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R Felix

Publications and source records attributed to R Felix.

At least 343 records · Page 19Linked to original sources
PubMed1997

Accuracy of staging rectal tumors with contrast-enhanced transrectal MR imaging.

OBJECTIVE: Our objective was to evaluate the accuracy of contrast-enhanced transrectal MR imaging in staging rectal adenoma and carcinoma by correlating with histopathologic findings. SUBJECTS AND METHODS: Thirty-five patients underwent transrectal MR imaging on a 1.5-T superconducting unit using unenhanced T1-weighted and T2-weighted spin-echo and turbo spin-echo sequences, a dynamic gadopentetate dimeglumine-enhanced turbo fast low-angle shot sequence, and enhanced T1-weighted spin-echo sequences. For all patients, histopathologic correlation was available from biopsy (n = 15) or surgical resection (n = 20). Two radiologists unaware of each other's interpretations of the scans interpreted each case from which we evaluated qualitative and quantitative data. RESULTS: Rectal adenomas (n = 15) were identified when imaging revealed an intact muscularis mucosae, a homogeneous internal structure, and high contrast enhancement of the lesion. Carcinomas staged as T1 by TNM criteria (n = 6) were best revealed by dynamic turbo fast low-angle shot sequences, in which an intact muscularis propria could be seen. Visualization of enhancing tumor tissue in the muscularis propria indicated T2 carcinoma (n = 5). All T3 (n = 5) and T4 (n = 4) carcinomas were correctly staged with dynamic and static MR imaging. The stage revealed by MR imaging correlated well with histologic staging results in 89% (observer 1) and 86% (observer 2) of interpretations. However, when interpreting MR imaging, observers tended to overstage and never understaged. CONCLUSION: Transrectal surface-coil MR imaging provided reliable information in staging patients before surgery and in evaluating rectal adenoma and carcinoma.

Adenoma, Villous↗
PubMed1997

["Second opinion" in online radiology via Internet: report on implementation and analysis of reliability of findings in sectional images].

Numerous medical on-line services have already been established in the world-wide internet. In connection with the Information service TELESCAN, sponsored by the EU, a pilot project has been initiated which offers a radiological "second opinion" via the transmission of radiological findings and images that have been previously rendered anonymous. In addition to a description of the basic implementation, tests of the diagnostic certainty of the transmitted cranial computed tomographs have been performed. The CT images were digitized with a document camera, transmitted over the Internet, and then evaluated on the receiver's monitor. Both the transfer of originally generated digital image files (in ACR-NEMA or DICOM) as well as graphic files after digitization of X-ray films, for example by a document camera, is possible via electronic post (e-mail). Visualization by the receiver requires the use of current proprietary software for special medical image formats, while standard graphic formats such as GIFF or JPEG can be visualized with the usual Internet software. In an ROC analysis, 56 individual images of cranial computed tomographs, half with pathological findings such as space-occupying lesions, infarcts, or brain edema, were tested with regard to the diagnostic certainty after digitization and transmission. In comparison with the original film findings, there was a slight but statistically not significant reduction in diagnostic certainty of the images evaluated on screen after transfer via the Internet. We believe that this result is due to the low local resolution, low dynamic range, the high image noise and of CT arising from the window technique. The same parameters are probably valid for MRI. The result cannot be applied to conventional radiography including mammography because, in comparison to the mentioned image techniques, their local resolution is high and image noise is considerably lower.

Computer Communication Networks↗
PubMed1997

[Initial nuclear magnetic resonance tomography results of the treatment course of avascular femur head necrosis after femoral core decompression].

The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head.

Adult↗
PubMed1997

Imaging of the orifice of the left ventricular outflow tract: technique and initial results.

