Biomedical subjects
Publications and source records attributed to M Breitenseher.
In the assessment of shoulder joint abnormalities plain films must still be used today as primary imaging modality. For soft tissue, cartilage, tendon and ligament lesions, CT with arthrography and particularly MRI with arthrography is available today. Especially latter method leads to a significantly extended diagnosis, which in many cases implies a major therapeutical significance.
To determine whether estimates of volumetric bone density from projectional scans of the lumbar spine have weaker associations with height and weight and stronger associations with prevalent vertebral fractures than standard projectional bone mineral density (BMD) and bone mineral content (BMC), we obtained posteroanterior (PA) dual X-ray absorptiometry (DXA), lateral supine DXA (Hologic QDR 2000), and quantitative computed tomography (QCT, GE 9800 scanner) in 260 postmenopausal women enrolled in two trials of treatment for osteoporosis. In 223 women, all vertebral levels, i.e., L2-L4 in the DXA scan and L1-L3 in the QCT scan, could be evaluated. Fifty-five women were diagnosed as having at least one mild fracture (age 67.9 +/- 6.5 years) and 168 women did not have any fractures (age 62.3 +/- 6.9 years). We derived three estimates of "volumetric bone density" from PA DXA (BMAD, BMAD*, and BMD*) and three from paired PA and lateral DXA (WA BMD, WA BMDHol, and eVBMD). While PA BMC and PA BMD were significantly correlated with height (r = 0.49 and r = 0.28) or weight (r = 0.38 and r = 0.37), QCT and the volumetric bone density estimates from paired PA and lateral scans were not (r = -0.083 to r = 0.050). BMAD, BMAD*, and BMD* correlated with weight but not height. The associations with vertebral fracture were stronger for QCT (odds ratio [QR] = 3.17; 95% confidence interval [CI] = 1.90-5.27), eVBMD (OR = 2.87; CI 1.80-4.57), WA BMDHol (OR = 2.86; CI 1.80-4.55) and WA-BMD (OR = 2.77; CI 1.75-4.39) than for BMAD*/BMD* (OR = 2.03; CI 1.32-3.12), BMAD (OR = 1.68; CI 1.14-2.48), lateral BMD (OR = 1.88; CI 1.28-2.77), standard PA BMD (OR = 1.47; CI 1.02-2.13) or PA BMC (OR = 1.22; CI 0.86-1.74). The areas under the receiver operating characteristic (ROC) curves for QCT and all estimates of volumetric BMD were significantly higher compared with standard PA BMD and PA BMC. We conclude that, like QCT, estimates of volumetric bone density from paired PA and lateral scans are unaffected by height and weight and are more strongly associated with vertebral fracture than standard PA BMD or BMC, or estimates of volumetric density that are solely based on PA DXA scans.
Colour Doppler sonography allowed noninvasive confirmation of bilateral common carotid artery dissection in a patient with previous aortic dissection. It also cast light on the pathophysiology.
The purpose of this study was to determine precision and diagnostic capability of bone mineral density measurements using lateral dual-energy X-ray absorptiometry (DXA) of the lumbar spine in supine position. Duplicate postero-anterior (PA) and lateral DXA measurements were performed in 60 women. Precision errors of the single vertebral levels using lateral DXA ranged from 3.3% to 4.9%. The combination of all levels improved the precision errors to 2.0%. Paired PA and lateral DXA measurements (Hologic QDR 2000) including the vertebral levels L2 to L4 were performed in 331 postmenopausal women. In 42 women an overlap of L4 by the pelvis was suspected on the lateral DXA images. Vertebral fractures were assessed as a fracture/non-fracture dichotomy. L4 and combinations of vertebrae including L4 showed the best discriminatory capabilities with respect to vertebral fractures in receiver operating characteristic (ROC) analyses, t-tests and Z-scores, with smaller variability of the results when multiple vertebral levels were used. The areas under the ROC curves were 0.662 and 0.639 for lateral and PA measurements of L2 to L4, respectively when all women were included. Excluding the women with pelvic overlap on lateral DXA scans improved the ROC area for lateral scans to 0.686 while that for PA scans remained almost constant (0.641). The differences between PA and lateral measurements were not statistically significant. In 162 women of our study cohort an additional quantitative computed tomography (QCT) measurement of the vertebral levels L2 to L4 was performed and overlapping bony structures at the three levels were studied.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
Analysis of roentgenograms by location, pattern of destruction, classification of tumor matrix and periosteal new bone formation, together with clinical data, preserves valuable information for discrimination of neoplasms in the foot. Furthermore, specific information on tumor histology and tumor extension in the bone marrow and soft tissues can be obtained by CT and MRI. Preoperative staging, guided biopsy of tumor tissue, monitoring of chemotherapeutic response and postoperative observation are further indications for MRT and other modern imaging modalities.
