[Diagnosis of disease of the lymphatics (author's transl)].
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Diagnosis, Differential↗
Biomedical subjects
U Mödder
Publications and source records attributed to U Mödder.
[CT diagnosis and differential diagnosis of renal spaca occupying lesions (author's transl)].
In 76 patients with space occupying lesions of the kidneys CT scans were performed. Size, shape and localisation of the kidneys could well be demonstrated by this method. Space occupying lesions were clearly seen, and solid tumors could be differentiated from cysts. However differential diagnosis between either primary renal cell carcinoma and metastases or between malignant and benign mass lesions was not possible. There was no problem in the diagnosis of hydronephrosis where as a differentiation between inflammatory changes and solid masses proved to be difficult. CT scanning seems to be usefull in the diagnosis of renal space occupying lesions. As a non invavise method it should be performed previous to renal angiography, which thereby becomes unnecessary in many cases.
Adenocarcinoma↗
[The multiplicity of radiological findings in pulmonary hamartomas (author's transl)].
Difficulties in the differential diagnosis of pulmonary hamartomas are illustrated on the basis of 19 patients with this condition, and with reference to the radiological literature. All the patients in the present series were treated surgically, either because a mistaken diagnosis of a bronchial carcinoma had been made, or because a carcinoma could not be excluded with sufficient certainty. In several cases the patient requested removal of the tumour in order to clarify the diagnosis after several years without symptoms. Pulmonary hamartomas do not always show the appearances described as typical; atypical appearances occur and were rather frequent in our material, amounting to 25%. Despite various difficulties, it is occasionally possible to put an hamartoma first in the differential diagnosis of a lung tumour, particularly if there are no clinical features to suggest malignancy. A definitive diagnosis can be made only by histology after removal of the tumour.
Adult↗
[Effects of xeroradiographic contour amplification in intramammary calcifications (author's transl)].
The pronounced edge-effect occurring in xeroradiography of intramammary calcifications leads to a change in size of the object, namely, a reduction in the positive and an enlargement in the negative print, to a hard-to-evaluate zone in the border of the object which is in about the same size range for both developing procedures. The extent of edge-enhancement is directly related to the structures in the immediate neighborhood. Form and density of microcalcifications can be better assessed with the positive procedure.
Adenofibroma↗
[Primary lymphedema of the lower limbs in childhood (author's transl)].
Report on 3 cases of primary lymphedema in childhood. Lymphangiography, introduced by Kinmonth into radiodiagnosis, is essential. Aplasia, hypoplasia and hyperplasia of the lymphatic system can thus be differentiated. Conservative treatment is discussed.
Adolescent↗
[A case of extreme gouty arthritis, shown xeroradiographically (author's transl)].
A case of extreme, obviously lead-induced gouty arthritis is described testing xerography for typical gouty changes. Xerography is less effective in showing differences of density than film-techniques. But highly structures shapes or their sudden abolition will be particularly clear owing to the effect of contour reinforcement. Defects of bone induced by tophi and new formations can be identified with certainly.
Aged↗
[Lymphangiosis carcinomatosa of the lung and cardiopulmonary shock as initial findings in gastric cancer (author's transl)].
A case is reported of a 34 year old woman, who was hospitalized because of cardiopulmonary shock of sudden unsuspected onset. X-ray examination revealed diffuse interstitial pulmonary infiltration. Intra-aortal counter-pulsation did improve the condition only for short time. On autopsy an adenocarcinoma of the stomach was found, as well as diffuse carcinomatous infiltration of pulmonary lymph and arterial vessels. Thus lymphangiosis carcinomatosa has to be taken into consideration in discussing the differential diagnosis of diffuse interstitial pulmonary infiltration in young patients. The presence of microangiopathic hemolytic anemia may help to establish the diagnosis.
Adenocarcinoma↗
[Vocational rehabilitation of juveniles with cerebral damage acquired in early infancy].
