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  • 1
    Electronic Resource
    Electronic Resource
    Book review (1996)
    Springer
    European radiology 6 (1996), S. 374-374 
    Details
    ISSN: 1432-1084
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00180616
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  • 2
    Electronic Resource
    Electronic Resource
    Visualization of cranial nerves I–XII: value of 3D CISS and T2-weighted FSE sequences (2000)
    Springer
    European radiology 10 (2000), S. 1061-1067 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Cranial nerves – MR imaging – Pulse sequences – 3D MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the sensitivity of the three-dimensional constructive interference of steady state (3D CISS) sequence (slice thickness 0.7 mm) and that of the T2-weighted fast spin echo (T2-weighted FSE) sequence (slice thickness 3 mm) for the visualization of all cranial nerves in their cisternal course. Twenty healthy volunteers were examined using the T2-weighted FSE and the 3D CISS sequences. Three observers evaluated independently the cranial nerves NI–NXII in their cisternal course. The rates for successful visualization of each nerve for 3D CISS (and for T2-weighted FSE in parentheses) were as follows: NI, NII, NV, NVII, NVIII 40 of 40 (40 of 40), NIII 40 of 40 (18 of 40), NIV 19 of 40 (3 of 40), NVI 39 of 40 (5 of 40), NIX, X, XI 40 of 40 (29 of 40), and NXII 40 of 40 (4 of 40). Most of the cranial nerves can be reliably assessed when using the 3D CISS and the T2-weighted FSE sequences. Increasing the spatial resolution when using the 3D CISS sequence increases the reliability of the identification of the cranial nerves NIII–NXII.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000452
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  • 3
    Electronic Resource
    Electronic Resource
    Echo-planar magnetic resonance imaging (EPI) with high-resolution matrix in intra-axial brain tumors (1999)
    Springer
    European radiology 9 (1999), S. 1392-1396 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Magnetic resonance ; Brain ; Brain tumors ; Echo planar imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to assess the potential of high-speed interleaved echo-planar imaging (EPI) to achieve diagnostic image quality comparable to T2-weighted imaging in patients with brain tumors. Seventeen patients with intra-axial, supratentorial tumors (10 untreated gliomas, 7 radiated gliomas) were investigated on a 1.5-T scanner. The conventional scan (SE, TR/TE = 2200/80 ms, 18 slices) was acquired in 8 min, 4 s, and EPI (TR/TE = 3000/80 ms, 18 slices) was completed in 25 s. The films were compared in a blinded trail by three radiologists. On the general impression and anatomic display, both sequences were rated to be of similar quality. Artifacts were slightly more pronounced at the skull base and around surgical clips using EPI. Tumor delineation was nearly equivalent using EPI, compared with the T2-weighted sequence. Echo-planar imaging reached diagnostic quality in all patients. Interleaved high-resolution EPI yielded sufficient quality to depict intra-axial, supratentorial brain tumors. Since EPI can be obtained in a small fraction of the time needed for conventional spin echo, in addition to other indications it could be considered to study patients unable to cooperate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050854
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  • 4
    Electronic Resource
    Electronic Resource
    Dural arteriovenous fistulas including the transverse and sigmoid sinuses: Results of treatment in 30 cases (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 307-318 
    Details
    ISSN: 0942-0940
    Keywords: Dural arteriovenous fistulas ; transverse sinus ; sigmoid sinus ; arterial embolization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report about the treatment and outcome of 30 patients with durai arteriovenous fistulas including the transverse and sigmoid sinuses treated between 1986 and 1995. All patients underwent panangiography for definitive diagnosis. The dAVF were supplied by the external carotid artery system alone (14 patients), both external and internal carotid systems (10 patients) or both anterior and posterior circulation (6 patients). Depending on the venous drainage the fistulas were classified following a modification of Djindjian's description with 18 patients revealing Type I (main sinus with antegrade flow), 5 Type II a (main sinus with reflux into the contralateral sinus), 5 Type II b (cortical veins), 1 Type II a + b (both) and 1 of Type III (direct cortical drainage). Bruit, pulsatile tinnitus and headaches were the most common symptoms. 6 patients presented with intracranial haemorrhage, 4 with progressive neurological deficit or seizures and 3 with dementia. Arterial embolization was performed in all cases except one, where a transvenous approach for balloon occlusion of the transverse sinus was performed. 