[Imaging procedures in neuromuscular diseases].
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Diagnosis, Differential↗
Biomedical subjects
T Vogl
Publications and source records attributed to T Vogl.
[Fasciola hepatic infection in a family: diagnosis and therapy].
A 39-year-old man was hospitalized because of a 5-week history of feeling very ill, with fever up to 39 degrees C and nonspecific upper abdominal pain. He looked very pale and his spleen was painful on palpation. There was a blood eosinophilia of over 50% and computed tomography demonstrated hypodense areas in the liver, suggesting a parasitic infection with liver involvement. An ELISA factor of over 100 and the finding of liver fluke eggs in bile confirmed the diagnosis of Fasciola hepatica infection, which was probably acquired by eating wild watercress when visiting in the Allgäu. A fasciola infection was also proven in his 37-year-old sister who for some time had complained of colicky right-sided upper abdominal pain, her 40-year-old husband with similar symptoms and their 10-year-old daughter. All four were successfully treated for two days with 10 mg/kg triclabendazole daily by mouth. Persons eating raw vegetables and salads of wild-growing plants are at risk of being infected with Fasciola hepatica.
Adult↗
Decrease of D2 receptors indicated by 123I-iodobenzamide single-photon emission computed tomography relates to neurological deficit in treated Wilson's disease.
Single-photon emission computed tomography with 123I-iodobenzamide, a dopamine D2 receptor antagonist, was employed to study dopamine D2 receptor densities in 17 patients with biochemically proved Wilson's disease and stable neurological status with therapy and in 5 age-matched control subjects. Of the 17 patients with Wilson's disease, 5 were neurologically asymptomatic, 3 had cerebellar signs, 1 exhibited a mild parkinsonian syndrome, 7 showed a parkinsonian syndrome and cerebellar signs, and 1 had generalized dystonia and a parkinsonian syndrome. In 5 age-matched control subjects specific isotope binding as calculated by the basal ganglia to frontal cortex ratio was 1.57 +/- 0.04 (mean +/- standard deviation). The ratio in patients with Wilson's disease ranged from 1.56 +/- 0.05 (n = 5, asymptomatic patients) to 1.17 +/- 0.02 (n = 4, marked neurological impairment). We observed an almost linear correlation between the reduction of 123I-iodobenzamide (IBZM) binding and the severity of neurological signs at the time of IBZM-SPECT (correlation coefficient, -0.84; p < 0.01). We suggest that the reduction of postsynaptic striatal dopamine D2 receptors as detected by IBZM-SPECT reflects striatal neuronal damage in Wilson's disease.
Adolescent↗
Marked reduction of striatal dopamine D2 receptors as detected by 123IBZM-SPECT in a Wilson's disease patient with generalized dystonia.
[123I]iodobenzamide-single photon emission computed tomography (IBZM-SPECT) was employed to study the distribution of dopamine D2 receptors in a patient with biochemically proven Wilson's disease presenting with generalized dystonia. IBZM is a dopamine D2 receptor antagonist with high affinity and specific binding to basal ganglia detectable by SPECT. IBZM-SPECT in this patient (age, 20 years) displayed a striatum to frontal cortex ratio of 1.2 compared to 1.55 +/- 0.05 (mean +/- SD) in normal controls (n = 7; mean age, 53.3 years). In parallel with this finding, MRI with heavily T2-weighted sequences showed atrophy and low signal intensity changes of the basal ganglia. There was no improvement of dystonia after a subcutaneous injection of apomorphine. In contrast, IBZM-SPECT of a neurologically asymptomatic Wilson's disease patient (age, 21 years) displayed a striatum to frontal cortex ratio of 1.6. The MRI scan of this patient was normal. It is suggested that the observed apomorphine-unresponsive generalized dystonia in this Wilson's disease patient is related to striatal lesions proven by IBZM-SPECT and MRI.
Adult↗
Imaging techniques in myotonic dystrophy. A comparative study of ultrasound, computed tomography and magnetic resonance imaging of skeletal muscles.
Limb and trunk muscles of 57 patients with the juvenile or adult form of myotonic dystrophy were studied by imaging techniques (ultrasound, computed tomography, magnetic resonance imaging). Typical findings were atrophy of the tibialis anterior and triceps brachii muscles and fatty degeneration of the vastus intermedius, sartorius, tibialis anterior and soleus muscles as well as of medial head of the gastrocnemius muscle. Magnetic resonance imaging was the most sensitive technique in depicting mesenchymal muscle alterations, followed by computed tomography and ultrasound. The data support that imaging is more sensitive in detecting the myopathy than measurement of the creatine kinase activity.
Adolescent↗
[Provocable tumor of the cheek as a manifestation of so-called "infiltrating lipoma" of the masseter muscle].
