[Value of CT and transthoracic lung ultrasound in patients with systemic sclerosis : Joint statement of the ÖRG/ÖGP/ÖGR/ÖGUM]. / Wertigkeit der CT und des transthorakalen Lungenultraschalls bei PatientInnen mit systemischer Sklerose : Gemeinsame Stellungnahme der ÖRG/ÖGP/ÖGR/ÖGUM.

Lung involvement is the most frequent cause of death in patients with systemic sclerosis (SSc). As lung involvement is frequently asymptomatic, the current recommendation is to carry out thoracic computed tomography (CT) in all patients newly diagnosed with SSc. There is currently disagreement on how patients with SSc for whom no lung involvement was found at the time of diagnosis, should be followed up. Based on a consensus of Austrian rheumatologists, pneumologists and radiologists it is recommended that for asymptomatic patients with a negative CT at the time of initial diagnosis, a transthoracic ultrasound examination should be carried out annually and a lung function examination every 6-12 months. In the presence of a positive lung ultrasound finding a supplementary CT for further clarification is recommended. Based on the data situation, annual CT follow-up controls are recommended for patients with a high risk as defined by appropriate risk factors.

[Mimics of lung cancer]. / Es ist nicht immer ein Lungenkarzinom .

Lung cancer is a histologically, immunologically and therefore morphologically and functionally very heterogeneous group of neoplasms with the highest cancer mortality worldwide. Therefore, the range of diseases mimicking lung cancer is also very broad and includes congenital, infectious and inflammatory changes as well as other benign space-occupying lesions and other primary and secondary pulmonary neoplasms. The difficulty in radiology lies in the ability to diagnose lung cancer with a high degree of certainty. This must take the limits of the specific diagnosis, knowledge of the classical pitfalls and rare entities that can imitate lung cancer into consideration. Narrowing the differential diagnosis requires close interdisciplinary cooperation and consideration of the patient's clinical and medical history. An accurate analysis of the computed tomography (CT) pattern and distribution of the lesions as well as consideration of additional changes and involvement of other organ systems can be the key to the diagnosis. The use of fluorodeoxyglucose positron-emission tomography CT (FDG-PET-CT) is helpful only in a few mimics of lung cancer. The article describes clinical and radiological findings of mimics of lung cancer also pointing out the limitations of CT and PET-CT for the diagnosis.

[Management of subsolid pulmonary nodules]. / Management subsolider pulmonaler Rundherde.

The finding of subsolid pulmonary nodules poses a frequent problem in the daily routine of the radiologist. The biological behavior of such subsolid lesions differs significantly from solid nodules. The risk of malignancy is significantly higher in subsolid nodules as compared to solid or purely ground glass opacities or nodules. The recommendations regarding the diagnostic management of subsolid nodules have been adapted according to the tendency of growth and the risk of malignancy. A benign etiology is also seen quite often in subsolid lesions and in this case they will show a reduction of size or disappear completely by the follow-up examination. Therefore, in many cases a short-term follow-up examination is primarily recommended. As the findings will often show no changes for a long period of time, further annual follow-up examinations over a longer, not yet specified period of time are recommended. Subsolid lesions that grow in size and/or show an increase in density or develop a solid part within a ground glass lesion should remain as suspected malignancies until proven otherwise.

[Lung cancer screening - where are we in 2013?]. / Lungenkrebsscreening aktuell - Wo stehen wir 2013?

Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. For this reason, early diagnosis of lung cancer might save lives. The National Lung Screening Trial (NLST), in the U. S. A., provided evidence that screening with low-dose CT (LD-CT) is able to reduce lung cancer mortality by 20.0 %. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. Even if the European trials are able to confirm a reduction in lung cancer mortality by LD-CT, a number of important questions must be answered before the implementation of nationwide screening programs. First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.

[Automated breast ultrasound vs. handheld ultrasound: BI-RADS classification, duration of the examination and patient comfort]. / Automatisierter Brustultraschall vs. handgeführter Brustultraschall: BI-RADS-Einstufung, Untersuchungsdauer und Erlebnisqualität der Untersuchung.

