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Aim: To establish the diagnostic accuracy and adequacy of fine needle aspiration cytology (FNAC) within a regional cancer network, and to determine what service improvements may be required to allow successful implementation of an FNAC-based, ‘one-stop’ head and neck clinic, as proposed by the current National Institute for Clinical Excellence guidelines.Materials and methods: The Sussex cancer network serves a population of 1 200 000 and contains five hospitals within three acute trusts. In 2004, an audit was undertaken retrospectively to examine the diagnostic adequacy and accuracy of head and neck FNAC across the network. Comparisons were then made with the results of subsequent relevant surgery. For the purposes of the audit, FNAC was subdivided into three main groups: salivary gland, thyroid gland and neck node. As part of the data analysis, we also noted the clinical source of the FNAC and whether it was performed blind or under image guidance.Results: In 2004, 712 FNAC procedures were undertaken in 647 patients, 276 of whom underwent subsequent surgery. Fine needle aspiration cytology was non-diagnostic in 52 per cent of patients in the neck node group, in 50 per cent in the salivary gland group and in 30 per cent in the thyroid group. With these non-diagnostic results removed, statistical analysis was performed on data from those patients who had undergone both FNAC and subsequent surgery. This gave a sensitivity of 89 per cent and a specificity of 57 per cent in the neck node group, a sensitivity of 64 per cent and specificity of 100 per cent in the salivary gland group, and a sensitivity of 62 per cent and specificity of 86 per cent in the thyroid group. Diagnostic problems with FNAC were noted, particularly in the differentiation of reactive nodal hyperplasia from lymphoma and in diagnosing follicular thyroid lesions. Ultrasound guidance was used in 50 per cent of the thyroid FNAC procedures but in only a minority of patients in the neck node and salivary gland groups.Conclusion: This audit demonstrated widespread diagnostic difficulties associated with head and neck FNAC in a large patient sample. It is likely that these problems will be mirrored in other cancer networks. In order for one-stop head and neck clinics to succeed, the non-diagnostic rate of FNAC in particular must be minimised. There are strategies to enable this, depending on local resources, including increased access to cytologists or cytology technicians, diagnostic ultrasound, image guidance for FNAC and the use of ultrasound-guided core biopsy.

PURPOSE: To evaluate a new coronary MR angiography technique covering the whole coronary artery tree in one data set acquisition. MATERIALS AND METHODS: Six healthy volunteers and 15 patients with known CAD were examined with a navigator gated and corrected (NAV) free-breathing 3D steady-state free precession sequence covering the whole heart (WH-MRA) (TR = 5.4, TE = 2.7, SENSE factor = 2, 160 slices, 0.75 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time 14 min [50 % NAV efficiency]) and a vessel targeted 3D SSFP MRA sequence (t-MRA) (TR = 5.6 ms, TE = 2.8 ms, 20 slices of 1.5 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time = 7 min [50 % NAV efficiency]). Subjective image quality (4-point scale) and objective image quality parameters including vessel sharpness, vessel diameter and CNR were calculated for WH-MRA and t-MRA. In patients, the accuracy for detection of stenosis larger than 50 % was compared to the accuracy of X-ray coronary angiography (XA), which was considered the standard. RESULTS: WH-MRA demonstrated good vessel visibility in healthy subjects (100 %) whereas vessel visibility in patients was limited (78 % in an 8 segment evaluation). Vessel sharpness was inferior to that of t-MRA in patients (37 vs. 42 %) but equal in healthy subjects (42 %). Vessel diameter did not differ significantly between WH-MRA and t-MRA. CNR was significantly reduced for WH-MRA (CNR 7.4 vs. 11.5). The diagnostic accuracy for the detection of CAD was comparable for both MRA approaches (85.5 vs. 86.2 %). CONCLUSION: WH-MRA allows good coronary artery visualization in healthy subjects and patients and provides a simplified scanning procedure and advantages in 3D post-processing. Regarding image parameters and the detection of CAD, the results are comparable to those acquired with t-MRA. The major disadvantage remains the high number of diagnostically insufficient images.

