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Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as... more
Routine radiographs and PA dual x-ray absorptiometry (DXA) of the lumbar spine were performed in 253 patients. A T-score of -2SD (approximately 20% reduction from young normal bone mineral density (BMD)) as measured by DXA, was used as threshold for the diagnosis of osteopenia. A lumbar spine index (LSI) as proposed by Barnett and Nordin was assessed by one radiologist. The correlation between LSI and bone mineral density, measured by DXA, was poor, and our results indicate that osteopenic patients cannot be differentiated from non-osteopenic patients by LSI. 100 radiographs of the lumbar spine were evaluated by 9 observers in order to determine observer variation in the detection of osteopenia. A complete agreement between the readers for the diagnosis of osteopenia was achieved in 43 percent of all radiographs. DXA and observers agreed in 68 to 76 percent of all cases. For a decrease of BMD of more than 60 percent compared to young normal adults, as determined by DXA, all readers ...
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An increase in bone mineral content (BMC) as well as a decrease in the incidence of fracture of the proximal femur have been described in patients on thiazide diuretic treatment. A study was undertaken to assess, by means of dual X-ray... more
An increase in bone mineral content (BMC) as well as a decrease in the incidence of fracture of the proximal femur have been described in patients on thiazide diuretic treatment. A study was undertaken to assess, by means of dual X-ray absorptiometry, the effect of chronic low-dosage antihypertensive treatment with hydrochlorothiazide (HCT; < or = 25 mg daily) on lumbar vertebrae (representing the axial skeleton) and the nondominant radius (peripheral skeleton). Measurements were made on 27 women (mean age 63.8 +/- 8.2 years) and 23 men (65.9 +/- 9.5 years) and compared with a control group of 19 women (62 +/- 8.7 years) and 20 men (65.9 +/- 9.5 years) with minor surgical or dermatological lesions who had never taken HCT or other drugs with potential effects on mineral bone metabolism. In men who had been on HCT for more than 5 years, BMC of the lumbar vertebrae was higher by 10.3% and of the radius by 3.8% than among the controls (differences not significant). In women who had b...
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In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of... more
In 100 patients (20 male, 80 female) radiographs of the lumbar spine were obtained in both planes, anteroposterior and lateral. Nine readers independently and without specific criteria or training assessed the radiographs for presence of osteopenia in the form of a binary decision. A posteranterior dual x-ray absorptiometry (PA DXA) measurement of the lumbar spine was performed in all patients using the Hologic QDR 1000 bone densitometer. A bone mineral density (BMD) of 0.83 g/cm2 (T-score about 2 SD and 2.5 SD lower than BMD in normal young female and male subjects respectively) was used as a threshold for the diagnosis of osteopenia. Complete agreement amongst the 9 readers was achieved in 43 patients. In 26 more patients at least 8 readers agreed. kappa-coefficients for interobserver variation ranged from 0.458 to 0.691 for reader pairs. For agreement between the observer ratings and the DXA results, kappa-coefficients ranging between 0.347 and 0.555 were found. The vast majority of readers agreed in the diagnosis of osteopenia in cases where the BMD was less than 0.73 g/cm2. Where the BMD was between 0.73 and 1.03 g/cm2 a substantial disagreement was found between reader evaluation and DXA measurement, and also amongst the readers. We conclude from our results that osteopenia can reliably be detected from lumbar spine radiographs by all readers only after a substantial amount of BMD is lost. On the other hand, a diagnosis based solely on PA DXA measurement of the spine may also lack accuracy, due to a substantial influence of degenerative changes of the lumbar spine and aortic calcification.(ABSTRACT TRUNCATED AT 250 WORDS)
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Research Interests: Anthropometry, Ultrasound, Linear models, Postmenopausal Women, Osteoporosis, and 18 moreHumans, Tibia, Female, Bone Density, Clinical Sciences, Aged, Middle Aged, Quantitative Ultrasound, Adult, Bone Mineral Density, Cortical Bone, Cortical Thickness, Correlation coefficient, X ray Computed Tomography, Cross Sectional Studies, Femur Neck, Total Hip, and Spinal fractures
Techniques for measuring bone mineral density have been widely accepted for the diagnosis and management of osteoporosis. These techniques are clinically feasible, and their fracture prediction capability has been proven in numerous... more
Techniques for measuring bone mineral density have been widely accepted for the diagnosis and management of osteoporosis. These techniques are clinically feasible, and their fracture prediction capability has been proven in numerous studies. However, it has been demonstrated that bone strength and fracture risk are affected not only by the density of bone but also by other skeletal features including bone composition and microarchitecture. Available techniques for measuring bone mineral density have some disadvantages because they offer limited ability to assess bone quality, are relatively expensive, and use ionizing radiation.
