Werner Judmaier

Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation.

Contradictory results have been obtained in classifying various renal diseases when trying to use the resistive index measured by duplex Doppler technique in renoparenchymal arteries. These measurements may have been influenced by the lack of standardization of the anatomic site at which the renoparenchymal artery is sampled. To elucidate this influence, we measured the resistive index, peak systolic velocity, end diastolic velocity, and pulsatility index in 120 healthy kidneys at three different positions of the renal vasculature. The resistive index at the level of the interlobar‐arcuate arteries proved to be the parameter with the most consistent results and should be preferred in clinical applications.

Dynamic T1 mapping predicts outcome of chemoradiation therapy in primary rectal carcinoma: Sequence implementation and data analysis

To describe details about the implementation of a dynamic T1‐mapping technique and a simple data analysis strategy that can be used to predict therapy outcome in primary rectal carcinoma and to investigate the physiologic meaning of the obtained parameter.

Pretreatment Evaluation of Microcirculation by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Survival in Primary Rectal Cancer Patients

PURPOSE To investigate the prognostic value of the perfusion index (PI), a microcirculatory parameter estimated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), which integrates information on both flow and permeability, to predict overall survival and disease-free survival in patients with primary rectal cancer. METHODS AND MATERIALS A total of 83 patients with stage cT3 rectal cancer requiring neoadjuvant chemoradiation were investigated with DCE-MRI before start of therapy. Contrast-enhanced dynamic T1 mapping was obtained, and a simple data analysis strategy based on the calculation of the maximum slope of the tissue concentration-time curve divided by the maximum of the arterial input function was used as a measure of tumor microcirculation (PI), which integrates information on both flow and permeability. RESULTS In 39 patients (47.0%), T downstaging (ypT0-2) was observed. During a mean (±SD) follow-up period of 71 ± 29 months, 58 patients (69.9%) survived, and disease-free survival was achieved in 45 patients (54.2%). The mean PI (PImean) averaged over the group of nonresponders was significantly higher than for responders. Additionally, higher PImean in age- and gender-adjusted analyses was strongly predictive of therapy nonresponse. Most importantly, PImean strongly and significantly predicted disease-free survival (unadjusted hazard ratio [HR], 1.85 [ 95% confidence interval, 1.35-2.54; P<.001)]; HR adjusted for age and sex, 1.81 [1.30-2.51]; P<.001) as well as overall survival (unadjusted HR 1.42 [1.02-1.99], P=.040; HR adjusted for age and sex, 1.43 [1.03-1.98]; P=.034). CONCLUSIONS This analysis identifies PImean as a novel biomarker that is predictive for therapy response, disease-free survival, and overall survival in patients with primary locally advanced rectal cancer.

Erratum to: Evaluation of liver fat in the presence of iron with MRI using T2* correction: a clinical approach

Due to a transcription error, the author names in the article entitled “Evaluation of liver fat in the presence of iron with MRI using T2 correction: a clinical approach”, were incorrectly published. We would like to clarify that the author list should read as follows: Benjamin Henninger, Christian Kremser, Stefan Rauch, Robert Eder, Werner Judmaier, Heinz Zoller, Henrik Michaely, Michael Schocke We apologise for this error in the author list; the error was multifactorial.

Upper Extremity Nerves

The major nerves of the upper extremity include the axillary nerve, the musculocutaneous nerve, the medial brachial cutaneous nerve, the medial antebrachial cutaneous nerve, the radial nerve, the ulnar nerve, and the median nerve. A basic knowledge of regional anatomy and topography of these nerves and their major branches is an essential prerequisite for sonographic examinations. By means of landmarks the respective nerve can be easily localized in specific sections of its course. In addition, certain locations exist, where these nerves traverse through narrow tunnels or along bony ridges (such as the carpal tunnel, the ulnar sulcus, or the radial groove). These regions are especially prone for nerve compression or injury and have distinct anatomical features, which must be known to constantly achieve high-quality sonographic diagnoses.