The mechanism of left ventricular outflow tract (LVOT) obstruction in the patient after mitral valve replacement or repair was examined with the aid of 2D echocardiography. For the interpretation of the spatial relationship between the aortic root and mitral annulus, however, the 2D display is sometimes inadequate since it may not simultaneously capture these structures in each center. We developed a method to clarify this relationship in 3D based on magnetic resonance images. We defined the office of the left ventricular outflow tract (LVOT orifice), consisting of, in turn, a muscular region, i.e., edge of the interventricular septum, and an annular region, i.e., the annulus of the anterior mitral leaflet. In this paper we present image data obtained from one of eight normal subjects examined and compare this with data of one of two patients who preoperatively suffered degenerative mitral regurgitation and subsequently underwent chordal-preserving mitral valve replacement, in which anterior chordae were reattached to the anterior annulus. In the normal subject, the mitral annulus exhibited a flexible change in shape during the systole, maintaining sufficient LVOT orifice size. In the patient, the prosthetic valve exhibited translational motion during systole, resulting in dynamic LVOT obstruction. This phenomenon was also observed in one other case. Furthermore, the lateral view of the LVOT orifice revealed a projection of the prosthetic valve into the LVOT, causing mechanical LVOT obstruction. The finding that translational motion of the prosthetic valve with an inflexible mitral annulus results in dynamic LVOT obstruction may support the hypothesis that annular rigidity causes dynamic LVOT obstruction after mitral valve repair with a rigid prosthetic ring.

Adult↗
PubMed1997

MR of the eye with retrobulbar anesthesia.

MR imaging with retrobulbar anesthesia was performed in eight patients with uveal melanoma. Injection of 2 mL prilocain hydrochloride in 2% epinephrin into the eye muscle cone resulted in improved image quality in seven patients, without side effects. Ocular MR imaging can be indicated to clarify indeterminate sonographic findings in cases of extrascleral growth or to exclude optic nerve invasion in patients with tumors located at the posterior pole of the globe.

Anesthesia, Local↗
PubMed1996

Expression and subunit interaction of voltage-dependent Ca2+ channels in PC12 cells.

Nerve growth factor (NGF)-induced differentiation in PC12 cells is accompanied by changes in the expression of voltage-dependent Ca2+ channels. Ca2+ channels are multimeric complexes composed of at least three subunits (alpha1, beta, and alpha2delta) and are involved in neuronal migration, gene expression, and neurotransmitter release. Although attempts have been undertaken to elucidate NGF regulation of Ca2+ channel expression, the changes in subunit composition of these channels during differentiation still remain uncertain. In the present study, patch-clamp recordings show that in addition to the previously documented L-type and N-type Ca2+ currents, undifferentiated PC12 cells also express an omega-agatoxin-IVA-sensitive (P/Q-type) component. In addition, the corresponding mRNA encoding the pore-forming alpha1 subunits for these channels (C, B, and A, respectively) was detected. Likewise, mRNA for three distinct auxiliary beta subunits (1, 2, 3) were also found, beta3 protein being dominantly expressed. Immunoprecipitation experiments show that the N-type Ca2+ channel is associated with either a beta2 or beta3 subunit and that NGF increases the channel expression without affecting its beta subunit association. These results (1) indicate that the diversity of Ca2+ currents in PC12 cells arise from the expression of three distinct alpha1 and three different beta subunit genes; (2) support a model for heterogenous beta subunit association of the N-type Ca2+ channel in a single cell type; and (3) suggest that the regulation of the N-type Ca2+ channel during NGF-mediated differentiation involves an increase in the number of functional channels with no apparent changes in subunit composition.

Animals↗
PubMed1996

Local hyperthermia of N2/N3 cervical lymph node metastases: correlationof technical/thermal parameters and response.

PURPOSE: Patients with advanced head and neck carcinomas, primarily nonresectable as well as recurrent cases, were treated in multimodality regimens with radiotherapy, chemotherapy, and local hyperthermia. Commercially available microwave and radiowave applicators were used in 50 patients with N2/N3 cervical lymph node metastases during more than 250 heat treatments. To assess technical suitability, the achieved power densities and thermal parameters were tested for correlation with anatomical and geometrical factors. To assess effectiveness, the response was compared with derived parameters of the achieved temperature distributions. METHODS AND MATERIALS: The temperature measurement points (in thermometry catheters) documented by computerized tomography are labeled according to tissue depth, shielding by osseous structures, and location in relation to the external applicators. Relative and absolute specific absorption rates (SAR) and cooling coefficients are extracted from the temperature-time curves. Time-averaged temperature-position curves are evaluated to obtain index temperatures (T90, T50, T20), minimum/maximum tumor temperatures, cumulative minutes T90 > or = 43 degrees C, and 43 degrees C-equivalent min T90. Radiation dose, treatment time, and chemotherapy regiment are also considered. A response parameter is defined using the pre- and posttherapeutic tumor volumes. A multivariate variance analysis is performed for the dependent variables power density, thermal parameters, and response. RESULTS: A significant correlation exists between power density and absorption, presence of a fat layer, and applicator illumination. The maximum depth is 5 cm, where SAR of >= 10 mW/g are registered. Achieved temperatures at individual measurement points are dependent on the SAR, and to a lesser extent, the perfusion-dependent cooling coefficients, but the index temperature T90 is only significantly related to intratumorally achieved SAR. The thermal gradient (T20-T50) and temperature peak (T20) are significantly influenced by the tumor volume. The response is directly related to the index temperature T90, equivalent minute T90 43 degrees C, and cumulative minutes T90 > or = 40.5 degrees C, and inversely related to the tumor volume. CONCLUSIONS: Local hyperthermia using microwave and radiowave applicators in the head and neck region is a tolerable and clinically practical supplementary therapy used as part of multimodal regimens, and has already been proven to be effective. However, the analyses also demonstrated the limits of currently available technology, and confirm the need for continued methodical research.

