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While 3D sonography has become established in gynecology, abdominal applications have been mainly restricted to case reports. However, recent advances in computer technology have supported the development of new systems with motion detection methods and image registration algorithms - making it possible to acquire 3D data without position sensors, before and after administration of contrast enhancing agents. Hepatic (and also splenic) applications involve the topographic localization of masses in relation to the vessels, e.g. hepatic veins and portal vein branches prior to surgical procedures (segment localization). 3D imaging in the characterization of liver tumors after administration of contrast enhancing agents could become of special importance. We report on the first use of 3D imaging of the liver and spleen under real time conditions in 10 patients, using contrast enhanced phase inversion imaging with low mechanical index, which may improve the detection rate and characterization of liver and splenic tumors.

Aim: The value of ultrasonography in the diagnosis, follow-up and for the detection of complications in patients with celiac sprue has not yet been sufficiently evaluated. A pronounced back and forth motility with echo-rich hump reflexes in a fluid-filled small bowel with a reduction of Kerckring's plicae circulares and with a loss of their density and uniformity was empirically defined as a diagnostic sign of celiac sprue. In the present study, the sonographic signs of celiac sprue were examined as an indicator of active sprue., Method: 50 patients with histologically proven celiac sprue were examined with real time ultrasonography (3.5-7 MHz). The detection or exclusion of the defined sonographic signs of celiac sprue with intensified motility and reduction of Kerckring's plicae circulares with a loss of their density and uniformity were evaluated by two independent examiners and documented without knowledge of the clinical findings. The clinical activity (active vs. remission) was assessed according to clinical criteria (diarrhea, steatorrhea, weight loss). 38 healthy subjects and 50 patients with Crohn's disease served as controls., Results: In all 138 patients and controls adequate visualization of the bowel was achieved. In 16/50 (32%) patients with active celiac sprue changes of motility and reduction of Kerckring's plicae circulares with a loss of their density and uniformity were detected, whereas all 34/50 (68%) of patients with celiac sprue in remission did not have this pattern. In none of the controls with Crohn's disease or in the healthy subjects comparative sonographic signs of active celiac sprue were observed. In four patients with active celiac sprue a circumscript echopoor tumor of the small bowel wall could be sonographically detected, which turned out to be T-cell lymphoma in three and a carcinoma of the small intestine in one patient. An increased number of and/or enlarged mesenteric lymph nodes were found in patients with active celiac sprue., Conclusion: Changes of motility and reduction of Kerckring's plicae circulares with loss of density and uniformity at ultrasonography are a reliable indicator of active celiac sprue.

Purpose: To compare the diagnostic value of gallium scintigraphy using a SPECT technique with spiral CT for evaluating activity following chemotherapy in patients with malignant lymphoma and to determine treatment options., Material and Method: The results of gallium scintigraphy in 28 patients with malignant lymphoma (19 Hodgkin's disease, 9 high grade non-Hodgkin's lymphoma) following curative treatment were compared with the CT morphology in relation to inactive regions and residual masses., Results: Ga-67-SPECT proved superior to CT for evaluating the activity in 85 initially involved nodes (sensitivity 94.4% against 83.3%; specificity 100% against 92.5%). It was, however, inferior for demonstrating organ involvement in 28 instances. In seven patients with residual masses, Ga-67-SPECT directly affected staging and further therapy., Conclusion: The increasing use of secondary treatment schemes for curative purposes makes Ga-67-SPECT a suitable method for the early recognition of residual activity in Hodgkin's disease and high grade non-Hodgkin's lymphoma.