[Radiologic diagnosis of the skeleton].
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Bone Diseases↗
Biomedical subjects
A Stäbler
Publications and source records attributed to A Stäbler.
Musculoskeletal MR: knee.
Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. During the past 15 years knowledge of pathologic conditions of the knee had evolved significantly. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage.
Anterior Cruciate Ligament Injuries↗
Images in hepatology. Periportal lymph edema in a patient with acute hepatitis A.
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Acute Disease↗
[Spondylolysis in the developmental stage: diagnostic contribution of MRI].
PURPOSE: To assess the value of MR imaging in demonstrating ongoing spondylolysis in adolescents. METHODS: MRI was performed in 9 juvenile patients (3 female, 6 male aged 8-16 years; mean 12.5 y) with pain during hyperextension. In 6 patients a CT scan and in 5 a plain film was available. RESULTS: In all patients bone marrow edema was found in the pars interarticularis and the pedicle, which was bilateral in 4 patients. In 7/9 cases the L5 vertebra was affected, in 2/9 cases spondylolysis was found in L4. In 3 cases the edema reached the middle third of the vertebral body and a tumor was suspected. In all CT scans a bilateral incomplete or complete cleft in the pars inter-articularis was found. In 4/6 CT-scans a sclerosis was seen in the area of the bone marrow edema. Only in 1/5 plain films was there a suspicion for a spondylolysis, four examinations were completely normal. CONCLUSIONS: To eliminate underlying causal conditions of spondylolysis and to install specific therapy, early diagnosis is mandatory. MR imaging should be the first and only imaging modality in young patients with low back pain during and after exercise and pain with hyperextension. Bone scans and CT scans should be avoided due to irradiation, plain films usually do not reveal pathological findings in developing sponylolysis.
Adolescent↗
[Magnetic resonance imaging of the wrist--comparison of high resolution pulse sequences and different fat signal suppression techniques in cadavers].
PURPOSE: To evaluate high resolution sequences with and without fat-suppression techniques for MR imaging of the wrist. MATERIALS AND METHODS: 10 cadaver wrist specimens were imaged with 12 MR sequences (SE: 400 ms/20 ms, TSE: 3000 ms/119 ms/17 ms, fatsat (FS) TSE: 3000 ms/17 ms and 3000 ms/45 ms, STIR: 2619 ms/29 ms/160 ms, DESS 3D: 43.7 ms/9 ms/35 degrees FS and 25.4 ms/9 ms/35 degrees water excitation (WE), CISS 3D: 12.2 ms/5.9 ms/40 degrees and FLASH-sequences: 53 ms/11 ms/40 degrees FS, 23 ms/11 ms/40 degrees WE and 45 ms/11 ms/30 degrees FS) at 1.5 T. Slice thickness was 3 mm, FOV 80 x 70 mm (pixel size 0.31 x 0.31 mm). Signal intensity was measured by an ROI in bone marrow, fluid, hyaline cartilage, scapholunate (SL) ligament and triangular fibrocartilage and S/N- and C/N-ratios were calculated. Additionally, a visual evaluation was performed. RESULTS: The highest homogeneity and the least artifacts were achieved by the T1-w SE sequence. For the STIR and PD-FS TSE sequence high rankings were found for the detection of free water. The PD FS sequence had high ranking also for visualization of the SL ligament and the triangular fibrocartilage. The best sequence for the assessment of hyaline cartilage was the FLASH-FS sequence. For detailed analysis of bony structures the CISS sequence performed best. CONCLUSION: The isolated use of a PD-FS-TSE sequence enables for evaluation of all clinically relevant structures at the wrist. Dedicated questions for hyaline cartilage are answered best by the use of a FLASH 3D-FS sequence. Selective water excitation reduces acquisition time to 60%, nevertheless FS sequences are still diagnostically superior to WE sequences.
Adipose Tissue↗
Partial rupture of the distal biceps tendon.
Partial rupture of the distal biceps tendon is a relatively rare event, and various degrees of partial tendon tears have been reported. In the current study four patients with partial atraumatic distal biceps tendon tears (mean age, 59 years; range, 40-82 years) are reported. In all four patients, a common clinical pattern emerged. Pain at the insertion of the distal biceps tendon in the radius unrelated to any traumatic event was the main symptom. In all patients the diagnosis was based on magnetic resonance imaging or computed tomography imaging. In three of four patients the partial rupture of the tendon caused a significant bursalike lesion. The typical appearance was a partially ruptured biceps tendon, with contrast enhancement signaling the degree of degeneration, tenosynovitis, and soft tissue swelling extending along the tendon semicircular to the proximal radius. In three patients, conservative treatment was successful. Only one patient needed surgery, with reinsertion of the tendon resulting in total functional recovery.
Adult↗
[Fever and lumbalgia in a 22-year-old patient. Vertebral osteomyelitis mit epidural abscess].
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Adult↗
[Somnolence and vomiting in a patient after parathyroid gland carcinoma surgery].
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Carcinoma↗
[Reliability of functional x-ray analysis of cervical vertebrae flexion and extension].
