Search

But: Evaluer la croissance des testicules, leur structure echographique et apprecier la revascularisation testiculaire par les vaisseaux collateraux apres une dissection laparoscopique avec le laser (PLLD) de l'artere spermatique interne dans la cryptorchidie. Materiel et Methodes: La position post-operatoire, l'augmentation de volume, les anomalies de structure et vasculaires, et l'incidence des anomalies epididymaires sont evaluees par echographie chez 32 enfants (âge moyen: 6.5 ± 1.34 annees) apres PLLD. Le flux vasculaire intratesticulaire et le flux des anastomoses deferentielles et cremasteriennes sont apprecies par un Doppler couleur (7.7 MHz transducer). Resultats: Tous les testicules sont en permanence dans le scrotum et augmentent de volume apres traitement chirurgical. Aucun des testicules n'a montre de signe echographique d'atrophie. Il n'y avait pas de difference evidente dans la perfusion intra-testiculaire compare au testicule non opere. Un flux arteriel collateral par l'artere deferentielle etait retrouvee dans 44 cas par Doppler. Une perfusion du pole inferieur du testicule etait retrouvee dans 29 cas. En per-operatoire, 12 inversions epididymaires etaient observees et un epididyme allonge etait retrouve par echographie dans 3 testicules. Conclusion: L'echographie peut etre utilisee pour le controle post-operatoire de la structure du testicule, de l'augmentation de volume aussi bien que la detection des flux. La vascularisation collaterale apres PLLD est suffisante pour entrainer une croissance consequente du testicule dans tous les cas.

32 patients with chronic polyarthritis were examined by MRT. Following intra-articular application of 25 mg prednisolone, 18 patients were re-examined after two of three weeks and 7 out of 18 patients were re-examined after 8 to 16 weeks, both by MRT and clinically. After an initial double echo sequence, we carried out a dynamic series of FLASH measurements (TR 30, TE 10 ms, 70 degrees) following an intravenous bolus of 0.1 mmol gadolinium-DTPA. Single intensity-time curves were treated quantitatively in relation to the pannus, muscles and effusions. Two or three weeks after treatment the curve parameters showed a reduction in pannus vascularisation which remained constant for the 8 to 16 weeks of further observation. Contrast diffusion in the pannus is initially reduced but approaches the early measurements at the time of the second examination.

43 patients suspected clinically of having tumours of the adnexa were examined by MR and 40 by endosonography in a prospective study. All underwent surgery. Correct lateralisation of the tumour was achieved by MR in 39 out of 43 cases (91%) and by endosonography in 32 out of 40 cases (80%). By means of MR it was possible to recognise the affected organ in 79%, and by vaginal sonography in 70% of women. Prediction of malignancy was possible with MR in 39 out of 43 cases (91%) and by endosonography in 30 out of 40 cases (75%). Infiltration into the omentum and gut and peritoneal metastases was missed by both methods (4 out of 4 cases).

Tubal patency was studied in 17 sterile women by means of colour-coded duplex sonography (CCDS) with local injection of an ultrasonic contrast medium. The results were compared with a conventional hysterosalpingogram. CCDS demonstrated all the soft tissues and their mobility. The ultrasonic contrast medium was SH U 454 (Schering). The colour signals generated by the air bubbles makes it possible to demonstrate tubal patency on both sides. The combination of an ultrasonic contrast medium and CCDS provides a simple, rapid, accurate and safe method for demonstrating tubal patency. Tubal patency can be demonstrated in the presence of anatomical complications and requires only a small amount of contrast medium.

The diagnostic use of microbubble consisting transpulmonary ultrasound contrast media in combination with color-coded duplex sonography (CCDS) has not been evaluated. Perfusion of the orthotopic kidney was therefore examined in an animal experiment with CCDS and transpulmonary echocontrast agent. The contrast agent consists of tiny stabilized air bubbles which survive the lung passage after peripheral venous injection and cause echo-enhancement of the arterial blood. The combination of CCDS and this contrast agent permits demonstration of the renal perfusion including the peripheral parenchyma. Even small experimental perfusion defects can be identified by this method. The use of this contrast agent in combination with CCDS might contribute significantly to the diagnostic potential of ultrasound.

