Percutaneous transluminal angioscopy is opening up exciting possibilities for the interventional radiologist, since it can picture vascular features with an accuracy and clarity that previously has not been possible. Dr. Beck paves the way for the use of this new tool in clinical diagnosis; he details the technical prerequisites, gives step-by-step instructions for applying the technique and discusses how to interprete the resulting images. The amazing results of percutaneous angioscopy are compared with the results of conventional angioscopy. This approach introduces the new and unknown in perspective with the tried and trusted of the past. Major advantages become obvious: unclear or uncertain angiographical findings can be cleared up, interventional procedures can be supported, and the effects of interventional radiology can be seen before and after vascular treatment. The author's unique insight and systematic approach to the vascular system make this atlas a truly pioneering work.

In the past ten years, there have been significant advances in the diagnosis and therapy of arterial vascular disease. While long-term morbidity can only be improved by changing the patient's life-style and removing any risk factors that may be present(hypertension, hyperlipidemia, obesity, diabetesmellitus, nicotine abuse), symptomatic relief may be obtained by various procedures. Besides conservative treatment of arterial occlusive disease (physical therapy, medical treatment) and surgical vascular interventions (thromboendarterectomy, bypass procedures), balloon catheters introduced percutaneously under local anesthesia have found increased application in virtually all areas for the dilatation and recanalization of obstructive lesions in the past few years. The technique of balloon dilatation, as introduced by Griintzig as a further development of the percutaneous interventions by Dotter and Judkins, is no longer the decisive issue. The main objective of present clinical research is to de termine the proper indications and patient selection for this procedure, which has found its place between conservative treatment and surgery. The contents of this Symposium should provide some guidelines for the indi cations and postprocedural therapy for the referring physician, the angiologist, and for the radiologist and cardiologist performing the dilatation. We owe our thanks to all the specialists involved, who have provided us with the benefits of their experience. Mrs. H. Beilmann and Dr. M. Wojtowycz con tributed substantially to the preparation of the text. I would like to thank them and the staff of Springer-Verlag for their conscientious work in the interest of composition and publication quality."

It is not surprising that so much investigation has been undertaken to establish the cause of childlessness, especially when the potentia coeundi of the male is not impaired. As long ago as 1957 the German Society for the Study of Fertility and Sterility was founded, embracing gynecology, andrology, and veterinary medicine. After its inception, meetings conducted in the spirit of its foundation were held every 2 years. This interdisciplinary, coordinated scientific work in the field of human reproduction achieved its value as a result of the stimuli provided by the permanent involvement of veterinary scientists. After about 20 years of activity, the Society adopted a highly differentiated pattern of work-directions in the field of human and veterinary medicine. Since 1976 annual meetings have been held on the topic of animal and human reproduction. These meetings have proved of great value, especially in the area of comparative medicine, and have led to excellent interdisciplinary associations. One of the most evident successes was the first extracorporal fertilization in humans with subsequent embryo transfer and full-term pregnancy. Gynecologists have found that in 40% of cases the cause of undesired childlessness rests with the male, and it is therefore no surprise that also in the field of andrology certain factors concerned with infertility have received great attention.

Applications of angiography have expanded to include not only diagnostic proce- dures but also therapeutic interventions. The introduction of regional administra- tion of vasoactive drugs through percutaneously placed angiographic catheters was soon followed by methods of transcatheter vessel occlusion using temporary or permanent embolic materials. At the same time methods of opening up nar- rowed or completely obstructed blood vessels with percutaneously introduced balloon catheters were being perfected. Thus, regional blood flow reduction or regional blood flow increase can now be accomplished with percutaneous angiographic methods in lieu of major surgical interventions. The advantages in terms of reduced morbidity, length of hospital stay and cost are evident. Therapeutic angiography is a rapidly advancing and therefore changing field. This monograph aims at capturing some of the most recent advances and also at presenting some of the controversies. In order to accomplish this task the editors invited a selected group of cardiovascular radiologists, to contribute in their respective fields of therapeutic angiography. For a balanced view other experts - usually nonradiologists - were also asked to present their views, com- ments, and criticisms. Whenever opinions were far apart an opportunity was given for reply or rebuttal. Thus, up-to-date information with supporting or oppos- ing expert views is presented on the topics of transluminal angioplasty, transcath- eter vessel occlusion, regional drug infusions, and radiologic interventions in thromboembolic disease.

