Search

We examined 22 intramedullary, 17 intradural extramedullary and 20 extradural lesions, with direct involvement of the spinal cord by magnetic resonance tomography, using surface coils and 5 mm., or narrower continuous sections. Spinecho pulse sequences are suitable for multi-slice examinations. T.1-weighted examinations are suitable for demonstrating the syrinx in syringomyelia, in all other circumstances T1 and T2 sequences are essential. Gd-DTPA is unnecessary. The results of these recommendations are illustrated.

Iohexol has a slightly higher osmolarity in comparison with iopamidol; therefore it might induce a more pronounced diuretic effect and then a better distension of the excretory pathway. A trial was carried out in two groups of 50 patients with normal renal function who underwent urography, namely with 50 ml (15 gI) of iopamidol and of iohexol. No significant differences in the evaluated parameters (nephrography, calyces, pelvis, ureters and bladder) have been found. Both contrast media allowed to perform good quality urographies.

Basing on a follow-up study of 31 fractures of the condylus radialis humeri in childhood, the authors present suggestions for surgical and conservative therapy. Despite the fact that fractures of the condylus radialis are epiphyseal fractures of the Salter III and IV types, conservative treatment is advocated provided the fracture is not or only slightly dislocated and can be reset to produce closure. Kirschner wiring can be employed to prevent possible recurrence of dislocation if such a tendency is suspected. In case of considerably dislocated and rotated fragments, open repositioning and fragment fixation is indicated. To avoid medial instability, such fixation should be accomplished by means of small-fragment screws.

The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.

Visualisation of the renal arteries and image quality of intravenous DSA were evaluated in 62 patients. The left renal artery is visualised less well than overlying more frequently the right renal artery because of gas in the stomach and colon. IV DSA is not adequate for visualisation of the subsegmental arteries, and cannot be used for tumor angiography. It is not possible to prove that central venous injection technique is superior to peripheral venous injection. Patients must be carefully prepared as is necessary for the urogram. Examination is carried out using Buscopan and a compression device.

The opacification of the maxillary sinuses following Caldwell-Luc procedure seen with plain films depends to a great deal on bony changes. Based on 60 cases the advantages of the computed tomography especially in high-resolution mode are described in comparison with plain films. CT-scans clearly demonstrate the bony changes following Caldwell-Luc procedure, they show the size of the air-filled antrum and reveal inflammation of fibrous soft tissue within the sinus maxillares. Computed tomography facilitates differential diagnosis with regard to other pathological changes of the antrum. If radiological examination following Caldwell-Luc procedure is indicated, CT represents the method of choice.

The evaluation of 21 patients with non-Hodgkin-Lymphoma and primary extranodal manifestations involving the orbits, the paranasal sinuses, and the parapharyngeal spaces shows no typical features in malignant lymphoma. The analysis of the morphological features in computed tomography allows no classification of the tumor type. The most important differential diagnoses within the region of the facial skeleton are discussed.

The computerized tomography of 9 cases of neurofibromatosis is compared with routine X-rays. Gliomas of the optic nerve, sphenoidal dysplasias, plexiform neurofibromas and buphthalmos are shown in detail. CT today is an indispensable procedure for the diagnosis of neurofibromatosis of the orbit. Often it is up to the ophthalmologist to initiate CT in collaboration with other disciplines. This holds for diagnosis, surgical interventions and the follow-up examinations.

Dissemination of tumour cells via CSF occurs if there is close proximity of a malignant space-occupying growth to the CSF circulation system. According to the anatomic localisation of the metastases a distinction is made between intra- and extra medullary metastases. Magnetic resonance tomography is a highly sensitive method that can point not only to the pathological process, but also to its localisation and extent, especially if paramagnetic substances are used, to a much more accurate degree than had been possible so far with invasive myelography or computed tomography.

The value of CT was investigated in sixteen children and adolescents with neurofibromatosis affecting the skull and neck. Its advantage is the simultaneous demonstration of bone and soft tissue changes, which frequently occur together in this condition. Demonstration of the extent of the neurofibromatous soft tissue changes is of crucial importance to the surgeon when planning treatment. Serial observations provide information on progress of the disease and helps in the decision of the optimal time for surgery. The differential diagnosis is discussed.

18 patients with avulsions of the medial epicondyle 1 10/12 to 16 2/12 years after trauma are presented. Non-union occurs very often after conservative treatment involving avulsion with or without displacement. Although non-union of the medial epicondyle gives no or only little disability, the fixation with one or two Kirschner wires is recommended to avoid non-union. Open reposition is necessary in cases with injury of the n. ulnaris and in cases with incarceration of the epicondyle in the elbow joint.

The CT findings in 120 patients following trauma to the orbits, and in 60 patients with iatrogenic abnormalities, have been analysed. CT has been found to be extremely useful in the diagnosis of trauma and postoperative changes by its ability to demonstrate fractures, foreign bodies, haematomas, abscesses, soft tissue displacement or perforation of orbital structures, as well as showing prosthetic material.

The typical CT visualisation of silicone implants and prostheses after ophthalmological operations to the eye and orbit are described. Changes following surgery or trauma, such as haemorrhage, inflammation or abscess, are discussed and the difficulties in differential diagnosis are dealt with.

Diagnosis and surgical treatment of a leiomyoma of the small bowel are described. The special findings in this case are the unusual location of this tumors and the fact that histological examination revealed a benign process, although the tumor had a diameter of more than 16 cm.

Based on ten patients suffering from internal jugular vein thrombosis the use of modern radiological procedures is discussed. The clinical examination should be followed by high-resolution ultrasonography. In most cases ultrasonography is able to reveal the correct diagnosis. Complementary computed tomography is recommended, if ultrasonography cannot establish the diagnosis of jugular vein thrombosis or if the thrombosis involves the v. cava superior, respectively the mediastinum. Retrograde catheter venography of the internal jugular vein is unnecessary, phlebography of one or both upper extremities should be completed, if the internal jugular vein thrombosis continues to the v. subclavia or v. cava superior and surgical intervention is discussed.

Standard CT examinations of the orbit and the petrous bone were simulated with a tissue-equivalent human skull phantom on a Somatom DR 2 scanner. The orientation of the scan planes and the scan parameters including thickness, number of slices and mAs were varied according to the assumed diagnostic problems. The total radiation doses in the region of the eye lenses were measured with thermoluminescent dosimeters. If the globes are located within the X-ray field, the total radiation doses received by the lenses increased with the number and the thickness of the slices and the mAs. The highest radiation doses were found in contiguous thin-section scans of the orbit in axial (52 mGy) or direct coronal (47 mGy) orientation. In cases where the globes were located outside the X-ray field, the radiation doses received by the eye lenses could be reduced by a factor of 16, resulting in only 3.1-3.4 mGy for a complete axial study of the inner ear. Recommendations are given how to reduce the radiation exposure to the eye lenses without loss of diagnostical information.

Various types of fibromuscular dysplasia of the extracranial portion of the internal carotid artery are described; morphologically, the common group shows abnormality of the media. The distribution, with sparing of the carotid bifurcation and of the artery in the carotid canal, as well as the sex and age of the patient, are typical. Possible treatment is discussed.

The authors report an extensive recurrent pleomorphic adenoma of the submandibular gland with destruction of the ramus of the lower jaw. The advantages of computed tomography are the possibility of assessing the osseous structures, the extension of the soft parts, and the relation to the adjacent neck structures. Despite the unusual bone infiltration, histological examination did not point to malignancy.