This phenomenon is more likely to occur in patients who receive high-dose (or multiple) injections of UCA. It may occur as early as 2 minutes after contrast administration, and therefore, may affect the evaluation of focal liver lesions in the late phase. This phenomenon should not be misdiagnosed as a pathological finding of the liver.

In 1168 women patients operated on between January 1981 and July 1984 at the Department of Gynaecology of the University of Tübingen it was possible to control retrospectively the suspected diagnoses that had been made preoperatively, both clinically as well as sonographically, the control being based on an examination of the site of operation and/or the histological preparation. Sonographic examination was mostly effected after clinical examination while being aware of the clinically suspected diagnosis. Preoperative clinical diagnosis was found to be mostly correct in 816 patients (69.9%). After subsequent sonographical examination the proportion of correct diagnoses rose to 961 cases (82.3%). The diagnostic "positive addition"--a total of 145 cases (12.4%)--represents a significant improvement in preoperative clinical diagnosis (p less than 0.001), especially also in the diagnosis of carcinoma of the ovary (p less than 0.05). No impairment of sonographic diagnosis was seen as a result of obesity. In addition, it was also possible to clarify by sonography another 73 cases of 107 that had remained unclear after clinical examination (68%). The results are discussed in detail, broken down according to 19 typical gynaecological diagnoses. For the clinician it is quite evident that there are clear indications for the additional use of sonography after clinical examination. In the following prospective part II of the study this result is analyzed in respect of its causes by clinical and sonographic examination conducted independent of each other.