Ultraschall in der Medizin (ULTRASCHALL MED)

Publisher: Österreichische Gesellschaft für Ultraschall in der Medizin; Schweizerische Gesellschaft für Ultraschall in Medizin und Biologie; Deutsche Gesellschaft für Ultraschall in der Medizin; European Federation of Societies for Ultrasound in Medicine and Biology, Georg Thieme Verlag

RG Journal Impact: 0.32 *

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2019Available summer 2020

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Cited half-life3.50
Immediacy index0.62
Article influence0.81
Website descriptionUltraschall in der Medizin website
Other titlesUltraschall in der Medizin (Stuttgart, Germany: 1980), Ultraschall in der Medizin, European journal of ultrasound
Material typePeriodical, Internet resource
Document typeJournal / Magazine / Newspaper, Internet Resource

Publications in this journal

The aim of the study was to assess the prevalence of thyroid enlargement by ultrasonic volume measurements. 1336 adults living in the iodine-deficient area of Aachen, West Germany (760 females, 576 males, mean age: 54.05 +/- 16.09 years) were included in the investigation. The ultrasonic examination was carried out in patients who did not suffer from thyroid disease at the time of study. The thyroid volume was age-dependent and varied from 13.3 +/- 10.4 ml in patients < 21 years to 29.9 +/- 24.3 ml in patients > 70 years. The prevalence of thyroid enlargement ranged from 14.3% in young people to 51.3% in the elderly. There was no difference in the volumes of the left and right thyroid lobe. The prevalence of thyroid enlargement was higher in females compared to males (p < 0.05). Retrosternal thyroid mass was detected in 25% of all patients > 70 years. There is evidence of a high prevalence of thyroid enlargement in iodine-deficient areas.
Sonographic diagnostics are increasingly brought forward into the first trimenon. Lately, more and more expert studies have been published on echocardiography in the context of the Nuchal Translucency (NT) screening (gestational age 11-14 weeks). The aim of this study has been to evaluate the feasibility of early echocardiography on the occasion of first trimenon screening in the context of routine operation. From February 2003 to March 2004, an echocardiography was prospectively sought in 130 assigned, unselected pregnant women during the first trimenon screening. Three doctors with different OGUM/DEGUM (Austrian and German societies for ultrasound in medicine) qualifications at our ward tried to represent the four-chamber view (4CV) and the outflow tracts (OFT), each via B-mode and color Doppler. The study conditions were "routine", in particular they were temporally limited. In case no sufficient visual representation was achievable with the transabdominal examination, transvaginal sonography was also used. Via B-mode, 4CV was indicated as successful in 86/130, and OFTs in 37/130. Via color Doppler, on the other hand, it was possible to sufficiently represent 4CV in 75/130 and OFTs in 87/130. In routine screening, early heart examination is a big challenge and in many cases even with good equipment no complete diagnostic echocardiography can be achieved. The utilisation of the color Doppler is helpful particularly for the representation of the outflow tracts.
The Meckel-Gruber syndrome (MKS) is a rare autosomal recessive disorder that is characterized by typical sonographical findings: occipital encephalocele, postaxial polydactyly and cystic enlargement of the kidneys. Its recurrence risk of 25 % demands an exact diagnosis. Retrospective analysis of the sonographic characteristics in relation to the gestational age in eight cases with the pathologic diagnosis of MKS. The sonographic characteristics depend on the gestational age. The classic trias was solely seen in the case diagnosed before 14 (th) week of gestation. In the other seven cases, diagnosed between the 17 (th) and 20 (th) week of gestational age, only two of three characteristic signs of MKS could be visualised by US. Polydactyly was missed by ultrasound in all seven cases due to the marked oligohydramnion. The Meckel-Gruber syndrome can be confidently detected and diagnosed by sonography at the 11th to 14th gestational week. Later in the pregnancy, severe oligohydramnion makes it more difficult to establish the diagnosis by US alone. In these cases a meticulous autopsy is necessary to establish the diagnosis of MKS.