Cardiac nuclear medicine has grown dramatically over the past decade to the point where it is now an integral part of the routine diagnostic workup in patients with heart disease, particularly coro- nary artery disease. In no small part, this is the result of dramatic improvements in technology and the application of these improve- of diagnostic techniques. ments to the development and refinement In this book, authorities on cardiac imaging techniques provide an up-to-date description of the field, covering the clinical appli- cability, efficacy, and future potential of myocardial perfusion scinti- graphy, quantitation of regional blood flow, assessment of ventricu- lar performance, and detection of acute infarction using radio- tracers. This book provides the physician involved in cardiac diag- nosis with the background necessary to integrate the radiotracer method into his diagnostic armamentarium. Boston, August 1979 B.L. HOLMAN Contents Cardiac Nuclear Medicine: An Overview By B.L. HOLMAN ...1 Assessment of Ventricular Function with First-Pass Angio- cardiography By N. ScHAD and 0. NICKEL With 7 Figures ...9 Equilibrium (Gated) Radionuclide Ventriculography By W.E. ADAM, A. TARKOWSKA, F. BITTER, M. STAUCH, and H. GEFFERS With 15 Figures ...21 ...Myocardial Scintigraphy with Infarct-Avid Tracers By B.L. HOLMAN and J. WYNNE With 3 Figures ...35 ...Quantitative Assessment of Thallium-201 Images By U. BuELL, E. KLEINHANS, M. SEIDERER, and B.E. STRADER With 10 Figures ...43 ...Thallium-201 Myocardial Perfusion Scintigraphy during Rest and Exercise By A. LENAERS ...55 ...

The number of patients with occlusive peripheral vascular disease of the lower ex- tremities is still growing as rapidly as the number of patients with coronary heart disease and cerebrovascular disease. Due to the increase in average life expectancy during the last few decades, more patients now need surgical vascular reconstruc- tion. This actually means a demand for more centers specializing in vascular surgery and equipped with intensive care facilities, since the number of patients with cardio- vascular and bronchopulmonary complications is increasing as well. In addition, the number of patients needing repeated vascular surgery has been growing. Therefore, the search for simple procedures to recanalize the arterial lumen which could be performed under local anesthesia is no surprise. Unfortunately peripheral vascular disease is still frequently treated by amputations. In 1967, the fIrst report in German on percutaneous recanalization of arteries with thrombotic occlusions and stenoses appeared in Rontgenfortschritte. The meth- od described in this report had been published by Dotter and Judkins in 1964. Today, 10 years after their report, more data have been systematically collected on this method in Europe than in the United States, where it was developed. Possibly an explanation of this state of affairs is that nonsurgical treatment is favored more in Europe than in the United States. The scientifIcally based angiology established by Ratschow served as the foun- dation for the development of diagnostic work-up and therapy in other directions beyond the questions of operability and surgical results.

Die Strukturierung der speziellen Skeletbande muBte von der Aufgabe ausgehen, daB fur jeden einzelnen Skeletteil nach der Einstellungstechnik die Anatomie, die normale Entwicklung, die Variationen und Mif3bildungen, die traumatischen Veranderungen und die Begutachtungsfragen getrennt abgehandelt werden, wahrend generalisierte oder systematische Erkrankungen, Strahlenschaden und Entzundungen, Geschwiilste und Erbkrankheiten - um nur einige zu nennen - wegen ihres die einzelnen Skeletteile ubergreifenden Charakters oder ihrer grundsatzlichen Erscheinungsbilder zusammen- gefaBt werden, weil sich nur auf diese Weise unertragliche Uberschneidungen und Wieder- holungen vermeiden lassen. Dieser Aufgabe entsprechend bildet dieser Band eine Zusammenfassung un seres heutigen Wissens auf einem Gebiet, auf welchem vor den Radiologen schon viele Anatomen- Generationen wissenschaftlich erfolgreich tatig waren, eines Wissens, zu dem neb en den Anatomen, Pathologen und Radiologen auch Chirurgen, Orthopaden und Padiater intensiv beigetragen haben. Das dadurch zwangslaufig sehr breit gestreute Schrifttum muBte ausgewertet und dem wissenschaftlich Tatigen in einer noch praktikablen Form zuganglich gemacht werden. Hier die richtige Auswahl zu treffen, durfte zu den schwierig- sten Aufgaben eines Autors gehoren. Dariiber hinaus solI dieser Band jedoch auch fur die tagliche Praxis ein nutzlicher Helfer und in schwierigen Fragen ein zuverliissiger Ratgeber sein.