21 patients were treated by single or repeated embolization alone. Only in 9/21 cases did arterial embolization result in complete occlusion of the fistula. In 12/21 patients incomplete occlusion was achieved. Following embolization 8 patients underwent additional surgery including coagulation of the feeding arteries and arterialized veins, sinus resection and reconstruction of the sinus. Overall, 18 patients were cured, 11 improved and 1 patient was unchanged. There was a total number of 5 complications including transient stroke, transient facial nerve palsy, and a small necrotic skin area following embolization. Venous infarction of the occipital lobe was induced by transvenous occlusion and surgical resection of the transverse sinus in one patient each, respectively. From our results we conclude that the endovascular therapy alone is the treatment of choice in case of Type I fistulas. In dAVF of Type II and III repeated endovascular treatment seems not to be sufficient and additional surgery is necessary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01808826
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  • 5
    Electronic Resource
    Electronic Resource
    Diagnosis and results of different treatment regimes in patients with spinal abscesses (1993)
    Springer
    Acta neurochirurgica 125 (1993), S. 105-114 
    Details
    ISSN: 0942-0940
    Keywords: Spinal abscess ; epidural ; subdural ; surgical treatment ; antibiotics ; risk factors ; diagnostic procedures ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality. Most frequently, these lesions are found in the epidural, rarely in the subdural space. In this report, our clinical material consists of a series of 16 patients treated during the last seven years. The clinical presentation included local neurological signs (back pain, para-/tetraparesis, bladder dysfunction), disturbances of consciousness (ranging from drowsiness to deep coma) and general inflammatory signs (meningism, fever). All patients presented with risk factors (septic foci, chronic diseases, and iatrogenic causes). Laboratory investigations revealed typically pathological blood sedimentation rate, leucocytosis and CSF-pleocytosis. Radiologically, the diagnosis was confirmed by myelography, CT and preferably MRI. The abscesses were located epidurally in 14 and subdurally in 2 cases. The surgical treatment included laminectomy, or multiple flavectomies in extensive lesions. Drainage systems (either simple silicon outflow drains or suction-/irrigation systems) were installed in all cases, as well as antibiotic treatment. Results of treatment: Following an observation period of 0,5–6 years, we found complete recovery in six (38%) cases, six (38%) others were mildly disabled and four (25%) patients died. Focussing on the results of the two different drainage systems, we found a statistically significant superiority of the inflow-/outflow system. Complications included mandatory re-exploration, post-inflammatory hydrocephalus, syringomyelia, spinal instability, surgical treatment of peripheral septic foci and therapy resistant septicaemia. In conclusion, we propose that spinal epi-or subdural abscesses require surgical evacuation, using a suction-/irrigation drainage system, as well as antibiotic and intensive care treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01401836
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  • 6
    Electronic Resource
    Electronic Resource
    Ungewöhnliche Kombination einer Karotis-Sinus-cavernosus-Fistel und Sinusthrombose Erfolgreiche Therapie durch Antikoagulation (1997)
    Springer
    Der Nervenarzt 68 (1997), S. 135-138 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Karotis-Sinus-cavernosus-Fistel ; Antikoagulation ; Venenthrombose ; Venöser Infarkt ; A-V-Malformation ; Key words Carotid cavernous fistula ; Anticoagulation ; Venous thrombosis ; Venous infarct ; A-V malformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Dural carotid cavernous fistulas (DCCF) can be associated with venous thrombosis. We report on a rare case of a patient who developed a venous infarct, which was diagnosed on CT and MRI. The DCCF predominantly drained through a frontobasal cortical vein into the superior sagittal sinus. The shunt volume was small and was therefore thought not to be sufficient to explain the massive ocular signs, such as severe exophthalmus and reduction of visual acuity. We therefore postulated a venous congestion owing to a secondary spontaneous venous thrombosis of the draining venous pathways to be responsible for the ocular signs. Under anticoagulative medication, the patient's signs and symptoms improved gradually. Control angiography after 3 months showed that the DCCF had disappeared. In the presence of DCCF, anticoagulation should always be considered when a venous thrombosis is suspected.
