<em>In Vivo</em> Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Meni&#232;re's Disease Ears and Normal Hearing Ears

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this ...

LMU Munich

MR imaging is an excellent tool for use in diagnosing congenital malformations of the brain. Such malformations cannot be reliably recognized or classified without an insight in to the basic processes of the fetal development of the brain. Cortical malformations are classically divided into (1) malformations of neuronal proliferation, i.e. of stem cell proliferation in the periventricular germinal matrix zone, (2) disorders of neuronal migration, i.e. of the radial migration of the neurons from the periventricular germinal matrix zone to the cortical surface, and (3) disorders of cortical organisation. Other cerebral malformations are agenesis or dysgenesis of the corpus callosum, encephaloceles and various kinds of holoprosencephaly. Chiari malformations and disorders on the Dandy-Walker spectrum are relatively common, primarily infratentorial disorders. Rarer infratentorial disorders are Joubert syndrome, rhombencephalosynapsis and Lhermitte Duclos syndrome.

[MR imaging in congenital disorders of the brain].

MR imaging is an excellent tool for use in diagnosing congenital malformations of the brain. Such malformations cannot be reliably recognized or classified without an insight into the basic processes of the fetal development of the brain. Cortical malformations are classically divided into (1) malformations of neuronal proliferation, i.e. of stem cell proliferation in the periventricular germinal matrix zone, (2) disorders of neuronal migration, i.e. of the radial migration of the neurons from the periventricular germinal matrix zone to the cortical surface, and (3) disorders of cortical organization. Other cerebral malformations are agenesis or dysgenesis of the corpus callosum, encephaloceles, and various kinds of holoprosencephaly. Chiari malformation ans disorders on the Dandy-Walker spectrum are relatively common, primarily infratentorial disorders. Rarer infratentorial disorders are Joubert syndrome, rhombencephalosynapsis and Lhermitte Duclos syndrome.

Reliable assessment of tumor growth in malignant glioma poses a common problem both clinically and when studying novel therapeutic agents. We aimed to evaluate two software-systems in their ability to estimate volume change of tumor and/or edema on magnetic resonance (MR) images of malignant gliomas. Twenty patients with malignant glioma were included from different sites. Serial post-operative MR images were assessed with two software systems representative of the two fundamental segmentation methods, single-image fuzzy analysis (3DVIEWNIX-TV) and multi-spectral-image analysis (Eigentool), and with a manual method by 16 independent readers (eight MR-certified technologists, four neuroradiology fellows, four neuroradiologists). Enhancing tumor volume and tumor volume plus edema were assessed independently by each reader. Intraclass correlation coefficients (ICCs), variance components, and prediction intervals were estimated. There were no significant differences in the average tumor volume change over time between the software systems (p > 0.05). Both software systems were much more reliable and yielded smaller prediction intervals than manual measurements. No significant differences were observed between the volume changes determined by fellows/neuroradiologists or technologists.Semi-automated software systems are reliable tools to serve as outcome parameters in clinical studies and the basis for therapeutic decision-making for malignant gliomas, whereas manual measurements are less reliable and should not be the basis for clinical or research outcome studies.

Reliability of tumor volume estimation from MR images in patients with malignant glioma. Results from the American College of Radiology Imaging Network (ACRIN) 6662 Trial.

Quality management (QM) cannot be successfully implemented and performed without audits. The PDCA (Plan-Do-Check-Act) cycle is the core component of QM systems. In this cycle an audit represents the crucial step "check". Audits verify whether the performed actions and their results conform to the requirements. It is especially important to verify whether the principles of QM are omnipresent and fully implemented in a department or institution. The announcement of an audit may cause mixed feelings or even anxiety among the personnel to be audited. Without previous information and training the audit may be perceived as an act of control and intrusion into departmental affairs. The colleagues often fear sanctions if lapses are found or consider the audit to be a cross-examination. However, an audit is rather meant to be a helpful aid and a chance to continuously improve the departmental QM system by means of a constructive communication among colleagues. In the year 2009 the European Commission published guidelines for the performance of clinical audits in medical radiology, including diagnostic radiology, nuclear medicine and radiation therapy (Council Directive 97 / 43 / EURATOM). The aim is an optimal protection of the individual from the hazards of ionizing radiation and the directive expects radiological departments to perform clinical audits in accordance with national procedures.

[(No) Fear of audits? Control is good, trust is better. Audits as a core element of quality management].

[Quality management and certification - what for?].

