Search PubMed⌕ Search

Biomedical subjects

B Hamm

Publications and source records attributed to B Hamm.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Comparison of the cost-effectiveness of the most common diagnostic methods for coronary artery disease].

BACKGROUND AND OBJECTIVE: The cost-effectiveness of medical procedures is becoming a crucial factor besides their efficacy in clinical decision-making. We performed a cost-effectiveness analysis of the most common diagnostic modalities used in assessing coronary artery disease (CAD). METHODS: A decision tree model for determining the cost-effectiveness in CAD diagnosis was applied to the situation in Germany to calculate the cost-effectiveness of exercise ECG (ExECG), stress echocardiography (ECHO), myocardial scintigraphy (SPECT), and coronary angiography (ANGIO). The cost-effectiveness was defined as direct and induced costs per correctly identified patient. A sensitivity analysis was performed varying the predictive accuracies, the complication-related costs, and costs and complication rates of ANGIO. RESULTS: The costs per correctly identified patient decreased in a hyperbolic fashion as the pretest likelihood of CAD increased due to the higher incidence of positive findings. For a pretest likelihood between 10 and 40%, ExECG and ECHO were most cost effective with costs per CAD patient of 5,880 - 2,500 EUR and 6,410 - 2,280 EUR, respectively. The combination of ExECG und ECHO (application of the second modality in case the first one was nondiagnostic) further improved the cost-effectiveness up to a pretest likelihood of 35%. For a pretest likelihood of 50% or greater, ANGIO costing 1,880 - 940 EUR per correct diagnosis was most cost-effective. Sensitivity analysis revealed no significant changes demonstrating the robustness of the model. CONCLUSION: ANGIO is the most cost-effective procedure for a pretest likelihood of 50% or greater. At lower pretest likelihoods, ExECG, ECHO and the combined ExECG/ECHO strategy based on economic considerations are the preferred modalities for diagnosis of CAD.

Cohort Studies↗
PubMed2004

[Technical success rate, peri-interventional complications and radiation exposure of the transarterial embolization for leiomyomas of the uterus].

PURPOSE: To analyze the technical success rate, incidence and type of peri-interventional complications, and radiation exposure of uterine artery embolization (UAE) in symptomatic leiomyomas of the uterus. MATERIALS AND METHODS: This prospective study includes 75 patients consecutively treated with UAE from October 2000 through August 2002, with all interventions performed by the same radiologist. Technical success rate, interventional material, and incidence and type of peri-interventional complications (length of hospitalization) were recorded and categorized according to the definitions of the Society of Interventional Radiology (SIR). Fluoroscopy time (FT), dose-area product (DAP), and effective dose (ED) were determined for each intervention and the influence of the radiologist's experience on the radiation exposure analyzed. RESULTS: UAE was technically successful in 97.3 % of the cases. Peri-interventional complications occurred in 14.7 %. Four complications (5.3 %) were classified as major class C according to the SIR (post-embolization syndrome requiring prolonged drug treatment and hospitalization [n = 3] perforation of the uterine artery [n = 1]). None of the complications led to discontinuation of the intervention, subsequent surgical intervention, or permanent sequelae. FT decreased significantly (p < 0.05) until the 35th intervention. The median FT decreased from 18.8 min (13.4 - 28 min [25th to 75th percentile]) to 11.8 min (9.7 - 13.3 min [25th to 75th percentile]). The DAP decreased by 25.3 % to a median of 8.547 (6.527 - 11.590 cGy*cm (2) [25th to 75th percentile]). The median ED was 31.5 mSv from the 36th intervention onward. CONCLUSION: UAE has a high technical success rate with a low rate of peri-interventional complications. The study showed a statistically significant learning effect with a decrease in radiation exposure for the first 35 interventions. The effective dose of UAE is comparable to that of 1 to 2 small bowel enema.

Adult↗
PubMed2004

Multislice CT coronary angiography: evaluation of an automatic vessel detection tool.

