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OBJECTIVE: The purpose of this study was to assess the width of ribs in patients with chronic pleural disease. MATERIALS AND METHODS: On posteroanterior radiographs, we measured the horizontal width of ribs in the midaxillary line of four groups of patients: 41 selected patients with widened ribs and chronic pleural disease (group I), 30 consecutive patients with the clinical diagnosis of tuberculosis for 5 or more years who had radiographs that showed unilateral pulmonary or pleural disease (group II), 25 consecutive patients with the clinical diagnosis of empyema who had radiographs that showed unilateral pleural and often pulmonary parenchymal disease (group III), and 60 consecutive persons who received routine preemployment examinations that revealed no pulmonary or pleural disease (control subjects). Available clinical data were reviewed. RESULTS: We found a significant difference between the size of the ribs on the side of disease and the nondiseased side for groups I and II (p = .0008 and p = .045, respectively). We found no such difference for group III or the control group. The mean absolute values of the different widths of ribs on the side of disease and the nondiseased side were greater for groups I, II, and III than the absolute values of the different widths for the right and left ribs of the control subjects (p < .05). We identified tuberculosis, nontubercular empyema, thoracic surgery, blunt trauma, and metastatic tumor as causative agents in 24 (59%) of the 41 patients in group I. CONCLUSION: Rib enlargement is occasionally displayed radiographically in cases of chronic pleural disease and is confirmed by comparison of the two sides. In our selected patients (group I) with rib enlargement, tuberculosis was the most common cause of pleural disease, but nontubercular empyema, thoracic surgery, blunt trauma, and metastatic tumor were also found. Conversely, we found no rib enlargement in association with pleural disease of short duration. We have shown that rib enlargement can indicate the chronicity of pleural disease.

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There is a variety of methods to aid in the diagnosis of fractures requiring operative treatment. A computer program that produces pseudo-three-dimensional (3D) images from sets of axial computed tomograms is used for examining fractures in areas of complex skeletal anatomy. The resulting reconstructions, representing the surface in a form similar to that of anatomic preparations, can facilitate the process of diagnosis. They are also valuable for planning operations. The 3D information can be used to define the size, shape, and location of the various fracture types. We have used the technique in more than 500 patients with injuries to the skull, spine, acetabulum, sternoclavicular joint, shoulder, knee, and calcaneus and are able to demonstrate the benefit of special investigation protocols.

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A traumatic osseous bridge between lumbar transverse processes is a bone formation occurring after severe or even mild trauma of the back. However, only few of the patients with a contusion of the back or a fracture of a lumbar transverse process develop such an osseous bridge. The localisation of the haematoma plays an important role in this process, but myositis ossificans is a mandatory condition. Anamnesis will not lead to traumatic aetiology in all cases, because sometimes the patient is not aware of the fact that a transverse process has been fractured. The diagnosis finally depends on the recognition of the different shapes. The traumatic osseous bridge is characterised by the kind of trauma that causes the fracture of the transverse process. The shapes can be classified as "h", "H", "K", or "Z". Among 72 patients with inter-transverse osseous bridges, only 11 patients have congenital bridges. The congenital osseous bridge shows typical features that can be explained by means of embryogenic and functional dynamic considerations. These symptoms are the O-shape, concavity of the lumbar spine of a pathological nature and the absence of degenerative changes in the corresponding intervertebral space.

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We present a general review of the literature concerning the role of the 31 P spectroscopy in studying the metabolic effects of drugs like verapamil, chlorpromazin, propranolol, acebutolol, 2-mercaptopropionylglycine, insulin, 2-deoxyglucose, cardioplegic solutions, as well as perfluorocarbon solutions on the energy status of the ischemic myocardium. Using 31 P spectroscopy several important results have been found concerning the changes of the concentration of the high energy phosphates and of the intracellular pH during myocardial ischemia. It is now possible to gain interesting insights into the metabolic effects of different drugs. By using these drugs, changes in the high energy phosphates, as PCr and ATP were attenuated during the myocardial ischemia. A better recovery of the PCr and ATP contents during reperfusion was noted. The myocardial pH changes during ischemia are attenuated compared to controls. A good correlation between the preservation of the high energy phosphates and myocardial pH and the recovery of the ventricular function was described. An in vivo documentation of the mitochondrial oxidative phosphorylation is now possible. A short overview is presented about the phosphorylation potential and its prognostic value for various cardiac diseases. The 31 P spectroscopy successfully shifted the research interest towards biochemical processes at the cellular level in the diagnosis and therapy monitoring. It extends our knowledge on the pathophysiology of the myocardium.

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We report on the basic principles concerning in vivo P-31 MR spectroscopy and give a short review of the corresponding studies on skin tumors described in the literature. Malignant melanoma and squamous cell carcinoma are both characterized by high concentrations of phosphomonoester and phosphodiester. By means of the P-31 spectroscopy technique, we are able to detect changes regarding the tumor metabolism as a response to chemotherapy, irradiation, or biological immune modifiers (e.g. interferon).

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The aortic nipple, a small "pseudotumor" adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate vein obstruction.

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We studied the collateral circulation of 56 patients with occlusion of the extracranial arteries. The results of this study showed that there is often a dominant collateral circulation, mainly of the anterior communications arteries, which supply the blood from one half of the brain to the other.

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CT examinations were conducted in 47 patients with staghorn calculi in the renal pelvis. Density measurements in the region of the calculus supplied pointers to the structure of the calculus.

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In 57 rats the radiation absorption or proton relaxation times were determined in vitro after single carbon tetrachloride poisoning. The inflammatory changes induced by CCl4 result in marked water absorption and moderate of fat. Histologically, there are cell necroses, toxic swellings of cells, regenerating cells rich in water content, and fatty vacuoles. These phenomena result in a reduction of radiation absorption due to the increased water and fat accumulation. Prolongation of both relaxation times is mainly due to water absorption.

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The contents of the medullary space exercise an influence on the absorption of radiation by spongy tissue of cancellous bone. This quantifiable dependence qualifies the value of CT densitometry of the spongiosa, for the CT number alone will not allow proportionate determination of the three main components: bone mineral, haematopoietic marrow and fat marrow. CT densitometry is reliable only if one can assume constant composition of the marrow. MR reveals hitherto unknown possibilities of noninvasive determination of the fat content in cancellous bone. The present study is limited to the determination of proton relaxation times, among the wide application possibilities offered by spectroscopy.

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The exact knowledge of the physical properties of the blood is of great help in image interpretation. Accumulations of liquid with different components of protein and cells must be differentiated from neoplastic tissues. The blood with its composition will influence from the imaging point of view all other blood supplied tissues. The CT number (radiation absorption) of the entire tissue is the sum of the radiation absorption of its single components. To demonstrate this we used human blood as a "tissue model". The proton-relaxation times (T1 and T2) were measured in their dependence on the red cell concentration.

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