For stress radiography, the inversion stress test can be performed during radiographic examination and widening of the lateral joint space can be measured quite accurately. However, there is no general agreement on the meaning of various degrees of talar tilt. Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. The appropriate combination of foot position and imaging plane is very important to achieve the best visualization of each ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-length visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the ankle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments We found that none of the patients in whom the angle of lateral tilt was less than 5 degrees had rupture of two lateral ligaments, while 32% of patients with angles of tilt of 6-14 degrees and 42% of those with angles of tilt over 15 degrees on stress X-ray had two ruptured lateral ligaments. When a stress X-ray with a 6-14 degrees angle of tilt suggests only slight ligamentous injury, MRI could be indicated in specific cases to allow identification of the 32% with rupture of two ligaments. The only practical means of imaging tendons is high-frequency ultrasound and MRI.(ABSTRACT TRUNCATED AT 250 WORDS)
Sinus tarsi syndrome is a well-defined clinical pathological entity. The sinus tarsi is an anatomic space between the inferior aspect of the talus and the superior aspect of the calcaneus, anterior to the posterior subtalar joint. The entire space is filled with fat, five ligaments and vessels. MRI demonstrates characteristic findings with obliteration of normal fat and lack of visualization of the ligaments. This syndrome is relatively frequent and is related to trauma in about 70% in association with the lateral collateral ligament and tibialis posterior tendon injuries. In the remaining 30% the reason is an inflammatory condition.
Clinical findings and symptoms of tarsal tunnel are commonly vague and diffuse and electrodiagnostic studies do not provide definitive diagnosis. MR imaging with its excellent soft tissue contrast can demonstrate clearly the anatomy of the tarsal tunnel and its contents. MRI is able to demonstrate a space-occupying lesion and its relationship to the posterior tibial nerve and its branches. This information aids in surgical planning by determining the extent of the decompression required. MR imaging may also be used to follow up non-surgical causes of tarsal tunnel syndrome such as tenosynovitis.
Ultrashort turbo spin-echo sequence (TSE) has the advantage of shorter scan times, minimizing motion artifacts, but has the disadvantage of a lower signal-to-noise ratio and suffers from different artifacts. T2-weighted ultrashort TSE (echo train 24) and TSE (echo train 11) were compared in degenerative lesions of the spine (n = 9) and ligamentous lesions associated with sprained ankle injuries (n = 5). The imaging quality of ultrashort TSE was very similar to TSE. There was no difference in diagnostic reliability with ultrashort TSE compared to TSE in the spine or ankle. With regard to contrast properties a higher signal intensity of fatty bone marrow was obtained with ultrashort TSE, with consecutive lower contrast between fluid and edema on the one hand and fatty tissue on the other.
In a retrospective study of 21 children with portal hypertension (P. H.) four patients (19.2%) presented with gallbladder varices as documented by colour-coded Doppler sonography (CCDS) gallbladder varices (GV). Three of four patients with GV had portal vein thrombosis, one patient had cholestatic cirrhosis. Thickening of the gallbladder wall with serpentine anechoic structures was visible in all cases. Blood flow could be documented within the widened veins of the gallbladder wall in 3 of the 4 patients with duplex Doppler US, but in all patients with CCDS. US follow-up studies within 3-5 years were done on 2 patients and showed that GV appeared 2 years after the clinical diagnosis of P. H. With CCDS, varices of the gallbladder wall may be diagnosed readily and differentiated from other diseases associated with thickening of the gallbladder wall.
The retrospective study under report assessed the diagnostic capability of colour Doppler sonography (CDS) with measurement of the resistive index (RI) in the long-term follow-up of patients with renal allografts. 210 CDS examinations were performed in 115 patients. The time since transplantation ranged from 6 months to 22 years. The RI was correlated to laboratory parameters of renal allograft function (serum creatinine, urinary protein levels and serum-cyclosporine). In 97 of 210 examinations, serum creatinine was elevated (> 1.5 mg% or an increase of more then 0.3 mg% within the last 6 months). In 35 out of these examinations RI was > 70%, in 62 RI was < or = 70%. Thus, with a threshold RI of 70%, sensitivity of the RI in the diagnosis of renal allograft dysfunction is 36% and specificity 62%, respectively. There was no significant difference in the RI between examinations of allografts with normal function (68.2% +/- 7.5%) and those with dysfunction (68.5% +/- 8.5%). Furthermore, there was no significant correlation between the RI and any of the laboratory parameters. CDS with calculation of the RI cannot differentiate in the long-term follow-up between allografts with normal function and those with dysfunction.
