Univ. Prof. Dr. Hannes Gruber

Tirol Kliniken - Medizinische Universität Innsbruck · Radiology

PurposeIn this retrospective study we examined whether size is a viable marker of tumour malignancy in soft tissue masses (STM) and if the ratio of width and length (RALD) of an STM reflects tumour biology more accurately. Methods Measurements of maximal lesion size and perpendicular diameter were performed in available MRI and ultrasonography stud...

Immunologic reactions in transplanted organs are in more or less all allograft patients detectable: clear parameters exist as e.g. in renal transplants where the clearance power reduces by rejection. On the contrary, in composite tissue allografts clear and objective indicators stating a rejection episode lack. We present the case of a hand-transpl...

Purpose: Ulnar nerve neuropathy is mainly caused by compression at the level of the cubital tunnel. Two main approaches are currently known for the surgical treatment of this condition: decompression of the nerve in its usual position or transposition to the ulnar flexor side. This study was performed to define the usefulness of ultrasound in pati...

Hand transplantation is challenging, especially with respect to postoperative care. Serious complications including rejection of the transplant are possible. To date, imaging has relied mainly on plain radiography, CT and MRI. High-resolution ultrasound (HRUS) has the potential to be a quick, cost-effective and dynamic alternative at least for the...

Aim: Novel minimally invasive techniques aimed to reposition the haemorrhoidal zone have been established for prolapsing haemorrhoids. We present a prospective randomised controlled trial to evaluate the efficacy of additional Doppler-guided ligation of submucosal haemorrhoidal arteries in patients with symptomatic grade III haemorrhoids. The tria...

See the Flyer

Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily c...

Occlusion of a ventriculoperitoneal shunt system is a potentially life-threatening complication in patients suffering from hydrocephalus. However, there is no imaging established as standard approach in this acute setting. In the present study, we evaluate the use of superb microvascular imaging for investigation of the patency of ventriculoperiton...

Background and Objectives Occlusion of a ventriculoperitoneal shunt system is a potentially life threatening complication in patients suffering from hydrocephalus. However, there is no imaging established as standard approach in this acute setting. In the present study, we evaluate the use of superb microvascular imaging for investigation of the pa...

Anatomical variants of peripheral nerves of the lower limb are relatively frequent and vulnerable to injury if not considered by the surgeon. Surgical procedures or percutaneous injections are often performed without knowing the anatomical situation. In a patient with normal anatomy, these procedures are mostly performed smoothly without major nerv...

Changes in the microvascular environment are considered crucial in the pathogenesis of compression neuropathies. Several studies have demonstrated elevated intraneural vascularity in severe neuropathy compared with healthy subjects, where intraneural vascularity is considered predominantly undetectable. The aim of this study was to assess and quant...

Aim: To compare ultrasound (US)-guided versus computed tomography (CT)-controlled periradicular injections of the first sacral spinal (S1) nerve in a prospective randomized clinical trial. Materials and methods: Thirty-nine patients with S1-radiculopathy were consecutively enrolled for 40 periradicular injections and assigned to an US or CT guid...

Arterial pseudoaneurysms (PSAs) typically occur after (iatrogenic) damage (i.e., puncture) to the arterial wall and are the most frequent complication following percutaneous interventions.In this article we report on successful treatments of two iatrogenic PSAs in two patients (87-year-old male; 69-yearold-female) with a brachial (10 x 7 mm; 10 mm-...

Introduction There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome. Materials and methods Surgically or conservatively treated patients with acute Achilles tendon rupture were retro...

Nerve ultrasound has become an integral part of the diagnostic workup of peripheral neuropathies. Especially in the examination of small nerves, ultrasound provides superior image quality by using high frequency transducers. For a selection of small nerves, this article summarizes the local anatomy and common pathologies and offers simple instructi...

