Feasibility of transrectal ultrasonography for assessment of cervical cancer

PURPOSE

To retrospectively compare the maximum target width and target thickness in patients with locally advanced cervical cancer between magnetic resonance imaging (MRI) and transrectal ultrasonography (TRUS) in the course of primary radiochemotherapy.

PATIENTS AND METHODS

T2-weighted MRI and TRUS were performed on patients with locally advanced cervical cancer at the same timepoint-either at the time of diagnosis, or at the time of brachytherapy before or after insertion of the applicator. Patients treated from 2009 to 2011 were selected for this study based on the availability of MRI and TRUS at the defined time points. The target was defined as the complete macroscopic tumor mass and the remaining cervix and was measured on transversal planes. Descriptive statistics and a linear regression analysis were performed for the groups.

RESULTS

Images from 17 patients were available for analysis. Mean maximum target width was 4.2 ± 0.83 cm and 4.2 ± 0.79 cm for MRI and TRUS, respectively. Mean maximum target thickness was 3.3 ± 1.03 cm and 3.1 ± 1.15 cm for MRI and TRUS, respectively. Linear regression analysis for target width and thickness between TRUS and MRI demonstrated a correlation with R(2) = 0.842 and R(2) = 0.943, respectively.

CONCLUSION

The feasibility of TRUS for the assessment of local target extension could be demonstrated. Comparison of the target width and thickness showed a high correlation between TRUS and MRI, indicating the potential of TRUS for target definition in image-guided adaptive brachytherapy.

Standardization of three-dimensional images in obstetrics and gynecology: consensus statement

Standardization of the display of ultrasound images has so far only been achieved in transabdominal two-dimensional (2D) sonography. In contrast, there is a lack of uniformity in the demonstration of transvaginal 2D ultrasound images. The described non-uniformity frequently leads to confusion in the assessment of an image, in particular with regard to the accurate anatomical assignment of left/right and dorsal/ventral. Three-dimensional (3D) sonography offers a unique opportunity to avoid this confusion in the interpretation of ultrasound images, because, independent of primary volume acquisition, the volume can always be rotated so that the stored object can at all times be visualized in a known anatomical position, rendering it of no importance whether the image acquired transvaginally is demonstrated from above or from below. This will also be important in allowing fusion of ultrasound image data with computed tomographic, magnetic resonance and/or positron emission tomography images. In this article we suggest that standardization of transabdominal and transvaginal 3D images does not only provide the inexperienced physician/sonographer with a guide to spatial orientation, but also serves to avoid erroneous topographical interpretations.

Networking of three dimensional sonography volume data

Three-dimensioned (3D) sonography enables the examiner to store, instead of copies from single B-scan planes, a volume consisting of 300 scan planes. The volume is displayed on a monitor in form of three orthogonal planes--longitudinal, axial and coronal. Translation and rotation facilitates anatomical orientation and provides any arbitrary plane within the volume to generate organ optimized scan planes. Different algorithms allow the extraction of different information such as surface, or bone structures by maximum mode, or fluid filled structures, such as vessels by the minimum mode. The volume may contain as well color information of vessels. The digitized information is stored on a magnetic optical disc. This allows virtual scanning in absence of the patient under the same conditions as the volume was primarily stored. The volume size is dependent on different, examiner-controlled settings. A volume may need a storage capacity between 2 and 16 MB of 8-bit gray level information. As such huge data sets are unsuitable for network transfer, data compression is of paramount interest. 100 stored volumes were submitted to JPEG, MPEG, and biorthogonal wavelet compression. The original and compressed volumes were randomly shown on two monitors. In case of noticeable image degradation, information on the location of the original and compressed volume and the ratio of compression was read. Numerical values for proving compression fidelity as pixel error calculation and computation of square root error have been unsuitable for evaluating image degradation. The best results in recognizing image degradation were achieved by image experts. The experts disagreed on the ratio where image degradation became visible in only 4% of the volumes. Wavelet compression ratios of 20:1 or 30:1 could be performed without discernible information reduction. The effect of volume compression is reflected both in the reduction of transfer time and in storage capacity. Transmission time for a volume of 6 MB using a normal telephone with a data flow of 56 kB/s was reduced from 14 min to 28 s at a compression rate of 30:1. Compression reduced storage requirements from 6 MB uncompressed to 200 kB at a compression rate of 30:1. This successful compression opens new possibilities of intra- and extra-hospital and global information for 3D sonography. The key to this communication is not only volume compression, but also the fact that the 3D examination can be simulated on any PC by the developed 3D software. PACS teleradiology using digitized radiographs transmitted over standard telephone lines. Systems in combination with the management systems of HIS and RIS are available for archiving, retrieval of images and reports and for local and global communication. This form of tele-medicine will have an impact on cost reduction in hospitals, reduction of transport costs. On this fundament worldwide education and multi-center studies becomes possible.