During the BALTEX BRIDGE Campaign (BBC) of CLIWA-NET, conducted at Cabauw, The Netherlands, from 1 August through 31 September 2001, cloud radar parameters like reflectivity, linear depolarization ratio and Doppler velocities have been observed using a 95 GHz cloud radar. These observations along with other remotely sensed parameters from the ground, have been used to derive the liquid water content of clouds which is one of the most important parameters to be known when the radiative transfer of clouds needs to be calculated. Simultaneously a multi-channel passive microwave radiometer and a lidar ceilometer have been operated close to the radar. While drizzle could be ruled out to have a significant impact on the return signal, corrections due to atmospheric absorption (gaseous) and attenuation due to clouds (mainly loss of signal due to absorption) had to be applied to the radar data. The corrections will be discussed in detail and have been applied to the radar reflectivity profiles before estimating cloud liquid water profiles. After the liquid water content profile has been calculated (for a fixed integrated liquid water path) the maximum in liquid water content of the cloud increased by about 14% and shifted upward within the cloud. The applied corrections bring the liquid water profile closer to adiabatic in the middle and upper part of the cloud. Examples of time series of corrected vertical profiles and average profiles are shown and are discussed. The ground based remotely sensed liquid water profiles show, on average, excellent agreement with simultaneously in situ measured liquid water content from aircraft measurements.

ZusammenfassungViele Beobachtungsstudien haben eine übermäßige Gewichtszunahme nach Tonsillektomie oder Adenotonsillektomie bei Kindern beschrieben. Folgende mögliche Gründe werden diskutiert: weniger Atemarbeit, vermehrte oder veränderte Nahrungszufuhr, weniger körperliche Aktivität, Operationszeitpunkt zu einer kritischen Phase für die Entwicklung einer Adipositas und hormonelle Veränderungen. Bis jetzt konnte aber noch keine Studie einen kausalen Zusammenhang herstellen. Dennoch sollten HNO- und Kinderärzte den postoperativen Gewichtsverlauf ihrer Patienten aufmerksam verfolgen.

Clouds are important for global climate since they have a strong impact on solar and terrestrial radiation as well as on the formation of precipitation. The different types of clouds in the atmosphere are linked to the climate system by a multitude of dynamical and thermodynamical processes including numerous feedback mechanisms. In present-day climate, on average, clouds cool our planet, the net cloud radiative forcing at the top of the atmosphere is about -20 Wm -2 . One of the most interesting questions concerning clouds is: how will they respond to a change in climate? A slight change in cloud amount or a shift in the vertical distribution of clouds might have a considerable impact on the energy budget of the Earth. The Third Assessment Report of the Intergovernmental Panel on Climate Change (IPCC) states clearly that cloud processes and related feedbacks are among the physical processes leading to large uncertainties in the prediction of future climate. The main reason for this is that many microphysical and dynamical processes controlling the life cycle and radiative properties of clouds are not adequately implemented in global climate models. The interaction of aerosols and clouds and the resulting radiative forcing (indirect and semi-direct aerosol effect) is one of the major fields of active cloud research at present. This chapter introduces various aspects of the cloud-climate relation and summarizes the discussions of topics currently under scientific debate.

Neuroimaging studies have demonstrated activations in the anterior cingulate cortex (ACC) related to the affective component of pain, but not to stimulus intensity. However, it is possible that the low spatial resolution of positron emission tomography, as used in the majority of these studies, obscured areas coding stimulus intensity. We revisited this issue, using a parametric single-trial functional magnetic resonance imaging design, and investigated pain, stimulus intensity, and stimulus awareness (i.e., pain unrelated) responses within the ACC in nine healthy volunteers. Four different stimulus intensities ranging from warm to painful (300-600 mJ) were applied with a thulium yttrium-aluminum granite infrared laser in a randomized order and rated by the subjects on a five point scale (P0-P4). Pain-related regions in the ventral posterior ACC showed a response that did not distinguish between innocuous trials (P0 and P1) but showed a positive linear relationship with the blood oxygenation level-dependent contrast signal for painful trials (P2-P4). Regions in the dorsal anterior ACC along the cingulate sulcus differentiated between P0 (not perceived) and P1 but exhibited no additional signal increase with P2; these regions are related to stimulus awareness and probably to cognitive processing. Most importantly, we identified a region in the dorsal posterior ACC showing a response that discriminated between nonpainful trials (P0 and P1); therefore, this region was simply related to basic sensory processing and not to pain intensity. Stimulus-related activations were all located adjacent to the cingulate motor area, highlighting the strategic link of stimulus processing and response generation in the posterior ACC.