Mit einem experimentellen Aufnahmemode wurde untersucht, welche diagnostischen Fragestellungen in der CT auch mit einer reduzierten Strahlendosis beantwortet werden konnen. Die Untersuchungen wurden mit 85 kV bei 1,7-3,0 mGy (statt 125 kV und den gebrauchlichen 20-50 mGy) durchgefuhrt. Bisher wurden uber 500 Patienten untersucht. Diese Technik konnte erfolgreich bei Knochenmineralmessungen sowie bei otorhinologischen und orthopadischen Fragestellungen eingesetzt werden. Alle Untersuchungen mit Hochkontrastdarstellung (Knochen, Sinus) und mit kleinem Querschnitt (Extremitaten) lieferten bezuglich der Interpretierbarkeit der Strukturen adaquate Bilder im Vergleich zum bisherigen Standard. Mit Ausnahme der zerebralen Computertomographie (CCT) zur Darstellung des Schadelinhaltes (Strukturen mit niedrigem Kontrast) ist sie bei Untersuchungen an Kindern und Kleinkindern in Betracht zu ziehen. In einer ersten Studienphase sollte die grundsatzliche Einsatzmoglichkeit des Verfahrens abgeschatzt werden. Der subjektive Bildeindruck und die Detailerkennbarkeit im Vergleich mit einem „Normalbild„ aus der gleichen Schnittebene waren zufriedenstellend. Als quantifizierbarer Parameter der Bildqualitat wurde das Bildpunktrauschen gemessen. An experimental method was used to determine which diagnostic CT problems could be solved while using reduced radiation doses. The examinations were carried out using 85 kv and 1.7 to 3.0 mGy (instead of the usual 125 kv and 20 to 50 mGy). More than 500 patients have been investigated so far. The method has been used successfully for bono mineral estimations and for otorhinological and orthopaedic problems. All examinations with high contrast (bones, sinuses) and small diameters (extremities) produced adequate images compared with the usual pictures. With the exception of cerebral CT for demonstrating the brain (structures with little contrast), the method can also be used for children and infants. During the first phase of this study the role of this method has been evaluated. Subjective impressions and demonstration of detail, when compared with a 'normal' image for a corresponding cut, were satisfactory. Signal-to-noise ratio was measured by a quantifiable parameter of image quality.

The knees of 20 patients with rheumatoid arthritis and two healthy volunteers were evaluated with magnetic resonance (MR) imaging. Spin-echo sequences were performed, and the signal-intensity patterns of normal and pathologic articular soft-tissue structures were quantitatively evaluated with a dynamic FLASH (fast low-angle shot) sequence after bolus intravenous injection of gadolinium diethylenetriaminepentaacetic acid. In contrast to the spin-echo images obtained before injection of contrast material, it appears possible with this technique to distinguish joint effusion from hypervascular pannus formations and to grade the vascularity of proliferative synovitis. Flat pannus deposits on the articular surface and subchondral pannus masses were identified only by their marked enhancement of signal intensity after injection of contrast material. Dynamic MR imaging appears to yield decisive information for diagnosing rheumatoid arthritis.

Eighteen patients with inflammatory lesions of the knee joints (ten with rheumatoid arthritis, eight with undiagnosed lesions) and two normal subjects were examined by MRI. In addition to spin-echo measurements, the signals from normal and pathological tissues were evaluated quantitatively by dynamic flash sequences following the injection of gadolinium DTPA. The latter method was able to distinguish active pannus from other proliferative synovial changes; the degree of activity could be related to synovial histology and relevant clinical features in eight patients. Areas of flat articular and subchondral pannus could be identified by the enhanced signal following the administration of gadolinium DTPA. Dynamic MRI is able to provide important information for the early diagnosis and follow-up of patients with rheumatoid arthritis.