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Neben dem transrektalen Ultraschall (TRUS) hat sich in den letzten Jahren die MRT als nichtinvasive Methode zur Bildgebung von Prostatatumoren etabliert. Mittels T2-gewichteter Sequenzen ist eine exakte anatomische Darstellung der Prostata und ihrer umliegenden Strukturen moglich. Andere MRT-Techniken ermoglichen Ruckschlusse auf das biologische Verhalten des Tumors: dynamische kontrastmittelverstarkte T1-gewichtete Sequenzen zur Darstellung der Angiogenese, diffusionsgewichtete Aufnahmen zur Beurteilung der Zelldichte und die Spektroskopie zur Bestimmung von Gewebemetaboliten wie Cholin und Kreatin (multiparametrische Bildgebung). Prostatatumoren, die nur mittels MRT nachweisbar sind oder verdachtige Tumoren, die hauptsachlich anterior in der Prostata lokalisiert sind und in wiederholten TRUS-gezielten Biopsien verfehlt wurden, benotigen eine MRT-gezielte Biopsie zur Diagnosesicherung. Die bisherigen Ergebnisse der MRT-gesteuerten Prostatabiopsie zeigen eine gute Korrelation zwischen suspekten Arealen auf den MRT-Bildern und der Histologie des bioptisch entnommenen Gewebes. Die MRT-gesteuerte Prostatabiopsie stellt daher eine viel versprechende Alternative zur TRUS-gesteuerten Biopsie dar.

Tumorgrose ist ein prognostischer Marker, der direkt mit der tumorfreien Uberlebensrate nach chirurgischer Sanierung korreliert. Von 287 kleinen (≤4 cm) soliden Nierentumoren im Krankheitsgut der Urologischen Universitatsklinik Wien erwiesen sich 19,5% der Nierentumoren als gutartig und somit harmlos. Der Rest aber waren durchwegs Nierenzellkarzinome. 4,9% wurden erst bei der Abklarung von Fernmetastasen entdeckt. Bei Tumoren mit einem Tumordurchmesser ≤3 cm fanden sich 10,9% pT3a-Tumoren, 4,7% Fuhrman-Grad-3- bis Grad-4-Tumoren, 8,5% multifokale und 2,4% Tumoren mit Metastasen. Bei einer Tumorgrose zwischen 3,1-4,0 cm stiegen die vergleichbaren Werte aber auf 35,7% ≥pT3a, 25,5% ≥ Fuhrman-G3, 20,4% multifokal, 8,4% metastasiert. Die Bestimmung des Tumordurchmessers ist mit einem betrachtlichen Messfehler von mindestens ±0,3 cm behaftet, der sich bei Errechnung des Tumorvolumens potenziert. Das Wachstum als Parameter der Aggressivitat ist daher unsicher. Mit Ausnahme des fetthaltigen Angiomyolipoms ist auch die Beurteilung der Dignitat in modernen bildgebenden Verfahren von kleinen soliden Raumforderungen unzuverlassig. Nur 17% der 80 gutartigen Lasionen dieser Serie wurden praoperativ im CT richtig als benign beurteilt. Daher wird die pratherapeutische Abklarung sinnvoller Weise auf die perkutane Nierentumorbiopsie gestutzt, zumindest bei Patienten mit problematischer Operabilitat. Damit sind mit einer diagnostischen Genauigkeit von ca. 90% gutartige Tumoren erkennbar und zumindest beim Patienten mit hoheren Operationsrisiko eine entsprechende Therapiebeeinflussung vorhanden.

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 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 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.

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.

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.

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.

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 [11]. 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.

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.

Segmental dilatation of the colon is an uncommon entity of unknown etiology. It may be caused by coproliths giving rise to chronic constipation, abdominal distension, tenderness, pain, and colonic obstruction. We report radiographic and clinical findings in an 85-year-old female geriatric patient with recurrent constipation and acute onset of pain in the lower abdomen. Radiography revealed a massively dilated segment of the proximal sigmoid colon containing a huge coprolith. The condition was successfully treated conservatively.

The goal of imaging, when investigating the postoperative stomach and duodenum, is to rule out or to detect early and late postoperative complications. Clinical and laboratory findings, as well as endoscopy and imaging have to be considered in an interdisciplinary setting. Fluoroscopy and CT represent the basic imaging modalities which provide specific information on the evaluation of the normal postoperative state, as well as the detection of leaks, fistulas, haematomas, abcesses, obstruction, malignant disease and functional disorders.

Tumor size is a prognostic marker and correlates to survival after surgical therapy. Of 287 patients with small (or=4 cm) renal tumors, 19.5% had a benign lesion and thus harmless. All others were renal cell cancers; 4.9% of tumors were detected because of metastases and consecutively treated. Tumors with a diameteror=3 cm showed a tumor stageor=pT3a in 10.9%, a high Fuhrman gradeor=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 stageor=pT3a, 25.5% Fuhrman gradeor=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.

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.

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.

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.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.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).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.

To evaluate the functional disorders of the oral and pharyngeal phases of deglutition after repair of esophageal atresia in children.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.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.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.

To compare the accuracy of wire and carbon localization in stereotactically localized open breast biopsy.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.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).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.

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.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.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) (p0.05). Particularly, in calcifications 11-G DVABB scored better (score = 2.92) than 14-G DVABB (score = 2.88) (p0.05). 14-G LCNBB had a lower false negative rate (1.8 %) than 11-G DVABB (3 %) and 14-G DVABB (3.2 %) (p0.05). There was no difference in the complication rate between the different needle types.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.

Dilatation und Myotomie sind wirksame Behandlungsmethoden der Achalasie. Der Einflus vorangegangener Dilatationen auf das Ergebnis nach Myotomie wurde bei 25 Patienten (12 ohne oder mit einer Dilat. [Gruppe I] und 13 mit ≥2 Dilatat. [Gruppe II]) untersucht. Schweregrad, Dauer und Ausmas der Dysphagie wurden mit standardisierten Interviews (Score 0–5) pra-/postoperativ quantifiziert. Der UOS-Residualdruck wurde manometrisch erfast. Der praop. Dysphagiescore war in Gruppe I + II gleich (median: 5), nach Myotomie in Gr. I signifikant niedriger (0 vs. 3) (Wilcoxon: p< 0,05). Der mediane UOS-Rest-druck betrug praop. 8 mmHg (Gr. I) und 12 mmHg (Gr. II) (NS). Nach Myotomie lag er in Gr. I mit 3 mmHg signifikant niedriger als in Gr. II (p< 0,001). Vorangegangene Dilatationen konnten das Ergebnis nach Myotomie beeintrachtigen.

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.

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.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%).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.

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.