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The aim of this case report is to present real-time CEUS-guided biopsy for diagnosing rare benign splenic pathologies after inconclusive findings on cross-sectional imaging. We present the case of a 50-year-old male patient who received a contrast-enhanced computed tomography scan of the thorax during the evaluation for lung transplant due to lung fibrosis, with incidental finding of disseminated hypodense splenic lesions. During follow-up imaging, the patient did not tolerate a complete MRI examination, and two acquired pulse sequences did not confirm the final diagnosis. While CT-guided biopsy revealed no results, CEUS-guided target biopsy with repeated contrast injections showed a benign littoral cell angioma of the spleen. The use of real-time CEUS-guided target biopsy during lesion washout may be a useful tool to improve the accuracy of biopsy and accelerate the diagnosis in patients with parenchymal lesions after inconclusive cross-sectional imaging findings which may pose a challenge for CT-guided biopsy.

To answer the question whether the TSI (tissue strain imaging) sonoelastography technique can contribute to the diagnosis of chronic renal allograft damage.A prospective study of 112 patients between June 2010 and April 2011 was conducted to compare elastography data with biopsy results and laboratory parameters in order to determine whether any correlations exist. Elastography parameters were acquired with a high-end ultrasound system and analyzed using the semiquantitative strain ratio. For comparison, patients were divided into three groups based on biopsy findings (Banff classification): group A: biopsy not necessary; group B: Banff grade I; group C: Banff grades II and III. Correlations were assessed by means of correlation (Pearson) and regression analysis. Differences between ordinal groups were tested for statistical significance by the Mann-Whitney U test.Mean patient age was 54.2 ± 15.01 years. Fifty-nine percent of the patients were male. The calculated TSI strain ratio of groups A and C differed significantly (p = 0.024). Groups B and C (p = 0.056) and groups A and B (p = 0.88) showed no significant difference. The TSI strain ratio did not correlate with glomerular filtration rate (r = 0.105) or creatinine (r = 0.092).The TSI sonoelastography technique can contribute to the differentiation of different stages of renal graft damage (according to Banff classification). However, significant results were not observed for all investigated features. The TSI technique should be further evaluated in future studies including larger numbers of patients.

Epidemiologic data suggest that the incidence of breast cancer is on the rise, as is the incidence of early-onset breast cancer in premenopausal women. Breast cancer is the most common malignancy worldwide. According to data of the International Agency for Research on Cancer (IARC), over one million women are newly diagnosed with breast cancer each year, and the annual mortality rate is 410,000. In view of this situation, ultrasound is gaining an increasing role as a breast imaging modality. It is the most widely used complementary imaging modality supplementing mammography in the workup of unclear breast lesions in young women, in women with a family history of breast cancer, and in women with dense breasts. Therefore, ultrasonography should have high sensitivity and specificity in characterizing focal breast lesions. An important prerequisite is a standardized examination procedure and documentation of findings. The Polish Ultrasound Society adopted the BIRADS classification in 2010. As described in the article of W. Jakubowski, K. Dobruch-Sobczak and B. Migda in the “Journal of Ultrasonography”(1), the sonographic characterization of focal breast lesions relies on morphologic evaluation. Besides a focus on how to differentiate between malignant and benign lesions, the authors provide a comprehensive overview of the use of elastography in conjunction with inspection, palpation, B-mode ultrasound, and histology. Evaluation of tissue compressibility is part of standard breast ultrasound in the characterization of focal lesions. A tumor that cannot be compressed in the B-mode examination is more likely to be malignant. Many international studies have shown the new technique of elastography to improve the specificity of ultrasound in characterizing breast lesions. The 2003 version of the BIRADS classification of the American College of Radiology (ACR) does not yet include elastography among breast imaging modalities. The Polish authors highlight the classification of breast lesions according to BIRADS categories 1 to 6 including histology and clinical consequences. In contrast to other European countries, the Polish policy is to perform annual ultrasound examinations already in women after age 30. The authors not only present the technical prerequisites and required skills but also provide an excellent overview of interpretation algorithms according to the BIRADS classification. This can ultimately improve the comparability of publications and the quality of documentation of sonographic findings on an international scale. In summary, the authors provide a detailed and comprehensive overview on the interpretation of breast ultrasound findings in Poland. The classification allows estimating the probability of malignancy of a focal breast lesion. The sonographic findings should be interpreted in conjunction with the patient's history, palpation and clinical findings, and other imaging findings such as mammography and MRI. Elastography is a novel technique; however, many studies have proven its benefit, and it should be included in the ACR BIRADS lexicon. Taken together, the results of major international publications(2, 3) indicate that the use of elastography can be recommended in women with suspicious B-mode findings (subjective classification) and in high-risk women (SR calculation). The elastography findings should be classified according to the BIRADS lexicon.