Search

Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases. We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt.

This paper gives an overview of experience and success of percutaneous transhepatic interventions in malignant biliary obstruction. Even after exhaustion of surgical and endoscopic therapy options, the percutaneously inserted stents provide effective palliation. The palliative treatment of malignant jaundice using a stent is an established procedure in clinical practice, particularly whenever the endoscopic, transpapillary approach is not possible due to high obstructions or previous surgery. The technical success rate is very high (about 95-100%), and the complication rate is about 10-30%. Since the patency rate of stents is higher than that of plastic endoprostheses, their primary use is justified despite higher costs, provided the patients are adequately selected.

In diesem Beitrag wird ein neues Verfahren vorgestellt, das eine navigierte Positionierung von RF-Sonden fur die perkutane CT- gesteuerte Radiofrequenz-Ablationstherapie (RFA) von Lebertumoren ermoglichen soll. Der Vorteil dieses Navigationsverfahrens ist das Potential zur Vermeidung von Rezidiven durch das Verschleppen von Tumorzellen beim Einbringen der RF- Sonde. Ein weiterer Vorteil dieses Verfahrens ergibt sich aus der verminderten Strahlenexposition durch Minimierung der erforderlichen CT-Aufnahmen.

Cross-sectional imaging based on navigation and virtual reality planning tools are well-established in the surgical routine in orthopedic surgery and neurosurgery. In various procedures, they have achieved a significant clinical relevance and efficacy and have enhanced the discipline's resection capabilities. In abdominal surgery, however, these tools have gained little attraction so far. Even with the advantage of fast and high resolution cross-sectional liver and pancreas imaging, it remains unclear whether 3D planning and interactive planning tools might increase precision and safety of liver and pancreas surgery. The inability to simply transfer the methodology from orthopedic or neurosurgery is mainly a result of intraoperative organ movements and shifting and corresponding technical difficulties in the on-line applicability of presurgical cross sectional imaging data. For the interactive planning of liver surgery, three systems partly exist in daily routine: HepaVision2 (MeVis GmbH, Bremen), LiverLive (Navidez Ltd, Slovenia) and OrgaNicer (German Cancer Research Center, Heidelberg). All these systems have realized a half- or full-automatic liver-segmentation procedure to visualize liver segments, vessel trees, resected volumes or critical residual organ volumes, either for preoperative planning or intraoperative visualization. Acquisition of data is mainly based on computed tomography. Three-dimensional navigation for intraoperative surgical guidance with ultrasound is part of the clinical testing. There are only few reports about the transfer of the visualization of the pancreas, probably caused by the difficulties with the segmentation routine due to inflammation or organ-exceeding tumor growth. With this paper, we like to evaluate and demonstrate the present status of software planning tools and pathways for future pre- and intraoperative resection planning in liver and pancreas surgery.

The increasing demand for high temperature circuits for applications in automotive, aerospace and oil/geothermal drilling industries over the last few years has created a demand for high temperature memory circuits. Silicon-on- insulator technologies, though well suited for the design of high temperature applications, prove to be problematic for the design of EEPROM circuits. SOI specific leakage currents lead to data loss at high temperatures. To successfully design high temperature EEPROM, new memory cell structures have to be developed.

To evaluate safety and mid term efficacy (or = 1 year follow-up) of uterine fibroid embolization (UFE) using spherical particles (Embosphere) in a study applying criteria identical to those submitted to the FDA for initial material approval.Twenty of the first 26 consecutive patients referred for potential UFE were enrolled in the study. Pre-interventional MRI was used to assess morphologic contraindication to UFE. The embolization procedures were performed from a unilateral femoral approach using 4F selective catheters in straight vessels,2 mm in diameter, and micro-catheters in smaller and tortuous arteries. The endpoint of the "flow guided" embolization was defined by reaching the angiographic "pruned tree" appearance and sluggish flow in the main stem of the uterine artery. Assessment of morphologic mid term success was done by MRI 10 days, 3 months, 6 months, 9 months and 1 year after UFE. The clinical mid term success was assessed by having questionnaires completed for menstrual bleeding, retention of clinical (symptomatic) benefit and quality of life.Technical success was 100 %, with 8 minor (2 post-interventional collapses, 2 hematomas, 4 relevant post-embolizations syndromes, 1 spontaneous expulsion of a submucous myoma) and 3 major complications (1 hysterectomy because of vaginal bleeding for 5 weeks, 1 transient amenorrhea and 1 spontaneous expulsion of myoma with transient bleeding requiring admission). In 17 of 19 patients, MRI showed total fibroid devascularization throughout the entire follow-up. The average shrinkage of the dominant fibroid was 71.3 % at one year. The menstrual bleeding record in the cohort group fell from an average of 501.6 before treatment to 76.2 points at one year. At the same time, the clinical symptoms significantly improved. The patient satisfaction with the applied therapy was95 % at 1 year. One patient with residual fibroid perfusion underwent a second procedure, which achieved complete devascularization and adequate clinical success at one year. The second patient with incomplete devascularization had a persistent clinical benefit.Under controlled study conditions, flow guided UFE with spherical particles achieves high overall success and patient satisfaction. MRI provides exact morphologic description of the fibroid for the initial evaluation and for post-procedural follow-up.

