Redo Laparoscopic Gastric Bypass in a Patient with Intestinal Malrotation: Report of a Case and Video Vignette.

Unknown intestinal rotation anomaly poses a challenge in laparoscopic gastric bypass surgery. We present a case of a patient with intestinal non-rotation that stayed undetected throughout performing a laparoscopic Roux-en-Y gastric bypass. As a result, the alimentary limb was constructed in an anti-peristaltic way, and the whole gastric bypass was located far more distally than usual. Postoperatively, the patient presented with recurring nausea and vomiting. After several diagnostic steps, a computed tomography finally revealed the inadvertently reverse directed gastric bypass and the pre-existing condition of intestinal non-rotation. This was followed by a diagnostic laparoscopy and the reconstruction of the gastric bypass in "mirrored" technique.

Premature calcifications of costal cartilages: a new perspective.

Background. Calcifications of the costal cartilages occur, as a rule, not until the age of 30 years. The knowledge of the clinical significance of early and extensive calcifications is still incomplete. Materials and Methods. A search was made to find patients below the age of 30 years who showed distinct calcifications of their lower costal cartilages by viewing 360 random samples of intravenous pyelograms and abdominal plain films. The histories, and clinical and laboratory findings of these patients were analyzed. Results. Nineteen patients fulfilled the criteria of premature calcifications of costal cartilages (CCCs). The patients had in common that they were frequently referred to a hospital and were treated by several medical disciplines. Nevertheless many complaints of the patients remained unsolved. Premature CCCs were often associated with rare endocrine disorders, inborn errors of metabolism, and abnormal hematologic findings. Among the metabolic disorders there were 2 proven porphyrias and 7 patients with a suspected porphyria but with inconclusive laboratory findings. Conclusion. Premature CCCs are unlikely to be a normal variant in skeletal radiology. The findings in this small group of patients call for more intensive studies, especially in regard to the putative role of a porphyria.

Image quality and artefact generation post-cerebral aneurysm clipping using a 64-row multislice computer tomography angiography (MSCTA) technology: A retrospective study and review of the literature.

PURPOSE: Computed tomography angiography (CTA) is a time and cost saving investigation for postoperative evaluation of clipped cerebral aneurysm patients. A retrospective study was conducted to analyse image quality and artefact generation due to implanted aneurysm clips using a new technology. METHODS: MSCTA was performed pre- and postoperatively using a Philips Brilliance 64-detector-row CT scanner. Altogether, 32 clipping sites were analysed in 27 patients (11 female and 16 male, mean ages 52a, from 24 to 72 years). Clip number per aneurysm was 2.3 mean (from 1 to 4), 54 clips were made of titanium alloy and 5 of cobalt alloy. RESULTS: Altogether, image quality was rated 1.8 mean, using a scale from 1 (very good) to 5 (unserviceable) and clip artefacts were rated 2.4 mean, using a 5 point rating scale (1 no artefacts, 5 unserviceable due to artefacts). A significant loss of image quality and rise of artefacts was found when using cobalt alloy clips (1.4 versus 4.2 and 2.1 versus 4.0). In 72% of all investigations, an excellent image quality was found. Excluding the cobalt clip group, 85% of scans showed excellent image quality. Artefacts were absent or minimal (grade 1 or 2) in 69% of all investigations and in 81% in the pure titanium clip group. In 64-row MSCTA of good image quality with low artefacts, it was possible to detect small aneurysm remnants of 2mm size in individual patients. CONCLUSION: By using titanium alloy clips, in our study up to 85% of postoperative CTA images were of excellent quality with absent or minimal artefacts in 81% and seem adequate to detect small aneurysm remnants.

The normal width of the linea alba in nulliparous women.