PURPOSE: Automated breast ultrasound (ABUS) is a potentially valuable adjunct to mammography in breast cancer screening. The reliability and the inter-observer variability in the BI-RADS classification, compared to handheld ultrasound (US), as well as the duration of the examination and patient comfort have only been investigated in a limited number of papers to date. MATERIALS AND METHODS: In a prospective study, we examined 148 breasts of 76 patients with handheld US and ABUS. The ABUS data were evaluated separately by two investigators. Patient comfort was assessed using a standardized questionnaire. RESULTS: The inter-observer agreement for the BI-RADS classification among the two observers using ABUS was high (κ = 0,750), the agreement with handheld US was moderate. The sensitivity in the detection of breast cancer was 87.5 % for handheld US and 75 % for the ABUS evaluation by observer 1. The sensitivity was 87.5 % for the ABUS evaluation and 83 % for mammography by observer 2. The ABUS examination was rated as completely painless by 64 % of the patients. 25 % of the patients indicated minor pain, and 10 % indicated moderate pain. Handheld US was rated as completely painless by 66 % of the patients. 26 % of the patients indicated minor pain, and 8 % indicated moderate pain. CONCLUSION: ABUS examinations focusing on the BIRADS classification have low inter-observer variability, compared to handheld US. The sensitivity of ABUS did not differ significantly from handheld US.

APPC--a new standardised coding system for trans-organisational PACS retrieval.

OBJECTIVES: As part of a general strategy to integrate the health care enterprise, Austria plans to connect the Picture Archiving and Communication Systems (PACS) of all radiological institutions into a nationwide network. To facilitate the search for relevant correlative imaging data in the PACS of different organisations, a coding system was compiled for all radiological procedures and necessary anatomical details. RESULTS: This code, called the Austrian PACS Procedure Code (APPC), was granted the status of a standard under HL7. Examples are provided of effective coding and filtering when searching for relevant imaging material using the APPC, as well as the planned process for future adjustments of the APPC. DISCUSSION: The implementation and how the APPC will fit into the future electronic environment, which will include an electronic health act for all citizens in Austria, are discussed. A comparison to other nationwide electronic health record projects and coding systems is given. Limitations and possible use in physical storage media are contemplated.

[Sonography of the liver following CT staging of patients with lung cancer: a retrospective analysis]. / Sonografie der Leber nach CT-Staging von Patienten mit Bronchialkarzinom: eine retrospektive Analyse.

PURPOSE: Liver lesions are frequently detected in the CT staging of lung cancer patients and may require further investigation. The aim of our study was to assess the value of an ultrasound (US) examination of the liver in addition to routine CT staging. MATERIALS AND METHODS: In this retrospective study we included 174 consecutive patients with lung cancer who underwent US of the liver in addition to contrast-enhanced CT of the thorax and upper abdomen. The reports of the examinations were evaluated for the presence of liver lesions. Based on CT and US standard criteria, liver lesions were grouped into unequivocal cysts, hemangiomas, metastases and undefined lesions. RESULTS: With CT, liver lesions were detected in 56 / 174 patients (32 %). These included 24 cysts in 11 patients, 2 hemangiomas in 2 patients and 18 patients with liver metastases. In 31 patients, 66 small (< 1.5 cm) hypodense lesions were detected, which could not be further defined by CT. Using US, 21 of these 66 liver lesions were confirmed as benign (cysts, hemangiomas), and two lesions were diagnosed as metastases. In 2 patients US revealed metastases that were not visible on the CT scans. CONCLUSION: The study demonstrates that a complementary US of the liver in patients with lung cancer may reveal information relevant for treatment. Therefore, liver US may play an important role in the staging of lung cancer. When equivocal small liver lesions are detected with CT, a complementary US examination may help to diagnose these lesions or detect metastases not visible on the single-phase staging CT of the liver.

[Sonographic localization of non-palpable implanon hormone implants]. / Sonografische Lokalisation nicht tastbarer Implanon(R)-Hormonimplantate.