Ultrasound evaluation of fetal spine length between 14 and 24 weeks of gestation

The objective of our study was to establish a nomogram of fetal spine length in the second trimester of pregnancy by using two and three-dimensional ultrasound. Fetal spine length was measured prospectively by means of transabdominal ultrasonography in 114 normal singleton pregnancies between 14 and 24 weeks of gestation. Regression analyses were performed on spine length, gestational age, biparietal diameter and femur length. Supplementary three-dimensional ultrasound to assess fetal spine length was performed in 75 cases. Fetal spine length, as a function of gestational age, was expressed by the following regression equation: spine length (mm) = -47.2 + 7.16 x gestational age (weeks), with a Pearson correlation coefficient of R(2)=0.956. The results of the measurements revealed no difference between two and three-dimensional ultrasound. Our study defines the normal limits of fetal spinal length in the second trimester of pregnancy and demonstrates a high correlation between spinal length, gestational age, biparietal diameter and femur length. However, there are still too few prenatal research data to say whether and to what extent an assessment of fetal spine length at this stage of pregnancy can be used for prenatal diagnosis of congenital syndromes, which, among other manifestations, are marked by fetal spine lengthening or shortening.

Three-dimensional ultrasonographic imaging of fetal tooth buds for characterization of facial clefts

The purpose of this prospective study was to investigate whether the antenatal characterization of fetal facial clefts can be improved by three-dimensional ultrasonographic visualization of fetal tooth buds. Between January 1996 and June 1998, seventeen consecutive fetuses with facial clefts were examined for fetal maxillary tooth buds in the cleft area using three-dimensional multiplanar reconstruction. It was possible in all cases to classify the clefts either as cleft lip alone or unilateral cleft lip and palate or bilateral cleft lip and palate. Three-dimensional computed tomography and histological jaw sections of three stillborn infants were produced in order to examine the correlation between the sonographic, radiographical and histological findings. The prenatal characterization of the facial clefts by means of a visualization of the tooth buds showed to be accurate postnatally in all cases. The sonographic proof of tooth buds might gain increasing importance as this technique seems to facilitate and improve the prenatal classification of suspected facial clefts.

Three-dimensional ultrasound evaluation of fetal tooth germs

OBJECTIVE

A total of 126 genetic syndromes are associated with oligodontia or anodontia. The most frequent of these are ectodermal dysplasias, all types of facial cleft and Down's syndrome. With the advent of three-dimensional ultrasonography, accurate assessment of many fetal abnormalities has become possible. The objective of this study was to determine the effectiveness of three-dimensional ultrasonography in the visualization of fetal tooth germs.

DESIGN

We examined 45 women with singleton pregnancies between 16 and 36 gestational weeks who were undergoing routine ultrasound check-ups for fetal tooth germs with conventional two-dimensional ultrasonography, followed by three-dimensional ultrasonography using multiplanar reconstruction.

RESULTS

In the 45 fetuses studied, fetal tooth germs were visualized at the first attempt in 36 cases (80%). In the group of fetuses aged between 19 and 36 weeks of gestation, the overall detection rate in both jaws was at least 86% for three-dimensional ultrasonography, compared to at least 56% for two-dimensional ultrasonography.

CONCLUSIONS

Three-dimensional ultrasonography was clearly superior to conventional ultrasonography in the visualization and evaluation of fetal tooth germs. Three-dimensional ultrasonography therefore has a potential for enhanced visualization of fetal tooth germs and may aid in the antenatal detection of syndromes associated with oligodontia or anodontia.

Endometrial volume change during spontaneous menstrual cycles: volumetry by transvaginal three-dimensional ultrasound

OBJECTIVE

At present, only limited data are available on endometrial volume during the menstrual cycle. Most of these studies deal with animal models and use magnetic resonance imaging for volume measuring. The application of three-dimensional ultrasound in endometrial volume estimation is the subject of this study.

SETTING

Patients visiting the outpatient unit of the division of endocrinology and reproductive medicine of a university hospital.

