A report is presented on two patients who received surgery on a disc prolapse between the lumbar vertebrae 4 and 5 as treatment for compression of the fifth lumbar root, but in whom the clinically relevant disc prolapse was located higher (lumbar vertebrae 1/2 or thoracic vertebra 12/lumbar vertebra 1). Magnetic resonance tomography made a major contribution to the later diagnosis of the high disc prolapses. Besides precise localization of the lesion, MRT made it easier to understand why such a high disc prolapse can cause a compression syndrome of the fifth lumbar root.

Die in München entwickelte Methode zum Einsatz des Afterloadingverfahrens für die intraoperative Strahlentherapie wurde in ein multimodales Therapiekonzept für das fortgeschrittene Rektumkarzinom eingebunden. Für die nach dem klinischen Staging voraussichtlich R0-resektablen Patienten (n=15) wurde nach Operation und intraoperativer Radiotherapie (IORT) eine postoperative Radio-/Chemotherapie konzipiert, für primär wahrscheinlich nicht R0-resektable Patienten (n=16) hyperfraktionierte, präoperative Radio-/Chemotherapie mit nachfolgender Operation und IORT. Die Ergebnisse der letzten Gruppe zeigen einen auffällig niedrigen Anteil an nodal positiven Patienten (3/11) mit Primärtumoren, in 10 von 11 Fallen konnte ein Down-Staging des Tumors um einen Grad erreicht werden, und entsprechend gelang bei 10 von 11 Patienten eine R0-Resektion. Die postoperativ behandelten Patienten wiesen eine relativ hohe Anzahl an nodal positiven histopathologischen Befunden auf (4/5) bei den Primärtumorpatienten, entsprechend schlecht erwies sich ihre Prognose. Der positive Einfluß der IORT läßt sich aus der Gruppe der Patienten mit Rezidiven ableiten, bei denen sich die Prognose als relativ unabhängig vom Resektionsgrad zeigte. Die intraoperative Strahlenbehandlung mit dem High-dose-rate-Afterloadingverfahren («Münchner Flab-Methode») erwies sich als einfache, sichere und nebenwirkungsfreie Applikationsform für die IORT

A total of 292 patients with tumors of the nasopharynx, the nose and the paranasal sinuses--264 cases with malignant tumors--were examined with magnetic resonance imaging (MRI) and computed tomography (CT) for comparison. MRI yielded better results than CT in the detection and staging of neoplasms of the nasopharynx (detection: CT 84.9%, MRI 96.7%; staging: CT 75.2%, MRI 92.4%). The walls and septae of the paranasal sinuses and of the skull base were in all cases best visualized on high-resolution CT with thin slices. Tumor detection, differentiation of tumor and inflammatory tissue and staging, however, were better achieved using MRI than CT (detection: CT 84.7%, MRI 91.6%; staging: CT 78.6%, MRI 80.9%). The use of fast and ultrafast MR sequences (alternatively or additionally to 'conventional' spin echo sequences) improved the tumor diagnosis. We therefore recommend that patients with tumors of the nasopharynx, the nose and the paranasal sinuses undergo MRI with fast spin echo and gradient echo sequences as first imaging modality.

The aim of this prospective study was to compare the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of tumors of the nasopharynx, oropharynx and hypopharynx. For this reason, we performed CT and MRI in a total of 473 patients with neoplasms of the nasopharynx [116], oropharynx [282] and hypopharynx [39]. Furthermore, the MR imaging protocol had to be optimized including 2D and 3D gradient echo sequences. We compared the use of conventional and fast spin echo and 3D gradient echo sequences for the evaluation of tumors of the nasopharynx and the skull base, and we evaluated 2D fast and ultrafast MR sequences for the detection and delineation of tumors of the oropharynx and hypopharynx. MRI yielded better results than CT in the detection of pharyngeal neoplasms. The differentiation of tumor and inflammatory tissue was best achieved using MRI. Contrast-enhanced 3D GE sequences improved the diagnostic value of MRI of the nasopharynx. Fast and ultrafast 2D MR sequences increased the contrast between orofacial tumors and surrounding tissues. Functional MR images (phonation studies, Valsalva's maneuver) were attainable using ultrafast sequences thus enhancing the diagnostic value of MRI in the case of tumors of the hypopharynx. T2-weighted turbo (fast) spin echo sequences with relatively short acquisition times proved to be superior to conventional T2-weighted spin echo sequences. In conclusion, MRI is the imaging modality of choice in the evaluation of pharyngeal neoplasms. Conventional T2-weighted SE should be substituted by fast T2-weighted SE sequences. 3D GE sequences should be integrated in the MR imaging protocol of the nasopharynx. Fast and ultrafast 2D GE sequences should be applied in the evaluation of tumors of the oropharynx and hypopharynx.