To evaluate multislice-CT versus MRI in the diagnosis and staging of pancreatic carcinoma in a prospective multi-reader analysis.Fifty patients with suspected pancreatic carcinoma underwent both multislice-CT (4-Row, "hydro-technique") and state-of-the-art MRI (two 1.5 T units). In correlation with histopathologic findings or in case of a non-lesion diagnosis by follow-up (6-month interval), we evaluated MRI versus CT in a multi-reader analysis (2 reader pairs) for: 1. diagnostic quality; 2. examination time; 3. accuracy of potential resectability; 4. kappa analysis of observer variations; and 5. overall diagnostic reliability.A total of 28 lesions (n = 22 malignant, n = 6 benign) were present in the cohort group versus 22 patients without a focal lesion (n = 10 pancreatitis, n = 12 no tumor). For lesion detection, CT had a sensitivity of 100/89 % (reader pair 1/2) and specificity of 77 %, and MRI had a sensitivity of 75/89 % and specificity of 77/73 %. For the subgroup of adenocarcinomas of the pancreas (n = 17), we found a sensitivity of 100 % and a specificity of 61 % for CT versus a sensitivity of 82/94 % and a specificity of 67/61 % for MRI. The accuracy for determining the resectability was 91/82 % for CT and 90/82 % for MRI. The kappa analysis showed a good correlation for CT (0.71) and a moderate correlation of both groups for MRI (0.49).CT and MRI showed comparable results in the detection of pancreatic carcinomas as well as in the determination of resectability. Chronic pancreatitis as a "tumor-like-lesion" was the major factor of a missed diagnosis. The results of multi-reader analysis for both reading groups were almost identical with a moderate to good kappa correlation. There is no reason to prefer MRI (more expensive) over CT for patients with the presumptive diagnosis of pancreatic cancer.

To evaluate whether stent placement is superior to percutaneous transluminal angioplasty (PTA) in the treatment of chronic symptoms in short femoropopliteal arterial stenoses.One hundred twenty-four limbs in 116 patients, who ranged in age from 39 to 87 years (mean age, 67 years), were randomized to PTA (n = 53) versus PTA followed by implantation of long-medium Palmaz-Stents (n = 71). Inclusion criteria were intermittent claudication or chronic critical limb ischemia, short stenosis or occlusion (lesion lengthor = 5 cm), and at least one patent run-off vessel at angiography. The follow-up included clinical assessment, measurement of ankle/brachial index (ABI), color duplex ultrasound, and/or angiography at 6, 12 and 24 months. Angiographic follow-up between 12 and 36 months was available in 54 limbs (45 %).Initial technical success was achieved in 50 of 53 limbs (94.4 %) in the PTA group versus 70 of 71 limbs (98.6 %) in the stent group. Overall, major complications occurred in 9.5 % (n = 11), with n = 4 in the PTA group compared to n = 7 in the stent group. No difference was found between the groups of treatment: clinical success at 1 and 2 years was 80.5 and 77.1 % in the PTA group versus 78.1 and 71.0 % in the stent group. The cumulative 1-year and 2-year angiographic primary patency rates were 66.1 and 49.1 % in the stent group versus 76.1 and 66.1 % in the PTA group. The secondary 1-year and 2-year angiographic patency rates were 88.5 and 53.3 % in the stent group versus 82.7 % and 76.2 % in the PTA group.The primary success rate was slightly higher after stent placement than after PTA. However, the angiographic, clinical and hemodynamic success after 1 and 2 years tends to be slightly better for PTA.