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... J?rg Schmiedeskamp5, Eckhard Mayer6, Claus Peter Heussel7, Klaus Markstaller8, Hans-Ulrich Kauczor9, Balthasar Eberle8, ... kern-\nulldelimiterspace} Q $$\end{document} ] ratio. Since BO is an airway disease, ventilation becomes... more
... J?rg Schmiedeskamp5, Eckhard Mayer6, Claus Peter Heussel7, Klaus Markstaller8, Hans-Ulrich Kauczor9, Balthasar Eberle8, ... kern-\nulldelimiterspace} Q $$\end{document} ] ratio. Since BO is an airway disease, ventilation becomes impaired in affected regions of the lung. ...
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With the advent of multislice technology computed tomography experienced a boost in image quality, comparable to the introduction of spiral CT one decade ago. In the chest, the improved performance may be utilised to scan faster or to... more
With the advent of multislice technology computed tomography experienced a boost in image quality, comparable to the introduction of spiral CT one decade ago. In the chest, the improved performance may be utilised to scan faster or to obtain an almost isotropic spatial resolution. For examinations of the lungs multislice CT offers considerable advantages over single slice spiral CT: reduced breathing and pulsation artefacts, the ability to cover large volumes with thin slices, the simultaneous evaluation of high resolution and standard imaging protocols from one data acquisition, high resolution multiplanar sections through the lung parenchyma, and 3D techniques like volume rendering and virtual bronchoscopy. In this review the technical principles of multislice CT of the lungs are discussed. Major clinical applications such as evaluation of focal and diffuse lung disease are reviewed.
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Ultrasound transmission velocity at the appendicular skeleton is determined by elastic properties of the bone as mass density. We evaluated ultrasound transmission velocity at the os calcis of both feet and at the proximal phalanges of... more
Ultrasound transmission velocity at the appendicular skeleton is determined by elastic properties of the bone as mass density. We evaluated ultrasound transmission velocity at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 51 male subjects. 28 of them were professional soccer players of the 1st German division, 11 subjects performed non-professional exercise in various athletic organisations regularly and 12 did not exercise at all. A significant difference in the speed of sound could be seen at os calcis, where the soccer players had higher velocities than the other groups. The differences between the groups at the upper and lower extremities suggest that changes in ultrasound transmission velocity are not only affected by structural changes in the aging skeleton, as it might be suggested by age differences, but by exercise. Physical exercise can change the properties (structure and/or density) of weightbearing bone and this can be detected by measuring ultrasound velocity.