The function of the linea alba is to maintain the abdominal muscles at a certain proximity to each other. In the case of long-lasting increased intra-abdominal pressure, the linea alba widens. Yet, as the existence of the linea a priori implicates a physiological distance between the two rectus muscles, the question arises as to what the normal width of the linea alba is. To evaluate the normal width of the linea alba, we examined 150 nulliparous women between 20 and 45 years of age with a body mass index < 30 kg m(-2) by ultrasound at three reference points: the origin at the xiphoid and 3 cm above and 2 cm below the umbilicus. The examination revealed a broad range of widths at the three reference points. The linea was widest at 3 cm above the umbilicus (-35 mm), followed by the reference point 2 cm below the umbilicus (-31 mm) and the origin at the xiphoid (-31 mm). The mean width was 7 +/- 5 mm at the xiphoid and 13 +/- 7 mm above and 8 +/- 6 mm below the umbilicus. For the definition of the normal width of the linea, the 10th and 90th percentiles were taken. The linea alba can be considered "normal" up to a width of 15 mm at the xiphoid, up to 22 mm at the reference point 3 cm above the umbilicus and up to 16 mm at the reference point 2 cm below the umbilicus in nulliparous women.

De novo superficial femoropopliteal artery lesions: peripheral cutting balloon angioplasty and restenosis rates--randomized controlled trial.

PURPOSE: To prospectively determine, in a randomized controlled trial, whether cutting balloon angioplasty (CBA) yields superior morphologic and clinical outcomes at 6 months compared with the 6-month outcomes after conventional percutaneous transluminal angioplasty (PTA) in patients with short de novo superficial femoropopliteal artery (SFA) lesions. MATERIALS AND METHODS: This study was approved by the ethics committees of the two participating centers, and informed consent was obtained from all patients. The authors randomly assigned 43 patients (26 men, 17 women; median age, 69 years) who had 5 cm or shorter de novo SFA lesions in association with intermittent claudication or chronic limb ischemia to undergo CBA or PTA. The patients were followed up clinically, and restenosis was assessed with duplex ultrasonography (US) at 6 months. chi(2) and Mann-Whitney U tests were used to compare data between the two treatment groups. RESULTS: The US-determined 6-month restenosis rate was 32% (seven patients) in the PTA group versus 62% (13 patients) in the CBA group (P = .048). Sixteen (73%) PTA group patients versus eight (38%) CBA group patients were asymptomatic at follow-up (P = .059). There was no significant difference in ankle-brachial index (median, 0.83 vs 0.77 for PTA vs CBA group, respectively; P = .56) or pain-free walking distance (median, >1000 m vs 600 m for PTA vs CBA group, respectively; P = .17) between the two groups. CONCLUSION: CBA did not prove to be superior to conventional PTA for treatment of short de novo SFA lesions and yielded increased restenosis rates at 6 months.

Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method.

PURPOSE: To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). MATERIALS AND METHODS: Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. RESULTS: A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%. CONCLUSION: In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.

alpha-Blockers improve chronic ischaemia of the lower urinary tract in patients with lower urinary tract symptoms.

OBJECTIVE: To investigate whether a mechanism of action of alpha-blockers on lower urinary tract symptoms (LUTS) involves improved perfusion of the LUT. PATIENTS, SUBJECTS AND METHODS: The accuracy of perfusion measurements using transrectal colour Doppler ultrasound (TRCDUS) and colour pixel density (CPD) was initially confirmed in a porcine model. Following this confirmation, measurements were taken from four healthy male volunteers and 19 patients with LUTS. The urinary bladder was filled slowly (50 mL/min) with 0.2 m KCl, which resembles the osmolarity of concentrated urine, and evaluated by cystometry. In parallel, TRCDUS and measurement of the CPD of the LUT were performed. The patients with LUTS were then treated with daily alpha-blocker (0.4 mg tamsulosin) for 5 weeks and urodynamic variables as well as perfusion were evaluated again. RESULTS: In the healthy men, perfusion of the LUT increased considerably (157%) during filling of the bladder to a mean (sd) maximum cystometric capacity (C(max)) of 481 (28.9) mL. All the patients with LUTS had a reduced mean C(max) during filling with KCl at 322.4 (58.5) mL. The mean CPD in the urinary bladder and the prostate were only increased by 58.4% during filling with KCl. After alpha-blocker therapy the mean C(max) during filling with KCl rose to 382.5 (42.9) mL; furthermore, perfusion of the LUT measured by CPD was significantly increased (132.8%). CONCLUSIONS: The present data strongly suggest that LUTS are associated with chronic ischaemia of the prostate and urinary bladder. alpha-blockers increase perfusion in the LUT and C(max). These results might explain the therapeutic effects of alpha-blockers on LUTS.

