key: cord-0007018-c3rt4a48
authors: nan
title: Scientific Exhibition
date: 2015-08-31
journal: Eur Radiol
DOI: 10.1007/bf03354975
sha: ca3b257e81f7a833af66653a26ad9d3ffa6cae0b
doc_id: 7018
cord_uid: c3rt4a48

nan

The Interventional Radiology of chest has acquired an important role in the diagnosis and treatment of many thoracic illnesses. The nuoroscopy, ultrasounds and C.T. give a clear enough picture of the lesions of the thoracic wall, pleura, lungs and mediastinum. To permit the accurate percutaneous access to these lesions. Among the interventional procedures we have carried out in our department are the fine-needle aspiration biopsy of chest and the treatment of the pleural and mediastinal collections by drainage using very narrow catheter. We have used these techniques to treat empyema, pneumothorax, abscesses, mediastinal cysts and pericardial collections.

We will discuss WHEN and HOW to apply these treatments and make an evaluation of the results obtained and of any complications that may have arisen.

Bronchial atresia -report of 4 cases A. Alvarez Castells (Presenter), J. Capellades, C. Torrents, P. Vicente de Vera, l. Gifre, M. Noguera; Barcelona Bronchial atresia is a rare, well known congenital abnormality. There are reported less than 100 cases in the literature. It is discovered commonly as an incidental finding in young adults. In the past, the diagnosis was made surgically. Nowadays the condition is characterized by nearly pathognomonic radiologic features wich have significant implications in the patient management. The plain film and CT findings consists in a lobar hyperinsunation associated with bronchomucocele. Endoscopic examination is necessary for excluding other causes of mucoid impactation. If the diagnosis is supported by both radiological and endoscopic methods, conservative treatment is recommended. We present 4 cases of bronchial atresia in young adults and discuss the CT, DAS, bronchographic and plain film findings. We emphasize the necessity of to be used with this condition in order to prevent unnecessary further explorations, including thoracotomy.

Macleod's syndrome: radiological findings A. Alvarez Caste lis (Presenter), E. Pallisa, C, Torrents, S. Coli, L. Gifre, P. Vicente de Vera; Barcelona Macleod (or Swyer-James) syndrome is often diagnosed with plain chest radiographs. Other radiological procedures are also very useful to confirm the suspected diagnosis. Features of distinct radiological procedures such as scintigraphy of the lung, angiography, bronchography and C.T in 7 patients with Macleod syndrome are presented and evaluated comparatively. Plain chest radiography shows a hyperlucent lung of reduced or normal size with diminished vascular markings and little change in lung volume during respiration. Pulmonary scintigraphy shows markedly decreased perfusion in the affected lung. The perfusion image alone does not exclude other vascular abnormalities. Ventilation-perfusion imaging is helpful in confirming the presence of this syndrome. C.T findings are: I. reduction of attenuation values of the affected lung 2. loss of normal anteroposterior gradient attenuation 3. diminishing of central and peripheric pulmonary arteries. Other associated findings, in C.T, include parenchymal changes such as bronchiectasis. Conventional or digital pulmonary angiography demonstrates the ipsilateral pulmonary artery to be smaller than normal with thin branches and diminished vascularity in capillary and venous phases.

Abnormalities 01 lung development: a continuum spectrum 01 abnormal vascular and parenchymal development S. Borruel (Presenter), C. lopez, J. L. Raya, J. Albiilos, J. Roldan; Madrid

The major abnormalities of lung development can be classified into six discrete categories: pulmonary arteriovenous malformation, hypogenetic lung syndrome, bronchopulmonary sequestration, congenital cystic adenomatoid malformation, bronchogenic cyst and congenital lobar emphysema. These major abnormalities should be considered as a continuum spectrum of lung malformation, with pure vascular abnormalities on the one hand (i.e. pulmonary arteriovenous fistula) and pure parenchymal malformations on the other (i.e. congenital lobar emphysema). Between these "pure" abnormalities there are other major abnormalities with different degrees of vascular and parenchymal compromise, and some minor or overlap syndromes that present features of more than one major anomaly. The aim of this presentation is to show cases of each of these major anomalies of lung development, studied by conventional radiology, CT scanning and vascular procedures. We also make a differential diagnosis of these conditions, highlighting the typical features of each one.

S 231 SPACE 11!!l The value of transthoracic percutaneous biopsy of focal pulmonary lesions P. Bracke (Presenter). B. Corthouts. A. De Schepper; Edegem

In a retrospective study. 218 fine needle aspiration lung biopsies were performed in 200 patients with an age distribution from 4 to 88 years. 85% of the punctions were performed to exclude malignancy. By using cutting biopsy needles. the amount and quality of biopsied tissue (tissue core instead of cytologic material) allowed histopathologic evaluation in 89%. In 125 patients malignancy was confirmed and further histopathologic differentiation was possible in 54%. The rate of intra parenchymatous hemorrhage and pneumothorax were concordant with literature findings. Transthoracic lung biopsy is a major diagnostic tool in the evaluation of: 1. lung lesions of unknown etiology that are not likely to require resection 2. metastatic disease 3. two lesions in different lung lobes 4. opportunistic infections in patients with immunosuppression SPACE 1299

The dense azygos lobe: a normal variant J. Caceres (Presenter). J. M. Mata. X. Alegret. J. Palmer; Barcelona Purpose: To demonstrate that a dense azygos lobe that looks abnormal on the PA chest radiograph may be a normal variant. Methods and Materials: Eight patients with a dense azygos lobe on PA chest radiographs were studied with CT. Slices were 8 mm thick. with a 10 mm interval. Results: None of the patients had any pathologic process of the lung or mediastinum. All of them had a shallow azygos lobe and increased depth of the mediastinal soft tissues in front of it. We measured the depth of the mediastinal soft tissues and of the lung within the azygos lobe at the level of the sternoclavicular joint. The ratio soft tissue/lung was greater than one in all our patients, whereas it was less than one in ten other patients with normalappearing azygos lobes. The cause of the increased depth of the mediastinum was marked elongation of the great vessels in seven cases and tumor infiltration of the right chest wall in one. Conclusions: We conclude that the increased density is due to the combination of a shallow azygos lobe and increased depth of the mediastinum, caused in the majority of cases by elongated vessels. Characteristically. free pleural fluid has a lenticular shape and uniform density on CT studies. In the last two years we have seen several cases of pleural effusion that show atypical features. either in shape or in density. In some cases. free pleural fluid adopts a convex shape simulating encapsulation. In other cases, the fluid had a nodular appearance, mimicking pleural masses. In one case. fluid in an azygos lobe simulated a mediastinal mass. In all cases. the diagnosis was easily made with prone CT, that showed that the fluid moved freely within the pleural space. Increased density of the fluid may be secondary to bleeding. Localized dense areas suggest metastatic implants or primary tumors. Occasionally a dark transverse band within the fluid is seen, representing displaced extrapleural fat.

High-resolution CT of Interstitial lung disease: dlfferantiel diagnosis E. Castella Fierro (Presenter). A. Alvarez Castells. C. Torrents Odin, L. Gifre Bassols. P. Vicente de Vera. M. D. Miranda; Barcelona High-resolution CT appears to be more sensitive than CT and conventional radiographs for the detection of lung abnormalities. CT has become capable of imaging the lung with excellent spatial resolution and anatomic detail, demonstrating both the normal and abnormal interstitium, as well as morphologic characteristics of localized and diffuse parench ymal processes. Alteration in anatomy can be identified at the level of the secondary pulmonary lobule. and although often nonspecific, in certain situations high-resolution CT findings can be diagnostic. In basis to the HRCT findings. we classified the clinical entities in the following groups: -distortion of the secondary pulmonary lobule (scleroderma) -bronchovascular bundle thickening (lymphangitic carcinomatosis).

-presence of cysts (sclerosis tuberose. histiocytosis X. Iymphangioleiomyomatosis, emphysema). -nodules (silicosis, sarcoidosis): -associated findings (subpleural line, patchy air-space disease).

Traumatic hernias of the diaphragm i. Castells Ferrer (Presenter), R. Dominguez Orozco, E. Castella. J. Capellades, J. Alvarez. C. Triginer; Barcelona

The traumatic lesions of the diaphragm are not rare condition. but usually the diagnosis is delayed due to the absence of specific clinic and radiologic signs. As a consequence of diaphragmatic tears is frequent the herniation of abdominal viscera or omentum. We present eight cases of traumatic hernia of the diaphragm. surgically com proved. Seven were caused by blunt trauma and one by penetrating injury. We discuss the radiologic findings on portable plain film that may suggest the possibility of diaphragmatic rupture.

Advances in imaging technology, improvements in cytopathology and the use of fine needles extended the application of percutaneous transthoracic needle biopsies by making it possible to safely perform biopsy ofintrathoracic masses. Application of ultrasound to the guidance of aspiration biopsy of the peripheral pulmonary lesions currently become the method of first choice because of its simplicity and low rate of complications. We report our experience in ultrasonically guided aspiration biopsy in 40 patients who had peripheral pulmonary masses. The mass was analyzed with respect to the size. margin and internal sonographic pattern. Distances from the skin to the anterior and posterior surfaces of the mass were measured. We used a 22 gauge Chiba needle for the aspiration biopsy. Ultrasonically guided percutaneous needle biopsy of pulmonary masses in contact with the chest wall is a safe simple procedure. The lack of ionising radiation, the relatively low cost and wide availability, the ability to visualise the anterior and posterior wall of the mass and the ni:edle tip, which provides continuous guidance during the biopsy are advantages of ultrasound when compared with fluoroscopy and computerised tomography guided biopsy. Methods and Materials: PET studies were obtained using a whole-body PET scanner with F-18-labelled deoxyglucose (FOG) . Dynamic studies as well as endpoint measurements 15 post injection of 440 Mbq FOG iv. were obtained. Emission scans of 15 minutes and transmission scans of 5 minutes were obtained 50 minutes post injection. Tracer uptake concentrations lire quantified using the standardised uptake value. More than 150 PET studies of thoracic lesions have been performed. Results: All malignant untreated tumors showed significant FOG uptake with uptake values above 1.8 SUY. All benign lesions showed significant lower FOG accumulation with some overlap for patients with tuberculosis. PET shows a great potential in the preoperative evaluation of indetermined lesions with a high sensitivity and specificity for T-as well as N-staging. PET also shows tremendous potential in the evaluation of therapy response by correctly predicting the therapy success prior to midpoint of the protocol.

CT -pathologic correlative study of Interatltlal pneumonia Hiroyuki Koba (Presenter), Seiya Katoh, Hideaki Watanabe. Masahlko Yamaglshl. Yujl Morl. Akira Suzuki; Sapporo A direct CT-pathologic correlative study of interstitial pneumonia was performed using inflated and fixed lungs. The specimens, which were obtained from 26 patients at the time of autopsy or during surgery, had pathologic findings of interstitial pneumonia (UIP and/or DAD) . The specimens were fixed in distension and air dried. They were scanned with GE CT/T9800. HRCT images of the specimens could be correlated with two different types of pathologic processes. One was the chronic fibrotic change which was seen in the subpleural area and the other was the acute alveolar change which was seen in the diffuse area. HRCT images of the chronic fibrotic change showed nodular opacities, ring like opacities, increased density (high density), and air-bronchiologram. These findings were correlated with patchy fibrotic lesions, honeycombing, mucus stasis in cysts of the honeycomb and <Ii1atation of the airways. HRCT images of the acute alveolar change showed mainly diffuse increased densities and diffuse nodular opacities. These findings were correlated with a diffuse thickening of the alveolar walls, hyaline membranes and their organization. Understanding of the difference between H RCT images of these chronic and acute pathologic processes is helpful for the evaluation of disease processes of interstitial pneumonia by HRCT.

Computed tomography of pleural fissures and a new scanning method for detecting fissures Y. Kodama (Presenter), S.Sakuma; Aichi-ken A review was made of computed tomography of the pleural fissures by conventional and thin scan of the axial image, and a new technique ofthin scanning is performed by tilting the gantry cephaladly to improve detection of the pulmonary fissures is discussed. All 203 cases were scanned sequentially from lung apex to base in inspiratory apnea, using contiguous 10 mm sections. Sections were partially obtained with collimation of 5 mm in 13 cases and 2 mm in twelve. Scanning was performed by tilting the gantry cephaladly to about 20 degrees with 5 mm collimation in 2 cases and 2 mm in 5 cases. Studies were performed with a TCT 60A or 70A (TOSHIBA; TOKYO). The present CP..::: in which pleural fissures were recognized not as the hypovascular zone but as the opaque density are discussed. By conventional scanning with 10 mm collimation, a bilateral major fissure was recognized in 36 cases and unilateral major fissure in 43 cases. Sixty-six cases showed linear or bandlike density of the major fissure. In 38 cases, the major fissure was demonstrated by the difference in pulmonary density between the upper and lower lobes. By thin scanning with 5 mm and 2 mm collimation, all cases showed linear density of the major fissure. It was quite difficult to detect minor fissure as opaque densitiy in conventional scanning, but 5 of 13 cases with 5 mm collimation and 10 of 12 cases with 2 mm collimation showed an opaque line. In 7 cases of thin scanning by tilting the gantry cephaladly, pleural fissures could be seen more clearly than in other cases of axial thin scanning. Thin scanning is thus shown useful of detecting pleural fissures and improving detectability not only of the major fissure but ofthe minor fissure as well by thin scanning tilting the gantry cephaladly within the possible range.

Optimized procedure of description and Interpretation of results for the assessment of chest X-rays H. M. Kulke (Presenter); Wurzburg

In order to improve and standardize the previously diverse and troublesome descriptions of radiological analysis, as well as to make use of computer analysis, the findings, which might be observed on a thoracic X-ray, were analyzed. The chest X-rays of 2,684 inpatients and ambulatory patients with diseases of the lung and bronchial system as well as the cardiovascular system were examined. Exact regions of description were defined in which findings of description, the detailed characteristics of pathological changes and phenomena, including foreign objects and anomalies, might be observed. Using this basis, and taking in consideration the features of individual diseases, both the radiological examination of the thorax as well as its interpretation could be optimized and the findings were able to be stored in a computer.

High resolution CT of the lung In scleroderma M. D. Miranda (Presenter), A. Alvarez Castells, C. Torrents, P. Vicente de Vera, L. L. Gifre, V. Fonollosa, C. P. Simeon; Barcelona

We prospectively studied 22 patients with know Progressive Systemic Sclerosis by using HRCT. The age of the patients varied from 42 to 68 years old, with a male to female ratio of I :4. We correlated HRCT findings with chest radiographs and lung function tests. CT study consists of a scanning with contiguous 10 mm slice thickness from the apex to the diaphragm. Further thin sections (1.2 mm) were ohtained at predetermined levels (aonic arch, carina and 1-3 cm above diaphragm). Additional scans were performed with the patient in the prone position. The most characteristic pathologic findings were a diffuse reticular pattern with a predominantly basilar distribution, without nodules. There was evidence of distortion of secondary lobules eithout thickening of the intralobular interstitium. Thickening of interlobar fissure were frequently identified and subpleural line as well, typically described in Asbestosis and Pulmonary Fibrosis. Peribronchial thickening was seen not associated with bronchiectasis, cystic dilatations or emphysema. Another findings were recognized such as esophageal involvement. Our data suggest that HRCT is more accurate than chest radiography and in some cases results more sensitive than lung function tests.

Radiologic-pathologic correlation of chronic eosinophilic pneumonia Yumiko Nakai (Presenter), Yoshirou Mochizuki, Tetsuji Kawamura, Rieko Kawanami, Yoichiro Kohashi, Toshiharu Nakai, Fumiyuki Kuze, Harumi Ito; Otsu Purpose: Chronic eosinophilic pneumonia (CEP) and BOOP have some common radiologic, clinical and pathologic features. This study were undertaken to establish radiographic and CT features of CEP based on pathologic study. Methods and Materials: Open lung biopsy with informed concent was performed on 6 cases clinically diagnosed eosinophilic pneumonia which could not be confirmed by TBLB or which were difficult to distinguish from BOOP. Results: All the cases had eosinophilia in peripheral blood (9-75%) and BAL fluid (3-43%) . Chest radiographs and CT showed multiple alveolar shadows in the peripheral lung field (4 cases), both alveolar and interstitial shadows (I case) and only interstitial shadow (I case). Pathologically these radiologic abnormalities corresponded to infiltrate of eosinophils and other cell in the aveolar space and interstitial tissue of the lung (alveolar wall, inter lobular septum, peribronchiolar and vascular space and pleura), respectively. In 2 cases, typical organizing materials were found in both alveolar space and bronchiolar lumen, which was also responsible for airspace shadows. Conclusions: The most important pathologic features of CEP were a wide aspect of interstitial involvement of the lung in addition to airspace consolidation, while in BOOP interstitial involvement was confined to the alveolar septum.

Purpose: The cure of pulmonary adenocarcinoma greatly depends upon the detection at an early stage. It is known that solitary pulmonary nodules on chest radiograms failed to detect as many as 30% of the positive cases. In order to increase the accuracy of detecting pulmonary nodules, a computerized system to classify chest radiograms by existing nodules was developed. Methods and Materials: This system used digital image-processing techniques based on the information which were extracted from 266 chest radiograms (192 with a cancerous nodule and 74 normals). This system can a) detect nodules using a previously developed called as Directional Contrast Filter for Nodules which is effective for detecting nodules with obscure margins, b) eliminate false positive foci and c) classify radiograms by existing nodules. An experiment using 108 practical radiograms (30 with nodules and 78 normals) was performed. Each nodule on a chest radiogram is pathologically proven to be primary pulmonary carcinomas and less than 30 mm in diameter. Results: As a result, figures of76. 7% for sensitivity and 69.2% for for specificity of the system were obtained. This result indicates that the system will be useful to further increase the accuracy of detecting pulmonary nodules.

Mycoplasma pneumonia: CT assessment and correlation with chest radiographic findings Hiroshi Tanaka (Presenter), Hiroyuki Koba, Takujl Morl, Mitsuo Asakawa, Akira Suzuki; Sapporo Purpose: To identify and characterize the CT manifestations of mycoplasma pneumonia (MP) and to evaluate the contribution of CT compared with chest radiography in estimating disease severity. Methods and Materials: A total of 65 pairs ofCTscans and chest radiographs obtained in patients with serologically proved MP, clinically mild cases (group I, n -55) and severe cases with hypoxemia (group 2, n -10), were analyzed retrospectively. Results: Three characteristic CT patterns of MP were demonstrated. First, thickness of the bronchoarterial bundles: 92% (group I), 90% (group 2). Second, nodular opacities which having a centrilobular distribution, at the ends of the branches of the pulmonary arteries and bronchi: 92% (group I), 100% (group 2). Third, consolidation with an air bronchogram: 72 % (group I), 90% (group 2). Mediastinal or hilar lymph nodes swelling was noted 20% (group 1),70% (group 2), pleural effusions were revealed 17% (group 1),70% (group 2). In 10/65 patients, chest radiograph could not detect the thickness of bronchoarterial bundles nor nodural shadows that CT could. The superiority of CT over chest radiography was supported in the early detection of small opacities, and recognition of mediastinal or hilar lymph nodes swelling and small amount of pleural effusions that important in estimating MP severity.

Evaluation of small aIrway lesions using computed tomography. selective alveolobronchography and ultrathIn bronchoflberscopes Mitsuru Tanaka (Presenter); Tokyo Small airways less than 2 mm in diameter are injured by various causes and diseases. Among them, smoking and air pollution have now become social problems. A pathophysiologic understanding of these sites will give important clues to clarify the etiology of many pulmonary diseases. These pulmonary sites are called "silent zones" because they do not attract too much attention until the disease advances. We developed the first ultrathin endoscopes which facilitate observation and photography of small airways or less than 2 mm in diameter. We examined various pulmonary diseases by endoscopy, and obtained findings that are impossible to obtain by conventional roentgenography and endoscopy. In normal subjects and patients with pulmonary diseases, CT scan findings and selective alveolobronchograms were examined by conforming the sites or lung biopsy findings to those of endoscopic observation. As a result, we obtained findings of the small airways which have not been described in other publications.

Diagnosis of medIastinal vascular Involvement In lung central cancer by methods of Imaging M. Torres (Presenter), P. Valdes, R. Varela, J. Vicente, F. Serrano, F. Rodriguez; Malaga Purpose: The aim of this work is to show our experience in the value of different radiological diagnostic methods in the study of vascular invasion (pulmonary and aort arteries) in central lung cancer (T-3 versus T -4 stage). Methods: We present 8 male patients aged between 40 and 60 years with bronchoscopic diagnosis of centra bronchial epidermoid carcinoma. Posteroanterior and lateral thoracic radiography, CT with and without intravenous contrast, dynamic CT and Nuclear Magnetic Resonance were all performed in each patient. Arteriography was carried out in five. We compared our data with the surgical findings. We considered as criteria of invasion a contact angle greater than 90°, absence of fat-plane between tumour and vessel wall, and either concentric or non-concentric irregularity of the vessel lumen. Results: The most useful criteria of invasion was the irregularity of the lumen in both pulmonary and aortic invasion, being present in 100% of the surgical positive cases. Of the imaging techniques, NMR in axial slices for the pulmonary artery and axial and coronal slices for the aorta, were the most useful in the diagnosis of the irregularity and its extension, surpassing the arteriography in cases where invasion is excentric or there is adventicia I and perivascular affectation. Purpose: We show our experience in the radiological findings of bacterial pneumonias in HIV positive patients, findings about which little has been published because this pathology is less frequent than others typical opportunistic infections. Methods: We present a series of 13 male patients, all of them intravenous drug abusers in whom different causative agents were isolated, and two of them presented two concomitant germ ens. 2 died because the pulmonary infection and the remainder recovered completely. No patient had neither previous pulmonary infections nor other AIDS critera. Results: We found inferior lobes affected in 8 patients (mostly right and either diffuse or multiple alveolar infiltrates in 5 cases, cavitary lesions were present in 7 cases as an actual parenquimal destruction. Associated pleural effusion was observed in 6 cases. Radiological evolution to normal was found in 10 cases, included those with pulmonary parenchymal destruction, after a prolongate course. These findings lead us to think that bacterial pneumonia in HIV positive patients, characteristically presents a torpid evolution due to an increased aggressivity of causative agents in comparison with non-immunosuppressed hosts in general population and a good response to treatment, with a complete cure in a high proportion of patients.

contrast MRI may be a good indicator for the identification of myocardium at further risk. Purpose: To study the feasibility of MRI for morphologic localization of arrhythmogenic tissue as defined functionally by magnetocardiographic and invasive electrophysiologic techniques a 3-dimensional orthogonal grid was developed, whose extrathoracic markers could be detected in the MRI (CUS04), Cine-Angiographie (lead) and the magnetocardiogram (inductioncoil) and were arranged within a 5 mm diameter capsule. Methods and Materials: In 12 patients with overt Wolff-Parkinson-White-Syndrome and preexcitation ofthe right (2) or left free wall (7) or the posterior septum (3) , the MRI of the heart (ECG-triggered Spinechosequence, TE = 12, TR = RR) was performed. The functional localization of ventricular preexcitation was defined by MCG (magnetic shielding. 37-channel SQUID-Magnetometer) and electrode catheter position at the side of the accessory pathway (Cine-film). All localization results were related to the constant grid position. Results: EP and MCG localization were comparable with a deviation of I cm. Both were projected at the A V groove in patients with free wall accessory pathway (AP) or at the os of the coronary sinus in patients with preexcitation syndrome (PS). Conclusions: Using a multifunctional precardial grid as a reference, cardiac MRI provides exact morphologic information on arrhythmogenic tissue, which is important for interventional electrophysiology (catheter ablation or antitachycardiac surgery). We performed a clinical evaluation of strecker stent. Twenty-one patients (23 extremities) with arteriosclerotic stenoses and occlusions of the iliac and femoro-popliteal arteries were treated with 30 stents measuring 4-8 mm in diameter. Indications were poor results with percutaneous transluminal angiopathy (PTA) in all cases. In two patients with femoro-popliteallesions the indication was a limb at risk for amputation. Follow-up was available in 20 patients (average 7 months; range 1-14 months). On 23 extremities, 20 were patent and two occluded. In the follow-up, clinical grade (Lafontaine) and ankle-brachial indexes improved significantly in 21 extremities (100% in iliac lesions). The technique of implantation and complications are analyzed.

Abdominal aortic coartactlon: treatment with aortic PTA, a case report Enrico Casalini (Presenter); Milano

Abdominal aortic coartaction is a congenital rare vascular disease, characterized by severe stenosis of the abdominal aorta. Surgical management is complex. Percutaneous transluminal angioplasty (PTA) is an effective method of treatment for vascular stenosis and obstruction. We report a successful case of balloon dilatation angioplasty of an abdominal coartaction combined with surgical revascularization of the stenotis right renal artery.

Interventlonal angloscopy's promises J. P. Cecile (Presenter), J. C. Baudrillard, H. Foucart, Ch. Carlier; Lens But: Since the angioscopy specifies the pathological nature of the arteriopathy, it enables some intravascular procedures. Its development could give way to the "ENDOLUMINAL SURGERY". Methods and results: Since 1987, the authors have systematically associated the angioscopy with 290 cases of lower limbs arteries angioplasties, including 42 cases of endoluminal procedures. After instruments presentation, the results are described: -aspiration of three fresh clots unbedded in stenosis previous balloon angioplasty, preventing distal migration; -one altered clot extraction with dormia cage; -angioscopy monitoring of four severe stenoses, preventing laceration due to over inflation; six balloon catheters correctly driven into the true channel preventing false channel laceration; -four recanalisations by thermo-laser; -10 stents insertion under angioscopy control. Later endoscopy demonstrates the evolution is different according to the type and location of the stent; -successfully extraction of 6 atheromas. One example of every technique is displayed on video tape. Conclusions: Percutaneous angioscopy looks useful if not necessary previous angioplasty: WATCHING FOR BETTER UNDERSTANDING. It extends recanalisation indications to iliac arteries occlusions (12% of iliac arteritis); femoral arteries procedures are carried out more safely and ";1 la carte" according to the pathologic lesion: "UNDERSTANDING FOR BETTER TECHNIQUE". Increasing interest of radiologists and surgeons should "ENDOLUMINAL SURGERY" progress.

Histologic examination of specimens obtained with the translumlnal extraction catheter during arterial recanalization M. Chiesura-Corona (Presenter), G. P. Feltrin, G. Thiene, S. Savastano, D. Miotto, A. Torraco, L. Castellan; Padova Purpose: To evaluate the histology of retrieved material, obtained during arterial recanalization with the Transluminal Extraction Catheter (TEe). Methods: 35 lesions (12 stenoses and 23 occlusions) were recanalized with the TEC in 27 patients. At the end of the procedure pathologic analysis was performed on the excised material in 20 cases; both usual and particular stains were used. Results: Histological examination revealed a whole plaque in one case; in all the others the retrieved material appeared disrupted and grinded. Fibrotic components were evident in all cases (20120), while atheromatous material was demonstrated in 5 cases. Thrombus, both fresh and organizing, was present in almost all specimens (19120): calcium components were found in 6 cases; in 7 cases elastic fibers from tunica media were present. Conclusions: This analysis indicates that the atherosclerotic plaque grows mainly by deposition and thrombosis, with subsequent fibrotic organization. Recent mural thrombosis is frequently found in complete occlusions (80%) also in patients with history of chronic disease, attesting the effectiveness of TEC in recanalizing such long lesions. The presence of fibrotic material, atheromatous components and calcium indicates the capability to remove also material often resistant to conventional PTA. The absence of adventitia confirms the sure intraluminal action of the instrument.

Yeon Hyeon Choe (Presenter), Jae Hyung Park, Joon Koo Han, Man Chung Han, Chu-Wan Kim; Kyonggi-do Twenty-seven Gianturco type self-expandable stainless steel intravascular stents were placed into the infrarenal abdominal aortas (n = 17) stents were placed into the infrarenal abdominal aortas (n = 17) and inferior venae cavae (n = 10) in 10 mongrel dogs. In eight aortas, stents were delivered after balloon catheter-induced denudation of intima and in four out of the eight aortas, stents were also placed into the normal sites to compare neointimal thickness of the normal and denuded sites. Angiography, light microscopic and scanning electron microscopic examinations were performed lifter I week (n = I), 2 weeks (n = 6), 3 weeks (n = 5) and 6 weeks (n = 2). The patency rate and thrombosis rate were 100% and 35% in aortas and 100% and 60% in inferior venae cavae. The aortic stent wires were covered with thin fibrinous membrane, blood cells and scanty myointimal cells after I week. Nearly complete transparent neointimal covering was found in aortas and caval veins after 2 weeks. There was no significant difference in intimal thickness betweell the denuded and normal aortas after 2 weeks (p = 0.51) and 3 weeks (p = 0.56). In four dogs with caval vein stents, there were evidences of hemorrhagic infarction in lungs. The thrombosis rate of 12 stents with stent-artery ratio (SAR) 1.5 or higher was 41 %, while there was no thrombus on the four stents with SAR 1.2 or lower except one specimen after I week. The high SAR of aortic stents may be a cause of thrombosis due to prolonged damage to intima and media. It is suggested that stents with SAR 1.2 or lower are more suitable. The high thrombosis rate of inferior venae cavae may be related with slow blood flow.

Results: There was excellent correlation of conventional and MR-Angiography. Length of occlusions, degree of stenosis and number of collateral vessels were visualized in all situations except one: Short and high grade stenoses may be visualized as occlusions because of the limited local resolution. All intimal tears were depicted by MR-Angiography. CO\1clusions: MR-Angiography proved clinically useful as regional, nort-invasive follow-up after PTA and may vary after vascular surgery as well. Lack of spacial resolution was very well compensated by the high flow sensitivity of the method.

CongenItal anomalies of Inferior vena cava and left ranal vain: non-Invasive diagnosis wIth duplex-Doppler sonography L. E. Derchi (Presenter), G. Crespi, F. Pretolesi, A.D'Amica, L. Oliva; Genova

The sonographic findings observed in five patients with congenital anomalies of the inferior vena cava and left renal vein are presented. We met two patients with duplication of the inferior vena cava, two with transposition of the vessel, and one with retroaortic left renal vein. In four cases the diagnosis was confirmed through demonstration of venous flow within the imaged anomalous vascular structures using duplex Doppler equipment. The diagnostic capabilities of sonographic imaging and Doppler analysis of blood flow allow a non-invasive diagnosis of these vascular anomalies. In our opinion, contrast studies are needed only when retroperitoneal structures are difficult to evaluate by ultrasound due to obesity and/or overlying abundant intesti nal gas. Introduction: The purpose of our study is to test the variability and reproducibility of left ventricular volumes and functional parameters using Cine-MR. The introduction of Cine-MR as a routine procedure will be discussed. Methods: 16 volunteers were evaluated by MRT using a 1.5 Tesla equipment. The left ventricle was shown in different planes. We used a gradientecho-sequence (TE -12 ms; FL = 60; TR = RR). The calculation procedures (monoplane, biplane, 3-dimensional, reconstruction by adding the areas of each slice) were tested for their concordant results, The images were evaluated by two independant observers. The reproducibility was tested by follow-up examinations. Results: The 3-dimensional reconstruction of the left ventricle as well as the biplane calculation procedure showed a very low standard deviation (SD) of the means (stroke volume: SD< 16ml; ejection fraction: SD<2%). The standard deviation of the monoplane calculations were higher (SV: SD 20 ml; EF: SD 5%). Control examinations showed well reproducible (r> 0.75, p < 0.001). A low interobserver variability was observed (%variability < 5%). Conclusions: Cine-MR is a very accurate procedure in the assessment of left ventricular volumes and functional heart parameters. It should not only be used for follow-up studies but also for routine applications.

Computed tomography and magnetic resonance Imaging In perlcardlal and retrostemal adhesions subsequent to cardiac surgery Olov Duvernoy (Presenter), Torsten Maim, Karl-Ake Thuomas, Sven G. Larsson, Hans-Erik Hansson; Uppsala Abstract: The visibility of the pericardium as well as the space between the dorsal aspect of the sternal surface and the pericardial surface was determined in CT and/or MRI in ECG-gated spinecho (SE) and gradient echo (GE) sequences. Seventeen patients who had undergone cardiac operations, and were admitted for cardiac reoperation were investigated with CT and/or MRI prior to sternal reentry. Five patients were investigated with CT, ten with both CT and MRI and two with MRI only. Retrosternal adhesions were classified as present or absent, intrapericardial adhesions were classified; absent, minimal, moderate or severe at re-operation. A similar classification was applied to the findings at CT and MRI. In 14/15 patients, the findings at CT were in accordance with those found at operation regarding postoperative retrosternal extrapericardial adhesions in the cranial retrosternal space, and in 12115 in the caudal retrosternal space. CT could not detect intrapericardial adhesions. MRI was sensitive to metal artefacts from sternal sutures in both sequences and could therefore not be used to detect postoperative retrosternal extrapericardial adhesions. MRI with ECG-gated SE sequences confirmed intrapericardial adhesions in 44/57 locations. Absence of intrapericardial adhesions revealed at operation was shown in 13 locations.

Practical intravascular ultrasound: evaluatIon of arteriosclerosIs and arterial Interventions Christopher E. Engeler (Presenter), Claudia M. Engeler, Joseph W. Yedlicka, Jr., David W. Hunter, Janis Gissel Letourneau, Wilfrido R. Castaneda-Zuniga, Kurt Amplatz; Minneapolis, MN Purpose: Demonstration of the practical application of intravascular sonography in the diagnosis and management of arteriosclerosis. Methods and Materials: High-resolution intravascular catheter-based ultrasound (US) of 40 patients was performed with a 6.6 Fr 20 MHz probe (Diasonics Inc. Milpitas, CA and Boston Scientific Corporation, Watertown, MA) and correlated with angiography in the aorta, iliac arteries, and arteries of the lower extremities. Intravascular US was used to monitor revascularization procedures including angioplasty, atherectomy, and stenting. Results: A step-by-step approach to the application and the unique abilities of this new technology are illustrated in I. the diagnosis of vascular disease not evident by angiography; 2. accurate calculation of stenotic area; 3. sonographic characterization of pathologic deposits; and 4. effects in interventional procedures with special emphasis on intimal flaps and dissections after angioplasty. Conclusions: The broad spectrum of arteriosclerotic disease is within the reach and resolving power of catheter-based intravascular US. We believe the US appraisal of arterial wall characteristics will ultimately aid in the choice of vascular interventional strategies in addition to reducing the amount of angiographic contrast and fluoroscopy needed to monitor procedures.

Colour Doppler ultrasonography In atherosclerotic obstructive dIsease of lower extremities Laszl6 Erdelyi (Presenter), M6zes Peter, Judit Nagy; Debrecen

The lower extremities of 50 patients with atherosclerotic obstructive disease were studied by both color Doppler sonography and arteriography. Stenosis and obstructions of main arteries and collateral circulation were detected by colour Doppler sonography. In the majority of cases this method can be used instead of arteriography. The signs of changes in atherosclerotic obstructive disease and the advantages and handicaps of this technique are summarised in the poster. The patent ductus arteriosus (PDA) is closed with conical-shaped device which consists of polyurethane foam mounted on stainless steel frame. The plug is delivered into the duct through the transvenous Teflon sheath. Since 1981 till 1991 the procedure was undertaken in 262 pts. Permanent complete duct closure was achieved in 248 (94,7%). In 7 cases the occlusion was partial. The complications occurred in 10 pts. There were migration of the plug into the abdominal aorta in 4 pts, wrong fixation of the device in the left subclavian artery origin -2 pts, preliminary fixation of the plug on the wall of the descending aorta -I pt, migration of the plug into the pulmonary artery bed -3 pts. 7 of these failures were treated surgically. After 10 years of experience we consider the developed technique as very effective, safe and applicable in more than 80% of patients with PDA in the age older than 2,5 years.

PItfalls In the ultrasonography diagnosis of lower-extramlty deap venous thrombosis J. Fernandez Sanchez (Presenter), W. BOcklein, E. Klotz; Augsburg Real-time B-mode duplex Ultrasonography (US) is a highly accurate, noninvasive method for the diagnosis of lower-extremity deep venous thrombosis (DVT). Knowledge of the potential vascular malformations and variants in the pelvis and legs is essential for the correct interpretation of US. Familiarity with such variations can provide a correct diagnosis and obviate the need of venography. The aim of this study was to evaluate these vascular anomalies with US using venography for correlation. In 145 patients (169 extremities) with clinically suspected DVT of the lower extremity a venography and an US were performed. In these examinations we have found some venous anomalies, such as bifurcation of the femoral or popliteal vein, and several pathological conditions, such as venous aneurysms and arteriovenous fistulas, that may lead to diagnostic problems in patients with suspected DVT. Other potential diagnostic pitfalls of US are small nonocclusive thrombi, e1(traluminal compression of the deep veins caused by soft tissue abnormalities, positive compression US-test in some fresh thrombi, which may be slightly compressible, non-adequate performance of compression US in obese patients and other possible interpretative errors caused by technical limitations of the study. This scientific exhibit provides illustrations and discussion of these venous anomalies and pitfalls.

A study of the assessment of coronary flow by vldeodensltometry In the closed chest canine model: validation by mlcrospheres G. Finet (Presenter), M. de lorgeril, M.Ovize, D. Revel, M. Amiel; lyon

The aim of this study was to validate with radiolabelled microspheres the quantification of the different coronary flow rates hy studying contrast density obtained by digital subtraction angiography (DSA) in an experimental canine prep.lration. Methods: 2 sequences [rest state/during DPD (0.75 mg/kg during 4 min und followed by 0.1 mg/kg/min») in 5 intact Beagle dogs have been realized providing for each dog 2 coronary flow reserve (CRF: hyperemic flow/hasal now) according to 2 methods. J. Regional myocardial blood flow (RMBF) was measured with microspheres (4 radionuclides) by the reference sample method (now results: mllmin per g). 2. The time-density curve (TDC) was obtained within a region of interest chosed over the part of myocardium supplied by the left circumnex artery in the consecutive images by DSA. The TDC remaining was fitted to a gamma-function and 3 measurements were calculated: the aera under the curve (A), the peak density (PD), the mean transit time (MTT). Index of CFR was computed as the ratio of hyperemic to basal measurements for each of these methods and was compared with index assess.ed by microspheres.

Results: 9 CRF have been calculated 3.47 ± 1.67 (mean ± SD). The correlation between the 3 index of CRF determined by videodensitometry and the CFR measured with microspheres are for A r = 0.97 (y = .77x + .58). for DP r = 0.92 (y = .7x -.11), and MTT r = 0.95 (y = .72x + .52).

Conclusions: These results indicate that the 3 videodensitometric index can be used to accurately assess changes in myocardial perfusion. Purpose: To assess the usefulness of a combined technique in the catheterization of vascular structures in patients undergoing diagnostic procedures or interventional maneuvers in the vascular system. Methods and Materials: The patients lay on the CT table and a mobile C-armed digital subtraction X-ray system provides the fluoroscopic control of the entire procedure. 57 arterial portographies were performed by injecting the contrast medium directly into the superior mesenteric artery, carrying out the entire procedure in the CT room. I procedure was performed to retrieve a piece of a non-radiopaque catheter lost in the bloodstream, which CT easily identified. 5 percutaneous embolizations of artero-venotls fistulas were performed using CTF, so that CT could localize the emboli and give a real-time assessment of the reduction of the vascular pattern. In 10 cases of multifocal hepatocellular carcinoma, a percutaneous chemoembolization was carried out using Mitomicin C microcapsules and Lipiodol. Results: All procedures were safely carried out. CTF provided little discomfort to the patient, less radiation exposure to both the patient and the radiologic staff. less contamination when the procedure had to be performed on HlY-positive subjects.

ClinIcal usefulness of rotational stereo digItal angiography for the diagnosis of aortic dissection Kazuhito Gemma (Presenter), Toru Ohya, Hiroyuki Tajima, Koichiro Ito, Tatsuo Kumazaki, Kinichi Ebata; Tokyo Purpose: To evaluate a clinical usefulness of rotational stereo digital angiography (RSDA) for diagnosing aortic dissection. particularly for the detection of intimal tear sites. Methods and Materials: Twelve cases with aortic dissection of opacified false lumen were examined by RSDA. Thoracic, abdominal. pelvic aortographies were performed using 12 inch I.I.-TV system. The X-ray apparatus rotates transversely at a speed of 2 seconds during 180 degrees when pulse mode exposures are done. Through digitation images are displayed real time on two CRTs (matrix SIS x 512) with an anlge of 5 different degrees, so that observers can see three-dimension angiograms from any angle during 180 degrees. Results: In 12 patients. a total number of 48 intimal tear sites could be detected. They were 2 in ascending norta, 2 in aortic arch, 17 in descending aorta, 19 in abdominal aorta, and 8 in pelvic artery. An adequate angle for the demonstration of each lesion could easily be obtained following just a single injection of contrast medium.

PTA of renal artery, the risk of the procedure in relation to morphological type of stenOSiS S. Goryn (Presenter), O. Rowinski, B. Pruszynski, M. Szostek, A. Kulesza; Warszawa The main aim of the study is evaluation of the prognosis of PTRA in relation to morphological type of the renal artery stenosis. The material consists of 250 procedures. Our experience allows for the conclusion that the most important risk factors are location and extent of the stenosis.

Percutaneous translumlnal implantation of the Guenther caval filter experience in 22 patients F. Grabenwoger (Presenter), W. Dock, V. Metz, K. Eibenberger, H. Magometschnig; Vienna

Purpose: The goal of this study was to determine the success rate as well as the complication rate of the Guenther caval filter. Methods: In the last 3 years, 24 patients were referred to our institution for placement of a caval filter. The indication for operation was either recurrent pulmonary emboli Dr prophylaxis against emboli from pelvic Dr deep vein thrombosis. In 2 cases implantation of a caval filter was not attempted due to a low take-off of the renal veins. In the remaining 22 patients a Guenther caval filter was successfully placed. Seventeen patients could be followed with a mean follow-up of 14 months .. Results: In no patient was th~re clinical evidence of new pulmonary emboli after successful implantation of the caval filter. An occlusion of the inferior vena cava was found in one patient ahd a caudal dislocation of the caval filter in 6 patients. In one patient one of the fixation feet of the caval umbrella broke. Conclusions: This study demonstrated that the Guenther caval filter has both a low complication rate and a high success rate with regard to the prevention of recurrent pulmonary emboli. The vascular wall of patients during the active phase of Takayasu's aortitis (T A) was investigated on CT. Four female patients, aging 12-22 years, were examined. Final diagnosis ofTA wa, made by both clinical findings and aortography. The vascular wall thickness and the ratio of the thickness to inner circumference of common carotid arteries and thoracic aorta were calculated. These items were compared with normal anatomic values. Findings of the vascular wall before and after the administration of contrast medium were also examined. The vascular wall thickness and the ratio to inner circumference were markedly increased in all cases. On plain CT, the vascular wall clearly distinguished from the vascular lumen by similar to or higher density than that of the muscle. Following contrast medium injection, the wall showed a "double ring-like pattern"; a poorly enhanced inside ring and a densely enhanced outside ring. The inside ring is considered to be mucoid or gelatinous swelling of the intima. while the outside ring be an active medial and adventitial inflammatory change with neovascularization. These CT findings. which have not been reported previously, will be useful for the early diagnosis of TA.

Experience in low-speed rotational angloplasty M. O. Cizmeli, E. T. IIgit (Presenter); Ankara Arterial occlusions oCthe lower extremities are not amenable to balloon angioplasty (PTBAl alone. The low-speed rotational transluminal angioplasty catheter system (ROTACS) is a recently available device for recanalization prior to PTBA. Heavily calcified occlusions and the presence of a large collateral originating proximal to the occlusion, constitute limitations for ROTACS. To avoid the entry of rotating catheter to the collateral, tip of the catheter is placed just proximal to the occlusion and the hard tip of a 0.020" guide-wire is used to create an inlet by repeated small, probing movements carefully. Afterwards the tip of the ROTACS catheter is engaged in this inlet and started to rotate at low speed. When ipsilateral approach is not possible as there is no sufficient distance to place an introducer sheath between the puncture site and the occlusion, contralateral antegrade approach is considered. Follow-up angiographic examinations of the successfully recanalized and dilated 16 occlusions in 15 patients up to one year revealed 87.57% patency rate. We conclude that, creation ofa pilot inlet and cross-over S 239 recanalization will increase the number of candidates for the recanalization with ROTACS prior to PTBA.

Magnetic resonance tomogrephy (MAT) In congenital defects of the left perlcardlal sac W. Judmaier (Presenter), I. GaBner, K. Wicke, I. Hammerer; Innsbruck A. We report the findings in 4 patients with left sided pericardial defects, and compare the value of MRT with other imaging modalities. B. Cardiac MRT was performed on a 1.5 T system using multiplanar ECG triggered TI weighted Spin Echo Sequences. The appearance of the pericardial sac and anomalies in position and shape of the cardiac chambers were evaluated. C. In 3 cases with complete defects an abnormal position of the heart, a partial enlargement of the left atrial appendage, and a marked prominence of the pulmonary artery were demonstrated. In one case with partial defect MRT showed the herniation of the left ventricle through the apical pericardial gap. D. Since in children with little epi-and pericardial fat layers the pericardial sac is not always visible with radiological methods, we have to rely on indirect signs ot assess its integrity. Whereas the total absence of the left pericardium is considered to have little clinical effect, partial absence in the apical region can be fatal. The ringlike constriction of the cardiac chamber, so far described in seven cases only upon autopsy, was seen for the first time in vivo on MRT. This 'myocardial strangle' sign should be noted as evidence of a life threatening disease. The diastolic compression of the coronary arteries however, could only be visualized by angiography.

Quantltatlon of cardiac valvular regurgitation with ultrafast CT scanning Tatsurou Kaminaga (Presenter), Hiroaki Naito, Seiki Hamada, Satoshi Imakita, Naoaki Yamada, Tadashi Nakanishi, Yoshiaki Hirose, Makoto Takamiya; Osaka Purpose: A new method with ultrafast CT scanning to quantify cardiac valvular regurgitation is proposed. Methods: Forty-two patients aged from 15 to 71 years (average 48 years) were examined with contrast UFCT. Twenty patients had mitral regurgitation and  patients had tricuspid regurgitation. Multislice cine mode UFCT scanning was performed to measure ventricular output with modified Simpson's method. Ventricular output (VO) was defined as follows: VO = stroke volume x heart rate. Flow mode UFCT scanning with bolus contrast injection was applied to measure cardiac output (CO) from time-density curve of the pulmonary artery and ascending aorta using Stewart-Hamilton's formula. Regurgitant fraction (RF) was calculated as follows: RF -(VO -CO)/VO. RF value was compared to the grade of regurgitation measured with cine angiography and/or Doppler ultrasonography. Results: Regurgitant fractions derived from UFCT scanning favorably correlated to the grade of mitral and tricuspid regurgitation measured with cine angiography and/or Doppler ultrasonography. Conclusions: Contrast UFCT could be used for precise quantitation of valvular regurgitation with combination of volumetry and densitometry. Furthermore, this method could separately measure the regurgitation of right and left side of the heart.

Usefulness of MAl In the fleld of cardlovescular pathology -a retrospective study B. Kastler (Presenter), Ph. Germain. A. Livolsi, A. Gangi, R. Allal, J. L. Dietemann, A. Sacrez, A. Wackenheim; Strasbourg Aim: In order to assess the practical value of spin echo MRI as function of various indications in the field of cardiovascular (CV) applications, we rewieved the contribution ofthe MR results for the clinical management of 550 patients studied from 1986 up to April 90. All examinations performed for research protocol were excluded (600 pts). Methods: A 3 grade score was attributed to each exam according to the relevance of the M R finding with regard to the clinical question: I = no significant data provided, 2 -additional clinically significant information & 3 = outstanding new information solving diagnosis problems or therapeutic decisions. Results: In our center, patient referred for CV-MR (protocol excluded) represented 3% of all MR exams (based on either echographic, X-rays or clinical findings). 255 observations have yet been rewieved. The list below carry back the number and % of indications and the corresponding retained diagnostic score: Our results indicate, that color Doppler ultrasound is an effective tool in diagnosis of venous valvular incompetence. There is a high degree of correlation between the results of color Doppler ultrasound and ascending phlebography.

ArchItecture of cutaneoua vascular network by postmortem mlcroanglography Heinz-Jakob Langen (Presenter), C. M. Breiden-Langen, A. Thron, S. Handt, M. Korber; Aachen

Purpose: Demonstration of the cutaneous vascular architecture by microangiography.

Methods: A suspension of barium sulphate was injected into the main arteries of nine amputated lower limbs. Skin sections of 2 mm thickness were obtained from the feet. Subsequently, these sections were fixed in formalin, embedded in paraffin and than exposed to X-rays on high-resolution photographic plates. Slices of 5 11m thickness from these paraffin blocks were cut for histologic examination and correlated to microangiography. Results: In comparison to histology, microangiography visualizes cutaneous vascularisation in a greater volume. For this reason, microangiograms provide a nearly threedimensional overview of microcirculatory anatomy. Capillary loops in the papillae, the sub-papillary plexus, the glandular components (with the capillaries surrounding the sweat glands), the candelabra arterioles and the descending venous system in the cutis could be demonstrated over a prolonged course. Direct comparison between microangiographic and histologic pictures of the same tissue slice helps to differentiate artifacts from lesions. Results: -Initial results: disappearance of the claudication was noted in all patients with a mean 0,4 increase in the ankle-arm-index. A residual stenosis lower than 30% was noted in 16 cases (the severity of the residual stenosis was lower when the catheter used was a 9 french, and when the lesion was short and non calcified. Seven mild dissections were noted. One distal embolization occurred without sequelae.

-Mid-term results: clinical and doppler improvement remained stable in IS patients with a maximum follow-up of 32 months (mean: 17,3 months); one restenosis at four months; one death, non related to the arterial disease, at 6 months. Atherectomy along with a conventional angioplasty seems to be a safe and effective treatment of short femoro-popliteal obstructions.

Anglographlc diagnosis of acute Intestinal Ischemia R. Dalla Valle, C. Marcato (Presenter), E. Banchini, L. G. Villani, U. Ugolotti; Parma

The diagnosis and treatment of acute mesenteric ischemia is still a debated and often unsolved problem. In case of intestinal infarction, angiography enables to distinguish occlusive from non-occlusive ischemia and can define nature and position of a lesion as well as the conditions of the distal vascular bed. Furthermore angiography represents an important method for both instrumental and pharmacological treatment. In the last decade we recorded in our Institute 40 cases of acute mesenteric ischemia. Nine patients underwent to global aortography and selective angiography of the superior mesenteric artery (SMA); in 5 cases the examination was carried out by traditional technique (Dos Santos), whereas in 4 patients we performed digitalized angiography. The angiographic details of our cases are shown in the poster. We diagnosed in 4 cases embolism and 2 cases thrombosis of SMA main trunk, which later were surgically treated. One case of embolism of the distal branches of SMA and 2 cases of functional ischemia were successfully treated both by local and systemic conservative therapy. In this latter cases only the traditional angiography permits to display the morphology of the distal splanchnic vascular bed. In conclusion we believe that, in the angiographic diagnosis of the acute intestinal ischemia, it is still fundamental to combine traditional and digitalized angiographic techniques in order to supply a detailed map of the splanchnic circulation and therefore to suggest the most suitable therapeutic approach.

Selective arterial embolization of symptomatic renal anglomyollpoma In a patient with tuberous sclerosiS A. Mariscal (Presenter), J. Dominguez, C. Sancho, A. Martinez, X. Montana; Barcelona Angiomyolipomas (AML) are benign tumors that commonly occur in association with Tuberous Sclerosis (TS) (60-80%) and in these cases they are generally bilateral and multiple. The majority are asyntomatic, but they can present themselves clinically with pain, a palpable mass and hematuria. Today, thanks to ecography and CAT it is possible to arrive at a correct diagnosis in almost all cases. Symptomatic AML's, particularly in patients with TS should be treated in a conservative way, in order to preserve intact as much of the normal renal parenchyma as possible. Herag we present a case in which we have employed selective renal arterial embolization to achieve this aim.

A 24 year old woman with traces of TS, had complained of left nank pain for one month. An analysis detected anemia which was the motive for further examinations (I.V.U., Ecography, CAn which enabled a diagnosis of multiple intra-abdominal AM L within the context of TS. A large AM L was seen in the lower pole left kidney. Later we carried out a diagnostic and therapeutic selective renal arteriograph of the mass. For this we used a 5.0-F catheter and Gelfoam and Coil as the embolization materials. A control cat three months later, revealed a large reduction in the size of the tumour. The clinical follow-up did not show any complication. The patient remaining asymptomatic with good renal function.

