The use of contrast-enhanced ultrasound in the characterisation of focal liver lesions.

PURPOSE: To determine the potential application of contrast-enhanced ultrasound in the characterisation of focal liver lesions encountered in radiological practice at a district general hospital. MATERIALS & METHODS: Retrospective analysis of 68 sequential patients undergoing contrast-enhanced ultrasound (CEUS) of liver. All patients were referred for CEUS following identification of 1 or more focal liver lesions on conventional ultrasound or CT imaging. After baseline US examination (Acuson), a bolus of 1.0-2.4 ml of SonoVue (Bracco, UK) was administered intravenously. CEUS images were obtained during arterial, portal venous and delayed phases. Patients were followed up for a mean period of 6 months. The CEUS diagnosis was compared to that indicated by other imaging modalities, histopathology, and clinical follow up. RESULTS: CEUS correctly identified malignant liver lesions in 19 patients, with the final diagnosis confirmed by histopathology in 5 cases and clinico-radiological follow up in 14 cases. 47 patients were correctly identified with benign liver lesions on CEUS imaging, with all these cases confirmed on clinico-radiological follow up. In the detection of malignancy, the sensitivity was 95.0% and the specificity was 97.9%. CONCLUSIONS: In our experience to date, contrast-enhanced ultrasound imaging is highly accurate in characterising malignant and benign focal liver lesions. It therefore has significant potential for utilisation in most general radiology departments.

Magnetic resonance (MR) imaging of lumbar spine: use of a shortened protocol for initial investigation of degenerative disease.

PURPOSE: To assess the potential use of shortened protocol MRI of lumbar spine in the investigation of degenerative disc disease in Northern Ireland. MATERIALS & METHODS: Prospective study of 35 patients having MR imaging of lumbar spine performed during a 12-month period by one consultant radiologist. T1-weighted and T2-weighted sagittal images of lumbar spine were obtained in all cases, as well as T2-weighted axial images. The detection of degenerative disc disease by sagittal T2-weighted imaging alone was compared with the diagnostic information obtained by combined use of axial T2 and sagittal T1 and T2 images. RESULTS: In comparison with the full protocol, the shortened protocol had 100% sensitivity and 100% specificity in detecting loss of disc hydration and loss of disc height. In the detection of disc prolapse, the sensitivity was 87% and the specificity was 91% using the shortened protocol. The sensitivity was 35% for detection of thecal sac indentation, and 33% for nerve root encroachment. Therefore, the shortened protocol had high sensitivity and specificity in the detection of disc degeneration and prolapse, but was less sensitive in the detection of nerve root or thecal sac encroachment.

CT-guided fine-needle aspiration of lung nodules: effect on outcome of using coaxial technique and immediate cytological evaluation.

PURPOSE: To evaluate the risk of pneumothorax during CT-guided fine-needle aspiration (FNA) of lung nodules with single needle and coaxial needle techniques and to assess the effect on diagnostic accuracy of immediate cytological examination of lung FNA samples. MATERIALS AND METHODS: This prospective study analysed 53 patients undergoing transthoracic FNA biopsy of lung. 36 cases were performed by a radiologist using a coaxial technique, with 17 cases performed by a radiologist using a direct single-needle method. Effect of technique on occurrence of pneumothorax was recorded. FNA samples from all the patients in the study were examined immediately on-site by a cytologist or MLSO to determine whether sufficient aspirate had been obtained. Provisional diagnosis at immediate examination was compared to final diagnosis following full pathological evaluation. RESULTS: Coaxial and non-coaxial groups were comparable for age and gender. Number of pleural passes was significantly lower in coaxial group (P < 0.01). Pneumothorax occurred in six (17%) of the 36 patients biopsied by coaxial technique, compared to four (24%) of the 17 patients by non-coaxial method (P = 0.55). Chest tube placement was required in four patients (11%) in the coaxial group, and two patients (12%) in the non-coaxial group (P = 0.85). A provisional cytological diagnosis was recorded for 74% of the patients in the study. 83% of the provisional reports were accurate on comparison with full pathology report. Specimen size was sufficient in 81% of cases. CONCLUSIONS: The use of coaxial technique for CT-guided lung FNA biopsy reduced the number of pleural passes but did not significantly reduce the occurrence of pneumothorax. Immediate cytological examination of FNA specimens provided an accurate provisional diagnosis in the majority of cases, and should be routinely employed.