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We performed a retrospective study to determine the sensitivity of mammography in detecting breast cancer arising in women with augmented breasts. Of eight women with breast implants in whom breast cancer developed, six had mammograms before biopsy. Only two of the six cancers were identified mammographically (sensitivity = 33%), and one of these two was seen only in retrospect. In both cases, the mammographic findings suggested a benign rather than a malignant process. All eight women had a palpable mass and early disease, and all are clinically disease-free at present. The sensitivity of mammography in detecting palpable cancers in a control group of women without implants was 92% (118 of 128). For tumors of 2 cm or less, the sensitivity was 88% (58 of 66). These results suggest that the sensitivity of mammography in detecting breast cancer is decreased when implants are present. Further investigations are needed to determine the effects of prostheses on mammographic evaluations.

Although secondary renal involvement is a common manifestation of systemic lymphoma, primary renal lymphoma is a rare and controversial entity. Since 1980, only 32 cases have been reported, and diagnostic criteria are not firmly established. 1-6 We report a case of primary renal lymphoma in a child and describe the sonographic and CT findings before and after treatment.

Doppler color flow imaging has been used to identify obstruction, rejection, and nonfunctioning renal allografts. When done in the immediate posttransplant period on poorly functioning kidneys, it allows early and accurate detection of surgically correctable changes such as arterial or venous thrombosis or early obstruction by blood, urine, or lymph. Further, it determines changes in intrarenal flow patterns that may indicate early transplant dysfunction, such as acute tubular necrosis and/or acute rejection as well as obstruction. Additionally, baseline values can be obtained in uncomplicated cases for serial follow-up. Between July 1980 and February 1991, 20 transplant patients had Doppler color flow imaging in the immediate posttransplant period. The kidney contour, perirenal collections, vessel flow patterns, and resistive indexes were assessed. In two patients, immediate surgical intervention salvaged the allograft. In several other patients with primary nonfunctioning kidneys, the study distinguished between acute tubular necrosis and obstruction due to external compression. We concluded that protocol Doppler color flow imaging is valuable in the immediate posttransplant period for determining surgically correctable complications.

Sixty-nine patients were evaluated prospectively by sonography and history to determine the presence of cholelithiasis. Sixteen patients (23%) had a positive diagnosis. A control group was also prospectively evaluated. We have determined that patients above age 50 with a permanent ileostomy are at statistically significant risk of having cholelithiasis, and their risk is greater than that of a control group matched for age and sex. Radiologists should recognize this association and carefully evaluate the gallbladder of any patient with a permanent ileostomy who has abdominal pain.

Over the past 15 years the development of diagnostic ultrasonography has been marked by a series of major technological steps, of which the introduction of Doppler color flow imaging (DCFI) is the most recent and potentially one of the most significant. The transition from A-mode to B-mode display of the ultrasound signal, followed by the introduction of gray scale imaging in the early 1970s represented the first major improvements in ultrasound imaging since the beginning of the clinical use of ultrasound. Several years later real-time imaging became commercially available, making possible an entirely new range of diagnostic applications. Each of these steps has resulted in major improvements in the clinical utility of ultrasound for diagnosis. The most recent technological development comparable in potential impact to the development of gray scale and realtime is the introduction of methods to process both tissue and flow data from the backscattered ultrasound signal simultaneously — Doppler color flow imaging.

The uses of Doppler in the abdomen and pelvis include the identification of vessels, the determination of the direction of blood flow, the evaluation of narrowing or occlusion, and the characterization of flow to organs and tumors. Although most of the reported work using pulsed Doppler has emphasized the detection of stenosis and flow disturbances in major vessels, Doppler information may also be valuable in inference of abnormalities in the peripheral vascular bed of an organ or tissue (Fig. 1). Changes in the spectral waveform, or in the case of Doppler color flow imaging (DCFI), in the appearance of flow in diastole, provide insight into the resistance of the vascular bed supplied by the vessel and indicate changes due to a variety of pathologies. In abdominal and pelvic applications, information obtained from both large and small vessels may be of clinical value. For example, large vessel changes such as flow reversal in the portal vein, the presence of portosystemic collaterals, the occlusion of portal, splenic, or renal veins, and mesenteric or renal artery stenosis are all identifiable by ultrasonographic methods. Small vessel changes reflecting the impedance of the vascular bed may also be important in the early identification of rejection of transplanted organs and may aid in differentiation of benign from malignant masses.

High-resolution real-time ultrasound scanning of 54 patients was performed with a sector scanner during a variety of neurological procedures. Scans obtained at the time of craniotomy were successful in characterizing and localizing tumors, abscesses, arteriovenous malformations, and hematomas within the brain of 15 of 16 adult patients. One attempt to visualize a brain cyst through a 15-mm burr hole was unsuccessful. Scanning of 37 infants and young children was performed through the anterior fontanelle during placement of ventricular shunts. This allowed for the accurate placement of shunts in all patients and resulted in fewer short-term and long-term complications. Intraoperative ultrasound is a practical and highly effective means of providing intraoperative localization of intracranial anatomy and disease.

Visualization of the vascular system, and the assessment of blood flow and organ perfusion are several applications of this emerging area of medical imaging.