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The value of CT in the preoperative management of tumors of the sacrum is demonstrated. Essential informations for treatment planning are: involved sacral segment, infiltration of sacral foramina and nerve roots, involvement of the sacroiliac joints, ingression of the lumbar spine, infiltration of the pelvic organs and vessels, sciatic nerve and the dorsal soft tissues. In order to prove the competence of the CT in answering these questions we evaluated the CT-examinations of 30 pat. with 14 primary tumors, 9 metastatic tumors and 7 tumors involving secondary the sacrum. The CT findings were correlated with clinical symptoms and surgical reports in 11 pat., with clinical symptoms alone in 19 pat. There was good correlation in the criterias: location and number of involved segments (8/11, 17/19), infiltr. of SI-joints (11/11), infiltr. of lumbar spine (9/11, 18/19), and infiltr. of pelvic organs (10/11), worse correlation in the criterias: nerve root-involvement (2/11, 3/19), and sciatic nerve-infiltr. (7/11, 15/19). Our conclusions are that CT gives helpful preoperative informations deciding about extent of surgical procedure, and surgical approach. The major problem, however, consist in diagnosis of nerve root and sciatic nerve involvement, therefore in poor prediction of postoperative conservation of neural functions. The knowledge of CT-anatomy of sacrum- and important condition for correct segment-location of the tumor is refreshed by outlines of characteristic segmental CT-sections of the sacrum.

In a 16-year-old girl with left upper abdominal pain of two months' duration fine-needle biopsy (guided by computed tomography) revealed a solid-cystic acinar-cell tumour of the pancreas. The tail of the pancreas was resected and the spleen removed. On inspection, the tumour--about 9 cm in diameter--was encapsulated and consisted of soft, brownish, partly haemorrhagic tissue. Histologically and immunohistochemically the diagnosis of an acinar-cell tumour was confirmed. Analysis of steroid hormone receptors revealed a high progestogen content. Since the operation the patient has remained symptom-free without any sign of tumour recurrence.

MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous application of Gd-DTPA, enhancement of the marrow and disk was seen. With progressive healing increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. Corresponding to the clinical healing process T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA application. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.

In a study of 21 patients with osteogenic sarcoma of the apendicular skeleton proven by biopsy, the diagnostic value of computed tomography (CT) for the assessment of intramedullary tumor growth, epiphyseal and joint involvement was determined. CT findings were correlated with histopathologic findings. 10 of the 21 tumors were located far from the epiphysis, in 11 cases the epiphysis was infiltrated. Tumorous involvement of the articular cartilage occurred in 3 patients, in one case the tumor extended beyond the joint. In 85% of the cases the CT report concerning tumor location in regard to the epiphysis was verified histologically. In 3 cases CT overestimated tumor extension.

The absence or hypoplasia of the hepatic segment of the inferior vena cava with azygos continuation is a rare entity, sometimes associated with congenital heart disease, situs inversus or polysplenia syndrome. Ultrasonography as an easy, non-invasive procedure enables reliable diagnosis of this anomaly replacing inferior cavography. Ultrasonic scans performed in various directions allow a more subtle analysis of vessels and location of azygos continuation. We present an analysis of the sonographic feature in this anomaly, as studied in 2 patients. The diagnosis of this usually incidental finding (chest X-ray) can be of major clinical importance e.g. if special surgical procedures such as ligature of the azygos vein are considered.

The value of sonography for examining the thyroid has long been recognised. Secondary tumours are rarely demonstrated surgically. We examined retrospectively 14 patients with histologically proven secondary tumours which had been investigated by us tumours which had been investigated by us preoperatively. We were unable to determine any differential features between primary and secondary thyroid tumours. One can point out only that the development of thyroid tumours in the presence of a known primary may be due to metastases.