Duplex Doppler ultrasound: an easy way to detect alterations In renal blood flow non-Invaslvely 1. Mastorakou (Presenter), J. Firth, D. Young, C. Garrard, D. Lindsell, J. Ledingham; Oxford

Purpose: Duplex Doppler Ultrasound as a method to assess alterations in renal blood now in intensive care patients after intravenous infusion of a vasoactive agent such as dopamine. Methods and Materials: 20 persons, including 6 healthy volunteers, 6 patients with impaired renal function and 8 patients with normal renal function were examined. The peak systolic, end diastolic and mean velocities were measured from a waveform of an interlobar artery. Pulsatility and Resistance Indices (PI, RI) were then calculated before and after the infusion of dopamine at doses of 2.5 and 5.0Ilg/kg/min. Results: The mean values of both indices were reduced during the infusion of the 2.5llg/kg/min dose and return to baseline levels during the infusion of the 5.0llg/kg/min dose. The reduction in the mean values of PI was statistically significant in all subgroups (p < 0.0 I-paired t-test). It has already been shown that dopamine at 2.5llg/kg/min increases renal perfusion in healthy subjects, so a reduction in indices was expected. However, similar changes produced in patients with and without renal impairement provides some new evidence that this also occurs in renal impairement. It was also demonstrated that the mean values of the indices were significantly higher in patients than in normals suggesting that renal vasoconstriction may occur in ICU patients with normal renal function. Finally, the use of Duplex Doppler Ultrasound as a non-invasive method for the clarification of renal haemodynamics' in humans it was clearly shown. The authors propose a new method of treatment of arterial hypertension by X-ray endovasular occlusion of the central adrenal veins. The use of the new method would help portalize adrenal venous blood circulation as well as to inactivate cathecholamines and aldosterone. The proposed method has bean successfully used in 34 cases of essential arterial hypertension as well as in cases of arterial hypertension caused by chronic pyelonephritis and glomerulonephrities. The results of the use of this method would make it possible to discuss at a new angle the treatment of patients of renindependent arterial hypertension complicated through secondary aldosteronism.

Color Doppler assisted duplex sonography In the stenosis of the carotid arteries P. Milassin (Presenter), E. Nagy, Z. Morvay; Szeged

In 82 patients color Doppler assisted duplex sonography and angiography were performed. The grade of stenosis was divided into 6 groups. The same diagnosis was established with both methods in-80% of the cases. In most of the remaining cases with sonography a higher grade of stenosis could be observed than with angiography. Technical pitfalls in sonography of three cases caused significant differences in the evaluation of grading. Our results suggest that color Doppler duplex sonography should precede the application of other methods in the diagnosis of carotid stenosis.

Intra-arterial technique In advanced breast cancer C. Sogo Manzano, B. Acea Nebril. R. Gayoso Garcia, A. Parjo Calvo,

Breast cancer is one of the major problems affecting occidental women of today. In the U.S.A. every four minutes a breast tumor is diagnosed and every twelf a woman dies due to this cause. In Spain we will diagnose approximately 40,000 breast cancers in 1991 and 4,000 patients will die this year. Our objective is to present a new technique, that following the studies started by I. Koyama in Japan improves the interval free of disease and the survival rate and also permits a less mutilant surgery. We will show the supraselective intra-arterial chemoembolization technique in stage III cancers, that through the internal and external mammary arteries makes it easier for the medication to reach the tumor and later closing the vascularization. Our results are backed by our experience in 17 cases in which we have obtained a survival rate of 55% at 5 years. This represents a clear advance due to the prognosis of the cases in which this technique were applied to.

Significance of meg netic resonance Imaging (MRI) In patients with pulmonary hypertension A. Neuhold (Presenter), H. Frank. M. Stiskal, S. Globits, D. Glogar, J. Mlczoch; Vienna Purpose: To determine the diagnostic impact of MRI in pulmonary hypertension (PH) 21 patients (pts.) were studied. Methods: Double-angulated multislice-multiphase images (using a 0.5 Tesla magnet) were recorded using spinecho TI and gradient echo sequences. MRI studies were analysed for right ventricular (RV) volumes, function, segmental wall motion, and diameters of pulmonary arteries and caval veins. These measurements were compared with pulmonary pressure measured within 48 hours of MRI. The underlying disease was in 3 pts. VSD, in 2 pts. ASD, 4 pts. suffered a drug induced pulmonary hypertension, 5 pts. had mitral valve disease, 2 pts. had multiple pulmonary embolism, and 5 pts. a dilated cardiomyopathy. In addition 10 healthy volunteers were studied. Results: Pts. with PH showed increased RV-volume indices and abnormal septal motion irrespective of severity of PH. RV function was reduced in 3 pts., tricuspid regurgitation was demonstrated in all pts. There was good correlation S 242 between pulmonary mean pressure and diameter of inferior vena cava (r = 0.82), right ventricular EF and volumes showed no significant correlation. Conclusions: pts. with PH show a typical pattern of the right heart, although alterations do not correlate with the degree of PH, with exception of inferior vena cava diameters.

Supraselectlve embolization in renal trauma: our experience Guillermo Parga (Presenter), Rafael Fernandez, Roberto Villar, Ram6n Garcia-Martin, Javier Abad, Enrique Garcia-Hidalgo; Madrid

We report 23 cases of renal trauma treated with supraselective embolization. In 7 cases the cause of the renal injury was iatrogenic due to aggressive procedures: biopsy, nephrostomy ... The embolization was made with two types of embolic materials: gelfoam and blood clot; and in a few cases with stainless-steel coils too. All the patients had resolution of their disease after the embolization. No complications appeared. We think that supraselective embolization is a good treatment in some cases of renal trauma.

Prosthetic aortic valve for percutaneous transcatheter Insertion . We compared thrombogenicity of six angiographic catheters offour materials: nylon (Maliinkrodt, Surgimed), polyamide polymer (Meditech), polyethylene (Cook), and polyurethane (Cordis, Usci). Each catheter was used in two pieces: one untreated and the other filled with heparinized saline. Catheters were filled with blood from a healthy donor and incubated at 37° Jor 5 or 15 minutes. Then physiologic saline was injected through the catheters with a flow of 5 mils and clots were identified on a filter. EDTA was used to SlOP coagulation. The catheters were re-injected with a flow of 50 mils and clots were registered. 23 donors were used and 552 catheters tested.

All untreated catheters contained a clot at 15 min and 59% at 5 min.

Differences between the catheters were not significant (p > 0.5). 96% of the heparinized catheters contained a clot at 15 min and 24% at 5 min. Heparini-zation reduced the number of the clot containing catheters highly significantly at 5 min (p < 0.(01) but differences between the catheters were small: the only significant difference was found between the catheters by Mallinkrodt and Usci (clots in 9123 and 2123, respectively, p < 0.02). High pressure injection never revealed clots after a negative low pressure injection. Platelets labelled with in-I J I-oxine require more than 24 hours after administration before a definitive scintigraphic assessment of thrombogenicity can be made. The aim of our study was to investigate whether platelets labelled with Tc-99m-HMPAO would allow evaluation of thrombogenicity shortly after intraluminal intervention. Autologous platelets, labelled with Tc-99m-HMPAO were re-injected an hour before angioplasty. Scintigrams were made before, as well as I and 4 hours after angioplasty. In 5 patients studies thusfar, accumulation of Tc-99m was found at all 6 sites of angioplasty one hour after intraluminal intervention. Scintigraphic images, performed 3 hours later,!did not yield extra information. These results demonstrate that this technique is a sensitive and rapid method to assessing the thrombogenicity of (damaged) endothelium and has a practical avantage above currently used methods because the total procedure (blood withdrawal-angioplasty-scintigraphy) can be performed within 4 hours. The method cannot be used for platelet survival studies, but may be of use for evaluation of the effect of thrombocyte inhibiting medication.

Fusion of DSA-sequences and EeT -Images to display morphological and functional myocardial Information N. Rilinger (Presenter), H. Niemann, G. H. Reil, A. Hewett, J. Schwanke, L. Kohler, J. Schwanke, P. Jensch; Oldenburg

It is our aim to support the clinical routine in the management of coronar heart disease by integrated diagnoses. For this purpose we pursue a fusion of coronary angigrams and ECT images, to integrate morphological and functional images. Methods: Currently we are able to merge coronary trees, obtained from post-processed bi-plane angiogram sequences, with myocardial scintigrams after administration of thallium 201. This approach of fusion results in innovative multidimensional models whose constituents may be depicted in different colours, at arbitrary angles, and annotated with density information. A series of displays may also be viewed as an animated 3 D-model showing the coronary tree and the ECT-data illustrating perfusion and function of the myocardium. Results: To be able to perform integrated imaging repetitively we defined standards and processing facilities for each individual imaging system. Parts of the image data are prestructured, allowing specific items to restrict ROIs in an object-oriented and model-based way. Conclusions: This paper demonstrates the normalization and matching processes and shows the advantage of information-integration modelling. The presented concept allows a combined diagnosis of morphological and functional data in the management of coronar heart disease.

A comparative study of the efficacy of lower-limb Isotopic phlebography, Doppler-sonography and conventional phlebography In acute pulmonary embolism A. Segarra (Presenter), M. Moreiras, J. M. Rius, R. Boye, E. Grive, M. Fralle;

We instituted a prospective blinded study to assess the accuracy of Doppler-Sonography and isotopic phlebography in the detection of deep venous thrombosis (DVT) of the lower extremities, using contrast phlebography as the gold standard. 45 patients, between 22 and 78 years old, gammagraphically suspected of having acute pulmonary embolism were studied by contrast phlebography. 43 of these patients had Doppler-Sonography and 34 had Isotopic Phlebography. Contrast venography was positive in 29 patients for DVT. Doppler-Sonography was positive in 22 and normal in 21 patients (sensitivity was I, specificity was 0.72). Isotopic Venography was pathologic in 15 and normal in 19 patients (sensitivity was 0,74, specificity was 0,93). Contrast venography is the most accurate study in the detection of DVT of the lower extremity. Doppler-Sonography and Isotopic Venography because of their noninvasiveness and specificity could be used as prior filter to contrast venography.

Bronchial arteriography and therapeutic embolization in hemoptysis A. Segarra (Presenter), J. M. Rius, M. Moreiras, E. Grive, L. Casas, C. Sanchez; Barcelona A group of 63 patients (51 men and 12 women) between the ages of 21 and 79 years, with pulmonary hemorrhage, were evaluated by means of bronchial arteriography and treated with transcatheter embolization. Chest X-Ray film was obtained in all the patients been orientative in only 30 cases. Bronchoscopy was performed in 53 patients and could locate the bleeding site in only 38. Arteriography was positive in 54 patients. Angiographic signs include: hyperplasia of the bronchial arterial trunk and branches, extravasation of contrast medium, bronchopulmonary anastomoses and bronchial arterial aneurysms. Results: Transcatheter embolization was performed in 48 cases. 41 of them stopped immediately. Recurrent bleeding 24 hours after the procedure was observed in 3, and only partial improvement was obtained in 4. The treated patients were followed 6-30 months: Recurrent bleeding was observed in 5 patients. 3 of them underwent surgery, I was re-embolized and I died. Major complications in our series were: subintimal dissection (4), acute iliac thrombosis (I), segmentary mesenteric ischemia (I) and mediastinal hematoma (I).

Conclusions: Transcatheter therapeutic embolization may be a very useful method for the control of hemoptysis in nonoperative candidates and for initial hemostasis before surgery in the operables ones. SPACE 11l!!.

Comparison of 99"'1'c-MIBI and ECG In exercise and rest conditions for the diagnostiCS of CAD E. Sheiretova (Presenter), M. Garcheva, H. Hadjlkostova, L. Terzieva, S. Kovacheva; Sofia 67 patients with CAD were examined with 99mTc-MIBI at rest and bicycle exercise. The diagnostic value ofMIBI was compared with that of the classical ECG working test. In 22 patients with suspected CAD, MIBI and ECG test were negative in 77% and positive in 4.5%. MIBI was positive in addition in 14%; ECG test in 4.5%. In 24 patients with stable or unstable angina pectoris both tests were negative in 38% and positive in 16%. MIBI was positive in addition in 34%; ECG test in 12%. For patients with previous myocardial infarction both methods were confirmative in 48% and without diagnostic value in 14% (cases with non-Q myocardial infarction). MIBI didn't visualize the scars in 33%-cases with postero-inferior localisation. In 5% there was a difference between the localisation of MIBI-defect and the ECG-changes. Ischemic changes in this group were detected in 48% of the patients: in 24% by both methods, in 19% by MlBi and in 5% by ECG test. Conclusions: In the visualization of scare the diagnostic value of MIBI is high, but not for the postero-inferior region. For ischemia detection MIBI is more successful than ECG working test.

Evaluation of cardiac function by serum human atrial natriuretic peptide Mitsuharu Shimizu (Presenter), Yanako Hirata, Shinobu Nakagawa, Michiko Agiki, Shinji Hashimura, Yoshio Hiraki; Okayama Purpose: Serum human atrial natriuretic peptide (hANP) was measured in subjects consisting of 58 heart disease patients. A comparison was made of these results with cardiac function parameters determined by echocardiography, cardiocatheterization, cardiac blood pool scintigraphy. A study was then made regarding the evaluation of cardiac function by hANP. Methods and Materials: Measurement of serum hANP was performed by radioimmunoassay. Testing was performed on 58 subjects consisting of 23 cases of ischemic heart disease, 30 cases of valvular disease and 5 cases other related disorders. Results: In the elevated hANP group, left ventricular ejection fraction and cardia index were significantly lower in comparison to the normal group, and hANP renected a decrease in left ventricular function. Also in the elevated hANP group, left atrial diameter was significantly increased in comparison to the normal group, and a significant positive correlation was observed between hANP and mean right atrial pressure. It was concluded that hANP become elevated accompanying extension of the atrial wall, and a parameter which reflects decreased left ventricular function.

The leiomyosarcoma of the vena cava Inferior: a difficult diagnosis P. Vandermarcq (Presenter), J. B. Talon, A. Alluaume, J.Drouineau, O. Azais, A. S. Lagrange, C. Gasquet; Poitiers a) The preoperative diagnosis of leiomyosarcoma of the vena cava inferior is very rarely made because of the scarcity of this affection. S243 b) Two cases with suggestive preoperative modern imaging are reported. c) Three radiologic investigations are useful: -Both sonography and vena cava inferior angiography show either hyperechoic intraluminal polylobed lacuna located on one segment of the vena cava inferior without thrombosis or obstruction with collateral circulation and hyperechoic right paraaortic mass.

-CT demonstrates the extraluminal extension, the right lateroaortic location of the tumor and the heterogeneous soft tissue density where the vena cava inferior abuts. The association of an intraluminal lacuna and a right sided tumor seems to be very suggestive for the diagnosis. These three radiological investigations are equally essential for the assessment of this tumor which has a bad prognosis and needs a delicate surgery.

Digital subtraction angiography (DSA) In cerebral and arterto-venous malformation K. Velkova (Presenter), P. Stefanov, V. Chervenkov; Plovdiv

Presented is the experience yielded from 347 cerebral angiographic examinations. Among them were 54 cases (15%) of cerebral aneurysms (CA) and 28 cases (8%) of arterio-venous malformations (AVM). Analysed are both, the CA's and AVM's regarding position, size and status as well as the angiographic symptomatology, related to these factors. An attempt is also done to evaluate the diagnostic information of the intravenous and intraarterial DSA in cases of CA and AVM. The personal preference of the authors is to utilize the intraarterial DSA as primary preserved diagnostic test, when the place for the intravenous DSA is reserved in follow-up examination. Emphasized is the opportunity provided by DSA for analysing the morphology and hemodynamics of the CA-AVM using less contrast medium and reducing the radiation hazard.

Thermal dlstrtbutlon of sapphire probe: Influence of flow rate of CO2 gas and saline perfusion Xiaoming Yang (Presenter), Hannu Manninen, Hongxiu Ji, Seppo Soimakalllo; Kuopio

Purpose: To evaluate thermal distribution characteristics of sapphire probe. Methods: Together 162 temperature measurements on a 2.2 mm sapphire probe surface were obtained in a circulation model within 37° C flowing whole blood. A thermocouple wire was directly contacted onto the sapphire probe at: I. metal connector, 2. lateral side and 3. top of sapphire crystal. During lasing with Nd-YAG laser, carbon dioxide (C02) gas or saline was infused through the sapphire probe at different flow rates. Results: Mean peak temperatures at all three sites increased with increasing flow rates of CO2 gas and decreased with increasing flow rates of saline perfusion. Mean temperature rise at the lateral side of the sapphire crystal was statistically lower (p < 0.05) than that at the sapphire crystal top, but higher than that at the metal connector. Moreover, the mean temperature rise at all three sites was statistically higher (p < 0.05) with CO2 gas than with saline perfusion. Conclusions: Present study shows the experimental basis: I) there is direct thermal conduction from the lateral side of the sapphire crystal. 2) CO2 gas perfusion offers more favorable mode of action for the thermal efficiency of the sapphire probe than saline perfusion.

Ell Mammography (03) SPACE ~ Results of the ravlslon of the first 20,000 women pertlclpants In an early detection breast cancer program In Navarra, Spain Luis Apesteguia Ciriza (Presenter), Alberto Murillo Espinal, Angel Del Moral Aldaz, Nieves Ascunce Elizaga; Pamplona Purpose: Detection of breast cancer in its early stages in women residents in Navarra betwen 45 and 65 years old. Methods and Materials: Screening technique: a mammograph (OML projection). Initially 5,000 women were involved in a double blind reading until satisfactory agreement rates were reached. Later, only random samples of the women examined (15%) were carried out. In necessary cases new mammograph projections, physical examinations, FNA-citologies are carried out. Citologies for estereotaxia and biopsies with and without radiologicallocalization for a definite diagnosis and treatment, will be carried out in 2 tertiary-level hospitals with the participation of radiologists from the detection unit. Results: To date have been examined 10,436 women. New mammograph projections were necessary in 15 % of the cases and 3 % needed an echograph.

2% of the women were sent to the hospital unit for citology and/or biopsy. To date 58 cancers have been detected, giving a detection rate of about 5 per 1,000 of a predictive positive value of 34%. These results will be presented along with stages, treatments applied and percentages of the application of different techniques for women examined, up to 31 July 1991 (20,000).

The earty detectIon breast cancer program In Navarra, Spain, general organisation, participation data Nieves Ascunce Elizaga (Presenter), Angeli Del Moral Aldaz, Luis Apesteguia Ciriza, Alberto Murillo Espinal; Pamplona Purpose: Reduction of breast cancer mortality, increase survival rate, improve quality of life. Methods and Materials: Carry out mammographs (OML) every 2 years on all women resident in Navarra (60,000) between 45 and 65 through personal citations (census based). Test are free. In all cases an epidemiological questionnaire will filled out with hormonal, gynaecological and mammary data. A permanent urban unit and rural mobile unit have been set up, equipped with mammographs and processors. Personnel in each unit is formed by sanitary auxiliaries and radiology technicians. The general organisation of the program has been entrusted to the manager, radiologists and secretaries of the central coordination unit. 2 hospitals have been entrusted with the diagnostic and treatment process, according to previously agreed protocols. Participation will be obtained through the collaboration of primary health teams using too press, radio, TV, posters, pamphlets, and conferences. This program is included in the European network supported by the EC (Europe against cancer), being piloted in Navarra for Spain. Results: The general coordination program scheme, along with strategies to attract women, the organisation of units etc. will be presented. To date, 10,436 women have been examined (82.3% of those invited to participate), and 58 cancers confirmed.

Corralations of CA-15-3 radioimmunoassay values In patients with breast cancer with radiologic and clinical evaluations Kirkman G. Baxter (Presenter), James Bergh, David F. Preston, Ralph G. Robinson, Arch W. Templeton; Kansas City, KS Purpose: The CA-IS-3 assay utilizes monoclonal antibodies that react with a circulating antigen expressed by human breast carcinoma cells. Methods and Materials: We examined the relationship ofCA-IS-3 radioimmunoassay values to the scintigraphic, radiographic, and clinical evaluations of patients with metastatic breast carcinoma. The CA-\5-3 values were correlated with imaging impressions of improvement, worsening, or no change. Patients who had insufficient radiographic evaluation were rated by final clinical impression of the current status of their disease. Results: There is a positive correlation of CA-\5-3 values with the level of soft-tissue metastatic breast cancer involvement. This new assay provides useful clinical information regarding the status of metastatic breast carcinoma.

Phosphor plate mammography C. H. Joseph Chang (Presenter), Norman L. Martin, LarryT. Cook, Michael F.lnsana, Samuel J. Dwyer III, Arch W. Templeton; Kansas City, KS Purpose: A photostimulable phosphor imaging plate system has been used for over one year for mammography examinations. Methods and Materials: Conventional screen-film and phosphor plate mammograms were obtained. Special high resolution cassettes and imaging plates were used. A 50 percent exposure reduction was employed for the imaging plate examination. Digital mammogram images were archived on an optical disc. A comparison between conventional and reduced exposure phosphor plate mammograms has been completed for patients with masses, micro-and macrocalcifications, and dense fibrocystic changes. This study shows equivalent results. Results: The inter relationship of the linear wide dynamic range and improved imaging efficiency of phosphor plates is discussed.

Sensitivity and specificity of ultrasound in palpable breast masses J. Danes (Presenter). L. Vyhnanek, E. Gutwirthova; Praha Methods: The purpose of the study is to estimate the reliability of the ultrasound investigations in comparison with the mammography in the diagnostics of the pathological conditions of the breast. Methods and Materials: The study is based on experiences with the ultrasound examinations of the breast in more than 3000 women. From this group of patients, 508 selected women with the palpable lesion of the breast were simultaneously examined by mammography and ultrasonography. All of the findings were verified. Results: In the estimation of the carcinoma, the sensitivity of the US was higher (98%) than of the mammography (78%). On the contrary, the specificity was a little lower (94/96%). The ultrasonography proved to be especially valuable in the women with dysplasia of the mammary gland, in which the sensitivity of the mammography was very low (58%). Excellent results were achieved by the combination of both of the methods. Ultrasonography was highly reliable in the diagnosis of the cysts, including galactoceles and intlammatory lesions, too.

Sonographic features of cystosarcoma phy"oldes T. H. Dao (Presenter), T. Nguyen-Tan, L. Ollivier; Paris Purpose: To assess the ability of sonography to identify cystosarcoma phylloides when X-ray mammography reveal only benign-appearing mass compatible with other diagnosis. Methods and Materials: Sonographic features of 9 cases of proven cystosarcoma phylloides are reviewed. Results: The ultrasound findings included hypoechoic multilobulated lesions with sharp demarcations. posterior enhancement. These lesions are predominantly solid with tluid-filled space surrounding nodular lesions, usually described as a "cleft" pattern. Association of this aspect of "bunch of grape" with this cleft pattern is. in our experience strongly suggestive of cystosarcoma phylloides. Computed tomographic and histologic correlations are shown. Conclusions: When a "bunch of grape" pattern is found on sonography, the diagnosis of cystosarcoma phylloides must be considered for adequate treatment, until sarcomas are indistinguishable from benign lesions. Purpose: Is it acceptable to use the grid systematically in mammography? With grid, mammographic images are qualitatively better, anyway the advantages in terms of diagnostic contribution have not yet been quantified with certainty and the dose is greater. The aim of this study is to value the possibility of employing more sensitive systems in such a way as to can obtain the advantages by using the grid without increasing the dose. Methods:

A conventional mono-emulsion system (KODAK MIN-R/ORTHO-M) used without grid was compared with II new system using dual reinforced screen and dual emulsion film (FUJI HR-FAST/HR-MH) used with the interposition of the mobile grid. Qualitative valutations and quantitative ones (H&D curve, "Wiener spectrum", MTF) have been done. Results: The dual-emulsion films appeared to be better in sensitivity and contrast and slightly noisier. The resolution was superimposable. Conclusions: The results suggest that if the grid is used systematically it is better to use more sensitive systems to reduce the dosimetric problem. The dual-emulsion system used in this study is suitable_ As a last consideration. the use of a dual-emulsion film minimizes the problems deriving from bad treatment and makes it possible to utilize quicker treatment times_

Nonpalpable breast lesions: double localization with wire and dye track P. Cosmacini, V. Sacchini, C. Ferranti (Presenter). L. Aiani, G. Piragine, S. Bergonzi, G. Coopmans de Yoldi; Milano A method of double localization. in order to make easier the remotion of nonpalpable breast lesions, has been performed at the National Cancer Institute of Milan. Between August and October 1990, 10 consecutive patients underwent double localization and then surgery. The first localization is performed the day before surgery. placing by means of mammography a self-retaining anchor wire needle near the lesion; the second localization is performed immediately before surgery, injecting a Methylen Blue solution through a lateral-holed needle. This needle is introduced cannulating the previously placed wire. The Methylen Blue solution spreads through the lateral holes situated in the last cm near the point of the needle. making a dye track that leads to the lesion. In our 10 cases the dye track was always well visible. with a width until 1.2 em around the wire. This method allows the surgeon who follows the dye track to easily recognize the lesion and to plan an adequate and radical excision, avoiding to cut the wire.

Mammographic study In male-to-female transsexual In hormonal therapy Maria Grazia Genovese (Presenter), Renato Bocchini, GianPaolo Cavallotti, Riccardo Violante; Torino Often the male transsexual takes hormonal drugs to obtain a development of mammary gland and the disappearance of hair from facial skin. The authors present radiological aspects of breasts in 20 patients (age between 20 and 46 years) before and after therapy of 2 years at least. Nobody transsexual had mammary lesion before hormonal therapy. After therapy we ohserve 6 normal and 14 pathologic radiographic reports (7 adenofibrosis. 5 fibrocystic disease and 2 patients with dystrophic calcifications) without breast cancer. We relate work-up in table.

Primary lymphoma 01 the breast, report of 4 cases A. Gomez Gomez (Presenter), E. Castaner, V. Villalba, A. Zidan, C. Traid, Y. Pallardo, P. Alvarado; Barcelona Purpose: Primary non Hodgkin lymphoma of the breast is a rare entity, and few cases have been reported in the radiological literature. Methods and Materials: We present 4 patients with primary breast non Hodgkin lymphoma. Results: They presented with palpable masses associated with skin edema and axillary lymph nodes in one case. Plain mammography showed ill defined irregular masses, considered as malignant, in two patients. and well defined masses. considered as indeterminated, in the other two. One patient presented diffuse breast edema, and skin thickening. No microcalcifications were demonstrated. Pneumooncography (air injection into the lesion) showed cryteria of malignancy in the indeterminated masses. The preoperative citology was not diagnostic. No case diagnosed preoperatively as lymphoma. The peroperative biopsy diagnosis excluded epitelial neoplasm but no definitive diagnosis could be made. Primary non Hodgkin lymphoma of the breast can be differentiate preoperatively from other malignant lesions, only definitive pathologic study can made the diagnosis.

Breast tuberculosis V. Villalba Nuiio, A. Gomez Gomez (Presenter), M. Velasco; Barcelona Affectation of mammary glands by Tuberculosis (Tbc.) is not frequent. Out of 86.500 explorations carried out within the last 22 years, 5 cases have been located. In one of them (I c.). association with carcinoma was observed. Presentation radiologic stllndards are checked, and diagnostic methodology is expounded. Results: I. Affectation non-frequent (0,05%). 2. Presentation radiologic standards in common with malignant lesions. 3. Diagnosis guided by the presentation of Tuberculosis in other organs. 4. Non-conclusive citology. 5. Histological and microbiological diagnosis. Unless bacillus is isolated, diagnosis labelled as Granulomatous Caseose Mastitis.

Value of pneumooncography in the diagnosis of medullary carcinoma and colloid carcinoma A. Gomez Gomez (Presenter). A. Zidan, E. Castaiier, Y. Pallardo, C. Traid; Barcelona Purpose: Colloid carcinoma (mucinous) (CC), and medullary carcinoma (MC) of the breast usually present as well circumscribed lesions that are difficult to differentiate from benign lesions. We described the value of pneumooncography (air injection into the lesion) in the preoperative diagnosis of these neoplasms. Methods and Materials: We present 22 MC and 24 CC which represent respectively 0,5% and 0.6% of all breast cancers diagnosed in the last 17 years in our center. The mean age (range) was 56,5 (21-79) for MC and 52,5 (45-83) for cc. The mean duration of symptoms was 3,5 months for MC and 16 months for Cc.

Results: 10 of the MC (45%), and 15 of the CC (62,5%) presented as a well circumscribed mass and underwent pneumooncography. This showed criteria of malignancy and consisted in: I. Absence of capsule in all of them. 2. Vaquolar pattern in 7 (70%) ofMC, and in 8 (53%) ofCC. 3. Demonstration of irregular contours in all MC and II (73 %) Cc. 4. Absence of malignant ductal pattern, which is diagnostic of ductal carcinoma, in all of them. Pneumooncography is a valuable aid in the diagnosis of MC and CC.

Nonpalpable breast lesions: mammographic and localization procedure Imaging, review of 90 cases M. Irlbar (Presenter), A. Yilarrasa, S. Borruel. C. Lopez. C. Mira; Madrid

Radiographically guided localization of nonpalpable breast lesions before biopsy avoids unnecessary excessive removal of breast tissue. Marking of these lesions for biopsy has become a routine procedure in patients in whom mammography has suggested malignancy. We present 90 cases of occult breast lesions detected by mammography in which biopsies were performed from 1984 to 1990. The patients ranged in age from 30 to 80 years, with a mean of 44 years. The radiographic lesion size ranged from 2 to 40 mm (mean 13 mm) and 15 cases had previous diagnosis of malignancy in the contralateral breast. Suspicion of malignancy was based on the presence of the following radiological patterns (given together with their Positive Predictive Value PPV): I/microcalcification alone (PPV 0.40). 21stellate opacities (PPV 0.64), 3/asymmetric densities (PPV 0.16), 4/regular border densities (PPV 0.27), and 5/microcalcifications associated with 2, 3 or 4 (global PPV 0.46). Neither the presence of microcalcifications in a pattern of stellate opacities nor its prensence in a pattern of regular border densities seems to yield a higher suspicion index than both patterns alone (PPV 0.62 vs 0.64 and PPV 0.20 vs 0.27 respectively). On the other hand, the higher PPV (0.50) of asymmetric densities with microcalcifications compared to that of asymmetric densities alone (0.20) should be taken with caution due to the small number of cases. The average detection rate of preclinical cancer was 2.10%0 and the ratio of benign to malignant biopsy findings was 1.6 : I for the whole series. Examples of mammographies will be shown, as well as tables with the results according to age group, radiological pattern and histological diagnosis.

Inflammatory carcinoma of the breast: Clinical and roentgenologic findings U. Keske (Presenter), M. Langer. P. Uhrmeister, R. Felix; Berlin

Purpose: Clinical and roentgen findings of inflammatory carcinoma of the breast (Ie) were evaluated retrospectively. Patients and methods: A total of 39 patients was examined. Histologic confirmation of the diagnosis was present in all cases (26 primary/13 secondary IC). Results: Mean age was 55.8 years and slightly higher for secondary than for primary IC (61.5/54.6 years). Patients presented with a firm induration of the entire breast (83%) and palpable axillary lymph nodes (69%). Redness of the skin (57%) or a palpable tumor (46%) were other frequent criteria. The roentgen findings were dominated by an overall increased tissue density of the breast (100%) and skin-thickening (97%), a localized tumor could only be seen in 27%. Means survival was poor (21 months) and worse for secondary than for primary IC (14/28 months). Conclusions: Whenever the clinical and radiologic criterias mentioned above are present, furtber evaluation for IC should be undertaken (cytology or skin biopsy). The latter proved to be very helpful in the diagnosis of Iymphangiosis carcinomatosa.

Comparison of breast structure and findings by x-rey mammogrephy and ultrasound H. R. Laine (Presenter). J. Rainlo, H. Arko; Helsinki Even nowadays, X-ray mammography (XRM) cannot always reveal small breast cancers in breasts rich in dense normal glandular and/or mastopathic tissue. Ultrasound (US) is very sensitive for soft tissue characterization. In this study we tried to evaluate the quality of the methods for our routine breast diagnoses in our hospital. This material has been collected during a year 1988-89. All XRMs and US examinations and fine needle aspiration biopsies (FNAB) of breasts performed to these patients, were collected. 489 female patients underwent XRM and 293 patients of these underwent also US examination and 88 patients FNAB, too. All cases, found cytological diagnoses PAPA Gr III-Y were operated. Results indicated, that 25% of malignant nodules would have been missed, if only XRM would be performed. The results also revealed, that the smaller nodule and/or denser breast tissue, the better visualization will be reached by US compared to XRM. This study also indicated, that only 20% of breasts, found malignant tumour, had calcifications of malignant type, whereas in S246 cases, whose breasts contained malignant type microcalcifications in XRM, the malignancy was found in 50%. We did not found any calcifications in quarter of the cases, found malignant tumour histologically. In conclusion we can present, that soft tissue breast examination by US must be performed always, especially, when dense normal glandular and/or mastopathic tissue is found in one or more quarters of a breast. That means. that number of unnecessary breast operations will be reduced and more sparing breast operations can be performed. Purpose: To evaluate the role of double-contrast ductography or pneumoductography in the diagnostic evaluation of small intraductal lesions that can be obscured by contrast material used in the routine single-contrast ductography Methods and Materials: After routine single-contrast ductography and evacu· ation of the contrast material, we inject 0.5 to 2 ml of air using a small 2 ml syringe that is connected to a catheter inserted in the duct. Routine mammographic examination is performed prior to removal of the syringe and catheter in order to avoid air reflux. Results: We used double-contrast ductography in 25 patients with a mean age of 46.8 years. Pneumoductography showed two 3 mm elevated lesions that were not seen during routine single-contrast ductography. Intraductal papilloma was diagnosed in both cases by histologic examination. Also our doublecontrast technique allowed us to differentiate intraductal lesions from artifacts seen during routine single-contrast. All the patients tolerated well the procedure and we did not find any complication. We conclude that double-contrast ductography or pneumoductography is a complimentary technique to routine single-contrast ductography in the diagnostic evaluation of small lesions in the main duct. Pneumoductography allowed us a detailed view of the main duct walls and helped in differentiating true intraductal lesions from artifactual filling defects observed during routine ductography.

Mammographic changes aHer lumpectomy: review of 29 cases C. Lopez (Presenter). S. Borruel. A. Yilarrasa. M. lribar. R. Calero. C. Miro; Madrid

Since more than fiveteen years there has been a trend toward conservative surgery in the treatment of operable breast malignancy. Surgical procedures ranging from radical mastectomy to lumpectomy with or without radiation. When lumpectomy is achieved a wide variety of postoperative mammographic abnormalities may be found: skin changes parenchymal scar, fat necrosis, asymmetric glandular tissue defect and local recurrence imaging may be stood out. We searched 29 cases of breast carcinoma in last three years in whom lumpectomy was achieved in our institution. We show mammographic imaging of those postsurgical abnormalities and radiologic evolution. We emphasize differential criteria which can help distinguish benign scarring from malignant local recurrence. Study included 105 unselected breast cancer female patients diagnosed and treated at the Osijck General Hospital, Yugoslavia. All patients were over 30. The procedure included clinical examination. mammography. surgery with pathohistology and steroid receptor levels. The aim was to assess the reliability of parenchymal patterns in predicting the steroid receptor status and to correlate steroid receptor levels and mammographic patterns with age and menopausal status of the patients. No significant associations were observed between the steroid receptor content in the primary tumor and mammographic parenchymal patterns, suggesting that it is not possible to predict hormonal dependency from the mammographic pattern. P2 and Dy pattern were more frequent among premenopausal and patients under the ago of 50. (P2 44.2%, Dy 32.6%). Lower shares were observed in the group over 50 (P2 37.1 %, Dy 22.6%). Observation was not significant (t-values 0.37 for P2 and 1.12 for Dy: p > 0.05). Estrogen receptors correlated strongly with age (maximum at the age of 60; N -77: R = 0.37: p < 0.01). Progesterone receptors showed no significant correlation with age of patients but correlated with menopausal duration (maximum 20 years after menopause, N = 40: R = 0.39; p < 0.05).

Physical examination, mammography and ultrasound In the detection of axillary lymph node metastases In breast cancer J. Morgado Ferreira (Presenter), B. Assis, M. Flores, C. Cunha; Lisboa A prospective blind study was carried out with the objective of assessing the value of physical examination, mammography and ultrasound in the detection of axillary lymph nodes metastases in patients with breast cancer. We studied 84 female patients admitted consecutively at a surgical department of an oncological hospital with mammographic suspicious lesions. All patients were subject to a standard physical examination, axillary view and ultrasound performed by independent physicians. 31.5% patients had a histological diagnosis of benignity. Of the remainder, 82% were subject to an axillary dissection and there were 40% of metastases in axillary lymph nodes. Physical examination presented the higher specificity (92.4%), but a very low sensitivity (45%). Ultrasound had the higher sensitivity, 80%, with 88.7% specificity. There were no false positives in patients with benign disease. However, all methods failed to detect lesions smaller than 5 mm. In Oil Cyst, Hematoma in male and abscess the diagnosis was made by clinical history, mammography and evolution of the lesions. Besides it the abscess was punctured and cultured.

Discomfort and pain In breast due to foreign bodies V. Rathaus (Presenter), M. Shapira; Kfar Saba 5 cases of various radiopaque foreign bodies in the breast tissue were found in mammography. All women presented with discomfort and pain. In two of them a mass was also palpable. In three of the patients unreported catheter was found to be for therapeutic purposes: no additional breast pathology was found. In the other two cases remains of previous surgical procedures causing the palpable masses were seen. These unexpected mammographic findings explained the patient's complaints and in fact mammography was the only study required to evaluate these women. Purpose: Breast sonography can be used to differentiate cystic from solid masses, and to characterize masses as an adjunct to mammography. The combination of mllmmography and sonography can characterize with liability a high percentage of breast disorders. However in some cases the differentiation between benign and malignant breast conditions is difficult. The purpose of our work is to evaluate the role of duplex-Doppler sonography in the evaluation of breast masses. Methods and Materials: All the women with solid breast masses assisted in our Service over a 9-month period, were included in the study. A real-time sonography unit with Dopper capabilities was used for the breast examination. A 7.5 MHz transducer (5 MHz for Dopper analysis) was employed. The range gate sampling was 2-4 mm. The lowest available filter of the Doppler unit (100 Hz) was selected. The scale of the velocity range of the spectral display was set at 0.25 m/sec. Fine-needle aspiration-biopsy was performed on all patients immediately after sonography. Results: In more than 50% of the patients with breast cancer there was positive tumor flow signals. No patients with benign breast conditions showed positive Doppler signal. Therefore, duplex-Doppler sonography can play an useful role, as an adjunct to mammography and sonography, in the evaluation of breast masses.

Ultrasonography v,s. mammography In diffuse benign breast diseases Elena Rabanal Bodelon, Joan Salvia Farre, Roser Garcia Abella, Jaume Planas Roquerols, Ramon Rosell Mir (Presenter); Barcelona

We studied 250 women between 30 and 70 years, diagnosed radiographically as mammary dysplasia, as stablished by the following parameters: A) Evenly dense breast: Predominantly fibrous disease B) Breasts with mUltiple nodular images with more than 3 mm of 0: Fibrocystic disease c) Nodular images with less than 3 mm 0: Fibrocystic disease of ductal or lobular hyperplasia. We have tried to establish a correlation between the images obtained by mammography and those obtained by sonography. We have observed that the presence of nodules in the mammography, which we diagnosed as being small cysts or fibroadenomas, do not have sonographic reciprocity in certain cases. Moreover dense breasts, that have evenly fibrous aspect may have cysts of up to several mm of 0. We believe that sonography confirms the need of a new classification of breast fibrocystic diseases, the review of the concept of mastopathy and the normality, of many explorations diagnosed radiologically as diffuse intraglandular disease. The use of sonography and mammography together allows to establish a more precise diagnosis of benign breast diseases, and helps to confirm the presence or absence of nodules in dense breasts without palpable masses. We present a preliminary report on a breast cancer detection program in hospital workers, which was begun in January 1989, and it was controlled and carried out by the Radiodology Department and the Preventive Medicine Department in the General Hospital Vall d'Hebron of Barcelona. It was a part of the main general reviews in the feminine workers of the hospital. The program included the female hospital workers older than 45 and consisted in a physical examination and a double view mammogram. The patients that accomplished the revision were 336 (37.7% of the 892 who were convocated). An elevated incidence of carcinoma was confirmed, 4 cases representing a 1.2 %. It probably represents the high prevalence of the disease, a fact reported by many authors in their first examination. We made an ultrasonographic study in 169 breast lesions included under two conditions: I. Either clinical or radiological breast lump, and 2. Tumor bigger than 5 mm. All the lesions were studied by ultrasound (US) and by a two-view mammography. A new US maneuver is described and evaluated: The a. p. axis was measured and how it shortened under US probe-compression, classifying the lesions as probably malignant and definitively benign according to this sign alone. Three different patterns were observed: I. -Malignant pattern. Those tumors with an upper compression limit of I mm. All the malignant tumors were included in this pattern (sensitivity = 100%, sepcificity > 60%).

2. -Slight compression benign pattern. The border compression limit was stablished between 1 and 3.4 mm. All of them were benign conditions: Fibroadenomas. Small cysts, epitheliosis, etc. 3. -Soft benign pattern. The lower compression limit was 3.4mm. Here were included only two different benign processes. Fatty tumors (lipomas. hamartomas), and the biggest cysts (more than 2 cm). Not any malignant lesion was observed to diminish far more than I mm. Results: Based on generally principles of elasto-mechanics an infiltrating mammary carcinoma can be recognized by a concentration of structures resulting from the concentrated tension and elongation. This finding can be demonstrated arithmetically and by stress analysis. Further advantages of this Mammo-Elastogram are as follows: I. Better view of the retromamillary space. 2. Inclusion of the tissue which were contiguous to the pectoral wall into the x-ray beam. 3. Control of the mobility of suspect mammary inclusions regarding the compression of peritumoral structures. 4. Enlargement of the radiological projection of organs and thus a better view of detail. 5. Always the nipple marginally on the picture, giving a clear point of reference as to the localisation of the tumor. Conclusions: Analogous with the retraction phenomenon which we have clinically in cases of breast carcinomas and proved by stress analysis, these tension and elongation concentrations which can be visualised radiologically and which have been described above. turn out to be most reliable radiological signs of malignity.

Malignant calcifications In mammographic appearance of Invasive papillary breast carcinoma: report of two cases Renato Silva (Presenter), Francesco Ferrozzi, Pietro Quaretti, Armando qossi; Piacenza

The invasive papillary carcinoma is an uncommon neoplasm of the breast. The radiologic features were described recently (I). Our cOOlribution is concerning two cases both occurred in the elderly (above 80 y.). Mammographic pattern was characterized by a cluster of round or oval, smoothly circumscribed areas of density in one quadrant of a breast. In both patients, calcifications were found (finding not previously reported). Sonography revealed hypoechoic solid, smooth-walled abnormalities. In agreement with others (I), we believe that the diagnostic imaging of the breast may be suggestive for invasive papillary carcinoma. It is noteworthy that the presence of malignant calcifications cannot rule out the diagnosis of papillary breast carcinoma when the well-known pattern is shown at mammography. The mammographic check-up is developing more and more among people and it involves asymptomatic women, for whom the age represents an indication to the test. Mass media have certainly influenced this line of conduct, so that the number of patients now turning to the clinical mammography is getting higher and higher. The frequency of check-up shall depend on the "kind" of breast, i.e. its clinicalradiological characteristics, together with the careful evaluation of the risk factors. We have considered 20.000 women who underwent mammography; the under 35 have been excluded from this study, since this age class is not covered by the records. Normal cases were 17.100 (85.6%), neoplasias 120 (3.7%), while in 2.150 cases (10.7%) mammography gave suspicion data (Class R3) and required percutaneous or surgical bioptic checks. The diagnostic accuracy of the enquiries by image on the breast shall have the false positive as its term of comparison, which, more than the false negative, represents the real "mistake" in Senology.

Mammographic, sonographlc and Color Doppler findings In patients with conservative surgery and Irradiation (QU.A.RT.) of breast carcinoma C. Vanoli, M. Carlotto, R. Campi, L. Tufarulo (Presenter); Como Purpose: The normal appeanIDce of irradiated and operated breast is presented in comparison with the abnormal findings of recurrent cancer. Methods and Materials: 150 patients have been examinated short time later surgery with clinical palpation, mammography and sonography. 40 patients presented suspicious findings for recurrent breast carcinoma. Mammography roused suspicion when there were microcalcifications, thickenings, distorsion of the normal breast structure. Sonography roused suspicion when there were solid hypoechoic nodes, a non-homogeneous structure of the breast, irregular outline of breast, cysticlike nodes. Color doppler was not useful. All 40 patients underwent thin needle biopsy. Results: in 40 patients a recurrent cancer was suspected, but only in 15 patients we found a recurrency. That is to say a specificity of 37,5% with the utilization of both mammography and sonography.

The male breast M. Velasco (Presenter), A. G6mez, T. Pujol, M. Sole, J. Pomes; Barcelona One hundred and sixty mammographic studies of male breast performed during the last four years were reviewed. All patients presented clinical breast induration. The youngest was a 12 year old and the oldest a 85 year old. The radiological findings were as follows: 137 cases af gynecomastia, three abscesses, three inflammatory mastitis, three epidermoid cysts, one simple cyst and a 18 years old boy with gynecomastia, two cases with intramammary lymph nodes, two myofibroblastomas, one leiomyoma of the nipple with breast tissue infiltration and six malignant breast tumors. We present the most relevant cases of these mammographic studies of male breast pathology with special mention on gynecomastia and those cases hardly reported on the literature such as myofibroblastoma and leiomyoma of the nipple with breast tissue infiltration. Purpose: Salmonella typhi splenic abscesses (SA) are classically a rather rare complication of typhoid fever (TF). The aim of this study was to stress the role of US and CT to the diagnosis and follow up for these patients. Methods: 400 patients with proven biological diagnosis ofTF were systematically examinated by abdominal US. 20 patients with either persistent or recurrent symptoms (despite adequate treatment) or presenting acute lower thoracic pain, were performed again by US and CT with contrast media. Results: In 8 patients, both imaging modalities revealed anomalies compatible with splenic abscesses; none of these patients had classical predisposing factors such as sickle cell disease. 1 patients were treated by splenectomy. In one case of small splenic abscess, repetitive US controls allowed follow up of total regression of abscess under medical treatment only. Conclusions: SA are not so rare as previously described. Non invasive imaging modalities like US combined with CT allow the exact diagnosis and improve the prognosis by preventing a possible fatal issue like splenic rupture and peritonitis. The purpose of this exhibit is to present the typical and unusual radiological features in Crohn's disease and its complications. Radiological examinations in 102 cases of Crohn's disease are presented. Atypical forms of radiological presentations with their pathological correlations are described. The value of barium examinations and CT in the diagnosis of complications are discussed. CT adds valuable information in certain instances but is not necessary in every case.

Role of CT In the evaluation of gastriC disease J. Andreu (Presenter), J. A. Jimenez, S. Pedraza, A. Alvarez Castells, M. C. Sanchez, J. Alvarez; Barcelona CT permits a correct visualization of the gastric wall and extramucosal extension of gastric lesions. The purpose of this exhibit is to evaluate the usefulness ofCT in gastric diseases and to present the different CT features and their correlations with gastric lesions. We reviewed the radiological findings in 52 cases of gastric process. Congenital, neoplastic and inflammatory etiologies are included. Barium studies, endoscopy, surgical and pathological findings are correlated with CT findings. Gastric wall thickening and mass effect are the most common findings. CT features in several cases can suggest the diagnosis and could be the only radiological sign of disease. Authors present 5 case reports illustrating the diagnostic and therapeutic problems in management of portal hypertension caused by abnormal arterio-venous anastomoses. In all cases US with Doppler studies and CT with angio-dynamic procedure were performed as a first, non-invasive method. These studies showed the placement, width and patency of vessels, direction and level of blood-flow. Angiographies, performed in all cases as the most specific method, showed the details of anatomy of anastomoses (fistulas). These enabled us to introduce the best way of treatment -embolization or surgical procedure. The studied material included 51 patients in whom for recurrent bleeding from esophageal varices 54 different porto-systemic shunts were performed (portocaval shunt in 31 cases, splenorenal shunt modo Linton in 6 cases, spleno-renal shunt modo Warren in 6 cases, mesenterica-caval modo Drapanas -4 cases, other types -3 cases). The anatomical condition of each shunt, direction of blood flow and collaterals were diagnosed by US with Doppler studies and CT with dynamic-angio procedure. Both methods allowed a simple and safe visualisation of porto-systemic anastomoses. CT is more sensitive and specific in diagnosis, especially of port-caval shunts, and can be used in early postoperative period. US is the useful method for long-term monitoring of the shunt condition.

Comparative study of dynamiC CT and ultrasonic pulsed Doppler flowmeter on estimation of portal blood flow Sachio Awai (Presenter), Shin Kimoto, Kotaro Yasui, Setsuko Istihara, Sumiyo Kuroki, Kaori Kobayashi, Yoshlo Hiraki; Okayama Purpose: To evaluate the portal blood flow, we performed liver dynamic CT and used a pulsed Doppler flowmeter in normal volunteers and examined the results of both methods comparatively. Methods and Materials: In the dynamic CT Toshiba CT 900S was used. We administrated non-ionic hypotonic contrast medium by bolus injection in normal volunteers (16 males, 14 females) to a slice that allows a simultaneous grasp of the abdominal aorta and main portal vein for dynamic CT. We constructed time density curves of the abdominal aorta and main portal vein on the basis of picturers obtained, named the ratio of area of each steep rise portal blood flow coefficient. On the other hand, an ultrasonic pulsed Doppler flowmeter (Toshiba SSA 270A) was used for the same subjects, and the mean blood flow velocity (F mean) and the mean blood flow volume (V mean) of the main portal vein were determined. Results: The portal blood flow coefficient was 0.46 ± 0.18, F mean 0.21 ± 0.06 M/sec, V mean 1.01 ± 0.45 Llmin. A significant correlation was observed between the portal blood flow coefficient and values obtained with the ultrasonic pulsed Doppler flowmeter. SPACE 1419 X-Ray check up aHer total gastrectomy (Roux-Y-Esophagojejunostomy) M. Baldt (Presenter), Ch. Armbruster, W. Anzbock, H. Mosser, W. Hruby, K. Stellamor; Vienna a) From Jan 1986 to Dec 1989 110 patients underwent Roux-Y-Esophagojejunostomy after total gastrectomy. 32 patients are presented in a radiologic study regarding morphology and functional testing. b) Long term follow up studies are performed by using double contrast method with Barium (350 ml Prontobario HD, 6 g Duplotrast Z), 3 to 36 months post operation. c) We found 2 local recidives of tumor (I only by endoscopy). 2 tight proximal anastomoses, caused by metastases. All proximal and distal anastomoses are well viewed. The average passage time from proximal anastomosis to the i1eocoecum is 20 to 30 minutes. (n = 15). 11 patients showed an increased time: 2 with diarrhoea. 6 patients showed a decreased time: I with obstipation. Jejunoesophageal reflux was seen in 26 patients (81 %). Only 7 needed therapy for esophagitis. The feeding loop was viewed in 19 cases. d) Barium double contrast examination seems to be useful for showing the feeding jejunal loop (56%) in case endoscopy fails. The high number of jejunoesophageal reflux and variable passage times do not correspond with clinical complaint. Methods: After the occasional observation in a nourished baby of good contrast delineation of the upper 01 tract, we tried a series of different commercial fresh and lyophilized milks both in experimental and in clinical tests. The laboratory evaluations were made with a .5 T while imaging was performed with an 1.5 T magnet. After the selection of the most effective lyophilized product, prepared in conformity with commercial intructions, we examined a group of patients with gastric and rectal cancer. Results: The most intense positive contrast effect, due to shortening of the TI relaxation time, was obtained with Nidina I (Nestle'). This attitude is related to the concentration of the paramagnetic ions (Mn-Fe) binded in the macromolecules of milk, such as casein. The best imaging sequence was a spin-echo Tl.w. After ingestion of milk a good delineation of the stomach with sufficient distribution in duodenum and in the very proximal bowel was achieved as well as a good depiction by enema of rectum and recto-sigmoid junction. Conclusions: The practical value of this paramagnetic complex depends on its non invasivity, economicity and acceptability thus we suggest the use of the lyophilized milk "Nidina I" in patients with gastric and rectum-sigmoid cancer in order to increase the diagnostic efficacy of MR.

US serial evaluation of volumes of hepatiC metastase.: growth rates of untreated nodules Alberto Banderali (Presenter), Lorenzo Egildo Derchi, Pierluigi Brovero, Patrizia Votano; Genova

The quantitative study of neoplastic growth patterns is the ground for a correct clinical approach to patients with malignant tumour. We followed-up the growth of 23 hepatic metastases (HM) in 16 patients measuring the three orthogonal diameters of any lesion by means of US, calculating their volumes and plotting the results in semilogarithmic scale. Doubling times (DT) were also calculated, as an index of growth speed. We obtained values of DT scattered from 13 to 770 days. In the fast growth group (DT less than 50 days) we found all the HM from pancreas and stomach and about 50% of HM from sigmoid colon and rectum. In the intermediate growth group (DT more than 50 and less than 100 days) we found the remaining 50% of HM from sigmoid colon and rectum and 67% of HM from breast. In the slow growth group (DT more than 100 days) we found the remaining 33% of HM from breast and HM from small intestine carcinoid, Vater·s ampulloma and parotid gland cylindroma. Considering the obtained results, we stress the importance of a correct volumetric study during US follow-up of patients with untreated HM. SPACE 1422 U! !" the volumetric evaluation of hepatIc metastases' response to chemotherapy Alberto Banderali (Presenter), Lorenzo Egildo Derchi, Patrizia Votano, Pierluigi Brovero; Genova

The accurate evaluation of the response of hepatic metastases (HM) to chemotherapy is still an unattained goal. We followed-up 60 HM in 31 patients during chemotherapy, measuring the three diameters and calculating their volumes. The period of follow-up was longer than I year in 52% of patients and the number of observations was more than 3 in 58% of HM. The curves of growth were completed with data concerning chemotherapeutic courses. 90% of H M derived from a gastroenteric primary tumour, the remaining 10% from breast tumour. In the initial period of chemotherapy we observed shrinkage in 55% of HM, slower growth in 40% and unchanged growth rate in 5%. In the late period of chemotherapy we observed reduced or absent response in 64% of the HM and a better response in 36%. At the end of the therapeutic course the prevailing feature was faster growth or new growth in 75% of HM: finally, in the period after the sixth month from the end of the chemotherapeutic course the prevailing feature was faster growth rate (58%). We stress the importance of a correct volumetric approach to HM during chemotherapy as a precious tool for evaluating its effects.