PATIENT(S)

Twenty patients with a history of a normal menstrual cycle were selected.

INTERVENTION(S)

Ultrasound examinations were performed during a single menstrual cycle in addition to routine laboratory tests.

MAIN OUTCOME MEASURE(S)

Uterus-endometrial volume ratio.

RESULT(S)

Data from 18 patients could be evaluated. In 81 examinations the endometrium volume could be determined. Mean endometrial volume measured by three-dimensional ultrasound was 1.23 cm3. Mean uterus volume was 48.93 cm3. The change of the uterus-endometrial volume ratio showed a good correlation with the day of menstrual cycle. Quadratic regression analysis of volume and cycle length was R2 = 0.432.

CONCLUSION(S)

Three-dimensional ultrasound allows assessment of volume data of the female internal genitalia. In this study changes of the endometrial volume in menstrual cycles were measured. Additional studies are required to give information on the clinical impact of this new technique of endometrial volume estimation.

Intrauterine device localization by three-dimensional transvaginal sonography

Our objective was to investigate the possible role of three-dimensional transvaginal ultrasound in the visualization of an intrauterine device (IUD) for routine follow-up after insertion. A total of 96 women were examined after insertion of a TCu380A IUD. Three-dimensional ultrasonographic imaging was carried out using a special vaginal probe and a commercially available ultrasound machine at a mean interval of 22 days after insertion. Complete simultaneous imaging of all parts of the IUD was possible in 95% of cases. In the three-plane mode, all parts of the IUD could be visualized in 64% and in a further 30 cases this was possible only after volume rendering. In two women, incomplete opening of the two arms of the device was demonstrated. In one of these cases, the entire IUD was displaced into the cervical canal. In another case, an intrauterine pregnancy was found together with an IUD in the correct position. Three-dimensional ultrasound provides useful information on the location of the IUD following insertion. It enables imaging of the entire IUD, i.e. the shaft and the arms, simultaneously. Additionally, the examination time can be kept to a minimum with this new technique.

Three-dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology

A new technique that combines saline contrast hysterosonography with three-dimensional surface rendering for the visualization of uterine intracavitary pathologies is described. A total of 32 patients suspected of having uterine cavity pathologies on the basis of previous ultrasonography, hysterosalpingography or hysteroscopy were involved in the study. They were examined by three-dimensional high-frequency endovaginal probes (Combison 530, Kretztechnik, Zipf, Austria), with normal saline used as an expander and contrast medium. Three perpendicular planes could be evaluated simultaneous, and surface renderings were readily available. Following the instillation of normal saline, the uterine cavity appears as an echo-free, well-defined structure, and the endometrium appears as an echogenic homogeneous lining around the cavity. Data acquisition time is short and images can be stored for later evaluation. Surface rendering of polypoid structures shows echogenic masses on a pedicle protruding into the uterine cavity. Submucous fibroids appear as mixed echogenic sites bulging into the cavity. Intrauterine synechiae appear as bands of varying thickness traversing the uterine cavity. Simultaneous display of the zone of interest in three perpendicular planes enhances imaging capabilities, while surface rendering provides a comprehensive overview of the surface area of the findings and their topographical orientation. Further research using this new technique is required to document its real contribution to ultrasonographic imaging.

Antenatal depiction of fetal digits with three-dimensional ultrasonography

OBJECTIVE

The effectiveness of three-dimensional ultrasonography in visualizing fetal digits was examined.

STUDY DESIGN

The digits of 72 fetuses, including 2 with skeletal dysplasia, were examined prospectively with both conventional and three-dimensional ultrasonography.

RESULTS

Complete visualization of all fetal digits was obtained more often with three-dimensional ultrasonography than with two-dimensional ultrasonography.

CONCLUSION

Three-dimensional ultrasonography has the potential to facilitate depiction of fetal digits, which may enhance prenatal identification of fetal malformations and chromosomal abnormalities in high-risk pregnancies.

Fetal lung volume determination by three-dimensional ultrasonography

OBJECTIVE

Pulmonary hypoplasia is common in compromised pregnancies. However, prenatal diagnosis by volume measurement has not become routine until now. The performance of three-dimensional ultrasonography in fetal lung volume determination was evaluated in this study.

STUDY DESIGN

In a total of 78 singleton pregnancies 108 measurements were performed. Lung volume was calculated by subtraction of the fetal heart volume from the volume of the fetal thorax.