In this prospective study the performance of transrectal or transvaginal endoscopic ultrasonography (EUS) was compared with that of computed tomography (CT) in the diagnosis of perirectal fistulae, abscesses and diffuse inflammatory changes in the lower pelvis in 25 patients with Crohn's disease. Results were verified by surgery in eight patients and by correlation with findings on endoscopy, barium radiography and fistulography, and the clinical course in all other patients. EUS was superior to CT in diagnosing fistulae (14 vs 4 correct diagnoses) and inflammatory infiltration of the lower pelvic muscles (11 vs 2 correct diagnoses). The methods were equivalent in diagnosing perianorectal abscesses. CT was superior in the detection of inflammatory changes in the pararectal fasciae and fatty tissue which could not be detected by EUS. It is concluded that EUS should be used as the primary method for diagnosing perianorectal changes in patients with Crohn's disease especially in the case of fistulae and abscesses, having the added advantage of lack of radiation for the patient.

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes.

Fifty-five breast cancer patients underwent high-resolution computed tomography (HRCT) of the lungs before, 8–12 weeks, 6, 9 and 12 months after adjuvant radiotherapy. During the follow-up time, 17 of them (30%) were found to develop minimal parenchymal alterations in the irradiated lung volume by HRCT evidence. The parenchymal alterations were classified by five scores. Scores 1–4 described chronic radiologic changes, score 5 acute radiologic changes. Three patients presented with acute radiologic changes (alveolar filling) within the first 3 months after radiotherapy. Two did not show any abnormalities at later follow-ups. Chronic radiologic fibrosis (15 patients) was not seen before the sixth month post irradiation except in 2 cases. There was no correlation between acute changes and chronic fibrosis. None of these changes were seen at a lung dose of less than 40 Gy. The appearance of interstitial pulmonary lesions secondary to breast irradiation was comparable to that of other interstitial diseases of the lungs. Chest radiographs were normal in all patients. None of the 55 patients presented with clinical symptoms.

To define the appearance of degenerative changes of the triangular fibrocartilage (TFC) of the wrist on magnetic resonance (MR) images, the TFCs in one wrist of each of 30 healthy subjects in three age groups (20-35, 36-50, and greater than 50 years) and six TFCs from fresh cadavers were examined by means of coronal T1-weighted spin-echo sequences. Histologic findings were compared with findings on MR images in the cadaveric TFCs. It was proved that patches or lines of signal hyperintensity within the cadaveric TFCs were caused by degenerative changes and tears. Similar changes of the TFCs on MR images of the healthy subjects may have been caused by degeneration. In the healthy subjects, degenerative changes of the TFC, usually well defined on MR images, occurred at a very early age. The TFC appears to undergo stages of degeneration comparable to those of the menisci of the knee, but differentiation between traumatic and degenerative tears may be difficult.

Die Pathologie der Luxation der Kniescheibe wird von unserer Arbeisgruppe in die traumatische Luxation, die rezidivierende Luxation und in die habituelle Subluxation unterteil. Prinzipiell wird primar versucht, durch ein physikalisches Muskelaufbauprogramm und Muskeltraining eine funktionelle Besserung zu erreichen. Erst nach frustraner Physikotherapie wird die Operationsmethode nach Slocum und Larson durchgefuhrt. Die Diagnostik wurde von uns durch die Computertomographie eindeutig erweitert. Durch die Entwicklung eines neuen Schemas zur Auswertung der Computertomogramme kann die Kniescheibeninstabilitat (Subluxation) erstmals radiologisch dargestellt werden.

Acute mediastinitis (AM) has become a rare disease since the introduction of antibiotics but still has an unchanged high mortality-rate if the diagnosis is not readily established, and adequate therapy is performed. Clinical signs of AM are often uncharacteristic, plain chest films do not allow a reliable diagnosis because of lack of sensitivity as well as specificity. In a retrospective study the CT-results of 23 patients clinically suspect for AM were evaluated in order to determine the diagnostic value of CT-findings were compared to operation, percutaneous drainage procedures and clinical course. In 15 patients the diagnosis of AM was established correctly by CT, 8 patients were reported normal. Diffuse infiltration of mediastinal fatty tissue was found in 3 patients, mediastinal fluid collections were demonstrated in 12 (infected hematomas = 4, abscess formation = 8). The extension of inflammatory changes could be exactly assessed by CT in all patients.

