[MR-imaging of the breast at 0.5 Tesla: menstrual-cycle dependency of parenchymal contrast enhancement in healthy volunteers with oral contraceptive use?]. / MR-Mammographie bei 0,5 Tesla: Menstruationszyklusabhängigkeit der Kontrastmittelanreicherung unter hormoneller Kontrazeption?

INTRODUCTION: To evaluate changes of contrast medium enhancement of the breast parenchyma due to menstrual cycle in healthy volunteers with oral contraceptive use in MR-imaging of the breast. MATERIAL AND METHODS: 15 healthy volunteers (age: 22 - 36, mean 28,2) without breast disease were examined two times during one menstrual cycle (days 7 - 14 and days 21 - 2). Two volunteers were examined only in the second part of the cycle (days 21 - 2). All volunteers used oral contraceptives for more than 6 month continuously. Examinations were performed with a 0,5 T magnet (dynamic 3D-gradient echo protocol with subtraction postprocessing). We evaluated the number of enhancing foci and the parenchymal contrast medium enhancement during the different phases of the cycle by region of interest. RESULTS: Only a total of two enhancing foci were found in 2 of 17 volunteers. Time/signal intensity diagrams in these both cases were not suspicious (< 80 % initial signal increase after of contrast medium injection, no wash-out phenomenon) and sonography of the breast in these two cases was inconspicuous. Contrast medium enhancement of breast parenchyma in cycle days 7 - 14 (mean enhancement: 0.12 - 0.26, minutes 1 - 9 p. i.) was not significantly different (p = 0.2209; Wilcoxon signed rank test) from cycle days 21 - 2 (mean: 0.13 - 0.32). CONCLUSION: Menstrual cycle dependency of parenchymal contrast medium enhancement seems to be of minor relevance for premenopausal women with use of oral contraceptives.

[Percutaneous core-needle biopsy of palpable breast tumors. Do we need ultrasound guidance?]. / Perkutane Hochgeschwindigkeitsstanzbiopsie palpabler Brusttumoren: Ist die Sonographie notwendig?

INTRODUCTION: Percutaneous core-needle biopsy is widely accepted for preoperative histologic assessment of suspicious breast lesions. The purpose of this study was to asses the impact of continuous sonographic guidance on diagnostic accuracy of large core needle biopsy of palpable breast lesions. METHOD: We analysed 170 breast lesions in a retrospective study. Percutaneous breast biopsies were performed by using a biopsy gun with 14-gauge needles. Eighty-eight biopsies were performed under continuous ultrasound guidance (group II) and 82 biopsies without ultrasound documentation of the procedure (group I). Core needle diagnoses were compared with the patients final tissue diagnosis as based on surgical excisional biopsy. RESULTS: In patient group I, 17 lesions were categorized as core breast biopsy cancer misses (sensitivity 79 %). The sensitivity in this group showed an obvious dependency on tumor size. Among the 17 false negative lesions, 13 lesions were 3 cm in mean diameter or smaller. Two false negative findings occurred in group II (sensitivity 98 %), with a tumor size of 0.5 and 1.0 cm. CONCLUSION: Sonographic guidance is indispensable to ensure adequate diagnostic accuracy for core-needle biopsy of palpable breast lesions.

[Value of triple phase helical CT for the detection of hepatocellular carcinoma in cirrhotic liver]. / Stellenwert der dreiphasischen Spiral-CT in der Detektion des hepatozellulären Karzinoms bei Leberzirrhose.

PURPOSE: Purpose of this study was to determine the value of the delayed-phase (DP) of helical CT in the detection of hepatocellular carcinoma (HCC) in cirrhotic liver in comparison to the arterial phase (AP) and the portal-venous phase (PP). MATERIAL AND METHODS: 51 patients with liver cirrhosis and suspected HCC were examined by triple-phase helical-CT (THCT). Images were standardized and obtained 20 seconds - AP, 60 - 70 seconds - PP, and 300 seconds - DP after injection of 140 ml of intravenous iodinated contrast material. Pictures were reviewed by two experienced radiologists for typical intrahepatic lesions. First, each single phase of contrast distribution were seen separately. Then all contrast phases were reviewed together. RESULTS: In 17 patients 49 typical lesions were found, histological work-up was performed, whereas in 34 patients clinical follow-up of at least 6 months was obtained. The arterial phase (AP) itself depicted 55 % of these lesions, whereas the portal-venous phase (PP) depicted 57 % and the delayed phase 78 %. DP showed a significantly higher detection rate in comparison to the PP (p = 0.008). By performing a biphasic helical CT 40 lesions would have been detected with AP and PP, whereas all 49 lesions would have been visualised by combining AP and DP. This means a significantly higher detection rate for AP/DP instead of using AP/PP (p = 0.031). CONCLUSION: Additionally to the AP and PP, a delayed phase should be performed when cirrhosis is present. Even though AP and DP depicted all HCC's in this study, the PP provides undispensable additional information, so that, in our opinion, a THCT should be given preference when HCC is suspected.

[MRI in the preoperative diagnosis of chronic sinusitis: comparison with CT]. / MRT in der präoperativen Diagnostik der chronischen Sinusitis im Vergleich mit der CT.

PURPOSE: To determine the value of MRI in the preoperative evaluation of chronic paranasal sinusitis and to compare the results with CT and intraoperative findings. METHOD/MATERIALS: 42 patients with clinical signs of chronic paranasal sinusitis underwent MRI after CT evaluation on one day, with subsequent functional endoscopic sinus surgery on the next day. Coronary CT was obtained with 5-mm slices and table-feed in the prone position, while MRI was performed in the supine position with coronary T2-TSE + pd and coronary and transverse HASTE, each with 5-mm slice thickness. Aquisition time in MRI was less than 8 minutes. Two radiologists reviewed the CT and MRI scans for signs of sinusitis and detection of anatomical landmarks. The results were correlated with the intraoperative findings. RESULTS: MRI offered no artifacts of dental work and showed more often high quality pictures than CT. CT and MRI demonstrated a good correlation in the detection of mucosal pathologies (kappa = 0.46-0.87) and anatomic variants (kappa = 0.55-0.86). All important anatomical structures could be evaluated sufficiently with MRI for preoperative management. Both diagnostic tools showed an unsatisfactory correlation with intraoperative findings in the ethmoidal complex and maxillary sinus (tau = -0.08-0.3). CONCLUSIONS: MRI is a fast and reliable alternative to preoperative CT in examining paranasal sinuses and offers a good visualization of mucosal changes. CT and MRI both give an unreliable representation of the ethmoidal complex.