Intra-individual randomised comparison of gadobutrol 1.0 M versus gadobenate dimeglumine 0.5 M in patients scheduled for preoperative breast MRI.

OBJECTIVE: To demonstrate non-inferiority of gadobutrol versus gadobenate dimeglumine by intra-individually comparing 0.1 mmol/kg body weight doses for contrast-enhanced breast magnetic resonance imaging (MRI) and prospectively evaluating lesion detection and characterisation in a multicentre trial. METHODS: Two identical breast MRI examinations were performed in 72 patients with biopsy-proven breast cancer, separated by 1-7 days. Gadobutrol 1.0 M or gadobenate 0.5 M were administered in a randomised order. Lesion detection and characterisation were performed by two independent blinded readers. Lesion tracking, which compared on-site readings and histology from surgery or biopsy, was performed by a third reader. Differences in lesion detection and characterisation were compared between the two contrast agents. RESULTS: Among 103 lesions, 96 were malignant and 7 were benign. No difference in lesion detection was identified between the contrast agents (82.33 % for gadobutrol, 81.60 % for gadobenate). Assessment of sensitivity in lesion characterisation and Breast Imaging Reporting and Data Systems showed no difference between gadobutrol (92.63 %) and gadobenate (90.53 %). Regarding morphology, there was more non-focal enhancement for gadobutrol than for gadobenate (P = 0.0057). CONCLUSION: Non-inferiority of gadobutrol compared with gadobenate was demonstrated for breast lesion detection and sensitivity in lesion characterisation in breast MRI.

[Torsion of a pedunculated subserous myoma - a rare differential diagnosis of the acute abdomen]. / Torsion eines gestielten subserösen Myoms - eine seltene Differentialdiagnose des akuten Abdomens.

We report about a rare case of acute abdomen in a 43 years old female patient who noticed a sudden onset of severe lower abdominal pain, increasing in strength within a few hours. The transabdominal and transvaginal ultrasound showed an enlarged leiomyomatous uterus with a questionable torsion of a pedunculated subserous leiomyoma. The following magnetic resonance imaging confirms this diagnosis. During the laparoscopy a myomectomy has been performed.

[Pelvic congestion syndrom]. / Beckenvenensyndrom.

We describe imaging findings and interventional therapy of a 37-year old female patient suffering from chronic pelvic pain with associated vulvar varicosis. MR-angiography showed multiple varices in the left hemi-pelvis, a dilated draining vein from the left ovary as well as a left-sided vulvar varicosis, which was clinically evident. In addition, the MRI suggested insufficiency of the great saphenous vein with varicosis of its tributaries. After crossectomy and infragenual stripping of the great saphenous vein, we proceeded with a left phlebectomy and ligation of the supplying veins. Due to post-operative persistence of the vulvar varicosis the patient underwent coil-embolisation and liquid sclerotherapy (Aethoxysklerol) of the varicose pelvic veins and the left ovarian vein with good results.

[Non-invasive assessment of the perfusion of wounds using power Doppler imaging: vacuum assisted closure versus direct wound closure]. / Beurteilung der Perfusion vakuumversiegelter Wunden mittels Power Doppler.

AIM: The goal of our study was to assess the perfusion in wounds treated by vacuum assisted closure (VAC) compared to primary wound closure. METHOD: Power Doppler Ultrasound (PDUS) was carried out under standardised conditions in 15 VAC-treated and 10 primarily closed wounds as well as on altogether 25 intraindividual reference areas. All data were sent to a work station for post-processing to determine the perfused area. Statistical data analysis was performed with the Mann-Whitney test. RESULTS: Both VAC-treated wounds and primarily closed wounds showed a significant increase of the perfusion when compared to the intraindividual reference area (p < 0.0001). In VAC-treated wounds, a markedly increased perfusion was measured compared to the wounds closed primarily (p < 0.0001). Perfusion decreased during treatment, but in two VAC-treated wounds, an initial increase of the perfusion was observed. Both these wounds were grossly infected. CONCLUSION: PDUS allows the quantification of the differences in wound perfusion. This can be helpful in the detection of progressive local wound infections.