Diagnostic Work-Up

At ANOVA we offer a full range of diagnostic work-up, with up-to-date clinical knowledge and innovative medical techniques.

Diagnostic Imaging - MRI, CT, Ultrasound

We use state-of-the-art CT (computed tomography) and MRI (magnetic resonance imaging) scans on-site at our partner precision diagnostic clinic, while PET/CT and other specific scans are performed by nuclear medicine partners, and we use these findings to identify the cause of your pain or discomfort. Of course, you are free to choose clinics and radiology practices for MRI, CT and ultrasound exams. We will then support you with precise details of which examinations need to be performed and how, in order to visualize all relevant aspects in the imaging.

Prof. Dr. M.K. Stehling, the founder of ANOVA IRM is not only a physician but also a physicist. This enables him, e.g. in MRI diagnostics, to create optimal settings for the standard devices in order to generate optimal images as well. This is of great benefit for our diagnostics. In addition, Prof. Stehling also advises other radiologists and the company Siemens, which manufactures MRI scanners.

Arthro-MRI Reveals the Cause of your Pain

At the ANOVA Institute for Regenerative Medicine, we use the possibilities of special magnetic resonance imaging techniques to examine the joints - arthro-MRI - in order to detect signs of wear and tear of the joint cartilage and bone, ligaments and menisci at an early stage. With special 3D sequences and the use of contrast medium (CM), inflammations can be identified and thus the cause of joint pain can be precisely assigned to anatomical structures. This is because not every structural change (e.g. a tear in a meniscus) necessarily leads to pain. Only if the structural change is associated with a KM image can it be confirmed as the trigger of the complaints.

In the future, it may even be possible to detect early changes in osteoarthritis by a simple blood test. Until then, clinical and imaging examinations, most notably arthro-MRI, remain the best way to detect osteoarthritis at an early stage.

Diagnostics - Medical History - Blood Tests

Our services range from a thorough review of the patient's medical record and medical history to a comprehensive physical examination and individual laboratory diagnostics with special tests for tumor marker screening, endocrinology and immunological parameters, etc. We perform the laboratory diagnostics in cooperation with our certified and officially approved contract laboratory in Offenbach. Our tests for donor selection comply with German and European drug regulations for the production of ATMP and tissue preparations.

In addition to the basic blood tests such as blood count, blood cells, critical salts and infection parameters, etc., we also test other parameters such as inflammatory factors or hormones known to play a role in the course of disease, such as hormone status in osteoarthritis, for certain diseases in consultation with you.

Why a Detailed Diagnostic Work-Up is Very Important

A treatment is only as good as the diagnostic work-up that took place prior to it. The diagnostic work-up reveals the nature of the disease and the extent to which is has affected the patient. The best individualized treatment option for a patient can only be determined when all the relevant information from the diagnostic phase is obtained. A detailed and specialized diagnostic work-up is thus an indispensable prerequisite for any kind of effective therapy. To find out what is best for you, our specialists will proceed with a diagnostic work-up of your whole body before deciding on the optimal treatment for you.

Frequently asked questions - Diagnostics - MRI- CT - X-ray

What is an X-ray Suitable for?

X-ray images are basically photographs, but they are taken with X-rays instead of light rays. Moreover, it is not the light reflected (reflected back) from the object that is imaged on the film, but the X-rays that penetrate the object. Soft tissue weakens (absorbs and scatters) X-rays very little, air almost not at all, so these areas will be dark in the image. Bones, on the other hand, which contain a lot of calcium, attenuate X-rays strongly, i.e., less light passes through them and this produces bright areas in the image. Therefore, X-rays are good for imaging bones, but only as two-dimensional projections of what are actually three-dimensional structures. Therefore, overlays of multiple bones can complicate interpretation. This problem does not occur with the 3D images achieved with computed tomography. X-rays are poor when it comes to assessing soft tissue structures.

What is the Radiation Exposure of an X-ray?