Initial diagnosis and follow-up of metastatic endocrine GI-tumora R. Benning (Presenter). J. Froelich. Ch. Neuhaus. K. J. Klose. R. Arnold; Marburg Eighty patients with endocrine GI-tumors have been followed up with abdominal CT. chest X-ray and sonography in three month intervals. Most frequent primary tumor sites were ileum (27 pts.) and pancreas (32). Rare localisations were stomach (3) . duodenom (2) , jejunum (3), colon (2) , rectum (I) and retroperitoneum (I). Imaging failed diagnosis of primary tumor site in 19 cases. In 10 of these cases surgery or autopsy was identifying the primary tumor. Liver metastasy was most common (74). 17 patients revealed extraabdominal metastases (skeletal 8. ovarian 3. CNS 3, breast I, subcutaneous 2). Compared to the well-described Krukenberg's tumor there are only few reports about CNS-involvement in literature so far. Generally chest x-ray. sonography and computed tomography are sufficient for diagnosis and follow up of endocrine GI-tumors. Additional procedures should be performed only in certain cases. Based on our experience we are discussing the most effective procedure of initial diagnosis and follow up.

Cholecystollthlasls In women in Czechoslovakia -ultrasonographlc study from Slovakia -town Tren~ln J. Bielik (Presenter); Trencln

In the years 1986-1989 a coliective of2 102 girls and women at the age of 15-80 years was examined ultrasonographically. Cholecystolithiasis occurred in 17,21 %, with a cholecystectomy group equal to 23,12%. Cholecystolithiasis was present in 8,19% as asymptomatic, in 17,67% as atypical and in 75,0% as typical form. In mothers cholecystolithiasis was documented in 15,52% and in fathers in 3,17%. Cholecystolithiasis occurred within fat women in 28,99%, while within normal ones -11,31 %; childless women -6,7%, one birth -21,81 %, two and more births -23,33%; association with diabetes mellitus was in 36,91 %. without diabetes -15,85 %; using hormonal contraception -14,49 %, without using hormonal contraception -17,31 %; with smoking -11,5% and with not smoking -17.96%; with drinking coffee -15,24%, with not drinking coffee -18,24%; with intellectual work (over 19 years) -18,7% and with manual work -25,6%. We stated these risk factors: I. mothers genetic influence, 2. age, 3. obesity (mainly in the early and middle age), 4. gravidity -mainly in the early age, markedly numerous and 5. diabetes. Neither hormonal contraception nor smoking were proven to be risk factors. Coffeine is the possible protective factor of the beginning of cholecystolithiasis (by the literature it is the first occurrence).

Imaging findings In pellosls hepatitis, a review of four patients D. Bodnar (Presenter). L. Henry. G. Genin. P.-J. Valette; Lyon Goal: 4 cases of peliosis hepatitis have been studied by different imaging modalities including CT, DSA, and MRI in order to define some potential specific findings allowing a precise diagnosis. The pathological appearance of this rare entity is characterized by the presence of multiple permanent bloodfilled cysts of variable size. Methods: After US detection. CTwith contrast agent injection, DSA and MRI were used in all patients and the data correlated with the pathological findings obtained by aspiration cytology (n -2), percutaneous biopsy (n = I), and surgical biopsy (n = I). Results: US demonstrated nodular lesions, which were confirmed by CT as hyperdense lesions after contrast media bolus injection, without any finding in favor of malignancy or benignity. The MRI appearance evoked potentially malignant lesions based on the heterogeneous signal intensity without major increase on T2-weighted images. On the other hand. DSA appeared as the more adapted imaging modality to approach the right diagnosis. demonstrating an early opacification lasting at the venous phase. From these four patients. DSA could be suggested as the more specific imaging modality to orient the diagnosis and the pathological evaluation.

Treatment of small hepatocellular carcinomas by US-guided percutaneous ethanol InJection (PEl), results In 15 patients Maurizio Borghetll (Presenter). Giampaolo Benelli. Roberto Bonardi; Crema Purpose: This report shows the results obtained by US-guided PEl in 15 patients affected by small HCC (diam 3 cm). Methods: PEl consisted in 2 weekly sessions (max II for each nodule). The dye (2-4 cc per session) was injected by means of a US-guided fine spinal needle. In S250 addition to nodule US changes. the criteria confirming the success of this treatment were: a) absence of malignant cells at the final FNAB; b) lack of enhancement during the TC arterial phase and formation of a peripheric hyperdense ring. US, TC and the AFP levels were used for follow-up. Results: All patients are still alive and in only one case, recurrencies of the neoplasia were reported. The follow-up varies from I to 24 months. Nodules have progressively reduced and in some cases they have disappeared. US shows a nearly constant posterior acustic shadow revealing the postnecrotic fibrosis. Treatments have been usually well tolerated by all patients. Conclusions: Since surgery is influenced by the conditions of cirrhotic patients. PEl. being easily available, can be a successful alternative for small HCC. The main disadvantages of PEl are due to the site of the tumor and the hardness of the cirrhotic liver which might cause deviations of the fine needle. Five patients with malignant peritoneal mesothelioma were treated; four of them for a period of two years. The fifth patient who was treated for eight years underwent surgery several times. Four patients had insignificant clinical pictures. Computed tomography (Cn examination revealed typical irregular thickening of peritoneum and tumor of omentum. The diagnosis was later confirmed by the cytologic evaluation. In one case the MPM diagnosis was confirmed by histologic evaluation after surgery. All patients were treated with systematic cytostatic therapy combined with radiotherapy. The success of the therapy was monitored by ultrasound (US) and CT. The response to the treatment was satisfactory. The remissions were of different duration. Four of five patients died. The results of diagnosis of MPM with US and CT and the success of therapy for five patients are described. 

Primary adenocarcinoma of the small bowel is an uncommon tumor, accounting for less than 1 % of all gastrointestinal neoplasms. We reviewed 10 cases of jejunum and ileum malignancies diagnosed from 1977 to 1989 in our institution, with histopathologic correlation. They were 4 men and 6 women. Ranging age from 22 to 82 years (mean 59 years). More usual clinical symptoms were abdominal pain and weight loss. Topographic localization was jejunum in 6 cases and ileum in 4 cases. Radiologic imaging was strongly suggestive of malignancy in 7 cases: 6 showed a typical annular "napkin-ring" configuration, one of them simultaneously presenting 2 lesions in jejunum; and the other displayed destruction of the mucosa with a large ulcerating lesion. In 3 cases radiological findings were atypical: mucosal diffuse involvement with gross folds of whole small bowel; lesion of terminal ileum suggestive of Crohn's disease, and one patient had no radiologically detectable abnormalities. Aim of our study is to define the different semiological aspects of the gastrointestinal ultrasonographic "target" sign. The purpose of this study is therefore to search for the various features of the "target" that can help in the differential diagnosis of disease that cause bowel thickening. The ultrasound examination was performed with 7 MHz linear probe. together with a plain XR of the abdomen in a large number of patients (over 100) with acute abdomen, intestinal occlusion or subocclusion. Ultrasonographic findings were afterwards compared to the radiological, surgical or artificial diagnosis. The "target" sign found in Crohn's disease, in lymphoma, in peritoneal carcinomatosis, in intestinal infarction, in volvulus. in intussusception, in acute appendicitis have different morphological features (radial target in lymphoma, irregular and thick target in carcinoma, etc.) that, together with clinical data, have shown a high diagnostic specificity. Purpose: The aim of this study was to present the CT and US findings of midgut malrotation, with and without volvulus, and to show by US a well known CT sign of volvulus in intestinal malrotation (whirl-like encircling loops of bowel around the mesenteric vessels). Methods and Materials: Five patients (age range: 16-31 years) with midgut malrotation (one of them with volvulus) were studied with CT and US . Diagnoses were confirmed surgically in volvulus, and with barium studies in al\ patients. Results:

Abnormal position of the jejunum: Abnormal position of the cecum: Abnormal disposition of the mesenteric vessels·: Dilatation of proximal midgut: Whirl-like encircling loops of bowel around the mesenteric vessels: Numerous vessels in the mesentery: (*: the superior mesenteric vein was seen to lie: -to the left of the superior mesenteric artery -on the left ventral aspect of the SMA -immediatly anterior and slightly to the right of the SMA SPACE 1m. nodules were detected only in one. Our results indicate that US demonstrates great effectiveness in determining the size and echographic patterns of the tumor. However, low sensitivity was observed in the detection of satellite nodules. We conclude that the surgical resection should include a safe peritumoral margin even though the tumor is well-defined echographically. In a significant percentage of cases, radiographic patterns are helpful to make a differential diagnosis between infections and neoplasms.

Methods and Materials: 250 patients underwent double-contrast esophagography. Results: Candida infections are the most frequent cause of esophagitis in patients with A.I.D.S.; the radiographic appearance is characteristic and it includes diffuse ulcerations, cobblestoning, plaques and thickened folds.

Radiographic patterns of C.M. V. esophagitis are also characteristic with focal ulcers and well defined areas of edema. Giant ulcers may often be seen at the gastroesophageal junction. In Herpes simplex esophagitis, discrete ulcerations with no specific character may be seen. Neoplasm can be radiographically separated from infections. Conclusions: The radiographic appearance of esophageal lesions is important and is useful for a differential diagnosis in a significant percentage of cases.

Ultrasound In acute appendicitis B. Cortina (Presenter), N. Alegre; Madrid

Purpose: We make a prospective study on the usefulness of the U.S. in acute appendicitis. Methods and Materials: We included eighty-two patients attended in the emergency ward with a diagnosis of acute appendicitis made just on clinical basis. We used a 7.5 MHz. transducer applied on the right iliac fossa and a 3.5 MHz. to ellplore the rest of the abdomen. Results: By US the appendix was identified in 63.3% of cases, an appendicolithiasis was seen in 3.33 %, a periappendicular abscess in 5 % and free peritoneal nuid in 3%. The classic US pattern of acute appendicitis was found in 72.72% of cases, the hypoechoechoic form in 18.18% and periappendicitis in 9.09% All cases with an ultrasonographic diagnosis of appendicitis were surgically confirmed.

In our experience the US showed a diagnostic reliability of 64% and in 8% it led to a diagnosis of another pathology.

SPACE JJY. Purpose: Transhepatic biliary endoprosthesis placement is well established procedure for the relief of obstructive jaundice. Recently stainless steel biliary stents became a new alternative to the conventional endoprostheses because of the high frequency complication of the latter. We placed self-expandable metallic mesh stents for the treatment obstructions. Methods and Materials: Self-expandable mesh stents have been placed in 13 patients. Ten patients had malignant obstruction and 3 patients had benign strictures as a result of several surgical interventions to the biliary system. We placed Wall stents (Medinvent, Switzerland) with diameter of30 F when fully open. Results: No major complications observed. The mean follow-up period was 6 months and during the follow-up all the stents were patent. One patient died of his disease on the 39th day after ihe procedure. Conclusions: The initial result suggests that metallic stents can be used successfully instead of conventional endoprostheses which have relatively small diameter and high complication rate. Also the ability of the placement of Wallstents through a 7F catheter reduces the risks of the procedure. Our results are encouraging. We believe that further studies will clarify the long-term success.

Gastric Women are studied with a 3.5 and 5 MHz. transducer. Echographic findings are compared with surgical pieces. Tumor echogenicity (anechoic, hypoechoic or hyperechoic) and structure (homogeneous, inhomogeneous) are analyzed. Septal appearance (thin < 3 mm and thick> 3 mm), parietal nodules «0) than 2 cm) and calcification frequency are also studied. We note other features like ascitis, bilaterality, good delimitations by capsule, etc. We show echographic features in each tumoral group: epithelial tumors (C.Ad., C.adca.), stroma gonadal tumors, germinal cell tumors (teratoma, etc.) mesenchymal tumors (fibromas, thecomas, etc.), metastasis, etc. As all of you know, echography is a high fyability method for detecting masses, but not so much for establishing a diagnosis. We propose you some echographic features that you can use in differential diagnosis of ovarian tumors. Purpose: To improve radiologic presurgical assessment of hepatic neoplasms we have evaluated technique, findings, accuracy and limits of CT angiography and portography. Methods: From January 1989 to December 1990 we have performed intraarterial CT in 33 patients affected by primitive or secundary hepatic neoplasms. 10 cases were porto-CT, 23 were arterio-CT. All patients previously underwent US and angiography, 23 patients Lv. angio-CT, 12 RM, 26 percutaneous fine needle biopsy. These methods did not exclude surgical treatment. Subsequently 15 patients underwent surgery or laparotomy; the remainders were periodically observed. Results: Interpretation of arterio-CT findings was difficult in 50% of cases: transient vascular contrast enhancement caused images not always demonstrated for localizing tumor set. The accuracy of portal CT has been superior to all diagnostic methods in regard to number, seat and size of lesions. The results of both methods decreased in patients with arterial anomalies. Intra-arterial CT has been useful to exclude surgery in 30% of patients not previously excluded by US or conventional CT. Conclusions: Intra-arterial-CT is useful in presurgical evaluation of hepatic tumor. Hepatic arterio-CT is better than porto-CT to recognize neoplastic nature of lesions; we prefer porto-CT in evaluation of size, number and seat of lesions. When angiography demonstrates vascular anomalies results of intraarterial-CT decrease.

CT of less severe forms of colonIc diverticulitis E. Doringer (Presenter), P.Sattlegger, R. Forstner, H. Schmoller; Salzburg

Purpose: The value of CT in less severe forms of colonic diverticulitis is determined in a prospective study. Methods: 33 patients (20 female, 13 male, mean 71 years) with clinically suspected diverticulitis (left lower quadrant pain, leukocytosis, elevated erythrocyte sedimentation rate) were studied prospectively by CT. CT examinations were compared with contrast enema in 24 patients and with endoscopy in 6 patients. The results are proven by histologic specimen in 9 cases, the rest by the clinical course. Results: The predictive value of symptoms, such as thickening of the colonic wall (86,6%), inflammatory changes of the pericolic fally tissue (87,5%), the presence of diverticula (73,3%) and abscess formation (100%) were examined separately and their significance was evaluated. True positive results by CT were reached in 20121 cases (sensitivity = 95.2%), true negative findings in 9/12 (specificity = 75,0%). The results of CT examinations were compared with those of contrast enemas and/or endoscopy. The number of cases was too low to achieve statistic significance but the relatively high percentage of questionable results (7124 = 29%) shows the difficulties inherent in these methods.

Conclusions: Our study shows that CT is a good means to demonstrate even less severe forms of colonic diverticulitis with sufficient reliability.

Diagnosis and differential echographlc diagnosiS of ascites

Ascites is the result of varius ethiopathogenetic causes, it becomes echographically evident only when it is more than 30, 40 cc.; for lower values evidence is obtained only with paracentesis. We have reviewed retrospectively 150 echographic examinations of patients with ascites. in order to determine, through direct and indirect signs the cause of the disease. It was found that for 90 cases, out of those reviewed, the etiology was due to cirrhosis, of these 40/90 presented evident echo-pathognomonic signs such as: portal hypertension, collateral vascular bed, megalosplenia; for 6 the cause was due to portal thrombosis of which 4 on neoblastic basis. in all of them the obliteration of vessel appeared evident; in 4 cases the cause was a phlogistic process and the ascites was corpuscolated; constrictive heart failure was noted in 3 cases and echography showed a clear dilation of the hepatic veins; a neoblastic pathology was found to be the etiology of 47 cases reviewed, of which 28/47 showed evident typical signs (such as ascites saccatus in the absence of any previous surgical operations, peritoneal vegetation, diffuse ascites except for the Douglas bay). The retrospective review of 150 echo-examinations performed in the half of 1990 shows indicant echo-signs in about 40% of the cases reviewed and the signs appear to be more frequent in the neoblastic, in the inflamed and cardiac ascites as well as in the portal venous thrombosis. The research of these signs, which are sometimes undervalued, enable us to reach. in a considerable number of cases, a diagnosis, thus avoiding further tests, which often result useless and expensive.

AllergIc and anaphylactIc reactIon during a double contrast X-Ray examination of the gastroenteric tract F.Draghi (Presenter), P. Simonelli, G. Ferrozzi; Pontremoli

The first symptoms of anaphylactic reactions, though seldom occurring during an X-ray examination, generally become manifest with an unusual developement of urticaria shortly after assumption of the contrast medium. The methylparaben, a preservative contained in the barium mixtures. is likely to be the responsible allergen. The male patient P.O .• under our observation before being submitted to an X-ray study of stomach and duodenum presented, in his personal and family anamnesis no occurrence of allergic diseases. The examination was performed, as usual. in a double contrast without using the hypotonic agent. At about 20 minutes from the assumption of the barium mixture the patient developed urticaria all over his body but mostly on his face, trunk and arms. Emergency treatments were immediately applied. The patient soon recovered. In the following radiograms performed, a rapid transit of barium into the small bowel was noted; a likely consequence of histamine release. The case reported proves how idiosyncracy phenomena occurring during X-ray examinations of the digestive apparatus are caused by the sulphate of barium mixture and not by the hypotonic agent. Therefore we consider it advisable to maintain an antiallergic kit at hand in the diagnostic suite, for any emergency. The classic gallstone ileus triad (pneumobilia, obstruction and ectopic gallstone) can be diagnosed by abdominal plain films and sonography. We compare the findings of these two techniques in 12 patients with gallstone ileus. Results:

Plain films Sonography Pneumobilia 8 10

Obstruction 7 9

Ectopic gallstone 5 7

No cases showed clear vesicular lumen on ultrasound: in 3 cases a doublearch-shadow image was identified and in 9 cases an echogenic line with acoustic shadowing was seen in the gallbladder bed. Four patients had a previous sonographic study which demonstrated a gallbladder of normal lumen, with gallstones. This appearance changed to non visualization of the gallbladder lumen. Conclusions: Sonography is superior to abdominal plain films to evaluate the classic triad of gallstone ileus. Visualization of a normal vesicular lumen helps to rule out the diagnosis of gallstone ileus. Fistulas between hepatic artery and hepatic veins or portal vein branches are seldom encountered and difficult to diagnose diseases with potentially poor prognosis. Ultrasonic Doppler study with evaluation of hepatic vessels flow was performed in 6 patients with various connections of hepatic artery with venous and portal systems. The results were confirmed with DSA, CT, surgery (3 cases) and autopsy (I case). In 3 patients when colour Doppler was available diagnosis of 2 fistulas between hepatic artery and hepatic veins as well as one fistula with portal vein trunk was stated. In one patient plain Doppler examination was sufficient for making diagnosis of connection between splenic artery and splenic vein. In 2 patients Doppler study could not state the reason for huge portal vein collaterals. that showed to be related with arterioportal fistulas -one demonstrated in DSA. the other diagnosed only on autopsy.

The results show that only colour Doppler study allows definite ultrasonic diagnosis of hepatic vascular fistulas. They should be suspected in every case of abundant portal vein collaterals with no apparent reason (liver pathology, portal vein thrombosis), or hepatic veins malformations.

Tc-99m-DISIDA hepatobiliary ImagIng In patients wIth liver transplantation: correlatIon wIth liver biopsies C. M. Engeler (Presenter), C. C. Kuni, R. Nakhleh, C. E. Engeler, R. P.

duCret, R. J. Boudreau; Minneapolis, MN

Purpose: Comparison of Tc-99m-D1SIDA hepatobiliary scintigraphy with biopsy results in patients after liver transplantation. Methods and Materials: Seventy-six Tc-99m-DISIDA hepatobiliary studies with corresponding liver biopsies were reviewed. Radionuclide scintigrams were evaluated for uptake (normal = minimal cardiac blood pool activity at the 10 minute image) and excretion (normal -prompt decrease of activity subsequent to the 15 minute image). Biopsies were graded on scales of a) 0 to 6 for hepatocyte damage (0 = normal), b) 0 to 12 for findings of cholestasis (0 = normal) and c) 0 to 9 for rejection (0 -normal). Results: Sixty/seventy-five (80%) showed normal Tc-99m-DISIDA uptake and 65176 (85%) showed delayed excretion. Forty-nine/seventy-six (64%) demonstrated a combination of normal uptake and delayed excretion. At 3, 8, 14 and 31 days after transplantation 71%; 79%; 82% and 78% had normal uptake and 0%; 4%, 3% and 6% had normal excretion. Comparison of biopsies with scintigrams showed a positive association of hepatocyte damage scores with uptake (p < .001) and of cholestasis/rejection scores Tc-99m-DISIDA excretion (p = .0110.05).

Conclusions: Tc-99m-D1SIDA scintigraphy of liver transplants usually demonstrates normal tracer uptake with delayed excretion. Comparison with biopsy results suggests that cholestasis/rejection can be differentiated from pure hepatocyte dysfunction. These findings will be illustrated with examples from liver scintigrams and biopsies.

CT patterns of perItoneal carcinomatosis as predicting signs of primary ovarian carcinoma G. C. Ettorre (Presenter), G. Angone, D. Brindicci, A. P. Garribba, F. Grimaldi; Barl CT specific findings in peritoneal spread of some tumors are widely described. The aim of this investigation was to analyze two aspects of peritoneal metastasis calcifications inside metastatic nodule and peritoneal pseudomixoma. 120 abdominal contrast enhanced CT scans, obtained in patients affected by peritoneal carcinomatosis, retrospectively reviewed in order to detect calcified peritoneal pseudomixoma. CT showed calcifications in 12 (10%) and peritoneal pseudomixoma in 5 cases (4.10%).

Calcified metastases were noted in right paracolic gutter, near the spleen, liver, diaphragm, in the hepatorenal fossa and on the anterior abdominal wall and sigmoid colon. In peritoneal pseudomixoma CT showed huge cystic masses, filling peritoneal cavity, metastatic nodules. Calcified metastases in 10 cases of serious ovarian cystoadenocarcinoma and peritoneal pseudomixoma in 3 cases of mucinous ovarian carcinoma were found.

In conclusion, we believe that calcified metastasis and peritoneal pseudomixoma identified by CT, may suggest diagnosis of primary ovarian carcinoma.

Percutaneous aspIration and catheter drainage of pyogenic liver abscesses guided by computer tomography Tibor Fazekas (Presenter), F . and November 1990. CT-guided aspirations and drainages of bacterial liver abscesses in 26 patients accomplished definitive sanitation (26/33 = 78,8%). In 7 cases surgical revision was required. Percutaneous drainage of abscesses was able to achieve a temporal improvement in these cases and therefore was an effective pre-surgical measure. Postdrainage complications were in 4 patients (4/33 -12.1 %). I patient died (1/33 = 3%).24 patients had solitary and 9 ones had multiple abscesses. Treatment involves antibiotics together with drainage or puncture. We conclude that percutaneous aspiration and catheter drainage is an effective method for treatment of pyogenic liver abscesses.

Differential diagnosiS of mucocele of the appendix J. Fermindez Sanchez (Presenter), W. BOcklein. E. Klotz; Augsburg

Mucocele of the appendix (MA) is uncommon. Its differential diagnosis is broad and includes intraperitoneal and extraperitoneal lesions. Sonography (US) and CT imaging can suggest in many cases a MA and differentiate this entity from other cystic masses. However, sometimes it is not possible. The purpose of this study was to evaluate and describe the US, CT and conventional radiological appearance of MA and other liquid space-occupying lesions of the right iliac fossa. especially in cases of difficult differentiation beween these lesions. Our report includes 20 patients: 3 cases of MA and 17 cases of other cystic masses in the right middle and lower abdominal quadrant. such as mesenteric cysts, Iymphoceles, benign ovarian cysts, malignant ovarian tumors (cystadenocarcinoma. malign cystic teratoma), abscesses, malignant coecum tumor, psoas pancreatic pseudocyst and hematomas. In all these cases the lesions showed similar US and CT features, so that the definitive diagnosis only by means of US/CT puncture or drainage and/or intraoperative could be established. In this scientific exhibit these cases are presented and discussed. I. The purpose of our work is to evaluate the images obtained by computed radiography (CR). and their comparison to conventional radiographies in patients with pancreatic-biliary pathology. S254 2. We studied thirty patients and evaluated each of them on hard copy, high resolution monitor and conventional radiograpbies. The images were assessed by three well trained radiologists. The identification of biliary tree and/or pancreatic duct was mad.e by endoscopy retrograde cholangio-pancreatography (ERCP), percutaneous cholecystomy or transhepatical cholangiography (TCP). 3. Our results show a quite good correlation between the digital images and the conventionals. The degree of diagnostic accuracy is high and comparable in both of them. However. the post-processing facility of the digital radiography improves image quality. affords greater flexibility in image display. yields always consistent contrast on images. avoids incorrect exposure repetitions, reduces exploration time. 4. Computed radiography seems to be a good alternative to conventional radiography for pancreatic-biliary examinations. Permanent archiving of images and their retrieval and reevaluation possibility is really useful. The digital system also conveys a remarcable lowering of the radiation dose. This digital studies are very well accepted by the clinicians.

Radiologic Imaging of focal, spleniC lesions with pathologic correlation T. Franquet (Presenter), R. Cozcolluela. L.lnaraja. M. Montes; Pamplona Splenic disease (uni or multifocal) are usually associated with generalized symptoms or when another examination discloses splenomegaly or a mass in the left upper abdomen. In this exhibit the imaging findings (plain films. sonography, CT and angiography) in cystic, tumoral, inflammatory and focal vascular conditions of the spleen are described and differential diagnostic criteria are reported. Several different pathologic entities of focal splenic masses will be presented along with pathologic (gross or microscopic) findings. All cases are pathologically proved and include false (secondary) cysts, epithelial (epidermoid) cysts, hydatid cysts with and without associated complications such as fistulization and abscessification. abscesses, tuberculosis, nodular sarcoidosis, inflammatory pseudotumor, hemangioma, metastases. hematomas, infarction. aneurysm and splenic peliosis.

Anglographlc aspects of diffuse parenchymatous desease of the liver with dynamic CT J. M. Friedrich (Presenter). P. Schnarkowski. A. Goldmann. A. Jentschura; Ulm

Morphology and distribution of the main intrahepatic vessels are well known and are corresponding to definite anatomical standards. These parameters show modifications in diffuse parenchymatous desease. Therefore we studied 150 patients with dynamic CT. 50 patients had histologically proved liver cirrhosis. 50 patients presented with liver steatosis, 50 patients with normal liver were scanned routinely. A cross section was defined at the level of the hepatic bifurcation. Criteria to evaluate the anatomic feature included the total number of vessels, the number of portal vein branches. the diameter of the vessels. Vessels with a diameter of more than g mm were observed mostly in normal liver and steatosis (p 0.01). In cirrhosis the number of vessels larger than 8 mm in diameter was significantly reduced (p 0.0 I).

Branches of the portal vein were also significantly reduced in patients with cirrhosis. In all patients with normal liver the hepatic vein could be opacified, but only in 33% of patients with cirrhosis. Although the diagnosis of hepatic cirrhosis is not primarily established by CT, these findings may be helpful in the evaluation of hepatic diseases. A higher percentage of contralateral hernia was found among patients with palpable left inguinal hernia (6/9 :67%) than among patients with palpable right hernia (14/55 :25%).

Resection and colo-anal anastomosis with and without colonic reservoir for rectal carcinoma and large villous adenoma: redlologlcal aspects Maria Grazia Genovese (Presenter), Mario Delle Piane, Renata Bocchini, GianPaolo Cavallotti, Luigi Locatelli; Torino

Long term survival and local recurrence rates after anterior resection are similar to those obtained by excision when the length of rectum "laudable" removed below the tumor is 2 cm or more. In this cases the whole of the rectal mucosa can be treated without an abdominal perineal resection by means of a sutured anastomosis between the colon and the anal canal. We study 18 patients; in 6 cases the rectal lesion was a large villous adenoma and in 12 cases was an adenocarcinoma of the middle third (distance from the anal margin em 6-7). The rectum was divided and transected at ano-rectal junction level, after peranal mucosectomy two types of colo-anal anastomoses were then constructed: simple end to end (9 cases) and side to end after construction of a colonic J reservoir (9 cases). Contrast X-ray, in AP, OAS, OAO and L-L projection, at small and great filling, is of great value in neo-rectum morphological and functional evaluation. It is possible to quantize the continence degree: alvus rate is in fact, proportional at rectal motor length. Imaging of rare benign focal hepatiC lesions M. Giudice (Presenter), E. Andorno, T. Avataneo, S. Cirillo, D. Regge, L. Garrettl; Torino

The purpose of this study is to describe the radiological aspect of rare benign focal hepatic lesions and to suggest which imaging technique is most adequate for their diagnosis. We have included in our series 27 patients with surgically (67%) and biopsy (33%) proven diagnosis. Patients underwent US, CT, MR and in 44% of cases liver angiography.

In 10 patients i.v. infusion of cholangiographic contrast material was performed if doubt persisted in differential diagnosis between hepatic adenoma and focal nodular hyperplasia. Twenty-one patients were females and 6 males with the following rare focal lesions: adenomas (59%), focal nodular hyperplasia (22%), tubercolomas (II %), haemorrhagic cysts and biliary cystoadenomas (4%). The typical aspect and abnormal pallerns of lesions are reviewed with all digital imaging techniques available. Purpose: To evaluate the efficacy of enteroclysis in diagnosing leiomyomatous tumors of the small intestine, preoperatively. Methods and Materials: The medical records, radiologic appearances and pathologic findings in 7 patients with histologically proven leiomyomatous tumors, amongst 760 referred to us for an enteroclysis in a 5-year period, were reviewed. Results: There were six leiomyomas and one leiomyosarcoma. Gastrointestinal bleeding were the presenting symptoms in 6 and partial small bowel obstruction in one. The time interval between onset of symptoms and radiologic diagnosis ranged 3 months to five years. The jejunum was involved in one patient and the ileum in six. The type of growth was intraluminal in two cases, extraluminal in four and bidirectional in one. Radiological features for leiomyomas included: a) round or semilunar intraluminal filling defect with encroachment on the lumen or intussusception, b) tending deformity, displacement and/or identation of the intestinal wall with effacement of the overlying mucosa or ulceration and c} mass effect on neighbouring loops. Leiomyosarcoma featured as a largely ulcerated exoenteric mass. Preoperative radiologic diagnosis was correct in five and suggestive in two patients. The morphological changes of the resected specimens resembled closely the appearances shown with enteroclysis in all cases.

Arterial chemoembollzatlon of liver tumors with liposoluble chemotherapeutic drug Anatoly M. Granov (Presenter), Pavel G. Tarazov, Dmltry A. Granov; Leningrad

Percutaneous transcatheter arterial chemoembolization was performed in 20 patients with primary and metastatic liver neoplasms. Liposoluble chemotherapeutic drug "OX" dissolved in iodized oil was introduced superselectively in the hepatic artery for one to five times. "OX" mixed with iodized oil formed more homogeneous mass if compared with widely used oily emulsions of watersoluble cytostatics. Retention of "OX"-iodized oil within the tumor was seen during a 20 days period postsembolization. Pathologic investigation showed 60% to 90% aseptic necrosis and fibrosis of tumor tissue. Most patients are well and asymptomatic up to 56 months after the treatment. "OX"-iodized oil chemoembolization can be used for treatment of liver neoplasms. Purpose: Tumoral, innammatory or pseudotumoral diseases of the gastrointestinal tract explored by U FCT are illustrated. Methods and Materials: UFCT with short exposure times (300 to 400 ms) avoids motion artifacts and allows high resolution examinations of the digestive tract. The 43 patients evaluated include tumors (in 21 cases) innammatory diseases (in 18 cases) and pseudotumors (in 4 cases).

Results: AlIlocalisations are reported: large bowel (15 cases) small bowel (12 cases) duodenum (10 cases) gastric (6 cases). Tumors and thickening of wall or villosities are well defined even without oral contrast because highly enhanced by intravenous contrast material. Mesenteric infiltration and lymphadenopathy are easily detected. Conclusions: UFCT improves image quality, especially for bowel which has independent motion. The rapid acquisition capability allows the obtaining of multiple contiguous scans of the whole abdomen during the same bolus. It increases the possibilities of detection of gastrointestinal diseases. Lesions of the abdominal wall are usually identified by physical examination. The problem in these cases is to determine the nature. origin and extension of these lesions. CT is a good method for evaluating it.

To determine the computed tomographic characteristics the CT scans of 60 patients with abdominal wall lesions were reviewed. Hematomas were found in 19 patients, abscesses in IS, neoplasms in II, hernias in 8. intestinal fistulas in 6 and hydatid cysts in I patient.

In all the cases CT localized the pathology and allowed an evaluation of the extent of the disease and involvement of adjacent structures. Features found to be more characteristic included a hyperdensity of acute hematoma, low-attenuation central zone of abscess with peripheral enhancement after intravenous contrast administration and herniation of air-containing bowel. We employed the femoral access, according to Seldinger's method, and we catheterized hepatic artery where an emulsion of Doxorubicin and Lipiodol, followed by fibrine sponge, was injected. Results: We evalued survival percentuals (follow-up between 3 and 24 months) at 3, 6 and 12 months comparing them with (NH) and (Sn of HCC (as reported by Okuda 1985). I n the 1 0 class we had 100% survival rate at 3 months (78 % in NH; 87% in ST), S5% at 6 months (60% in NH; 7S% in ST) and 53% at 12 months (35% in NH; 70% in ST). The survival percentuals of patients in the 2 0 class were 60% at 3 months (50% in NH; 80% in ST). 48%at 6 months (IO% in NH: 65% in ST) and 20% at 12 months (5% in NH: 50% in Sn. Conclusions: Surgery remains first choice treatment in HCC. TCE must be performed in patients with unresectable hepatoma as it gives a better survival rate if compared with N H. few complications and, as our experience revealed in some cases, a reduction of HCC volume allowing radical surgery.

Dependence of the ultrasound B-scan on the composition and thickness of the abdominal wall: a phantom study Uwe Haberkorn (Presenter), GOnter Layer, Volker Rudat, Ivan Zuna. Adolf Lorenz. Gerhard van Kaick; Heidelberg

The innuence of different examination conditions on the ultrasound B-scan was investigated using a tissue mimicking phantom and a computerized ultrasound system. Several fat-muscle-combinations were used to simulate different patients with varying thickness and composition of the abdominal wall. The ultrasound B-scans were then analyzed using mathematical statistical parameters usually applied in ultrasound tissue characterization. Thereby the innuence of the abdominal wall thickness and composition on the ultrasound S256 image brightness, microtexture and macrotexture (image sharpness) was studied. An increasing fat path caused a decrease. in ultrasound image brightness and microtexture. The macrotexture was mainly unaffected. Muscle tissue had a weak innuence on the microtexture parameters. Our results show that an increase in the fat layer of the abdominal wall causes a darker and unsharp image and may lead to false diagnoses especially in adiposity.

Abdominal MR Imaging: barium-kaolin suspensions es negative gastrOintestinal contrast agents Andreas Heuck (Presenter), Arnulf Breinbauer, Josef Gmeinwieser; Munich

Purpose: To develop and evaluate a negative GI contrast agent for MRI based on readily available and safe compounds. Methods and Materials: In-vitro Studies: Studies were performed at 0.5 and 1.5 Tusing Tl-and T2-weighted spin-echo (SE) sequences (Tl: TR 300-600/TE 15-30: T2: TR 2000/TE 50-400). Samples of barium-kaolin suspensions (BKS) in concentrations from 10-30% wt/wt barium added with l00-200g/1 kaolin were imaged and signal intensity (SI) reduction of samples relative to a water reference was determined. In-vivo Studies: 20 volunteers were imaged at 1.5 T using Tl-and T2-weighted SE sequences (600120, 2100/50/100). After abdominal pre-contrast imaging volunteers drank I I of 30% barium sulfate added with 200 g/I kaolin. A first post-contrast scan was performed 5 min. p.c., repeat exams every 30 min. over 2-4 h. Peristalsis was reduced by Buscopan® i.v. Contrast effects, distribution, safety and tolerance were evaluated. Results: In-vitro Studies: At 1.5 T BKS yielded a maximum SI reduction compared to water ofSI %and 9S% in TI-and T2-weighted sequences, respectively. At 0.5 T the maximum SI changes resulted in signal increase up to 110% in TI-and a SI decrease of 97% in T2-sequences. In-vivo Studies: With 30% BKS the whole GI tract showed strong and homogeneous negative contrast, and even distribution throughout the G I tract: it was well tolerated and showed no side-effects. Conclusions: BKS hold high potential as negative GI contrast agents for MR imaging at 1.5 T.

The automatic biopsy gun Kenneth D. Hopper (Presenter), Dean E. Baird, Steve H. Parker. John F. Cardella; Hershey, PA

Purpose: This study compares the efficacy of 5 types of biopsy guns versus 10 other commonly used biopsy needles. Methods and Materials: We performed open hepatic and renal biopsies in 15 pigmy pigs. The specimens were evaluated separately in a double-blind fashion by two histopathologists using graded criteria. Results: Significantly better tissue was obtained with a 14 gauge Tru-cut needle. Of the IS gauge biopsy needles, the best tissue was obtained with the long-throw Bard Biopty gun. the Franseen needle. and the Cook biopsy gun. The cores obtained with the IS gauge Chiba and 17 gauge Jamshidi needles were also above average, and all five of these biopsy needles yielded adequate tissue 80% of the time or better. The short-throw 18 gauge Bard Biopty gun, the 14 and 18 gauge Klear-Kut gun, the Cook and Turner IS gauge biopsy needles, the 14 gauge Vim Silverman needle, and the 18 gauge Cook Vacuum biopsy needle yielded adequate tissue in less than 67% of the biopsies. The long-throw Bard Biopty gun appears the best of the automated biopsy systems. However, the 14 gauge Truc-cut biopsy needle consistantly provides an excellent histopathological specimen for diagnosis.

Eveluatlon of the pencreas by MR Imaging Yoshimasa Imanishi (Presenter). Vivian Y. Hou, Alexander C. Chako, Elias A. Zerhouni. Clare M. C. Tempany; Kawasaki MR imaging criteria for the normal pancreas were established and compared with MR images of patients with pancreatic diseases. Eighty-nine patients without pancreatic disease served as controls. Pancreatic disease cases included 23 pancreatic carcinomas with or without pancreatitis, 4 cholangiocarcinomas invading the pancreas, 4 extrapancreatic masses mimicking primary pancreas neoplasms. and 9 cases of pancreatitits. Axial TI-weighted (TR = 500-600; TE = 20), Proton-and T2-weighted (TR -2500-2700; TE = 30/S0) images using spin-echo sequences were obtained on a 1.5 T system. On TI-weighted images. imaging criteria were developed from measurements of pancreas size in eight sites. On T 1-. Proton-, and T2-weighted images. border definition, and signal intensity of the pancreas were compared with that of renal cortex, spleen, and fat to develop imaging criteria. Using this criteria, 21 of 40 pancreatic disease cases showed an abnormality of pancreas size. Total or partial obliteration of the pancreatic border was seen in 18 of 22 patients with evidence of pancreatitis on T2-weighted images. Signal intensities in tumor and pancreas were abnormal in 23 and 20, respectively. of the 40. All 4 extrapancreatic masses were differentiated from intra pancreatic tumors by T2-weighted images. M RI is useful in detecting abnormality of the pancreas. Purpose: We present our sonographic experience as radiologists-sonologists in the diagnosis of acute gynecologic diseases. Methods: A total of 49 abnormal sonographies were reviewed. Surgery was performed in 35 cases; the other 14 cases were resolved spontaneously. Our cases include: 23 ectopic pregnancies (E.P.), 8 pelvic inflammatory diseases (P.J.D.), 7 haemorrhagic ovarian cysts, 2 endometriomas. I ovarian torsion and I hematometra caused by an imperforate hymen. Conventional equipment (without transvaginal transducer) was always used. The sonographic signs were analyzed and integrated with clinic and biochemical findings. Results: Important signs in the diagnosis were: extrauterine gestational sac in E.P.; adnexal masses with septations, intracystic debris and/or high trough transmission in haemorrhagic masses or in P.LD. The sensibility in E.P. was 100%, specificity 80%, positive predictive value 88%, negative predictive value 100% and accuracy 92%. Conclusions: Sonography with conventional equipment has been very useful in the diagnosis of acute gynecologic pain. The knowledge of the clinic and biochemical findings is essential to the correct interpretation of the sonographic signs. So that, in daily practice, the radiologist-sonologist has to play a more active role in the diagnosis of these diseases without need a non radiologist-sonologist.

Preoperative staging of rectal carcinoma by Intrarectal sonography Purpose: Evaluation of intrarectal sonography in comparison to histopathological findings in patients with rectal carcinoma. Patients and methods: 54 patients with rectal carcinoma accessible for intrarectal sonography were examined to stage local tumor extension. Sonographic results were compared to histopathologic findings of surgical specimens. In this study a radial 7 M Hz and a linear array 5 M Hz transducer were used. Results: In this group of 54 patients intrarectal sonography proved to be accurate in 48 of 54 cases (accuracy 88%). The sensitivity for invasion of the perirectal fat was 94%, the specificity was 78%. The false negative results were influenced by transducer related artifacts and the experience of the radiologist. Two patients were understaged, four patients were overstaged. Patient selection and experience of the radiologist are necessary to reach high accuracy. Perirectal pathologic Iymphnodes could only be detected in a minority of cases (8) and the sensitivity was low (53%). Conclusions: Intrarectal sonography can give accurate preoperative information about extension of rectal carcinoma but is of limited value in detection of perirectal Iymphnode metastases.

Digital f1uorography In the examination of the alimentary tract C. Bosio, E. Juliani (Presenter), G. Margarita, R. Zatteri; Torino This study has been performed employing Philips Digital Spot Imaging (DSI). connected to a remote-controlled table.

The digital image processing provides high resolution images at programmed acquisition speed (up to 8 ifs), on a matrix of 5122/1020 2 • Digital fluorography allows both morphological and dynamic studies, such as deglutition (even in paediatric age), or gastric pouch emptying both in gastrectomized patients and after Mason's gastroplasty for severe obesity. Double contrast small bowel enteroclysis has been improved by the employement of DSI; truly comprehension of functional disorders occurring in malabsorption, the emptying of surgical stumps, as well as surgical anastomoses' wideness has gained from dynamic studies. We carry out the intraarterial application of cytostatic drugs in inoperable tumours of the liver, gallbladder, kidneys, colorectal carcinoma and the metastatic processes of the liver. We try to reach the decrease of tumours as far as is possible to be operated. and so to improve the last time of patient's life. The catheter is inserted via Seldinger method into the nutrient artery of the tumour. We apply cytostatic drugs in form of the intraarterial slowly dripping infusion and partly in repeated injections. In most of the cases we try to carry out a microembolization with microcellulose which functions as the obliteration of the small arteriolas of a diameter 5-100 microns. We link cytostatic drug on the microcellulose and so we prolong the time of its effect in the pathological tumorous bed and partly the cytostatic effect is potentiated with induced ischemia. As far as the operation is not possible we repeated this way of treatment in intervals of6-8 weeks. With this therapy we treated 115 patients with colorectal carcinomas, 36 patients with tumours of kidney, 10 with hepatomas, 40 with metastatic tumours of liver, 7 with tumours of gallbladder and 15 with cancer of pancreas. The best results we reached with the treatment of colorectal cancer, the average time of survival of operated patients were 5 years, not operated 3 years.

The computed tomographic (C.T.) appearances of choledochal cyst (lodani classification I-V) and their diagnostic valua Shahid Khan (Presenter), Nigel Raby, John Karani, Edward Howard; London Introduction and Methods: Choledochal cysts are rare with some types being extremely rare. Several case reports have appeared of C.T. findings of choledochal cysts. These cysts can however have widely different appearances according to the type of cyst (Todani types I-V). This is the first attempt to illustrate the different types and describe their appearances. Results and Conclusions: The C.T. appearances have been illustrated and have been shown to be a useful non-invasive diagnostic tool. Classification of the cysts into intra hepatic/extra hepatic or both is of value to the surgeon pre-operatively. C.T. may also obviate the need for invasive procedures such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangio pancreatography when Ultrasound is not diagnostic.

Unusual causes of cystic lesions of the liver seen on computed tomography (C.T.) Shahid Khan (Presenter), Nigel Raby; London

Purpose: To show the Computed Tomography appearances of cystic liver lesions and to highlight the similarities and differences in patients with many different diagnoses. Methods: A review of all cystic lesions seen on C.T. scanning over a 3 year period was undertaken. This included true cysts. false cysts and lesions mimicking intrahepatic cysts. All the diagnoses were confirmed by either serology. cyst asperation/biopsy, operative findings or post-mortem findings. Results: The differential diagnosis is much wider than usually considered. There is a large overlap in the C.T. appearances in most cases, although some conditions have features highly suggestive of the diagnosis. Some of the more unusual causes have been highlighted with illustrations, i.e. sub-capsular spread of hydatid cysts, mesenchymal hamartomas, cholangiocarcinoma, lymphoma. choledochal cysts, carcinoid tumours, and cystic haematoma. Conclusions: It is unwise to assume cystic lesions of the liver are simple cysts on the C.T. appearances alone. Only rarely are the appearances highly suggestive of a diagnosis.

Casuistic radiological findings In the female genitalia in condition of translucent hysterosalpingography -our modification Christina Kovatcheva (Presenter); Vidin

The report presents abundant material of vaiuable radiological findings using the translucent hysterosalpingography by means of the Schulze's device, modified by us.

The goal is to prove the advantages of this new technique of double contrast of the uterine cavity in comparison with the usual HSG. I. Visualization of the female genitalia in congenital and acquired incompetence of the cervical os. The most feared complication of the splenic transcatheter embolization is the splenic abscess formation caused by major splenic infarction. This complication was considerably reduced by partial and stepwise embolization of the spleen. In an attempt to perform more homogeneous and safe splenic embolization, we used small (0.05 mm) dextran microspheres (Sephadex G 50) in humans.

Eight patients with hyperplenism were treated with dextran microspheres partial occlusion of the splenic artery. Repeated embolization was carried out in three cases. We followed a strict aseptic technique during procedure, antibiotic prophylaxis and pain control after the methodology outlined by Spigos et aI., 1979. White blood cell and platelet response to embolization marked improvement in all cases. Lowgrade fever and mild abdominal pain were present in all patients the following four days. One patient had remained febrile for twenty days. Ultrasonography examination of her embolized spleen revealed areas of hypoechogenity correlated presumably with infarcted splenic tissue.

The reliability of biochemical liver function tests In patients with ultrasonically diagnosed hepatic metastases

The study included 205 female breast cancer patients (Bc), 54 large-bowel cancer patients (LBc) and 54 lung cancer patients (Lc). Serum AF, SGOT, SGPT and Gamma-GT were measured together with abdominal ultrasound. Gamma-GT showed highest sensitivity, and SGOT was most specific for detecting hepatic metastases. In Bc and Lc patients SGOT showed highest overall accuracy. In LBc patients, Gamma-GT and AF were more accurate. SGPT was less specific in Bc and LBc patients. Increased numbers of true positive Gamma-GT and false negative SGPT were observed in LBc (Chi-square 22.45, p < 0.0 I).

In 21 Bc, 25 LBc and 7 Lc patients number of hepatic lesions was multiplied with average lesion diameter as a liver involvement product (LIP) and correlated to the values of biochemical tests.

Regressions were significant only for LBc patients. AF curve (i = 0.537, p < 0.01) attributed elevated values to LIP over 3, SGOT curve (i -0.440, p < 0.05) to LIP over 5 and SGPT curve (i = 0.393, p < 0.05) to LIP over 10. Gamma-GT (i -0.536, p < 0.01) curve attributed pathological values to all LIP values. Gamma-GT remains the most sensitive liver function parameter for the detection of hepatic metastases, but less specific than SGOT.

SPACE !1!9. Purpose: The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in one hundred patients with carcinoma of the esophagus and gastroesophageal junction. Methods and Materials: CT, US and palpatory findings were compared and US guided fine needle aspiration biopsy (UGFAB) was performed of nodes with a small axis of 5 mm or more. Results: Supraclavicular metastases were detected on CT in 84.6% and on US in S7.5% of cases, but were palpable in only 18.7%. The predictive value of a supraclavicular node indicating metastases was 0.74% on US and 0.85% on CT. Metastases were diagnosed in 21.7% of patients with squamous cell carcinoma (relative risk = 1.5) and 10% of patients with adenocarcinoma. Carcinomas of the upper and middle esophagus metastasized most frequently to the supraclavicular nodes (relative risk = 1.9). Metastastic nodes had a round configuration with a statistically significant greater short to long axis ratio than benign nodes (0.89 V.s. 0.54, p = 0.05). In 25% of cases supraclavicular metastases were not associated with radiologically detectable mediastinal or abdominal adenopathy. Supraclavicular US or CT and UGFAB should be included to optimalise the preoperative staging of esophageal and gastroesophageal junction carcinoma.

99m-Tc-HMPAO labelled leucocytes (WBC) In acute colonic dlvertl· culltls E. Lantto (Presenter), T. Lantto, R. Mokka, S. Ristkari, M. Vorne; Hollola

The diagnosis of acute colonic diverticulitis is based largely on clinical judgement. Barium enema and endoscopy are contraindicated in the acute stage.

Eleven patients with clinical suspicion of acute diverticulitis were imaged with labelled leucocytes to evaluate the value of this method in this disease. Images were obtained at 0.5, 2 and hr after reinjection of labelled cells. The results were compared with computed tomography (CT) in 9 cases and with ultrasonography (US) in 9 cases. WBC showed a focal "hot" spot in all cases with the final diagnosis of diverticulitis (Sill) and in one colonic adenocarcinoma with chronic inflammation. Oiverticulas and thickening of the colonic wall and lor pericolic oedema was seen in all cases of the disease imaged with CT (719) and in the colonic adenoca. CT was true-negative in one case. US was true-positive in three, false-negative in four and true-negative in two cases. The findings were correct in 10/11 cases with WBC, in S/9 with CT and in 5/9 with US, respectively.

In conclusion, 99m-Tc-HMPAO labelled leucocytes offer a rapid, safe and accurate method in the confirmation of the diagnosis of colonic diverticulitis in the acute stage. Authors report a prospective study comparing the findings at computed tomography (CT) and magnetic resonance imaging (MRI) in evaluation of the pelvis in 30 patients after abdominoperineal resection for colorectal carcinoma. MRI was performed in patients with suspected presacral recurrency on CT examination or when CT was unable to discriminate fibrosis from recurrent tumor.

The results were compared and verified with findings at biopsy, surgical exploration or follow-up. By characterizing TI and T2 values. MRI has demonstrated a superior ability to distinguish malignancy from fibrosis and both from normal soft tissue of various relocated organs. Recurrent tissues have prolonged TI and T2 values, which give a low signal on TI weighted images but medium-to high signal on T2 weighted images. Postoperative and radiation fibrosis consistently displays low intensity signal both in TI and T2 weighted images. Posteriorly relocated organs (especially uterus and seminal vesicules) can be easily recognized by high contrast and multiplanar section of MRI.

Adult presacral cystic hamartoma: US, CT and MRI evaluation F. Laurent (Presenter),

Cystic hamartoma is a rare lesion believed to originate from the embryonic tailgut that normally disappears in early fetal development. Our purpose was to describe the spectrum of US, CT and MR findings of these lesions and to emphazise the differential diagnosis with other presacral masses. Methods: Features of imaging studies (US. CT and M RI) were retrospectively correlated with surgical and pathological findings in 10 patients. A comparison with imaging studies of more than 30 other presacral masses was performed. Results: Shape, volume, content, rectal wall involvement and coccygeal attachment. the latter representing the most suggestive findings were well demonstrated by CT. Transrectal US and MR imaging showed the precise location of the lesion originating between internal and external sphincter. Differential diagnosis included bone and soft tissue neoplasms. rectal and ovary tumors, meningocele. dermoid cysts, chordoma, abscesses and neurogenic tumors. Conclusions: Imaging studies can suggest the diagnosis of presacral cystic hamartoma and modify the surgical strategy.

The effects of treatment of malignant liver tumors by the method of superselectlve arterial perfusion with 011 contrast media and cytostatlcs Siobodan Lavrni6 (Presenter), S. Radojkovl6, O. Ljubisavljevi6; Belgrad

Our intention is to show that superselective arterial (transcatheteral) perfusion of the liver is a very simple, excellently tolerated, most effective and the cheapest palliative method of treatment of malignant (primary and secondary) non-resectable liver tumors. Over the last 5 years we performed this procedure in over 200 patients and in a few of them in more than 6 sessions in 4 months interval. We have encountered no complications and a therapeutical response was prompt (in the first days after the procedure) with diminution of liver swelling and better general condition of the patients. The results were not favorable only in the patients who were in the terminal stadium of disease. The survival rate of our patients was similar to those published up to date. 