PURPOSE: To investigate the potential of a new detection tool for multislice CT (MSCT) coronary angiography with automatic display of curved multiplanar reformations and orthogonal cross-sections. MATERIALS AND METHODS: Thirty-five patients were consecutively enrolled in a prospective intention-to-diagnose study and examined using a MSCT scanner with 16 x 0.5 mm detector collimation and 400 ms gantry rotation time (Aquilion, Toshiba). A multisegment algorithm using up to four segments was applied for ECG-gated reconstruction. Automatic and manual detection of coronary arteries was conducted using the coronary artery CT protocol of a workstation (Vitrea 2, Version 3.3, Vital Images) to detect significant stenoses (> or = 50 %) in all segments of > or = 1.5 mm in diameter. Each detection tool was used by one reader who was blinded to the results of the other detection method and the results of conventional coronary angiography. RESULTS: The overall sensitivity, specificity, nondiagnostic rate, and accuracy of the automatic and manual approach were 90 vs. 94 %, 89 vs. 84 %, 6 vs. 6 %, and 89 vs. 88 %, respectively (p = n. s.). The vessel length detected with the automatic and manual approach were highly correlated for the left main/left anterior descending (143 +/- 30 vs. 146 +/- 24 mm, r = 0.923, p < 0.001), left circumflex (94 +/- 35 vs. 93 +/- 33 mm, r = 0.945, p < 0.001), and right coronary artery (145 +/- 36 vs. 144 +/- 37 mm, r = 0.925, p < 0.001). The time required to create reformations along the coronary arteries was significantly shorter with the automatic tool compared to the manual approach (203 +/- 77 vs. 391 +/- 104 sec, p < 0.005). In 90 % of the coronary branches automatic detection required less time than the manual approach. CONCLUSION: Automatic coronary vessel detection is feasible and reduces the time required to create reformations by a factor of approximately two without deteriorating the diagnostic accuracy.

Aged↗
PubMed2004

Early postoperative ultrasound of kidney transplants: evaluation of contrast medium dynamics using time-intensity curves.

OBJECTIVE: To evaluate kidney recipients in the early posttransplant phase by semiquantitative analysis of the arterial arrival of ultrasound (US) contrast medium using time-intensity curves. PATIENTS AND METHODS: Twenty-two kidney recipients underwent US examination after intravenous bolus administration of 2.4 ml of US contrast medium (SonoVue, Bracco Altana) 5 to 7 days after transplantation. The examinations were performed with the Aplio US system (Toshiba) and a 3.5-MHz wideband transducer using contrast harmonic imaging at a low mechanical index of 0.1. Arterial arrival was documented digitally over 60 sec (image repetition rate: 10 images per sec) for subsequent evaluation of contrast medium kinetics in the main renal artery, interlobar artery, subcapsular area, and renal vein using the system's integrated time-intensity curve (TIC) software. The increase, decrease, and percentage enhancement factor were calculated from the curves. Four patients were excluded from analysis because of perirenal hematoma (n = 3) or a polar perfusion loss demonstrated by power Doppler (n = 1). RESULTS: Twelve of the remaining 18 patients assigned to the nonrejection group showed an uneventful clinical course. These had uniform TICs with an early and steep increase of similar magnitude in the main renal artery (11.7 +/- 4.5 intensity units/sec), interlobar artery (8.7 +/- 4.6 intensity units/sec), and subcapsular area (8.3 +/- 3.7 intensity units/sec) followed by a washout and subsequent plateau phase. Six patients showed histologically proven acute rejection on day 5 or 6 after transplantation (rejection group). This group had a delayed (time to peak in the subcapsular area: 32.9 +/- 8.3 sec in the rejection group versus 20.9 +/- 4.7 sec in the nonrejection group, p < 0.05) and smaller subcapsular percentage increase (41.2 +/- 21.9 % versus 114.4 +/- 59.8 %, p < 0.05). In the rejection group the subcapsular area (3.8 +/- 2.3 intensity units/sec) showed a less pronounced increase than the main renal artery (7.9 +/- 5.9 intensity units/sec) and interlobar artery (8.7 +/- 3.8 intensity units/sec). The RI in the rejection group was in the normal range at the time of contrast-enhanced US (day 5: 0.78 +/- 0.06) and increased to abnormal levels in the further course (day 7: 0.94 +/- 0.09). CONCLUSIONS: Quantitative determination of arterial arrival of an US contrast medium in the early phase after kidney transplantation is possible. This new US procedure might identify acute rejection earlier than conventional techniques.