Our goal was to evaluate risks and complication rate of uterine fibroid embolization (UFE).The most frequent complications reported in the literature are associated with angiography procedure, serious complications are extremely infrequent.The embolization of fibroids is a safe angiographic intervention. Nevertheless, the interventional radiologist must be aware of the common risks and complication and the strategies to avoid them.

In acute diverticulitis accurate diagnosis and staging are mandatory to decide on the treatment of the patient. The impact of computed tomography (CT) on the treatment of acute diverticulitis will be discussed.CT is performed after distension of the distal colon by means of positive,water-soluble contrast media to depict intestinal perforation or penetration. Then intravenous contrast material is administered and spiral scanning is repeated to judge enhancement patterns of the abdominal structures/organs especially of the intestinal wall and to diagnose abscess formation. CT-morphologies of different stages of acute diverticulitis will be described.CT imaging is the only diagnostic method that in case of an acute diverticulitis combines safety with accuracy. On the one hand, it is fast and therefore safe with respect to patient control and on the other hand, it allows accurate staging of the inflammatory process reaching a sensitivity and specificity of up to 100%, each. CT is an appropriate tool to diagnose acute diverticulitis complicated by abscess formation, intestinal penetration or perforation and therefore has direct impact on the treatment of the patient.If acute diverticulitis is suspected CT is the method of choice for imaging because of its high impact on the choice of therapy and on the management of complications.

We present recent results from spectroscopic data and modeling of the biconical ionized gas in the Seyfert-2 galaxy NGC 4388. A field of ~2.6 x 2.4 kpc centered on the nucleus has been observed by means of the modern technique of integral field spectroscopy. The analysis of more than two hundred spectra allowed to study the physical characteristics of the gas in the surroundings of the active nucleus. The South-West ionization cone, revealed by the [O III]5007/H-beta excitation map, shows high emission line ratios not completely supported by simple photoionization. Composite models which account for the combined effects of photoionization and shock show that such high [O III]/H-beta line ratios are emitted by low density (n_0=30 cm^-3) gas inside large (D > 1 pc) shocked clouds (V_s=100 km/s) reached by a relatively low flux from the active nucleus. The data of the VEELR in the North-East cone by Yoshida et al. (2002) have been modeled. The results confirm that photoionization is the prevailing mechanism, but nontheless weak shocks are under way between colliding clouds with small (< 1 pc) sizes and low densities n_0, Accepted for publication in Astronomy & Astrophysics

We present an analysis of the multiwavelength behaviour of the blazar OJ 248 at z = 0.939 in the period 2006-2013. We use low-energy data (optical, near-infrared, and radio) obtained by 21 observatories participating in the GLAST-AGILE Support Program (GASP) of the Whole Earth Blazar Telescope (WEBT), as well as data from the Swift (optical-UV and X-rays) and Fermi (gamma-rays) satellites, to study flux and spectral variability and correlations among emissions in different bands. We take into account the effect of absorption by the Damped Lyman Alpha intervening system at z = 0.525. Two major outbursts were observed in 2006-2007 and in 2012-2013 at optical and near-IR wavelengths, while in the high-frequency radio light curves prominent radio outbursts are visible peaking at the end of 2010 and beginning of 2013, revealing a complex radio-optical correlation. Cross-correlation analysis suggests a delay of the optical variations after the gamma-ray ones of about a month, which is a peculiar behaviour in blazars. We also analyse optical polarimetric and spectroscopic data. The average polarization percentage P is less than 3 per cent, but it reaches about 19 per cent during the early stage of the 2012-2013 outburst. A vague correlation of P with brightness is observed. There is no preferred electric vector polarisation angle and during the outburst the linear polarization vector shows wide rotations in both directions, suggesting a complex behaviour or structure of the jet and possible turbulence. The analysis of 140 optical spectra acquired at the Steward Observatory reveals a strong Mg II broad emission line with an essentially stable flux of 6.2 e-15 erg cm-2 s-1 and a full width at half-maximum of 2053 km s-1., Comment: 16 pages, 20 figures, 2 tables, in press for MNRAS

Therapeutic strategy and prognosis of malignant lymphoma are influenced by staging. Therefore, evaluation of pattern of lymphatic involvement is highly relevant. There are numerous pitfalls possible in detection and description when malignant lymphomas are visualized by computed tomography (CT). Normal anatomic structures may be interpreted as pathologic lymph nodes by inexperienced radiologists. Assessment and detection of lymphomas require precise knowledge of normal anatomic structures as well as roentgenological criteria and adequate methods of imaging. This report provides an overview of the relevant pitfalls and often overlooked areas in staging of malignant lymphomas.