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PURPOSE/AIM 1. To illustrate typical and rare findings on a CXR indicating abdominal diseases or abdomino-thoracic disease extension. 2. To alert the radiologists to findings on a CXR that indicate life threatening abdominal diseases... more
PURPOSE/AIM 1. To illustrate typical and rare findings on a CXR indicating abdominal diseases or abdomino-thoracic disease extension. 2. To alert the radiologists to findings on a CXR that indicate life threatening abdominal diseases requiring immediate therapeutic action. 3. To outline appropriate diagnostic pathways CONTENT ORGANIZATION The poster will demonstrate cases in an interactive pictorial essay format with key findings on the CXR that are pathognomonic and allow for immediate diagnosis, or alert the readers’ attention towards underlying abdominal diseases. Findings in subsequently indicated diagnostic procedures will be demonstrated (ERCP, CT or MRI). Cases refer to abdomino-thoracic extension of infections, complications of pancreatitis, gastrointestinal operations, vascular diseases and pathologic air collections. SUMMARY Major teaching points of this exhibit are: 1. To learn about findings on a CXR that are pathognomonic for specific abdominal diseases. 2. To learn abo...
PURPOSE The purpose of this study was to investigate whether running a marathon causes alterations of bone, menisci, ligaments, and/or cartilage that are demonstrable on MR images. METHOD AND MATERIALS Twenty non-professional marathon... more
PURPOSE The purpose of this study was to investigate whether running a marathon causes alterations of bone, menisci, ligaments, and/or cartilage that are demonstrable on MR images. METHOD AND MATERIALS Twenty non-professional marathon runners underwent magnetic resonance (MR) imaging of the knee before and immediately after running a marathon, using sagittal dual TSE-, 3D WATS-, coronal STIR, and axial T2-TSE-images. Two experienced radiologists interpreted the scans and graded the presence of lesions of menisci and cartilage on a 5-point scale, and bone marrow edema, ligamentous lesions, and joint effusion on a 3-point scale. RESULTS Bone marrow edema was neither present before nor after the marathon. In one runner, a punctate signal alteration in the anterior cruciate ligament was revealed after the marathon. Joint effusion was present in the pre-run scans of eighteen out of twenty runners and increased slightly after the marathon. No cartilage defects were noticed. CONCLUSIONS No...
Overuse syndromes due to lifestyle problems or sporting activities commonly lead to foot abnormalities. The tendons of the long flexor and extensor muscles are specifically prone to degeneration. The various disorders may be classified by... more
Overuse syndromes due to lifestyle problems or sporting activities commonly lead to foot abnormalities. The tendons of the long flexor and extensor muscles are specifically prone to degeneration. The various disorders may be classified by a grading system that includes peritendinous inflammation, degenerative tendon disease, and ruptures. Bone marrow edema is another typical manifestation of overuse. It may be differentiated from inflammatory or traumatic forms of edema by its anatomic distribution. Systematic pattern recognition is based on the concept of musculotendinous and osseous kinetic chains.
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PURPOSE To evaluate the added value of a commercially available computer-aided detection system (CAD) for the detection of solid pulmonary lesions in older patients with increased anatomical noise. METHOD AND MATERIALS Two-view digital... more
PURPOSE To evaluate the added value of a commercially available computer-aided detection system (CAD) for the detection of solid pulmonary lesions in older patients with increased anatomical noise. METHOD AND MATERIALS Two-view digital chest radiographs of 114 patients (mean age 62y) were retrospectively selected. Sixty patients had 101 CT-proven solid pulmonary lesions (5-15mm, mean 10mm). Varying degrees of smoking related lung disease were present in 66% of patients. Conspicuity of lesions was generally low with 60% judged as subtle or very subtle. Three inexperienced (<1,5y) and three experienced readers (>10y) evaluated the images with and without CAD (xLNA Enterprise, Philips) in 2 separate reading sessions. Sensitivity and false positive rate (FP/FP+TP) were calculated on per lesion basis. Kappa statistics were used to determine interreader agreement and McNemar test was applied to compare sensitivities. RESULTS The stand-alone sensitivity of CAD was 47% (47/101) with a...