Depending on the type of X-ray, the radiation exposure is about 0.1 to 5 mSv (milli Sievert). The natural annual radiation exposure in Germany is 1 - 4 mSv. A flight from Frankfurt/Main (Germany) to New York (USA) exposes about 50 mSv each way. In contrast, tumor irradiation (radiation therapy) involves 60,000 to 80,000 mSv. In children, adolescents and younger adults, any radiation exposure should be avoided and an MRI (magnetic resonance imaging) should be taken rather than an X-ray, because an MRI is done completely without radiation exposure. In older people, radiation exposure, as occurs with X-rays, is largely meaningless because growth is complete.

What is an MRI ?

An MRI - magnetic resonance imaging or nuclear magnetic resonance - is an imaging technology used in diagnostics to image the human body. To produce images, MRI uses the interaction of protons (nuclei of hydrogen atoms) with magnetic fields and radio frequency fields. It works without high-energy ionizing radiation (e.g., X-rays), and is therefore largely harmless to the human body. Therefore, people of any age can be examined in MRI, even pregnant women.
MRI can be used in a variety of ways with different imaging techniques, known as "pulse sequences." In contrast to computed tomography (CT), it provides a wide range of tissue contrasts, including soft tissue. In this way, organs and tissues can be examined for different structural and functional characteristics, e.g. for inflammation or cancer.

What do you see on an MRI ?

MRI (Magnetic Resonance Imaging) is the only imaging method that is capable of showing all tissues and organs of the body in three dimensions, with high resolution and multiple tissue contrast. In recent decades, it has become the most important diagnostic method in medicine. It can image the brain, abdominal organs, bones, vessels, the heart and nerves, but also distinguish between benign processes and malignant tumors, detect inflammations, strokes as well as heart attacks earlier than other methods. As a functional MRI, MRI can even make the function of the brain and thoughts visible.

What is not Visible or Only Poorly Visible on an MRI?

Air and calcification are poorly visible on an MRI. Although special MRI sequences (techniques) can also image air and calcification, MRI is primarily suited for imaging tissues containing water and fat - which are almost all tissues and organs in the body. Even bones, which contain high levels of calcium salts (calcium hydroxylapatite), can be imaged with MRI because they also contain water and fat.

When Should a Diagnostic MRI be Done?

For almost all diseases involving changes in tissues and organs, MRI (magnetic resonance imaging - nuclear magnetic resonance) is far superior to conventional diagnostic procedures. While doctors still use X-rays to examine bones, joints and the spine due to their widespread availability, MRI is actually the method of choice today in terms of quality for these indications. It shows disease in its early stages and throughout its spread, including, for example, articular cartilage, ligaments, muscles and tendons, and the inflammation responsible for pain - important diagnostic information that X-rays do not provide. MRI is also far superior to ultrasound exams in most applications, such as examining the thyroid, heart, abdominal organs, female breast, bladder, prostate, vessels and soft tissues. In addition, MRI is free of stressful X-rays. Consult with an expert before wasting time or being wrongly treated by an inferior exam.

Does an MRI Produce Radiation Exposure? Is the Contrast Agent Radioactive?

MRI (magnetic resonance imaging - nuclear magnetic resonance) is a completely gentle examination method. It does not use any ionizing radiation - radiation that, due to its high energy, can cause radiation damage to cells and their genetic material. These include X-rays, but also gamma rays, which are produced during radioactive decay. Radioactive decay plays a role in radionuclides used in nuclear medicine. But not in MRI. MRI contrast media, for example, are not radioactive in any way, unlike those used in nuclear medicine, and are therefore largely harmless to the human body.

What Early Detection Options Does a Whole-Body MRI Offer?

Whole-body MRI offers a wide range of screening options and thus more than any other early detection method, because MRI (magnetic resonance imaging - nuclear magnetic resonance) is an extremely versatile examination method that can be used to examine the entire body in detail. Such a whole-body MRI examination (whole-body scan) can provide information about the following organs and diseases:

  • Stroke, dementia, brain tumors, inflammatory brain diseases, etc.
  • Degenerative and inflammatory changes of the spine, joints, tendons and ligaments, etc.
  • Whole body staging for bone metastases - superior to bone scintigraphy in terms of sensitivity and specificity for about 20 years.
  • Malignancies/tumors/cancer of the lymphatic system, thyroid, lung, liver, pancreas, kidneys, spleen, colon, uterus, prostate, bone, etc.

