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BackgroundOsteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions.PurposeTo evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty.Study DesignCase series; Level of evidence, 4.MethodsClinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography–computed tomography (SPECT-CT) analysis of both the ankle and the knee joint.ResultsTwelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n 5 11) and poor in 8% (n 5 1). The average VAS pain score was 3.9 (preoperative, 5.9; P 5 .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P< .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P 5 .035), and ankle dorsiflexion was significantly reduced (P 5 .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%.ConclusionIndications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

Eine 39-jährige Patientin wurde vom Hausarzt in die Hypertoniesprechstunde überwiesen mit einer kürzlich diagnostizierten therapieresistenten arteriellen Hypertonie. Bei anamestischen Hinweisen für ein Phäochromozytom haben wir dieses mittels erhöhten Metanephrinen und Computertomographie nachgewiesen und operativ entfernen lassen.

Introduction: Magnetic resonance imaging (MRI) of soft tissues after total hip arthroplasty is of clinical interest for the diagnosis of various pathologies that are usually invisible with other imaging modalities. As a result, considerable effort has been put into the development of metal artifact reduction MRI strategies, such as slice encoding for metal artifact correction (SEMAC). Generally, the degree of metal artifact reduction with SEMAC directly relates to the overall time spent for acquisition, but there is no specific consensus about the most efficient sequence setup depending on the implant material. The aim of this article is to suggest material-tailored SEMAC protocol settings. Materials and Methods: Five of the most common total hip prostheses (1. Revision prosthesis (S-Rom), 2. Titanium alloy, 3. Muller type (CoNiCRMo alloy), 4. Old Charnley prosthesis (Exeter/Stryker), 5. MS-30 stem (stainless-steel)) were scanned on a 1.5 T MRI clinical scanner with a SEMAC sequence with a range of artifact-resolving slice encoding steps (SES: 2 – 23) along the slice direction (yielding a total variable scan time ranging from 1 to 10 min). The reduction of the artifact volume in comparison with maximal artifact suppression was evaluated both quantitatively and qualitatively in order to establish a recommended number of steps for each case. Results: The number of SES that reduced the artifact volume below approximately 300 mm3 ranged from 3 to 13, depending on the material. Our results showed that although 3 SES steps can be sufficient for artifact reduction for titanium prostheses, at least 11 SES should be used for prostheses made of materials such as certain alloys of stainless steel. Conclusion: Tailoring SES to the implant material and to the desired degree of metal artifact reduction represents a simple tool for workflow optimization of SEMAC imaging near total hip arthroplasty in a clinical setting. Key Points: • Five of the most common total hip prostheses have been investigated in vitro. • Tailored SEMAC protocols – in terms of scan duration – have been determined. • Tailoring was similar for T1-weighted and inversion recovery SEMAC MRI. • The suggested prosthesis-related SEMAC adaptation shortens clinical scan times. Citation Format: • Deligianni X, Bieri O, Elke R et al. Optimization of Scan Time in MRI for Total Hip Prostheses: SEMAC Tailoring for Prosthetic Implants Containing Different Types of Metals. Fortschr Rontgenstr 2015; 187: 1116 – 1122

Non-invasive or minimal invasive imaging techniques, such as CTA and MRA, are widely used and lead to an increasing number of incidentally diagnosed intracranial aneurysms. This review answers questions regarding pathogenesis, risk of rupture and treatment options. In conclusion, treatment guidelines based on the individual's risk profile are presented.

Fragestellung: Verbessert ein superparamagnetisches Kontrastmittel (monocrystalline iron oxide nanoparticle, MION) die MR-tomographische Abgrenzbarkeit mikroskopischer Tumorgrenzen im Vergleich zu Gd-DTPA? Methodik: 28 Wistar-Ratten mit stereotaktisch implantiertem Gliom (C6-Gliom) wurden MR-tomographisch und mikroskopisch untersucht. 14 Tiere hiervon wurden nach intravenoser (i.v.) Gabe der MION untersucht [9 Tiere erhielten 179 μmol Fe/kg Korpergewicht (=Dosierung 1), 5 Tiere 893 μmol Fe/kg (=Dosierung 2)]. 14 Tiere wurden zuerst nach i.v. Gabe von Gd-DTPA (0,2 mmol/kg) und anschliesend nach i.v. Gabe der MION untersucht. MR-tomographische und mikroskopische Tumorausdehnungen wurden verglichen. Ergebnisse: Eisenpartikel konnten mikroskopisch in Tumorzellen und im Tumorinterstitium nachgewiesen werden. Nach Gabe der MION in Dosierung 1 war die Ausdehnung des KM-anreichernden Areals in der MRT im Durchschnitt 1,55fach groser als der in der Histologie erkennbare Tumor, bei Dosierung 2 sogar 2,15fach. Im Vergleich mit Gd-DTPA war die KM-anreichernde Flache nach Gabe der MION in Dosierung 1 um den Faktor 1,38 groser, in Dosierung 2 um den Faktor 1,91. Schlusfolgerungen: MION fuhren zu einer intra- und extrazellularen KM-Anreicherung. Die Ausdehnung des KM-anreichernden Areals ist dosisabhangig ausgedehnter als die KM-Anreicherung nach Gd-DTPA Gabe und auch ausgedehnter als die morphologisch nachweisbaren Tumorgrenzen.

