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Cytoreductive surgery is the backbone of the multimodal therapy in primary ovarian cancer patients. Despite the effect of various tumor biological factors such as grading and histological subtype, the surgical outcome is the most important prognostic factor for both progression free- and overall survival. In contrast, the management of recurrent situation has long remained a subject of an emotional international discussion. To date, only few prospective studies have focused on the effect of surgery in relapsed ovarian cancer. The available retrospective data associate complete cytoreduction with prognosis improvement. However, the selection of patients eligible for surgery in recurrent situation is the essential issue. The establishment of predictive factors for complete tumor resection and defining the patient group with recurrent disease who might profit from this approach are crucial. The available predictors of complete resection depend on the results of primary surgery and the current patient's situation. Women who underwent primary complete cytoreduction are in good performance status, and those who have only minimal ascites volume (less than 500 ml) in the recurrent situation have 76% likelihood of undergoing complete resection and survival prolongation. Moreover, the complete cytoreduction in the tertiary cytoreductive approach has been evaluated and showed a potential positive influence on patients' survival. This review concentrates on the recent data and highlights the need of further randomized trials to develop and incorporate operative standards in recurrent ovarian cancer.

Supplemental digital content is available in the text., The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.

Despite the increase in radical cytoreductive surgery and an initial high response rate to first-line chemotherapy with carboplatin plus paclitaxel, most women with ovarian cancer will relapse and die due to tumor progression. According to a survey performed by the NOGGO (Nord-Ostdeutsche Gesellschaft fur Gynakologische Onkologie), survival represents the most important goal of treatment for patients with platinum-sensitive relapse, while in platinum-resistant relapse there is a shift to providing disease control and symptom palliation with a generally well-tolerated regimen and an emphasis on the patients' quality of life. Thus, weekly topotecan dosing instead of the standard 5-day regimen offers a promising expansion of the therapeutic spectrum. The pharmacokinetic rationale for the weekly schedule is that the inhibiting effect of topotecan on topoisomerase I is reversible after one week. The results of the randomized phase-II study of the NOGGO, which investigated the weekly schedule in comparison to the conventional 5-day schedule of topotecan, are expected for the end of this year.

Purpose: Measures for secondary disease prevention have not found much acceptance by the German general population in spite of many possibilities on offer. We conducted a pilot study to assess lay aetiology of various diseases as a possible reason for these circumstances. Material and Methods: Based on earlier literature, a questionnaire was developed (KPM - V1.0) which assessed perceived aetiology and risk of disease as well as several other aspects of disease prevention. The questionnaire was distributed in a gynaecologists office to 450 patients. Results: With a 93.3 % response rate it was found that osteoporosis, breast cancer and other gynaecological malignancies are mainly considered to be due to fate whereas stress and personal behaviour were believed to be the causes of cardiovascular disease. With respect to perceived subjective risk most patients felt themselves to be protected against the diseases with the exception of breast cancer. Interestingly, patients who felt susceptible for a certain disease were also more likely to feel susceptible for another disease. Here, trait anxiety may be an important underlying reason. Conclusion: Disease concepts based on lay aetiology differ significantly from the findings of modern medicine. Using these results may help to initiate better communication with patients in order to convince them more efficiently to undertake primary or secondary preventive measures.

Epithelial ovarian cancer (EOC) is the major cause of death due to gynecological malignancies. The most important prognostic factors are residual tumor mass after surgery and platinum-response. No predictive biomarkers are available to identify patients who will benefit from standard treatment. The aim of our study was to analyze the role of HE4 in predicting surgical and clinical outcome in primary EOC.In the European multicentric project "OVCAD", 275 consecutive patients with primary EOC were enrolled. Patients were eligible if radical cytoreductive surgery was performed and platinum-based chemotherapy was applied. Plasma and ascites samples were collected before or during surgery. The concentrations of HE4 and CA125 was determined using ELISA and Luminex technique, respectively.Median age at first diagnosis was 58 years (range 18-85 years). Most patients presented with advanced stage disease, FIGO III or IV (94.6%), grades II-III (96%) and serous histology (86.2%). In most cases a complete cytoreduction to no residual tumor mass was achieved (68.4%). Higher plasma HE4 levels correlated with poor surgery outcome in terms of macroscopically residual tumor mass (p0.001) and platinum-resistance (p=0.009). Plasma CA125 and the risk index (HE4 and CA125) were independent predictive factors for surgical outcome (p=0.001, OR=3.37, 95% CI=1.61-7.06 and p0.001, OR=6,041, 95% CI=2.33-15.65, respectively). FIGO stage III was an independent predictive factor for platinum response (p=0.039, OR=0.436, 95% CI=0.198-0.960).The presented data are showing that the combination of HE4 and CA125 expression in plasma might predict the surgical outcome in EOC and by this may have a prognostic impact on PFS and OS.