Whole-body MRI is completely non-invasive because, unlike computed tomography (CT) and nuclear medicine methods (bone scintigraphy and PET), it does not use ionizing radiation. Compared to an ultrasound (US) scan, whole-body MRI has the advantage of being able to image the entire body and all organs: Ultrasound cannot image the brain, spine, lungs, intestines, and many other important body structures.

What is a CT?

CT (computed tomography) is the oldest medical cross-sectional imaging technique. Like MRI (magnetic resonance imaging), it was invented in Great Britain. It was the first procedure in medical history to allow direct, cross-sectional imaging of the brain. CT uses X-rays to image the tissues, just as they are used in X-ray images. Tissue contrast is therefore lower compared to MRI (magnetic resonance imaging - nuclear magnetic resonance), so contrast agents administered intravenously and orally play an important role in CT.

Modern computed tomography scanners can image the human body three-dimensionally in a few seconds at submillimeter resolution. They are therefore used in modern emergency medicine, e.g. for accident victims, to detect damage such as bone fractures, bleeding, organ and vascular injuries, lung damage, brain injuries, etc. throughout the body within a very short time - in just one examination. In addition, CT can also be used to examine the lungs, vessels, coronary arteries, and even the intestines, as in an endoscopy. Bones and joints, even endoprostheses can be depicted three-dimensionally with high resolution and detail, with much higher diagnostic significance than through the conventional two-dimensional projection images of the X-ray era.

What do you see on a CT?

Computed tomography images the electron density of tissues. Unlike x-rays, which are projection images, CT images the body in cross-sections (axial slices) that are typically 1 - 10 mm thick.
Because soft tissues (e.g., the abdomen) do not differ significantly in electron density, CT can image soft tissues, but without good contrast. Bones, due to their calcium content, have a higher electron density than soft tissues, and air, e.g., in the lungs, which has a very low electron density, image with good contrast on CT compared to soft tissues. Due to the low contrast that different soft tissues exhibit on CT, contrast agents are often used in CT examinations that, when applied either through the vascular system or through the intestines, allow for better contrasting and differentiation of different tissues and organs on CT.

What can't be Seen on a CT Scan, or can Only be Seen Poorly?

Soft tissues such as the abdomen are difficult to image on CT. Without contrast, most soft tissues show up on CT scans only as gray on gray. For imaging soft tissues and organs, MRI (magnetic resonance imaging) is far superior to CT.

When Should a Diagnostic CT be Done?

The most important applications of computed tomography are:

  • Imaging of the lungs
  • Imaging of larger sections of the body in severely injured patients
  • Examination of the abdominal and pelvic organs in the elderly

Special CT examinations:

  • Imaging of the coronary arteries to determine the risk of heart attack (calcium scoring) or to rule out a heart attack (CT coronary angiography).
  • Examination of the colon as part of colon cancer screening without an endoscope (virtual colonoscopy)
  • Lung cancer screening in smokers (low-dose CT of the lung)

Is a CT Radioactive?

In a CT, X-rays emitted from an X-ray source (X-ray generator) are passed through the object to be imaged in a sharply focused beam, and attenuated depending on the electron density of the tissues.

What is Radioactivity?

Radioactivity is the decay of unstable atomic nuclei, which in the process emit energy in the form of high-energy rays (gamma rays, X-rays) or through the emission of particles (particles, fragments of atomic nuclei). β-"rays" are electrons, α-rays helium nuclei. However, the emission of positrons, neutrons, and neutrinos is also a component of radioactivity.

What is a PET Scan?

PET stands for poritron emission tomography. PET is a nuclear medical examination procedure in which so-called radioligands are used that bind more or less specifically to certain cells and receptors and can thus detect changes in the body with high specificity. A radioligand in turn consists of a molecule, the ligand, which binds to a receptor or is metabolized, and a radioactive atom, often fluorine18 or gallium68 , which is bound to the ligand. The radioactive atom decays to emit a positron, which decays into two gamma quanta that are registered in the PET scanner's detector and used to calculate the PET images.

