500 dives)., Main Outcome Measures: Incidence and number of ACFs visualized by cranial MRI and presence and size of a PFO as documented by echocardiography and transcranial Doppler ultrasound (TCD) with echocontrast., Results: A total of 137 ACFs was found in the 50 subjects, with a significant correlation between the number of dives and number of ACFs (r = 0.28; p < 0.05); but after correction for age, the remaining correlation (r = 0.15) did not reach significance. In 18 divers, a PFO was present by either the application of echocardiography or TCD; in 12 divers, the PFO was of high hemodynamic relevance. Ten of 18 divers with a PFO had at least one ACF, while in the remaining 32 divers, only 14 had at least one ACF (56% versus 44%, p = NS). Seven of 14 divers (50%) with 4 ACFs had a PFO, compared to 11 of 36 (31%) with less than 4 ACFs (p = NS)., Conclusion: In this cohort of healthy divers, in contrast to an earlier report, no significant association was found between PFO presence and incidence or number of ACFs.

Objective: The purpose of this work was to investigate whether or not navigation abilities are impaired in construction divers and if putative deficits can be related to MRT-verified brain lesions and/or to diving experience., Methods: Nineteen construction divers and 19 controls matched for age, intelligence, and socioeconomic background were studied by use of a "locomotor search through" task which resembled working conditions at ground. The task incorporated a spatial working memory and a spatial reference memory component. Moreover, navigation parameters (i.e., rotational turns, distances traveled, speed of navigation) were derived from the participant's locomotor behavior, which was recorded automatically. Groups were compared by navigation performance, standard neuropsychological tests, and the number of brain lesions obtained by MRT-scans., Results: Divers were widely comparable with respect to neuropsychological test scores, exploration behavior and speed of navigation during testing. Performance deficits in divers were seen in the three test trials with respect to the number of reference memory errors and navigation behavior. Only in controls were age and the number of MRI-verified lesions related to neuropsychological test performance and to maze variables, but in divers the number of lesions seemed to be related to hyperbaric exposure., Conclusion: Despite possible positive selection effects in long-term construction divers, these results may have implications for health care of middle-aged divers who are exposed to critical depths of more than 60 meter sea water (msw).

Purpose: To evaluate the prevalence of cerebral white matter changes on MR imaging in healthy elderly compressed air divers with a long diving history in comparison with control subjects who have never dived., Material and Methods: The investigation employed 59 experienced elderly divers and 48 control subjects matched for age, body mass index, alcohol and smoking history. MR studies included a fluid attenuated inversion recovery sequence and T1- and T2-weighted pre- and postcontrast images in axial orientation of the whole brain to localize white matter changes., Results: MR images did not show any morphologic abnormalities in the brains of divers. Both groups - divers and controls - did not differ significantly with respect to white matter changes of the brain., Conclusion: No increased prevalence of cerebral white matter changes in compressed air divers compared with a healthy worker sample of similar age were found. Thus, extensive compressed air diving may not necessarily be related to radiological changes on MR.

We investigated the association between MR signal abnormalities of the central nervous system, neuropsychologic performance and exposure indices in 20 experienced elderly compressed-air divers who had no history of neurological decompression illness (DCI). Results of MRI of the brain and psychometric testing were compared with 20 matched healthy commercial employees who never dived: 60% of the divers and 45% of the controls had hyperintense MR abnormalities. Among divers, both the number and the size of abnormalities correlated with hours diving in the deep air-diving range of 40-60 m (p < 0.05). Divers' mental flexibility and visual tracking performance were decreased in comparison with controls (p < 0.05 and p < 0.01). Divers thus are at risk of detrimental long-term effects of compressed-air diving on the central nervous system even in the absence of a history of neurological DCI., (Copyright 1999 S. Karger AG, Basel)

Purpose: This investigation was conducted to determine whether MR imaging showed cerebral or spinal damage in acute diving-related decompression illness, a term that includes decompression sickness (DCS) and arterial gas embolism (AGE)., Material and Methods: A total of 16 divers with dysbaric injuries were examined after the initiation of therapeutic recompression. Their injuries comprised: neurological DCS II n = 8; AGE n = 7; combined cerebral-AGE/spinal-DCS n = 1. T1- and T2-weighted images of the brain were obtained in 2 planes. In addition, the spinal cord was imaged in 7 subjects. The imaging findings were correlated with the neurological symptoms., Results: MR images of the head showed ischemic cerebrovascular lesions in 6/8 patients with AGE but showed focal hyperintensities in only 2/8 divers with DCS. Spinal cord involvement was detected in 1/7 examinations, which was the combined cerebral-AGE/spinal-DCS case. There was agreement between the locations of the documented lesions and the clinical manifestations., Conclusion: MR readily detects cerebral damage in AGE but yields low sensitivity in DCS. A negative MR investigation cannot rule out AGE or DCS. However, MR is useful in the examination of patients with decompression illness.