We present our first experience with MR in bone grafts in 23 patients. Graft implantation followed curettage of benign bone lesions. The locations were, rather exclusively, the long tubular bones. T1-and T2-weighted spin echo-sequences including intravenous application of Gadolinium-DTPA were performed (Magnetom 63, 1,5 T). A total of 29 examinations (1 follow-up control in 6 pat.) was divided into 5 groups, with regard to different stages after surgery, which varied from 1 week to more than 3 years postoperatively. The MR results were related to the respective groups. The results show typical stages of bone graft incorporation, but also greater individual variations in the duration of incorporation. Our first results, however, represent only "snapshots" of different patients at different stages after bone graft surgery. Therefore some important questions are still unanswered but may perhaps be explained with the help of subsequent prospective studies.

Two different head coils--one with linear polarization and the other with circular polarization--were compared under the same measurement conditions. Comparison was done on a phantom with water-filled and gadolinium-filled pin-holes, as well as on anatomical MR images of 23 volunteers. In three volunteers the whole brain was examined while, in the remaining 20 volunteers the sella region or cerebellopontine angle region was examined. Criteria for comparison were signal-to-noise ratio, background noise, and detail resolution (phantom), as well as subjective criteria--image sharpness, anatomical, contrast, and recognition of anatomical details--, evaluated on anatomical MR images by four radiologists independently of each other. The results show a significant improvement of signal-to-noise ratio, lower background noise and therefore marked improvement of images sharpness, and moderate improvement in the recognition of anatomical details using the circular polarized head coil; as for as detail resolution and anatomical contrast were concerned, however, no significant difference was seen between the two coils. Major advantages of the circular, polarized head coil in clinical application are shorter measurement times (reduced number of acquisitions), as well as thinner slices without loss of signal-to-noise ratio.

Magnetic resonance examinations were performed in 15 patients suffering from echocardiographically detected intracardiac masses. All patients were examined with a 1.5 T superconducting machine, using spin echo technique, including Gd-DTPA, and gradient echo sequences. The MR findings were confirmed partially by histology and angiography, otherwise by good correlation to clinical findings. MR results were divided into three groups: 1. tumour, 2. thrombosis, 3. pseudotumorous mass, and corresponded well with the final diagnosis: in 8 patients tumour, in 5 patients thrombosis, and in two patients pseudotumorous masses, including one hydatid cyst and one case of lipomatosis. Tumours showed in contrast to thrombosis marked enhancement after gadolinium injection, whereas the hydatid cyst and the lipomatosis demonstrated characteristic signal behaviour. Problems existed in differentiation mass vs slow flow, in the detection of very small masses, and in the assessment of wall-fixation and motion of a mass during cardiac cycle. The results demonstrate that MRI with Gd-DTPA can give important additional information in the differential diagnosis of echocardiographically detected intracardiac masses.

Evaluation of the incidence of a midline sternal foramen, as a developmental anomaly, in order to avoid fatal complications following sternal puncture of sternal acupuncture treatment.100 chest computed tomograms were evaluated in reference to the incidence of this anomaly and its various features.The variety of CT aspects ranged from very incomplete types with only sandglass-like retraction of sternal cortex, to a complete foraminal defect. The incidence of midline sternal foramen in a feature bearing a risk of complication, is approximately 6%.We conclude that--if sternal acupuncture is planned in the region of corpus--previous radiographs should be done to rule out this anomaly. Furthermore, we strongly recommend the acupuncture technique of the "Wiener Schule", which prescribes a safe superficial-oblique approach to the sternum.

