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Vasculitis of small and medium sized vessels mostly affects several organ systems and causes unspecific symptoms. The trunk, lungs, heart and the gastrointestinal and urogenital tracts are most frequently involved. Due to an unclear clinical picture imaging is part and parcel of diagnostics. The knowledge of typical and rare imaging patterns as well as knowledge of the correct imaging method is crucial for classification. Projection radiography is still the gold standard for imaging of the lungs. Using computed tomography discrete ground-glass pattern opacities, nodules and consolidations can be depicted. In the abdomen computed tomography and magnetic resonance imaging can depict swelling of the intestinal wall. Digital subtraction angiography may contribute to further differentiation and reveal microaneurysms in cases of polyarteriitis nodosa.

In der Diagnostik von initialen Veranderungen bei Rheumatoider Arthritis (RA) wird bisher neben der Projektionsradiographie (PR) im bilddiagnostischen Stufenkonzept die Magnetresonanztomographie (MRT) und die 3-Phasen-Skelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit klinischem Verdacht auf eine RA die Wertigkeit der Handsonographie im Vergleich mit den etablierten Verfahren PR, MRT und 3P-SZ zu beurteilen. Bei 30 Patienten mit klinischem Verdacht auf das Vorliegen einer initialen RA wurden am selben Tag eine Sonographie der Hande, eine 3P-SZ, eine Niederfeld-MRT und eine PR der Hande durchgefuhrt. Alle Bilder wurden unterteilt in RA-typisch und nicht-RA-typisch. Als Goldstandard diente die nach jeweils 2 Jahren durchgefuhrte abschliesende klinische Diagnose des Rheumatologen. Insgesamt wurde vom Rheumatologen bei 19/30 Patienten die Diagnose einer initialen RA gestellt. Sonographisch konnte initial bei 14/19 Patienten die richtige Diagnose gestellt werden. Dem gegenuber ergab die PR nur bei 11/19 Patienten die richtige Diagnose. Erwartungsgemas hohe Sensitivitaten ergaben sich sowohl in der 3P-SZ (100%) als auch in der MRT (95%). Sonographisch lies sich ein unauffalliger Befund von entzundlich bedingten Veranderungen in den Sehnenscheiden der Sehnengleitlager und Gelenken der Hand unterscheiden. In der Hand eines erfahrenen Untersuchers stellt die Sonographie in der Initialdiagnostik der RA eine sinnvolle Untersuchungsmodalitat dar. Auch aufgrund der geringen Kosten ist die Sonographie somit eine echte Alternative zur PR.

Zielsetzung Analyse weichgeweblicher magnetresonanztomographischer (MRT-)Befundmuster fruher Stadien rheumatischer Erkrankungen durch retrospektive Auswertung von MRT-Untersuchungen der Hand.

Ziel der Arbeit ist, die Bedeutung inflammatorischer Wirbelsaulenerkrankungen fur das Leitsymptom Ruckenschmerz zu erortern. Die Aussagekraft der verschiedenen radiologischen Verfahren wird diskutiert. Basierend auf der Einteilung der seronegativen Spondylarthropathien (SpA) sowie der rheumatoiden Arthritis (RA), erfolgte eine systematische Literaturrecherche. Die Ergebnisse dieser Recherche und die eigenen Erfahrungen mit einem grosen rheumatologischen Krankengut werden analysiert. Die Pravalenz der RA (1–2%) und der Gruppe der SpA (1,9%) ist vergleichbar, wobei die Atiologie letztlich bei keiner der genannten Erkrankungen bekannt ist. Die bildmorphologische Kriterien konnen sich uberlappen. Die MRT wird zunehmend bei Fruherkennung und Verlaufsbeurteilung der immunmodulatorischen Therapien (TNF-α-Antagonisten) eingesetzt. Ein Odem im Knochen, das nur mit der MRT nachweisbar ist, zeigt die Aktivitat der Entzundung bereits im fruhen Stadium. Der Einsatz von TNF-α-Antagonisten wird neben klinischen und laborchemischen Kriterien zunehmend von den Zeichen der Floriditat in der MRT abhangig gemacht. Das Ansprechen oder Versagen einer medikamentosen Therapie kann mit der MRT bewertet werden.

