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ABSTRACT: Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures.
To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility.
Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire.
dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be further assessed.
dMR-HSG with cervical cannulation and intracavitary gadolinium injection is feasible and allows assessment of the uterus, the fallopian tubes, and extra-uterine pelvic structures, while avoiding all ionizing radiation in infertile women aiming at pregnancy.
Acta Radiologica 07/2010; 51(6):693-701. · 1.37 Impact Factor
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ABSTRACT: The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.
European Radiology 09/2008; 18(8):1644-52. · 3.22 Impact Factor
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ABSTRACT: In patients with multiple sclerosis (MS) non-communicating syringomyelia (NCS) has been described as an incidental finding in case studies and small case series. NCS in MS patients commonly leads to uncertainty particularly as the clinical picture of NCS is variable and surgical therapy may be considered. Up to date little is known about the prevalence and clinical importance of NCS in MS. We report the imaging and clinical characteristics of NCS formations in nine MS patients from a 1 year follow-up study in a representative group of 202 MS (4.5%) patients. Brain and spinal cord MRI was performed as part of a genetic study. NCS did commonly extend the central canal and the cord was slightly distended at the level of the syrinx. The cord and syrinx showed no tendency to change in size or shape over 1 year. Despite thorough search into the clinical history and current clinical status no definite but only minimal indications of symptoms potentially related to the NCS were found. We confirm that NCS may occur in MS patients with spinal cord pathology. It can be a subtle finding without clinical correlates. Syrinx formations are more likely to be a consequence of MS cord pathology than a coincidental finding.
Brain 06/2008; 131(Pt 7):1776-82. · 9.46 Impact Factor
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ABSTRACT: At present, X-ray hysterosalpingography is used commonly as a screening method for testing Fallopian tube patency, but the results are often unreliable due to mucous plugs or muscular contractions. Selective catheterization of the tubes under X-ray control is feasible, but is rarely used due to exposure of young individuals aiming for pregnancy to a high ionizing dose. Here, a case is described of a patient whose Fallopian tubes were selectively catheterized and visualized three-dimensionally under contrast-enhanced magnetic resonance imaging (MRI) guidance using a high-viscous gadoteric acid solution (Dotarem). In this patient, bilateral peritubal adhesions caused a blockage of the fimbrial part of the tube leading to transuterine spilling of tubal fluid. Laparoscopy followed by bilateral salpingectomy was then performed, which confirmed the three-dimensional MRI images, and the excised specimens were examined histologically. The advantages of this novel technique include the avoidance of ionizing damage to the gonads and the potential for development of more elaborate interventional methods, such as ballooning and stenting. It is intended to develop contrast MRI further, both for improved non-invasive visualization and for manipulative technology of the Fallopian tubes.
Reproductive biomedicine online 06/2007; 14(5):593-7. · 2.04 Impact Factor
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ABSTRACT: Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) has been used to measure T2* changes in skeletal muscle tissue of healthy volunteers. The BOLD effect is assumed to primarily reflect changes in blood oxygenation at the tissue level. We compared the calf muscle BOLD response of patients with peripheral arterial occlusive disease (PAOD) to that of an age-matched non-PAOD group during postischemic reactive hyperemia.
PAOD patients (n=17) with symptoms of intermittent calf claudication and an age-matched non-PAOD group (n=11) underwent T2*-weighted single-shot multiecho planar imaging on a whole-body magnetic resonance scanner at 1.5 T. Muscle BOLD MRI of the calf was performed during reactive hyperemia provoked by a cuff-compression paradigm. T2* maps were generated with an automated fitting procedure. Maximal T2* change (deltaT2*(max)) and time to peak to reach deltaT2*(max) for gastrocnemius, soleus, tibial anterior, and peroneal muscle were evaluated. Compared with the non-PAOD group, patients revealed significantly lower deltaT2*(max)-values, with a mean of 7.3+/-5.3% versus 13.1+/-5.6% (P<0.001), and significantly delayed time-to-peak values, with a mean of 109.3+/-79.3 versus 32.2+/-13.3 seconds (P<0.001).
T2* time courses of the muscle BOLD MRI signal during postocclusive reactive hyperemia revealed statistically significant differences in the key parameters (deltaT2*(max); time to peak) in PAOD patients compared with age-matched non-PAOD controls.
Circulation 06/2006; 113(25):2929-35. · 14.74 Impact Factor
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ABSTRACT: Our objective was to compare the image quality of reconstructed thin sections obtained from a 16-MDCT scanner with that of axial high-resolution CT scans of the same patient.
