Magnetic resonance imaging and histopathology of cerebral gliomas

Summary The correlation of magnetic resonance imaging (MRI) with histopathological findings was analysed in 26 patients with untreated cerebral gliomas. In low-grade gliomas, T2-weighted images demonstrated relatively homogeneous high-intensity lesions involving both the grey and the white matter. In high-grade gliomas, especially grade IV, T2-weighted images demonstrated prominent heterogeneity in signal intensity, which consisted of a hyperintense core, less hyperintense or normal intensity rim and surrounding finger-like areas of high intensity. Marked and irregular contrast enhancement was evident in all but one case of these high-grade gliomas in which gadolinium-DTPA was used. Histological examination revealed tumour cells extending as far as the borders of the high-intensity areas shown on T2-weighted images in both high-and low-grade gliomas, but in 5 of 8 low-grade and 4 of 18 high-grade gliomas, isolated tumour cells extended beyond the hyperintense areas shown on T2-weighted images.     

Unspecific white matter lesions: prevalence,number and distribution in cranial MRI

To establish data about prevalence, number and topography of unspecific white matter lesions as seen on MRI, the T2-weighted MRI scans of 83 patients with hyperintense focal white matter changes were reviewed. Patients with known inflammatory central nervous system disease were excluded. There was an approximately linear increase in prevalence and number of lesions with age. Prevalence ranged from 18% in the third decade to over 90% in those over 70 years. We found a close correlation with concomitant periventricular hyperintensity. However, rating of Virchow-Robin spaces did not correlate with the number of white matter lesions. Both hemispheres were involved nearly equally with a minimal non-significant right side preponderance. Lesions showed a strong predilection for the frontal and parietal paraventricular watershed areas. Offprint requests to: Erich Hofmann     

PET and MR imaging in a neuro-behçet syndrome

Positron emission tomography (PET) and magnetic resonance imaging (MRI) studies were performed on a case of neuro-Behçet's syndrome. In accordance with the clinical signs, FDG PET (using¹⁸F-labeled 2-F-2-desoxyglucose) revealed disseminated storage defects in the cerebrum and cerebellum. Focal regions of enhanced signal intensity were demonstrated in the parietal white matter of the cerebrum in T2-weighted images and in the brain stem by MRI.This article was presented at the 1st EEC workshop on accuracy determination in PET, January 19–20th. 1989 Pisa, Italy (COMAC-BME Concerted Project Characterization and Standardization of PET Instrumentation)     

Hemorrhage associated with “bone crisis” in Gaucher's disease identified by magnetic resonance imaging

Children suffering from Gaucher's disease were examined by magnetic resonance imaging (MRI) during a characteristic episode of bone crisis. An unexpectedly high intramedullary as well as subperiosteal signal was observed on both the T1 and T2-weighted sequences in 5 patients, suggesting a subacute hemorrhage or hematoma. It is conceivable that such a painful hemorrhage is an important component of the bone crisis phenomenon. Furthermore, in these cases this is a specific sign which may enable differentiation of bone crises from other types of bone pain associated with Gaucher's disease.     

Fogging on T2-weighted MR after acute ischaemic stroke: how often might this occur and what are the implications?

Fogging is the temporary loss of visibility of an infarct on CT which occurs in the subacute phase at about 2 weeks after stroke. It occurs in up to 40% of medium to large infarcts on CT. It is unclear whether or how often fogging occurs on T2-weighted MR, but if it does occur, it can cause underestimation of true infarct size. This study examined the possible frequency and time scale of fogging on T2-weighted MR. We conducted a blinded, independent review of prospectively collected MR scans from patients with symptoms of cortical ischaemic stroke, scanned sequentially up to 7 weeks after stroke. On each scan maximum infarct area was measured, and the infarct extent and swelling were coded on a validated scale. Fogging was suggested by reduced infarct extent between initial and subsequent scans. In 30 patients (with 74 scans) there was some apparent fogging in 50% of patients between 6 and 36 days (median 10 days) after stroke. Reduction in infarct extent on T2-weighted MR which may be attributed to fogging occurs in a significant proportion of patients with cortical infarcts. This may lead to an underestimation of true final infarct extent. This suggests that true infarct extent on T2-weighted MR can probably only be assessed on scans obtained beyond 7 weeks after stroke.     