    Notes: Zusammenfassung Durale Karotis-Sinus-cavernosus-Fisteln (DCCF) können mit einer Venenthrombose vergesellschaftet sein. Wir berichten über 1 Patientin mit einer DCCF, die einen ausgedehnten venösen Infarkt entwickelte. Die Drainage der DCCF erfolgte überwiegend über eine frontobasale Vene in den Sinus sagittalis superior. Das geringe Shuntvolumen der DCCF konnte die ausgeprägte okulare Symptomatik mit deutlichem Exophthalmus und erheblicher sekundärer Visusverschlechterung nicht erklären. Daher gingen wir von einer spontanen Thrombose im Bereich der Drainagewege der DCCF aus und haben die Patientin antikoaguliert. Unter dieser Therapie bildeten sich Exophthalmus und Visusstörung rasch zurück. In der Kontrollangiographie nach 3 Monaten war die DCCF nicht mehr nachweisbar. Eine Antikoagulation sollte bei vorliegender DCCF immer dann erwogen werden, wenn eine ausgeprägte venöse Thrombose vermutet wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050108
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  • 7
    Electronic Resource
    Electronic Resource
    Atheromeinblutung Eine kernspintomographische Differentialdiagnose zur Dissektion der Arteria carotis (1997)
    Springer
    Der Nervenarzt 68 (1997), S. 671-673 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Dissektion ; Intramurales Hämatom ; Atherom ; Therapie ; Key words Dissection ; Intramural hematoma ; Atheroma ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Improved methods of imaging the cerebral vascular system have increased the detection of traumatic or spontaneous dissection of the vertebral and carotid arteries. Especially MRI allows direct demonstration of intramural hematomas that are a sign of dissection of the vessel wall. We report on a patient who had an acute onset of dysarthria and monocular blurred vision, which recurred several times. Doppler ultrasound showed stenosis in both internal carotid arteries with reduced velocity of the flow; angiography confirmed the stenosis, showing a long stretch of stenosis (70%) of the right and a short stretch of stenosis (60%) of the left internal carotid arteries. MRI demonstrated a narrowing of the lumen by an intramural mass, whose signal characteristics were typical for blood. The MRI findings were thus consistent with the diagnosis of a spontaneous dissection of the carotid arteries. Since the Doppler ultrasound follow-up showed no change during the following 3 days, we interpreted the MRI findings as an indication of bleeding in an atheroma. The carotid disobliteration, performed first on the left side and later on the right side, confirmed this interpretation. Since stenosis due to a fissuring atheroma or bleeding in an atheroma requires different therapy than a dissection, it is thus important to consider the possible differential diagnosis in interpreting the MRI.
    Notes: Zusammenfassung Durch die Fortschritte in den bildgebenden Verfahren werden traumatische, bzw. spontane Dissektionen der A. carotis und der A. vertebralis zunehmend häufiger diagnostiziert. Insbesondere die Magnetresonanztomographie ermöglicht dabei einen direkten Nachweis von intramuralen Hämatomen als Zeichen der Dissektion. Wir berichten nun über einen Patienten, der akut beginnend und im Verlauf rezidivierend eine Dysarthrie sowie monokuläre Sehstörungen des linken Auges bemerkte. Dopplersonographisch fand sich beidseits, rechts betont, eine im Bulbus der A. carotis communis beginnende, bis in die A. carotis interna reichende Stenose, in der arteriellen digitalen Subtraktionsangiographie eine langstreckige etwa 70%ige A.-carotis-interna-Stenose rechts und eine kurzstreckige etwa 60%ige Stenose links. Diese Befunde ließen sowohl an eine ausgeprägte arteriosklerotische Makroangiopathie als auch an eine Dissektion denken. In der Kernspintomographie fand sich dann eine verdickte Gefäßwand der A. carotis interna beidseits mit einem schmalen Restlumen. Dieses wurde beidseits von in der T1w-Gewichtung mit selektiver Fettunterdrückung hyperintensivem Gewebe, am ehesten einem intramuralen Hämatom entsprechend, eingeengt. Dieser Befund ließ dann an eine beidseitige Dissektion der A. carotis interna denken. Auf Grund der in der Duplexsonographie über Tage unveränderten Befunde wurde das Bild dann als eine Einblutung in Wandatherome beidseits bei arteriosklerotischer Makroangiopathie gewertet und der Patient wegen der rezidivierenden, hämodynamisch bedingten Symptomatik operiert. Bei der zweizeitig durchgeführten Karotisdesobliteration beidseits bestätigte sich der Verdacht auf intramurale Atherome. Intramurale Atherome mit oder ohne Einblutung sind eine kernspintomographische Differentialdiagnose zu intramuralen Hämatomen bei Karotisdissektion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050180
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  • 8
    Electronic Resource
