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Die Magnetresonanztomografie der Mammae (MRM) gehort neben der Mammografie und der Sonografie zu den etablierten diagnostischen Verfahren in der Brustdiagnostik. Sie ist die sensitivste und eine spezifische Methode zur Detektion von invasiven und pra-invasiven malignen Brustbefunden. Die klassischen Sequenzen an 1,5- oder 3T-Scannern sind T1- und T2-gewichtet und eine i. v. Kontrastmittelgabe ist obligatorisch. Die Einfuhrung neuer Sequenztechniken in die MRM wie die Diffusionswichtung und die Spektroskopie erweitern die diagnostischen Moglichkeiten der MRM. Die Indikationen fur die MRM beinhalten unter anderem die Fruherkennungs-MRM bei Hochrisikofrauen fur ein Mammakarzinom, die pra-operative MRM bei bestimmten Fragestellungen und in der Nachsorge den Rezidivausschluss.

The purpose of this work was to find out how often the clinician asks for a conventional angiography (CA) in patients with peripheral arterial occlusive disease (PAOD) after a magnetic resonance angiography (MRA) has been performed and how often the CA reveals additional information for therapy planning. Quality criteria for the MRA were defined and tested to see whether they can predict the need for an additional CA. In this prospective study, 81 patients suffering from PAOD (Fontaine classification IIa, n = 13; IIb, n = 33; III, n = 10; IV, n = 25) were examined with a 1.5-T MR-scanner with dedicated coils using a step-by-step technique. The vascular surgeon decided whether he could plan the therapy on the basis of the MRA or if he needed an additional CA. The MRA was assessed in terms of the image quality of the MRA and regarding therapeutic management of the patient in a two-grade scale: sufficient and insufficient. In 27/81 (33%) patients, the clinician asked for a CA, which revealed new information in only 11 patients. The relative number of MRAs with insufficient image quality was significantly higher (p < 0.01) in the group with additional information on CA (8/11) compared to the group without additional information (0/16). The assessment of an MRA based on image quality and regarding therapeutic management of the patient might reduce the number of CAs for therapy planning in patients with PAOD.

AIM To evaluate the diagnostic potential of the new vacuum-assisted method VacuFlash (VF) in clinical routine of breast diagnostics. METHOD From april 2002 to march 2003, the new sonographically guided vacuum-assisted system VacuFlash was used in 75 patients with a BI-RADS 5 lesion (analogue). The patients were aged between 31-75 yrs (median: 51 yrs), the size of the lesions measured 8-33 mm (median: 14 mm). 5 specimens were taken from each lesion. RESULTS In 69 of the 75 lesions (92 %, respectively), malignancy was confirmed. In 8 lesions (8 %, resp.), we found a benign histology, confirmed by consecutive surgery. CONCLUSION The new vacuum-assisted device VacuFlash is a technically perfected and applicable diagnostic method. Especially in the view of the cost it has to be compared with high-speed core cut biopsy, the hand-held Mammotome system and open surgical biopsy. High-speed core cut biopsy seems to be the standard procedure in diagnostic percutaneous breast intervention to clarify sonographically detected breast lesions.

Die Untersuchungsmoglichkeiten der Mamma sind vielfaltig. Erste Hinweise auf Mammabefunde konnen die Selbstuntersuchung und die arztliche Tastuntersuchung geben. Als Screening-Verfahren eignet sich derzeit nur die Mammografie. Erganzende Masnahmen der diagnostischen Abklarung sind die Mammasonografie und die Kontrastmittel(KM)-Magnetresonanztomografie. Die histologische Diagnostik unklarer Befunde (BI-RADS 4/5) erfolgt durch eine Stanzbiopsie, Vakuumbiopsie oder offene Biopsie. Bei nicht tastbaren, mammografisch oder sonografisch nachgewiesenen - gegebenenfalls schon histologisch gesicherten - Befunden ist die praoperative Markierung erforderlich. There are various methods for breast assessment. Self breast palpation or professional palpation may give the first hint about a breast mass. Mammography is the by far best screening method. Breast ultrasound and contrast dye MRI are additional diagnostic methods. The histological assessment of the diagnostic classifications (BI-RADS 4/5) by punch biopsy, vacuum biopsy or open biopsy. Preoperative localisation has to be done by non-palpable, mammographic or sonographic detected lesions.

AIM To evaluate the potential of three-dimensional ultrasound (3D US) in core biopsy of suspicious breast lesions. METHOD 3D US controlled core biopsy was performed in 107 breast masses in 100 women by using an automated biopsy system (11G coaxial needle, 12 G biopsy needle). Mean diameter of the lesions was 1.55 cm (0.5 - 3.5 cm). A linear 3D US volume scanner was used for the procedure. Localization of the lesion and placement of the needle were initially done under 2D US guidance. After core needle stroke a 3D US volume acquisition was performed to correlate lesion and needle position. In the case of eccentric needle position the needle was repositioned under 3D control. 5 specimens were taken from each lesion. The histological results from the specimens were correlated with the results from surgery or clinical follow-up (> 2.5 years). RESULTS Biopsy was taken from 59 probably benign (BI-RADS 3 - 4) and 48 malignant (BI-RADS 5) lesions. 3D US revealed 61 central, 44 eccentric and 2 marginal needle positions after the initial 2D guidance. Central repositioning of the needle was achievable under 3D guidance in all patients. Histological examination of the specimens revealed 41 invasive carcinomas and one in-situ carcinoma (DCIS). In one lesion, the carcinoma was missed in the core biopsy, despite central hits of the biopsy needle. This led to a sensitivity of 98 %, specificity of 100 %, PPV of 100 %, NPV of 98.5 % and accuracy of 99 % for the diagnosis of a malignant lesion. CONCLUSION 3D US improves needle positioning as well as the depiction of correct needle placement in freehand core biopsy.

Dermatofibrosarcoma protuberans (DFSP) is a slow growing soft tissue neoplasm of dermal fibroblastic origin characterised by local invasion and a high propensity for local recurrence. We report a 31-year-old woman with subcutaneous DFSP of the breast, which is an unusual localisation. Diagnostic work-up comprised clinical examination, mammography and ultrasound. Definitive diagnosis was not possible prior to histological analysis of the lesion. Wide excision of the tumour was performed, which is the therapy of choice in DFSP. Ultrasound played an important role in histological diagnosis before definitive surgery and might be helpful in follow-up of patients with DFSP of the breast.