Peritoneal cavity is lined with an areolar membrane of mesothelial origin, the peritoneum, and contains several communicating spaces. Such spaces, usually not visualized on CT scans, can be distended by fluid. Specific pathologic conditions affecting the peritoneum include inflammatory diseases, such tuberculous peritonitis, and tumoral diseases, primary (mesothelioma) or secondary (peritoneal carcinomatosis). Small-bowel mesentery and transverse mesocolon are peritoneal folds that connect visceral structures with the abdominal wall. Like the peritoneum, pathologic conditions can affect the mesentery, including congenital abnormalities (mesenteric cysts), inflammatory and tumoral diseases. CT is the method of choice in the diagnosis of peritoneal and mesenteric diseases. Representative examples of these conditions are presented and main radiological findings are described.

LIver tumors: CT-portography evaluation J. L1auger (Presenter), C. Perez, P. Coscojuela, C. Traid, A. Gim{mez, E. Sanchis, X. Alomar; Barcelona CT and sonography have become the primary imaging methods for the detection of hepatic metastases and hepatocellular carcinomas. However, their success rate in detecting small lesions is low for planning surgery. New advances and increasing number of indications for hepatic resections have prompted the development of new methods with a greater sensibility. In recent years, several techniques, including CT with ethiodized oil emulsion (EOE-CT), delayed scanning, CT-angiography and Magnetic Resonance, have become available and are now frequently used to provide more complete information about the number of lesions, intrahepatic segmental location, and presence of portal vein thrombosis. CT angiographic techniques include CT-angiography (CTA), performed during contrast injection into the hepatic artery and CT during arterial portography (CTAP), the most commonly used. The purpose of this essay is to present the technique. results, and advantages of CTAP and illustrate the findings on hepatic tumors, particularly those that may be confusing. Several no reported causes of false positive or false negative CTAP scans are decribed. has allowed to avoid surgery in all cases. We had no complications. Large catheters allow a more efficient drainage, especially in case of thick debris. Thus, they may enhance the success rate and reduce the duration of percutaneous drainage. Purpose: To assess the usefulness of CT and MRI in diagnosis and management after liver transplantation. Methods: We reviewed the CT scans and MR examinations of 21 patients. The imaging studies were done between 2 days and 27 months after hepatic transplantation. MRI was performed at 1.5 T. All patients had state of the art CT examinations with iv contrast administration. Results: In all patients a periportal and pericaval edema due to disruption of lymphatic drainage was seen. This resolves, albeit slowly. The evolution and resolution of postoperative complications such as perihepatic fluid collections (N = \1). hepatic perfusion defects (N =4) and hemorrhage of the right adrenal gland (N = 3) was documented. Several patients had biliary leaks, of which no evidence was seen on CT or MRI, confirming that these are not the primary imaging modalities for biliary pathology in hepatic transplants. Two patients received livers from child donors and another a "reduced-size" liver, i.e. only part of the donor liver was transplanted. Compensatory hepatic hypertrophy was visible as early as the seventh post-operative day. Conclusions: Many of the complications seen after liver transplantation are self-resolving, but monitoring with CT or MRI is useful to confirm resolution or reveal the need for therapeutic intervention. Duplex-doppler (DO) and most recently color doppler imaging (COl) have become established non-invasive imaging methods of the vascular compartments. Presently. MR is not yet considered diagnostic modality of choice to assess splancnic vessels thrombosis although being effective technique in evaluating flows. This prospective work was undertaken to investigate the sensitivity and accuracy of doppler vs. fast MRI in making diagnosis of portal thrombosis (PVT). DO and COl was obtained respectively with Hitachi AU 450 and AU590 scanners with 3.5 MHz convex probes. MRI was performed with a 0.5 T apparatus using gradient echo sequences (70 ms TR; 13 ms TE, 70 FA) on breath-holding patients. Due to entry slice phenomena, this pulse sequence was very efficient in detecting portal flow andlor thrombosis with diagnostic resolution as far as the hepatic segmental branches. Flow within liver was assessed by axial plane. On the contrast, spleno-portal axis flow was determined by coronal sections. 12 patients with PVT (incomplete PVT in 2 cases; complete PVT in 3 cases; thrombosis of PV and its intrahepatic branches in 4 cases; portal cavernomas in 3 cases) were imaged with both techniques. Briefly, fast MRI demonstrated similar accuracy to doppler techniques in diagnosing thrombosis of the main PV but lower efficiency in detecting residual flow within incomplete PVT, canalized cavernomas and periportal collaterals.

Examination about MR Signal Intensity of hepato cellular carcinoma Hiromichi Matsuda (Presenter), Fumio Kotake, Kimihiko Abe, Saburo Amino; Tokyo Purpose: It's said that MRI of H.C.C. (Hepato-Cellular Carcinoma) showed low-high signal intensity on T1WI (T1 weighted image). But, on T2WI (T2 weighted image), some report that all cases showed high signal intensity, some report that in part showed iso signal. So. this time. we studied signal intensity of H.C.C. on TI WI and T2WI. and in some cases obtained pathological findings, we compared those with signal intensity of H.C.C. Methods: We used TOSHIBA MRT-50A (0.5 tesia). Pulse sequences used were spin echo (SE) 500120 (TRITE) for TI WI and SE 2000/80 for T2Wl. Objects of this study are H.C.C. 70 cases. Results: On T1WI. MRI showed various signal intensity of low-high signal. In particular, tumors below 2 cm were frequently described high signal intensity. On T2WI, most of 70 cases H.C.C. showed high signal intensity. But, we acknowledged 20% of these were described iso signal intensity. The case performed an operation was well differentiated H.C.C. showed iso signal. Conclusions: MRI of H.C.C. showed not only high signal intensity but also iso signal intensity on T2Wl. And we think signal intensity of H.C.C. correlates to each differentiated type.

Unresectable liver metastases therapy: comparison of single with serial IIplodol-eplrublcln transcatheter arterial embolization Giorgio Minonzio (Presenter), Gian Piero Puricelli, Giulio Carcano, Marco Tettamanti, Fabio Baruzzi, Alberto Caresano; Varese

Purpose: To perform a study on effectiveness of trans catheter arterial embolization (TAE) with Lipiodol-Epirubicin (L-E) comparing volume variations of liver metastases after single or serial treatments. Methods and Materials: Twenty-six patients with un resectable liver metastases from gastrointestinal tract underwent TAE with Lipiodol-Epirubicin (20-50 mg). Gelatin sponge was not employed. Eighteen of the 26 patients underwent one treatment and were followed with CT after 1,3, and 6 months. Eight patients were submitted to 3 or more treatments (I month intervals) and CT after I, 3 and 6 months. Volume was assessed with ROI-evaluation. Results: After single L-E TAE a mean volume decrease of 8.1 % was recorded after I month, with an increase of 17.5% after 3 months without further therapy. In patients submitted to monthly repeated L-E TAE we observed a volume increase of 8.3% at 3 months and 2.8% after 6 months. Low dose Epirubicin did not cause major complications. With single L-E TAE, though Lipiodol can stop longer within liver metastases, an antitumoral effect was observed only during the first month. After multiple monthly repeated L-E embolizations little changes of metastatic volume were recorded up to six months. The lalter method proved effective and promising for improvement of survival.

MRI of small hepatocellular carcinomas less than 3 em at 1.5 T, especially the efficacy of dynamic MRI Takeshi Miyamoto (Presenter), Hideyuki Nakajima, Noriaki Usuki, Shigeo Saiwai, Haruyuki Fukuda, Jittoku Nishikawa, Jyouji Kawabe, Masatoshl Kudou, Syuusuke Tomita; Kobe City

The efficacy of diagnosis of small hepatocellular carcinomas (HCCs) using plain MRI and dynamic MR) was studied. Materials were a total of 73 small HCC lesions less than 3 cm in 60 patients. In 44 of73 HCCs, clear dynamic MR images of HCCs were obtained. Diagnosis of the HCCs were confirmed surgically in 20 lesions, in 8 by biopsy and in 45 by various examinations including US, angiography, Dynamic CT, CT after Iipiodol infusion, CT during arterial portography, US under arterial infusion of CO2 micro-bubbles, color dopplering, and clinical data. Dynamic gradient echo MR images using fast low angle shot (FLASH) technique at 90· pulse angle were obtained after bolus injection of Gd-DTPA (0.1 mmol!kg) under suspended respiration. Eighty-two % of HCCs showed high-intensity on T2-weighted images. Ninetythree % of HCCs revealed enhancement of tumors at early phases after injection of Gd-DTPA on dynamic MR images. HCCs which did not reveal enhancement were highly differentiated HCCs, which showed high-intensity on TI-weighted images and iso-intensity on T2-weighted images. Dynamic MR) further increases the qualitative value of plain MRI diagnosis. The comparison with adenomatous hyperplastic nodules was also studied. Beh~et"s syndrome is a multisystem inflammatory disorder, of unknown etiology, however some authors consider this entity as a vasculitis. Diagnosis focuses on clinical findings characterized by three major criterias: Recurrent aphtous oral ulcerations, genital ulcers and ocular inflammatory involvement. In addition Beh~et"s syndrome can also involve many other organs and systems: Skin, vessels, gastrointestinal tract, etc ... Gastrointestinal tract involvement affects any location, predominating in colon and terminal ileum. Ulcers of varying size have the radiological appearance of a colitis. Differential diagnosis of Beh~et"s syndrome must be carried out taking into account the possibility of inflammatory intestinal disease (Crohn's disease and ulcerative colitis). In our study we present four patients diagnosed as having Beh~et"s syndrome. Two of them developed gastrointestinal manifestations and radiologically severe pancolitis. The value of double contrast radiography of the esophagus, LES manometry and pH testing of esophageal reflux were comparatively assessed on 39 patients operated for sliding hernia. The time elapsed from surgery ranged from 2 to 9 years (mean: 5 years); in 7/39 patients clinical symptoms suggestive for disease recurrence were reported. X-ray examination showed a recurrent hiatus hernia in 4/39 cases (10%). Manometry revealed a LES in supradiaphragmatic position in the same 4 patients. PH testing did never demonstrate a gastro-esophageal reflux: however, an abnormal detersion time after acid test was observed in 4 different cases. There was a remarkable agreement between x-rays and manometric findings. The 4 patients with an abnormal radiographic and manometric picture were reoperated and the results of both investigations were confirmed by surgery. Double contrast examination of the esophagus and LES manometry may be considered the combined approach of choice for the diagnosis of recurrent sliding ernia and for the follow-up of operated cases. PH testing is a complementary procedure that can be useful for detecting the esophageal reflux which may be present without recurrent hiatal hernia.

Kaopectate as a negative rectal contrast agent In MA Imaging of colorectal disease Jorg Neuerburg (Presenter), Klaus Ch. Klose, Klaus Bohndorf, RoIfW.

The potential of the generic Kaopectate (Upjohn) as a negative rectal contrast agent in MR imaging was investigated in the assessment of colorectal disease. Fifty MR examinations in patients with colorectal disease (colorectal carcinoma: 29 patients, inflammatory disease: 13 patients, miscellaneous disorders of the colon: 8 patients) were evaluated. All examinations were performed with TI and T2 weighted SE sequences after rectal application of Kaopectate. Gd-DTPA enhanced TI SE sequences were obtained as well. Kaopectate revealed a signal void of the lumen of the large intestine in TI and T2 weighted SE sequences. A sufficient contrast between bowel and nonbowel could be obtained in 47 of the 50 examinations. Intravenous administration of Gd·DTPA allowed a good discrimination of the high signal intestinal wall, malignant or inflammatory tissue and the low signal lumen of the bowels. No side effects were registrated. Kaopectate improved diagnostic quality by providing a good negative contrast between bowel and nonbowel and by reduction of moving artifacts.

Ovarian neoplasms = sonographic criteria of benign and malignant tumors (a retrospective study of 210 cases) Thu Nguyen-Tan (Presenter), Thu-Ha Oao, Liliane Ollivier; Paris Purpose: To compare sonographic features of benign and malignant ovarian neoplasms and to evaluate preoperative prediction of malignancy. Methods and Materials: 98 examinations performed with 3.5-5 MHz external probes were reviewed with respect to 9 criteria including: unilbilaterality -size -echogenicity -wall and septa pattern -calcifications -fluid/fluid levelascites -metastases. These criteria were then used to predict benignity or malignancy of J 12 histological proven ovarian neoplasms. Results: Retrospectively, benign tumors (n = 25) are unilateral with anechoic or homogeneous solid pattern containing calcifications. Malignant tumors (n = 73) are more often bilateral with size exceeding 5 em and wall/septa are thick and irregular or predominantly echoic and heterogeneous solid pattern associated with ascites and metastases. Prospectively, ultrasound failed to diagnose 7 benign tumors (n = 37) and 9 malignant tumors (n -75). Conclusions: With an overall accuracy of 85.7%, a sensibility of 89% and a specificity of 75.6%, sonographic tumor type prediction with external probes is not enough reliable to affect the surgical practice to remove all ovarian masses. But the wide use of endovaginaJ high frequency probes should improve sonographic accuracy and specificity. Endoscopic extraction of common duct stones (CDS) is performed in patients who have had cholecystectomy and in other patients who are considered a poor surgical risk. In about 10% CDS cannot be removed, usually because the stone is too large to pass through the lower segment of the common bile duct. This paper describes our experience using a second generation lithotripter (Siemens "Lithostar") for CDS in patients in whom endoscopic extraction had failed or was not appropriate. With this machine no waterbath or general anaesthesia is required. Preliminary investigations to assess possible complications included: serum LFT's, U&E's. FBC, serum amylase, bile culture and urinalysis. Abdominal CTwas performed in the first 20 patients. 54 patients, 34-89 years old (mean 74.3 years), with common bile duct stones (6-36 mm) have been treated. All patients had nasobiliary catheters (52) or cholecystostomy tubes (2) in situ. Patients received 4000-6000 shocks per session over approximately 60 minutes. Seventeen patients underwent two ESWL sessions and two patients three or more sessions. Thirty-seven patients had one stone, ten had two and seven had three or more. Spontaneous clearance of fragments occurred in three patients and ducts were cleared endoscopically in a further 32 patients (total = 35 patients -65%). Fragmentation occurred in a further 9 patients but remaining fragments were large and have not yet been cleared. 10 patients stones remained unchanged. The response to lithotripsy was dependent on the size of stones, with number having little effect. ESWL was well tolerated without the development of any haematological, biochemical or CT abnormality. Second generation ESWL is a promising adjunctive treatment for CDS with a low complication rate, which compares favourably with elective surgery. when preliminary endoscopic extraction has failed. The position of the gallbladder (GB) was evaluated on 200 consecutive CT scans. 188 patients showed no significant hepatic abnormality and were used as controls to assess normal GB position. The GB angle was measured between the coronal plane and the axis of the GB. The normal range varied from 35°_75° (mean 52°). The shortest distance of GB fundus to abdominal skin surface varied from 2-5 cm (means 3.2 cm). Although liver substance lay between fundus and skin surface in only 55% of controls, in no normal patient did the fundus project beyond the surface of the liver. Six of eight patients with cirrhosis, showed an abnormally positioned GB. In four, part or all of the GB projected beyond the surface of the liver. In two the GB fundus to abdominal skin distance measured more than 5 em. In all eight the GB angle remained within normal limits. Interposition of the colon between liver and anterior abdominal wall was also noted in 4. In two patients with lobar atrophy secondary to sclerosing cholangitis, the GB was malpositioned, although it maintained its normal position between the left and right lobes (GB angles 5° and 20°). Two patients with large right intrahepatic masses, showed subsequent increase of the GB angle (90· and 95°). These acquired mal positions of the GB due to cirrhosis. lobar atrophy and mass effect. have potential clinical implications with increased risk of inadvertent injury during percutaneous liver biopsy or interventional procedures and such procedures should be performed using image guidance.

Diagnostic Imaging of Ileocecal diseases J. Palmer (Presenter), C. Perez, J. Uauger, A. Gimenez, P. Alvarado.

x. Alomar; Barcelona

The ileocecal area is an abdominal region that often is the preferential site of infectious. inflammatory, neoplastic, vascular, and numerous other diseases. It is also a region whose location. other than upper digestive tract or distal colon. is not well suited for endoscopic evaluation. Imaging procedures have proved to be very important for the evaluation of such diseases. Several techniques are available for imaging the ileocecal area, including plain films, antegrade bowel examination, small bowel enema, colon enema, double contrast enema, ultrasound, computed tomography and angiography. All have strengths and limitations. and there is some controversy regarding their role. We report the radiologic findings, using different techniques. in these diseases and assess the usefulness of these findings in stablishing diagnosis and differential diagnosis.

The diagnostic accuracy of US, CT and ERCP In the diagnosis of Jaundice K. Partanen (Presenter). P. Pasanen, P. Plkkarainen, A. Plrlnen, S. Solmakallio, E. Alhava, E. Janatuinen; Kuopio

The purpose of this study was to investigate prospectively the diagnostic accuracy of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) in the disctinction between extra-and intrahepatic causes of jaundice in 187 consecutive patients. The limit for the inclusion to the study was defined as serum bilirubin concen-tration > 40l1molli. Results: The sensitivity rates of US, CT and ERCP in the detection of obstruction were 63,77 and 87%, respectively. The differences between all these methods were statistically significant. The specificity and the positive predictive values of all methods reached 96-99%, but the negative predictive values were 37, 48 and 63%, respectively. The low values of sensitivity and negative predictive values could be explained by a large number of cases with choledochal stones that could not be detected by imaging methods or that had already passed spontaneously. On the basis of this study it seemed reasonable not to construct a rigid flow chart for the workup of an jaundiced patient. A flexible use of the present investigative methods is recommended, and the optimal use of them requires a good knowledge of their advantages, limitations, risks and costs.

MRI evaluation of the liver aHer gallstones lithotripsy with shock waves P. Pavone (Presenter), D. Lomanto, S. Giuliani, G. Cardone, V. Speranza, R. Passariello; L'Aquila Purpose: To verify the status of the liver parenchyma surrounding the gallbladder with MRI after shock waves lithotripsy. Methods: 10 patients submitted to shock waves lithotripsy by means of a Dornier MPL 900 system were included in the study. The average energy was 22kv, with a number of shock waves of 1200 to 1500. The MRI examination was performed within 24 hours from the treatment. A 0.5 T superconductive system was used. Spin echo TI and T2 weighted sequences were acquired on the axial and sagittal planes. Results: The MR images did not show any signal intensity alteration in all but one case. In this female patient. weighing 45 kilos, a diffuse increase of signal intensity was seen, ill-defined at the level of the hepatic parenchyma surrounding the gallbladder fossa. The alteration was related to contusive microtrauma (edema or microhemorrhages). Control study was performed at two weeks, and no residual alteration was evident. Conclusions: This study confirms the safety of shock waves lithotripsy treatment of gallbladder stones. Even in the positive case, the signal intensity alterations were mild, and no residual alteration was evident at follow up.

Selective enhancement of the liver by magnetic resonance arterial portography (MRAP): studies with rapid acquisition spin echo (RASE) sequence Paolo Pavone (Presenter), Silvia Giuliani, Paolo di Renzi, Casimiro Simonetti, Giampiero Cardone, Roberto Passariello; L'Aquila Purpose: To evaluate organo specific enhancement of the liver in the portal phase during injection of Gd-DTPA in the superior mesenteric artery, with use of breath holding T I weighted spin echo sequences. Methods: 10 patients with hepatic malignancies undergoing angiography for different reasons were studied with MRAP. MR images were obtained with a 0.5 T superconductive equipment. Breath holding RASE sequences were acquired, with TR 230msec., TE 16msec., I Nex and 128 x 256 matrix. 6 slices are obtained in 30 seconds. Gd-DTPA was injected at a dose of 4 ml of 0.5 mmol/l solution, diluted in water. The injection was started 15 seconds prior to the beginning of the pulse sequences and lasted as long as the acquisition time (30 sec.). Results: Strong enhancement was observed in normal liver parenchyma, with values of Signal Enhancement over Noise (SE/N) of 9.5. The liver lesions did not present significant enhancement (measured value of SE/N -0.5). Distal to segmental portal vein occlusion no enhancement was observed in two cases. Conclusions: This technique provides selective hepatic enhancement. The use of RASE sequences is favourable because of the number of slice obtained and the high TI weighting. CT findings in 27 cases of surgically proved bowel ischemia are reviewed. Bowel ischemia is a common cause of acute abdominal pain. Clinical and laboratory data are unspecific and diagnosis is usually delayed, resulting in a high mortality. Radiologic diagnostic is also difficult. Barium studies and angiography are time-consuming, invasive or not specific. CT has been used increasingly to evaluate patients with acute abdominal pain, allowing identification of bowel ischemia findings. These include bowel changes (Fluid-filled loops, thickened wall, contrast mural enhancement and intramural low attenuation zones or air) and/or vascular changes (portal or mesenteric air. mesenteric vein thrombosis and mesenteric artery occlusion).

CT is specially useful to identify secondary ischemia changes in closed-loop obstruction (volvulus). An early diagnosis of this condition results in a very good postoperative prognosis. We have tried to institute the diagnostic criterions intervening imaging methods (ultrasonography, CT, angiography) which let us establish an accurate pathological correlation among the primary mesenteric and omental tumors, differentiating two broad groups in relation with their characteristics (solid or fluid tumours). Everyone were verified by surgery and/or biopsy. We have studied thirteen patients with cystic mesenteric tumors. Seven of them had real cysts, with revetment epithelium (3 serous cysts, I quilous cyst, 2 duplication cysts, I enteric cyst), three mesenteric pseudocysts which were not of pancreatic origin and three primary peritoneal echinococcus cysts. The most valuable criterions to diagnose them were established by CT and ultrasonography. They are: uni or multilocularness, wall thickness. evidence of calcium, fat density in CT and their location and relation with bowel loops. We have found twelve patients with primary solid tumors of the mesentery: 2 liposarcomas, 2 sarcomas, I peritoneal mesothelioma, 2 primary mesenteric lymphoma. 2 mesenteric desmoid. I Castleman's syndrome. I neurofibromatosis, and I retractile mesenteritis. In these patients, the best diagnostic method has been CT, with very specific findings in some entities. resulting of little value diagnostic angiography. Duplex-Doppler sonography was also helpful to assess biliary complications (bilomas in 4 patients which were drainaged percutaneously guided by ultrasound. and obstructive jaundice in a patient with choledocholitiasis), extrahepatic fluid collections (12 patients). hepatic hematoma (4 patients). hepatic infarction (2 patients), hepatic abscess (I patient) and one tumour relapse in transplanted liver (hepatoblastoma). We have correlated our Duplex-Doppler findings with the results obtained by other methods of diagnosis (nuclear medicine. CT and angiography). We remark the absence of significant variation in the resistance index of the hepatic artery during the rejection, the high specificity (98%) and sensitivity (94%) to show portal vein permeability, the high accuracy of this technique to diagnose hepatic arterial thombosis and stenosis, and the biliary complications in hepatic transplant.

Inhomogeneous echo-pattern In pancreas

Purpose: By means of ultrasound examinations radiologists often experience and describe in the report the inhomogeneity of the echo-pattern of the pancreas. What is the significance and value of this diagnosis concerning the condition of the patient and for the physician? Methods and Materials: 38 patients we performed the US examination of the pancreas to determine the distribution of the intensity of the echos (histogram Purpose: The aim of this study was to make deep thermal lesions in liver by laser in a non-operative way, as a potential therapy for liver metastases. Methods and Materials: Via a percutaneous needle (14 Gauge) a flat cleaved optical fibre (core diameter 600 m) was inserted into several sites of normal liver in four piglets under ultrasonographic guidance (5.5 MHz linear). To maximize lesion size. a low power (1.5 Watt) per lesion was administered during 600 s from a ND:Y AG laser (wavelength 1064 nm). Ultrasound lindings were correlated with histology at day 0, 7,14,21 and 28 and liver enzymes were tested at day 0, 1,2,7. 14,21 and 28. Results: During treatment ultrasound showed a growing echogenic zone with a maximum diameter of 2 cm around the fibre end which corresponded microscopically with a spherical coagulation zone. Central carbonisation in the lesion varied from I to 3 mm. Follow-up an inflammatory reaction with fibrosis, healing within 4 weeks and transient biochemical changes during the first week. Conclusions: Percutaneous laser treatment under ultrasound monitoring is capable of inducing intrahepatic thermal lesions. This method should be studied further as a potential therapy for liver metastases.

Sonographlc diagnosis of hepatosplenlc tuberculosis G. Pia (Presenter), L. Pascalis, G. Aresu; Cagliari 30 patients (20 females and 10 males) between 25 and 50 years of age with hepatic and/or splenic localization of tubercular disease. were studied with ultrasonography. Previously a form of pulmonary tuberculosis had been diagnosed in these patienL~. All of them were subjected to CTscan: 5 to hepatic angiography and 20 to percutaneous biopsy of the liver under ultrasound guidance. In 25 subjects ultrasonography evidenced a nodular formation restricted to the liver whereas in the other 5 patients, besides at hepatic level. lesions were also present in the spleen. These formations were roundish with a diameter varying from 5 to 7 cm and presented a hyperechoic central area and a peripheral hypoechoic halo. Liver biopsy of the lesions under ultrasound guidance made it possible to evidence fact of inflammatory cells and more specific epithelioid cells in caseous necrotizing areas. Ziehl coloration revealed the presence of alcohol acid resistant bacilli. Treatment was started with Ethambutol 800 mg/day. pyridoxine 500 mg/day and INH 200 mg/day and was protracted from a minimum of 6 months to a maximum of 10 months. Patients rapidly improved and after a period of 5 to 9 months from the beginning of treatment. the ultrasonic and tomographic values returned to normal. Our results allow us to affirm that the hepatosplenic localization of tubercular disease is all but rare and must therefore be considered in differential diagnosis of space occupying lesions, at a hepatic as well as at renal levels, in the same way as other pathologies such as neoplasia, parasitic cysts etc. According to our data it is also possible to affirm that with adequate medical therapy the prognosis of these patients is good. Results: In no case was sphincteric damage nor poor emptying function seen. Phase I: the total volume infused was retained in all but one case (3.7%) and minimal (S 40 ml) leakage on coughing and/or straining was seen in 4 (14.8%).

Extraluminal collections of contrast (dehiscence, fistula) were observed in 5 (18.5%). Phase II: a progressive ileal loop enlargement was seen in 16 (59.2%). While not preventing normal emptying sharp angulation at the site of anastomosis occurred in 2 (7.4%) and recurrent fistula in 3 (11.1 %). Overall, the stool frequency (range 1-7 movs.lday), based on the X-ray study alone, could not be predicted either during Phase I or Phase I I of the examinations.

Quantitative analysis of the pelviC floor function by direct coronel (DC) pelvic CT

Purpose: To describe a method of dynamic DC CT imaging of the pelvis with emphasis focused on the definition of four parameters as entera for normal pelvic floor physiology. Methods and Materials: DC pelvic CT was carried out using a GE/CT Pace scanner (gantry opening: 64 em) in IS consecutive patients, 6 males. 9 females, mean age 52.3 yrs, without functional disorders of the pelvic floor. The following protocol was used: I. three hours before scanning 600 ml of oral contrast is taken (2 per cent solution of Gastromiro Bracco); 2. the bladder is distended by natural urine; 3. ISO ml of air are insumated through a rectal tube just prior of scanning: 4. the patient seats facing away from the gantry opening and is scanned at rest and on straining: 5. following a lateral scanogram of the pelvis 10 mm-thick sections are obtained from the femoral head to the tip of the coccyx: 6. technical factors are: Kv 120, Ma 130, sec 3, Rec fov 35, WW 500, WL+ 22. Results: The following parameters, related to functionality of pelvic floor, were noted to provide numerical data: a) Levator Ani Angle (LAA): mean 105 0 ± 5.00 at rest and 125 0 ± 5.00 on straining: b) Ano-Rectal Junction (ARJ) level (mm) above (+) or below (-) the ischial tuberosities: +25.13 ± 1.08 at rest and + 12.06 ± 3.11 on straining; c) supra and infra levator spaces area (cm2) Purpose: This study was undertaken to evaluate the CT spectrum of lymph node metastases in hepatocellular carcinoma (HCC). Methods and Materials: During the last 4 years, 102 consecutive cases of HCC were examinated by CT and histologically confirmed metastatic adsominal lymph node enlargement was detected in 9 of them. Results: The adenopathies were located in periportal (n = 6), peri pancreatic (n = 5), para-aortic (n = 5), superior mesenteric artery (n = 2), celiac (n = 2), peridiaphragmatic (n = I), mediastinal (n = I) and axillar (n = I) regions. Six patients had two or more regions involved. The size of the nodes was (15-40mm) in 7 cases and(> 10cm) in 2. On post-contrast scan the nodes were of homogeneous attenuation in 6 cases and showed necrotic areas in the other 3. In six cases, the hepatic tumor was in advanced stage and was associated to tumoral thrombus of portal and/or inferior vena cava systems.

Radiologic evaluation In adult constipated and In Idiopathic Incontinent patients F. Pomerri (Presenter), S. Curtolo, F. Pittarello, P. C. Muzzio; Padua

Radiology can evaluate not only morphodynamic aspects of the anorectum, but pelvic plane too. Our method needs two complementary times: "phasal" and "dynamic" defecography. In severe constipation 2 groups of patients are identified: patients, middle aged 38.7, without meaningful changes in width of the anorectal angle and in distance between anorectal angle and pubococcigeal line; patients, middle aged 63.3, show a meaningful reduction in width of the anorectal angle on straining and an increasing of distance of anorectal angle from pubococcigeal line on squeezing. Constipated patients reveal a narrow anal canal (60%), rectocele (42.6%), mucosal prolapse (27.8%), rectal prolapse (18%), solitary ulcer (14.7%). In idiopathic incontinent patients, middle aged 63.3, we found a lowering of anorectal region on squeezing and, in the most serious ones, also at rest, with the patient sitting. Incontinent patients reveal, in dynamic defecography, a larger anal canal (67.6%), rectocele (36.7%), mucosal prolapse (14.7%), rectal prolapse (11.7%). In conclusion, in the elderly constipated patients, we found a deficiency in contractility of pelvic floor's muscles and, in serious incontinent ones, also a deficiency in tonicity of the pelvic floor. Results: In all patients with NHL of the pancreas, the relatively large, unsharply defined, nearly homogeneous hypodense pancreatic masses infiltrated the retroperitoneal fatty tissue and surrounding organs. After i.v. administration of contrast medium, a slight to marked uniform enhancement was noticed. No calcifications were seen. Conclusions: The described CT-feature is not specific but highly suggestive of pancreatic involvement in NHL. Because of the different management of patients with NHL, neoplastic or inflammatory pancreatic disease, accurate and rapid diagnosis is essential. In the evaluation of postoperative complications of hepatic transplantation clinical and laboratory data usually do not provide a specific diagnosis. Thus imaging procedures are pivotal in characterizing parenchymal, biliary or vascular complications. The CT findings in the abdomen after liver transplantation as seen on 37 examinations in 33 allograft recipients are described. CT was most useful in the evaluation of parenchymal abnormalities of the allograft and in detection of extrahepatic fluid collections. Low density foci within the allograft parenchyma were seen in 18 patients (54%) and were associated with infection (4 cases), infarction and necrosis secondary to vascular insufficiency (6 cases), bilomas (7 cases) and one pseudoaneurysm that was causing a porto hepatic shunt. Localized extrahepatic fluid collections were present in 17 cases (51 %) corresponding to 6 bilomas, I hematoma and 7 free peritoneal fluid collections. 3 of the focal fluid collections were infected. Since the nature of these fluid collections could not always be determined by CT characteristics, fine needle aspiration wa.~ required in 8 cases for a specific diagnosis. Catheter drainage of fluid collections was performed using CT in 6 cases.

CT is a noninvasive method in the evaluation of postoperative complications that occur after hepatic transplantation. The behavior of smooth muscle tumors of the intestine (leiomyoma, leiomyoblastoma, leiomyosarcoma) is of special interest because of the characteristics of their growth and dissemination. The aim of this communication is to assess the radiologic findings of their dissemination, both contiguous and distant, within the abdominal cavity. Thirty-five smooth muscle tumors of the intestine have been studied by means of ultrasound (US), computed tomography (CT) scan and magnetic resonance imaging (MRI) to assess the features of the internal structure of the primary tumor and of the intraperitoneal metastases. They consist of one or more nodules formed by smooth muscle fibers and have a whorled appearance. Their marked tendency to degenerate at the center and the subsequent cystic transformation produce their known radiologic aspect. However, we demonstrate the frequency of the multi cystic transformation and the multi partitioned aspect that the primary tumors show on occasion. Nonetheless, the most interesting finding is that these masses grow by producing peripheral nodules which infiltrate neighbouring organs, detach and, by way of the peritoneum, are implanted far from the primary tumor. They also undergo cystic degeneration with one or more cavities, depending on the number of nodules. These US, CT and MRI findings are virtually pathognomonic signs, and can lead to the exact diagnosis of this type of abdominal tumoral process.

A splenic hamartoma: diagnostic problem

We present a case of splenic hamartoma presented with asymptomatic anemia and splenomegaly in a 47 years old woman. Imaging studies (CT and US) revealed an enlarged spleen with an inhomogeneous mass in it and a focal gross calcification in the hilus. The diagnosis was referred also after fine needle aspiration guided by US and splenectomy was necessary.

We propone that splenic hamartoma should be included in differential diagnosis of a splenic mass. (6), barium small-bowel study (4) and CT (3) were performed. Tuberculosis in extraabdominal sites (sputum, cervical adenopathy) was documented by acid-fast smear or culture in all cases, and in two of them biopsy specimens from omentum and terminal ileum showed granuloma formation. Good clinical response to antituberculous chemotherapy was observed in all but one case, which presented intestinal obstruction requiring surgical treatment. Results: Barium studies showed involvement of terminal ileum (6), cecum (4) and duodenum (I). Thickened folds (4), nodularity (5), ulcerations (2), spasticity (2), ileal structures (I), ileocecal valve gaping (5) and retracted cecum (3) were seen. On CT, one patient had mild ileal wall thickening. Two, had more characteristic findings: severe wall thickening involving terminal ileum, valve and medial side of cecum with regional lymphadenopathy. One patient had massive low-density peri pancreatic adenopathy with duodenal involvement and fistulization. Other patient had ascites and irregular soft tissue densities in the omental area (Tuberculous peritonitis). Although pneumoperitoneum is a well recognized complication of colonoscopy, to our knowledge, no case of pneumoperitoneum, pneumoretroperitoneum, pneumothorax, pneumomediastinum and subcutaneous emphysema has been described as a complication of therapeutic colonoscopy. A 37-year-old woman with colonic adenomatous polyps, underwent therapeutic colonoscopy, noted chest pain and minimal respiratory difficulty. At physical examination there was no evidence of peritoneal irritation, but chest and abdominal plain film revealed pneumoperitoneum, pneumoretroperitoneum, pneumothorax, pneumomediastinum and subcutaneous emphysema. The patient was managed nonsurgically, showed improvement and the air disappeared after seven days. It's important to recognize this complication and to differentiate it from true colonic perforation, where surgery will be imminent.

CT and barium correlation In duodenal tumours and pseudotumours C. Sanchez Torres (Presenter), A. Alvarez Caste lis, J. Alvarez Fdez, J. Andreu, J. A. Jimenez, S. Pedraza; Barcelona

We attempt to define the utility of adding CT scaning to the barium radiographic evaluation of local mass lesions involving duodenum. Every mass in the duodenal area should be evaluated cautiously. Errors may result in misinterpretation of pancreatic disease, unopacified duodenal diverticulum, vascular structures, and extrahepatic bile duct abnormalities. Nineteen patients with mass lesions involving duodenum were studied retrospectively.

We present radiological images combined radiographs and CT scans of distinct tumoral and pseudotumoral processes of duodenal area such as duodenal primary adenocarcinoma, lymphoma, colonic metastasis, pancreatic, renal, and gallbladder neoplasms with duodenal invasion for contiguous spread. ampulomas. duodenal divertivula mimicking tumours and a rare case of duodenal neurofibroma in a patient with Von Recklinghausen's disease.

CT and barium studies analyzed separately can be misinterpreted. However, a correct correlation between both and clinical findings allows a diagnostic accuracy and avoid misleading.

Vldeofluoroscopy of disordered esophageal motor activity W. Schima (Presenter), G. Stacher, K. Uranitsch, P. Pokieser, D. Nekahm, D. Tscholakoff; Vienna

Purpose: Esophageal motor disorders are best evaluated by manometric studies. which. however are time-consuming and not generally available. We investigated if videol1uoroscopic studies of esophageal body and lower esophageal sphincter yield results comparable to those obtained manometrically. Methods and Materials: Videofluoroscopy (Sirecord recorder) was performed in a standardized fashion with up to three swallows in the prone oblique and one swallow in the upright position. 29 patients (7m, 221) with dysphagia (n = 15). globus sensation (n = 5), noncardiac chest pain (n = 4) or scleroderma without symptoms (n = 5) were referred to radiography and manometry, carried out 0 to 64 days apart (median = Id). Data were analysed independently and without knowledge of the results of the respective other examination. Results: In 2 pts. manometry was not possible. Manometry was normal in 7 and abnormal in 20 pts. (Achalasia. 7; nonspecific contraction abnormalities, 7; hypo-or amotility in smooth muscle esophagus, 6). Videonuoroscopy had a sensitivity of 80% (16120 pts.) and a specificity of 100% (717 pts.). Videofluoroscopy identified 4 of 7 patients with achalasia. 6 of 7 with nonspecific contraction abnormalities and all with hypo-or amotility in scleroderma. Conclusions: It is concluded that videonuoroscopy is a valuable. although not perfect tool to screen for disordered esophageal motor function. Results: In 22% of our normal small bowel studies, we found a granulanity of the mucosal surfaces. In 63% of the cases with mucosal lesions of the small bowel (Crohn's disease. NH lymphoma. Celiac disease. Whipple's disease, immunoglobuline deficiency, radiation injury. ischemic enteritis and miscellaneous lesions) we found several mucosal surface patterns: granulanity, recticular pattern, "areolar" pattern and nodular pattern. The pathologic correlation (biopsies and surgical resection) of these radiological features showed modifications of the villous mucosal surface. In the "areolar" pattern there was an inflammatory or tumoral infiltration with partial villous atrophy.

In the recticular pattern, we only found inflammatory processes, whereas in the nodular pattern, lymphoid infiltration and/or abnormal mucosal deposits were found. Conclusions: These modifications of the small bowel mucosal surface pattern should be considered along with the usual radiological features and should be helpful in pathologic differential diagnosis.

Ileal complications of sigmOid diverticulitis P. Gagne, G. Purpose: To assess whether 31 P MR spectroscopy following a fructose load has potential as a clinical test of hepatic function. Introduction. The administration of fructose induces changes in the con centratk-:< of the phosphorous metabolites in the human liver. which can be monitored by means of 31 P MR spectroscopy. This has raised the expectation that 31 P MR spectroscopy following a fructose load might eventually constitute the basis of a test of hepatic function. In this study, we have assessed whether a number of prerequisites to the clinical use of the fructose load 31 P MR examination are met. Methods: IH image-guided 31P MR spectroscopy was applied. Reproducibility was assessed by repeating the fructose load 31 P MR examination 5 times on one particular healthy individual, over a period of several months. Biological variability of the 31 P M R response was evaluated on a population of 10 healthy individuals. Clinical applicability was verified by examining 10 patients suffering from cirrhosis. The 31 P MR spectra were measured sequentially, every 2 minutes. The spectral parameters were determined by fitting the 31 P MR signals by means of a model function.

Results: The changes in the tissue pH and in the hepatic concentrations of fructose-I-phosphate, adenosine-triphosphate and inorganic phosphates could be monitored very accurately and reproducibly in the normal liver. The measurements performed on healthy individuals exhibit a characteristic normal response. Cirrhosis patients exhibit a response which is significantly different on the average from that ofthe healthy volunteers. The cirrhotic livers generate reduced phosphate signal intensity, rendering difficult the interpretation of individual patient examinations. Conclusions: The accuracy and the excellent reproducibility of the 31 P MR response observed with the normal liver suggest that 31P MR spectroscopy following a fructose load has potential as a clinical test of liver function with hepatic disorders which do not cause a marked reduction in phosphate signal intensity. 

A new technique is presented in order to improve the visualization of the choledocho by C.T. which is based on the knowledge of oral cholecystography. The study has been carried out on a group of 20 patients without a known hepatic pathology or digestive pathology. An oral cholecystographic contrast was administrated to all these patients. We carried out tomographic sections before and after giving them a preparation rich in proteins in order to visualize the contrasted choledocho. In some cases we have done oblique reconstructions above the choledocal section. Of the 20 patients without a known hepatic pathology or digestive pathology we got the opacification of the bladder from 14 of them and we got the opacification of the choledocho from 10 of them. Of the 10 patients with pancreatic pathology we got the opacification of the bladder from five of them and the opacification of the choledocho from four of them. With this non aggressive. economic and without side effects technique we can see the choledochal section by C.T. although the choledocho is not dilated. This technique is also applicable to mild jaundice and in those cases were there is pancreatic pathology. Methods and Materials: Ten patients (mean age, 28 years) with pathologically proved FL HCC were retrospectively studied. The patients were investigated by US (n = 10). coeliomesenteric angiography (n = 9), CT (n = 9) and MR (n = 3).

Results: The tumors were solitary (7/10), well delineated (7/10) and hypervascular (8/10 Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis characterized by yellow nodules in a thickened gallbladder wall. It is often associated with gallstones, which are believed to be significant aetiological factors.

We report four cases of XGC, in which ultrasound examinations permitted a pre-operatively diagnosis. In all patients the main presenting symptom was a right upper quadrant abdominal pain accompanied by fever, nausea and vomiting in three patients. Leukocytosis, hyperbilirubinemia and elevated alkaline phosphatase were found in two patients. Both oral cholecystogram and intravenous cholangiogram failed to image the gallbladder successfully. Ultrasonography revealed a distended gallbladder with thickened walls and irregular mucosal surface: within the gallbladder lumen a non-homogeneous content and gallstones were detected. These findings were similar in all the cases, suggesting an important role in the differential diagnosis with the cancer of the gallbladder. Infact the thickened wall was always well defined respect to the surrounding liver tissue: the mucosal surface was irregular in all the gallbladder and not limited to a little area: the gallbladder lumen was well detectable; all these findings are hardly revealed in the case of a cancer of gallbladder. In conclusion, XGC must be taken in consideration in the case of symptoms suggestive of a cancer of the gallbladder; ultrasonography may be an effective tool in differentiating the two diseases before surgical intervention, significantly affecting the prognosis.

Referrals to double contrast colon examination: a general practitIoner's view Siri Steine (Presenter); Oslo

It is generally recognized that the double contrast colon examination of the large bowel (DCE) is very useful in the detection of colorectal cancer and polyps. The majority of the performed DCE in Norway is initiated by general practioners. The aim of this study is to relate the occurrence of specific symptoms, anamnestic/biological data, and symptom duration, to the radiologic findings of neoplasms. 2414 consecutive patients, examined with DCE were evaluated radiographi-calIy. 1852 patients answered a questionnaire indicating symptoms, their duration and other anamnestic information. The prevalence of polyps was II % and of cancersuspect tumors 3% in this material.

In bivariate analysis the following was found: 1. Significant association between polyps and age, family history of cancer, earlier polyps, and rectal bleeding. 2. Significant association between colorectal cancer and age, sex, earlier colorectal cancer, rectal bleeding and weight loss. The further plan is to study the association in a multivariate setting, and to investigate which groups of factors are important for predicting the existence of colorectal neoplasms. This may become a tool for doctors when selecting patients for further investigation. The results will be available in time for the congress. The size of the cysts ranged form 0.8 em to 15 cm (mean 3.7 em). 62% were anechoic, 12% hypoechoic, 8% isoechoic and 2% showed mixed echogenicity. In 4% the content was invisible because of heavily calcified walls. The majority of large cysts (> 5 cm) were echogenic and smaII cysts anechoic. 20% had calcified walls. The mean diameter of calcified cysts was 6.2 cm and noncal-cified 3.0 cm. At follow-up the size of the cysts remained unchanged in 62%, market increase in the diameter was seen in 7% and a slight increase in 21 % (10% had been aspirated. There was a spontaneous appearance of a second cyst in 7% and a 1.8 em and a 1.5 em cyst disappeared. I n spite true cysts were very rare in the material, a history of trauma was available in only 2 patients.

Percutaneous drainage of pancreatic pseudocysts as an alternative of the surgical treatment J. Szmeja, K. Rzymski, A. Lemke, K. Linke, I. Szpakowska-Rzymska (Presenter), J. Rosinski; Poznan

Eighty-five patients with pancreatic pseudocyst were treated by percutaneous drainage in our Department between 1984-1990. All patients had Endoscopic Retrograde Cholangiopancreatography (ERCP) and abdominal ultrasonography to determine the size and place of the pseudocyst. Cyst biopsies with percutaneous drainage were taken in 80 cases (we use Cystofix Braun) and percutaneous cystogastrostomy were done in 5 cases (G U PC-S, 5-10-PEl. Single drainage procedure was the sole treatment in 65 cases, the other 20 patients needed two or maximum three times drainage. We conclude that percutaneous drainage is safe and simple offers good treatment of pancreatic pseudocyst.

Vassil Zefov, Atanass Talaganov (Presenter); Plovdiv

Presented are ultrasonographic findings in four cases with a pericholecystic abscess. Two cases are classified as having pericholecystic abscess in the gallbladder bed and the two other have abscess with intramural location. Demonstrated are some difficulties in the ultrasonic differential diagnosis within these two types. All four cases underwent surgical exploration. Finally comparision between classical X-Ray diagnosis (plain films, cholecystography), ultrasound and surgical findings regarding the management of the pericholecystic abscess is performed.

The On the basis of 50 examinations we report on the method and its capacity in the diagnostic of inflammatory small bowel diseases especially concerning Crohn's disease in relation to clinical and histological analysis.

Newly devised contrast media for double contrast barium enema, low density barium sulfate suspension with high adhesion

Purpose: To evaluate double contrast barium enema using newly devised low density contrast media with high adhesion. Methods and Materials: 400 ml of the contrast media comprising an aqueous suspension containing 30 w/v % of barium sulfate and 2.0 to 0.5 w/v % of gum tragacanth was used for double contrast barium enema of 25 men and 25 women aged 26-S0. Results: Even in the overlapping portion of intestinal tubes or pooling portion of barium sulfate, transmissivity optimal for observation of mucosal and peripheral image can be obtained, whereby minute lesions will never be overlooked.

Adhesion of contrast media can be effected simultaneously with passing through intestinal tube, and no postural change to great extent is required. By use of an amount of 400 ml, movement of contrast media to the proximal portion of colon is rendered possible. The inspection time is remarkably short. Due to little postural change. effective double contrast barium enema can be done for physically handicapped patients or aged people. Due to good water retentivity, the contrast media adhered will not be cracked for a long time. Conclusions: Our method using this contrast media was considered as simpler and better double contrast barium enema, especially for mass screening.

Imaging of ascariasis This video presentation (10 to 15 minutes) demonstrates the dynamic appearance of normal and pathologic deglutition examined with videofluoroscopy. Designed as a teaching tool it will cover anatomy, physiology and basic pathology of deglutition. Characteristic appearance of sphincter dyskinesia, early stage of Zenker's diverticulum and intradeglutitive aspiration are presented. Materials: We investigated patients with symptoms of dysphagia, globus sensation or aspiration with videofluoroscopy using a standardized examination protocol with nonionic iodine contrast medium, liquid barium and barium gelatine balls (13 mm). The oral and pharyngeal phases were examined in a.p. and lateral projections upright, the esophagus in upright RAO and prone oblique positions. Videofluoroscopy is documented using a Sirecord (Siemens) and a U-matic (Sony) video tape recorder. Results: During the oral phase the patient should be able to hold the bolus. Initiating the swallow the tongue propells the bolus backwards while the soft palate closes the nasopharynx. Hyoid and larynx move anterior and superior, giving way to the bolus while the totally inverting epiglottis as well as the true and false vocal chords protect the airways. The pharyngoesophageal segment should be relaxed as the bolus arrives and closes again after the entire bolus has passed without cutting the bolus tail. The esophagus should be generally cleared with a single peristaltic wave.

Primary hepatic abscess -percutan US diagnostics and therapy

Among 97 abdominal abscesses only some of them were evident in the postoperative period, most were unexpected -without characteristic anamnesis, clinical and laboratory symptoms. At 78 patients abscesses were verified by ultrasonic intervention, 64 of them had been cured by percutaneous punction, 52 resulted complete abscessfree recovery. 7 of S "primary" hepatic abscesses of unknown origin had neither characteristic symptoms, nor typical ultrasonic appearance, and the patients were in relatively good condition, observed at ambulatory or medical departments. The early diagnostic needle punction differentiated from malignant tumor, haem angioma or other cystic-solid lesion, resulted in purulent content for laboratory identification. The liquid content of the abscess had been evacuated and the procedures were repeated twice or several times. Single or repeated suction proved satisfactory in 5 cases, while catheter drainage was necessary for the other 3 cases. One of the above patient needed further surgical intervention, and after a few months two more needed different types of operation in much better condition. The early direct diagnostics and therapeutic procedures resulted recovery for all those 8 patients. The engagement of early detection plans based on U.S. andlor A.F.P. determination for H.C.C. has induced a progressive increase in the number of small tumors suitable for surgical treatment. However, surgical resection or liver transplantation can still be performed only in a reduced proportion of cases. This has prompted the development of other therapeutic modalities such as P. E.1.

The present study was aimed to assess to evaluate the efficacy and tolerance of P.E.I. in a series of 30 patients with H.C.C. smaller than 4 em, who have been followed at least 6 months after being treated. Five of the 30 patients did no complete the treatmenL The remaining 25 patients received between 6 and 18 sessions of ethanol injection. The follow-up after treatment range between 6 and 36 months. 13 patients have developed new intrahepatic tumoral nodules. The other 12 cases are still free of disease being regularly checked by US and CT. Thus a complete response to the treatment has been obtained in 48 % of the cases. Repeated P.E.I. was well tolerated and no major complications were observed.

A study of the contrast enhanced CT of the pancreas -the most available procedure for using high-speed CT Jun Watari (Presenter). Nobuhito Katayama, Vasuo Amano. Taro Ichikawa, Tatsuo Kumazaki. Toshiaki Yokokura. Kinichi Ebata; Tokyo

Purpose: To determine the best procedure of the incremental rapid sequential contrast enhanced CTofthe pancreas, a comparative study of various contrast patterns using high-speed CT was carried out. Methods and Materials: The incremental rapid sequential contrast enhanced CT of the pancreas was carried out in 70 patients with no pathological pancreatic lesion and time density measurement was done in each patient, using high-speed CT (TCT-900S). The density values following various injection rates (I mllsec 4ml/sec) of contrast medium (iohexol) from 300 mgl/ml to 350 mgl/ml and injection volume of 100 ml to 130 ml were compared.

Results: The density value of the pancreas was improved significantly with an increase of injection rates and of iodine contents, while no significant difference was noted in the density following the injection of the various volume of the medium. The present study suggested that rapid injection of 100 ml contrast medium with 350 mgl/ml was the most available procedure for incremental rapid sequential contrast enhanced CT of the pancreas. For the 18 catheterisations of the hepatic artery, distal hyperselective catheterisation of the proper hepatic artery in order to avoid Lipiodol embolism to the gastroduodenal, gastric or other anastomic arteries could be achieved using conventional diagnostic catheters (5 cases), or, if this was not possible, using an easy to use and non-expensive coaxial catheterisation system (13 cases). Radiological follow-up of the lesions was performed by means of a C.T.-scan, obtained 24 hours and 6 weeks after chemoembolisation. Further CT follow-up studies were performed depending on the clinical evolution. We report the computed tomographical evolution of 12 patients, which had a CT follow-up of at least 6 weeks. It appears that hypervascular hepatocellular carcinomas have a tendency to diminish in volume, especially those which retain Lipiodol after 6 weeks, and that the survival under IA chemotherapy is lesser in patients with hypovascular tumors that do not retain Lipiodol.

Application of metallic stents In benign strictures of bile ducts Eugenio Zanon (Presenter). Giovanni Gandini. Dorico Righi. Paolo Fonio; Torino

In the last 7 years we have treated 108 patients with benign strictures of bile ducts with percutaneous transhepatic bilioplasty (PTB), by means of Gruntzig balloon catheters. We obtained an overall success rate of 70%. after at least 18 months of follow-up: these results are similar to the surgical ones. In the last 15 months, in selected cases, we used auto-expandable (4 cases) or balloon expandable (9 cases) metallic stents after PTB. We obtained good results in 12 of 13 patients treated with metallic stents. Episodes of cholangitis and an increase of cholestasis indexes occurred in I patient with sclerosing cholangitis, 3 months after treatment.

The mean period of follow-up was 5 months. We believe that the use of metallic stents. in selected cases, should ulteriorly improve the results of biliary stricture dilatations.

Color Doppler In the detection of portosystemlc collaterals In portal hypertension P. S. Zouboulis (Presenter Purpose: We present our experience on U.S. guided renal biopsies on 42 patients. We consider the echography as the best technique to locate the kidney and to choose the place of punction, the two basic elements for a safe renal biopsy.

