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To classify mammary microcalcifications for the prediction of malignancy by using computer-aided analysis of morphometric characteristics.Seven-fold microfocus magnification radiography (direct magnification) was performed on 2975 paraffin embedded microcalcifications. After digitization of the radiographic films and segmentation of the microcalcifications, the morphometric characteristics, such as circumference, surface and polar transformation with determination of the greatest and smallest radius, were measured. Using the classification and regression tree (CART) statistical analysis program, the calcifications were classified by computer on the basis of the morphometric characteristics and the known histological result.Benign conditions were essentially represented by small round calcifications with a greatest radius ofor = 114.2 microm, a smallest radius of18.5 microm and a circumference ofor = 462.3 microm. Using70 % microcalcifications classified in a patient by the computer as "malignant," CART increases the frequency of malignant conditions, with the diagnostic separation between benign and malignant at an Az value (surface below the ROC curve) of 0.7863.A computer-assisted classification of individual microcalcifications on the basis of morphometric characteristics can supplement the information for a computer assisted mammographic diagnosis (CAD).

To develop a device for specimen radiography of impalpable breast lesions with microcalcifications in order to perform compression-free radiography in two planes and to document the original orientation of the specimen on the radiographic film.A curved plate with its radius equal to the film-focus-distance enables specimen radiography without compression and with minimizing artifacts induced by beam divergency. Adjustable markers can document the topographic orientation of the specimen on the radiographic film.The presented specimen device for biplanar radiography avoids interfering compression artifacts for both radiologist and pathologist. Documenting the original topographic orientation of the specimen on the film helps to guide the surgeon in cases requiring further resection.Biplanar specimen radiography without compression of the specimen measures the distance of microcalcifications to the margin of the resected tissue more accurately and thus provides a better basis for planning any necessary additional resection.

Evaluation of specimen radiography as a quality control for the detection of microcalcifications by the pathologist during histopathological examination of breast biopsies.29 breast biopsy specimen with microcalcifications were radiographed using the magnification (x4) mammography System DIMA Plus MI I before and after the histopathological examination. Tissue with detected microcalcifications after the histopathological examination was reexamined histologically.In 55% (16/29) of all specimen we could identify missed microcalcifications. In 5 specimens the microcalcifications were missed completely. The radiologically detected areas of residual microcalcifications were reexamined histologically and in one case invasive parts of a carcinoma were detected, which primarily had been diagnosed as an in-situ carcinoma. In 6 cases the radiographs of the intraoperative specimen radiography were sent to the pathologist together with the biopsy. In these cases the rate of complete detection of the microcalcifications increased from 39% to 66%.Specimen radiography should be performed not only intraoperatively but also as part of the histopathological examination.

The purpose of this study was to investigate the efficacy of 4-fold magnification breast specimen radiography (direct magnification, DIMA) compared to conventional 1.5-fold magnification radiography in evaluating the presence or absence of carcinoma at the surgical margins by detection of microcalcification.Fifty breast specimens with non-palpable microcalcifications were examined during surgical biopsy using both DIMA (4-fold) and conventional (1.5-fold) magnification specimen radiography. The number of detected microcalcifications of the whole specimen, of an area of 5 mm distance to the margins and of the area of the suspicious cluster of microcalcifications was counted and the results compared with the histological examination as a gold standard.In 50 specimen 2821 (1305 within 3 mm distance to the margins) microcalcifications were detected with the DIMA mammography technique compared to 1608 (446) microcalcifications with the conventional technique. This increased detection rate by DIMA-magnification radiography was accompanied by a decreased specificity in comparison to the conventional magnification radiography (33.3% DIMA versus 83.3% conventional) regarding the evaluation of presence or absence of carcinoma at the surgical margins. Differentiating the microcalcifications into calcifications belonging to the suspicious cluster and those that are located outside the cluster led to an increase in specificity (83.3% DIMA versus 100% conventional).The efficacy of breast specimen radiography in evaluating the presence or absence of carcinoma at the surgical margins by detection of microcalcification is not improved by 4-fold magnification radiography (direct magnification, DIMA) compared to conventional 1.5-fold magnification radiography due to an increase in false-positive results. Analysis of the attachment of the microcalcifications to the cluster can improve the specificity.