This paper reviews the examination technique, normal findings, and pathological findings in conventional radiographic diagnosis of the salivary glands. The clinical importance of plain radiographs and sialography today despite the availability of modern imaging modalities is discussed. Of the ultrasound equipment is adequate and the examiner has enough experience in small-parts ultrasonography, application of conventional X-ray methods should be limited to confirmation of ultrasonographic suspicion of sialolithiasis or tumor-erosion of adjacent bone, especially the mandible (plain films), further imaging of extra- and intraglandular salivary duct abnormalities in chronic inflammatory salivary gland disease, and demonstrating salivary gland involvement in special entities, such as sialadenosis (pseudo)cystica in Sjögren-syndrome by sialography.

The value of sonography for examining the thyroid has long been recognised. Secondary tumours are rarely demonstrated surgically. We examined retrospectively 14 patients with histologically proven secondary tumours which had been investigated by us tumours which had been investigated by us preoperatively. We were unable to determine any differential features between primary and secondary thyroid tumours. One can point out only that the development of thyroid tumours in the presence of a known primary may be due to metastases.

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes.

Anorectal complications in long-term Crohn's disease are frequent and evaluation of inflammatory changes in the lower pelvic region is difficult. Abnormalities are fistulas and abscesses which can be demonstrated rapidly and easily by endosonographic measures. Further topographical localization of the abnormalities is possible. Over a period of 2 yr, 55 patients with anorectal complications were examined. Using endosonography, 46 fistulas were found in 36 patients. Forty patients presented inflammatory changes. Abscesses were demonstrated in four cases. Our findings were verified by surgery, fistulography, and correlation with clinical course of illness. Limiting factor of the examination procedure proved to be painful and strictures in male patients, whereas in female patients the alternative of performing the examination via vagina was given. Our results demonstrate that endosonography is an excellent screening method for detecting and evaluating fistulas and abscesses in Crohn patients. Omitting radiation exposure is a further advantage of endosonography.

The aim of this study was to document the grading-related response of carcinoma of the prostate to radiotherapy, especially in views of the fact that the PSA values of hormonal therapy are not evaluable if hormonal therapy is done prior to radiotherapy or in patients with high likelihood of metastatic spread. Controls were done on 55 patients before, during and after primary external radiotherapy of carcinoma of the prostate with volumetric analysis of transrectal ultrasound (TRUS) of the prostate. There were significant differences between G1 and G2 tumors on the one hand and G3 tumors on the other hand. The latter had a much larger volume to start with and their volume reduced more rapidly after therapy.

Nineteen patients with potentially operable bronchial carcinoma were included in a prospective study to assess the staging capabilities of plain and contrast-enhanced magnetic resonance imaging (MRI) in comparison with computed tomography (CT) and to compare the results to post-operative histopathological staging (HS). The evaluation focused on the following T-staging criteria: (i) direct invasion of the pleura; (ii) neoplastic invasion of the mediastinum; (iii) differentiation of the primary tumour from alterations of the surrounding lung parenchyma such as inflammation or atelectasis; and (iv) intrathoracic lymph node involvement by tumour. MRI and CT produced similar results for pleural invasion (sensitivity of 0.4 and 0.75 respectively and a specificity of 0.86 and 0.93 respectively). Mediastinal invasion was overdiagnosed in four patients (no false negatives), whereas CT had only one false positive result (two false negatives). Our results showed CT to be superior to MRI for the preoperative evaluation of patients suffering from bronchogenic carcinoma.

The pathology of patella dislocation is divided into different groups: primary, secondary, recurrent dislocation and patella subluxation. In the diagnosis, in addition to clinical and X-ray investigations a certain computerized tomography extended on the SEG examination. A new examination of the EG tomographs had increased the diagnostic facilities. Our therapeutical program is based on physical therapy. After failure of physiotherapy to achieve satisfactory results the operation technique according to Slocum and Larson is performed.