Ultrasound and MRI in the diagnosis of penile induration (Peyronie's Disease)

Penile induration, a disease of connective tissue, requires the precise delineation and differentiation of inflammatory changes (plaques) for accurate therapy. Seventy two patients with clinically suspected Induratio penis plastica (IPP) underwent ultrasound examination between 1984 and 1991. In 37 patients (aged 18 to 80) the diagnosis was proven by ultrasound. Out of this group 27 patients were examined with magnetic resonance imaging (MRI), 15 of them with additional intravenous application of adolinium DTPA (Gd-DTPA). All examinations were performed within four weeks. The results showed, that ultrasound was able to detect plaques and changes of the tunica albuginea in all 37 cases, but MRI was more sensitive in the detection of possible inflammatory change (T2-prolongation and moderate Gd-DTPA enhancement in gradient-echo sequences.MRI revealed inflammatory changes in 22 of 27 examined patients while ultrasound detected only nine such cases out of 37. Ultrasound is the method of choice in diagnosing IPP, due to the overall sensitivity to plaques and changes in the tunica. On the other hand MRI offers valuable additional information with respect to inflammatory changes particularly after Gd-DTPA. Therefore MRI has the potential to improve therapeutic planning and should be used in monitoring therapeutic effects.

Lower Extremity Nerves

The sensory and motor innervation of the entire lower extremity derives from the lumbosacral plexus. According to its clinical significance, the major nerves of this anatomic region include the sciatic, the femoral with the saphenous nerve, the tibial nerve, and the common fibular nerve. These nerves or some of their branches may be affected by blunt or sharp trauma and by compression/entrapment or tumors and tumor like lesions, such as nerve sheath tumors, schwannomas, and neurofibromas. Initial presumptive diagnoses of such lesions are based on clinical diagnostics, but high-resolution ultrasound (HRUS) proves high potential for a direct visualization and definition of relevant pathologies.

Effects of deletion and duplication in a patient with a 46,XX,der(7)t(7;17)(q36;p13)mat karyotype.

Exact breakpoint determination by DNA‐array has dramatically improved the analysis of genotype–phenotype correlations in chromosome aberrations. It allows a more exact definition of the most relevant genes and particularly their isolated or combined impact on the phenotype in an unbalanced state. Here, we report on a 21‐year‐old female with severe growth retardation, severe intellectual disability, hypoplasia of the corpus callosum, unilateral sacral hypoplasia, tethered cord, various minor facial dysmorphisms, and a telomeric deletion of about 4.4 Mb in 7q36.2‐>qter combined with a telomeric duplication of about 8 Mb in 17pter‐>p13.1. Fine mapping was achieved with the Illumina® Infinium HumanOmni1‐Quad v1.0 BeadChip. Most of the major clinical features correspond to the well‐known effects of haploinsufficiency of the MNX1 and SHH genes. In addition, review of the literature suggests an association of the 17p duplication with specific facial dysmorphic features and skeletal anomalies, but also an aggravating effect of the duplication‐deletion for severe growth retardation as well as sacral and corpus callosum hypoplasia by one or more genes located on the proximal half of the segmental 17p duplication could be elaborated by comparison with other patients from the literature carrying either the deletion or the duplication found in our patient.

Nerves in the Neck

Under the prerequisite of a good anatomical knowledge, even the nerves in the neck and the brachial plexus with its complex regional anatomic topography can be clearly visualized with high-resolution ultrasound (HRUS). The typical appearance of nerves has to be distinguished from other surrounding structures, which may be especially challenging in this delicate region because of the many different types of surrounding structures.

Nerves in the Trunk and Abdominal Wall

One of the major advantages of sonography compared to other imaging modalities of peripheral nerves beyond availability and cost-effectiveness is its ability to obtain images in any orientation along the course of a nerve. However, a profound anatomical knowledge of neural topography and especially of crucial landmarks is mandatory for the ultrasonographic (US) localization and assessment of these structures. Compared to extremity nerves pathologies of the nerves in the trunk, abdominal wall and pelvis are rare, and therefore, the assignment of patients for diagnostic US of these nerves is uncommon. Nevertheless procedures for pain management or regional anesthesia, such as ilioinguinal and iliohypogastric nerve blocks for inguinal surgery in children, are often performed under US guidance.