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58 patients with recent transient or permanent neurologic deficits of with proven carotid stenoses were examined by dynamic CT at the level of the internal capsule. In the presence of cerebral infarcts there was marked delay in the time/density curve with reduced peaks. Abnormal perfusion could be demonstrated by early examinations before definite morphological changes were seen. With transient ischaemic attacks there were no significant changes in perfusion; in the presence of carotid stenoses the results were variable. The perfusion abnormalities in the hemispheres shown by dynamic cranial CT could be confirmed to some extent by 99mTc-HMPAO-SPECT.

Regional cerebral blood flow reduction was measured in 84 patients with CVI using 99mTc-HMPAO-SPECT. 53 patients received 1 g acetazolamide to evaluate cerebrovascular reserve capacity. Differentiating between hemispheric (87%) and vertebrobasilar ischaemia (64%) revealed markedly increased sensitivity for the provocative test with acetazolamide. In 62% of high grade but asymptomatic carotid stenoses a haemodynamic effect was demonstrated with acetazolamide and thereby the indication for surgery was supported.

A retrospective study was carried out involving 39 patients with malignant tumours of the head and neck in order to differentiate by CT changes due to local tumour or lymph node recurrences and various post-operative or post-irradiation changes. In these patients, two or more CT examinations of the neck were available, derived from a fourth generation scanner. The suspected lesions were classified according to their type and the appearances correlated with the treatment and clinical findings. There was frequent overlap between the appearances of benign and malignant changes, so that in individual cases a definite decision often proved impossible.

The diagnosis of colorectal carcinoma is based on double-contrast barium enema and endoscopy. However, in contrast to computed tomography (CT), these modalities do not permit a precise preoperative prediction wether a tumour is limited to the bowel wall or has spread into surrounding tissue. To improve the detection of colorectal neoplasms by CT we prospectively studied the use of intrarectally administered water for CT scan in 16 patients with colorectal cancer proved by barium enema and endoscopy. The water repletion technique allowed an improved depiction of the large bowel wall, and the primary tumour was demonstrated by CT in all cases. Furthermore the use of water prevented artifacts which was helpful in the evaluation of the liver for suspected metastases.

Digital image intensifier radiography visualises all traumatological changes of clinical relevance and can therefore be used in traumatology. However, the quality of conventional radiographs cannot be attained as yet. Radiation exposure is markedly reduced, and radiographs are obtained directly after exposure, so that this is an extremely rapid radiographic procedure. Images can be quickly transmitted by video cable to the relevant departments and working places.

Despite the availability of endoscopy, radiological examination remains an essential method in the investigation of Crohn's disease. Various authors agree that it has an accuracy of 75% (1, 8, 14, 20). In our experience accuracy is somewhere between 70 and 85%. These figures depend on the fact that in about 16% histology is also unable to make a definite diagnosis. Crohn's disease of the large bowel is of significance since it is often misinterpreted as ulcerative colitis, because in 10% of cases there is no involvement of the terminal ileum. The final diagnosis depends on the summation of the individual features whose individual significance must be considered. Malignant involvement of the peritoneum, which has not been extensively described in the radiological literature, may result in changes in the wall of the colon and lead to an appearance resembling Crohn's disease, with consequent errors in diagnosis.

We compared the results of CT and conventional tomography examinations of the thorax of 137 patients with each other and with the final results. In the diagnosis of bronchial carcinomas we found no significant differences between the two methods. In all other investigated items CT proved to be superior to conventional tomography, especially of the evaluation of mediastinum (90% vs. 35%). We conclude that CT is the method of choice in the staging of intrathoracic tumours and especially in the evaluation of hilar and mediastinal masses and there is no need for conventional tomography in these cases.

To assess the safety of nonselective intraarterial digital subtraction angiography (DSA) performed from a transbrachial approach with 4-French-catheters, the complications occurring in 158 examinations were studied. Two patients developed local thrombosis and in four patients there were temporary pulse deficits. Three brachial artery catheterisations were unsuccessful due to transient arterial spasm. Our data support the conclusion that nonselective transbrachial DSA is a safe and accurate method, easily employed in an outpatient population.

On the grounds of a suspected localised tumorous lesion of the lung core biopsy (Tru-cut-needle) was performed in 127 patients to obtain a histologic diagnosis. This was successful on an average in 71.6% of the cases. The smaller lung lesions (less than 2.5 cm) showed a lower accuracy (65.2%) than the larger tumours (73.1%). Correct judgement of tumour status was effected in 88.2%. But in these cases also correct assessment of tumour status was less successful with the smaller tumours (69.6%) than with the larger ones (92.3%). In our case material core biopsy had a high complication rate: pneumothorax resulted in 54.3%, requiring special treatment in 9.4%. Haemoptisis was observed in 22.9% of which 2.4% had a severe and life-threatening clinical course. A correlation between these complications and the patient's age, the depth of the tumour in the lung and the frequency of the punctures was established. Pleural fluid was seen in 16.5% but in all cases it was negligible and no treatment was required. The pleural reaction showed no correlation to the age, to the tumorous lesion and to the frequency of puncture. The diagnostic advantage and the high accuracy of the core biopsy are evident. Nevertheless, we gave up this method in routine application in our lung tumour patients in favour of needle biopsy techniques. Core biopsy is still being used in examining special problems only.