The perioperative use of anticoagulants (AC) and platelet aggregation inhibitors (PAI) in the field of spinal surgery suggests an increased rate of epidural bleeding. However, evidence is lacking and these medications are most often indispensable in the prevention of thromboembolic complications. Comprehensive recommendations for the correct use of AC and PAI are lacking.The aim of this study was an analysis of the current situation with regards to the use of AC and PAI in spinal surgery and development of new recommendations.Two independent surveys on the perioperative use of AC and PAI were obtained from centers for spinal surgery in Germany. The study obtained information on the perioperative use of AC and PAI, risk assessment of thromboembolic and hemorrhagic events as well as on the type and extent of the substance groups used.Almost the entire patient collective (98%) received perioperative low molecular weight heparin. In 64% the medical prophylaxis was started before surgery and in 36% after surgery. The period of prophylaxis was determined arbitrarily. Approximately 40% of interviewees employed paravertebral infiltration and 19% injected into the epidural space in patients on PAI medication. Open spinal canal surgery was performed in 30% of PAI medicated patients and closed spinal canal surgery was executed in 40%. The risk assessment of PAI differed significantly between aspirin and receptor blocker medication as well as dual administration of PAI.The use of AC and PAI in spinal surgery in Germany is very heterogeneous and large deviations from the guidelines frequently occurred. Therefore, there is a strong need for further studies to accurately assess the perioperative use of AC and PAI and to formulate precise recommendations.

We report a case of a 76-year-old woman with metastases to both parotid glands almost 25 years after mastectomy and chemotherapy for primary carcinoma of the breast. Immunohistochemical staining is invaluable in establishing the origin of metastatic deposits, in this case, expression of oestrogen receptors in a previously resected adenocarcinoma of the breast. The information can be used to target treatment accurately in selected cases of advanced malignancy.

In this study, data obtained from measurements with a ground-based vertical-pointing 95-GHz polarimetric cloud radar are analyzed. The investigations concentrate on the relationships between the Doppler spectral moments observed in different regions of nonprecipitating cirrostratus and altostratus decks connected with warm fronts approaching the radar site. In some of these cases, a remarkably well-defined relationship between the radar reflectivity and the spectral width is found. It is demonstrated how this relationship can be used to obtain information on the size distributions and the fallspeeds of the particles in the investigated cloud sections. It is found that if single parameters of the size distributions, for example, are parameterized by a lognormal distribution, they cannot be determined with an acceptable accuracy. However, at least the changes of these parameters, such as mean particle diameter and particle concentration, with changing reflectivity as well as the behavior of the cor...

Cloud radars operating at millimeter wavelengths have proven to be invaluable for studying the 3-dimensional distribution of stratiform clouds. An improved knowledge of the occurrence of multiple cloud layers as well as of heights of their upper and lower boundaries is important for the determination of radiative fluxes with a higher accuracy. In this study measurements with the 95 GHz radar of GKSS Research Centre, Geesthacht, are used to determine base and top heights of layers of different cloud types. However, an accurate retrieval of cloud boundaries by remote sensors is not obvious, e.g., it is known that simultaneous measurements of the radar and backscatter lidars often show significant differences in cloud base heights. Reasons for inaccuracies in the determination of cloud boundary heights are discussed. Possibilities for corrections are illustrated that will finally lead to more reliable cloud boundary statistics necessary to improve radiative transfer calculations within large-scale weather forecasting and climate models.

Comparisons have been made of the cloud profiles obtained from the backscatter signals of a 95-GHz radar and a 720-nm lidar system between 23 May and 4 November 1997 at Geesthacht (53°24′ N, 10°26′ E). Although the wavelengths of the two systems differ by a factor of 4 000, remarkably similar data have been obtained in many cases. There are differences, though. Small droplets do not interact significantly with the radar pulses, and hence can only be seen by the lidar due to their strong scattering in the UV/VIS. On the other hand, attenuation of the lidar pulses by underlying clouds and gas absorbers makes upper cloud regions and especially cloud top heights better detectable for the radar. Rain and snow falling out of a cloud and evaporating on the way down cannot be distinguished from the cloud region by the radar, but a fast downward component in the Doppler spectrum is indicative of precipitation in or under a cloud. For quantitative cloud studies collocated radar-lidar systems considerably add to the experimental capabilities of each of the two systems alone.