    Electronic Resource
    Intracranial dural arteriovenous fistula with spinal medullary venous drainage (2000)
    Springer
    European radiology 10 (2000), S. 1606-1609 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Dural arteriovenous fistula – MR imaging – Endovascular therapy – Myelopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000382
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  • 9
    Electronic Resource
    Electronic Resource
    Multiple sclerosis: interobserver agreement in reporting active lesions on serial brain MRI using conventional spin echo, fast spin echo, fast fluid-attenuated inversion recovery and post-contrast T1-weighted images (1999)
    Springer
    Journal of neurology 246 (1999), S. 920-925 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Magnetic resonance imaging ; Disease activity ; Fast spin echo ; Fast fluid-attenuated inversion ; recovery ; Reproducibility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies have addressed the question of the precision in assessing multiple sclerosis (MS) activity by counting enhancing lesions on gadolinium enhanced brain magnetic resonance imaging (MRI). However, counting the active lesions on serial unenhanced MRI obtained by various pulse sequences has not been yet considered. We compared the interobserver levels of agreement in reporting active MS lesions on serial enhanced and unenhanced MRI to assess whether the use of various unenhanced techniques may change the degree of interobserver measurement reproducibility. Dual-echo conventional spin echo (CSE), dual-echo fast spin echo (FSE), fast fluid-attenuated inversion recovery (FLAIR) and Gd-enhanced T1-weighted brain MRI were obtained from five MS patients at baseline and monthly for 2 months. Six experienced observers independently identified and counted active MS lesions on the two follow-up MRI scans. Active lesions were considered to be all the enhancing lesions and any new or enlarging lesion on enhanced and unenhanced scans. Interobserver levels of agreement were calculated by weighted κ values. Very good agreement was reached only for counting total and new Gd-enhancing lesions. Good agreement was achieved for counting new lesions on the three unenhanced techniques, whereas the agreement for counting enlarging lesions was poor with all the MRI techniques. The level of agreement was significantly heterogeneous for various MRI techniques but not for various lesion sites. These results confirm that counting enhancing lesions is the most reliable method for assessing MS activity, but the use of any of the available unenhanced MRI techniques did not result in different levels of interobserver agreement when reporting new and enlarging MS lesions on serial scans.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050483
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  • 10
    Electronic Resource
    Electronic Resource
    The use of magnetic resonance imaging in multiple sclerosis treatment trials: power calculations for annual lesion load measurement (2000)
    Springer
    Journal of neurology 247 (2000), S. 34-40 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Treatment trial ; Power calculations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Phase III definitive treatment trials of new multiple sclerosis (MS) therapies now routinely incorporate an annual magnetic resonance imaging protocol, with change in T2-weighted brain lesion load providing an important outcome measure. To date the accepted strategy has been to perform a core imaging protocol on all patients in such studies. The aim of this study was to provide power calculations based on this MRI endpoint. Serial MRI data from 128 patients with either relapsing remitting (RR) or secondary progressive (SP) MS were used to calculate sample size requirements using a repeated measures analysis of variance design. We provide sample size calculations based on various follow-up intervals and effect sizes. Sample sizes for the SPMS cohort were substantially larger than for the RRMS group, reflecting the greater variance in lesion load changes between patients in the SPMS group. With a follow-up of 3 years, we estimate that only 12 and 33 patients per arm are needed to show stabilisation of MRI lesion load in the RRMS and SPMS groups, respectively. Our results suggest that ongoing phase III treatment trials are more than adequately powered to detect even subtle treatment effects, and indicate that incorporating measurements from longer follow-up durations increases power substantially. We conclude that an annual imaging protocol provides a robust and powerful tool for assessing effects on the radiological appearance of the disease process.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050007
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