Evaluation of the diagnostic contribution of colour duplex sonography of the superficial temporal and the carotid arteries and Doppler sonography of the periorbital arteries by analysing the results in patients with giant cell arteritis with and without neuroophthalmological complications and patients with other diagnoses and neuroophthalmological complications. In a case control study, ultrasonographic findings in patients with neuroophthalmological complications (25 giant cell arteritis, 23 non giant cell arteritis) were compared to those of 62 patients suffering from giant cell arteritis without neuroophthalmological complications. Concentric hypoechogenic mural thickening (a so-called halo) was considered as an ultrasonographic finding typical of giant cell arteritis. Absent or retrograde signals not corresponding to carotid occlusive disease were classified as Doppler sonographic findings typical of giant cell arteritis of the periorbital arteries. There are higher rates of abnormalities in Doppler sonography of the periorbital arteries as well as halos in combination with stenosis of the temporal arteries in patients with giant cell arteritis with neuroophthalmological complications. This suggests that in patients with giant cell arteritis and neuroophthalmological complications, the haemodynamic situation is more severely disturbed. Patients suffering from giant cell arteritis with and without neuroophthalmological complications had the same rate of temporal artery abnormalities on colour duplex sonography (72 vs. 71 %), whereas abnormalities in the periorbital arteries were clearly different (40 vs. 8 %). Only 1 patient with giant cell arteritis without neuroophthalmological complication had anomalies of the carotid arteries typical of giant cell arteritis. In patients with other diagnoses and neuroophthalmological complications, the rate of anomalies in temporal artery colour duplex sonography and Doppler sonography of the periorbital arteries was 9 % and 0 %. Colour duplex sonography of the superficial temporal and carotid arteries and Doppler sonograpy of the periorbital arteries are complementary methods and should be part of the evaluation of all patients suspected to suffer from giant cell arteritis.
The recent development of a new multigate pulsed Doppler system used in conjunction with an A-mode scan allows real time display of the velocity profiles across the vessel and quantitative flow measurement. Experimental in-vitro and in-vivo studies showed an excellent correlation between flow measurements obtained by this noninvasive method and by direct timed collection. Preliminary results of the post-occlusive hyperaemic response in normals and in patients with iliac stenosis are presented. Although no statistical comparison is allowed, it appears that the hyperaemic response is diminished when an iliac stenosis is present. A non-invasive method of quantifying the haemodynamic significance of profunda femoris artery stenosis is described. Finally, the velocity profiles and the flow curves in PTFE grafts were studied and compared to the flow patterns of the normal superficial femoral artery. The differences observed between the two conditions might explain the low patency rate of the synthetic grafts. Other fields of application of the method are suggested. The future development of a Duplex scanner combining B-mode imaging and the multigate Doppler system will allow the exploration of vessels within the abdomen and thorax: portal vein, in situ or transplanted renal arteries, ascending and abdominal aorta.
Transcutaneous ultrasound enables visualization of pleural based lesions but with a poor correlation to specific pathology. Ultrasound contrast agents in conjunction with contrast specific imaging techniques are increasingly accepted in clinical use. Up to date there are no data about the use of contrast enhanced sonography (CES) in a large series of pleural based pulmonary lesions. From August 2004 to August 2005, 137 consecutive patients with pleural based pulmonary lesions on B-mode sonography were studied by CES using a transcapillary second-generation contrast agent (SonoVue(R)). The following CES parameters were retrospectively evaluated. Time to enhancement (TE) of contrast agent after i. v. application was determined and classified as short TE (< = 6 sec) vs. delayed TE (> 6 sec). Extent of enhancement (EE) was evaluated during the arterial phase (2 - 30 sec) and the parenchymal phase (1 - 5 minutes) by using the normal splenic tissue as an in vivo reference, and classified in reduced EE (anechoic/hypoechoic) vs. marked EE (isoechoic/hyperechoic) during both phases. Homogeneity of enhancement (HE) was classified as homogeneous vs. inhomogeneous. 60 patients had histologically confirmed malignant lesions due to central lung cancer (n = 31), and peripheral malignant lesions (n = 29). 77 patients had benign pleural based lesions including pneumonia (n = 32), pulmonary embolism (n = 20), compression atelectasis (17), and other benign pleural based lesions (n = 8). Malignant and benign lesions did not vary significantly regarding TE, EE, and HE. However, there were highly significant differences in the ratio of short vs. delayed TE and reduced vs. marked EE between the six disease groups. Characteristic patterns were short TE with marked EE in all compression atelectasis cases and in 62 % of patients with pneumonia. Delayed TE and reduced EE was seen in all patients with pulmonary embolism and in 62 % of patients with peripheral malignant lesions. Central lung cancer and benign nodules did not present with such specific patterns. No significant differences in HE were seen between subgroups. Pulmonary lesions are characterized by different CES-patterns of arterial supply as evidenced by TE and EE which depends on underlying causes, but CES does not allow to distinguish benign from malignant pleural based lesions in general.
