[Malignant breast tumors in males].
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Breast Neoplasms↗
Biomedical subjects
C Fellner
Publications and source records attributed to C Fellner.
Magnetic resonance angiography of the peripheral vessels in patients with peripheral arterial occlusive disease: when is an additional conventional angiography required?
The purpose of this work was to find out how often the clinician asks for a conventional angiography (CA) in patients with peripheral arterial occlusive disease (PAOD) after a magnetic resonance angiography (MRA) has been performed and how often the CA reveals additional information for therapy planning. Quality criteria for the MRA were defined and tested to see whether they can predict the need for an additional CA. In this prospective study, 81 patients suffering from PAOD (Fontaine classification IIa, n = 13; IIb, n = 33; III, n = 10; IV, n = 25) were examined with a 1.5-T MR-scanner with dedicated coils using a step-by-step technique. The vascular surgeon decided whether he could plan the therapy on the basis of the MRA or if he needed an additional CA. The MRA was assessed in terms of the image quality of the MRA and regarding therapeutic management of the patient in a two-grade scale: sufficient and insufficient. In 27/81 (33%) patients, the clinician asked for a CA, which revealed new information in only 11 patients. The relative number of MRAs with insufficient image quality was significantly higher (p < 0.01) in the group with additional information on CA (8/11) compared to the group without additional information (0/16). The assessment of an MRA based on image quality and regarding therapeutic management of the patient might reduce the number of CAs for therapy planning in patients with PAOD.
Aged↗
Magnetic resonance of the disk of the temporomandibular joint. MR imaging protocol.
Disk displacement can be well detected using proton density-weighted and T2*-weighted two-dimensional gradient-echo sequences. In uncertain cases, especially if the bilaminar zone is not sufficiently represented, a contrast-enhanced T1-weighted spin-echo sequence should also be performed. Also in patients with disk degeneration and osteoarthritis of the temporomandibular joint, proton density-weighted and T2*-weighted two-dimensional gradient-echo sequences are of great diagnostic value. In this collective, however, T1-weighted contrast-enhanced spin-echo sequences should be generally performed, to demonstrate inflammatory reaction of the synovia.
Adolescent↗
The quality of functional MR images in patients with brain tumors: influences of neurological disorders and tumor location.
The aim of our study was to investigate the influence of neurological disorders, and the influence of tumor and perifocal edema location on functional magnetic resonance imaging (fMRI) quality. fMRI quality tended to be better the closer the tumor and the perifocal edema were located to the pmc. Hemipareses and seizures had no significant influence on fMRI quality. Therefore, hemiparetic patients do not have to be excluded beforehand. The evaluation of time courses is essential before using z-maps to localize eloquent brain regions preoperatively.
Adult↗
MR diagnosis of vein of Galen aneurysmal malformations using virtual cisternoscopy.
Vein of Galen aneurysmal malformations (VGAMs) are rarely seen intracranial congenital vascular malformations with extremely complex vascular architectures. We present two newborns with an unclear intracranial mass being discovered in routine intrauterine ultrasonography. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) identified these lesions as VGAMs. Besides conventional MRA analysis, "virtual cisternoscopy"-a special kind of virtual endoscopy combining perspective volume rendering and motion-was applied to assess the intracranial vasculature. One newborn was treated by means of interventional neuroradiology with coiling of the median prosencephalic vein. The clinical outcome in this case was excellent. The other will undergo interventional therapy shortly.
Cerebral Veins↗
MRI of the hypopharynx with provocative maneuvers.
The purpose of this study was to assess the validity of magnetic resonance (MR) functional images of the hypopharynx. Following T2-weighted spin-echo sequences during quiet respiration, contrast enhanced 2D-Turbo-FLASH sequences were obtained during Valsalva-maneuver, quiet respiration, A- and U-phonation, respectively. Tumor detection was clearly improved using functional MRI (sensitivity of 97.4%, specificity 83.3%, accuracy 95.5%) when compared with MRI during quiet respiration (sensitivity of 87.1%, specificity 33.3%, accuracy 80%). Rapid MR sequences such as 2D-Turbo FLASH allow functional imaging of the hypopharynx, thereby improving MR diagnosis of hypopharyngeal tumors.
Adult↗
Correlation of 3D MRI and clinical findings in the patients with sensorineural hearing loss and/or vertigo.
