Reinhard Walter

Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation.

To evaluate the histopathologic changes influencing Doppler measurements of the resistive index (RI) in renal arteries in renal parenchymal diseases, 68 kidneys in 34 consecutive patients with various forms of renal parenchymal diseases were studied by duplex Doppler ultrasound (duplex US) immediately before percutaneous renal biopsy. The RI, renal length, and renal cortical echogenicity were correlated with the amount of glomerular, interstitial, and vascular changes graded on a scale from 0 to 100. The renal vascular resistance and therefore the RI are significantly correlated with the prevalence of arteriolosclerosis, glomerular sclerosis, arteriosclerosis, edema, and focal interstitial fibrosis. There was no significant difference of the RI in five groups of different renal parenchymal diseases. Of 34 patients, 24 presented with an RI less than 0.7, which was thought to be within the normal range so far. Additionally, the RI increases as the patients age increases, due to higher incidence of arteriosclerosis. Of our patients, 44% presented with normal cortical echogenicity. Quantitative duplex US using the RI does not reliably distinguish different types of renal medical disorders.

Duplex Doppler sonography of celiac trunk and superior mesenteric artery : comparison with intra-arterial angiography

DDS was compared to intra‐arterial angiography for the diagnosis of significant (> 50%) stenoses of the celiac trunk and the SMA in 38 consecutive patients referred for angiographic evaluation of peripheral arterial occlusive disease. Celiac trunk occlusion was correctly identified by DDS in three of three patients. In patients with significant celiac trunk stenoses, mean peak systolic velocity was 246 (+/‐ 154) cm/sec and differed significantly (P < 0.05) from the peak systolic velocity (101 +/‐ 22 cm/sec) of 22 patients with no angiographic evidence of significant stenosis. Five false‐negative DDS examinations in patients with > 50% celiac trunk stenoses were noted. Using a peak systolic velocity of > 160 cm/sec (mean value in normal vessels plus 3 standard deviations) to diagnose > 50% celiac trunk stenosis, sensitivity of DDS was 57% and specificity was 100%. However, considering celiac trunk stenoses and occlusions as a single group, the sensitivity rate of DDS in diagnosing significant stenosis and occlusion of celiac trunk was 70%.

Comparison of Duplex sonography and color Doppler imaging in renal allograft evaluation: a prospective study

A prospective study compared the diagnostic capability of quantitative Duplex sonography (DS) and color Doppler imaging (CDI) in 49 consecutive patients with 50 renal allografts. Sixty five DS examinations and 65 CDI examinations were performed by two independent investigators on two different machines on the same day. The resistive index (RI) was calculated and the color flow of renal arteries was observed up to the arcuate arteries. There was good correlation of RI values obtained by DS and CDI at all vascular sites. Thirty one allografts were functioning stably and 19 were in a state of dysfunction, defined by histology (n = 17). Forty allografts presented with a RI less than 0.9 and normal color flow. All five allografts with a pathologic RI greater than or equal to 0.9 showed abnormal color flow (missing flow in arcuate and/or interlobar arteries). Five allografts had a RI less than 0.9 but abnormal color flow, possibly due to atrial fibrillation, hypertension, heart failure or a combination of these. A normal color flow pattern excludes severe vascular compromise to the allograft. In addition, CDI revealed three biopsy-related vascular lesions; two of them had been missed by DS.

Contrast MRI in multiple endocrine neoplasia type 1 (MEN) associated with renal cell carcinoma

The radiologic work-up of a patient with multiple endocrine neoplasia type 1 (MEN 1) syndrome and multiple endocrine nodules, with coincidental renal cell carcinoma, is described. Parathyroid adenoma was differentiated from multiple thyroid nodules by gadolinium-enhanced MRI. Adrenal enlargement due to a nonfunctioning adenoma and a renal cell carcinoma next to a simple renal cortical cyst were identified by typical signal intensities on T1- (pre- and post-Gd-DPTA) and T2-weighted images. Insulinoma was visualized only retrospectively.

Der transjuguläre intrahepatische porttosystemische Stent-Shunt “TIPSS”—erste Ergebnisse

ZusammenfassungDer transjuguläre intrahepatische portosystemische Stent-Shunt (“TIPSS”) ist eine neue, nichtoperative Methodezur Behandlung von Patienten mit Varizenblutungen. Ohne Laparotomie kann eine hämodynamisch den englumigen Interponatshunts entsprechende Verbindung zwischen einem Pfortaderhauptast und einer Lebervene etabliertund durch eine ballonexpandierbaren, Metallstent offengehalten werden. Die ersten Erfahrungen mit 3 Patienten in Wien werden berichtet. Bei 2 Patienten konnte der TIPSS erfolgreich und komplikationslos durchgeführt werden, beide sind im Follow-up (17 bzw. 3. Wochen) ohne Rezidivblutung. Beim 3. Patienten konnte wegen einer sehr kleinen Leber die Pfortader transjugulär nicht punktiert werden. Der TIPSS stellt eine Alternative zur frühzeitigen Lebertransplantation bei CHILD-B- und-C-Patienten mit schlechten Sklerotherapieergebnissen dar, möglicherweise in Zukunftauch zur Sklerotherapie im Stadium CHILD A nach Erstblutung.SummaryThe “Transjugular intrahepatic portosystemic stent-shunt” (“TIPSS”) is a new nonoperative method for the treatment of recurrent variceal bleedings in patients with portal hypertension Without a need for laporotomy an balloon-expandable sent is placed in an intrahepatic tract between a main portal branch and a hepatic vein. The first experiences with three patients in Vienna/Austria are reported. TIPSS were placed successfully and without complications in2 patients, both are without recurrent bleedings at a follow up of 17 and 3 weeks. In a third patient with a very small liver the portal vein could not be punctured. TIPSS is an potential alternative to shunt surgery in CHILD A patients and an early liver transplantation in CHILD B and C patients with poor results of endoscopic sclerotherapy.