The theoretical basis for measuring speed of flow in vessels of conscious patients obtained by estimating dilution of injected contrast is described. Previously, measurements at two separate points had to be carried out in order to obtain a flow profile, but with the present method, a single measurement point is adequate. If contrast is distributed evenly in the circulation during its flow to the periphery, the measurement can be carried out at some distance from the point of injection. The ability to select ones point of measurement makes it possible to avoid areas covered by overlying shadows and eliminates the difficulties inherent in measurements in curved vessels.

Hereditary hemorrhagic teleangiectasia is transmitted by an autosomal dominant character with typical vascular dysplasias in form of teleangiectasias and angiomas which occur on the skin, on the mucous membranes and also in nearly all organs of the body. More than 50% of patients with Osler's disease also have arteriovenous lung malformations. Therefore, pulmonary arteriovenous fistulas should be studied by x-rays for every member of a family suffering from this disease. To prove the suspicion of pulmonary arteriovenous fistula, the procedure of intravenous DSA should be used.

Eighty-seven unselected gall stones were examined radiologically and by ultrasound in vitro. No relationship of diagnostic value could be established between the amount of calcification and stone demonstration, the sonogram being influenced by the size of the stone, its surface contour and its position in the ultrasound beam. Sonography is therefore not suitable for selecting those patients on whom litholysis could be carried out. Sonography appears to be useful only in a negative way by establishing the exact size of the concretion.

Hyperplastic changes of the bronchial arteries may take the form of a racemose arteriovenous angioma or result from chronic bronchitis. Clinically, recurrent haemoptysis is a striking feature occurring in otherwise fit patients. The two forms can be distinguished by bronchial arteriography because of the difference in the appearance of the vessels. In the one condition there are circumscribed areas of arterial and venous, vascular abnormalities, in the other there is vascular hyperplasia, which is less clearly circumscribed. In both forms, broncho-pulmonary, i.e. arterio-venous anastomoses can be demonstrated; these may be considered as the cause of the haemoptyses.

Communication about two patients with Wegener's granulomatosis of the mamma. In both cases the rare disease was detected on the occasion of a mammographic examination. The results of the mammography could cause misinterpretations, e.g. it might be mistaken for an advanced mamma carcinoma. Up to now, the manifestation of a Wegener's disease of the female breast was neither mentioned in collective statistics of more than 324 cases nor it could be found in examining the publications of additional 231 cases. Both patients showed an unusual course of the disease with a slow progression as well as an unimportant affection of the respiratory tract. The regression of the tumor like lesions in the breast was remarkable.

Various expressions of the speed of flow of blood in arteries are discussed, such as instantaneous speed, integral speed, pulse wave speed (phase speed) and velocity of a moving front. The flow profile of the abdominal aorta was obtained by cine-densitometry, bearing in mind the above considerations, and the densitometric curves have been analysed. Differences of the flow velocities in different persons have been interpreted as a result of these theoretical considerations. The effects of the point of measurement, the distance over which the measurement was carried out and the pulse wave length on velocity were examined. In order to obtain a median blood stream velocity by angio-cine-densitometry, repeated injections of small volumes of contrast medium (random sampling method) are recommended.

Nuclear medical techniques (such as isotope nephrograms, renal scintigrams) which are suitable as screening methods, have been unable to improve the diagnosis of reno-vascular hypertension. Amongst conventional procedures, the excretion urogram following a bolus injection was the most informative, particularly if performed together with nephro-tomography. Although ultrasound is of some use in evaluating the kidneys, the excretion urogram remains essential for the diagnosis of reno-vascular hypertension. Additional exposures and modifications (e.g. early phase urogram only add unnecessary radiation and cost without providing additional information. On the other hand, it would be useful to obtain digital subtraction angiograms of the renal arteries during the contrast injection. In this way, reliable information can be obtained on the cause of reno-vascular hypertension in more than 90% of patients. Similar results can be obtained by photographic subtraction (ISA). This should be used where DSA apparatus is not available. Angio-CT and sequential CT is not reliable for the diagnosis of renal artery stenosis. On the other hand, these methods provide density measurements or time-density curves of selected areas in the cortex or medulla of the kidney, which indicated abnormalities of the circulation and provide a comparison of the two sides.