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Each abnormal sonographic finding in the gastrointestinal tract requires further evaluation including other diagnostic means, since differentiation of abdominal diseases is not possible by sonography alone. The pathologic finding of a stomach-cocarde is suspicious for a malignoma. Sonographic control is useful in patients with chronic inflammatory diseases of the intestinal tract, since intestinal as well as extraintestinal complications determining further treatment can be anticipated.

Real time ultrasound findings in 137 patients with proven or suspected liver metastasis and 51 patients with suspected malignant lymphoma were analyzed in order to define the accuracy of this method in tumour staging procedures. Sensitivity of liver metastasis was low (54.4%), while specificity (92.0%) and negative predictive value (95.8%) were good. Sensitivity for malignant lymphoma was better (84.6%), but specificity was less satisfactory (72.0%). Accuracy was dependent of the type of the primary tumour, bronchial carcinoma resulting in a very poor detection of liver metastases and suspected metastatic lymphoma leading to a large number of false positive results. We conclude from our data that only positive ultrasound findings of liver metastases or multiple lymphoma and probably a negative examination of the liver in patients with colonic carcinoma are sufficiently reliable to be used for therapeutic decisions in patients with malignant diseases.

Two patients with complicated acute pancreatitis are demonstrated. Sonographic factors are compared to laboratory and clinical findings. Ultrasound can add relevant information for classification and thereby supply an indication for surgery in patients with acute pancreatitis. This is especially true since laboratory classification of the grade of the disease is as yet not generally accepted.

In order to define the clinical significance and the need for further clinical work-up in patients where abnormalities of the stomach or bowel are found by ultrasound, we performed a prospective study on 100 patients with such findings. Of all patients, 35% were found to have a malignant tumor, 73% had a diagnosis as made by reference methods which was probably (18%) or definitively (55%) related to the US finding. Eighteen percent had definitive false positive findings, in 9% no final diagnosis was obtained. Thus, a positive predictive value of 80% was calculated for the US finding of a mass or a target sign related to bowel or stomach in US. The positive predictive value was lowest for target signs related to the bowel (75%) and highest for bowel conglomerates (100%). Patients with target signs of the stomach, bowel conglomerates, or masses were more likely to have malignant disorders (72%) than those with target signs related to the bowel (16%). We conclude from this study that the ultrasound finding of a target sign or a mass related to stomach or bowel has a high clinical relevance and should in any case worked up by appropriate investigations when clinical consequences are possible.

19% of 1490 abdominal sonograms from 1192 patients led to findings which were not related to the original purpose of the sonogram or to the actual disease, and of which neither the treating physician nor the patient were aware. The most frequent findings were those in liver, kidneys and gallbladder. The majority of ultrasonographically detected lesions were benign; tumour diseases were suspected only in 26 cases. The incidence of such findings increased with the patients' age. The positive, predictive value of the findings was around 90%. In 20% of the patients with unexpected findings, further diagnostic measures were taken; therapeutic consequences were recorded in only twelve cases. Further measures were recommended in 20% of the patients, a majority of which had pancreatic and vascular abnormalities. Because such findings may considerably facilitate the diagnosis of subsequent complaints, all accessible organs should be examined during abdominal ultrasonography.

In 502 patients, length, thickness and width of the spleen as well its location with respect to the ipsilateral kidney were determined by means of ultrasonography, and a relationship was established with the incidence of diseases accompanied by enlargement of the spleen. A significant correlation to the incidence of such diseases was found only with respect to spleen thickness. The probability of a corresponding disease was 80% for a spleen thickness of 5 cm, 90% for 6 cm and 100% for more than 7 cm. A comparison between palpation and ultrasonography supported the fact that enlargement of the spleen can, in many cases, not be ascertained by palpation, but that palpation findings are indeed positive in splenic enlargement of minor degree. The most suitable parameter for ultrasonographic detection of splenomegaly is thus spleen thickness, for which a limit value of 5 cm should be assumed. If the spleen is found to exceed this value, further examinations are indicated to clarify the underlying disease.

The accuracy of ultrasonography in the detection of liver metastases was studied in 245 patients. Sensitivity, specificity and positive and negative accuracy were defined and calculated. Taking into account only metastases more than 15 mm in diameter, sensitivity was 75.5%, positive accuracy was even higher at 83.0%. Specificity and negative accuracy were above 90%. The results are largely dependent on the type of primary tumour. Sensitivity for metastases of a bronchial or gastric carcinoma was about 50%. The results indicate that a positive ultrasound finding generally need not be checked by other methods, while a negative result, especially in certain types of tumour, is by no means sufficient to exclude metastases.

Sonographically guided puncture of intra-abdominal and retro-peritoneal masses for cytological diagnostic is widely employed. However, processing of cytological material may result in artifacts and in the case of certain malignant tumours, of benign tumours or diffuse organ changes, cytology is only relatively reliable. Special experience on the part of the investigato is therefore required. Hence, in far-reaching therapeutic decisions such as operation, cytostatic therapy or radiotherapy, diagnosis based on histological findings is preferred. Preliminary experience with a new type of fine needle (Schneidbiopsiekanüle) suitable for obtaining histological material is presented.

Ultrasound is the method of choice in the detection and differentiation of solid or cystic masses in the abdomen. The differential diagnosis of anechoic and hypoechoic lesions comprises a large variety of benign and malignant diseases or abnormalities. This paper describes a number of such lesions and, in addition, discusses the possible differential diagnoses so far reported in the literature. An attempt is made to describe the different features of such lesions. Most of them are rare but have to be considered if a lesion of unknown origin or clinical relevance is detected by ultrasound.