IntroductionThe diagnosis of spine infections can be difficult, because the patient's history, subjective symptoms and physical findings are often inconclusive, particularly in the early stages. Nuclear medicine procedures, which identify pathophysiological reactions preceding morphological changes, can play a useful role in the diagnosis of spondylodiscitis. Specific tracers are used in infectious bone disease: Ga-67, Tc-99m nanocolloid, Tc-99m-HMPAO-and In-111-labeled leukocytes, Tc-99m and In-111 polyclonal human immunoglobulin, and Tc-99m-labeled monoclonal antibodies [10]. However, for diagnosing spine infections, these procedures are still not optimal [10,19]. On white cell imaging, up to 50% of all patients with spondylodiscitis show photopoenic defects, which are not specific for infection [12].Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly playing an important role in the diagnosis, staging and monitoring of malignant tumours [3,5,15]. Not only tumours but also infections show an increased uptake of FDG. The FDG uptake depends on the increased glucose metabolism in activated inflammatory cells such as leukocytes, granulocytes and macrophages [20]. In detecting osteomyelitis with FDG-PET, first studies reported a sensitivity of up to 100% [6,7,9,18]. However, there are limited experiences Abstract Nuclear medicine procedures can be helpful in diagnosing spine infections. The purpose of the study was to evaluate the findings of positron emission tomography with fluorine-18 fluorodeoxyglucose (FGD-PET) in the detection of spondylodiscitis. We performed FDG-PET in 16 patients with suspected spondylodiscitis. All the patients were operated and underwent histopathological examination. The FDG-PET findings were graded and evaluated by two independent nuclear medicine physicians. Of the 16 patients, 12 had a histopathologically confirmed spondylodiscitis. In all these 12 patients, FDG-PET was true-positive. In the four patients without spondylodiscitis, FDG-PET showed three true-negative and one false-positive result. In spondylodiscitis, the mean standard uptake value (SUV) of FDG was 7.5 (SD± 3.8). The PET scans depicted the paravertebral soft tissue involvement in cases of spondylodiscitis. Our first results showed that FDG-PET is a very sensitive imaging procedure in the detection of spondylodiscitis. Compared to other nuclear medicine procedures, PET enables a rapid imaging with acceptable radiation dose and high spatial resolution.

The benign vascular tumours known as angioleiomyomas, which originate from smooth muscle cells of arterial or venous walls are rare, particularly in the region of the hand. Frequently, the diagnosis is only made after surgical extirpation and histological assessment. The occurrence of an angioleiomyoma in a haemophiliac has not yet been reported, to our knowledge. A 62-year-old patient with a haemophilia B complained of increasing pain in the vicinity of the soft tissue covering the carpo-metacarpophalangeal joint of his left palm. In the T1-weighted magnetic resonance images a hypointense well-demarcated mass was found, showing a homogeneous enhancement after intravenous application of contrast medium. T2-weighted images showed a hyperintense signal. Based on clinical and radiographic findings, the tumour was initially thought to be a haemophilic pseudotumour arising from a prior local haematoma. Intraoperatively, the mass was found to be solid, and histological assessment diagnosed an angioleiomyoma, without signs of malignant transformation. Descriptions of the clinical symptoms of angioleiomyoma in an extremity vary considerably in the literature. Although rare, the vascular leiomyoma should therefore be contemplated in the differential diagnosis in patients with a solid nodular lesion of unclear aetiology in arms or legs. Especially in a haemophiliac patient, the growth can easily be mistaken for a pseudotumour because of its clinical and radiological similarities.

In this paper we show the clinical application of a simple method for calculating three-dimensional shape in scoliosis by the use of two tables based on normal standard X-rays in the anteroposterior and lateral projections. The three-dimensional alignment should be considered in both conservative and operative correction. In 57 patients with 87 scoliotic curves we measured the well-known Cobb angle (alpha) and determined the vertebral rotation according to the method of Nash and Moe. We compared this information with the results of the calculated three-dimensional angles of scoliosis (angle beta between the curvature plane and the sagittal plane, angle sigma as the true angle of scoliosis in this curvature plane). In 76 curves (87%) our method was practicable. The true angle sigma is always higher than the projected angle alpha, especially in the clinically relevant range of 20 degrees-40 degrees. Poor correlation is shown between the projected angle alpha and the true angle sigma (r = 0.41 for thoracic curves and r = 0.57 for lumbar curves) and almost no correlation between vertebral rotation and the true angle sigma (r = 0.10 for thoracic curves and r = 0.44 for lumbar curves) and the curvature plane (beta) (r = 0). The three-dimensional shape of scoliosis cannot be estimated by the well-established projected angles and indices and we recommend the use of our simple method for the radiological investigation of scoliotic patients.

By the case of a now 14 year old boy with severe orthopedic complications considerations are made concerning therapeutic principles due to the TRPS II.

Our method enables us to determine the real angle of scoliosis and to avoid techniques with any radiation risk for the patient.

Eine 45jährige Patientin klagte seit 10Jahren ohne erinnerliches Trauma über allmählich zunehmende und vorwiegend in der Hocke bestehende Schmerzen am anteromedialen rechten Kniegelenk. Seit zwei bis drei Jahren hatte sich eine zunehmende Schwellung am Ort der Schmerzlokalisation gebildet. Mittlerweile bestanden auch Ruheschmerzen nach längerer Belastung.Klinisch fand sich bei hinkfreiem und flüs-sigem Gangbild sowie bei symmetrischer Einnahme der Hocke eine in Beugestellung sichtbare, prallelastisch tastbare und sehr druckempfindliche, ca. haselnuß-große Schwellung medial der rechten Patellasehne. Die darüberliegende Haut war verschieblich und wies keine Rötung auf. Die aktive und passive Beweglichkeit des rechten Kniegelenkes war frei. Es bestand ein Druckschmerz am vorderen medialen Gelenkspalt ohne eindeutige Meniskuszeichen. Die Laborwerte, insbesondere die Entzündungsparameter, lagen im Normbereich. Die Nativ-Röntgenaufnahmen des rechten Kniegelenkes zeigten einen altersentsprechenden Befund, insbesondere keine Verkalkungen im auch ansonsten unauffälli-gen Weichteilmantel. In den auswärtigen MR-tomographischen Aufnahmen mit nativen T1-gewichteten Spin-Echo-und T2-gewichteten Spin-Echo-Sequenzen imponiert im T1-gewichteten Bild eine signalarme, paraossäre Raumforderung, welche gegenüber dem umgebenden subkutanen Fettgewebe glatt abgegrenzt ist (Abb. 1a). Diese Läsion liegt medial des kaudalen Ansatzes des Ligamentum patellae und medial der Tuberositas tibiae und zeigt im T2-gewichteten Bild ein wasseräquivalentes hyperintenses Signalverhalten (Abb. 1b). 1999 • 39: 703-705 © Springer-Verlag 1999 Radiologe QuizDer Radiologe 8•99 703 Ihre Diagnose? Abb.1 a,b ᭡ In der T1-gewichteten Spin-Echo-Sequenz des rechten Kniegelenkes in sagittaler Schnittführung (1a) zeigt sich eine glattbegrenzte Raumforderung im praetibialen Weichteilgewebe (Pfeil in a). Die T2-gewichtete Spin-Echo-Sequenz zeigt eine deutliche wasseräquivalente Signalsteigerung der Raumforderung (Pfeil in b) ¨¨

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Regarding to the duration of symptoms and large scale of the primary treatment and operative hazards the results are showing the benefit of the medium energetic extracorporal shock wave application in the treatment of patients with no response on regular therapy.