[Automated mammary sonography and mammography: the differentiation of benign and malignant breast lesions]. / Automatisierte Mammasonographie und Mammographie: Differenzierung benigner und maligner Mammaläsionen.

PURPOSE: A prospective study on the differentiation of breast lesions was carried out using experimental combination schemes of mammography and automatic sonography. MATERIALS AND METHODS: X-ray mammograms and a B image from automatic sonography of 39 malignant and 41 benign lesions as well as 40 cases without lesions were separately examined by four experienced diagnosticians. The observers differentiated the findings mammographically and by measurement in the B images. RESULTS: For two examiners the combination of mammography and automatic sonography gave with regard to the differentiation of breast lesions an improvement in sensitivity of 3 or 5% and in specificity of 31 and 18%, respectively, as compared to mammography alone while for the other two examiners an improved specificity of 21 and 36%, respectively, was accompanied by an 8 and 10% decrease in sensitivity as compared to mammography alone. CONCLUSIONS: The differentiating criteria from automatic sonography and mammography can, in principle, be used to evaluate the dignity of breast lesions. However, an optimization is necessary since the improvement in specificity does not compensate the loss in sensitivity.

Detection of malignant and benign breast lesions with an automated US system: results in 120 cases.

PURPOSE: To evaluate clinically an automated ultrasound (US) system for detecting benign and malignant breast lesions. MATERIALS AND METHODS: A prototype automated US system was used to examine 119 patients: 38 patients with 39 proved malignant breast lesions (7-50 mm), 41 patients with 41 proved benign breast lesions (8-40 mm), and 40 patients without breast lesions. The device yields a three-dimensional set of B-mode scans and reconstructed US images comparable to mammograms. All patients had undergone mammography. Four radiologists who had not performed the examinations independently assessed the mammograms and US images to detect benign and malignant breast lesions. RESULTS: Each of the four readers did not recognize one to three detectable malignant lesions on mammograms, one to two detectable malignant lesions on US images, two to four detectable benign lesions on mammograms, and five to seven detectable benign lesions on US images. All readers identified the 39 cancers with at least one of the modalities. The 40 cases without lesions were diagnosed correctly more frequently on the US images by three readers and on the mammograms by one reader. CONCLUSION: Depiction of breast lesions at automated US is reproducible. Automated US is complementary to mammography.

[Screening and diagnosis for eliminating renovascular hypertension. Value of 24-hour blood pressure monitoring and color-coded duplex ultrasound diagnosis]. / Screening and Diagnostik zum Ausschluss einer renovaskulären Hypertonie. Stellenwert der 24-Stunden-Blutdruckmessung und der farbkodierten Duplexsonographie.

BACKGROUND: Direct renal angiography is still the method of choice for identification of renal artery stenosis. Newer non-invasive diagnostic methods include color coded duplex sonography and also ambulatory 24-h blood pressure monitoring, since in a large proportion of patients with secondary forms of hypertension the usual blood pressure fall during nighttime disappears. PATIENTS AND METHODS: In a prospective in-hospital study we investigated 86 patients with suspected renovascular hypertension. Circadian blood pressure was measured oscillometrically and color coded duplex sonography was performed immediately before direct renal angiography. RESULTS: Angiography revealed renal artery stenosis (> or = 50%) in 42 patients. This compared to a sensitivity of 92.9% and specificity of 91.7% for the use of sonography in those patients (70.4%) who could be adequately examined. Mean 24-h pressure values as well as standard deviations of blood pressure means as an indicator for blood pressure variability were not different in the 2 groups of patients, when all the data were analysed together and also when the data for nighttime and daytime were examined separately. The percent of blood pressure fall during nighttime was also not different in the 2 groups. In both groups 4 hypertensive patients had a blood pressure increase during nighttime. In 11 patients without renal artery stenosis a blood pressure fall of < 10% was observed, compared to 12 patients with renal artery stenosis. The circadian pattern of pulse rate was similar in both groups. CONCLUSION: We conclude that ambulatory blood pressure monitoring has a considerably lower diagnostic value for renal artery stenosis compared to angiography and also to color duplex sonography. This method therefore does not appear to be an appropriate screening approach for this kind of secondary hypertension. The color coded duplex sonography, however, seems to be the best non-invasive diagnostic method in those patients, who can be adequately examined.

Minimally invasive catheter implantation for regional chemotherapy of the liver: a new percutaneous transsubclavian approach.