Intra-operative sonography: a valuable aid during breast-conserving surgery for occult breast cancer.

BACKGROUND: Breast cancer is increasingly detected during an early non-palpable stage. Together with pre-operative marking of the mass, intra-operative imaging provides invaluable clues. This study was designed to evaluate the usefulness of intra-operative sonography in the hands of the surgeon. METHODS: Between July 2001 and October 2006, 567 patients underwent treatment for operable breast cancer at the landeskrankenhaus (LHK) Feldkirch. Three hundred and sixty lesions were not palpable. Two hundred and ninety-nine patients with poorly definable or non-definable lesions well seen by ultrasound imaging underwent intra-operative sonography (group 1), while 61 patients with non-palpable lesions only seen on mammography (group 2) were subjected to pre-operative needle localization. The study was non-randomized with prospective data acquisition RESULTS: All lesions were identified by both sonography and pre-operative needle localization. In the ultrasound group (group 1) 81% of the lesions were successfully removed by primary intention without metachronous secondary surgery versus 62% in group 2 (p < 0.00228). Eighty-eight percent of the lesions in group 1 were eligible for breast-conserving surgery versus 75% in group 2. The mean clear margin in group 1 was substantially smaller (4.8 mm) than in group 2 (7.2 mm) (p < 0.0001). CONCLUSION: Intra-operative sonography proved to be a reliable and helpful tool in the hands of the surgeon, not only for tumor localization, but also for orientation during tumor excision. It simplifies organizational work and spares the patient the discomfort of pre-operative needle localization.

Cavernous malformations of the orbit: a distinct entity? A review of own experiences.

We collected data to provide evidence that orbital cavernous malformations (CMs) are histopathologically, neuroradiologically, and clinically different from cerebral CMs and may represent a distinct entity. In this study, the main clinical, histopathological and radiological characteristics of 19 patients (11 females and eight males, mean age 49.1 years) with orbital CMs out of a series of 376 orbital tumors are analyzed and compared with 107 cases with cerebral CMs treated in the same period. Decrease of visual acuity and painless progressive proptosis were the main clinical signs observed in 17 patients (89%). Complete microsurgical excision of lesions via individualized approaches was obtained in all cases. Follow-up examinations were obtained after a mean of 3.1 years (11 months to 7 years) and yielded complete recovery in 14 patients, while five remained clinically unchanged. Based on clinicopathological and neuroradiological studies of these 19 patients with orbital and 107 patients with cerebral CMs treated in the same period, we found evidence that orbital CMs have specific features to distinguish them from cerebral CMs. Orbital CMs, in contrast to the cerebral CMs, showed non-degenerated well-developed vessel walls and were covered by a hard and compact capsule. Clinical symptoms are characterized by the growth of orbital CMs due to intraluminal thrombosis and subsequent recanalization of cavernous vessels; there were no signs of hemorrhage. We found evidence to suggest that orbital CMs represent a distinct clinicopathologic and neuroradiologic entity.

Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction.

