Biomedical subjects

A Lienemann

Publications and source records attributed to A Lienemann.

At least 19 recordsLinked to original sources

PubMed2001

Evaluation of breast lesions by power Doppler sonography.

The aim of this study was to determine the value of power Doppler sonography in the detection of tumor vascularity in breast lesions and to find new diagnostic criteria for differential diagnosis. Power Doppler sonography was prospectively performed in 102 patients with 118 histologic (n = 116) and cytologic (n = 2) results. A semisubjective scoring system for the intratumoral increase in blood flow compared with the flow in normal breast parenchyma (reference structure) was introduced and the flow pattern registered. The difference in the flow increase for benign and malignant breast disease was highly significant (p < or = 0.0001). This applied especially to invasive cancer above a maximum tumor diameter of 5 mm excluding cancer stage Tis and T1a. A positive correlation between cancer size and flow increase were found. The flow pattern was an additional feature. The sensitivity was calculated to be between 74.5 and 78.8%, and the specificity between 74.6 and 77.8%. The level of flow increase in Power Doppler sonography is an important feature in the differential diagnosis of breast lesions and should be considered together with the established criteria in B-mode ultrasound. The flow pattern might also add some important information.

Adolescent↗

PubMed2001

On the impact of calcified deposits within the rotator cuff tendons in shoulders of patients with shoulder pain and dysfunction.

We wanted to prove the hypothesis that calcified deposits within the rotator cuff tendons are merely an epiphenomenon of complex morphological alterations in the shoulders of patients with shoulder pain and dysfunction. The shoulders of 92 patients with calcified deposits within the rotator cuff tendons as noted on plain radiographs were investigated by means of magnetic resonance imaging (MRI; mean age of patient 51.1 years), as well as the shoulders of 28 age- and sex-matched patients with similar clinical symptoms but without any signs of such calcified deposits on plain radiographs. The MRI protocol comprised a coronal, oblique, T1-weighted, spin-echo sequence, a T2-weighted, turbo spin-echo sequence, a sagittal, oblique, T2-weighted, turbo spin-echo sequence, and an axial, T1-weighted, spin-echo sequence. Furthermore, a coronal, oblique, short tau-inversion recovery sequence and a gradient echo sequence were used. The results were compared with data from healthy, asymptomatic volunteers as reported in the literature. The MRI investigations showed no substantial differences between patients with or without calcified deposits within the rotator cuff tendons, but distinct differences between such patients and healthy, asymptomatic volunteers. For patients with shoulder pain, shoulder dysfunction, and calcified deposits within the rotator cuff tendons, these calcified deposits are most probably not the main cause of the clinical symptoms. Rather, it seems to be useful to consider the results of MRI investigations whenever planning therapeutic procedures for patients with shoulder pain and dysfunction, irrespective of whether or not there are signs of calcified deposits within the rotator cuff tendons on plain radiographs.

Adult↗

PubMed2001

Functional cine magnetic resonance imaging in women after abdominal sacrocolpopexy.

OBJECTIVE: To evaluate whether functional cine magnetic resonance imaging (MRI) is a reliable method for verifying postoperative anatomy and function in women after abdominal sacrocolpopexy. METHODS: We did postoperative functional cine MRI in 25 women who had sacrocolpopexies. Visibility of grafts and vaginal and sacral fixation points were assessed and correlated with intraoperative results. Ranges of vaginal movement were calculated and compared with results of postoperative gynecologic examinations. RESULTS: Functional cine MRI achieved full view of vaginas in all cases. The mean vaginal axis was 142 degrees. Grafts were entirely visible in 13 women, partly visible in nine, and not visible in three. Functional cine MRI defined exactly the sacral fixation points in 22 women. Compared with intraoperative results, functional cine MRI showed a higher level of fixation in nine of 11 women. Functional cine MRI defined exact vaginal fixations point in 15 of 25 women. According to the pubococcygeal reference line, the postoperative range of movement of the vaginal apex was 1.8 cm. Recurrent vaginal vault prolapses in three women were detected equally by functional cine MRIs and gynecologic examinations. In those cases, no parts of patches were seen on the images. CONCLUSION: Functional cine MRI provided reliable abdominal sacrocolpopexy follow-up data. It might help with individual surgical planning and augment understanding of benefits and flaws of various surgical approaches to repair of vaginal vault prolapse.

