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The presented evaluation of the relative uncertainty (δ'CCC) of the (choline + creatine)/citrate (CC/C) ratios can provide objective information about the quality and diagnostic value of prostate MR spectroscopic imaging data. This information can be combined with the numeric values of CC/C ratios and provides metabolic-quality maps enabling accurate cancer detection and user-independent data evaluation. In addition, the prostate areas suffering most from the low precision of CC/C ratios (e. g., prostate base) were identified., (© Georg Thieme Verlag KG Stuttgart · New York.)

In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy.

Purpose: To retrospectively compare the image quality, lesion detection, and the diagnostic efficacy of 5-megapixel (MP) cathode ray tube monitors (CRTs) and 5-MP liquid crystal display monitors (LCDs) for soft-copy reading in full-field digital mammography (FFDM)., Materials and Methods: Informed consent was waived by the Institutional Review Board for the data analysis. A total of 220 cases were compared with two 5-MP (2048×2560 pixels) CRTs and two 5-MP (2048×2560 pixels) LCDs. Nine aspects of image quality (brightness, contrast, sharpness, noise, skin, fat, retromamillary space, glandular tissue, and detection of calcifications) were evaluated. In addition, the detection of breast lesions (mass, calcifications) and diagnostic efficacy, based on the BI-RADS classification, were correlated with histologic results (n=70) and follow-up (n=150)., Results: Each aspect of the image quality was rated significantly better for 5-MP LCDs (p<0.05) compared to the 5-MP CRTs. With 5-MP CRTs, 31 masses and 119 calcifications were detected, compared to 30 and 121 with 5-MP LCDs. The differences in diagnostic efficacy between 5-MP CRTs and 5-MP LCDs were not significant (p=0.157) although 5-MP CRTs yielded two false-negative results. Both lesions were rated BI-RADS 3 with 5-MP CRTs. Both were invasive carcinomas at histology. The sensitivity, specificity, positive and negative predictive values, and accuracy were 0.966, 0.975, 0.933, 0.988, and 0.973 for 5-MP CRTs, compared to 1.0, 0.963, 0.903, 1.0, 0.973 for 5-MP LCDs., Conclusion: The image quality of 5-MP LCDs is significantly better than that of 5-MP CRTs for soft-copy reading in FFDM, based on histologic and follow-up correlation. However, lesion detection and diagnostic efficacy are comparable to 5-MP CRTs. The interpretation of the false-negative results suggests that the characterization of breast lesions with FFDM is not defined solely by the monitors, but is strongly influenced by the radiologist., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Interference with T-cell function increases the risk of infections, especially during the early post-transplant period. Belatacept, a costimulation blocker, is currently being tested in phase III clinical trials. Here we report a renal transplant recipient who received belatacept and developed severe Pneumocystis jirovecii pneumonia (PCP) with fatal superinfections 4 years post transplant. Cytomegalovirus infection preceded PCP, which typically occurs in overimmunosuppressed patients, but has not yet been reported under T-cell costimulation blockade in transplant patients. This case illustrates the possibility of excessive immunosuppression even with a lymphocyte-specific regimen.

Purpose: To retrospectively determine the false-negative rate and the underestimation rate of ultrasonography (US)-guided 14-gauge core-needle breast biopsy (CNB) in nonpalpable lesions, with validation at surgical excision histologic examination and with stability during clinical and imaging follow-up., Materials and Methods: Informed consent was waived by the institutional review board for this retrospective review of 1352 cases. In 1061 cases, patients underwent surgical excision of lesions visible at US subsequent to US-guided 14-gauge CNB. Follow-up of another 291 benign lesions at US-guided 14-gauge CNB histologic examination showed stability during clinical and imaging follow-up for at least 2 years. US and histologic findings were reviewed and compared for agreement. A false-negative finding was defined as pathologically proved cancer for which biopsy results were benign. The false-negative rate was defined as the proportion of all breast cancers with a diagnosis of benign disease at US-guided 14-gauge CNB. The underestimation rate was defined as an upgrade of a high-risk lesion at US-guided 14-gauge CNB to malignancy at surgery., Results: US 14-gauge CNB yielded 671 (63.2%) malignant, 86 (8.1%) high-risk, and 304 (28.7%) benign lesions. Each of the 291 benign lesions without surgery remained stable during follow-up. The agreement of US-guided 14-gauge CNB results, surgical excision findings, and follow-up results was 95.8% (kappa = 0.93). False-negative findings were encountered in 11 (0.8%) of 1352 cases, and the false-negative rate was 1.6% (11 of 671 malignancies). All false-negative findings were prospectively identified owing to discordance between imaging results and US-guided 14-gauge CNB histologic findings. The underestimation rate was 31.4%., Conclusion: US-guided 14-gauge CNB is an alternative to surgical excision for assessing nonpalpable breast lesions.