Purpose: Intensive care unit-acquired weakness occurs frequently in intensive care unit patients, including critical illness myopathy (CIM) and critical illness polyneuropathy (CIPN). The authors present a prospective study to assess the ultrasound pattern sum score to differentiate between confirmed CIM, sensory neuropathy, and CIPN cases. Metho...

Repetitive vibratory trauma in cyclists is one of the most common causes of ulnar nerve compression at the wrist. This study describes five cases of clinically suspected compression syndrome of the deep terminal branch of the ulnar nerve (DBUN) defined by high-resolution ultrasound (HRUS) with a 18-MHz linear transducer. Reliable HRUS visualization...

Purpose To present a safety-optimized ultrasound-guided minimal invasive carpal tunnel release (CTR) procedure. Materials and Methods 104 patients (67 female, 37 male; mean age 60.6 ± 14.3 years, 95% CI 57.9 to 63.4 years) with clinical and electrophysiological verified typical carpal tunnel syndrome were referred for a high-resolution ultrasound...

PurposePeripheral nerve sheath tumors are hallmark findings in neurofibromatosis types 1 and 2. With increasing size, they typically lead to neurological symptoms, and NF1 patients have a lifetime risk of 8–13% for developing malignant peripheral nerve sheath tumors. Medical imaging is therefore highly needed for early detection and exact localizat...

Introduction Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents ar...

Aims: To assess the feasibility and preliminary results of ultrasound guided medial branch cryoneurolysis in the management of facet joint syndrome. Material and methods: Between March 2017 and August 2017, a total of 20 patients underwent medial branch blocks, 12 of which were positive. Five patients chose to participate in the study and 8 medi...

This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly...

Background Peripheral nerve pathologies of the upper extremity are increasingly assessed by high-resolution ultrasonography (HRUS), yet rapid identification of nerve segments can be difficult due to small nerve diameters and complex regional anatomy. We propose a landmark-based approach to speed up and facilitate evaluation and intervention in this...

This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast-enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly...

Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingeme...

Nerves of the gluteal region are presented based on our unique and simple landmark technique: define the points-of-optimal visibility (POV) of the nerves of the gluteal region by external (ELM) and internal (ILM) landmarks, define the nerves by high-resolution sonography, and follow them to whatever nerve segment you want to assess or where it shou...

Nerves of the trunk (including segmental nerves) are presented basing on our unique and simple landmark technique: define the points of optimal visibility (POV) of the nerves of the trunk by external (ELM) and internal (ILM) landmarks, define the nerves by high-resolution sonography, and follow them to whatever nerve segment you want to assess or w...

Nerves of the lower extremity (thigh, lower leg, and foot) are presented based on our unique and simple landmark technique: define the points-of-optimal visibility (POV) of the nerves of the lower extremity by external (ELM) and internal (ILM) landmarks, define the nerves by high-resolution sonography, and follow them to whatever nerve segment you...

As a consequence of what we said above, we want to illustrate here how this book may be used most effectively with an example, having first presented a short overview (valuable time can also be lost by consulting an “unknown” manual!). Finally we present a short list of generally valid statements.

Aims: Injection therapies play an increasingly decisive role in the treatment of lower back pain. Cumulative studies could show the benefits of ultrasound-guided instillation procedures in the cervical and lumbar spine. We conducted this study to provide a new simple sonographic approach for pararadicular injections of the sacral spinal nerves and...

https://eu.medical.canon/ecr2019/workshop-registration/

This first of its kind richly illustrated book provides a tabular and schematic representation of all the peripheral nerves in the human body using a standardized landmark-based algorithm for the definition of the nerve’s “Point of optimal visibility (POV)”. In this atlas the nerves of the human body are depicted with high-frequent ultrasound probe...

None

This first of its kind richly illustrated book provides a tabular and schematic representation of all the peripheral nerves in the human body using a standardized landmark-based algorithm for the definition of the nerve’s “Point of optimal visibility (POV)”. In this atlas the nerves of the human body are depicted with high-frequent ultrasound probe...

