F. Frauscher

Comparison Of Contrast Enhanced Color Doppler Targeted Biopsy With Conventional Systematic Biopsy: Impact On Prostate Cancer Detection

Purpose: We performed a prospective study to determine whether a limited biopsy approach with contrast enhanced color Doppler ultrasound targeted biopsy of the prostate would detect cancer as well as gray scale US guided systematic biopsy with a larger number of biopsy cores.Materials and Methods: We examined 230 male screening volunteers with a total prostate specific antigen of 1.25 ng./ml. or greater and free-to-total prostate specific antigen less than 18%. Two independent examiners evaluated each subject and a single investigator performed 5 or fewer contrast enhanced targeted biopsies into hypervascular regions in the peripheral zone during intravenous infusion of the US contrast agent Levovist (Schering, Berlin, Germany). Subsequently another examiner performed 10 systematic prostate biopsies. The cancer detection rates of the 2 techniques were compared.Results: Cancer was detected in 69 of the 230 patients (30%), including 56 (24.4%) by contrast enhanced targeted biopsy and in 52 (22.6%) by system...

Variability of Doppler parameters in the healthy kidney: an anatomic-physiologic correlation.

Contradictory results have been obtained in classifying various renal diseases when trying to use the resistive index measured by duplex Doppler technique in renoparenchymal arteries. These measurements may have been influenced by the lack of standardization of the anatomic site at which the renoparenchymal artery is sampled. To elucidate this influence, we measured the resistive index, peak systolic velocity, end diastolic velocity, and pulsatility index in 120 healthy kidneys at three different positions of the renal vasculature. The resistive index at the level of the interlobar‐arcuate arteries proved to be the parameter with the most consistent results and should be preferred in clinical applications.

Laparoscopic pyeloplasty for UPJ obstruction with crossing vessels: contrast-enhanced color Doppler findings and long-term outcome.

Objectives. To evaluate, in the present long-term follow-up study, contrast-enhanced color Doppler imaging (CDI) findings and the clinical outcome of patients with crossing vessels at the obstructed ureteropelvic junction (UPJ), who underwent laparoscopic pyeloplasty. In a previous study, contrast-enhanced CDI proved capable of detecting crossing vessels at the UPJ. n nMethods. A total of 23 patients, who had undergone laparoscopic pyeloplasty and displacement of crossing vessels for UPJ obstruction at least 2 years before this study (mean 27 months), underwent contrast-enhanced CDI, intravenous urography, and renography. Contrast-enhanced CDI was performed using intravenously administered Levovist to assess the displacement of the vessels relative to the UPJ. All patients completed analog follow-up pain scales and quality-of-life assessment questionnaires. n nResults. Contrast-enhanced CDI revealed a cranial displacement (mean 1.3 cm) of the crossing vessels from the UPJ in all 23 cases. Intravenous urography showed a decrease in the degree of hydronephrosis, with a success rate of 100% in low-grade and 86% in high-grade hydronephrosis. The split renal function improved from 39.7% to 48.1%. Analog pain scale measurements demonstrated a mean improvement in pain of 92% (range 73% to 100%) and a mean quality-of-life score of 94 (range 78 to 100). n nConclusions. Our series of patients with crossing vessels at the UPJ treated by laparoscopic pyeloplasty showed an excellent long-term successful outcome. Contrast-enhanced CDI allows for preoperative detection, as well as postoperative assessment, of the displacement of the crossing vessel. We recommend that the presence of a crossing vessel be routinely determined preoperatively, because it may influence the choice of treatment modality and thereby the clinical outcome.

Sonographie des Prostatakarzinoms

ZusammenfassungDie Sonographie der Prostata zeigt eine zunehmende Bedeutung, welche sich in erster Linie durch die steigende Inzidenz des Prostatakarzinoms, dem häufigsten Malignom des Mannes, ergibt. Die Prostatasonographie ist das bildgebende Verfahren der ersten Wahl in der Abklärung von Prostataerkrankungen. Die Wertigkeit der konventionellen transrektalen B-Bild-Sonographie wurde intensiv evaluiert. Dieser Beitrag soll insbesondere neue Ultraschalltechnologien zur Detektion des Prostatakarzinoms darstellen. Die farbkodierte Duplexsonographie, Powerdopplersonographie nativ und mit Anwendung von Ultraschallkontrastmitteln (Echosignalverstärker) haben neue Möglichkeiten zur Früherkennung des Prostatakarzinoms eröffnet, bzw. bieten auch wertvolle Information sowohl in der präoperativen Abklärung als auch in der therapeutischen Verlaufskontrolle. Die Anwendung von Ultraschallkontrastmitteln mit neuen Ultraschalltechnologien (z. B. “B-Bild-Harmonic-Sonographie”) scheint eine weitere Verbesserung des diagnostischen Potenzials zu ermöglichen. Weiterführende Studien sind jedoch notwendig, um den eindeutigen klinischen Stellenwert der derzeitig sehr erfolgversprechenden kontrastmittelverstärkten Sonographie zu evaluieren.AbstractThe value of ultrasound (US) in the diagnosis of prostate cancer has increased in importance in the past decade, which is mainly related due to the increasing incidence of prostate cancer, the most common malignancy in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated. The introduction of US contrast agents has dramatically changed the role of US for prostate cancer detection. Advances in US techniques were introduced to further increase the role of US contrast agents. Although most of these advances in US techniques, which use the interaction of the contrast agent with the transmitted US waves are very sensitive for the detection of microbubbles, are mostly unexplored, in particular for prostate applications. First reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional US technique. We present a critical evaluation of the current status of transrectal US imaging for prostate cancer detection. Furthermore, we give background information on US contrast agents and imaging modalities. Early results of contrast-enhanced US suggest the feasibility of the use of US contrast agents to enhance US imaging of the prostate. The application of US contrast agents for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine the promise of contrast-enhanced US of the prostate evolves into clinical application.