There is an on-going controversy about venous drainage abnormalities in multiple sclerosis (MS). We applied cardiac-gated phase-contrast and venographic magnetic resonance (MR) techniques to compare venous drainage patterns in patients with MS, healthy controls, and subjects with migraine.

Non-specific alterations of craniocervical venous drainage in multiple sclerosis revealed by cardiac-gated phase-contrast MRI.

The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs.

MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations.

Miliary brain metastases are a rare condition but associated with an exceedingly poor prognosis. We present the case of a patient suffering from malignant melanoma with an acute progressively worsening of neurological symptoms up to the loss of consciousness. The magnetic resonance imaging (MRI) demonstrated a new onset of disseminated, miliary spread of central nervous system metastases from a malignant melanoma within 4 days.

Miliary pattern of brain metastases - a case report of a hyperacute onset in a patient with malignant melanoma documented by magnetic resonance imaging.

Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location.

Cost-Effectiveness of Endovascular Stroke Therapy: A Patient Subgroup Analysis From a US Healthcare Perspective.

Stereotactic radiosurgery (SRS) is an effective and well tolerated treatment for selected brain metastases; however, local recurrence still occurs. We investigated the use of diffusion weighted MRI (DWI) as an adjunct for SRS treatment planning in brain metastases. Seventeen consecutive patients undergoing complete surgical resection of a solitary brain metastasis underwent image analysis retrospectively. SRS treatment plans were generated based on standard 3D post-contrast T1-weighted sequences at 1.5T and then separately using apparent diffusion coefficient (ADC) maps in a blinded fashion. Control scans immediately post operation confirmed complete tumour resection. Treatment plans were compared to one another and with volume of local recurrence at progression quantitatively and qualitatively by calculating the conformity index (CI), the overlapping volume as a proportion of the total combined volume, where 1 = identical plans and 0 = no conformation whatsoever. Gross tumour volumes (GTVs) using ADC and post-contrast T1-weighted sequences were quantitatively the same (related samples Wilcoxon signed rank test = -0.45, p = 0.653) but showed differing conformations (CI 0.53, p < 0.001). The diffusion treatment volume (DTV) obtained by combining the two target volumes was significantly greater than the treatment volume based on post contrast T1-weighted MRI alone, both quantitatively (median 13.65 vs. 9.52 cm, related samples Wilcoxon signed rank test p < 0.001) and qualitatively (CI 0.74, p = 0.001). This DTV covered a greater volume of subsequent tumour recurrence than the standard plan (median 3.53 cmvs. 3.84 cm, p = 0.002). ADC maps may be a useful tool in addition to the standard post-contrast T1-weighted sequence used for SRS planning.

Use of diffusion-weighted MRI to modify radiosurgery planning in brain metastases may reduce local recurrence.

The purpose of this study was to correlate MR pelvimetric pelvic inlet measurements with mode of delivery and neonatal outcome in patients with suspected fetopelvic disproportion or breech presentation.

MR pelvimetry: prognosis for successful vaginal delivery in patients with suspected fetopelvic disproportion or breech presentation at term.

The aim of this study was to assess the diagnostic value of x-ray dark-field radiography to detect pneumothoraces in a pig model. Eight pigs were imaged with an experimental grating-based large-animal dark-field scanner before and after induction of a unilateral pneumothorax. Image contrast-to-noise ratios between lung tissue and the air-filled pleural cavity were quantified for transmission and dark-field radiograms. The projected area in the object plane of the inflated lung was measured in dark-field images to quantify the collapse of lung parenchyma due to a pneumothorax. Means and standard deviations for lung sizes and signal intensities from dark-field and transmission images were tested for statistical significance using Student's two-tailed t-test for paired samples. The contrast-to-noise ratio between the air-filled pleural space of lateral pneumothoraces and lung tissue was significantly higher in the dark-field (3.65 ± 0.9) than in the transmission images (1.13 ± 1.1; p = 0.002). In case of dorsally located pneumothoraces, a significant decrease (-20.5%; p > 0.0001) in the projected area of inflated lung parenchyma was found after a pneumothorax was induced. Therefore, the detection of pneumothoraces in x-ray dark-field radiography was facilitated compared to transmission imaging in a large animal model.

Birgit Ertl-Wagner

Department of Radiology,
University Hospital,
Department of Radiology, University Hospital

LMU Munich

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Menière's Disease Ears and Normal Hearing Ears

Birgit Ertl-Wagner

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Radiology,University Hospital,Department of Radiology, University Hospital

LMU Munich

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Menière's Disease Ears and Normal Hearing Ears

Department of Radiology,
University Hospital,
Department of Radiology, University Hospital