Collagen based vascular diseases with pulmonary involvement comprise rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, dermatomyositis and polymyositis, ankylosing spondylitis, Sjogren's syndrome, and mixed connective tissue diseases. The different characteristics of pulmonary involvement are described. In such circumstances, early recognition of lung involvement is of considerable significance and the relationship to the corresponding disease has to be made. Frequently unrecognised pulmonary involvement ends up as fibrosis with irreversible deficits in respiratory function.

ZusammenfassungIn der Initialdiagnostik bei rheumatoider Arthritis (RA) wer-den neben der Projektionsradiographie (PR) auch die Mag-netresonanztomographie (MRT) und die 3-Phasen-Skelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit Verdacht auf RA die Wertigkeit der PR, der 3P-SZ und der MRT anhand von Verlaufsbeobachtun-gen über 2 Jahre zu beurteilen. Patienten, Methoden: Bei 42 Patienten wurden am selben Tag je eine 3P-SZ, Niederfeld-MRT und PR der Hände im dorsovolaren Strahlengang durchgeführt. Verlaufskontrollen erfolgten im jährlichen Abstand. Alle Bilder wurden von jeweils zwei erfahrenen Radiologen/ Nuklearmedizinern befundet und in rheumatypisch und nicht rheumatypisch unterteilt. Als Goldstandard diente die abschließende klinische Diagnose des Rheumatologen unter Berücksichtigung des Ritchie-articular-Index. Ergebnisse: Bei 24/42 Patienten wurde die Diagnose einer initialen RA gestellt. In der PR konnte bei 20/ 24Patienten imzeitlichen Verlauf die richtigeDiagnose gestellt werden. Demgegenüber wurde sowohl in der 3P-SZ als auch in der MRT bei allen 24 Patienten eine beginnende RA erkannt. Lediglich im Detektionszeitpunkt gab es Variationen mit insgesamt tendenziell späterer Diagnosestel-lung in der PR. Schlussfolgerung: In der bildgebenden Initialdiagnostik der RA ist die PR weiterhin als Verfahren der ersten Wahl anzusehen. In der weiterführenden Diagnostik von unklaren Befunden stellt die Niederfeld-MRT ein der 3P-SZ annähernd vergleichbar sensitives Verfahren dar. Trotzdem sollten – wenn möglich – aufgrund des geringen Field-of-view neben der 3P-SZ zur weiteren Abklärung unklarer Befunde Hochfeldtomographen bevorzugt werden.

ZusammenfassungIn der Initialdiagnostik bei rheumatoider Arthritis (RA) werden neben der Projektionsradiographie (PR) auch die Magnetresonanztomographie (MRT) und die 3-PhasenSkelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit Verdacht auf RA die Wertigkeit der PR, der 3P-SZ und der MRT anhand von Verlaufsbeobachtungen über 2 Jahre zu beurteilen. Patienten, Methoden: Bei 42 Patienten wurden am selben Tag je eine 3P-SZ, Niederfeld-MRT und PR der Hände im dorsovolaren Strahlengang durchgeführt. Verlaufskontrollen erfolgten im jährlichen Abstand. Alle Bilder wurden von jeweils zwei erfahrenen Radiologen/ Nuklearmedizinern befundet und in rheumatypisch und nicht rheumatypisch unterteilt. Als Goldstandard diente die abschließende klinische Diagnose des Rheumatologen unter Berücksichtigung des Ritchie-articular-Index. Ergebnisse: Bei 24/42 Patienten wurde die Diagnose einer initialen RA gestellt. In der PR konnte bei 20/ 24 Patienten im zeitlichen Verlauf die richtige Diagnose gestellt werden. Demgegenüber wurde sowohl in der 3P-SZ als auch in der MRT bei allen 24 Patienten eine beginnende RA erkannt. Lediglich im Detektionszeitpunkt gab es Variationen mit insgesamt tendenziell späterer Diagnosestellung in der PR. Schlussfolgerung: In der bildgebenden Initialdiagnostik der RA ist die PR weiterhin als Verfahren der ersten Wahl anzusehen. In der weiterführenden Diagnostik von unklaren Befunden stellt die Niederfeld-MRT ein der 3P-SZ annähernd vergleichbar sensitives Verfahren dar. Trotzdem sollten – wenn möglich – aufgrund des geringen Field-of-view neben der 3P-SZ zur weiteren Abklärung unklarer Befunde Hochfeldtomographen bevorzugt werden.

