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A Mundinger

Publications and source records attributed to A Mundinger.

At least 19 recordsLinked to original sources
PubMed1996

[Ultrasound and mammography follow-up of findings after breast saving operation and adjuvant irradiation].

AIM: The aim of our controlled retrospective study was to assess the diagnostic value of sonography for detection and characterisation of changes compared to mammography and palpation. METHOD: In 80 patients sonographic and clinical follow-up examinations were performed every 3 to 6 months, mammography examinations were performed every 6 to 12 months during the first 2 years after breast-preserving therapy (BPT) and irradiation. Extension, echogenicity, and configuration of lesions in sonography, and semiquantitiative description of diffuse or circumscribed changes in mammography were the basis of comparative follow-up observation. RESULTS: Postoperative seromas and haematomas, initially presenting echo-free or as hypoechoic lesions, showed an increase in echogenicity within 18 months after irradiation. Fat necrosis occurred in 9.5% of patients, lymph cysts developed in 4%, granuloma in 3%, recurrence of neoplasma in 1.6%. The diffuse loss of transparency in mammography that was associated with radiation therapy, showed a peak 6-12 months after irradiation. CONCLUSION: Sonography and sonographic guided puncture are mandatory tools to characterise circumscribed unclear lesions after breast-conserving therapy and irradiation in specialised centers. We recommend a 6-month interval for combined sonography, palpation, and mammography within the first 2 years after BPT and irradiation, because shorter control intervals did not result in relevant diagnostic advantages.

Adult↗
PubMed1996

[Phantom studies of ultrasound equipment for quality improvement in breast diagnosis].

AIM: According to the German guidelines for quality control of ultrasonic equipment, the following conditions are required for breast ultrasound: A transducer frequency between 5-7.5 MHz and a minimum field of view of 5 cm. Satisfactory images must be obtained in a depth between 0.5 and 4 cm with a wide tolerance of the focal zones. This allows the use of poor quality equipment which does not produce satisfactory image quality and it excludes a number of high frequency and high resolution transducers with a field of view below 5 cm. This study with a test phantom was performed to define image quality objectively. METHOD: Sixteen ultrasound instruments in different price categories were used to perform standardized examinations on a breast phantom model 550 (ATS Laboratories, Bridgeport, USA). Contrast and spatial resolution in different penetration depths were investigated on cyst phantoms from 1-4 mm diameter and wire targets with defined distances between 0.5-3 mm 4 investigations reported the images. RESULTS: A positive correlation was seen between price category and image quality. CONCLUSION: This study demonstrates that transducer frequency and image geometry do not allow sufficient quality control. An improvement of ultrasound diagnosis is only possible if equipment guidelines are based on standard examinations with test phantoms.

Breast Neoplasms↗
PubMed1996

[Computerized tomography findings score in the differentiation of adrenal tumors in patients with extra-adrenal malignomas].

PURPOSE: In a retrospective study the diagnostic accuracy of computed tomography for the differentiation of benign from malignant adrenal masses in patients with extra-adrenal malignancies was evaluated. For this differentiation a new score system was tested. PATIENTS AND METHODS: Size, density, structure, and borders of adrenal masses in 60 patients with extra-adrenal tumours were analysed and scored. The single criteria and the total score values were correlated with the final diagnosis achieved either by histology or by follow-up CT examinations. RESULTS: Score values above 4 indicated always metastases and score values below 2 were benign lesions. An overlap occurred at score values between 2 and 3 resulting in an overall accuracy of 83.3%. CONCLUSION: Single CT criteria are not reliable enough to differentiate benign from malignant adrenal lesions: better results are achieved by using our scoring system.

Adenoma↗
PubMed1996

HIV-related metabolic abnormalities in the brain: depiction with proton MR spectroscopy with short echo times.

PURPOSE: To analyze brain metabolite changes in human immunodeficiency virus (HIV)-positive neurologically asymptomatic patients and patients with acquired immunodeficiency syndrome (AIDS) dementia complex (ADC). MATERIALS AND METHODS: Twelve ADC patients, 11 HIV-positive asymptomatic patients, and 10 healthy control subjects underwent magnetic resonance (MR) imaging and proton MR spectroscopy with short echo times. Changes in N-acetyl aspartate (NAA), choline (Cho), myoinositol (MI), and creatine (Cr) were presented as ratios with Cr as the reference. RESULTS: Statistically significant (P < .05) differences were noted. In ADC patients, all with MR findings of brain atrophy and diffuse white matter disease, NA/Cr decreased (white matter, -31.8%; gray matter, -22.3%), MI/Cr increased (white matter, +42.5%; gray matter, +51.8%), and Cho/Cr increased (white matter, +20.6%; gray matter, +51.7%) compared with healthy control subjects. In HIV-positive asymptomatic patients, NA/Cr decreased slightly (white matter, -6.9%; gray matter, -5.1%), MI/Cr increased slightly (white matter, +13.7%; gray matter, +10.7%), and Cho/Cr did not change. CONCLUSION: ADC has a uniform pathologic metabolic pattern that affects NAA, MI, and Cho. Proton MR spectroscopy with short echo times helps detect early abnormalities in clinically asymptomatic patients.