The aim of the study was to correlate clinical and magnetic resonance imaging (MRI) (3D CISS and MP-RANGE) findings in patients with sensorineural hearing loss (SNHL) and/or vertigo. We found a high correlation of MRI and symptoms (17 out of 18 patients, 13 out of 13, respectively) concerning detectability of tumors and acute labyrinthitis. In the case of labyrinthine fibrosis, the correlation between clinical and MRI findings was lower. In conclusion, high-resolution MRI is very suitable in patients with SNHL or vertigo caused by tumors or acute labyrinthitis.
Adolescent↗
Definitive radiotherapy based on HDR brachytherapy with iridium 192 in uterine cervix carcinoma: report on the Vienna University Hospital findings (1993-1997) compared to the preceding period in the context of ICRU 38 recommendations.
UNLABELLED: According to the reports described in the literature, fractionated HDR brachytherapy seems to represent one option for the primary treatment of cervical carcinoma. In order to render such treatment transparent and comparable for those interested in the field, we have attempted to report our recent experience obtained in Vienna from 1993-1997 using the terminology proposed by the ICRU report 38, focusing in particular on dose and volume reporting and a linear-quadratic model. Based on these parameters, a comparison with the preceding period in Vienna (LDR/HDR) has been made, with an attempt to correlate different methods and parameters with outcome. MATERIAL AND METHODS: One hundred and eighty-nine patients (mean age 67 years) were treated with curative intent (stage Ia: 2, Ib: 11, IIa: 11, IIb: 79, IIIa: 19, IIIb: 59, IVa: 5, IVb: 3 patients) using a combination of intracervical high-dose rate (HDR) brachytherapy (ring-tandem applicator) and a box technique for external-beam therapy (EBT: 48.6-50 Gy, linac 25 MV). Small tumors were treated with 5-6 fractions of 7 Gy at point A and 50 Gy EBT (25 Gy in the brachytherapy reference volume) which is isoeffective to 76-86 Gy at point A. Large tumors received 3-4 fractions of 7 Gy after 50 Gy EBT with open fields, which is isoeffective to 82-92 Gy at point A. TRAK varied from mean 1.4 cGy (3 fractions) to 2.8 cGy (6 fractions) at one meter. 3-D treatment planning for brachytherapy was based on conventional X-rays and in 181/189 patients on computed tomography (CT) with the applicator in place. Computer-calculated volumes of the brachytherapy reference isodose (7 Gy/fraction) ranged from 46-155 ccm (mean 87 ccm); the respective mean hwt-volume (height x width x thickness) was 180 ccm. The 60 Gy HWT volumes (25 Gy from EBT) for the irradiation of small tumors ranged from 240 to 407 ccm (mean 337 ccm) and for larger tumors (50 Gy for EBT) from 452 to 785 ccm (mean 607 ccm). The mean dose for brachytherapy was 16.2 Gy (6.2-37.8 Gy) at the ICRU rectum reference point and 14.4 Gy (4.6-35.7 Gy) at the ICRU bladder point. Taking into account the dose for EBT, the mean isoeffective dose at the ICRU rectum reference point was 69.9 Gy (28.4-98.7 Gy). Overall treatment time was six weeks for small tumors and eight weeks for large tumors. RESULTS: After a mean follow-up of 34 months, actuarial pelvic control and disease-specific survival rates at three years were 77.6/68.6% for all patients, 100/77.1% for stage Ib, 100/100% stage IIa, 87.0/78.0% stage IIb, 52.7/52.1% stage IIIa, 69.1/58.6% stage IIIb and 60/53.3% stage IVa. According to the LENT/SOMA score which had been prospectively introduced, the actuarial late complication rate for grades 3 and 4 was 2.9% for the bladder, 4.0% for the bowel, 6.1% for the rectum and 30.6% for the vagina (shortening and obliteration); in total for all grades 23.6, 18.4, 24.2, and 67.6%, respectively. CONCLUSION: In our experience, HDR brachytherapy combined with EBT is an efficient method if sufficient radiation doses and volumes are applied, both with regard to tumor control and adverse side effects. In future, the therapeutic window will be increased by systematic integration of magnetic resonance imaging (MRI) into treatment planning, thus allowing for a highly individualized approach with further adaptation of radiation dose and volume both to the target and to the individual topography of organs at risk.
Adenocarcinoma↗
Intraluminal 192Ir brachytherapy following transjugular intrahepatic portosystemic shunt revision: long-term results and radiotherapy parameters.