Methods and Materials: Prior to the punction we explore both kidneys and we choose the best place for puncture. In tbe vast majority of the cases this was the inferior pole of right kidney. We use a modified Menghini Surecut 15 and a set of punction adapted to a 3.5 MHz transducer. Purpose: Pelvic Inflammatory Disease (PID) is one of the most serious complication of the sexually transmitted diseases. Sonography contributes significantly to the diagnosis and treatment of PID. To assess the role of CT in evaluation of PID, a retrospective analysis of CT findings in 15 women with PID was correlated with pathological findings at surgery or laparoscopy. Methods: CT features were correlated with the different anatomo-pathologic stages of disease: I -initial salpingitis with edema and hyperemia; IIexsudative phase; 111 -tubo-ovarian abscess; IV -pelvic peritonitis. Results: In I phase CT demonstrated none abnormalities in adnexa; in some cases there were findings suspecting pyometra. In II phase adnexa appared wide and enlargement of salpinx was visualized. In 111 phase enlarged salpinx were never separated from adnexal mass; there was contrast enhancement ring; mass and uterine borders vanished and surrounding soft tissue became inhomogeneous. In IV phase fascial and peritoneal thickening, inhomogeneous and increased density of pelvic adipous tissue. extragenital structures involvement and inhomogeneous and poor-defined masses were described.

Conclusions: CT features of PID had good specificity in advanced stages especially when disease appeared as pseudoneoplastic clinical masses and in order to evaluate extragynaecological involvement in presurgical evaluation. Purpose: We reviewed our experience with 22 patients who had ureteral leaks to assess the role of percutaneous urine diverting procedures in their treatment. Methods and Materials: The location of the leak was ureteropelvic junction in 5 patients. proximal ureter in 3, distal ureter in II, and ureteroileal anastomosis in 3. In 20 patients the fistulas resulted from surgical injury. In all patients the fistulas were treated by percutaneous nephrostomy or ureteral stenting. Results: One patient died 2 weeks after treatment. Another patient was operated 3 days after treatment. In 10 of the remainder 20 patients, the ureteral fistula healed without development ofa stricture or further intervention during a follow-up from 6 months to 2 years. The results were more favorable in patients with underlying nonneoplastic disease (success in 8 of 13 cases) than in patients with underlying neoplastic disease (success in 2 of 7 cases). The ureteropelvic junction was the most favorable location of the leaks (success in 4 of 5 cases). In the patients treated by ureteral stenting the success rate was 77%, while in the patients treated by percutaneous nephrostomy this rate was 27%.

MAl and transurethral ultrasound In urinary bladder neoplasms staging P. We evaluated the role of urethral sonography as an alternative technique to conventional retrograde and or voiding urethrography in the diagnosis of penile and bulbar urethral stenosis. Methods and Materials: Sonography examination of the urethra was performed using a 7.5 MHz and 10 MHz transducer that is applied over the penis. The lumen of the urethra was well seen after the instillation of 6 cc of S270 sterile saline within the distal portion of the urethra. Results: Fourteen patients with ages ranging between 35 and 68 years underwent urethral sonography for suspected stenosis. Complete correlation between the results of urethral sonography and conventional urethrography was found among the 10 patients with stenosis in the penile urethra. Three of four (75%) of the bulbar stenosis were correctly diagnoses by urethral sonography. There were no complications related to the procedure.

The Purpose: To assess the value of ex vivo MRI in extracorporal conservative surgery of small renal carcinomas with autotransplantation. Methods and Materials: After an enlarged nephrectomy, 21 kidneys perfused with a cold sterile Collins solution were imaged. We performed TI and T2-weighted SE sequences and Gradient echo sequences (TR 300-400 ms, TE 30 ms, flip angle ISO) with a surface coil, using 5 mm slice thickness. MR findings were correlated to in vivo MRI and with macroscopic and histologic results. Results: Ex vivo MRI permitted the detection of 2 other small neoplastic lesions less than 5 mm in size and a small angiomyolipoma of 5 mm. The results demontrated also the value of T2-weighted images in the diagnosis of small renal tumors. Regarding the peripheral capsule, they showed a poor correlation between MR findings and histopathologic results. Conclusions: Ex vivo MRJ seems to be able to improve the effectiveness of extracorporal partial nephrectomy of small renal tumors avoiding uncomplete conservative surgery in case of another intrarenal neoplastic lesion. -20 patients were studied for morphological anomalies and 15 patients underwent a flow study (transplanted kidney in 5 cases). Results: -Repercussion of vascular disease on the parenchyma is reliably detectable better than on a conventional CT because of perfect opacification of the cortex: infarction and hypo perfusion (5 cases). -Anomalies of the renal arteries are easily recognized, illustrated by aneurysms, dysplasia. traumatic fistula (2 cases), or ostium lesions in aortic diseases.

-The flow program allows a dynamic visualisation of tumor vascularisation and parenchymal hypo perfusion. Quantification of the renal bood flow is expected with this technique. Results about 8 patients are presented. Conclusions: UFCT with perfect arterial bolus is a reliable technique for detection of vascular anomalies of the kidney, but more than with a conventional CT the method of injection has to be adapted to the presumed pathology to avoid pitfalls or false negatives.

Interpreting ultrasonic properties of normal ranal tissues In terms of microscopic anatomy Michael F. Insana (Presenter). Timothy J. Hall. Linda Harrison. Stanton J. Rosenthal. James l. Fishback. Samuel J. Dwyer III; Kansas City, KS Purpose: To explain the echographic appearance of normal renal tissues in terms of the acoustic properties and microscopic anatomy. Methods and Materials: Tissue characterization techniques and a low-resolution acoustic microscope « 15 M Hz) were used to measure speed of sound, attenuation and backscatter coefficients, and the average size and number density of scatterers for excised human and dog kidneys. Data were obtained between I and 15 MHz in the medullary and cortical regions as a function of the angle between the transducer beam axis and tissue structures. Parametric images of acoustic parameters were obtained using clinical instrumentation for comparison with B-mode images. Results: The attenuation and backscatter coefficient values exhibit a significant directional dependence, which is more pronounced at frequencies > 5 MHz. Both measurements increased when the transducer beam axis was oriented perpendicular to structures such as the medullary rays. Backscatter anisotrophy was highly correlated with scatterer number density; the scatterer size and speed of sound measurements were isotropic. The dominant scattering structures below 5 MHz are the renal corpuscles. Above 5 MHz, scattering from renal tubules and blood vessels dominate, as indicated by greater anisotrophy and scatterer size measurements. Several of these methods may be used in vivo to identify anatomical changes associated with pathology. To obtain objective and reproducible results of prostatic size and echo pattern, patients must undergo transrectal ultrasonography. The painless, noninvasive examination can be done in a short time (about 10 minutes) without special treatment of the patient, except for cleaning the rectum by giving an enema at least I hour before examination. It is advisable to use a real-time. biplane, 5 MHz transducer, which can be handled easily after being painless inserted into the cleaned rectum of the patient. During the last four years transrectal sonography was performed in 724 men, in each case the seminal vesicles and prostata were evaluated. The average age of examined men was about 71 years. In 73%(n = 528) of examined patients the volume of the prostate increased up to 80 cc. Benign prostatic hyperplasia yields a heterogeneous sonographic pattern. In the sonogram stroma tissue is of echo-poor appearance, while glandular tissue show a dense, lamellar echo pattern. The sonographic results were confirmed by biopsy and clinical investigations. In 15% prostatic cancer was detected. Transrectal sonography of the prostate, for revealing benign prostatic hyperplasia is the most valuable noninvasive examination.

CT evaluation of renal cell carcinoma In patients with acquired renal cystiC disease Atsushi Kohno (Presenter), Toshiroh Hayano, Mimi Harasawa, Chisato Kawai. Akiko Narimatsu, Akiko Shigeta, Hiroshi Tohma; Tokyo I. Purpose: It is well known that there is a high incidence of the occurrence of renal cell carcinoma (RCC) in patients with acquired renal cystic disease (ARCD) and it is considered to be difficult to diagnose RCC in ARCD by diagnostic imaging. No reports of the assessment of the diagnosis of RCC in ARCD by CT have been published. Accordingly, this study was undertaken to evaluate the capability of CT in the diagnosis of RCC in ARCD. 2. Methods and Materials: The subjects consisted of eight patients with pathologically proven RCC in addition to ARCD. Preoperatively, plain and contrast-enhanced CT was performed in all patients. Contrast enhancement was performed by the bolus injection technique. The CT findings were assessed retrospectively. 3. Results: The size of the RCCs ranged from 1.7 to 8 cm. Four tumors were solid and 4 were cytic. All tumors demonstrated contrast enhancement within the solid portion or the cyst wall, though the degree of enhancement tended to be less than that of tumors in normal kidneys. 4. Conclusions: We conclude that contrast enhancement is mandatory to detect RCC in patients with ARCD, and if a mass shows contrast enhancement the diagnosis of RCC should be considered.

CT versus lymphangiography In assessment of lymph nodal metastases In cervical uterine cancer Alfredo La Fianza (Presenter), Roberto Dore, Lorenzo Preda, Luciana Babilonti; Pavia Purpose: The presence of lymph-nodal metastases in patients affected with cervical uterine cancer is of the upmost clinical relevance. We have evaluated accuracy of CT and lymphangiography in nodal staging in a retrospective series of 95 patients. Methods: From January 1986 to April 198858 women were evaluated preoperatively by CT and lymphangiography (49 subsequently submitted to radical hysterectomy, the remainder underwent percutaneous fine needle biopsy). Other 37 patients previously treated were evaluated by CT for clinically suspected relapse. Results: In the first series accuracy was 91 %, sensitivity 88% and specificity 92.5% for lymphangiography; accuracy was 87.9%, sensitivity 72.2% and specificity 95% for CT. In the second group CT accuracy was 94%, sensitivity 100% and specificity 91 %. Conclusions: In early stages of the disease (I-II) lymphangiography gives better results than CT; in advanced stages and relapse CT gives high accuracy. This information is useful for avoiding unnecessary surgical exploration. We retain that CT plays a role in staging cervical cancer, recognizes lymph-nodal metastases in advanced stages and in treated patients, in early stages CT is complementary to lymphangiography and needs percutaneous biopsy.

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular treatment option in chronic renal failure, particularly in elderly patients. Abdominal hernias are well recognized complications of CAPD, with a prevalence of around 15% in several series. Most of these hernias are not clinically apparent prior to the commencement of CAPD, the increased intraabdominal pressure being an important contributory cause. We have recently encountered five patients on CAPD with inguinal hernias. Because of the considerable edema due to leakage of dialysis fluid associated with hernias, it is often diflicult or impossible to lateralize the side of the hernial sac, necessitating bilateral inguinal exploration. We describe a method of lateralizing the sides of origin of hernias by the simple procedure of adding technetium 99m-labelled DTPA to the dialysis fluid, and imaging over the groin area with the patient in the erect position. Representative images are demonstrated. Recently we have also demonstrated a leakage of dialysis fluid into the thorax causing recurrent effusion. Although this method has been previously described in the nephrology literature, it warrants wider recognition in view of the increasing number of patients undergoing CAPD.

The effects of transcatheteral ablations of tumorous kidneys with absolute Ethanol oarko Ljubisavljevie (Presenter), Siobodan Radojkovie, S. Lavrnie; Belgrade

We intend to show that tumorous kidney ablation with absolute ethanol is a very useful and safe procedure if performed by proper technique. We have been injecting absolute ethanol through the occlusive balloon catheter in the previously estimated amount in the last 7 years in more than 1000 patients. The procedure was performed either as a preoperative or a palliative (definite) one. We never had a single local or systemic complication. Peroperative blood loss after ablation was negligible, patients with distant metastases showed regression in number and dimensions of such metastases and their general condition significantly improved.

Retrograde and voiding urethral sonography: diagnostic evaluation of the anterior urethra Jose M. Llerena (Presenter), Vicente Garcia-Medina, Juan D. Berna,Janis G. Letourneau; Minneapolis, MN Purpose: To evaluate the role of retrograde and voiding urethral sonography as an alternative to conventional urethrography in the diagnostic evaluation of strictures within the anterior urethra. Methods and Materials: Retrograde urethral sonography was performed after the instillation of 6 cc. of sterile saline within the distal portion of the penile urethra, with the aid of a 7.5 MHz linear array transducer, that is applied over the penis. Voiding urethral sonography was also performed while the patient was voiding. In both instances the anechoic fluid within the urethral lumen gave us an excellent view of the penile and bulbar portions of the anterior urethra. Results: Fourteen patients with a mean age of 51.5 years (range: 35 to 68 years) underwent retrograde and voiding urethral sonography for ruling out suspected anterior urethral stenosis. All the patients had conventional retrograde and voiding urethrography after urethral sonography was performed. Among the ten patients with stenosis in the penile portion of the anterior urethra, there was complete correlation between the findings of retrograde and voiding urethral sonography and the results observed with conventional urethrography. Three of four (75%) of the bulbar stenosis were correctly diagnosed by urethral sonography. All the patients tolerated well urethral sonography with none complications. We conclude that urethral sonography is a technically easy, accurate, non expensive and safe procedure in the diagnostic evaluation of anterior urethral stenosis.

Different metallic Intraprostatlc endoprostheses

Metallic intra prostatic spirals of original construction as a functional urinary bladder-urethra stent we've performed in 170 patients with chronic urinary retention. We used iron spirals covered by silver, gold, chrome as well as simple ones made of elementary iron. By means of echotomography and CT we analysed reaction between urin, prostatic tissue and spiral material. We found out following: spirals covered by rare metals cause minimal irritable reaction and can be successful replacement for retentional catheter. Elementary iron spirals cause local aseptic necrotic reaction, fibrosis and scaring of prostatic urethra, which constitute physiological stent and spiral is supposed to be taken out due to new borne recanalisation enabled normal miction!

Lipomas of the spermatic cord A. Maroto (Presenter), J. Barcel6, X. Serres, J. C. Vilanova, I. L1ad6, F. Castaiier, J. Ferrer; Girona Purpose: Scrotal masses are common urologic problems and include a variety of benign nontesticular tumors such as lipomas, fibromas, dermoid cysts, lymphangiomas and others. We report four cases of lipomas of the spermatic cord presenting as scrotal masses. Methods and Materials: We performed ultrasound and computed tomography (CT) in all four patients. Their ages ranged from 32 to 69 years. In all cases the prime clinical consideration didn't include the diagnostic of a lipoma and ultrasound exploration was indicated to rule out testicular malignancy. Results: Sonography revealed in our patients large homogeneous, hyperechogenic paratesticular masses extending to the inguinal canal. CT confirmed the low absorption coefficient of the masses which represented fat. Ultrasound and CT findings may suggest the correct diagnosis of a lipoma in cases dealing with a problematic scrotal mass. Purpose: We present a brief introduction of the technique and advantage of trans rectal ultrasonography, as well a selected image of the anatomy and pathology of the prostate gland. We present the results and statistics of our experience. Methods and Materials: We have studied 300 patients with TRUS. Diagnoses were confirmed by biopsy, surgery or clinical follow-up. Results: Actually TRUS is the method of choice in prostatic pathology: Early diagnosis of malignancy, local staging, and follow-up treatment.

Translumlnal angloplasty of renal transplant arterial stenoses Umman Sanlidilek (Presenter). Sadik Bilgic;:, GOlden $ahin, Cemil Yagci, Meral Dogan, Neval Duman, BOlent Erbay, Uluhan Bark; Ankara Purpose: Percutaneous transluminal renal angioplasty has been used with success in the management of renovascular hypertension. The purpose of this study was to determine the role of renal angioplasty in the treatment of renal transplant arterial stenoses. Methods and Materials: Percutaneous transluminal renal angioplasty was performed in six renal transplant recipients aged 15-44 years. A contralateral femoral approach was selected in all patients. 4-5 F Balloon Angioplasty catheters (Schneider and Medi. tech.) 20 to 40 mm in length and 4 to 6 mm in diameter were used for dilatation. The patients were referred to angiography because of sudden onset of hypertension and/or signs of chronic rejection after renal transplantation. Significant renal artery stenosis (more than 50% of the original diameter) were determined on angiography. Transluminal angioplasty was attempted in the same session in three, and a week later in the remainder. Time for angioplasty was 2 to 24 months following transplantation. Results: Technical and early success were achieved in all patients. The stenotic segment was dilated up to 70 to 90% of original artery size. Restenosis occurred in one patient within three months and a second angioplasty was performed. No complications developed due to the procedure. Despite technical and early success, nephrectomy was performed in two patients with persisting chronic rejection signs and two patients underwent regular dialysis program for the same reasons developed in 2 to 6 months following the angioplasty. One patient remained symptomless for 10 months after the procedure. Transluminal renal angioplasty remains an alternative in the management of renal transplant arterial stenoses despite the relatively high late failure rates in this series. Results: All the procedures were successfully performed. CT ensured optimal choice of percutaneous access in every case, while fluoroscopy monitored all phases in real time; something no other imaging modality can do. The whole procedure was performed on the CT scanner table, operators' exposure to radiation was low. CTF increased the precision and speed of the maneuvers. Purpose: The purpose of this study was to assess the potential of M R imaging in the evaluation of bladder invasion of malignant pelvic tumor. Methods and Materials: Seventy-six patients, including rectal and sigmoid colon cancer (n = 22), uterine cancer (n = 25), malignant ovarian tumor (n = 28), and prostatic cancer (n = I) were studied. Imaging was performed at 0.5 T Toshiba unit using TI and T2 weighted spin echo sequences. Sagittal plane was obtained and coronal plane was added when necessary. Each image was studied as for intensity of the bladder wall, deformity of the bladder and existence of fat plane between the bladder and the tumor. Results: Bladder invasions were proved surgically in eighteen patients and MR imaging correctly identified 17 of these cases. These cases had deformity of the bladder and only I case showed abnormal intensity of the bladder wall. There were 8 false positive cases and these cases had relatively dilatated and thin wall bladder. Conclusions: MR imaging is a valuable tool in the diagnosis of the bladder invasion. And appropriate bladder distension is recommended.

A new, non-surgical treatment for recurring urethrel strictures: long-term temporary urethral stentlng by Urocoll® Daniel Yachta (Presenter), Mordechay Beyar; Hadera

Recurring urethral strictures are a great concern to us because their successful treatment is a challenge. Various dilatation techniques, internal urethrotomy or open urethroplasty techniques may partly resolve this disappointing problem. We are presenting a new, self-expanding and self-retaining stent made of medical grade stainless steel alloy (Urocoil<lll). This stent was used in 55 patients who had recurrent strictures of various etiologies (traumatic, inflammatory or iatrogenic) and varying lengths (0.5-8.0 cm) along the urethra, from the external sphincter to the urethral meatus. The stent was inserted, under topical anesthesy of the urethra in reduced caliber under fluoroscopy after an adequate dilatation was made either by balloon dilatation or internal urethrotomy. This stent when released from its introducer to reach its maximal caliber (26/32 F) by radial self-expansion. The stents were left in the urethra up to 14 months and they could be removed without surgery. Mean follow-up is 14 months (range 3-24 months). All patients voided well and were continent after insertion of the stent. Distal migration occurred in 5 patients and repositioning was performed under fluoroscopy. During the followup period of6-16 months (mean II months) after removal of the stent 88% of the patients remained free of recurrent stricture. In failed cases a new stent was inserted. No tissue ingrowth or stone formation was observed during the followup period in the stents. This temporary stent which can be easily inserted as well as easily removed anytime is a very promising tool for the non-surgical treatment of recurring urethral stricture.

A new, self-expanding and self-retaining large caliber intraprostatlc stent (ProstacolI®) in the treatment of prostatic obstruction Daniel Yachia (Presenter), Mordechay Beyar; Hadera Urethral catheterization is the mainstay in the treatment of complete prostatic obstruction until definitive treatment. Long-term catheterization is needed when patients are poor operative risk permanently or are recuperating after a cardiorespiratory or circulatory ailment waiting to become eligible for surgery. Despite the well known complications of long-term catheterization. the lack of an established non-surgical alternative for overcoming bladder outled obstructions leaves this manipulation as a widely used palliative treatment. Laterly intraprostatic stenting devices are entering our armamentarium as alternatives to indwelling catheterizations. Instead of the fixed caliber (20F) intraurethral stents and the self-expanding large caliber stents which become incorporated into the prostatic urethral lining within 4-6 months becoming permanent implants, a new, large caliber (26/32F), self-expanding and self-retaining, long-term but temporary intraprostatic stent (Prostacoil<ll» was developed. The insertion of this new metallic stent is performed under fluoroscopy. This stent was used successfully during the last 2 years in 35 patients who needed indwelling catheterization who were not fit for surgery. Insertion of the stent under topical anesthesia using 2 % Lidocaine jelly allowed 90% of the patients spontaneous voiding with good control of the external sphincter.

Perinephric and subcapsular renal hemorrhage: CT Imaging and therapeutic Implication D. Yaffe (Presenter), R. Zissin, V. Rathaus; Kfar Saba

The records of 6 patients with acute spontaneous perinephric or subcapsular hemorrhage were retrospectively reviewed for evaluation the value of computed tomography (CT) in its diagnosis and etiology. The initial CT study demonstrated the hemorrhage in all cases. An accurate diagnosis of the cause was established in 4 patients (two cases of perinephric liposarcoma one case of angiomyolipoma and a leaking abdominal aortic aneurism in the other) necessitated operation. No case of renal cell carcinoma. the most common cause, was found. I n the other two patients no distinct pathology was identified in the kidney or perirenal space, neither by CT nor by a subsequent angiography. These two patients were followed by CT for a period of up to three years showing resolution of the hemorrhage with no additional pathology. This conservative approach of serial, detailed CT examinations is recently recommended in the radiological literature, preventing unnecessitated nephrectomy. Hydatidic disease is a tissue infection caused by the larval stage of Echinococcus granulosus that produces cystic lesions involving the liver (75%), the lungs (25%) and occasionally other organs. The musculoskeletal system is affected in 1-2.4% of cases. We have retrospectively evaluated with MRI 4 patients with histologically proven musculoskeletal echinococciasis (3 patients with recidivism of vertebral echinococciasis and I patient with echinococciasis synovitis) and I patient with a soft tissue mass in the left thigh. MRI has been performed on a 1.5 T in 4 patients and on a 0.5 T in I patient. MRI ist not specific in hydatidic disease but has been useful in delineating the extension of the lesion for planning its surgical treatment in the 3 patients with vertebral echinococciasis and in the patient with a soft tissue mass in the thigh. In this last patient, the MR appearance of the image has been highly suggestive of hydatidic disease. MRI has not been useful in the echinococciasis synovitis. showing only a joint effusion.

Systemic sarcoidosis with skull Involvement A. Anguera (Presenter), X. Pruna, I. Segarra, A. Sanchez, V. Fabregas, X. Jori; Tarragona Bone lesions in sarcoidosis are uncommon, and often their appears in chronic stage. Characteristically lesions are osteolytic without evidence of marginal sclerosis or periostal reaction and skull involvement are the rarest manifestations. We report a case of skull sarcoidosis: a 54 year old woman was diagnosticated pulmonar sarcoidosis in 1989. In March 1990 she noted headache. lymph nodes in lateral cervical region and subcutaneous nodul in right front-parietal region. Skull radiographs and CT showed numerous erosive lesions of varying size in the calvarium and in jaw. A Ga and Tc99 scan showed numerous areas of increased uptake. The interest of this case is to present iconography about skull sarcoidosis and the resolution with steroid treatment. The prognosis of bone lesions has been changed in the last ten years. result to the new techniques for bone tumors management. The radiologist's role now is the characterization of bone lesions, founding the extension, aggressivity and histological type. We have been studying 120 solitary bone lesions. with X Ray plain film, CT and MR. The sensibility for to establish the limits were different. The index for MR are 95% while the CT are 55% and X Ray plain film 27%. In the determination of the aggressivity the differences were less. The index is around 92% in all techniques. The new techniques don't provide new semiological information. For finding the histological type the CTwas superior, with 36% of index, while the X Ray plain film are 22% and the MR 29%. In the characterization of bone lesions the X Ray plain film has an important mission. although the correct treatment needs also to know the real extension. The new techniques give us this information. Purpose: Cervical spine involvement is frequent in rheumatoid arthritis (R.A.), but it is difficult to appreciate joint lesions except with roetgenograms. It is known that Gadolinium DOTA (Gd-DOTA) IV administration is taken up by inflamed synovium and we report the study with MRI and Gd-DOTA of 12 patients with cervical spine arthritis in R.A. Methods: The 12 patients had clussical of definite RA according to the ACR criteria. examined at our center in the years 1989 and 1990. All patients had clinical symptoms of cervical spine involvement (pain, stiffness, medullary or other neurological compressions). Plain radiographs are always performed (normal findings, erosions, subluxation, diastasis of CI-C2. inflammatory spondylodiscitis). MRI is realized on 0,5 Tesla Magniscan with a cervical coil in all patients: TI weighted sequences before and after Gd-DOTA; T2 weighted sequences in sagittal and axial planes. Results: MRI with Gd-DOTA IV administration seems very helpful in cervical spine of RA and allows better findings than T2 weighted sequences. Lesions are always most important in comparison with standard X rays.

Magnetic resonance Imaging of bone marrow In the staging of malignant lymphomas: correlation with bone marrow biopsy J. Assoun (Presenter). C. Poey, M. Attal, P. Brousset, R. Aziza, P. Fajadet, P. Maquin, J. J. Railhac; Toulouse

Purpose: The evaluation of bone marrow status is usually obtained by bone marrow biopsy. However, small samples taken by iliac crest biopsies may not be representative of marrow elsewhere. MRI of the bone marrow has been shown to be a sensitive method for detecting a variety of marrow diseases and may be able to detect lymphomatous involvement. Methods: To correlate magnetic resonance imaging (MRI) with bone marrow histology, a prospective clinical study was performed in 43 patients with malignant lymphomas. 8 patients with Hodgkin's lymphoma and 35 patients with non Hodgkin's lymphoma. Images were obtained ofthe proximal femora, pelvic and vertebral marrow with a 0,5 tesla MR system using a T1-weighted spin echo sequence. MRI and unilateral iliac crest biopsies were performed before initiation of therapy. Results: In all except five cases, results of M RI and bone marrow histology were concordant in three patients with low grade non Hodgkin's lymphoma (NHL), bone marrow histology revealed malignant infiltration without MRI abnormalities. Two patients with high grade NHL had marrow lesions detected by MRI that were not detected on initial bone marrow biopsies.

Popliteal masses in hemodialysis patients: the role of diagnostic Imaging Popliteal masses have recently been described as a possible manifestation of dialysis-related amyloidosis (ORA). The aim of the present study was to evaluate the role of diagnostic imaging in detecting popliteal masses in hemodialysis patients. By means of ultrasonography (US), popliteal cysts have been demonstrated in 12 (bilateral in 9) out of 37 patients (32.4%) dialyzed for more than 60 months (range 60-225, mean 122 ± 48). In the 3 patients who were investigated by CT, cysts could be demonstrated to communicate with the joint cavity (Baker's cysts). In I case, immunocytochemical analysis showed diffuse 112Microglobulin-amyloid deposition within the synovial wall of the surgically removed cyst. The 8 patients with largest cysts (medium size> 20 mm) suffered some of the major features of ORA: carpal tunnel syndrome (7 cases), destructive arthropathy (5 cases), shoulder and carpal cystic radiolucencies (6 and 5 cases). In I patient, in association to Baker's cyst, MR showed two small extraarticular, subcutaneous masses (probably amyloid-tumors). These findings document the high prevalence of popliteal masses among chronic hemodialysis patients, often associated to ORA; the importance of US to detect popliteal masses must be stressed. Many long-time (> 60 months) hemodialysis patients develop a severe osteoarticular disease, termed "dialysis arthropathy", which is characterized by the deposition in bone and synovia of a new type of amyloid composed predominantly ofj32-microglobulin. In the present study, 45 patients (25 males, 20 females; age 56.7 ± 12.6 years), undergoing chronic hemodialysis for 60-225 months (mean 115 ± 49), were screened for dialysis arthropathy by means of clinical examination and radiological investigations (standard radiography and computed tomography). Twenty·four patients (53.3%) had radiographic evidence of dialysis arthropathy: geodes (shoulder 18 cases; wrist, 18; hips, 6; and knees, 2) and/or destructive arthropathies (cervical spine, 15 cases; dorsolumbar spine, 2; hands, 2; and hips, I). Within 24 months, these lesions were found to progress slowly in the majority of cases. Patients with dialysis arthropathy had been maintained on hemodialysis for longer periods of time than these without it (p < 0.001), and showed a significantly higher incidence of both carpal tunnel syndrome (p < 0.0005) and shoulder pain (p < 0.01).

Our findings confirm the high prevalence and clinical importance of dialysis arthropathy in long-term hemodialysis patients and the usefulness of diagnostic imaging in screening such patients for these lesions.

Evaluation of "Impingement point" using MRI In tha degenerative painful shoulder A. Barile (Presenter), C. Masclocchi, E. Fascetti, R. Passariello; L'Aquila

The purpose of this study is to illustrate our preliminary experience with MRI in the evaluation of "impingement point" in the degenerative painful shoulder. From January '88 to December '90, I 00 patients (with clinical findings of rotator cuff abnormalities) selected by 850 cases of shoulder MRI examinations, were considered. MRI was performed with a 0.5 T superconductive (Esatom MR 5000) and with a 0.2 permanent (Esatom PM 4000) system. In all cases a "dedicated" surface coil was used. Transverse, sagittal and coronal oblique TI and T2-weighted images first using spin-echo and gradient-echo sequences were used. All scans were considered of diagnostic quality. MRI showed in 9 patients impingement syndrome due to isolated subacromial bursitis (type I), type lIa (tendinitis) in 55 patients, type lib (small or partial rotator cuff tear) in 12 patients and type III changes (complete rupture of the rotator cuff) in 24 cases. In conclusion the results of this experience demonstrate that MRI has considerable potential in the evaluation of patients with shoulder pain.

Atlas of serendipitous findings of soft-tissue abnormalities discovered on bone SCintigraphy Kirkman G. Baxter (Presenter), David F. Preston, Ralph G. Robinson, Mark D. Murphey; Kansas City, KS Purpose: A wide variety of soft-tissue diseases and conditions may be demonstrated serendipitously on Tc·99m phosphate bone scans. The appreciation of these extnlOsseous soft-tissue accumulations of phosphate often adds to the diagnostic quality of the bone scan and improves its clinical utility. Methods and Materials: This exhibit will present a wide spectrum of abnormal studies with extraskeletal phosphate deposits in both benign and malignant conditions. Abnormal soft tissue findings will be demonstrated for nearly every major abdominal organ. Radiographic and pathologic correlations will be presented to accompany the scintigraphic findings. The subtlety and importance of these findings will be demonstrated through a series of case presentations. Results: The exhibit demonstrates the importance of soft-tissue abnormalities on the routine bone scan and directs the attention of the physician to these important findings,

Ultrasonographic examination of muscle hematomas in hemophiliacs I. Castells Ferrer (Presenter), R. Dominguez Oronoz, L. Casas Gomila,

Spontaneous hemorrhage into soft tissues is not rare in patients with hemophilia. Ultrasonographic examination is of great value in diagnosis of intramuscular and subcutaneous bleeding. Although such bleeding may be clinically apparent, the exact location is difficult to establish, The muscle bleeding may be interstitial, with increased size of muscle and dislocated intramuscular fasciculi, or a localized lesion, anechoic or complex with regions of hyperechoic structures indicating blood clot formation. Sonography was performed on 21 hemophilic patients with suspected intramuscular bleeding, within 24-48 hours after the onset of the symptoms. Commercially available real time sonographic equipment was used with 5·MHz linear array transducer. In 18 of the 21 patients studied, sonography confirmed the presence of 24 hematomas. 19 hematomas were intramuscular, 10 interstitial and in the other 9 the muscle bleeding was a localized lesion. 4 were insubcutaneous tissue and the other one was a hemophilic pseudotumor of the pelvis. were diagnosed in the General Hospital of Vic. Of these cases, 4 began their symptomatology before the patients were 40 years old. A radiologic study was performed on the families of these 4 patients. This study consisted of, at least, x-ray films on the knees, pelvis, wrists and hands which showed that some others members of each family were also affected. Radiological pattern of disease was heterogeneous, with a poliarticular involvement and destructive arthropathy in one family, oligoarticular involvement in two families and the coexistence of the two forms in the other family. 3. Classically. the HACC has been considered more infrequent than the ACC of idiopathic type or the ACC related to metabolic illnesses. The description of these 4 families is the first one of the HACC type in Catalonia and it brings the following considerations: a) that early onset of the ACC symptomatology is suggestive of the hereditary type (HACC). b) The different expressivity of HACC among members of the same family.

Examination of cruclate ligaments of the knee by ultrasonography and computer tomography Z. Cs6kasi (Presenter). I. Bali; Szeged

The cruciate ligaments have an important role in the statics of knee. However the injury of cruciate ligaments is frequent and the operation can be favourable. The early diagnosis enhance the chance of recovery. The ligaments can be represent by UH and CT. The authors examined 48 patients with suspicion of rupture of cruciate ligament. The examination were performed by Acuson 128 with 5 MHz linear transducer and Somatom ORG machine. During both examinations they tried to represent the anatomical structures as well as direct and indirect signs of rupture. According to their experiences the normal situation can be represented well. In many cases during US examinations indirect signs only refer to rupture. The authors have found that the locality and the degree of rupture can be determined by CT. The US can be used to exclude the rupture, however the CT examination is necessary for a precise valuation. In the posttherapeutic care of tumor patients with bone metastases. the use of MRI would be increase in future. if clinical status differs from conventional radiographs and/or bone scintigraphy in evaluating the metastatic extension or complications (e.g. compression of the spinal cord of non-bony metastatic specimen). Because of the spine can be cleared up sufficiently by all of these diagnostic procedures, we have performed bone scintigraphy and MRI of about 40 tumor patients to compare these three imaging modalities.

Radlonucllde assessment of the rasults from correction of blood supply of the femur head E. Baltoy, M. Dontchey (Presenter); Pleyen Authors are estimating the vitality of the bone transplant using noninvasive methods of nuclear medicine. 52 patients were followed by Tc 99mC scintigraphy. The operations were performed according to the methods of: Vanable and Stuck (46 patients), Ficat (2 patients). Pho (2 patients) and authors' own method (2 patients). The results were evaluated by comparison of the level of fixation of Tc 99m (" in the area of operated and nonoperated side and also the donor area in some suitable patients. The possibilities of the methods used are argued.

Radlonucllde and sonography control of the small joint prostheses success M.Dontchey (Presenter), D. Vassilev, E. Baltoy, H. Todoroy; Pleven Tc 99mC scintigraphy and ultrasonography were used for the success assessment of small joints endoprostheses. 42 endoprostheses were placed in the same number of patients. They were followed by scintigraphy and sonography. The patients were operated on due to RA. TBC, aseptic necrosis and traumas. As it is well known in these patients sometimes the placement of small joint prostheses is nessessary. These endoprostheses are mainly under torsion pressures which could lead to the prostheses loosening. The authors will give their conclusions about the advantages and disadvantages of both control methods used.

Ultra low field MRI (0.064 T) of the knee and arthroscopy: a double blinded study In 50 patients Massimiliano D'Erme (Presenter), Michele Rossi, Massimo Ventura, Piero Maceroni, Marco Pasqua Ii Lasagni; Latina Purpose: To prove the possibility of ultra low field MRI (ULFMRI) to perform diagnostic exams of the knee in comparison with arthroscopy. Methods and Materials: From June 1989 to February 1991 more than 150 exams of the knee have been performed with a 0.064 T unit (TOSHIBA ACCESS), having obtained with 3D partial flip angle (3dPF) sequences excellent results in term of quality of imaging and diagnostic capability. To prove these impressions we have decided to perform a double blinded prospective study based on 50 consecutive patients examinated both with MRI and arthroscopy. With MRI we are using the following imaging parameters: -Coronal 3dPF (TR 68ms, Te 24ms. FA45. 16 4.S mm slices in 4'25") -Sagittal 3dPF (TR 68ms. TE 24ms. FA4S. 32 3.5 mm slices in 9') -Sagittal 3dPF (TR 1I0ms, TE 40ms. FAI2, 32 3.S mm slices in II'). If need. for a better evaluation of the anterior cruciate (LCA), a transaxial 2.2 mm 3dPF or a Sagittal 5 mm SE is used. The day after the MRI examination. an arthroscopy is performed. Results: The early findings (IS/50 patients) from ULFMRI and arthroscopy agree in 93% of the time on meniscal tears, in 75%on LCA lesions and 87%on grade III and I V chondritis. Conclusions: These preliminary results seem to confirm the possibility of ULFMRI to be used in the study of the knee, being able to perform diagnostic study in short time, at low price and with results comparable to what obtained at higher field strength.

The Significance of the streakes of Harris In the lower limbs fractures: resulting from a study on 53 cases G. Ferrozzi (Presenter), F. Ferrozzi, F. Draghi. A. Morandi: Piacenza Metabolic deficiency of various kinds, acute or chronic deseases and physical stress especially due to fractures may give rise to the formation, in the metaphysis. of same transverse thickening lines known as "Harris's streakes". The Authors have selected 53 cases concerning lower limbs fractures in young people. These cases were accompanied by X-Ray photograph of the injured segment at a significant space of time from trauma. The importance of the discovery of these thickening lines. which appear in a high percentage of cases, is being discussed also according to a medico-legal point of view, as these streakes clearly show the time in which the fracture occurred and consequently the cause of an eventual hypermeter of the injured limb. Purpose: Femoropatellar wear due to malt racking is one of the most frequent causes of pain. unrelated to trauma. in the knees of sportsmen. In patients with this pathology. conventional axial radiology has traditionally proved to be negative. Thus we were prompted to make use of CT in order to evaluate the imbalance in extension. at a few degrees or flexion. Methods and Materials: 22 athletes. 17 females. in the last 4 years. Standard radiological projections. axial projection at 30· with external rotation of the tibia. and a CT scan at 20·, ., and O· nexion both with and without contraction of the cuadriceps, were taken in all the patients. The orthopaedic treatment failed in 22 cases, therefore they had to undergo surgery. Postoperatory CT control was carried out after 3 months. Results: The utility of CT in the athletes studied here. is above all useful for realignement or correction obtained by the treatment applied rather than a strict method of diagnosis.

Tuberculous dactylitis M. Gil (Presenter), E. Andia, A. Sanchez, V. Fabregas, F. Jori; Barcelona Tuberculous dactylitis is a rare musculoskeletal infection that mainly affects children. The radiologic features are soft tissue swelling, periostitis with bone expansion and cortical destruction, diffuse uniform infiltration and localized osteitis. A positive chest radiograph for tuberculosis is more common in children than in adults. We report a case of a 24 year old woman who had been treated of pulmonar tuberculosis several years ago. She was admitted at our hospital and diagnosticated of miliary tuberculosis. Physical examination revealed circumscribed swelling over the palm of the right hand discharging purulent material. Roentgenograms showed localized osteitis of the distal phalanx of the third and fourth finger of the right hand. Chest radiograph was positive for tuberculosis. Cultures from the draining material of the hand and from bronchial secretions grew Mycobacterium Tuberculosis. The patient underwent a combined medical and surgical treatment and had a good evolution. Purpose: The purpose of the study is to evaluate the performance of ultrasound in the evaluation of suspected subcutaneous lipoma. Methods: 21 patients were prospectively evaluated with an Acuson 128 computed tomography unit equipped with a 5 M Hz transducer. The following parameters were studied: the size, the margins, the echogenicity towards the surrounding fatty tissue and the presence of distal sound enhancement or acoustic shadowing. MRI was performed in 4 patients with large masses with ill-defined margins. Surgery and pathological examination were performed in all patients. Results: The histological diagnosis included I epidermoid cyst, I liposarcoma and 19 benign lipomas. The patients have been classified in 3 different groups on the basis of sonographic features. The first group includes the 4 patients who underwent MRI: at ultrasound, all had large heterogeneous tumor with posterior acoustic shadowing or ill-defined margins. MRI demonstrated typical lipoma in 3 cases as proven by the pathological examination. The last case did not exhibit a lipoma pattern on MRI and corresponded to the liposarcoma. The second group included 3 patients wiht hyperechoic small subcutaneous tumors. All were confirmed to be lipomas. The last group included 14 patients with hypoechoic heterogeneous well-defined masses. 6 masses had distal acoustic enhancement, 5 were proven lipomas and one an epidermoid cyst that was indistinguishable from the other masses on the basis of sonographic criteria. The other 8 masses exhibited no acoustic enhancement and were all proven to be lipomas. Conclusions: Ultrasound is a useful method in the evaluation of small subcutaneous lipomas. For large masses, especially when the margins are ill-defined, ultrasound cannot make the differential diagnosis with other soft tissue tumors and MRI may be helpful. An avulsion fracture is a failure of bone resulting from the application of tensile force through a musculoskeletal unit or a ligament the weakness is commonly a reflection of the young unfused apophysis or a weak osteopenic bone of any cause. The panel attempt to study the different radiographic manifestations of these injuries helps the physician to arrive at an accurate diagnosis and leads to prompt and appropriate treatment for the patient. Understanding the mechanisms of injury knowledge of the specific tendons or ligaments involved. To show the many normal variants, commonly presents in the ossification center, same localizations this type of fractures, waking easy the differential diagnosis. Methods and Materials: We review all the avulsion diagnosed in 150.000 traumatic injuries attended in our Hospital between March 1983 and June 1990. We show a broad spectrum of avulsion fractures of the skeletal system. Some of then very incommon showing in some cases the radiological outcome and the normal variants that can lead to diagnostic errors. Our purpose was to describe a cystic form of rheumatoid arthritis (RA). Methods: Patients were selected with peri-articular intraosseous cysts, without erosions, at their radiographs. The radiographs and medical histories were reviewed. Results: We found a cystic form of RA in 9% of 220 consecutive patients with RA. The mean follow-up time was 10 (1-39) years. The cysts were distributed symmetrically, often located at the proximal side of the joints and predominantly found around the PIP, MCP, and wrist joints of the hands, and the IP-I and MTP joints of the feel. CT showed a peripheral intraosseous cyst localisation. MRI showed that the cysts may contain fluid, inflamed synovia, or both. Radiological and clinical progression, during the course of the cystic RA, was far less compared to classic RA. Conclusions: -Cysts can be an important diagnostic feature, and a supplement to the ARA-criteria, in the diagnosis of RA.

-Patients with cystic RA may have a relative benign course of their disease. In this exhibit radiographs, radionuclide bone-scans, CT and MRI images will illustrate the presentation and course of cystic RA. Lateral radiography during traction-compression provocation has recently been reported as an accurate method of radiographic diagnosis of segmental instability of the lumbar spine, especially in patients with spondylolisthesis and -lysis. The purpose of this study was to compare traction-compression (I.c.) method with flexion-extension (f.e.) method for detection of segmental instability. Methods and Materials: F.e. and t.c. radiographs of 306 patients with clinically suspected lumbar spinal instability were analysed. The mean age of the patients was 43 years. In f.e. and I.c. films 4 mm or more forward/backward displacement and in f.e. films also excessive angular motion or signs of axial rotation of individual motion segments revealed instability. The chi-square test and statistic kappa were used as statistic method. Results: Up to 92 % (87/94) of the instability findings could be seen only on f.e. films, while 3% (3/94) of the instability cases could be diagnosed only on the I.e. films. In 4% (4/94) of the instability cases, signs of instability could be seen with both methods. For diagnosis of inst<lbility f.e. and I.c. tilms were not significantly interrelated, intertechnique agreement by statistic kappa remained fair. The usefulness of t.c. films in diagnosis of lumbar spinal instability is evidently very limited.

Dual-energy X-ray absorptlometry (DXA): extended clinical applications Franz Kainberger (Presenter). G. Seidl, P. Hubsch, A. Sterk, S. Trattnig.

Purpose: To illustrate the broadened spectrum of clinical applications of modern dual-energy projection methods (OXA). Methods: Using body scanners with a X-ray source (Hologic QOR-lOOOTM, Norland-XR 26) bone mineral density (BMO) and content (BMC) were measured in 346 adult patients: 277 patients with disturbance in calcium metabolism (primary hyperparathyroidism, renal osteodystrophy) or with diabetes mellitus, 29 patients with localized abnormality of calcium content (metastasis, Sudeck's atrophy, or after implantation of hip prosthesis), and 40 patients having performed ahnormal physical exercise (immobilization, sporting activities). Correlation was done between measurements before and after treatment and lor final clinical outcome. Results: OXA, although providing integral measurements, is suitable to quantify calcium content with high spatial resolution and low radiation exposure. In renal osteodystrophy, B M 0 values improved significantly after renal transplantation (total body-BMC from 2501 ± 437 g to 2582 ± 411 g, P = 0,105 within 3-8 months). Peri prosthetic BMO measurements are not influenced by metallic artifacts. Significant changes could be documented in handball players or after physical therapy (lumbar BMO from 0.838 ± 211 g/cm to 0.908 ± 345 g/cm).

Conclusions: OXA is a useful adjunct in grading not only osteoporosis but also various generalized and localized abnormalities of calcium content of the bone. Purpose: To study the influence of a cyclically changing stress on lumbar spine stability. Methods: Seven isolated lumbar vertebrae and 17 motion segments consisting of two adjacent lumbar vertebrae connected by their intervertebral disc were subjected to various modes of compression in vitro, thus simulating a narrow spectrum of everyday stresses on the lumbar spine. Magnification radiography and bone densitometry were done before and after testing. Preparations were halved sagitally and examined histologically for morphology of possibly present fractures. Stress testing consisted of I kN preload for I hour with a first cycle of 80 ms, I kN impulses and then a second cycle of 80 ms, 2 kN impulses superimposed. Dynamic stiffness was determined by sinusoidal 0.5 kN impulses at 12.5 Hz superimposed on a I kN preload. Results: The static deformation of an isolated vertebra after the first cycle was 70% of that experienced by a motion segment, after the second cycle there was no significant difference. Dynamic deformation of an isolated vertebra was only 45 % compared to a motion segment. Half of the preparations (417, 10/17) showed microfractures in their bony end plate. Conclusions: I. Static measurements do not sufficiently demonstrate the amount of deformity of a motion segment. 2. In a motion segment the disc is responsible to 55% for the elastic behaviour. 3. Elasticity loss of the disc results in a higher risk for vertebral microfractures.

Rheumatoid arthritis of the hand and wrist: unenhanced versus Gadopentetata-Dlmeglumine enhanced MR Imaging Philipp Lang (Presenter), Michael Stevens, Kenneth Sack, Sharmila Majumdar, Martin Vahlensieck, Ulrich Speck, Harry K. Genant; San Francisco, CA Purpose: Conventional radiography is limited in delineating inflammatory soft-tissue changes in rheumatoid arthritis (RA). We evaluated the use of unenhanced and gadopentetate-dimeglumine (Gd-DTPA) enhanced MR imaging in 15 RA patients with wrist involvement. Methods: AP-, lateral, and oblique radiographs of the wrist were obtained in all patients. MR imaging was performed before and after i.v. administration of 0.1 mmollkg body weight Gd-DTPA (Magnevist"', Schering, Berlin) (Precontrast: spinecho, TR = 600 msec, TE = 20 msec, T2-WI: gradient-echo, TR = 500msec, TE = 15 msec, 9 -30°; postcontrast: spinecho, TR = 600 msec, TE = 20msec). Results: MR imaging demonstrated twice as many erosions in the carpal and metacarpal bones than conventional radiography. In contrast to conventional radiography, MR imaging efforded direct delineation of inflammatory soft-tissue changes. In 4 patients, granulation tissue was demonstrated that infiltrated the sheath of the flexor tendons. Radiocarpal subluxation due to destruction of the radio-scaphoid-Iunate ligament was observed in 3 patients. In these patients, M R imaging demonstrated an erosion in the distal radius that was filled with markedly enhancing granulation tissue which extended 1-3 cm from the articular surface into the marrow. The erosive granulation tissue was thought to have caused the ligamentous destruction initially. Conclusions: MR imaging is unique in assessing inflammatory soft-tissue changes related to RA and may be used to recognize and prevent potential complications of RA such as tendon rupture or radiocarpal subluxation. Results: Radiological findings consisted of round and oval spots of increased density situated in the metaphyseal and epiphyseal areas of the shoulders and pelvis. The CT showed round and oval dense and homogeneous lesions grouped particularly in the femoral neck along lines of stress. Moreover lesions in the pelvis not seen on the X-ray were identified. The MRI showed the lesions as oval areas of low signal intensity on TI and T2 weighted images. Conclusions: The distribution of the lesions, the associated skin lesions, the radiographic appearances and those of the CT and MRI typical of multiple bone islands ruled out the diagnosis of metastasis and osseous dysplasias.

Stress .ractures o. the sacrum C. Le Breton (Presenter), K. TIjani, C. Wallays. J. M. Faintuch, P. Rolloy, J. M. Bigot: Paris AIM: To examine the appearance of stress fractures of the sacrum by CT scan. Methods: 7 cases of stress fractures reviewed retrospectively. Results: Two appearances were seen: interruption of the cortical bone of the lateral parts of the sacrum with discrete overriding of fragments, and linear areas of sclerosis either with or without clear images inside corresponding to the fracture. The diagnostic in 3 cases had been suspected clinically and on bone scan but never visualised on plain films. Conclusions: CT scan is the sole method to date capable of showing sacral fractures. This ability is however dependant on technique, requiring a detailed examination centred on the sacrum. Methods: The knee was involved in 2 cases and the elbow in one. TI and T2 weighted images were obtained at 1,5 Tesla with intravenous Gadolinium GTPA in I case. Results: The diagnosis was indicated in the 3 cases because of intra-and extraarticular soft-tissue masses containing low signal intensity masses at TI and T2 weighted images. The subchondral lytic lesions showed a low signal intensity TI and high signal intensity T2. The diagnosis was confirmed histologically in all cases. Surgery consisted of synovectomy in 2 cases and knee arthroplasty in I case. The low signal images in the sequences were explained by the presence of haemosiderin. Conclusions: MRI is a useful and atraumatic technique both for diagnosis and management of these lesions.

Epiphyseal chondroblastoma is a rare benign tumor affecting young people. In 17 to 25% of cases it is associated to aneurysmal bone cyst (ABC), and is called "cystic chondroblastoma". The cystic aneurysmatic component modifies the imaging aspects. I ntra-tumoral mottled calcifications are absent, but is not a specific finding because these calcifications are inconstant. CT scans and T2 weighted MRI images can evoke a cystic chondroblastoma when fluid-fluid levels are identified. The fluid levels are due to cystic component and setting of red blood cells within the cavities. They have been reported to occur in ABC, but are not a specific finding. They can also be observed 

Radiological findings In scoliosis due to lower extremity dysmetria Augusto Manganiello (Presenter), Francesco Pierazzoli, Andrea Sampieri; Padova Following 8.000 radiological investigations of the spine and the pelvis carried out in standing position, the authors report that even slight lower extremity dysmetriae can cause different lateral deviations each one with its own, mainly asymmetrical, weight distribution at the lumbosacral level. Asymmetrical weight distribution plays a very important role in the development of scoliosis because. acting on relatively fixed anatomical structures (discs, sacrum and developing vertebrae), causes asymmetrical narrowing of the disc space between L4-LS and LS-S I, asymmetrical lowering of the sacrum and axial asymmetry of L4 and L5. Such alterations, modifying the orientation of the resting surface of the sacrum and basal vertebrae, may cause spine deviations on the frontal plane. If it has been established between scoliotic deviation due to dysmetria and the lateral deviation due to asymmetrical weight distribution an acting synergism or a functional compensation, there will be respectively a progress or a reduction of the curve. Lasting the dysmetria, curves, initially mobile (para morphism), may increase and later be fixed (dysmorphism). Percutaneous needle biopsy of bone has become an alternative to the open biopsy for the diagnosis of bone lesions. It is a safe and quick procedure with satisfactory results. The mayor indication for this technique is suspected metastatic disease. Percutaneous needle biopsy can also be performed in almost any bone lesion (inflammatory or infectious disease, tumors or pseudotumors). We use two kinds of needles: aspiration type needles (18 to 22-gauge) which are more useful in biopsy of soft tissue areas of the lesion and in lytic lesions. The second type are trephine needles (12 to I 7-gauge) which can cut the bone itself. To the date, we have performed 37 C.T. guided percutaneous needle biopsies (metastatic disease (16), osteomyelitis, arthritis, hydatid cyst disease, chondrosarcoma, giant cell tumor, myeloma, histiocytosis X, Ewing sarcoma and lymphoma). In this exhibit we show the different techniques for percutaneous needle biopsy of bone in the different lesions and the results that we have had in our Service. Purpose: This work tries to contribute to the consolidation of the recently obtained role of the US in the evaluation of the Musculoskeletal System pathology. With this purpose we describe the sonographic semiology of the inflammatory, traumatologic and tumoral pathology of the Musculoskeletal System. Methods and Materials: We present selected images performed with real-time scanners using 5 MHz sector, 7'5 and 10 MHz trapezoidal and 7'Slinear transducers. We mainly study pathology of the periarticular structures of the shoulder, knee and ankle. We also include some descriptions of lesions such as tumors, injuries, inflammations and surgical sequels involving the muscles, tendons, subcutaneous tissue and bone which were examined in different anatomical regions. Results: We think that Sonography demonstrates that it can be a reliable tool for the diagnosis and evolutive evaluation of the Musculoskeletal System pathology. Besides, the advantages of its inocuity and easy availability can make of this technique the first diagnostic examination to consider in certain cases. has been used to exclude erosive osteoarthritis in distinction from psoriatic arthritis. However, previous studies have not controlled observer bias. The purpose of this study was to determine the incidence of bare area and subchondral erosions in the hands of patients with psoriatic arthritis and erosive osteoarthritis with control of observer bias. Methods and Materials: We performed a double blind retrospective study separately evaluating 690 interphalangeal and metacarpophalangeal joints in 23 patients with psoriatic arthritis or erosive osteoarthritis. Classic definitions of bare area and subchondral erosions were used. An additional category of combined erosions was developed to reduce ambiguity. Results: This exhibit demonstrates that bare area erosions constitute 12 percent of erosions in erosive osteoarthritis and were identified in all patients. Subchondral erosions were seen in both disorders but were more numerous in erosive osteoarthritis. We conclude that bare area erosions are frequent in erosive osteoarthritis. The ability to distinguish psoriatic arthritis from erosive osteoarthritis lies in the relative predominance of erosion location.

