Breath-hold divers employ glossopharyngeal insufflation (GI) in order to prevent the lungs from compressing at great depth and to increase intrapulmonary oxygen stores, thus increasing breath-hold time.The presented case study shows the physiological data and dynamic magnetic resonance imaging (dMRI) findings of acute hyperinflation, deliberately induced by GI, in a breath-hold diver and discusses the current state of knowledge regarding the associated hazards of this unique competitive sport.Static and dynamic lung volumes and expiratory flows were within the normal range, with vital capacity and peak expiratory flow being higher than the predicted values. Airway resistance and diffusing capacity of the lung for carbon monoxide were normal. Static compliance was normal and increased five-fold with hyperinflation. dMRI revealed a preserved shape of the thorax and diaphragm with hyperinflation. A herniation of the lung beneath the sternum and enlargement of the costodiaphragmatic angle were additional findings during the GI manoeuvre. After expiration, complete resolution to baseline was demonstrated.Hyperinflation can be physiological and even protective under abnormal physical conditions in the sense of acute adaptation to deep breath-hold diving. Dynamic magnetic resonance imaging is adequate for visualisation of the sequence of the glossopharyngeal insufflation manoeuvre and the complete reversibility of deliberate hyperinflation.
Messungen erfolgten an drei anästhesierten und beatmeten Schweinen (18 kg) unter Beimischung von SF 6 -Gas in das Inspirationsgas. Ergebnisse: Es ergab sich ein linearer Zusammenhang zwischen der SF 6 -Konzentration und dem Signal-RauschVerhältnis (SNR). Ohne Schichtselektion betrug das maximale SNR = 30,9, mit der 3D-Sequenz 14,9. Es wurden keine Unterschiede in der Verteilung des SF 6 -Gases zwischen den beiden Lungen beobachtet. Schlussfolgerungen: Die räumliche Verteilung von SF 6 -Gas in der Lunge konnnte erstmals innerhalb einer Atemanhalteperiode dargestellt werden. Die geringe Spindichte wird hierbei durch eine hohe Anzahl von Signalmittelungen kompensiert. Insgesamt erscheint die beschriebene Methodik als ein interessantes neues Verfahren zur bildgestütz-ten Analyse der Verteilung der Lungenventilation, das mit geringem Aufwand realisiert werden kann und ohne Einsatz radioaktiver Substanzen auskommt.
The proliferation of digital data sets and the increasing amount of images, e. g. through the use of multislice spiral CT or multiple follow-up examinations in the context of new therapies, are ideal prerequisites for computer-aided diagnosis (CAD) in chest radiology. Multiple studies have described the applications and advantages of computer assistance in performing different diagnostic tasks. More powerful computers will enable the introduction of these systems into the clinical routine and could provide an enormous increase in morphological and functional information. The commercial introduction of tools for detection and visualization of pulmonary nodules has already begun. This is one of the most widely-reported applications in view of the ongoing studies on lung cancer screening. The next generation of tools will improve the diagnosis of emphysema through detection, quantification and classification. Many more uses are being developed, for instance the detection and classification of infiltrates, volume measurements or functional pulmonary imaging (e. g. dynamic ventilation CT or (3)Helium-MRI). Grossly simplified, most systems use a three level structure consisting of segmentation/feature extraction, classification of extracted features and an output unit. The output can be mere visualization through color-coding, volume measurements or calculated probabilities. The output supports the radiologist in establishing his findings and preparing differential and final diagnoses as well as providing quantitative data for follow-up studies. Different techniques are used for segmentation of lung areas as the basis for a variety of applications. Some commonly-used techniques for this and other tasks are density masks and threshold-based algorithms. Data processing is predominantly carried out with Bayesian classifiers or neural networks. This article describes the current status of research and provides insight into the common schemes and capabilities of the systems. It focuses particularly on common topics such as segmentation, volume measurement, detection of pulmonary nodules, quantification of emphysema and analysis of ground glass opacities.
In case of fever of unknown origin and suspicion of liver involvement, MRI of the liver should be performed due to data given in literature and its sensitivity of 100%. Because of the delayed detectability of cerebral manifestations, in cases of persisting suspicion even a previously normal MRI of the brain should be repeated.
In HRCT reports multiple different, often synonymous, German and English terms are used. The variety of terms impede understanding and acceptance of HRCT. Purpose of this paper is to present a scheme, which is based on the anatomic landmarks (secondary lobule), and the density of pathologic changes, as well as a glossary from the German HRCT-literature, including suitable terms, definitions, synonyms and English terms. Low attenuation changes include emphysemas, air-filled cavities (bullae, cysts, cavitations, honeycombing) and bronchial dilatation, changes with increased density consist of diffuse (ground glass opacity, consolidation) and focal processes (reticular and nodular densities). Reticular densities are categorised in thickened interlobular septae and translobular lines with differentiation of a reticular pattern and curvilinear lines. Nodular processes are categorised according to size, density, morphology, localisation and distribution. Parenchymal distortion and destruction indicate the severity of these processes. Certain patterns are indicative for possible differential diagnoses, and a recommendation for further procedures is given.
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