To describe B-mode sonographic patterns of splenic metastases and to evaluate clinical data regarding tumour staging, kind of tumour and survival of patients with splenic metastases. From 1988 till October 2002, about 168 000 abdominal examinations were performed in an internal ultrasound laboratory. During this time, n = 59 patients with splenic metastases were detected who qualified for the retrospective study design. The following data were evaluated: echomorphology of splenic metastases, tumour staging, kind of underlying tumour, and survival rates of patients with splenic metastases. The median age of patients was 61.8 years (SD +/- 10.9). Lesions were hypoechoic n = 19 (32%), isoechoic n = 15 (25.5%), hyperechoic n = 10 (17%) und complex n = 15 (25.5%). A hypoechoic rim was found in n = 18 patients (31 %). An additional spread into other organs was seen in 56 cases (95%). Underlying cancers were carcinoma of unknown primary tumours (CUP) n = 12 (20.3%), lung cancer n = 11 (18.6 %), ovarian cancer n = 7 (11.9%), colorectal cancer n = 6 (10.2%), breast cancer n = 6 (10.2%), malignant melanoma n = 5 (8.4 %), and others n = 12 (20.3%). The median survival time for all patients was 8.7 months. The worst prognosis within the subgroup analysis was found for patients with CUP-syndrome who had a median survival time of 2.7 months. The sonographic pattern of splenic metastases is variable. Metastases to the spleen indicate a terminal stage cancer disease and is associated with an extremely short survival time. 20 % of underlying cancers were CUP-syndromes with the worst prognosis of all subgroups.
Bei der Routine-Ultraschalluntersuchung in der 17. Schwangerschaftswoche wird ein Epignathus diagnostiziert. Epignathi sind Teratome in der Mundhöhle. Nach unserem Wissen wurden bisher nur 3 derartige, in der ersten Schwangerschaftshälfte diagnostizierte Mißbildungen publiziert. Meistens besteht ein Polyhydramnion und ein erhöhtes Alfafetoprotein, gelegentlich eine intrazerebrale Ausbreitung des Teratoms. Bei fehlender zerebraler Beteiligung ist eine radikale Operation nach der Geburt möglich, falls keine Komplikationen im Schwangerschaftsverlauf auftreten. Bei Diagnose in der ersten Schwangerschaftshälfte ist ein Abbruch der Schwangerschaft zu diskutieren.
Unlabelled: Objective of our study is qualitative and quantitative comparison of contrast enhanced ultrasound (CEUS) and 18F-FDG PET-CT in monitoring hepatic alveolar echinococcosis (HAE). Parasitic liver lesions were examined regarding number, size, morphology, vascularization and metabolic activity. Patients, methods: 36 patients with medically-treated HAE were included in this prospective clinical study. Abdominal ultrasound and CEUS were carried out using ultrasound contrast amplifier SonoVue®. As part of monitoring, patients were examined by 18F-FDG-PET-CT. Quantitative analysis of CEUS was performed using the Software VueBox™ Quantification Toolbox. Maximum contrast enhancement in lesions peak enhancement (PE) was used as parameter. For quantification of 18F-FDG PET-CT, maximum Standardized Uptake Value (SUVmax) of lesions was specified and statistically compared with PE. Results: 18F-FDG uptake in parasitic liver lesions was diagnosed by 18F-FDG PET-CT in 32 of 36 patients. Vascularization of liver lesions was detected by CEUS in 22 of 32 FDG-positive patients with sensitivity of 69% and specificity of 100%. Mean maximum diameter of lesions was 69.5mm in CEUS and 63.7mm in B-scan ultrasound (p < 0.0001). No significant correlation was found between SUVmax and PE (p = 0.8879). Conclusion: In comparison to FDG PET-CT, the gold standard for detecting viable lesions by depicting metabolism, CEUS detects viable lesions with high specificity and moderate sensitivity by showing vascularization. CEUS must be regarded as an important tool in monitoring HAE. Dimensions of parasitic lesions are displayed more precisely through CEUS than in B-scan. With currently available methods, CEUS quantification has no benefit in monitoring HAE lesions in daily clinical practice.