What do you see on a PET Scan ?

A PET scan is a functional examination. It shows the distribution of metabolic processes or receptors in the body that are more or less specific to certain tissues. For example, most malignant tumors have increased sugar metabolism, which can be detected with the radiologand 18Fluoro-Deoxy-Glucose (18FDG). In prostate cancer, PET exploits the increased density of prostate specific antigen (PSMA) receptors on prostate cancer cells. A Ga68-PSMA radiologand docks onto these receptors, providing relatively specific detection of prostate cancer. Specific PET radioligands can be produced radiochemically for many other pathological changes in the body.
What doesn't show up on a PET scan, or shows up poorly?

Anatomical details are poorly imaged on positron emission tomography scans because PET is a functional imaging modality. Therefore, PET is now usually combined with computed tomography (CT) (PET/CT combination scanner). CT images anatomical details so that PET data can be matched anatomically.

When Should a Diagnostic PET Scan be Done?

There are many indications for positron emission tomography. The most important applications are in the diagnosis of malignant tumors (cancer) and in the diagnosis of diseases of the brain. Depending on the indication, PET uses different radionuclides and ligands that bind more or less specifically to certain cells and receptors and can thus detect changes in the body with high specificity.

Main applications for PET:

  • 18Fluoro-deoxy-glucose-PET: whole-body staging (detection of metastases) in malignant tumors, e.g. lung cancer, colon cancer, etc.
  • 68Gallium-PSMA(prostate specific membrane antigen)-PET: staging of prostate cancer, detection of local recurrence after prostatectomy and radiotherapy.

Is a PET Scan Radioactive?

A positron emission tomography - PET scan - is not radioactive per se, but the drug/contrast agent used for imaging is radioactive. It consists of a so-called radioligand that binds to specific structures in the patient's body or is metabolized by cells. Bound to this radioligand is a radioactive atom, which emits other high-energy particles and radiation in addition to a positron (hence the name) during radioactive decay. The positron itself decays into two high-energy photons, which are registered by the PET scanner's detector and from which the PET image is calculated. So, in colloquial terms, you could say that a PET scan is "radioactive." The radiation exposure for the patient is roughly 10 mSv. The natural annual radiation exposure is about 1 - 4 mSv.

What is a Scintigram ?

A scintigram or a szitingraphy is a nuclear medicine examination method in which different radio-pharmaceuticals and nuclides are used to functionally and image organs. The best known are bone scintigraphy and thyroid scintigraphy, as well as cardiac and renal function scintigraphy.
Bone scintigraphy utilizes the attachment of technetium99m-labeled bisphosphonates to bone. This is particularly pronounced where remodeling processes occur in the bone, such as in inflammation or when the bone is altered by tumors or metastases. In older people, in whom wear-related remodeling processes in joints and the spine are common, the detection of bone metastases by skeletal scintigraphy is more difficult because both metastases and the wear processes absorb the radio-pharmaceutical. Therefore, whole-body MRI has been providing better results in finding bone metastases for about 10 years.

What do you see on a Scintigram?

Depending on the radio-pharmaceutical used, scintigraphy can show changes in the chid gland, e.g. thyroid nodules, inflammation and degenerative changes in the musculoskeletal system and bone metastases, circulatory disorders in the heart muscle, kidney dysfunction and other pathologic changes.
In this context, scintigraphy, like all nuclermedical examinations, provides more functional information than anatomical information, since the spatial resolution in scintigraphy is much poorer than in computed tomography (CT) and magnetic resonance imaging (MRI).

How Often can you do a Scintigram?

As often as necessary. It radiation exposure is low at 1 - 10 mSv, depending on the application. The natural annual radiation exposure is between 0.5 and 20 mSv. As with any medical examination, the potential benefit of the examination must be weighed against the potential harm.
To reduce radiation exposure, MRI (magnetic resonance imaging, nuclear magnetic resonance) can now be used in many cases, especially in younger people, often with more comprehensive and specific results.

