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Forty-five patients with known or suspected musculoskeletal tumors were examined with static and dynamic MR imaging to evaluate the safety, tolerability and diagnostic utility of gadodiamide injection and to assess the diagnostic value of dynamic MR imaging and parametric “first-pass” (FP) images. The proportion of patients presenting more diagnostic information on the contrast-enhanced compared to the precontrast spin-echo examinations was determined. The dynamic enhancement characteristics were evaluated with time-intensity curves and parametric images of the FP enhancement rate. The tolerance of gadodiamide injection was good. Contrast enhancement was useful for delineating tumor from muscle, and differentiating viable from necrotic tissue and cystic from solid lesions. Malignant tumors showed a significantly higher slope value, earlier onset of enhancement, and higher maximum enhancement than benign lesions. However, slope values could not be used to predict the malignant potential of a lesion, due to overlap between highly vascular benign and low vascular malignant lesions. By displaying highly vascular areas, parametric FP images provided useful information on the most active part in a tumor before biopsy and for assessing the incorporation of bone-chip allografts. Static, dynamic and FP MR imaging using gadodiamide injection appears safe and provides useful information for diagnosis, biopsy and follow-up of musculoskeletal lesions.

The compressive properties of the heel pad during the heel strike when running (barefoot and shed, two subjects, 4.5 m s(-1)) were studied by means of a high-speed two-dimensional cineradiographic registration (150 frames s(-1)) of an actual running step. Vertical ground reaction forces were measured with a force platform. In barefoot running the heel pad deforms to a maximal percentage deformation of 60.5 +/- 5.5%. In shed running the heel pad deforms only 35.5 +/- 2.5% and the nonlinear force-deformation relationship reflects an increasing stiffness when deformation rises. Although the amplitudes of the vertical ground reaction forces do not differ notably in both conditions, barefoot running implies a maximal deformation to the fatty heel tissue, reducing its functional role from shock reduction towards local protection of the heel bone. It is argued that embedding the foot in a well-fitting shoe increases the effective stiffness of the heel pad.

Transcatheter treatment of varicoceles by means of embolization with a tissue adhesive is performed under local anaesthesia, on an outpatient basis, and has a low technical failure (

A case is reported of an asymptomatic intraluminal duodenal diverticulum (IDD) in a 21-year-old male patient with associated congenital abnormalities. During endoscopy for anemia an ostium in the duodenum was visualized, presumed to be the entry to an extraduodenal diverticulum. Upper gastrointestinal (UGI) barium examination showed, however, findings compatible with IDD. This diagnosis was supported by an abdominal computed tomographic (CT) examination. Surgical resection revealed a web in D2 with coexistent large IDD.

A patient with sinonasal adenocarcinoma is presented with leptomeningeal metastases affecting multiple cranial nerves and spinal nerve roots. Head and neck cancer is known to be an extremely rare source for leptomeningeal metastatic spread. The cranial nerves, the spinal cord and roots and the cerebral hemispheres can be affected in case of leptomeningeal metastatic spread. Examination of the CSF is the hallmark of the diagnosis if leptomeningeal metastatic spread is suspected, but this case illustrates that the combination of specific clinical features on one hand and specific lesions on the Gd-enhanced T1-weighted MRI study on the other hand is reliable enough to make a presumed diagnosis if the CSF analysis remains negative. We suggest that in our patient direct leptomeningeal spread occurred through the cribriform plate to the CSF, followed by further spread in a gravity dependent way.

Subdural hygroma is a cerebrospinal fluid accumulation in the subdural space. It is an epiphenomenon of head injury. CT is the preferred diagnostic imaging modality. Differential diagnosis has to be made with chronic subdural hematoma, and atrophy with enlargement of the subarachnoid space. As time goes by, subdural hygroma either resolves, or it becomes a chronic subdural hematoma. Neurosurgical evacuation is only required when mass effect creates neurologic symptoms.

