Ziele: Ziel war es, co-registrierte und fusionierte Gd-EOB-verstärkte Ga-68-DOTANOC PET/MRT Bilddaten mit Ga-68-DOTANOC PET/DWI (diffusionsgewichtete MRT) Bilddaten hinsichtlich der Erfassung neuroendokriner Tumore (NETs) des oberen Abdomens zu vergleichen. Methode: 18 Patienten mit histologisch verifizierten oder klinisch suspizierten abdominellen NETs wurden in die retrospektive Studie eingeschlossen. Bei allen Patienten wurde eine Ga-68-DOTANOC PET/CT sowie eine MRT des Abdomens (mit dynamischen Gd-EOB-verstärkten T1-gewichteten Sequenzen und atemgetriggerten DWI-Sequenzen [b-50, b-300 und b-600]) zur Primumsuche, zum Staging oder zum Restaging durchgeführt. Die co-registrierten und farbfusionierten Gd-EOB-verstärkten PET/MRT und PET/DWI Daten wurden separat von einem Nuklearmediziner und einem Radiologen im Konsens ausgewertet. Sensitivität und Spezifität für die NET-Detektion wurden auf Regions-, Organ- sowie Patientenbasis ausgewertet. Ergebnis: 87 von 684 analysierten anatomischen Regionen in 23 von 270 Organen wurden in 14 von 18 in die Studie eingeschlossenen Patienten als NET-positiv gewertet. Regions-basierte Sensitivitäten und Spezifitäten waren 97,7% und 99,7% für die Gd-EOB-verstärkte PET/MRI, und 98,9% und 99,7% für die PET/DWI. Organ-basierte Sensitivitäten und Spezifitäten waren 91,3% und 99,6% für die Gd-EOB-verstärkte PET/MRI, und 95,7% und 99,6% für die PET/DWI. Patienten-basierte Sensitivitäten und Spezifitäten waren 100% und 100% für die Gd-EOB-verstärkte PET/MRI, und 100% und 75% für die PET/DWI. Es fand sich kein signifikanter Unterschied hinsichtlich der Sensitivität und Spezifität der beiden Methoden. Schlussfolgerung: Die Gd-EOB-verstärkte Ga-68-DOTANOC PET/MRT und die Ga-68-DOTANOC PET/DWI sind in gleichem Maße für die Detektion von NETs des oberen Abdomens geeignet.

Ziele: Die Wertigkeit des Pulse-Inversions Harmonic Kontrast US nach i.v. Applikation eines Ultraschallkontrastmittels (Sonovue, Bracco) zur Unterscheidung von malignen und benignen Schilddrüsenknoten. Methode: 25 präoperative Patienten mit szintigraphisch kalten Schilddrüsenknoten wurden mittels Pulse-Inversions Harmonic US mit einem 4–7MHz „small parts“-Ultraschallkopf (HDI 5000, Philips Medical Systems) nach i.v. Bolusapplikation von 2.4ml Sonovue untersucht. Das Kontrastmittelverhalten wurde für einen Zeitraum bis zu 3 Minuten aufgezeichnet. Die Kontrastmittelan/abflutung wurde objektiv mit einer speziellen Software (Q-LAB, Philips Medical Systems) evaluiert und mit der Histologie korreliert. Ergebnis: In 11 Patienten lag ein benignes histologisches Resultat vor, bei 14 Patienten zeigte sich ein Schilddrüsenkarzinom. Die Auswertung der Kontrastmitteldynamik zeigte einen langsameren Abfall bei malignen Knoten. Der mittlere Abfall betrug 5 dB bei malignen Läsionen und 8.0 dB bei benignen Knoten. Schlussfolgerung: Pulse-inversions Harmonic US nach i.v. Applikation von Sonovue erlaubt die Differenzierung von benignen und malignen Schildrüsenknoten mittels objektiver Quantifizierung der Kontrastmitteldynamik.