Female↗

PubMed2000

Diagnosing enteroceles using dynamic magnetic resonance imaging.

PURPOSE: Enteroceles are in part difficult to detect but a frequent finding in pelvic floor disorders. The aim of this study was to evaluate magnetic resonance colpocystorectography in the diagnosis of enteroceles. METHODS: In this prospective study 11 volunteers and 55 patients with pelvic floor descent were examined. In addition to magnetic resonance colpocystorectography, a dynamic cystoproctography was performed on 34 patients. Opacification of organs was used. An enterocele was assessed in relationship to the pubococcygeal reference line (magnetic resonance colpocystorectography) or the width of the rectovaginal space (dynamic cystoproctography). A clinical gynecologic examination served as reference. RESULTS: The clinical examination diagnosed an enterocele in 43, magnetic resonance colpocystorectography in 49, and dynamic cystoproctography in 14 cases. Magnetic resonance colpocystorectography further subdivided the enteroceles according to their contents (mesenteric fat or fluid, 12; small bowel, 32, large bowel, 3; and rectosigmoidocele, 2). Magnetic resonance colpocystorectography proved statistically significantly superior to dynamic cystoproctography (15 cases) and the reference. Sensitivity and specificity of magnetic resonance colpocystorectography were 100 percent each. It was able to reveal clinically missed enteroceles as being peritoneoceles associated with a rectocele or a uterovaginal prolapse (10 cases). CONCLUSION: Magnetic resonance colpocystorectography is a promising method for diagnosis of enteroceles, because hernial canal, sac, and contents are reliably identified.

Adult↗

PubMed2000

Chondromyxoid fibroma of bone.

Chondromyxoid fibroma is a benign, although potentially aggressive tumor, with a cartilage-like matrix, accounting for approximately 1% of all bone tumors. It usually affects the metaphyseal region of long bones of patients in their first or second decade of life. An additional peak of incidence has been observed between 50 and 70 years of age. Three cases are presented here: 10-, 13-, and 52-year-old patients, with lesions in the proximal tibia, the proximal humerus, and the proximal femur, respectively. The literature is reviewed in terms of clinical behavior, diagnostic procedures, prognostic factors, treatment, and outcome. Preferred treatment is complete local excision with tumor-free margins. Intralesional curettage with or without local adjuvants shows a local recurrence rate of approximately 25%. Radiation therapy may be useful in nonresectable cases but bears the well documented risk of radiation-induced malignancies.

Adolescent↗

PubMed2000

[Morphological and functional pelvic floor disorders from the gynecological viewpoint].

PURPOSE: The following article is designed to describe the diagnostics and therapy of morphological and functional defects in the female pelvic floor from a gynaecological point of view. Assessment of the relevance of imaging techniques is of particular importance. MATERIAL AND METHODS: The main diagnoses are: in the anterior compartment of the pelvic floor, urethro- cystocele; in the middle compartment, uterine descent/prolapse or enterocele; and in the posterior compartment, rectocele. They are clinically examined by means of a standardised gynaecological examination and classified according to recommendations from the International Continence Society (ICS) in order to obtain internationally comparable results. Comparison with the usual imaging procedures (introitus- and perineal sonography, colpocystorectography/defaecography and functional MRI of the pelvic floor) are described and critically discussed. The most important functions affected are storage and evacuation of the bladder and rectum. They are clinically examined by means of stress test and padweigh test and technically examined using urodynamics, sphincter-rectum manometry and EMG. Imaging procedures play a very important role here also. RESULTS: Comparison of clinical and imaging procedures shows that the two methods are at present limited in comparability, mainly because different points of reference are used to quantify results. The line of the hymen is a good point of reference in grading descent and prolapse. During the gynaecological examination, the three compartments can readily be assessed separately by use of split gynaecological specula. This is presently practically impossible using imaging procedures. The pubococcygeal line is generally used to describe findings. DISCUSSION: Scientific progress can only be expected if and when these problems are studied as a whole. Imaging procedures have securely established themselves in the diagnostic repertoire, but do not as yet influence therapy decisions. The indication and choice of operation depend on the severity of the patient's symptoms the clinical findings and the results of urodynamic investigations. Dynamic CTG is presently the most reliable method of showing all three compartments at rest and during function. It has largely replaced colpocystorectography. Sonography is found to be varied in ist results at the moment.