RESULTS

Linear regression of transformed fetal lung volume growth gave best results (R2 = 0.77, p < 0.001), ranging from 2.8 ml at 14 weeks' gestation to 148 ml at term.

CONCLUSION

Three-dimensional ultrasonography provides not only access to surface rendered images but it also enables more sophisticated volume measurements. In this study three-dimensional ultrasonography provided fast, easy access for volume estimation of the fetal lung. This technique can be used to reasonably predict fetal lung volume.

Three-dimensional ultrasound in diagnosing phocomelia

Deformations of the extremities with limb reduction are rare congenital defects which affect one in 1692 live babies. Three-dimensional ultrasound can be of value in the prenatal diagnosis of such deformities. We present a case of upper phocomelia and congenital thrombocytopenia (TAR syndrome). Visualization of the upper extremities was achieved by three-dimensional ultrasound after surface and volume rendering. This new technique allows imaging not only of surfaces like the fetal skin, but also of internal structures like the fetal skeleton.

[Use of sonography at the peripheral hospital in the diagnosis of kidney tumors]

33 kidney tumours were detected in 15,500 routine scans of the upper abdomen. 13.7 per cent of these tumours were asymptomatic at the time of diagnosis. The size of these accidentally detected tumours was evidently smaller than in the case of symptomatic ones and the patients were younger at the time of diagnosis. The diagnosis was falsely positive in one case and falsely negative in 3 cases. In 2 cases of incorrect negative findings the sonographic diagnosis was hydronephrosis, but IVP and cytology of the specimen proved that these tumours were urothelial carcinomas. Apparently the weak point in sonographic diagnosis is the diagnosis of urothelial carcinomas. In cases of suspected kidney tumour or a sonographic diagnosis of hydronephrosis additional diagnostic methods must be undertaken. Our results show that adequate and cost-effective diagnostic information in the detection of kidney tumours is obtained in the majority of cases by sonography and urography.

Prenatal diagnosis of fetal malformations by ultrasonography

Ultrasonography is today able to detect many details of the fetal anatomy, so that prenatal diagnosis of malformations becomes possible. However, as 60% of all detected fetal abnormalities develop spontaneously, a screening program is recommended. At least two ultrasonic examinations should be performed. To cope with the huge number of examinations obstetricians in their offices are integrated in this program. Women carrying fetuses with identified or suspected anomalies are sent for further evaluation, management, and counseling to special clinics. The task is to differentiate between lesions which are incompatible with postnatal life, lesions which will necessitate a supporting person for the life of the patient, and lesions which are correctable by surgery. To gain more experience, close cooperation with neonatologists, pediatric surgeons, neurologists, and geneticists is recommended. The first advantages of early prenatal diagnosis have been elective cesarean and reduction of postnatal evaluation and treatment required.

[Obstetric and gynecologic ultrasonic diagnosis]

The possibilities and advances of sonography in obstetrics and gynecology are discussed.

[Diagnostic sonography of the female breast]

The female breast can be easily examined by sonography due to its anatomical site. Today water-coupling methods or real-time scanners with high transducer frequency are the procedures of choice. The sonographic picture of the normal breast is described and a discussion presented of the criteria on which the differential diagnosis between cystic and solid lesions is based. The domain of sonography is the demonstration of cystic lesions as from a diameter of 3 mm. Solid lesions must be bigger to become demonstrable by sonography. Sonography is at present incapable of replacing mammography as a screening method for the early detection of breast cancer for several reasons. Primarily one has to spend at least half an hour for an exact examination of both breasts. A more serious disadvantage, however, is the fact that the majority of breast cancers demonstrated by sonography is far beyond the early stages. It was, moreover, observed that the sonographic appearance of the tumour was dependent on the cellular content of the tumour as well as the connective tissue density. Tumours with a high cellular content are more easily penetrable by ultrasonic waves and might, therefore, be misinterpreted as being a benign lesion. On comparing mammography and sonography it is interesting to note that tumours in a dense breast are more easily detectable by sonography, whilst tumours in a breast rich in fatty tissue are more easily demonstrated by mammography.

[Ultrasonic diagnosis in cervical pregnancy (author's transl)]

The cervical pregnancies are most times complicated by severe uterine haemorrhages which can be stopped generally only by hysterectomy. Ultrasonic diagnosis provides new possibilities in diagnosing this dangerous localization of pregnancy prior to the onset of clinical symptoms. The characteristic sonographic findings of two cases are discussed: one early and one advanced case, both were symptomless. Although in rare cases a delivery at term could be observed, the termination of pregnancy seems to be indicated in cases of a doubtless ultrasonic diagnosis.

