RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
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Approximately 6 - 50% of all ischemic strokes are caused by intracranial arterial stenosis (IAS). Despite medical prevention, patients with symptomatic IAS have a high annual risk for recurrent ischemic stroke of about 12%, and up to 19% in the case of high-grade IAS (≥ 70%). Digital subtraction angiography remains the gold standard for the diagnosis and grading of IAS. ⋯ The rate of re-stenosis is reported between 10 and 40% depending on patient age and stenosis location. Further randomized studies comparing medical secondary prevention and endovascular therapy are currently being performed. With regard to the improvement of endovascular methods and lower complication rates, the indication for endovascular therapy in IAS could be broadened especially for stenosis in the posterior circulation.
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Radial nerve compression caused by crossing branches of the recurrent radial artery - so called hypertrophic "leash(es) of Henry" (LoH) - is rare. Nevertheless it is important to diagnose the type of compression neuropathy in the forearm. ⋯ In summary, both presented patients showed a unique topographic concordance of a textural change of the deep radial nerve (i. e., swelling and inner hypoechoic fascicular change) and the causative hypertrophic crossing artery. The use of power Doppler ultrasound in addition to caliber and texture changes shown on grayscale ultrasound and the functional visualization of pulsating vessels should be included in every sonographic examination of patients with chronic forearm pain symptoms.
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The imaging of systemic disorders without radiation exposure by whole-body MRI (wb-MRI) represents a paradigm shift for pediatric radiology. The reduction of multiple regional examinations, if necessary under sedation, results in a faster treatment start. Modern scanner techniques using automatic table movement and allowing the combination of multiple coil elements and synchronized signal recording with numerous independent receiving channels are the basic prerequisite for high-resolution wb-MRI. ⋯ However, wb-MRI has been shown to yield a higher diagnostic performance than bone scintigraphy and comparable results to FDG-PET for the detection of bone metastases. Due to the low number of published studies, it is uncertain for which entity of solid tumors wb-MRI is the modality of choice and for which tumors wb-MRI will play only a complementary role in the diagnostic work-up. Methodical strategies, pitfalls in image analysis, indications and diagnostic accuracy will be discussed based on already published results as well as our own experience from over 400 examinations, thus providing an overview of the recent research as well as supplying relevant aspects of the daily routine in pediatric wb-MRI.
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Comparative Study
Estimation of the minimum dose required to measure ventricular width in follow-up cranial computed tomography (CCT) in children with hydrocephalus.
To estimate the minimum dose needed at follow-up cranial computed tomography (CCT) to reliably determine ventricular width in children with hydrocephalus. ⋯ There is no single cut-off dose or setting for tube voltage and current which guarantees reliable ventricular width measurements with the least radiation exposure for both scanners. As a guideline, it is safe to use the standard protocols with a reduced tube current of 100 kV.
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To evaluate non-enhanced 3D MR angiography using turbo spin echo (TSE) imaging with non-selective refocusing pulses (NATIVE SPACE MRA) for the visualization of the arteries of the lower extremity. ⋯ ECG-gated SPACE MRA is a promising imaging technique for non-enhanced assessment of the arteries of the lower extremity.