BACKGROUND AND PURPOSE: Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT- or fluoroscopic guidance. We conducted this study to evaluate the accuracy, time savings, radiation doses, and pain relief of US-guided pararadicular injections versus CT-controlled interventions in the lumbar spine in a prospective randomized clinical trial. MATERIALS AND METHODS: Forty adult patients were consecutively enrolled and assigned to a US or CT group. US-guided pararadicular injections were performed on a standard US device by using a broadband curved-array transducer (9–4 or 5–1 MHz). In the in-plane technique, the needle was advanced through the respective segmental intertransverse ligament. The needle tip position was verified by CT. The CT-guided approaches were performed under standardized procedures by using the CT-positioning laser function. RESULTS: The accuracy of US-guided interventions was 90%. The mean time to final needle placement in the US group was 4.0 ± 1.8 minutes, and in the CT group, 7.6 ± 2.1 minutes. The mean radiation doses, including CT confirmation for study purposes only, were 20.3 ± 9.0 mGy cm for the US group and 42.6 ± 36.1 mGy cm for the CT group. Both groups showed the same significant pain relief (P < .05) without relevant “intermethodic” differences of pain relief (P > .05). CONCLUSIONS: US-guided pararadicular injections show a therapeutic effect similar to that in the time-consuming, expensive, ionizing CT or fluoroscopically guided pararadicular injections and result in a significant reduction of procedure time expenditure and avoidance of radiation.

OBJECTIVE. The purpose of this study was to assess and compare contrast-enhanced ultrasound and MRI patterns in the diagnosis of soft-tissue masses. MATERIALS AND METHODS. Two hundred fifty-five consecutively registered patients with histologically confirmed soft-tissue masses were included in this retrospective study. The diagnostic properties of four predefined contrast enhancement (CE) patterns were assessed, and logistic regression analysis was performed to determine the correlation between diagnosis and CE pattern, lesion size, and patient age and sex. The influence of lesion size on the occurrence of inhomogeneous CE patterns in malignancies was also determined. RESULTS. Homogeneous CE patterns were highly specific for benignity, and inhomogeneous CE was moderately specific for malignancy in both ultrasound and MRI. A combination of homogeneous and inhomogeneous CE patterns led to 88.3% and 88.7% sensitivity, 66.7% and 59.7% specificity, 73.4% and 68.2% correct classification, 54.6% and 47.8% positi...

Problemstellung: Wir berichten über eine neuartige Prozedur zur Verbesserung der sonografisch gezielten Biopsie muskuloskelettaler Raumforderungen mit Hilfe der pre-liminären Anwendung von Ultraschallkontrastmittel. Patienten und Methoden: Im Rahmen der hier vorgestellten Pilotstudie wurden 25 Patienten mit muskuloskelettaler Raumforderung nach einem standardisiertem Algorithmus sonografisch untersucht (iU22®, Philips, USA): es erfolgte jeweils eine B-Bild-Sonografie inklusive Duplexmodus (12 – 5 MHz) und kontrastmittelunterstützte Sonografie (9 – 3 MHz; SonoVue®, Bracco, Italy) zur Definition relevanter Tumorregionen für die unmittelbar angeschlossenen Biopsie. Nach dem sonografischen Definitionsvorgang erfolgte die sonografisch geführte bioptische Gewebsentnahme aus der jeweiligen Läsion (tru-cut™ Biopsievorrichtung) in Koaxialtechnik. Ergebnisse: Die Definition von kontrastierenden und somit vitalen und relevanten Tumorabschnitten resultiert in einer diagnostischen Ausbeute der jeweils angeschlossenen Biopsie von 100 %. Von den von uns so untersuchten Raumforderungen stellten sich 17 als maligne und 8 als benigne – durch die jeweils endgültige histopathologische Aufarbeitung oder durch den weiteren Verlauf – heraus. Schlussfolgerung: Die hier vorgestellte Pilotstudie mittels eines kleinen Patientenkollektivs verbesserte die diagnostische Ausbeute auf 100 %, was derzeit als zumindest richtungweisend angesehen werden kann. Der hier vorgestellte, einfache Algorithmus sollte grundlegend dazu beitragen helfen, nicht diagnostische Biopsien an muskuloskelettalen Tumoren – was in den meisten Fällen auf Probenentnahmen in falschen Tumorregionen zurückführbar ist – auf ein Minimum zu reduzieren. Purpose: We report on a novel approach to the work-up of musculoskeletal lesions with addition of an ultrasound contrast agent followed by focal ultrasound-guided biopsy. Materials and Methods: In this pilot study 25 patients (age: 12 – 75) with unclear musculoskeletal tumors underwent grayscale ultrasound, color Doppler, contrast-enhanced ultrasound and subsequent ultrasound-guided biopsy. Grayscale and color Doppler ultrasound were performed with a 12 – 5 MHz broadband linear transducer and contrast-enhanced ultrasound with a 9 – 3 MHz broadband linear transducer (iU22®, Philips, USA) using a second-generation contrast agent (SonoVue®, Bracco, Italy). After the definition of the target area by contrast-enhanced ultrasound, guided biopsies were performed with a spring-loaded tru-cut™ biopsy needle using the coaxial technique. Results: The definition of enhancing and viable tumor regions resulted in a diagnostic yield of the subsequent biopsy of 100 %. Seventeen tumors were classified as malignant and eight as benign, which was finally confirmed by histological work-up or the further clinical follow-up. Conclusion: This pilot study with a limited series of patients improved the diagnostic yield of ultrasound-guided biopsy to 100 %, which is at least rather promising. Our easy-to-use algorithm should reduce the rate of inconclusive histology results mainly caused by sampling errors to an unrivaled minimum.

Purpose: To present a safety-optimized ultrasound-guided minimal invasive carpal tunnel release (CTR) procedure. Materials and Methods: 104 patients (67 female, 37 male; mean age 60.6 ± 14.3 years, 95% CI 57.9 to 63.4 years) with clinical and electrophysiological verified typical carpal tunnel syndrome were referred for a high-resolution ultrasound of the median nerve and were then consecutively assigned for an ultrasound-guided CTR after exclusion of possible secondary causes of carpal tunnel syndrome such as tumors, tendovaginitis, ganglia and possible contraindications (e.g., crossing collateral vessels, nerve variations). Applying a newly adapted and optimized algorithm, basing on the work proposed by Petrover et al. CTR was performed using a button tip cannula which has several safety advantages: On the one hand, the button tip cannula acts as a blunt and atraumatic guiding splint for the subsequent insertion of the hook-knife, and on the other hands, it serves as a “hydro-inflation”-tool, i.e., a fluid-based expansion of the working-space is warranted during the whole procedure whenever needed. Results: In all patients, successful releases were confirmed by the depiction of a completely transected transverse carpal ligament during and in the postoperative ultrasound-controls two weeks after intervention. All patients reported markedly reduction of symptoms promptly after this safety-optimized ultrasound-guided minimal invasive CTR and at the follow-up examination. No complications were evident. Conclusion: The here proposed optimized algorithm assures a reliable and safe ultrasound-guided CTR and thus should be taken into account for this minimal invasive interventional procedure.