Coming up soon ... in press

Purpose Diabetes mellitus (DM) and carpal tunnel syndrome (CTS) are common pathologies. The diagnosis of CTS can be facilitated by the use of an ultrasound-based wrist-to-forearm ratio (WFR) of the nerve diameter. However, the applicability of WFR in DM-patients is not yet clear. Materials and Methods 233 wrists of 153 patients were examined. Cross...

Dieser Taschenatlas stellt erstmals die topographische Anatomie aller peripheren Nerven im Ultraschall mit Fokussierung auf spezielle Landmarken dar: mit den Punkten der optimalen Visibilität (POV). Annähernd alle Nerven des menschlichen Körpers sind mit hochauflösenden Schallköpfen bis zu 24 MHz im Detail dargestellt. Nützlich für den Anfänger wie...

von Dr. Nitto auf den Leserbrief von Prof. Dr. Staub und Mitar. bzgl. ihrer Arbeit Nitt A, Baur EM, Gruber H, Löscher W, Loizides A, Mattesich M, Pülzl P. Betreffend der Wrist-to-Forearm-Ratio des N. medianus ist die Sonographie zur Verlaufskontrolle nach Operation eines Karpaltunnelsyndroms ungeeignet. Handchir Mikrochir Plast Chir 2018; 50: 14-18...

Celiac plexus block has been used in various upper abdominal malignant and nonmalignant pain syndromes with variable success. Pain signals stemming from visceral structures that are innervated by the celiac plexus can be interrupted by blocking the celiac plexus or the splanchnic nerves. These structures include the pancreas, liver, gallbladder, me...

Lumbar periradicular infiltrations (nerve root blocks) are well established in the diagnosis and management of lumbar radiculopathy [1]. Lumbar periradicular injections are preferentially performed as fluoroscopically or computed tomography (CT)-controlled interventions [2, 3]. However, both guidance modalities have significant radiation exposure,...

Background and objectives: Real-time ice-ball formation during cryoneurolysis has sparsely been assessed with ultrasound (US). Cryoneurolysis in lower back pain syndrome represents a validated management option in cases of facet joint syndrome. Ultrasound may be a useful tool to perform facet joint cryodenervation. The objective of this study was...

Zusammenfassung Ziel Primäres Ziel der Untersuchung war es zu ermitteln, ob und inwieweit eine Korrelation zwischen dem klinischen Verlauf nach Karpaltunneldekompression bei Karpaltunnelsyndrom (KTS) und der sonographisch ermittelten Wrist-to-Forearm-Ratio (WFR) des N. medianus besteht und diese somit zur Verlaufskontrolle postoperativ geeignet ist...

In diesem Kapitel werden die folgenden Nerven mit Hilfe externer und interner Landmarken beschrieben: Nervi clunium medii, Nervi clunium superiores, Nervus coccygeus, Nervus genitofemoralis Ramus femoralis, Nervus genitofemoralis Ramus genitalis, Nervus ilioinguinalis, Nervus iliohypogastricus Ramus cutaneus anterior, Nervus iliohypogastricus Ramus...

Dem im Vorwort gesagten treu bleibend, wird in diesem Kapitel an einem Beispiel dargestellt, wie dieses Buch am effektivsten zu nutzen ist – denn auch beim Nachschlagen kann man Zeit verlieren! Abschließend wird noch eine kurze Liste allgemeingültiger Aussagen zur Nervensonographie präsentiert.

In diesem Kapitel werden die folgenden Nerven mit Hilfe externer und interner Landmarken beschrieben: Nervi clunium inferiores, Nervus gluteus inferior, Nervus gluteus superior, das subgluteale Segment des Nervus ischiadicus sowie der Nervus pudendus.

In diesem Kapitel werden die folgenden Nerven mit Hilfe externer und interner Landmarken beschrieben: N. cutaneus dorsalis intermedius, N. utaneus dorsalis lateralis, N. cutaneus dorsalis medialis, N. cutaneus femoris lateralis, N. cutaneus femoris posterior, N. cutaneus surae lateralis, N. cutaneus surae medialis, N. digitalis dorsalis pedis, N. d...