PURPOSE: Development of a percutaneously implantable catheter system for regional chemotherapy of liver metastases and its application in patients with surgically implanted but dislocated catheters. METHODS: Thirty-three patients with liver metastases of colorectal tumors were submitted to percutaneous puncture of the subclavian artery and insertion of a catheter whose tip was placed in the proper hepatic artery and whose end was subcutaneously connected with an infusion pump. RESULTS: The mean duration of therapy via the percutaneously inserted catheter was 27 weeks (+/-14 weeks). The most frequent complication was disconnection of the therapy catheter from the tube of the infusion pump. Eighty percent of all complications were corrected by reintervention. The therapy drop-out rate due to catheter-associated complications was 9%. CONCLUSION: Percutaneous insertion of a catheter for regional chemotherapy of the liver is a relatively uncomplicated method with high patient acceptance and simple access for reintervention.

Evaluation of acute scrotal pain by color-coded duplex sonography.

In light of the high sensitivity of color-coded duplex sonography (CCDS), we analyzed a group of patients with acute scrotal pain to evaluate the use of CCDS in routine clinical examination. During March 1988 through April 1991, CCDS was used in 31 patients with acute scrotal pain before they underweight surgery in our department. In 15 patients, the structural and perfusion changes of the scrotal contents were such that a definitive diagnosis was possible. In the rest of the patients, the pathologic changes seen with CCDS were more complex, and the correct interpretation needed more expertise; this was especially true in patients with partial torsion, posttorsion status, and torsion of hydatids. CCDS with the simultaneous display of anatomic scrotal structures and blood flow over the entire scan field is an excellent method for evaluating patients with acute scrotal pain. However, apart from the classical case of no perfusion (as in testicular torsion) and increased perfusion (as in inflammation), more complex changes are more difficult to interpret. The correct diagnosis in the latter cases requires considerable experience and evaluation of all facts, including clinical history, results of palpation, and structural and perfusion changes of the scrotal contents.

Magnetic resonance imaging-controlled laser-induced interstitial thermotherapy.

RATIONALE AND OBJECTIVES: Laser-induced interstitial thermotherapy (LITT) may become an attractive modality for minimally invasive tumor therapy. Magnetic resonance imaging (MRI) could be used to assist this procedure. METHODS: A T1-weighted turbo fast low-angle shot (FLASH) sequence for on-line monitoring of the laser-influenced region (liver, muscle) was investigated. Sequence parameters were optimized for maximal image contrast. Magnetic resonance imaging-controlled LITT was performed in vitro, in vivo (rabbits), and in 8 human investigations (6 patients). Special laser applicators were used to establish a uniform laser light distribution. RESULTS: With the MRI sequence used, the LITT region is visualized as a bright area outlined by a dark border. This dark border corresponds to an isotherm of 45 +/- 2 degrees C depending on the sequence parameters used. CONCLUSION: With the T1-weighted turbo-FLASH sequence, MRI can be used for on-line monitoring of interstitial laser-induced thermotherapy in moving organs.

[Sonography of malignant liver lesions: establishing the current status]. / Sonographie maligner Leberläsionen: Eine Standortbestimmung.

Ultrasound of the liver is the most widely used screening method to detect focal lesions in connection with malignant basic diseases. The efficiency of US is compared to that of other common imaging procedures, and new US methods, e.g. color-coded duplex sonography, intraoperative ultrasound, and the use of contrast agents, are discussed.

[Chemoembolization of liver tumors (VX-2) using lyophilized Spherex]. / Chemoembolisation von Lebertumoren (VX-2) unter Verwendung von lyophilisiertem Spherex.

Chemoembolisation is a new promising approach. Until now no standardized procedures exist for the production of the embolisate-cytostatics mixture. A main technical problem when doing chemoembolisation is the proof of the complete peripheral vascular occlusion. By using lyophilized Spherex and cytostatics, diluted in x-ray contrast media, frozen pictures can be obtained and the complete proof of the embolisation is possible. Therefore the conventional x-ray examination can be used to monitor the embolisation treatment instead of the much more sophisticated DSA technique.

[Color-coded duplex sonography of liver tumors. Does the blood supply permit a conclusion on staging?]. / Farbkodierte Duplexsonographie von Lebertumoren. Erlaubt die Blutversorgung eine Aussage zur Dignität?

Real-time ultrasonography is a sensitive screening method in patients with suspected liver tumors. However, sonomorphology does not differentiate between benign and malignant tumors. In a prospective study we examined patients with liver tumors with color-coded duplex ultrasonography to find out whether the perfusion status of the liver tumor permits a differential diagnosis. A total of 108 patients with liver tumors were included, and the results of color-coded duplex sonography were compared with histology, MRI and CT. No correlation was seen between the final diagnosis and the perfusion pattern. The vascular status visualized by color-coded duplex ultrasonography does not permit differentiation between benign and malignant liver tumors.