Radiologic assessment of bone grafting Mark D. Murphey (Presenter), James L. Quale, David J. Sartoris. John M. Bramble; Kansas City, KS Purpose: Bone is the second most frequently transplanted tissue with more than 200.000 procedures annually in the United States. Bone grafting thus constitutes a vital tool in the management of many orthopedic abnormalities. Radiologic evaluation of bone graft has unfortunately received only limited attention. This exhibit illustrates the radiographic appearances of the various types of bone graft both normal and abnormal. Methods and materials: This exhibit demonstrates the normal appearance of many types of osseous implants including autograft. allograft, osteochondral graft, and bone substitutes. Abnormal radiographic alterations of bone graft failure from infection, fracture, nonunion and graft rejection are also stressed. The utilization of multiple modalities including conventional radiography and tomography, scintigraphy, CT and MR imaging are illustrated. Results: Knowledge of the radiographic techniques available and their appropriate application as well as an awareness of the roentgenographic appearance is imperative to evaluate osseous implants. This exhibit illustrates these features with conventional radiography as the foundation upon which diagnostic imaging is based. Indeed, radiographic assessment often provides the initial information of successful bone grafting procedures. Perhaps more importantly, however. early complications may be recognized allowing improved management and ultimate clinical outcome.

AbnormalitIes of the sacroiliac Joint Mark D. Murphey (Presenter). James L. Quale, Louis H. Wetzel, John M. Bramble, Solomon Batnitzky; Kansas City, KS Purpose: Numerous pathologic conditions involve the sacroiliac joint and symptoms from these various abnormalities may be indistinguishable from mechanical causes of low back pain. Consequently radiologic assessment plays a major role in evaluation. This exhibit illustrates the radiographic appearances of these disorders in and about the sacroiliac joint. Methods and Materials: This exhibit will present the wide spectrum of pathology that involves the sacroiliac joint including the spondyloarthropathies, other arthritides, pyogenic arthritis, trauma, and secondary neoplastic extension. We will demonstrate and contrast the utilization of multiple modalities (conventional radiography and tomography, CT, MR imaging, and scintigraphy) in investigation of this interesting articulation. Results: Conventional radiography remains the primary screening modality for disease about the sacroiliac joint. Unfortunately the complex anatomy of the sacroiliac joint frequently makes interpretation of conventional radiographs difficult and findings are often initially subtle. CT and M R imaging are however, becoming increasingly important because of their high sensitivity enabling earlier detection of disease and their ability to accurately evaluate soft tissues in and around the sacroiliac joint. Purpose: Computed Radiography (CR) is a relatively new digital radiographic technique employing a photostimulable phosphor as the x-ray detector and is an evolution of conventional analogue radiography. This exhibit demonstrates our experience utilizing a 2K x 2K x 10 bit phosphor plate CR system for musculoskeletal examinations. Methods and Materials: This exhibit illustrates a wide spectrum of musculoskeletal applications (portables, spine series, scoliosis, pelvis, and extremities) and pathology using CR. Use of an interactive workstation and advantages and disadvantages of computed radiography technology are also demonstrated. An observer performance investigation comparing conventional radiographs to phosphor plate images was performed on 100 skeletal examinations with various levels of dose reduction. Results: The observer performance study suggests that the spatial and contrast resolution of our phosphor plate system is adequate for the vast majority of clinical applications in musculoskeletal imaging. Exposure dose reduction of 30-50% is possible without loss of diagnostic accuracy and the interactive workstation provides an effective method to modify display parameters and salvage improperly obtained images. We conclude that the 2K x 2K x 10bit CR phosphor plate system is an alternative to conventional film-screen images in evaluation of the musculoskeletal system without significant differences in diagnostic quality.

Muscular sarcoidosis: radiologic diagnosis Shoichiro Otake (Presenter), Hirokazu Mizutani, Satoru Ohba, Masaharu Noda, Masahiko Yamamoto; Nagoya Purpose: Muscular sarcoidosis is a granulomatous disease and often forms intramuscular mass lesions which should be differentiated from neoplastic tumors. However imaging analysis has not been described enough. We present radiological appearances of this rare disease. Methods and Materials: Fifteen patients with histopathologically proved muscular sarcoidosis were examined. MR was performed in all the patients, CT was in 5 patients, gallium imaging study was in 10 patients and angiography was in I patient. Results: In all the patients, T2-weighted axial images demonstrated star-shaped decreased intensity lesion within increased intensity mass lesion. T2-weighted coronal and sagittal images clearly delineated longitudinally extension of the mass with decreased intensity area sandwiched between increased intensity areas. Correlation with histology revealed central decreased intensity area was dense fibrous tissue and peripheral increased intensity area was inflammatory granulomas. Gallium imaging study demonstrated increased uptake along longitudinally extended lesion, however, the detectability was lower than that of MR. CT showed poor tissue-contrast between mass and normal tissues. Angiography performed for a large sarcoid nodule showed non-specific hypervascular pattern. The results suggest MR is a most useful imaging tool for detecting and characterizing muscular sarcoidosis.

Ultrasonography of the shoulder, a teaching approach J. Piqueras Pardellans (Presenter), R. Dominguez Oronoz, I. Castells Ferrer, A. Grife Balasch, D. Casas Curto; Barcelona Ultrasonography is an useful technique for study of periarticular diseases of the shoulder joint. It has some limitations, but is an easy way to perform an initial study. This technique is not very well known even within the radiology specialists. We have edited a videotape intended to teach a systematic study of the shoulder joint by ultrasound, with normal anatomy, ultrasound and pathology correlation. In a step by step method the technique and the most usual pathologies are depicted. (Fluid collections, calcifications, tendinitis, tendon rupture, rotator cuff tears). The video includes cadaver dissection, animation schemas, and real-time video from normal volunteers and patients. The studies have been performed with 2 linear (5 MHz) transducers, with and without ultrasound pads. Methods and Materials: A total of 20 hemophiliac males and I female with Von Willebrand disease, aged between 12 to 70 years (mean 30), were followed in our hospital for a ten years period. All patients had osteoarticular complications, with a total of 60 joints affected. 15 had severe factor deficiency, and 6 had moderate deficiency. At initial presentation, 2 patients with moderate factor deficiency had a pseudotumor. One was intraosseous and developed without previous injury. All patients were studied with conventional radiography and those with pseudotumor were referred for scintigraphy, computed tomography (CT) and magnetic resonance (MR) imaging studies. Results: The affected joints were: knee (17), ankle (16), elbow (16), hip (2), others (9). The main radiological findings were: erosions of joint margins (50), narrowing of joint space (48), sclerosis and osteophytoses (39), enlarged epiphysis (33), osteoporosis (22), and intraarticular effusion (II). Regarding patients with pseudotumor, the involved bone were: the radius and the femur. CT was able to detect blood density within the pseudotumor (HU: 77) and with MR many different combinations of signal intensities on TIand T2-weighted images were observed. The report describes results of therapeutic embolization of aneurysmal bone cysts and bone tumors in 16 patients. Therapeutic embolization was undertaken in 10 patients with aneurysmal bone cyst, I patient with giant cell tumor, 3 patients with intraosseous hemangioma and 2 patients with solitary metastasis from thyroid gland follicular carcinoma. Angiography to evaluate tumor process was performed prior to embolization, while embolization was done during the same session or later. Therapeutic embolization was performed with )valon, Marbagelan particles and Gianturco coils. The postembolization period was characterised by complete or marked pain relief in all cases. Also, all patients experienced subjective improvement as well as decrease in size of tumors. Patients whose follow-up was longer than 12 months had objective evidence of sclerosis and bone recalcification. There were no complications during therapeutic embolization procedure.

Evaluation of acetabular cup orientation In computed tomography and radiography: phantom and clinical studies Dorothee Radtke (Presenter), Roman Sokiranski, Stefan Exner, Michael Seidel, Andreas Radtke, Rahim Rahmanzadeh; Berlin Several radiographic methods for the evaluation of socket angles after total hip replacement have been proposed, but a precise and reproducible method does not exist. We want to show that computed tomography offers an easy and reliable method for determining acetabular cup position. A phantom was constructed that allows positioning a metal ring corresponding to the rim wire of the socket in various combinations of lateral opening and version. On CT images this ring is represented by two points, which are well characterized by the coordinates x, y and z. After determination of those coordinates angles can be calculated. Conventional radiographs and CT images were reviewed in 50 patients, who had been examined because of suspicion of prosthesis loosening, with regard to the possibility of determining acetabular cup orientation. There was good correlation between the true and calculated angles in computed tomography and we could easily distinguish between ante-and retroversion. which is virtually impossible on a single radiograph. A method of metal artifact reduction makes possible routine employment of computed tomography even in diagnosis of metallic implants. Used for evaluation of total hip replacement computed tomography is offering an easy and highly accurate method of determining acetabular cup position.

Acetabular fractures: value of three-dimensional CT Imaging J. J. Railhac (Presenter), M. Brunet, P. Maquin, P. Samaran, J. Assoun, E. Bloom; Toulouse Purpose: Evaluation of 3 0 imaging in the pre-operative analysis of acetabular fractures. Methods: Twenty-five patients with a recent acetabular fracture were submitted to plain radiographs and conventional CT scans along with 30 imaging. All patients were evaluated for the type of the fracture, degree of comminution and displacement, intra-articular fragments. Each of the techniques was compared in respect to its diagnostic accuracy. Results: -30 imaging did not bring any complemental information than conventional explorations. Plain radiographs and axial CT scans were more sensitive than the 3 0 images in detecting undisplaced fractures. -However, 30 technique allows a perfect spatial representation of the lesion. The multidirectional view is most helpful in the evaluation of the importance, the disruption and the orientation of the bone fragments. It has an overwhelming interest in the study of the fractures involving posterior acetabular wall and comminuted fractures which analysis is known to be most difficult. It provides the surgeon with an anatomical representation of the lesion, much alike its surgical appearance.

The compressive strength of trabecular bone In patients with different kinds of osteopenla by means of a mechanical test W. S. Rau (Presenter). B. Nagele-Wahrle, A. Schulz, K. Rauber, H. Stracke; GieBen Radiological measurements of trabecular bone mineral density show only a moderate correlation to the risk of vertebral fracture and are not able to distinguish between osteoporosis, osteomalacia and hyperparathyreoidismus. In borderline cases, a mechanical test of compressive strength should be useful. It is our aim to develop such a test, that is applicable in vivo. In patients with blurred osteopenia we take fluoroscopically guided Jamshidi needle biopsies of the iliac crest as a matter of routine. The diameter of the bone core is 2 mm, the length ranges from 30 to 65 mm. The larger part of the bone core is investigated microscopically, while an exactly 10 mm long section is compressed in an especially developed apparatus by twisting a micrometer screw. During compression, the exerted force and the resulting loss of height were measured and registered continuously.

To check the validity of these experiments, we removed two or more complete vertebral bodies of cadavers and measured their mineral content by quanti· tative computed tomography. load·deformation experiments were carried out on one vertebral body in toto, on several biopsies from the adjacent vertebral body and on several biopsies from the iliac crests of each cadaver. load-deformation experiments and quantitative computed tomography show surprisingly non·uniform results. Histomorphometric analysis of trabecular bone architecture seems to be necessary.

Subacromial pathology: diagnostic Imaging Luciano Riboldl (Presenter), Luca Belli, Carlo Neri, Maurizio Mentasti, Cristiana Vanoli; Varese Painful shoulder and impingement syndrome with or without rotator cuff tears can be evaluated by different procedures: plain radiography, arthrography, ultrasonography, CT arthrography and MRI. Our purpose is to compare the imaging of the different methods. For each technique we selected 15 patients affected by subacromial disease in order to delineate advantages, disadvantages and usefulness of each imaging technique. The results were correlated with surgical findings or clinical follow·up. On the basis of this study, our opinion is that each imaging technique we tested keeps its own indications in the evaluation of the subacromial disorders and no one of them is of absolute value.

Radiological approach to variable spine plating systems (V.S.P.) with oblique views and C.T. scans A. Rivas (Presenter), E. Caceres, R. Perez-Andres, A. Grife-Balasch;

Purpose: To describe a new radiologic method to evaluate the success and failure of pedicle and vertebral body screw placement due to unreliability of radiographic studies utilized since now in these spinal instrumentations. Methods and Materials: 39 patients underwent a V.S.P. from October 1988 to August 1990. 31 patients (25 Steffee and 6 Luque devices) were included in the study by means of the following sequence: plain AP and lateral films, 60 degrees oblique projections and C.T. scan series through the pedicles and vertebral bodies. Correct pedicular and vertebral cortex images were obtained in all patients, permitting the radiographic evaluation of success and failure in these techniques. C. T. metal artifact was diminished performing oblique transpedicular scans. Results: I J3 pedicles and 57 vertebral bodies were evaluated obtaining the following results: Purpose: To describe four new cases of pustulotic arthro·osteitis seen in our hospital between 1984-1990, emphasizing CT findings. Methods and Materials: All patients fulfilled palmoplantar pustulosis and/or swelling and tenderness on anterior chest wall with or without lumbosacral pain. Other conditions as traumatic, tumoral, infectious and HlA-B27 diseases were ex c1uded by means of a clinical questionnaire, a radiological study and laboratory tests. All patients were ellamined by CT scan performing contiguous scans (slice thickness 2.5 mm, slice increment 2-2.5 mm) with angulation of the gantry to a position perpendicular to the manubrium. Multiplanar CT images were obtained. Results: 2 patients (50%) were female and 2 (50%) male, mean age 42.2 (range 32-53). All patients were having anterior chest pain, half of them palmoplantar pustulosis and 3 (75%) lower back pain. B27 was negative in all patients and pathological studies showed chronic inespecifical inflammation. Hyperostosis, sclerosis and erosions over manubrium and first chondroesternal joints were the CT hallmarks in all patients. Furthermore, i1ial or sacral sclerosis always unilateral without narrowing of the joint space was seen in 3 (75%) patients. A sclerotic (ivory) vertebra was seen in one (25%) patient. Purpose: In a patient with arterial occlusive disease, dynamic CT was performed in order to exclude abdominal abscess after an aorto-bifemoral bypass operation. Patients and methods: A 59-year-old patient developed after an aortobifemoral bypass operation an acute renal failure due to rhabdomyolysis requiring hemodialysis. In addition to a myoglobinuria and increased levels of serum urea nitrogen and creatinine, serum creatine kinase was shown to be elevated immediately after the operation up to 81600 UII. Because of continuous fever, dynamic CT (Somatom Plus, Siemens, 100 ml Ultravist 370) was performed to exclude abdominal abscess. Results: In CT, no abdominal abscess was demonstrated. In contrast to preoperative CT, the muscles of the back and the gluteal region showed an irregular inhomogenous contrast enhancement as a correlate of rhabdomyolysis. This case was compared to other data already published.

So-called lemoral head antaposition aHer operatIve traatment 01 CDH and Its reasons In computerised tomography K. Rzymski (Presenter), M. Napiontek; Poznan

The clinical appearance of so called femoral head anteposition recognised as a rare complication after operative treatment of CDH has been described. This clinical picture comprises a bulge in the groin corresponding with femoral head, fixed external rotation of the extremity and movement restriction in the operated hip. Computerised tomography scans in the horizontal and sagittal plaines of 22 "antepositioned" hips from 22 children operated on because of CDH were studied. Among those, 15 hips from children aged between 2 y 2 m and 8 y 3 m were primarily operated at our Clinic by open reduction with subtrochanteric varus derotation osteotomy with shortening of the femur and transiliac osteotomy described by Dega. There were 7 hips from children aged between I y and 2 y 6 m operated primarily at other hospitals where similar operative treatment was attempted. An evaluation of CT scans and clinical examination combined, made possible to differentiate homogeneous clinical appearance of so called femoral head anteposition and establish its one or several coexisting reasons: anterior dislocation of the hip, coxa magna after avascular necrosis, gluteal muscles fibrosis and periarticular ossifications. Purpose: To determine whether it was possible to distinguish between synovial fluid and inflammatory pannus by MRI with contrast enhancement, we evaluated patients with known rheumatoid arthritis. Methods and Materials: Fourteen patients (14 joints) with known rheumatoid arthritis were imaged with a 1.5 T M R system with surface coil. The scans were obtained in the coronal and sagittal planes with TI-weighted and T2-weighted images. Gd-enhanced TI-weighted images were also obtained. Results: Ten patients with symptom of pain and/or swelling of the knee showed collection of low signal intensity about the knee joint on precontrast TI-weighted images, and high signal intensity in the same area on T2-weighted images. Only Gd·enhanced TI-weighted images could make a differentiation between the pannus formation and the fluid as inhomogeneous enhancement and without enhancement respectively.

Chronic osteomyelitis (OM): comparison of magnetic resonance Imaging (MRI) and white blood cell scintigraphy (WBC) Thirteen patients with rheumatoid arthritis (10 women and 3 men), aged 39-66 years, were studied. All subjects were examined by X-Rays and US of the hands and wrists in static and dynamic conditions. Linear array real-time transducers (3.5 and 5 MHz) and a 7.5 MHz sectorial array, using a gel material as a water delay system (Kiteko 3M) were used. US resulted to be very accurate in showing the hypoechoic swelling of soft tissue surrounding ulna extremity and the hypoechoic metacarpo-phalangeal joint lesions. Moreover the "fuse-shaped" thickening of the joint capsule because of hypertrophic teno-synovitis was delineated. Finally by a dynamic examination, performed during flexion and extension maneuvers, eventual tendon involvement was evaluated. In conclusion, US may be considered a reliable and non-invasive first approach procedure both in establishing the diagnosis of rheumatoid arthritis and in the follow-up of patients with long-standing disease. It should be performed in addition to X-Rays in order to improve diagnostic accuracy.

Changes In bone minerai density In renal calculosis I. Delov, S. Tsvetkova, S. Tabakov (Presenter); Plovdiv

It is known that renal calculosis and especially the oxalate one is associated with certain changes in calcium homeostasis. Therefore we have studied spinal bone mineral density (BMD) as a referee for bone mineral content (BMC) in patients with nephrolithiasis. Methods: Single-energy quantitative computed tomography (QCT) has been performed on a CE 10000 scanner using a K2HP04 calibration phantom. The second and the third lumbar vertebrae (L2-LJ) trabecular BMD has been measured. An empirical fat correction has been made. The study comprises 60 patients males and females, aged 25-65 years. Results: We established that in all cases BMD had been lower than the age mean values. The percentage bone loss varied from 5-10% up to 35-40% and was related with the type of the calculosis as well as with its heaviness and duration. In patients with oxalate calculosis BMD was 27% in average lower than the statistical age mean values. Conclusions: The significant bone loss in nephrolithiasis should be taken into account when making an effective therapy.

Radiologic examination of the rheumatoid wrist M. Taljanovie In this tumour a presumptive diagnosis can be made by X-ray films, but we can get a definitive diagnosis with CT by measuring the CT attenuation numbers of the lesion, which fall within the range of fatty tissue. Thus, MR specific relaxation times of the tumour, with a very short n, confirm the presumptive diagnosis; all those findings can avoid any surgical biopsy.

The study of clinical utility of positive Imaging In soft tissue tumors with 99mTc(v)-DMSA Wang Rongfu (Presenter); Suresnes 2-3 dimercaptosuccinic acid (DMSA) is generally taken as a renal cortical imaging agent. This work has reported that DMSA, labelled with 99mTc at PH 8 99mTc(v)-DMSA by modifying method, was administered intravenously to 20 patients (15 to 20mCi) with and without soft tissue tumors after stationing at 30 minutes_ Labelled 99mTc(v)-DMSA was evaluated by thin layer chromotography (TLC), the labelling yield ~96'10 and the radiochemical purity of98%. SPECT was performed L, 2, 4 and 24 hr respectively after injection. 1 case was not always imaged. We observed important accumulation of radioactivity in primary and secondary lesions in 11 patients with various benign and malignant soft tissue tumors. 2 patients with abdominal occult abscess surgically determined were slightly imaged. Tumors were relatively visualized already after I hr but the uptake was more intense at 2 hr. The targetto-nontarget ratios at 2 hr varies from 1.8 to 2.5. Biodistribution studies in mice and human showed that renal uptake was minute. It is concluded that 99mTc(v)-DMSA has a potential clinical use for the detection of soft tissue tumors. The mechanism of the tumor uptake and the differentiation between inflammation and tumors will soon be continuing the research and undergoing clinical evaluation.

Comprehensive (392) in our initial study group and showed lesions in six symptomatic patients with negative bone scans. There was poor correlation of lesion size on MRI with activity on bone scan. Several large expansile metastases were not found by bone scan. MR imaging is clearly superior to bone scintigraphy for detection and assessment of osseous spinal metastases. Since bone scanning images the entire skeleton and costs less than MRI, it will continue to have a role in routine screening and follow up of patients at high risk for osseous metastases and those with stable metastases. However. for initial staging of patients prior to spinal radiation therapy and assessment of new spinal pain or neural compression symptoms, MR imaging should be performed.

Holmium-Yag laser for lumbar dlscectomy Gerhard Wittich (Presenter), Ann Bjorkengren; Stanford, CA Purpose: Percutaneous lumbar diskectomy is evolving as an alternative to surgical treatment of herniated lumbar disks. We present the result of in vitro studies aimed at developing a refined percutaneous delivery system for CT-guided laser diskectomy in patients with contained herniated lumbar disks. Methods: A holmium-yag laser with a peak power of 6 Kw and a pulse duration of 350 microseconds was used for in vitro ablation of the nucleus pulposis of lumbar disks. Results: These studies demonstrated the feasibility of ablation of disk material by laser energy. They have resulted in the design of a prototype delivery system for translumbar, CT-guided laser diskectomy. Conclusions: Initial in vitro results suggest that a holmium-yag laser probe in conjunction with a refined delivery system may be clinically useful for percutaneous treatment of selected patients with herniated disks.

Correlation between magnetic resonance Imaging, visual evoked potentials and clinical findings in multiple sclerosis Ayr;a Altug (Presenter (23), by disease activity as acute. chronic with acute exacerbation or chronic progressive. The visual evoked potentials were obtained by the checkerboard method. MR examinations utilized a GE-CGR 0,5 Tesla unit in which TI and T2 weighted images (WI) were acquired and the IR sequences were applied to demonstrate the brain stem and cerebellar plaques. 11 was demonstrated that MRI was sensitive in 94% of the patients with clinically definite MS and 76% with clinically probable MS. There was a significant correlation between attack period and edema and conglomerate formation of the lesion, and no correlation between the clinical course, duration of disease, and the size of lesions. Cerebral atrophy did not correspond to the age of the patient. YEP findings corresponded to clinical diagnosis, positive YEP results were obtained in 41 patients.

Ell Neuroradiology (07) Purpose: The aim of this multicentric study was to evaluate MRl's ability to diagnose spinal neurinomas in 30 subsequently operated cases. Methods and Materials: The spinal locations were as follows: 7 cervical. 5 thoracic and 18 at the lumbar level. An MR Max 0.5 T imager was used in 17 cases and a Gyroscan 1.5 T or 0.5 T in 13. The sequences used were: GE or SE T1 (fast), T2 and gadolinium enhanced TI. Results: MRI showed well-limited lesions in 22 cases. In comparison to normal spinal cord, TI neurinomas signals were hypo-(14 x) or isointense (16 x). All neurinomas were hyperintense on T2; they exhibited heterogeneous appearances at the lumbar level (10 x I. which were confirmed on gadolinium-enhanced T1 sequences. Significant enhancement was constantly observed. Extraspinallocations were infrequent (3 x); hourglass neurinomas were found (5 x). In investigating intradural tumors (22 x), supplementary axial sections were necessary to determine their relationship to the cord of cauda equina nerve roots.

Conclusions: In addition to the classic diagnostic pitfall of dorsal meningiomas. the authors emphasize the possible variable appearances of lumbar neurinomas: other medullary tumors need to be ruled out.

The Neurocysticercosis is a parasitic infestation of the CNS that is common in some parts of the world (Mexico. Portugal, Spain. Central America. Eastern Europe, Africa, and Asia). Increased travel to and from endemic areas has resulted in an increasing number of neurocysticercosis cases being diagnosed in non-endemic areas. The purpose of this exhibit is to review and compare imaging modalities in the evaluation of neurocysticercosis. Methods and Materials: Cases of neurocysticercosis were obtained retrospectively from CT, MRI. and surgical pathology records. Results: In our clinical setting most patients with neurocysticercosis were initially evaluated with CT, usually after presenting with seizures. The presence of multiple intracranial calcifications suggested the diagnosis of neurocysticercosis. CSF immunologic studies and/or pathologic examination of resected lesions confirmed the diagnosis. CT was superior to MRI in detecting the calcifications of cysticercosis. MRI was superior to CT in demonstrating the S284 non-calcified lesions of cysticercosis whether parenchymal, intraventricular, or subarachnoid in location. MRI could identify intraventricular lesions without the need for intraventricular contrast. Gadolinium enhanced images were particularly useful for demonstrating active lesions.

Granulometrlc analysis of spherical and non-spherlcal embOlization particles R. Beaujeux (Presenter), A. Laurent, L. Domas, M. Wassef, J. J. Merland; Paris

We have carried out the granulometric analysis of different embolization materials by the mean of two methods: optical microscopy and semi-automatical shape measurement. We have measured the size of particles according to two dimensions and determined an index adapted to the embolization particles.

We have studied following particles: -non spherical: dura mater, gelfoam, PVDF, polyvinyl alcohol -spherical: polystyrene, dextran, silicone, acrylic beads The a. m. particles have been obtained by different fabrication methods which will innuence the granulometric distribution. The granulometry of the non-spherical particles (obtained by mechanical fragmentation) is wider than advertised on the commercial leanet and frequently tends to concentrate on the minimal dimension.

On the opposite the spherical particles are well calibrated, and especially the acrylic beads which we have been able to divide into very narrow granulometric peaks.

Dynamic computed tomography: kinetics of non-ionic contrast media In brain metastasis of lung cancer Bruno Betsch (Presenter), Michael V. Knopp, Udo Trost, Stefan Delorme, Gerhard van Kaick; Heidelberg

Purpose: The optimal timing for cerebral CT after i.v. administration of non-ionic contrast media for detection of brain metastasis is still controversely discussed. To provide a rational basis the kinetics of non-ionic contrast media in brain metastasis of lung cancer has been studied. Methods: The kinetics of non-ionic contrast media (100 ml, 62% lopromide) after intravenous bolus administration (Flows: 40 mllmin.) in brain metastasis of bronchial carcinoma has been studied with dynamic computed tomography. The pharmacokinetic calculations and the compartiment-model analysis have been performed separately for blood, brain tissue and metastasis. Results: In normal brain tissue the kinetics of non-ionic contrast media can often be described best with a I-compartiment model (Maximum shortly after administration -monophasic decline of tissue iodine concentration). In brain metastasis the kinetics of non-ionic contrast media can frequently be described best with a 2-compartiment model (Maximum shortly after administration -biphasic decline of tissue iodine concentration). Conclusions: Non-ionic contrast media shows a different pattern of kinetics in brain metastasis compared with normal brain tissue. Considerable differences already appear in the early phase after administration. The ongoing investigation will clarify whether these differences are suitable for a rapid and sensitive detection of brain metastasis shortly after administration of non-ionic contrast media especially using modern, fast cycle CT-systems.

Magnetic resonance Imaging in the early assessment of spinal injuries Roger Bodley (Presenter). Ali Jamous, Debbie Short, Philip Savage; Aylesbury

Purpose: To assess the role of Magnetic Resonance Imaging (MRI) of the spinally injured patient in the acute phase of injury. Methods: All new acute admissions to the National Spinal Injuries Centre at Stoke Mandeville Hospital underwent MRI of the affected part of the spine within five days of injury and within 24 hours if possible. Using a modified frame enabling continuous cervical traction during imaging where appropriate, patients were assessed using a Hitachi MRP 20 Permanent Magnet System with T1 and T2 weighted sequences and Gadolinium enhancement if necessary.

Results: Excellent images of the damaged spinal cord and surrounding tissues were obtained. Several patterns of cord injury were seen. ranging from complete disruption through focal altered signal changes to apparent normality. In several cases appreciation of the state of adjacent intervertebral discs and of focal changes in the cord that may herald the onset of syringomyelia led to a change in the operative strategy. Conclusions: MRI in the acute stage of spinal cord injuries is feasible and useful. It allows rational decision on early management to be made and it is crucial if surgery is contemplated.

Degenerative disease of the spine: a review P. Coscojuela (Presenter), J. Ruscalleda, M. de Juan, E. Guardia; Barcelona

Purpose: Lumbar pain and back pain are mainly related to discal pathology and many degenerative processes may be involved. The different phenomena implied are discussed. Methods and Materials: We reviewed X-Ray studies, myelographies, CT and M RI of a large series of patients with degenerative disease of the spine and low back pain. The structural degenerative changes were evaluated and we describe the different degenerative processes affecting cartilaginous, synovial and fibrous articulations and also their complications: Iistesis, alineation alteration, discal hernia, canal stenosis. We describe these progressive changes and the most appropriate studies for diagnosis. Results: Degenerative disease of the spine is a biologic process generally appearing in the 3,d decade of life. It's often difficult to differentiate from pathologies which give rise to low back pain. Clinical signs and symptoms should be related to the radiologic image and diagnosis should be made globally.

Tc-99m-HMPAO-Spect In patients with reversible cerebrovascular disease ( SPECT imaging of the brain was performed in 66 patients with reversible CVD utilizing Tc-99m-HMPAO; 35 patients were studied after intravenous administration of Ig Acetazolamid. 31 patients got none. Sensitivity of these two methods were compared differently in reversible hemispheric (TIA) and vertebrobasilar insufficiency (VBI). Cerebral infarction was excluded by TCT. Sensitivity in TIA without provocation was 55%, in VBI 36%. Acetazolamid improved sensitivity to 90% and 64%. In reference to total CVD sensitivity increased from 48% to 80%. II patients who were investigated with both methods within a few days, showed an increase of sensitivity from 45%to 81 %. 3 patients with amaurosis fugax and severe stenosis of the internal carotid artery were normal with Acetazolamid. However, in 8 patients with asymptomatic severe carotid stenosis the ipsilateral hemispheric blood flow was reduced by the provocation test.

Conclusions: SPECT imaging with Tc-99m-HMPAO shows in patients with reversible CVD in provocation with Acetazolamid a distinct higher sensitivity. In subarachnoid hemorrhage (SAH), angiography reveals no source of the bleeding in about [5 to 35 % of cases, as has been shown in the literature. In order to find out whether a certain SAH distribution -as seen on CT -corresponds to negative angiograms or not, the neuroradiological findings in 28 patients with SAH were evaluated. In all cases SAH was confirmed with CT, but the angiograms showed neither aneurysm nor angioma. In 20 cases angiography was repeated, and three patients had a third angiographic study (with re-angiography, an aneurysm was ascertained in two patients). I n most cases CT showed but a small amount of blood within the prepontine andlor the interpeduncular cistern, whereas hemorrhage in one or both Sylvian fissures was found in four cases only. Nearly all patients with prepontine or interpe-duncular SAH fully recovered. Patients with other SAH distribution had hypertension and lor angiographic findings pointing to arteriosclerosis. Based on our study, it is suggested that SAH confined to the prepontine or to the interpeduncular cistern may be rather seldom caused by an aneurysm. Hence, if CT shows such a pattern of SAH and the angiograms are negative, the question is raised, whether or not a second angiographic study should be carried out.

Studies of the hypophysis of patients with primarily aldosteronism of postoperative treatment by MR Imaging I. D. Fedina (Presenter), N. M. Chikhladze, S. K. Ternovoy; Moscow

All studies were performed using MR Imager (Bruker, FRG). The state of the hypophysis was studied in 25 patients (pts) with primarily aldosteronism (PA) after adrenalectomy: 16 pts with residual arterial hypertension (RAH) and 9 pis with normal arterial pressure (NAP). The comparison group consisted of 19 pis with hypertension disease (HD). In 16 pts with residual arterial hypertension (RAH) only I I pts showed hyperintensive sections in different parts of the hypophysis, unevenness and diffusion of the contour of the hypophysis in 9 pts with normal arterial pressure (NAP) only 4 pts showed analogous changes. All patients with PA had normal sizes of the hypophysis and the unevenness of its structure. In 19 pts with HD only 7 pts showed the heterogeneity of the structure, and 3 pts had hyperintensive sections. Visualized by M R Imaging the changes of the substance of the hypophysis have proved the necessity of the further studies of the morphological and functional state not only of the adrenal glands but also of the hypophysis in patients with PA and especially in patients with residual arterial hypertension.

The The purpose of the study was to evaluate MR effectivity in the diagnosis and characterization of the neoplasms of the cauda equina. Twenty-three subjects suffering from cauda tumors were evaluated by plain and enhanced MR. Other examinations were acquired in 15 cases (myelography, CT and CT-myelography). [n all the cases surgical procedures were performed and pathological evaluation obtained. There were 5 neurinomas, 7 meningiomas, 4 epidermoids and 7 ependimomas. MR proved to be useful in the diagnosis of all the cases examined although it was not always able to differentiate the neoplasms each other. Nevertheless differential patterns mostly based on location and type of enhancement were identified on MR.

Magnetic resonance and mlcroprolactlnoma E. Gomez (Presenter), M. P. Sanz, A. Capdevila, J. Aldoma, P. Martinez, J. Gili, M. Baquero; Barcelona

We have studied a 100 patients, who all had high plasmatic values of prolactin. In 50% of them MR was positive and we were able to see the lesion. 25% of the cases we couldn't see any abnormalities in the hypophysis. We used TI weighted images (TR = 400-600 ms/TE = 20 ms) on all of them, and T2 weighted images (TR = 2000-2500ms/TE = 30-100).

In 25 patients the study was performed after administration of Gd-DTPA. We present the tables of the morphological findings, which allow us the diagnosis of the different sequences carried out, as well as the behaviour of lesion shown after contrast administration. The best information was obtained on coronal plane in TI weighted images after administration of Gd-DTPA. Purpose: The benzodiazepine-antagonist Ro 16-0154 (JI23-lomazenilll, Mallinckrodt) was introduced for SPECT-imaging of the brain. In order to optimize the acquisition protocol, ils biokinetic was evaluated. Patients and methods: Via sequential scintigraphy 0-90 min after injection of 120 MBq Jl23-lomazenil, time-activity-curves of brain, heart and liver were calculated in 30 patients. Multiple plasma and urine samples were taken. Results: The maximum brain uptake of lomazenil is reached after 17.8 minutes. Afterwards, a linear decrease with an average of 5.6% per 10 min is noted. The maximum plasma-concentration is found after a few seconds and is followed by a fast and exponential decrease (63% in 120 min). An average of 63% of the injected activity is found in the urine after 90 min. A smaller part is excreted by the Ii ver.

Conclusions: An acceptable noise-background-ratio for SPECT-gamma camera images of the brain is found 30 min after injection. This does not significantly change up to 150 min p.i. When long SPECT-acquisition times are chosen, it has to be considered that the brain-Iomazenil-concentration decreases with 5.6% per 10 min. Sequential scintigraphy of the brain with lomazenil enables quantification of the global benzodiazepine-receptor kinetic of the brain. Classical embolization particles present a lot of problems due to their irregular shape (bad calibration) and to the kind of the polymer. The authors describe a new type of embolization materials; acrylic microspheres which are synthetized by reversed emulsion. Experimentation has been practised on Sprague Dowley rats to check out on biocompatibility.

The materiel improvements are following: -adaptation of the synthetis techniques as to obtain a complete range of diameters (150-120011) -adaptation of the microsphere surface as to boost the cellular adhesion -division into different calibers by the mean of watered sieves which allow us to obtain very narrow peaks of granulometry (± 5011, ± 10011) -polymer coloration These microspheres present many advantages and allow accurate targeting of the embolization.

Optimized MRI-sequences and parameters to avoid pitfalls In detection of discus pro laps of the spine Th. Lehnen (Presenter), E. G. Eising, R. W. Dalicho; Recklinghausen MRI is known as an important diagnostic procedure to clear up discus pro laps of the spine. I n spite of using contrast media, pitfalls might result of scarring in postoperative patients or in cases of lateral protrusions or small sequestrated masses.

To avoid diagnostic errors in such cases, we have tried to optimize MRI-parameters (e.g. imaging-sequence, TE, TR, slice-orientation, time of application of contrast medium) in about 50 patients with such problems.

Magnetic resonance Imaging In pediatric neuromuscular disorders Results: MRI clearly demonstrated the abnormality of subcutaneous fat and muscular bundles with its advantages of multiplanar capability and excellent tissue contrast. The findings of MRI are: a) DMD: preserved muscular groups S286 ofgraciJis (15/15), sartorius (12115), semitendinous (9/15). b) SMA: increased subcutaneous fat in all SUbtypes with ragged islands of muscular tissue within a large mass of panniculus adiposus in intermediate type. c) acute stage of DM/PM: high T2-signal intensity. d) CM: partly preserved semimembranous and biceps muscle. e) LSD: increased subcutaneous fat. t) AMC: severe fatty degeneration. g) Pompe's disease: preserved muscle with mild degeneration. h) MD and MO: normal.

Conclusions: MRI provides a complementary study and guidance of muscular biopsy for differential diagnosis of neuromuscular disease and can serve as a tool for follow up study of disease progression or treatment response.

A Accurate definition of the site of CSF leakage is essential for successful surgical management of CSF rhinorrhoea and associated recurrent meningitis. Previous imaging methods, including conventional CT, have been disappointing.

We use a dedicated high-resolution CT technique comprising fine slices in coronal and sagittal planes with a bone algorithm for data manipulation. The site of the responsible communication between cranial cavity and sinus is well demonstrated and additional features of adjacent intracranial air bubbles or adjacent sinus soft-tissue mass are frequently shown. The technique is described and the result obtained in 20 patients are discussed.

CT -guided stereotaxy L. Mistina (Presenter), M. Galanda; Banski! Bystrica CT-stereotactic interventions are used for evacuation of brain hematomas, abscesses, biopsy, interstitial radiotherapy, but are not so common in functional stereotactic neurosurgery. We present our experience with CT (Siemens) calculation of the target area for stereotaxy (Fischer instruments) in the VL thalamus, the brachia conjuctiva cerebelli (the motor disorders) and periaqueductal gray (intractable pain), where the electrodes for permanent stimulation (Tesla neurostimulating devices) were implanted. After neurophysiological control CT examination confirms the precision of positioning of the electrodes in the target, even applying Multiplanar reconstruction. The advantages and the drawbacks of CT-stereotaxy are discussed. Purpose: To evaluate regional cerebral blood flow (rCBF) distribution in schizophrenia using Tc-99m hexamethyl-popyleneamine oxine (HM-PAO) SPECT by both qualitative and quantitative methods. Methods and Materials: Eleven patients with schizophrenia and 7 healthy volunteers were studied. Ten minutes after the injection of 740 MBq Tc-99m HM-PAO, SPECT images were taken using a rotating gamma camera system. Regions of interest (ROfs) were drawn on the imaging of bilateral frontal, temporal, occipital, parietal cortex, basal ganglia and cerebellar hemisphere. The rCBF distribution in schizophrenia was evaluated by the mean value activity of all pixels within each ROI and was compared with that of healthy volunteers.

Results: The rCBF distribution in schizophrenia was obviously different from that in healthy volunteers. There were variable patterns of rCBF distribution e.g. hypofrontality, asymmetric accumulation and crossed cerebellar diaschisis in patients with schizophrenia. In 5 cases the rCBF distribution has been markedly improved during a long term follow up treatment. Purpose: We have revised 194 patients with AIDS and neurologic complications, studied by CT and MRJ. 35 of these patients were diagnosed ofCMTB by CSF Ziehl staining or culture. This incidence is higher than the ones published in other series. Our purpose is to investigate if there exists some difference in the radiological findings in CT or MRI between patients with AIDS and non-immunosuppressed patients. Methods and Materials: We have performed CT in all patients, with i. v. contrast (iohexol), and MRI in three of them, following i.v. paramagnetic contrast injection (gadolinium DTPA). Results: We found hydrocephalus (51 % of the patients), meningeal enhancement (48%), parenchymatous lesions (34%) and vascular complications (23%). Imaging studies were normal in 23% of the patients. We have not found significant differences between AIDS and non-AIDS patients. The more frequent CT feature was non-obstructive hydrocephalus associated in 70% of the cases to meningeal enhancement. This finding is opposed to the one reported by other authors. This justified the absence of meningeal enhancement by a supposed lower immunedefense capability in AIDS patients. Finally, MRI has been very useful in showing meningeal enhancement in three patients with normal CT studies, providing a more precocious diagnosis and proper treatment. Purpose: To determine the usefulness of MRI in assessing embolization related changes of cerebral A VMs. Patients and methods: 31 patients with angiographically proved cerebral AVMs were studied by MRI posttherapeutically. Pretherapeutical examinations were available in 20 patients. Tl-and T2-weighted SE-sequences were performed in at least two imaging planes on a superconducting magnet operating at 1,5 Tesla.

Results: AVMs could be demonstrated excellently by MRI before and after embolization therapy. Complete thrombosis was seen in 5, partial thrombosis in 26 patients. Posttherapeutically, ischemic infarction and/or small hemorrhage were noticed in 8 patients. Changes of the nidi assessed by MRI correlated with angiographical reports in all patients. Conclusions: MRI is a valuable non-invasive tool in assessing embolizationrelated changes of both cerebral A VMs and surrounding brain tissue. Purpose: The purpose of this research work is to analyse the application of "now-colour" images as an addition to the cerebral angiography study in different pathologic processes. Methods and Materials: We have made a study by means of using "flow-colour" images in the cerebral angiography of two different groups of patients. The pseudo-colour scale assigns a colour to every single pixel in the image, at any moment in the sequence, depending of the maximum concentration of contrast. Within group I we examined 50 patients with normal cerebral angiography, and the second group was formed by 30 patients with different types of cerebral pathology: arteriovenous malformations, vascular obstructions, aneurysms, meningiomas and some other cerebral tumors. We have studied the differences and variations appearing in the "flow-colour" cerebral angiography map of the different pathologies in relation to the normal group. Results: The application of "flow-colour" images in cerebral angiography offers additional information in different groups with intracranial pathology, specifically in vascular processes. Purpose: The purpose of this research work is to give detailed description of the embolization technique in cerebral aneurysms. We pay special attention not only to the indications and counterindications of the technique, but also to the attention and care given to the patient in pre-and post-embolization periods. Methods and Materials: We make a femoral puncture by inserting a 5F catheter as far as the origin of the carotid artery. Then, we make a carotid direct puncture by means of which a TRAKER-18 is introduced until it penetrates the aneurysm. When this is done, we insert Complex Helical Platinum Coils by means of a PULSER 16 trying to occupy about the 70% of the lumen of the aneurysm. During the exploration, we make several angiographic controls using the femoral catheter. Results: Having performed this clinical experience, we consider that the embolization technique with microcoils should be taken into account as a method to treat aneurysms, especially when they are pediculated or giant.

CT and IntraoperatIve ultrasound In cerebral tumours Ewa Zajac, John Koivukangas, Juhani Pyhtinen (Presenter); Oulu

Intraoperative ultrasound imaging (lOUS) has been used at our center for cerebral tumour surgery control since 1982. Purpose: To compare CT and 10US findings in cerebral tumours. Methods: 10US was performed with 5-7 MHz linear and sector transducers during craniotomy and these findings were compared with CT findings in 22 consecutive adult cerebral tumours operated during 1997-88. These tumours consisted of 9 astrocytomas grade 1-2, 5 astrocytomas grade 3-4, 2 oligodendrogliomas, 4 meningeomas and 2 metastases. Results: Nonuniform contrast enhancement was associated with similarly nonuniform echogenicity. Calcifications in 6 cases could be found by both methods. 10US was found to better differentiate cystic parts of the tumours. Grade 1-2 astrocytomas which were non-contrast enhancing uniformly hypodense lesions on CT showed up as uniformly hyperechogenic lesions in IOUS. Corresponding diameters of the tumours showed high statistical correlation.

Conclusions: 10US serves to localize and demarkate subcortical tumours, especially grade 1-2 astrocytomas, with most tumour features (size, cysts, calcifications, necroses) being similar in both CT and 10US and in certain cases, 10US gives critical supplementary information. Thus far, imaging of PN has been rather limited. Our study was designed to evaluate the diagnostic value of US in PN of the lower and upper extremities. Methods and Materials: We examined 20 healthy volunteers and 43 patients with various pathology to evaluate imaging features of normal and pathological conditions. We used Sonoline AC/SL US-machines (Siemens) and 7.5 MHz and 5 MHz transducers. Results: PN are hyperechoic bands with parallel internal structures and an echogenicity that is strongly dependent on the tilt angle of the transducer. All major PN could be demonstrated with e"ception of sural and peroneal nerves. Neuroma (n = 10) were almost round and hypoechoic and neurinoma (n = 4) were often oval and hypoechoic. Neurofibroma (n = 4) were oval or round and hyperechoic. Neurofibrosarcoma Cn = 2) were irregular, hypoechoic and inhomogeneous. Focal morphological changes could be found in following cases: carpal tunnel syndrome (n = 10), ulnar sulcus syndrome (n -4), lipomatosis (n = 2) and amputation of radial nerve Cn = I). Compression of the nerves by surrounding masses were seen in 6 cases. Summary: US proved to be an easy, non-invasive and effective method to examine PN and their lesions.

Value of IV paramagnetiC contrast (Gd-DOTA) Injection In lumbar disk and nerve root pathology of the non-operated spine B. Roger (Presenter), C. Grataloup, D. Folinais, J. P. Benazet, M. Laval-Jeantet; Paris a) Aim of the study: The authors present 5 cases oflumbar MRI representing 5 different typical diagnoses and raising problems of differential diagnosis or choice oftreatment: foraminal L4-LS disk hernia, extruded L5-S1 disk hernia, posterior articular synovial cyst of L5-S I, radicular cyst, intradural neuroma of L3 and foraminal neuroma. b) Methods: These 5 patients underwent TI-and T2-weighted sequences after intravenous injection of paramagnetic contrast agent (Gadolinium-DOT A, i.e. Dotarem®, Guerbet) in the sagittal and transverse planes. c) Results: This study analyses and compares, for each lesion, the site, appearance and variation in the signal in order to define the MRI signs. The post-contrast sequence was found to be essential for the demonstration and characterisation of the lesion. d) Conclusions: A summary table is proposed as a function of the variation in the signal, allowing the positive diagnosis and differentiation of each of the aetiologies presented.

AcquIred and congenital abnormalities of the cerebral cortical pattern: differential diagnosis by MR white matter and the ability to generate images in a variety of planes. These imaging attributes are useful in identifying and learning about the spectrum of congenital cerebral abnormalities that arises from disturbances in neuronal migration. These pathologies are often not-differentiable from encephaloclastic acquired disturbances. The purpose of our study was to identify the criteria that permit a correct differential diagnosis between mal formative and acquired pathologies. We included in the study 61 subjects correlated by MR examinations in which cortical abnormalities were demonstrated. In 30 cases the pathologies were encephaloclastic. In the remaining 31 cases mal formative (7 schizencephaly. 6 polymicrogyria, 9 pachygyria, 9 neuronal heterotopia). In 15 cases there was surgical confirmation. MR resulted to be the examination of choice able to recognize and characterize the disorder, giving a satisfactory differential diagnosis, in order to better assess the prognosis, the therapeutic approach and the prevention. Purpose: Aim of the study was to define the importance of Magnetic Resonance (MRI) for patients with clinically and laboratory confirmed rheumatoid arthritis, especially to evaluate the significance of Gd-DTPA enhancement of the pannus in the occipito-cervical region. Methods and Materials: We examined 90 patients with rheumatoid arthritis and neurological symptoms. All investigations were done with a 0,5 T superconductive unit. Sagittal and coronal planes 5 mm SE technique, short TRITE sequences (450 msec/30 msec) before and after Gd-application, 6 mm slices gradient echo technique (555 msec/40msec. puis. ang 20) were obtained. The patients were categorized according to the morphology and signal intensity of the pannus as seen on unenhanced scans and further classified their enhancement status into three groups. Results: MR-morphology reflects the different phases of the inflammatory process at the odontoid level. 30 patients in whom a clearcut enhancement of the pannus was noted received a combination therapy (non-steroid antirheumatic agents, low dose cortisone). 3 months follow-up examinations showed a quantitative and qualitative significant decrease of signal intensity of the pannus tissue as well as a normalization of the laboratory values. In the other 20 patients signal of the pannus was still high also the laboratory values pathologically elevated. Conclusions: Our results show a possible positive association between enhancement status of pannus tissue in chronic rheumatoid arthritis patients and pathological serological values reflecting the activity status of the disease.

MR findings of hypoxic brain damage Satoru Tazawa (Presenter). Shoki Takahashi, Kiyoshi Ishii. Kou Matsumoto. Kiyohiko Sakamoto. Makoto Takahashi. Mikio Suzuki; Sendai I. Purpose: Evaluation of hypoxic brain damages on MR images. 2. Methods and Materials: TJ-and T2-weighted images and contrast enhanced TJ-weighted images were obtained in 5 patients with hypoxic brain damage with 1.5 T and 0.5 T MR systems. Patients included were two who had cardiac arrest, two who had systemic hypotension and the other who had hypoglycaemia. 3. Results: On MR images, diffuse brain swelling progressed from 3 days to 12 days after the ictus, and it subsided after 2 weeks. T2-weighted images showed hyperintense lesions in the cerebral cortex. From 10 days to 2 months after onset, TJ-weighted images with and without contrast medium showed findings which suggested diffuse laminar necrosis of the cerebral cortex. Distribution of such lesions was most prominent in the parieto-occipital region. Unfortunately I of 5 patients died, and 3 of them became vegetative, follow-up M R images of whom showed brain atrophy and hyperintensity changes in the white matter (T2WI). Another patient who had minor changes on MR images recovered well. MR findings in patients with hypoxic brain damages corresponded well to the neuropathological findings described in the literature.

Evaluation of perfuslonal abnormalities in carotid occlusive disease by transcranlal Doppler (TCD) and 99mTcHMPAO brain SPECT M. G. Toni (Presenter). L. Fiori, G. Parenti, F. Marconi. C. de Gaudio.

After carotid occlusion, collateral circulation inadequacy might cause cerebral hypoperfusion with chronical cellular impairment and increasing risk of ischemia after embolic event. To verify the compensatory system efliciency and select patients for surgery, in the last two years we evaluated 127 pts with carotid occlusion by doppler continuous wave, TCD and CT; 33 pts underwent 99mTcHMPAO brain SPECT as well. The pts were divided into two groups according to the presence (group I) or not (group 2) of a CT stabilized ischemic S288 lesion. and into subgroups according to their neurological symptoms. All pts were classified on the basis ofTCD pulsatility index (PI) symmetry. Group I: agreement between PI asymmetry and SPECT hypo perfusion in all cases but for a patient with stroke (PI asymmetry, SPECT hypoperfusional area corresponding to CT lesion). Group 2:6 pts with PI symmetry showed SPECT hypoperfusional areas (2 pts had bilateral occlusion justifying PI symmetry) and 4 pts had significant TCD mean velocity asymmetry on middle cerebral artery territory. SPECT can reveal, especially when CT is negative, areas of insuflicient vascular flow not detectable using other techniques; TCD allows to identify the compensatory mechanisms and the haemodynamic situation to select patients for surgery. Results: MR did not usually enable a more specific histologic diagnosis than other imaging techniques. However, extraosseous and proximal spinal extent of tumors was well defined without use of oral or intravenous contrast material. MR imaging is an excellent noninvasive technique for evaluating most sacral and perisacral lesions and is particularly helpful when precise tumor extent must be determined for treatment planning.

HIgh-Dose Gadolinium-enhanced MR study In the evaluation 01 CNS metastases William T. C. Yuh (Presenter). Jack D. Engelken. Michael G. Muhonen. Nina A. Mayr. David J. Fisher; Iowa City, IA

We studied the efficacy of higher doses of gadolinium in the evaluation ofCNS metastases. Twenty-three patients with a clinical suspicion of CNS metastases were prospectively studied with gadoteridol (ProHance®, Squibb Diagnostics), a non ionic, low osmolality contrast agent. Each patient received an initial injection of 0.1 mmollkg gadoteridol. followed 30 minutes later by an additional dose of 0.2 mmollkg. No clinically significant effects were noted. No significant difference in lesion contrast was noted between the images obtained immediately after the initial injection of gadoteridol and those obtained after 10 and 20 minutes. After the additional dose of gadoteridol. however, there was significant improvement in visualization (70171) Needle aspiration biopsy was done in 33 cases. Accurate diagnosis was revealed in 31 cases, hence the significance of this method was 94%. The rate of malignancy in cold solitary nodules was 22%. US and needle aspiration biopsy obtained better results especially when they were combined with the scintiscanning method. Nevertheless it should be remembered that the role of CAT is very important in malignant cases and in cases having suspicious evidence of malignancy.

