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Einleitung: Die intraoperative Praparateradiografie mikrokalkhaltiger mammarer Lasionen wird haufig nur in einer Ebene durchgefuhrt. Hierfur durften auch methodische Schwierigkeiten verantwortlich sein, die mit der Praparateradiografie in zwei Ebenen verbunden sind. Wir haben einen Praparateradiografiecontainer entwickelt, der diese methodischen Probleme kompensiert. Unter Verwendung dieses Containers wurde untersucht, inwieweit die Praparateradiografie in zwei Ebenen einen verbesserten Nachweis von Mikrokalk in der Randzone als Kriterium fur die Entscheidung zu einer Nachresektion ermoglicht. Material und Methode: Vorstellung eines Praparateradiografiecontainers zur kompressions­freien Zwei-Ebenen-Praparateradiografie ohne Divergenzartefakte. 44 mammare mikrokalkhaltige Operationspraparate wurden intraoperativ mit diesem Container praparateradiografiert und der kurzeste Abstand der Mikroverkalkungen zum Praparaterand in 2 senkrecht aufeinander stehenden Ebenen bestimmt. Ergebnisse: Die minimalen Abstande der Mikroverkalkungen zum Praparaterand wiesen in den korrespondierenden zwei Ebenen deutliche Unterschiede auf (Mittelwert = 4,1 mm, Maximalwert = 22 mm). Bei 16/44 Operationspraparate unterschieden sich die minimalen Abstande der Mikroverkalkungen zum Praparaterand fur die zwei Ebenen um 5 mm und mehr, bei 5/44 Praparaten um 10 mm und mehr. Bei einer geforderten mikrokalkfreien Randzone von 5 mm (10 mm) sind bei alleiniger Berucksichtigung der Praparateradiogramme in der Ebene mit dem jeweils groseren Abstand des Mikrokalks zum Praparaterand 51,6 % (29,3 %) der Ergebnisse hinsichtlich der Diagnose einer mikrokalkfreien Randzone falsch negativ. Schlussfolgerung: Eine Praparate­radiografie in zwei Ebenen ist zur intraoperativen Abschatzung des mikrokalkfreien Randbereichs bei mikrokalkhaltigen Mamma-Operationspraparaten zur Vermeidung falsch negativer Diagnosen unbedingt erforderlich. Der von uns entwickelte Praparateradiografiecontainer ermoglicht eine problemlose Zwei-Ebenen-Praparateradiografie ohne Artefakte durch Kompression der Praparate oder Strahlendivergenz. Bei einer Praparateradiografie in einer Ebene konnen falsch negative Diagnosen dazu fuhren, dass notwendige Nachresektionen nicht in der primaren Operation durchgefuhrt werden und eventuell in einer zweiten Operation nachgeholt werden mussen.

Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper- and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of "normal" and "thickened" epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with "thickened" epididymides. The sonographically determined diameters of doppler-negative blood vessels were significantly smaller than those of doppler-positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients.

UNLABELLED A Direct Comparison with Percutaneous Angiography: AIM To compare colour-coded Doppler sonography (CCDS) with conventional angiography in severe occlusive vascular disease of the lower limb. METHODS In 55 patients 1141 vessel segments were evaluated, 700 of them with atheromatous plaques, 270 with stenoses, 208 with occlusions and 6 with aneurysms. RESULTS 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. CONCLUSION 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.

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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%). CONCLUSION: 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.

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.

Purpose: The quality of breast examinations with mammography and breast ultrasound outside a screening scheme was analysed. Special interest focused on the detection of ductal carcinoma in situ (DCIS) by breast ultrasound. Materials and Method: In 92 out of 4600 patients investigated by mammography and 3500 patients investigated by breast ultrasound a biopsy was recommended (BI-RADS™ classification IV and V). In 74 patients we obtained the histological results after biopsy. Results: The global positive predictive value (mammography and/or ultrasound) was 74.3% (mammography 74.6%, ultrasound 74.2%). In 10 cases (2 cases with DCIS) the carcinoma was seen solely with breast ultrasound. In 2 patients carcinoma was detected by mammography only. 5 patients had ductal carcinoma in situ (DCIS). Ultrasound was able to detect 3 of those patients. 2 patients with DCIS were diagnosed by mammography exclusively because of the detection of microcalcifications. Conclusion: In our breast cancer diagnosis outside a screening scheme we had high positive predictive values both for mammography and breast ultrasound. Breast ultrasound was able to detect ductal carcinoma in situ (DCIS) at a rate comparable to that of mammography.

Purpose: To classify mammary microcalcifications for the prediction of malignancy by using computer-aided analysis of morphometric characteristics. Materials and Methods: 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. Results: Benign conditions were essentially represented by small round calcifications with a greatest radius of 18.5 μm and a circumference of ≤ 462.3 μm. Using > 70% 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. Conclusion: A computer-assisted classification of individual microcalcifications on the basis of morphometric characteristics can supplement the information for a computer assisted mammographic diagnosis (CAD).

Purpose 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. Materials and methods 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. Results 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. Discussion 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.

