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H J Hansmann

Publications and source records attributed to H J Hansmann.

12 recordsLinked to original sources
PubMed2001

[Radiologic after-care of transjugular intrahepatic stent shunt (TIPSS)]].

The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinations essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS. Ultrasound is helpful to detect shunt dysfunction, but nevertheless its failure rate is considerable despite the use of contrast enhancers such as Levovist because of anatomic and physical limitations, particularly when TIPSS-tracts deep in the liver are present. Reintervention rates approach 90-100% after 24 months, with 100% in child's A patients with comparatively good liver function. However, a strict shunt surveillance program with early portography and reintervention when necessary guarantees high clinical success rates associated with very low rebleeding rates below 10%. Overall the secondary success rate is 80%. Secondary failures are mainly caused by lack of patient compliance during follow-up. In a subgroup of patients no shunt maturation is observed, requiring multiple shunt revisions. In cases of recurrent shunt occlusions an association with bile leaks is presumed. In selected cases patients with chronically recurrent shunt stenosis or occlusions may benefit from placement of TIPSS stent grafts.

Aftercare↗
PubMed2001

[Rational radiologic after-care of endoluminal aortic bypass].

GOAL: To identify essential and relevant diagnostic algorithms in the follow-up of stent-grafts placed for aortic dissections and aneurysms based on our 7 years experience including the use of more than 10 different devices. MATERIAL AND METHODS: Evaluation of conventional biplane imaging, angiography, sonography, CT and MR in the efficacy of demonstrating endoleaks, sac shrinkage, changes of stent-graft integrity and, with special reference to MR-compatibility of various stent-graft devices. RESULTS: Endoleaks are found in 20-30% of patients after endovascular exclusion of abdominal aortic aneurysms. However, this rate neither necessarily reflects the clinical course nor the onset and course of sac shrinkage. Physical long-term integrity of the devices is seen best on conventional bi-plane radiographs. Sonography is helpful only in selected patients (non-obese, good compliance) otherwise not providing information precisely enough for sac control. As gold standard both CT (CTA) and MR (MRA) are equally effective in the follow-up of endovascular stent-grafts, allowing 3D control of sac geometry in aneurysmal disease or hemodynamic changes in stent-grafts for aortic dissection. MRI is considered to be more effective in the detection of small endoleaks. Angiography is inferior to CT and MRI in the diagnosis of endoleaks and thus is required only for intervention planning in patients with suspected endoleaks. Two of 8 evaluated stent-graft devices proved to be prohibitive for MRI because of their severe artifacts productions (Life-path, Zenith) as a result of their thick metallic meshwork. CONCLUSION: CT including CTA with 2D and 3D reformatting is the method of choice for the follow up of stent-graft treatment of aortic disease. Depending on availability, MRI may be used alternatively. In young patients and for those with contraindications to iodinated contrast media MRI is a perfectly equivalent alternative. Especially in patients with known contraindications to iodinated contrast media the MR-compatibility should be taken into consideration in the choice of the endovascular device.

Aged↗
PubMed2001

[MRI in chronic inflammatory bowel disease].

Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T1-weighted gradient echo and T2-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data.

Adult↗
PubMed2001

Long term changes of the throwing arm of former elite javelin throwers.

The aim of this study was to determine long term changes in shoulder and elbow joints of former elite javelin throwers. Twenty-one elite javelin throwers were examined at an average of 19 years after the end of their high performance phase. Mean age at examination was 50 years. Functional assessment of both shoulders was determined by the Constant-score. The shoulder of the throwing arm was examined by magnetic resonance imaging. Both elbow joints were examined clinically and radiographically. Five athletes complained about transient shoulder pain in their throwing arm affecting activities of daily living, fourteen athletes had a deficit of internal rotation of at least ten degrees. Constant-scores of throwing arms were six points lower than those of non-throwing arms (P < 0.05). Complete ruptures and partial tears of the rotator cuff were frequent. Three athletes complained about transient elbow pain in their throwing arm affecting activities of daily living; ten athletes had a deficit of extension of more than five degrees. All dominant elbows had advanced arthrotic alterations (osteophytes, sclerosis) compared to the non-dominant side. Athletes who trained with weights of more than 3 kg had a significantly higher risk of degenerative changes than athletes who did not (P < 0.01). We therefore recommend to avoid throwing training with weights of more than 3 kg.

