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If sufficient speech understanding can no longer be achieved with conventional hearing aids, the indication for a cochlear implant is very often present. Imaging plays an important preoperative role, as it is the only way to decide whether a cochlear implant is possible or not. The preoperative evaluation of the temporal bone for the precise selection of the candidates for cochlear implant is including CT (Computed Tomography) and MRI (Magnetic Resonance Imaging).

To compare dynamic magnetic resonance imaging (MRI) with videofluoroscopy (VFS) regarding image quality and assessment of gap size between soft palate (SP) and posterior pharyngeal wall (PPW) in children and adolescents following surgical correction of velopharyngeal dysfunction (VPD). Twenty-one patients undergoing unenhanced 3-T MRI and contrast-enhanced VFS were included in this IRB-approved prospective study. The MRI scan protocol comprised refocused gradient-echo sequences in transverse and sagittal planes during speech, with TE 1.97 ms, TR 3.95 ms, flip angle 8°, matrix size 128 × 128, and 5-mm slice thickness. Radial k-space sampling and sliding window reconstruction were used to achieve an image acquisition rate of 28 frames per second (fps). VFS with 30 fps was similarly performed in both planes. Closure of the velopharyngeal port during phonation was evaluated by two experienced radiologists. Eleven (52.4%) patients displayed a complete closure, whereas ten (47.6%) patients showed a post-operative gap during speech. VFS and MRI equally identified the cases with persistent or recurrent VPD. Differences in SP-PPW distance between VFS (3.9 ± 1.6 mm) and MRI (4.1 ± 1.5 mm) were not statistically significant (p = 0.5). The subjective overall image quality of MRI was rated inferior (p

Beschwerden im Bereich der Wirbelsaule betreffen einen grosen Teil der Bevolkerung und fuhren zu zahlreichen Arztbesuchen. Verschiedene Techniken der CT-gesteuerten Infiltration bei Wirbelsaulenbeschwerden unter Berucksichtigung der Facetteninfiltration, der periradikularen Infiltration sowie der epiduralen Umflutung werden dargestellt. Grundlagenarbeiten und Expertenempfehlungen werden diskutiert sowie verschiedene Behandlungsschritte fur den klinischen Alltag dargestellt. Die CT-gesteuerte Anwendung der verschiedenen Infiltrationsarten ermoglicht eine prazise Durchfuhrung der Therapie. Sowohl die Facetteninfiltration als auch die periradikulare Infiltration und die epidurale Umflutung haben in Abhangigkeit von der klinischen Symptomatik ihren Stellenwert. Die optimale Kombination der zu applizierenden der Medikamente ist immer noch Gegenstand zahlreicher Studien und zum Teil kontroverser Diskussionen. Eine exakte klinische und bildgebende Evaluation der Schmerzsymptomatik im Bereich des Ruckens ist die Grundvoraussetzung fur eine zielgerichtete Therapie.

If sufficient speech understanding can no longer be achieved with conventional hearing aids, the indication for a cochlear implant is very often present. Imaging plays an important preoperative role, as it is the only way to decide whether a cochlear implant is possible or not. The preoperative evaluation of the temporal bone for the precise selection of the candidates for cochlear implant is including CT (Computed Tomography) and MRI (Magnetic Resonance Imaging).

Spinal complaints affect a large proportion of the population and lead to numerous doctor visits.The different techniques of CT-guided infiltration of spinal disorders, taking into account facet infiltration, periradicular infiltration and epidural flooding are demonstrated.Discussion of basic work and expert recommendations as well as presentation of different treatment steps for everyday clinical practice.The CT-guided application of the different types of infiltration allows precise execution of the therapy. Both facet infiltration and periradicular infiltration and epidural flooding have their place depending on the clinical symptoms. The optimal combination of drugs to administer is still the subject of numerous studies and sometimes controversial discussions.An exact clinical and imaging evaluation of the pain symptoms in the back is the basic requirement for a targeted therapy.

Repositioning of the jaw in orthognathic surgery must produce precise and stable long-term results; an effective and practical method of intraoperative condyle positioning is required to achieve this. Most traditional methods, such as manual positioning or positioning plates do not permit intraoperative monitoring of the temporomandibular joint (TMJ) position. This study evaluates the results of intraoperative, sonographically-monitored joint positioning, comparing preoperative and postoperative MRI scans.Of the 97 patients who were originally assessed (53 female, average age 29 ± 10.93; and 44 male, average age 28 ± 9.25), 21 had incomplete data sets and were excluded, leaving 76 evaluable patients. MRIs were performed preoperatively between 2 days and 100 weeks (median 30.5 days), and postoperatively between 12 and 96 weeks (median 150 days). Condyle positioning, intercondylar distance, and disc degeneration and dislocation were compared in preoperative and postoperative MRIs, and differentiated by Angle class on horizontal, axial and sagittal scans. Condyle to fossa distances were measured on parasagittal images from 0° (the vertical sagittal plane), 45° anteriorly and 45° posteriorly. The intercondylar distances between the condylar head midpoints were measured on axial sections. Two-sided t-tests (α0.05) were used for comparisons within classes; the interclass correlation was performed using univariate ANOVA and linear correlation for paired sample correlation settings.In 27 Angle class II cases, the anterior distance of both condyles increased on average 0.3 ± 1.0 mm, the posterior position decreased 0.1 ± 1.2 mm, and the vertical position decreased 0.2 ± 1.1 mm postoperatively. In 47 Angle class III cases the anterior distance of both condyles increased on average 0.3 ± 0.8 mm, the posterior 0.1 ± 0.8 mm and the vertical distance 0.1 ± 0.8 mm postoperatively. All alterations of the condyle-fossa relation were non-significant except for the anterior distance in Angle class ІІІ (p = 0.02). Alterations of the disc position and disc degeneration were non-significant in class II. In class ІІІ, the disc degeneration deteriorated slightly on the left side (p = 0.02). Intercondylar distance increased 1 ± 5.5 mm in class ІІ and decreased by 1 ± 5.5 mm in class ІІІ postoperatively, alterations were non-significant.Sonography is a non-invasive, comfortable, fast, economical and effective intraoperative method of condyle positioning. The results of the present study support this statement because the degree of disc degeneration and luxation remained unaltered and the condyle position did not change significantly. Prospective randomized comparison to manual positioning is in preparation and will be conducted in the near future.