Objective: Modern imaging modalities increase the detection of small (

Purpose: To correlate the presence of secondary signs of non-enhanced computed tomography (NECT) in renal units harboring ureteral calculi with intraoperative findings and treatment outcome after holmium:yttrium-aluminum-garnet laser (Ho:YAG) ureterolithotripsy., Subjects and Methods: Two-hundred patients were prospectively included after ureteral calculi were detected on NECT. All patients underwent Ho:YAG ureterolithotripsy at the Medical University of Vienna. All CT studies were reviewed by one specialized uroradiologist blinded to pre- and postoperative parameters for secondary signs as renal enlargement, perinephric stranding, ureteral dilation, periureteral edema, and ureteral rim sign. The impact of secondary signs on intraoperatively-verified impaction and treatment outcome was evaluated., Results: Of the 200 patients 85 (42.5%) harbored proximal and 115 (57.5%) harbored distal ureteral calculi. The stone-free rates for proximal and distal calculi were 80% and 97%, respectively. Although proximal stone location and intraoperatively-verified impaction correlated significantly with stone-free rates (P < 0.0001, P = 0.01), the presence of secondary signs could not predict intraoperatively-verified stone impaction or stone-free rates (renal enlargement: P = 0.2, P = 0.5; perinephric stranding: P = 0.7, P = 0.5; ureteral dilation: P = 0.7, P = 0.7; periureteral edema: P = 0.8, P = 0.06; ureteral rim sign: P = 0.8, P = 0.3)., Conclusion: Preoperative secondary signs seen on NECT in patients harboring ureteral calculi do not correlate with intraoperative findings of impaction, and do not predict treatment outcome after Ho:YAG ureterolithotripsy.

Objectives: In delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study., Methods: A total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded., Results: In colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000+/-4000 versus 6700+/-3400 (p=0.1). Mean time to stone clearance was 9.5+/-12.1 d versus 4.6+/-3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9)., Conclusions: Treatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.

Objective: The objectives of our study were to assess whether coronal reformations improve the diagnostic performance of MDCT in patients with acute flank pain and suspected urinary stone disease; and to determine if performing such reformations from 3-mm-thick sections is sufficient or if it is necessary to perform reformations from thinner sections., Materials and Methods: We included 147 consecutive patients (72 women and 75 men; mean age +/- SD, 58 +/- 18.1 years) with suspected urinary stone disease who underwent unenhanced MDCT. Scans were obtained with a 4 x 1 mm collimation and were reconstructed with a section thickness of 1.25 and 3 mm. We compared the diagnostic yield of 3-mm axial sections with that of coronal reformations reconstructed from 1.25- and 3-mm axial sections. Imaging data were evaluated in random order by two radiologists. The significance of the difference between the axial sections and coronal multiplanar reformations (MPRs) was tested for the number, size, and location of uroliths and for the presence of alternative diagnoses. The time required for review by both observers was recorded., Results: We found uroliths in 72 patients. There was no difference between 3-mm axial sections and coronal reformations from 1.25-mm sections with regard to the number of detected stones (n = 264 for both protocols), whereas coronal reformations from 3-mm sections revealed significantly fewer calcifications (n = 255, p = 0.016). Coronal reformations did not improve the localization of calcifications. Review time, however, was significantly shorter for coronal reformations than for axial sections (p = 0.001); however, coronal reformations were less sensitive than axial sections for the detection of additional findings suggestive of alternative diagnoses in 16 (30%) of 53 patients., Conclusion: Coronal reformations from MDCT do not improve urinary stone detection but may reduce evaluation time; however, there is the danger of missing additional findings. Coronal reformations reconstructed from thick (i.e., 3-5 mm) axial sections may result in reduced detection of small stones and should therefore be avoided.