Female↗

PubMed2000

[Functional MRI of the pelvic floor: its normal anatomy and pathological findings].

PURPOSE: Functional MRI of the pelvic floor allows mapping and definition of different forms of pelvic floor dysfunction. METHODS: We performed functional MRT of the pelvic floor in 39 healthy nulliparas and 324 patients. The diagnosis of a pathological organ descent was made if certain landmarks of the pelvic floor compartments descended below the pubococcygeal reference-line (PC-line). RESULTS: If there was no organ descent below the PC-line on straining and if the pelvic floor muscles hardly changed position, a normal finding was diagnosed. 70% of organ prolapses came in the combined form. The generally gradual development of an organ descent led to a change of the main finding in 21.6%. The masking of a cystocele (48.6%) or of an enterocele (34.3%) by a rectocele was most frequent in these cases. DISCUSSION: The use of functional MRI of the pelvic floor appears to be especially useful in young patients, in cases of divergent clinical and sonographic or radiological findings and if the presence of a predominant hernial sac with or without enterocele/rectocele is supposed.

Adolescent↗

PubMed2000

[Functional MRI of the pelvic floor. The methods and reference values].

PURPOSE: Functional cine MRI of the pelvic floor is a yet another modality in addition to various radiological fluoroscopic techniques. This article describes our own method in view of the recent literature and provides morphometric reference values. MATERIAL AND METHOD: We examined 20 nulliparous women (range of age: 25-51 years) with normal findings in the gynecological and urodynamic examination. Functional cine MRI was performed on a 1.5 Tesla equipment after opacification of the vagina and rectum. We used a T2-weighted gradient-echo sequence (Ture-FISP) to determine the position of the reference organs at rest and during straining/defecation. Two different reference lines were used. In addition 29 morphometric and functional parameters were measured, all of them being observer independent. RESULTS: Functional cine MRI was able to show the extent and interaction of the pelvic floor organs in all cases with the reference organs always remaining above the pubococcygeal reference line. The depth of the rectocele was 2 cm. With the exception of the diameter of urogenital hiatus the different parts of the levator ani muscle could not be determined. DISCUSSION: Functional cine MRI using an appropriate organ opacification and slice positioning is an objective, unifying diagnostic approach of the pelvic floor. The reference data given can be of help to distinguish normal from abnormal findings.

Adult↗

PubMed2000

Shockwave application in calcifying tendinitis of the shoulder--prediction of outcome by imaging.

This prospective study examined 62 patients (65 shoulders) with chronic courses of calcifying tendinitis of the shoulder before and after low-energy extracorporeal shockwave application (ESWA) in order to identify variables associated with the outcome of this treatment. Before ESWA, radiographs and contrast-enhanced magnetic resonance imaging (MRI) of the affected shoulders were obtained in order to document the size and morphology of the calcifications and the contrast media reactions in areas of interest (deposit, synovia, bursae), respectively. In addition, a clinical evaluation was performed. After ESWA (mean follow-up 18.2 months), clinical evaluations of all 65 shoulders revealed an increase in the Constant score from 44% to 78% (p < 0.0001). While size (p = 0.61) and morphology (p = 0.7) of the deposits before ESWA were not associated with the clinical outcome, negative contrast reactions around the deposits (p) = 0.0001), synovia (p = 0.0049) and bursae (p < 0.01) were associated with improved clinical outcomes. After the total study group was divided into two groups, one with Constant scores > or = 75% (n = 43) and the other with scores < 75% (n = 22), the positive predictive value (ppv), specificity (sp) and sensitivity (se) were determined for the negative reaction around the deposit (ppv: 0.94; sp: 0.95; se: 0.38), synovia (ppv: 0.84; sp: 0.82; se: 0.49) and bursae (ppv: 0.86; sp: 0.86; se: 0.44). In 5 cases (7.7%), surgery of the affected shoulder during the follow-up period was performed. No major side-effects were seen in the study group. In conclusion, our results suggest that in patients with chronic calcifying tendinitis, the absence of contrast enhancement, especially around the deposit, is a strong predictive parameter of a positive clinical outcome of ESWA.