The purpose of this study was to evaluate the efficiency of first trimester screening for chromosomal abnormalities using the sonographically determined thickness of nuchal translucency (NT) combined with maternal age. Risk screening was offered to all patients with a fetal crown rump length (CRL) between 45 and 84 mm after extensive counselling. For the risk assessment the software provided by the Fetal Medicine Foundation was used. In accordance with the recommendation of the Swiss Working Group on First Trimester Screening a cut-off risk of 1 : 400 was chosen. A total of 1980 consecutive pregnancies participating in the risk screening programme with due dates prior to May 1, 2001 were included. Mean maternal age was 30.1 yrs and 522 (26.4 %) patients were 35 yrs or older. A positive risk screening result was obtained in a total of 219 (11.1 %) pregnancies including 33 of the 37 (1.9 %) cases with unbalanced chromosomal abnormalities. The detection rate for unbalanced chromosome abnormalities in general (89.2 %) as well as the one for trisomy 21 (93.3 %) in particular are very high with a moderate false-positive rate (9.6 %) in this series. As a comparison in the series presented here, traditional "maternal age screening" (cut-off age 35 yrs) would have yielded detection rates of 64.9 % for all unbalanced chromosome abnormalities and 73.3 % for trisomy 21 at a false-positive rate of 25.0 %. Reducing the false-positive rate by raising the cut-off age to 38 yrs would yield detection rates of 40.5 % for all unbalanced chromosome abnormalities and 46.7 % for trisomy 21 at a false-positive rate of 8.9 %. The number of invasive procedures performed to detect one unbalanced chromosome count may be calculated as 21.75 using the cut-off age of 35 yrs as compared to 6.4 using NT measurement and maternal age. The outcome of this ongoing study is in good accordance with the earlier observation that the main benefit of the addition of first trimester NT measurements to the risk screening protocol is a very high detection rate at a moderate false-positive rate.
In a retrospective study of our hospital of the years 1983 to 1989 we diagnosed a hepatocellular carcinoma (HCC) in 30 patients. The diagnosis was confirmed by histology or cytology, ultrasound and clinical symptoms. The tumours presented sonomorphologically different patterns. Some were hypoechoic (n = 9), some hyperechoic (n = 16) and 5 had a mixed pattern. Nine of the hyperchoic lesions looked like a metastasis with a halo. 13 patients had multiple tumours or diffuse infiltration of the liver. Due to the variable sonomorphology only 16 patients were assumed to have a HCC, no definite diagnosis by ultrasound being possible. The concomitant cirrhosis of the liver was sonomorphically detected in 19 patients and was suspected in 2 further patients. Four patients had no cirrhosis; in 3 patients, the available information was insufficient. Because of the variable sonomorphology of HCC no definite diagnosis by ultrasound can be achieved. The combination of liver tumour and cirrhosis or elevated serumfetoprotein leads to the diagnosis. The diagnosis of HCC must be confirmed by histology.
Endoscopic ultrasound (EUS) allows for intraluminal sonographic imaging of the oesophagus, stomach, pancreatobiliary duct system, the papilla of Vater, as well as the colon and rectum. EUS has proved valuable for diagnosis and staging of tumours of the upper intestinal tract. EUS can also provide valuable additional information concerning lesions that cannot be immediately classified. As doing this involves, first, removal of the conventional endoscope and, second, insertion of the echo endoscope, EUS is not suitable for routine examinations. Therefore EUS has remained an independent endoscopic diagnostic modality. Moreover, due to their diameter conventional echoendoscopes cannot be inserted into the pancreatobiliary duct system. Fine calibre high frequency ultrasound probes promise a resolution of less than 2 mm in diameter. The following report is a summary of a one-day workshop which took place in Muenster, Germany on Oct. 28, 1995. Its goal was to define the current state of the art of miniaturised endoscopic ultrasound probes in the field of gastroenterology. During this workshop, possible clinical applications for diagnosis, therapy, as well as follow-up were described and discussed. The potential of miniaturised endoscopic ultrasound probes was explored in terms of possible future technical developments.
The diagnostic value and the complication rate of transabdominal chorionic villi and placental sampling was compared with standard amniocenteses. The method ist especially helpful in cases with conspicuous fetal sonographic findings. The results of 475 biopsies were retrospectively compared with 983 amniocenteses and chorionic villi samplings (CVS). 64% of chorionic villi samplings (CVS) were performed in the first, 30% in the second and 6% in the third trimester. The indications were advanced maternal age (45%) and psychological problems (14%) in the first trimester and conspicuous maternal serum markers (11%) or fetal ultrasound anomalies (12%) in the second and third trimester, respectively. 10 out of 20 aneuploid cytogenetic results were found in fetuses with sonographic anomalies. In 4 cases we found confined placental mosaicism, which was clarified by means of amniocentesis and cordocentesis. We had 8 miscarriages in a total of 475 CVS procedures; 6 in 304 before the 15th week of gestation (1.97%). The natural abortion rate in this gestational age is about 1%, the CVS-related abortion rate therefore is near 1%. Transabdominal CVS is a low risk method for rapid karyotyping during the entire pregnancy.