Diffusion weighted imaging gained attention as an imaging modality, which provides information on the microstructure of a tissue, which can be used for tissue characterization. This is of importance in patients where other diagnostic tools provide equivocal or unspecific information. In addition quantitative diffusion measurements provide objective parameters for unbiased comparison of treatment response, which is mandatory for therapy monitoring. Technical restriction limited the use of Diffusion Weighted Imaging to the brain. However, with the improvement in scanner technology and the availability of new MR sequences investigation of the Muskulo Skeletal System was made possible. We describe the potential of Diffusion Weighted Imaging as a non-invasive technique to evaluate pathological, inflammatory and physiological processes in osteoradiology.

Objective: To compare histopathological findings as a function of radiological tumour size, as published data suggest that small renal tumours are often benign and large tumours are renal cell cancer (RCC)., Patients and Methods: Data from 543 surgically treated patients with solid renal tumours were analysed retrospectively. Tumour size measured by computed tomography (CT) before surgery was stratified into seven subgroups (cm): 0-2, 2.1-3, 3.1-4, 4.1-5, 5.1-6, 6.1-7 and >7, and correlated with final histology., Results: In all, 80 lesions (14.7%) were benign on final histology; tumour size did not correlate with benign histology (P=0.660). Histopathological tumour size was not statistically significant different (P=0.521) from measured tumour size on CT, and there was no statistical significance between CT and histopathological tumour size (P=0.528). Only 13 (17%) of lesions were correctly defined as benign on CT before surgery, whereas 67 (83%) were considered to be suspicious for malignant disease. Only one patient with a tumour correctly defined as benign had a radical nephrectomy; by contrast, 28 of 67 (42%) had a radical nephrectomy for benign lesions not correctly identified as benign on CT before surgery (P<0.001)., Conclusion: Substantially many renal masses are benign, independent of tumour size. Radical nephrectomy could potentially have been avoided in 42% of patients with benign renal tumours. These data provide a good argument for the use of a more refined preoperative diagnostic evaluation, in particular needle biopsy.

Tumor size is a prognostic marker and correlates to survival after surgical therapy. Of 287 patients with small (or=pT3a in 10.9%, a high Fuhrman grade >or=3, multifocality in 8.5%, and metastases in 2.4%. Tumors with a diameter of 3.1-4 cm showed dramatically more aggressive parameters; 35.7% had stage >or=pT3a, 25.5% Fuhrman grade >or=G3, and 8.4% metastases (M+). However, evaluation of the tumor diameter on CT has an error of about +/-0.3 cm, which will lead to an even more pronounced error in volume determination. Therefore, determination of growth in follow-up imaging is unreliable. With the exception of the typical angiomyolipoma, determination of dignity for small solid kidney lesions is unreliable even with modern imaging. Only 17% of 80 benign lesions in our series were assessed as benign on preoperative CT. Thus, preoperative evaluation not only based on imaging seems to be valuable, especially in patients with higher surgical risk. Percutaneous renal mass biopsy has an accuracy of over 90% for detecting benign lesions and can influence therapeutic decisions, especially in patients with higher surgical risk.