MRI plays an important and specific role prior to tumor surgery in the head and neck region. It is especially interesting in providing a detailed description of the exact tumor extent close to the skull base and to investigate perineural and perivascular tumor spread. In selected cases this technique can give a presumed histopathological diagnosis for a mass that is clinically detected. This is especially true for some benign masses, such as hemangiomas, cysts and lipomas. The role of MRI with regard to a lymph node imaging survey in the neck is rather limited. MRI is moreover not routinely performed in neck regions where many motion artifacts can be expected, such as in the larynx.

The case of a 12-year-old Caucasian boy, living in a non-endemic area, with two intrapulmonary masses is presented. Conventional X-rays and computed tomography images were highly suggestive of pulmonary Echinococcus disease because of the presence of pericystic emphysema in one of both masses, a finding known as the "crescent" or "meniscus" sign. This radiological feature and other highly suggestive imaging findings of pulmonary hydatid disease are presented and discussed.

Early detection and identification of infraclinic breast lesions are a challenge for the radiologist. Diagnostic accuracy relies on careful analysis of some important mammographic clues, which are discussed in this paper. In particular, asymmetric breast tissue, focal asymmetric density, nonpalpable solid masses, stellate lesions and calcifications are reviewed.

A non-ionic, monomeric, low-osmolar contrast medium, iopentol (Imagopaque, Nycomed Imaging AS, Oslo, Norway) has been compared with iohexol (Omnipaque, Nycomed Imaging AS, Oslo, Norway) in a double-blind, randomized, parallel-group trial in children. The aims of the study were to compare the safety and radiographic efficacy of iopentol 350 mg I/ml versus those of iohexol 350 mg I/ ml in pediatric cardioangiography. Seventy-three children, of whom 35 received iopentol and 38 iohexol, were included in the evaluation. The quality of overall diagnostic information was excellent or adequate in all patients. There were no statistically significant differences between numbers of patients reporting adverse events nor number of patients reporting discomfort in the two groups. Three patients in the iopentol group and two patients in the iohexol group reported adverse events. Heat sensation was reported by 4 patients in the iopentol group and 5 patients in the iohexol group. Following injection of contrast medium, there were no differences between the groups regarding ECG, heart rate and systolic blood pressure at the site of injection. Iopentol was demonstrated to be as effective, safe and well tolerated as iohexol in pediatric cardioangiography.

The first attempts at stereography date back to the early days of radiography itself; already at the turn of the century, a series of papers on this subject had been published. This is not surprising, as the problem of reading correctly a plain X-ray film was rapidly recognized. A plain X-ray film is a summation of all the more or less opaque structures contained in the different planes of an object. Stereoradiography not any copes with this problem, but enables a three-dimensional localization of all these structures. Stereofluorography and stereocineradiography may also be performed. The different stages in the development of hard and soft ware to achieve these goals are described and an example is provided.

Calcifications are found in many women undergoing mammography. The majority of these calcifications are benign. Calcifications suggestive for malignancy prove to be cancer in about 30% of cases after biopsy. Study and personal experience should result in ready recognition of characteristically benign calcifications. Calcifications suggestive for malignancy should be biopsied and the ratio of malignant over benign biopsies should be as high as possible. The purpose of this paper is to present a practical approach to the evaluation of breast calcification, by means of a survey of the pattern of calcifications in breast pathology. We describe six types of typically benign calcifications and six criteria that entail an increased risk of malignancy.

In a series of 23 patients with chronic and unexplained painful wrist, three-compartment arthrography was carried out using digital subtraction. Pathologic conditions were disclosed in 19 patients. Digital subtraction both allowed for a stronger diluting of the dye and for the demonstration of a larger amount of lesions of smaller size than conventional wrist-arthrography, as long as motion artefacts had been avoided. Obtaining successive views without having to wait for complete contrast resorption in the injected compartments represents a significant advantage. The importance of three-compartment injection is stressed and the best way to perform the technique is discussed. As it proved to be a fast and reliable examination procedure the authors advocate using digital subtraction arthrography of the wrist whenever the method is available. However, this relatively new technique does not rule out careful correlation between arthrographic findings and clinical complaints.

