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Biomedical subjects

K Terstegge

Publications and source records attributed to K Terstegge.

At least 19 recordsLinked to original sources
PubMed2002

Feasibility of source images of computed tomographic angiography to detect the extent of ischemia in hyperacute stroke.

BACKGROUND AND PURPOSE: Computed tomographic angiography (CTA) is suggested to be a promising tool for patient selection for thrombolytic therapy of acute stroke. It does not only provide information on intracranial vasculature, but also on the capacity of the collateral circulation and the pattern of poorly perfused brain tissue. The objective of our study was to evaluate whether the presence and size of critically hypoperfused tissue assessed with flow positron emission tomography (PET) as a gold standard can reliably be identified on CTA source images. METHODS: Fifteen potential candidates for early thrombolysis underwent CTA 65-170 min (mean 107 min) after the onset of acute anterior circulation stroke. Regional cerebral perfusion was measured between 27 and 86 min (mean 59 min) later with [(15)O]-H(2)O and PET, and the volume of critically hypoperfused cortical tissue was assessed. CTA source images were evaluated by a neuroradiologist and an experienced stroke neurologist. The patients were classified into three groups according to the presumed size of the perfusion deficit on CTA (large, small, no perfusion deficit). RESULTS: PET revealed the presence of critical cortical hypoperfusion in 10 patients, 5 had no critical cortical hypoperfusion. The neuroradiologist correctly identified the presence of a perfusion deficit in all patients, the neurologist had two false negative and one false positive ratings. Concerning the size of the perfusion deficit, there was considerable inaccuracy in both raters. CONCLUSIONS: The usefulness of CTA source images in yielding information about the perfusion state of stroke patients in clinical routine should not be overestimated.

Adult↗
PubMed2000

[The sacral perineural system--are there radiological criteria for an indication for surgery? First results and literature survey].

PURPOSE: To establish recommendations for diagnostic imaging of cystic lesions of the sacral region and to evaluate for potential predictors of therapeutic outcome. METHODS: Conventional imaging of the lumbar spine, conventional CT, myelography, post myelo-CT and MRI were performed in 7 symptomatic [corrected] patients. All patients underwent operative decompression and histological examination. The radiographic examinations were reevaluated retrospectively and correlated with the postoperative outcome. RESULTS: In one patient the differential diagnosis of a neurinoma could not be excluded with CT and CT-myelography alone. In all 7 patients MRI provided a definite diagnosis and a precise presentation of the cyst extension. A complete postoperative remission of symptoms was noticed in 4, a partial remission in three cases. The correlation of cyst extension, cyst shape, and the communication with the subarachnoid space did not provide predictive information concerning operative outcome. CONCLUSION: MR can be used as the sole imaging tool for demonstration of cystic lesions. Relevant disadvantages in comparison to myelography and myelo-CT were not evident. No imaging modality could predict the value of surgical intervention.

Decompression, Surgical↗
PubMed2000

Early x-ray hypoattenuation of brain parenchyma indicates extended critical hypoperfusion in acute stroke.

BACKGROUND AND PURPOSE: The presence of early x-ray hypoattenuation is an important selection criterion for thrombolytic therapy. However, knowledge about the pathophysiological constellation reflected by this hypoattenuation is lacking. Our objective was to study the relationship between the presence of early CT hypoattenuation and the volumes of critical cortical hypoperfusion. METHODS: In 32 patients with acute ischemic stroke, CT was performed 20 to 170 minutes (mean, 94 minutes) after symptom onset, and [(15)O]H(2)O-PET 20 to 120 minutes (mean, 67 minutes) later. CTs were scrutinized for the presence of hypoattenuation. On the PET scans, the volumes of critical cortical hypoperfusion were assessed. RESULTS: CT hypoattenuation was present in 18 patients (56%), all of whom had critical cortical hypoperfusion and developed infarction. Of the 14 patients with normal CTs, critical hypoperfusion was found in 6, and 7 developed infarction. The mean volumes of critically hypoperfused tissue differed significantly (P=0.0001, Wilcoxon test) between the CT normal (mean 13.9 cm(3), range 0 to 71 cm(3)) and the CT abnormal (mean 116.3 cm(3), range 4 to 389 cm(3)) groups. CONCLUSIONS: Early presence of hypoattenuation is indicative of extended volumes of critically hypoperfused cortical tissue. The extent of hypoperfusion may exceed that of hypoattenuation, and some of that tissue might still be salvageable.

