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Objective: To assess technical efficacy, accuracy, and safety of epidural (interlaminar) injections performed blindly in patients with a severely degenerated lumbar spine. Methods: Over 12 consecutive months, 138 patients with a severe degenerative lumbar spine underwent epidural (interlaminar) injection as therapy for low back pain and neuralgia. Patients had already undergone a blind epidural infiltration with minimum or no pain reduction. The session was repeated in the angiography suite. Patients were placed in the lateral decubitus position. The injection was performed without image guidance by an anaesthesiologist; the target level was defined before the beginning of the procedure. Once air resistance loss was felt it was presumed that the needle was inside the epidural space. Verification of needle position was performed by injection of 1-3 mL of iodinated contrast medium under fluoroscopy in a lateral projection. Results: C orrect needle position inside the epidural space was documented in 82/138 cases (59.4%); unexpected extraepidural location was seen in 56/138 cases (40.6%). Target level was reached in 96/138 cases (69.6%); in 42/138 cases (30.4%) the needle was positioned in a non-target level. In 5/138 (3.6%) cases, there was inadvertent intradural position of the needle. Image guidance was subsequently used for correct positioning of the needle, which was feasible in all cases. Conclusion: Blind interlaminar epidural injections lack the accuracy of exact needle location that imaging guidance offers in approximately 40% of cases, when there is difficult spine anatomy and the initial epidural approach has failed to provide pain relief. Image guidance for interlaminar epidural injection ensures accurate needle placement, enhancing the safety and efficacy of the procedure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.

BACKGROUND: Micro-computed tomography (micro-CT) is a novel tool for monitoring acute and chronic disease states in small laboratory animals. Its value for assessing progressive lung fibrosis in mice has not been reported so far. Here we examined the importance of in vivo micro-CT as non-invasive tool to assess progression of pulmonary fibrosis in mice over time. METHODS: Pulmonary fibrosis was induced in mice by intratracheal delivery of an adenoviral gene vector encoding biologically active TGF-beta1 (AdTGF-beta1). Respiratory gated and ungated micro-CT scans were performed at 1, 2, 3, and 4 weeks post pulmonary adenoviral gene or control vector delivery, and were then correlated with respective histopathology-based Ashcroft scoring of pulmonary fibrosis in mice. Visual assessment of image quality and consolidation was performed by 3 observers and a semi-automated quantification algorithm was applied to quantify aerated pulmonary volume as an inverse surrogate marker for pulmonary fibrosis. RESULTS: We found a significant correlation between classical Ashcroft scoring and micro-CT assessment using both visual assessment and the semi-automated quantification algorithm. Pulmonary fibrosis could be clearly detected in micro-CT, image quality values were higher for respiratory gated exams, although differences were not significant. For assessment of fibrosis no significant difference between respiratory gated and ungated exams was observed. CONCLUSIONS: Together, we show that micro-CT is a powerful tool to assess pulmonary fibrosis in mice, using both visual assessment and semi-automated quantification algorithms. These data may be important in view of pre-clinical pharmacologic interventions for the treatment of lung fibrosis in small laboratory animals.

Over the past few years, fast-paced technological progress has lent imaging techniques increasing importance. Without the use of modern imaging techniques, accurate diagnosis and therapy in patients in almost any medical setting has become virtually unthinkable. In addition to the oldest projection radiography techniques ("X-rays"), new methods such as ultrasound examination, computed tomography (CT) and magnetic resonance tomography (MRT) now allow the morphology of pathological changes to be accurately mapped while keeping the burden on the patient to a minimum. Pathological changes in metabolic activities can also now be demonstrated non-invasively with positron emission tomography (PET).

Hypothesis: High-resolution imaging as provided by flat-panel based Volume Computed Tomography (fpVCT) could increase navigation accuracy and could therefore be valuable on lateral skull base procedures. Methods: In the first part of the study we evaluated the accuracy of the image guided surgery (IGS) system using a custom made phantom that was scanned both in a Multislice CT scanner (MSCT, GE Lightspeed 16Pro, GE Healthcare, Milwaukee, WI) and in an experimental fpVCT scanner (GE Healtcare). We performed measurements of the Target Registration Error (TRE) with the optoelectronic navigation system VectorVision2 (BrainLAB, Feldkirchen, Germany). In the second part of the study four temporal bone specimens were scanned in the fpVCT device. The data were transferred to the VectorVision2 planning station. The route from the surface of the mastoid to the scala tympani of the cochlea was planned as a direct channel passing the facial recess without injuring the facial nerve and other functionally important anatomical structures of the temporal bone. During surgery the preoperatively defined trajectory was followed from the entry point to the target point using a navigated and hand-held surgical drill. MSCT imaging was acquired to document the position of the drilled channel's position. In addition a routine mastoidectomy and posterior tympanotomy was performed on each specimen to document the drilled route. Results: The accuracy measurements on the phantom revealed that the average TRE using MSCT (0.82 mm, SD: 0.35 mm) was significantly higher than using fpVCT (0.46, SD: 0.22 mm) (p

Das Akustikusneurinom (AN) ist ein gutartiger Tumor, der aus den Schwann-Zellen des VIII. Hirnnervs hervorgeht. Es werden verschiedene genetische Auslöser für die Entstehung des AN diskutiert. Bislang existieren jedoch kaum Kenntnisse hinsichtlich der wachstumsbeeinflussenden Faktoren.Ziel dieser immunhistochemischen Studie war es, die Expression des neurotrophen Faktors Erythropoietin (EPO) und seines Rezeptors EPO-R an einer Serie von 38 AN der sporadischen Variante und an 16 AN, die sich im Rahmen einer Neurofibromatose Typ II manifestierten, zu untersuchen. Zusätzlich erfolgte der Nachweis des Hypoxia Inducible Factor-1a (HIF-1a), der den wichtigsten Regulator der EPO-Expression darstellt, sowie des anti-apoptotischen Proteins bcl-2. Um die Bedeutung von EPO für das Wachstumsverhalten des AN zu untersuchen, wurde der Ki-67-Proliferationsindex (PI) sowie die Vaskularisation der Tumoren ermittelt.36 der 54 (66%) untersuchten AN zeigten eine positive Immunreaktion für EPO und in 46 Fällen (85%) ließ sich EPO-R nachweisen. In 41 Fällen (76%) konnte HIF-1a, in 48 Fällen (89%) bcl-2 nachgewiesen werden. Die Expression von EPO und EPO-R korrelierte dabei mit der Expression von bcl-2. AN mit hoher Expression von HIF-1a, EPO und bcl-2 zeigten einen signifikant höheren PI.Die in beiden Varianten des AN demonstrierte Expression von EPO und EPO-R legt eine funktionelle Bedeutung für das biologische und klinische Verhalten dieses Tumors nahe. Die Korrelation der Expression von EPO und EPO-R mit bcl-2 kann als Hinweis gewertet werden, dass EPO seine anti-apoptotische Wirkung auch im AN über bcl-2 entfaltet. Die Korrelation der Expression von HIF-1a, EPO und bcl-2 mit dem PI spricht für eine Bedeutung dieser Faktoren für das Wachstumsverhalten des AN.