CLINICAL/METHODICAL ISSUE: Dose reduction and adequate image quality in digital radiography - a contradiction? STANDARD RADIOLOGICAL METHODS: Digital radiography has already replaced traditional screen-film systems. METHODICAL... more
CLINICAL/METHODICAL ISSUE: Dose reduction and adequate image quality in digital radiography - a contradiction? STANDARD RADIOLOGICAL METHODS: Digital radiography has already replaced traditional screen-film systems. METHODICAL INNOVATIONS: Substantial improvements in both dose efficiency and spatial resolution demonstrate the rapid developments in digital radiography. PERFORMANCE: Needle-detector systems have shown up to a 50% dose reduction compared to traditional screen-film systems. There is also a dose reduction capability of up to 50% comparing direct radiography (DR) systems to computed radiography (CR) systems for chest X-rays. However, despite the most recent achievements of CR technology, the dose efficiency of DR systems (caesium iodide flat-panel detector) is unparalleled. ACHIEVEMENTS: The progress in detector technology has contributed to dose reduction and improved image quality, while saving time and providing a higher examination rate. PRACTICAL RECOMMENDATIONS: The ...
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PURPOSE To evaluate the performance of a computer aided detection system (CAD) as a second reader, depending on the readers’ experience and the visibility of artificial lesions. METHOD AND MATERIALS The study group comprised 116 pa CXR... more
PURPOSE To evaluate the performance of a computer aided detection system (CAD) as a second reader, depending on the readers’ experience and the visibility of artificial lesions. METHOD AND MATERIALS The study group comprised 116 pa CXR (a-CSI-TFT). Fifty-seven of them contained one or multiple superimposed lesions, simulating nodules of different size (5-15mm), density and contour sharpness. Images were evaluated without and with CAD (xLNA Enterprise 2.0, EDDA systems, Philips) used as a second reader. Four readers of vastly different experience with respect to reading CXRs (A and B: <1 yr, C: >5 yrs, D: > 15 yrs) and experience with CAD (A and B: < 6 wks, C and D: >12 months) were asked to assess the presence of nodules and to localize them. The rating scores were tested for statistical differences using analysis of variance with repeated measures. RESULTS Lesion detection was dependent of anatomical location, size and shape (p<0,01). The sensitivity of the experi...
Chest radiography still represents the most commonly performed X-ray examination because it is readily available, requires low radiation doses and is relatively inexpensive. However, as previously published, many initially undetected lung... more
Chest radiography still represents the most commonly performed X-ray examination because it is readily available, requires low radiation doses and is relatively inexpensive. However, as previously published, many initially undetected lung nodules are retrospectively visible in chest radiographs. The great improvements in detector technology with the increasing dose efficiency and improved contrast resolution provide a better image quality and reduced dose needs. The dual energy acquisition technique and advanced image processing methods (e.g. digital bone subtraction and temporal subtraction) reduce the anatomical background noise by reduction of overlapping structures in chest radiography. Computer-aided detection (CAD) schemes increase the awareness of radiologists for suspicious areas. The advanced image processing methods show clear improvements for the detection of pulmonary lung nodules in chest radiography and strengthen the role of this method in comparison to 3D acquisition...
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Frequent assessments of rheumatoid arthritis (RA) disease activity allow timely adaptation of therapy, which is essential in preventing disease progression. However, values of acute phase reactants (APRs) are needed to calculate current... more
Frequent assessments of rheumatoid arthritis (RA) disease activity allow timely adaptation of therapy, which is essential in preventing disease progression. However, values of acute phase reactants (APRs) are needed to calculate current composite activity indices, such as the Disease Activity Score (DAS)28, the DAS28-CRP (i.e. the DAS28 using C-reactive protein instead of erythrocyte sedimentation rate) and the Simplified Disease Activity Index (SDAI). We hypothesized that APRs make limited contribution to the SDAI, and that an SDAI-modification eliminating APRs - termed the Clinical Disease Activity Index (CDAI; i.e. the sum of tender and swollen joint counts [28 joints] and patient and physician global assessments [in cm]) - would have comparable validity in clinical cohorts. Data sources comprised an observational cohort of 767 RA patients (average disease duration 8.1 +/- 10.6 years), and an independent inception cohort of 106 patients (disease duration 11.5 +/- 12.5 weeks) who ...
