Kathrin Hochmuth

Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis.

RATIONALE AND OBJECTIVES This study assessed the diagnostic potential of magnetic resonance imaging for the evaluation of the tibiofibular syndesmosis. METHODS A total of 38 patients with an acute ankle trauma and clinical suspicion of a syndesmotic tear were prospectively studied with conventional plain film radiography and magnetic resonance imaging. Magnetic resonance imaging studies included plain T1-weighted (T1-w) and T2-weighted (T2-w) sequences and contrast-enhanced T1-w sequences 0 to 3 days after trauma. All images were read by two independent radiologists before surgical intervention. Sensitivity and specificity were determined for the two observers and the concordance of the two observers were calculated using the interobserver analysis (Kappa-Test). Intraoperative inspection (n = 21) revealed rupture of the anterior tibiofibular ligament (ATIF) in 15 patients, intact ATIF in 6 patients, and intact posterior tibiofibular ligament (PTIF) in 21 cases. Clinical and follow-up examinations revealed an intact syndesmotic complex in another 17 patients. RESULTS Primary diagnostic criteria for diagnosing a ligamentous tear included tibiofibular diastasis in conventional plain films; nonvisualization of the ATIF; an abnormal course, a wavy, irregular contour of the ligament; increased signal intensity of the ligament in T2-w sequences, in plain T1-w sequence, and marked enhancement in T1-w after contrast. Important secondary signs were defined as joint fluid in the tibiofibular space and prolapse of interspace fat. Highest diagnostic accuracy was achieved if three or more diagnostic criteria could be visualized. Both readers performed best with the enhanced T1-weighted and the T2-weighted images in transverse orientation. The interobserver analysis resulted in high concordance: Kappa = 0.9 (confidence interval: 0.76 to 1.00) for all patients, and in Kappa = 0.76 (confidence interval: 0.45 to 1.0) for surgically treated patients. CONCLUSIONS Magnetic resonance imaging of the syndesmotic complex is a highly sensitive and specific tool for the pretherapeutic-evaluation of syndesmotic injury.

Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review

Percutaneous vertebroplasty has become an efficient technique for the treatment of painful vertebral fractures. Osteoporotic vertebral compression fractures are characterized by severe back pain and immobilization causing other complications like thrombosis or pneumonia. Vertebral cement augmentation provides increased strength of the vertebral body and an obvious pain relief. Between 1989 and 2004, 30 studies and a total of 2,086 treated patients have been published in literature. A review of these studies has been performed. The number and age of the patients, number of treated vertebrae, pre- and postoperative outcome of pain and complications of the different studies were assessed and analyzed. Percutaneous vertebroplasty is an efficient technique with low complication rates and a significant reduction in pain. It rapidly improves the mobility and quality of life of patients with vertebral compression fractures. With an increasing number of treated patients, experience with this interventional technique has become excellent. But still there are no randomized controlled trials available, showing that percutaneous vertebroplasty has a significantly better outcome than other treatment options, especially after a long-term follow-up.

CT-guided intratumoural administration of cisplatin/epinephrine gel for treatment of malignant liver tumours

To analyze prospectively the interventional and clinical aspects of computed tomography-guided direct intratumoural injection of a novel chemotherapeutic administration and the parenchymal changes of tumour and necrosis in malignant liver tumours. Eight patients with 17 colorectal liver metastases were treated with a mean of 5.1 injections and nine patients with 13 hepatocellular carcinoma nodules with a mean of 3.1 treatments with computed tomography guided local applications of a novel cisplatin/epinephrine gel. This application provides a higher local and lower systemic drug concentration. Volumes of tumour and necrosis prior and after treatment were measured by computer generated volumetric analysis. Contrast enhanced studies verified pretherapeutic viable tumour volumes with a value of 77.4 ml in the metastases and 29.2 ml in the hepatocellular carcinoma nodules. Intratumoural drug application resulted in a significant increase of necrosis and a decrease in viable tumour volume to be 68.3 ml in metastases and 14.5 ml in hepatocellular carcinoma. Local therapy control rate for the follow up to 6 months was 38 and 71% for the group of metastases and hepatocellular carcinoma, respectively. Direct intratumoural injection of cisplatin/epinepthrine injectable gel is a feasible and good tolerated method and results in the development of a statistically significant increase in necrosis in malignant liver tumours. For hepatocellular carcinoma a higher local therapy control rate compared to colorectal metastases can be reported.

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures.

The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42–83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3–52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5–9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5–4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.

