Spleen size: how well do linear ultrasound measurements correlate with three-dimensional CT volume assessments?

Ultrasound measurement of splenic length is standard practice, but it is not known how well this represents the true size of the spleen. Previous studies, using a combination of measurements from in vivo and resected spleens, were subject to error because of changes in splenic size. The aim of this study was to correlate the dimensions of the spleen measured by ultrasound with the splenic volume measured by helical CT. Ultrasound examination was performed on 50 adult patients at the time of their attendance for abdominal CT. Linear dimensions of the spleen were measured with the patient first in the supine and then in the right lateral decubitus (RLD) position. The splenic volume was calculated from a three-dimensional reconstruction of the CT images. There was good correlation, using Spearman's rank correlation, between ultrasound measurements and CT volumes with correlation coefficients exceeding 0.7 for all parameters except one. The linear measurement that correlated most closely with CT volume was the spleen width measured on a longitudinal section with the patient in the RLD position (correlation coefficient (r)=0.89, p<0.001). There was also good correlation between splenic length measured in the RLD position and CT volume (r=0.86, p<0.001). We conclude that a good correlation exists between in vivo ultrasound assessment of splenic size and true splenic volume. The most accurate single measurement is spleen width measured on a longitudinal section with the patient in the RLD position. However, measurement of splenic length, which is the most commonly used in clinical practice, also correlates well with splenic volume, particularly when performed with the patient in the RLD position.

Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast

AIM

To investigate the relationship between ultrasound characteristics, mammographic findings and histological grade in cases of invasive ductal carcinoma which produce a mass on ultrasound.

MATERIAL AND METHODS

A retrospective review was performed of the imaging findings in 120 patients diagnosed with invasive ductal carcinoma of the breast between January 1996 and December 1997. Imaging findings were correlated with the histological grade of tumour.

RESULTS

High-grade tumours were significantly larger both on ultrasound and mammography (P < 0.016). A spiculated margin on mammogram was documented in 72% of low-grade tumours compared with only 24% of high-grade tumours (P = 0.001). Twenty-two per cent of low-grade tumours had a poorly defined margin on mammography compared with 66% of high-grade tumours (P = 0.001). At ultrasound, 16% of high-grade tumours (95% confidence limits 7-29%) had a well-defined margin. Acoustic enhancement was seen in 36% of high-grade tumours compared with only 9% of low and intermediate-grade tumours (P = 0.003): 22% of all tumours showed acoustic enhancement. Acoustic shadowing was seen in 71% of low-grade tumours compared with only 28% of high-grade tumours (P = 0.003). Malignant-type microcalcification was seen on mammogram in 6% of low-grade tumours compared with 31% of high-grade tumours (P = 0.045).

CONCLUSION

The classical appearance of a malignant breast mass as a spiculated mass on mammogram associated with acoustic shadowing on ultrasound is more typical of a low-grade tumour. In comparison, high-grade tumours are more likely to demonstrate posterior acoustic enhancement, and a proportion has a well-defined margin on ultrasound. Therefore, high-grade invasive ductal carcinoma may paradoxically display similar imaging features to a benign breast mass.

Local radiotherapy for alveolar air leak

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Waldenstrøm's macroglobulinaemia of the breast detected by colour Doppler ultrasound

Waldenstrøm's macroglobulinaemia (lymphoplasmacytoid lymphoma) is a low grade B cell non-Hodgkin's lymphoma. The majority of patients present with advanced disease. Lymphoma of the breast is rare and usually arises as part of a disseminated disease process. A case of disseminated Waldenstrøm's macroglobulinaemia is reported in which the breast was involved. The findings using standard mammographic and ultrasound techniques were non-specific and only when colour Doppler examination was performed could an abnormality be detected.