In a patient with weight loss and a systolic epigastric murmur, aortography demonstrated positional celiac axis occlusion. Color Doppler imaging of the celiac axis showed occlusion in the supine position, but patency was documented during deep inspiration and with the patient in the upright position. This report documents a rare example of extreme celiac axis compression with position-dependent celiac patency.

Rapid sequence scintigraphy was used to study testicular arterial perfusion and venous stasis in 53 patients with varicocele-associated infertility, 17 with idiopathic testicular failure and 9 treated for varicocele. Arterial blood supply to the diseased testicle was decreased in 63 per cent of the patients with subclinical or low grade varicocele compared to 18 per cent with idiopathic testicular failure. In the majority of cases the disturbance of perfusion disappeared immediately after interruption of retrograde blood flow in the internal spermatic vein by transcatheter embolization, whereas persistently impaired perfusion was found in a few cases with no improvement of semen quality after treatment. Venous stasis was found in only 18 per cent of the patients with low grade varicocele compared to 88 per cent with large varicoceles. It is suggested that impaired arterial blood supply rather than venous stasis is the pathogenic factor in epididymo-testicular dysfunction associated with low grade varicocele.

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.

The diagnostic venography of the internal spermatic vein evaluating varicocele induced sterility in men, has become a standard procedure. It can now immediately be followed by a non-surgical treatment of this disease by means of a transcutaneous catheter embolisation. In this new technique use is made of isobutyl-2-cyanoacrylate (Bucrylate, Ethicon), a tissue adhesive. The method is relatively simple, safe and successful. Up to now 35 patients were cured according to this technique, once even bilaterally, on an out patient basis. The occlusion was complete in all cases as objectivated by a control venography directly after the embolisation, as well as by the normalisation of the clinical, thermographic, Doppler, hormonal and sperm findings.

SummaryA sonographically guided fine needle aspiration biopsy of a well circumscribed echodense liver nodule disclosed a hepatic localization of a malignant plasma cell dyscrasia in a 51-year-old female. On computed tomography (CT) the lesion presented as a hypodense nodule. Further examinations revealed overt non-excretory multiple myeloma with intracellular kappa chains. Differential diagnosis of an echogenic hepatic mass should thus include extramedullary plasmocytoma.

SummaryThe authors report 4 cases of Marfan’s syndrome with cardiovascular lesions : aortic insufficiency and aneurysm of the ascending aorta (1 case), mitral insufficiency and dilatation of the sinus of Valsalva (1 case), aortic insufficiency (2 cases). The patient presenting aortic insufficiency and aneurysm of the ascending aorta was successfully operated upon. The pathogenesis of the aortic and mitral lesions is discussed. In one patient association with cystinuria and in another with polycystic kidneys was found.

A superior vena cava-right pulmonary artery (SVC-RPA) anastomosis was constructed in a 2-year-old boy with tetralogy of Fallot. Ten years later and 5 years after “corrective” surgery without removal of the shunt, cyanosis and heart failure developed. Stereocineangiography and lung scanning revealed arteriovenous fistulas and dilated vessels in the right lung. The SVC-RPA anastomosis was taken down, the SVC being reimplanted in the right atrium and the RPA end being closed with a few stitches. Neither lobectomy nor pneumonectomy was performed. Immediately after the operation and during a follow-up period of almost 2 years, the boy has remained asymptomatic. Whenever a correction is planned in a patient with SVC-RPA anastomosis, the vessels of the right lung should be examined by scanning and angiography. If important arteriovenous fistulas do exist, the affected lung should be excluded from the pulmonary artery circulation.

