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Purpose: To evaluate acoustic radiation force impulse imaging (ARFI) of the liver and spleen as a new method for the noninvasive assessment of liver fibrosis (LF)., Materials and Methods: Three groups of 58 examinees were studied: (A) 20 healthy volunteers; (B) 18 patients with chronic viral hepatitis (CVH) B or C having liver fibrosis stages F 1 - 4 (assessed by liver biopsy; Ishak classification); and (C) 20 patients with liver cirrhosis (LC). All participants were examined using the Siemens ACUSON S 2000 Ultrasound Virtual Touch Tissue Quantification system. Ten measurements were performed on both liver lobes and three measurements on the spleen, and the obtained mean values (shear wave velocities [SWV] expressed in m/s) were compared between the groups. In 20 patients the splenic artery pulsatility index (SAPI) was also measured and correlated to the liver and splenic ARFI and histological stage of LF., Results: Hepatic ARFI measurements demonstrated a significant correlation to LB results (Spearman's ρ = 0.766; ρ < 0.001) and SWV cut-off values of 1.3 (AUC 0.96) and 1.86 (AUC 0.99) could reliably differentiate between healthy (A) and non-cirrhotic CVH (B), as well as between non-cirrhotic CVH (B) and LC (C). Splenic SWV cut-off value of 2.73 (AUC 0.82) could differentiate between the patients with LC and non-cirrhotic CVH. A significant correlation was also observed between the SAPI and liver ARFI results (ρ = 0.56; p = 0.013)., Conclusion: The hepatic and splenic SWV measured by ARFI increase with the LF stage, and the hepatic SWV correlate well with SAPI. This new technology enables simultaneous morphological, Doppler and elastometric examinations and might improve the accuracy of noninvasive liver fibrosis assessment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: Radiofrequency ablation (RFA) is a promising minimal invasive modality to treat small breast cancer (BCA). In most studies cancers were surgically excised shortly after RFA. We present six patients inoperable when diagnosed with BCA, and performed RFA instead of surgery., Materials and Methods: Ultrasound-guided bipolar RFA was performed under local anesthesia in six women aged 63 - 85 years. They had core-biopsy proven T 1 - 2N0 M0, grade I or II, 1.0 - 2.7 cm sized invasive ductal cancers, with positive estrogen receptor status. Four tumors measured > 2 cm, and three 1.0 - 1.2 cm in diameter. Patients were at high-risk for general anesthesia and surgery because of severely impaired cardiac function, advanced age, or associated diseases (acute myeloid leukaemia (AML), diabetes, hypertension, depression) and/or refused surgery., Results: Six tumors in five patients were completely ablated, without recurrence during follow-up (range: 9 - 49 months). One superficially located cancer was partially ablated; the patient died two months later from myocardial infarction. The Patient with AML and BCA had an infection of the treated breast after 4 months and postponed mastectomy to an AML remission status. There were no signs of malignancy in histopathology; the patient finally died of leukemia 42 months after RFA. The remaining four patients are well, without complications., Conclusion: Ultrasound-guided percutaneous RFA under local anesthesia is an effective alternative to surgery for BCA < 3 cm in patients with a high-risk for surgery., (Georg Thieme Verlag KG Stuttgart . New York.)

Purpose: Frequency encoded Doppler ultrasound (DUS) imaging has allowed identification of flow in thyroid tumours, but its role in evaluation of thyroid nodules for malignancy has not been accurately defined. We wanted to investigate the possible role of DUS in differentiation of benign and malignant nodules., Materials and Methods: DUS and spectral parameters were analysed in 50 benign and 20 malignant thyroid nodules. The following patterns of vascularity were identified: pattern 0--no visible flow; pattern 1--minimal internal flow without a peripheral ring; pattern 2--peripheral ring of flow but minimal or no internal flow; pattern 3--peripheral ring of flow and a small-to moderate amount of internal flow; pattern 4--extensive internal flow with or without a peripheral ring. Peak systolic velocity (PSV) and end diastolic velocity (EDV) was measured and resistance index (RI) was calculated., Results: Significantly more benign nodules had vascularisation patterns 1.2 and 3. Significantly more malignant nodules had vascularisation patterns 3 and 4, and only pattern 4. EDV was significantly lower in malignant than in benign nodules (6.06 +/- 4 cm/sec vs. 13.01 +/- 8.74 cm/sec). RI was significantly higher in malignant than in benign thyroid nodules (0.75 +/- 0.08 vs. 0.56 +/- 0.09). For RI > or = 0.70: 80% sensitivity, 92% specificity, 80% positive predictive value, 92% negative predictive value, and 88.6 % accuracy, were calculated in characterising malignant thyroid nodules., Conclusion: We believe that internal flow without or with minimal peripheral flow on DUS and RI > or = 0.70 can be used to distinguish between malignant and benign thyroid nodules fairly reliably. Nodules with prevailing peripheral vascularisation and minimal or no internal vascularisation, and RI below 0.70 are probably benign.