Fifty consecutive patients referred for CT of the chest underwent 16-MDCT and, subsequently, axial high-resolution CT. The volumetric raw data from the MDCT scans were reconstructed into slices 2-mm thick using a high-spatial-frequency reconstruction algorithm. Two blinded reviewers independently rated the images from both methods for subjective image-quality criteria. The results were tested for statistical significance using Wilcoxon's signed rank test, and p values of less than 0.05 were considered significant. The effective dose for axial high-resolution CT and volumetric MDCT was calculated.
Motion artifacts were significantly more common on high-resolution CT scans than on reconstructed thin-section images (p < 0.001). The two methods differed significantly in lung attenuation (p = 0.008), mainly because of the presence of ground-glass opacities. The assessment of ground-glass attenuation was superior on axial high-resolution CT. The effective doses were 3.8 mSv for MDCT and 0.9 mSv for high-resolution CT.
Reconstructed high-resolution images generated from a single MDCT data acquisition are of comparable quality to images obtained using conventional axial high-resolution CT. However, contiguous MDCT is not recommended for diseases showing predominantly ground-glass patterns, because axial high-resolution CT delineates ground-glass attenuation significantly better.
American Journal of Roentgenology 10/2005; 185(3):602-7. · 2.78 Impact Factor
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ABSTRACT: OBJECTIVE: The aim of this study was to optimize detection of angioinvasive pulmonary aspergillosis by showing direct vessel involvement at a peripheral level with high-resolution MDCT angiography in patients with antibiotic-resistant fever of unknown origin under immunosuppression. Twelve CT angiographic examinations were prospectively performed in 10 patients with an optimized CT angiography protocol with 16-MDCT after IV administration of contrast agent using care bolus (Siemens Medical Solutions). Axial images and maximum intensity projections were evaluated for vascular occlusion by an experienced radiologist blinded to the clinical histories. Results were correlated with histology and clinical follow-up data including follow-up CT. Fourteen focal pulmonary lesions were detected by CT in eight patients. Eight of 14 lesions were confirmed by histology. In the remaining six lesions, diagnosis was made by clinical and CT follow-up. In nine of nine lesions in which angioinvasive infection was excluded, CT angiography showed patent vessels. In four of five lesions with histologically proven fungal angioinvasion, vascular occlusion was detected on CT angiography. CONCLUSION: High-resolution MDCT angiography has been shown to be a feasible technique to depict directly vessel occlusion in the setting of suspected fungal infections, especially for early diagnosis of angioinvasive pulmonary aspergillosis in immunosuppressed patients.
American Journal of Roentgenology 04/2005; 184(3):746-51. · 2.78 Impact Factor
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ABSTRACT: The diagnostic accuracy of multidetector row computed tomography for the prospective diagnosis of acute bowel ischemia in the daily clinical routine was analyzed. Two hundred ninety-one consecutive patients with an acute or subacute abdomen, examined by MDCT over a time period of 5 months, were included in the study. All original CT diagnoses made during the daily routine by radiological generalists were compared to the final diagnoses made by using all available medical information from endoscopies, surgical interventions, autopsies and follow-up. Finally, all CT examinations of patients with an initial CT diagnosis or a final diagnosis of bowel ischemia were reread by a radiologist specialized in abdominal imaging in order to analyze the CT findings and the reasons for initially false negative or false positive CT readings. Twenty-four patients out of 291 (8.2%) had acute bowel ischemia. The age of affected patients ranged from 50 to 94 years (mean age: 75.7 years). Eleven patients were male, and 13 female. Reasons for acute bowel ischemia were: arterio-occlusive (n=11), non-occlusive (n=5), strangulation (n=2), over-distension (n=3) and radiation (n=3). The prospective sensitivity, specificity, PPV and NPV of MDCT for the diagnosis of acute bowel ischemia in the daily routine were 79.17, 98.51, 90.48 and 98.15%. MDCT reaches a similarly high sensitivity in diagnosing acute bowel as angiography. Furthermore, it has the advantage of being helpful in most of its clinical differential diagnoses and of being less invasive with the consecutive possibility of being used earlier in the diagnostic process with all the resulting positive effects on the patients prognosis. Therefore, nowadays MDCT should probably be used as the first step imaging modality of choice in patients with suspected acute bowel ischemia.
European Radiology 01/2005; 14(12):2347-56. · 3.22 Impact Factor
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American Journal of Roentgenology 11/2004; 183(4):1000-2. · 2.78 Impact Factor
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European Radiology 10/2003; 13(9):2238-40. · 3.22 Impact Factor
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ABSTRACT: Purpose: To demonstrate the technical feasibility of the anterior approach to the coronal roof component of carefully selected acetabular
fractures in computed tomography (CT)-navigated closed reduction and percutaneous fixation (CRPF).
