Kenneth Ocran

Evaluation of Diagnostic Criteria for Liver Metastases of Adenocarcinomas and Neuroendocrine Tumours at Conventional Ultrasound, Unenhanced Power Doppler Sonography and Echo-Enhanced Ultrasound

Purpose: In order to improve the differential diagnosis between liver metastases of neuroendocrine tumours and adenocarcinomas, criteria for the masses at conventional ultrasound, unenhanced power Doppler sonography and echo-enhanced ultrasound were evaluated. Methods: Seventy-three patients with histologically proven liver metastases of a neuroendocrine tumour (n = 26) or an adenocarcinoma (n = 47) were investigated by conventional ultrasound as well as unenhanced power Doppler sonography and echo-enhanced ultrasound focusing on specific properties of the lesions. Results: Liver metastases of neuroendocrine tumours and adenocarcinomas showed a different contrast behaviour with echo-enhanced sonography. A hypervascularisation at the arterial and capillary phase were found in 85% of the neuroendocrine metastases, and in 17% of the masses of adenocarcinomas, respectively (p < 0.05). Conclusions: The successful treatment of liver metastases requires a highly sensitive and specific diagnostic procedure for their differentiation. A hypervascularisation of the lesions during the arterial and capillary phase at echo-enhanced ultrasound may point to a neuroendocrine primary tumour. However, histology is the only standard of reference for the differentiation of liver metastases, and is necessary for optimal therapy.

Cinematographic techniques in the diagnostics of intestinal diseases using MRT enteroclysma

PURPOSE We investigated whether an additional cine sequence in MR enteroclysis examination is practicable and would provide additional findings in the diagnostics of patients with abdominal diseases. MATERIALS AND METHODS Seventeen consecutively presenting patients with known or presumed abdominal disease (known or presumed intestinal illness; age range, 21-57 years; mean age, 34.1 years; male:female ratio, 4:13) were retrospectively studied. All patients underwent MRI enteroclysis at 1.5 T subsequent to conventional ileocolonoscopy, which was used as reference standard. A gastroenterologist and a radiologist evaluated the MRI examinations together to see whether the additional cine sequences would provide any additional findings. RESULTS The cine sequences provided relevant diagnostic information in at least 11 of 17 patients (60.6%). In five patients, we were able to determine a stenosis as scarred; in two patients, normal peristalsis of the bowel was demonstrated, showing that the stenosis had not been scarred. CONCLUSION This study provides strong evidence that the implementation of cine sequences in MRI enteroclysis examination provides additional findings with clinical relevance, especially for distinguishing scarred and functional stenoses.

Differentiation of neuroendocrine pancreatic tumors using echo-enhanced power-doppler sonography with 2nd harmonic imaging

Objective: Differentiation of neuroendocrine from other pancreatic lesions is difficult. We investigated prospectively the value of echo-enhanced power-Doppler sonography for the differential diagnosis of neumendocrine pancreatic tumors. Patients and methods: 04 patients with a pancreatic tumor in conventional ultrasound were investigated by power-Doppler sonography with 2nd Harmonic Imaging using the echo-enhancer LevovisP (300 mg/ml, bolus i.v., Schering AG, Berlin, Germany). Previously defined criteria of signal behaviour and vascularizetion pattern of the tumors compared to the surrounding tissue were used for the ultrasound diagnoses. 17 of 19 patients with the suspected diagnosis of a neuroendocrine tumor at sonography were investigated in addition by octreotide-scintigraphy. Histological diagnoses for all patients were obtained alter surgical tumor resection or by percutaneous needle biopsy. Results: Echo-enhanced power-Doppler sonography with 2nd Harmonic Imaging allowed the differential diagnosis of neuroendocrine pancreatic tumors with a sensitivity of 100% and a specificity of 96%. Conclusion: Echo-enhanced power-Doppler sonography has a higher accuracy in the differentiation of neuroendocrine tumors from other pancreatic lesions than octrsotide-scintigraphy.