Today there are different subcutaneous and three oral applicable medications for prevention of venous thromboembolism after knee and hip replacement. It is a general opinion that patients will prefer oral administration. However, until today there has been no study that analysed patient preferences and motives for deciding on the kind of administration. These data would be of interest since the consideration of patient preferences could improve adherence. The present study analysed patient preferences regarding oral or subcutaneous administration of medication after elective hip or knee replacement surgery. The results will have implications for clinical practice and for decision-making concerning the kind of administration.This prospective, multi-centric, observational study was conducted in six emergency hospitals and six rehabilitation hospitals. 178 current hip and knee replacement patients undergoing thromboprophylaxis and at least one further oral medication were interviewed. Subjective assessment data of patients were collected on study-specific questionnaires (epidemiological data, amount and background of general oral medication, details on subcutaneous thromboprophylaxis, preference of administration, causes for preference).71.91 % of the interviewed patients preferred the daily intake of a tablet, whereas only 14.61 % favoured the daily subcutaneous injection. Main causes for the preference of oral administration were easier (86.6 % of nominations) and less complex (73.1 % of nominations) handling. 70.9 % reported that one more oral application would be unproblematic. Painlessness of oral administration was relevant for 65.7 %. Causes for preferring subcutaneous administration were "safety" (55.3 % of nominations) and an assumption of a generally better effectivity of subcutaneous (47.4 % of nominations) administration. Subjective discomfort induced by subcutaneus administration increased with the time interval since surgery. Less than 5 % of patients prefer subcutaneous administration due to the high volume of their existing oral medication.Patient approval of oral administration is governed by practical and comfort issues. In general, patients on existing oral medications are uncritical concerning a temporary additional oral medication. The clear discomfort measured in association with subcutaneous administration supports the idea that the oral route will have advantages for patient adherence. In particular this is of relevance with increasing time interval since surgery. Patients who have a very high volume of oral medications will probably profit from subcutaneous administration. The main reasons that patients gave for the preference of subcutaneous administration are based on incorrect knowledge. Therefore it is necessary to improve patient education concerning the existing alternatives for thromboprophylaxis.

In-situ measurements with the counterflow virtual impactor (CVI) during the ICE-89 campaign are presented. These include measurements of size distribution of ice crystal residues and independent measurements of crystal number concentration and cloud water content (CWC). The investigated clouds appeared to consist predominantly of small ice crystals with a number density weighted radius of mean mass (RMM) of less than 30 μm. This is also supported by a comparison of the CVI and concurrent PMS 2D2-C probe data. Crystals number concentrations and CWC were low and typically less than 301 −1 and 3 mg m −3 respectively. The flight average residual size distributions, as measured by the PMS ASASP-X-SP, showed two very distinct modes around 0.17 μm and 0.35 μm radius. A closer look at the evolution of the residual distribution as a function of time, revealed that the modes usually do not appear together, but rather excluded each other.

Degenerative spondylolisthesis (DS) is a common cause of lumbal and lumbosacral pain as well as radicular pain. Retention and fusion is a good treatment option. Some patients have a symptomatic adjacent degenerative disc disease (DDD) in addition to DS. In these cases the adjacent segments should be fused as well. There are different techniques of fusion available, such as posterior with instrumentation or additional anterior support. This study evaluated results of transforaminal lumbar interbody fusion (TLIF) in patients with monosegmental DS and adjacent DDD.A total of 28 patients with monosegmental DS and adjacent DDD were included into the study (all patients with bisegmental posterior instrumentation and fusion, 14 patients 1 level TLIF, 14 patients 2 level TLIF). Before surgery and 12 months after surgery the following measurements were made: pain (visual analog scale VAS), Oswestry disability index (ODI) and plain radiographs with radiometric analysis. In a sub-analysis patients with 1 and 2 level TLIF were compared.Pain reduction (average VAS from 8.7-3.1) and ODI (63% to 28%) showed significant improvements. Radiometric analysis showed a significant disc height reconstruction and a significant reduction of spondylolisthesis (TLIF level with spondylolisthesis). Bisegmental anterior support showed a significantly better relordosation compared to monosegmental anterior support. The complication rate was 21.4% including hemorrhages, dura leakage, wound infection and adjacent segment degeneration. There were no fatal complications.The TLIF procedure is a safe and effective treatment for monosegmental DS with adjacent symptomatic DDD. Clinical results (pain, function) show no difference between both kinds of fusion (dorsal fusion and instrumentation versus dorsal fusion with instrumentation and TLIF) for the adjacent DDD. However, additional anterior support is more effective for relordosation of the segment. This could have impact on the mid-term and long-term outcome or in cases of adjacent segment fusion.