OBJECTIVE: To determine if there are areas of major and minor perfusion in a single testicle, and if the quality and quantity of sperm are correlated with the level of perfusion, we collected testicular tissue from areas with different levels of perfusion. DESIGN: Controlled clinical study. SETTING: Consecutive patients with azoospermia. PATIENT(S): Patients with azoospermia undergoing testicular sperm extraction (TESE) biopsy for the retrieval of sperm to be used in an assisted reproduction program. INTERVENTION(S): Perfusion mapping was performed with the use of color Doppler ultrasound. Areas with different levels of perfusion were marked with needles. After incision with radiofrequency cutting, the exposed tissue was examined with a laser Doppler flowmeter, and biopsies were taken for TESE and histology. Sperm were analyzed using World Health Organization criteria, and prepared for intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Correlation of sperm quality and quantity in testicular-tissue biopsies, with tissue-perfusion units (TPU) measured by laser Doppler flowmeter. RESULT(S): From 40 biopsies taken from 20 testicles of 12 patients, tissue was analyzed for sperm quality and quantity. Sperm quality was highest in areas of high tissue perfusion. In areas of 70 TPU, 72.3% progressive sperm were detected, whereas in areas of 10 TPU, only 13.3% progressive sperm and elevated numbers of precursor cells could be observed. The number of motile sperm isolated from tissue samples correlated well with the intensity of tissue perfusion. CONCLUSION(S): We have shown for the first time that in patients suffering from azoospermia, sperm quality and quantity depend on tissue perfusion within the testicle.

A case of fulminant post-transplant lymphoproliferative disorder and septicemia.

The fulminant form of post-transplant lymphoproliferative disorder (PTLD) is very uncommon and occurs in approximately 1% of PTLD patients. Approximately 85% of these lesions are of B-cell origin, and most of them are associated with Epstein-Barr virus infection. Fulminant PTLD is frequently associated with a systemic inflammatory response syndrome, and may be difficult to differentiate from septicemia. We describe the case of a 59-yr-old man who suffered from prolonged septicemia in the immediate post-transplant period, and presented again four months after cardiac transplantation with fever, painful liver edge and gastrointestinal bleeding. The diagnosis of fulminant PTLD with advanced multiorgan infiltration by a diffuse large-cell lymphoma of B-cell phenotype was made. During treatment with rituximab, the patient died from Enterococcus faecium septicemia. The sequence of septicemia, PTLD and, finally again, septicemia is an unusual challenge and urges for an aggressive diagnostic approach, where markers like procalcitonin may aid in the discrimination of fulminant PTLD from septicemia.

The thoracoacromial vessels as recipient vessels in microsurgery and supermicrosurgery: an anatomical and sonographic study.

The purpose of this study was to investigate the presence and the precise course of the pectoral branch of the thoracoacromial vessels on the underside of the pectoralis major muscle by anatomical dissection and by color Doppler ultrasound. A further goal was to determine whether these vessels were suitable as recipient vessels in microsurgery and supermicrosurgery for breast reconstruction. In 18 cadavers, the pectoral branch of the thoracoacromial vessels was followed caudally until the diameter of the artery diminished to 1 mm. The same examination was carried out in 40 young female volunteers by tracing the vessel course with color Doppler ultrasound. The 1-mm cutoff point of the artery was measured with reference to the manubrium, the midsternal line, the clavicle, and the upper border of the closest rib. In addition, in the cadavers, the 2-mm cutoff point was determined. At both cutoff points, the diameter of the accompanying vein was measured. The pectoral branch of the thoracoacromial vessels with the artery and concomitant veins could be detected on all 100 undersides of the pectoralis major muscle, anatomically and sonographically. In their course from the acromial region downward, the arteries reached a diameter of 1 mm at an average of 9.9 cm from the manubrium, horizontally 9.4 cm from the midsternal line, and vertically 4.0 cm from the lower border of the clavicle. The 1-mm reference point was situated on the upper border of the third rib in 85 percent of cases. The average distance between the 1-mm and the 2-mm cutoff points was 3.5 cm. At the 1-mm cutoff point, the diameter of the vein was 0.9 mm, and at the 2-mm cutoff point, it was 1.7 mm. Because of their central position at the anterior hemithorax, these vessels are easily accessible from mastectomy incisions, even in skin-sparing mastectomies; the donor-site morbidity is negligible; and as the diameters of the vessels gradually decrease along their caudal course, the recipient site can be chosen precisely according to the length and the diameter of the donor vessels and major mismatch can be avoided. Thus, the pectoral branches of the thoracoacromial vessels are well suited as recipient vessels for (super)microsurgery and are a very promising addendum to the thoracodorsal and internal mammary vessels.