A case of fatal Mycoplasma pneumoniae pneumonia in a previously healthy 18-year-old girl is reported. On hospital day 9, the antibody titer to M. pneumoniae was 1:512 in the complement fixation test and 1:5120 in the microparticle agglutination assay. After five weeks in the intensive care unit, the patient died from necrotizing hemorrhagic pneumonia with multi-organ failure. No significant superinfections occurred during ICU treatment. Corticosteroids (hospital day 8 onward) did not influence the course of the disease. It is noteworthy that, as in some previously reported cases, the clinical state deteriorated during presumably adequate antibiotic treatment (2 days before admission onward), and despite documented eradication of the pathogen from the respiratory tract (PCR from bronchoalveolar fluid on hospital day 22 was negative). However, the illness had lasted for several days before admission to the hospital, therefore the potentially beneficial effect of antibiotic treatment at an early stage of the disease cannot be assessed. Clearly, in default of other treatment options, correct diagnosis and early treatment of mycoplasma community-acquired pneumonia seems mandatory. This is the third case of fatal mycoplasma pneumonia reported from Austria in recent years, making this topic worthy of further scientific attention.

Purpose: To prospectively assess the accuracy of nonenhanced versus ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance (MR) imaging for depiction of axillary lymph node metastases in patients with breast carcinoma, with histopathologic findings as reference standard., Materials and Methods: The study was approved by the university ethics committee; written informed consent was obtained. Twenty-two women (mean age, 60 years; range, 40-79 years) with breast carcinomas underwent nonenhanced and USPIO-enhanced (2.6 mg of iron per kilogram of body weight intravenously administered) transverse T1-weighted and transverse and sagittal T2-weighted and T2*-weighted MR imaging in adducted and elevated arm positions. Two experienced radiologists, blinded to the histopathologic findings, analyzed images of axillary lymph nodes with regard to size, morphologic features, and USPIO uptake. A third independent radiologist served as a tiebreaker if consensus between two readers could not be reached. Visual and quantitative analyses of MR images were performed. Sensitivity, specificity, and accuracy values were calculated. To assess the effect of USPIO after administration, signal-to-noise ratio (SNR) changes were statistically analyzed with repeated-measurements analysis of variance (mixed model) for MR sequences., Results: At nonenhanced MR imaging, of 133 lymph nodes, six were rated as true-positive, 99 as true-negative, 23 as false-positive, and five as false-negative. At USPIO-enhanced MR imaging, 11 lymph nodes were rated as true-positive, 120 as true-negative, two as false-positive, and none as false-negative. In two metastatic lymph nodes in two patients with more than one metastatic lymph node, a consensus was not reached. USPIO-enhanced MR imaging revealed a node-by-node sensitivity, specificity, and accuracy of 100%, 98%, and 98%, respectively. At USPIO-enhanced MR imaging, no metastatic lymph nodes were missed on a patient-by-patient basis. Significant interactions indicating differences in the decrease of SNR values for metastatic and nonmetastatic lymph nodes were found for all sequences (P < .001 to P = .022)., Conclusion: USPIO-enhanced MR imaging appears valuable for assessment of axillary lymph node metastases in patients with breast carcinomas and is superior to nonenhanced MR imaging.

Purpose: To evaluate the outcome of 16 patients after percutaneous radiofrequency ablation of renal tumors., Materials and Methods: Sixteen patients (nine women, seven men; mean age, 61+/-9 years) with 24 unresectable renal tumors (mean volume, 4.3+/-4.3 cm3) underwent CT-guided (n=20) or MR imaging-guided (n=4) percutaneous radiofrequency ablation using an expandable electrode (Starburst XL, RITA Medical Systems, Mountain View, CA) with a 150-W generator. The initial follow-up imaging was performed within 1-30 days after RF ablation, then at 3-6 month intervals using either CT or MRI. Residual tumor volume and coagulation necrosis was assessed, and statistical correlation tests were obtained to determine the strength of the relationship between necrosis volume and number of ablations., Results: Overall, 97 overlapping RF ablations were performed (mean, 3.5+/-1.5 ablations per tumor) during 24 sessions. Five or more RF ablations per tumor created significant larger necrosis volumes than 1-2 (p=.034) or 3-4 ablations (p=.020). A complete ablation was achieved in 20/24 tumors (primary technical success, 83%; mean volume of coagulation necrosis: 10.2+/-7.2 cm3). Three of four residual tumors were retreated and showed complete necrosis thereafter. Three major complications (one percuatneous urinary fistula and two ureteral strictures) were observed after RF ablation. No further clinically relevant complications were observed and renal function remained stable. During a mean follow-up of 11.2 months (range, 0.2-31.5), 15/16 patients (94%) were alive. Only one patient had evidence of local recurrent tumor., Conclusion: The midterm results of percutaneous RF ablation for renal tumors are promising and show that RF ablation is well-suited to preserve renal function.