The GCSS working group on cirrus focuses on inter-comparison of model simulations for models ranging from very detailed microphysical and dynamical models through to general circulation models (GCMs). In the previous GCSS inter-comparison, it was a surprise to the modeling community how much of a range there was in ice water path predictions by different cirrus models for such idealized cases. There was some grouping according to the complexity of models; however, there were no observations with which to distinguish between model performance. The aim of the current GCSS cirrus inter-comparison is to base the study on a rigorously observed case study. In this way, the case may be used to identify which models in the inter-comparison are performing well and highlight areas for model development as well as provide a base case for future models to compare against when being developed or when testing new developments within existing models. In this paper, we present the case development for the current GCSS working group study on cirrus cloud. This paper summarizes how the case was developed and based on the 9 March 2000 Atmospheric Radiation Measurement (ARM) Southern Great Plains (SGP) intensive observation period (IOP). To our knowledge, this case offers the most detailed case study for cirrus comparison available, with extensive effort to derive the most appropriate large scale forcing as possible which is such a significant determinant of clouds. We anticipate this will offer significant improvement over past comparisons which have mostly been loosely based on observations. Notably this study makes use of retrievals of observations of ice water content, ice number concentration, and fall velocity, thus offering several constraints to evaluate model performance. The case study is developed utilizing various observations including ARM SGP remote sensing including the Millimeter cloud radar (MMCR), radiometers, radiosondes, aircraft observations, satellite observations, objective analysis and complemented with results from the Rapid Update Cycle (RUC) model output and bespoke gravity wave simulations using the 3-dimensional velocities over mountains (3DVOM) model. An initial modelling assessment of the case has been shown using the UK Met Office Large Eddy Simulation Model (LEM) which supports the use of this case for the full inter-comparison study.

Einleitung: An unserem Zentrum wird eine Studie mit dem Ziel der Identifizierung und Charakterisierung zirkulierender Metaboliten des hepatischen Lipid- und Proteinstoffwechsels mittels LC-MS/MS durchgeführt, um bei Patienten nach allogener Lebertransplantation frühzeitig und pathophysiologisch[for full text, please go to the a.m. URL], 127. Kongress der Deutschen Gesellschaft für Chirurgie

Today the indication for thrombosis prophylaxis is a relevant and daily concern in orthopaedic surgery. Recently there are some changes concerning the German guidelines, which are approved by 27 German medical societies. For the first time the guidelines give distinct recommendations for the different indications, the kind of thrombosis prophylaxis and its duration. Some of the recommendations will lead to changes of both processes in outpatient and inpatient management. In parallel 2 new oral anticoagulants have been approved for the prevention of thromboembolic events after elective knee and hip replacement. Dabigatran is an oral thrombin inhibitor. Compared to enoxaparin it has a comparable profile of side effects and efficacy. Rivaroxaban is an oral Xa inhibitor which shows a significantly better efficacy compared to enoxaparin and no difference in side effects. The significant reduction of symptomatic thromboembolisms after elective knee and hip replacement was shown for rivaroxaban compared to enoxaparin in a pooled analysis of phase III data. This review discusses the main topics of the new German guideline and impact of the new oral anticoagulants on in- and outpatient treatment procedures.

The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals.An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office.44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments.Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.

Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10 degrees in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5-1 degree per year), kyphosis, or both. The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient's specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient's age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes.This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.