The aim of this study was to evaluate the accuracy of real-time magnetic resonance imaging (MRI) T1-based treatment monitoring for predicting volume of lesions induced by laser-induced thermotherapy (LITT) of liver metastases.This prospective study was approved by the institutional review board and informed consent from all included patients was obtained. In 151 patients, 237 liver metastases were ablated during 372 LITT procedures. 1.5 T MRI treatment monitoring was performed based on longitudinal relaxation time (T1) using fast low-angle shot (FLASH) sequences. Patients underwent additional contrast-enhanced MRI directly after LITT, 24 h after the procedure and during follow-up at 3, 6 and 12 months. The amount of energy necessary to induce a defined necrotic area was investigated within the various liver segments.The total amount of energy applied during LITT varied from 6.12-225.32 kJ (mean 48.96 kJ). Ablation in liver segments 5 (2.12 kJ/cm(3)) and 8 (2.16 kJ/cm(3)) required the highest energy. The overall pre-ablative metastasis volume ranged from 0.5-51.94 cm(3) (mean 1.99 cm(3), SD 25.49 cm(3)) while the volume measured in the last available T1 image varied from 0.78-120 cm(3) (mean 26.25 cm(3), SD 25.66 cm(3)). Volumes measured via MRI T1-based treatment monitoring showed a stronger correlation with necrosis 24 h after LITT (r = 0.933, p0.001) than contrast-enhanced MRI directly after the procedure (r = 0.888, p0.001).Real-time MRI T1-based treatment monitoring during LITT of liver metastases allows for precise estimation of the resulting lesion volume and improves control of the energy necessary during ablation.

OBJECTIVES This study aimed to evaluate the possibility of predicting radiologically the scalar localization of a 31.5-mm-long, free-fitting electrode carrier for cochlear implantation, using conventional planar computed tomography. STUDY DESIGN A cross-sectional human temporal bone study was conducted. SETTING Twenty human temporal bones were acquired postmortem and implanted with 31.5-mm-long electrode carriers. Ten of these were implanted into the scala tympani using the round window approach, whereas the other 10 electrodes were inserted into the scala vestibuli by cochleostomy. Computed tomography was then performed, and 2 experienced blinded radiologists evaluated the intracochlear position of the array. MAIN OUTCOME MEASURE The estimated position of the electrode carrier was described using a 5-point scale. After sectioning and histologic investigation, the results of the radiologic and histologic investigations were compared. RESULTS In 17 of 20 cases, it was possible to estimate the correct position of the electrode carrier within the basal turn of the cochlea by means of computed tomography. As the insertion angles widened beyond 360 degrees, it became increasing difficult for the radiologists to correctly determine the position of the electrode carrier. CONCLUSION The comparison of our temporal bone experiment results with the computed tomography results revealed the difficulty of assessing the correct position of intracochlear electrodes. Scalar localization of deeply inserted electrode carriers cannot be precisely determined by means of computed tomography.

Background: To evaluate a treatment protocol with repeated transarterial-chemoembolisation (TACE) downsizing before MR-guided laser-induced interstitial thermotherapy (LITT) using different chemotherapeutic combinations in patients with unresectable colorectal cancer (CRC) liver metastases. Methods: Two hundred and twenty-four patients were included in the current study. Transarterial-chemoembolisation (mean 3.4 sessions per patient) was performed as a downsizing treatment to meet the LITT requirements (number⩽5, diameter

Purpose To evaluate MR-thermometry using fast MR sequences for laser induced interstitial thermotherapy (LITT) at 0.2 and 1.5 T systems. Methods & Materials In-vitro experiments were performed using Agarose gel mixture and lobes of porcine liver. MR-thermometry was performed by means of longitudinal relaxation time (T1) and proton resonance frequency shift (PRF) methods under acquisition of amplitude and phase shift images. Four different sequences were used for T1 thermometry: A gradient-echo (GRE), a True Fast Imaging with Steady Precession (TRUFI), a Saturation Recovery Turbo-FLASH (SRTF), and an Inversion Recovery Turbo-FLASH (IRTF) sequence (FLASH—Fast Low Angle Shot). PRF was measured with four sequences: Two fast-spoiled GRE sequences (one as WIP sequence), a Turbo-FLASH (TFL) sequence (WIP sequence), and a multiecho-TrueFISP sequence. Temperature was controlled and verified using a fiber-optic Luxtron device. The temperature was correlated with the MR measurement. Results All sequences showed a good linear correlation R2 = 0.97–0.99 between the measured temperature and the MR-thermometry measurements. The only exception was the TRUFI sequence in the Agarose phantom that showed a non-linear calibration curve R2 = 0.39–0.67. At 1.5 T, the Agarose experiments revealed similar temperature accuracies of 4–6°C for all sequences excluding TRUFI. During experiments with the liver, the PRF sequences showed better performance than the T1, with accuracies of 5–12°C, contrary to the T1 sequences at 14–18°C. The accuracy of the Siemens PRF-FLASH sequence was 5.1°C. At 0.2 T, the Agarose experiments provided the highest accuracy of 3.3°C for PRF measurement. At the liver experiments the T1 sequences SRTF and FLASH revealed the best accuracies at 6.4 and 7.0°C. Conclusion The accuracy and speed of MR temperature measurements are sufficient for controlling the temperature-based tumor destruction. For 0.2 T systems SRTF and FLASH sequences are recommended. For 1.5 T systems SRTF and FLASH are the most accurate. Lasers Surg. Med. 44:257–265, 2012. © 2012 Wiley Periodicals, Inc.

Die Einfuhrung und Umsetzung von ATLS® („advanced trauma life support“) in die Routine der Schockraumversorgung ist eine Herausforderung, die nicht ausschlieslich durch Absolvierung eines ATLS®-Kurses einzelner Teammitglieder bewerkstelligt werden kann. Zur konsequenten Umsetzung an einem uberregionalen Traumazentrum wurde ein teamorientiertes „In-house-Training“ unter Einbeziehung aller an der Schockraumversorgung beteiligten Fachdisziplinen und Berufsgruppen entwickelt und im Jahr 2009 umgesetzt. Die theoretische Grundlage des vorliegenden Trainings war das TEAM®-Konzept („Trauma Evaluation and Management“) des American College of Surgeons, welches fur die studentische Ausbildung sowie „multidisciplinary team members“ entwickelt wurde. Vor dem Training wurde eine Befragung aller 84 Teilnehmer durchgefuhrt, um den subjektiven Kenntnisstand in Bezug auf ATLS®-Inhalte zu ermitteln. In dem 90-minutigen Hands-on-Teil des Trainings wurden von je 10 Mitgliedern eines Schockraumteams 3 Szenarien von mehrfachverletzten Patienten bearbeitet. Die Szenarien wurden mittels Simulatoren dargestellt. Die Evaluation nach dem Training ging der Frage nach, ob die Teilnehmer subjektiv von dem Training profitiert haben. Die Auswertung der Versorgungszeiten im Schockraum ein Jahr vor und ein Jahr nach dem Training wie auch die Haufigkeit der im Schockraum ubersehenen Verletzungen wurde als Parameter der Prozess- bzw. Ergebnisqualitat herangezogen. Vor dem Training beurteilten 57% der Teilnehmer das eigene Wissen hinsichtlich ATLS® als optimierungsbedurftig. Die Erwartungen wurden durch das Training zu einem Grosteil erfullt. Die Gesamtzeit der Schockraumversorgung war ein Jahr nach dem Training unverandert (36±16 min) im Vergleich zum Jahr vor dem Training (39±18 min). Demgegenuber konnte die Anzahl der im Schockraum ubersehenen Verletzungen (5,6% vs. 3,2%) signifikant reduziert werden. Neben der Ausbildung einzelner ATLS®-Provider kann die Einfuhrung eines interdisziplinaren und interprofessionellen Teamtrainings vor Ort die Umsetzung ATLS®-spezifischer Algorithmen in der klinischen Routine fordern.