Objective: To compare two different expandable electrodes in radiofrequency ablation of renal cell carcinoma., Methods: Percutaneous ablation was performed at two centers using either an expandable 7F umbrella-shaped LeVeen probe (diameter 2-4 cm) and a 200-W generator (group A), or an expandable Starburst XL electrode with a 150-W generator (group B). From each center, eight patients with one tumor each were matched retrospectively with regard to tumor volume, which was 9.71+/-6.43 cm3 for group A and 8.74+/-4.35 cm3 for group B (mean tumor diameter: 2.47+/-0.9 cm versus 2.50+/-0.4 cm, respectively). An unpaired t-test showed no significant difference in tumor volume between the two groups (p=0.820)., Results: Sixteen patients with 16 tumors were treated. The primary technical success of radiofrequency ablation was 94% (15 of 16 patients). After retreatment of residual tumor in one patient from group B, secondary technical success was 100%. No major complications were observed. The resulting mean volume of the almost spherical necroses was 21.1+/-9.1 cm3 versus 14.6+/-6.7 cm3 for groups A and B (diameter of necrosis: 3.5+/-0.7 cm versus 3.1+/-0.6 cm, respectively). A Mann-Whitney U-test showed no significant difference in necrosis volume between the two groups (CI [-0.215; 0.471]; p=0.2892). The calculated shape value of S (ratio of length to height of the coagulation necrosis) was 0.9+/-0.1 and 1.0+/-0.1 for groups A and B, respectively. No local recurrence was observed during a mean follow-up of 14.8+/-11.6 months, while extrarenal tumor progression occurred in three patients., Conclusions: No significant differences in coagulation volume and shape were found after RF ablation of renal cell carcinoma using two different expandable electrodes. To avoid local recurrence, however, accurate placement of probes and appropriate expansion of the electrode is necessary.

Purpose: To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard., Materials and Methods: The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients (17 male, 12 female; age range, 17-62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement (P < .05)., Results: The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only three [corrected] cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures (P = .25) but were significant for cortical involvement (P = .03)., Conclusion: Multidetector CT is highly accurate in depicting occult cortical scaphoid fractures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement., (RSNA, 2006)

Purpose: To retrospectively determine the lesion miss rate and false-negative rate of needle-localized open breast biopsy (NLOBB) with stereotactic guidance in a large study population., Materials and Methods: The ethical review board approved the study; the need for informed consent was waived. A total of 1115 stereotactic NLOBBs performed in 1068 women aged 22-90 years (mean age, 54 years) were tracked to determine outcomes. In cases of malignancy, NLOBB was considered to be diagnostically successful. The mammographic outcomes in all patients with benign results at NLOBB were tracked for at least 2 years. Cases without such mammographic follow-up were cross-referenced with a tumor registry after at least 54 months. The lesion miss rate was based on all malignant lesions and all lesions with long-term mammographic follow-up. Results from all 1115 NLOBBs were used to report the false-negative rate., Results: Of 1115 NLOBBs, 472 (42%) had malignant results. Mammographic follow-up data were available for 535 (83%) of 643 NLOBBs with benign results. Mammographic follow-up revealed 11 lesions that were missed with NLOBB, of which five were malignant and six benign. Thus, the lesion miss rate with NLOBB was 1.1% (11/[472 + 535]). Among the 643 cases, in 108 of them without mammographic follow-up (17%), cross-referencing with a tumor registry did not reveal missed cases of breast carcinoma. The false-negative rate was therefore 1.0% (5/[472 + 5])., Conclusion: On the basis of the results of long-term follow-up, the authors noted a lesion miss rate of 1.1% and a false-negative rate of 1.0%, which indicate that NLOBB with stereotactic guidance is an accurate method for diagnosing breast lesions., (RSNA, 2005)