Acute Disease↗
PubMed2000

MRA in patients with cerebrovascular disease. Considerations of clinical effectiveness.

OBJECTIVE: To establish in which clinical contexts cerebral MR angiography (MRA) is routinely carried out in a neurological university department and to describe its clinical impact. MATERIAL AND METHODS: Medical records, reports of findings and documentation of imaging examinations carried out in all 69 patients referred to the Department of Radiology from the Department of Neurology between 1995 and 1998 for cerebral MRA were evaluated. The clinical impact of all imaging findings was assessed on the basis of the medical records. RESULTS: Circulatory disturbances in the vertebrobasilar arteries (n = 34) were the most frequent indication for investigation. MRA followed CT or duplex sonography in 66 of the 69 patients with a mean delay of 8 days. MRA was considered diagnostically inferior to conventional MR in 11 cases, comparable in 30 and superior in 25. Comparing MRA and duplex sonography, the corresponding figures were 12, 29 and 23. In retrospect, 56 MRAs were judged unnecessary. CONCLUSION: Controlled clinical studies on optimal use of MRA are needed to avoid wasting resources and to exploit the method's full diagnostic potential in appropriate cases.

Adult↗
PubMed1999

[How can Romberg disease be evaluated by means of MRI?].

Romberg disease, also known as progressive facial hemiatrophy (PFH), is an uncommon disease with progressive facial asymmetry as the major symptom. It is a atrophic process of the subcutaneous fatty tissue whose etiology is unknown. Skin, muscles and bones can be secondarily afflicted. With MRI evaluation we were able to show in 14 patients with PFH thinner subcutaneous fat, as well as flattening of the dermis in 12 of the 14. We divided the patients into three stages by the means of the MRI findings and found tendency towards concurrence between the MRI stage and the clinical stage.

Adolescent↗
PubMed1999

High-resolution magnetic resonance imaging in patients with facial haemiatrophy.

The aim of this clinical study was to evaluate the use of high-resolution magnetic resonance imaging (MRI) in the diagnosis of facial haemiatrophy. A total of 14 patients with clinically suspected facial haemiatrophy were investigated using high-resolution MRI. The T1- (500/25) and T2- (2200/50) weighted images were analysed visually and numerically. The results of the affected skin portions were compared with the contralateral skin and correlated with the clinical results. The subcutis could not be delineated by high-resolution MRI in 9 patients with facial haemiatrophy. The dermis was not discernible in 6 cases and was "smooth" in a further 6 patients. The signal-to-noise ratio of affected skin portions and contralateral skin or clinical severity did not correlate. The higher the clinical severity, the more pronounced was the magnetic resonance ratio between dermis and subcutis thickness. Thus high-resolution MRI is a useful method for objective description of pathological changes in clinically suspected facial haemiatrophy.

Adult↗
PubMed1998

[Subperiostal hematoma of the orbit and epidural hematoma in patients with skull-brain trauma].

Subperiostal hematomas (SPOH) of the orbit are mostly of traumatic origin, but may occur spontaneously. In patients with frontal and temporal extradural hematomas, concomitant SPOH of the ipsilateral orbit have sporadically been observed. We report clinical and radiological findings of a patient and a review of the literature and discuss the development of SPOH.

Accidents, Traffic↗
PubMed1997

MR anatomy and small lesions of the eye: improved delineation with a special surface coil.

To develop an improved investigation protocol for MRI studies of intraocular lesions, imaging with a small surface coil (diameter 6 cm) was compared with a standard surface coil (diameter 11 cm). Both coils were assessed initially on an eye phantom and then by studying 22 patients with uveal melanoma and similar lesions of the eye. The influence of bandwidth and field or view (FOV) were systematically studied and evaluated quantitatively. A smaller bandwidth improved image quality independent of surface coil size. The subsequent secondary increase in chemical shift artefact was acceptable. Smaller FOVs (60-80 mm) necessitated the use of a smaller surface coil. A smaller bandwidth also proved to be advantageous with the use of the smaller surface coil. In conclusion, a smaller-diameter surface coil improves MR imaging of ocular lesions. Pulse sequences with a small bandwidth maintain an acceptable signal-to-noise ratio when the FOV is reduced.

Artifacts↗
PubMed1996

Fast spin-echo MR imaging of the eye.