Adult↗
PubMed1996

Synthesis of membrane- and matrix-bound colony-stimulating factor-1 by cultured osteoblasts.

Colony-stimulating factor-1 (CSF-1) is synthesized as a secreted or membrane-bound molecule. We investigated whether osteoblastic cells produce these forms of CSF-1. Glutaraldehyde-fixed cell layers supported proliferation of the macrophage cell line BAC1.2F5, suggesting the presence of membrane- or/and matrix-associated CSF-1. Furthermore, CSF-1 activity could be either extracted from the matrix or released from the cell membrane. A neutralizing antiserum against CSF-1 inhibited these activities. After labeling the cellular proteins with [35S] met/cys or [35S] SO4(2-), CSF-1 was immunoprecipitated and analyzed by SDS-PAGE. Under nonreducing conditions, bands with MW more than 200, 200, 100, and 50 kd were detected. These bands shifted to lower MW under reducing conditions. Treatment with chondroitin lyase ABC decreased the MW of the 200 kd monomer, proving the proteoglycan structure. Much smaller quantities of CSF-1 were found in the matrix extract than in the conditioned medium. Transforming growth factor beta (TGF-beta) increased both the synthesis of CSF-1 and its accumulation in the matrix. CSF-1 released with trypsin from the membrane fraction yielded on SDS-PAGE a band with MW of 60 and 30 kd under nonreducing and reducing conditions, respectively. Transcripts encoding both the secreted and the membrane-associated forms of the cytokine were detected in osteoblasts by reverse transcription polymerase chain reaction. These data indicate that osteoblastic cells produce the secreted forms, either remaining in the culture supernatant, or being associated to the matrix, and the membrane associated form of CSF-1.

Animals↗
PubMed1996

Hyperthermia in the multimodal therapy of advanced rectal carcinomas.

The synergistic effects of hyperthermia (raising temperatures to 40 degrees C and above) when combined with radiotherapy and cytotoxic drugs and a modulation of immunological phenomena have been demonstrated in the laboratory. Pre-clinical data relating to hyperthermia are summed up, along with their implications for clinical application. Controlled studies of local and regional hyperthermia have been performed during recent years, and these show us that the adjunction of hyperthermia provides at least an improvement of local control compared with radiotherapy alone. Current clinical results are summarized. Therapy systems based on radiowave irradiation have been commercially available for regional hyperthermia of the pelvis since the mid 1980s. This technology allows us to perform sufficiently tolerable and effective regional hyperthermia on rectal carcinomas. Used as part of curative preoperative and postoperative multimodal therapeutic strategies, hyperthermia can lead to improvement in local control (resectability, down-staging, progression-free time, recurrence rate), at least for certain risk groups. The preoperative radio-chemo-thermotherapy of advanced primary and recurring rectal carcinoma, uT3/4, was tested in a phase-I/II study of 20 patients. Therapy procedure, acute toxicity, thermal parameters, and response are described and discussed for this patient group. The regimen proved to be sufficiently tolerable, and complications did not occur. Tumor resection was performed on 14 of the 20 patients; 13 of the procedures were R0-resections and one was an R2 resection. In 64% of the resected rectal carcinomas, histopathological down-staging of the pretherapeutic endosonographical stadium was achieved; in three of the patients, despite continued non-resectability, local control has now been maintained for more than 12 months. In two patients with nonresectable rectal carcinomas, local progress was seen during the neoadjuvant combination therapy.