[Comparative determination of the vesico-urethral angle in incontinence via ultrasound and lateral urethro-cystogram (author's transl)]

Pre-operative diagnostic procedures in evaluating stress urinary incontinence in women became increasingly important within the last years. In many clinics the measurement of the posterior vesico-urethral angle using lateral urethro-cystograms has become an eminent criterion for the selection of the operative method applied. Until now, this angle could be measured by employing X-ray examination techniques. In this paper, an ultrasonic examination with the same accuracy as in X-ray. The technique of both methods and their advantages and disadvantages are discussed.

[The place of sonography in the diagnosis of recurrence of malignant gynaecological tumours (author's transl)]

The scope of sonography in the diagnosis of tumour recurrence is discussed on the basis of 134 patients with suspected recurrence of malignancy. In 67 cases recurrence was verified by means of ultrasonic diagnosis. In 63 cases the tentative diagnosis proved to be negative. In the remaining 4 cases the examination result was equivocal. The ultrasonic results were compared with physical examination, I.V.P., scintigraphy, histological examination of specimens of second-look operations and curettages, and autopsy material. It is pointed out that small tumours posterior to the urinary bladder can be overlooked because of the enhancement caused by the impedance mismatch between the fluid-filled bladder and the solid structures posterior to it. In cases of local and lymphonodal recurrent tumour the examination is extended to the upper abdomen to detect possible hydronephrotic changes. Two different echographic patterns can be observed after primary irradiation of cervical and endometrial cancer. The enlarged uterus with inhomogeneous structures is more likely to be a recurrent tumour. A more "cystic" appearance of the enlarged organ would suggest a mucometra caused by cervical occlusion. In recurrent ovarian tumours ascites is detectable which sometimes even disturbs the examination owing to the extreme curvature of the abdominal wall hindering a sufficient coupling of the probe. Ultrasound is applied with good results in irradiation planning and for the monitoring of therapeutic results.

[Pregnancy-conditioned dilatation of the calyceal system-sonographic diagnosis and urologic control (author's transl)]

Ultrasonic diagnosis provides the possibility without any irradiation hazards to follow-up the urinary excreting system in pregnancies as often as necessary. Thus it becomes possible to detect the true percentages of pregnant women with dilatation of the calyceal system, and to evaluate the course of dilatation in those women examined at different intervals. There exists as well the possibility to avoid urinary tract infections by an intensive urologic surveillance in such cases.

[Comparison of different methods for estimating fetal weight by cephalo- and abdominometry (author's transl)]

To check the accuracy of different published methods of fetal weight estimation based on head and abdominal parameters, all methods were used in every individual case in 123 pregnancies. It became apparent that the single methods gave the best results in different indications. As far as normal fetal development at term is concerned the best results were achieved by estimating the weight from the biparietal and the abdominal diameters whereas in macrosomy the prediction of fetal weight became much more precise in using head and abdominal circumferences. In premature and small-for-date infants, however, the best results were recorded if only the abdominal circumference was used for this reason reflecting the importance of the severe reduction in volume of the big parenchymateous organs of the abdomen.

[Ultra-sound study on the growth of the fetal kidney in the second half of pregnancy (author's transl)]

Sonography was used to detect and measure the fetal kidneys. In 250 cases of pregnancies ranging from the 20th week to term growth charts for the normal growth of the fetal kidney were constructed. Considering the normal anatomical variations it is possible using these curves to detect growth retardations of the fetal kidneys. The importance of these measurements for fetal anomalies and cases of placental insufficiency with growth retardation of these organs is discussed.

[Ultrasonic diagnosis of fetal ascites (author's transl)]

Fetal ascites is relatively rare, but confronts the obstetrician with difficult decisions. By X-ray methods such as plain X-ray or fetography fetal ascites may only be suspected. Performing ultrasonic examinations however it is not only possible to detect the fluid collection in the peritoneal cavity but as well to recognize the inducing causes. This is documented by sonograms of three cases observed within the last year. The different decisions for the obstetrician in respect to fetal ascites with or without malformations are discussed.