Adult↗
PubMed2004

[Preoperative MRT of the breast in invasive lobular carcinoma in comparison with invasive ductal carcinoma].

PURPOSE: To evaluate the role of preoperative MRI of the breast in invasive lobular carcinoma (ILC) compared to invasive ductal carcinoma (IDC). MATERIALS AND METHODS: For one year, all patients transferred by the hospital's gynecologic outpatient service for suspicious findings in routine mammography and/or ultrasound (conventional modalities = CM) underwent preoperative MRI of the breast. Retrospective analysis of the histologic findings identified 17 patients with ILC. These were compared with 30 proven IDC patients, chosen by random. The MRI findings of these 2 patient groups were compared with regard to the detection of additional lesions. The average number of additional lesions detected by MRI was compared for significant differences between both groups using the T-test for paired samples. RESULTS: In the 17 patients with ILC, conventional modalities (CM) identified 21malignant lesions whereas MRI detected a total of 30 lesions. At least one additional lesion was detected by MRI in 7 of the 17 patients with ILC. In the 30 patients with IDC, on the other hand, MRI detected an additional lesion in three instances only. In one patient of the ILC group, MRI identified an additional lesion in the contralateral breast that had escaped detection by CM. No additional contralateral lesion was detected by MRI in any of the IDC patients. Benefit of MRI in ILC-Group: The mean numbers of detected malignant lesions differed significantly between diagnosis by MRI and CM in the ILC group (1.77 carcinomas per patient with MRI versus 1.24 with conventional modalities, T-test, p = 0.0078). Benefit of MRI in IDC-Group: although it was possible to find 1.27 carcinomas vs. 1.17 carcinomas per patient in the IDC-Group, this benefit was not statistical significant (T-test, p = 0.0831). CONCLUSION: Preoperative MRI detects multiple additional lesions compared to the ones already known by CM. The higher incidence of multiple lesions in ILC compared to IDC and the difficult diagnosis of ILC in CM might be the reason for the fact that preoperative MRI is particularly useful in patients with ILC.

Breast↗
PubMed2004

[Evaluation of regional wall motion abnormalities of the heart--comparison with doppler tissue echocardiography, MR-tagging and levocardiography].

PURPOSE: To compare the visual analysis of magnetic resonance imaging (MRI) with the tagging technique and Doppler tissue echocardiography with invasive ventriculography in detecting and quantifying regional left ventricular wall motion abnormalities. MATERIALS AND METHODS: Sixteen patients with coronary artery disease and a history of prior myocardial infarction underwent invasive ventriculography, Doppler tissue echocardiography and MR-tagging within one week. Regional wall motion abnormalities (WMA) were detected in all patients. WMA were graded as normal = 1; hypokinetic = 2; akinetic = 3; or dyskinetic = 4. For agreement between MRI, echocardiography, and ventriculography the kappa coefficient (kappa) according to Cohen was calculated. RESULTS: The kappa coefficient (kappa) was 0.962 for agreement between MRI and echocardiography and 0.602 for agreement between MRI and ventriculography as well as between echocardiography and ventriculography. CONCLUSION: Reliable analysis of regional left ventricular wall motion abnormalities is feasible using visual analysis of MR-tagging. MRI and Doppler tissue echocardiography detect more WMA than invasive ventriculography and grade them as more severe.

Aged↗
PubMed2004

[Value of electron beam tomography (EBT)].