Ziele: Es erfolgt die Präsentation der Ergebnisse der Bilddatenfusion von CT und MRT Bilddaten zur computerassistierten Schädelbasisoperation mit Hilfe eines Navigationssystem. Methode: 25 Patienten mit Schädelbasistumoren erhielten eine computertomographische und MR-tomographische Untersuchung. Die Computertomographie wurde mit einem Multidetektor Spiral-CT (MDCT) mit Hilfe von 4×0,75mm dicken Spiral-CT-Schichten in der Auswertung im hochauflösenden Knochenfenster angefertigt. Die Untersuchungsebene war streng axial ohne Neigung der Gantry. Die Magnetresonanztomographie wurde mit T2-gewichteten Turbo-Spin-Echo-Sequenzen und nativen T1-gewichteten Spin-Echo-Sequenzen sowie kontrastmittelverstärkten T1-gewichteten Spin-Echo-Sequenzen in axialer und coronaler Ebene durchgeführt. Dann wurde eine 3D T1-gewichtete Gradienten-Echo-Sequenz mit einer Schichtdicke von 1,0mm streng in axialer Ebene ohne Neigung durchgeführt. Die so erhalten Bilddaten von CT-Bilder und der 3D T1-gewichteten Gradienten-Echo-Sequenzen wurden auf einer speziellen Workstation fusioniert und standen intraoperativ zur computergestützten-navigierten Operation direkt zur Verfügung. Es wurde zudem die Genauigkeit der Navigationseinheit und die Operationszeit gemessen. Ergebnis: Die fusionierten CT- und MR-Bilder zeigten exzellent die Tumore und die, die Tumore umgebenden Knochen- und Weichteilstrukturen, um den Chirurgen zu unterstützen. Die Genauigkeit der Navigationseinheit lag kleiner als 1mm. Die so gewonnen Bilddaten verkürzten durch die direkte computergestützt-navigierte Operation die Operationszeit um etwa 30%. Schlussfolgerung: Die computergestützte Schädelbasischirurgie, insbesondere jener von Tumoren durch die Fusionierung von Multidetektor-Sprial-CT und 3D MR-Bildern, hilft dem Operateur bei der Planung und Ausführung der Operationen und verkürzt auch die Operationszeit was auch zu einer möglichen Kostenreduktion führen könnte.

Interferon (IFN)-&ggr; and Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) enhance tumor immunogenicity. The authors assessed tolerability and effectiveness of a combination therapy of these recombinant human (rh) cytokines in patients with inoperable hepatocellular carcinoma (HCC). In a monocentric, open, nonrandomized pilot study, rhGM-CSF (5 &mgr;g/kg qd, Monday and Tuesday) and rhIFN-&ggr; (100 &mgr;g qd, Wednesday and Thursday) were subcutaneously administered in 9-week cycles. Primary objective was survival, as secondary outcomes volumetric changes of tumor mass and biologic parameters reflecting systemic immunologic or local tumor responses were measured. Only patients with complete response (CR), partial response (PR), or stable disease (SD) proceeded to new treatment cycles. Fifteen patients (median 63 years, range 46–74 years, all men) were enrolled. Survival after the first cycle was 80% with SD in 9 of 15 patients (60%). PR was detected in one patient after the second cycle. Two patients finished five treatment cycles. Overall survival at 26 and 52 weeks was 40% and 20%, respectively. Median survival in patients with inducible HLA-DR on hepatoma cells (40%) was increased (42 weeks, 27–100) as compared with HLA-DR negative cases (60%; 13 weeks, 8–23; p < 0.0001), and a control group (p = 0.01). Parameters reflecting systemic immunomodulatory activities were not associated with clinical outcome. In 13 of 15 patients (87%), adverse events were reported, all less than grade 2 and none requiring therapy discontinuation. Immunotherapeutic approaches hold promise to prolong survival in selected patients with advanced HCC who respond by enhanced tumor immunogenicity.

The purpose of this study was to examine if an unusual bilaminar pattern of lateral tibial condyle cartilage layer on the fat-suppressed three-dimensional (3D) spoiled gradient echo sequence is artifactual or correlates with structural and/or biochemical composition of cartilage. The laminar appearance of the lateral tibial condyle cartilage layer was studied on fat-suppressed 3D spoiled gradient echo MR images of the knee joint in 67 patients (mean age: 28y) performed at 1.0 Tesla. After i.v. administration of gadopentetate dimeglumine, diffusion of the contrast media into cartilage layer was qualitatively analysed over time on inversion recovery spin echo images of knee joints of five asymptomatic volunteers (mean age: 25y). In a patient with osteosarcoma and total knee replacement, MR examination of cartilage layer of lateral tibial plateau was compared with histologic specimens stained with Safranin-O, demonstrating proteoglycan distribution in cartilage. The retrospective analysis of 67 knee joints revealed a bilaminar appearance of lateral tibial condyle cartilage layer in the gradient echo images in the majority of cases (81%) with a statistically significant tendency to a trilaminar pattern in patients older than 20 years. With i.v. contrast administration, the contrast enhancement was only observed in the superficial zone of tibial cartilage layer. Histologic specimens in one patient demonstrated a good correlation between thickness of proteoglycan-free and proteoglycan-rich laminae of lateral tibial condyle on Safranin-O staining with hyperintense and hypointense zones, respectively, on corresponding fat-suppressed 3D spoiled gradient echo images (correlation coefficient of 0.87). Bilaminar pattern of tibial condyle cartilage layer on fat-suppressed 3D spoiled gradient echo images in younger subjects is not an artifact or an intrachondral lesion, but it may represent a regional difference in composition of extracellular cartilage matrix possibly produced by a highly-oriented collagen fiber structure associated with a high concentration of proteoglycans in the middle and deep portion of the cartilage layer.