PURPOSE: Implanon is a rod-shaped hormone implant which leads to reliable contraception. The rod is implanted in the subcutis of the upper arm and is usually removed easily after its effective period. In the scenario where the rod is not palpable, the removal of the rod can be difficult or impossible. The purpose of this study was to evaluate the reliability of US in locating non-palpable Implanon implants and to investigate the optimal technical parameters for determining the location. MATERIALS AND METHODS: In a prospective study we evaluated 21 women between June 2004 and June 2008. In 14 patients previous examinations with US, radiography, CT and/or MRI were non-diagnostic. The US evaluation followed a standardized protocol in transverse and longitudinal sections. The technical parameters US frequency, position and number of focal zones and compound imaging were varied to define the optimal parameters for the visualization of the Implanon implant. RESULTS: The Implanon implant was detected in all 21 patients. Reasons for negative palpability were mainly an intramuscular or subfascial location as well as a significant migration of the Implanon implant in 2 patients. The use of a high US frequency, the position of the focal zones in the near field and the deactivation of compound imaging all facilitate visualization of the characteristic US morphology of the plastic rod. CONCLUSION: High resolution US is the method of choice for determining the location of non-palpable Implanon implants. Knowledge of US morphology and optimal technical settings as well as the use of high-resolution scan heads are essential for determining the correct location.

Quantification of left to right atrial shunts with velocity-encoded cine nuclear magnetic resonance imaging.

OBJECTIVES: The purpose of this study was to evaluate the ability of velocity-encoded nuclear magnetic resonance (NMR) imaging to quantify left to right intracardiac shunts in patients with an atrial septal defect. BACKGROUND: Quantification of intracardiac shunts is clinically important in planning therapy. METHODS: Velocity-encoded NMR imaging was used to quantify stroke flow in the aorta and in the main pulmonary artery in a group of patients who were known to have an increased pulmonary to systemic flow ratio (Qp/Qs). The velocity-encoded NMR flow data were used to calculate Qp/Qs, and these values were compared with measurements of Qp/Qs obtained with oximetric data derived from cardiac catheterization and from stroke volume measurements of the two ventricles by using volumetric data from biphasic spin echo and cine NMR images obtained at end-diastole and end-systole. RESULTS: Two independent observers measured Qp/Qs by using velocity-encoded NMR imaging in 11 patients and found Qp/Qs ranging from 1.4:1 to 3.9:1. These measurements correlated well with both oximetric data (r = 0.91, SEE = 0.35) and ventricular volumetric data (r = 0.94, SEE = 0.30). Interobserver reproducibility for Qp/Qs by velocity-encoded NMR imaging was good (r = 0.97, SEE = 0.20). CONCLUSIONS: Velocity-encoded NMR imaging is an accurate and reproducible method for measuring Qp/Qs in left to right shunts. Because it is completely noninvasive, it can be used to monitor shunt volume over time.

Case report: Gluteal injection site granulomas: false positive finding on FDG-PET in patients with non-small cell lung cancer.

Positron-emission-tomography (PET) with fludeoxyglucose F-18 ([(18)F] fluoro-2-deoxy-D-glucose, FDG) has become an established imaging modality in patients with lung cancer for mediastinal lymph node staging and the detection of extrathoracic metastases. However, tracer accumulations are not limited to malignant tissue but are also found in muscles and benign inflammatory processes. We report on two patients with lung cancer in whom FDG-PET revealed suspicious tracer accumulations in the buttock. Ultrasound (US) revealed a hyperechogenic nodule with poorly defined margins in both patients. On specific inquiry both patients reported on repeated "intramuscular" gluteal injections. Histology after US guided biopsy showed an accumulation of macrophages within fibrous tissue, compatible with injection site granulomas. The reported cases underline that (18)F-FDG may accumulate in benign, ancillary processes that have to be distinguished from distant metastases. Tracer accumulation in the buttocks may be highly suggestive of injection site granulomas, especially if the patient reports on "intramuscular" injections. In this setting, US is a widely available modality to distinguish metastasis from adipose tissue necrosis.