AIM The early stage of rheumatoid arthritis (RA) is primarily manifested in the soft tissue of the hand. Although ultrasound (US) is regarded as an important imaging process in diagnostic medicine, precise characterization of sonomorphological changes has not yet been undertaken. METHOD 20 patients with RA were examined with US. Two radiologists described semiquantitatively the characteristics of synovial changes in the hand in a consensus-based process and measured the synovial width. Statistical methods were used to determine whether the various synovial changes differed significantly and to identify the most frequent locations of changes. RESULTS On the basis of the significant differences in morphology and synovial width, it is possible to distinguish between unremarkable findings, pannus tissue and band-like synovitis. Pannus tissue is most frequently found on the finger flexor tendons (FFT), the metacarpophalangeal joints (MCP) and the tendon of M. extensor carpi ulnaris (ECU). Band-like synovitis exhibits an uncharacteristic distribution pattern with a slight propensity to favour these locations. CONCLUSION The FFT, MCP joints and ECU tendons are particularly important in systematic US screening of the hand for the purpose of establishing reliable evidence of inflammatory changes. Different stages of RA can be identified on the basis of the characteristic types of synovitis and the number of joints and tendons affected.

ZusammenfassungZur Diagnostik initialer Veränderungen bei rheumatoider Arthritis (RA) werden neben der Projektionsradiographie (PR) im bilddiagnostischen Stufenkonzept die 3-Phasen- Skelettszintigraphie (3P-Sz) und die Magnetresonanz- Tomographie (MRT) eingesetzt. Ziel dieser Studie war es, die neu entwickelte Niederfeld-MRT mit den etablierten Verfahren (PR, 3P-Sz) in der Initialdiagnostik der RA an der Hand zu vergleichen. Methode: Bei 65 Patienten (47 w, 18 m; 20-86 Jahre) wurden an einem Tag 3P-Sz (550 MBq Tc-99m DPD), Niederfeld-MRT und PR der Hände durchgeführt. Alle Bilder wurden von zwei erfahrenen Nuklearmedizinern/Radiologen geblindet befundet und unterteilt in a) rheumatypische, b) entzündliche, nicht rheumatypische und c) nicht entzündliche Veränderungen sowie der 3P-Sz als Goldstandard gegenüber gestellt. Ergebnisse: Im Vergleich zur 3P-Sz zeigt die Niederfeld-MRT bei nahezu gleicher Sensitivität gegenüber rheumatypischen und entzündlichen Veränderungen nur eine gering niedrigere Spezifität. Bei der PR war sowohl bei rheumatypischen als auch bei entzündlichen Veränderungen die Sensitivität vermindert bei gleicher Spezifität wie die Niederfeld-MRT. Die quantitative Auswertung der 3P-Sz mittels ROI-Technik ergab signifikant höhere Werte bei rheumatypischen Veränderungen. Schlussfolgerung: Die Niederfeld-MRT stellt ein der 3PSz vergleichbar sensitives Verfahren in der Initialdiagnostik zum Nachweis rheumatypischer und entzündlicher Veränderungen im Bereich der Hände dar. Neben der Basisuntersuchung der PR empfiehlt sich die 3P-Sz durch Erhebung eines Ganzkörperstatus sowie quantitativer ROI-Technik für die weiterführende Diagnostik bei Verdacht auf RA.

The psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS-H) for the evaluation of inflammatory and destructive changes in PsA hands was validated on 0.6-T scanners. The applicability of the PsAMRIS-H on a low-field MRI system as a well-accepted, low-cost imaging modality was evaluated.In 65 consecutive patients (31 males, median age 52 years), 73 scans on a 0.2-T dedicated extremity MRI system were obtained for evaluation of PsA. Images were scored for synovitis, tenosynovitis, periarticular enhancement, bone erosion, bone oedema, and proliferation, and the PsAMRIS-H score was calculated. The intraclass correlation coefficient (ICC) was calculated and the paired t-test conducted.Intra-reader reliability for the total PsAMRIS-H score was good, with an ICC of 0.81 and 0.77 for readers 1 and 2, respectively, and inter-reader agreement was moderate (0.57 for each reader). However, the PsAMRIS-H score differed significantly between the two readers (22 vs. 31; p0.05). When individual components of the PsAMRIS were evaluated, intra- and inter-reader agreement was poor to moderate, especially for tenosynovitis and periarticular inflammation.Low-field 0.2-T MRI is capable of quantifying the PsAMRIS-H with good intra-reader reproducibility. However, low signal-to-noise ratio (SNR), low spatial resolution, and system artefacts limit the application of the PsAMRIS-H, leading to low inter- and intra-reader agreement for individual features.

Vasculitis of small and medium sized vessels mostly affects several organ systems and causes unspecific symptoms. The trunk, lungs, heart and the gastrointestinal and urogenital tracts are most frequently involved. Due to an unclear clinical picture imaging is part and parcel of diagnostics. The knowledge of typical and rare imaging patterns as well as knowledge of the correct imaging method is crucial for classification. Projection radiography is still the gold standard for imaging of the lungs. Using computed tomography discrete ground-glass pattern opacities, nodules and consolidations can be depicted. In the abdomen computed tomography and magnetic resonance imaging can depict swelling of the intestinal wall. Digital subtraction angiography may contribute to further differentiation and reveal microaneurysms in cases of polyarteriitis nodosa.

Jahrelange Beschwerden in beiden Schultergelenken, ab 1998 Schwellungen der Sternoklavikulargelenke. Seit 1 Jahr rezidivierende Diarrhoen ohne Blut- und Schleimbeimengungen. Hautsymptome: Keratosis pilarsi und Akne comedonica an Dekollete und Rucken sowie Pityriasis simplex der Kopfhaut. Diagnostische Masnahmen: 3-Phasen-Skelettszintigraphie mit 99mTc-HDP (fruh- und spatstatische Aufnahmen) (Abb. 1), CT (Abb. 2) und Kernspintomo-¶graphie (Abb. 3).

To report on radiological and epidemiological characteristics of pulmonary disease in patients with HIV infection in times of highly active antiretroviral therapy (HAART).Clinical data of 130 HIV infected adults with acute pulmonary symptoms were compared with findings in chest radiography (n = 130) and computed tomography (CT, n = 42). Presence and distribution of consolidation, interstitial changes, pleural effusion, and adenopathy were evaluated. Results were compared to findings from sputum, bronchoalveolar lavage, transbronchial biopsy, or empirical therapy results.48% of patients presented pathologic findings. Overall sensitivity for the detection of pulmonary involvement was 0.87 (chest radiography) vs. 0.97 (CT). Disease specific sensitivity was 0.33 compared to 0.70. Bacterial pneumonia (BP, n = 26, 20%) was the most frequent diagnosis, followed by pneumocystis jiroveci pneumonia (PJP, n = 17, 13%), mycobacterium avium complex (MAC, 6%), Kaposi's sarcoma and lymphoma (KS and NHL, each 4%), fungal pneumonia (2%), and tuberculosis (TBC, 1%). Focal pulmonary infiltration was predominantly present in BP (50%, n = 13). Reticular (35%; n = 6) and micronodular (35%; n = 6) infiltration were predominantly found in PJP.Despite HAART, lung involvement is still common. Only contrast-enhanced computed tomography shows an acceptable disease-specific sensitivity. In unclear cases, CT should be performed.

Besides the use of conventional x-rays in the diagnostic work-up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of ultrasound of the hands with proven methods such as conventional x-rays, low-field MRI and 3P-Sz.A total of 30 patients were studied using a 1 day protocol with ultrasound, 3P-Sz, MRI and x-ray of the hands. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA typical and non-RA typical changes. All methods were compared to the summarized findings interpreted by a rheumatologist after 2 years.Of the 30 patients, 19 presented with clinical symptoms of initial changes due to rheumatoid arthritis. Ultrasound revealed 14/19 patients with the correct diagnosis. Conventional x-rays indicated 11/19 patients, while 3P-Sz (100%) and low-field MRI (95%) showed high sensitivity. It was possible to differentiate between inflammation and inconspicuous findings.An experienced examiner can use ultrasound effectively for the initial diagnosis of RA. Based on its low cost, ultrasound is a valid alternative to conventional x-rays.