Due to muscular deformation and movement, standard radiology provides only a snapshot of a probably never recurring situation. The scope of this project is dynamic rendering of muscular structures, starting from 4D-radiology, namely 3D+time, to macroscopic visualization and simulation based thereon. As full real time 4D-MRI is still beyond the technical possibilities for most human muscles, we follow kind of multi level approach. The first step is the analysis of muscular tissue of cadaveric preparations where validation can be performed by direct comparison. Secondly, nearly static, but living muscular tissue is studied based on standard 3DMRI. The first step towards time dependency are ex post composed series of static MRI where the muscle goes back to relaxed position between the acquisition steps. This is followed by so called “quasi-continuous” acquisition where, though not real time, the muscle does not go back to its original state, however remains in stretched position during acquisition. The final goal is full real time data acquisition. The radiological acquisition is followed by highly detailed image processing, segmentation, and visualization where the deforming muscular tissue is subjected to direct volume rendering with special transfer functions. The applied methods are demonstrated for the flexion of a human ankle joint and deforming human upper arm musculature. The visualization techniques proved to be well suited for capturing dynamics, but additional radiological research is strongly needed. The area of application of 4D-modeling ranges from biomechanics to medical diagnosis and therapy of muscular disorders. Key words: 4D-visualization, dynamic MRI, sequential MRI, upper arm musculature, ankle joint flexion, lower leg musculature, biceps brachii muscle, gastrocnemius muscle, direct volume rendering, 3D-reconstruction

The purpose of this article is to determine the degree to which the skin entrance dose could be lowered, by adjusting exposure parameters and filtration, and the subsequent effect on readers' confidence levels of digital radiographs.The study was prospectively performed on a cadaver. Digital radiographs of bones were evaluated and scored on a 9-point scale separately by four radiologists who were blinded to the types of filtration and doses used. The study entailed three phases: phase 1, random dose and filter; phase 2, fixed filter and varying radiation doses (100%, 75%, 50%, and 25% of the standard recommended dose); and phase 3, fixed dose and varying filtration (no filtration, aluminum filter, and aluminum-copper filter). Skin entrance dose was measured using a dosimeter placed on the skin. Differences in scores were tested using a Friedman test.The mean scores given to images with 100%, 75%, 50%, and 25% of the recommended standard dose were 6.18, 6.1, 5.11, and 4.07, respectively. No significant difference was noted between 100%- and 75%-dose images (p = 0.1). A significant difference (p0.0001) was noted when we compared the 100%- and 75%-dose images with the 50%- and 25%-dose images. The mean scores given for no filtration, aluminum filtration, and aluminum-copper filtration were 5.67, 5.43, and 5.18, respectively. No significant difference between no filtration and aluminum filtration (p = 0.411) was noted. A significant difference was detected between no filtration and aluminum-copper filtration (p = 0.012). The combination of an aluminum filter and a 75% standard dose achieved a 31.1% reduction in skin entrance dose.It is possible to achieve a 31.1% reduction in skin entrance dose for imaging bony structures by using 75% of the standard dose and aluminum filtration without significantly affecting image quality.

To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system.The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented.The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed.Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.

OBJECTIVES This study aimed to evaluate an atraumatic prototype electrode carrier for cochlear implantation, the FLEX electrode. This electrode is designed to preserve hearing and to achieve a 360-degree insertion. STUDY DESIGN A cross-sectional human temporal bone study was conducted. SETTING Preliminarily, the prototype electrode was inserted in a scala tympani model to measure the insertion force. Thirteen human temporal bones were acquired postmortem and implanted with the new device using the round window approach. Three of them were implanted under radiologic control to demonstrate the insertion path. After embedding, the remaining 10 temporal bones were sectioned undecalcified and examined macroscopically and histologically. MAIN OUTCOME MEASURES The insertion force was measured to determine intracochlear resistance peaks. The insertion angle was measured, and the degree of intracochlear trauma was determined. RESULTS The round window approach caused cochlear trauma in 1 of 10 specimens. An exact 360-degree insertion was achieved in 7 of 10 specimens (mean overall insertion angle, 360 degrees). Radiologic examination and insertion force measurements revealed the smooth and atraumatic insertion. CONCLUSION The new prototype electrode carrier is suitable for clinical application. It can be handled easily and allows atraumatic 360-degree insertion of all electrode contacts. Therefore, this electrode concept allows good coverage of the cochlea for electrical and additional acoustic stimulation.

The aim of this study was to evaluate the accuracy of pedicle screw placement after computed tomography (CT)-assisted positioning of guide wires and subsequent insertion of transpedicular screws in particularly narrow pedicles in the thoracic spine. Transpedicular pedicle screw placement has been commonly used for a number of decades. However, a significant number of malpositioned screws still occur, especially in the thoracic spine, potentially correlating with relevant complications, e.g., neurological deterioration. A retrospective analysis was performed after CT-assisted and -controlled implantation of guide wires into the pedicle. A total of 39 patients underwent dorsal spondylodesis using two different internal fixation systems, i.e., with a cannulated or a solid screw design. The postoperative screw position was evaluated with CT scans in three planes in a total of 254 screws. The number of the screws inserted at each level were as follows (total n = 326): T1, n = 8; T2, n = 26; T3, n = 26; T4, n = 36; T5, n = 50; T6, n = 37; T7, n = 38; T8, n = 32; T9, n = 24; T10, n = 18; T11, n = 10; T12, n = 6. Indications for the operative treatment were fractures, tumors, and infectious diseases. A total of 254 screws inserted were evaluated by CT scan in order to determine the screw position inside the pedicle and potential perforation of the pedicle wall. The overall rate of pedicle wall perforation was 7.5%, including 1.2% perforations of the medial wall. A significant correlation between the perforation rate and the type of fixation system in favor of the cannulated system was found (P = 0.033). During the study, no revision surgery due to screw misplacement was necessary. None of the treated patients showed neurological deterioration after screw implantation during the presented study. The CT-assisted pedicle screw implantation procedure using guide wires implanted prior to surgery is an accurate, reliable, and safe method for dorsal spondylodesis in the treatment of a variety of spinal instabilities, including fractures, tumors, and infections.