Eighteen children with West syndrome underwent MRI-examination of the brain. Five children were examined twice. Myelination of ten regions of the brain was retrospectively assessed on the MRI-examinations. The children could be divided in three groups of main diagnosis (cryptogenic West syndrome, tuberous sclerosis, pre-/perinatally acquired brain lesions). Delays in myelination were found in 17 out of a total of 23 examinations. In children with cryptogenic West syndrome and with tuberous sclerosis myelination was normal or only mildly delayed in the first month after onset of the spasms, but delays seemed to increase in the course of the West syndrome in these groups. In children with pre- or perinatally acquired brain lesions severe delays of myelination could be found already in the first weeks after the onset of the West syndrome. The assessment of myelination can therefore contribute to the diagnosis and understanding of the underlying disease in children with West syndrome.

777 cerebral MRI examinations of children aged 3 days to 14 years were staged for myelination to establish an age standardization. Staging was performed using a system proposed in a previous paper [1], separately ranking 10 different regions of the brain. Interpretation of the results led to the identification of four clinical diagnoses that are frequently associated with delays in myelination: West syndrome, cerebral palsy, developmental retardation, and congenital anomalies. In addition, it was found that assessment of myelination in children with head injuries was not practical as alterations in MRI signal can simulate earlier stages of myelination. Age limits were therefore calculated from the case material after excluding all children with these conditions. When simplifications of the definition of the stages are applied, these age limits for the various stages of myelination of each of the 10 regions of the brain make the staging system applicable for routine assessment of myelination.

A total of 86 patients with malignant tumours of the hypopharynx and larynx were examined with CT and MRI. The most frequent malignant tumours of the larynx namely, the glottic carcinomas, were better detected with CT than with MRI. The other tumours of the larynx, however, were better visualised with MRI. MRI proved superior to CT in the detection and staging of carcinomas of the hypopharynx. Functional MR images (phonation studies, Valsalva's manoeuvre) were attainable using ultrafast sequences, thus enhancing the diagnostic value of MRI. MRI proved superior to CT enabling a better differentiation of recurrent tumours, inflammatory tissue and scar. For this purpose, T1-weighted plain and contrast-enhanced spin-echo images and T2-weighted spin-echo images were necessary in most cases. T2 weighting turbo spin-echo sequences with relatively short acquisition times proved superior to conventional T2 weighting spin-echo sequences; thanks to shorter acquisition times, the motion artifacts could be reduced and the image quality improved.

The aim of this paper was to compare the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of malignant tumors of the temporal bone, of paragangliomas of the glomus tympanicum and jugulare as well as of malignant tumors of the para- and retropharyngeal space. 67 patients with tumors of the temporal bone--28 cases with malignant tumors and 39 cases with paragangliomas--were examined with MRI and CT. MRI had true-positive findings in nearly 93, CT in 89% of the patients with malignant tumors of the temporal bone. MRI is therefore recommended as the primary imaging investigation of malignant tumors of the temporal bone. Whereas the temporal bone is best visualized by high-resolution CT with thin slices, the tumor extension--especially cranial spread into the middle and posterior cranial fossa and caudal spread into the infratemporal fossa--is better detected on MRI. Enhanced T1-weighted spin-echo images with fat-signal suppression are most suitable for this purpose. Using 3D sequences, partial volume effects can be avoided with an attainable slice thickness of 0.8-1.0 mm. Furthermore, arbitrary slices--very helpful when studying the complex anatomy of the skull base--can be calculated from a 3D data set. MRI had true-positive findings in 97, CT in nearly 90% of the patients with paragangliomas. Furthermore, the response of paragangliomas to radiotherapy can be more accurately assessed on MR--independent of and before volumetric changes.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 86 patients with malignant tumours of the hypopharynx and larynx were examined with CT and MRI. The most frequent malignant tumours of the larynx namely, the glottic carcinomas, were better detected with CT than with MRI. The other tumours of the larynx, however, were better visualised with MRI. MRI proved superior to CT in the detection and staging of carcinomas of the hypopharynx. Functional MR images (phonation studies, Valsalva's manoeuvre) were attainable using ultrafast sequences, thus enhancing the diagnostic value of MRI. MRI proved superior to CT enabling a better differentiation of recurrent tumours, inflammatory tissue and scar. For this purpose, T1-weighted plain and contrast-enhanced spin-echo images and T2-weighted spin-echo images were necessary in most cases. T2 weighting turbo spin-echo sequences with relatively short acquisition times proved superior to conventional T2 weighting spin-echo sequences; thanks to shorter acquisition times, the motion artifacts could be reduced and the image quality improved.