PURPOSE: The stenosis or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) occurs in up to 75% of patients within 12 months after treatment. The aim of our investigation was to evaluate the feasibility, safety and efficacy of intraluminal high-dose rate brachytherapy (HDRBT) with Iridium-192 following TIPS revision to prevent restenosis due to pseudointimal hyperplasia. MATERIALS AND METHODS: Between September and November 1996, intraluminal BT was performed in five patients after TIPS revision. The indications for initial TIPS were a Budd-Chiari syndrome in two female patients and recurrent variceal bleeding by alcoholic liver cirrhosis in three male patients. TIPS was created with Wallstents (10 mm diameter in four patients) and Palmaz stent (10 mm diameter in one patient). The re-dilatation was done in all five patients 6 months after first stenting because of restenosis (>50% stent lumen reduction) or occlusion of the stent. A 5-French closed-tip, noncentered BT delivery catheter was used for subsequent radiotherapy. The whole length of the stent and performed dilatation (interventional length - IL) was taken as clinical target length (CTL). A 10-mm safety margin was added proximal and distal to the CTL due to uncertainties of BT source positioning, so forming the planning target length (PTL). To ensure that prescribed dose covers the whole PTL, the active source length (ASL) was 5 mm longer proximal and distal than PTL, so forming the reference isodose length (RIL). A dose of 12 Gy was prescribed in 3 mm distance from the source axis in the mid-plane of the applicator for three patients and in 5 mm distance for two patients. RESULTS: A normal patency (<50% lumen reduction) of the stent was achieved at 44 months follow-up (duplex sonography+portography) in all three patients with liver cirrhosis, whereas further revisions were necessary in two patients with Budd-Chiari syndrome (after 5.5 and 18 months). No acute, subacute or late brachytherapy (BT)-related side effects were seen until now. CONCLUSIONS: HDRBT following TIPS revision was safe and feasible in all patients. The exact impact of BT on the TIPS patency should be evaluated in larger clinical trials. Moderate dose escalation and use of today's commercially available centering radiation catheters seem to be necessary.
Adult↗
Signal, contrast, and resolution in optimized PD- and T2-weighted turbo SE images of the knee.
OBJECTIVE: Signal and contrast behavior, delineation of anatomical details, and flow artifacts were compared in dual echo SE and turbo SE (TSE) sequences. Results were correlated with theoretical aspects of the TSE technique. MATERIALS AND METHODS: A TSE sequence (TR = 3,500 ms, TEeff = 19, 93 ms, ETL = 3) and a conventional SE sequence (TR = 2,500 ms, TE = 20, 70 ms) were applied to 64 patients with knee injuries. Signal intensities of anatomical structures were measured in regions of interest. Contrast and edge sharpness of menisci and posterior cruciate ligament were evaluated by three independent observers. RESULTS: The TSE sequence yielded similar signal and contrast behavior compared with SE. Visual evaluation revealed nearly equivalent contrast and edge sharpness of menisci and posterior cruciate ligament in proton-density (PD)-weighted TSE images. Contrast and edge sharpness of menisci were significantly lower in T2-weighted TSE images. Reduced flow artifacts were found in PD- and especially in T2-weighted TSE images. Differences between both techniques are interpreted, taking into account influence of TEeff, ETL, k-space trajectory, magnetization transfer effects, and J-coupling. CONCLUSION: The TSE sequence yielded good image quality in PD-weighted, but slightly inferior quality in T2-weighted, images, reducing the time of acquisition by 50%.
Adult↗
Renal transplantation and the living donor. Decision and consequences.
Renal transplantation in end-stage renal disease is now an accepted medical procedure but the source and origin of the grafted organ (living donor vs. cadaveric kidney) remain controversial and it appears that each transplant team has to work out its own guidelines. We present the results of questionnaires and interviews of a large number of donors, many of them looking back on their experience with the knowledge that unfortunately, and in the long run, their sacrifice proved to be in vain. All our subjects evaluated their participation as donors in the transplant program in a very positive way. There was general agreement that none of them was significantly harmed by his action and that, in the realms of self-knowledge and feelings of self-worth and self-respect, the act of donorship turned out to be a very positive and very highly valued experience. These donors' opinions and attitudes, their relatively unconflicted conduct, are in sharp contrast with the agonizing appraisal of many a transplant team. It remains the task of the team doctors to weigh and balance risks and advantages of such an intervention and to be the advocate of both the donor and the recipient. It is to them that we offer our findings in the hope that it may help them in that difficult decision-making process.
Decision Making↗