Vascular malformations of the female and male genitalia: type and distribution patterns revealed by magnetic resonance imaging.

BACKGROUND: Vascular malformations of the genitalia often go undetected in clinical examination. These vascular malformations can cause a variety of clinical symptoms such as swelling, pain and bleeding. AIM: To characterize the distribution patterns of genital vascular malformations using magnetic resonance imaging (MRI) and to correlate these patterns with clinical findings in order to guide diagnostic decisions. METHODS: A retrospective analysis of MRIs of the pelvis and legs in 370 patients with vascular malformation was performed to determine the involvement of the internal and external genitalia. RESULTS: In 71 patients (19%), genital involvement could be identified by MRI. Of these, 11.3% (8 of 71) presented with internal involvement, 36.6% (26 of 71) with external involvement and 52.1% (37 of 71) with both internal and external involvement. Over half (57.1%) of the 49 patients with visible external genital signs detected during a clinical examination had additional internal genital involvement. CONCLUSIONS: Genital involvement is a common finding in patients with vascular malformation of the legs and/or pelvis. Based on our data, we recommend MRI of the legs and pelvic region in patients with externally visible signs of a vascular malformation of the external genitalia in order to exclude additional internal involvement.

Stereotactic Percutaneous Electrochemotherapy as Primary Approach for Unresectable Large HCC at the Hepatic Hilum.

Electrochemotherapy (ECT) is a novel non-thermal ablative technique that combines chemotherapy and the application of electric pulses for reversible cell membrane electroporation. This method was recently performed in the treatment of deep-seated liver tumors during open surgery but experience about percutaneous ECT is rare and further developments like combination of percutaneous ECT with stereotactic navigated devices may be very promising. We report on a case of a 4.7 × 4.5 × 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation. Follow-up imaging 6 weeks and 6 months after ECT showed complete response.

Super selective percutaneous transhepatic coil embolization of intrahepatic pseudoaneurysm after pediatric liver transplantation: a case report.

BACKGROUND: Intrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia. CASE PRESENTATION: We report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm. CONCLUSION: Super selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.

Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel.

INTRODUCTION: Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS: In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS: In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION: All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.

Radiofrequency Ablation of the Marginal Venous System in Patients with Venous Malformations.

PURPOSE: To evaluate radiofrequency ablation (RFA) for closure of marginal veins in pediatric and adult patients with venous malformations. MATERIALS AND METHODS: Medical records, imaging and procedure details were retrospectively reviewed in patients who underwent RFA of the marginal vein in a 17-month period. Additional sclerotherapy (n = 19) and coil embolization of the marginal vein were performed (n = 2). RESULTS: A total of 23 marginal veins were treated in 20 patients. Mean age at treatment was 16 years ± 9.4 (1-37 years). Pre-procedural magnetic resonance imaging revealed thoracoabdominal marginal veins in 3 patients. A type I marginal vein (draining in the great saphenous vein below the popliteal vein) was identified in 1 and type IIa/IIb (draining in a median/lateral accessory saphenous vein) in 2/8 cases. Type III (draining into the profunda femoral vein) was detected in 8, and type IV (draining into gluteal veins) in 1. Mean diameter of the marginal veins was 13.2 mm ± 4 (7-20 mm). Patency was found in 1 during follow-up (22 months ± 9.8). Complete or partial occlusion was achieved in 94.5% of the veins. One patient showed signs of thrombophlebitis after the procedure, and another incomplete paresis of the peroneal nerve. CONCLUSION: RFA is effective as minimally invasive treatment of the marginal venous system. These veins should be treated early in life. Marginal veins with large diameter, residual tributaries and the intrafascial courses usually require adjunct coil embolization and sclerotherapy. LEVEL OF EVIDENCE: Case series, Level IV.

Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment.

This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.

Value of different ultrasound elastography techniques in patients with venous malformations prior to and after sclerotherapy.