Electron beam tomography (EBT) has been scientifically evaluated to a much lesser degree for non-cardiac indications than for cardiac purposes. Therefore, four groups of investigators in Berlin (2), Mannheim and Munchen, which were supported by the Deutsche Forschungsgemeinschaft (DFG), included applications outside the heart in their evaluation of EBT technology. EBT has proven useful to look for pulmonary embolism and to assess other vessels (aorta, aortic branches, and intracranial arteries). Imaging of the lung parenchyma benefits from its intrinsic high contrast and from the fast data acquisition of EBT. Limited photon efficiency, higher radiation exposure, increased noise levels and other artifacts, however, markedly reduce the value of EBT for imaging of low contrast objects compared to conventional spiral CT and multislice CT (MSCT), compromising, in particular, the morphologic depiction of parenchymal abdominal organs and the brain. Consequently, scientific studies to further evaluate EBT for scanning of the brain and parenchymal abdominal organs were not pursued. Radiation exposure for non-cardiac EBT studies is up to three times higher than that for respective spiral CT studies, and in children EBT can only be advocated in select cases. Radiation exposure for the various prospectively triggered cardiac examination protocols of EBT is lower than that for conventional coronary angiography. Radiation exposure in cardiac multislice CT exceeds severalfold that of EBT, but the dose efficiency of EBT and MSCT are similar due to higher spatial resolution and less image noise of MSCT. In addition, modifications of MSCT (ECG pulsing) can further reduce radiation exposure to the level of EBT. Technical improvements of the EBT successor scanner "e-Speed" enable faster data acquisition at higher spatial resolution. Within comparative studies, the "e-Speed" will have to prove its value and competitiveness, particularly in comparison with multislice CT. After profound scientific assessment in a multicenter evaluation supported by the Deutsche Forschungsgemeinschaft (DFG) and regardless of the specific suitability of electron beam tomography for various cardiac and some non-cardiac indications, the investigators unanimously find the electron beam tomograph Evolution C150 XP not suitable as a whole body CT scanner.

Age Factors↗
PubMed2004

[Diagnostic value of electron-beam computed tomography (EBT). I. Cardiac applications].

Electron beam tomography (EBT) directly competes with other non-invasive imaging modalities, such as multislice computed tomography, magnetic resonance imaging, and echocardiography, in the diagnostic assessment of cardiac diseases. EBT is the gold standard for the detection and quantification of coronary calcium as a preclinical sign of coronary artery disease (CAD). Its standardized examination protocols and the broad experience with this method favor EBT. First results with multislice CT indicate that this new technology may be equivalent to EBT for coronary calcium studies. The principal value of CT-based coronary calcium measurements continues to be an issue of controversy amongst radiologists and cardiologists due to lack of prospective randomized trials. Coronary angiography with EBT is characterized by a high negative predictive value and, in addition, may be indicated in some patients with manifest CAD. It remains to be shown whether coronary angiography with multislice CT is reliable and accurate enough to be introduced into the routine work-up, to replace some of the many strictly diagnostic coronary catheterizations in Germany and elsewhere. Assessment of coronary stent patency with EBT is associated with several problems and in our opinion cannot be advocated as a routine procedure. EBT may be recommended for the evaluation of coronary bypasses to look for bypass occlusions and significant stenoses, which, however, can be equally well achieved with multislice CT. Quantification of myocardial perfusion with EBT could not replace MRI or other modalities in this field. EBT has proven to be accurate, reliable and in some instances equivalent to MRI, which is the gold standard for the quantitative and qualitative evaluation of cardiac function. Some disadvantages, not the least of which is the limited distribution of electron beam scanners, favor MRI for functional assessment of the heart.

Adult↗
PubMed2004

[Current state of uterine artery embolization for treating symptomatic leiomyomas of the uterus].

A number of new approaches in treating symptomatic leiomyomas of the Uterus have been introduced in recent years. Only little scientific data is available an percutaneous or laparoscopic myolysis using focussed ultrasound, laser, or coagulation guided by magnetic resonance imaging or an laparoscopic ligation of the uterine vessels by means of bipolar coagulation or clipping. Established therapeutic options are limited by a number of disadvantages, except for total laparoscopic hysterectomy with morcellation. The latter is a minimally invasive procedure that spares important pelvic structures and thereby reduces the risk of prolapse and is associated with rapid recovery of the patients. Another minimally invasive therapeutic approach with preservation of the uterus is transarterial catheter embolization of uterine leiomyomas in which the vessels supplying the leiomyomas, in particular the branches of the uterine artery, are partly occluded by injection of synthetic (polyvinyl) beads. Uterine artery embolization has since developed into a good alternative to other therapeutic options. Studies report cure rates ranging from 77-93 %.

Embolization, Therapeutic↗
PubMed2004

Evaluation of a wavelet-based computer-assisted detection system for identifying microcalcifications in digital full-field mammography.

