An extensive epidermoid cyst in the posterior fossa was diagnosed in a 59 year old male patient. The most valuable indicator for differential diagnosis was given by plain skull x-ray showing a peripheral zone of sclerosis as the leading x-ray sign of epidermoids. CT and MRI complemented the preoperative diagnostic measurements.
The authors report on two cases of multicentric glioblastoma multiforme, one of them being a trilocular glioblastoma, whereas in the second case a second focus developed contralaterally. Both patients received whole skull radiation of 40 Gy. The patient who suffered from the primarily unilocal tumour was given a tumour boost. The article reports on the imaging via CT and MR.
Usually chordomas involve the intracranial and sacrococcygeal sites of the skeleton. We describe the uncommon localisation in the thoracic spine.
We report a case of osteopathia striata, which is an osseous dysplasia with linear striations of the metaphyses of long bones. Our case is very unusual as there are no associated abnormalities of the bones. Osteopathia striata should not be mistaken for osteopoikilosis. Osteopathia striata is not only a peculiar roentgenologic feature: when it is diagnosed other abnormalities should be looked for, especially cranial osteosclerosis, which may result in complications.
Intracranial arachnoid cysts are usually non-symptomatic. Intracystic and subdural haematomas induced by even minor head injury may turn an asymptomatic AC into a symptomatic one, necessitating surgical treatment. We present a case of a previous asymptomatic AC, spontaneously complicated with subdural hygroma and development of intracystic and subdural haematoma. Clinical follow-up and control CT regime of patients with AC are recommended.
In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations.
Eighteen patients clinically suspected of having acoustic neurinoma were studied in both orbitomeatal and clivoaxial (CA) (the plane perpendicular to clivus) CT scanning planes during the same sessions. On the CA cuts there were highly significantly less (p less than 0.001) artifacts. Also, the tentorium was highly significantly (p less than 0.001) better visualized on the CA cuts. CA cuts could be recommended in cases when artifacts disturb the diagnostics of posterior fossa pathology or when detailed topographic information about pathologic anatomy round the tentorium is needed.
Cholescintigraphy after food stimulation was carried out in 40 patients (13 patients with biliary enteric bypass, 14 patients with bile duct stenosis, demonstrated by ERC, 5 patients with endoprothesis and 8 patients with clinically suspected post-cholecystectomy syndrome. Biliary-bowel transit time of one hour or less was considered to be normal. In patients with biliary enteric bypass 11 had a normal transit time; however, one with a concomitant anastomotic leakage, and 2 patients had prolonged transit time and a significant obstruction by the anastomosis. All 14 patients with demonstrated biliary stricture had normal transit time. In 5 patients with endoprothesis, 2 had prolonged transit time in spite of patent endoprothesis. Finally, in the 8 patients with suspected post-cholecystectomy syndrome, 4 had normal sphincter of Oddi manometry and normal transit time, and 4 had abnormal sphincter of Oddi manometry, but only one with prolonged transit time. It is concluded that in patients with biliary enteric bypass (hepatico-jejunostomia) or biliary strictures a biliary-bowel transit time of one hour will be discriminatory between normal and abnormal conditions. This is in contrast to patients with endoprothesis and suspected sphincter of Oddi dysmotility, where a transit time of one hour only will have limited predictive value.
Mucoceles are rare lesions in the region of the appendix and occur in only 0.4% of all tumours of the appendix. Although their radiological-morphological pattern varies, a correct preoperative diagnosis is nevertheless possible in most cases via imaging methods and taking the pattern of clinical findings into consideration.
Usually chordomas involve the intracranial and sacrococcygeal sites of the skeleton. We describe the uncommon localisation in the thoracic spine.
Prerequisite for successful split-skin flap transplants of myocutaneous flaps is the presence of adequate adjacent afferent and efferent vessels, thus making an arteriography of the receiving region mandatory during surgery preparation. In 20 or 29 patients in whom a split myocutaneous flap was transplanted to the lower leg, angiography revealed 22 pathological or other therapyrelevant findings. Besides the afferent vessels it is basically necessary to visualise the peripheral efferent pathways in order to prevent that vascular anastomosis to the split-skin flap obstructs the blood supply of the leg.
Increased density of the right paracardiac lung field is frequently visible in patients with pectus excavatum. This sign is due to compression of the lungs by the bent costal cartilages of the pectus and should not be interpreted as evidence of pulmonary infiltrate.
Diagnostic difficulties in the assessment of osteoid-osteoma of os hamatum (its recidive or persistence) are outlined by means of a case report. Even by great expenditure in diagnostic (esp. by large-scaled diagnostic apparatus) a 100% safe diagnosis is not achieved in any case.
A case of cavernous haemangioma of the thymus is reported, including the findings of conventional X-ray imaging, computed tomography, surgery and histology. In addition, the literature of thymic angiomatous mesenchymomas as well as of mediastinal haemangiomas is reviewed. The tumour of a 29-year old and asymptomatic woman was located in the anterior mediastinal compartment at the site of the left thymic lobe. The tumour contained phleboliths and was surrounded by a small capsule of fat. After bolus infusion of contrast agent a delay of enhancement could be detected by CT, which led to the diagnosis. Due to the fact that the status of thymic tumours must assessed with special care, operation and histologic investigation were required. Thymic haemangiomas in contrast to other mediastinal haemangiomas are most amenable to surgical treatment. One year after surgery the patient is still in good health without evidence of tumour regrowth.
Abdominal x-ray examinations represent a variety of indications with different demands on exposure latitude, contrast resolution and spatial resolution of screen-film system combinations. The diagnostic value of digital luminescent radiography (DLR) was thus compared to conventional x-ray examinations carried out with screen-film systems, speed class 200, by analysing matched digital and conventional exposures in 46 abdominal and 25 pelvic x-ray examinations in supine and left lateral view, 156 contrast examinations of the gastrointestinal tract, 140 excretory urographies, 8 cholecystographies, 22 lymphographies and in 6 phlebographies. The digital exposure dose was 50% of the conventional one. In DLR two differently post-processed images were obtained from one x-ray exposure: a display with low spatial frequency enhancement was processed to look like a conventional radiograph and was complemented by a display with high spatial frequency enhancement. Analysing the results statistically, DLR proved to be diagnostically equivalent to conventional radiography despite the reduction in exposure dose and the lower digital spatial resolution. Since high spatial frequency enhancement did not provide further diagnostic information and eventually resulted in border line artifacts, high spatial frequency enhancement is superfluous in abdominal x-ray examinations.
The authors report on two cases of multicentric glioblastoma multiforme, one of them being a trilocular glioblastoma, whereas in the second case a second focus developed contralaterally. Both patients received whole skull radiation of 40 Gy. The patient who suffered from the primarily unilocal tumour was given a tumour boost. The article reports on the imaging via CT and MR.
Radiation absorbing foreign material in the patient's body, such as palacos, may mimic significant vascular stenoses in DSA. The potential pitfalls of geometric and videodensitometric quantification of stenosis are discussed.
In 124 patients with different types of gliomas signal intensity was studied with and without contrast material using T1-weighted sequences. The diagnostic possibilities equal those of computed tomography scans. Except grade II and III astrocytomas, the extent of the observed disorders of the blood-brain-barrier corresponds to the malignancy of the tumour. A distinction between glioblastomas, anaplastic astrocytomas and mixed gliomas is not possible. The differences on examination with and without contrast medium in grade I and II astrocytomas and grade I oligodendro-gliomas can be important for differential diagnosis. In addition the T1-weighted sequences require less time for investigation than other sequences which demonstrate disorders of the blood-brain-barrier without contrast material.