Das Buch befa t sich mit Problemen der Qualit{tssicherung bei der Herstellung und Anwendung von Kontrastmitteln. Nach einf}hrenden Beitr{gen zur Fertigung und Lagerung wird die klinische Anwendung von Kontrastmitteln f}r R-ntgen-, CT- und MRT-Untersuchungen ausf}hrlich er-rtert.

Mit der Einfuhrung der nichtionischen Rontgenkontrastmittel hat ein mehrere Jahrzehnte wahrender Prozess der pharmakologischen Entwicklung zum Erfolg gefuhrt. In dem vorliegenden Buch werden die Ruckwirkungen von Rontgenkontrastmitteln auf die Gefasswand, auf Herz, Kreislauf und Lungenstrombahn, Nieren- und Schilddrusenfunktion sowie ihre Toxikologie und Pharmakologie ubersichtlich dargestellt. Weitere Beitrage befassen sich mit der klinischen Wertigkeit der Rontgenkontrastmittel im Rahmen der Angiographie und Computertomographie sowie mit den nichtvaskularen Applikationen. Die hohe Sicherheit nichtionischer Rontgenkontrastmittel bei Arthrographie, Sialographie, Pankreatikographie und indirekter Lymphographie wird belegt. Ein besonderer Abschnitt ist medikolegalen Fragen im Zusammenhang mit der Patientenaufklarung gewidmet. Forschungsergebnisse der letzten Jahre zur Kontrastmittelvertraglichkeit und zur Vermeidung von Kontrastmittelnebenwirkungen schliessen das Buch ab.

1. Der Dosisvergleich zwischen Angiographiefilm auf hochverstarkender Seltener-Erde-Folie (Quanta 3) und digitalem BV-TV-Bild im "pulsed mode" fallt eindeutig zu ungunsten des digitalen BV-TV-Bildes aus. Zumindestens beim DVI-II-System (Fa. PHI LIPS) und DIGITRON-II-System (Fa. SIEMENS) liegen die Dosen an den 3 MeBorten Oberfiache, Kor permitte und Austrittsseite bei Verwendung der auto matischen Belichtungsregelung und eines 25 cm Bild verstarkerformates urn den Faktor 2 hoher als bei der hochverstarkenden Angiographie-Film -F olien-Kom bination (Quanta 3). Diese Aussage gilt unabhangig yom entgegengesetzten Strahl en gang bei Filmangio graphie und DSA. 2. Durch Wahl einer niedrigeren Dosisleistungsstufe oder Manipulation der kV-Zahl und Videokamera apertur laBt sich die Dosis bei digitalen BV-TV-Bild in die GroBenordnung der Filmdosis bringen. Die zuge horigen Qualitatsvergleiche stehen noch aus. 3. Es besteht eine Diskrepanz mind est ens urn den Faktor 10 zwischen yom Hersteller angegebener "Eingangs dosis" am Bildverstarker und der yom Anwender tat sachlich zu messenden Dosis vor der Bildverstarker abdeckung. Diese Diskrepanz erkHirt sich zum Teil durch unterschiedliche MeBbedingungen und den zwi schengeschalteten Streustrahlenraster und Abstand. Fiir die Praxis ist jedoch mit realen Dosiswerten zwi schen 3 und 5 mR pro Bild im "pulsed mode" vor der Bildverstarkerabdeckung zu rechnen. Diese Werte werden von mehreren Arbeitsgruppen bestatigt 1, 5-8]."