Management of diagnosing malignant lymphomas has changed with development of CT-guided techniques and reliable biopsy tools. Pathologists can use representative tissue samples for sub classification in more than 90%. Evaluation of residual lymphoma or relapse can be nearly as effective. Therefore percutaneous biopsy can be considered as primary diagnostic tool in the absence of peripheral lymphadenopathy. CT-guided biopsies can be performed on an outpatient basis under conscious sedation considering contraindications as well as regional complications. Acceptance of percutaneous biopsy by the pathologist and oncologist is based on diagnostic effectiveness that is significantly improved if more than 3 dagger solid tissue samples are taken. This article reviews the value of CT-guided biopsy in comparison to surgical procedures in patients with malignant lymphoma. Essential aspects that lead to a diagnostic percutaneous biopsy are discussed on grounds of the current literature.

Detailed modeling of the different regions of NGC 7130 is presented, accounting for its composite nature of an active galactic nucleus (AGN) and a starburst galaxy. Shock waves, created by stellar winds from hot massive stars and by supernova ejecta, are evident in the continuum and line spectra emitted from the clouds. Therefore, the SUMA code, which accounts consistently for photoionization and shocks, is adopted in model calculation. The results show that the nuclear region is dominated by gas ionized by a power-law radiation flux from the active center (AC). High-velocity (Vs = 1000 km s-1) clouds, which account for the broad FWHM component of the line profile, are found close to the AC and are characterized by a high dust-to-gas ratio (>10-12, while the dust-to-gas ratio is about 10-14 throughout the galaxy). Massive stars with temperatures of (5-7) × 104 K photoionize and heat the gas in the outer regions, and old star population (T* = 3000 K) background radiation contributes to the fit of the continuum in the optical-near-IR range. The AGN-starburst connection is discussed on the basis of model results, considering, particularly, the distribution of densities and velocities throughout the galaxy.

Neben dem etablierten Stenosegrad als Pradiktor des Apoplexrisikos scheint auch das Plaqueverhalten, d.h. die vaskulare Biologie des Carotisplaque, eine entscheidende Rolle in der Pathogenese des Schlaganfalles zu spielen: die zugrunde liegenden Pathomechanismen der Destabilisierung eines Carotisplaque sind noch nahezu unbekannt. Ziel der vorliegenden Untersuchung war die Analyse der vaskularen Biologie, die den Unterschieden in der Plaquestabilitat zugrunde liegt und ein Vergleich mit der praoperativen Plaquemor-phologie durch ein EKG-getriggertes hochauflosendes Spiral-CT. Ein tieferes Verstandnis dieser Vorgange der Plaque Destabilisierung konnte Behandlungsstrategien und Patientenselektion beeinflussen, um bislang asymptomatische Patienten mit einem besonders hohen Schlaganfallrisiko zu identifizieren. Material und Methoden: Die prospektive Studie umfast 50 chirurgische Patienten mit hamodynamisch signifikanten Carotisstenosen (> 70% Stenose im Bulbus und/oder proximalen ACI), wo die Operationsindikation bestand zur Endarterektomie aufgrund der hochgradigen extracraniellen ACI Stenose. Die praoperative Bildgebung erfogte mit einem standardisierten Protokoll. Ergebnis: Die Auswertung der Daten ist z.Z. im Gange und wird Ende Januar 2002 beendet sein.