Functional radiographic analysis of the cervical spine in flexion and extension position is increasingly used as screening method for the diagnosis of segmental functional disorders. The objective of this study was to prove Penning's evaluation method for the metrical recording of segmental angles in the sagittal plane for selectivity, reliability and usability. Passive functional radiographs of the cervical spine in flexion and extension were taken of 20 patients with painful limitation of mobility of the cervical spine and 20 subjects, similar in sex and age, without complaints. The radiographs were duplicated. Five physicians measured the angles of segmental mobility in a blind study. Statistical analysis was conducted using the t-test and calculating the correlation coefficient "r". The results of the study prove that the evaluation method by Penning shows a usable and, for segments C3/C4 to C6/C7, significant selectivity. The selectivity of p < or = 0.05 and p < or = 0.01 is sufficient to distinguish patients from healthy subjects. The correlation between the five reviewers showed good to very good results (0.6 < r < or = 0.8; r > 0.8). The measured values, however, have to be considered, in connection with the appropriate clinical symptoms, as still "normal" or "functionally disordered" in the context of segmental hypo-resp. hypermobility.
Adult↗
Erdheim-Chester disease: a case report and literature overview.
Erdheim-Chester (EC) disease belongs to the group of lipoid granulomatosis. Symmetric sclerosis of the meta- and diaphysis of long tubular bones are pathognomonic radiologic changes. Additionally, other skeletal segments can be affected. Extraskeletal manifestations can occur in almost all organs; lungs, pericardium, retroperitoneum, skin, and orbita play particularly important roles. The last case of 38 cases of Erdheim-Chester disease with an extraordinary mediastinal and perirenal involvement is described. For the second time following the initial description by Chester, an axial skeletal pattern of eburnated vertebra is shown.
Aged↗
MRI findings of muscle involvement in idiopathic hypereosinophilic syndrome.
A 40-year-old white man presented with fever, muscle pain, skin nodules and persistent hypereosinophilia over a period of 1 year. In addition, he had ventricular arrhythmias with episodes of tachycardia. Besides a lack of response to antiparasitic therapy, laboratory and pathological data excluded the diagnosis of trichinosis or any other parasitic infection. The patient's course of the disease over the previous 1(1)/2 years was compatible with hypereosinophilic syndrome. In a muscle biopsy several eosinophilic perivascular and leucocytic intravascular infiltrates were found, indicative of muscle involvement by the disease. This is a report on the MRI findings of muscle involvement in idiopathic hypereosinophilic syndrome.
Adult↗
Symptomatic fibrous lunato-triquetral coalition.
In general, carpal coalitions are considered to be asymptomatic. Incomplete separated joints and associated changes similar to osteoarthritis and pseudoarthrosis are known as possible causes of wrist pain. We present the clinical history, plain-film, and MR imaging findings of two patients with symptomatic fibrous lunato-triquetral coalition. Conventional films disclosed a narrowed space between the lunate and triquetral bone with cysts and sclerosis similar to pseudoarthrosis. Magnetic resonance imaging showed bone marrow edema adjacent to the incomplete separated lunato-triquetral joint and Gd-DTPA enhancing fibrovascular tissue in the synovium and subarticular cysts, explaining the pain over the ulnar-sided wrist. Patients with congenital lunato-triquetral coalition may poorly tolerate stress loading or trauma, resulting in a symptomatic state similar to degenerative arthritis or pseudoarthrosis, which is demonstrated by enhanced MR imaging.
Adult↗
[Evaluation of right heart load with spiral CT in patients with acute lung embolism].
PURPOSE: Purpose of this study was to evaluate whether spiral-CT allows judgment of right ventricular failure in patients with acute pulmonary embolism. MATERIALS AND METHODS: 61 patients underwent spiral-CT due to suspicion of acute pulmonary embolism. Patients with pulmonary embolism were divided into subpopulations according to the severity of pulmonary embolism in the CT scan. Cardiac measurements were performed on axial spiral-CT images and compared to those of patients without suspicion of pulmonary embolism or cardiac diseases. RESULTS: In 30 patients spiral-CT revealed acute pulmonary embolism. Significant differences in cardiac measurements in patients with severe and less severe pulmonary embolism were found on comparing the following dimensions: left ventricular width (p = 0.0003), left (p = 0.008) and right (p = 0.009) ventricular cross-sectional area, proportion of right to left ventricular width (p = 0.0003) and proportion of right to left ventricular cross-sectional area (p = 0.0001). The proportion of the cross-sectional areas (r = 0.65) and the proportion of the width (r = 0.60) of both ventricles correlated well with the severity of central pulmonary embolism. CONCLUSION: Besides reliable assessment of pulmonary embolism spiral-CT allows the evaluation of cardiac dimensions for judgment of right ventricular failure.
Adult↗
[Pseudoaneurysm of the lingual artery after tonsillectomy. A rare complication].