Magnetic resonance imaging of the eye usually includes T2-weighted images both for screening purposes and for characterization of melanoma. Conventional T2-weighted spin-echo (SE) imaging suffers both from long acquisition times and incomplete recovery of the vitreous' signal. A fast SE sequence was therefore compared prospectively with conventional sequences in 29 consecutive patients with lesions of the eye. Fast SE images delineated melanoma and other lesions of the eye from vitreous better than conventional T2-weighted images. Image quality and lesion conspicuity were improved on the fast sequence. Whereas melanoma appeared hypointense to vitreous on both types of images, subretinal effusion was hypointense on fast images and hyperintense on conventional T2-weighted images. Ghosting of the globe, which, however, did not decrease diagnostic value, was more pronounced on fast images. Conventional T2-weighted images may be replaced by fast SE images in MR studies of the eye with a gain in lesion conspicuity and significant time saving.

Eye Neoplasms↗
PubMed1996

Regional association of developmental venous anomalies with angiographically occult vascular malformations.

This study reviews the neuroradiological findings of 43 patients with a developmental venous anomaly in order to discuss the clinical significance of this entity. All patients underwent unenhanced and contrast-enhanced computer tomography and magnetic resonance tomography, as well as selective angiography, and were followed for at least 2 years. In 40% (17 of 43) of patients a cryptic vascular malformation was found in the proximity to the developmental venous anomaly. Neurological symptoms were present in 8 of 17 patients (47%) in this group. Patients with an isolated developmental venous anomaly had symptoms in 19% (5 of 26), but none of them had experienced a hemorrhage. Magnetic resonance was the most sensitive method for the diagnosis of both types of lesions and alterations of the adjacent parenchyma. These results further support that developmental venous anomalies represent a clinically benign entity. However, patients with an association of a developmental venous anomaly and a cryptic vascular malformation are at risk for hemorrhage from their angiographically occult vascular malformation. Magnetic resonance proved to be the imaging modality of choice for both entities and is appropriate for diagnosis and follow-up.

Adolescent↗
PubMed1995

Otorhinolaryngological complications of progressive facial hemiatrophy (Romberg's disease).

Progressive facial hemiatrophy (PFH) is characterized by slowly progressive atrophy of subcutaneous tissue. Bone, muscles, nerves, the eye, and the brain may be affected by atrophy. Four patients suffering from various otorhinolaryngological complications of PFH or Romberg's disease are reported. Unilateral hearing loss could be located in the inner ear of one patient by audiologic examination. Localized bone destruction and disintegration of a portion of the anterior wall of the frontal sinus were observed in a patient after more than three decades. Marked shrinking of the homolateral parotid gland and homolateral masticatory spasm are reported as further otorhinolaryngological manifestations. The various complications of PFH call for close interdisciplinary cooperation.

Child↗
PubMed1995

[Magnetic resonance of brain involvement in progressive facial hemiatrophy (Romberg's disease). Reconsideration of a syndrome].

UNLABELLED: Progressive facial hemiatrophy (PFH) is a sporadic disease of unclear etiology, characterized by shrinking and deformation of one side of the face. Reports and interpretations of CNS involvement in PFH, as deduced from the occurrence of seizures in some patients and documented by pneumoencephalography and CT findings in small series of patients, are contradictory. We examined three female patients with PFH, one with partial epilepsy, with the view to gaining further insight into the pathogenesis of the disease. METHODS: Routine MR examinations of the head and face were performed. RESULTS: Only the patient with epilepsy showed pathological findings, confined to the cerebral hemisphere homolateral to the facial hemiatrophy, and including monoventricular enlargement, meningo-cortical dysmorphia and white matter changes. CONCLUSIONS: The MR morphology, and corresponding neuroradiological and histopathological findings disclosed by a review of the literature, indicate that homolateral hemiatrophy is a typical finding for a subgroup of PFH patients, but do not support the model of a simple or nutritive atrophic process. We reconsider chronic localized meningo-encephalitis with vascular involvement as possible underlying cause of the occasional brain involvement in PFH.

Adult↗
PubMed1995

[Magnetic resonance angiography of intracranial aneurysms after subarachnoid hemorrhage].