The purpose of this study was to evaluate local tumor control and survival after use of a downstaging protocol of repeated transarterial chemoembolization (TACE) with two chemotherapeutic combinations followed by laser-induced thermotherapy in the care of patients with liver metastasis of breast cancer.This prospective study included 161 patients with liver metastasis of breast cancer origin. TACE (mean, 3.5 [SD, 1.3] sessions per patient; range, 1-9 sessions) was performed as downstaging treatment to achieve the size and number of metastatic lesions that met the requirements for laser-induced thermotherapy (diameter5 cm, number ≤ 5). The TACE protocol was performed with either mitomycin C alone (n = 53) or mitomycin C in combination with gemcitabine (n = 108).In response to TACE overall, the mean reduction in diameter based on the longest diameter of the target lesions was 27%. The difference between diameter reduction in the mitomycin C group and that in the mitomycin C-gemcitabine group was not statistically significant (p = 0.65). The mean survival time of all patients was 32.5 months, calculation starting from the first TACE treatment. The mean local tumor control period calculated as of completion of therapy was 13 months, and the mean time to progression was 8 months. In the mitomycin-gemcitabine group, mean time to progression was 10.7 months, and in the mitomycin group it was 6.9 months (p = 0.5).TACE can be used for sufficient downstaging of liver metastatic lesions of breast cancer to allow laser-induced thermotherapy. A combination of mitomycin C and gemcitabine seems to improve the reduction achieved with TACE.

Der Larynxtubus (LT) gewinnt zunehmend auch in der Notfallmedizin an Bedeutung. Es wird uber 2 Patienten berichtet, bei denen es im Rahmen einer praklinischen Atemwegssicherung mithilfe des LT zu einer schwerwiegenden Aspiration bzw. einer gastralen Luftinsufflation mit Unmoglichkeit der Beatmung kam. Die zu diesen Ereignissen fuhrenden Pathomechanismen, deren Erkennung und Behebung werden diskutiert.

Der vorliegende Beitrag stellt interventionelle Therapieverfahren auf der Basis thermischer Ablationsverfahren wie Radiofrequenzablation (RFA), laserinduzierte Thermotherapie (LITT) und Mikrowellenablation (MWA) fur die palliative Therapie von malignen primaren und sekundaren Leber- und Lungentumoren vor. Er befasst sich mit der vergleichenden Bewertung der lokalen Tumorkontrollraten, Langzeituberlebensraten (LUR), das progressionsfreie Uberleben („progression-free survival“, PFS) und Komplikationen. Bei Lebermetastasen des kolorektalen Karzinoms (CRC) liegen die Daten fur RFA, LITT und MWA fur die lokale Tumorkontrollrate bei jeweils ca. 85%, 95% und 93%, die LUR bei 22, 37 und 32 Monaten und das PFS bei 84, 97 und 93 Monaten. Neue Studien zeigen verbesserte Ergebnisse bei Kombinationen mit systemischer und regionaler Chemotherapie (TACE). Seltenere Indikationen fur die Thermoablation stellen lokale Rezidive von Kopf-Hals-Malignomen, Lymphknoteninfiltrationen und Beckenneoplasien dar.

Objective To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

Die MRT (Magnetresonanztomographie) gewinnt in der Diagnostik von Verletzungen im Kindes- und Jugendalter zunehmend an Bedeutung, die therapeutische Relevanz der hiermit gewonnenen Zusatzinformationen wird kontrovers diskutiert. Neben den Einsatzmoglichkeiten der MRT bei Verletzungen im Kindes- und Jugendalter werden eigene Ergebnisse einer retrospektiven Studie prasentiert, bei welcher die posttraumatischen Rontgenbilder und MRT-Aufnahmen in insgesamt 45 Fallen von jeweils 2 Radiologen und 2 Unfallchirurgen anonymisiert voneinander unabhangig standardisiert ausgewertet sowie bezuglich ihrer therapeutischen Relevanz beurteilt wurden. Zusammenfassend ist festzustellen, dass die MRT weniger der Akutdiagnostik von Frakturen dient als vielmehr der Verlaufsbeurteilung z. B. prolongierter Heilverlaufe, um Komplikationen aufzudecken. Haufig wird sie zur Planung weiterer therapeutischer Schritte genutzt. Zudem gibt es spezielle Indikationen, bei der sie eine zentrale Rolle spielt, wie zum Ausschluss von Kniebinnenschaden, von Begleitverletzungen nach Patella- oder Schulterluxation, zur Stadieneinteilung der Osteochondrosis dissecans, zur Darstellung posttraumatischer Durchblutungsstorungen und zur Abgrenzung zu Differenzialdiagnosen.

BACKGROUND AND PURPOSE: PCT studies hold short-term predictive value in patients treated with chemoradiotherapy. Our aim was to examine the long-term predictive value of baseline PCT studies for local tumor control and overall survival in SCCA of the upper aerodigestive tract treated with chemoradiotherapy. MATERIALS AND METHODS: Eighty-four patients with advanced SCCA underwent PCT followed by concomitant chemoradiation. The acquired perfusion maps represented BF, BV, MTT, and PS. Visual analysis of the parametric maps for identification of tumor perfusion patterns was conducted. ROC curves, t tests, and Kaplan-Meier survival curves were plotted for local disease control and overall survival. RESULTS: The median time of local tumor control was 24 months. The BF and PS values were significantly higher in patients who had no recurrence than in those with local failure (P ≤ .02). The BF and PS were predictive (P ≤ .0006) but BV and MTT held no significant predictive values for local tumor control. The patients with high BF and PS had a longer local tumor control than the patients with hypoperfused tumors (P = .0007). A visually detected BF-BV mismatch had a sensitivity/specificity of 63%/66% (P = .03) and 59%/69% (P = .03) for local tumor control and OS, respectively. Patients without mismatch lived significantly longer than patients with mismatch (P = .01). CONCLUSIONS: BF, PS, and mismatch of BF-BV are significant predictors of local tumor control after chemoradiation in SCCA of the upper aerodigestive tract.

A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room. We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch® from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry. In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001). Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage. Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.

The purpose of this paper is to evaluate the impact of adding combined 18F-PET/CT to MRI for T and N staging of the oral and oropharyngeal cancer and calculation of the gross tumor volume (GTV) having histopathology as reference standard.PET/CT and MRI were performed in 66 patients with suspected oral and oropharyngeal cancer (41 primary tumors/25 recurrent tumors) and nodal disease (114 nodes). Statistical analysis included the McNemar test, sensitivity, specificity for the diagnostic modalities as well as regression analysis, and Bland-Altman graphs for calculated tumor volumes.There was no statistically significant difference between the two modalities compared to pathological findings regarding detection of disease (Por =0.72). The sensitivity/specificity for tumor detection were 100/80% and 96.72/60% for MRI and PET/CT, respectively. The sensitivity/specificity for nodal metastases were 88.46/75% and 83.81/73.91% for MRI and PET/CT, respectively. In 18% of cases, the MRI-based T staging resulted in an overestimation of the pathologic tumor stage. The corresponding rate for PET/CT was 22%. Regarding the treated necks, both modalities showed 100% sensitivity for detection of the recurrent lesions. In necks with histologically N0 staging, MRI and PET/CT gave 22% and 26% false positive findings, respectively. The mean tumor volume in the pathologic specimen was 16.6 +/- 18.6 ml, the mean volume derived by the MR imaging was 17.6 +/- 19.1 ml while the estimated by PET/CT volume was 18.8 +/- 18.1 ml (Por =0.007 between the three methods). The Bland-Altman analysis showed a better agreement between PET/CT and MRI.The diagnostic performance of FDG-PET/CT in the local staging of oral cancer is not superior to MRI.