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Adolescent↗
Preliminary experience with the application of gadolinium-DTPA before MR imaging-guided laser-induced interstitial thermotherapy of brain tumors.
The purpose of this study was to investigate the potential value of i.v. gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) applied before MRI-guided laser-induced interstitial thermotherapy (LITT) of brain tumors without original enhancement, especially in defining total lesion size during therapy. MRI-guided LITT was performed on two patients with astrocytoma WHO II. For both patients, Gd-DTPA was administered intravenously after a first irradiation period and LITT was continued after pulling back the light guide to coagulate the upper parts of the tumor. In both patients, the whole irreversible damaged zone of the second irradiation period after Gd-DTPA showed an intense increase of signal intensity. The spatial expansion correlated with the diameter of an enhancing rim after Gd-DTPA on follow-up studies. Our preliminary results indicate that the application of Gd-DTPA before MRI-guided LITT may be of value in defining exactly the size of the irreversible damaged zone during therapy in nonenhancing brain tumors.
Adult↗
In vivo MRI thermometry using a phase-sensitive sequence: preliminary experience during MRI-guided laser-induced interstitial thermotherapy of brain tumors.
The purpose of this study was the application of the proton-resonance-frequency method to monitor laser-induced interstitial thermotherapy (LITT) in a patient with an astrocytoma WHO II. A phase-sensitive two-dimensional (2D) fast low-angle shot (FLASH) sequence was used to determine the temperature-related phase shifts during LITT. Temperature maps were displayed during therapy with a temporal resolution of 20 seconds. Irradiation was discontinued as soon as the 60 to 65 degrees C isotherm reached the margin of the tumor. A contrast-enhanced MRI study performed immediately after therapy showed a good correlation of the size of an enhancing rim around the lesion with the 60 to 65 degrees C isotherm. The preliminary results of our study indicate that MRI guidance of LITT may be improved by temperature quantification based on the proton-resonance-frequency method.
Astrocytoma↗
Gaucher disease of the spleen: CT and MR findings.
We present a 26-year-old male patient with Gaucher disease who presented with epigastric pain and a palpable mass in the left abdomen. Ultrasound, abdominal computed tomography, and magnetic resonance imaging showed massive splenomegaly with multiple splenic nodules up to 7 cm in diameter. Splenic nodules should be included in the differential diagnosis of splenic masses. Follow-up is necessary because of the increased incidence of hematologic malignancies in Gaucher disease.
Adult↗
Idiopathic ileoileal intussusception in an adult with spontaneous reduction during enteroclysis: a case report.
We report a rare case of recurring idiopathic ileoileal intussusception in an adult. Diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination. After a short period of physical improvement, a follow-up CT showed a recurrence. Surgery proved the diagnosis, but no predisposing factor was found.
Adult↗
An efficient and robust PC program to calculate MR based regional cerebral blood volume maps.
In addition to morphological and anatomical information, functional information is increasingly used in clinical routine to assess pathological alterations of the brain. In addition to nuclear-medical methods there is a growing interest in using magnetic resonance imaging (MRI) to investigate tissue perfusion of the brain. The method employed is based on the indicator-dilution method after bolus injection of a contrast agent. In this paper we present the implementation of an efficient algorithm to calculate quantitatively the regional cerebral blood volume (rCBV). Computation requires about 1 min on a Macintosh Quadra 660AV. The results are represented as parameter images that allow global overall visual inspection as well as quantitative local evaluation by means of user-defined regions of interest.
Adolescent↗
[MRI follow-up study of aseptic osteonecrosis (AON) in children treated with chemotherapy for malignant diseases].