The therapy of gynecological malignancies and breast cancer requires a multimodal therapy approach based on current individualized and risk adapted state of the art therapy concepts. The aim of this online tumor conference project is to reach a broad interdisciplinary and cross-sectoral participation of specialists in order to develop high-quality therapy recommendations for complex casuistics.The concept of the interdisciplinary online tumor conference was established in 2004 at the Department of Gynecology, Charité Campus Virchow, University Hospital of Berlin to conduct online tumor board meetings of specialists in the field of gynecological cancer from different hospitals and gynecological and oncological practitioners from the outpatient sector. Following a systematic approach, patient data, relevant external clinical evidence and therapy preference are presented to the participants. An individual therapy recommendation for each patient is reached by consensus discussion.By July 2009, 131 online tumor conferences had been performed with a total of 275 participants were developed. Per session, a median of 14 participants logged in online. Additionally 398 second opinion recommendations were performed. In an anonymous survey, carried out at the beginning of 2009, 95% of the participating physicians reported being satisfied with the information content and 50% were stimulated to seek more second opinions by the possibility of the online tumor conference. All contributors attested to a high comprehension of the developed therapy recommendations; 70% confirmed further that the conference presents an optimal possibility for fast and detailed exchange of information between disciplines and care sectors (in- and out-patient) and improves advanced educational training (81%).The online tumor conference provides a time saving and high quality possibility for receiving a treatment recommendation based on the best available clinical and scientific evidence and contributes to continuously advanced training for therapists in the field of gynecological cancer.

In the present study, we report the first analysis of the clinical management [corrected] of patients with primary ovarian cancer following the summarized data of the Joint Clinical Registries of the Coordinating Tumor Center of Berlin (Dachverband Tumorzentrum Berlin e.V.). All data were summarized for the period of 2005 to 2008 regarding age, histopathology, time of surgical intervention, follow-up and survival, based on 1124 provided data sets of patients with suspected ovarian tumours. We identified 946 patients with a diagnosis of primary ovarian cancer, mostly of advanced T3 tumour stage (63.7%), FIGO III and IV stage (40.6%) or grade II and III (91%) histology. The median age at time of diagnosis was 61 years (range 15 to 94 years). Most patients (n=414, 69.8%) underwent cytoreductive surgery within one month of diagnosis. The median follow-up period was 26 months; 241 patients died in the analyzed period. The calculated 3-year survival rate was 63.3%, although the median overall survival has not yet been reached. We detected positive correlation of tumour stage (p0.001) and of FIGO stage (p0.001) with survival, and these were evaluated as being prognostically significant. The implementation of institutional based clinical registries as part of the modern clinical management of patients with ovarian cancer is feasible and well accepted inside the gynaecological departments of Berlin.

Paclitaxel is one of the most common antitumour agents paclitaxel for the treatment of primary and relapsed ovarian cancer. Based on a German multicentre observational study, this article reflects the use of paclitaxel in German daily clinical practice.Data for a total of 541 patients in Germany were analysed, including 315 patients with primary ovarian cancer and 226 patients treated with paclitaxel with relapsed ovarian cancer.The mean age was 61.2 years, ranging from 22 to 85 years. No unexpected toxicities were ascertained. In general, grade III/IV haematological toxicities were rare. Only 15% of the patients suffered from grade III/IV leucopenia and 5% from thrombocytopenia. Alopecia and polyneuropathy were the most frequent non-haematological side-effects noticed. Response evaluation was provided in 183 patients with primary ovarian cancer (CR 39.8%, of these achieved a complete response (CR), and 27.9% a partial response (PR), resulting in an overall response rate (ORR) of 67.7%. In 13.7%, stable disease (SD) and in 19.7%, tumour progression (PD) were documented. In 196 patients with recurrent ovarian cancer, response evaluation was provided. A total of 28.6% of the patients achieved a CR, and 31.6% a PR, which produced an ORR of 60.2%. In 33.2%, SD and in 6.6%, PD were documented.Paclitaxel is broadly used in the management of patients with primary and relapsed ovarian cancer. The toxicity profile observed seems to be within the range of the results of clinical phase-III studies. The doses applied and the schedules based on the official recommendation of the working groups seem to have been influenced by international studies.