PURPOSE, METHODS: This study (50 patients; Ø 25 years) compared surgically assisted rapid maxillary expansion (SARME) with (+/-PP) to SARME without pterygomaxillary (-PP) disjunction due to dentoskeletal effects in 3D CT preoperatively and Ø 11 weeks post-expansion.In t test, SARME-PP declined in transverse width from anterior to posterior but more symmetrically than SARME+PP. It produced more segmental inclination and vestibular bone resorption in the premolars. SARME+PP also declined in transverse width from anterior to posterior but more asymmetrically with an extreme convergence to the molars. It produced more segmental inclination and vestibular bone resorption (second molar) in the molars and a palatal bone plate thickness increase in the second premolar. With variance analysis, a further differentiation between the two independent groups due to secondary variables was made: SARME+PP produced the biggest decline in transverse width (patients20 years) and the biggest segmental outward inclination from anterior to posterior in patients with bone-borne devices. SARME-PP in patients20 years and SARME+PP in patients20 years both produced the biggest lateral pterygoid bending.Pterygomaxillary disjunction should be based on patient age and individual requirements, i.e., in patients20 years (SARME-PP) and20 years (SARME+PP).

Comparison of bone-borne (BB) versus tooth-borne (TB) distraction in surgically assisted rapid maxillary expansion, secondary variables were bipartite (2S) or tripartite (3S) osteotomy, pterygomaxillary osteotomy (+PP) or not (jPP), and age (920 years old [920] and G20 years old [G20]). Fifty patients received three-dimensional computed tomography examination preoperatively and after expansion; 24 had BB, and 26 had TB distraction. Predefined preoperative landmarks versus postexpansion positions were assessed in multiplanar viewing. Bone-borne devices had bigger overall skeletal and dental maxillary expansion declining from anterior to posterior, more asymmetric expansion, less vestibular bone resorption, and less dental tipping; TB devices showed similar dorsal decrease in transverse skeletal and dental maxillary expansion from anterior to posterior, more vestibular bone resorption, particularly in the premolars, and more dental tipping. Bone-borne 3S +PP G20 had the biggest decrease in transverse skeletal widening and biggest segmental outward inclination; BB 3S +PP 920 had the biggest decline in transverse dental widening; TB 2S YPP G20 had the biggest segmental inward inclination; BB 2S YPP 920 had the biggest dental tipping; BB 2S G20 had the biggest vestibular bone resorption in molars; and TB 3S 920 and BB YPP had the biggest vestibular bone resorption in premolars. There was a significant correlation between transverse widening and segmental inclination; that is, a bigger amount of transverse widening provokes less segmental inclination.

Die perineurale Tumorausbreitung bei Kopf-Hals-Tumoren ist eine Form metastatischer Erkrankung, bei der sich der Tumor entlang der Nervenbahnen zentrifugal oder -petal ausbreitet. Die perineurale Tumorausbreitung hat entscheidenden Einfluss auf das therapeutische Ergebnis und die Uberlebenszeit der Patienten. Haufig sind die Patienten initial bei einer perineuralen Tumorinfiltration asymptomatisch, weshalb die Bildgebung (insbesodere die MRT) eine entscheidende Rolle bei der Detektion der Lasionen spielt. Der Radiologe sollte mit den relevanten anatomischen Landmarken und den haufigen Ausbreitungsbahnen vertraut sein. Diese Kenntnis im Zusammenhang mit der dazugehorigen diagnostischen Strategie ermoglicht es meistens, die perineurale Tumorausbreitung zu diagnostizieren.

Objectives/Hypothesis: To assess the insertion forces and feasibility of insertion of a prototype electrode carrier coated with a flexible and biodegradable coating developed for lubrication and drug delivery. Study Design: Experimental study. Methods: Eight coated and eight uncoated electrode carriers were inserted into a scala tympani model by means of an insertion device, and forces produced during insertion were determined in near real time. The maximum insertion depths and insertion angle were determined. To test the handling and operability, five coated electrode carriers were implanted into human temporal bones. Additionally, the bones were processed undecalcified and the distribution of the coating material within the cochlea evaluated. Results: Insertion forces were markedly reduced in the group of coated electrode carriers for insertion depths above 15 mm. The insertions were less fitful and led to a higher maximum insertion angle. The insertion of the coated electrode carrier was feasible, and the coating material was evident up to the apical parts of the cochlea postimplantation. Conclusions: Coating of a cochlear implant electrode carrier may reduce insertion forces responsible for the surgical trauma. Loaded with active substances, the coating may help to deliver drugs to the apical parts of the cochlear where hair cells reside in patients with residual hearing. Laryngoscope, 2009

Rationale and Objectives To evaluate the interchangeability of perfusion parameters between two software packages for the postprocessing of dynamic contrast-enhanced (DCE) computed tomographic images of head and neck tumors. Materials and Methods DCE computed tomographic images of 75 patients with head and neck tumors were postprocessed using a software package based on the maximum-slope approach and Patlak analysis, as well as a software package with deconvolution-based analysis incorporating an adiabatic approximation of tissue homogeneity (ATH) model. The evaluated perfusion parameters included blood flow (F), blood volume (v), and permeability–surface area product (PS). Region-of-interest (ROI) analysis of the tumors and the metastatic lymph nodes was performed. The perfusion parameters were compared using the Wilcoxon matched-pairs test and Bland-Altman plots. Results One hundred fifty-two ROIs of tumors and nodes were outlined and analyzed. Moderate to good correlations were demonstrated between the various perfusion values (r = 0.56–0.72, P Conclusion There were significant differences in the perfusion parameters obtained using the two software packages, and thus, these parameters are not directly interchangeable.

Objective To evaluate whether symphyseal distraction for correction of mandibular transverse deficiencies and dental crowding provokes lateral shift of the condyles, because this may have secondary influence upon temporomandibular joint function. Study design Nine patients' routine pre- and postoperative computerized tomography scans were evaluated for intercanine distance and condylar position before and 3 months after mandibular symphyseal distraction osteogenesis (MSDO). Identical bone-borne distraction was applied in all cases at 0.6 mm distraction per day, starting 5 days after surgery. Results Intercanine distance increased effectively by 3.8 ± 1.8 mm (P = .004), condylar distance decreased by 1.2 ± 0.8 mm (P = .02), condylar angulation decreased by 0.03 ± 4.3 degrees (P = .7), and lateral, cranial, and inner condylar cortex to fossa distances changed by 0.4 ± 0.5 mm (P = .8), 0.4 ± 0.5 mm (P = .7), and 0.4 ± 0.3 mm (P = .4), respectively. Conclusions MSDO causes no lateral displacement and rather a decrease of condylar transversal distance whereas angulation, vertical medial, cranial, and lateral distance to the fossa remain unchanged. This finding asserts the clinical absence of temporo-mandibular dysfunction associated with MSDO as reported in the literature, even though soft tissue changes and long-term outcomes require further follow-up studies.