The clinical value of TRS in diagnosis and staging of radiogenic rectal disorders is discussed. TRS was performed on 120 patients with tumours of lower pelvis who were treated by radiotherapy. They were divided in this trial into 2 groups. Group I (n = 113, with a mean interval to radiotherapy of 2 years) including patients who were under a routine control. Group II (n = 7, with a mean interval to radiotherapy of 13 years) including patients with strong local pain of the radiotherapy zone. The sonographic changes were divided into 4 grades (0-III) and verified histologically in group II patients by means of biopsy. A control group (n = 35) was also examined by TRS. The patients of this group were not treated radiotherapeutically. We concluded in our study that TRS in radiogenic rectal disorders, give us a very precise grading of the tumours which in turn, is of great importance in the further therapeutic procedure and in the evaluation of tumour recidives and second malignomas of the rectal wall.

Acute mediastinitis (AM) has become a rare disease since the introduction of antibiotics but still has an unchanged high mortality-rate if the diagnosis is not readily established, and adequate therapy is performed. Clinical signs of AM are often uncharacteristic, plain chest films do not allow a reliable diagnosis because of lack of sensitivity as well as specificity. In a retrospective study the CT-results of 23 patients clinically suspect for AM were evaluated in order to determine the diagnostic value of CT-findings were compared to operation, percutaneous drainage procedures and clinical course. In 15 patients the diagnosis of AM was established correctly by CT, 8 patients were reported normal. Diffuse infiltration of mediastinal fatty tissue was found in 3 patients, mediastinal fluid collections were demonstrated in 12 (infected hematomas = 4, abscess formation = 8). The extension of inflammatory changes could be exactly assessed by CT in all patients.

Compared with normal X-ray examination, a CT scan can give more information about patellar alignment, especially close to full extension of the knee-joint. We compared the normal knee-joints of 10 volunteers with the knee-joints of 15 patients (19 recurrent luxations, 5 habitual subluxations). We were able to distinguish between instabilities with and without changes seen on the X-ray pictures, making it possible to develop a systematic concept of treatment. In the case of recurrent dislocation with radiologically visible instability, surgical repair is the treatment of choice, while for habitual subluxation without radiologically visible instability the primary treatment of choice is conservative therapy with physiotherapy and muscle training. This is successful in most cases. If physiotherapy fails surgical repair is the next step in treatment. This dynamic type of investigation (the patella is stabilized by tension of the quadriceps femoris muscle) makes an objective judgement of the result of therapy possible.

We present our first experience with MR in bone grafts in 23 patients. Graft implantation followed curettage of benign bone lesions. The locations were, rather exclusively, the long tubular bones. T1-and T2-weighted spin echo-sequences including intravenous application of Gadolinium-DTPA were performed (Magnetom 63, 1,5 T). A total of 29 examinations (1 follow-up control in 6 pat.) was divided into 5 groups, with regard to different stages after surgery, which varied from 1 week to more than 3 years postoperatively. The MR results were related to the respective groups. The results show typical stages of bone graft incorporation, but also greater individual variations in the duration of incorporation. Our first results, however, represent only "snapshots" of different patients at different stages after bone graft surgery. Therefore some important questions are still unanswered but may perhaps be explained with the help of subsequent prospective studies.

MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous application of Gd-DTPA, enhancement of the marrow and disk was seen. With progressive healing increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. Corresponding to the clinical healing process T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA application. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.

Two different head coils--one with linear polarization and the other with circular polarization--were compared under the same measurement conditions. Comparison was done on a phantom with water-filled and gadolinium-filled pin-holes, as well as on anatomical MR images of 23 volunteers. In three volunteers the whole brain was examined while, in the remaining 20 volunteers the sella region or cerebellopontine angle region was examined. Criteria for comparison were signal-to-noise ratio, background noise, and detail resolution (phantom), as well as subjective criteria--image sharpness, anatomical, contrast, and recognition of anatomical details--, evaluated on anatomical MR images by four radiologists independently of each other. The results show a significant improvement of signal-to-noise ratio, lower background noise and therefore marked improvement of images sharpness, and moderate improvement in the recognition of anatomical details using the circular polarized head coil; as for as detail resolution and anatomical contrast were concerned, however, no significant difference was seen between the two coils. Major advantages of the circular, polarized head coil in clinical application are shorter measurement times (reduced number of acquisitions), as well as thinner slices without loss of signal-to-noise ratio.