Variability is one of the most observable characteristics of active galactic nuclei, and it is important when considering the emission mechanism. In this paper, we report optical photometry monitoring of two nearby brightest quasars, PHL 1811 and 3C 273, using the ST-6 camera attached to the Newtonian focus and the Ap6E CCD camera attached to the primary focus of the 70 cm meniscus telescope at the Abastumani Observatory, Georgia. PHL 1811 was monitored during the period from 2002 September to 2012 December, while 3C 273 was monitored during the period from 1998 February to 2008 May. During our monitoring period, the two sources did not show any significant intra-day variability. The largest detected variations are ΔR = 0.112 ± 0.010 mag. for PHL 1811, ΔB = 0.595 ± 0.099 mag, ΔV = 0.369 ± 0.028 mag, ΔR = 0.495 ± 0.076 mag, and ΔI = 0.355 ± 0.009 mag for 3C 273. When the periodicity analysis methods are adopted for the observations of the sources, a period of p = 5.80 ± 1.12 yr is obtained for PHL 1811 in the R light curve in the present work, and periods of p = 21.10 ± 0.14, 10.00 ± 0.14, 7.30more » ± 0.09, 13.20 ± 0.09, 2.10 ± 0.06, and 0.68 ± 0.05 yr are obtained for 3C 273 based on the data in the present work combined with historical works.« less

The transjugular intrahepatic stent-shunt (TIPSS) is a well accepted minimal invasive therapy for complications of portal hypertension: recurrent variceal bleeding, refractory ascites and liver failure due to the Budd-Chiari syndrome. The high frequency of shunt stenoses and occlusions makes regular follow up examinations essential. Despite modern non invasive imaging methods direct portography still is the gold standard for shunt surveillance in TIPSS. Ultrasound is helpful to detect shunt dysfunction, but nevertheless its failure rate is considerable despite the use of contrast enhancers such as Levovist because of anatomic and physical limitations, particularly when TIPSS-tracts deep in the liver are present. Reintervention rates approach 90-100% after 24 months, with 100% in child's A patients with comparatively good liver function. However, a strict shunt surveillance program with early portography and reintervention when necessary guarantees high clinical success rates associated with very low rebleeding rates below 10%. Overall the secondary success rate is 80%. Secondary failures are mainly caused by lack of patient compliance during follow-up. In a subgroup of patients no shunt maturation is observed, requiring multiple shunt revisions. In cases of recurrent shunt occlusions an association with bile leaks is presumed. In selected cases patients with chronically recurrent shunt stenosis or occlusions may benefit from placement of TIPSS stent grafts.

To demonstrate the Heidelberg results of the previous 2 years in patients referred for acute aortic dissection.93 patients referred for acute aortic dissection were treated by cardiac surgery, vascular surgery and interventional radiology according to a novel therapeutic algorithm including stent-grafts and combined open and interventional procedures and conservative medical therapy when no malperfusion syndrome was present or patients were considered prohibitive for even minor surgical procedures. Stent-graft placements were done assisted by short term cardiac arrest to facilitate correct device deployment.36 patients presented with type A and the other 57 with type B dissection. 32 of the A patients were operated and 20 of the B patients, respectively. 12 patients with B dissection were treated with stent-grafts. 3 required additional interventional therapy for organ malperfusion. The mortality was 0% in these 12 patients The overall mortality rate in the A group was close to 40% mainly as a result of postoperative organ malperfusion while it was 15% in the B group. In both groups mortality was highest in the respective untreated patient subgroup (3/4 and 8/37, respectively). The main mortality factor was visceral (mesenteric or liver) ischemia. Paraplegic complications occured in neither group. In 4 patients a combined approach applying cardiac surgery of the ascending aorta and endluminal stent-graft placement for the residual B dissection was successfully performed. In one patient this was done simultaneously.Acute aortic dissection of type A with or without valve involvement, coronary artery ischemia can be treated with high technical success rates. However, remaining distal aortic dissection associated with true lumen collapse and organ malperfusion is the main causative factor for clinical failures. Successful combination of open proximal aortic surgery with endoluminal treatment of residual B dissection encourages further use of this novel approach. Acute B type dissection appears to be effectively and safely treated by endoluminal approach in selected cases. Unsolved questions of this less invasive therapeutic approach focus mainly on the design of the proximal anchoring part of the devices.