Clinical Trials as Topic↗
PubMed1996

Radiological modalities in the staging of colorectal tumors: new perspectives for increasing accuracy.

The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced endorectal MRI for the staging of rectal adenoma versus rectal carcinoma in correlation to findings from biopsy and histopathology. Ten volunteers and 20 patients underwent body-coil and endorectal MRI (1.5T supraconducting unit) using plain, T1-weighted (w) T2-w SE and TSE-w sequences, a dynamic Gd-DTPA enhanced protocol (turboFLASH), and postcontrast T1-w-SE sequences. Histopathological correlation via biopsy (n = 10) and surgical resection (n = 19) were conducted for all patients. An independent, two-observer, reader evaluation was performed and qualitative and quantitative data calculated. In volunteers and all patients endorectal MRI reliably delineated normal wall layers. Rectal adenomas (n = 7) were identified by a visualization of an intact muscularis mucosae, a homogeneous inner structure, and a significant contrast enhancement. T1 carcinomas (n = 4) were best identified in dynamic turboFLASH sequences by delineation of an intact muscularis propria. The visualization of contrast-enhancing tumor tissue was indicative of a T2 carcinoma (n = 4). All T3 (n = 3) and T4 (n = 2) carcinomas were correctly staged on dynamic and static MRI. The endorectal MRI stage agreed with the staging results from pathological study in 16 of 20 (80%) patients. Endorectal surface coil MRI provides reliable data for the preoperative staging and evaluation of rectal lesions.

Adult↗
PubMed1996

Fast spin-echo MR imaging of the eye.

Magnetic resonance imaging of the eye usually includes T2-weighted images both for screening purposes and for characterization of melanoma. Conventional T2-weighted spin-echo (SE) imaging suffers both from long acquisition times and incomplete recovery of the vitreous' signal. A fast SE sequence was therefore compared prospectively with conventional sequences in 29 consecutive patients with lesions of the eye. Fast SE images delineated melanoma and other lesions of the eye from vitreous better than conventional T2-weighted images. Image quality and lesion conspicuity were improved on the fast sequence. Whereas melanoma appeared hypointense to vitreous on both types of images, subretinal effusion was hypointense on fast images and hyperintense on conventional T2-weighted images. Ghosting of the globe, which, however, did not decrease diagnostic value, was more pronounced on fast images. Conventional T2-weighted images may be replaced by fast SE images in MR studies of the eye with a gain in lesion conspicuity and significant time saving.

Eye Neoplasms↗
PubMed1996

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations.

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.

Adult↗
PubMed1996

Epidural lipomatosis: case report and literature review.

We report a case of symptomatic epidural lipomatosis in a 36-year-old man following a heart lung transplant and 3.5 years of steroid medication. A review of the pertinent literature emphasises the importance of including this diagnosis in the differential diagnosis of patients receiving steroid medication or markedly obese patients with back pain or symptoms suggesting spinal cord or cauda equina compression.

Adult↗
PubMed1996

Cardiac activation mapping by MRI.

To establish cardiac MRI as a tool for noninvasive evaluation of activation patterns, 10 healthy volunteers were examined by cine segmented turboFLASH imaging sequences. Sequence modifications for low signal blood-pool appearance were applied, i.e., bilateral spatial saturation for segmented turboFLASH imaging. Pixelwise calculation of first-harmonic Fourier phase values (displayed as color-encoded maps) reveal either anterior septal or left ventricular free-wall sites as areas of earliest phase spreading towards posterior paraseptal sites in segmented turboFLASH scans. Phase scatter is lower in unsaturated than spatially presaturated segmented turboFLASH studies. Phase standard deviation in areas of endocardial displacement is higher in basal than apical slice positions in these scans. Early results indicate that first-harmonic Fourier phase analysis of cardiac-segmented turboFLASH MRI cine studies may provide a tool for noninvasive studies of cardiac activation sequence.

Adult↗
PubMed1996

Applications of specialized coils for high-resolution MRI on a whole-body scanner.