A new approach to computer-aided comparison of skull and photograph

A computer-based method developed for the purpose of checking the results of identification performed with the traditional method of video-superprojection (developed by Helmer and Grüner) is demonstrated; it does not require any special programs in addition to those necessary for digitising the video pictures. The method is suitable for filtering out false-positive cases. A great advantage is that the phase of computer evaluation can be separated from the job performed in the video studio, both in time and space. The process can be reconstructed, which means it can be checked. The results can be easily documented and interpreted for lay people.     

“Menigeal sign”: a characteristic finding of meningiomas on contrast-enhanced MR images

Summary In meningiomas, a flat, contrast-enhancing, probably dural structure adjacent to the tumor can occasionally be observed on Gadolinium-DTPA enhanced MR images. This so called meningeal sign was evaluated with respect to the differential diagnosis of meningiomas in MR imaging. The study included 29 patients with intracranial meningiomas and 24 patients with non-meningeal brain tumors. In all meningiomas, MR studies included T2-weighted as well as unenhanced and Gadolinium-DTPA-enhanced T1-weighted images. In all nonmeningeal tumors, Gd-DTPA-enhanced MR images were available. All images were evaluated with respect to the presence of the meningeal sign. In meningiomas, a meningeal sign was seen in 15/29 cases on Gadolinium-DTPA-enhanced images. No abnormalities corresponding to the areas of contrast enhancement were found on unenhanced T2- and T1-weighted MR images. In nonmeningeal tumors only 2/24 cases showed a meningeal sign. In conclusion, with a sensitivity of 52% and a specificity of 92%, the demonstration of the meningeal sign improved the differential diagnosis of intracranial meningiomas in contrast-enhanced MR imaging.     

T2 relaxation time analysis in patients with multiple sclerosis: correlation with magnetization transfer ratio

The aim of the current study was to perform T2 relaxation time measurements in multiple sclerosis (MS) patients and correlate them with magnetization transfer ratio (MTR) measurements, in order to investigate in more detail the various histopathological changes that occur in lesions and normal-appearing white matter (NAWM). A total number of 291 measurements of MTR and T2 relaxation times were performed in 13 MS patients and 10 age-matched healthy volunteers. Measurements concerned MS plaques (105), NAWM (80), and dirty white matter (DWM; 30), evenly divided between the MS patients, and normal white matter (NWM; 76) in the healthy volunteers. Biexponential T2 relaxation-time analysis was performed, and also possible linearity between MTR and mean T2 relaxation times was evaluated using linear regression analysis in all subgroups. Biexponential relaxation was more pronounced in black-hole lesions (16.6%) and homogeneous enhancing plaques (10%), whereas DWM, NAWM, and mildly hypointense lesions presented biexponential behavior with a lower frequency(6.6, 5, and 3.1%, respectively). Non-enhancing isointense lesions and normal white matter did not reveal any biexponentional behavior. Linear regression analysis between monoexponential T2 relaxation time and MTR measurements demonstrated excellent correlation for DWM(r=–0.78, p<0.0001), very good correlation for black-hole lesions(r=-0.71, p=0.002), good correlation for isointense lesions(r=–0.60, p=0.005), moderate correlation for mildly hypointense lesions(r=–0.34, p=0.007), and non-significant correlation for homogeneous enhancing plaques, NAWM, and NWM. Biexponential T2 relaxation-time behavior is seen in only very few lesions (mainly on plaques with high degree of demyelination and axonal loss). A strong correlation between MTR and monoexponential T2 values was found in regions where either inflammation or demyelination predominates; however, when both pathological conditions coexist, this linear relationship is lost.     

The influence of orthoses on the proprioception of the ankle joint

The ankle joints of 14 healthy volunteers and 16 patients with unstable ankle joints were tested regarding their functional and proprioceptive capabilities. All of them were active athletes. Three tests were used of the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace/Mikros, stirrup-brace/ Aircast, taping) on the proprioceptivity of stable and unstable ankle joints was evaluated. The scores of the singleleg jumping course without any stabilizing device (category standard) ranged between 8.06 and 13.68 (10.65±1.29). In the categories Mikros (9.85±0.99), and Aircast (9.99±1.14) as well as with the tape bandage (10.27±0.81) better scores were achieved. The differences standard vs. Mikros and standard vs. Aircast revealed a significant reduction of the scores with orthoses (P<0.01). The error rate in the single-leg stance test was within the range of 0–16 (5.12±2.85) for the category standard. It was lower for the categories Mikros (3.65±2.65) and Aircast (4.17±2.59). The error rate was highest in the group with a tape bandage (5.79±3.53). The differences standard vs Mikros as well as standard vs. Aircast were significant (P<0.01). There was also a significant difference between these categories regarding injured and not injured ankle joints (P<0.01). The angle-reproduction-test showed higher values for the category standard (2.36°±0.97) in comparison to the categories Mikros (1.46°±0.72), Aircast (1.62°±0.91) and taping (1.84°±0.41). In the category standard the reproduction error was lower testing not injured ankle joints (2.30°±1.04) than testing the group of unstable ankle joints (2.44°±0.81), whereas in all other categories the reproduction error was higher in the group of not injured joints. The differences in all measurements between standard vs. Mikros and standard vs. Aircast were significant (P<0.01). The results of the three tests showed a highly significant difference between injured and not injured ankle joints (P<0.01).     