Dieser Taschenatlas stellt erstmals die topographische Anatomie aller peripheren Nerven im Ultraschall mit Fokussierung auf spezielle Landmarken dar: mit den Punkten der optimalen Visibilität (POV). Annähernd alle Nerven des menschlichen Körpers sind mit hochauflösenden Schallköpfen bis zu 24 MHz im Detail dargestellt. Nützlich für den Anfänger wie...

Clinical/methodical issue: Muscular injuries represent the most common musculoskeletal lesions. Especially in professional athletes an imaging clarification is essential in order to define the exact location of the lesion, the affected muscles, the extent and degree of the injury as well as to define possible concomitant complications. The best po...

Objective To quantify the diagnostic utility of imaging features in soft tissue masses (STMs) and to provide a ranked list of predictors for malignancy. Subjects and methods Imaging features in 260 cases of STMs with verified histology were assessed. Diagnostic properties including sensitivity, specificity, positive and negative predictive values,...

The soleus arcade syndrome is a rare compression neuropathy of the tibial nerve that often remains undiagnosed due to low clinical awareness and difficult diagnosis. We present the case of a female patient admitted with acute worsening of a pre-existing sensory tibial neuropathy and acute tibial nerve palsy after knee joint injection. After a knee...

Objectives To define the diagnostic value of high-resolution ultrasound (HRUS) of the suprascapular nerve (SSN) in the diagnosis of neuralgic amyotrophy (NA). Methods The cross-section areas (CSA) of the SSN at the C5 root (CSA1) and the omohyoid muscle in the midclavicular line (CSA2) were assessed bilaterally in 15 healthy volunteers and 14 pati...

Clinical/methodical issue: Up to the advent of high-resolution ultrasound, interventions on the peripheral nervous system, including local anesthesia and pain treatment were performed without visual guidance, which in some cases led to treatment failure or local tissue and nerve damage. Methodical innovations: Progress in the field of ultrasound...

Anatomical variants can be found throughout the whole body. Especially in the knee region, some variability has been reported concerning the osseous, tendinous, and muscular system. Beside a few cases of patellar tendon aplasia, no anatomical variations of this tendon are known. We present a rare case of a doubled patellar tendon as an anatomical v...

Peliosis hepatis is a rare benign disorder of the liver, histologically characterized by blood-filled cystic cavities of various sizes and irregular shapes, communicating with the hepatic sinusoids. Only a few cases of peliosis hepatis have been describedusing contrast enhanced ultrasound showing admittedly various dynamic enhancement patterns. We...

Objective: The purpose of this study was to assess and compare contrast-enhanced ultrasound and MRI patterns in the diagnosis of soft-tissue masses. Materials and methods: Two hundred fifty-five consecutively registered patients with histologically confirmed soft-tissue masses were included in this retrospective study. The diagnostic properties...

Purpose To evaluate whether ultrasound findings of the median nerve cross-section area (CSA) and wrist-to-forearm ratio (WFR) correlate with neurophysiological and patient-reported outcome after surgery for carpal tunnel syndrome (CTS). Materials and Methods Subjective pain, CSA, WFR, postoperative scar tissue formation and nerve conduction velocit...

Introduction: We report on a rare case of an atypical located aneurysmal bone cyst (ABC) in the patella presenting with pathological fracture after trauma. Materials and methods: Using all available diagnostic modalities and by means of ultrasound-guided core-needle biopsy an unclear and suspected pathological fractured cystic bone lesion in the...

Purpose High-resolution ultrasound is increasingly used in the diagnosis of carpal tunnel syndrome; yet little is known about gender differences in clinical presentation and ultrasound findings. Materials and methods In this high-resolution ultrasound-based retrospective study in 170 cases, we assessed gender influence in CTS in terms of the severi...