For more than 2 decades ventral derotation spondylodesis (Zielke VDS) as a major improvement over Dwyer instrumentation (DI) was the gold standard of instrumented curve correction and stabilization from the anterior approach. As the first available system it enables a true three-dimensional curve correction. A disadvantage is the low internal stabilization capability with a need for long-term external stabilization by means of cast and brace treatment postoperatively. Meanwhile with the development of modern single and dual solid rod systems these disadvantages can be avoided completely. Video-assisted (thoracoscopic) anterior scoliosis surgery accounts for less than 2% of anteriorly treated scoliosis cases, mainly due to a long operating time and significant learning curve.From the posterior approach the Cotrel-Dubousset instrumentation (CDI) as a polysegmentally attached posterior hook threaded dual rod system used to be state of the art for a long time, since it eliminated the disadvantages of Harrington instrumentation (HI) in terms of only one-dimensional correction and low stabilization capabilities. However even with CDI effective derotation was impossible. In posterior scoliosis surgery there is a strong trend away from hook systems towards transpedicular segmentally fixed dual rod systems not only in the lumbar spine but also in the thoracic area. Advantages of these newer techniques are shorter fusion, improved correction, and less loss of correction over time.Advantages of modern anterior instrumentation systems in comparison to posterior transpedicular instrumented dual rod systems are less blood loss, better derotation, slightly shorter fusion levels, and a better influence on sagittal plane control or improvement especially for hypokyphotic thoracic scoliosis cases. Our data also document a superior spontaneous correction of the lumbar curve after selective anterior instrumented correction (Lenke 1B+C), although other studies could not find significant differences. In our experience the neurological risk of anterior instrumented correction is also lower than that of posterior scoliosis surgery, although the morbidity and mortality data of the Scoliosis Research Society could not prove that anymore in recent years. A negative effect of anterior transthoracic scoliosis surgery in comparison to posterior surgery is a more negative effect on lung function, which improves slower after surgery and does not quite reach the levels of posterior surgery at follow-up. But new data on posterior segmental transpedicular correction and fusion also prove a lordosating effect with negative effect on lung function.

In the German health system the payment of a hospital stay is standardised. The common basis is the G-DRG System (German diagnosis-related groups) in which every stay is paid by a lump sum. Scoliosis correction in our times means pedicle screw-based multilevel double rod instrumentation or anterior plate-rod instrumentation with primary stability. The outcome of those methods has improved the results of correction and decreased the complication rate but also means high costs due to the implants. Scoliosis correction is covered by DRG I06. Due to constant efforts a general improvement took place in the assessment of DRG I06. That is the reason why the losses incurred in DRG I06C could be lowered to 38% and in I06D to 22% in 2008. For an appropriate assessment further improvements are required.

To evaluate a new coronary MR angiography technique covering the whole coronary artery tree in one data set acquisition.Six healthy volunteers and 15 patients with known CAD were examined with a navigator gated and corrected (NAV) free-breathing 3D steady-state free precession sequence covering the whole heart (WH-MRA) (TR = 5.4, TE = 2.7, SENSE factor = 2, 160 slices, 0.75 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time 14 min [50 % NAV efficiency]) and a vessel targeted 3D SSFP MRA sequence (t-MRA) (TR = 5.6 ms, TE = 2.8 ms, 20 slices of 1.5 mm reconstructed slice thickness, in-plane resolution = 0.99 x 0.99 mm(2), scan time = 7 min [50 % NAV efficiency]). Subjective image quality (4-point scale) and objective image quality parameters including vessel sharpness, vessel diameter and CNR were calculated for WH-MRA and t-MRA. In patients, the accuracy for detection of stenosis larger than 50 % was compared to the accuracy of X-ray coronary angiography (XA), which was considered the standard.WH-MRA demonstrated good vessel visibility in healthy subjects (100 %) whereas vessel visibility in patients was limited (78 % in an 8 segment evaluation). Vessel sharpness was inferior to that of t-MRA in patients (37 vs. 42 %) but equal in healthy subjects (42 %). Vessel diameter did not differ significantly between WH-MRA and t-MRA. CNR was significantly reduced for WH-MRA (CNR 7.4 vs. 11.5). The diagnostic accuracy for the detection of CAD was comparable for both MRA approaches (85.5 vs. 86.2 %).WH-MRA allows good coronary artery visualization in healthy subjects and patients and provides a simplified scanning procedure and advantages in 3D post-processing. Regarding image parameters and the detection of CAD, the results are comparable to those acquired with t-MRA. The major disadvantage remains the high number of diagnostically insufficient images.