[Early diagnosis of fetal malformation by ultrasonography (author's transl)]

Today, echography can be considered as routine diagnosis in every pregnancy. Besides the detection of growth retardation very often in early stages of the fetal life malformations can be diagnosed incompatible with postnatal life. Reviewing the cases of the II. Women's Department of Obstetrics and Gynaecology in Vienna within the last 2 years, 13 cases of serious malformations could be detected by regular routine ultrasonic examinations. The echographic appearance of these partially very rare cases is discussed and documented by pictures. The advantage of ultrasonic diagnosis in comparison with other diagnostic procedures in the detection of malformation is discussed. The necessity and importance of regular ultrasonic examinations of all pregnancies as well in respect in the detection of malformations are stressed.

Ultrasonic diagnosis in obstetrics and gynecology

Ultrasonic diagnosis is widely used today in obstetrics and gynecology. As no harmful side-effects, neither to the mother nor to the fetus can be detected, the method can be used to study the fetal development in its natural environment. The technics used for this study are either compound-scan or real-time scan. Progressing from the early to the late pregnancy the clinical problems, in which ultrasonic diagnosis is of importance are discussed. In early pregnancies these problems are related with the symptoms of abortion, whereby intact pregnancy, blighted ovum, missed abortion, ectopic pregnancy and hydatidiform mole, can be differentiated by ultrasonic examination. In advanced pregnancies ultrasonic examinations are used to achieve biometric data reflecting normal and abnormal progress in the uterine fetal development. Such data are the biparietal diameter and abdominal measurements such as diameter and circumferences which may be influenced by placental insufficiency resulting in growth retardation. The importance of the exact location of the placenta using echography as well as the possibility of the exact diagnosis of the fetal position are stressed. In gynecology echography can be used for monitoring the ovarian cycle in demonstrating the maturing follicle and the corpus luteum. Tumors of the genital organ can be differentiated to a certain extent. In the management of patients suffering from cancer, ultrasonography can be used for treatment-planning and in the follow-up study to detect local or lymphonodal recurrences as early as possible and to plan second-look operations.

[Ultrasonics in the modern diagnosis of biliary tract diseases]

The ultrasound diagnostics is of high value in revealing the diseases of the biliary ducts. Prerequisite for an exact diagnosis is an exact knowledge of the arterial, venous and biliary vascular systems of the porta hepatis. Using real-time-devices a differential diagnosis of these several systems can quickly be made in systematic examination. The examination is indicated at suspicion for cholelithiasis, cholecystitis, choledocholithiasis and obstructive jaundice. The differential diagnostic criteria are demonstrated. The number of success in cholecystolithiais for the ultrasound diagnostics is at present 93%. In differentiation of the obstructive jaundice it is about 85%.

[Hormone profiles and hormone therapy in early pregnancy (author's transl)]

Hormone profiles in early pregnancy were established in 67 women and correlated to simultaneously performed ultrasonic examinations. Normal values for human chorionic gonadotropin (HCG), human chorionic somatotropin (HCS), oestradiol (E2) and progesterone (P) were established from the data obtained in 30 early pregnancies which culminated in the birth of a living child. Lowered HCG values were found in 17 out of 23 pregnancies which ended in miscarriage. In these cases ultrasonic examination failed to detect any heart action. Lowered HCS values after the 9th week of pregnancy are also certain proof of missed abortion. P and E2 values are shown to be a parameter reflecting activity of the corpus luteum graviditatis. In clomiphene- and gonadotropin-induced pregnancies higher values were found than in pregnancies managed by substitution treatment with twice weekly 10 mg oestradiolvalerianate + 500mg 17alpha-hydroxyprogesteronecapronate. Lowered P and E2 values with HCG values in the normal range indicate imminent insufficiency of the corpus luteum graviditatis. Pros and cons of hormonal therapy in early pregnancy are discussed.

[Ultrasonic diagnosis of ovarian tumours (author's transl)]