PURPOSE: To evaluate a new wavelet-based computer-assisted detection (CAD) system for detecting and enhancing microcalcifications. MATERIAL AND METHODS: A total of 280 mammograms acquired by full-field digital mammography (Senographe 2000D; G.E. Medical Systems Milwaukee, Wisc., USA) were analyzed with and without a new wavelet-based CAD system for detecting and enhancing microcalcifications. The mammograms comprised roughly equal numbers of cases from each of the BIRADS (Breast Imaging, Reporting and Data System, according to the American College of Roentgenology) categories 1-5. Histologic confirmation was available for all of the 180 cases assigned BIRADS categories 3-5. Four readers interpreted all 280 images for suspicious microcalcifications using a scale of 1-5. The readers alternately assessed 5 images with and 5 without CAD. In a second reading immediately following the first, the readers had to reassess the 280 mammograms. The images that had already been interpreted without CAD were now presented with CAD and vice versa. The images were interpreted as soft copies on a diagnostic mammography workstation (Image Diagnost GmbH, Neufahrn/Munich, Germany). All images interpreted with CAD were presented with enhancement of microcalcifications by wavelet algorithms and prompting of microcalcifications. ROC (receiver operating characteristic) analyses were performed, and image interpretation time with and without CAD was measured. RESULTS: The overall time for interpretation required by all 4 readers together was 483 min with CAD compared to 580 min without CAD. ROC analysis revealed no significant advantage of CAD for the individual readers. Readers 3 (0.811/0.817) and 4 (0.799/0.843) had a slightly improved AUC (area under the curve) with CAD. Readers 1 and 2 had a slightly lower AUC with CAD (0.832 versus 0.861 and 0.818 versus 0.849). CONCLUSION: The CAD system significantly (P<0.05, t test) speeded up image interpretation with respect to the identification of microcalcifications, while the diagnostic quality remained almost identical under the study conditions.

Breast Diseases↗
PubMed2004

Unusual enhancement pattern of liver lesions in hepatosplenic candidiasis.

PURPOSE: To describe an unusual enhancement pattern of hepatosplenic candidiasis (HSC) liver lesions in biphasic spiral liver computed tomography (CT). MATERIAL AND METHODS: Twenty-one patients with suspected HSC were scanned with a biphasic liver CT perfusion protocol. The liver lesions detected were assessed for their morphology and enhancement pattern during both perfusion phases. A liver biopsy was performed in 11/21 patients. RESULTS: The majority of hepatic lesions in 15/21 patients showed the well-known abscess-like pattern. In 6/21 patients an uncommon central contrast enhancement with a peripheral double ring was detected in the arterial phase. In some cases the lesions showed decreased diameter or even seemed to disappear completely in the portalvenous phase. CONCLUSIONS: CT in the arterial phase showed an unusual enhancement pattern of liver lesions in HSC. Scanning only in the portalvenous phase implies possible pitfalls, because lesions may be overlooked or undersized. Therefore, biphasic liver CT is considered essential in the diagnosis and follow-up of HSC in clinical practice.

Adult↗
PubMed2004

Assessment of left ventricular volumes and function: intraindividual comparison of multi-slice spiral CT and electron beam CT in an animal model.

PURPOSE: To evaluate multi-slice spiral computed tomography (MSCT) for measurements of left ventricular volumes, ejection fraction (EF), and myocardial mass in comparison with electron beam CT (EBCT) as a reference method. MATERIAL AND METHODS: Six minipigs underwent both standardized contrast-enhanced MSCT (effective acquisition time per cardiac cycle 125.7+/-30.1 ms, reconstructed slice thickness 8 mm) and EBCT (acquisition time 50 ms, collimated slice thickness 8 mm). The contrast-to-noise ratio of the left ventricle was measured in each animal, and the contour sharpness of the myocardium was analyzed. Volumes (EDV, ESV, SV) ejection fraction (EF), and muscle mass were calculated by MSCT and by EBCT using the slice summation method. RESULTS: MSCT had a higher contrast-to-noise ratio and delineated the myocardial contours more sharply than EBCT. There was a close linear correlation between both modalities for all parameters (EDV: rP=0.88, ESV: rP=0.91, SV: rP=0.85, EF: rP=0.93; mass: rP=0.90; P<0.05 each). MSCT slightly overestimated ESV and slightly underestimated SV and EF compared with EBCT (P<0.05 each). CONCLUSIONS: Image quality in MSCT is superior to that of EBCT. Functional parameters correlate well between both modalities, but the accuracy of MSCT is limited by its lower temporal resolution.