AIM: Comparison of different ultrasound elastography techniques for detection of changes after sclerotherapy within venous malformations. MATERIAL AND METHODS: In patients with venous malformations sonography was executed at exactly the same position prior to and after ethanol-gel sclerotherapy. Both examinations included B-Mode, vascular sonography with Color-Coded Duplex Sonography, and additional sonography with different elastography techniques (strain, qualitative and quantitative Acoustic Radiation Force Impulse (ARFI) elastography) with a linear transducer (6-9 MHz). Qualitative elastograms were read in consensus and scored. Differences of elasticity scores were statistically analyzed, p-values <0.05 were regarded significant. RESULTS: Elasticity scores of strain and qualitative ARFI elastography in 25 patients (21 females, averagely 24.4 years old) were comparable before treatment (p = 0.69). After therapy qualitative ARFI scores changed significantly compared to pre-treatment scores (p = 0.0017), whereas strain elastography scores revealed no significant changes (p = 0.13). Quantitative ARFI values obtained after sclerotherapy within the venous malformations were significantly higher compared to pre-treatment values (p = 0.049), and significantly higher to values obtained in surrounding tissue (p = 0.030). Comparison of pre- and post-treatment ARFI values of the surrounding tissue was not significant (p = 0.67). CONCLUSION: Elasticity scores of qualitative ARFI elastography reliably detect ethanol-gel induced changes in venous malformations. Quantitative ARFI may be a tool for therapy planning, and for monitoring sclerotherapy outcome as well as the effect of sclerosing agents on malformation and surrounding tissue in patients with venous malformations.

Interventional Removal of Intravascular Medical Devices: Methods and Technical Success.

PURPOSE: Evaluation of the technical success rate and complications when retrieving dislocated intravascular foreign bodies. MATERIAL AND METHODS: Between 1999 and 2015 38 patients (21 female; 17 male; Age: 17 - 92; Average 54.3 years) underwent an extraction of intravascular dislocated foreign bodies, which were not lost during a radiological intervention. The extracted material included 29 port catheters, 3 tips of tunneled dialysis catheters, 2 stents, 2 guide wires, 1 CVC tip and 1 AS occluder device. Various catheters for repositioning and extraction were used. The access was transarterial as well as transvenous. Technical success was defined as complete removal of the foreign body. RESULTS: The technical success rate was 92.1 % (35 of 38). In 17 patients an additional catheter was necessary to reposition the foreign body in order to make it accessible for the extraction catheter. In one case a stent was relocated and remodeled within the patient and was not extracted. In another case we experienced a dislocation of a small fragment of the port catheter into the distal parts of the pulmonary artery, which couldn't be extracted. A guide wire could not be extracted as it was already adhered with the vessel wall. Peri-interventional complications were not documented. CONCLUSION: The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and poor of complications. Interventional therapy can avoid surgical removal. KEY POINTS: • The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and safe.• In most cases surgical removal can be avoided.• The gooseneck-snare catheter was mainly used for the extraction of intravascular foreign bodies. Citation Format: • Ayx I, Goessmann H, Hubauer H et al. Interventional Removal of Intravascular Medical Devices: Methods and Technical Success. Fortschr Röntgenstr 2016; 188: 566 - 573.

Percutaneous treatment of symptomatic superior mesenteric vein stenosis using self-expanding nitinol stents.

PURPOSE: To evaluate the technical and clinical success of percutaneous superior mesenteric vein (SMV) stenting in symptomatic patients using self-expanding nitinol stents. METHODS: We retrospectively analyzed the technical and clinical success of percutaneous SMV stenting of 6 symptomatic patients (3 men, mean age 67 years, range 48-81 years). Stenosis of the SMV was caused by postoperative stricture (n=3), pancreas carcinoma (n=1) and pancreatitis (n=2). As a result of the stenosis, 3 patients had symptomatic ascites, 2 patients showed signs of mesenteric ischemia and 1 patient had recurrent gastrointestinal bleeding. Stenting was performed by a percutaneous transhepatic approach using self-expanding nitinol stents. RESULTS: Stenting of the SMV was technically and clinically successful in all patients. No peri-interventional complications occurred. The stent diameters ranged from 6 to 14 mm. During the mean follow-up of 6 months (range, 2-10 months) 1 patient presented early stent occlusion 2 weeks after placement. CONCLUSION: Stenting of a symptomatic SMV stenosis using self-expanding nitinol stents is feasible and clinically effective.

Percutaneous treatment of biliary complications in pediatric patients after liver transplantation.