To investigate the application of a mini-coil surface system for high-resolution MRI, 60 volunteers were examined in a 1.5-T whole-body scanner. Two replaceable probe heads were available: a circular 2.5-cm coil and a quadratic 5-cm coil, both of which were placed directly on the skin. The skin layers, Achilles tendon and finger joints were examined with the 2.5-cm coil and a FOV of 25 X 25 mm2. A matrix of 256 pixels resulted in a pixel size of 0.098 X 0.098 mm2. For imaging of the carpal tunnel, the 5-cm coil was used in transverse orientation. The FOV was 50 X 50 mm2 so that a matrix of 256 X 256 pixels led to a pixel size of 0.195 X 0.195 mm2. The resulting spatial resolution permitted visualization of the epidermis, dermis and subcutis, resulting in clear definition of anatomical detail of the musculoskeletal system. MRI measurement of skin-layer thickness did not correlate with histometric data (p < 0.05). This discrepancy was due in part to shrinkage of the tumor specimen on histologic preparation. Other causes include the motion artifacts and the limited accuracy of determining thickness on the MRI display unit.

Achilles Tendon↗
PubMed1996

[Experimental evaluation of contrast medium enhanced high resolution MR angiography in the animal model. Gd-DTPA compared with Gd-DTPA-polylysine].

PURPOSE: To evaluate the qualitative and quantitative efficacy of Gd-DTPA and Gd-DTPA polylysine for contrast-enhanced high resolution MRA (CMRA) of the abdominal vessels. MATERIALS AND METHODS: In ten anesthesized rabbits (average weight 4.3 kg) MR angiography was performed using a 1.5 T MR unit (Magnetom SP 63; Siemens Erlangen) and a CP head coil. Arterial MRA (FISP 3D TONE, TR/TE = 33/8, Flip 20 degrees) and venous MRA (FLASH 2D, TR/TE = 37/10, Flip 60 degrees) was performed before and after administration of the paramagnetic contrast agents Gd-DTPA (n = 5) or Gd-DTPA polylysine (n = 5) at a dosage of 0.1 mmol/kg. In all studies the single sections and the MIP reconstructions were evaluated quantitatively by measuring and calculating signal intensity, percentage enhancement, signal-to-noise and contrast-to-noise ratios. All studies were assessed qualitatively for visualization and distinction of the arterial and venous vessel system by three independent observers before and after the administration of contrast agent. RESULTS: Gd-DTPA-enhanced arterial FISP 3D tone led to a percentage enhancement of 30% for the kidneys, 12% for the superior mesenteric artery, 18% for the deep circumfluent iliac artery, and 7% for the internal iliac artery. In FLASH 2D sequences Gd-DTPA led to a good C/N only for venous abdominal vessels like the left renal vein (2.59) and internal iliac vein (1.66); the percentage enhancement of these structures was between 16 and 21%. Qualitative comparison also showed no significant improvement after injection of Gd-DTPA. In FISP 3D TONE sequences Gd-DTPA polylysine led to a strong percentage enhancement of right and left kidney (21 and 40%) and deep circumfluent iliac artery (17%). Qualitative evaluation showed improved delineation and contrast of low-diameter vessels, while the soft tissue was only slightly enhanced and did not impair vessel visualization. CONCLUSION: CMRA using Gd-DTPA and Gd-DTPA polylysine significantly improved the delineation of abdominal vessels, with Gd-DTPA polylysine being superior.

Abdomen↗
PubMed1996

Incidental white-matter foci on MRI in "healthy" subjects: evidence of subtle cognitive dysfunction.

The clinical significance of incidental white-matter foci seen on MRI is controversial. Mainly using a computer-assisted neuropsychological test battery, we tested the hypothesis that there is a clinical correlate of these foci. We studied 41 individuals aged 45-65 years with no history of neurological or psychiatric disorder, in whom no indication of central nervous system abnormalities was found on standardised neurological examination. A computer-assisted neuropsychological test battery, with the advantage of precise measuring of both time and deviation (e.g. in position memory tests), and rating scales for emotional dysfunction were administered; selected soft neurological signs were assessed. In 16 subjects (39%) MRI showed high-signal foci in the white matter on spin-echo sequences. White-matter foci not adjacent to the lateral ventricles were found to be related to performance on immediate visual memory/visuoperceptual skills, visuomotor tracking/psychomotor speed and, to a lesser degree, learning capacity and abstract and conceptual reasoning skills. Subtle cognitive dysfunction would appear to be a clinical correlate of punctate white-matter foci on MRI of otherwise "healty" individuals.

Aged↗