RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
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We reviewed the results of US-guided fine-needle biopsies of peripheral pulmonary, pleural, mediastinal and chest wall lesions in 200 patients. Sufficient material for cytological analysis was obtained in 95%, 92%, 96% and 100%, respectively. Sensitivity was 88%, 94%, 96%, 100% and specificity 89%, 100% and 100%, respectively. ⋯ All but two of the histological samples (92%) were adequate for diagnostic purposes and a correct diagnosis was established in 86% (19/22) of these. 8 patients (4%) with pleural or pulmonary targets had minor complications (5 pneumothorax, 3 haemoptysis), which did not require treatment. Cutting needle biopsies and biopsy of mediastinal lesions proved safe. Due to the many advantages US may be considered for guidance in peripheral larger-sized pulmonary lesions, particularly those abutting the pleura, and also in pleural, thoracic wall and mediastinal masses.
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MR examinations were performed in 9 patients suffering from severe pain of the hip during the third trimenon without any relief after birth. Pathologic signal changes could be observed in 11 hips (oedema in the region of the femoral head and neck (n = 8); avascular necrosis of the femoral head surrounded by bone marrow oedema (n = 3)). ⋯ In two patients, treated conservatively, markedly delayed healing was evident. MR imaging is the modality of choice for early diagnosis as well as follow-up of therapy of the bone marrow oedema syndrome or avascular necrosis and can be performed already during pregnancy.
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Comparative Study
[Diagnosis and staging of blunt kidney trauma. A comparison of urinalysis, i.v. urography, sonography and computed tomography].
In a retrospective study of 1230 patients with blunt abdominal or flank trauma, the results of microscopic urinalysis, urography, sonography, and computed tomography in the diagnosis and staging of renal injuries were compared. Haematuria was present in 98% of renal lacerations and in all pedicle injuries, whereas among 1038 patients without haematuria only one small laceration was found. The degree of haematuria showed no correlation with the severity of renal injury. 92 renal injuries were diagnosed radiologically, including 58 lacerations, 31 contusions, and three pedicle injuries. ⋯ Sensitivity in the diagnosis of clinically relevant injuries (lacerations and pedicle injuries) was 98% (specificity: 99%), when both modalities were combined. Based on the results of our study, we suggest the use of sonography as a screening modality in blunt abdominal or flank trauma, and additional urography in case of haematuria. Computed tomography is the method of choice for exact staging of suspected renal injury.