AIDS Dementia Complex↗
PubMed1996

Magnetic resonance imaging (MRI) for detection of active sacroiliitis--a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI.

OBJECTIVE: Sacroiliitis is often difficult to diagnose in the absence of radiographic alterations. For the diagnosis of active sacroiliitis, plain radiography, scintigraphy, and contrast enhanced magnetic resonance imaging (MRI) were evaluated in a prospective study. METHODS: In 44 consecutive patients with complete clinical and laboratory evaluation, plain radiographs, quantitative sacroiliac (SI) scintigraphy, and MRI were performed to evaluate the contribution of these imaging techniques to the diagnosis of active sacroiliitis. Scintiscanning and MRI were done in 20 control subjects to define the normal range of imaging findings. We determined the sensitivity and specificity for each imaging method using a reference standard based on clinical symptoms of inflammatory low back pain with or without laboratory signs, and on clinical and radiographic followup during 1.5-2.5 years to confirm diagnosis. RESULTS: MRI was most sensitive (95%) and superior to quantitative SI scintigraphy (48%) or conventional radiography (19%) for the detection and confirmation of active sacroiliitis. For the assessment of inflammatory signs, MRI had higher specificity (100%) than scintigraphy (97%) or plain radiography (47%). At repeat MRI after 2-30 months, there was persistent pathologic signal intensity in the subchondral bone area despite clinically successful antiinflammatory drug therapy. CONCLUSION: For the assessment of active changes in the synovial portion and the subchondral bone marrow, contrast enhanced MRI is superior to quantitative SI scintigraphy or conventional radiography. MRI picks up an additional 75% of early cases not diagnosed by plain radiography. Scintigraphy is only of limited value. Persistent pathologic signal intensity in the subchondral bone marrow seems to be closely associated with previous inflammatory episodes, thus limiting specificity of MRI for active sacroiliitis. Based on our findings we suggest an algorithm for the evaluation of patients with suspected active sacroiliitis.

Adolescent↗
PubMed1995

Differential diagnosis of breast lesions by color Doppler.

Color Doppler allows flow detection in small tumor vessels. Due to the vascularity associated with the growth of malignancies, this method can be used to differentiate between benign and malignant breast lesions. In order to study the typical flow characteristics, we investigated multiple Doppler flow parameters. A UM9 HDI (ATL) was used with a linear transducer L 10-5. The number of tumor vessels and the mean, maximum and total flow velocity were measured in 325 benign and 133 malignant lesions and showed highly significant differences (p < 0.0001). Flow profiles (resistance index and systolic/diastolic frequency ratio) showed a large overlap and did not allow accurate tumor differentiation when mean and minimum values were analyzed. Surprisingly, the maximum resistance index and systolic/diastolic frequency ratio were significantly higher in carcinomas than in benign lesions, but the overlap of the values was wider than the flow velocity measurements. Using the vessel number and the total tumor vascularity, 90% of all lesions could be differentiated. A difficulty that we encountered was that a few cancers have very low flow values and some of the proliferative benign lesions can have increased flow.

Adolescent↗
PubMed1995

Digital optical card. A promising technology for documentation and communication of images.

PURPOSE: To assess a patient-oriented digital optical card (OC) for documentation and communication of images using the analysis of breast microcalcifications to illustrate its resolution power. METHODS: Fifty film mammograms with histologically proved clustered microcalcifications were digitized using a 5 lp/mm CCD-scanner. A region of interest containing the cluster was selected for documentation on an OC as an overview OC-image and as a magnified OC-image (5 lp/mm). The shape (spherical/nonspherical) as well as the total number of microcalcifications were quantitatively analyzed by 2 radiologists. RESULTS: The detection rate for total number of overall and spherical microcalcifications using digital media was significantly reduced (p < 0.01) compared to analog mammography. There were no significant differences in the detection rate of nonspherical microcalcifications between film mammograms (100%) and magnified section OC-images (92.7%). The overview OC-image revealed 72% of those calcifications (p < 0.01). CONCLUSION: According to our results, this technology is not appropriate for diagnosis of breast microcalcifications, but may be a promising communication digital medium for transmitting an image/report unit to referring physicians.

Breast Neoplasms↗
PubMed1994

[Value of high resolution sonography in breast cancer screening].

Breast ultrasound has mainly been used for differentiation of cystic and solid lesions. With high resolution technique, which was introduced several years ago, early cancers can now be detected by ultrasound. In this study, 1016 women were examined within 3 months. Mammography was used independently. According to the expected prevalence, 4 nonpalpable carcinomas were detected by sonography. The study proves that high-quality ultrasound equipment allows a primary detection of subclinical breast cancers. In premenopausal patients the sensitivity of mammography is reduced. Therefore, ultrasound should be used complementary to mammography in this age group. Widespread use is not possible due to a deficiency in experienced staff. However, in experienced centres, ultrasound could be used as a supplement to mammographic screening to prove if breast cancer mortality in premenopausal women can be reduced.