PURPOSE: The aim of the study was to evaluate by MRI the course of aseptic osteonecrosis (AON) after chemotherapy in children with different malignancies. MATERIAL AND METHODS: Retrospective analysis of 72 MRI studies in 20 children (age: 3.2-18.4 years) presenting with AON after chemotherapy. 8 children were treated exclusively with relief of weightbearing structures, whereas 12 children were additionally treated with hyperbaric oxygen therapy (HBO). Within a range of 3-76 months each patient received 1-6 follow-up exams. The acquired series included multi planar spin-echo as well as fatt-suppressed inversion recovery sequences. The MRI examinations were evaluated by a point-score system (1-6) by two radiologists. RESULTS: AON was most commonly seen in the pedal bones (26.4%), in the hip (23.6%), and in the knee joints (19.4%). Initial findings revealed an average score of 3.1 points. Based upon these initial findings, subsequent analyses show a statistically significant (p < 0.05) score increase of 0.6 score-points. For the observed intervals a: < 6 months, b: 6-12 months, and c: > 12 months the mean scores were: a: 3.3, b: 3.7, and c: 4.5 points. During the observed time period 5 patients were surgically treated in the affected bone areas. CONCLUSION: The majority of chemotherapy associated AON which initially present with advanced findings showed in MRI a progression with frequent destruction of the joint surface over their further course. More discrete forms of AON, especially osteoedema, can be positively influenced by conservative therapy.
Adolescent↗
Bone marrow oedema and aseptic osteonecrosis in children and adolescents with acute lymphoblastic leukaemia or non-Hodgkin-lymphoma treated with hyperbaric-oxygen-therapy (HBO): an approach to cure? -- BME/AON and hyperbaric oxygen therapy as a treatment modality.
BACKGROUND: There is a striking need for additional therapies of bone marrow oedema (BME) and aseptic osteonecrosis (AON) in paediatric oncology patients. Hyperbaric oxygenation (HBO) therapy used in the treatment of osteoradionecrosis is demonstrated effectiveness. Aim of this retrospective analysis was to investigate whether HBO-therapy might lead to subjective as well as objective effects in the treatment of BME and/or AON in paediatric oncology patients with acute lymphoblastic leukaemia (ALL) or Non-Hodgkin lymphoma (NHL). PATIENTS AND METHODS: Between 11/1988 and 01/2001 27/291 (9.3 %) patients with ALL or NHL were diagnosed with a BME and/or AON in the Clinic for Paediatric Oncology, Haematology, and Immunology at University of Dusseldorf. 19/27 patients were submitted to HBO-therapy. Patients received average 45 HBO-treatments per patient (min. 13, max. 80 treatments). The affected regions were re-evaluated with MRI for radiological extent of lesions every 3 months. Pain in its intensity and localisation was serially recorded during HBO-therapy as key symptom in 11 of 19 patients. RESULTS: 27 patients (15 females, 12 males; mean age at diagnosis of malignancy 8.2 +/- 4.7 (SD) years, range 7 months to 16 years) presented with 138 lesions. 133/138 lesions were localised in the lower extremities. At diagnosis of BME and/or AON, 78/133 lesions were shown in females and 55/133 lesions in male. Girls < 10 years predominantly presented BME (33 BME vs. 6 AON), girls aged > 10 years predominantly offered AON (28 AON vs. 11 BME). BME was more often exhibited in boys < 10 years (34 BME vs. 10 AON) and rarely in boys > 10 years (4 BME vs. 6 AON). 11 patients treated with HBO-therapy were serially evaluated for pain intensity throughout their HBO-therapy courses by visual analogue scale (VAS) assessment. During the first 15 treatment courses the HBO-therapy a clear-cut reduction of pain was observed. The mean pain score before the first HBO-treatment unit was 2.4 +/- 2.7 (X +/- SD), decreased before the fifth to 1.6 +/- 1.7 and prior to the 35 (th) and 40 (th) HBO treatment to 0. Girls < 10 years treated with HBO showed an increase of BME (31 --> 46) and declining AON numbers (6 --> 2). Girls > 10 years with and without HBO-therapy showed decrease of BME lesions (7 --> 4 vs. 4 --> 0), whereas AON increased in the HBO-treated group (28 --> 29) as well as the non-treated group (0 --> 4). Males < 10 years showed an increase in BME lesion numbers despite HBO intervention (24 --> 26). The AON lesion numbers dropped in parallel (6 --> 3). Male patients not treated with HBO showed constant numbers of BME (11-->11) and a decreased numbers of AON (4 --> 2). All differences are statistically not significant. CONCLUSIONS: Children and adolescents diagnosed with ALL or NHL have a risk for accruement of BME and/or AON irrespective of the age, with an almost exclusive involvement of the lower extremities. Lesions of pedal bones and ankle joints predominantly affect children < 10 years. Lesions of knee and hip joints predominantly affect children > 10 years. In children < 10 years of age we demonstrate declining AON numbers and conversion of AON to BME thereby implicating possible beneficial effect of HBO in such patients. HBO failed to show beneficial effect on BME whether by preventing new lesions or by improving existent lesions in children > 10 years.