A 37-year-old male patient with no significant past medical history presented with a 6-month history of intermittent epigastric pain which was partially relieved by antacid medication. Gastroscopy showed a peptic ulcer and the biopsies that were taken did not show signs of malignancy. Conservative treatment was initiated, but healing was prolonged, and the epigastric pain persisted. The patient was referred to our department for further diagnosis.

A 37-year-old male patient with no significant past medical history presented with a 6-month history of intermittent epigastric pain which was partially relieved by antacid medication. Gastroscopy showed a peptic ulcer and the biopsies that were taken did not show signs of malignancy. Conservative treatment was initiated, but healing was prolonged, and the epigastric pain persisted. The patient was referred to our department for further diagnosis.

Diseases of the hindfoot are associated with considerable functional impairment and therefore may hamper patients' movements during gait considerably. Because of biomechanical overload, articular structures, tendons and ligaments are prone to early degenerative changes during the course of rheumatic diseases as visible with plain film radiography, sonography (US), or magnetic resonance imaging (MRI). Findings may occur as arthritis of major joints or in the form of fibroostitis and bursitis of the os calcis. Despite the progressive course of rheumatic diseases and characteristic imaging findings, high variability of X-ray signs may occur. Plain film radiograms and high-resolution ultrasonography play a key role in imaging rheumatic diseases of the hindfoot. MRI supports imaging diagnosis in selected cases. The principal goals of diagnostic imaging are precise and reproducible documentation of morphologic abnormalities and differentiated analysis for planning proper conservative or surgical treatment.

BACKGROUND & AIMS:In patients with Wilson's disease presenting with liver involvement, the correct diagnosis is often missed or delayed. The aim of this study was to find an algorithm for diagnosis of this difficult patient group. METHODS:Clinical and laboratory findings of 55 patients with Wilson's disease were evaluated at diagnosis before treatment. Presenting symptom was chronic liver disease in 17 patients, fulminant hepatic failure in 5 patients, hemolysis in 3 patients, and neurological disease in 20 patients, and 10 patients were detected by family screening (siblings). Evaluation included neurological and ophthalmologic examination, routine laboratory tests, and parameters of copper metabolism including liver copper content in 43 liver biopsy specimens. RESULTS:In the whole group, serum ceruloplasmin level was <20 mg/dL in 73%, urinary copper excretion was increased in 88%, and liver copper content was elevated in 91% at diagnosis. Kayser-Fleischer rings were detected in 55%. In contrast to patients with neurological disease (90% Kayser-Fleischer rings, 85% low ceruloplasmin), only 65% of patients presenting with liver disease were diagnosed by these typical findings. Ceruloplasmin levels were lower in patients with Kayser-Fleischer rings or with neurological disturbances than in patients without these symptoms. CONCLUSIONS:The commonly used clinical and laboratory parameters are not sufficient to exclude the diagnosis of Wilson's disease in patients with liver disease of unknown origin.

Background: To distinguish whether the improvement of hepatic encephalopathy by benzodiazepine receptor antagonists is mediated by their antagonistic or their inverse agonistic properties, the neurobehavioral effects of a variety of benzodiazepine receptor ligands in rats with thioacetamide-induced acute liver failure were tested. Methods: The neural inhibitory effect of the benzodiazepine agonist flunitrazepam and its reversibility by the “pure” antagonist Ro 14-7437 were examined in thioacetamide-treated rats and controls. The effects of Ro 14-7437, of the partial inverse agonist Ro 15-4513, and the inverse agonist DMCM in rats with hepatic encephalopathy grade II/III were tested. Encephalopathic rats were pretreated with Ro 147437 or vehicle and then injected with Ro 15-4513. Results: Thioacetamide-treated rats were more sensitive to flunitrazepam than controls. In both groups, its effect was completely antagonized with Ro 14-7437. Encephalopathy was significantly improved by Ro 154513, although Ro 14-7437 and vehicle had no effect. DMCM worsened the condition of encephalopathic rats but had no effect in controls. Pretreatment with Ro 14-7437 abolished the beneficial effects of Ro 154513. Conclusions: In rats with thioacetamide-induced liver failure, endogenous benzodiazepines do not precipitate hepatic encephalopathy. The amelioration of hepatic encephalopathy is mediated by benzodiazepine receptor ligands with both antagonistic and inverse agonistic properties.