Abstract INTRODUCTION: Peripheral compression neuropathy of the ulnar nerve is a frequent condition, most likely encountered at the ulnar sulcus or the Guyon's canal. High-resolution ultrasound (HRUS) can often identify the site of injury. Primarily idiopathic, compression neuropathy can stem from a punched nerve syndrome, in which direct contac...

Peripheral compression neuropathy of the ulnar nerve is a frequent condition, most likely encountered at the ulnar sulcus or the Guyon's canal. High-resolution ultrasound (HRUS) can often identify the site of injury. Primarily idiopathic, compression neuropathy can stem from a punched nerve syndrome, in which direct contact between an arterial bran...

Supinator syndrome or posterior interosseous nerve (PIN) syndrome is a compression neuropathy of the deep branch of the radial nerve in the region of the Arcade of Frohse. An extremely rare cause of an acute onset supinator syndrome is the hourglass-like fascicular constriction of the posterior interosseous nerve due to torsion. To our knowledge, o...

IntroductionThe multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) or Lewis–Sumner syndrome is a rare acquired neuropathy. It is distinguished from other acquired demyelinating polyneuropathies such as the chronic inflammatory demyelinating polyneuropathy (CIDP) by asymmetric motor and sensory impairment, and the multifocal mot...

Purpose: The axillary nerve (AN) is frequently injured during shoulder trauma and imaging is required to define the site and extent of nerve injury. However, the AN has a rather complex course through several soft tissue compartments of the shoulder and axilla. Therefore, imaging of the nerve with MRI and sonography is troublesome. Thus detection...

Interaktiver und integrierter Workshop zur Diagnostik des peripheren Nervensystems unter Berücksichtigung aller diagnostisch relevanten Möglichkeiten: • Refreshing: klinische Untersuchung – elektrophysiologische Methoden – sonographische Diagnostik („One Stopp Shopping“) • Darstellung problemorientierte Lösungsalgorithmen zur sicheren Diagnostik u...

Introduction: Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy of the PIN in the region of the supinator muscle, most common by the arcade of Frohse. We aimed to specify ultrasonographic findings in patients with PIN syndrome in comparison to healthy volunteers. Methods: Ultrasound images and clinical data of 13 patie...

Objectives: A prospective randomized clinical trial was conducted to evaluate accuracy, time-saving, radiation doses and pain relief of ultrasound-guided (US) facet joint injections versus Computed Tomography (CT)-controlled interventions in the cervical spine. Material and methods: Forty adult patients were consecutively enrolled and randomly assi...

Background: Successful anal fistula care in complex cases can be assisted by specialized imaging which accurately defines the site of the internal fistula opening and the fistula type. There are currently limited data concerning the clinical indications for and accuracy of transperineal ultrasound (TP-US) in acute perianal sepsis. The aims of this...

In recent years, sonography of the peripheral nervous system has gained widespread acceptance. New diagnostic applications have emerged, and the field of ultrasound-guided interventions has expanded significantly: regional anesthesia, peripheral nerve blocks, and similar techniques are now frequently performed under ultrasound guidance by anesthesi...

Background and purpose: Little is known about the natural history of non-traumatic compressive mononeuropathies. To improve patient management, prognostic factors and outcome in patients with non-traumatic peroneal and radial mononeuropathies were studied. Methods: Retrospective clinical, electrophysiological and sonographic data of patients wit...

Injection therapies play a major role in the treatment of back pain and radiculopathy and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of pain patients. Pararadicular and facet-joint injections in the spine are preferentially performed under computed tomography or fluoroscopy guidance. In this article...

A prospective randomized clinical trial was conducted to evaluate accuracy, time-saving, radiation doses and pain relief of ultrasound-guided (US) facet joint injections versus Computed Tomography (CT)-controlled interventions in the cervical spine. Forty adult patients were consecutively enrolled and randomly assigned to the US- or CT group. US-gu...