To investigate the risk of congenital malformations for newborn of obese women (BMI > or = 30) compared with women of average prepregnancy weight. We performed a prospective, population-based case-control study of 20,248 newborn born in the city of Mainz. A total of 1,451 infants (cases) with and 8,088 without congenital malformations (controls) were analysed. The relative risks of associations between obesity and malformations were calculated as odds ratios (OR) with 95% confidence intervals (CI). The prevalence of malformations in children of obese mothers is 11.1% and thus approximately 4% higher than those of the total study population. There is a significant odds ratio for major malformations (OR 1.3; KI 1.0-1.7). Statistically significant associations were calculated for malformations of the internal urogenital system (OR 1.7; 1.1-2.8), the eyes (OR 5.0; 1.3-20.0) and for orofacial clefts (OR 1.7; 1.1-2.8). Among the specific malformations the highest associations occurred for encephalocele (OR 7.3; 1.1-50.6), common truncus arteriosus (OR 6.3; 1.6-24.8) and Potter sequence (OR 6.3; 1.6-24.8). Adjustment for confounding factors (e.g. maternal diabetes mellitus and age) did not change the odds ratios. Our data demonstrate that newborn of obese mothers are at an increased risk for malformations. An adequate prenatal examination of these pregnancies should include ultrasound screening by specially trained ultrasonographers in tertiary units (DEGUM II/DEGUM III) and serum alpha-fetoprotein measurements. Public health campaigns for prevention are advised.
Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.
In this study foetal weight as estimated by ultrasound was compared with the true birth weight of children having a birth weight of less than 2000 g (n = 105). The estimation of foetal weight was achieved using the authors' own diagram containing a curve for the biparietal and the thoracal diameter as well as for the foetal weight. The data for the weight curve were taken from two European populations (Bonn and Winterthur). There was a highly significant correlation between the ultrasonically estimated foetal weight and the true birth weight. Only in the group less than 1200 g a significant overestimation of foetal weight could be shown by using the weight curve of the population of Bonn, whereas the percentage deviation of both weight curves was comparable: when using the curve of Bonn 68% of readings had a deviation of less than 10%, whereas with the curve of Winterthur this was the case for 65% of the readings.
Ultrasound-guided interventions are presently performed as free-hand-type procedures or using biopsy transducers. In this article we report on our experience with a new navigation-system for sonographically guided interventional procedures under OR-conditions. The US-Guide 2000 trade mark is an electromagnetic guidance system that assists physicians in ultrasound-guided interventional procedures. This system accommodates both in-plane and out-of-plane needle placement. We evaluated this system for the first time under OR-conditions. Overall, for 39 interventional procedures (23 thermoablations of malignant liver lesions, 16 diagnostic punctures) were performed. All targets were reached successfully without any complications. No interactions with other OR-devices were seen. The US-Guide 2000 trade mark as a virtual needle-guiding system allows a safe and accurate sonographically assisted intervention. The major advantage is the possibility of out-of-plane needle placement and the combination of flexibility of free-hand-type procedures with the accuracy of a biopsy transducer. This increases the safety of punctures especially when lesions are difficult to reach and/or are situated next to vulnerable structures. It also reduces the interventional trauma.
The number of articles on abdominal ultrasound has been declining in the last few years. The proportion of presentations containing significant new developments amongst the 23 submitted papers which were accepted is low, some presentations are partially new or utilise ultrasound as a clinical tool, and about half the articles have already been presented in a different form or context at former meetings. Without contrast enhanced ultrasound, innovative contributions would be a rarity. The following article summarises the scientific meetings of the DLT in Graz. In addition to a short evaluation, the scientific objectives of abdominal ultrasound in the next few years are discussed.
Contrast-enhanced sonography is unquestionably the scientific highlight of any ultrasound congress at present. Recent results of studies on contrast media in the liver indicate that the diagnosis of tumours and metastases has reached the standard of CT and MRT and may even surpass it. The sessions dealing with contrast sonography in Graz are therefore a good indicator of the general enthusiasm and increasing acceptance for this technique and its prevalence. The talks delivered and the posters presented also point out difficulties in spreading this new technique and applying it to new indications.