MR urography is an evolving and promising technique in the evaluation of the urinary tract. MR urography is currently considered the method of choice for imaging of the renal parenchyma and the collecting systems in patients who cannot undergo routine radiographic studies such as pregnant women, pediatric patients, patients allergic to iodinated contrast agents, or patients with impaired renal function. The future development of MR urography in terms of functional, cellular, and molecular imaging is presently the subject of research. The ability of MR imaging to provide quantitative functional information (e.g., on blood flow, perfusion, glomerular filtration rate, and excretion as well as urine drainage) in addition to morphologic assessment of the parenchyma and the collecting system could lead to a single, "all-in-one approach" examination technique.

The introduction of multislice computed tomography (MDCT) with the possibility of acquiring isotropic datasets has been an ideal prerequisite for development of virtual MDCT cystoscopy. Remarkable technical progress regarding post-processing of high-resolution 3D datasets as well as a considerable reduction of the time required for post-processing made it possible to introduce virtual MDCT cystoscopy into the clinical routine. 3D post-processing that often required 7-8 h when virtual endoscopy techniques were first developed can now be performed in less than 5 min after transfer of data to the 3D workstation. With the limitations and contraindications of conventional cystoscopy in mind, virtual MDCT cystoscopy may be seen as a valuable alternative to conventional cystoscopy for evaluation of hematuria.

Purpose: To assess prospectively the effect of section width in multi-detector row computed tomographic (CT) evaluation of patients with acute flank pain who are suspected of having or known to have urinary stone disease., Materials and Methods: This study was approved by the ethics committee of the authors' university, and written informed consent was obtained from all patients. One hundred forty-seven patients (age range, 11-101 years; mean, 51.4 years +/- 18.7 [standard deviation]) suspected of having urinary stone disease underwent unenhanced multi-detector row CT. CT was performed with four detector rows, a section thickness of 1.0 mm, an effective tube current-time product of 100 mAs, and a tube voltage of 120 kVp (CT dose index, 11.4 mGy). From these data, three sets of transverse images were reconstructed with section widths of 1.5, 3.0, and 5.0 mm and approximately 50% of overlap each. Scans were evaluated in varying random orders by two radiologists for the number, size, and location of uroliths and nephroliths and for the presence of phleboliths, renal cysts, and secondary signs of obstruction. The significance of differences between the numbers of detected calcifications and the numbers of associated abnormalities on the scans obtained with varying section widths was tested with the McNemar test at a P level of less than .05. Spearman rho rank correlation coefficients were calculated to assess the correlation between the presence of uroliths and the presence of secondary signs., Results: Uroliths were found in 72 of 147 (49.0%) patients, and nephroliths were found in 16 patients (10.9%). There was no significant difference between section widths of 1.5 and 3.0 mm with regard to the number of detected stones (264 uroliths and 61 nephroliths for both protocols). Transverse sections 5.0-mm wide revealed significantly fewer uroliths (n = 231; P < .001) and nephroliths (n = 47; P < .016). The final diagnosis was changed in four of 72 patients. All missed renal and ureteral stones measured less than 3 mm in diameter., Conclusion: Overlapping 3-mm sections are sufficient for the detection of urinary stone disease. Small calculi (<3 mm) may be missed on 5.0-mm-thick sections., ((c) RSNA, 2005.)