Adult↗

PubMed2000

Malignant hemangiopericytoma of the bone.

Hemangiopericytoma is a rare vascular tumor of pericyte origin with variable malignant potential. Very rarely, this tumor occurs as a primary bone lesion. We present a case of a highly malignant hemangiopericytoma of the proximal tibia. Current therapy consists of radical resection of the tumor with postoperative radiation therapy being recommended. Chemotherapy seems to be useful in disseminated disease. The prognosis correlates to the histological grading of the tumor. Early or late recurrence and distant metastases with fatal outcome, as shown in our case study, are not uncommon.

Amputation, Surgical↗

PubMed2000

Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results.

PURPOSE: To identify and map intraabdominal adhesions by using functional cine magnetic resonance (MR) Imaging. MATERIALS AND METHODS: Twenty-seven patients suspected of having intraabdominal adhesions were examined. Section-by-section dynamic depiction of induced visceral slide throughout the whole abdomen was achieved by using a transverse or sagittal true fast imaging with steady-state precession sequence. Location and type of diagnosed adhesions were documented by using the nine segments of the abdominal map. These criteria and intraoperative results were compared in 13 patients. RESULTS: MR images depicted a total of 42 intraabdominal adhesions; 21 (50%) were in the lower abdomen. The most common types of adhesions were located between the ventral abdominal wall and small-bowel loops (n = 10 [24%]) and between adjacent small-bowel loops (n = 9 [21%]). Comparison with the intraoperative results showed a sensitivity of 87.5% and a specificity of 92.5%. MR imaging was most accurate in depicting adhesions to the abdominal wall (15 [94%] of 16) and subperitoneal space (eight [100%] of eight). The presence of adhesions between bowel loops was overestimated. CONCLUSION: Detection of visceral slide at functional cine MR imaging is easy to perform and represents a well-tolerated and accurate procedure for use in the identification of intraabdominal adhesions in patients with chronic pain and equivocal clinical findings.

Abdomen↗

PubMed1999

Speech processing in radiology.

The goal of this study was to evaluate the recognition rate, learning potential and amount of time needed to complete a report with the Philips speech recognition system SP 6000 (Philips, Best, The Netherlands). Four radiologists dictated reports of interventional radiology, MRI examinations of the musculoskeletal system and CT examinations of the thorax and abdomen with the Philips system using the German language. The recognition rate of each report and improvement rate after each learning phase of the Philips system was assessed. The time needed to complete a report using the Philips system was then compared with the time needed to complete a report using the tape-based system via a time analysis. The average recognition rate for the four radiologists using the Philips system was 79.6 %, which improved to 92.5 % after the third adaptation. Initially, the average time demand to dictate and correct one report was approximately 16.8 min, but this time decreased to 8.1 min after the third adaptation. In contrast, only 3. 6 min were needed to dictate and correct one report using the tape-based system. However, with the speech recognition system, dictation, correction and transcription of the report can be completed within 15 min, whereas with the tape-based system, it takes nearly 1 day. With the Philips system, speech recognition can reach as high as 95 % since each adaptation of the system improves the recognition rate by approximately 5 %. While the Philips system is associated with longer dictation times than the tape-based system, turn-around time for a complete report is substantially shorter with the Philips system than the tape-based system.

Computer Communication Networks↗

PubMed1999

Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment.

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection.

Adult↗

PubMed1999

[Radiologic diagnosis of chronic constipation and outlet obstruction].