Precise knowledge of the echoanatomy of the normal female pelvis is a prerequisite in the diagnosis of ovarian tumours. Diagnostic criteria for the differentiation between cystic and solid lesions are discussed. The echographic appearance of uni-, multilocular, dermoid and endometriosis cysts and of ovarian cancer is described. 183 ovarian tumours were examined in the period from January 1st, 1976 until December 31st, 1977 and the preoperative diagnosis compared with the findings at operation, both macroscopic and histological. 158 cases (86.3%) were correctly diagnosed. In 13 cases (7.1%) the diagnosis was only partially correct. An incorrect ultrasonic diagnosis was made in only 12 cases (6.6%). Out of 183 cases the side of the lesion was correctly diagnosed in 128 patients (70.0%). Localization of the tumour could not be achieved or was totally wrong in 19 cases (10.4%). Estimated tumour dimensions concurred with the macroscopic measurements of the specimen in 90.7%. A false-positive result was recorded in 7 cases (3.8%), mostly due to a full bowel simulating a cyst of barely 4 cm in diameter. In 5 cases (2.7%) ultrasonic examination failed to detect the existence of a tumour. 2 of these tumours were follicular cysts under 4 cm in diameter. 2 ovarian cancers were missed. In 1 case the ovary was only slightly enlarged and the diagnosis was made only by frozen-section histology. In the second case the tumour was erroneously interpreted as originating from the sigmoid colon. Ultrasonic diagnosis is recommended for the detection and differentiation of ovarian tumours on the basis of the good results achieved.

[Ultrasound in tumor diagnostics and treatment planning (author's transl)]

The fundamental requirements of irradiation planning are discussed delimitating the minimum and maximum demands of planning. Different possibilities to represent the topographic relations within the irradiation plane of the patient's cross-section are described. The computer-assisted system for irradiation planning, installed at our hospital by means of MAT construction, is discussed. A pathway is shown which leads to individual treatment planning and considers dosimetrically the actual conditions of the patient who will undergo radiation therapy. The possibilities and limits of ultrasonic cross-sectional imaging are demonstrated.

[Ultrasound diagnosis in bone and soft tissue tumors (author's transl)]

The value of ultrasound diagnosis as an additional examination to x-ray and angiography is proved in various tumors and tumor like conditions of the locomotor system. It shows that the echotomogramms are helpful in various cases. This help results mainly in a better preoperative diagnosis of tumor size and topography and in some cases in the cognition of tumor structures. Therefore, this method can be a valuable information for surgery. In some cases the finding of soft tissue tumors is possible even when the x-ray and angiography do not give any information. In the search for tumor recurrence the ultrasound can also be applied.

[Studies in the diagnosis of breast disease (author's transl)]

The relative diagnostic accuracy of clinical examination, mammography, thermography and ultrasound was investigated in a comparative study. Mammography proved to be the most accurate diagnostic method, followed by clinical examination, thermography and ultrasound. Whereas in cases of advanced cancer (T2 to T4 tumour diameter greater than 2 cm) the correct diagnosis was made most reliably by clinical examination, mammography was superior to all other procedures in T1 tumours and in impalpable tumours. In our opinion thermography and ultrasound should be excluded for routine use or as a screening test because of the high false negative results. It is, however, noteworthy, that small intraparenchymal cysts can be detected and localized by ultrasound in a very high percentage of cases.

[Ultrasound diagnosis of bone and soft tissue tumours]

The findings of ultrasonic examination in bone and soft tissue tumours are evaluated for their usefulness in preoperative tumour diagnosis, with particular reference to size, demarcation, structure, as well as the topographic situation of the tumour. Furthermore, the results of ultrasonic tomograms are compared with those of X-rays and angiography. It seems that this simple method, which is without risk to the patient, is a valuable additional investigation in the diagnosis and therapy of tumours of bone and soft tissue.

[The value and limitation of echotomography in the diagnosis of abdominal lymphomas in malignant diseases(author's transl)]

The indication for ultrasonic examination in addition to endolymphatic methods is discussed. In 23 histologically proved advanced cases the accuracy of lymphography was 77% and in echotomography 74%. In the diagnosis of lymphonodal enlargements in the area of the liver and spleen hilium echotomography proved to be a valuable diagnostic method independent from endolymphatic methods. In X-ray treatments echotomography enables us to estimate the therapeutic result and to evaluate the lymphonodal status. The controls are performed in an out-patient manner.

[The value and limitations of ultra sound in the follow-up of patients with urological tumors]

The application of ultrasonic diagnosis in the care of patients suffering from tumors of the urogenital tract is discussed. The indication for demonstration of enlarged paraortic and lumbar lymphnodes is emphasized. Of special value is this new diagnostic tool for X-ray treatment planning and for the evaluation of the therapeutic success.

[Ultrasound as a diagnostic aid in psoas abscesses (author's transl)]

In 2 cases of psoas abscesses ultrasonic tomograms have been made in addition to the routine examinations. The experiences of these results show that the implication of this method seems to be of great help for a more exact preoperative diagnosis.