Methods: Four patients with nondisplaced or slightly displaced coronal fractures of the acetabular roof were treated with percutaneous
screw fixation. Screws were implanted over guidepins placed under CT navigation. Mean clinical and radiological follow-up
was 16 months.
Results: All screws could be placed as intended. There were no peri- or postoperative complications. Radiological follow-up showed
primary osseous union. Clinical results were excellent according to a median Merle-d'Aubigné score of 18.
Conclusion: Nondisplaced or slightly displaced coronally oriented fractures of the acetabular roof can be treated by minimally invasive
percutaneous CT-navigated fixation through an anterior approach that does not endanger the sciatic nerve. Early clinical results
are encouraging. Close cooperation between trauma surgeons and radiologists and careful selection of cases is mandatory.
CardioVascular and Interventional Radiology 08/2000; 23(5):327-331. · 2.09 Impact Factor
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ABSTRACT: Purpose: To describe a new catheter for the percutaneous mechanical removal of fresh and organized thrombi, and to assess its efficacy
and safety in vitro and in vivo.
Methods: The catheter consists of a coated stainless steel spiral that rotates at 40,000 rpm over a guidewire inside the whole length
of an 8 Fr, single-lumen, polyurethane catheter, driving a dual-blade cutting crown. Abraded occlusion material is sucked
into the catheter head through distal side holes and transported by the spiral into a reservoir at the proximal end. The efficacy
of the device was tested in arterial models and fresh bovine carotid arteries (n=72). In a clinical pilot study 10 patients (8 women, 2 men; mean age 70.6 ±10.1 years) with occlusions of the superficial
femoral artery (2–12 cm, mean 5.8 cm), not older than 4 weeks, underwent thrombectomy with the new catheter.
Results: In arterial models and bovine cadaver arteries the catheter completely removed fresh thrombi. Occlusion material of higher
consistency was cut into particles of 100–500 μm and transported outside. Thrombectomy was successful and vessel patency restored
in all 10 patients. The ankle/brachial pressure index significantly (p<0.0005) increased from 0.41±0.18 before intervention to 0.88±0.15 after 48 hr and to 0.84±0.20 after 3 months. Two reocclusions
occurred within 14 days after the intervention.
Conclusion: Thrombectomy with the new device appears to be feasible and safe in patients with acute and subacute occlusions of the femoropopliteal
artery.
CardioVascular and Interventional Radiology 04/1999; 22(6):504-509. · 2.09 Impact Factor
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ABSTRACT: Purpose: To report the results of thrombus fragmentation in combination with local fibrinolysis using recombinant human-tissue plasminogen
activator (rtPA) in patients with massive pulmonary embolism.
Methods: Five patients with massive pulmonary embolism were treated with thrombus fragmentation followed by intrapulmonary injection
of rtPA. Clot fragmentation was performed with a guidewire, angiographic catheter, and balloon catheter. Three patients had
undergone recent surgery; one of them received a reduced dosage of rtPA.
Results: All patients survived and showed clinical improvement with a resultant significant (p < 0.05) decrease in the pulmonary blood pressure (mean systolic pulmonary blood pressure before treatment, 49 mmHg; 4 hr
after treatment, 28 mmHg). Angiographic follow-up in three patients revealed a decrease in thrombus material and an increase
in pulmonary perfusion. Two patients developed retroperitoneal hematomas requiring transfusion.
Conclusion: Clot fragmentation and local fibrinolysis with rtPA was an effective therapy for massive pulmonary embolism. Bleeding at
the puncture site was a frequent complication.
CardioVascular and Interventional Radiology 08/1997; 20(5):364-368. · 2.09 Impact Factor
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ABSTRACT: PurposeTo assess the midterm results of closed reduction and percutaneous fixation (CRPF) with computed tomography (CT)-guided sacroiliac
screw fixation in longitudinal posterior pelvic ring fractures.
MethodsThirteen patients with 15 fractures were treated. Eleven patients received a unilateral, two a bilateral, screw fixation.
Twenty-seven screws were implanted. Continuous on-table traction was used in six cases. Mean radiological follow-up was 13
months.
ResultsTwenty-five (93%) screws were placed correctly. There was no impingement of screws on neurovascular structures. Union occurred
in 12 (80%), delayed union in 2 (13%), and nonunion in 1 of 15 (7%) fractures. There was one screw breakage and two axial
dislocations.
ConclusionSacroiliac CRPF of longitudinal fractures of the posterior pelvic ring is technically simple, minimally invasive, well localized,
and stable. It should be done by an interventional/surgical team. CT is an excellent guiding modality. Closed reduction may
be a problem and succeeds best when performed as early as possible.
CardioVascular and Interventional Radiology 04/1997; 20(4):285-294. · 2.09 Impact Factor