In a retrospective study, 198 contrast venographies were evaluated by two blinded observers for quality of opacification of the venous system and quality of documentation. There was good correlation between the two observers in 91% of the cases. They found an adequate contrast quality in 183 cases (92.4%), while in 15 cases (7.6%) incomplete contrast was found in some parts of the calf or pelvic veins. Most venograms (195, or 98.5%) were adequately documented. In conclusion, contrast venography is an excellent method for evaluation of the venous system, if performed adequately. Nevertheless, there is room for improvement of both technique and documentation.
The ultrasonographic (US) appearance of Achilles tendon was examined in 34 patients with hypercholesterolemia (10 with familial (FH), and 24 with secondary hypercholesterolemia (SH)), and in 22 patients with normal tendons. US findings were compared with clinical, laboratory, and radiologic results. In patients with FH, typical xanthomas in the form of hyperechoic tendinal tumors were found in only 15% while various forms of inhomogeneity of tendon structure without xanthoma formation were found in 75%. The high rate of tendon inhomogeneity may be due to the concomitant occurrence of both xanthomas and degeneration of tendon fibers. Physical examination revealed abnormalities in 60% of these patients. At CT of the tendons, abnormalities were found in 65% of the FH patients and in 40%, abnormalities were shown by plain radiography. In SH, the results did not differ significantly from normal controls. In our opinion US should be used to prove or rule out Achilles tendon abnormalities in patients with FH for prophylaxis and treatment of tendinitis and tendon rupture.
In a prospective study we proved the value of high-resolution computed tomography (HRCT) and the CT scoring system developed by Stiglbauer et al. on 47 young patients suffering from cystic fibrosis (CF) (median age: 10.1 years). The most frequent pulmonary finding was bronchial wall thickening (BWT) in 43 patients (94.6%), followed by bronchiectasis (BE) in 36 patients (79.2%). A less frequent finding was ill-defined patchy consolidation (39.6%). We found an almost even distribution of BWT and BE in the upper and lower lobes of the lung. These two findings were scored according to their severity and extent. The maximum possible score for BWT and BE was 72 in a single patient. For both the overall score was 19.9 +/- 11.1. A statistically significant correlation of the CT scoring system with the lung function tests FEV1/FVC (P = 0.03) and MEF50 (P = 0.02) was found. The results of HRCT and the CT scoring system were shown to be valuable methods in the assessment of pulmonary changes, in young patients suffering from CF.
In a prospective study 54 patients with 62 saphenous vein arterial bypass grafts were examined by colour-coded Doppler sonography and angiography. Five cases of graft occlusion were diagnosed by colour-coded Doppler sonography and confirmed by angiography. In comparison with angiography, colour-coded Doppler sonography showed a sensitivity of 92% and a specificity of 100% in the detection of focal graft stenosis. Only two stenoses in the region of the distal anastomosis could not be detected by colour-coded Doppler sonography. In 28 cases a marked dilatation of the proximal anastomosis was found corresponding to the surgically used patch angioplasty. Within this dilated bypass segment, turbulence and flow reversal zones were demonstrated, which might be predisposing factors for graft stenosis. Colour-coded Doppler sonography can accurately detect saphenous vein arterial bypass graft stenoses and should be routinely used in postoperative screening.
The value of colour Doppler sonography in the diagnosis of renal artery stenosis has been studied retrospectively. 17 patients were examined (34 main renal arteries and 7 accessory renal arteries; ages 37 to 84 years; 7 males and 10 females). We studied 1) ability to study the main renal arteries, 2) visibility of accessory renal arteries and 3) the sensitivity and specificity of colour Doppler sonography for the diagnosis of renal artery stenosis. The results were compared with intraarterial angiography. Demonstration of the main renal arteries with colour Doppler sonography was possible in 23 of the 34 vessels. Not a single of the 7 accessory renal arteries was demonstrated by colour Doppler sonography. Of 8 angiographically demonstrated stenoses (more than 50% narrowing) 2 were missed by colour Doppler sonography. One stenosis was correctly diagnosed and 5 were incorrectly evaluated by sonography. 16 out of 18 angiographically normal main renal arteries were correctly evaluated by colour Doppler sonography but 2 showed a false positive finding. This results in a sensitivity of 17% and a specificity of 89% per kidney. Colour Doppler sonography cannot be recommended as a screening method for renal artery stenosis in view of its limited accuracy.
The diagnostic value of pulsed Doppler sonography for the detection of renal artery stenosis was questioned by recent studies. Until now, the diagnostic value of colour-coded Doppler sonography of the renal arteries is not clearly defined in relation to pulsed Doppler. This study deals with specific problems of colour-coded Doppler sonography in the examination of the renal arteries. Because of basic technical principles of colour-coded Doppler sonography a stenosis can be imitated especially at the origin of the right renal artery by using a ventral approach to the vessel. This pseudo-stenosis is due to a change of colour similar to an aliasing-phenomenon in a curved vessel. In order to avoid false positive results, a laterodorsal approach to the vessel should be applied additionally. A spectral waveform should be also registered routinely.