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Magnetic resonance arteriography, duplex ultrasonography and conventional arteriography in the evaluation of peripheral arterial occlusive disease (In German)
APRIL-JUNE
ABSTRACTS
1994
THREE-DIMENSIONAL DEMONSTRATION OF PELVIC VEINS BY MAGNEFIC RESONANCE ANGIOGEAPHY (In German) Richter ChS, Duewell S, Krestin GP, et al. (Strahlenklinik u. Poliklinik, Klinikum Rudolf Virchow, Freie Universitat Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany). Riifo 1993;159:161-166. The veins in the pelvis and lower limbs have been demonstrated by means of magnetic resonance angiography (MRA) in 11 normal subjects and in 20 patients, using a “time-of-flight”(TOF) technique. In normal subjects, changes in the measurement parameters were used in order to optimize the examination protocol; consequently, the internal and external iliac veins and the superior and inferior gluteal veins could be identified in all subjects and the internal pudendal veins in six of 11 subjects. This examination protocol was then used in patients with clinical suspicion of lower limb or pelvic vein thrombosis. Comparison of the MRA findings with those of phlebography (seven cases), duplex sonography (six cases), and color Doppler examinations (11 cases) showed that MRA was better for diagnosing thrombosis of the internal iliac veins (ten cases) than the other methods. In two patients, thromboses of the common iliac veins and the inferior vena cava that were missed by color Doppler examination were demonstrated by MRA. On the basis of our present experiences, MRA, using a two-dimensional TOF technique, appears to be a reliable noninvasive technique for demonstrating the veins of the pelvis and thigh. Authors’Summary
MAGNEI’IC RESONANCE AETEIUOGRAPHY, DUPLEX ULTRASONOGEAPHY AND CONVENTIONAL AETERIOGEAPHY IN THE EVALUATION OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (In German) Baumgartner I, Maier SE, Koch M (Department fiir Innere Medizin, Abteilung Angiologie, Universitatsklinik Zurich, Ramistrasse 100,CH8091 Zurich, Switzerland). Rijfo 1993;159:167-173, A prospective controlled study of 41 peripheral arterial occlusions was carried out, comparing duplex sonography (DUS) , magnetic resonance arteriography (MRA) ,
163
and contrast arteriography (CA). This study revealed that 87.8% of DUS findings and 80.5% of MRAs agreed with the appearances of CA (gold standard). DUS tended to overestimate the length of an occluded segment by an average of 2 cm (0.5 to 5.0 cm), whereas MRA showed less deviation from CA (f 2 cm). The advantage of DUS lies in its ability to provide morphological and functional information concerning the obliterated segment. Its disadvantage is that it can only demonstrate one segment and that the examination must be carried out in individual segments. MRA provides vascular demonstration in several planes similar to angiography but signal voids due to limited resolution and flow changes may limit diagnosis of occlusions. Additional phase-contrast techniques may provide quantitative information on flow velocities and flow rates. Both DUS and MRA are suitable methods for the noninvasive investigation of peripheral arterial occlusion disease. Authors’Summary
BONE MARROW EDEMA-AN EARLY FORM OF NECROSIS OF THE HEAD OF THE FEMUR (In Gema@ Neuhold A, Hofman S, Engel A (Institut fiir bildgebende Diagnostik, Krarikenhaus Rudolfinerhaus, Billroth Strasse 78, A-1190 Vienna, Austria). Rijfo 1993;159:120-125. We examined 15 patients (16hips) with painful hips whose radiographs were either normal (nine hips) or showed a minimal decrease in radiodensity (seven hips). The available bone scintigrams of nine hips were positive. m-weighted images visualized a diffuse signal loss of the bone marrow in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions were hyperintensive on T2-weighted images. Focal anomalies were not seen in any of the hips. All patients underwent core decompression treatment. Histology of 13 hips confirmed not only the presence of bone marrow edema but also bone changes corresponding to those of avascular necrosis. Follow-up examinations with magnetic resonance after core decompression showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for identifying bone marrow edema. Due to our histological results, bone marrow edema should be in-