The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis.A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis.The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%).Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).

The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed.A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed.The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-alpha antagonists.Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-alpha antagonists is based on clinical and laboratory criteria, and signs of inflammation in MRI. MRI is useful for assessment of the effectiveness of anti-inflammatory therapy.

Collagen based vascular diseases with pulmonary involvement comprise rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, dermatomyositis and polymyositis, ankylosing spondylitis, Sjögren's syndrome, and mixed connective tissue diseases. The different characteristics of pulmonary involvement are described. In such circumstances, early recognition of lung involvement is of considerable significance and the relationship to the corresponding disease has to be made. Frequently unrecognised pulmonary involvement ends up as fibrosis with irreversible deficits in respiratory function.

Besides conventional x-ray, in the diagnostic work up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The AIM of this study was to compare the diagnostic value of a newly developed low field MRI with proven methods such as conventional x-ray and 3P-Sz.42 patients were studied using a one days protocol with 3P-Sz, MRI, and x-ray of the hands with yearly follow up examinations. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA-typical and non-RA-typical changes. All methods were compared to the summarised findings interpreted by a rheumatologist in consideration of the Ritchie articular index as gold-standard.24/42 patients presented with clinical symptoms of initial changes by rheumatoid arthritis. Conventional x-ray revealed in 20/24 patients within the correct diagnosis in the study period. On the other hand 3P-Sz and low field MRI concordantly showed all 24 patients with initial changes due to RA. Time of detection showed variations with a tendency to later findings by conventional x-ray.In the diagnostic work up of initial changes conventional x-ray should be the first choice in imaging. Our findings suggest that MRI represents an equally sensitive method for the diagnosis of initial changes due to RA in the region of the hands as compared to the 3P-Sz. The limitation of the low field MRI is the small field of view, so we prefer 3P-Sz or high field MRI in the diagnosis of patients with suspected RA.

The early stage of rheumatoid arthritis (RA) is primarily manifested in the soft tissue of the hand. Although ultrasound (US) is regarded as an important imaging process in diagnostic medicine, precise characterization of sonomorphological changes has not yet been undertaken.20 patients with RA were examined with US. Two radiologists described semiquantitatively the characteristics of synovial changes in the hand in a consensus-based process and measured the synovial width. Statistical methods were used to determine whether the various synovial changes differed significantly and to identify the most frequent locations of changes.On the basis of the significant differences in morphology and synovial width, it is possible to distinguish between unremarkable findings, pannus tissue and band-like synovitis. Pannus tissue is most frequently found on the finger flexor tendons (FFT), the metacarpophalangeal joints (MCP) and the tendon of M. extensor carpi ulnaris (ECU). Band-like synovitis exhibits an uncharacteristic distribution pattern with a slight propensity to favour these locations.The FFT, MCP joints and ECU tendons are particularly important in systematic US screening of the hand for the purpose of establishing reliable evidence of inflammatory changes. Different stages of RA can be identified on the basis of the characteristic types of synovitis and the number of joints and tendons affected.

In 1993 in Germany an estimated number of 50,000-70,000 individuals were infected with the human immunodeficiency virus (HIV), WHO estimations ranged up to 14 million HIV-positive individuals including 1 million children. AIDS-related diseases frequently occur in the lung. 65% of all AIDS-defining illnesses begin with life-threatening pulmonary infections. Most frequently HIV-positive patients present with Pneumocystis carinii pneumonia, followed by atypical mycobacteriosis, bacterial infections, Kaposi's sarcoma and non-Hodgkin lymphoma. The purpose of this article is to identify pulmonary HIV-associated diseases by focusing on radiological patterns and correlating them with clinical findings.