Vorstellung eigener Erfahrungen und Ergebnisse eines fruhklinischen Behandlungsalgorithmus unter Integration der Notfallembolisation (TAE) bei instabilen Beckenfrakturen mit arterieller Blutung. Retrospektive Untersuchung einer konsekutiven Patientenserie der Jahre 04/2002-12/2006 an einem Level-1-Traumacenter. Die Daten der Online-Schockraumdokumentation (Traumawatch®) bei Patienten mit Beckenfraktur und einer im Multislice-Computertomographie (MSCT) nachgewiesenen arteriellen Blutung wurden auf folgende Parameter hin untersucht: demographische Daten, Unfallmechanismus, Frakturklassifikation nach Tile/AO und Verletzungsschwere Becken nach „Abbreviated Injury Score“ (AIS), Begleitverletzungen mit Erhebung der Gesamtverletzungsschwere nach „Injury Severety Score“ (ISS), physiologische Aufnahmeparameter (Kreislaufparameter und initialer Hb-Wert) sowie Transfusionsbedarf wahrend der Schockraumversorgung, Zeit bis zur Embolisation, Dauer der Embolisation und identifizierte Blutungsquelle. Von insgesamt 162 Schockraumpatienten mit instabiler Beckenfraktur wurde bei 21 Patienten eine arterielle Blutung durch Kontrastmittelextravasation im MSCT nachgewiesen. 12 Patienten waren mannlich und 9 weiblich, das Durchschnittsalter lag bei 45 (17–80) Jahre. Als Unfallmechanismus lagen ausschlieslich Hochrasanztraumen vor. Es handelte sich zu 33% um Becken-B-Verletzungen und 67% um Typ-C-Verletzungen mit einem durchschnittlichen AISBecken von 4,4 Punkte (3-5) und einer Gesamtverletzungsschwere anhand des ISS von 37 Punkte (21–66). Bei Aufnahme lag bei 47,6% eine Kreislaufinstabilitat vor mit einem durchschnittlichen Hb-Wert von 7,8 (3,2–12,4) g/dl und einem durchschnittlichen Transfusionsbedarf von 6 (4–13) Erythrozytenkonzentraten wahrend der Stabilisierungsphase. Die Zeit von Eintreffen im Schockraum bis zur Durchfuhrung der TAE betrug im Mittel 62 (25–115) min mit einer Durchfuhrungsdauer der TAE von 25 (15–67) min. Als Blutungsquelle wurden ausschlieslich Aste der A. iliaca interna identifiziert. Die primare Erfolgsrate der TAE betrug >90%. Die interventionelle Notfallembolisation (TAE) stellt sowohl ein effektives als auch schnelles Verfahren zur Blutstillung bei einer im MSCT nachgewiesenen arteriellen Blutung bei Schockraumpatienten mit stabilen oder stabilisierbaren Kreislaufverhaltnissen und Beckenfrakturen dar. Bei gesicherter 24-h-Bereitschaft durch die Radiologie und effizienter Infrastruktur kann diese zeitnah nach Klinikaufnahme durchgefuhrt werden und sollte somit in das fruhklinische Behandlungsprotokoll integriert werden.

Imaging of the oral cavity, the larynx, and the pharynx must be coordinated with the clinical exam [1, 2]. The information acquired at imaging usually emphasizes the deeper tissues as the superficial assessment is done by direct visualization. The description of the anatomy is key to description of any lesion.

Treatment of polytrauma patients has been discussed extensively during the past decades. Management in the prehospital phase, on admission, and in the early postoperative/ICU-period has to refer to injury severity, priority of injuries, and likelihood of development of multi organ failure. Cervical spine injuries are reported in 4-34% of polytrauma cases. Securing the cervical spine by a hard collar is one of the basic procedures in the prehospital phase. Different strategies of assessing the cervical spine are still discussed controversially. Since plain radiographs, CT-scan, MRI, and flexion/extension fluoroscopy still play a role in early diagnosis of cervical spine injury, we present an analysis of cervical spine injuries in our multiple trauma patients to elucidate our algorithm. We reviewed our data between January 2003 and December 2006 concerning epidemiology, diagnosis and treatment of cervical spine injury in polytrauma patients. Multislice-CT (MSCT) or Multidetector-CT was used as standard diagnostic procedures in the polytraumatized patient. In 97% of patients, CT-scanning showed to be a reliable tool in detecting injuries of the cervical spine. Only in two patients (3%), additional MRI lead to a change in treatment strategy. Of 66 polytraumatized patients with significant cervical spine injury, 25 (37.9%) received surgical treatment within 24 h. Sixteen patients (24.2%) were treated surgically after stabilization on ICU. There was a better outcome concerning length of hospitalization in the "day-onesurgery" group. We consider MSCT as standard approach towards diagnosis of cervical spine injury in polytrauma patients. MRI and flexion/extension fluoroscopy can give additional information in selected cases.

Ziel dieser Arbeit ist die Darstellung der aktuellen Indiaktionen und Techniken zur Interventionellen Therapie von schweren Blutungen im Rahmen der interdisziplinaren Behandlung polytraumatisierter Patienten. Entscheidend ist dabei, dass bei Patienten mit schweren Blutungen, die die Klinik erreichen, die Blutungen schnell diagnostiziert und therapiert werden. Zur Verfugung stehen heute im Wesentlichen entweder die Embolisation, die Stentimplantation oder die temporare Ballonokklusion. Diese Verfahren werden dabei entweder alleine oder in Kombination mit chirurgischen Verfahren eingesetzt. Die Multidetektor- CT (MDCT) spielt dabei bei der schnellen Diagnostik und der Stratifizierung der Ptienten eine entscheidende Rolle.