Research Interests: Immunology, Nonparametric Statistics, Rheumatoid Arthritis, Linear models, Clinical Practice, and 17 moreProspective studies, Humans, Female, Confidence intervals, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Public health systems and services research, Analysis of Variance, Disease Progression, Acute Phase Proteins, Disease Activity, Erythrocyte Sedimentation Rate, Cross Sectional Studies, and Cohort Studies(Prospective studies, Humans, Female, Confidence intervals, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Public health systems and services research, Analysis of Variance, Disease Progression, Acute Phase Proteins, Disease Activity, Erythrocyte Sedimentation Rate, Cross Sectional Studies, and Cohort Studies)
(Prospective studies, Humans, Female, Confidence intervals, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Public health systems and services research, Analysis of Variance, Disease Progression, Acute Phase Proteins, Disease Activity, Erythrocyte Sedimentation Rate, Cross Sectional Studies, and Cohort Studies)
Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is a major contributing factor for poor outcome in rheumatoid arthritis (RA). Although early therapy has been shown to be particularly effective, there is still uncertainty... more
Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is a major contributing factor for poor outcome in rheumatoid arthritis (RA). Although early therapy has been shown to be particularly effective, there is still uncertainty about the optimal time point of DMARD introduction. We wanted to test if a therapeutic window of opportunity may exist within the first few months of the disease. In this case-control parallel-group study, 20 very early RA (VERA) patients with median disease duration of 3 months were age and gender matched to a group of 20 late early RA (LERA) patients with median disease duration of 12 months until first DMARD initiation. Follow-up time was 36 months. Primary outcome measures were the disease activity score (DAS28) and radiological joint destruction using the Larsen method. Already after 3 months of DMARD therapy we found a significant difference of improvement in favour of the VERA patients in the DAS28. This trend continued over the study period. A...
Research Interests: Rheumatology, Immunology, Optimal Control, Treatment Outcome, Rheumatoid Arthritis, and 15 moreProspective studies, Humans, Female, Male, Statistical Significance, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, First Year, Disease Progression, Early Rheumatoid Arthritis, Early Diagnosis, and Case Control Studies
To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation. In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling... more
To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation. In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling or pain in at least one joint and laboratory signs of inflammation [elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis, or rheumatoid factor (RF)] within the last 3 months. Clinical and laboratory assessments were performed every 3 months. Radiographs of hands and feet were taken at entry and after one year. Treatment decisions were left to the discretion of the participating center. In total, 108 patients included between 1996 and 2000 had followup investigations during at least one year; 61.1% of these patients had rheumatoid arthritis (RA). Over 65% of RA diagnoses were made at the first visit. Lag time to referral was significantly longer in patients with RA than in patients with other inflammatory joint diseases (median 8...
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Substantial advances in detector technology characterize digital chest radiography. This article compares the various systems from a radiologist&amp;amp;amp;amp;amp;amp;amp;amp;#39;s point of view. Computed radiography (CR) is a... more
Substantial advances in detector technology characterize digital chest radiography. This article compares the various systems from a radiologist&amp;amp;amp;amp;amp;amp;amp;amp;#39;s point of view. Computed radiography (CR) is a well-established system that is robust, has good reproducibility, and is relatively inexpensive. Image quality has been continuously improved in recent years while the physical size of the readout units has been reduced and the throughput increased. CR is the only digital system that can be used for bedside chest radiographs. Improved detector properties and dual reading have made it a dose-efficient system. Although now widely available, a 4K image matrix does not appear to offer a general diagnostic improvement for imaging the chest. New developments with respect to detector composition and readout process can be expected in the future. Direct radiography (DR) is the common name for different technologies that are characterized by a direct readout matrix that covers the whole exposure area. Conversion of x-ray intensity into electric signals can either be direct (selenium-based systems) or indirect (scintillator/photodiode systems). Advantages of DR systems are a high image quality and the potential for dose reduction. The role of selenium radiography (Thoravision) has decreased after the advent of DR systems although this dedicated chest unit offers high image quality at 400 speed acquisition dose. Especially in a PACS environment, CR and DR systems will increasingly substitute for conventional radiography with advantages for CR for bedside chest radiographs and for DR for high-end chest stands.