Computed tomography, though few previous reports have dealt with this aspect of it, is an excellent aid when percutaneous skeletal biopsies have to be taken, especially in critical skeletal regions. Our own series consists of 48 CT-guided musculoskeletal biopsy procedures, mainly concerning the spine and pelvis. We used biopsy needles with calibers between 22 G and 14 G; specifically, the sure-cut needle was used in most cases. There were no complications. The results were conclusive in 29 cases, semiconclusive in 10 cases, and inconclusive in 9 cases. The advantages of CT guidance are most obvious in the case of lesions of the axial skeleton and pelvis: it allows precise planning of an adequate biopsy approach, better location of small cortex leaks for intraosseous entry of the puncture needle, and more sensitive selection of the best place for tissue sampling. Therefore, with CT guidance intraosseous lesions are more accessible, even to less highly invasive instruments. The risk of complications is low, and the accuracy similar to that obtained with fluoroscopic guidance.

Magnetic resonance examinations were performed in 15 patients suffering from echocardiographically detected intracardiac masses. All patients were examined with a 1.5 T superconducting machine, using spin echo technique, including Gd-DTPA, and gradient echo sequences. The MR findings were confirmed partially by histology and angiography, otherwise by good correlation to clinical findings. MR results were divided into three groups: 1. tumour, 2. thrombosis, 3. pseudotumorous mass, and corresponded well with the final diagnosis: in 8 patients tumour, in 5 patients thrombosis, and in two patients pseudotumorous masses, including one hydatid cyst and one case of lipomatosis. Tumours showed in contrast to thrombosis marked enhancement after gadolinium injection, whereas the hydatid cyst and the lipomatosis demonstrated characteristic signal behaviour. Problems existed in differentiation mass vs slow flow, in the detection of very small masses, and in the assessment of wall-fixation and motion of a mass during cardiac cycle. The results demonstrate that MRI with Gd-DTPA can give important additional information in the differential diagnosis of echocardiographically detected intracardiac masses.

Ultrasound has taken a solid position in the diagnostic management of aneurysms of the abdominal aorta as it is a non-invasive, simple and quickly practicable method with a low expenditure. After clinical examination ultrasound holds the second place in the sequence of various diagnostic procedures in the case of an aneurysm of abdominal aorta. Diagnostic problems are demonstrated in the sonographic judgement of aortic aneurysms. 42 patients with an abdominal aortic aneurysm have been evaluated in relation to the sonographic features of the aneurysm.

Forty-three patients with proven bronchogenic carcinoma were evaluated with computed tomography (CT) to search for mediastinal and broncho-pulmonary nodal metastases. Definitive staging was achieved by thoracotomy (34 patients) and mediastinoscopy or transbronchial nodal sampling (9 patients). Three parameters of lymph node appearance on CT were studied to improve the sensitivity and specificity of CT in detecting malignancy in bronchogenic carcinoma: 1) node size, 2) node location and 3) border regularity and definition. 762 clearly defined nodes were studied by CT - 391 metastatic and 371 non metastatic. The most useful CT parameters were node size over 10 mm, and node location, which results in a sensitivity of 80% and a specificity of 88%. A combination of all 3 CT parameters increased sensitivity to 82% and specificity to 90%. These results show clearly, that size is not the only relevant CT-parameter in successful preoperative identification of mediastinal nodal metastases.

