Ruth Langer

Assessment of local recurrence after breast-conserving therapy with MRI.

PURPOSE The purpose of our study was to evaluate the relevance of MR mammography in the diagnosis of early and late tumor recurrence after breast-conserving therapy. METHOD Sixty-seven patients receiving breast-conserving therapy underwent 84 MR mammographies in a period between 1 month and 14 years after end of therapy. Dynamic measurements were made following application of contrast agent. The course of signal intensity changes was evaluated in focal lesions and irradiated and contralateral glandular tissue. RESULTS All 10 malignant lesions (7 local recurrences, 1 chest wall recurrence, 2 contralateral carcinomas) showed a > 75% increase in signal intensity within th first minute after contrast agent application. In all patients examined during the first year after end of therapy (n = 29), increased enhancement in irradiated parenchyma was observed compared with the contralateral breast, but only in two patients the increase was > 75% within the first minute. CONCLUSION Already in the first year after end of therapy, MRI can improve diagnostic accuracy in the assessment of breast cancer recurrence. More than 12 months following end of therapy, MR mammography can demonstrate tumor recurrence with a sensitivity of nearly 100% and a specificity rising to > 90% in differentiating tumor from therapy-induced changes.

Focal epilepsies: HM-PAO SPECT compared with CT, MR, and EEG.

Regional cerebral blood flow (rCBF) was evaluated quantitatively by 99mTc hexamethyl propyleneamine oxime and single photon emission CT (SPECT) during the interictal phase in 52 patients with focal epilepsy. The results were compared with those obtained by electroencephalography (EEG), CT, and magnetic resonance (MR) imaging. Twenty-four of the 52 patients had one area of local hypoperfusion whereas 7 patients showed an area of local hyperperfusion. In 20 of the 52 patients, both reduced and elevated rCBF values were found. One patient had a normal perfusion pattern. The SPECT findings correlated well with the foci shown by EEG, both with regard to the sides affected and the locations of the regions of altered perfusion. The MR images showed focal lesions in only approximately one-half of the patients examined, and CT in even fewer.

Ultrasonic investigation of the hip in newborns in the diagnosis of congenital hip dislocation: classification and results of a screening program

SummaryThe method of ultrasonic examination of the hip is described, the latest updated Graf classification is explained, and the results of a prospective screening program are described. One thousand four hundred and sixty newborn infants were examined by ultrasound and clinically by independent observers. The distribution of the ultrasound types was determined. Recommendations are given for the use of ultrasonic investigation of the hip for groups at risk in the neonatal period.

Transcranial Doppler Sonography: Collateral Pathways in Internal Carotid Artery Obstructions

Fifty-four patients with stenoses and occlusions of the extracranial internal carotid artery (ICA) demonstrated by intravenous digital subtraction angiogra phy (IVDSA) were studied by extracranial duplex and transcranial Doppler. Two hundred healthy volunteers served as control group. Intracranial collateralization was demonstrated in 32 patients with ICA stenoses >80% and occlusions. Twelve patients with unilateral and 8 patients with bilateral ICA obstructions >80% showed collateral supply via the anterior (ACA) and/or posterior cerebral artery (PCA). In 5 cases of unilateral ICA oc clusion and in 7 patients with bilateral ICA stenoses >80% and occlusions, the ophthalmic artery and ACA and/or PCA served as collateral vessels. Five pa tients with ICA occlusions showed leptomeningeal anastomoses in the region of the postocclusive middle cerebral artery (MCA). All 54 patients showed normal time-mean flow velocity in the postobstruc tive MCA. In unilateral ICA stenoses >80% and occlusions, the pulsatility in dex in the ipsilateral MCA was reduced in comparison with the contralateral side, indicating that this parameter is more sensitive to hemodynamic effects of ICA obstructions than time-mean velocity.

Acetazolamide stimulation test in patients with unilateral internal carotid artery obstructions using transcranial Doppler and 99mTC-HM-PAO-Spect

Fifteen patients with symptoms of cerebral ischaemia and angiographically confirmed unilateral stenoses or occlusions of the extracranial internal carotid artery (ICA) and 20 controls were studied by a 2 MHz transcranial Doppler (TCD) at rest and after stimulation with 1 g acetazolamide i.v., a cerebral vasodilator. In addition, the patients underwent 99mTc-HM-PAO-Spect measurement of regional cerebral blood flow (rCBF) at rest and after stimulation with 1 g acetazolamide. In 10 patients with ICA stenoses greater than 80% or occlusions, time-mean velocity (Vmean) increase and pulsatility index (PI) decrease in the postobstructive middle cerebral artery (MCA) as well as the increase of the ipsilateral rCBF were reduced in comparison with the contralateral side. The remaining 5 patients showed a normal Vmean increase and PI decrease in TCD.

Transcranial Doppler ultrasound in internal carotid artery and middle cerebral artery disease.

Using noninvasive transcranial Doppler sonography, we studied cerebral collateral patterns in 30 patients with stenosis and/or occlusion of the extracranial internal carotid artery (ICA). All patients with unilateral ICA stenosis ⩽ 80% had normal transcranial Doppler findings. 80% of patients with unilateral and 50% of patients with bilateral ICA stenosis of more than 80% including those with occlusion showed a collateralization via the ipsilateral anterior and/or posterior cerebral artery. 20% of patients with unilateral and 50% of patients with bilateral ICA stenoses of more than 80% (including occlusion) had two or three collateral pathways, including the ophthalmic artery.Another ten patients with stenosis or spasm of the middle cerebral artery (MCA) showed increased flow velocities with turbulence in the narrow segment. In four patients with severe MCA disease with a systolic peak velocity of more than 200 cm/s, the Doppler waveform distal to the lesion was damped.Decreased regional cerebral blood flow (rCBF) measured by99mTc-HMPAO-SPECT was found in two patients with severe MCA stenosis. Another patient with moderate MCA stenosis with a systolic peak velocity of 140 cm/s showed a normal cerebral perfusion pattern.

Transkranielle Doppler-Sonographie Indikationen, Möglichkeiten und Grenzen

Die 1982 erstmals beschriebene [1] und in den letzten Jahren zum sogenannten „Doppler-Flow-Mapping“ [5] weiterentwickelte transkranielle Doppler-Sonographie (TCD) erlaubt den direkten Nachweis intrakranieller Gefasstenosen sowie zerebraler Kollateralkreislaufe.

Quantitative Dynamic CT of Malignant Liver Tumors

The goal of this study was to evaluate the time depending perfusion pattern of malignant liver tumors in dynamic CT. The time density curves of hepatocellular carcinomas (HCC), cholangiocarcinomas (CAC) and metastases were analyzed and quantified. All investigations were performed with a subsecond CT scanner and controlled injection of nonionic contrast medium.

Doppler-Duplexsonographie bei femorokruralen Bypässen — Methodik und diagnostischer Stellenwert

Bei der postoperativen Verlaufskontrolle gefaschirurgischer rekonstruktiver Masnahmen an den unteren Extremitaten stehen zur Erganzung klinischer Methoden bildgebende diagnostische Verfahren zur Verfugung. Neben den angiographischen Masnahmen bietet sich die Doppler-Duplexsonographie an (2, 5). Diese hat sich bereits als Methode der Wahl bei der Primardiagnostik pathologischer Veranderungen an den extrakraniellen Karotiden sowie der postoperativen Verlaufskontrolle nach Karotis-TEA etablieren konnen (8,9).