Zusammenfassung Selektive retrograde Venographie der Vena spermatica interna: Ein uberzeugendes Vorgehen zur Sicherung der Diagnose einer Varikocele Bei 25 Patienten mit Verdacht auf eine Varikocele wurde eine selektive retrograde Katherisierung der linken Vena spermatica interna vorgenommen; hierzu wurde parcutan eine Punktion der rechten Vena femoralis nach der Methode Seldinger durchgefuhrt und der Katheter unter dem Monitor in die linke Vena renalis vorgeschoben. Dann wurde in stehender Lage des jeweiligen Probanden das Kontrastmedium injiziert, das bei Vorhandensein einer Varikocele eine retrograde Fullung der varikosen Vena spermatica ergab, wahrend dieser Effekt bei normalen Mannern, d.h. ohne Varikocele, nicht eintritt. Nach Ansicht der Autoren ist die Venographie indiziert fur diagnostische und therapeutische Zwecke. Sie ist die einzig brauchbare nicht chirurgische Technik zum Nachweis eines gestorten Venenflusses der Hodenregion. Resumen Venografia retrograda selectiva de la vena espermatica interna un metodo definitivo para el diagnostico de varicocele En 25 pacientes sospechosos de varicocele se efectuo la cateterizacion retrograda selectiva de la vena espermatica interna izquierda a nivel de su desembocadura en la vena renal. Quando se inyecta el contraste, el paciente con varicocele, estando en posicion de pie, muestra un llenado retrogrado de la vena espermatica varicosa, en contraste con la ausencia de tal reflujo en el hombre normal. La venografia esta indicada con fines diagnosticos y terapeuticos y es la unica tecnica util no quirurgica para probar la existencia de alteracion del flujo venoso en la region testicular.

The diagnostic venography of the internal spermatic vein evaluating varicocele induced sterility in men, has become a standard procedure. It can now immediately be followed by a non-surgical treatment of this disease by means of a transcutaneous catheter embolisation. In this new technique use is made of isobutyl-2-cyanoacrylate (Bucrylate, Ethicon), a tissue adhesive. The method is relatively simple, safe and successful. Up to now 35 patients were cured according to this technique, once even bilaterally, on an out patient basis. The occlusion was complete in all cases as objectivated by a control venography directly after the embolisation, as well as by the normalisation of the clinical, thermographic, Doppler, hormonal and sperm findings.

The results of CT scan are discussed with special reference to the value of density measurements in several cases of mediastinal cyst lesions. Although in some cysts with watery content, the CT attenuation values can be indicative, in most other lesions with heterogeneous structure and viscid fluid content, attenuation values in CT scan cannot be considered conclusive for diagnosis.

In 1975–1976 we described a method for selective retrograde venography of the internal spermatic vein [3, 4] which is now widely used all over the world [1, 2, 6, 7, 9]. After having examined more than 350 patients suspected of primary varicocele by means of transfemoral, selective retrograde venography of the internal spermatic vein, a new method was developed for the nonsurgical cure of this disease, i.e., embolization with the tissue adhesive isobutyl 2-cyanoacrylate (IBC2, Bucrylate from Ethicon).

While the diagnosis of large varicoceles should not cause any problems, small varicoceles are often more difficult to detect on clinical palpation. Besides, some patients do present reflux in the internal spermatic vein without palpable distension of the pampiniform plexus [1]. Four objective techniques are available to diagnose such subclinical reflux. Scrotal thermography, Doppler blood-flow measurement and testicular perfusion analysis using radioisotopes are non-invasive, and useful for routine patient screening, whereas retrograde venography of the internal spermatic vein should be reserved for selected cases.

A superior vena cava-right pulmonary artery (SVC-RPA) anastomosis was constructed in a 2-year-old boy with tetralogy of Fallot. Ten years later and 5 years after "corrective" surgery without removal of the shunt, cyanosis and heart failure developed. Stereocineangiography and lung scanning revealed arteriovenous fistulas and dilated vessels in the right lung. The SVC-RPA anastomosis was taken down, the SVC being reimplanted in the right atrium and the RPA end being closed with a few stitches. Neither lobectomy nor pneumonectomy was performed. Immediately after the operation and during a follow-up period of almost 2 years, the boy has remained asymptomatic. Whenever a correction is planned in a patient with SVC-RPA anastomosis, the vessels of the right lung should be examined by scanning and angiography. If important arteriovenous fistulas do exist, the affected lung should be excluded from the pulmonary artery circulation.

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.