Morphological detection of X- and Y-chromosomes in smears and paraffin-embedded tissues using a non-isotopic in situ hybridization technique (NISH)

Pharyngeal smears and paraffin-embedded tissue specimens (skeletal muscle, kidney) obtained from 10 male and 10 female individuals were evaluated using non-isotopic in situ hybridization (NISH) with commercial X- and Y-specific biotinylated probes which recognize the pericentromeric regions DXZ1 and DYZ1/DYZ3 of the X- and Y-chromosome, respectively. The results provide evidence that the morphological sex determination of a single cell can be performed by critical application of this staining method leading to one nuclear signal in male cells using the Y-specific probe whereas female cells are negative. In situ hybridization of female tissues with an X-specific probe results regularly in 2 signals whereas male cells show only one spot in the nucleus.     

Zum „Utilitäts“-Prinzip im Rahmen der gerichtlichen Feststellung von Blutsverwandtschaft mittels Serostatistik

Zusammenfassung Die realistische A-priori-Wahrscheinlichkeit bei serologischer Abstammungsbegutachtung — welche stets ein Akten-a-priori bedeutet — stellt eine Teilinformation im gesamten, dem Richter zur Verfügung stehenden Beweiskonvolut dar und nimmt keine eigentliche Sonderstellung ein. — Eine neutrale A-priori-Wahrscheinlichkeit kann es der Sache nach nicht geben. Entweder ist eine solche mit Nichtwissen gleichzusetzen, dann entfällt sie als Information, oder sie steht mit dem Utilitäts-Prinzip in Zusammenhang und stellt damit keine Wahrscheinlichkeit dar. — Das Utilitäts-Prinzip ist rechtspolitisch definiert; es kann zahlenmäßig nicht ausgedrückt werden. — Das Utilitäts-Prinzip wird nur wirksam, wenn der Richter (unter Benutzung aller ihm zur verfügung stehenden Beweise) eine Entscheidung fällt. Es bestimmt dabei die Gewichtung der im Prozeß zur Debatte stehenden Rechtsgüter der Beteiligten. — Der Gutachter hat eine neutrale Utilitäts-Komponente anzuwenden, d.h. er gibt in Zweihypothesenfällen (welche die Regel sind) der Null- wie der Gegenhypothese dasselbe Bedeutungsgewicht. Null- und Gegenhypothese können dabei aus mehreren Einzelhypothesen zusammengefaßt sein; deren Häufigkeiten werden gemittelt. — Die Mitführung eines Akten-a-priori bei der Berechnung eines W-Werts sollte in aller Regel unterbleiben. — Eine Irrtumserwartung soll einen möglichst realistischen Charakter haben; sie sollte daher unter Mitwirkung eines Akten-a-priori zustandekommen.     

The “dural tail” adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology

We examined 32 patients with intracranial tumors (17 meningiomas, 8 neuromas, 7 pituitary adenomas) by conventional and dynamic contrast-enhanced MRI. Our aim was to clarify whether the pathological dural contrast enhancement adjacent to meningiomas (the dural tail) is specific to meningiomas and, more important, whether it represents neoplastic dural infiltration or hypervascularization as a tumor accompanying reaction. A dural tail was found in 9 of 17 meningiomas. None of the other extra-axial tumours (neuromas, pituitary adenomas) showed comparable dural enhancement. Dynamic examinations with an ultrafast single slice imaging technique (snapshot-FLASH) after a bolus injection of contrast medium showed a dural tail in seven out of these nine meningiomas, while in two cases the dural tail turned out to be a cortical vein with a characteristic dynamic contrast enhancement pattern. In the dynamic study all seven dural tails were found to have earlier, steeper contrast enhancement than the corresponding tumours. All the tumours and part of the adjacent dura mater in four of the seven meningiomas with dural enhancement were examined histopathologically. In none of these four cases was neoplastic tissue found more than 2 mm away from the main tumour. The results strongly support the suggestion that the dural tail adjacent to meningiomas represents a hypervascular, non-neoplastic dural reaction.     