PURPOSE: Evaluation of the efficiency and safety of the percutaneous treatment of biliary complications in pediatric liver transplant recipients. METHODS: We conducted a retrospective analysis of children who underwent biliary percutaneous interventions after pediatric liver transplantation (PLT) over a 4-year period. Kind of biliary complication, interval between liver transplantation and intervention, status of the vessels, procedural interventional management, technical and clinical success, course of cholestasis, PTBD-related complications and patient survival were analyzed. RESULTS: 23 percutaneous transhepatic biliary drainages (PTBD) were placed in 16 children due to 18 biliary complications. The drains were customized individually by shortening and cutting additional holes. PTBD placement was performed with technical and clinical success in all children. 4 children received PTBD to bridge the time to retransplantation and surgical revision. One child received PTBD for successful treatment of anastomotic leakage. Long-term dilation of biliary stenoses was performed in 13 children using PTBD. One of these 13 patients showed recurrent stenosis during a median follow-up of 295 days. Bilirubin values decreased significantly after PTBD placement for biliary stenosis. One patient suffered from bacteremia after PTBD replacement. CONCLUSION: PTBD treatment for biliary complications after PLT is effective and safe.

Gelfoam for closure of large percutaneous transhepatic and transsplenic puncture tracts in pediatric patients.

PURPOSE: Evaluation of the efficacy and safety of Gelfoam for the closure of transhepatic or transsplenic parenchymal puncture tracts with large-bore sheaths in pediatric patients. MATERIALS AND METHODS: Between January 2012 and May 2013, 8 percutaneous transhepatic accesses and 3 percutaneous transsplenic accesses were closed using percutaneous Gelfoam in pediatric patients. The primary study endpoints to determine treatment efficacy and safety were patient survival, technical success defined as successful closure of the puncture tract without signs of bleeding, and complication rates. The secondary study endpoints were the occurrence of local and systemic inflammation. RESULTS: Overall survival was 100 % with a median follow-up of 256 days. The procedure was technically successful in 10 of 11 procedures. One patient suffered from bleeding, which was successfully managed by a single blood transfusion. No re-bleeding was detected during follow-up and no surgical interventions were necessary. No signs of local or systemic infections related to the Gelfoam application occurred. CONCLUSION: Percutaneous Gelfoam application is an effective and safe technique for the closure of transhepatic or transsplenic accesses in pediatric patients. KEY POINTS: Interventional closure of large transhepatic and transsplenic parenchymal accesses in children after interventional treatment is recommended to avoid bleeding. Gelfoam application does not cause artifacts in magnetic resonance imaging and does not increase the risk of local or systemic inflammation in comparison to permanent embolic agents. Thus, especially children under immunosuppressive therapy can benefit from the application of Gelfoam.

[Potential and limitations of modern embolization therapy]. / Möglichkeiten und Grenzen moderner Embolisationsverfahren.

Correct clinical and angiographic classification of vascular anomalies, including consideration of their flow pattern (high-flow versus low-flow), is the basis of accurate indications for minimally invasive therapy modalities such as embolization. Technical advancements and miniaturization of catheter materials (including steerable microwires, flow-directed microcatheters and detachable tips) gained access for embolotherapy to lesions anywhere in the body. The aim of embolization, which is mainly indicated for therapy of high-flow arteriovenous malformations, is the complete, permanent occlusion of the lesion nidus. Nowadays, embolotherapy is performed using permanent liquid embolization agents, in multiple staged sessions. This technique reduces complications such as ischemic necrosis and peripheral nerve lesions compared to alcohol embolization. Sole occlusion of the arterial inflow by surgical resection or interventional coil application is considered obsolete. The size of the lesion and the high treatment costs limit the use of embolotherapy.

Percutaneous management of postoperative bile leaks with an ethylene vinyl alcohol copolymer (Onyx).

PURPOSE: The management of postoperative bile leakage is challenging especially if the leak rises from the cut surface of the liver and endoscopic treatment fails. Percutaneous transhepatic treatment of bile leaks with biliary drainage is accepted but often requires long-term placement of the drains and is associated with treatment failures. This series evaluates selective embolization of bile ducts with an ethylene vinyl alcohol copolymer (Onyx) in patients with postoperative bile leaks as an alternative treatment option. MATERIALS AND METHODS: Between January and September 2012, five consecutive patients with persistent postoperative bile leaks underwent percutaneous transhepatic Onyx application and were analyzed regarding procedural management, complications and success rates. RESULTS: The persistent bile leaks were situated at the cystic stump (after cholecystectomy, n = 2), at the cut surface of the liver (after extended liver resection, n = 2) and at the surface of the liver after surgical exploration and perihepatic abscess (n = 1). Bile drainage alone (endoscopic or percutaneous) failed in all patients and open redo-surgery was deemed potentially harmful. Bilomas were externally drained in all patients before Onyx application. For the closure of bile leaks, Onyx was injected through a microcatheter in a previously built coil nest to keep Onyx in place. All bile leaks were initially closed immediately. In the 2nd week after Onyx embolization, 2 patients showed recurrent small bile leaks without clinical symptoms. In the 4th week after Onyx application, all leaks were closed. No complications occurred. CONCLUSION: All leaking bile ducts were initially closed immediately after Onyx application. In the 2nd week after Onyx application, 2 patients showed small bile leaks without clinical symptoms. All leaks were closed in the 4th week after Onyx application.