Uncommmon tumors of the para pharyngeal space, report of three cases J. Barcelo (Presenter), J. Teruel, J. C. Vilanova, J. M. Trull, A. Maroto,

We describe three parapharyngeal space tumors whose origin does not belong to the typical bordering structures (parotid gland, pharynx, pterygoid muscles and the vascular bunch). The first case appeared to be a minor salivary gland monomorphous adenoma. The second one was a squamous cell carcinoma of the epidermis, and the third one a cystic adenoid carcinoma or a minor salivary gland cilindroma. There was no defined border between the parotid gland and the mass in both cases of minor salivary gland tumor. In the other case there was a deep inliltration displacement of the pharynx fat to the inner, making impossible to separate from a parotid gland tumor. Computed tomography (CT) offers a consistently good examination for the involvement of the parapharyngeal spaces, and contributes to predict the origin of the tumor according to the displacement pattern of the bordering fatty planes. Innammatory disease of nose and paranasal sinuses is a common challenge in diagnostic imaging. Conventional radiography (RX) is mostly employed as a first step diagnosis. Alternatively a newly developed technique named computed radiography (CR) can be used: photostimulable phosphor imaging plates are employed with the following advantages: exposure dose reduction, digital conversion of x-ray image information with image processing capabilities, wide exposure and registration range. In this paper a comparison was made among RX, CR, CT and MRI in a series of 56 adult pts., using a craniostat (4 standard projections), a TCR 201 system, a high resolution CT (OM -10° plane, 8-10 slices of 10 mm) and a 0.22 T resistive magnet (multi planar acquisition, 10-12 slices of 10 mm, TI-, PD-and T2-WI). The following aspects were considered: spatial resolution, dosimetry, time consumption, anatomical detail, costs and diagnostic outputs; a global performance index was derived (RX < I, CR -I, MRI = 2.2, CT = 7.3).

CT and, to a greater extent MRI, resulted superior to RX and CR; MRI is the most sensitive technique, while CT is to be proposed as the method of choice when looking also at cost analysis. We are presenting our experience in the study with CT of 20 patients with exophthalmos produced by orbital involvement by periorbital diseases during 18 months. There were 7 mucoceles (3 ethmoidal and 4 frontal), I aspergiliosis, 4 meningiomas, 2 osteomas (I frontal and I ethmoidal), I osteosarcoma, I adenoid cystic carcinoma, I adenocarcinoma, 2 orbital cellulitis and I meningoencephalocele.

Vestibular equeduct dilatation: a still underestimated cause of congenital deafness N. Sellier, C. Maudelonde, M. Gandar, E. Coderc (Presenter); Bondy a) Isolated vestibular aqueduct dilatation is a rare cause of nuctuant hearing loss and vertigo. We report 17 cases of such anomaly. b) The diagnosis is based upon computed tomography on an axial view; the normal aqueduct has a shape of an inverted 'T'.

In one case, MRI discloses the presence of lymphatic nuid in an enlarged vestibular aqueduct and endolymphatic sac. c) According to the different segments of the vestibular aqueduct on CT, one can differentiate several types of aqueduct dilatation: -dilatation of the long limb of the "J" often unilateral (3 cases), -dilatation of the short and long limbs of the "J" (5 cases), -dilatation of the two limbs of the "1" with posterior petrous building corresponding to a large endolymphatic sac (9 cases). These two last types are most often bilateral and the value of MRI must be pointed out.

Comparison of US, CT and MR in the evaluation of malignant uveal melanoma O. QokyOksel (Presenter), U. Korman, G.OgOt, U. Denizci, A. Altug; Istanbul

Malignant uveal melanoma is the most common ocular neoplasm in adults. Those involving ciliary body and choroid are thought to originate from pre-existing nevi. US, CT and MR findings of 9 cases with malignant uveal melanoma were compared. Following enucleation 8 cases were proved pathologically. One of the cases was presumed to be a small malignant melanoma who underwent radioactive implant treatment. All three methods were accurate in determining the location of the tumor. Compared to the other modalities CT was especially effective in detecting the episcleral invasion and evaluating the morphology of the tumor. Ultrasonographic B mode examination revealed typical findings of melanoma, and A mode examination demonstrated the kappa angle which was strongly suggestive in the diagnosis of malignant uveal melanoma. On M R the characteristic TI and T2 shortening of the melanoma was thought to be the result of the paramagnetic effect of melanin.

Thyroid nodule: a comparative study of US versus PAAF and surgery B. Cortina (Presenter), N. Alegre; Madrid

Purpose: We make a retrospective study about the diagnostic reliability of the US in 160 patients which came to our Radiology Service with the diagnosis of thyroid nodule. We compare the US findings with those of punction-aspiration and both with surgical findings. Methods and Materials: We make a statistical analysis comparing the sensitivity and specificity of all methods. Results: Of the 160 cases, 143 was women and 15 men. It was made a citologic diagnosis of papilar carcinoma in 8 cases, folicular carcinoma in I case, folicular proliferation in 30 and proliferation of Hiirtle's cells in 4 cases. We suggest the follow-up of patients with the last two diagnoses.

High resolution CT for the detection of cervical lymph node metastases Stefan Delorme (Presenter), Michael V. Knopp, Hans-Ulrich Kauczor, Friedheim Raue, Heinz Buhr, Gerhard van Kaick; Heidelberg

Purpose: To exhibit the advantage of a CT technique with improved detail resolution in imaging of the cervical region. Methods: 30 patients enrolled in a clinical follow-up-study who had undergone thyreoidectomy and modified neck dissection for medullary thyreoid carcinoma were studied in continuous slices with 4 mm thickness from the mandibula to the carina. The patients received intravenous non-ionic contrast medium at a controlled infusion rate. Imllges were reconstructed with a high resolution algorithm at an average 16 cm field of view. Attenuation values of vessels, lymph nodes, muscles and sonographically suspected metastases were measured and compared to previous studies without contrast medium and with normal technique. All patients were also studied by ultrasound, and concordance of sonographic and CT findings was assessed.

Results: The presented technique enables a significant improvement of contrast between muscular and vascular structures. The improved resolution as well as the optimized contrast enhancement by a controlled infusion technique enables excellent anatomical identification of all structures; lesions as small as 5 mm were reliably identified as adenopathy which could be confirmed by surgical resection. CT was superior to sonography in the deeper sternocleidomastoid region and the lateral cervical region. Sonography proved superior in the para tracheal region and in the jugular and medial retroclavicular region.

The effectiveness of Water's graphies in the Interpretation of paranasal sinus Infections: an analogy with magnetiC resonance imaging Baris Diren, Oguz Dicle (Presenter), Dinc Ozaksoy, Tugrul Pirnar; Izmir

Water's graphy of the parana sal sinuses is one of the most popular conventional techniques used in the routine examinations of sinus pathologies. In recent years Magnetic Resonance Imaging (MRI) brought the most sensitive diagnostic possibilities and became a gold standard in studying the paranasaI sinus abnormalities. In our study, we examined the effectiveness of Water's graphies in the detection of the acute and chronic sinus infections and had some conclusions about the conventional interpretation criterias. With this purpose 100 patients, who were diagnosed to have sinus infections on MRI were subsequently examined with Water's graphies with standard techniques. These radiographs were interpreted by five different radiologists blindly and independently. The results were correlated with MR findings and analyzed with Receive Operating Characteristics (ROC). Despite the high sensitivity of the Water's graphies, the accuracy in detection of the maxillary sinus infections was found as low as 56%. The accuracy rate for frontal and ethmoidal sinuses were even lower. Purpose: Study of the efficacy of sonography for the diagnosis of no-tumoral diseases of the salivary glands. Methods and Materials: Sonography of the parotid and/or submandibular glands was performed in 113 patients with clinical history of salivary pathology. The age of the patients ranged from 13 to 82 years. 46 were female and 67 were male. Histology, follow-up or sialography in other cases were performed as the gold standard. High frequency transducers (5 and 7.5 MHz) were used. The salivary glands on both sides were examined in transverse and longitudinal sections.

Results: Sonography has identified: 40 calculi (33 submandibular and 7 parotid), 15 parotid inflammations, 31 submandibular inflammations, 10 abscesses, 4 fistulas, 12 lymphadenopathy and I hypertrophic masseter. Conclusions: In acute inflammation sonography helps to define abscesses, fistulas or sialectasia, but it is worse to detect chronic inflammation. Sonography is also very useful in salivary calculi in most cases, especially in concrements larger than 2-3 mm and intraglandular location. Diseases of the middle ear and mastoid can be reliably diagnosed and described by CT. Our intention is to demonstrate the high potential of CT in preoperative diagnostics of patients suffering from middle ear pathology by comparison of CT and operative findings. High resolution CT scans with I mm thick slices on SIEMENS Somatom DR were used to examine 22 adult patients. In 10 of them CT examination was followed by surgery. Clinical diagnoses ranged from suspected cholesteatoma to chronic middle ear inflammation with granulations and destruction of small ear bones. Attic cholesteatoma visible on CT scans was found in 6 patients. The smallest one occupied only the epitympani cal recessus while the largest one fulfilled the entire atticoantral space with tympanic cavity and propagated inflammatory process to the temporal cerebral lobe. Granulations were found in all cholesteatoma patients and majority of them had small ear bones destructed. One patient had isolated anvil destruction without cholesteatoma. Surgery confirmed CT visible pathology (granulations, liquid content, adhesions) in operated patients. Surgery planning was influenced by CT images in some patients, particularly in choosing appropriate approach or in prepairing reconstructive surgery for hearing improvement.

Radioiodine therapy of a struma with tracheal stenosis: can a CT study make a contribution to the documentation of the result of the therapy? Jurgen Frohn (Presenter), Volkmar Jacobi, Detlev Rubesam, Gustav Hor; Frankfurt am Main

For patients with a struma and with symptoms of a mechanical displacement of the trachea, radioiodine therapy is generally suggested as an alternative therapy, if the risk of surgery is increased, and if the iodine uptake is sufficiently high. Investigations of the struma reduction therapy with Iodine-131 have shown that an objective assessment of the result of the therapy is difficult. The goal of our study was to determine whether CT studies of these patients can provide additional information for an objective assessment of the result of the therapy. A CT study is able to image the intraluminal and extraluminal structures of the trachea non-invasively and without administration of a contrast medium. Comparability of CT measurements prior to and after radioiodine therapy is, however, impaired by the individual selection of the slices in the scout view. Even investigators with substantial expertise experience deviations of up to several millimeters when trying to reproduce the same slice. Such shifts lead to significant differences in the measurement of the tracheal lumen. For the quantification of the result of the therapy the CT study has, therefore, only limited usefulness. As a complement to the measurement of the circumferential of the neck, the determination of the thyroidal volume, and lung function studies, the CTstudy of the trachea can make a contribution to the documentation ofthe result of the therapy. It can, however, not provide any information which would be additional to a conventional radiograph of the trachea.

Ultrasonographlc volumetry of the thyroid In school children related to the Iodine Intake Judit Gonczi (Presenter), Klara Sajg6, IIdik6 Farkas; Budapest

The purpose of the study was to survey the goiter prevalence in school-children from classes I, 5 and 7 in different areas of Hungary. The capital served as control, the other towns were chosen because of the high goiter incidence, the decreased iodine supplementation. Ultrasonographic volume determinations were correlated to the age and the body weights and compared to the estimated volume results by palpation and inspection. The ultrasonographically measured thyroid volume corresponds to the iodine intake and the urinary iodine excretion. This measurement may prevent the overestimation of goitre prevalence in epidemiological surveys. The effectiveness of prophylaxis will be measured by goitre frequency data after five years.

PET In patients with advanced head and neck cancer: measurement of early metabOliC changes during combined therapy Uwe Haberkorn (Presenter), Ludwig Strauss, Antonia Dimitrakopoulou, Michael Knopp, Eberhard Seiffert, Christoph ReiBer, Wolfgang Maier-Borst; Heidelberg PET using fluorodeoxyglucose (FOG) delivers quantitative data about the glucose uptake and can be used to study therapy induced changes in the tumor metabolism. In 12 patients PET studies were performed prior and after the first cycle with cisplatinum and 5-FU. Tumor and lymph node volumes were determined in CT cross sections and the growth rate was calculated. The images were analysed using a region of interest technique and the data were standardized to the injected dose and the body weight. FOG data were evaluable for 6 tumors and 8 lymph nodes, volumetric data for 5 tumors and 7 lymph nodes. All malignant lesions showed an increased FOG uptake as compared to normal muscle tissue. During therapy 50% had a decrease in FOG uptake, the rest remained unchanged or increased. Multiple lymph nodes in the same patient may show a different baseline value and also a difference in response to therapy. A high correlation between the change in FOG uptake and the growth rate was found with different regression functions for tumors and lymph nodes. These results demonstrate that early changes in tumor uptake due to therapy can be detected with PET. Radiological examinations included panoramic views. detailed images with narrow beam radiography and cross-sectional tomography. Methods: The radiographs were evaluated for bone resorption within the graft and under the plate, changes in graft size. integrity of reconstruction plate and bony union. The authors present a technique oflong-term selective lingual artery catheterization for intraarterial regional chemotherapy. The transtemporal approach enables safe introduction of catheters through the superficial temporal artery. Catheterization technique is presented in 19 patients with the diagnosis of carcinoma baseos oris and carcinoma linguae. Both the lingual arteries were infused simultaneously in four patients with the tumors spreading over the midline. The dislocation of the catheter was found for eight times of twentythree catheterizations. The following catheter reposition was always successful. We want to present two patients with a swelling in the mandibular region on the left side. The clinical course in the two cases was nearly identical: a painful. rapidly growing mass lesion of the left cheek without temperature nor history of trauma. A scan was performed and again the CT appearance was identical in the two cases: the m. masseter was inhomogeneously enlarged with areas of liquid density and only slight infiltration ofthe subcutaneous fat. There were no signs of bone involvement. A biopsy was performed and revealed non-hodgkin lymphoma in one case and myositis in the other case.

Concluding that lymphomatous and inflammatory involvement of the m. masseter cannot be differentiated on imaging grounds.

MA Imaging of supraglottic cancer M. Horvath (Presenter). J. L. Termote. S. F. Lemahieu; Leuven

We wanted to establish the value of MR in the diagnostic work-up of supraglottic cancer. Retrospectively a study was made of 15 patients with supra· glottic carcinoma. CT and MR of these patients were carefully compared with respect to tumor delineation. MR was superior in 7 cases, MR and CT did equally well in 7 cases and in I case MR was inferior (due to motion artifacts). MR was able to delineate the fibrocartilage of the epiglottis, with respect to the tumor. MR showed to a better extent the extension into the base of the tongue and the pre-epiglottic space. Moreover MR was a valuable tool for the follow-up of carcinomata treated with radiotherapy.

Concluding that to us M R is the method of choice for the diagnosis and follow-up of supraglottic cancer.

The technique and advantages of digital subtraction sialography M. O. Cizmeli, E. T. IIgit (Presenter); Ankara

Sialography is a useful investigation in the diagnosis and management of inflammatory and calculous diseases of the parotid and submandibular salivarys glands. Its use for space-occupying lesions of the region is controversial. High contrast between bone and air in the sinuses and pharynx and overlapping structures in the head and neck region impede clear demonstration of the ducts of salivary glands in conventional sialography. Digital Subtraction Sialography (DSS) is an important non-vascular application of digital radiography. High-contrast resolution and advantage of subtraction improves quality in digital imaging of salivary glands. In 62 patients with suspected inflammatory, calculous disease or space occupying lesions. we performed 50 parotid and 16 submandibular DSS. Following the insertion of catheter, 0.5-1 mllipiodol was injected after the acquisition of mask images. Image acquisition rate was I frlsec. for  seconds and pulse width was 50msec. The images were stored in a 512x512x 10 bit memory. Image selection and subtraction, reregistrations. window manipulations and other post-processing facilities were performed. Although the value of sialography has been debated, we think that in comparison to conventional sialography, DSS is a less time-consuming examination with less radiation exposure and superior image quality.

Evaluation of thyroid nodules by CT value Y. Imanishi (Presenter), N. Ehara, K.Sakuyama, T. Itoh, T. Ishikawa, T. Shinagawa, T. YamagUChi, K. Kuroki; Kawasaki

To make a diagnosis of thyroid nodules based on their iodine concentration as measured by CT, thyroidectomy was conducted on 50 thyroid nodules (29 benign nodules, 21 malignant nodules) of 35 patients (32 females, 3 males). Each nodule was pathologically diagnosed. These patients had undergone CT examination of the thyroid without intravenous contrast material before surgery. Iodine concentration in fragments (5-120 mg) of operative thyroid tissues was measured by neutron activation analysis. CT scans were obtained using contiguous 5-mm collimated sections through the thyroid without intravenous contrast material. Correlation between CT value and iodine concentration in thyroid tissues was evaluated. Histograms ofCT values of the nodule in all images were presented by CTcomputer from the region of interest (ROI) along the margin of the nodule. Correlation between iodine concentration and CTvaluewas most nearly expressed as follows:(n = 31), r = 0.96);

Iodine The rare occurrence of an encephalocoele through a defect in the tegmen of the petrous bone is reported. A male, aged 43 years, was referred for investigation following two episodes of meningitis. Neurology examination showed the patient to be lethargic. CT scan of the middle ear showed a soft tissue opacity in the right atticoantral area with evidence of a deficiency of the related tegmen. The other areas of the middle ear and mastoid air cell system suggested a chronic infection or a cholesteatoma. An MRI was performed, confirming the area of dehiscence and suggesting the presence of a small encephalocoele with a signal intensity similar to brain within the cavity. There was an abnormal inflammatory signal intensity in the adjacent mastoid air cells. On surgical exploration a soft pulsating brain mass was noted in the alticoantral region. covered with granulation tissue and thick dura mater. The intraoperative conclusion was that this was an encephalocoele occupying the alticoantral region, having prolapsed through a secondary tegmen dehiscence following a cholesteatoma. The case illustrates the association of this abnormality with recurrent meningitis and the importance of imaging in defining the nature and site of the lesion prior to surgery. Methods: Our clinical studies were performed on a Siemens OPH scanner and reconstruction program 30CT (software), 420 mAs were employed with 120kVp. Each scan time was within 4 seconds on condition with narrow section of 1-2 mm. For each case was used 30 scans. About SOO cases were examined with best image quality. Results: The complexes feature of bony structure were well demonstrated because of reduction of motion and noise artifact. This is due to rapid scanner with well qualified software.

Ultrasonogrephy of the larynx and the vocal cords Orhan Oyar (Presenter), Erkan Sevinc, Nevra Elmas, Hadi (:)zer; Izmir

It is seen that the recent sonographic studies directed towards the evaluation of the larynx. tongue and mouth noor promise great progress in the future. Especially the real time imaging of the vocal cord movements is the main advantage of US. In this study. the normal and pathologic laryngeal cases are examined with a 1.5 MHz. linear. water pad transducer. The vocal cords are tried to be imaged both stationary and during fonation.

The thyroid cartilage is seen as an inversed U or V shaped uninterrupted echogenity in the sections obtained by transverse projections. The false cords have echogenic and the true vocal cords have hypoechogenic internal structures and they are both seen as symmetrical. triangular formations which show pendular movements during fonation. The vocal cord paralysis is detected by the loss of the typical movements and the destruction of the thyroid cartilage is explained by the interruption of the echogenity. In addition to this. especially the larynx carcinomas localised in the supraglottic region. the preepiglottic invasion of the tumor and the attraction of the enviromentallymph nodes can be determined sonographically. Sonography, together with the laryngoscopic methods is applied successfully in the evaluation of the larynx and vocal cords.

V1deofluoroscopy of free jejunal greft reconstruction for vocal rehabilitation Peter Pokieser (Presenter), Wolfgang Schima, Konrad Uranitsch, Matthiius Grasl, Thomas Helbich, Klaus Ehrenberger, Dimiter Tscholakoff; Vienna

Purpose of our study was to evaluate the protective function of free jejunal grafts (Speech Siphons) in laryngectomized patients against aspiration. 23 examinations were performed in 14 patients (2 patients presented clinically with aspiration), 12 patients without aspiration using videolluoroscopy (50 frames/second) and high density barium. Following parameters were evaluated I) Boluspenetration (BP) from the hypopharynx into the graft: a) no penetration b) penetration limited to the ascending limb of the Speech Siphon c) penetration limited to descending limb d) penetration into the trachea 2) The minimal distance from the level of the hypopharyngeal anastomosis to the vertex of the Siphon. Results: I)  patients presented boluspenetration limited to the ascending limb of the Siphon. One had no boluspenetration: I asymptomatic patient and both patients with clinical aspiration had a boluspenetration into the descending limb.

2) The minimal distance was reduced to zero in patients with aspiration as opposed to the patients without aspiration (distance: 20-50 mm). Conclusions: Boluspenetration into the ascending limb is not a pathologic finding. The vertex of the Siphon should not reach the level of the hypopharyngeal anastomosis during swallowing. if so aspiration may occur. In 60 patients with head and neck tumors, lymph nodes involvement was assessed by physical examination, CT and ultrasonography. Positive lymph nodes were detected with palpation in 26 patients (44%) and by CT and ultrasound scans in 34 (56%). Forty positive nodes were identified with S292 physical examination, 61 by CT and 10 by ultrasonography. CT and ultrasound can visualize deep metastatic nodes in the neck, difficult to discover with palpation, more over this cannot evaluate whether or not the jugular vein is truly thrombosed. Ultrasonography allows to distinguish a single enlargement in nodal masses and gives an accurate evaluation of the relations between nodes and vascular structures. CT is of unquestionable value in the study of retropharyngeal nodes, moreover permits to determine the number and position of enlarged nodes and their relation with the neck vessels.

Sialography. usefulness and Images A. Rosendo Gonzalez (Presenter), M. D. Martorano Navas, J. C. Albillos

There are many methods for the radiologic examination of the salivary glands: plain file radiography, conventional sialography, computed tomography, ultrasound, radioscintigraphy and magnetic resonance. A summary of the indications and contraindications of conventional sialography is shown in this poster, and also its usefulness in the diagnosis of the different pathologic conditions which involve the salivary glands: calculi and calcifications; innammatory disorders and infections and tumors and cysts. We conclude. on the basis of our experience and the bibliographic review that, while computed tomography is the method of choice for the examination of mass lesions and bland enlargement of one or several glands, sialography is the optimal method to demonstrate calculi. strictures, sialectasias and fistulas.

Magnetic resonance Imaging of the nasopharynx and the skull base: normal anatomy

Matthias Schutz (Presenter), J. Gaa, H. K. Deininger; Darmstadt

Purpose: Skull base, nasopharynx and related spaces are crossover areas between the extra-and intracranial structures of the head and neck. They are pathways of tumors and innammatory diseases. We analyzed the normal anatomy of the skull base with magnetic resonance (MR) imaging using for a teaching model. Methods and Materials: Head and neck from three healthy volunteers were studied by 1,5 T MR imaging. Tl-weighted images (repetition time = 500 ms. and echo time = 15 ms.) were obtained in axial. coronal and sagittal plains using 5 mm slice thickness. The axial MR images were correlated with wholeorgan sections from a cadaver and with computed tomography (CT). Results: Parapharyngeal space, infratemporal fossa, pterygopalatine fossa, the skull base with its foramina, the cranial nerves and superficial soft tissues are well seen and demonstrated in MR images. The inherent contrast between fat. muscle and bones allows excellent \'isualisation of these anatomic details. Conclusions: MR imaging gives a detailed anatomic view of head and neck. It is an excellent possibility for learning anatomy in different planes.

Evaluation of scintigraphy of the salivary gland by factor analysis In patients receiving radiation therapy for the head and neck Yoshihiro Takeda (Presenter), Kelko Okuno, Tomio Nakagawa, Mitsuharu-Shimizu, Kotaro Yasui, Yoshio Hiraki; Okayama City

Purpose: Evaluation was made of dysfunction of the salivary gland by factor analysis in patients receiving radiation therapy for the head and neck. Methods and Materials: A total of 18 patients who were to receive radiation therapy for the head and neck were taken as subjects. and scintigraphy of the salivary gland was performed on them with 99mTcO. before start and after completion of the radiation therapy. Then, study was made by 2-factor analysis based on two factors -one being physiological component consisting of background such as oral excretion. and the other being salivary gland component. Comparisons were made between values observed before and after radiation therapy of the contribution rate of the salivary gland component and inclination formed by bringing the functional curve of the salivary gland factor into a linear approximation. Results: The contribution rate increased from 26.9% to 34.8% showing a significant difference. while the linear inclination decreased from 2.18 to 1.51 also showing a significant difference. Factor analysis makes it possible to objectively assess the accumulation of99mTc04' Thus, it is useful in evaluation of the functioning of the salivary gland before and after radiation therapy for the head and neck. SPACE !.Z1! Sagittal autotomography on nasopharyngeal cavity to detect tumoura Tan Tjin Joe (Presenter); Medan

There are many nasopharyngeal tumours in Indonesia. For 27 years 8250 patients with malignant tumours were treated in St. Elisabeth Hospital. Out of these unselected patients, we found as the biggest group to be nasopharyngeal tumours (± 19%) and lung tumours were rare (±2%). The diagnosis was made by biopsy only and it wasn't possible to detect tumours neither with conventional tomography nor with CT scanner. An experiment has been carried out using AUTOTOMOGRAPHY, an old principle described by Vallebona in 1930 entitled TRATATO DI STRATI-GRAFIA, which employed the rotational movement of the patient, but utilized both a fixed X-ray tube and film. My experiment has been performed on a fibreglass chair placed on a rotating disc with a fixed verticle axis. The chair can be moved to both sides to place the lesion on the axis. The chair can also be moved in the direction of the X-ray beam for making the different slices of the tomograms. The whole unit can be placed between the table and screen of an ordinary X-ray unit in upright position.

It has been proven that with this small and simple unit, tomograms of all parts of the human body can be made, also sagittal tomograms of the nasopharyngeal cavity to detect tumours and destructions of the base of skull.

The role of CT In clarifying the etiology of chronic sinusitis E. Tanscs (Presenter), T. Hartai; Szeged

We carried out the CT examination of the paranasal sinuses of 25 patients with symptoms of chronic sinusitis. Clarifying the reason of the chronic inn ammati on we studied the so-called "osteomeatal unit" the role of congenital malformations and the after-effects of earlier operations. Patients were examined at the same time by endoscopy according to the same aspects.

Results of the two methods were compared to decide the additional value of CT. Results of findings found during operation were compared to the results of the two above-mentioned diagnostic methods. Our experiences suggest that CT is an essential method in the surgical indication of chronic sinusitis. In recent yrs an increasing interest on neck US and US guided FNA cytology in patients with DTC has been reported. The present study was undertaken to investigate the effective role of US in the follow-up of these pts, comparing US to TBS results. We considered 65 pts previously treated by total thyroidectomy for DTC and with elevated serum Thyroglobulin (Tg) levels (Tg 3 nglml is considered pathologic in our laboratory for these pts). To search metastases (mts), they were studied by means of US, TBS, conventional radiology, CT scan and, in cases with lymph node (LN) Symptomatic TMJ dysfunction may affect about 25% of the adult population with a smaller, but significant percentage of patients suffering serious disability. From 1986 to 1989 102 pts with significant TMJ symptoms and with various TMJ diseases, were evaluated with conventional radiology and cJosedopen-mouth TMJ tomograms: 20 pts were submitted to CT and 5 to MR as well. SPECT and planar imaging were performed in 27 pts with a rotating gamma-camera equipped with a general purpose collimator. Transaxial, coronal, sagittal tomograms were reconstructed. TMJ increased radiotracer localization was regarded as a positive finding, and the intensity of TMJ activity was compared with that of adjacent calvarium using ROIs. Our results indicate that SPECT rather than planar imaging provides useful information for diagnostically difficult, symptomatic pts: CT although useful in assessing the TMJ structure and articular surfaces, is not always a good indicator of dysfunction: MR gives a more detailed image of soft tissue anatomy and may identity functionally significant TMJ abnormalities, but cost limits its application. Either MR or SPECT is suitable for non-invasive confirmation of the TMJ derangement clinical diagnosis, and if better joint diagnostic accuracy is desired both techniques should be employed.

Comparison between malignant lymphoma and anaplestlc carcinoma of the thyroid using 67Ga Imaging, US and CT K. Toshima (Presenter), K. Shimizu, A. Kubo, H. Nagakura, K.ldo, K.lto, T. Shoji; Tokyo

Purpose: Malignant lymphoma and anaplastic carcinoma of the thyroid patients usually have a large goiter which enlarges rapidly in a short period of time. It is difficult to discriminate between them using typical clinical findings.

In this report, we studied the differential diagnosis between malignant lymphoma and anaplastic carcinoma of the thyroid, using 61Ga imaging (61Ga), ultrasonography (US) and computed tomography (CT Interventional radiology is TOutinary in adults but has only recently been introduced in pediatrics and in this age group its common application is in urological pathology. Since 1984, 78 procedures were performed in the Radiology Department of our Hospital using the percutaneous route with echographic and or radioscopic guidance. In 74 cases (94,8%) the procedure was correctly performed while in 4 cases (5,2%) this did not possible succeed: in 3 patients it wasn't possible to place the nephrostomic drain: in one patient the percutaneous dilatation of a stenotic uretherosigmoidostomy was functionally insufficient. Only in 2 cases (2,5%) there were complications (endopyelic bleeding during percutaneous nephrostomy) that resolved spontaneously. Jones; New Orleans, LA Computed radiography using photostimulable phosphor receptors allows dissociation of X-ray dose from film density. This permits diagnostic quality radiographs of the thoracolumbar spine to be obtained with doses as small als 5 to 10% of those required using conventional film screen techniques. When used for serial evaluation, this technique has the potential for significantly reducing the cumulative radiation exposure in young patients followed for observation and treatment of scoliosis. Over 1600 spine examinations in children ranging in age from 4 to 18 years have been performed using low dose techniques with computed radiography over a 5 year period. Records were reviewed to calculate the total savings in radiation burden resulting from the use of low dose techniques and the adequacy of diagnostic image quality in the serial evaluation of scoliosis. Our studies indicate that clinically useful studies can be routinely achieved at average exposure levels of less than 5% of those required for normal radiography, with significant reduction in cumulative dose to bone marrow and breast tissue in patients receiving serial examinations. Low dose computed radiography is recommended as the method of choice for serial evaluation of scoliosis in pediatric patients. 

Imaging procedure is better tolerated (20-30 min. for 4 to 6 runs). Moreover, improved image quality allows precise diagnosis of complex cardiac anomalies and demonstrates very small vascular structures like coronary arteries, pulmonary veins and palliative shunts. Conclusions: MRI with strip scanning and averaging is a very rapid and efficient method for the evaluation of CHD in newborns.

Ultrasound examination of legg-perthes-calve dlseese Herve Leclet (Presenter), Pierre-Marie Oelforge, Christian Morin; Berek sur Mer Ultrasonography is not a common method to study LEGG-PERTHES-CALVE disease (L.P.c.). However it seems to be useful method to appreciate femoral head deformity and to study articular cartilage. Twenty-one patients with LPC were examined prospectively. Ultrasound was compared to anteroposterior and lateral X-Rays andlor arthrography-Femoral head deformities and lateral articular cartilage are well defined. Thickness of femoral cartilage is variable and its echogeneticity is increased. Sub-chondral fracture is visible in the early stage of the disease. We have not observed hip joint effusion during the evolution. Ultrasound cannot appreciate acetabular deformity and thickness of the acetabular cartilage. Metaphyseal cysts and changes in shape of the femoral neck are not visible. We conclude that ultrasonography can perhaps be a useful method to survey the evolution of cartilaginous femoral head deformity but it must not replace arthrography in the preoperative management of LEGG·PERTHES-CALVE disease.

Color Purpose: To study the anatomic and physiologic characteristics of the ductus venosus in a population of normal neonates, and to establish the time curve for ductus closure in this population. Methods and Materials: 56 healthy newborn infants were examined with B-mode, color flow, and duplex Doppler imaging at age 1-2 days. Those with a patent ductus venosus were examined every 3 days thereafter until ductus closure was ascertained, or until age 14 days. Results: The ductus venosus was patent in 100% ofinfants at 1-2 days; in 60% at 6-7 days; 22% at 9-10 days; 7% at 14 days. We present pictorial representation of the ductus with the modalities listed above and graphic representation of the time curve of ductus closure.

The after Gd-DTPA administration. All patients showed gyral contrast enhancement, even when the CT study did not show any. This enhancement allowed to differentiate the leptomeningeal angioma from prominent sulci, that is difficult in T2WSE, and to delineate the full extent of the disease -in I case an affected temporal lobe was not noticed in the CT study. It also permitted to demonstrate the anomalous vessels of the occasionally associated venous angioma. and to differentiate between this venous anomalies and prominent draining veins. The combination ofTI WGE and Gd-DTPA permitted to detect calcifications (GE technique) and patency of the angioma (Gd-DTPA administration). MRI, with T2WSE and TIWGE contrast enhanced, is the imaging modality of choice in the management and follow-up of these patients. CT should be used only if the MRI study is negative, to rule-out characteristic cortical calcifications.

Effectiveness of pneumatic reduction of ileocolic Intussusception In children Intussusception reduction by rectal insuflation of air with manual controlled pressure is a simpler. faster and more successful alternative than the classical hydrostatic enema. A total of 158 therapeutical enemas were performed to \33 patients (16 patients with one or more recurrent episodes). Perforation andlor an important impairment of the children's general condition were the only main contraindication for the reduction attempt. An appropiate-sized (18-20 F) Foley catheter. with 20-25 cc of ballooning into the rectum, is connected to a sphyngomanometer to control the pressure administered (80-120 mm Hg); no previous pharmacologic treatment was used. An almost always sudden small bowel aeration results in reduction success. Up to date 141 successes (89%) with no complications were achieved. In 16% of the patients. following pneumatic reduction, a thickening of the ileocecal valve showing a mUltiple appearance was observed. This fact sometimes results in a differential diagnosis with incomplete reduction; when small bowel aeration is observed, it has always been a sign of complete reduction, no false positive has been found. We have undoubtedly improved the previous success rate at our Hospital with the hydrostatic reduction (79%) as well as we have attained a simpler and faster technique for intussusception reduction in children.

Multlcystlc Twin gestations are at high risk of developing serious complications. When a twin has died in utero thromboplastine like material andlor debris from the died fetus are released to the circulation of the surviving co-twin. This fact may lead to multiple embolic ischemic events. In the central nervous system (CNS) the type and severity of the structural defect which may follow are intimately related to the gestational period when the eNS has been damaged. Four different lesions have been described in the brain including hydranencephaly. ischemic infarcts. multicystic encephalomalacia and porencephaly. We report the wide spectrum of radiological and clinical findings in  cases of twin embolization syndrome with severe neurological involvement including 2 cases with evolutive lesions. CT was available in all our cases and ultrasound in 6 patients. A MR was performed in one patient.

The fetal profile, an aid In the diagnosis of fetal anomalies P. Twining (Presenter); Nottingham

Purpose: In order to assess the significance of the facial abnormalities associated with congenital anomalies, a three year review was made of all fetuses referred for a detailed scan at Queen's Medical Centre. Nottingham. Methods: Detailed scans are usually carried out on fetuses at I g to 20 weeks gestation. A full anatomical assessment is made and in addition where possible transverse, coronal and profile views of the fetal face are obtained. All antenatal scans were reviewed as were pathological specimens and postmortem reports. Results: Facial abnormalities were seen in 20 fetuses. The most common finding was 6 cases of micrognathia and this was present in 4 out of 9 fetuses with Trisomy 18, one case of camptomelic dysplasia and one case of short rib polydactyly syndrome. The most striking appearances were seen in the 6 cases of alobar holoprosencephaly. 5 cases showed facial abnormalities ranging in severity from cyclopia with proboscis. cebocephaly. to hypothelorism, midline clefting and nasal hypoplasia. One case however demonstrated normal facial structures. Facial c1efting was present in 2 cases of Trisomy 13 and one case of Roberts Syndrome. Depression of the nasal bridge was seen in one case of thanatophoric dwarfism and typical facial appearances were seen in the S cases of anencephaly. Conclusions: We feel the visualization of the fetal face is essential in the assessment of intracranial abnormalities and in any situation where a chromosomal abnormality is suspected. It also provides additional information in the assessment of skeletal dysplasias. The poster will be presented in the form of the front page of that well known newspaper The Daily Scanner. The headline will read: "The fetal profile. have you seen these faces 'I" The effects of iotrolan (n = 4) a water soluble non ionic dimer (300 mgl/mL, osmolality 320 mosmol/KgH20) and sodium-meglumine diatrizoate (n = 4) an ionic monomer (300mgl/mL. osmolality 1600 mosmllKgH20) on renal function were studied using the IPRK. The model permits the evaluation of the direct renal effects of contrast media independent of their systemic influences. Kidneys from adult male wistar rats were perfused at constant pressure (lOOmm Hg) in a recirculating system with ISOmL of perfusate based on Krebs-Henselit solution. After a 40 minute equilibration period. the renal functional parameters were measured over 10 minutes control period. 10 mL of the contrast medium was then added to the perfusate reservoir and further measurements were taken during the next 30 minutes experimental period. Both agents induced significant (P<0.05) reduction in glomerular filtration rate (GFR), renal perfusate flow (RPF) and a marked increase in the fractional excretion of albumine (FEAlb In the last years screening programs allowed the recognition of a relatively high percentage of newborns with hypothyroidism that had undergone exposition to or excess of iodine during pregnancy or in the early days of life. The intravenous administration of hydrosoluble contrast media require high quantities of iodine. We studied the thyroid functionality through RIA dosage of T3. T4, 1T4 e TSH in a group of 10 newborns that underwent intravenous pielography (IVP) through injection of 5-7 mmllkg of hydro soluble non ionic contrast media (Iopamidolo).

The evaluation of thyroid function tested at 10 and 30 days from IVP did not show significant changes. According to our experience the administration of non ionic hydrosoluble contrast media in newborns does not yield a block of the thyroid function caused by excess of iodine, which -on the contrary -is a current problem if traditional contrast media are used.

• SPAC E !I1Z

Renal tolerance of loxaglate In patIents wIth chronIc renal failure G. Deray (Presenter). C. Jacquiaux. M. Drobniski. M. C. Jaudon. C. Jacobs; Paris

The aim of the present investigation was to precise the renal tolerance of loxaglate in patients with chronic renal failure. Eight male patients (mean age 55 ± 5 years) with chronic renal insufficiency (glomerular filtration rate less than 60 ml/mn) undergoing diagnostic cardiac catheterization were enrolled in this study. Renal clearance study (inulin and PAH clearances) and enzymuria were carried out one day before and one day after loxaglate administration. The amount of contrast medium which was injected was 167 ± 43 ml. None of the patients experienced any adverse reactions. All the patients had markedly depressed renal clearances values before angiography. Mean serum creatinine. glomerular filtration rate (GFR). effective renal plasma flow (EPRF) and urinary beta-2 microglobulin excretion were unaltered by angiography. Only one patient had an increase in serum creatinine of more than 10% (from 136 to 156 micromoles/l; 1.3 to 1.8 mg/dl) after the procedure with a decrease in GFR from 34 to 27 mllmn. In this patient serum creatinine and glomerular filtration rate normalized within 72 hours. Purpose: To investigate the lung weights and histological changes induced by intravenous administration of ionic and nonionic contrast media in rats. Methods and Materials: A comparative study of non-treated. physiological saline, Diatrizoate, lohexol and loxaglate was carried out using male wister rats. Each contrast medium prepared in solution containing 6 g iodine per kg or corresponding volume of saline was administered at a rate of 1.5 mL per minute. Animals were necropsied 20, 60. and 120 minutes after the administration of contrast media. The lung was removed and weighed. Histological specimens were analyzed for further investigation of microscopic changes. Results: Although the lung weights were significantly increased after intravenous administration of all contrast media. no statistical significance was obtained in each material. Perivascular edema and dilatation of hilar lymph vessels were histologically confirmed in the contrast media groups. There was no statistical significance of perivascular edema gradings in each material. There were well proportional correlation between increased lung weights and perivascular edema gradings and dilatation of hilar lymph vessels gradings. The evaluation of cerebral perfusion by magnetic resonance imaging was impossible until now, because of the very long sequence acquisition time.

The purpose of the present study was to develop a technique for the evaluation of cerebral perfusion with MRI, using technological progresses in the rapid acquisition of sequences (TURBO FLASH) and the original pharmacokinetic properties of a new contrast product, AMI 25 (diffusion strictly limited to the intravascular space, plasmatic epuration by capture by the reticuloendothelial system).

The study was performed in two steps: I. an in vitro study to define the TURBO FLASH T2-weighted sequence and select the doses to be used in vivo.

2. an in vivo study to evaluate the variations in signal intensity of the cerebral parenchyma of the rabbit, after an T.V. bolus injection of super-paramagnetic particles (AMI 25). The signal loss of the cerebral parenchyma due to transit of the contrast medium was determined by the ratio between the measure of R.O.I. and the background noise. A curve of the decrease of the signal over time was performed, using normal rabbits as well as a pathology model of cerebral ischemia, to demonstrate the interest of this technique in the early diagnosis of cerebral ischemia. Infusion of r.c.m. is followed in 4-8% of cases by reactions whose pathogenic mechanism is still not well understood. Recently an involvement of Lt's, biologically active arachidonic acid metabolites in these reactions has been proposed since their biologic activity resembles some of r.c.m. reaction symptoms.

We measured therefore LTD. and peptido-Lt's (LTC.-LTD.-LTE.) levels in 20 subjects undergoing intravenous urography with two different low-osmolarity r.c.m.: ioxaglate (ionic dimer) and iopamidol (non ionic). Lt's levels were measured by radioimmunoassay after silica column nonpolar extraction from plasma. LTB. ieveis(ng/ml) before infusion ofr.c.m. were 1.46 ± 0.37 and 1.31 ±0.30 in patients treated with ioxaglate and iopamidol respectively. Peptido-Lt's pre-infusion levels (ng/ml) were 6.07 ±2.96 and 6.39±2.48. Neither significant variation in LTB. and peptido-Lt's levels nor evidence of their biologic activity (leukopenia or change in blood pressure) was observed I-S-IS minutes after r.c.m. infusion. Three ioxaglate-treated subjects mildly reacted to infusion (urticaria, nausea, vomiting) without any significant modification of LTs levels. We conclude therefore that Lt's are not released during r.c.m. infusion and are not responsible of reactions to contrast agents. The effect of intrauterine injection of meglumine-sodium-diatrizoate-60% on ECO was studied during routine hysterosalpingography (HSO) in 28 young healthy women. 12 Lead computerized ECO was recorded at baseline, during instrumentation, immediately after intrauterine injection of up to 20 cc of contrast medium (CM) and 2-3 minutes thereafter (late phase). In order to rule out a mechanical dilatatory effect of the CM, up to 20 cc of saline were injected prior to CM in 10 women, serving as a control group. The most important single finding observed was significant QTc prolongation in 2S (90%) out of the 28 women examined. QTc increased from 417± 18 msec to 4S1 ±30 msec (P<O,OOI). This effect disappeared within 2-3 minutes. QTc returning to the baseline values (414 ± 18 msec). The QTc did not change significantly after saline injection (418 ± 18 msec). The mechanism causing the QTc prolongation is unclear. Anxiety is obviously not the cause as QTc changed only during CM injection. Dilatation of the uterine cavity was ruled out due to the fact that saline injection did not cause the same effect. A plausible explanation may be the local endometrial effect with neuro-vegetative reaction.

A multlcentre study of Omnlpaque® In urography, comparing plastic (polypropene) containers to glass vials The purpose of the trial was to compare the general tolerance of iohexol (Omnipaque8) 3S0 mg Ilml filled in polypropene containers and in routinely used glass vials by recording adverse events before. during and up to one hour after injection. Allergy like reactions (coughing. sneezing, nausea, vomiting, urticaria and itching) were especially focused upon. The trial was designed as a randomized double-blind parallel multicentre trial performed in 6 hospitals, representing 4 countries. Premedication, known hypersensitivity and use of compression was recorded. Patients with known previous serious reactions to contrast media were not included. Patients in the Norwegian and English hospitals received SO ml and patients in the Belgian and French hospitals received 100 ml of contrast medium. Totally 1482 patients were included. Fourteen of 740 patients in the polypropene group (1.9%) and 15 of the 742 patients in the glass vial group (2.0%) had allergy like reactions with no difference between the centres. No difference was found in the frequency of allergy like reactions between the groups compared. Neither was a difference found in the frequency of adverse events in general. We thus conclude that polypropene is suitable as a container material for Omnipaque<PI.

The pharmacodynamics of the vascular MR contrast agent Gd-DTPA Polylyslne In the rabbit and the rat P. Van Hecke (Presenter We report about a 40 year old patient who presented with febril temperature and left sided hemiparesis. In the history there was a lung resection because of tuberculosis 20 years ago. One of the diagnostic examinations was the MR-tomography of the brain. Supra-and infratentorial multiple circular lesion with central necrosis, perifocal edema and marginal contrast enhancement were seen. The histological result of the stereotactic biopsy represented a granulomatosis inflammation with central necrotic areas. There was no sign for metastasic genesis or other inflammations. Under tuberculostatic therapy there was a good regression of the radiological and clinical findings. Therefore retrospectively the diagnosis of cerebral tuberculosis is verified. This case does not agree with the well known manifestation of cerebral tuberculosis. MR-images demonstrate very clearly the exact location of the lesions and their regression after therapy. Ten patients with cystic pancreatic neoplasms, were explored on MR! after US and CT examination. Several criterias as signal intensity modifications of morphologic aspects were studied. for expose specific findings. These examinations were performed on a low field magnet in 4 ca.~es. and on a high field magnet· in 6 cases, with transversal slices on these lesions in TI and T2 sequences. Those patients had serous cystadenomas in 3 cases, and mucinous tumors in 4 cases, but cystadenocarcinomas in 3 other cases. MRI allowed only measurements of these cysts and particularly their size, number, and also the thickness of their septas. However signal intensity, neither homogeneity of these cysts, were at all specific of a kind of tumor, or even different of some pancreatic pseudocyst. Diagnosis was essentially based on morphologic criterias well known, such as more than 6 lesions of less than 2 em for serous cystadenomas, and as less than 6 cysts of more than 2 cm for mucinous lesions. This study showed also, that signal modifications on MRI in TI and T2 sequences are not specific, and not sufficient for differentiated histologic type of cystic pancreatic tumors. Spontaneous regression of disk herniation in the lumbar spine has already been described as well as reduction or disappearance of acute back pain or sciatica after conservative treatment. None correlated on follow-up studies disk herniation evolution to clinical course of the disease. Moreover there are not series of patients followed after the radiological diagnosis of disk herniation large enough to assess a possible statistical analysis about the natural evolution of this disease. In the course of 1116 MR examinations performed in our Institution in the past three years the diagnosis of disk herniation was made in 286; out of these, 81 underwent the follow-up MR, performed 6to 15 months after the first one. A volumetric evaluation of disk herniation was performed on sagittal and axial planes. Based on the modification of the volumetric values obtained in the two MRs we classified the patients in 4 groups. The clinical evaluation was performed using a method stated by Pearce and Moll. Our data showed a high incidence of regression of herniated material (63%), a low incidence of progression (8%) and a tight correlation between morphologic and clinical findings. SPACE lID. is represented by a curve which is an estimate of the underlying physiological function, a factor image which is the associated spatial distribution and a contribution which quantifies the relative importance. The 13 processed studies include 3 examinations from patients with transplant rejection histologically proved. Preliminary findings correlate positively with biological results and renal biopsy. Conclusions: DMRI sequences FADS processing automatically extracts objective features (cortical, medullary, excretory factors) enabling to evaluate the renal cortex and medulla function.

Focel fatty Inflltretlon of the liver mimicking metastatic disease: velue of MRI Magnetic resonance imaging and magnetic resonance spectroscopy are very important and promising techniques in biomedical applications. All the instruments developed so far (especially MR tomographs) are very sophisticated and expensive. In addition, very often they are work.ing like a "black box" for the clinical user. A simple, low cost NMR spectrometer and MR imager was developed. It includes a permanent magnet and a data acquisition system. In order to allow MR imaging, a gradient system is added, that can generate a linear magnetic gradient. The data acquisition unit has all the performances of a digital oscilloscope and can also communicate with an external computer. This communication allows the projection of live NMR signals of basic and imaging experiments on a large screen using a digital LCD overhead projector. Small MR imager and spectrometer allows the demonstration and practising of NMR techniques without occupying expensive professional NMR spectrometers and MR imagers for teaching purposes.

Longterm quality control of MR Imager/spectrometer G. Gomiscek (Presenter), H. Imhof, E. Moser; Vienna

Magnetic resonance imaging and spectroscopy became a powerful tool in modern medicine. However, the performance of this very complex diagnostic method is strongly depending on the machine optimization, hence on the quality control measurements. The EC test objects (COMAC-BME 11.1.3) were used in order to check the quality of MR tomograph. The test measurements were performed each year after its installation. The first quality control discovered some failures which could be repaired and they did not repeat any more. It also showed a good quality of the instrument. Although the quality control measurements in the following two years confirmed its good performance, they also indicated some minor deviations from its initial status.

Our results show that these manufacturer independant quality control measurements are an additional guarantee for the optimal performance of the MR tomograph. MR-Angiography in the thorax is disturbed by motion artifacts (breathing, pulsation) and is thought to be of insufficient sensitivity.

Using the time-of-flight technique (1.5 Tesla Siemens Magnetom SP) sequence parameters were optimized for detection of intrapulmonary blood now. FLASH-2D gradient echo sequences with sequential scan acquisition (TR 30 msec, TE 10 msec, FA 30·, I Ac) in a 10-second breath-hold period revealed to be most sensitive. Optimal slice thickness was found to be 5 mm with I mm overlap (matrix of256 x 256 with oversampling, FOV 400 mm). Frontal orientation results in the best overall contrast allowing the best delineation of the pulmonary trunk. Sagittal or oblique orientations are mandatory for hilar regions. Parallel travelling presaturation pulses in oblique orientation enable selective detection of pulmonary arteries and veins, whereas transverse presaturation avoids overlap of different vessels, making anatomical identification easier. An automized control procedure with instant image and individual continuation allows patient-monitoring and guarantees high quality angiograms. In MIP-postprocessing box size reduction and slice selection are used to create angiograms of interest (AOI) ensuring confident anatomical identification without overlap from neighbouring vascular structures. This technique allows display of the mediastinal vessels, the hilar arteries and veins as well as the more peripheral intrapulmonary and intercostal vascular structures. This excellent delineation and identification of vessels will be the base of successful application of MR-angiography in the thorax.

Erdhelm-Chester disease Purpose: Hematopoietic hyperplasia is a frequent finding on MR imaging of the knee. We investigated the magnitude of the different relaxation processes such as chemical shift effects and inhomogeneous magnetic susceptibility contributing to the red-yellow marrow contrast on gradient-echo images. Methods: MR imaging (1.5 T, GE Signa) was performed in 4 patients with known hematopoietic hyperplasia of the knee. Spinecho images were acquired with TR = 600 msec and TE = 20 msec. Gradient-echo (GRE) images were obtained with TR = 250 msec and 9 = 90· , TE was increased from 10-21 msec at I msec increments. Water-suppressed and fat-suppressed GRE images were generated with the same parameters using chemically selective presaturation pulses. Results: Red-yellow marrow contrast on out-of-phase ORE images may be related to chemical shift effects or intracellular iron in hematopoietic marrow causing inhomogeneous magnetic susceptibility and intravoxel static field variation. Signal intensities of red and yellow marrow demonstrated an oscillating pattern with increasing TE on GRE images. Red-yellow marrow contrast was minimal on in-phase images (TE = 9, 14, 18 msec); it was maximal on out-of-phase images (TE = 7, II, 16msec). When the fat or water component were suppressed, red-yellow marrow contrast was not greater on out-of-phase ORE images than on in-phase ORE or spinecho images. Conclusions: Improved red-yellow marrow contrast on out-or-phase gradient-echo M R images is primarily related to chemical shift effects resulting from the different fat and water content of hematopoietic and fatty marrow. Out-of-phase ORE imaging may be used to monitor distribution of hematopoietic marrow as a function of age and erytrocyte demand. Magnetic resonance imaging and computerized tomography was performed in ten patients with obstructive sleep apnea syndrome proved by polysomnography. Computerized tomography have been established method for presenting oropharyngeal airway narrowing, which affects overweight men with hystory of loud snoring and disrupted sleep. The purpose of the study was to compare CT and MR transaxial slices in defining the degree of airway narrowing. Computerized tomography, and magnetic resonance imaging (ultra-low field) was performed in ten patients (6 males. 43 females, mean age 45, 13) with obstructive sleep apnea syndrome proved by polysomnographic data and patient's history. Cross-sectional area measurements of the narrowest part of airway in the oropharynx was made by drawing a region of interest on transaxial CT and MR slices. Results were expressed in square centimeters, and comparison of two methods discussed. The introduction of MRI in the evaluation of fetus is a recent achievement, with special interest in the evaluation of the Central Nervous System and its malformations. We consider this technique valuable not only in the morphological evaluation of the different cerebral structures, but in its capacity to certain the process of maturation and the distribution of myelin. To discuss about the possible clinical usefulness of these findings and its possible advantages with regard to the other nuclei that have been used for renal spectroscopy investigation, basically lip. Methods: 40 rat kidneys were used in these experiments: normoxic (10) and ischemic by vascular occlusion for 2' (10), 45' (10) and 60' (10). The Kidneys were exposed through a ventral incision, removed and minced in perchloric acid, homogenized and centrifuged. The supernatant was lyophilized and reconstitued in 0'5 ml of D20. NMR spectra were obtained by presaturation using a Brucker AM-300 spectrometer tuned to 297,85 MHz for protons. Purpose: The diagnosis of local recurrencies in the small pelvis with conventional diagnostic procedures may be difficult, especially the differentiation between recurrencies and scars. The study presents preliminary results with dynamic MRI after Lv. Gd-DTPA. Methods and Materials: 12 patients (53-79 years) were examined (15 examinations). There were 7 recurrencies and 5 scars (histologically proven). The primary diagnosis were carcinoma of the rectum (1), urethra (I), endometrium (4), ovary (3) and cervix (3). Contrast medium Gd-DTPA Lv. 2 mlliO kg/BW. Signal intensities (SI) were determined and measured before and after Gadolinium injection. The differences were calculated in relation to the precontrast value. The signal intensities were measured every minute till 7 minutes. As reference tissues we used fat and muscle. Results: Recurrencies showed a statistically higher enhancement after the injection of contrast medium in contrary to scars, fat and muscle ( Purpose: Cervical carcinoma is classified by FIGO criteria as stage IA when the stromal invasion is limited to 5 mm or less and as stage IB when the invasion is more than 5 mm. Conization is possible in stage IA; hysterectomy is mandatory in stage lB. Purpose of this study is the evaluation of 0.5 T MRI sensitivity in staging early cervical carcinoma. Methods: 12 patients with clinically small uterine cervical carcinoma have been studied with 0.5 T MRI; the surgical specimens were evaluated (FIGO criteria). Results: Pathologic examination indicated stage IA carcinoma in 5 patients and stage IB in 7 patients. MRI correctly staged 2 patients with IA cancer (40%) and 6 patients with IB disease (85.7%). 3 patients were overstaged and I patient understaged. The pathologic examination of the specimens of the patients who were overstaged showed the presence of dilated cervical glands that mimicked neoplasia in T2W sequences. In the evaluation of stage IA/IB uterine cervical cancer MRI had sensitivity = 85%, specificity = 40%, positive predictive value = 66% and negative predictive value = 40%. Conclusions: Low specificity and low negative predictive value limit the usefulness of MRI in the evaluation of uterine cervical carcinoma FIGO stage I.