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We report the case of a 35-years-old renal transplant patient known to have familial Mediterranean fever with serum amyloid A (SAA)-amyloidosis, who presented with his second episode of bilateral pneumonia. As antimicrobials failed to... more
We report the case of a 35-years-old renal transplant patient known to have familial Mediterranean fever with serum amyloid A (SAA)-amyloidosis, who presented with his second episode of bilateral pneumonia. As antimicrobials failed to control the first episode of pneumonia and all studies done were non-contributory, we attributed the condition to the highly active Mediterranean fever presumably resistant to colchicine and treated the patient with the interleukin-1 receptor antagonist anakinra: the patient substantially improved by clinical symptoms, chemistry and radiological evidence within no more than 2 days and was discharged in good health after 4 days.
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Research Interests: Rheumatology, Immunology, Rheumatoid Arthritis, Humans, Female, and 22 moreMale, Follow-up studies, Cyclic peptides, Second Year, Risk factors, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Regression Model, Public health systems and services research, First Year, Prognosis, Biological markers, Disease Progression, Risk Factors, Disease Activity, Early Rheumatoid Arthritis, Early Diagnosis, Autoantibodies, and Cumulant(Male, Follow-up studies, Cyclic peptides, Second Year, Risk factors, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Regression Model, Public health systems and services research, First Year, Prognosis, Biological markers, Disease Progression, Risk Factors, Disease Activity, Early Rheumatoid Arthritis, Early Diagnosis, Autoantibodies, and Cumulant)
(Male, Follow-up studies, Cyclic peptides, Second Year, Risk factors, Clinical Sciences, Aged, Middle Aged, C reactive protein, Adult, Regression Model, Public health systems and services research, First Year, Prognosis, Biological markers, Disease Progression, Risk Factors, Disease Activity, Early Rheumatoid Arthritis, Early Diagnosis, Autoantibodies, and Cumulant)
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Aggressive systemic mastocytosis (ASM) is a hematopoietic neoplasm characterized by infiltration of visceral organs by neoplastic mast cells (MCs) with consecutive organopathy and respective clinical and laboratory findings (so called... more
Aggressive systemic mastocytosis (ASM) is a hematopoietic neoplasm characterized by infiltration of visceral organs by neoplastic mast cells (MCs) with consecutive organopathy and respective clinical and laboratory findings (so called C-Findings). Whereas, it is generally appreciated that patients with ASM are candidates for pharmacological intervention, no ideal drug or drug combination have been identified yet. One drug proposed to work in ASM is interferon alpha-2b (IFN-alpha2b). However, little is known so far about the quality of responses to IFN-alpha2b and actual response rates. We here report on five ASM patients treated with either a combination of IFN-alpha2b (3x3 million units per week) and prednisolone (n=4), or IFN-alpha2b alone (n=1). During therapy, two of the five patients showed a major response defined by complete resolution of C-Finding(s), one a partial response (partial regression of C-Findings), and one a stable disease (no changes in C-Findings). In one patient, progression to mast cell leukemia was seen after 3 months. In contrast to the other patients, this patient exhibited &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10% MCs in his bone marrow (bm) smear at first presentation. In summary, our data confirm beneficial effects of IFN-alpha2b (plus prednisolone) for a group of patients with ASM, whereas patients with mast cell leukemia may require more aggressive therapy. Prospective trials with more patients are now required to further document these drug effects and to better define subgroups of patients with ASM who show good and long-lasting responses to IFN-alpha2b.
