[en] This German translation of the second edition of 1998 of the US American bestseller is available as a completely revised and enlarged 2nd German edition published in 2000. The content opens up new perspectives in medical diagnostic imaging, focusing on the enhanced capabilities in computerized tomography and the new technique, 3D spiral CT angiography, at the turn of the millennium. (orig./CB)

[en] The clinical outcome was reviewed in 70 patients with CT evidence of periappendiceal inflammatory masses. Thirty-two patients had either phlegmons or small abscesses (less than 3 cm). These patients were initially treated with antibiotic therapy alone, with resolution of the inflammatory process in 28 of the patients (88%). Twenty-eight patients underwent percutaneous abscess drainage of periappendiceal abscesses that was successful in 26 patients (93%). Although 13 patients (46%) had low-output fistulas communicating with the cecum, 12 of 13 closed with 2 weeks of drainage. Ten patients had early surgical drainage for extensive, poorly defined abscesses. Based on CT, a rational approach can be chosen to reduce morbidity and optimize clinical outcome

[en] The clinical course of patients with portal hypertension may depend in part on whether the portal circulation is normal, hyperdynamic, or hypodynamic. This paper reports that this study was performed to validate and apply an MR technique for measuring portal blood flow in patients with cirrhosis and in normal volunteers. Portal venous flow measurement was performed using a modified gradient-echo pulse sequence (VIGRE). A Plexiglas phantom positioned 90 degrees, 77.5 degrees, and 45 degrees to the imaging section was imaged at 1.5 T with VIGRE. Water circulated at six different constant flow rates from 380 to 2,960 mL/min. An oblique 3-mm section approximately orthogonal to the undivided portal vein was acquired in five normal volunteers, and four patients with chronic ompensated cirrhosis were imaged after fasting for 2 hours

[en] This paper determines whether the use of a nonionic contrast agent when compared with an ionic contrast agent resulted in quicker patient CT throughput. Six hundred patients were randomized and given either Hypaque 60 or Omnipaque 300 during dynamic contrast material-enhanced body CT. Contrast material reactions and the quality of scans were recorded for each patient group. The number of studies that needed to be repeated due to an adverse reaction was recorded. Studies were adequately performed in 96.7% (292/302) of the Omnipaque group and 94% (280/298) of the Hypaque group. Images needed to be repeated due to movement during the contrast material injection or the CT study was aborted due to a contrast material-related reaction in 0.7% of the Omnipaque patients and 3% of the Hypaque patients (P = .04). When patient discomfort reactions were excluded, 21.2% (64/302) of the Omnipaque patients and 40.9% (122/298) of the Hypaque patients suffered at least one contrast material-related adverse reaction (P ≤ .001)

[en] The three-point Dixon technique is a new variant of the Dixon method that yields essentially error-free separation of water and fat images even in the presence of susceptibility differences or field inhomogeneities. This paper evaluates the ability of this technique to demonstrate prostate zonal anatomy and compares this technique with conventional spin-echo imaging in the imaging and staging of prostate carcinoma. The authors compared standard spin-echo images of the prostates of five normal subjects with water and fat images obtained by the three-point Dixon method. Patients undergoing radical prostatectomy were staged with both methods. These images and images of the prostatectomy specimens were compared with histopathologic maps. All patients were scanned with a 1.5-T General Electric Signa system

[en] Graded compression real-time sonography with a 5-MHz linear array scanner was performed to evaluate 60 patients (32 females and 28 males) with suspected acute appendicitis. US was considered positive for acute appendicitis if the appendix was visualized and negative if the appendix was not visualized. There were 19 true positive studies, with surgical confirmation. There were 34 patients with true negative studies, confirmed by benign clinical follow-up (33 patients) or a normal appendix at surgery (one patient). There were three false positive and three false negative studies. One study was nondiagnostic. The sensitivity of US was 90.4% and the specificity was 91.8%. The predictive value of a positive US study was 90.4%

[en] In a review of over 300 CT scans of abdominal trauma, we encountered 13 patients with surgically proved pancreatic injuries. CT correctly diagnosed pancreatic fractures, contusions, or posttraumatic pseudocysts in 11 of these patients. There were two false positive and two false negative diagnoses. The CT diagnosis of pancreatic trauma may be difficult in selected patients who are scanned soon after injury. Acutely, the actual plane of a pancreatic fracture may be difficult to identify with CT, and the peripancreatic soft-tissue changes of traumatic pancreatitis are often subtle. Eight of 11 correctly diagnosed pancreatic injuries showed thickening of the left anterior renal fascia on CT scans. This sign should prompt a critical evaluation of the pancreas of the traumatized patient

[en] Digital subtraction angiography (DSA) may have considerable impact on the work-up of patients who have suffered trauma. The angiographic evaluation of vascular injuries can be accomplished rapidly and with minimal catheter use and manipulation, which is particularly important for those critically ill patients who have significant immobility because of multiple fractures. The authors retrospectively reviewed the digital subtraction angiograms in 50 consecutive cases of extremity trauma. The quality of the images in 44 of these permitted a confident diagnosis, the accuracy of which was confirmed by surgical or clinical follow-up. DSA reduces the time required to perform the procedure, the amount of contrast material injected, patient discomfort, and film cost. Its major disadvantage is the limited field size of the image intensifier

[en] The CT findings in three patients with radiation-induced hepatic injury are discussed. In each patient a sharply defined band of low density was identified within the liver in an area of prior radiation. The low density bands resolved on follow-up examination. Computed tomography is useful in the diagnosis and follow-up of patients with suspected radiation hepatitis and in differentiating radiation change from metastatic disease

[en] This chapter focuses on the role of CT in diagnosing a broad spectrum of acute abdominal and GI disorders. It emphasizes that CT is often extremely valuable in resolving diagnostic dilemmas in patients with acute abdominal abnormalities. The CT demonstration of such specific findings as pneumoperitoneum, hemoperitoneum, intramural air, extravasated contrast, and focal thickening of the bowel wall often leads to the diagnosis of a specific underlying GI abnormality. Nevertheless, it is important to point out several important diagnostic limitations of CT and to argue for its judicious use in well-selected patients