Comparing the sensitivity in detecting microcalcifications in stereotactically guided core biopsy specimen of the breast of direct magnification (DIMA) specimen radiography (x7) with the histological examination.In 52 patients 509 stereotactically obtained core biopsy (14-gauge) specimens of the breast were radiographed by direct magnification (DIMA) specimen radiography (x7) and examined histologically.In 188 specimen microcalcifications were detected by magnification radiography compared to 98 by histological examination. Only 3% of the specimen microcalcifications were seen exclusively in the histological examination. In core biopsies with malignancy the relative proportion of biopsies with radiologically detected microcalcifications was increased (59% versus 32%).Concerning the detection of microcalcifications in core biopsy specimen of the breast, the direct magnification (DIMA) radiography (x7) was superior compared to the histological examination. Due to the high relative proportion of biopsies with radiologically detected microcalcification and malignancy, we recommend a comprehensive histological examination of these specimen. Confirmation of microcalcifications in core biopsies should be achieved by magnification radiography to prove that the suspicious area in the breast was truly sampled. Specimen radiography simultaneously with the biopsy procedure can reduce the number of punctures in the process of documenting the presence of calcifications early in the biopsy procedure.

A Direct Comparison with Percutaneous Angiography:To compare colour-coded Doppler sonography (CCDS) with conventional angiography in severe occlusive vascular disease of the lower limb.In 55 patients 1141 vessel segments were evaluated, 700 of them with atheromatous plaques, 270 with stenoses, 208 with occlusions and 6 with aneurysms.Deeper-seated vessels such as the abdominal aorta, the pelvic arteries, the superficial femoral artery at the level of the adductor canal and parts of the lower leg arteries are less accessible for direct CCDS. Many pathological changes however can be diagnosed indirectly by changes in the spectral wave form distal to the lesion. In superficial vascular segments (the common femoral artery, the profunda femoris artery, the superficial femoral artery above the adductor canal and the popliteal artery) image quality was excellent, more pathological changes were found, and the degree of stenosis was better estimated in comparison to angiography.The value of CCDS in patients with intermittent claudication is limited to those who have been examined with angiography e.g. before angioplasty, to follow-up examinations after vascular dilatation or surgery and to supplementary visualisation after angiography especially in readily accessible (superficial) vascular segments.

The value of colour-coded Doppler sonography to evaluate results of percutaneous transluminal angioplasty of the superficial femoral artery was tested in 26 patients. Because of good accessibility, morphology may be demonstrated similar to intravenous DSA. However, accurate evaluation of dilatation success also requires haemodynamic measurements. Numerous parameters were determined one day before, one day after and one month after angioplasty at various points of the extremity (dilated segment, popliteal artery, lower leg arteries). Results were compared with those of normal individuals. Because of the large range of scatter and overlapping between normal and pathological values, only a few parameters can be used as valuable indicators for successful PTA. Spectral wave form becomes bi- or triphasic pattern and due to this the Pulsatility Index rises distal to the dilated area. An increasing systolic acceleration rate, peak systolic velocity and prestenotic Pulsatility Index have excellent predictive value. Using a Damping Factor, the later walking range may be predicted.

Four years after implantation of an aorto-bi-iliac artery graft, a 53-year-old man suffered from intermittent claudication with a walking distance of 50 meters. By transaxillary aortography the left femoral artery could not be visualized. Selective angiography of the internal thoracic artery revealed a collateral circulation from the subclavian artery via the left internal thoracic artery, the superior epigastric artery and the inferior epigastric artery into the left external iliac artery (Winslow's pathway). Prior to using the internal thoracic artery for coronary bypass surgery, a function of this vessel as a collateral to the lower extremities should be excluded.

The importance of lymphangiography for diagnosing the formation of lymphatic fistulas and vascular dysplasias of the lymphatic vessels is on the increase within the scope of therapeutic invasiveness. Its importance and ranking in diagnosing lymphatic circular disorders is demonstrated and exemplified by case reports on three patients suffering from chylothorax of various origin, on one patient with chyluria, and one patient with lymphoedema in the soft parts of the neck. In two chylothorax patients, lymphangiography resulted in successful surgery. It is the decisive method in diagnosis and therapy planning in fistulas and dysplasias of the lymphatic vessel system.