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Peripheral T-cell lymphomas (PTCL) have a variable outcome. We have investigated the prognostic value of molecular staging in non-anaplastic PTCL. T-cell receptor gamma rearrangements were routinely determined in peripheral blood (n = 40)... more
Peripheral T-cell lymphomas (PTCL) have a variable outcome. We have investigated the prognostic value of molecular staging in non-anaplastic PTCL. T-cell receptor gamma rearrangements were routinely determined in peripheral blood (n = 40) and bone marrow (n = 38) of patients with PTCL (75% unspecified) by conventional PCR at diagnosis. Tissue controls for PCR included 24 tumour biopsies. Twenty-four patients (60%) had a PCR-detectable clonal TCR gamma rearrangement in PB or BM. These TCR gamma PCR positive patients had significantly more stage IV disease (14 patients of 15 patients; P = 0.001), elevated LDH (14 of 18 patients; P = 0.04), higher IPI (16 of 21 patients; P = 0.03), more anemia (15 of 19 patients; P = 0.02) and lower platelet counts (seven of seven patients; P = 0.02). Clinical outcome of this clonal group was characterised by lower complete remission rates (37.5% vs. 62.5%), and overall response rates (58.3% vs. 87.5%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) as well as a significantly shorter median overall survival (12.8 vs. 30.0 months; P = 0.006). Patients with clinical stages I - III but molecular stage IV had an equally poor overall survival when compared with patients with clinical stage IV (15.8 vs. 13.9 months). In contrast, patients with CS I - III in the absence of a TCR gamma rearrangement in PB or BM had a favourable outcome with an estimated overall survival of 70% at 3 and 5 years. Molecular staging in PB and BM by TCR gamma PCR at diagnosis may serve as a useful prognostic tool in PTCL.
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Spiral CT imaging findings including multiplanar reconstructions of an acute dissection of the pulmonary trunk in a 22-year-old female patient with primary pulmonary hypertension (PPH) are presented and discussed.
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We sought to evaluate whether soft-copy reading of simulated pulmonary chest lesions is influenced by ambient light and automatic optimization of cathode ray tube (CRT) monitor luminance. Four types of simulated lesions (nodules, lines,... more
We sought to evaluate whether soft-copy reading of simulated pulmonary chest lesions is influenced by ambient light and automatic optimization of cathode ray tube (CRT) monitor luminance. Four types of simulated lesions (nodules, lines, micronodules, and patchy opacities) were superimposed over an anthropomorphic chest phantom. Lesion detection with soft-copy reading was assessed using a high-contrast grayscale 2K CRT monitor under the following conditions: (1) subdued lighting (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50 lux); (2) normal lighting conditions (450 lux) without, and (3) with a sensitivity modulation to automatically adjust the CRT luminance to the increased amount of ambient light. Reading data were analyzed according to receiver operating curve. Significance of differences was tested using an analysis of variance for repeated measures. Ambient room light of 450 lux did not significantly influence the detection of nodules and patchy opacities. However, bright ambient light significantly decreased detection of micronodules (0.60 vs. 0.74) and lines (0.52 vs. 0.66) relative to subdued lighting conditions. Automatic luminance adjustment could compensate the effect of ambient light for the micronodules (0.77) but not for the lines (0.53). Bright ambient light significantly decreases detection of small low-contrast structures. This may be partially but not completely compensated by an automatic luminance adaptation.