Animals↗
PubMed2003

[Use of state-of-the-art ultrasound techniques in diagnosing sarcoidosis of the salivary glands (Heerfordt's syndrome)].

AIM: The parotid gland is a rare site of sarcoidosis (6% of all cases). The role of state-of-the-art ultrasound techniques in the diagnostic assessment of parotid sarcoidosis (Heerfordt's syndrome) is presented. PATIENTS AND METHODS: Four patients (three male, one female; aged 31-42 years) with inconclusive parotid swelling associated with fever and uveitis were referred for diagnostic assessment by the ENT outpatient service over a 1 year period. High-resolution ultrasound (US) was performed using the SONOLINE Elegra system with a 7.5-MHz wide-band transducer and various, special US techniques (tissue harmonic imaging, photopic imaging, color-coded duplex US, and power Doppler). Diagnoses were confirmed in all cases by puncture and histology. RESULTS: Two patients with typical lung findings (stage I and II sarcoidosis) and two patients without known sarcoidosis showed an inhomogeneous nodular appearance of the clinically enlarged salivary glands at US. Duplex US demonstrated hypervascularization in three cases and moderate, inhomogeneous vascularization in one. In comparison to plain B-mode scanning, optimal visualization of the hypodense, nodular, structural changes was achieved using contrast-enhancing techniques. All patients underwent US-guided puncture for determining the etiology of parotitis. Histology demonstrated granulomatous epitheloid cell inflammation. CONCLUSION: An inhomogeneous nodular appearance of the parenchyma of enlarged parotid glands with areas of hypervascularization, which is optimally depicted by state-of-the-art US techniques, should suggest Heerfordt's syndrome as a possible differential diagnosis.

Adult↗
PubMed2003

[Modern imaging modalities in renal disease: CT and MRI].

Considerable technical advances have been made in computed tomography (CT) and magnetic resonance imaging (MRI) over the last 10 years. Both modalities allow for high-resolution imaging of the entire abdomen before as well as during the arterial and parenchymal perfusion phase after intravenous contrast medium administration. Multiplanar reconstructions of the three-dimensional source data sets yield views in any spatial orientation. Maximum intensity projections enable the generation of CT or MR angiographies as well as CT or MR urographies from delayed images. Thus, both modalities today allow for comprehensive diagnostic evaluation of renal disease by a single examination comprising detailed visualization of the parenchyma as well as of arterial and venous vessels and assessment of excretion. CT and MRI thus enable efficient preoperative diagnostic assessment in particular in patients with renal masses.