Borderline tumours of the ovary (BOTs) are rare tumour entities that do not show any destructive or invasive growth in the majority of cases, even though they can display characteristics of malignant tumours The mucinous subtype can also originate from the appendix, and ovarian metastases can mimic primary ovarian BOTs, often accompanied by peritoneal manifestation in terms of pseudomyxoma peritonei. In cases where a concomitant appendiceal tumour is present, it may prove difficult to determine the primary tumour. This report describes a special case of BOT with a specific example of the complexity of the differential diagnosis of pseudomyxoma peritonei. Especially the case was simultaneously linked to appendiceal and ovarian cancer. Moreover, this case was exceptional for its unusual manifestation of BOT in the cervix.

According to the present guidelines for advanced epithelial ovarian cancer (EOC), bulky lymph nodes should be removed as part of the routine surgical staging and the primary goal being removal of all macroscopic tumor residuals. Furthermore, EOC-patients with bulky lymph node relapse seem to benefit from lymphadenectomy in terms of recurrence and overall survival.We present two cases of severe postoperative hemorrhage due to external iliac artery rupture ten and 12 days after radical bulky lymph node removal in primary and recurrent EOC-patients. Both cases were successfully managed by ligation of the two arms of the external iliac artery achieving immediate hemostasis. No crossover bypass was required to maintain lower extremity perfusion. Late rupture of the iliac vessels is a rare complication of systematic lymphadenectomy in EOC. This complication can be managed by unilateral external iliac artery ligation without mandatory subsequent graft interposition or crossover bypass.

Febrile neutropenia (FN) is a common toxic side effect of myelosuppressive chemotherapy. The cost-effectiveness of primary prophylaxis (PP) of FN with granulocyte colony stimulating growth factor (G-CSF) filgrastim for six or eleven days was compared to single dose pegfilgrastim in patients with early breast cancer receiving chemotherapy (or= 20 % FN risk) as simulated in a model.Based on a decision-analytical model we conducted a cost-effectiveness analysis (CEA) and a cost-utility analysis (CUA) from the perspective of the Statutory Health Insurance (SHI) in Germany. The model simulated three clinical alternatives being built on each other, that pegfilgrastim and filgrastim had differential impact on (1) the risk of FN, (2) on FN-related mortality, and (3) on the achieved chemotherapy relative dose intensity (RDI) leading to gain in long-term survival.Assuming a 5.5 % lower risk of FN for PP with pegfilgrastim than an 11-day course of filgrastim provided - from the perspective of the SHI - a cost saving of Euro 2,229. A gain of 0.039 quality-adjusted life-years (QALY) resulted when the third alternative was used. Assuming a 10.5 % lower risk of FN for PP with pegfilgrastim than a 6-day filgrastim course, the third alternative showed an incremental cost-effectiveness ratio (ICER) of Euro 17.165 per life-year gained (LYG) and Euro 18.324 per QALY with 0.074 QALYs gained.These results indicate that PP with pegfilgrastim is cost saving compared to 11-day use of filgrastim and cost-effective compared to 6-day use of filgrastim in patients with breast cancer treated in Germany.

Anthracyclines, such as pegylated liposomal doxorubicin (PLD) and epirubicin (EP), are effective for the treatment of malignant tumors. Unfortunately, their implementation in therapy is limited due to severe side-effects such as palmar-plantar erythrodysesthesia (PPE).As the exact pathogenesis of PPE still remains unclear, laser scanning microscopy was utilized to detect PLD, EP and their metabolites in and on the skin surface of patients.It was shown that PLD was significantly more frequently detectable on the skin than was EP (p0.05), whereas both substances were most frequently seen in the palms and soles. Additionally, it has been visualized that the substances reach the skin surface via sweat, where they distribute and then penetrate back into the skin.It was concluded that a high density of sweat glands and a thick stratum corneum might represent important predestined factors for the development of PPE. These findings will help to develop efficient prevention and therapy strategies for PPE.

Trotz deutlich verbesserter Operationstechniken und hoher Ansprechraten von ca. 75% der First-Line-Chemotherapie mit Paclitaxel und Carboplatin entwickeln etwa 65% der Patientinnen mit FIGO-Stadium III und IV ein Rezidiv oder eine Tumorprogression und versterben an dieser Erkrankung (Sehouli et al. 2003). Der Grosteil der Patientinnen weist ein primares Tumorstadium III oder IV auf. Der Lebensqualitat kommt somit beim Ovarialkarzinom eine besondere Rolle zu.