Aim To compare clinical feasibility of static two-dimensional (2D) to three-dimensional (3D) sonography of the temporomandibular joint (TMJ) in assessment of disk dislocation and joint degeneration compared to magnetic resonance imaging (MRI). Method Thirty-three patients, 66 TMJ were prospectively sonographed 2D and 3D (8–12.5 MHz step motor scan), in occlusion and maximum opening with a probe position parallel inferior to the zygomatic arch. Axial 2D images were judged independent from the 3D scans; 3D volumes were cut axial, sagittal, frontal and rotated in real-time. Disk position and joint degeneration were assessed and compared to a subsequent MRI examination. Results The specific appearance of the disk was hypoechogenic overlying a hyperechogenic condyle in axial (2D) or sagittal and frontal (3D) viewing. Specificity of 2D sonography for disk dislocation was 63%, sensitivity 58%, accuracy 64%, positive predictive value 46%, negative predictive value 73%; for joint degeneration synonymously 59/68/61/38/83%. 3D sonography for disk displacement reached synonymously 68/60/69/51/76%, for joint degeneration 75/65/73/48/86%. 2D sonographic diagnoses of disk dislocation in the closed mouth position and of joint degeneration showed significantly different results from the expected values (MRI) in χ 2 testing; 3D diagnoses of disk dislocation in closed mouth position, of joint degeneration, 2D and 3D diagnoses in open mouth position were nonsignificant. Conclusions Acceptable was the overall negative predictive value, as specificity and accuracy for joint degeneration in 3D. 3D appears superior diagnosing disk dislocation in closed mouth position as for overall joint degeneration. Sensitivity, accuracy and positive predictive value will have to ameliorate with future equipment of higher resolution in real-time 2D and 3D, if sonographic screening shall be clinically applied prior to MRI.

The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases.

We report a 75-year-old male patient with an aneurysm of the left femoral artery after cemented total hip arthroplasty. Two months after the operation, the patient showed a spherical resistance and pain in the left groin. Examination showed a big false aneurysm of the left femoral artery. After resection of the aneurysm, an endovascular stent graft vessel prosthesis was implanted. The aneurysm originated from a punctual lesion of the artery caused by a screw. Since the first description of vessel lesions in orthopaedic surgery in 1964, a total of 24 cases of aneurysm in hip surgery have been described. Therefore, a review of literature tries to explain causes and mechanisms of vessel injuries in hip surgery and the possibilities of repair.

In Deutschland wie in anderen Industrielandern stellen der Diskusprolaps und die damit verbundene Schmerzsymptomatik ein bedeutsames und zunehmendes Gesundheitsproblem dar. Wenn die Moglichkeiten der konservativen Therapie ausgeschopft sind, ist die Nukleolyse als minimalinvasive Alternative zur Operation zu diskutieren. Hierbei werden unter CT-Steuerung chondrolytische oder quelldruckmindernde Substanzen in den Nucleus pulposus einer protrudierten Bandscheibe injiziert. Unter den zahlreichen Substanzen, die bisher zum Einsatz kamen, erwies sich v. a. die Nukleolyse mit einem Ozon-Sauerstoff-Gemisch als viel versprechend. Neben seiner hohen Wasserbindungskapazitat vermag Ozon die Schmerzmediatoren vor Ort uber mehrere Monate zu hemmen, wirkt antiinflammatorisch und durchblutungsfordernd. Ozon wandelt sich im Korper in reinen Sauerstoff um und besitzt eine geringe Allergenitat. Bei der Nukleolyse handelt es sich um das alteste minimalinvasive Verfahren zur Therapie eines Bandscheibenvorfalls. Vergleichende Studien konnten eine Uberlegenheit neuerer Therapiekonzepte, z. B. der perkutanen Nukleotomie oder der Laserbehandlung, nicht bestatigen.

This study determines the value of three-dimensional (3-D) sonography for the assessment of disk dislocation of the temporomandibular joint (TMJ). Sixty-eight patients (i.e.,136 TMJ) with clinical dysfunction were examined by 272 sonographic 3-D scans. An 8- to 12.5-MHz transducer, angulated by step-motor, was used after picking a volume box on 2-D scan; magnetic resonance imaging followed immediately. Every TMJ was scrutinized in closed- and open-mouth position for normal or dislocated disk position. Fifty-three patients had complete data sets, i.e., 106 TMJ, 212 examinations. Sonographic examination took 5 min, with 74% specificity (62% closed-mouth; 85% open-mouth); sensitivity 53% (62/43%); accuracy 70% (62/77%); positive predictive value 49% (57/41%); and negative predictive value 77% (67/86%). This study encourages more research on the diagnostic capacity of 3-D TMJ sonography, with the advantage of multidimensional joint visualization. Although fair in specificity and negative predictive value, sensitivity and accuracy may ameliorate with future higher-sound frequency, real-time 3-D viewing and automated image analysis.

This study determined the value of three-dimensional (3-D) sonography for the assessment of osteoarthrosis and disk degeneration of the temporomandibular joint (TMJ). Sixty-eight patients (136 TMJ) with clinical dysfunction were examined by 272 sonographic 3-D scans. An 8- to 12.5-MHz motor-angulated trans- ducer positioned inferior-parallel to the zygomatic arch scanned the region-of-interest. 3-D condylar morphology was compared with subsequent magnetic resonance imaging (MRI). Fifty-three datasets were complete, i.e., 106 TMJ, 212 examinations. 3-D sonographic examination took 5 min and attained 70% sensitivity/76% specifici- ty/75% accuracy; positive predictive value was 44%%; negative predictive value was 90%. Disk degeneration was diagnosed synonymously with 64%/73%/71%/42%/ 87%. 3-D sonography proved to be reliable for exclusion of osteoarthrosis as disk degeneration compared with MRI, whereas the presence of osteoarthrosis and disk dislocation cannot be reliably diagnosed. Prospective use will include routine screening, using more sophisticated equipment with higher frequency in real-time 3-D viewing. (E-mail: c.landes@lycos.com) © 2006 World Federation for Ultrasound in Medicine & Biology.

Percutaneous vertebroplasty has become an efficient technique for the treatment of painful vertebral fractures. Osteoporotic vertebral compression fractures are characterized by severe back pain and immobilization causing other complications like thrombosis or pneumonia. Vertebral cement augmentation provides increased strength of the vertebral body and an obvious pain relief. Between 1989 and 2004, 30 studies and a total of 2,086 treated patients have been published in literature. A review of these studies has been performed. The number and age of the patients, number of treated vertebrae, pre- and postoperative outcome of pain and complications of the different studies were assessed and analyzed. Percutaneous vertebroplasty is an efficient technique with low complication rates and a significant reduction in pain. It rapidly improves the mobility and quality of life of patients with vertebral compression fractures. With an increasing number of treated patients, experience with this interventional technique has become excellent. But still there are no randomized controlled trials available, showing that percutaneous vertebroplasty has a significantly better outcome than other treatment options, especially after a long-term follow-up.