We report on a 29-year-old male patient, who presented at our outpatient clinic with a 6-year history of progressive swelling of the right cheek. Contraction of the masseter muscle increased the swelling. MR-Imaging revealed a tumor measuring 2 x 3 cm, which was located within the masseter muscle. The histological diagnosis was infiltrating lipoma, which to our knowledge has not been described in this area before. This particular type of lipoma is extremely rare in the head and neck. The diagnostic and therapeutic management of infiltrating lipoma is discussed, and guidelines for adequate follow-up suggested. In addition, the authors review other sites of this tumor and describe its histological characteristics and differential diagnosis.
Adult↗
[The diagnostic value of nuclear magnetic resonance tomography in Sjögen's disease].
Sjögren's syndrome is characterised by xerostomia, xerophthalmia and recurrent parotid swelling. There is a high coincidence with rheumatoid diseases. A variety of clinical and laboratory parameters offers important information for diagnosis, but none of them is specific for this disease. 36 patients with clinical diagnosis of Sjögren's syndrome were examined in a prospective study to evaluate the diagnostic significance of this technique. 34 patients showed an inhomogeneous, nodular pattern in the parotid gland. The signal intensity was very high, especially in the T2-weighted sequences. There was a significant correlation of the radiologic changes with the course of the disease. Four patients with the clinical diagnosis of sialadenosis demonstrated bilateral enlarged glands with a homogeneous signal pattern. Patients with acute purulent parotitis demonstrated enlargement of the gland without an alteration in the signal pattern. Patients with chronic recurrent parotitis and patients with radiogenic sialadenitis showed little inhomogeneous increase of signal intensity. Our results indicate that MRI is presently the radiological method of choice in the evaluation of Sjögren's syndrome.
Abscess↗
[Differential diagnosis of cervical space occupying lesion: the parapharyngeal rhabdomyoma].
A case of a parapharyngeal rhabdomyoma is presented. Only about 30 cases of this benign tumor of striated muscles are reported in the literature. Most tumors were located in the lateral cervical region. Histologically a rhabdomyoma must be distinguished from other mesenchymal tumors, especially from granular cell myoblastoma, hibernoma and reticulohistiocytoma. The value of magnetic resonance imaging in the radiological evaluation of parapharyngeal masses is emphasized. Operative resection is generally regarded as the therapy of choice. Local recurrences have been reported in some cases; malignant degeneration is not known.
Contrast Media↗
[Pre- and postoperative NMR tomographic studies in avascular femur head necrosis].
46 patients with avascular necrosis of the femoral head were examined by T2- and T1-weighted MR before and after infusion of Gd-DTPA. Both sides were involved in 12 cases. The classification was done according to Ficat. In early stages and in postoperative studies a correlation of signal intensity after infusion of Gd-DTPA and clinical symptoms was found. Hyperintensity of the avascular area or of the implanted material was assumed to be vascularised or vital components in 4 cases of Ficat I and in 15 postoperative studies. Contrariwise, we found in 5 patients with severe postoperative symptoms, low signal intensity areas due to avascular regions.
Contrast Media↗
[The clinical value of magnetic resonance tomography in cystic space-occupying lesions of the mouth floor].
11 patients with cystic lesions of the floor of the mouth were examined by MR imaging. Coronal slices provided an optimal visualisation of the lesions, but axial and sagittal slices added important information with regard to the exact topographic relationship between tumour and muscles. In particular, the mylohyoid muscle could be defined as a key structure. T1-weighted sequences enabled best visualisation of anatomic details, whereas T2-weighted sequences facilitated the primary diagnosis of cystic lesions. The contrast agent Gd-DTPA did not add information of significant diagnostic value. Our results indicate that MRI allows an exact visualisation of location and extent of cystic lesions and their relationship to surrounding muscles. We conclude that MRI is of high value in planning the operative strategy.
Cysts↗
Controlled MRI studies in psychiatric patients--relations to functional imaging methods (EEG mapping, SPECT and PET).
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Brain Mapping↗
Magnetic resonance imaging as a new diagnostic criterion in paediatric airway obstruction.
Magnetic resonance imaging of the trachea was performed in 21 children with congenital or acquired narrowing of the trachea or main bronchi. Diagnosis included aortic arch anomalies, innominate artery compression, pulmonary artery compression and tracheomalacia. All patients were examined after bronchoscopy. The demonstration of the trachea and the surrounding tissue and vessels on MR images enables the cause of tracheal compression and the degree and location of collapse to be evaluated. MRI is a modality well suited to characterizing tracheal narrowing without employing ionizing radiation or intravenous contrast medium. All MRI examinations were carried out with the patient under general anaesthesia so as not to risk pulmonary deterioration during sedation. In the cases presented MRI is the diagnostic step of choice after tracheobronchoscopy and broadens the diagnostic potential in extrinsic tracheal or bronchial stenosis in paediatric patients.
Airway Obstruction↗
Tracheal stenosis by innominate artery compression in infants: surgical treatment in 35 cases.