Humans↗
PubMed2003

Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To localize inflammatory and chronic changes to defined areas in the sacroiliac joints in patients with early-stage compared with late-stage spondylarthritis (SpA), using magnetic resonance imaging (MRI). METHODS: Using MRI, 93 patients with SpA and inflammatory back pain who had radiographs of the sacroiliac joints were examined, comprising 31 patients with ankylosing spondylitis (AS) and 62 with other SpA subsets, including 48 with undifferentiated SpA (uSpA). MRI was performed using T1-weighted, T2*-weighted, STIR, and dynamic contrast-enhanced (gadolinium diethylenetriaminepentaacetic acid) sequences. Two readers retrospectively analyzed the images by differentiating 9 areas of the sacroiliac joints: the ventral and caudal joint capsule, cavum, subchondral bone, bone marrow, ligament entheses, and ligaments; the sacral and iliac sides were tabulated separately. RESULTS: By MRI, sacroiliitis was more often bilateral in AS (84%) than in uSpA (48%) (P = 0.01). Inflammatory changes were found in a mean +/- SD 4.7 +/- 2.9 regions/joint, with involvement of 4.5 +/- 3.2 regions in early disease versus 5.2 +/- 2.3 regions in late disease (P not significant [NS]). Involvement of the iliac side of the sacroiliac joints was found to be more frequent than the sacral side in early disease (58% versus 48%; P < 0.01) as compared with that in late disease (58% versus 63%; P NS). The dorsocaudal parts of the synovial joint and the bone marrow were the most frequently inflamed structures in early disease (P < 0.001 for ventral versus dorsal joint capsule). In contrast, involvement of the entheses was more common in advanced disease (early 43% versus late 86%; P < 0.001). Similarly, the ligaments were more frequently involved in the late stages (early 26% versus late 40%; P = 0.06). Both patterns of bone marrow inflammation (focal and diffuse) were observed in equal frequencies in early and late disease (17% and 42% versus 26% and 43%, respectively; P NS). HLA-B27-positive patients (n = 80) had more entheseal involvement than did HLA-B27-negative patients (n = 13) (60% versus 39%; P = 0.05). HLA-B27-negative patients had a shorter disease duration (2.2 years versus 4.4 years; P = 0.05) and were more often female (62%; P = 0.02). When all pathologic changes were assessed, the STIR sequence (performed in 62 patients) was less sensitive than the contrast-enhanced sequences in that it was not able to show all relevant changes in 27% of these patients (n = 17), failing to reveal inflammation of the cavum in 15 patients and of the bone marrow and joint capsule in 1 patient each. CONCLUSION: As visualized by MRI, sacroiliitis in SpA is characterized by involvement of different joint structures. Whereas the iliac and the sacral side of the sacroiliac joints are almost equally affected, the dorsocaudal synovial part of the joint is involved significantly more often than the ventral part, especially in early disease. Sacroiliac enthesitis is not a special feature of early sacroiliac inflammation.

Adult↗
PubMed2003

[Role of magnetic resonance imaging (MRI) in establishing the indication for, planning, and following up uterine artery embolization (UAE) for treating symptomatic leiomyomas of the uterus].

AIM: To describe the role of magnetic resonance imaging (MRI) in establishing the indication for, planning, and following up uterine artery embolization (UAE) for treating symptomatic leiomyomas of the uterus on the basis of the current literature and our results. MATERIAL AND METHODS: Retrospective analysis of the MRI findings obtained in 130 patients before and after UAE. Presentation of characteristic MRI features and their relevance in establishing the indication for, performing, and following up of UAE. Discussion of the results in conjunction with published data. RESULTS: The intermediate results of UAE reported in the literature show a successful improvement of leiomyoma-related symptoms in 82-94% of cases and an average reduction of leiomyoma size by 36-64%. The typical MRI appearance of degenerating leiomyomas is presented together with that of relevant differential diagnoses. MRI findings allow for establishing the indication for UAE by providing reliable information on the location, size, and number of uterine leiomyomas. Analysis of 60 patients of our study population showed solitary leiomyoma in 16% of cases, 2-10 leiomyomas in 47%, and over 10 in 37%. Subserosal, pedunculated leiomyomas cannot be treated by UAE; these were present in 5% of the patients. MR angiography is useful in assessing pelvic vascular anatomy before the intervention and identifies collateral vascular supply to the uterus. Contrast-enhanced imaging is suitable for monitoring successful devascularization following embolization and evaluating complications.

Diagnosis, Differential↗
PubMed2003

Use of iodine-based contrast media in digital full-field mammography--initial experience.

AIM: To investigate the use of iodine-based contrast media in digital full-field mammography. METHODS: After performing initial phantom studies, seven patients underwent digital mammography (Senographe 2000D, GE Medical Systems, Milwaukee, USA) using a specially filtered beam before as well as 60, 120, and 180 seconds after injection of 80 ml of iodine contrast medium (Ultravist 370, Schering AG, Germany). The precontrast mammograms were then subtracted from the postcontrast mammograms and the resulting images compared with a contrast-enhanced dynamic MRI study, performed on all women. RESULTS: Contrast medium accumulation within the tumors was visualized with a good quality in all cases. The conditions under which successful contrast-enhanced digital mammography can be performed were determined in phantom studies. CONCLUSIONS: Contrast-enhanced digital mammography has a potential for improving the visualization of breast tumors in mammography using special beam filtering, adjusted x-ray parameters, proper timing, and suitable subtraction software.

Breast Neoplasms↗