In the last few years, the therapy of cervical carcinoma has progressed substantially due to the use of simultaneous platinum- containing radiochemotherapy. However, there are no data which evaluate an individualized treatment adapted to tumor biology, in spite of the fact that patients show remarkably different responses to chemotherapy. Therefore this preclinical phase I study aims at finding therapeutic alternatives to the current cytostatic drugs to treat cervical carcinoma.In a tumor chemosensitivity assay, 8 drugs were tested on freshly isolated tumor cells of 16 patients [carbo- and cisplatin, topotecan, paclitaxel as well as the 2 tyrosine kinase inhibitors imatinib (Glivec) and gefitinib (Iressa (R) ) and the 2 monoclonal antibodies cetuximab (Erbitux) and trastuzumab (Herceptin (R) )].Overall the test was evaluable for 16 specimens (100%). Ten of 15 tumor samples (66.6%) were sensitive to imatinib. A sensitive therapeutic response could be demonstrated in all tested FIGO stages. An interindividual comparison could establish sensitivity to cetuximab in 12.5% of cases, to gefitinib in 6.25%, to trastuzumab in 6.6%, to cisplatin in 13.3%, to carboplatin in 7.6%, to paclitaxel in 93.8% and to topotecan in 25%.Imatinib seems to be an efficacious therapeutic option for patients with cervical carcinoma, independently of tumor subtype.

Recently, the publication of the GOG 172 trial led to intraperitoneal (i. p.) chemotherapy in patients with ovarian cancer being regarded as potential new standard. The AGO Kommission Ovar, AGO-OVAR and NOGGO disagree with this view. In the GOG 172 study, several variables were mixed, and i. p.-therapy was not compared to the current standard paclitaxel plus carboplatin. The analysis was not based on an intention-to-treat (ITT) population, while even the slightest changes of significant results could lead to the elimination of their significance. Furthermore, the GOG 172 trial did not provide any details on second-line treatment which could have an impact on overall survival. High toxicity and the low number of cycles in i. p.-therapy might call the significant effect into question. The low median time of survival of the GOG 172 trial in the control arm (49.7 months) diverges from comparable collectives of three AGO-OVAR trials and the GOG 158 study (56.5-59.5 months). If the result of the GOG 172 trial had been similar, there would not have been any significance in comparison to i. p.-therapy. In order to change the current standard, it would be necessary to base the analysis on an ITT-population, provide details about second-line therapy, rule out bias regarding second-line therapy and to develop less toxic regimens.

Recommendations for diagnosis and treatment of malignant ovarian tumors with regard to the most recent data were worked out in a consensus process and valued by level of evidence (LoE) and grade of recommendation (GoR) of the Canadian Task Force for Preventive Health Care by the members of the Kommission Ovar der Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) in June 2005. A short version of these guidelines is presented.

Die benigne symmetrische Lipomatose Madelung ist eine seltene Erkrankung, die durch das diffuse Wachstum nicht-gekapselter Lipome charakterisiert ist. Uber eine enge atiopathogenetische Beziehung zu Alkohol- und Nikotinabusus, metabolischen Storungen und malignen Tumoren wurde berichtet. Rezidive nach chirurgischer Therapie sind haufig, wenn auch im Einzelfall zufriedenstellende funktionelle und kosmetische Resultate erzielt werden konnen. Wir berichten uber einen Fall mit ungewohnlicher Lipomverteilung.

Further improvements in the treatment of breast cancer can be expected with a better understanding of its pathophysiology and through biologically-oriented therapeutic interventions, as well as better identification of patient populations likely to benefit from specific therapies. Trastuzumab (Herceptin) is the first biological modifier, showing significant activity in patients with advanced breast cancer who exhibit HER-2/neu gene amplification and/or protein overexpression. Trastuzumab is approved for use in combination with paclitaxel or docetaxel as first-line chemotherapy. Combinations of a taxane, a platinum salt and trastuzumab are feasible and active and have proven an increased survival advantage. This is in addition to the benefit that has been shown for Herceptin in combination with monochemotherapy alone. Several groups have demonstated the ratio of serum HER-2/neu levels prior to initiation of Herceptin treatment to levels at the time of re-staging examination to be significantly higher in patients with a significant benefit from therapy as compared to patients with progressive disease. As a result of the survival improvements in the metastatic setting, Herceptin was quickly entered into development trials for adjuvant treatment. The significant cardiac toxicity that has been observed with trastuzumab/anthracycline combinations has led to two main strategies for integrating trastuzumab in the adjuvant setting: either the addition of trastuzumab to mostly anthracycline-based programs in a sequential approach, or the biologically-oriented strategy based on synergism between trastuzumab and chemotherapy agents including platinum compounds. Last but not least, the most important prerequisite for the optimal efficacy of Herceptin-based therapy remains a very strict selection of those patients with tumours that have HER-2/neu over-expression.