Sonographie der Schulter

ZusammenfassungDer Stellenwert der Schultersonographie unter standardisierten Untersuchungsbedingungen und entsprechender Erfahrung des Untersuchers ist unbestritten. Insbesondere im Bereich der Traumatologie ist die Wertigkeit bei Rotatorenmanschettenläsionen mit entsprechendem operativem Korrelat statistisch gut abgesichert. Die Overall-Sensitivität bei Rotatorenläsion liegt heute bei ca. 95 %. Partielle und Totalrupturen der Rotatorenmanschette sowie das Impingementsyndrom fallen unter den Sammelbegriff Subakromialsyndrome und sind sonographisch sowohl in statistischer als auch dynamischer Untersuchungstechnik gut beurteilbar. Eine wesentliche Bedeutung hat die sonographische Normalwertbestimmung von Schulterweichteilen als metrisches Fundament zur Bewertung pathologischer Veränderungen. Ein definiertes Staging (prä- wie postoperativ) ermöglicht eine exakte Operationsplanung sowie eine genaue Therapiekontrolle. Die Beurteilung der Gleitlager als indirekter Hinweis auf Traumen bzw. bei entsprechender Klinik als Anhaltspunkt entzündlicher Veränderungen mit exsudativ proliferativen Gelenkergüssen oder im Rahmen der Tendinitis calcarea ist heute sonographischer Untersuchungsstandard. Die Indikation für andere Untersuchungsverfahren wie Arthroskopie, Kontrast-CT oder MRT ist dadurch zurückgedrängt.SummarySonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90 %. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Diagnostik von Überlastungsschäden bei Sportkletterern

ZusammenfassungSportklettern zeigt eine zunehmende Popularität sowohl im Elitesport als auch im leistungsorientierten Breiten- und Schulsport. Dadurch kommt klettertypischen Beschwerden eine zunehmende medizinische Bedeutung zu. Bei dieser Sportart stehen Überlastungen (“overuse”) hauptsächlich im Bereich der oberen Extremität an erster Stelle der Beschwerden. Neben der klinischen Untersuchung, welche in der Akutphase limitiert sein kann, ist die bildgebende Diagnostik zur exakten Abklärung notwendig, um ein adäquates therapeutisches Management zu gewährleisten. Im Rahmen dieser Arbeit wird ein Überblick über den Einsatz der unterschiedlichen Bildgebungsmodalitäten wie konventionelles Röntgen, Ultraschall und Magnetresonanztomographie bei den klettertypischen Beschwerdebildern gegeben.AbstractSport climbing shows an enormous increase in participation, evolving to more popularity, including even school sport activity on high standards. Therefore the number of climbing related injuries is increasing and becomes a more frequently encountered medical problem. Typical climbing associated injuries involve predominantly the upper limb. Overuse injuries are the most common climbing related injuries.The clinical examination is the first line investigation, which is often limited especially in the acute phase. However, an exact diagnosis is desireable for therapeutic management. Imaging modalities have shown to be capable for detection of climbing related injuries. An overview about the current use of x-ray, ultrasound and magnetic resonance imaging in different climbing related overuse injuries is presented.

Anatomy of the eustachian tube as demonstrated by endoluminal ultrasonography.

Using a new application of the endoluminal approach, we were able to demonstrate the sonographic anatomy of the eustachian tube in vitro and in vivo and correlate it with the plastic‐embedded specimen. Five adult normocephalic cadavers, two patients, and one specimen especially prepared for embedding in plastic were examined. A specifically developed device was used to insert the ultrasound transducer employing an endo‐oral approach. The investigation was performed using an intravascular ultrasound unit. In all cases the tube could be visualized in its entirety and relevant anatomic structures identified and compared with the specimen at the corresponding levels. The deeper layers, including the paratubal structures and the mucosa, could be distinguished for the first time by means of endoluminal ultrasonography. Now that endoluminal ultrasonography has revealed this anatomic information, further studies will be able to gauge the clinical efficacy of our method in cases of ventilatory, drainage, and clearance problems. The images showed no difference between the structures in vitro and in vivo, and the vivo examination was even easier than the in vitro one owing to better tissue turgor.