During the past 20 years sonographic diagnosis of pancreatic diseases has developed from isolated case reports into a differentiated method. It is particularly suited for prognostic reviewing of acute pancreatitis and for detection of typical complications in acute pancreatitis and pancreatic trauma. Its contribution to the detection of chronic pancreatitis in on-target examination is also highly significant. Carcinomas of the pancreas can be detected with a good degree of sensitivity if their diameter is equal to or exceeds 1.5 cm. Other problems deserving attention are those of differential diagnosis of low-echo space-occupying growths at the pancreas and the differentiation against circumscribed chronic pancreatitis. Sonographically aimed fine needle puncture is a suitable complementary examination. Doubts must be voiced against the value of sonographic diagnosis of the pancreas within the overall framework of so-called mass screenings.
A 31-year-old Caucasian women was referred to our department after IUGR was suspected by her gynaecologist at 29 weeks' amenorrhea in her second pregnancy. Multiple anomalies were detected by prenatal ultrasound in the 29th week of gestation. Chordocentesis was performed and revealed a Trisomy 22 in all fetal blood cells. The pregnancy was terminated. Post-mortem investigations excluded chromosomal mosaicism. Prenatal ultrasound findings and post-mortem features are presented.
In 22 198 sonographic examinations of the epigastric region, the authors identified 759 renal cysts (3.4%) and 165 renal tumours (0.74%). The percentage of incidence of the renal cysts is identical with that found in post-mortem examinations, whereas tumours were distinctly more frequent. Tumours of the cystic wall had been found in 0.5% of all sonographically diagnosed cysts and in 4% of renal cysts examined via fine-needle biopsy. Of the latter cysts (i.e. out of the 4% of cysts diagnosed by fine-needle biopsy), which were associated with tumours, two had been diagnosed as tumour suspects via sonography. Hence, the sonographic absence of abnormal findings in carcinoma of the renal cyst wall is rare. However, cysts diagnosed via sonography which cannot be subjected to fine-needle biopsy, should be rechecked and followed up at regular intervals. If all possible methods of diagnosis are utilised (I.V. urography, sonography, fine-needle biopsy guided by sonography, computed tomography, angiography), successful differential diagnosis of localised pathological conditions of the kidneys can be achieved in 97% of all cases. Patient risk and cost of diagnosis can be kept at a minimum by proceeding in steps as described in the article. Primary surgical exposure of the kidneys in case of a cystic renal process would now appear justified for therapeutic reasons only, not for the purpose of arriving at a diagnosis.
To evaluate sonographic accuracy in the diagnosis of choledochal calculi 490 patients with cholestasis were examined prospectively with real-time scanner before ERCP or surgery. Ultrasound detected duct stones in 177 of 222 patients (sensibility 80%) and their absence in 242 of 268 (specificity 90%). Dilated extrahepatic bile ducts were demonstrated via ultrasound in 84% of cases with choledocholithiasis, dilated intrahepatic bile ducts in 57%. Intestinal gas obscuring the distal common duct was the most important factor limiting the ability of ultrasound to detect duct stones.
To assess the sensitivity and specificity of echocardiography in the detection of anomalies of the subclavian artery (cervical origin, aberrant origin from the descending aorta or isolation) in patients with monosomy 22q11. From 1/1998 until 03/2002 we examined 57 patients with conotruncal cardiac malformations. 30 patients had pulmonary atresia and ventricular septal defect (53 %), 13 interrupted aortic arch (23 %), 9 tetralogy of Fallot (16 %) and 5 common truncus arteriosus (9 %). Echocardiographic examination included identification of the laterality of the aortic arch as well as examination of the origin of the brachiocephalic vessels. The results were compared with angiographic and intraoperative findings. Median age at echocardiographic investigation was 74 days (range 1 d - 33.4 yrs.). Laterality of the aortic arch was assessed correctly in all patients. 20/57 patients had a right-sided aortic arch (35 %). Echocardiography detected all anomalies of the subclavian artery (14/57 patients, 25 %, sensitivity 100 %) and excluded these anomalies correctly in 43 patients (specificity 100 %). Exact classification of the anomaly of the subclavian artery was possible in 6/6 patients with a cervical origin of the artery and in 7/8 patients with aberrant origin from the descending aorta. Monosomy 22q11 was diagnosed in 21 patients (37 %). Echocardiography achieves a high sensitivity in the detection of anomalies of the subclavian artery. The diagnosis of cervical origin of the artery, in particular, can be easily established. As this anomaly appears to be a specific marker for monosomy 22q11, echocardiography facilitates reliable identification of these patients in clinical practice.