[Liquid embolic agents--Onyx as problem solver]. / Flüssigembolisate--Onyx als Problemlöser.

CLINICAL/METHODICAL ISSUE: Liquid embolic agents are used for permanent occlusion of capillaries but optimal administration properties are lacking. STANDARD RADIOLOGICAL METHODS: The lack of visualization by fluoroscopy and the risk of serious complications are disadvantages of conventional embolic agents, such as ethanol and Histoacryl. METHODICAL INNOVATIONS: Onyx is a liquid embolic agent consisting of ethylene vinyl alcohol copolymer dissolved in various concentrations of dimethyl sulfoxide (DMSO) and suspended micronized tantalum powder to provide contrast for fluoroscopy. PERFORMANCE: The physicochemical characteristics of Onyx allow controlled application, forming a defined cast and permanent occlusion. Disadvantages are the high costs. Furthermore, the solvent DMSO requires special catheter material and causes pain during Onyx application. ACHIEVEMENTS: Onyx has been primarily used for interventional neuroradiological treatment but peripheral applications are becoming increasingly more common. PRACTICAL RECOMMENDATIONS: Currently, Onyx is mainly used for embolotherapy of endoleaks after endovascular aortic aneurysm repair, for treatment of acute arterial bleeding and for treatment of arteriovenous malformations.

Degradable starch microspheres transarterial chemoembolisation (DSM-TACE) of HCC: Dynamic Contrast-Enhanced Ultrasonography (DCE-US) based evaluation of therapeutic efficacy using a novel perfusion software.

PURPOSE: To evaluate therapeutic efficacy of degradable starch microsphere (DSM)-TACE in hepatocellular carcinoma (HCC) using Dynamic Contrast-Enhanced Ultrasonography (DCE-US) based perfusion analysis. MATERIALS AND METHODS: A total of 60 DCE-US examinations were performed in 15 selected patients who underwent DSM-TACE with EmboCept®S for the treatment of advanced HCC. DCE-US was performed via i.v. application of ultrasound contrast media before and 24 hours post embolization. In addition DCE-US was performed with i.a. contrast application via the angiographic catheter right before and after the embolization. Microcirculation of embolized HCC lesions was quantified using a dedicated perfusion software by two experienced radiologists in consensus. RESULTS: Significant reduction of microvascularization (PE, WiAUC and WiR) was seen right after DSM-TACE and during 24 hour follow-up. Mean PE was 342.22 ± 97.80 prior to embolization, 59.28 ± 29.74 post embolization (p = 0.019) and 18.83 ± 7.03 during follow-up (p ≤ 0.01). Mean WiAUC was 1103.21 ± 432.05 prior to embolization 267.69 ± 151.80 post embolization (p = 0.023) and 105.10 ± 44.43 during 24 hour follow-up (p ≤ 0.01). The corresponding values for WiR were 224.91 ± 57.97 prior-, 38.14 ± 18.80 post embolization (p = 0.034) and 6.97 ± 2.68 during follow up (p ≤ 0.01). CONCLUSION: In this study, therapeutic efficacy of DSM-TACE in HCC using DCE-US based perfusion analysis could be demonstrated.

Real-time elastography of hepatic thermal lesions in vitro: histopathological correlation.

PURPOSE: To evaluate the reliability of elastography, a new ultrasonographic method, for delineating thermal lesion boundaries in porcine liver tissue by comparing lesion dimensions determined by real-time elastography with the findings at gross pathology. MATERIALS AND METHODS: A total of 15 thermal lesions with diameters ranging from 17 to 60 mm were created using radiofrequency ablation (RFA). Color-coded elastography was performed by one experienced examiner, using a 6 - 15 MHz high frequency linear transducer (LOGIQ E9, GE). Lesions were examined using B-mode and real-time elastography (RTE). Lesion detection, delineation and size were assessed using B-mode and RTE immediately after each thermal ablation ( < 5 min). Measurements of the sections representing the same image plane used for elastography were taken during pathologic examination and compared to the measurements obtained from the elastograms. RESULTS: In our sample a statistically significant correlation in vitro between RTE and pathological measurements with respect to the lesion's principal axis and area (r2 = 0.9338 long axis, r2 = 0.8998 short axis and r2 = 0.9676 area) was found. Overall, elastography slightly underestimated the lesion size, as judged by the digitalized pathologic images. CONCLUSION: These results support that RTE outperforms conventional B-mode ultrasound and could potentially be used for the routine assessment of thermal therapies.