To identify essential and relevant diagnostic algorithms in the follow-up of stent-grafts placed for aortic dissections and aneurysms based on our 7 years experience including the use of more than 10 different devices.Evaluation of conventional biplane imaging, angiography, sonography, CT and MR in the efficacy of demonstrating endoleaks, sac shrinkage, changes of stent-graft integrity and, with special reference to MR-compatibility of various stent-graft devices.Endoleaks are found in 20-30% of patients after endovascular exclusion of abdominal aortic aneurysms. However, this rate neither necessarily reflects the clinical course nor the onset and course of sac shrinkage. Physical long-term integrity of the devices is seen best on conventional bi-plane radiographs. Sonography is helpful only in selected patients (non-obese, good compliance) otherwise not providing information precisely enough for sac control. As gold standard both CT (CTA) and MR (MRA) are equally effective in the follow-up of endovascular stent-grafts, allowing 3D control of sac geometry in aneurysmal disease or hemodynamic changes in stent-grafts for aortic dissection. MRI is considered to be more effective in the detection of small endoleaks. Angiography is inferior to CT and MRI in the diagnosis of endoleaks and thus is required only for intervention planning in patients with suspected endoleaks. Two of 8 evaluated stent-graft devices proved to be prohibitive for MRI because of their severe artifacts productions (Life-path, Zenith) as a result of their thick metallic meshwork.CT including CTA with 2D and 3D reformatting is the method of choice for the follow up of stent-graft treatment of aortic disease. Depending on availability, MRI may be used alternatively. In young patients and for those with contraindications to iodinated contrast media MRI is a perfectly equivalent alternative. Especially in patients with known contraindications to iodinated contrast media the MR-compatibility should be taken into consideration in the choice of the endovascular device.

The non-invasive imaging modalities, color coded duplex sonography (CCDS), magnetic resonance tomography (MRT), and computed tomography (CT), have pushed conventional angiography out of most diagnostic fields. The experienced user will achieve fast, reliable answers with CCDS in dedicated clinical settings. MRT as well as CT are concurring imaging modalities for the most appropriate diagnostic answer. Not only pure image quality, but also patient management, and availability play a major role. Catheter based angiography will in the future still play a role in mesenteric ischemia (non occlusive disease) and for imaging of very small vessel pathology, e.g. on panarteritis nodosa. At the moment, peripheral leg run-offs are still best performed with conventional angiography, nevertheless, MR as well as CT seem to have the ability to perform diagnostic procedures. Ongoing studies will allow a solid judgement in the near future. The true value of catheter angiography is in the direct assessment, planning, and performance of interventional procedures, e.g. catheter based obliteration or revascularization. Implantation of stent devices and a whole range of different mechanical and pharmacological revascularization procedures have improved the interventional management of vascular stenoses and occlusions. The interventional radiologist is treating physician in the classical sense in this setting. Acute bleeding episodes, e.g. in the brain, thorax, abdomen, or pelvis, are best imaged with computed tomography. Conventional angiography still plays a major diagnostic and therapeutic role in bleeding into preformed cavities, such as the bile ducts or the intestine. In this setting, all available information including CT scans should be valued. For complex therapeutic regimens in oncology or in pure palliative situations, angiographic diagnosis followed by embolization and/or ablation therapy is established.

Development of an optimized Spiral CT protocol type for the diagnosis of aortic dissections.121 consecutive CT examinations applying 5 different protocol types were blindly read by two experienced radiologists and then compared with: (a) 45 biplane transesophageal echocardiographies (TEE), (b) 52 transthoracic echocardiographies (TTE), (c) 52 operative findings and, furthermore, related to the clinical course over at least six months in 79 patients.The sensitivity of the spiral computed tomography for detection of dissection was 97% (biplane TEE: 88%), the specificity 100% (biplane TEE: 91%). In 15% dissections with atypical origin and entries (mid-portion of the aortic arch, distal thoracic aorta, etc.) were found. The optimal CT-protocol was the one with a combination of two separate but adjacent spiral scans achieving high spatial resolution for the aortic arch and enough spatial resection for the residual aorta (1. helical scan 3 mm collimation, pitch 2. 2. helical scan 5 mm collimation and pitch 2, 130 ml contrast medium at 5 ml/s) with a classification accuracy of 100%, visualization of entries of 100%, reentries of 100% (40% direct, 60% indirect). The identification of the ostia of the aortic branches were: supraaortic 93%, visceral 100%, left renal artery 100%, right renal artery 93%, iliac 64%. The CT angiography, designed as aortic arch angiography, showed a good contrast in the aortic arch vessels (79-86%) and the visceral vessels too (91%).Thoracic CT angiography can be used as gold standard in the primary evaluation of aortic dissections.

