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Initial staging of Hodgkin's disease is crucial to determine the location and extent of disease, and is the hallmark for the choice of treatment. At present, the established radiological technique for staging Hodgkin's disease is computed tomography (CT). Modern multidetector row CT scanners allow fast imaging from the scull base to the groins during a single breath hold with a spatial resolution of approximately 1 mm. Both, nodal and extranodal involvement of Hodgkin's disease can be diagnosed with CT. Magnetic resonance (MR) imaging is another useful cross-sectional imaging modality for staging Hodgkin's disease. The development of fast MR imaging techniques has considerably reduced imaging time without compromising the quality of MR images. As a consequence, MR imaging is now considered to be as diagnostic as CT for staging Hodgkin's disease. The excellent soft-tissue contrast and the lack of exposure to ionizing radiation are the main advantages of MR imaging. For the detection of extranodal Hodgkin's disease, MR imaging is superior to assess involvement of the brain, the spinal cord and bone marrow; while CT allows excellent evaluation of lung disease. Common major problems in staging Hodgkin's disease are still the detection of nodal involvement in normal sized lymph nodes and residual tumor masses after therapy. In the future, newly developed lymphotropic contrast agents for MR imaging might be helpful to answer these questions.

The purpose of this report is to determine the value of a central specialist radiologic review and to determine the image quality of computed tomography (CT) in Hodgkin disease. The HD12 protocol is a multicenter prospective randomized trial of the GHSG for advanced stages of Hodgkin disease. The indication and effectiveness of additional radiotherapy (30 Gy), in the area of initial bulky disease and of residual disease, following intensive chemotherapy using the BEACOPP schema (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone), is to be investigated. A multidisciplinary panel of radiation oncologists, radiologists, and medical oncologists reviews, blinded to treatment arms, the diagnostic imaging with comparison to the documentation forms. For patients with poor response to chemotherapy, the panel recommends radiotherapy independent of the randomization. This procedure guarantees that patients with a poor response to chemotherapy receive additional radiotherapy. Furthermore, the panel evaluates the quality of CT examinations in this multicenter study. Since July 1999, a total of 2607 CT of 371 patients have been evaluated. Helical CT showed significantly higher contrast enhancement and imaging quality than conventional CT (P < 0.001). CT from university hospitals was assessed as superior to that from other institutions (P < 0.001). Compared with the written disease documentation by the study centers, the panel assessed different extensions of disease in 814 of 2607 CT (31%), resulting in a change of stage in 17 of 371 patients (5%). After chemotherapy, 167 of 371 patients (45%) showed residual disease (>1.5 cm), and for 53 of 371 patients (14%) the panel recommended additional radiotherapy independent of the randomization arm. Patients with Hodgkin disease receive high-quality CT imaging. A central independent multidisciplinary panel markedly improves quality assurance for these study patients.

Computer tomography changes after retroperitoneal trauma are described on the basis of 19 patients seen by the authors. It appears that this method is superior to conventional techniques, both as a screening method and for carrying out follow-ups. The indications for angiography are thereby reduced.

To determine whether current concepts of myocardial organization were in fact the result of artifacts introduced by the dissection technique, a method comprising air injection of the coronary arteries (which gently separated the myocardial fibers) and computerized tomography was devised. Viewing the tomographs cinematographically confirmed the concept that the heart is formed by a double looping of myocardial fiber bands was correct. Examination of abnormal hearts, eg, one with Duchenne muscular dystrophy, shows that pathologic tissue disarrangements could also be identified.

The value of computed tomography in the diagnosis of renal traumas is discussed for the individual stages of injury on the basis of 14 patients. it is evident that computed tomography is of great importance for selecting the proper therapeutic procedure. Stage I injuries usually do not require any further clarification if examined by CT. In cases of stage II injuries, short-term CT check up is necessary. Stage III injuries only will continue to require examination by angiography.

Congenital cystic dilatation of the intrahepatic bile ducts--Caroli's syndrome--is a rare disease of which about one hundred cases have been reported in the literature. Based on two observations, the value of various radiological procedures is discussed. Compared with other noninvasive procedures, computer tomography has the advantage of being able to show not only the changes in the liver, but also the changes in the liver, but also the medullary sponge kidney which often accompanies this condition. The indications for ERC can therefore be more strictly defined.

The computer tomographic appearances of space-occupying lesions in the renal pelvis in 15 patients are described, and the place of CT in the radiological diagnosis is discussed. The clinical symptoms of renal tumours are often not characteristic, and conventional radiological methods frequently produce nonspecific appearances. Computed tomography, which is non-invasive, is therefore a suitable method for diagnosing space-occupying lesions in the renal pelvis at an early stage. Prognosis depends greatly on extra-pelvic spread, which can be demonstrated by CT alone.

In a retrospective study the Ct morphology of cholecystocarcinomas, cholangiocarcinomas and papillary carcinomas is discussed on the basis of 36 patients. Particular attention is given to the differential diagnostic criteria.

The myocardial body consists of striated muscle fibers which branch densely to form a spiral substructure. Its functional significance is still subject to discussion. Recently, a model of this looping fiber system has been prepared, starting and inserting at the root of the aorta and of the pulmonary artery. Its arrangement fits well with the component lay out of the coronary and the conductive system. Since it is theoretically possible to produce a macroscopic preparation corresponding to any fascicular substructure in densely woven tissue, we used noninvasive means to ascertain whether, during life, the loop structure within the myocardial body is a dynamic arrangement of fiber trajectories, of which postmortem investigations are able to provide only a static impression. Computer tomography and thermography using coronary gas perfusion showed that the heart muscle contains spiral preferential fiber arrangements circling the ventricular cavities.

Characteristic CT findings of intramedullary, intradural and epidural as well as of vertebragenic and paraspinal tumours are described, basing on literature and on the authors patient material. The value of CT is discussed and compared with that of other imaging modalities. Attention is also drawn to the value of i.v. application of contrast medium and of primary or secondary CT myelography.