Purpose: To report the false-negative rate, sensitivity, and specificity of 14-gauge ultrasound-guided large-core needle biopsy (14-G USSB) performed on breast lesions at our institution and, furthermore, to compare and discuss our own results with those reported in the literature., Materials and Methods: This study includes 399 lesions examined by 14-G USSB. The results of the 14-G USSB were compared with the results of the surgical biopsy or, in cases of benign histology, were followed clinically. A key word search in two medical databases was undertaken to compare our data with those reported in the literature. The search was limited to the period from January 1990 to February 2002 and only original investigations published in English and German were included in our comparison., Results: At our institution, 238 (59.6 %) benign and 161 (40.4 %) malignant lesions were diagnosed by 14-G USSB. The 14-G USSB was false-negative in 5 (1.25 %) of 399 cases. It has a sensitivity of 95.7 %, and specificity 100%. The literature reports false-negative rates between 0 % and 1.26 %, sensitivities between 86% and 100%, and specificities between 99.7 % and 100 %. On the basis of 3880 results from seven selected original papers and our own study, the false-negative rate for 14-G USSB was calculated to be 0.4 % (16 of 3880)., Conclusion: Based on our results and those reported in the literature, 14-G USSB can be considered safe and reliable in the assessment of breast lesions.

Purpose: To compare the accuracy of wire and carbon localization in stereotactically localized open breast biopsy., Patients and Methods: From June 1995 to December 1997, a total of 725 stereotactic wire or carbon dye localizations were performed in 698 female patients. Success of localization was evaluated either by a malignant histopathological diagnosis or by mammographic follow-up. A lesion was considered to be missed if it could be still seen on follow-up mammography., Results: In 703 of 725 cases, the success of localization could be evaluated with 427 (61 %) lesions localized with a wire and 276 (39 %) with carbon. Seven (1 %) out of 703 lesions were missed at open biopsy. Three lesions of these had been localized with wire and three lesions with carbon. The miss rates were 0.9 % and 1.1 %, respectively (p = 1.0)., Conclusion: Both wire and carbon localization are reliable and accurate in the localization of non-palpable breast lesions. Concerning efficiency and costs, carbon dye seems to offer a promising compromise.

Purpose: To evaluate the functional disorders of the oral and pharyngeal phases of deglutition after repair of esophageal atresia in children., Material and Methods: 19 children (10 girls, 9 boys, mean age 22 months) underwent videofluoroscopy of deglutition after repair of esophageal atresia. The videofluoroscopic studies were assessed according to functional and morphological changes in the oral, pharyngeal and esophageal phases. The persistence of radiologic findings on videofluoroscopy was determined., Results: The oral phase was normal in all patients. The main functional disorder of the pharyngeal phase was aspiration in 7 (37%) children. A completely normal deglutition in the pharyngeal and esophageal phases was not seen in any patient., Conclusion: Videofluoroscopy after repair of esophageal atresia is helpful in differentiation of functional and morphological disorders that can lead to prandial aspiration and have an influence on the decision about continued therapy.

The aim of this study was to assess the role of videofluoroscopy in the detection of structural abnormalities of the pharynx and esophagus in patients with different symptoms of impaired deglutition. Dynamic radiographic recording of deglutition was performed in 3193 consecutive patients (1578 men, 1615 women; mean age 54 years) suffering from dysphagia, suspicion of aspiration, globus sensation, and non-cardiac chest pain. We assessed different structural lesions from the oral cavity to the esophagus and classified them into eight categories. Their frequency and association with the different clinical symptoms were evaluated. Videofluoroscopy revealed 1040 structural abnormalities in 833 patients (26%) including mass lesions from the oral cavity to hyoid/larynx ( n=66), pharyngeal diverticula ( n=181), pharyngeal masses ( n=78), other pharyngeal narrowings ( n=71), webs ( n=98), masses ( n=39), and other narrowings ( n=73) of the upper esophageal sphincter, esophageal diverticula ( n=80), esophageal webs, rings and strictures ( n=194), and intrinsic and extrinsic esophageal lesions ( n=160). There was a considerable variance of findings for different symptoms. In a large proportion of symptomatic patients videofluoroscopy detects morphological abnormalities along pharynx and esophagus often combined with functional disorders. This fact underlines the role of videofluoroscopy as a diagnostic test for function as well as morphology.