Sportverletzungen und -schäden der Wirbelsäule

ZusammenfassungDie verschiedenen Sportarten weisen unterschiedliche Verletzungshäufigkeiten und -muster auf, die im Rahmen dieser Übersichtsarbeit diskutiert werden sollen. Circa 3% der Sportunfälle betreffen die Wirbelsäule. Diese Verletzungen sind häufig von besonderer Tragweite für den Patienten. Eine frühestmögliche und umfassende Diagnose aller Veränderungen ist dabei entscheidend für die Einleitung einer adäquaten Therapie und somit für die Prognose der Verletzung. Auch in der Dokumentation von Spätschäden und in der Frage der Rehabilitation kommt der radiologischen Diagnostik eine entscheidende Bedeutung zu. Ein besonderer Fokus wird dabei auf die Magnetresonanztomographie-(MRT-)und Computertomographie-(CT-)Diagnostik gelegt.Die gesunde Wirbelsäule des Menschen ist in der Regel allen statischen und dynamischen Belastungen der üblichen Sportarten gewachsen. Formanomalien und Funktionsstörungen der Wirbelsäule können die Belastbarkeit reduzieren. Die Empfehlung sportlicher Aktivitäten richtet sich nach dem Ausmaß der Verbiegung und dem noch zu erwartenden Wachstum. Auch hierbei wird der Stellenwert der Radiologie bei der Primärdiagnostik und im Rahmen von Verlaufskontrolle bei typischen Veränderungen wie Skoliosen, Morbus Scheuermann, Spondylolyse, Spondylolisthese, diskutiert.AbstractDifferent sports show different patterns and frequencies of injuries, which are discussed in this paper. About 3% of all sports accidents relate to the spine. These injuries often have far-reaching consequences for the patients. A very early and extensive diagnosis of all changes is decisive for the start of an adequate therapy and thus for the prognosis of the injury. Radiological diagnosis is also of decisive importance for the documentation of late injuries and in the question of rehabilitation. Here special focus is put on MRT and CT diagnostics.A healthy spine of humans is normally able to resist all static and dynamic strains of the usual sports. However, anomalies and dysfunctions of the spine can reduce its capacity to resist strain. The recommendations of sporting activities are given according to the extent of deflection and the expected growth. The importance of radiology in primary diagnosis and in the follow-up due to typcial changes like scoliosis, Morbus Scheuerman, spondylolysis and spondylolisthesis is discussed here as well.

Kontrastmittelverstärkte Magnetresonanztomographie von Lebermetastasen: Positive versus negative Kontrastmittel

ZusammenfassungMit den Fortschritten in der onkologischen Leberchirurgie und den modifizierten interventionellen Therapiemöglichkeiten bei Lebermetastasen sind auch die Anforderungen an die bildgebende Diagnostik gestiegen. Die Entwicklung von Kontrastverstärkern für die MRT der Leber resultierte in verschiedenen Möglichkeiten mit dem gemeinsamen Ziel eines verbesserten Läsion-Leber-Kontrastes. Kontrastmittel in der MRT entfalten ihre Wirkung indirekt, indem sie auf die Relaxationszeiten einwirken. Für die Bildgebung der Leber können solche Kontrastmittel unterschieden werden, die den Extrazellulärraum beeinflussen, das hepatobiliäre System und das retikuloendotheliale System. Die beiden Erstgenannten resultieren in einem positiven Enhancement, die letzte Gruppe in einem negativen Enhancement. Positive Verstärker verbessern die Charakterisierung von Lebermetastasen durch die Möglichkeit der Anwendung dynamischer Sequenzprotokolle. Die Detektionsrate von Lebermetastasen zeigt sich bei hepatobiliären Kontrastmitteln im Vergleich zu nativen Schichtungen verbessert. Negative Verstärker, Eisenoxidpartikel dokumentieren einen verbesserten Tumor-Leber-Kontrast und damit eine gleich gute bzw. teilweise verbesserte Detektionsrate im Vergleich zu anderen bildgebenden Methoden wie CTAP bzw. Spiral-CT. Die Differenzialdiagnose von Lebermetastasen mittels eisenoxidverstärkter MRT erscheint möglich unter Einbeziehung der Morphologie in T2- und T1-Wichtung.AbstractThe development in oncologic liver surgery as well as modified interventional therapy strategies of the liver have resulted in improved diagnostic imaging. The evolution of contrast agents for MR imaging of the liver has proceeded along several different paths with the common goal of improving liver-lesion contrast. In MRI contrast agents act indirectly by their effects on relaxation times. Contrast agents used for hepatic MR imaging can be categorized in those that target the extracellular space, the hepatobiliary system, and the reticuloendothelial system. The first two result in a positive enhancement, the last one in a negative enhancement. Positive enhancers allow a better characterization of liver metastases using dynamic sequence protocols. Detection rate of liver metastases is increased using hepatobiliary contrast-enhanced MRI compared to unenhanced MRI. Negative enhancers, iron oxide particels, significantly increase tumor-to-liver contrast and allow detection of more lesions than other diagnostic methods. Iron-oxide enhanced MRI enables differential diagnosis of liver metastases comparing morphologic features using T2 and T1-weighted sequences.

[Contrast-enhanced diagnostics in orthopaedics].

ZusammenfassungDie konventionelle Funktionsdiagnostik stellt einen entscheidenden Zugang zu orthopädischen Problemen dar. Die diagnostische Kompetenz des Orthopäden ermöglicht es nicht nur, sinnvolle Therapiekonzepte durchzuführen, sondern sich auch den aktuellen sozialen und gesundheitsstrukturellen Herausforderungen zu stellen.Neben der klinischen Diagnostik gewinnt die apparative Diagnostik durch voranschreitende technische Entwicklungen zunehmend an Bedeutung. Eine Sonderrolle nimmt hierbei die kontrastmittelgestützte Untersuchung ein. Diese ermöglicht insbesondere in schwierigen oder unklaren Fällen einen entscheidenden Informationsgewinn.Die aktuellen Neuerungen auf den Gebieten der Phlebografie, Angiografie, Myelografie und Arthrografie werden vorgestellt. Indikationsstellungen, Risiken und Komplikationen sowie das technische Procedere werden kritisch diskutiert.AbstractThe diagnostic competence of the orthopaedist not only allows him to perform adequate therapy concepts, but also to meet the current structural challenges, both social and health related.In addition to clinical diagnosis, machine-aided diagnosis is becoming more important due to technical advances. In this context, contrast-enhanced examination has a special place, as it has an important diagnostic advantage in difficult or unclear cases.Current improvements in the areas of phlebography, myelography, arthrography and angiography are reviewed. Indications, risks and complications as well as the technical procedure are critically discussed.