BACKGROUND: Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology; however, life-threatening complications can occur in rare cases. PATIENTS: We report about a seven-year-old girl who developed a pseudoaneurysm of the lingual artery following elective routine tonsillectomy. RESULTS AND CONCLUSION: Initial ENT examination will reveal a painful cervical mass or unilateral palatal swelling that can easily be misinterpreted as a peritonsillar (or parapharyngeal) abscess. Computed tomography and angiography are indicated to confirm the diagnosis. Bleeding from a pseudoaneurysm of any branch of the external carotid artery represents a serious and life-threatening complication. Surgery is the treatment of choice.
Aneurysm, False↗
[Vena cava filter. Indications, complications, clinical evaluation].
INTRODUCTION: Pulmonary embolism is the third leading cause of death in the western countries. If anticoagulation fails or is contra-indicated, or if the risk for pulmonary embolism is increased for other reasons, the percutaneous implantation of a vena cava filter should be considered. METHODS: The available filters can be differentiated by the design (cone, basket, net-types), by the material, and by their removability. The rate of complications (caval thrombosis, fracture of filter) and the in vitro efficacy in trapping thrombotic clots is dependent on the specific filter type. RESULTS: In clinical practice there is no evidence for significant differences in trapping efficacy among the different filters. About 4% of all patients treated by caval filters still can have pulmonary embolism, and 1% will have a fatal outcome. Dependent on the filter type, the most common complication is caval thrombosis, in up to 25% of cases. CONCLUSION: The percutaneous implantation of caval filters can readily be performed by interventional radiologists. However, randomized clinical studies failed to clearly document efficacy of caval filters. Therefore, indication has to be considered carefully.
Humans↗
[Diagnosis of pulmonary embolism with spiral and electron-beam CT].
PURPOSE: To compare spiral (SCT) and electron-beam CT (EBT) for the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: From June 1997 to June 1998 188 patients with suspected acute or chronic thromboembolism of the pulmonary arteries were examined. A total of 108 patients were scanned using SCT and 80 patients using EBT. On each scanner two different scan protocols were evaluated. RESULTS: PE was diagnosed in 38 patients using EBT and in 49 patients using SCT. Especially with EBT, isolated peripheral emboli could be confidently diagnosed. When EBT and SCT were compared for the analysis of peripheral pulmonary arteries, some paracardiac segmental and subsegmental vessels were significantly better analyzable with EB. Additional or diseases other than PE were diagnosed in 112 patients. Other diagnoses included bronchial carcinoma and aortic dissection. CONCLUSIONS: Advanced CT scanning techniques allow the highly accurate diagnosis of central and peripheral PE. Other potentially life-threatening underlying diseases are also readily recognized.
Aortic Dissection↗
Light chain deposition disease in multiple myeloma: MR imaging features correlated with histopathological findings.
The clinical, histopathological, and imaging findings on MRI of a 56-year-old woman with light chain deposition disease occurring in multiple myeloma are presented. Light chain deposition disease is a variant of multiple myeloma with distinct clinical and histological characteristics. MRI of this patient also revealed an infiltration pattern in the bone marrow distinct from that of typical multiple myeloma. Multiple small foci of low signal intensity were present on T1- and T2-weighted spin echo and STIR images, corresponding to conglomerates of light chains in bone marrow biopsy. Contrast-enhanced T1-weighted spin echo images show diffuse enhancement of 51% over all vertebral bodies, with a minor enhancement of the focal conglomerates of light chains. Light chain deposition disease in multiple myeloma should be added to the list of those few entities with normal radiographs and discrete low-signal marrow lesions on T1- and T2-weighted spin echo pulse sequences.
Bone Marrow↗
[Magnetic resonance tomography in plasmacytoma: ranking of various sequences in diffuse and focal infiltration patterns].
PURPOSE: The aim of this study was to compare various pulse-sequences employing the spine array coil while considering the different infiltration patterns in multiple myeloma, in order to develop a fast and cost effective screening method. MATERIALS AND METHODS: In a prospective study, 50 patients with histologically proven multiple myeloma were examined with the following standardised sequences: T1-weighted SE, T2-weighted FSE, opposed phase GRE, FSE STIR, T1-weighted SE post gadopentate dimeglumine without and with fat saturation. The images were evaluated in a ROC analysis by three radiologists in consensus with a 5-grade scale separatively for diffuse and focal involvement. The gold standard was bone marrow histology in cases of diffuse infiltration and the combination of all sequences with the staging system according to Durie and Salmon. RESULTS: For focal bone marrow involvement the area under curve was greatest for FSE STIR sequences, in cases of diffuse infiltration the area under curve was superior for unenhanced T1-w SE-Sequenz images. The sensitivity can be increased by contrast material application and signal intensity measurements. A combined focal and diffuse infiltration and a "salt and pepper" pattern can be diagnosed with the combination of T1-w SE-Sequenz and FSE STIR sequences. CONCLUSION: With T1-weighted SE-Sequenz sequences pre- and post-contrast and FSE STIR all therapeutical relevant infiltration patterns of plasmocytoma can be identified and bone marrow screening of the spine can be carried out with an acquisition time of 5.58 minutes.
Adult↗