Biomedical subjects
Publications and source records attributed to L Guhl.
The report covers experience of high resolution computerized tomography examinations of eight patients suffering from pulmonary manifestations of Wegner's granulomatosis. Classification of the lesions according to Murata's scheme is of no diagnostic benefit. The only findings that are diagnostic are cavitary lesions. Cavitation was found in five cases in this series.
The report covers experience made with high-resolution computerized tomography in examining more than 100 patients with interstitial lung disease. Small bullous lesions, tiny linear bands in fibrosis and thickening of the bronchovascular bundle can easily be demonstrated by this method. Another advantage is the early detection of ground glass opacities. Although no truly pathognomonic patterns exist, this technique significantly reduces the spectrum of differential diagnosis, especially due to its ability to detect the anatomical relationship between pathological changes and substructures of the lung.
On the basis of the time-of-flight effect in 18 normal volunteers and 119 patients with different diseases of the abdominal veins (inferior vena cava, porto-splenic system, renal/hepatic/iliac veins) magnetic resonance (MR) angiograms were compared with the DSA, CT and US results. The MR technique included a series of 2D gradient-echo (Flash) images in which the patients held their breath and projection angiograms (PA) (MIP algorithm). PA of the inferior vena cava and renal veins had a sensitivity of 90% and a specificity of 88.8%. The results demonstrate that in all cases diseases of the large veins could be detected using all the MR information available. It is suggested that this method is so far not satisfactory in the evaluation of small vessels and slow intravascular flow conditions.
7 patients presenting with pulmonary manifestation of Wegener's granulomatosis are discussed. They were examined via high-resolution computerised tomography. In 5 cases pulmonary nodules with or without cavitation could be detected. 4 patients showed intrapulmonary opacities of the ground glass type; in one case, a reticular intrapulmonary infiltration was seen.
Three female patients with histories of lymphangiomyomatosis are reported. Each was examined by means of high resolution computerized tomography. All three cases showed homogeneous distribution of cystic lesions in the pulmonary parenchyma. This pattern may be regarded as typical and may even be pathognomonic. In two patients lymphomas of the retroperitoneal space and renal masses were found.
The case of a 38-year old man with a lipoma of the left cerebellopontine angle is presented. While the clinical signs of that tumour are unspecific, an exact diagnosis is possible by CT and MRI. As in other reported cases only an incomplete removal of the tumours was made because of the adherence of the lipoma to the nerves of the CPA.
Magnetic resonance imaging (MRI) patterns of 11 haemangioblastomas examined with a 1.5-T scanner are described. MRI was as effective as contrast-enhanced CT in the detection of vascular tumour components, but was less sensitive than angiography. MRI was superior to CT in delineating the exact extent of the lesions, for example contact with the arachnoid surface. Even if a cystic tumour component is absent, MRI can provide helpful criteria for differential diagnosis; in particular, T2 values allow differentiation from meningiomas. In three patients additionally administered gadolinium (Gd) diethylenetriaminepenta-acetic acid (DTPA) the angiomatous parts of the tumour showed a remarkable decrease in T1 value, but the time dependence of the enhancement was not the same as that seen in dynamic CT.
The detection and delineation of spinal tumors by magnetic resonance imaging (MRI) after intravenous administration of gadolinium (Gd)-diethylenetriaminepenta-acetic acid (DTPA) is demonstrated in eight cases of neurinoma or meningioma. The advantages of Gd-DTPA-enhanced MRI over other MRI techniques used in more than 100 cases of spinal cord diseases are described.
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Seven patients presenting rare vascular anomalies of the craniocerebral vessels are reported, six of whom suffered from subarachnoid haemorrhage (SAH). Angiography demonstrated typically located saccular aneurysms as the cause of bleeding in three of these cases. An increased coincidence of rare vascular anomalies and aneurysms is known from the literature. Our findings suggest that in cases of SAH and rare cerebrovascular anomalies additional aneurysms can be demonstrated almost as often as in unselected cases of SAH (70%). Despite controversial aspects regarding the pathogenesis of cerebral aneurysms, abnormalities of the vessel walls of genetic or embryologic origin seem to be the most likely reason for this high coincidence.
Quantification of Thorotrastosis is easily obtained by means of computerized tomography. Th-concentration, total Th-content in an organ and the percentage of contaminated parenchyms can be evaluated. Some examples of such measurements are presented. Conventional x-ray morphology and CT-findings are demonstrated by hand of several cases of thorotrast tumors and other patients with Th-induced lesions.
The influence of Zn-DTPA on the retention of 144Cer in several organs of the rat was investigated 4 days after 144Cer application either with intact or with prevented renal excretion. As the 144Cer activity mobilized from the liver is recovered in gut and faeces an excretion of DTPA bount 144Cer with the bile can be assumed. In animals with impeded renal function an amount of 144Cer is accumulated in blood and extracellular water which corresponds to that mobilized from the skeleton and is normally excreted with the urine.
Magnetic resonance angiography (MRA) of the abdominal aorta was performed in 36 patients using the "bright-blood" technique on the basis of a series of flow-compensated breath-hold 2 D-GE pulse sequences. Diverse diseases included complete occlusion, stenosis, atherosclerotic or dissecting aneurysm and renal artery stenosis. Coronal and axial projection angiograms [maximum intensity projection (MIP) algorithm] and individual GE images were compared with DSA and contrast-enhanced computed tomography (CT). Our data showed a good correlation of MR and digital subtraction arteriography (DSA) or CT resp. in all cases, when both rotating MIP angiograms and individual GE images were analyzed. Thus, MR is suggested to be a useful noninvasive diagnostic method for the abdominal aorta, particularly in preoperative staging of aneurysms, aortic occlusive disease, and stenosis of the proximal main renal artery. Drawbacks of the method are a signal loss in slow or turbulent flow conditions, and unsatisfactory spatial resolution in small vessels.
T1 values and T2 values (CPGM-sequence) of neurinomas and meningiomas were determined, and showed values close to those of white and grey matter or, in regressive cystic neurinomas, near the cerebrospinal fluid (CSF). By this overlapping in relaxation times, as well as by crossover and boundary effects, small tumors may be obscured. The application of gadolinium-DTPA allows easier identification even of small lesions, by the high contrast achieved on the T1 weighted imaging sequences, which also avoids crossover and boundary effects with the adjacent parenchyma and CSF. This is demonstrated in intrameatal acoustic neurinomas, vascular tumors, small and en plaque growing meningiomas, and tumors of the spinal canal.