Power Doppler ultrasound imaging for quantification of urinary bladder neck blood flow changes.

This study was designed to evaluate power Doppler imaging for assessment of urinary bladder neck blood flow in comparison with laser Doppler flowmetry (LDF) in an animal model. Transrectal power Doppler ultrasound (US) and LDF of the urinary bladder neck were performed in three anesthetized pigs during comparative cystometry. Normal saline (NaCl) was used for the first run, followed by a second run with 0.2 mol/L potassium chloride (KCl). Standardized sonographic equipment settings (Acuson Sequoia 512); MountainView, CA) were used for power Doppler imaging. Computer-assisted calculation of color pixel density (CPD) of power Doppler images was performed using Scion Image) software image analysis. Tissue perfusion units (TPU) were measured using a BLF21 laser Doppler flowmeter (Transonic Systems Inc., Ithaca, NY, USA). The power Doppler results were compared with the findings obtained by LDF. NaCl filling resulted in a mean CPD increase at the bladder neck from 18.65 (+/- 1.78) at empty bladder to 37.8 (+/- 1.84) at 100 mL and to 88.32 (+/- 1.35) at full bladder capacity (C(max)) of 270 mL, respectively. With KCl filling, a mean CPD increase from 18.65 (+/- 1.78) to 59.63 (+/- 0.5) at 100 mL and 110.82 (+/- 2.98) at full bladder capacity (270 mL) was observed. The CPD increase was significantly higher for KCl than with NaCl (p < 0.001). With NaCl filling, bladder neck blood flow increased from 22 TPU (empty) to 46 TPU (100 mL) and 62.5 TPU at C(max), compared to 22 TPU, 50 TPU and 102.5 TPU with KCl. CPD and TPU measurements showed a strong correlation at p = 0.01. In conclusion, transrectal power Doppler US image quantification is a feasible and accurate method for assessing blood flow changes in the urinary bladder neck.

The influence of left renal vein entrapment on outcome after surgical varicocele repair: a color Doppler sonographic demonstration.

OBJECTIVE: To evaluate the impact of left renal vein entrapment on outcome after surgical varicocele repair using color Doppler sonography. METHODS: Eighty-four men had varicoceles on color Doppler sonography (2 right sided, 74 left sided, and 8 bilateral), which were diagnosed on the basis of a venous diameter of 3 mm or greater and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver or when changing from a supine to an upright position. Diagnosis of the left renal vein entrapment was based on the following criteria: antero-posterior diameter of greater than 1 cm and peak velocity of less than 15 cm/s for the left renal vein at the mid portion and anteroposterior diameter of less than 0.2 cm and peak velocity of greater than 110 cm/s (or, alternatively, a diameter ratio and peak velocity ratio of >5) for the left renal vein between the aorta and superior mesenteric artery. All patients underwent surgical varicocele repair. In postoperative follow-up, we compared the presence of left renal vein entrapment with the frequency of varicocele recurrence. RESULTS: Sixteen (19%) of 84 patients had left renal vein entrapment with a left-sided varicocele. Postoperatively (mean follow-up +/- SD, 19.3 +/- 11.7 months), 27 (32.2%) of 84 had varicocele recurrence, including all 16 patients with left renal vein entrapment and 11 (20.1%) of 68 patients without left renal vein entrapment. The varicocele recurrence rate was significantly greater in patients with left renal vein entrapment (P < .001, Fisher exact test). CONCLUSIONS: The presence of left renal vein entrapment resulted in a significantly higher varicocele recurrence rate. Patients with varicoceles should routinely be evaluated for the presence of left renal vein entrapment before surgical repair.

