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

Ganglioneuroma is an uncommon benign tumor of the sympathetic nervous system. In most cases it originates from the thoracic or lumbar portion of the gangliated cord or from the medulla of the suprarenal glands. It is the differentiated form of malignant neuroblastoma. The tumor often manifests itself in young adults by displacement of the surrounding structures. In the case presented the special diagnostic problems of locating the tumor in the pelvis in early pregnancy are discussed.

The current situation with regard to vascular diagnostics in West Germany is analyzed on the basis of the results of a survey of large non-university institutes of radiodiagnostics. The operative equipment present is generally appraised as being adequate. However, equipment for the performance of digital subtraction angiography must be available. The importance of the intravenous technique is clearly diminishing. In some cases, large-format angiograms are completely dispensed with. The frequency of angiography is greatly decreasing. The expenditure of time and effort for the individual investigation has become greater, so that the angiographic equipment and rooms are used to a much greater extent in terms of time. A fairly uniform observation was that about 60% of all arteriographies are necessary because of sclerotic vascular conditions (AOD). These are often combined with interventional measures. The arteriographies are mainly carried out in the lower limbs (50-70%). The remainder is distributed in thoracic and, in particular, abdominal angiographies, among which the renovasographies still predominate. Numerous leg phlebographies are carried out everywhere and account for 85-95% of all venographic investigations. There has been a great decline in lymphographies throughout Germany.

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

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

Computed tomographic investigation of the brain is frequently accomplished by scanning parallel to the canthomeatal line. In these scans, evaluation of the brain stem and neighboring structures is often compromised by streak artifacts from bone-induced beam hardening. These artifacts may be reduced by introducing a change in gantry angulation. Results from a phantom study as well as from a clinical trial offer evidence that may be helpful in assessing different scanning planes. An inclination of 5 degrees below Reid baseline is suggested to minimize the interpetrous artifact. Variations in slice thickness and exposure parameters do not appear to affect significantly this typical posterior fossa artifact.

Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Variations in cardiac output, vessel superimposition, patient motion and poor vascular opacification frequently combine to produce nondiagnostic examinations. To assess the safety of nonselective intra-arterial DSA performed from a brachial artery approach, the complications of 103 examinations, most of which (85%) were performed on outpatients, were prospectively studied. The injection of contrast material into the aorta was made through a 4F multiple side-hole pigtail catheter, inserted percutaneously from the brachial artery. Images were good or excellent in nearly all cases. No permanent neurovascular complications or local artery complications such as thrombosis requiring surgery were encountered and only a few minor complications occurred. We believe that transbrachial intraarterial DSA is a safe, simple and well-tolerated out-patient procedure that can yield reliable, definitive, and complete cerebrovascular studies in nearly all patients referred for the examination.

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

Examination of the intestine by computed tomography can supply additional information on diseases of the intestinal wall. However, the successful interpretation of the bowel wall by CT requires a special technique by which normal structures are opacified, identified and not mistaken for abnormal masses. The rectal administration of water improves the visualisation of the bowel wall and the diagnostic accuracy. This safe, reliable and acceptable method for opacifying the colon and rectum is described. Its value is demonstrated by means of normal and pathological examples.

Modern imaging techniques are presented in a case of Budd-Chiari syndrome. The etiological, clinical and therapeutic aspects of this rare type of hepatic vein occlusion are discussed.

In connection with a case of pulmonary cryptococcosis, the clinical manifestations, radiological findings and therapeutic possibilities are discussed. Although pulmonary cryptococcosis is relatively uncommon, the diagnosis should be considered in any immunologically compromised patient with an abnormal chest roentgenogram.

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

Two cases of Wegener granulomatosis of the breast are reported. In both cases, this rare disease was detected on mammographic examination and was diagnosed for the first time by a fine-needle aspiration biopsy of the breast. The mammographic findings can lead to misinterpretations and can be confused with advanced mammary carcinoma or the alterations caused by lymphoblastoma, leukemia, or Hodgkin disease. The total regression of the tumorlike lesions in the breast, evidence of involvement of the lung with only slight clinical symptoms, and a very protracted course of the disease were remarkable in both cases.