The plasminogen activator-plasmin cascade plays a central role in tumor cell invasion and metastasis of solid tumors. The type-1 plasminogen activator inhibitor (PAI-1) is the major physiologic regulator of the plasminogen activation. The PAI-1 is suggested to play a crucial role in tumor cell invasion and metastasis of different solid tumors. The aim of this article is to give an overview of the function, clinical and prognostic role of PAI-1 in gynaecological malignancies.

Epithelial ovarian cancer is the leading cause of death from gynaecologic malignancies in western countries. In the clinical day treatment decision of the physician (e. g. surgery, chemotherapy) based on individual prognostic factors of the patient with ovarian cancer. The tumor stage at time of diagnosis and the postoperative residual tumor mass are prognostic factors and are unequivocally related to overall survival. Other prognostic factors are identified mostly in small series and are discussed in the literature controversially. This article discussing the value of conventional prognostic factors, as stage, postoperative tumor mass, age, lymph node status, ascites) and newer molecular biological factors, as Her-2-status, PAI-1, MMP, VEGF and CD24.

The majority of patients diagnosed with ovarian cancer are in an advanced stage of the disease at the time of first diagnosis. The standard clinical staging (FIGO) occurs intraoperatively. The FIGO classification hides ambiguities and is useful as a means of orientation. However, an exact assessment of stage at first diagnosis, can form the basis for the evaluation of diagnostic and prognostic factors and furthermore has influence on adjuvant treatment.We developed a systematic surgical and histopathological tumor documentation instrument, further we investigated its clinical and scientific application.Between September 2000 and July 2002, 128 patients with primary and recurrent ovarian cancer were operated and prospectively documented. The median age of the patients at the time of first diagnosis was 55 years. The majority of patients diagnosed with primary ovarian cancer had a diffuse tumor spread pattern (localised: 18 [32 %]; central: 14 [25 %]; diffuse: 24 [43 %]). In patients diagnosed with recurrent ovarian cancer the three defined tumor spread patterns showed a comparable distribution (localised 19 [28 %]; central: 19 [28 % ]; diffused: 29 [43 %]). While in most of the patients with primary ovarian cancer the highest tumor mass was concentrated in the lower abdomen/ pelvis, in comparison, in patients with recurrent ovarian cancer it was located mostly in the upper abdomen ("change of level", p=0,027).The IMO (Interoperative Mapping of Ovarian Cancer) represents a new instrument for a detailed and objective documentation of surgical and pathological results of patients with ovarian cancer and helps provide a more precise staging. Potentially this prospective documentation support the development of SOP's (Standard Operating Procedures) and could be an efficacious instrument of quality management.

Das Endometriumkarzinom gehort mit einer Inzidenz von 15—25/100 000 Frauen zu den haufigsten gynakologischen Malignomen der europaischen Frau [15]. Das Endometriumkarzinom manifestiert sich meist zwischen dem 5. und 7. Lebensjahrzehnt und wird in der Regel im Stadium I diagnostiziert. Die Uberlebensraten fur das Stadium I liegen gewohnlich zwischen 80 und 90% [15].

Das Mammakarzinom stellt mit einer Inzidenz von 45 pro 100 000 Frauen das haufigste gynakologische Malignom der westlichen Frau dar [11].