Fragestellung: Beeinflussen Form und Grose des praoperativen peritumoralen Hirnodems die Rezidiventwicklung bei malignen supratentoriellen Gliomen? Methodik: Prospektiv wurden 79 Patienten mit einem malignen supratentoriellen Gliom mit einem standardisierten MRT-Protokoll untersucht. MRT-Untersuchungen erfolgten vor der neurochirurgischen Operation, moglichst innerhalb der ersten 3 Tage nach Operation und wahrend der Nachbeobachtungszeit in Abstanden von 2–3 Monaten. Die mediane Nachbeobachtungszeit betrug 11 Monate. Die initiale praoperative Odemkonfiguration auf den T2-gewichteten MRT-Aufnahmen wurde mit der Rezidivtumorkonfiguration auf den Kontrastmittel verstarkten T1-gewichteten Aufnahmen verglichen. Ergebnisse: 47 Patienten entwickelten wahrend der Nachbeobachtungszeit ein Rezidiv. Die Konfiguration des Rezidivtumors imitierte in 35/47 Patienten (75%) die initiale praoperative Odemkonfiguration. Bei 11/47 Patienten entwickelte sich ein lokales und bei einem Patienten ein multilokales Rezidiv. Schlusfolgerungen: Die praoperative Tumorodemkonfiguration im T2-gewichteten MRT-Bild korreliert mit der Rezidivtumorausdehnung. Zukunftige Therapiestudien sollten daher die Ausdehnung des initalen praoperativen Odems als zusatzlichen prognostischen Faktor mitberucksichigen.

AIM Serial observations of acute ischaemic cerebral infarcts by MRI in order to define signal patterns, contrast uptake, oedema and secondary haemorrhage over a period of three months. METHODS Prospective serial examinations of 34 patients with acute cerebral ischaemia who were examined during the first 48 hours, on days 3 or 4, 7, 14, 21, 28 and after three months by MRI (spin echo TR/TE 2200/100/20, 500/20, +/- Gd). RESULTS T2 weighted spin echo sequences showed the highest sensitivity (88%) during the first 8 hours of cerebral ischaemia when compared with other spin echo sequences. Parenchymal contrast enhancement showed a distinct peak during the second and third weeks. The use of contrast did not improve diagnosis of an infarct during any stage. 87% of lesions showed haemorrhage at some stage. Vascular enhancement was observed in 25% of infarcts during the first 24 hours and was still present after three months in 20%. Parenchymal and vascular enhancement, and haemorrhage correlate with the size of the infarct. CONCLUSION Focal cerebral ischaemia produces an abnormality of the blood-brain barrier, oedema and finally necrosis, depending on the severity and duration of the lesion. Haemorrhage in 87% was considerably more common than has been described previously. Vascular enhancement is not an early sign of an infarct, contrary to what has been described in the literature.

Background Isolated unilateral corneal anaesthesia represents a very rare clinical entity. The underlying cause may be a hypoplasia of the trigeminal nerve. History and clinical findings A 7 year old otherwise healthy boy presented with mixed conjunctival injection of the left eye, fluorescein-positive punctuate epithelial keratopathy of the cornea and a central corneal ulcer OS. History revealed intermittent, painless redness of the left eye since the age of 4. Trigeminal defects caused by trauma or infection could be ruled out. Tyndall's phenomena was positive. There was no corneal sensitivity on the left side and facial sensitivity was reduced in all branches of the trigeminal nerve. All other ophthalmologic examination results were normal. Magnetic resonance tomography showed a hypoplastic left trigeminal nerve. Mesenchymal syndromes could be ruled out by neuropediatric examination. Therapy and clinical course Treatment with prednisolone and antibiotic ointment and eye patching were performed. The ulcer healed completely and artificial tear substitution was given for prophylaxis. Follow-up examinations after 4 and 6 years showed no signs of inflammation. Biomicroscopy showed only mild fluorescein-positive corneal epitheliopathy. Conclusions In cases with painless intermittent keratoconjunctivitis, sometimes associated with corneal ulceration, in early childhood, one should consider acquired or congenital trigeminal anaesthesia. This condition requires life-long corneal ulcer prophylaxis and regular ophthalmologic exams.