Activities of Daily Living↗
PubMed2001

[Prospective study to compare high-resolution computed tomography and magnetic resonance imaging in the detection of pancreatic neoplasms: use of intravenous and oral MR contrast media].

PURPOSE: To compare thin-section hydro-CT and MRI in the detection of pancreatic neoplasms. Evaluation of an oral, superparamagnetic contrast agent (OMP) for pancreatic MRI. MATERIAL AND METHODS: 45 patients with suspected pancreatic neoplasms were examined with consecutive thin-section helical CT (Hydro-CT, 3/6/3, 130 ml Ultravist, Schering) and MRI (1.0 T, breath-holding, T1w-GRE, T1w-GRE fat-sat, T2w-TSE). The MRI protocol included precontrast studies, studies after oral administration of OMP (Abdoscan, Nycomed Amersham) and studies after administration of OMP and Gadodiamide i.v. (Omniscan, Nycomed Amersham). All images were assessed by two independent radiologists in a blinded fashion. Radiologic diagnosis was correlated with histology or clinical follow-up (> or = 3 month). RESULTS: 39 patients could be included in analysis. In 13 cases a pancreatic neoplasm was proven by histology. Thin-section hydro-CT and MRI showed no statistically significant differences for the detection of pancreatic neoplasia. The sensitivity of helical hydro-CT was superior compared to MRI (88.5% vs. 65.44/73.1%/76.9%). The specificity of MRI was superior compared to helical hydro-CT (86.5% vs. 94.2%/90.4%/88.5%). CONCLUSION: Thin-section hydro-CT and MRI show similar results for the detection of pancreatic neoplasms. Compared to thin-section helical CT, MRI still has the drawbacks of much more time consumption and, still, lower spatial resolution. The use of an oral, superparamagnetic contrast agent added no advantage for pancreatic MRI.

Administration, Oral↗
PubMed2000

[Various spiral CT protocols and their significance in the diagnosis of aortic dissections: results of a prospective study].

PURPOSE: Development of an optimized Spiral CT protocol type for the diagnosis of aortic dissections. MATERIAL AND METHODS: 121 consecutive CT examinations applying 5 different protocol types were blindly read by two experienced radiologists and then compared with: (a) 45 biplane transesophageal echocardiographies (TEE), (b) 52 transthoracic echocardiographies (TTE), (c) 52 operative findings and, furthermore, related to the clinical course over at least six months in 79 patients. RESULTS: The sensitivity of the spiral computed tomography for detection of dissection was 97% (biplane TEE: 88%), the specificity 100% (biplane TEE: 91%). In 15% dissections with atypical origin and entries (mid-portion of the aortic arch, distal thoracic aorta, etc.) were found. The optimal CT-protocol was the one with a combination of two separate but adjacent spiral scans achieving high spatial resolution for the aortic arch and enough spatial resection for the residual aorta (1. helical scan 3 mm collimation, pitch 2. 2. helical scan 5 mm collimation and pitch 2, 130 ml contrast medium at 5 ml/s) with a classification accuracy of 100%, visualization of entries of 100%, reentries of 100% (40% direct, 60% indirect). The identification of the ostia of the aortic branches were: supraaortic 93%, visceral 100%, left renal artery 100%, right renal artery 93%, iliac 64%. The CT angiography, designed as aortic arch angiography, showed a good contrast in the aortic arch vessels (79-86%) and the visceral vessels too (91%). CONCLUSION: Thoracic CT angiography can be used as gold standard in the primary evaluation of aortic dissections.

Adolescent↗
PubMed1999

[Renal tumor embolization].