Magnetic resonance angiography is now commercially available for a variety of scanners and is being increasingly applied in the diagnosis of cerebrovascular disorders. Considering the clinical consequences, especially in intracranial aneurysms, studies to determine the sensitivity and specificity of the method are essential. Here we report our experience with a 3D-FISH time-of-flight magnetic resonance angiography protocol in 52 patients who have suffered an acute subarachnoid hemorrhage. In 26 of the 52 patients, conventional angiography identified 31 aneurysms (3-20 mm) that were confirmed during surgery or autopsy. Magnetic resonance angiography correctly identified 28 of the 31 aneurysms (sensitivity 90.3%) and missed one ruptured (3 mm) and two incidental aneurysms (3 mm) in patients with multiple aneurysms. The sensitivity for a ruptured aneurysm was 96%. The 26 patients who suffered subarachnoid hemorrhage without evidence of an intracranial aneurysm on repeated angiography served as a control group. Magnetic resonance angiography revealed no false-positive findings, resulting in a specificity of 100%. In correlation with the literature, we conclude that magnetic resonance angiography is not sensitive enough for the management of acute subarachnoid hemorrhage. However, the method provides important complementary information for definition of the bleeding site in patients with multiple aneurysms. In addition, the calculation of projections not possible with conventional angiography can aid surgical planning. Since only very small aneurysms were missed by magnetic resonance angiography, the sensitivity seems appropriate to screen asymptomatic patients who are at risk for intracranial aneurysms.

Adolescent↗
PubMed1994

Wernicke's encephalopathy--causes to consider.

Wernicke's encephalopathy (WE) is a thiamine deficiency disorder and is characterized clinically by the triad of ocular abnormalities, ataxia and disturbances of consciousness. We report on 3 patients with WE, of whom 2 had insufficient thiamine substitution. In the first patient symptoms disappeared during thiamine substitution. In the second patient acute WE was the terminating event in the sequence of parenteral nutrition, lactic acidosis and cardio-pulmonary decompensation. Possibly due to hereditary deficits WE developed in the third patient despite sufficient thiamine substitution. Attention to thiamine deficiency should be paid in all patients with history of alcoholism, malnutrition, malabsorption, tumors, inflammation, other severe diseases and in parenteral hyperalimentation. In order to prevent WE thiamine should be substituted with at least 100 mg/day i.v. or i.m.

Adult↗
PubMed1994

Vasculitic, hypoxic-ischemic leukoencephalopathy.

The case of a 67-year-old woman with terminal renal insufficiency, who developed extensive encephalopathy with predominant involvement of the white matter is reported. The encephalopathy was the consequence of preexisting hypertensive alterations, acidosis, hypoxia, ischemia, bacteremia and varicella-zoster meningoencephalitis. The vasculitic alterations associated with meningoencephalitis had a major influence on the development and the extent of the leukoencephalopathy.

Aged↗
PubMed1994

MR of brain involvement in progressive facial hemiatrophy (Romberg disease): reconsideration of a syndrome.

PURPOSE: To gain further insight into the pathogenesis of progressive facial hemiatrophy, a sporadic disease of unclear etiology characterized by shrinking and deformation of one side of the face. METHODS: We investigated possible brain involvement. MR of the head and face was performed in three female patients with progressive facial hemiatrophy. The central-nervous-system findings were correlated to a clinical protocol and a review of the literature. RESULTS: One patient with epilepsy had abnormal brain findings confined to the cerebral hemisphere homolateral to the facial hemiatrophy. These consisted of monoventricular enlargement, meningocortical dysmorphia, and white-matter changes. CONCLUSIONS: These MR findings, and corresponding neuroradiologic data disclosed by the review, indicate that homolateral hemiatrophy occasionally occurs in a subgroup of patients with progressive facial hemiatrophy. The MR features do not seem consistent with an underlying simple or nutritive atrophic process. We propose chronic localized meningoencephalitis with vascular involvement as a possible underlying cause of the occasional brain involvement in progressive facial hemiatrophy.

Adult↗
PubMed1994

Hyperostosis in meningiomas: MR findings in patients with recurrent meningioma of the sphenoid wings.

PURPOSE: We used MR imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. METHODS: Bone involvement was compared in 12 corresponding CT and MR studies of 10 female patients with sphenoid wing meningiomas recurrence after earlier surgical treatment. Four of these had histologically confirmed meningiomatous infiltration of the bone. RESULTS: All patients had CT findings of localized hyperostosis of parts of the sphenoid wings. MR revealed inhomogeneous areas of slightly increased signal intensity in hyperostotic bone on T2-, proton density- and T1-weighted sequences. In nine of 10 patients, segments of the hyperostotic bone showed different degrees of gadolinium enhancement. CONCLUSIONS: Because earlier studies have revealed high incidences of meningiomatous bone infiltration in sphenoid wing meningiomas, and because infiltration was confirmed in four of our patients, we postulate that the gadolinium enhancement in the area of hyperostosis may be related to meningiomatous bone infiltration.

Adult↗