PERSISTENT DETRUSOR INSTABILITY AFTER TRANSURETHRAL RESECTION OF THE PROSTATE IS ASSOCIATED WITH REDUCED PERFUSION OF THE URINARY BLADDER

OBJECTIVESnTo elucidate, in patients with benign prostatic hyperplasia (BPH), how often detrusor overactivity (DOA) is persistent after transurethral resection of the prostate (TURP) and if perfusion of the lower urinary tract influences postoperative outcomes.nnnPATIENTS AND METHODSnFifty men with urodynamically confirmed DOA and bladder outlet obstruction due to BPH had a TURP. Before and 1 year after TURP the International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA) level and total prostatic volume (TPV) were evaluated. Also, the lower urinary tract was evaluated using pressure-flow studies and transrectal colour Doppler ultrasonography to assess the vascular resistive index (RI) as a variable of the perfusion of the lower urinary tract.nnnRESULTSnAfter TURP the IPSS, QoL score, PSA level and TPV decreased. Cystometric measurements showed that in 15 (30%) patients DOA was persistent after TURP. The mean (sd) maximum urinary flow rate increased from 9.20 (4.03) to 15.98 (4.62) mL/s and postvoiding residual urine volumes decreased from 109.38 (73.71) to 29.24 (45.00) mL. When men with persistent DOA (15 patients; group 1) were compared with those with no DOA after TURP (35; group 2) there was a statistically significantly higher RI of the bladder vessels in group 1, at 0.86 (0.068) than in group 2, at 0.68 ( 0.055) (P < 0.001).nnnCONCLUSIONSnPersistent DOA in men after TURP seems to be associated with increased vascular resistance of the bladder vessels with subsequent reduced perfusion and hypoxia.

Ultraschallkontrastmittel und Prostatakarzinom

ZusammenfassungDas Prostatakarzinom ist das häufigste Malignom des Mannes und ist mit einer sehr hohen Mortalität verbunden. Die diagnostische Abklärung des Prostatakarzinoms basiert auf der Bestimmung des prostataspezifischen Antigens (PSA), der digitalen rektalen Untersuchung und der transrektalen Sonographie. Aufgrund der diagnostischen Limitationen ist die ultraschallgeführte Prostatabiopsie das Verfahren der Wahl in der Prostatakarzinomdiagnostik. Mit neuen Bildgebungstechnologien ist es möglich, das Prostatakarzinom zu detektieren und dadurch gezielte Biopsien aus diesen Arealen zu entnehmen. Die Einführung von Ultraschallkontrastmitteln („Echosignalverstärkern“) hat das diagnostische Potenzial dieser Methode signifikant gesteigert; dadurch ist es möglich, die Tumorvaskularisation darzustellen.AbstractProstatic carcinoma is the most frequent malignant disease in men and associated with very high mortality. The diagnostic work-up of prostatic carcinoma is based on tests to determine the level of prostate-specific antigen (PSA), digital rectal examination, and transrectal sonography. Due to diagnostic limitations, ultrasound-guided prostate biopsy is the method of choice for diagnosis of prostatic carcinoma. New imaging technologies allow detection of prostatic carcinoma, thus facilitating removal of specific biopsy specimens from these regions. Introduction of ultrasound contrast agents (“echo signal enhancers”) significantly increased the diagnostic potential of this method, making it possible to visualize tumor vascularization.

Ultraschallkontrastmittel und Prostatakarzinom@@@Ultrasound contrast agents and prostate cancer

ZusammenfassungDas Prostatakarzinom ist das häufigste Malignom des Mannes und ist mit einer sehr hohen Mortalität verbunden. Die diagnostische Abklärung des Prostatakarzinoms basiert auf der Bestimmung des prostataspezifischen Antigens (PSA), der digitalen rektalen Untersuchung und der transrektalen Sonographie. Aufgrund der diagnostischen Limitationen ist die ultraschallgeführte Prostatabiopsie das Verfahren der Wahl in der Prostatakarzinomdiagnostik. Mit neuen Bildgebungstechnologien ist es möglich, das Prostatakarzinom zu detektieren und dadurch gezielte Biopsien aus diesen Arealen zu entnehmen. Die Einführung von Ultraschallkontrastmitteln („Echosignalverstärkern“) hat das diagnostische Potenzial dieser Methode signifikant gesteigert; dadurch ist es möglich, die Tumorvaskularisation darzustellen.AbstractProstatic carcinoma is the most frequent malignant disease in men and associated with very high mortality. The diagnostic work-up of prostatic carcinoma is based on tests to determine the level of prostate-specific antigen (PSA), digital rectal examination, and transrectal sonography. Due to diagnostic limitations, ultrasound-guided prostate biopsy is the method of choice for diagnosis of prostatic carcinoma. New imaging technologies allow detection of prostatic carcinoma, thus facilitating removal of specific biopsy specimens from these regions. Introduction of ultrasound contrast agents (“echo signal enhancers”) significantly increased the diagnostic potential of this method, making it possible to visualize tumor vascularization.