Which Imaging Modalities are Radioactive?

Radioactivity describes the decay of atoms by emitting high-energy radiation or particles. The corresponding unstable atoms are called radioactive. In medicine, radioactive atoms are used for imaging in the field of nuclear medicine. The corresponding nuclear medicine imaging techniques are scintigraphy with gamma cameras, SPECT (single photon emission computed tomography) and PET (positron emission tomography). They are primarily used for the diagnosis of the thyroid gland, the heart, the kidneys, the skeletal system and for the detection of tumors in the body.

How can I Recognize at an Early Stage That I Have Osteoarthritis?

Osteoarthritis usually makes itself felt through pain and restricted movement in joints and the spine. However, by the time osteoarthritis becomes symptomatic, it has usually progressed considerably and the joint cartilage and bone structures are usually irreparably damaged.
Surprisingly, early detection tests for osteoarthritis do not yet exist, although this disease affects almost everyone in old age and leads to considerable limitations in quality of life. The progression of osteoarthritis can also be significantly slowed down in the early stages. Cartilage damage in the early stages can even be regenerated by stem cell treatments.
The best preventive examination for arthritic changes is MRI of the joints and spine, because it is the only examination method that shows all relevant structures, including the articular cartilage and bath discs. These cannot be seen on X-rays.
Which procedure can show metastases in the abdomen or lungs?

Many. Generally, CT (computed tomography), MRI (magnetic resonance imaging, nuclear magnetic resonance), and PET (positron emission tomography) are appropriate for finding metastases in the abdomen, depending on the specific question. Ultrasound examinations are also frequently used, but they are far inferior to CT, MRI, and PET. They are performed frequently because most physicians have ultrasound equipment.
Metastases in the lungs are usually detected by CT, very specifically by PET. MRI has been used less frequently for the lung.

Which Procedure Shows Bone Metastases?

Many. The oldest procedure is X-ray, which is still occasionally used.
For decades the standard procedure has been bone or skeletal scintigraphy with technetium 99m labeled bisphosphonates. However, skeletal scintigraphy also shows degenerative bone changes, which can then be mistaken for metastases and must be further clarified by other imaging techniques.

Therefore, for about 15-20 years, whole-body MRI has been superior to bone scintigraphy in terms of sensitivity and specificity in detecting bone metastases - and also shows lymph nodes and organ metastases that are not visualized by bone scintigraphy. Therefore, when staging with skeletal scintigraphy, computed tomography (CT) is usually still performed, along with 10 - 20 mSv of radiation exposure. MRI is radiation-free.

Recently, positron emission tomography (PET) with 18fluoro-deoxyglucose and, for prostate cancer, with gallium 68 PSMA (prostate specific membrane antigen) in combination with computed tomography (CT) in a combination device - PET/CT - has gained acceptance because it has the highest detection sensitivity and specificity and is superior to all other methods, especially in detecting lymph node metastases.

What Does an MRI Cost?

In Germany, medical services are billed according to GOÄ. An MRI costs between 350 and 1200 euros, depending on the effort involved and the region examined.

What Does an MRI with Contrast Agent Cost?

The contrast agent for an MRI examination costs between 50 and 200 euros. In addition, the injection with a high-pressure syringe is charged, and if necessary, special evaluations of the contrast medium dynamics. If necessary, several contrast agents are used at the same time. In general, it can be said that the use of contrast agent makes the MRI examination more expensive by about 100 - 120 euros.

What Does a Full Body MRI Scan Cost ?

A whole body scan costs between 1200 and 1500 Euro, depending on the effort. In certain cases, e.g. when multiple administration of contrast medium is necessary, e.g. when MR angiography and contrast medium dynamics are required, e.g. for the examination of the female breast, it may also be that the whole body scan has to be performed over two days. The costs can then rise to approx. 2000 - 2500 Euros. However, this is still much cheaper than if all body regions are examined individually and each is billed separately according to GOÄ.

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Patient Services at ANOVA Institute for Regenerative Medicine

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