A prospective study was conducted to determine the diagnostic value of sonography in suspected acute appendicitis. From September 1987 until May 1988, the end of the study, 152 patients suspected of having "acute appendicitis" were admitted to hospital. In contrast to other recently published studies conducted by a few highly qualified examiners, we dimed at determining whether this method is useful as a 24-hour-screening performed ba y number of more or less qualified examiners. In the beginning, the patients were examined with a 3.5 MHz scanner, later on exclusively with 5 MHz linear and sector scanners. 150 cases could be evaluated, 96 of which underwent surgery. We found 35 sonographically correct results, 89 correctly negative, 4 false positive and 13 false negative diagnoses. This means a sensitivity of 73% and a specificity of 96% for the sonographical diagnostic method. In 20 cases (13%) sonography led to other diagnoses. A large majority of these findings can be detected by less experienced examiners. The goal of a 24-hour-screening could not be reached because there a competent examiner was not always available at night. It became clear that clinically obvious cases do not require sonographic conformation. The value of sonography lies with doubtful cases of appendicitis: if the ultrasound examination is negative, appendectomy can be postponed; if sonography leads to other differential diagnoses, appropriate therapy can be started immediately.
To investigate the sonographic signs of epiploic appendagitis in a larger number of patients and to add new details. Over a period of approximately 8 years 28 patients were sonographically diagnosed to have epiploic appendagitis. The following sonographic signs were investigated: echogenicity of the lesion; compressibility; shape of the lesion; adherence to the anterior abdominal wall; peripheral rim; central hypoechoic line; thickening of the colonic wall. In 11 of these patients colour Doppler sonography was performed. In addition all 28 patients underwent CT. In 28/28 cases (100 %) a moderately hyperechoic, ovoid, non-compressible mass adjacent to the colon was demonstrated. The mass was surrounded by a hypoechoic rim in 20 cases (71 %) and was fixed to the abdominal wall in 26/28 cases (93 %). Five cases (18 %) revealed a central hypoechoic line, and slight thickening of the colonic wall was visible in 2 cases (7 %). In those cases where colour Doppler sonography was performed, colour flow was absent in the central part of the lesion. In the peripheral zone slightly increased colour flow was demonstrable in 9/11 cases. Epiploic appendagitis has a characteristic sonographic appearance with a moderately hyperechoic, ovoid, non-compressible lesion adjacent to the colon and adherent to the abdominal wall. The mass is frequently surrounded by a hypoechoic rim. Colour Doppler sonography shows a central avascular area and slightly increased colour flow in the peripheral zone.
Based on 427 patients with uneventful pregnancies and deliveries standard rates were established for the resistance index (RI) and the pulsatility index (PI) of the uterine, arcuate, and umbilical arteries. Percentiles, above all the 90th percentile, are more suitable localisation gauge than are standard deviations. In the observation period, i.e. from 18th to 42nd week of gestation, neither resistance nor pulsatility Index in the utero-placental compartment proved to be dependent on gestational age to any significant degree. By contrast, the umbilical artery showed a definite linear relation between the indices measured and gestational age. If the heart rates are in physiological ranges no clinically relevant effects of the heart rate on the measurement results were observed in either the maternal or the foetal compartment.
Establishing a technique employing 3D-ultrasound for the echocardiographic examination of foetuses. M-mode sonography has reached considerable importance in the detection of arrhythmia as well as pathological changes of the heart valves and contraction disorders of the foetal heart. The variability of the position of the foetus leads to problems typically arising with this method. The ventro-anterior position along the long axis of the foetal heart, being the optimal position for prenatal echocardiography, allows no examination in M-mode because the plane of the valve lies vertically in relation to the direction of the ultrasound. A special appliance of 3D-sonography solves the problem by providing a 2-dimensional examination technique of the heart in M-mode independent of the position of the foetal heart. The method allows simultaneous measurement of the movement of different parts of the myocardium in several different planes. By fixing the position of the applicator (in B-mode) and choosing the 3D-sequence in the "free-hand-mode" one gets a 2-dimensional time-tissue-block which contains all movements in the chosen axis. These "time planes" can be deliberately selected for the examination of different planes in the fixed B-mode image which shows their variations along the time axis. Our study describes the application and evaluation of this examination during pregnancy between the 28th and 40th week. Reliable images of the AV-valves or the aortic valve could be produced in 73% of examinations.
