Radiologia diagnostica最新文献

The introduction of modern methods of diagnostic imaging as sonography, CT and endoscopic retrograde cholangiopancreaticography has changed the value of intravenous cholegraphy. Since the introduction of the contrast medium Ioglycamide into clinical practice two years ago we evaluated the cholangiocholecystographies of 50 patients. The investigation was indicated, if no elucidation was achieved with sonography. Side effects were not registered with Ioglycamide. Indications and value of the method are discussed.

With a retrospective analysis of images from 39 patients with histologically proven liver tumours we tried to determine the best MRT-parameter for detection of cavernous hemangioma (n = 19) and its differentiation from malignoma (metastases n = 17, HCC n = 5). The best differentiation was achieved with the contrast-to-noise ratio between lesion and liver in multi-echo-images with TR/TE = 2,000/210 ms and a definite limit with an accuracy of 84% for hemangioma and 91% for malignoma. The respective intensity ratios (lesion/liver) were 95% and 77%. T2-relation times and the T1- and T2-ratios were also calculated. In contrary to the literature we think that these parameters are not sufficiently discriminating.

As every diagnostics also roentgenological diagnostics of breast carcinoma involves misinterpretations. By exact evaluation technique, profound clinical investigation and profound knowledge of x-ray symptoms errors can be reduced. The close cooperation of referring physician, radiologist and pathologist is an essential for the improvement of the diagnostics of carcinoma. The radiologist must know possible errors exactly to achieve high rates of correct diagnosis. Especially in the evaluation of mammography clinical and pathologic-anatomic knowledge is required besides much experience in image analysis.

In 34 patients with central bronchial carcinoma and in 28 patients with non-tumourous diseases of the bronchopulmonary system we investigated lung ventilation and perfusion with a self-made roentgen-functional method (x-ray cinepulmodensitometry) and an automated evaluation system. It appeared, that the automated evaluation of lung function with its high sensitivity facilitated the detection of small tumour-specific functional changes. Their early detection can improve the differentiation of lung carcinoma from non-tumourous lesions.

Complaints of angina pectoris after aortocoronary bypass surgery can be due to the obturation of one or more bypasses. The aim of our study was the evaluation of magnetic resonance tomography for the investigation of bypass patency in comparison with computed tomography. We investigated 18 patients. 33 of 35 bypasses were safely detectable with spin-echo techniques and 32 with fast-scan-techniques and presentation in cine-mode. 25 of 33 bypasses were identified as open with the SE-technique, 27 of 32 with the "fast" technique. No safe decision was possible for 4 bypasses with SE-technique and for 1 bypass with the "fast" technique. The results are in good agreement with the reference investigation by CT. For the investigation of bypass patency with MRT neither x-rays nor contrast media are necessary. It is therefore recommended for patients with allergy to contrast media and cases with high radiation risk.

Todays radiology is totally different from that 10-15 years ago. Consequences appear for radiologists, but no less for clinicians, health officials and financing. The radiologist gives advice to the clinician on the selection of investigation and technique and the demonstration of the results. For this he needs clinical information. Todays radiology should be organized as an centralized service. Splitting into fields or disciplines is inefficient. Financial bodies must recognize the high costs also for maintainance. The only way for cost reduction is central installation and multi-shift employment. Financing must provide the money for manpower and materials. The reduction of unnecessary radiologic investigations can be achieved by radiologists only with the help of economists. Modern diagnostic radiology has a central role in the health services. The pretentiousness of clinicians, the effectiveness of the administration and economy can be seen in their relation to diagnostics as a whole and especially diagnostic radiology. Clinicians and hospitals will have the diagnostic radiology that they deserve by their own efforts (material, organizational) for modern medical imaging.

CT is valuable to complete ultrasound findings in the evaluation of tumors of the eyeball. Tumoral and nontumoral space-occupying lesions and malformations of the orbit and the exact demarcation of these conditions within the periorbital structures are well demonstrated. In several different pathological conditions the CT appearances are often similar and only sometimes characteristic. Additional clinical data are helpful in giving hints for the diagnostic differentiation of the CT findings.

The value of enteroclysma in comparison to peroral roentgenologic imaging of the small bowel is beyond doubt. For the use of applicable double contrast media we carried out comparative investigations in 118 patients with inflammable diseases of the small bowel. 92 patients were investigated with air and 26 with 1% methylcellulose solution in double contrast. Advantages and shortcomings of both methods are discussed. For the diagnostic results as well as for the application of complementing techniques air seems to be better for double contrast studies than methylcellulose.

The quality of 96 infusion cholegraphies with isotonic Ioglycamide-85 solution and of 2,080 infusion cholegraphies with hypotonic adipiodone-50 gave equal images in 97% of the cases. Ioglycamide-85 caused side-effects in 15.6%, Adipiodone only in 1.5% of the cases. For improved compatibility of Ioglycamide and of new contrast media as Iotroxamide and Idoxamide the use of hypotonic solutions is recommended for infusion. Their concentration should be osmotically tolerated by the erythrocytes. For the prevention of liver necrosis by contrast media the amount of contrast medium should be limited to 10 g meglumine salt.

On the background of a continuous increase of knowledge in urologic oncology, the need for actual information and for interdisciplinary cooperation we discuss the diagnostics of prostatic and cystic carcinoma from the standpoint of the required therapy. The threshold of diagnostic detectability of prostatic carcinoma today is approximately the size of a matches head. By transrectal sonography and MRT the anatomic zones of the prostate are imaged and a selective biopsy becomes possible. Morphometric studies of prostatic carcinoma with pathologic-anatomical descriptions of the tumour volume and capsular penetration are described. The requirements for medical imaging for sufficient information on tumour volume, seminal bladder infiltration, capsular infiltration and lymph node diagnostics are derived. For the diagnostics of bladder carcinoma the significance of the lamina propria as a separating membrane between superficial and infiltrating carcinoma is discussed. Possibilities and limitations for the T- and N-determination of infiltrating carcinoma with CT and MRT and new therapy concepts (neoadjuvant chemotherapy) for the muscle-infiltrating cystic carcinoma are discussed.