To assess the effect of transcatheter arterial chemoembolization (TACE) combined with laser-induced thermotherapy (LITT) for treatment of liver metastases in an animal model.All experiments were approved by the German government and the institutional animal research review board. After subcapsular liver implantation of colorectal cancer cells in 30 WAG rats (on day 0), the animals were randomly assigned to three interventional treatment groups. In the 10 rats in group A, TACE was performed: Fourteen days after cancer cell implantation and within 20 minutes after laparotomy and retrograde placement of a microcatheter into the gastroduodenal artery, these rats were injected with mitomycin (0.1 mg), iodized oil (0.1 mL), and degradable starch microspheres (5.0 mg). In the 10 rats in group B, LITT was performed: Also on day 14, the tumors in these animals were exposed to Nd:YAG laser light of 1064 nm at 2 W for 5 minutes. In the 10 rats in group C, combined treatment was administered: TACE was performed on day 14, and LITT was performed on day 21. Tumor volumes were measured before (on day 13) and after (on day 28) treatment with magnetic resonance (MR) imaging, and the mean tumor growth ratio (day 13 tumor volume divided by day 28 tumor volume) was calculated.The mean tumor volumes measured before and after the treatments were, respectively, 0.11 and 0.60 cm(3) in group A, 0.11 and 0.68 cm(3) in group B, and 0.11 and 0.35 cm(3) in group C. The mean tumor growth ratio was 5.42 in group A, 6.14 in group B, and 3.15 in group C. According to Bonferroni test results, compared with the rats in groups A and B (controls), the group C rats had significantly inhibited tumor growth (P.01 for both comparisons).Use of combined TACE-LITT treatment, compared with the use of TACE or LITT alone, significantly inhibits tumor growth.

MR-guided LITT is a safe and effective treatment modality that improves survival in well-selected patients who have liver metastases. A major advantage of MR-guided LITT is that it can be easily performed under local anesthesia in an outpatient setting with a low complication rate.

The accuracy of 16-row multidetector CT in the visualization of different peripheral artery stents and in the appraisal of in-stent stenosis was assessed. Nine different stent types (nitinol and stainless steel) with three diameters (6, 8 and 10 mm) were used; altogether 27 stents were analyzed in a barrel-shaped vascular model. Low-grade (40%) and high-grade (60%) in-stent stenoses were simulated by polyurethane sticks (70 HU) of differing diameters (2-6 mm). Imaging was performed with 16x0.75-mm detector collimation, 130 mAs, 120 kV, 12-mm table feed/rotation, 1.0-mm slice thickness and 0.5-mm increment. The stent diameter, strut thickness, in-stent attenuation values, degree and degree of in-stent stenosis were evaluated. Nitinol stents showed significantly (P10-6) less stent lumen narrowing, artificial strut thickening and overestimation of the degree of in-stent stenoses than stainless steel stents. In-stent attenuation values and artificial strut thickening were significantly (P10-6) lower in 10- and 8-mm stents than in 6-mm stents. Stent lumen narrowing was significantly less in 10-mm stents than in 8-mm (P10-4) or 6-mm (P10-6) stents. In-stent stenoses were significantly overestimated, irrespective of the stent diameter. In 6-mm stents overestimation was significantly higher than in 8-mm (P0.01) or 10-mm stents (P10-6). Under in-vitro conditions 16-row MDCT allowed an accurate identification of in-stent stenosis, but significantly overestimated the effective degree of the stenosis.

Diese retrospektive Studie untersucht, ob die MRT eine therapeutisch relevante Zusatzinformation in der Diagnostik von Gelenkverletzungen bei Kindern liefert und ob es lokalisationsspezifische Unterschiede gibt. Es wurden 45 posttraumatische Rontgenbilder und MRT-Aufnahmen von jeweils 2 Radiologen und 2 Unfallchirurgen anonym, voneinander unabhangig und standardisiert ausgewertet sowie bezuglich der therapeutischen Relevanz beurteilt. Am Kniegelenk (n=18) erhielten wir in 11 Fallen (61%) eine Zusatzinformation durch die MRT mit einer Empfehlung zur Arthroskopie in 7 Fallen (39%). Am Sprunggelenk (n=21) ergaben sich in 12 Fallen (57%) zusatzliche Informationen durch die MRT, dabei anderte sich die Therapieempfehlung in 6 Fallen (29%), wobei keine zusatzliche Operationsindikation daraus abgeleitet wurde. Am Ellbogengelenk (n=6) beobachteten wir in 4 Fallen (67%) eine Diagnoseanderung, die jedoch ohne therapeutische Relevanz war. Die MRT liefert als Zusatzuntersuchung zum konventionellen Rontgen am Kniegelenk relevante Informationen im Hinblick auf die Therapie, wohingegen sie am Sprung- und Ellbogengelenk nur eine untergeordnete Rolle spielt.

Purpose: To evaluate MR-guided interstitial laser-induced thermotherapy (LITT) for the treatment of liver tumors. Materials and methods: To date, 1,632 patients with malignant liver metastases have been treated with LITT at our institute. A total of 10,310 laser applications were performed to treat 5,297 lesions. Results: MR-guided LITT achieves a reliable local tumor control and allows an improved survival in patients with primary and secondary liver tumors. Conclusion: MR-guided LITT is a safe method for the treatment of liver tumors and yields an acceptably low rate of major and minor complications due to its minimal invasive character.

Objective To evaluate cochlear implant trauma to intracochlear structures when inserting the electrode via the round window membrane. Material and methods Eight fresh human temporal bones were evaluated histologically after insertion using two types of cochlear implant array. Bones underwent a special fixation and embedding procedure that allowed sectioning of undecalcified bone with the electrode in situ. Insertions depths were evaluated radiologically and histologically. Results All arrays were found in the scala tympani of the cochlea. Basal trauma could be avoided in all but one specimen. The mean depth of insertion was 382.5°. Apically, only one implanted bone showed cochlear trauma exceeding lifting of the basilar membrane. Conclusion Insertions through the round window membrane were shown to be atraumatic, even in basal cochlear regions. This route of insertion might be very effective for combined electric and acoustic stimulation of the auditory system.

Photodynamic therapy (PDT) is a well-investigated locoregional cancer treatment in which a systemically administered photosensitizer is activated locally by illuminating the diseased tissue with light of a suitable wavelength. PDT offers various treatment strategies in oncology, especially palliative ones. This article focuses on the development and evaluation of interstitial PDT for the treatment of solid tumors, particularly liver tumors. The PDT is mostly used for superficial and endoluminal lesions like skin or bladder malignancies and also more frequently applied for the treatment of lung, esophageal, and head and neck cancer. With the help of specially designed application systems, PDT is now becoming a practicable option for solid lesions, including those in parenchymal organs such as the liver. After intravenous treatment with the photosensitizer followed by interstitial light activation, contrast-enhanced computed tomography shows the development of therapy-induced necrosis around the light-guiding device. With the use of multiple devices, ablation of liver tumors seems to be possible, and no severe side effects or toxicities related to the treatment are reported. PDT can become a clinically relevant adjunct in the locoregional therapy strategies.

Interventional therapeutic methods are presented in Carney triad, which is a syndrome defined as the simultaneous presence of gastric leiomyosarcoma, extra-adrenal paraganglioma, and pulmonary chondroma. The paragangliomas in the carotid bifurcation and the mediastinum were successfully treated via transarterial embolization with particles. Three intrapulmonary chondromas were ablated using MRI-guided laser-induced thermotherapy (LITT) after previous devascularization via transvenous pulmonary particle embolization. In summary, interventional techniques could be a therapeutic option in patients suffering from Carney triad.