In a retrospective study 516 cranial MRI examinations of children aged 1 month to 14 years were reevaluated for myelination. An objective staging system for the assessment of the degree of myelination was designed, based on the characteristic patterns of myelintypical signal which develop in the course of brain maturation. Thus myelination can be estimated using only routine MRI examinations; no additional measurements of signal intensities are necessary. In order to obtain detailed information, ten regions of the brain are ranked separately, with comparisons of the T1- and T2-weighted images for each region. The application of the staging system to the case material revealed typical age ranges for the stages, and retarded myelination in some children. In most cases the observed retardation affected several regions but never the whole brain. Such delays can only be detected by separate assessment of the degree of myelination in each region of the brain.

A total of 488 patients with neoplasms (in 474 cases with malignant tumours) of the oropharynx, floor of the mouth and oral cavity, were examined with MRI and CT. MRI proved superior to CT, on account of its coronal and sagittal slice orientation enabling not only a better demonstration of findings, but also improved tumour detection and staging. The diagnostic value of MRI was further enhanced with additional fast and ultrafast MR sequences rather than spin echo sequences alone, as previously practised.

A total of 488 patients with neoplasms (in 474 cases with malignant tumours) of the oropharynx, floor of the mouth and oral cavity, were examined with MRI and CT. MRI proved superior to CT, on account of its coronal and sagittal slice orientation enabling not only a better demonstration of findings, but also improved tumour detection and staging. The diagnostic value of MRI was further enhanced with additional fast and ultrafast MR sequences rather than spin echo sequences alone, as previously practised.

磁共振的三维技术使大体积的高分辨率检查成为可能。与二维序列相比,这种技术的发展保证了飞速发展的磁共振成像的不断进步。

The fast neutron facility at the Munich Research Reactor [Forschungsreaktor Munchen (FRM)] is briefly described, and data about the beam quality are given. After a listing of the biological experiments performed before and in parallel to the clinical irradiations, the treatment scheme, selection of cases and results of the reactor neutron therapy are reported. More than 80% of patients - all with poor prognosis - show complete remission of the tumor or stoppage of growth for at least several months. Possibilities for a support by boron neutron capture therapy are outlined. Preliminary data of an upgraded thermal-to-fast neutron converter for the planned 20-MW reactor FRM-II are given.

A basic problem in radiation therapy is definition of the exact target volume in adjuvant cases in which lymph nodes or the tumor bed are to be treated. In seminoma or Hodgkin’s disease the lymph nodes adjacent to large vessels represent the target volume. The vessels serve as guidelines to mark and define the treatment volume if no lymphography has been performed. The individual localization of the vessels is defined by angiography or tomographic techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). In the treatment of subdiaphragmal nodal disease we compared the radiation portals based on MRI and plain film with the portals obtained by three-dimensional CT treatment planning.

Using a combination of T1 weighted snap-shot-flash sequences and intravenous contrast bolus it was possible to demonstrate intraluminal signal differences in a period of seconds. 5 confirmed aortic lesions were studied; 2 old aortic dissections (with differentiation between the true and false lumen), 1 acute aortic dissection and a partially thrombosed thoracic aortic aneurysm were demonstrated. The advantage of this technique lies in its simplicity and reproducibility. Difficulties in interpreting the intraluminal phases arising from spin echo and flash techniques are made easier by interpreting the available signals from this method.

The therapeutic advantage of fast neutrons in the treatment of advanced low-grade tumors of the salivary glands and nasal cavity, such as adenoidcystic carcinomas, mucoepidermoid tumors, and adenocarcinomas, is well known and confirmed by the literature. Most reports describe local tumor control rates of 67%–85% after therapy with fast neutrons versus 24%–34% after photon therapy [2, 4, 9, 10, 15–17]. In contrast, the effect of fast-neutron therapy in squamous cell carcinoma is discussed controversely, and the results of random­ized studies reach from significant advantages to no benefit at all, in comparison to conventional radiotherapy. From the biological point of view the high repair rate and the high share of hypoxic cells in advanced squamous cell carcinomas indicate the use of fast neutrons.