Pulmonary gas exchange after cardiopulmonary resuscitation with either vasopressin or epinephrine.

OBJECTIVE: It is well established that epinephrine administered during cardiopulmonary resuscitation results in pulmonary gas exchange disturbances. It is uncertain how vasopressin affects gas exchange after cardiopulmonary resuscitation. DESIGN: Prospective, randomized experimental study. SETTING: Animal research laboratory. SUBJECTS: Twenty domestic pigs. INTERVENTIONS: Animals were subjected to ventricular fibrillation and cardiopulmonary resuscitation by using either vasopressin or epinephrine. Hemodynamic and pulmonary gas exchange (multiple inert gas elimination technique) variables were recorded before cardiopulmonary resuscitation and 10, 30, 60, and 120 mins after return of spontaneous circulation when either epinephrine (control) or vasopressin was used. MEASUREMENTS AND MAIN RESULTS: At 10 mins after return of spontaneous circulation, blood flow to low V /Q lung units was increased in animals treated with epinephrine (17.8 +/- 6 vs. 2.6 +/- 3%, mean +/- sd, p<.01). Resulting carbon dioxide elimination was impaired in animals treated with epinephrine but not in animals treated with vasopressin (PaCO2, 55 +/- 2 vs. 46 +/- 4 torr, p<.05). Thirty minutes after return of spontaneous circulation, blood flow to lung units with a normal VA /Q ratio was reduced in animals treated with epinephrine (79 +/- 1 vs. 84 +/- 12%, p<.05), resulting in a depressed PaO2 (147 +/- 4 vs. 127 +/- 10 torr, p<.05). CONCLUSION: Vasopressin compared with epinephrine for cardiopulmonary resuscitation resulted in better gas exchange variables in the early postresuscitation phase.

Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection.

PURPOSE: We performed a prospective study to determine whether a limited biopsy approach with contrast enhanced color Doppler ultrasound targeted biopsy of the prostate would detect cancer as well as gray scale US guided systematic biopsy with a larger number of biopsy cores. MATERIALS AND METHODS: We examined 230 male screening volunteers with a total prostate specific antigen of 1.25 ng./ml. or greater and free-to-total prostate specific antigen less than 18%. Two independent examiners evaluated each subject and a single investigator performed 5 or fewer contrast enhanced targeted biopsies into hypervascular regions in the peripheral zone during intravenous infusion of the US contrast agent Levovist (Schering, Berlin, Germany). Subsequently another examiner performed 10 systematic prostate biopsies. The cancer detection rates of the 2 techniques were compared. RESULTS: Cancer was detected in 69 of the 230 patients (30%), including 56 (24.4%) by contrast enhanced targeted biopsy and in 52 (22.6%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 17 patients (7.4%) and by systematic biopsy alone in 13 (5.6%). The overall cancer detection rate by patient was not significantly different for targeted and systematic biopsy (p = 0.58). The detection rate for targeted biopsy cores (10.4% or 118 of 1,139 cores) was significantly better than for systematic biopsy cores (5.3% or 123 of 2,300 cores, p <0.001). Contrast enhanced targeted biopsy in a patient with cancer was 2.6-fold more likely to detect prostate cancer than systematic US guided biopsy. CONCLUSIONS: Contrast enhanced color Doppler targeted biopsy detected as many cancers as systematic biopsy with fewer than half the number of biopsy cores. Although an increase in cancer detection was achieved by combining targeted and systematic techniques in this screening population, contrast enhanced targeted biopsy alone is a reasonable approach for decreasing the number of biopsy cores.