This is a report on 35 cases of innominate artery compression of the trachea and its surgical correction by means of aortotruncopexy. Diagnostic procedures of choice were tracheoscopy and magnetic resonance imaging, which offers representative images of inspiration and expiration, shows the anatomical relations between aortic arch and trachea and reveals the extent of tracheal compression. Surgical treatment is indicated if narrowing of the tracheal lumen exceeds 70%. By fixation of the aortic arch and the proximal innominate artery to the back of the sternum, tracheal compression is relieved. There was no unsuccessful operation in the 35 children. One late death occurred from cardiac failure, unrelated to tracheal compression.
Aorta, Thoracic↗
MRI in tracheal stenosis by innominate artery in children.
Pediatric airway obstruction due to anomalies of the course of the innominate artery may produce respiratory distress. MR imaging of the trachea was performed after bronchoscopy on forty-one children with congenital tracheal stenosis. Bronchoscopy only allows the evaluation of the lumen of the trachea, and the degree and location of collapse, and it may be difficult to determine the etiology of the tracheal narrowing. In eighteen out of the forty-one patients MR imaging showed a compression of the trachea by the innominate artery. The MR imaging diagnoses were subsequently compared for accuracy with the diagnoses determined by direct surgical observations. MR imaging of the trachea, the surrounding tissue and vessels allows the evaluation of the cause of tracheal compression and the degree and location of collapse. For evaluation of the cause of airway obstruction. MRI is an ideal method depicting detailed anatomic structure without employing ionizing radiation or intravenous contrast medium.
Brachiocephalic Trunk↗
[The predictive value of so-called secondary reconstruction in fractures of the frontal skull base].
While MRI offers excellent possibilities to visualize different planes of a structure of interest, CT is limited to the axial and coronal plane. In most cases, CT examination can be carried out in the traumatised patient in the axial plane only. Therefore, in the present study the authors tried to investigate the value of multiplanar reconstruction of CT scans in anterior skull base traumatology, 18 patients (6 female, 12 male) aged between 18 and 57 years with bony lesions of the anterior skull base caused by different traumatic events were examined under a CT scanner of the fourth generation. A high-resolution mode was used in 14 out of 18 patients. The axial scans were reformated in coronal and sagittal planes. The clinical value of the reconstructed images, however, was poor. They would not supply additional information compared to the original scans; the quality of the reconstructed scans was even worse. Artifacts could not be distinguished from bony lesions. The results indicate that multiplanar reconstructions of CT scans are not sufficient in the evaluation of bony lesions of the anterior skull base.
Adolescent↗
[Diagnostic approach in diseases of the parapharyngeal space].
Diseases of the parapharyngeal space (p.s.) are quite rare. Nevertheless, the clinical and therapeutic approach to this anatomical site is not easy in many cases. Possibly some of the patients suffering from lesions in the p.s. could be cured, if the disease were detected in an earlier stage. In the present paper the authors introduce the diagnostic evaluation of this region. Clinical and radiological procedures are demonstrated in selected patients with characteristic lesions of the p.s. in order to find out about reasonable and sufficient diagnostic approaches to this hidden area. While the clinical examination is limited mainly to inspection and palpation, diagnostic imaging--and particularly modern techniques like CT, MRI and 3-D-reconstruction--enables us to receive a better approach to the p.s.. Advantages and disadvantages of the different methods are discussed according to their diagnostic value for the various kinds of lesions in the p.s.
Adult↗
[Proton spin tomography in HIV 1-induced diseases in head and neck region].
Most HIV-infected patients present with associated diseases (inflammations, hyperplastic disorders of the lymphatic tissue and malignancies) in the head and neck region. Speculum, endoscopy, ultrasound and computed tomography are important tools in the diagnostic management of HIV presentations. Moreover, MR is known to be an excellent technique especially in the evaluation of soft tissue disorders. -A prospective study of 23 out of 161 HIV-seropositive patients was performed to determine the efficiency of magnetic resonance imaging in HIV-related disorders. T1- and T2-sequences, as well as the contrast medium uptake (Gd-DTPA), presentation in three planes and the morphology of the tissue were useful parameters to distinguish the different HIV-related diseases (lymphatic hyperplasia, inflammation, Kaposi's sarcoma, Hodgkin's und Non-Hodgkin lymphoma, lymphoepithelial cysts and carcinoma) in most cases even prior to histological examination. -MR proved to be a significant non-invasive diagnostic tool especially in HIV-associated soft tissue disorders in the head and neck.
Adult↗
[Current diagnosis and therapy of cysts of the mouth floor].
Cystic tumors of the floor of the mouth are relatively rare. Until today the exact localisation of the cysts in relationship to the muscles of the floor of the mouth is established mainly during operation. Therefore the preoperative decision for the optimal surgical approach can be difficult, at least in large space occupying lesions. In the present study the case of a 24-year-old female patient with an extensive dermoid cyst of the floor of the mouth is demonstrated. The preoperative use of magnetic resonance imaging enabled us to determine the exact localisation of the cyst in relationship to the muscular structures of the floor of the mouth. The differential diagnosis of dermoids of the floor of the mouth as well as the adequate therapeutic approach is discussed according to the relevant literature.
Adult↗