A 1-year-old girl presented with symptoms of nausea and vomiting, torticollis and paralysis of abducens and facial nerve. MR examination showed on Tl-weighted images a slightly hypointense mass lesion in the right cerebellar hemisphere and a moderately high signal on T2-weighted images, with parallel linear striations on the surface of the lesion. Administration of Gd-DTPA revealed an inhomogeneous, but marked enhancement of the lesion, suggesting the diagnosis of a posterior fossa neoplasm. A subtotal resection was performed. Histologic examination resulted in the diagnosis of Lhermitte-Duclos disease (LDD) (dysplastic gangliocytoma of the cerebellum). Short-term postoperative follow-up MRI showed slight but steady progression of the lesion. Review of literature revealed that this is a unique case of histologically proven LDD in a child showing contrast enhancement after administration of Gd-DTPA and lesion progression within a short postoperative interval.

Ziel der vorliegenden Studie war es, den Stellenwert der CT-Angiographie (CTA) bei der Diagnose von Dissektionen der A. carotis interna (ACI) zu ermitteln. Die Befunde der CTA wurden mit Ergebnissen der digitalen Subtraktionsangiographie (DSA) und der cw-Dopplersonographie (cw-DS) verglichen. Wir untersuchten 21 Patienten mit klinischem oder dopplersonographischem Verdacht auf eine ACI-Dissektion. Bei akuter extrakranieller ACI-Dissektion war die Sensitivitat der CTA 100 % (14/14). Eine intrakranielle ACI-Dissektion wurde durch die CTA nicht erfast, da sie auserhalb des Scanbereichs lag. Die in der cw-DS unspezifischen pathologischen Befunde konnten mit der CTA geklart werden. Haufigster Befund in der CTA war eine exzentrische Lumeneinengung und Wandverdickung sowie eine spitzauslaufende Verschmachtigung (sog. tapering) in der dreidimensionalen (3D-) Rekonstruktion. Die CTA ist bei akuter extrakranieller Karotisdissektion eine verlasliche und wenig invasive Untersuchungsmethode. Vergleichende Studien mit CTA, Duplexsonographie und Magnetresonanztomographie (MRT) sollten noch durchgefuhrt werden.

PURPOSE: Radiation protection is a major issue since the implementation of MSCT technology and its widespread indication for the detection of various diseases. In a European-wide trial (SECT) meta-analyses of imaging alternatives to CT have been initiated. This paper focuses on the diagnostic performance of transthoracic ultrasound (TUS) for the diagnosis of pulmonary embolism (PE) (5 studies, 652 patients). MATERIALS AND METHODS: Medical literature (from 1990 to 2006) in PubMed and EMBASE databases was searched for articles on studies that used TUS as diagnostic tests for PE. Studies were included if they reported the positive and negative rates of PE diagnoses from TUS compared with the rates of PE in CT, MRI or a combination of diagnostic tests. Two readers assessed the quality of the studies. RESULTS: Pooled sensitivity and specificity of TUS for PE were 80 % (95 % CI: 75 %, 83 %) and 93 % (95 % CI: 89 %, 96 %), respectively. CONCLUSION: In the time of MSCT, TUS is an imaging modality that is no longer part of recent diagnostic algorithms for the diagnosis of PE. Considering the increasing number of requested CT examinations and therefore increasing collective radiation dose, this meta-analysis shows that TUS is a diagnostic alternative for special clinical settings in the work-up of suspected PE that seems to have fallen into oblivion.

To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities. Neurosurgical Department, University of Essen, Germany. Between 1990 and 2000, a consecutive series of 78 patients were referred to our institution and underwent surgical treatment. There were 46 (59%) male and 32 (41%) female patients. Mean age was 43.3 years. Functional outcome was analyzed depending on histological features, age, tumor localization and the extension of involved spinal segments. The mean follow-up period was 34.4 months. Operative removal of the IMSCT was performed under standard microsurgical conditions with intraoperative monitoring of somatosensory-evoked potentials (SSEP). The most frequently involved localization was the cervical and cervicothoracic region (55%) followed by the thoracic region (32%) and the medullar conus (13%). The most frequent IMSCTs were neuroepithelial tumors in 44 patients (56.5%) including 32 patients with ependymomas, 15 astrocytomas, and two lesions without further histological classification. Non-neuroepithelial tumors included 10 metastases, nine cavernomas, eight hemangioblastomas, one dermoidal cyst and one enterogenetic cyst. Complete tumor removal was achieved in 65 cases (83.3%) and subtotal resection in nine cases. In four cases a biopsy was performed only. The overall postoperative neurological state was improved or unchanged in 51 patients (65.4%) and worsened in 27 patients (34.6%). A favorable functional outcome was observed in 94.1% of patients with vascular tumors, in 61.3% of patients with low-grade neuroepithelial tumors and in 53.3% of patients with malignant tumors. The strongest predicting factor of functional outcome was the preoperative neurological condition beyond the histological differentiation of the IMSCT. Although there was no outcome difference with respect to the age and tumor extension, thoracically located IMSCTs proved to harbor an increased risk of postoperative surgical morbidity.