65 newborns or low-birthweight infants with suspicion of intracranial hemorrhage were examined with B-mode small part scanners. In 12 cases the diagnosis made by ultrasound could be compared with CT. There was a similar accuracy of both methods in case of intraventricular (IVH) and subependymal (SEH) hemorrhage. SEH seems to be easier detected by US. On the other hand there are problems in diagnosing subdural (SDH) and intracerebral (IHC) hemorrhages by US. These problems are caused by the adjacent skull, but does not exist for CT. B-mode-Echoencephalography is the method of choice for examination of high risk infants and for the follow up, because US is a cribside method and of high diagnostic accuracy. CT-studies should be done in case of hemorrhage adjacent to the skull and if the US-diagnosis seems not to be reliable.

Aetiology and diagnostic procedure of calyceal fornix rupture during intravenous urography are discussed. In the literature the fornix rupture is described as a spontaneous event--not so in the four cases presented. In two cases a sudden increase in intrapelvic pressure was due to an ureteric calculus, in the other cases an obstruction of the ureter was secondary to neoplasm. It is recommended to perform a CT as soon as a contrast medium extravasation in intravenous urography is diagnosed.

The authors compared the value of sonography with I.V. urography and CT in the diagnosis of nephrolithiasis, employing a retrospective study conducted on 310 patients. False positive and false negative sonographic findings were analysed in retrospect and the differential diagnosis discussed. Sonography proved of equal value to I.V. urography. 90% correct diagnoses were made via sonography; its sensitivity was 89%, its specificity 91%. 29% of the sonographically correctly diagnosed kidney stones had been detected by chance. The smallest sonographically identified stone was 3 mm, whereas the biggest stone that had been missed out was 7 mm. Sonography is definitely superior to I.V. urography in the detection of nephrocalcinosis and of roentgen-negative stones. Sonographically questionable parenchymal calcifications without shadowing should be investigated further by CT in case of clinical significance, even if the plain film is negative. The number of false positive findings in sonography can thus be reduced. Sonographic differentiation between central parenchymal calcification and stone formation is difficult in rare cases only. If required, additional information can be obtained via I.V. urography. The authors recommend sonography as the method of choice for suspected nephrolithiasis before I.V. urography is performed.

It is out of question: Sonography should be the first diagnostic step in viewing the intestines, child's brain and in some parts, the organs of basal thorax. It is the method of first choice regarding the possibility of instantaneous application and permanent reproduction.

The chest radiographs of 54 neonates with respiratory distress syndrome have been reviewed. 24% fell into stages I and II, 65% into stages III and IV and in 11% bronchopulmonary dysplasia developed. Infiltrations due to pneumonia or aspiration, persistent ductus arteriosus and pneumothorax can be differentiated radiologically. There was a strong correlation between the level of ventilatory pressure and the development of bronchopulmonary dysplasia. After reducing ventilation pressure to below 15 cm of water with a frequency of 66 per minute, bronchopulmonary dysplasia dropped from 14.4% (35 cases) to 5.3% (19 cases).

The Working Group for Standardisation justifies and comments on the establishment of a standard series for image quality assurance in X-ray diagnostic services (DIN 6868). In order to promote compliance with these standards, the users are given some background information on the structure of the standard series and on the recommended procedures to be followed. The definitions for the various hierarchically arranged tests, such as constancy test, status test, acceptance test as well as a definition for the term "base-line image quality" are explained.

Based on a retrospective study of 413 patients, the accuracy of sonography compared to CT, laparoscopy, biopsy and scintigraphy in the primary diagnosis of liver masses is shown. False positive sonographic reports are analysed in retrospect. 190 of 338 solid space-occupying growths of the liver have sonographically been called definite growths and 148 have been considered suspicious of being such growths. 49 of the cystic lesions were considered definitely cystic and 26 suspicious. Sonography made correct positive diagnoses in 91.8% of the cysts and in 88.9% of the solid growths. The diagnostic accuracy of solid growths (without further specification) was 90%. Among the sonographically suspicious ones the specific diagnosis was correct in 80.8% of the cystic lesions and in 44.5% of the solid lesions and a correct diagnosis without further specification was made in 55.4%. The majority of false positive diagnoses corresponded to normal findings in other methods. The number of false positive diagnoses in sonography in contrast to CT depends to a high degree on the experience of the physician. Before the use of other more invasive methods the sonographically suspicious findings should therefore be double-checked by an experienced colleague with several years of sonographic experience.