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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

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.

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.

To evaluate the feasibility of determining patency of the transjugular intrahepatic portosystemic shunt (TIPSS) by non-invasive CT angiography (CTA).(1) Non-enhanced scanning of the shunt. (2) Bolus tracking by injecting 20 ml of non-ionic contrast material through a cubital vein access to determine the time to maximal shunt enhancement. (3) Contrast-enhanced spiral CT study applying a delay according to the time to peak of the shunt, 3 mm collimation, 5 mm table feed and 3 mm reconstruction interval. (4) 3D and multiplanar reconstructions. (5) Evaluation of the questions: intrahepatic shunt patent or not; evidence of intimal hyperplasia; evidence of stenosis and potential location. (6) Transjugular portography via the stent. (7) Comparison of angiographic findings and CT morphology.Eight patients had inconspicuous CTA. Four of them had a normal shunt at angiography, four had slight intimal hyperplasia. No intervention was necessary in these patients. CTA of three patients showed intimal hyperplasia (lumen reduction between 10% and 50%). The diagnosis was angiographically confirmed in all cases. Due to a high portosystemic gradient intervention was required in all. In five patients CTA and angiography showed a stenosis (reduction of shunt lumen50%). All required a revision including stent placement or PTA of the shunt tract. Four shunts were occluded; all occlusions were shown both in CTA and angiography.None of the shunts with normal findings at CTA required revision. All shunts conspicuous on CTA resulted in revision. In this study, CTA turned out to be an accurate, non-invasive method to evaluate the patency of TIPSS.

Evaluation by hydro-CT in diagnosing and staging of primary non-Hodgkin lymphoma of the stomach (MALT).15 patients with MALT lymphoma underwent imaging by hydro-CT (helical CT scanning optimised for parenchymal and vessel contrast with distension of the gastric wall by water). The CT scans were evaluated for the site, morphology, extent and contrast enhancement of gastric lymphoma; in addition, the number and location of abdominal lymph nodes were examined. The results of CT imaging were compared with the findings at endoscopy + biopsy and endosonography and in case of gastrectomy also with the histopathological results.All lymphomas were correctly diagnosed and were mostly located in the distal parts of the stomach. MALT lymphoma typically grew submucosally, infiltration of the mucosa was rare. Most tumours showed marked contrast enhancement of the mucosa and poor enhancement of the submucosa. Hydro-CT and endosonography had similar accuracies in respect of staging of compartment I and II lymph nodes. Staging of distant nodal groups was more accurate by hydro-CT.Hydro-CT is non-invasive and may be used for diagnosis and staging of primary gastric lymphoma with a typical morphology of gastric lymphoma. Hydro-CT may be regarded as complementary to endosonography and is well suited for the initial diagnosis of gastric lymphoma as well as for the diagnosis of recurrent tumour.

Adjuvant chemotherapy has significantly improved the prognosis of patients with bone sarcomas. Preoperative diagnostic imaging of tumor response to such therapy has become a mainstay for the assessment of prognosis, planning of surgery and further treatment. During therapy, responding tumors show characteristic changes on conventional radiography, angiography, sonography, radionuclide studies, CT and MR. The usefulness and the limitations of each imaging modality in assessing response to therapy are reviewed. The diagnostic importance of specific changes such as tumor volume reduction, calcification and tumor vascularization is discussed.

A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography.In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe.With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement.Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in finding small arteries.

Therapeutic interventions in the skeletal system are an essential part of interventional radiology. Although in terms of figures these procedures are applied less frequently, they are very effective. Percutaneous transarterial embolization of a spinal tumor is well-established interventional treatment. It is primary treatment for preoperative devascularization, but also for palliation of pain and for reduction of tumor volume. As an alternative access for embolization, direct percutaneous puncture of a vertebra is used. A new and promising technique is vertebroplasty, the percutaneous injection of acrylic surgical cement in destroyed vertebrae. The present paper discusses indications, technique, results and complications of these interventional therapeutic modalities in the treatment of primary and secondary spinal tumors.