Therapies involving a radical operation and radiation treatment for cervical carcinoma in stages I and II are not sufficiently effective in patient subgroups with high risk for recurrence. In recent publications, patients with high risk cervical cancer had with adjuvant simultaneous radio-chemotherapy a better disease free and overall survival but a higher toxicity compared with patients received an adjuvant radiotherapy alone.34 patients with at least 2 risk factors for recurrence of cervical cancer were treated with adjuvant chemotherapy after radical hysterectomy. The protocol consisted of 3 cycles of ifosfamide 1.6 g/m2 (d 1-3) and carboplatin (AUC 4, d1) every three weeks. For cell protection 21 patients received amifostine 740 mg/m2 d1-3; this was followed by standard radiation therapy (50.4 Gy percutaneous and high-dose-rate-after-loading for 21 patients, 2 x 5 Gy). The dose determination of the substances and their toxicity were investigated.Patient (p) data: Median age 43 years (range: 25-70); pT1b-2a: n = 22; pT2b: n = 12; pN1: n = 28; pN0: n = 6; G3: n = 10; adeno- and adenosquamous carcinoma: n = 9, G3: n = 10, R1-resection: n = 5. 70.6% of these high-risk patients were disease-free after a median observation time of 40 (18-62) months. Median number of cycles of chemotherapy: 2.8. There was no more dose escalation than carboplatin according to AUC 4 possible. Hematologic toxicity (CTC grading, % of 96 documented cycles): anemia-grade 3-4: 30; -grade 1-2: 10.4; leukopenia-grade 3-4: 13, -grade 1-2: 21.7; alopecia-grade 3: all p.; cerebral neurotoxicity-grade 3-4: 8.3, -grade 1-2; 17.7; diarrhea under radiotherapy-grade 3-4: 2 p., -grade 1-2: 6 p.This combined sequential adjuvant therapy was effective and had an acceptable level of toxicity. A phase III study comparing adjuvant sequential chemo-radiotherapy with and without Erythropoeitin to counteract the negative effects of anemia started in Germany in 1999 and had randomized now about 270 patients.

Evidence-based medicine is the synthesis of internal evidence (experience) and best external evidence (literature) aiming to solve a particular clinical problem. This paper gives an overview on different tools to appraise rationales and results of diagnostic tests such as CA-125 monitoring in patients with ovarian cancer.

Background: How precise and reliable is ultrasonography as a primary tool for injury scaling after blunt abdominal trauma? Material and Methods: Prospective clinical trials on ultrasound for blunt abdominal trauma were included in a meta-analysis. Authors and experts in the field were contacted to gain unpublished and original data. Statistical analysis focused separately on the detection of free intraabdominal fluid and the recognition of organ lesions. Pooled likelihood ratios (LR) with related 95% confidence intervals were calculated using fixed-effects and random-effects models where appropriate. Results: Twenty investigations providing a II b and III b level of evidence on a total of 6627 patients could be included. Targeting organ lesions, ultrasound provides a positive LR of 22.65 (95% CI 15.01 – 34.18) and a negative LR of 0.23 (95% CI 0.17 – 0.30). This means that the probability of revealing an organ injury will be 23 times higher than to miss it. Vice versa, the probability to definitely exclude the presence of a visceral lesion is only four times higher than for false-positive findings. For the detection of free intraabdominal fluid, a positive LR of 56.61 (95% CI 41.53 – 77.15) and a negative LR of 0.21 (95% CI 0.17 – 0.26) was calculated. By means of multilevel LRs, no relevant differences were seen comparing the capability of ultrasound for imaging of lacerations of solid and hollow viscera. Conclusions: Despite its high specificity, ultrasound shows remarkably low sensitivity for the detection of free fluid and organ lesions. In clinically suspected abdominal trauma, reference work-up (i.e. helical computed tomography) has to be advocated in case of both negative and positive sonograms.

To evaluate contrast-enhanced, fat-saturated spin echo sequences for the detection of peritoneal carcinosis with MRI.61 patients, 35 with and 26 without peritoneal carcinosis, were examined with abdominal MRI. Fat-saturated, T1-weighted spin echo sequences were performed before and after administration of Gd-DTPA. In addition, 22 patients with peritoneal carcinosis were examined with contrast-enhanced abdominal CT.32 of 35 patients with peritoneal carcinosis demonstrated contrast enhancement of the visceral and 30 of 35 enhancement of the parietal peritoneum (91 and 86%, respectively). Wall thickening of the intestine or parietal peritoneum were noted in 21 and 20 of 35 patients (60 and 57%, respectively), ascites in 18 of 35 patients (51%). False positive contrast enhancement of the peritoneum was noted in 4 of 26 patients (15%). In the direct comparison of MRI and CT, 22 of 22 patients versus 7 of 22 patients showed contrast enhancement of the visceral peritoneum (100 and 32%, respectively). For other signs of peritoneal carcinosis (e.g., ascites, peritoneal seedings), no differences in diagnostic reliability were demonstrated.The use of fat-saturated, spin echo sequences facilitates the diagnosis of peritoneal carcinosis by artifact reduction and improved detection of peritoneal contrast enhancement. MRI with fat-saturated sequences was superior to CT.