The use of contrast-enhanced ultrasound for the evaluation of solid abdominal organ injury in patients with blunt abdominal trauma.

BACKGROUND: The evaluation and management of blunt abdominal trauma is primarily nonoperative. Previous attempts to identify parenchymal solid-organ injury with sonography have been unsatisfactory. The use of Perflutren Lipid Microsphere (Definity) contrast-enhanced ultrasound (DUS) may provide an additional modality for evaluation of solid-organ injury with decreased risk of radiation exposure and contrast-related complications. METHODS: Injured patients admitted to a state-designated Level I trauma center (January 2008 to July 2009), who showed evidence of solid-organ injury after blunt abdominal trauma on initial computed tomography (CT) were eligible for entry into the study. Patients underwent DUS examinations within 12 hours of initial CT. Ultrasound images were then compared with findings of CT for organ location, size, and grade of injury. RESULTS: Twenty patients with evidence of solid-organ injury on CT were evaluated with DUS. DUS correctly identified five of eight liver lesions, with a sensitivity of 62.5%. DUS correctly identified all nine splenic lesions demonstrating a sensitivity of 100%. DUS correctly identified one of two kidney injuries, demonstrating a sensitivity of 50%. Overall, the positive predictive value for all solid-organ injuries was 100%, with negative predictive value of 20%. The overall sensitivity for DUS was 79% (15 of 19 patients), and specificity was 100% (15 of 15 patients). CONCLUSION: Contrast-enhanced sonography is a potential new modality for the evaluation of solid-organ injury for patients with blunt abdominal trauma. With further research, DUS may provide a safe and accurate alternative to CT. LEVEL OF EVIDENCE: Diagnostic study, level IV.

The rate of imaging-histologic discordance of benign breast disease: a multidisciplinary approach to the management of discordance at a large university-based hospital.

BACKGROUND: Suspicious abnormalities seen on screening mammography require further imaging and histologic analysis. Any imaging-histologic discordance necessitates further imaging or surgical excision. METHODS: A retrospective review of all patients with evidence of benign breast lesions having imaging-histologic discordance from January 2005 to December 2007 was compared with the results of a previous study from January 2002 to September 2004. RESULTS: Of 1,264 benign cases, 25 patients had discordance (2%). Surgical intervention was required in 14 of 25 of all discordant cases (56%). One discordant case was found to be malignant after open excision, giving a false-negative rate of 4%. Previous data reported an 8.8% discordance rate, with 65.2% requiring surgical intervention and a false-negative rate of 29.3%. On comparison, the rate of discordance and false-negative image-directed core biopsies were decreased (P<.05). CONCLUSIONS: An organized multidisciplinary approach to imaging-histologic discordance in benign breast disease decreases the rate of discordance and unnecessary surgical interventions.