Purpose: To document our experience with spiral hydro-CT of the pancreas based on a combination of pharmacologic intestinal paralysis and water distension of the stomach and duodenum with specific reference to tumor detection rate, differentiation of malignant versus benign tumors and assessment of tumor resectability in a prospective study on 211 consecutive patients. Material and methods: Between May 1994 und September 1997, 211 patients with suspect of pancreatic neoplasm from clinical, laboratory or other imaging data were examined. Our Hydro-CT techniques were based on intravenous injection of 40 mg N-butylscopolaminiumbromid (Buscopan) for intestinal paralysis, gastric and duodenal wall distension by oral administration of an average of 1.5 l warm tap water, 30 ° RAO patient's positioning, individualized contrast injection technique using portal vein enhancement as reference and thin slice spiral CT (3 mm slice thickness, 6 mm table feed and 3 mm secondary reconstruction). Examined parameters were: (1) tumor detection rate, (2) differentiation of malignant versus benign disease, (3) differential diagnosis and (4) accuracy of assessment of resectability by identification of infiltration into adjacent organs and vessel structures relevant for resectability such as splenic, superior mesenteric, portal vein and celiac trunk, superior mesenteric, splenic and hepatic arteries. As gold standard for positive tumor detection and description surgery (of potentially resectable tumors) and microscopic diagnosis (of clearly unresectable tumors) were used and for negative tumor detection an event-free survival of six months, respectively. Results: 96 % of the examinations were well tolerated. In only 4 % was on-site administration of a gastric tube required because of vomiting. In 2 % of the patients a slight allergic reaction to the contrast medium was seen. The prevalence of a pancreatic neoplasm was 37,8 %. In tumor detection Hydro-CT reached an overall accuracy of 94,8 % with a sensitivity of 93,7 % and a specificity of 95,2 %. 52 patients underwent surgical exploration 34 of whom with tumorfree resection margins (R0 resection) corresponding to a resection of 42,5 %. In those assessment of resectability reached an overall accuracy of 94,6 % with a sensitivity of 91,2 % and specificity of 95,6 %. Conclusion: The new technique of Hydro-CT based on thin slice and spiral methodology including pharmacologic intestinal paralysis and water distension results in a high tumor detection rate and reliable assessment of resectability.

To demonstrate and document 10 years of clinical experience gathered by us with TIPSS and to discuss achievements, problems and outlook.The analysis is based on the following parameters: portosystemic gradient; morphological delineation of the portal circulation; determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); arterial flow changes; hepatic encephalopathy; incidence of restenotic shunt occlusion and recurrent variceal bleeding.Variceal filling was widely reduced by TIPSS, and significantly reduced portal liver perfusion as assessed morphologically and rheologically. However, there was an immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion did not change significantly. In TIPSS portal decompression was readily achieved, the portosystemic gradient dropping from an average of 24 mm Hg to 10.5 mm Hg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post-TIPSS period. Early mortality was 4% and early rebleeding rate 3%. The 12-month re-intervention rate based on an invasive portography follow-up protocol was 76%, and the 24-month re-intervention rate was 90%. The definite occlusion rate was below 5%. Beyond a follow-up time span of 24-months the necessity for re-intervention dropped significantly: less than one-third of our patients required some sort of re-intervention.The concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post-TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by an invasive flow measurement results and by the clinical results. Lethality of TIPSS is low mostly as a result of a refined technique, careful patient selection, follow-up care and meticulous shunt surveillance.

We report our experience concerning a young, white, healthy woman who had a typical blunt chest injury caused by a severe car accident. We had to evaluate and differentiate the initial roentgenographic post-traumatic mediastinal enlargement in order definitely to exclude a suspected covered rupture of the thoracic aorta or the heart caused by this high-velocity deceleration trauma. The difficulties encountered are critically discussed with regard to the unexpected primary thymoma that was diagnosed postoperatively. The diagnostic algorithm in blunt chest injury is also discussed. The controversy about the classification and management options of primary thymic tumors is also presented.

The sonographic diagnosis of malignant lymphoma in childhood is described. Malignant lymphomas are sonographically relatively uniform: initial enlargement of the lymph nodes and organs involved and disturbance of normal echo texture by mainly hypoechoic lesions can be found. Generally, four sonographic patterns of infiltration are described: diffuse, small nodular, large nodular and bulky type. Secondary, tumor-related or inflammatory complications (e. g. dislocation or compression of vessels, thoracic inlet syndrome, venous thrombosis, ileus, urinary retention, abscess and effusion) can be sonographically evaluated. Response to therapy correlates with normalization of size and echo texture and recovery from tumor-related complications. Differential diagnosis with ultrasound is based on the topographic distribution and echo pattern of infiltration and, with certain restrictions, on the echogenicity of lesions and perfusion feasible with Doppler sonography. The primary diagnosis has to be established histologically.