ABSTRACTS
1994
THREE-DIMENSIONAL DEMONSTRATION OF PELVIC VEINS BY MAGNEFIC RESONANCE ANGIOGEAPHY (In German) Richter ChS, Duewell S, Krestin GP, et al. (Strahlenklinik u. Poliklinik, Klinikum Rudolf Virchow, Freie Universitat Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany). Riifo 1993;159:161-166. The veins in the pelvis and lower limbs have been demonstrated by means of magnetic resonance angiography (MRA) in 11 normal subjects and in 20 patients, using a “time-of-flight”(TOF) technique. In normal subjects, changes in the measurement parameters were used in order to optimize the examination protocol; consequently, the internal and external iliac veins and the superior and inferior gluteal veins could be identified in all subjects and the internal pudendal veins in six of 11 subjects. This examination protocol was then used in patients with clinical suspicion of lower limb or pelvic vein thrombosis. Comparison of the MRA findings with those of phlebography (seven cases), duplex sonography (six cases), and color Doppler examinations (11 cases) showed that MRA was better for diagnosing thrombosis of the internal iliac veins (ten cases) than the other methods. In two patients, thromboses of the common iliac veins and the inferior vena cava that were missed by color Doppler examination were demonstrated by MRA. On the basis of our present experiences, MRA, using a two-dimensional TOF technique, appears to be a reliable noninvasive technique for demonstrating the veins of the pelvis and thigh. Authors’Summary
MAGNEI’IC RESONANCE AETEIUOGRAPHY, DUPLEX ULTRASONOGEAPHY AND CONVENTIONAL AETERIOGEAPHY IN THE EVALUATION OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (In German) Baumgartner I, Maier SE, Koch M (Department fiir Innere Medizin, Abteilung Angiologie, Universitatsklinik Zurich, Ramistrasse 100,CH8091 Zurich, Switzerland). Rijfo 1993;159:167-173, A prospective controlled study of 41 peripheral arterial occlusions was carried out, comparing duplex sonography (DUS) , magnetic resonance arteriography (MRA) ,
163
and contrast arteriography (CA). This study revealed that 87.8% of DUS findings and 80.5% of MRAs agreed with the appearances of CA (gold standard). DUS tended to overestimate the length of an occluded segment by an average of 2 cm (0.5 to 5.0 cm), whereas MRA showed less deviation from CA (f 2 cm). The advantage of DUS lies in its ability to provide morphological and functional information concerning the obliterated segment. Its disadvantage is that it can only demonstrate one segment and that the examination must be carried out in individual segments. MRA provides vascular demonstration in several planes similar to angiography but signal voids due to limited resolution and flow changes may limit diagnosis of occlusions. Additional phase-contrast techniques may provide quantitative information on flow velocities and flow rates. Both DUS and MRA are suitable methods for the noninvasive investigation of peripheral arterial occlusion disease. Authors’Summary
BONE MARROW EDEMA-AN EARLY FORM OF NECROSIS OF THE HEAD OF THE FEMUR (In Gema@ Neuhold A, Hofman S, Engel A (Institut fiir bildgebende Diagnostik, Krarikenhaus Rudolfinerhaus, Billroth Strasse 78, A-1190 Vienna, Austria). Rijfo 1993;159:120-125. We examined 15 patients (16hips) with painful hips whose radiographs were either normal (nine hips) or showed a minimal decrease in radiodensity (seven hips). The available bone scintigrams of nine hips were positive. m-weighted images visualized a diffuse signal loss of the bone marrow in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions were hyperintensive on T2-weighted images. Focal anomalies were not seen in any of the hips. All patients underwent core decompression treatment. Histology of 13 hips confirmed not only the presence of bone marrow edema but also bone changes corresponding to those of avascular necrosis. Follow-up examinations with magnetic resonance after core decompression showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for identifying bone marrow edema. Due to our histological results, bone marrow edema should be in-