Pseudopathologic fracture of the femoral neck

We have seen two cases of traumatic subcapital fractures of the femoral neck which resembled pathologic fractures on plain radiography. We have named this entity pseudopathologic fracture of the femoral neck and offer suggestions for why it occurs.     

Enlargement of the pancreas in non-alcoholic cirrhosis: a computed tomography and pathological investigation

To evaluate the effect of hepatic dysfunction on pancreatic morphology, the antero-posterior width of the pancreas was measured by CT in 50 non-alcoholic cirrhotic patients without pancreatic disease and 221 age-and sex-matched normal controls. In addition, we reviewed the histology of the pancreas from 13 autopsies of the cirrhotics and 13 controls. The mean width of the pancreatic head in the cirrhotics was 2.94 0.34 cm (mean SD), which was significantly larger than that in the controls (2.17 0.32 cm) (P < 0.001). The width of the pancreatic body in the cirrhotics was also significantly greater than in the controls (1.95 0.24 cm versus 1.50 0.30 cm) (P < 0.001). Histological investigation revealed that lipomatosis and fibrosis increased with age in the controls, while they were seldom observed in the cirrhotics. And enlargement of acinar cells or of the islets of Langerhans was often seen in the cirrhotics. These data suggested that advanced liver dysfunction provoked pancreatic growth, probably through a trophic effect. Offprint requests to: T. Muranaka     

Bedeutung des Alkohols in der Embryofetalperiode und beim Neugeborenen

Zusammenfassung Es wird über Alkoholbefunde bei einem Neugeborenen berichtet, welches von der Mutter im Rausch geboren wurde. Aufgrund von zwei Blutentnahmen wurde für den Zeitpunkt der Geburt eine BAK von ca. 2 beim Kind ermittelt. Das Neugeborene zeigte das typische Bild einer Alkoholembryopathie.Aus der gynäkologisch-geburtshilflichen Literatur werden mehrere Anwendungsbereiche des Äthanols referiert, wobei Blutalkoholkonzentrationen zwischen 1 und 2 bei Mutter und Frucht als therapeutische Spiegel angesehen werden. Für die forensische Praxis bedeuten diese Befunde, daß BAK-Werten unter 2 bei Neugeborenen ohne zusätzliche Komplikationen allein keine todesursächliche Bedeutung zukommt.Herrn Prof. Dr. Erich Fritz zum 80. Geburtstag gewidmet     

γ-Glutamyltransferase test as a new tool for identification of seminal stains

Summary A simple qualitative method for identification of seminal stains based on a high activity of -glutamyltransferase (-GTP) in human semen is described. It employs the release of -naphthylamine from N--glutamyl--naphthylamide by the -GTP action; -naphthylamine couples with Fast Garnet GBC salt to produce a strong brownish-red color. The data on its simplicity, specificity, and stability show that the present method is suitable for medicolegal examination of seminal stains as a preliminary test.     

Zur ACP-Typendifferenzierung aus Blutflecken

Zusammenfassung Serien von frisch angelegten Blutspuren auf Glas und auf Baumwolle — alle sechs Phänotypen der sauren Erythrocytenphosphatase (acP) — werden verschiedenen Lagerungsbedingungen ausgesetzt: 37°C, hohe Luftfeuchtigkeit; 20°C, Raumtemperatur; 4°C, Kühlschrank; –20°C, Tiefkühlschrank. Die elektrophoretische Darstellung erfolgt parallel mit Hilfe der Cellogel-Elektrophorese sowie mit Hilfe der Agarose-Dünnschicht-Elektrophorese. Die Darstellung der Isoenzyme erfolgt mit Hilfe des fluorogenen Substrats 4-Methyl-Umbelliferylphosphat.Die wichtigsten Ergebnisse sind: Es werden zur acP-Typendifferenzierung nur Bruchteile eines Blutstropfens verwendet. Die Verwendung der Cellogel-Technik ermöglicht a) geringen Spurensubstanzverbrauch, b) sichere Typendifferenzierung, c) längere Nachweisgrenzen (im Vergleich zur Agarose-Technik). Spuren auf Glas lassen sich länger nachweisen als Stoffspuren. Die ungefähren zeitlichen Nachweisgrenzen sind: Bei feuchtwarmer Lagerung 0,5 Wochen, bei Raumtemperaturlagerung 4 bis 6 Wochen, bei Kühlschranklagerung 10 bis 12 Wochen, bei Tiefkühlschranklagerung 13 Wochen.Die Methode der acP-Typendifferenzierung aus Blutspuren unter Verwendung der Cellogel-Technik und des fluorogenen Substrats wird als praktikable und reproduzierbare Methode empfohlen.     