Anatomically, the biliary tree really originates at the level of the hepatocyte draining its bile into the intercellular microtubular structures. These microtubuli join at the lobular level to form small ducts, and from then on towards the papilla of Vater are lined with cholangiocellular epithelium. This cholangiocytic cell type accompanies the entire ductular arborization and is also found in the segmental ducts and the common bile duct near the papilla of Vater, with the same microscopic and biochemical properties. For practical reasons, therefore, this chapter is organized according to the disease types of this epithelioductular substrate.

to demonstrate and document TIPSS-induced changes of the perfusion pattern of the liver with special reference to several rheologic, morphologic, functional and biochemical parameters. Our analysis was based on a study in 100 consecutive cases.Evaluation and assessment of the following parameters before and within a 30-day post TIPSS period: portosystemic gradient; morphologic delineation of the portal circulation; invasive scintigraphic determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); transcatheter intraarterial flow change measurement; serum levels of albumin and bilirubin; assessment of hepatic encephalopathy by appropriate testing; assessment of recurrent variceal bleedingby TIPSS variceal filling was widely reduced; as assessed morphologically and rheologically portal liver perfusion was significantly reduced. However, there was immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion was not significantly altered. In TIPSS portal decompression was readily achieved with reduction of the portosystemic gradient from an average of 24 mmHg to 10.5 mmHg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post TIPSS period. Bilirubin levels were significantly increased after TIPSS from 2.45 to 2.61 mg/dl (p = 0.0067), while albumin levels were not altered. Early mortality was 4% and early re-bleeding rate 3%, respectively.the concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by invasive flow measurement results and by the clinical results. Letality of TIPSS is low.

Evaluation as to whether diagnosis of large bowel disease and TNM staging of colorectal carcinoma are possible by colorectal hydrosonography (HUS).52 patients with suspected neoplastic or inflammatory large bowel disease, underwent HUS. Before performing abdominal ultrasound, the colon was filled with fluid. Morphological alterations of the bowel wall were judged benign or malignant. Colorectal carcinomas were classified according to the TNM system.Laparotomy was performed in 46 of 52 patients. Correlation with surgery and histopathology showed that 77% of morphologic alterations of the colonic wall were detected by HUS. While benign lesions of the colonic wall occasionally mimicked malignant disease, colonic carcinomas were reliably diagnosed by HUS, because destruction and invasion of the bowel wall was visible. Carcinomas of the lower part of the rectum, however, were missed in most cases. Accuracy to determine the infiltration depth of colorectal carcinomas was 89%, but hydrosonographic N-staging was unreliable. Inflammatory disease of the large bowel as well as changes complicating the inflammatory bowel disease were accurately diagnosed by HUS.In selected patients, colorectal HUS is suited for diagnosis and staging of colonic tumours. It also helps to evaluate inflammatory bowel disease, because small and large bowel can be reliably distinguished from each other and the degree of stenosis of inflamed colonic segments becomes visible. Furthermore, HUS increases the visibility of fistulas.

Both thoracic and lumbar sympathectomy and celiac ganglion block could be established as effective methods; side effects are rarely reported. Only the high accuracy of CT-guided positioning can make this possible. Severe side effects are merely sporadic if the proper technique is applied.We used 21G or 22G fine needles. All CT-guided percutaneous neurolysis methods require a proper blood coagulation. Most common CT scanners are suitable for neurolysis if there is enough room for maintaining sterile conditions. All neurolysis methods involve sterile puncture of the ganglia under local anesthesia, a test block with anesthetic and contrast agent to assess the clinical effect and the definitive block with a mixture of 96% ethanol and local anesthetic. This allows us to correct the position of the needle if we see improper distribution of the test block or unwanted side effects. Though inflammatory complications of the peritoneum due to puncture are rarely seen, we prefer the dorsal approach whenever possible.Seven of 20 legs showed at least transient clinical improvement after CT-guided lumbar sympathectomies; 13 legs had to be amputated. Results of the methods in the literature differ. For lumbar sympathectomy, improved perfusion is reported in 39-89%, depending on the pre-selection of the patient group.It was recently proved that sympathectomy not only improves perfusion of the skin but also of the muscle. The hypothesis of a steal effect after sympathectomy towards skin perfusion was disproved. Modern aggressive surgical and interventional treatment often leaves patients to sympathectomy whose reserves of collateralization are nearly exhausted. We presume this is the reason for the different results we found in our patient group. For thoracic sympathectomy the clinical treatment depends very much on the indications. Whereas palmar hyperhidrosis offers nearly 100% success, only 60-70% of patients with disturbance of perfusion have benefited. Results in celiac ganglia block also differ. Patients with carcinoma of the pancreas and other organs of the upper abdomen benefit in 80-100% of all cases, patients with chronic pancreatitis in 60-80%.