Of the blazars detected by EGRET in GeV gamma rays, 3C 279 is not only the best-observed by EGRET, but also one of the best-monitored at lower frequencies. We have assembled eleven spectra, from GHz radio through GeV gamma rays, from the time intervals of EGRET observations. Although some of the data have appeared in previous publications, most are new, including data taken during the high states in early 1999 and early 2000. All of the spectra show substantial gamma-ray contribution to the total luminosity of the object; in a high state, the gamma-ray luminosity dominates over that at all other frequencies by a factor of more than 10. There is no clear pattern of time correlation; different bands do not always rise and fall together, even in the optical, X-ray, and gamma-ray bands. The spectra are modeled using a leptonic jet, with combined synchrotron self-Compton + external Compton gamma-ray production. Spectral variability of 3C 279 is consistent with variations of the bulk Lorentz factor of the jet, accompanied by changes in the spectral shape of the electron distribution. Our modeling results are consistent with the UV spectrum of 3C 279 being dominated by accretion disk radiation during times of low gamma-ray intensity., Comment: 39 pages including 13 figures; data tables not included (see ApJ web version or contact author)

We have analyzed the Lyα, Hβ and Hα line profiles of three active galactic nuclei: quasar 3C390.3 and two Seyfert 1 galaxies; Akn 120 and III Zw2. The blue- and red-shifted broad Gaussian components which are present in all considered 3C390.3 and Akn 120 lines cannot be explained by an accretion disk model because of the lines’ variation on longer time-scales. On the other hand, the line profiles as well as the variation of the III Zw2 spectral line shapes can be explained by an accretion disk model.

The aim of imaging of gastric carcinoma has to be to diagnose the carcinoma as early as possible and to sort out the tumors that are resectable. At the same time imaging of gastric carcinoma should reduce the number of futile laparotomies in patients with advanced, non-resectable tumors to a minimum. Today, endoscopy is the method of choice to diagnose gastric carcinoma. Endosonography is advantageous if small carcinomas have to be judged for depth of tumor infiltration (early gastric carcinoma vs. advanced gastric carcinoma) because high resolution images of the gastric wall are obtained. Staging of large carcinomas that have grown beyond the gastric wall is best performed by hydro-CT because CT scans most accurately delineate infiltrations of surrounding organs/structures and help to plan surgery. Nowadays MRI is not suited for gastric imaging. MRI, however, has the highest potential to fundamentally improve staging of gastric carcinoma if high resolution imaging of the gastric wall is combined with screening for metastases in one examination.

This study analyzed the interaction between the anterior cruciate ligament (ACL) and the intercondylar notch roof (INR) in hyperextension of the knee using magnetic resonance cinematography. Cinematographic image series of 15 knees were investigated. Two independent observers identified the image that displayed the beginning of contact between the ACL and the INR. They determined knee extension on this image and on the image that displayed maximum hyperextension of the knee. Correlations between a variable representing impingement and the inclination angle of the INR, the anterior laxity of the knee, and full hyperextension were examined. Theoretical, impingement-free tibial tunnel positions for the knees were calculated as a percentage of the anteroposterior tibial width. All ACLs of the knees in this study made contact with the INR. The average extension angle at the beginning of impingement was -6.3 +/- 3.8 degrees. There were significant correlations between impingement and maximum manual displacement as measured with the arthrometer (r = 0.77; P < 0.001), maximum hyperextension (r = 0. 67; P = 0.007), and notch roof angle (r = -0.73; P = 0.002). There were biomechanically acceptable tunnel positions for all knees but one. Hyperextension is physiologically associated with impingement of the ACL. In uninjured knees there was a correlation between ACL impingement and hyperextension, inclination of the INR, and maximum manual displacement of the tibia. Impingement free tibial tunnel positioning is possible in most knees without notchplasty.