Adolescent↗
[Proton spin tomographic changes of the femoral shaft in patients with kidney transplantation].
In a prospective study 43 patients were reviewed 3 and 12 months after renal transplantation. The patients had MRI examinations and plain x-rays of the hips as well as punch biopsies of the iliac crest. In 9 patients diffuse, inhomogeneous bilateral changes of the MRI-signal patterns of the femoral diaphysis were seen. They were hypointense in the T1-weighted images and hyperintense in the STIR-images. All plain x-rays were inconspicuous. These changes of the femoral shaft were significantly more frequent in patients with renal osteodystrophy of the histological type Delling Ila. We conclude that these changes of MRI-signals patterns might be connected with an osteoidosis.
Adult↗
MR measurement of spinal CSF flow with the RACE technique.
The purpose of our study was the application and validation of a phase-sensitive pulse sequence that allowed real time CSF flow measurement without need for electrocardiographic (ECG) synchronization. After excitation of a slice perpendicular to the axis of the spine, projective data were obtained with a gradient echo sequence [contrast enhanced Fourier acquired steady-state technique (CE-FAST)] without spin warp gradient [real time acquisition and evaluation of motion technique (RACE)], allowing one-dimensional spatial resolution across the region of interest with a total sampling time of 20-30 ms. The sequence was calibrated with a spinal CSF phantom with oscillatory fluid motion. The calculated mean pulsation amplitudes of 20 healthy volunteers in the cervical region were 16 mm (range 9-36 mm), in the thoracic region 11 mm (5-21 mm), and in the lumbar region 3 mm (1-6 mm). The technique was capable of demonstrating physiologic alterations of CSF flow during respiratory maneuvers and may provide a tool to evaluate the altered CSF dynamics resulting from spinal block, inflammatory processes, or hemorrhage.
Adolescent↗
Selective MR angiography and intracranial collateral blood flow.
This study evaluates the usefulness of MR angiography (MRA) in analyzing the individual collateral flow dynamics and anatomy of the circle of Willis in patients with high-grade extracranial carotid stenosis or occlusion. Selective MRA of the carotid or vertebrobasilar territory was performed by means of presaturation of up to three of the brain-supplying arteries at the level of the middle or lower neck (angled presaturation slabs). Results obtained with selective and nonselective arterial MRA in 45 consecutive patients were compared with findings at transcranial Doppler ultrasonography and intraarterial angiography, the latter serving as the "gold standard." Sensitivity of selective MRA in detecting intracranial collateral circulation via the anterior and posterior communicating artery was 95 and 97%, respectively; sensitivity in depicting extracranial to intracranial transorbital flow was lower (67%). Nonselective arterial MRA was 100% sensitive in detecting a nonfilling of the horizontal (A1) segment of the anterior cerebral artery and in identifying an origin of the posterior cerebral artery from the intracranial carotid artery. Visibility of the posterior communicating artery at MRA predicted for pathological collateral flow via this vessel in all cases. We conclude that selective and nonselective MRA of the cerebral arteries as used here is the most powerful noninvasive method to demonstrate collateral circulation via the basal communicating arteries and to identify hemodynamically relevant anatomic variants of the circle of Willis.
Adult↗