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To test a digital imaging X-ray device based on the direct capture of X-ray photons with pixel detectors, which are coupled with photon-counting readout electronics. The chip consists of a matrix of 256 × 256 pixels with a pixel pitch of... more
To test a digital imaging X-ray device based on the direct capture of X-ray photons with pixel detectors, which are coupled with photon-counting readout electronics. The chip consists of a matrix of 256 × 256 pixels with a pixel pitch of 55 μm. A monolithic image of 11.2 cm × 7 cm was obtained by the consecutive displacement approach. Images of embalmed anatomical specimens of eight human hands were obtained at four different dose levels (skin dose 2.4, 6, 12, 25 μGy) with the new detector, as well as with a flat-panel detector. The overall rating scores for the evaluated anatomical regions ranged from 5.23 at the lowest dose level, 6.32 at approximately 6 μGy, 6.70 at 12 μGy, to 6.99 at the highest dose level with the photon-counting system. The corresponding rating scores for the flat-panel detector were 3.84, 5.39, 6.64, and 7.34. When images obtained at the same dose were compared, the new system outperformed the conventional DR system at the two lowest dose levels. At the higher dose levels, there were no significant differences between the two systems. The photon-counting detector has great potential to obtain musculoskeletal images of excellent quality at very low dose levels.
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An investigation was conducted into whether running a marathon causes acute alterations in menisci, cartilage, bone marrow, ligaments, or joint effusions, which could be evaluated by magnetic resonance imaging (MRI). Twenty-two... more
An investigation was conducted into whether running a marathon causes acute alterations in menisci, cartilage, bone marrow, ligaments, or joint effusions, which could be evaluated by magnetic resonance imaging (MRI). Twenty-two non-professional marathon runners underwent MRI of the knee before and immediately after running a marathon. Lesions of menisci and cartilage (five-point scale), bone marrow, ligaments (three-point scale), joint effusion, and additional findings were evaluated and a total score was assessed. Before the marathon, grade 1 lesions of the menisci were found in eight runners, and grade 2 lesions in five runners. After the marathon, an upgrading from a meniscal lesion grade 1 to grade 2 was observed in one runner. Before the marathon, grade 1 cartilage lesions were found in three runners, and grade 2 lesions in one runner, all of which remained unchanged after the marathon. Before and after the marathon, unchanged bone marrow edema was present in three runners and unchanged anterior cruciate ligament lesions (grade 1) were seen in two runners. Joint effusions were present in 13 runners in the pre-run scans, slightly increased in four runners after the marathon, and newly occurred in one runner after the marathon. A total score comprising all knee lesions in each runner showed an increase after the marathon in two runners, whereas no runner showed an improvement of the radiological findings (Wilcoxon signed-rank test, P&gt;0.05). The evaluation of lesions of the knee with MRI shows that marathon running does not cause severe, acute lesions of cartilage, ligaments, or bone marrow of the knee in well-trained runners. Only subtle changes, such as joint effusions or increased intrameniscal signal alterations, were imaged after running a marathon.
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The image quality of dual-reading computed radiography and dose-reduced direct radiography of the chest was compared in a clinical setting. The study group consisted of 50 patients that underwent three posteroanterior chest radiographs... more
The image quality of dual-reading computed radiography and dose-reduced direct radiography of the chest was compared in a clinical setting. The study group consisted of 50 patients that underwent three posteroanterior chest radiographs within minutes, one image obtained with a dual read-out computed radiography system (CR; Fuji 5501) at regular dose and two images with a flat panel direct detector unit (DR; Diagnost, Philips). The DR images were obtained with the same and with 50% of the dose used for the CR images. Images were evaluated in a blinded side-by-side comparison. Eight radiologists ranked the visually perceivable difference in image quality using a three-point scale. Then, three radiologists scored the visibility of anatomic landmarks in low and high attenuation areas and image noise. Statistical analysis was based on Friedman tests and Wilcoxon rank sum tests at a significance level of P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05. DR was judged superior to CR for the delineation of structures in high attenuation areas of the mediastinum even when obtained with 50% less dose (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The visibility of most pulmonary structures was judged equivalent with both techniques, regardless of acquisition dose and speed level. Scores for image noise were lower for DR compared with CR, with the exception of DR obtained at a reduced dose. Thus, in this clinical preference study, DR was equivalent or even superior to the most modern dual read-out CR, even when obtained with 50% dose. A further dose reduction does not appear to be feasible for DR without significant loss of image quality.