Adult↗
PubMed1994

Radiographic course of pulmonary manifestations in Wegener's granulomatosis under immunosuppressive therapy.

Eleven patients with generalized Wegener's granulomatosis were studied. Pulmonary involvement occurred 1 month earlier than a rapid rise of serum creatinine value. Under immunosuppressive therapy, nodules and infiltrations abated slower in patients with bronchopulmonary superinfection (mean, 30 days) compared with patients without superinfection (mean, 18 days). In the short run, radiographic course was a better indicator for therapeutic success than the course of cytoplasmatic antineutrophil cytoplasm antibody titer. If the pulmonary findings did not begin to clear within 1 week after treatment had been started, either superinfection or insufficient immunosuppression was present. In this situation, a more aggressive therapy in combination with antibiotics is suggested.

Adult↗
PubMed1993

Quantitative image analysis of vertebral body architecture--improved diagnosis in osteoporosis based on high-resolution computed tomography.

71 women, 64 post-menopausal, were examined by single-energy quantitative computed tomography (SEQCT) and by high-resolution computed tomography (HRCT) scans through the middle of lumbar vertebral bodies. Computer-assisted image analysis of the high-resolution images assessed trabecular morphometry of the vertebral spongiosa texture. Texture parameters differed in women with and without age-reduced bone density, and in the former group also in patients with and without vertebral fractures. Discriminating parameters were the total number, diameter and variance of trabecular and intertrabecular spaces as well as the trabecular surface (p < 0.05)). A texture index based on these statistically selected morphometric parameters identified a subgroup of patients suffering from fractures due to abnormal spongiosal architecture but with a bone mineral content not indicative for increased fracture risk. The combination of osteodensitometric and trabecular morphometry improves the diagnosis of osteoporosis and may contribute to the prediction of individual fracture risk.

Adolescent↗
PubMed1993

[Imaging in rheumatoid arthritis].

The radiographic changes of rheumatoid arthritis (RA) consist of periarticular soft tissue swelling, osteoporosis, symmetric narrowing of the joint space associated with marginal or central erosions. Conventional radiography is the basic imaging method in RA due to its high impact on differential diagnosis. MRI and bone scintigraphy are second line imaging methods in early stages of arthritis. Hypervascularized pannus can noninvasively and in a detailed way be depicted using intravenously applied Gadolinium-DTPA. Follow-up examinations of the clinical and radiographic findings are adequate in advanced stages. Additional sonography and computed tomography are supplementary methods.

Arthritis, Rheumatoid↗
PubMed1992

CT and MRI: prognostic tools in patients with AIDS and neurological deficits.

To determine the prognostic value of CT and MRI in AIDS we studied the survival of patients with neurological involvement, in relation to the initial imaging results. Twenty-six initial CT and 15 MRI examinations of 41 patients were reviewed for the presence of cerebral atrophy and/or focal lesions. The mean survival time of patients with initially normal imaging was longer (700 +/- 89 days) than that of patients with isolated cerebral atrophy (326 +/- 65) or isolated focal lesions (202 +/- 97). The shortest survival (78 +/- 44 days) was found in patients with both cerebral atrophy and focal lesions. The risk of death in patients with atrophy alone was 3.6 times higher, that in patients with focal lesions alone 6.4 times higher, and in patients with both changes 19.3 times higher than in patients with initially normal imaging. Cerebral imaging with CT and/or MRI thus allows identification of AIDS-related cerebral changes and may contribute to assessment of prognosis.

AIDS Dementia Complex↗
PubMed1992

[Imaging in isolated pulmonary immunocytoma].

A extranodal pulmonary immunocytoma that originated from the lung is reported. It was hidden behind the picture of a mid-lobe syndrome at repeated imaging controls over a 1.5-year period. In the further course a local progression occurred displayed by roentgenography and computer tomography including calcifications within the pulmonary tumor. A newly developing monoclonal gammopathy was detected by immunoelectrophoresis at the same time. Bronchopulmonary symptoms due to the tumor did not exist. After local resection of the lymphoma monoclonal gammopathy disappeared. However, a recurrence of monoclonal gammopathy developed after eight months.

Biopsy↗
PubMed1991

[Magnetic resonance tomography in the diagnosis of peripheral joints].

Magnetic resonance imaging (MRI) provides an excellent soft tissue contrast with high spatial resolution. Using spin echo and fast gradient echo sequences all relevant joint structures such as the hyaline cartilage, the meniscus, the ligaments, the tendons, the capsulae, and their adjacent muscles and their pathology are visualized. Diagnosis of osteonecrosis, meniscal and cruciate ligament lesions, as well as tumors, represents the major current indication for MRI. Due to its high cost MRI should be employed for the diagnosis of joint disease only to clarify equivocal findings of conventional radiographic, nuclear and tomographic methods. Prior clinical examination and laboratory tests are mandatory. As a component of a stepwise diagnostic approach, MRI often provides reliable differential diagnostic information.

Bone Diseases↗