[Dens axis fracture, spinal pain and hematemesis].
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Biomedical subjects
Publications and source records attributed to M Meves.
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In a nation-wide multicentre study, the use of MRI was examined in its clinical context and in relation to other imaging methods and as a routine examination. It was found that examinations of the brain and spine were predominant. MRI is accurate for certain problems affecting the extremities, the pelvis and the liver. The findings also show that there are still technical limitations. A high degree of accuracy can only be obtained if there is adequate information concerning individual problems. Technical limitations include the frequent appearance of artifacts. In its present state, MRI can only supply additional information, concerning the trunk only, in certain situations. The study also outlines the development of MRI and the role of other conventional diagnostic procedures.
Within the framework of a national multi-centre study the spectrum of application and the ranking of magnetic resonance tomography were investigated. Although scans of the brain and vertebral column still dominate the scene, it has become evident that whole body scanning via MR can be very accurate for certain indications. This is particularly true for examinations of gynaecological diseases (95%) and for lesions of the liver (97%). However, the number of problems in which MR can provide answers to diseases in the whole body range is still limited, and hence it would be most desirable to achieve further instrumental and methodical improvements.
Within the framework of this study, the factors that impair the value of MR scans were also investigated and analysed. It was found that artifacts occurred in a large number of examinations that exercised a negative effect on the results. Artifacts are particularly seen in the thorax (54%) and upper abdomen (57%), but they have also been reported in 23% of the CNS examinations. The sources of such artifacts were mainly movements in the investigated layer, whereas other causes were negligible. In the 21,633 examined patients no undesirable effects caused by the examination were noted that would have impaired the patient or the course of the study. On an average, 88% of the examinations were performed with normal tolerance of the examination. In the remaining cases there was motor unrest or claustrophobia requiring special measures, thus hampering the course of the examination.
MR examinations of the extremities occupy the first place in whole body examinations via MR. Highest accuracy quotas in this area with an average of 93.8% were obtained for tumours, trauma and necroses of the bones. These high accuracy quotas, however, were achieved only if sufficient preliminary information was available. Other statistically significant factors were found to be the field strength, the combined use of spin echo and fast imaging sequences and the use of the multislice technique.
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Methods and possibilities of application of a doubled and interlaced pulse sequence ("interlaced sequence") are discussed. This makes it possible to perform contrast variations and pulse sequence variations subsequently, as well as to determine the parameters proton density, T1 and T2. The selectivity of the combination of all three parameters for tissue classification is demonstrated by means of an individual case and seems to promise a higher specificity of MR tomography.
A multiple spin-echo-sequence has been evaluated in diagnosis of demyelinating diseases. TE in these MR-experiments was between 14 and 336 msec, TR between 860 and 1660 msec. Three groups of patients were examined, and it could be shown that the probability to detect MS-plaques grows with long TE's up to 300 msec. T2-relaxation-time-values range between 126 and 250 msec. Different MS-plaques in the same patient might show different T2-values.
Analyses of T2 values (spin-spin relaxation time constant) in magnetic resonance tomography were carried out in 29 patients with brain tumours. 21 of these had tumours of the glioma group (17 astrocytomas WHO I-III and oligoastrocytomas, 4 glioblastomas). Measurements were effected both pixel by pixel and according to relevant ROI (regions of interest). Although the measurements yielded a T2 value which was typical of the disease, it was individually difficult to effect proper grading on account of the scatter occurring from case to case. Markedly more relevant information was obtained by the introduction of profile measurements in T2 images. The relation between T2 profile and histology of the gliomas permits rough grading between more or less differentiated gliomas.
The image quality of MR tomography, which is of particular value in diagnosis, is due to the possibility offered by MR of presenting a maximum of intrinsic biological information via suitable configuration of equipment and adjustment of parameters. Contrast resolution and spatial resolution are closely linked in this presentation. In the near future we may expect to be able to quantify the MR parameters rho, T1 and T2. Unconventional and newly developed impulse sequences will reduce the time required for an examination, which is at present still rather high at more than an hour. Hence, standardisation of data acquisition will be developed further, together with subsequent weighting of the MR parameters specifically according to findings. This will be achieved via computer-assisted evaluation and assessment.
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The secretory and motor function of the stomach and gastrin incretion were investigated in 68 patients with peptic ulcer of variable localization. In addition, a retrospective analysis of the course of prepyloric gastric ulcer and Billroth I resection was performed in 62 patients. Results show that gastric acid secretion and velocity of gastric emptying diminish significantly with increasing height of the localization of the ulcer. Prepyloric gastric ulcer cannot be likened to the duodenal ulcer. Moreover, experimental and clinical results suggest that prepyloric ulcer represents a disease entity per se requiring separate therapeutic approaches (gastric resection following Billroth I).
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In two patients with carcinoid syndrome and liver metastases embolization of the hepatic arteries was successful. In one case re-embolization was accomplished after one year. Embolization was followed by diminuation of serotonin-metabolites in the urine. The clinical symptoms improved, resulting in better quality of the patients lives. Embolization is to be preferred to application of systemic cytotoxic medication in cases of carcinoid syndrome with disseminated liver metastases.
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The use of CT has rarely reported in the work-up of cardiac patients. A case of a tumor in the wall of the left ventricle is reported which was much better visualized in regard to size, shape, and density by CT than by cardiac scanning and angiography.