Diagnosis of neuroendocrine tumours by retrospective image fusion: is there a benefit?

This study evaluated the use of image fusion in the preoperative staging of neuroendocrine tumors (NET) of the pancreas and the gastrointestinal tract (GIT). Thirty-eight patients suffering from a metastasized NET with location of the primary in the pancreas (n=15) or the GIT (n=23) were examined by somatostatin receptor scintigraphy (SRS) and computed tomography (CT). Consecutive image registration and fusion were performed using custom-built software integrated in AVS/Express (Advanced Visual Systems, Waltham, MA, USA). Registration was performed by a voxel-based algorithm based on normalized mutual information. Image fusion was feasible in 36/38 patients. A total of 87 foci were assigned to anatomical regions (e.g. gut, pancreas, liver, lymph node or others) by two independent observers in both SRS and SRS/CT fusion images. The assignments used a binary ranking system (1=definite, 0=not definite). These results were then retrospectively compared to the classification of the foci, based on postoperative histology or clinical follow-up. Imaging by SRS allowed a definite anatomical assignment in 57% (50/87) and 61% (53/87) of all lesions in the case of observers A and B, respectively. Image fusion improved the topographic assignment to 91% (79/87) and to 93% (81/87). The number classified as definite by both observers increased from 54% (47/87) to 86% (77/87). The increase in definite assignments was highly significant for both observers (P<0.0001 for each). In the case of foci classified as liver metastases, image fusion allowed improved assignment to the corresponding liver segment from 45% (18/40) to 98% (39/40) and from 58% (23/40) to 100% (40/40) by observers A and B, respectively. Furthermore, the improved assignment of foci classified as lesions by image fusion was relevant for therapy in 7/36 patients (19%). Therefore, the image fusion technique presented herein appears to be a very useful method for clinical routine.     

Die Abhängigkeit des Faktors β von der Konzentrationshöhe

Zusammenfassung Die Begriffe des Konzentrationsabfalles \ und des Reduktionsfaktors sowie die Variationsbreiten dieser Größen werden diskutiert.Die mittlere Abbaugeschwindigkeit während langer Zeitspannen lag bei Blutalkoholkonzentrationen oberhalb 1,5 mindestens bei 0,16, wenn der errechnete Höchstwert (r = 0,7) annähernd erreicht wurde.Die statistische Auswertung von den 4118 Einzelentnahmen und den Entnahmen in zeitlichem Abstand bei 922 Personen zeigt die am häufigsten beobachtete Blutalkoholkonzentration bei 1,8und ein mittleres \₆₀ von 0,184.Der Faktor nimmt mit steigender Blutalkoholkonzentration zu. Die Unterschiede zwischen den Bereichen 0,41—1,2 und oberhalb 2,0 sind statistisch gesichert, die mittleren \₆₀-Werte von 0,17 bzw. 0,203 damit signifikant.Auszugsweise vorgetragen auf dem Kongreß für Gerichtliche und Soziale Medizim 1954 in Kiel.     

Nachvergütung an Psychotherapeuten/Anspruch auf Aufhebung bestandskräftiger Honorarbescheide

Abstrakt 1. Aus dem Grundsatz der Honorarverteilungsgerechtigkeit und dem objektiv-rechtlichen Gehalt des x85 Abs. 4 SGB V ergibt sich hinsichtlich der Rücknahmeentscheidung bestandskräftiger Honorarverteilungsbescheide, soweit die Rechtswidrigkeit auf einer Verteilungsungerechtigkeit der Arztgruppen zueinander beruht, eine Vorprägung des Ermessens nach x44 Abs. 2 S. 2 SGB X in Richtung einer Rücknahmeversagung.2. Für Honorarnachvergütungsansprüche gilt die 4jährige Frist des x44 Abs. 4 SGB X. (Leitsätze des Bearbeiters)