MAl characterization of hydatid cysts Walther von Sinner (Presenter), Lambertus te Strake; Riyadh Twenty (20) patients with hydatid disease were examined (liver/abdomen n = 12, lungs/ chest n = 3, heart n = 3. brain n = I, bone n = I). Local magnetic field inhomogeneities induced by paramagnetic contrast agents applied as a bolus lead to a transient signal loss in T2* weighted gradient echo images while the bolus is passing through the tissue. This loss of signal intensity is correlated to the regional tissue perfusion. In our prospective study 30 patients (15 with no cerebrovascular disease, 15 with vascular stenosis brain infarctions or cerebral neoplasms) were examined. The goal of our study was to examine whether this method leads to clinically relevant results concerning local brain perfusion. We have applied a series of fast T2* weighted gradient echo images (2.9 sec/image) during and after bolus application of GdDTPA. From this series of images the local changes in the signal intensity were computed pixel by pixel. From these data a perfusion image was calculated. These perfusion images show significant perfusion differences between white and grey mailer. Regions of cerebral infarctions can be clearly identified as regions with lower perfusion. This method provides information about cerebral blood flow dynamics not available from conventional MR imaging. Personal computer as a low-cost Image workstation of MRI Soren Bondestam, Veli-Pekka Poutanen, Carl-Gustaf Standertskjold-Nordenstam (Presenter); Helsinki

Purpose: The aim of the project was to retrieve MRI images from Siemens Magnetom I Tto an Apple Macintosh IIci using commercial programs without using expertise or programming. Methods and Materials: A Macintosh llci with 8 bit display was linked to the Digital Micro Vax ([ of the Magnetom using Ethernet. The terminal program was a freely distributed demo from Thursby Software Systems. Inc (TSSnet v. 2.0). Images were converted and displayed using Explorerv. 0.9b (UCLA). The uncompiled version of the program was decoded using THINK C. Results: The images were copied to the Macintosh within 5 seconds per image. The source code of the Explorer program's pict I/O file included a 12 bit image conversion, which was activated instead of the 8 bit routine. Explorer enables ROI functions with histogram and saving. The savings are readily opened in spreadsheet or statistical programs for further analysis. Image mathematics are easily done, i.e. subtraction. Compared to dedicated workstations this system was very cost effective. Personal computer costs: hardware $ '" 5300, software $263. Purpose: Teleradiology systems provide for radiographic service to remote sites and under served areas. Our Department has implemented and is operating a wide area network with dial-up communications for transmitting radiologic image data. Two army base sites are operational on the Teleradiology system. This exhibit analyzes our teleradiology system components and our clinical experiences. Methods and Materials: Our teleradiology system uses fiber optics for the long-haul carrier portion ofthe wide area network. The local carrier portion of the connection into the two Army hospitals is a mixture of fiber optic cables and coaxial wire cables. The transmission service is a dial-up, selectable multiple of switched 56 k bit/second links (N x 56 k bit/second lines). The user selects the data rate to be used and is charged only for usage time. Data transmission is parallel over the switched 56 k bit/second lines at $ 0.06 per minute per switched line. A laser film digitizer is used at each site and a laser film printer and an interactive gray scale display is used at our Department. Results: The transmitted 2K x 2K x 12 bit radiologic images are all very diagnostic. An evaluation of six months of operation will be presented.

m Education (14) SPACE ~ Sonographlc Imago artifacts Beatrice L. Madrazo (Presenter), Ali Shirkhoda, Lance Hefner; Royal Oak, MI Imaging methods are fraught with artifacts that are frequently seen within the field of view. In diagnostic US, artifact can simulare disease, and therefore their recognition is essential, to avoid misdiagnosis. This exhibit will be illustrated with a variety of image artifacts, such as reverberations, duplication mirror images, comet tail, acoustic shadowing, acoustic enhancement, refraction, side lobes, slice thickness, and tissue velocity. Doppler artifacts, for both duplex and color Doppler techniques, such as aliasing, tissue vibrations and mirror images, will also be included. Each artifact will be illustrated with clinical examples as well as an explanation of the underlying physical principles.

m Technical developments (15) SPACE 1790

Omnlpaque filled In plastic bottles -pharmaceutical development Lisbeth Aanstad (Presenter), Bodil Weng; Oslo

The purpose of this work was to develop a plastic bottle of 50 ml for Nycomed's X-ray contrast media Omnipaque 300 and 350 mgl/ml. To achieve a high quality sterile plastic bottle, we decided to choose an aseptic blow, fill and seal method, the Bottelpack'" method, developed by Rommelag AG in Switzerland.

To ensure an autoclaved sterile bottle we decided to use polypropylene as plastic material. Polypropylene is an inert plastic material, practically free S304 from additives. Migration tests have been performed to ensure that no extractables migrate from the plastic material into the contrast media. The product has been tested on toxicity, both initially and after storage at elevated temperature. Thermal stability tests have been performed to ensure a long shelf life of the product. One of the main items of our development work was to achieve a user-friendly bottle with a design corresponding to the users demands. To get information about the demands we performed a marked research in France, England and Sweden. A survey of the production method, the conclusions from the market research and the results from the stability study will be presented in the poster.

3D-reconstruction and volume measurement of operation defects deformations of the ventricles by 2D-magnetlc resonance tomography K. Bootsveld (Presenter), B. Siewert, F. Triiber, W. A. Kaiser, M. Reiser, C. E. Elger; Bonn

Purpose: For the evaluation of operation defects due to surgical treatment of epilepsy an exact localisation and measurement of the volume of the defects is necessary. Furthermore, changes of the ventricle shape depending on time and therapyfollow up must be exactly analyzed. Methods: 2D-Gradient-Echo-Sequences (Fast Field Echo; TR 2000 ms, TE 45 ms, Flip angle 90 degrees) and 2D·Spinecho-Sequences (TR 3000 ms, TE 20,90 ms) were applied in a slice thickness below 3 mm in the investigation of 31 patients (22 surgical treatment of epilepsy, 9 congenital or acquired deformations of the ventricles). The reconstruction of these thin slices allowed a 3D· presentation of the brain or ventricles. Results: The reconstructed images allow an exact volumetric measurement of the defects and the ventricles and a precise delineation of the surgical resection borders.

Conclusions: The reconstructed 3D-images allow the exact analysis of operation defects and malformations of the ventricles and their relation to other brain structures. E.g. in the interpretation of the surgical treatment of temporal lobe epilepsy this method can be recommended. We report our experience about the use of Computerized Tomography (CT) imaging reformation programs in the clinical practice. Especially we emphasise the possibility to correct the image according to anatomical axes that is normally impossible with simple CT axial scans. We considered especially the application of continuous reformation that uses a single reference reformation image to create single or multiple reformation images along parallel planes to correct the parallelism between axial plane and intervertebral disk space in accentuated scoliosis or lumbar hyper-lordosis with optimum reconstruction of spaces and better visualization of herniated disk. The same program proved to be valuable in reconstructing from a regular axial scan sequence of the skull the complete sequence with correct inclination for tempera I lobe without excessive image degradation. We also studied the application of oblique reformation software that uses two member images to create a single or a multiple oblique image reformatted along parallel plaines. The program proved to be useful in the bronchial tree examination with better stenosis visualization and improved spatial appreciation of peri-bronchial lesions.

In conclusion modern CT reformation software programs with low or absent image degradation enable the use of plaines different from the normal axial CT plaines with anatomical angles correction and better lesion visualization.

Digital fluorography versus conventional radiography: comparison of diagnosis efficiency, film saving and radiation exposure J. Drouillard (Presenter), F. Laurent, V. Lafarge, G. de Verbizier, B. Houang,

The aim of the study was to compare image quality, film consumption and delivered radiation dose between digital spot imaging (DSI) and conventional cassette films. A prospective randomized study of 180 patients was conducted comparing DSI studies (92) and cassette films (88) obtained from the same remotecontrolled X-ray stand and a 14, 10,6.5 in image intensifier. A strict protocol was followed in gastro-intestinal studies (16), venographies (32), lumbar myelograms (10) and genito-urinary studies (72). Criteria of evaluation included diagnostic efficiency, film saving and delivered radiation dose.

In all cases imaging quality was sufficient for the diagnosis. The gain in film cost with DSI varied from 30% (hysterographies) to 72% (IVU). With DSI the delivered radiation dose was lower and the gain varied from 32% for small bowel examinations to 66% for IVU and 69% for esophagograms including swallowing evaluation. The experience obtained over two years of working with digital fluorography and our randomized study had led us to confirm the diagnosis efficiency, financial economy and reduction in radiation exposure obtainable with the DSI system.

Three-dimensional mapping of lithotripsy shock waves Timothy J. Hall (Presenter), Michael F.lnsana, Nannette M. Soller, Stanton J. Rosenthal, Samuel J. Dwyer III.; Kansas City, KS Purpose: A previous study has shown that the presence of a rippled fat-mimicking layer significantly distorts the shock wave pressure distribution in the focal plane of an extracorporeal shock wave Iithotripter. Methods and Materials: The use of a novel, very durable hydrophone will allow mapping the pressure distribution in three dimensions. A three dimensional pressure map will give a more complete description of the effects of wave front distortion (phase aberration) on stone breakage and tissue damage in ESWL treatments. Results: Comparisons of pressure maps both with and without aberrating layers will be included. Performance characteristics of this hydrophone will also be described.

Diagnosis of fractures using the digital storage phosphor system H. M. Klein (Presenter), B. Wein, A. Stargardt, R. W. Gunther; Aachen

Conventional screen-film radiographs were compared with storage phosphor images concerning diagnostic performance in traumatologic radiography. We used an image pool of 106 radiographs including 50 conventionally and 56 digitally produced images. The images were reviewed by four experienced radiologists. Detectability of fractures was coded in a five-point scale of confidence and analysed by ROC-statistics. Furthermore the image quality and the optical density were compared. Digital images are superior under difficult exposure conditions and offer advantages by additional image processing and documentation. For some indications (follow-up, functional examinations), reduced x-ray exposure is tolerable. The detectability of subtle lesions, which is essential for the primary diagnosis of fractures was significantly better by conventional radiography.

Clinical evaluation of a 100-mm film digitizer and image processor for film archiving Michio Kono (Presenter). Katsuhito Yamasaki. Eiichiro Itouji, Shuji Adachi, Masahiko Kusumoto. Eiro Sakai; Kobe

Purpose: The Japanese law recommended the use of 100-mm roll-film fluoroscopic radiograph for mass screening. Therefore we developed a roll-film digitizer and image processor and evaluated its effectiveness. Methods and Materials: This system is a prototype roll-film image digitizing system (Hitachi Medical Corporation) that consists of a laser scan digitizer, a high-speed image processing unit, and an optical disk drive or optical disk library. The contrast and spatial resolution of digitized IOO-mm fluoroscopic radiographs displayed on a CRT were evaluated experimentally with use of a Burger phantom and a Hewlett chart. Modulation transfer function characteristics were studied to assess the quality of the CRT Image. Results: This system was used for routine mass screening of 5.000 cases for lung cancer. These 100-mm fluoroscopic radiographs of the chest from mass screening for lung cancer were digitized with a lOO-j.Lm pixel size and 12-bit gray-scale resolution. Radiologists evaluated the digitized images as displayed on a CRT. The diagnostic accuracy of this system was compared with that of conventional 100-mm fluoroscopic radiographs and was found to be better. Conclusions: The IOO-mm roll-film digitizer and the image processor are useful as a miniature picture archiving and communication system for the mass screening of patients with lung cancer.

Phosphor plata imaging: exposure reduction Norman L. Martin (Presenter), Larry T. Cook. Samuel J. Dwyer III .• Michael F.lnsana. A. W. Templeton, Timothy J. Hall; Kansas City. KS Purpose: The diagnostic accuracy of a photostimulable phosphor imaging plate system with interactive workstation was studied using a 25 percent and 50 percent exposure reduction. Methods and Materials: Dose reduction was accomplished using constant kVp and a 25 percent and 50 percent decrease in mAs. Anatomical phantoms, thirty conventional and phosphor plate, and manipulated chest, cervical spine, breast, and extremity examinations have heen compared. Digital plate images were archived on an optical disc and displayed/manipulated on the interactive workstation. Laser printed film images were generated from both the digital plates and the workstation. Results: This study demonstrates equivalent results for 25 percent and 50 percent dose reduction. The impact of dose reduction on image manipulation and quality is presented.

Sonogrephlc diagnosis of hepatosplenlc tuberculosis G. Pia (Presenter), L. Pascalis. G. Aresu; Cagliari 30 patients (20 females and 10 males) between 25 and 50 years of age with hepatic and/or splenic localization of tubercular disease, were studied with ultrasonography. Previously a form of pulmonary tuberculosis had been diagnosed in these patients. All of them were subjected to CTscan: 5 to hepatic angiography and 20 to percutaneous biopsy of the liver under ultrasound guidance. In 25 subjects ultrasonography evidenced a nodular formation restricted to the liver whereas in the other 5 patients, besides at hepatic level, lesions were also present in the spleen. These formations were roundish with a diameter varying from 5 to 7 cm and presented a hyperechoic central area and a peripheral hypoechoic halo. Liver biopsy of the lesions under ultrasound guidance made it possible to evidence fact of innammatory cells and more specific epithelioid cells in caseous necrotizing areas. Ziehl coloration revealed the presence of alcohol acid resistant bacilli. Treatment was started with Ethambutol 800 mg/day, Pyridoxine 500 mg/day and INH 200mg/day and was protracted from a minimum of 6 months to a maximum of 10 months. Patients rapidly improved and after a period of 5 to 9 months from the beginning of treatment, the ultrasonic and tomographic values returned to normal. Our results allow us to affirm that the hepatosplenic localization of tubercular disease is all but rare and must therefore be considered in differential diagnosis of space occupying lesions, at a hepatic as well as at renal levels, in the same way as other pathologies such as neoplasia, parasitic cysts etc .. According to our data it is also possible to affirm that with adequate medical therapy the prognosis of these patients is good.

Vocal Input computer assisted reporting Gianni Saguatti (Presenter). Marco Miceli; Bologna

Vocal input computer assisted reporting provides immediately to draft, verify and deliver a radiological report.

In the Radiology Department of Maggiore Hospital in Bologna a system with different items has been tested: PC Philips 386; 12 Mb RAM memory; 160 Mb hard disk; VGA colour monitor; board; 1.2 Mb, 5" drive; mathematical co-processor; Kurzweil vocal digitization file; Kurzweil microphone; Kurzweil software application; 136 columns, 280 cps printer; MS-DOS software.

The system provides a real time answer, 15000 words vocabulary, 15 minutes user's training, structured phrases utilization and free text interpolation, statistical elaboration possibilities on memorized reports. Reviewing 2000 traditional draft reports a 4000 words vocabulary has been composed. However 6-7000 words are considered enough to satisfy all radiological reporting need. At present this system has not more than 5% margin of mistake, which is considered fully acceptable.

Moreover the system will soon be provided with RIS and PACS interface.

Ell Radiotherapy (16) SPACE 1800

Novel endogenous a-particle radiotherapy for undifferentiated thyroid cancer I. Brown (Presenter); Cambridge

Undifferentiated thyroid cancer has a poor prognosis; regardless of therapy, median survival barely exceeds 6 months. Such tumours rarely concentrate radioiodine to an extent sufficient for therapeutic application. Astatine (At), the highest radiohalogen, though more amphoteric than iodine, exhibits some similar physio-chemical properties; it concentrates in normal thyroid tissue to a significant degree. Though the in vivo metabolism ofastatine in thyroid tissue is not entirely dissimilar from that of iodide, a precise intracellular biochemical mechanism has not yet been fully elucidated. 211 At is most suited for therapeutic purposes as it decays by a-emissions of mean LET near optimal for radiotherapeutic effects. In order to exploit both its unique biochemical behaviour and nuclear properties, 211 At has been investigated as a potential S305 a-endoradiotherapeutic agent in a human thyroid tumour xenograft model in nude mice. Biodistribution and a-autoradiographic studies were carried out in euthyroid male MFI nu/nu mice, each bearing a single s.c. implanted human undifferentiated thyroid carcinoma. Mice received a single i.v. injection of 370-740 kBq Na 211 At and were sacrificed at intervals over 48 h. The uptake of 211At into thyroid carcinoma xenografts was rapid, and sustained. A significant degree of 211At localization (11-28% injected dose 211At/g tumour) was achieved in 6/8 anaplastic and 2/2 undifferentiated follicular thyroid carcinomata. 211At was found to be homogeneously distributed within malignant cellular areas, with few a-tracks originating from stroma. None of these tumours concentrated radioiodine. Radiodosimetric calculations suggest that a tumoricidal high-LET quality radiation dose can be delivered to such tumours by endogeneously targeted 21 lAt.

Non-Invasive control of the hyperthermia of tumors xenotransplanted Into nude mice G. Bruggmoser (Presenter), W. Hinkelbein, R. Saum; Freiburg a) Development and testing of a 4-channel-hyperthermia-system for the treatment of human tumors xenotransplanted into nude mice.

b) The tumors are heated by microwaves at 2.45 GHz. The treatment is controlled by a microwave radiometer at 3 GHz. The whole system is steered by a computer with individually adapted software. c) By phantom-measurements and in-vivo hyperthermia we could demonstrate, that the treatments can be monitored reliably by non-invasive measurements. d) Based on this development the effect of hyperthermia to different tumors, dependent on the temperature and the fractionation scheme can be evaluated.

Use of perloperatlve or split course Interstitial brachytherapy techniques for salvage Irradiation of Isolated local recurrences (ILR) after conservative management of breast cancer P. Brunei (Presenter). C. Rozec, C. Maulard, L. Ucla, S. Delanian, J. Huart,

Treatment of ILR after conservative management for breast cancer is mastectomy. When surgery is contra-indicated or refused brachytherapy may be an alternative. From 01/1979 to 06/1990. we treated 40 pts with ILR of 0,5 to 8,5 cm (mean T -3,5 cm), 13 were distant from the primary tumor site. Four ILR (mean T = 4 cm) were treated by classical interstitial brachytherapy (CIB) to 60 Gy, II ILR (mean T = 2.5 cm) by tumorectomy and perioperative interstitial implants (PIB) of 30-35 Gy, 25 ILR LA (mean T = 4cm) by split course implants (SCIB) of 35 and 30 Gy at a I month interval with a source shift. Complete tumor regression was obtained in all patients. Eight (20%) pts developed second LR: (1/4 CIB. 3/1 I 32% PIB. 4125 16% SCIB). 7 had associated distant metastases. 3/4 mastectomies performed after treatment revealed no tumor. The overall 5 years survival was 69%. Two patients developed local complications: skin necrosis which was associated with recurrent tumor in I case. Cosmetic results in controlled patients were: no trace = 4, acceptable sequelae = 9, unaesthetic results = 14 cases, unknown = 3.

Interstitial brachytherapy may occasionally be used as alternative therapy for I LR. PI Band SC I Bare 2 novel and distinct techniques. Their specific selected indications depend on the size of the tumor. Techniques will be presented.

Nucleosldes as markers In patients with cancer A. EI-Sharkawi (Presenter), C. A. Wellington; Swansea

Patients with cancer are known to excrete high level of nucleosides in their urine. Measurement of these nucleosides may offer the possibility of not only diagnosing the presence of cancer, but also assessing the response to treatment. We have measured (by high performance liquid chromatography) (HPLC) the nucleosides pseudouridine (\II), Creatinine (Cr), Cytidine (C), I-Methyladenosine (mIA), I-Methylguanosine (mIG). Uridine (Ur) in the urine of 19 volunteers assumed to be free of tumours and 20 patients with cancer before and after their radiotherapy treatment. Mean (± SO) concentrations (n mol cm']) in the first group found to be (\II) 2.8 ± 2.2; (Cr) 5.1 ± 4.6: (C) 3.3 ± 2.2. The other three nucleosides mIA, mIG and Ur were not detectable. The mean (± SO) total nucleosides concentration in the volunteers was 11.2 ± 5.9 n mol cm·-'. The mean (± SO) in the second group before their radiotherapy treatment were found to be (\II) 11.5 ± 9.1 ;

(er) 9.2 ± 3.1; (C) 10.9 ± 18.0. The mean (± SO) total nucleosides concentration in patients with cancer was 44.8 ± 29.5 before treatment, and 10.5 ± 4.7 after their radiotherapy treatment.

The results show higher concentration of nucleosides in urine of patients with cancer, and its reduction after radiotherapy treatment to the level of concentration in the volunteer groups who are assumed to be free of tumours. We feel S306 that measurement of urinary nucleosides by High Performance Liquid Chromatography (HPLC) is a very promising non invasive test for cancer diagnosis and monitoring therapy.

Radiotherapy planning for suprasellar tumors In children and young adults \. Golubicic (Presenter), Lj. Grzetic, O. Frim, M. Durbaba, V. Sobic; Beograd

Since 1982 we have been planning radiotherapy for suprasellar tumors from three fields. Treatment volume is defined according to the computerised tomography with computerised planning system. Appropriate isodose distribution being obtained by the use ofthree fields: two wedged opposite lateral fields and one unwedged frontal field. All patients were irradiated from the Linear Accelerator with photon beam 10 MeV. Tumor dose was 50-60 Gy, dose per fraction 1,6-1.8 Gy,five days per week, over 6-8 weeks.

By that approach we treated 25 children and young adults suffered from primary brain tumors with suprasellar localisation (from 2-22 years). All patients had had previous surgery (biopsy or partial removal). 24125 were histologically proven. With a follow-up after radiotherapy of 1-9 years all, but two patients are alive (one died from the tumor extension and one from an other cause of death). Assess of tumor response to radiotherapy was based on CT scanning and ophthalmology examination. Follow-up assessements include monitoring of vision, neurological status, endocrine status and school performance. and quality of life of longterm survivors. We will be presenting late complications which have been detected in our group of patients.

DOSimetry of Irradiated cultured cell lines using ESR spin trap Mitsuoki Hashiba (Presenter), Hiroyuki Matsuno. Norimoto Tanaka, Kohichi Murakami; Kyoto

Purpose: Detection of free radicals of irradiated cultured cell lines is performed by ESR (EPR) spin trapping method. The conventional measuring technique of ESR spectroscopy has required extremely low temperature of liquid nitrogen level though the biological environment requires room temperature. The purpose of this study is quantitative evaluation of free radicals formed by gamma ray irradiation at room temperature and to observe the relation between ESR spectra and the biological response in several graded doses. Furthermore behavior of SOD (superoxide dismutase) was attempted to confirm in both ESR spectra and biological response. Methods: PBN (phenyl t-butyl nitrone) was used as ESR spin trap for the stability after irradiation and for the solubility to organic solvent chloroform/methanol made effective to observe ESR spin adducts in room temperature.

Results: The concentration of PBN spin adducts formed by irradiation appeared to be directly proportional to each dose. Adding SOD, the amplitudes of ESR spectra decreased in consequence to irradiation dose. Conclusions: Quantitative evaluation of free radical formed by irradiation using ESR trapping was examined and the dosimetric usage was confirmed.

Treatment planning for ophthalmic tumours with 1·125 seeds J. Heikkonen (Presenter), H. Toivola, M. Forss, A. Tarkkanen; Helsinki

The low energy radioactive 1-125 seeds are ideal for treatment of intraocular tumours. The energy (28-35 keV) is suitable to irradiate tumours as high as 10 mm. The plaque is made from gold sheet about 0.5 mm thick. completely shielding the extraocular tissues located behind it. The eye applicators were made in pairs, so that a nonradioactive silver plaque can be used for suture positioning. The radioactive 1-125 seeds are attached to the gold plaque with silicone rubber caulk (RTV 3140). The 1-125 seed plaques can be individually designed for each tumour. depending on its size, shape and location. The depth dose curves and three-dimensional dose distribution in Gy/h units are calculated with a computer program based on the polynomical fitting of the measured data. The dose planning can be plotted at any plane desired. The developed program can be applied to optimize the plaque design, 1-125 seed positions and the treatment planning. The method is in routine use at our department.

Clinical application of MR-tomography and MR-anglography In subdiaphragmatic treatment planning of malignant lymphoma A. Koster (Presenter), B. Kimmig. M. Muller-Schimpfle. G. Layer. G. Brix. W. Semmler. M. Wannenmacher; Heidelberg Subdiaphragmatic radiation therapy in malignant lymphomas usually include the paraaortic and parailiacal region, the splenic pedicle, the spleen and rarely the liver hilus and prominent lymphatic masses in other locations. Organs with low radiation tolerance like kidneys have to be protected. Purpose of treatment planning is to define an individual and reproductible target volume. We developed and employed a technique to visualize simultaneously abdominal organ and blood vessel anatomy in frontal view by using MRT and MRA. A computer program was created to superimpose an optimal coronar MR-Tomogram and MR-Angiogram. By using a subtraskope the MRT/MRA-superposition can exactly be projected on a simulation film in correct scale. This novel method was evaluated in 15 patients. The individual target volume could exactly be defined and thereby individual field corrections were possible. Especially significant protection of renal parenchyma was achieved. Treatment planning on simulation film using a subtraskope is simple and can be performed within a mean of 10 minutes. We assume that renal contrast examination, CT-planning and i.v.-DSA can be replaced by this method. The presented technique is an accurately non-invasive method to optimize and individualize treatment planning in subdiaphragmatic lymphomas.

Antitumor effects of thermosensltlve IIposome-encapsulated cisplatln T. Nishita (Presenter), T. Nakajima. T. Tada Purpose: The combined therapy of thermo sensitive liposome and local hyperthermia is thought to enhance tbe anti-tumor effects. TAC-I 043 (Takeda Co.) is the thermosensitive liposome that releases entrapped cis-diamminedichloroplatinum (COOP) above 41°C. We studied the anti-tumor effects and concentrations ofTAC-1043 (TAC) in vivo.

Methods: sec VII tumors transplanted into the food pads of male C3H mice were used. TAC or COOP (2mg/Kg. 4mg/Kg) were given by tail vein injection, and tumors were heated at 40°C or 42"C. Anti-tumor effects were evaluated by a growth delay method. The concentrations in the blood and tumors were investigated by measuring the platinum concentrations with an atomic absorption spectrophotometer. Results: After heating at 42°C, antitumor effects of TAC were significantly better than those obtained by using COOP. No increase of the effects was observed after heating at 40°C. The concentration in blood was significantly high and the concentration in tumors after heating at 42°C or 40·C increased with heating time, but the concentration in tumors without heating did not show these changes. Conclusions: T AC-I 043 proved to be very effective when combined with local hyperthermia at 42· C.

The prognostic value of ploIdy in soft tissue sarcoma H. Pape (Presenter). C. Kolzer. Ch. pongen. R. Wurm. G. Schmitt; Dusseldorf

Only few reports are available in the literature regarding the ploidy value in soft tissue sarcoma. In our retrospective analyse we evaluated the prognostic relevance of ONA content in sarcoma cells relating to tumour volume and histological grading. Since 1978 paraffin embedded material of 80 patients has been collected. The histories of these patients have been correlated to the ploidy level in the tumour cells. Overall and disease free survival probability were calculated according to ONA content, tumour volume and histological grading as reference parameters. Ploidy destination was performed by automated image cytometry (LEITAS). In 56 patients DNA measurements have been completed. The characteristics of all 80 patients were: Sex: 44 F; 36 M, Age: range 1-90 years; mean 51 years. As demonstrated in Table I and 2 aneuploidy was mainly seen in bulky and undifferentiated tumours reflecting a poor prognosis. This new treatment modality of postoperative irradiation of rectal cancer, allows to increase total dose from 45-50 Gy to 60-65 Gy, reducing complications to small intestine, with a better control on relapses. Treatment phases are: I -tumor resection (Hartmann colostomy); during this phase a shaped expander, outside connected by two drainage tubes, is placed in the pelvis; the device can be filled with 1500 ml max. of physiological salt solution, to uphold the small bowel; II -postoperative irradiation (total dose 60-65 Gy) of pelvic portal; the small bowel is outside the irradiation field when the shaped expander is filled; the bladder is shielded and to the rectal stump a maximum dose of 50 Gy is delivered; III -surgical removal of the shaped expander, assessment of treatment with biopsy and recanalization by stapler.

Combined simultaneous radiation and chemotherapy as a treatment policy In locoreglonal recurrent breast cancer with macroscopical residual tumor H. Renner (Presenter). M. van Kampen; NOrnberg AIM: Our therapeutic concept in the situation oflocoregional recurrent breast cancer with macroscopical residual tumor is a combined radiation and chemotherapy to increase live quality by tumor control. Methods: 61 patients with 70 tumor areas (chestwall or/and lymphatic nodes) were treated during the last 12 years. Median follow up period was 24 months. The radiation was controlled by the rhythm of chemotherapy: 4 courses including 14 days of CMF-chemotherapy with simultaneous radiation followed by 14 days of interruption without any therapy. The overall treatment time is about 3 112 to 4 months. Results: The overall result is a 87% complete remission rate at the end of therapy and a 65% permanent local infield tumor control rate during the whole follow-up period (median 24 months). The result is depending on radiation dose. Doses higher than 60 Gy increase the complete remission rate to 93% and the permanent local tumor control rate (infield) to 86%. The rate of ipsilateral outfield recurrences is 6% and of contralateral tumors is 15%. The tolerance of this therapy is quite good. Acute side-effects (haematological, gastroenterological, degree I-II WHO) are reversible. The acute and chronical side-effects of the skin due to radiation are not more than degree I-II (EORIC). Conclusions: Considering the problems of the macroscopical persistent tumor the therapeutic control of locoregional tumor by combined radiation and chemotherapy is a reasonable treatment policy.

Intraoperative radiation therapy for carcinoma of the pancreas and the extrahepatic biliary system: special references on the combination of postoperative external radiotherapy Y. Tanaka (Presenter), T. Shimizu, N. Takeshita, T. Matsuda, A. Okamoto, I. Tabata; Tokyo From August 1976 to June 1990, ninety-one patients with carcinoma of the pancreas and fourty-five patients with carcinoma of the extrahepatic biliary system were treated with intraoperative radiation therapy (IORT). In combination with IORT, postoperative external beam irradiation was applied to about half patients in doses ranging from 30 to 54 Gy (average 40 Gy). The median survival time of patients with carcinoma of the pancreas was about 12 months and those with carcinoma of the extrahepatic biliary system was 8 months. The actuarial survival of these patients was 50% at I year and 20% at 2 years on the former, and 37% and 24% on the latter, respectively. Patients treated by IORT in combination with postoperative irradiation survived longer than those treated by IORT alone (13 months versus 5 months median survival on carcinoma of the pancreas and I I months versus 3 months on carcinoma of the extrahepatic biliary system). The treatment modality consisting of IORT plus postoperative irradiation was found to be the most important prognostic factor. After tumor resection, if possible, IORT with a dose of about 20 Gy combined with postoperative doses ranging from 40 to 48 Gy was considered to be feasible without causing severe adverse reaction.

Functional results of a therepy with a 300 Gy ablative dose in Greves' disease U. F. Willemsen (Presenter), C. A. Pickardt, P. Knesewitsch; Munich I. Recurrent hyperthyroidism due to Graves' disease can make an ablative radioiodine therapy necessary accepting to induce hypothyroidism. 2. Since 198527 patients (22 females, 5 males, age 26-70, mean 50 ± 13 years) were treated by ablative radioiodine therapy because of recurrent severe hyperthyroidism. Thyroid volume was determined by ultrasound; maximum storage and effective half-time by radioiodine test. The individually required activity (MBq) was calculated for a desired intrathyroidal absorbed dose of 300 Gy. Post-therapy controls were performed after 3 months and thereafter in 3-6 months intervals. 3. After 3 months hyperthyroidism is eliminated in 93%. 2 patients still remained hyperthyroid without needing anti thyroidal drugs. The rate of hypothyroidism is 59% after 3,76% after 7, 79% after 12 and 100% after 16 months. 4 euthyroid patients did not yet have their 16 months control. There is no correlation between pre-therapeutic Thyroidea-Stimulating-Immunoglobulin-(TSI) values, the applied activity and the latency period of developing hypothyroidism. Post-therapeutic TSI-values are positive in 12115 patients. Thyroid ablation with a 300 Gy absorbed dose should be restricted to recurrent cases. The main advantage to standard-activity therapies may be a reduction of the applied activity with a reliable elimination of hyperthyroidism.

Radlotherepy In the management of menlngeoma R. Wurm (Presenter), H. Pape, B. Bannach, Th. Schnabel, G. Schmitt; DOsseldorf

In our retrospective study we evaluated the role of radiotherapy in the management of meningeoma in comparison to a review of the available literature. Between 1980 Between -1989 patients with meningeoma (8 female, 6 male; median age: 55; range: 25-72) were treated for recurrent disease with radiotherapy at our department. I nitially all patients had a subtotal resection. After recurrence 10 patients underwent one or more reoperation and 4 a biopsy only. Radiotherapy was given to 5 patients after first recurrence, to 4 after second recurrence and 5 after third recurrence. Irradiation was performed with 6OCo-y-rays or high energy x-rays up to 45-60 Gy (mean 50 Gy) using 5 x 2 or 1,8 Gy/week. The relapse-free survival at 5 years of67% was belter, as opposed to 26% of patients not receiving postoperative irradiation after surgery from the literature. Furthermore, the review of the available literature indicates that the relapse-free survival at 5 years of 75% of our patients treated by radiotherapy after first recurrence and reoperation was similar with those patients receiving postoperative irradiation following attempted initial surgical resection and better compared to II % in patients treated by surgery alone after first recurrence. In conclusion achievement of local control in meningeoma appears to require whenever possible nearly complete or complete resection. Radiotherapy seems to be indicated following initial partial resection, where minimal residual disease remains. When gross residual disease remains, radiotherapy should be taken in account followed by delayed reoperation and attempted resection.

Radiotherapy of thymoma A. Wurm (Presenter), K. Gieseler, H. Pape, D. Skutta, G. Schmitt; DOsseldorf

We performed a retrospective study on 35 patients with histologically confirmed thymoma treated at our department between 1960 and 1990. 19 were male and 16 female. Median age was 45 years, with a range from 15-68 years. 10 had a complete, 22 a partial resection and 3 patients a biopsy only. 2 I received radiotherapy immediately post surgery and 14 for gross recurrence. 6 had myasthenia gravis, 2 anaemia and I rheumatoid arthritis. 16 were lymphocytic. 10 epithelial, 7 mixed and 2 spindle cell type thymoma. 2 were classified stage I, 3 stage II, 28 stage III and 2 stage IV. Irradiation was performed up to 30-60 Gy (mean 45 Gy) at 2 or 1,8 Gy daily. 12 patients had concomitant chemotherapy. The median follow-up is 9 years. For all patients the 5-, 10-and 20-year actuarial survival rates were 71 %, 33% and 33% respectively. The disease-free survival rates were 17%,8,5% and 8,5%. The 5-, 10-and 20-year actuarial survival rates were 69%, 46% and 46% and the disease-free survival rates 27% at 20 years for those who had radiotherapy after surgery. In contrast, the 5-and IO-year actuarial survival rates were 75% and 0% and the disease-free survival rates 0% for those who had radiotherapy for recurrence post surgery. The review of available literature and our results suggest that postoperative radiotherapy should be given to all cases of invasive thymoma regardless they had complete or incomplete surgical excision. m General radiology (17)

Evaluation of acute deep venous thrombosis of the lower 11mb, using an automated venous occlusion plethysmograph HAken Ahlstrom (Presenter), Stefan Nilsson, Andrezej Pawlowski; Uppsala Purpose: To ascertain whether it is possible to reduce the number of phlebographic investigations by using a plethysmograph for diagnostic screening of acute DVT. Methods: 175 consecutive patients who were referred for routine phlebography because of clinically suspected deep vein thrombosis (nVT) were also investigated with a new, simplified, computerized strain-gauge plethysmograph (Phlebotest, Eureka AB). An occlusion plethysmograph curve was obtained from each leg simultaneously. Different numerical parameters were defined and determined from curves with both fixed and variable time of cuff inflation. The parameters were correlated with the phlebographic diagnosis. Results: The diagnostic sensitivity of plethysmography with fixed inflation time was equal to that of variable inflation time. Two parameters of the outflow part of the plethysmograph curve correillted well with the phlebographic diagnosis, which proved correct in 60 patients without DVT, including 2 false negative cases, and in 36 patients with thrombosis. In 79 patients, plethysmography alone was not sufficient to establish a diagnosis. The plethysmograph described is easy to handle and a decision sequence is suggested for use in selecting those patients, with or without thrombosis, who do not require supplementary phlebography.

Presentation of a consultation system for diagnosis and therapy of bladder cancer V. Cavallo, F. Giovagnorio (Presenter), E. Cruciani, A. Volpe; Roma

The complexity of diagnostic and stadiation protocols for bladder cancer makes the whole procedure fully understandable only from specialists. An expert system has been built containing the uroradiological expertise needed to make the process easily applicable by non-expert personnel. The system aims at achieving a complete TNM stadiation of the tumor; the user provides, in an interactive way, the results coming from the different diagnostic methods employed, whose sequence is suggested by the system itself; in any moment informations on the status of diagnostic procedure are available, with informations on the nature and usefulness of the methods. The system provides, finally, the exact TNM stadium of the disease with appropriate therapeutic suggestions. The system has been developed using a low-cost expert system shell; the knowledge is structured in rules according to the appropriate syntax. The applicative experiences demonstrated a great usefulness of the system, even from a didactic point of view. The definitive validation, carried on with users' suggestions, will surely make the system more complete and interactive. SPACE 1l1! How do new diagnostic modalities Influence on older methods? Urinary tract examinations In Norway 1965 Norway -1989 Tor Erik Gudmundsen (Presenter), Bjl2lrg Vinje, Hans Krlstian Pedersen, Harald 0stensen; Drammen

The purpose of the study was to evaluate how the use of computerized tomography (CT) and ultrasonography (US) have influenced on the routine examinations of the urinary tract. New methods are only beneficial if they offer more information than previously obtained, or substitute other methods. The tendency in medicine has been to take up new methods in addition to other types. Methods and Materials: For the period from 1965 to 1989, the pattern of urinary tract examinations was registered retrospectively in six Norwegian hospitals: one university hospital, two central hospitals and three local hospitals. The registrations were performed by examining the hospitals' files and protocols by two radiologists. Results: Directly related to the introduction of CT in the various hospitals, the number of renal angiographies declined. The introduction of US and its almost linear increase reduced both the number of CT examinations and, more dramatically, the number of intravenous urographies (lVP). There was a statistically significant inverse correlation between the two modalities. Thus, it seems reasonable to assume, that at least in Norway, new diagnostic tools for medical imaging are substituting older modalities. (21), and cranial CT (21) were performed at presentation, and less frequently during follow-up. By January 1990,30 patients had died (complete autopsies 10 cases, partial 3). Results: Lymphadenopathy or visceral lesions were present in 29/45 (64%) cases at presentation. Visceral KS was radiologically presented as small nodules, and occasionally as larger masses. In the lung and liver, small KS nodules and tumoral bands were usually seen in a peribronchovascular (lung) or periportal (liver) location. In 1989 we changed film-screen-systems from blue to green sensitive. One goal has been to reduce radiation dose to patient without loosing image quality. Additionally we increased total filtering of the x-ray tubes from 2.5 mm AI to 4.5 mm AI.

The new orthochomatic film-screen-system with anti-cross-over films showed a much better sharpness in the images than the old blue one. The dose reduction due to the imaging system is presented for different kinds of examinations. The change of filtering reduces dose to the patients skin to 60%.

Lymphoma In AIDS A. Munoz (Presenter), C. Lopez, M. A. Gonzalez, A. Alvarez: Madrid

All patients diagnosed of AIDS associated with lymphoma in our institution were reviewed. Since 1981 there were 12 cases: II non Hodgkin lymphoma and one Hodgkin's disease. Patients with NHL were men and age ranging from 26 to 65 years (mean 35). Risk factors were: intravenous drug abuse 6 cases, homosexuality 4, promiscuous sexual relations 2 (one also intravenous drug abuser). Kaposi sarcoma was previously diagnosed in one patient, who was included in homosexual risk group. Histologic diagnosis was: diffuse large cell (4 cases), immunoblastic (3 cases), Burkitt (3 cases) and the other one was only reported as high grade lymphoma. 6 patients were clinically diagnosed as stage IV, 2 as IE, one as I and in the rest the clinical stage was unknown (one dead and other was lost to follow-up). 1 patients presented with B symptoms at the diagnosis time. Extranodal involvement was identified in whole series: 6 cases CNS, 6 cases liver and spleen, 5 cases bone marrow, 3 cases skin and mucoses, 2 cases pleuropulmonary and one case gastro-intestinal tract. There was nodal involvement in 2 patients. We present conventional radiologic and CT imaging and we compare with literature our results.

Drug effects on CA125 antigen expression and antl-CA125 antibody binding to cancer cells Toshiharu Nakai (Presenter), Keigo Endo, Makoto Hosono, Tsuneo Saga, Harumi Sakahara, Junji Konishi; Kyoto

Purpose: In order to regulate the expression of cancer associated antigen for the immunoscintigraphy and immunotherapy, we investigated the effect of drug administration on CAI25 antigen expression and radiolabelled monoclonal antibody binding to the cancer cells. Methods and Materials: Human ovarian and lung cancer cell lines which express CA 125 antigens were cultured with various concentrations of interferon-y, dexamethasone, or sodium butyrate. CAI25 release to the culture medium was measured and after 5 days exposure to drugs, cells were incubated with radiolabelled monoclonal anti-CAl25 antibody. Results: Interferon-y increased the release of CAI25 antigen and the binding of radiolabelled anti-CA 125 antibody to PC9 lung adenocarcinoma cells, but decreased A549 lung adenocarcinoma and SHIN3 ovarian carcinoma cells. Dexamethasone completely suppressed the CAI25 antigen expression in three out of 9 cell lines examined at a physiological concentration. The number of antibody binding sites decreased without affecting affinity constants. On the contrary, sodium butyrate increased CAI25 expression of the same 3 cell lines more than 2-folds. Conclusions: Drugs remarkably regulated the CAI25 expression in some, but not all, cancer cell lines. These effects may be applied to improve the tumor uptake and biodistribution of radiolabelled monoclonal antibodies. Results: On unenhanced scans the nodes were of low attenuation « 30 HU) in 18 cases and of soft-tissue attenuation (>35 HU) in 20. Three postcontrast patterns of enhancement were found: A) Peripheral rim enhancement without or with low to moderate increase of attenuation at the center of the nodes (22 cases), B) homogeneous enhancement (8 cases) and C) non-homogeneous enhancement (8 cases). In 1 cases a combination of A and (B-C) patterns was seen at the same nodal group. The central enhancement was usually moderate (mean 30 HU) but in 3 instances strong enhancement (mean 60 HU) was found. Obliteration of peri nodal rat was evident in 13 cases most of them with A pattern.

Reduction of radIatIon dose. Benefit quality ralation E. Rodriguez ( Our work evaluates the radiation dose received by the patient on skin by using different reinforcement screens.

We compared regular screens (barium-sulphate) with rare earth screens (Iantanum -oxibromurum). The film, X-Ray equipment and developer were the same in both cases. A phantom was used to obtain images. A "nomograma" was used to estimate the radiation dose on skin and com probations were done with an ionization camera. Although the "nomograma" gives us just a dose orientation, this is enough to verify the decrease of radiation received by the patient by using rare earth screens. The average obtained with different explorations shows us that the use of rare earth screens involves a reduction about 58,9% of the absorbed radiation by the patient without significative decrease of X-Ray quality. Due to the great volume of radiodiagnostic explorations in ambulatory patients, we must optimize the radiation dose suffered by customers, even more if we consider the check controls for chronical patients which represents a high percent of our explorations.

HIV-related lymphomas: radiological findings G. Santamaria (Presenter), M. C. Ayuso, P. Luburich, E. Salvad6, X. Tomas, C. Nicolau; Barcelona

Purpose: To study the radiological findings in HIV-related lymphomas. Methods and Materials: 23 cases of non-Hodgkin lymphoma (NHL) and Hodgkin's disease (HD) in HIV-seropositive patients, admitted at our hospital from 9/89 to 5/90 were reviewed. All patients were male. the mean age was 32 years (range: 22-65). 14 patients (60.8%) were parenteral drug abusers, 6 (26.8%) homosexual males, and 3 (13%) belonged to other risk groups. Conventional radiography, ultrasonography, and computed tomography were performed. Results: 16 patients (69.5%) presented NHL and 7 patients (30.5%) HD. Characteristically, all the lymphomas were of intermediate or high-grade SUbtypes. 13 patients (75%) with NHL and 7 (100%) with HD had advanced disease (stage 3 or 4) at presentation. Extensive abdominal adenopathy (retroperitoneum, mesentery) was found in 4 patients (25%) with NHL and in 4 (57.1 %) with HD. 10 patients (62.5%) with NHL and 5 (71.4%) with HD had extranodal involvement. NHL: liver (2), bone marrow (3), lung (2), nervous central system, stomach, rectum, pericardium, skin (I). HD: liver (4), bone marrow (3).

Radiologic findings of worm disease X. Tomas (Presenter). J. A. Clavero, R. Vilana. P. Luburich, T. Pujol, J. Pomes, M. Velasco; Barcelona I. Imported diseases, which for a long time have been an unusual diagnostic, have raisen in the last years due to migratory movements towards Europe. We would like to show the most interesting radiologic findings of worm diseases observed in our hospital. 2. We have studied in a retrospective way all the cases of worm disease which have been diagnosed in our department during the last five years, and have only chosen those which we think to be more outstanding, for instance, onchocerciasis, schistosomiasis and Katayama disease, paragonimiasis, fasciolosis, Guinea worm disease ... Many imaging strategies were performed: X-ray films, US, CT and MR. 3. We believe it is interesting to bear in mind the importance of the radiological findings of these diseases in our daily work, because of its increase of incidence in our environment.

Sensitivity 0' medical X-ray screen-fllm-processlng systems In Danish hospitals O. Hjardemaal, H. Westergaard (Presenter); BniJnshoj

The sensitivity of screen-film systems is a crucial factor in doses to patients, therefore it has been determined in 25 Danish hospitals. The sensitivity of screen-film systems in use depends on many different factors.

Besides the type of screen and film can be mentioned processing, radiation quality, cassette absorption and ageing of the screens. The nominal sensitivity quoted by the manufacturer may therefore be different from the actual sensitivity. The sensitivity can be determined according to standards, for instance the ANSI PH 2.43-1982 or the DIN 6867 standard. However, such standards are intended for laboratory use. For field use i.e. the conditions governing in X-ray departments modified principles have to be applied. Thus, a simplified DIN method using 90 kVand a total filtration of32.5 mm of aluminium has been used and the findings are compared with the nominal sensitivity of the systems.

spinal neurinomas. a study of 30 operated cases D. Baleriaux (Presenter)

The etiologies were: pleural lesions (6 cases), hepatic or right subphrenic diseases (4 cases), splenic lesions (9 cases), gastric tumor (3 cases), hernia (6 cases), pancreatic pseudo-cyst (3 cases). Results: All densities were visualized with MRI. The size of all lesions exceeded 2 cm in at least one dimension. The connections with diaphragm were always determined. MR Imaging was also helpful in the characterization of the lesions

Methods: CT Scans and MR Images were obtained in 32 patients with esophageal extramucosal disease detected on barium esophagograms. CT was performed before and after intravenous administration of contrast material. Spin-Echo sequences TI weighted and T2 weighted were obtained on a 0.5 T superconducting magnet. Surgically proved etiologies were malignant extrinsic involvement (10 cases), leiomyoma (5 cases), lipoma (3 cases), mediastinal abscess (3 cases), cystic duplication (4 cases), cystic lymphangioma (3 cases), pancreatic cyst (2 cases) and hydatid cyst (I case). Results: The size of all esophageal masses exceeded 2 cm in at least one dimension and all lesions were seen on both CT Scans and MR Images. TheCT and MR findings depended on the cause of the lesion. The connections with mediastinal structures were always determined. Conclusions: MR Imaging and CT were equally good in delineating the extension of an esophageal lesion and to evaluate the connections with mediastinal structures. However, except in the cases of lipoma, MR Imaging was superior to CT

Berlin Purpose: Aim of the present study was to assess the effects and the value of Gd-DTPA administration in MRI of degenerative cervical spine disease. Methods: The study included 5 normal controls and 32 patients with 30 disk herniations and 5 bony stenoses. Examinations were performed with an 1.5 T Magnetom (Siemens), using a 2D-FLASH sequence

Results: Displacement or interruption of the epidural enhancement, nonenhancing structures surrounded by epidural enhancement, and atypical intraforaminal patterns after enhancement were frequent findings in patients, whereas these features were not found in normal controls. The image's diagnostic value was found to be improved after Gd-DTPA administration in about 50% of the cases, mainly in patients with lateral and intraforaminal disk herniations. Conclusions: Gd-DTPA may improve diagnosis of degenerative cervical spine disease with M RI

Methods and Materials: 29 patients with histologically proven cervical carcinoma (stage IB or higher) were studied with MR imaging at 0.5 T. All patients underwent detailed histologic evaluation of the parametrium by means of radical hysterectomy. MR imaging findings were compared with microscopic pathologic findings in all cases. TI weighted (SE 350125) and T2 weighted

Results: MR imaging showed tumor positive parametrium in to patients; in seven of these cases histologic analysis demonstrated parametrial tumor involvement. In the remaining 3 cases no parametrial invasion was found on pathologic examination. MR imaging revealed tumor negative parametrium in 19 cases; in all these patients pathologic study confirmed no evidence of tumor extension into the parametria. The overall accuracy of MR imaging in demonstrating parametrial invasion by tumor was 89%. Conclusions: Precise knowledge of parametrial tumor extension affects the therapeutic decision between surgery and radiation therapy

therefore MR imaging should be used to determine appropriate therapy in patients with invasive cervical cancer

At corresponding sites we correlated signal intensities of pathologic and healthy bone marrow intraindividually and got the ratio SI (SE) path/SI (GEl path. Results: In all cases a tumor could be excluded, soft tissue involvement or invasion of the spinal canal could be demonstrated. The SE/GE-ratio can estimate the acuteness of the infection (acute = It 0.7, subacute = I, healing = gt 1.5). Due to bone marrow edeml\ in subacute spondylitis signal loss on TI-w images persists, but in case of susceptibility effects GE-signal returns nearly to normal. Healed spondylitis leads to reactive fatty bone marrow. Conclusions: Using Tl-w SE and opposed long TR GE sequences MRI provides

MRI follow-up of mediastinal Hodgkin's disease (HO) during and after treatment

A persistent mediastinal abnormality after successful treatment for HD is often present and can simulate persistent disease causing diagnostic difficulties

In order to evaluate the possible role of MRI in determining the true nature of these abnormalities, 92 MRI examinations performed in 36 HD patients during and after therapy were reviewed. All patients had proven mediastinal adenopathies at disease presentation and residual mediastinal mass during or after treatment. MRI was performed utilizing SE techniques and both mainly Tl and T2 gated images were acquired. M RI results were compared to clinical

High signal compatible with persistent or recurrent disease was observed in 26/92 (28%) examinations whereas in 44/92 (48%) low signal (fibrosis) was achieved. From the comparison with other evaluations, only six false positive (7%) and I false negative (I %) MRI results were encountered. The overall accuracy of MRI was 92%, sensitivity 96% and specilicity 90%. A correlation MRI/Ga 67 scan was available in 39192 examinations (42%) and 7 (18%) discordant reports were encountered