Purpose: Mobile radiological image display systems are becoming increasingly common, necessitating a comparison of the features of these systems, specifically the operating system employed, connection to stationary PACS, data security and rang of image display and image analysis functions. Material and methods: In the fall of 2013, a total of 17 PACS suppliers were surveyed regarding the technical features of 18 mobile radiological image display systems using a standardized questionnaire. The study also examined to what extent the technical specifications of the mobile image display systems satisfy the provisions of the Germany Medical Devices Act as well as the provisions of the German X-ray ordinance (RoV). Results: There are clear differences in terms of how the mobile systems connected to the stationary PACS. Web-based solutions allow the mobile image display systems to function independently of their operating systems. The examined systems differed very little in terms of image display and image analysis functions. Conclusion: Mobile image display systems complement stationary PACS and can be used to view images. The impacts of the new quality assurance guidelines (QS-RL) as well as the upcoming new standard DIN 6868 – 157 on the acceptance testing of mobile image display units for the purpose of image evaluation are discussed. Key Points: • The examined mobile image display systems differ very little in terms of image display and analysis functions. • The use of web-based software allows the mobile image display systems to function independently of their operating systems. • Individual PACS suppliers enable the mobile systems to connect to the network via their own internet server. • With zero-footprint technology, no patient data remains on the viewing system once the application is closed. Citation Format: • Grunert JH. Eigenschaften und Einschrankungen mobiler radiologischer Bildwiedergabesysteme. Fortschr Rontgenstr 2015; 187: 173 – 179

Purpose: Evaluation of specimen radiography as a quality control for the detection of microcalcifications by the pathologist during histopathological examination of breast biopsies. Materials and Methods: 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. Results: 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%. Conclusion: Specimen radiography should be performed not only intraoperatively but also as part of the histopathological examination.

Transcatheter embolization was performed in 45 patients suffering from potentially lethal bleeding originating from malignant tumours in the pelvic region. In 21 cases, the basic disease was rectosigmoidal and in 20, gynaecological in origin. Uncommon bleeding sites were embolized in four other cases. The median survival time (Kaplan-Meier) was 6 months. Most patients died from tumour cachexia. In 10 cases (22%), recurrent bleeding occurred, in three of these with lethal consequences. Successful reembolization was performed on seven patients. The different embolization materials used showed a minor impact on the therapeutic result. Embolization therapy proved to be an effective measure in potentially lethal malignant pelvic bleeding. Gianturco, Anderson and Wallace (GAW) coils should be given preference where there is urgency, as they are accurate, easily and quickly insertable, and cause few complications.

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.

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.

Bedside chest radiographic examinations in intensive care units with grids are impaired by artefacts caused by angulation of the grid (grid cut-off). Two different grids--a grid with a high strip density of 70 lines per cm and the "InSight portable imaging system"--were examined in an intensive care unit with respect to their susceptibility to angulation, image quality and handling of the grid. Five radiologists compared 50 radiographs of each grid considering ten image quality criteria. Using the "InSight portable imaging system" major artefacts were undetectable even at an angulation of 10%; no adjustment of the grid was required, which reduced the amount of time needed to take the radiograph by 26%. The increase in dosage demanded by the employment of the grids at low kilovolt peak setting could be partially compensated by the use of high kilovolt peak setting. The image quality of the "InSight portable imaging system" together with a high kilovolt peak setting is satisfactory, and due to its simplified handling, the portable imaging system has proved to be suitable for bedside chest radiography in intensive care.

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.

Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper- and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of "normal" and "thickened" epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with "thickened" epididymides. The sonographically determined diameters of doppler-negative blood vessels were significantly smaller than those of doppler-positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients.

In patients with severe underlying disease and in polytraumatized patients, clinical signs of septicemia caused by infections with gram-negative bacteria are observed postoperatively with increasing frequency. Using a photometric LAL test, a longitudinal assessment of LAL reactivity on 41 intensive care patients was performed. Postoperatively, all patients developed a septicemia of different severity with body temperatures greater than 38.5 degrees C. Dividing the individual disease course, related to body temperatures, into three phases (A-C) it was found that independent of the severity of septicemia, the majority of patients (38/41) yielded a positive LAL reactivity. In phase B (body temperature greater than 38.5 degrees C) more plasma samples contained LAL-reactive material than in phase A and C (body temperature less than 38.5 degrees C). A decline of fever (phase B to C) correlated significantly (P less than 0.05) with the change from positive to negative LAL reactivity. In patients with high leukocyte counts (15-50 X 10(9)/l) a positive LAL reactivity was found more frequently. The majority of patients (21/27) who survived were transferred with negative LAL reactivity to the general wards. The results suggest that single determinations of LAL reactivity are of limited clinical validity. Using the individual profile of LAL reactivity gained through a longitudinal assessment, data upon the development of the disease course can be obtained.

Human and bovine cervical mucus penetration tests (n = 57) were performed preceding IVF to test their prognostic value as sperm function tests for IVF. This evaluation also included results from conventional semen analysis and from a computerized sperm analysis system. The bovine cervical mucus penetration test was shown to be at least as valuable as the human cervical mucus penetration test in evaluating sperm function. The migration distance of the vanguard sperm (P less than 0.001) and the sperm density at a fixed migration distance in the mucus column (P less than 0.05) correlated most closely with the IVF results. A clear parallelism with the outcome of the 'swim up' technique was also found. Of the sperm parameters examined, only sperm motility in the ejaculate (P less than 0.05) correlated significantly with the results of IVF. It is concluded that the outcome of a bovine cervical mucus penetration test depends on the same sperm functions as required for IVF. Therefore, this test may be of predictive value in an IVF programme.

The influence of semen quality on fertilization rates in an in-vitro fertilization (IVF) programme was studied by analysing both conventional semen parameters and computerized movement characteristics. The study was based on 407 inseminated oocytes which were obtained from 50 patients in 113 laparoscopies. Sperm concentration did not correlate strongly with the fertilization rate. Sperm motility and morphology were the most meaningful parameters in predicting fertilization success. A drop in fertilization rate was found when sperm motility or normal morphology were below 40%. Sperm velocity measured in semen was the only sperm movement parameter which correlated with the fertilization rate, albeit weakly. The latter was reduced when average sperm velocity in semen was less than 50 microns/sec. Conventional semen parameters seem to be more predictive of the fertilizing potential of an ejaculate than movement characteristics obtained by computerized image analysis.