Objectives: To compare quality of harvested tissue, false-negative rate, and complication rate of large-core needle breast biopsy (LCNBB) and directional, vacuum-assisted breast biopsy (DVABB) in non-palpable breast lesions., Patients and Methods: From 1994 to 1999, in 580 non-palpable breast lesions a stereotactically-guided breast biopsy was performed. 14-G LCNBB was used in 168 lesions (29 %). DVABB was used in 412 lesions (71 %; 11-G DVABB: 134 lesions 32.5 %, 14-G DVABB: 278 lesions 67.5 %). Following biopsy, patients underwent either surgical excision (n = 533; 93.8 %) or mammographical follow-up (n = 36; 6.2 %). Histological results of LCNBB, DVABB, surgical breast biopsy and follow-up results were compared and scored for their tissue quality on a three-point scale (1 = disagreement between biopsy and surgery; 2 = partial agreement; 3 = complete agreement). In addition, we determined the false negative and complication rate for both systems., Results: Histological examination after surgery and follow-up proved 262 (45.2 %) to be benign, 15 (2.6 %) to be high-risk lesions and 303 (52.5 %) to be malignant. In the tissue quality there was no significant difference between 14-G LCNBB (score = 2.94), 11-G DVABB (score = 2.92) and 14-G DVABB (score = 2.91) (p > 0.05). Particularly, in calcifications 11-G DVABB scored better (score = 2.92) than 14-G DVABB (score = 2.88) (p > 0.05). 14-G LCNBB had a lower false negative rate (1.8 %) than 11-G DVABB (3 %) and 14-G DVABB (3.2 %) (p > 0.05). There was no difference in the complication rate between the different needle types., Conclusions: Our results indicate that both LCNBB and DVABB are reliable and safe techniques in the diagnosis of non-palpable breast lesions. However, the use of 14-G LCNBB seems to be advantageous in masses, the use of 11-G DVABB seems to be advantageous in asymmetric densities and calcifications.

Esophageal carcinoma: CT and endosonography are complementary and the most important imaging modalities at present for staging. After endoscopic and histological diagnosis, CT of the thorax and the abdomen is used. With the proof of local infiltration of a neighbouring organ or in the presence of distant metastasis, palliative therapy can be started. If CT is not conclusive or no local infiltration or distant metastasis is proven, endosonography should be performed. Gastric carcinoma: At present endosonography shows the highest accuracy for diagnosis of the T stage. For differentiation between T3 and T4 tumors the accuracy of CT is not sufficient to predict resectability. The N stage can be determined at present by no modality with sufficient accuracy. Distant metastasis can be diagnosed by CT with high sensitivity and specificity. Small bowel carcinoma: These rare tumors are diagnosed with high accuracy by enteroclysis, whereby the diagnosis takes place at a late stage due to the nonspecific clinical findings.

Unlabelled: OBJECTIVE/MATERIAL AND METHODS: In a prospective randomized study, the techniques of stereotactic breast biopsies in prone and sitting position were compared. Part of the data has already been published. A total of 103 women underwent stereotactic breast biopsies, either prone (n = 51; using TRC-Mammotest, Sweden) or in the sitting position (n = 52; using Stereotix 2, General Electric Medical Systems, Milwaukee, Wisconsin, USA). With the help of pre- and post-biopsy questionnaires, anxiety, pain, and subjective experience were recorded in all patients. Vasovagal reactions were scored from 0 to 2 according to their severity. All biopsy results were verified by surgery. The specificities and sensitivities for the two positions were calculated and statistically compared., Results: With regard to overall tolerance no statistically significant difference between biopsies performed in the sitting or the prone position was noted. Significantly more patients (p = 0.04) in the prone position stated they would prefer premedication prior to a repeat biopsy. Three patients (prone; n = 1; sitting; n = 2) fainted during the procedure. There was no statistically significant difference between the two biopsy positions regarding sensitivity (95%) and specificity (100%)., Conclusions: More attention should be paid to patient care and, especially, preintervention information. Biopsies in the prone or sitting position are equally well tolerated. Somatic reactions are not a major problem during breast biopsy. Success and validity are independent of the biopsy position.