[Plain abdominal radiograph - is there any additional clinical value based on the supine projection?]. / Konventionelle Abdomenübersichtsaufnahmen - welchen klinischen Nutzen hat die Aufnahme in Rückenlage?

BACKGROUND: To assess the diagnostic value of an additionally acquired plain abdominal radiograph in supine position. MATERIALS AND METHODS: Two experienced radiologists evaluated retrospectively 2148 consecutive patients having plain abdominal radiographs acquired in a tertiary care center. There were 1385 patients having an erect view and 763 patients with a left lateral decubitus view. All patients had a second examination in supine position. First the radiographs in erect or decubitus view were evaluated regarding the presence and details of pathological changes. After 4 weeks all radiographs including the supine view were evaluated again. Next to pathological changes the additional value of the supine projection was assessed. The results were compared and the additional diagnostic value using the supine view was noted. RESULTS: We evaluated 2148 patients having a plain abdominal radiograph (1325 men, 823 women, mean 58.9 years, range 15-96 years). The average age within the group acquired with left decubitus view was 61.1 years, while patients having an erect view had a mean age of 57.0 years. For the first evaluation we found pathological changes in 10.5% (decubitus view: 13.1%, erect view 9.5%; p = 0.01). The most frequent diagnosis was ileus (7.7%) followed by abdominal free air (2.4%). The results were confirmed during the second reading in 99.2%. In 3.5% (decubitus view 5.8%, erect view 2.2%) more anatomical structures were depicted considering the supine projection and the decubitus/erect projections. The anatomical information was in no case relevant for the diagnosis. CONCLUSION: Having the information of an supine view additionally to an decubitus/erect view increases the depiction of anatomical structures up to 5.8%. Nevertheless there was no additional diagnostic relevant information based on the supine view.

Evaluation of the microvascularization of pathologic parathyroid glands in patients with primary hyperparathyroidism using conventional ultrasound and contrast-enhanced ultrasound.

PURPOSE: The objective was to characterize the microcirculation of parathyroid adenomas using contrast-enhanced ultrasound (CEUS) and to evaluate if it can be used for diagnosis and localization of pathologic glands. PATIENTS AND METHODS: Thirty patients with primary hyperparathyroidism scheduled for parathyroidectomy were enrolled. Preoperatively, all patients underwent B-Scan sonography, Colour coded Doppler Sonography (CCDS), Power Doppler (PD) and CEUS. The diagnostic confidence concerning B-Scan, CCDS, PD and CEUS was classified into six grades (0: no adenoma; 5: adenoma). RESULTS: Using CEUS, all adenomatous glands showed a typical dynamic microvascularization. B-Scan showed a mean grade of 2.18, CCDS 2.29, PD 2.33, CEUS 4.29 (6-9 MHz transducer) and 3.52 (6-15 MHz). The differences between CEUS and conventional sonography were all statistically significant (p < 0.05). CEUS noted a sensitivity of 98.4% and specificity of 98.4% for the detection of adenomatous glands. CONCLUSION: CEUS facilitates the detection and diagnosis of pathologic parathyroid glands due to their typical microvascularization.

[Contrast-enhanced sonography. Therapy control of radiofrequency ablation and transarterial chemoembolization of hepatocellular carcinoma]. / Kontrastmittelverstärkte Sonographie. Zur Therapiekontrolle von Radiofrequenz-ablation und transarterieller Chemoembo-lisation beim hepatozellulären Karzinom.

Due to the imaging of dynamic perfusion, hepatocellular carcinoma can be detected with a sensitivity of >90% using contrast-enhanced sonography. The characterization of liver tumors with contrast-enhanced sonography is comparable to the diagnostic accuracy of contrast-enhanced computed tomography. The dynamic detection of microvascularization with contrast-enhanced sonography allows the differentiation between vascularized tumors and non-vascularized necrotic lesions before, during and after transarterial chemoembolization or percutaneous radiofrequency ablation. Image fusion with volume navigation can be useful in the followup control.