Successful completion of a transjugular intrahepatic portosystemic stentshunt (TIPSS) relies on knowledge of the individual hepatic vascular anatomy. The patients referred for TIPSS have an increased risk of contrast-medium-induced renal failure, and therefore the potential for a complete angiographic work-up during the procedure is limited. The same patient population also carries an increased risk of bleeding, which necessitates a rather accurate guiding technique for portal punctures. We have established transcutaneous sonographic guidance as a standard technique for transjugular portal puncture, reducing complication rates and intervention time. Competing imaging modalities for guidance are discussed.

For calculating cost-effectiveness in the context of diagnosis related groups (DRG) we analysed all radiological examinations for 56 consecutive liver transplantations during the primary stay in the surgical department (1052 chest x-rays, 296 ultrasonographies, 216 colour coded duplex sonographies, 72 cholangiographies, 35 CT, 23 angiographies, one MRI and one embolisation).For calculation we used the reimbursement that the surgical wards received per patient day and the special fee for liver transplantation. We compared this with the refunds received by the department of radiology.The hospital was reimbursed a total of 143785.80 DM per patient. The diagnostic and interventional procedures that were requested for the 56 patients amounted to a total of 225118.63 DM and 4019.96 DM per patient, respectively.This means that only 2.8% of all the costs during and after liver transplantation were caused by the radiological examinations. This represents only a small portion of the expenses during the time in hospital, taking into account especially that patients after liver transplantation are at high risk for developing complications.

To evaluate the clinical efficiency of percutaneously placed metallic stents in patients with malignant biliary obstruction.In a prospective study 92 consecutive patients with malignant biliary obstruction were treated percutaneously with expandable metallic stents. Technical and clinical parameters during the procedure and regular follow-up were evaluated.Technical and clinical success rates were 100 and 91% respectively. During stent implantation we observed no severe complications. 30-day morbidity and mortality were 12 and 13% respectively. Late complications occurred in 35%, in 20.7% due to reocclusion of the bile ducts which was treated successfully in 17/19 patients. 75% of patients benefited from the procedure. Primary and secondary patency were 79.3 and 97.8%, respectively.Percutaneous transhepatic implantation of expandable metallic stents is a reliable and safe therapy for malignant jaundice and has a definite positive impact on the patients quality of life.

Within a period of 12 months we preoperatively performed spiral CT portography (CT-AP) including individual determination of contrast injection kinetics, in 18 consecutive patients. The findings were compared with the microscopic findings in 15 resected specimens. A total of 51 perfusion defects were identified with CT-AP, 40 of which were finally diagnosed as metastases. A total of 36 hepatic lesions were identified at microscopy. 28 of which were metastases, all seen at CT-AP. 12 perfusion defects were misdiagnosed false positive as being of metastatic origin. Thus the sensitivity of CT-AP was 100%, the specificity 65% and the overall accuracy 78%. Therefore, CT-AP using the spiral CT technique is currently the most accurate method for preoperative staging of metastatic disease of the liver. Improvements of the scanning and contrast injection techniques will further improve the clinical value of this examination.

To evaluate a new ultrasonographic imaging technique of the pancreas (hydrosonography), based on a combination of chemical intestinal paralysis and water distension of the stomach and duodenum, regarding its significance for tumor detection, staging and assessment of tumor resectability.In an open prospective study 51 patients with suspected pancreatic neoplasm were examined between July 1995 and October 1995. The technique of hydrosonography included intravenous injection of 40 mg N-butyl-scopolaminiumbromid (Buscopan) and maximum gastric and duodenal wall distension by oral administration of an average of 11 warm tap water (0.5-1.51). A detailed evaluation form was used to assess (1) overall imaging quality; (2) accuracy of identification of the pancreas in its various anatomic regions and of peripancreatic vessel structures relevant for resectability, such as splenic, superior mesenteric, and portal veins, celiac trunk, and superior mesenteric, splenic and hepatic arteries; and (3) tumor size, sonographic structure and level of organ and vessel infiltration. As gold standards for positive tumor detection and description, surgery and microscopic diagnosis were used, and for negative tumor detection, event-free survival of 6 months.All examinations were diagnostic. Identification of the pancreas was complete in all 51 patients with an excellent overall imaging quality in 53%. In 86% of cases the various examined organ and vessel structures were depicted with either good or average imaging quality. In 48 of the 51 patients diagnosis positive for tumor or other organ pathology was made. A total of 16 pancreatic carcinomas and 5 benign tumors were diagnosed. Twenty-seven patients had pathology not related to a pancreatic neoplasm. For tumor detection, sensitivity was 82% and specificity 100%. For correct assessment of tumor resectability, sensitivity was 86% and specificity 100%.The new technique of hydrosonography combines the value of routine non-invasive abdominal ultrasound with increased sensitivity and specificity for tumor detection and assessment of resectability by improved imaging accuracy.