The aim of this review article is to present the role and extent of gastrointestinal radiology in adults with chronic obstipation and stool outlet obstruction. The radiological investigations are well established second-line diagnostic procedures. Special attention is given to the indications as well as to the imaging techniques which include barium enema, measurement of colon transit time and dynamic colpocystorectoviscerography. New emerging modalities such as functional MR Imaging provide an objective, unifying diagnostic approach to the pelvic floor and the colon. This will contribute to an improved perception of the composite entity of the pelvic floor and of the interactions of its adjacent structures. Consequently the longstanding "compartmentalization" practiced by the different medical specialties might be avoided in the future.

Adult↗

PubMed1998

[The demonstration of blood flow in focal breast lesions by power-Doppler sonography. A new approach to assessment?].

PURPOSE: Power-Doppler sonography is regarded as a very sensitive method for detecting low-velocity and low-volume blood flows. The purpose of our study was to investigate whether increased vascularity in breast carcinoma can be visualized by power-Doppler sonography and whether new criteria for differentiating benign and malign lesions can be found. METHOD: 315 patients were examined with a 13-MHz high-resolution linear transducer. If a suspicious lesion was found, it was evaluated further by power-Doppler sonography. Compared to normal breast parenchyma (reference structure), a focal increase in blood flow signals was registered using a 3-step grading system with a 4th step for no flow increase. RESULTS: In 97 cases the sonographic findings were correlated with histology (n = 95) or cytology (n = 2). There were 50 benign lesions, 42 cases of invasive and 5 cases of in-situ carcinoma. 73.5% benign lesions showed no or just minimal increases in flow signal. 81% of invasive cancer presented middle- or high-flow increases compared to normal breast parenchyma. The extend of flow increase was linked to tumor size in invasive cancer. In stage T1b to T4, 94.3% of invasive carcinoma presented middle or high flow increases. CONCLUSION: Power-Doppler sonography is able to visualize vascularization in breast tumors. According to first clinical results PD sonography is a promising additional diagnostic tool which seems to offer new criteria for differential diagnosis in breast tumors.

Adult↗

PubMed1997

Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion.

A case of calcific tendinitis of the pectoralis major insertion with cortical bone erosion is presented. Clinical and laboratory findings showed a significant inflammatory reaction. Both CT and MR images demonstrated the extent of the lesion providing additional information on the dimensions of inflammatory soft tissue and bone marrow reaction. Biopsy was performed and histology revealed the typical features of calcification, inflammation and giant cell reaction.

Adult↗

PubMed1997

MRI of posttraumatic cyst-like lesions of bone after a greenstick fracture.

Posttraumatic bone-cyst formation is a known but rare process. Typical location is the distal radius, usually as a result of a greenstick fracture. The pathogenesis is unknown; however, subperiosteal migration of fat or hemorrhage with later absorption may cause cyst formation. We present the first reported case of MR imaging of this lesion. At MRI subperiosteal hemorrhage was found to be the cause of cyst formation.

Bone Cysts↗

PubMed1997

Dynamic MR colpocystorectography assessing pelvic-floor descent.

Magnetic resonance colpocystorectography (MR-CCRG) is presented in the evaluation of patients with pelvic-floor disorders. Five healthy volunteers and 44 female patients with isolated or combined visceral descent underwent dynamic MRI and dynamic fluoroscopy (DF). MR-CCRG was performed with the patient in a supine position using a True FISP sequence (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor contraction, relaxation, and straining maneuvers. Relevant organs, such as urethra, bladder, vagina, and rectum, were opacified by using a saline solution, Magnevist (Schering AG, Berlin, Germany), and sonography gel, respectively. The clinical evaluation and the intraoperative results (30 cases) were used as reference. MR-CCRG and DF were non-diagnostic in 3 cases each. Most patients had a combined type of visceral prolapse, the most frequent combination being a vaginal vault prolapse and a cystocele. The points of reference were sufficiently outlined by DF and MR-CCRG. In comparison with the clinical and intraoperative results, MR-CCRG proved to be especially beneficial in the diagnosis of different types of enteroceles including a uterovaginal prolapse. MR-CCRG showed an equal or higher sensitivity and specificity for all individual sites when compared with DF. Also, predominant herniation obscuring other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolapse in women. The possibility of dynamic presentation (see enclosed CD-ROM) allows for a better understanding of the organ movements within a given topographic reference setting.

Contrast Media↗