The employment of a new transperineal ultrasound technique, which demonstrates the dynamics of the temporal change in the positions of the urethra and bladder under standardized Valsalva pressure, was evaluated with regards to the possibility of diagnosing and classifying the various types of descension. Transperineal ultrasound using a 3 - 5 MHz Curved array transducer was performed on 21 female patients with urinary incontinence. The results were compared with the clinical examinations and the urodynamic measurements. 17 of 21 profiles could be clearly classified as either rotatory or vertical descension types. 2 of the profiles could not be classified due to lack of patient cooperation, and 2 could not be classified due to technical problems. This new method allows a safe diagnosis of the descension types in most cases. All dynamics of the examination can be documented.
To examine whether three-dimensional ultrasound (3D US) is an accurate diagnostic method of clinical use in the ability to define the location and extent of facial clefting prenatally, compared to two-dimensional ultrasound (2D US). 18 foetuses suspected or diagnosed to suffer from a facial cleft by 2D US were examined with a targeted 3D US. 2D US and 3D US results were compared with postnatal outcome. Comparison of the number of foetuses with a cleft lip + primary palate diagnosed correctly with 2D US with the results of adjunctive 3D US (true positive + true negative) showed that adjunctive 3D US correctly diagnosed more cleft lips (100 %; 15/15 foetuses vs. 66 %; 12/18 foetuses) and more cleft primary palates (100 %; 12/12 foetuses vs. 58 %; 7/12 foetuses). Interactive review of standardised 3D multiplanar images allows to systematically evaluate lip defects and abnormalities of the maxillary tooth-bearing alveolar ridge. The accuracy of adjunctive 3D ultrasound is superior to 2D ultrasound alone for extensive prenatal diagnosis of cleft lip with or without cleft primary palate.
Weekly Dopplersonography measurements were performed on the fetal aorta abdominalis, the umbilical artery, the fetal carotid artery and the uterine arcuate artery from the 20th to the 41st weeks of gestation, mean and maximum blood flow velocities were measured, as well as the resistance index. The mean values calculated from 20 cases per week were translated into standard graphical representations serving as a criterion for the assessment of pathological pregnancies. The vessels were examined as to their value for a screening programme of fetal circulation. A sample curve of a severe placental insufficiency showed significant deviations from the standard curves.
To determine the usefulness of three-dimensional ultrasound volumetry of fetal thigh and upper arm in predicting weight at delivery. Inclusion criteria to our prospective study were single-ton pregnancies with a planned or expected delivery within 96 hours of enrollment. In 74 patients (formula-finding group) standard fetal biometry, followed by measurement of thigh and upper arm volumes by three-dimensional ultrasound, was performed. Subsequently, our new 3D-formulas were tested in a prospective validation group of 52 patients. Both upper arm and thigh volumes correlated well with birth weight (r2 = 0.95, respectively, p < 0.0001). The best result, however, was achieved by a combination of standard 2D-measurements with the volumetric data of upper arm and thigh (r2 = 0.98, p < 0.0001). With use of polynomial regression analysis we obtained two best-fit formulas: BIRTH WEIGHT: -263.8 +13.7269 x Arm Volume +7.16575 x Thigh Volume +148.2 x ATD. Birth weight: -1288.7 +51.9502 x Arm Volume -0.252 x Arm Volume 2 -2.1766 x Thigh Volume +0.0321 x Thigh Volume 2 +36.2509 x GA -0.7526 x GA2 +654.3 x BIP -36.6136 x BIP2 -381.8 x ATD +24.0927 x ATD2. Three-dimensional volumetry of the fetal thigh and upper arm may improve prediction of birth weight. Further larger studies are needed to validate our results.
Lymphangiome sind gutartige Tumoren des lymphatischen Systems. Frühzeitige pränatale Diagnostik ist wichtig. Dies erlaubt eine Planung der Geburt, adäquate postpartale Versorgung des Kindes, Verbesserung der Prognose und einen frühzeitigen Schwangerschaftsabbruch im Falle einer ungünstigen Prognose. Wir berichten von 2 Fällen, einem Hämangiolymphangiom und einem Lymphangiom. Die 2D- und 3D-US-Charakteristiken werden präsentiert, die Differenzialdiagnosen, therapeutischen Optionen und die Prognose diskutiert. Abstract. Lymphangiomas are benign tumours of the lymphatic system. Early prenatal diagnosis is important to permit a planned delivery and provide adequate postnatal care. It thereby improves prognosis and allows the option of terminating the pregnancy if poor outcome is predicted. We report two cases, a giant haemangiolymphoma and a lymphangioma. 2D and 3D US findings are presented and differential diagnosis, therapeutic options and prognosis are discussed.

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