To evaluate a new technique for imaging the pancreas (spiral hydro-CT) based on a combination of pharmacological intestinal paralysis and water distension of the stomach and duodenum with specific reference to tumor detection rate, differentiation of malignant versus benign tumors, differential diagnosis and assessment of tumor resectability.In an open prospective study, 151 patients with a suspected pancreatic neoplasm based on clinical, laboratory or other imaging data were examined between May 94 and October 95. Our newly developed Hydro-CT methodology included intravenous injection of 40 mg N-butylscopolaminium bromide (Buscopan) for intestinal paralysis, gastric and duodenal wall distension by oral administration of an average of 1.51 warm tap water, 30 degrees RAO patient positioning, an individualized contrast injection technique as determined beforehand by time-to-peak measurement in the portal vein and thin-slice spiral CT (3 mm increment, 6 mm table feed and 3 mm secondary reconstruction). A detailed evaluation form was used to assess (1) tumor detection rate, (2) differentiation of malignant versus benign disease, (3) differential diagnosis, and (4) accuracy of assessment of resectability by identification of infiltration into adjacent organs and vessel structures relevant for resectability such as splenic, superior mesenteric, portal vein and celiac trunk, superior mesenteric, splenic and hepatic arteries. As the gold standard for positive tumor detection surgery and microscopic diagnosis were used, and for negative tumor detection an event-free survival of 6 months.Almost all examinations were well tolerated. In only 4% was on-site administration of a gastric tube required because of vomiting. In 2% of the patients a slight allergic reaction to the contrast medium was seen. The prevalence of a pancreatic neoplasm was 38%. In tumor detection Hydro-CT reached an overall accuracy of 97.4% with a sensitivity of 100% and a specificity of 95.9%. In the differentiation of benign versus malignant disease Hydro-CT reached an overall accuracy of 89.7% with a sensitivity of 92.5% and a specificity of 83.3%. The prevalence of a pancreatic carcinoma was 24%; 4% other malignant tumors were found (distal common bile duct carcinoma, cystadenocarcinoma). Fifty-eight patients underwent surgical exploration. In those assessment of resectability reached an overall accuracy of 95% with a sensitivity of 90.5% and specificity of 100%.The new technique of Hydro-CT based on thin slice and spiral methodology, including pharmacological intestinal paralysis and water distension, results in a high tumor detection rate and increases sensitivity and specificity of tumor differential diagnosis and of assessment of resectability.

To determine the accuracy of hydrosonography (HUS) und hydro-CT (HCT) for staging colon carcinoma.74 patients in whom colorectal carcinoma was suspected were examined. At HUS the colonic wall ist distended by a methylcellulose/water suspension and the carcinoma is enlarged to perform staging of the tumour. HCT is a spiral-CT optimised for parenchymal and vessel contrast. Before the scan is started, up to two litres of fluid are given rectally and spasmolytics are administered to reduce peristalsis. Colorectal carcinomas were classified according to the TNM system and histopathologic correlation was achieved.Out of 43 (HUS) and 39 (HCT) colonic lesions 33 (77%) and 36 (92%), respectively, were diagnosed. T-stage accuracy was 88% (HUS) and 66% (HCT), N-stage accuracy 33% and 46% and M-stage accuracy 88% and 85%, respectively.The T-stage of sonographically visible tumours of the colon is determined precisely by HUS. In contrast to predicting lymph node involvement distant metastases are reliably detected by both methods. If performed together, HUS and HCT achieve high diagnostic accuracy for staging carcinoma of the colon.

Hydrosonography (HUS) and hydro-CT (HCT) were evaluated for diagnostic accuracy and staging efficiency of gastric carcinomas.68 patients suspected for gastric carcinoma were examined. At HUS the gastric wall is distended by water, the tumour is localised and enlarged to judge the depth of infiltration. At HCT the stomach is filled with water and after paralysis of the gut a spiral-CT optimised for parenchymal and vessel contrast is performed. Gastric carcinomas were classified according to the TNM-system and histopathological correlation was achieved.The number of normal/pathologic examinations was 10/30 (HUS) and 9/31 (HCT), the detection rate of gastric tumours was 77% (HUS) and 94% (HCT). The T-stage was correctly determined in 27% (HUS) and 55% (HCT), the N-stage in 65% and 45% and the M-stage in 81% and 73% of all cases, respectively.HCT is a reliable screening method for gastric tumors. Staging of gastric carcinomas, however, is not improved. Tumour extension beyond the wall and metastases can be assessed by a single examination.