Increased sarcolemmal permeability has been implicated as a major pathological event in muscular dystrophies. In our study, we evaluated whether damaged muscle fibres can be specifically targeted using albumin as a carrier. We tagged human serum albumin (HSA) with Gadolinium (Gd) and systemically applied this compound (Gd-DTPA-HSA) to wildtype and dystrophin-deficient mdx mice. We performed magnetic resonance imaging before and after intravenous administration of Gd-DTPA-HSA and found localised signal enhancement only in mdx skeletal muscle. We also examined skeletal muscle after contrast enhanced magnetic resonance imaging using anti-human albumin antibodies and demonstrated intracellular accumulation of Gd-DTPA-HSA in clusters of damaged mdx muscle fibres. Comparison of magnetic resonance imaging and histological data emphasised the value of contrast agent enhanced magnetic resonance imaging for the in vivo assessment of fibre damage in muscular dystrophies. Furthermore, our data provide evidence that albumin can be used as a carrier to target covalently bound molecules to degenerating muscle fibres.

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3–7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.

A 56-year-old woman was admitted to the hospital because of progressive paresis of the left arm. Clinical examination revealed upper brachial plexus palsy and complete anesthesia and analgesia in segments C5–7. MRI demonstrated diffuse tumorous infiltration of the left brachial plexus with centrifugal growth from the dorsal spinal root of segment C6. Biopsy of the lesion revealed a malignant …

Malignant tumors often show an increased uptake and metabolism of plasma proteins, especially albumin.Determine whether the accumulation of low loaded Gd-albumin improves visualization of malignant tumors by MRI.Twelve nude mice with heterotransplanted squamous cell carcinomas were studied. The signal intensity of tumor, blood, liver, kidney and muscle tissue was studied in MR images after application of Gd-albumin during a period of 144 hours. MRI results were histologically correlated after simultaneously injection of Gd- and fluorescein-labeled albumins in 9 nude mice.Although liver and kidney had a maximum increase in signal intensity within 30 minutes, tumors showed a delayed 51% increase in the 24 hours after application. Histologic and fluorescence evaluation demonstrated albumin localization in tumors predominantly in stroma and necroses.Gd-albumin is efficiently accumulated in SCC transplants. MRI with low loaded Gd-albumin may offer relevant opportunities for recognizing tumors sensitive to a therapy with cyostic drug-labeled albumins.

Introduction Magnet resonance imaging (MRI) is the gold-standard of non-invasive diagnostics in OCL of the talus. Single photon emission computed tomography – computed tomography (SPECT-CT) shows additional, high-resolutioned information of osteoblastic (szintigraphic) activity and bony morphology. The study aimed for evaluating the influence of the SPECT-CT on clinical application of the imaging information and decision-making in OCL therapy. Methods MRI and SPECT-CT of 26 patients (average age: 32 y) were analyzed separately by 3 blinded, independent orthopaedic foot and ankle surgeons experienced in treating OCL and working with MRI and SPECT-CT for treatment decision-making. Imaging information was analyzed by using a specified questionnaire. Results By the SPECT-CT, a change in treatment was documented in 46 of 78 decisions (59%) in comparison to the MRI. Following treatment decisions were chosen most often (total decisions: 156): Retrograde drilling: 64 (41.0%); microfracture and antegrade drilling: 28 (17.9%); osteochondral autologous transplantation (mosaicplasty): 23 (14.8%); excision and debridement: 16 (10.3%); physiotherapy: 9 (5.8%); autologous chondrocyte implantation: 5 (3.2%); joint-sacrificing therapy (e.g. joint replacement): 5 (3.2%); cancellous bone grafting: 4 (2.6%); passive conservative therapy (e.g. cast): 1 (0.6%); drug therapy (e.g. hyaluronic acid): 1 (0.6%); refixation: 0 (0%). However, overall distribution of therapies remained unchanged between MRI and SPECT-CT. The questionnaire revealed main differences in imaging interpretation for: subchondral bone plate morphology (17; 65%), subchondral sclerosis (16; 62%), subchondral cysts (11; 42%), and kissing lesions (10; 38%). The area of szintigraphic activity in comparison to bone bruise was found to be smaller in 50% of cases (13) and bigger in 27% (7 cases). Discussion The additional information provided by the SPECT-CT influences the decision-making for the treatment of OCL in the talus significantly. This is due to changed interpretation of subchondral bone plate morphology and subchondral bone activity. No study reported on SPECT-CT in OCL yet. SPECT-CT may become important in diagnostics and treatment decision-making in OCL of the talus.