An attempt has been made, using 21 patients with pelvic fractures, to determine the circumstances in which plain films provide adequate information and when additional information can be obtained by CT. It was found that in all cases of acetabular fractures the diagnosis could be suspected on plain films, but that it proved impossible to demonstrate accurately the position of fragments, the degree of dislocation or the presence of intra-articular bone fragments. These problems could be solved by using CT. In patients with injury to the sacro-iliac joints or of the sacrum, the extent of the injury and the degree of pelvic instability was better shown by CT. All other bony lesions, such as fractures of the ilium, pubis, ischium or the symphysis could be diagnosed adequately by simple radiographs.

Epithelkorperchenkarzinome entziehen sich haufig auf Grund der grosen histologischen Ahnlichkeit zu, Adenomen ihrer rechtzeitigen Diagnose und effektiven. Therapie. Es wird ein Fall geschildert, bei dem trotz mehrmaligen Revisionen erst bei der Obduktion die Diagnose Epithelkorperchenkarzinom gestellt werden konnte.

The authors developed a method to puncture neck muscles by means of computer tomographic control, enabling the introduction of an electrode into the obliquus capitis inferior muscle, to investigate the particular role of neck muscles in posture and head movement.

In a study of 21 patients with osteogenic sarcoma of the apendicular skeleton proven by biopsy, the diagnostic value of computed tomography (CT) for the assessment of intramedullary tumor growth, epiphyseal and joint involvement was determined. CT findings were correlated with histopathologic findings. 10 of the 21 tumors were located far from the epiphysis, in 11 cases the epiphysis was infiltrated. Tumorous involvement of the articular cartilage occurred in 3 patients, in one case the tumor extended beyond the joint. In 85% of the cases the CT report concerning tumor location in regard to the epiphysis was verified histologically. In 3 cases CT overestimated tumor extension.

A CT control scan of 32 patients after transsphenoidal resection of a pituitary tumour revealed sellar contents of different density and varying extent. Additional criteria were used to differentiate the intrasellar structures (size, extent, shape, structure, contrast enhancement, bone changes). CT made the definite diagnosis in 6 patients with pituitary tumour recurrence. Hormonal measurements were superior to CT in identifying recurrent tumours in another 3 patients. It is concluded that hormonal methods should be used in evaluating patients after surgery of a hormone-producing tumour. However, CT is the most useful method in detecting tumour recurrence in patients with non-functioning adenomas, and, if an adequate technique is used (coronal scanning, iv-contrast), even clinical asymptomatic tumours can be identified.

The CT findings of 22 patients with histologically verified malignant tumors of the oral cavity and pharynx were evaluated to demonstrate the value of CT. Comparison with conventional radiological methods was made. In 16 patients an attempt was made to define tumor expansion and 6 patients were examined after surgery and radiation therapy with regard to tumor recurrence. In the first group we found tumors of different stages: in advanced cancer it was evident that with CT it is possible to describe tumor expansion very exactly and its relationship to surrounding structures, as well as the invasion of the intracranial space or spinal cord. In malignomas of the tongue and mouth floor measurements of size by CT were very precise, as proved by surgery. Our results in the first group of patients show, that CT has a great influence on therapeutic management and is also very important for clinical staging of these malignomas. In the second patient group it is shown that by CT differentiation between postoperative changes and recurrent tumor is as difficult as it is in other organs. Based on the postoperative examination, appropriate follow-up is necessary.

The X-ray findings in temporal bone anomalies are reviewed. Radiological procedure and examination technique are presented, as are symptoms of important anomalies. The methods available are plain film X-ray of temporal bone, multi-directional tomography, and high-resolution CT. Although some of the abnormalities are visible even in plain films, consistent use of conventional tomography or CT is necessary for correct diagnosis. This procedure is indicated not only when an abnormality is clinically obvious, but also in all cases of unexplained hearing loss without evidence of acquired disease. The advantage of CT over conventional tomography is that soft tissue anomalies, such as primary cholesteatoma or tumor simulating vascular abnormalities, can be demonstrated. In these cases CT is obligatory.