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

In 1969 ROSCH et al. (1969) published initial results of a mainly nonsurgically created portosystemic connection between the inferior vena cava and the portal circulation in a canine model. Since then, similar models have been described in the literature, none of which, however, has achieved acceptable clinical relevance for the potential treatment of portal hypertension (KOCH 1973; REICH 1977; BURGENER 1979). The first realization of nonsurgical portosystemic shunting in humans was reported by COLAPINTO in 1982. By means of long-term balloon dilatation he tried to keep patent a connection between the liver veins and the portal circulation that had been previously established by transjugular puncture. Patency, however, was very poor. In larger series, the concept proved unsatisfactory due to high rates of tract occlusion and rebleeding (Abecassis 1985; Gordon 1987).

Bile duct cysts are rare abnormalities of the biliary tract. Surgical therapy has been recommended because of possible complications such as cholestasis with jaundice and the risk of bile duct carcinoma. Accurate preoperative radiological imaging is available for surgical planning. In addition to direct imaging of the biliary system in ERCP, high-resolution axial computerized imaging techniques are necessary. The use of MRCP is becoming more frequent in diagnostic imaging of the biliary tract. Similar to the diagnosis of pancreatic tumors with hydro-spiral CT technique, we demonstrate the benefits of hydro-CT in imaging of a distal choledochal cyst, the problems of differential diagnosis and the classification in the generally accepted Todani system in a case in which accurate clarification with MRCP and ERCP was not possible.

Today the relevance of renal tumor embolization is not determined only by the technical and clinical success of the method. Progress in diagnosis of early stages of renal carcinomas as well as the improvement of both surgical techniques and anesthetic procedures have lead to a change in the selection of patients for embolization. Preoperative embolization of advanced renal cell carcinomas with tumor thrombus into the vena cava or of T4 tumors is now an established clinical procedure. The complete occlusion of the vascular bed of the tumors leads to a considerable reduction in intraoperative blood loss and to simplification of the surgical preparation. By using Ethibloc for embolization, palliation of a hemorrhage or of tumor-related pain in inoperable patients is usually successful. Although local control of the tumor disease, including complete tumor ablation, is achieved by embolization, the median survival rate of our palliatively embolized patients is only 3.5 months. This short life expectancy in the group of inoperable patients has to be acknowledged individually in patients considered for palliative embolization who are free of symptoms related the tumor.

For imaging of renal pathology a broad spectrum of radiologic diagnostic procedures are available which are, sometimes and particularly more recently, competing among each other in their diagnostic yield and relevance. For tumorous lesions ultrasound, computed tomography and magnetic resonance imaging are performed predominantly. Angiography is no longer required with the exception of highly selected cases and in some specific preoperative workup requirements. Until recently, catheter based digital subtraction angiography has been considered as gold standard. However, non-invasive techniques such as CT-angiography and MR-angiography are evolving parallel to their quantum leap of resolutions and readiness to use. Nevertheless, well accepted criteria for quality assessement of these new modalities are still lacking. More comparison studies are urgently warranted. Despite the availability of ultrashort pulse sequences applying the T1 relaxation reduction effect of gadolinium enhanced MR techniques overestimation of renal artery stenosis still poses a substantial problem. Renal intervention implies a variety of procedures such as plain angioplasty, stent placement, embolization of traumatic and both benign and malignant tumors. These methods have emerged over the last two decades from a more experimental nature to a fully accepted treatment option. When renal artery angioplasty is embedded in an aggressive approach including stenting as an adjunct for more complex cases, renal ostial lesions and a well organized follow-up regimen its therapeutic potential for treatment of renal insufficiency, malignant hypertension, for organ preservation bears a very high potential. Provided adequat periinterventional drug regimen restenosis rates may be as low as 10%. In highly selected cases capillary embolization might be used as an alternative to nephrectomy with a similar clinical outcome. Particularly the development of superselective small caliber embolization catheters parallel to further refinement of embolization material has aided to use superselective occlusion techniques in benign vascular lesions and renal trauma.

Diagnostic imaging after renal transplantation is of high importance in the differential diagnosis of peri- and postoperative complications. Sonography with color duplex imaging is the method of choice in the diagnosis of acute transplant rejection. MRI is an additional method in the diagnosis of transplant dysfunction especially in diagnosis of perirenal fluid collections. MR angiography and MR urography are noninvasive diagnostic modalities with the potential to replace angiography and pyelography. Angiography, complemented by carbon dioxide angiography, still is the gold standard in the diagnosis of transplant artery stenosis.