Liver tumors: follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization.

The authors examined and quantified the changes observed in the phosphorus-31 magnetic resonance (MR) spectra of liver tumors after chemotherapy and chemoembolization to investigate the suitability of P-31 MR spectroscopy for follow-up. A 1.5-T unit was used before and at specific times during therapy to obtain spectra of liver tumors in 10 patients with liver metastases from colorectal carcinoma and two patients with hepatocellular carcinoma. A marked increase in inorganic phosphate and a decrease in the alpha- and beta-nucleotide phosphate portions of the spectra were observed during the first few hours after local chemotherapy or chemoembolization. Later, the phosphomonoester signals increased markedly and the phosphodiester signals decreased slightly. The effects of successful chemoembolization or local chemotherapy become apparent in the P-31 MR spectrum during the first few hours after the start of therapy. The results demonstrate that P-31 MR spectroscopy is a suitable method for follow-up. However, long-term studies are needed to determine whether it also yields prognostic information.

[Improvement in the diagnosis of scrotal diseases using color-coded duplex sonography]. / Verbesserung der Diagnostik skrotaler Erkrankungen mit der farbkodierten Duplexsonographie.

Two hundred and twenty-two patients with abnormalities of their scrotal contents were examined with colour-coded duplex sonography. The aim of this prospective study was to evaluate this new procedure for the investigation of the scrotal organs. Differentiation between testicular torsion and inflammation by colour-coded duplex sonography achieved 95% accuracy. The diagnosis of varicoceles was simplified and expedited (accuracy = 99%). In other abnormalities of the scrotum, particularly testicular tumours, a knowledge of the blood flow did not provide any important additional diagnostic information compared with conventional sonography.

Appearance of thyroid diseases using colour-coded duplex sonography.

One hundred and seventeen patients with various thyroid diseases were examined with colour-coded duplex ultrasonography permitting simultaneous real-time display of soft tissue and blood flow. Twenty-four out of 25 patients with an autonomous adenoma, all six patients with thyroid carcinoma and five out of 61 patients with simple nodular goitre showed increased vascularity. Absence of increased vascularity would seem an important parameter for the exclusion of autonomous adenoma and thyroid carcinoma in patients with nodular goitre.

Testicular cysts: differentiation with US and clinical findings.

In 34 of 847 patients (4%), testicular cysts were discovered with high-resolution ultrasound (US). Sixteen had a cystic testicular tumor, and US images showed multiple cysts and solid tumor portions in 12 of these 16 (75%). Eighteen patients had nonneoplastic cysts: Five had cysts of the tunica albuginea, and 13 had intratesticular cysts. All tunica albuginea cysts were palpable as small masses, and only US images showed that the masses were cystic. None of the 13 intratesticular cysts was palpable; all were accidentally discovered with US, which showed that 12 were single cysts with a marginal location (92%). On histologic studies, the nonneoplastic cysts were related to the spermatic ducts (rete testis, efferent ductules) and frequently appeared as postinflammatory alterations. Only five patients with intratesticular cysts were followed up with US, and no changes occurred. The combination of clinical and US findings facilitated the differentiation between nonneoplastic and neoplastic testicular cysts.

[Initial clinical experiences with angiodynography]. / Erste klinische Erfahrungen mit der Angiodynographie.

Angiodynography is a further development of duplex sonography. In addition to high-resolution realtime visualisation of tissue this technique permits the simultaneous demonstration of the blood flow over the entire image. The flow information is added in color to the grey scale display. This procedure can replace more complex and/or invasive investigations in the monitoring of kidney grafts, differentiation of goitres, and in diagnosing the patency of deep veins of the legs, the inferior vena cava and the portal vein. The examination facilitates the diagnostics of the limb arteries, extracranial brain vessels and varicoceles.

[Clinical experiences with ultrasound-reflection computerized tomography of the breast]. / Klinische Erfahrungen mit der Ultraschall-Reflexions-Computertomographie der Brust.

Ultrasound-reflection computed tomography (URCT) of the breast can produce astonishingly detailed high resolution images of the breast, particularly in the coronal plane. In some cases it improves the demonstration of the structure of scirrhous carcinomas in this plane. On the other hand, some valuable diagnostic features known from conventional breast sonography, such as acoustic shadows and hyper-reflective area (cysts) are suppressed on URCT images and are not readily recognized. Despite individual outstanding images, a comparison carried out on 100 patients showed no advantages of URCT compared with high-resolution real-time sonography.