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

A trial of the routine use of two test procedures for the evaluation of free L-triiodothyronine (FT3) was carried out (1070 patients). The normal values given by the manufacturers are not correct with respect to our patient group. In order to avoid false hyperthyroid (FT3-Amerlex) or false hypothyroid (FT3-DPC) values, the normal spectrum was redetermined for each. Under these conditions, both tests could show a definite difference between normal and overfunctioning of the thyroid. In substitution therapy with L-thyroxine, the quality of adjustment may be assessed according to the FT3 value. An extension of the normal spectrum, as for FT4, is not necessary. Since any additional assessment of the carrier protein concentration becomes irrelevant, the FT3 test is advisable also for economic reasons.

Diagnostic radiological procedures in tumors of the adrenals are demonstrated and correlated to their clinical symptoms. Radiographic findings and special symptoms are described in 21 cases. Various investigative methods are demonstrated and their diagnostic value and approach in cases of adrenal diseases are debated. Differential diagnostic problems of tumors of the adrenals are discussed also.

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

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

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

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

Angio-densitometry is a very sensitive method in the evaluation of vascular effects of a contrast medium. For that purpose the renal circulation is especially suitable. The method is based on the zero or subtraction method. Thus, the majority of the well known interference sources will not be recorded. Only changes of density caused by the passing blood are measured. Four different contrast media are compared. Their effects on the circulation cannot be predicted from a single measurement. The mean value of several measurements limits the scattering range and allows comparisons to be made. Accordingly there are some differences between the examined conventional contrast media and their influence upon the kidney circulation. They all slow down the blood velocity in the renal artery, but the extent is different. The causes responsible for the circulatory effects of the contrast media are discussed on the basis of current scientific knowledge. In addition the results of 144 angio-densitometric studies are reported. The analysis of the pharmacological effect of meglumine iothalamate (Conray 60) revealed only an unimportant influence upon the renal circulation.

Spontaneous transmural rupture of the esophagus (Boerhaave's syndrome) is a life-threatening emergency. Prompt diagnosis is essential to a better prognosis, successful operative outcome and patient survival. The chest roentgenogram and the contrast esophagograms to follow are the most helpful diagnostic tests. The clinical manifestations are variable and may be misleading and thus delay accurate recognition. In our case report the major clinical features and radiological signs of Boerhaave's syndrome are described. The pathogenesis, characteristic clinical symptoms and the signs and radiological evaluation are reviewed.

This new X-ray method is based on the densitometric measurement of the speeds and the flow of injected contrast media during an angiographic examination of the vessels and the parenchyma of the kidney. Pairs of highly sensitive photoconductive cells and a Wheatstone bridge circuit are used. Minimal doses of contrast media can be detected before vascular reaction influences the renal circulation. The measurement of various parameters allows the simultaneous hemodynamic analysis of kidney function and of factors related to the morphological substrate.

It is hardly ever assumed that pulmonary bleeding can be due to the presence of angioma racemosum arteriovenosum. This is not only because it is relatively rare, but also because it cannot be visualised in conventional x-ray films of the lung. It is also not accessible to more detailed and invasive lung diagnosis. Definite confirmation is only possible via selective bronchial arteriography, which is too rarely applied during diagnostic differentiation. The authors observed angioma racemosum arteriovenosum in seven out of 47 patients in whom angiography had been performed after single or repeated haemoptysis; in six of these patients, the angioma was removed by surgery. Bronchial arteriography not only enables visualisation of the characteristic vascular patterns, but also to differentiate this disease against other pulmonary disorders which may also be responsible for the occurrence of haemoptysis. Furthermore, the angiogram enables exact determination of the extension and localisation of the angioma, this being an important prerequisite of successful thoracosurgery.

Nephroangiotomography (NATG), intravenous subtraction angiography (ISA) and digital subtraction angiography (DSA) were compared with regard to their specificity and diagnostic value, their expenditure of time, equipment and staff as well as to their risk for the patients. The interpretation of NATG is inferior to ISA. The hitting quota of ISA and DSA is equal. The expenditure of time and staff for ISA is important, whereas the equipment for DSA is considerable; however, it has a wider use. In case of a low patient number, ISA delivers sufficient results in the diagnosis of renal hypertension with the advantage that it can also be performed in smaller radiological institutes.

We report on the diagnosis and treatment of a pancreatic pseudocyst of the mediastinum. The patterns of signs and symptoms, diagnosis and treatment of this rare disease are discussed on the basis of literature.