Today the relevance of renal tumor embolization is not determined only by the technical and clinical success of the method. Progress in diagnosis of early stages of renal carcinomas as well as the improvement of both surgical techniques and anesthetic procedures have lead to a change in the selection of patients for embolization. Preoperative embolization of advanced renal cell carcinomas with tumor thrombus into the vena cava or of T4 tumors is now an established clinical procedure. The complete occlusion of the vascular bed of the tumors leads to a considerable reduction in intraoperative blood loss and to simplification of the surgical preparation. By using Ethibloc for embolization, palliation of a hemorrhage or of tumor-related pain in inoperable patients is usually successful. Although local control of the tumor disease, including complete tumor ablation, is achieved by embolization, the median survival rate of our palliatively embolized patients is only 3.5 months. This short life expectancy in the group of inoperable patients has to be acknowledged individually in patients considered for palliative embolization who are free of symptoms related the tumor.

Aged↗
PubMed1998

[Radiologic diagnosis of bone metastases].

Metastases are the most common malignant tumors of the skeleton. Several imaging modalities can be engaged for the diagnosis of skeletal metastases. They may be combined, depending on the individual clinical setting. Plain films are used for evaluation of symptomatic regions of the skeleton. Sensitivity is low, but benign skeletal disorders causing clinical symptoms can usually be identified in plain films. Bone scintigraphy is employed for a survey of the entire skeleton with high sensitivity for the presence of metastases, but only poor specificity. Computed tomography (CT) and magnetic resonance imaging (MRI) are advanced diagnostic methods, essential particularly in the diagnosis of metastatic spinal disease. Using CT, additional percutaneous bone biopsies can be performed easily and safely. Of all imaging modalities, MRI has the highest sensitivity for skeletal metastases. Other advantages are the possibility of multidirectional slice positioning and excellent soft tissue contrast.

Bone Neoplasms↗
PubMed1998

[Diagnostic imaging for therapy control of primary bone tumors].

Adjuvant chemotherapy has significantly improved the prognosis of patients with bone sarcomas. Preoperative diagnostic imaging of tumor response to such therapy has become a mainstay for the assessment of prognosis, planning of surgery and further treatment. During therapy, responding tumors show characteristic changes on conventional radiography, angiography, sonography, radionuclide studies, CT and MR. The usefulness and the limitations of each imaging modality in assessing response to therapy are reviewed. The diagnostic importance of specific changes such as tumor volume reduction, calcification and tumor vascularization is discussed.

Adolescent↗
PubMed1998

[Interventional therapy of primary and secondary tumors of the spine].

Therapeutic interventions in the skeletal system are an essential part of interventional radiology. Although in terms of figures these procedures are applied less frequently, they are very effective. Percutaneous transarterial embolization of a spinal tumor is well-established interventional treatment. It is primary treatment for preoperative devascularization, but also for palliation of pain and for reduction of tumor volume. As an alternative access for embolization, direct percutaneous puncture of a vertebra is used. A new and promising technique is vertebroplasty, the percutaneous injection of acrylic surgical cement in destroyed vertebrae. The present paper discusses indications, technique, results and complications of these interventional therapeutic modalities in the treatment of primary and secondary spinal tumors.

Bone Transplantation↗
PubMed1997

[The hydro-MRT of chronic inflammatory bowel diseases].

PURPOSE: Evaluation of hydro-MRI in the diagnosis of chronic inflammatory bowel disease (IBD). MATERIAL AND METHODS: 33 patients with suspected Crohn's disease or ulcerative colitis were studied prospectively. After distension of the colon by a rectal enema, breathhold MR imaging was performed during bowel relaxation. Results were compared to the clinical diagnosis, endoscopy, barium studies and histopathology. RESULTS: 24/24 patients with active Crohn's disease were correctly diagnosed by MRI. Conversely, MRI was positive in only 2/5 patients with ulcerative colitis. In 5 patients the presence of IBD was excluded. There were no false positives. CONCLUSION: Hydro-MRI is a very reliable modality in the diagnosis of Crohn's disease. In the differentiation of Crohn's disease from ulcerative colitis, hydro-MRI seems to be a promising imaging procedure.

Adolescent↗