Zusammenfassung ! Ziel: Ziel der prospektiven Untersuchung war es, Ultraschall-Elastografie, B-Bild-Sonografie und Mammografie hinsichtlich ihrer Aussagekraft zur Dignität von Herdbefunden zu vergleichen. Weiterhin wurde untersucht, ob sich die Ergebnisse in der Gruppe palpabler Befunde von denen in der Gruppe nicht palpabler Befunde unterscheiden. Material und Methoden: Es wurden 97 histologisch ungesicherte Herdbefunde (66 benigne, 31 maligne) untersucht. Sensitivität, Spezifität, positiv (PPW) und negativ prädiktiver Wert (NPW) und Effizienz wurden berechnet. Die Wertigkeit der Elastografie wurde zusätzlich in der Gruppe palpabler Befunde und in der Gruppe nicht palpabler Befunde getrennt betrachtet und verglichen. Ergebnisse: Die Sonografie erreichte eine Sensitivität von 97 % und eine Spezifität von 82 % (PPW 71 %, NPW 98 %, Effizienz 87 %) bzw. 84 % und 89 % für die Mammografie (PPW 79 %, NPW 92 %, Effizienz 88 %). Die Sensitivität der Elastografie lag bei 71 %, die Spezifität bei 48 % (PPW 39 %, NPW 78 %, Effizienz 56 %). Die Kombination aus Sonografie und Elastografie brachte eine Sensitivität von 100 % und eine Spezifität von 38 % (PPW 43 %, NPW 100 %, Effizienz 58 %). Sensitivität und Spezifität waren zwischen den Gruppen der palpablen und nicht palpablen Befunden nicht signifikant unterschiedlich. Schlussfolgerung: Die Elastografie stellt ein klinisch einfach anwendbares Diagnoseverfahren dar. Die Effizienz der Methode in der alleinigen Anwendung zeigt keine Vorteile gegenüber alternativen Methoden. In Kombination mit der B-Bild-Sonografie aber wurde deren Sensitivität auf Kosten der Spezifität gesteigert. Abstract !Purpose: This prospective study aimed to compare sonoelastography, B-mode ultrasonography, and mammography in terms of their ability to distinguish benign from malignant breast lesions. We also assessed how the diagnostic value of sonoelastography differs between palpable and clinically occult lesions. Materials and Methods: Evaluation revealed a total of 97 lesions (66 benign; 31 malignant) without histological confirmation at the time of the initial examination. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) as well as efficiency were calculated. These parameters were separately assessed for palpable lesions and for non-palpable lesions. We subsequently compared these results. Results: Sonography had a sensitivity of 97% and a specificity of 82% (PPV: 71 %, NPV: 98 %, efficiency: 87%). For mammography, the respective figures were 84 % and 89 % (PPV: 79%, NPV: 92%, efficiency: 88 %). Sonoelastography had a sensitivity of 71 % and a specificity of 48 % (PPV: 39%, NPV: 78 %, efficiency: 56 %). The combination of sonography and sonoelastography yielded a sensitivity of 100 % and a specificity of 38% (PPV: 43%, NPV: 100 %, efficiency: 58%). The sensitivity and specificity were not statistically different between the groups of palpable and non-palpable lesions. Conclusion: Sonoelastography is easily performed and not very time-consuming. Used by itself, the met...

In this study there is no significant advantage of sonoelastography, although a tendency is apparent. The low interobserver variability also favors sonoelastography for preoperative diagnostics, since it may be less dependent on the observer than conventional B-mode imaging. The results of this prospective study require validation in a prospective multicenter study with larger case numbers.

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Background Gout is the most prevalent metabolic arthritis and affects about 8,3 million inhabitants in the USA. Epidemiologic data from Europe are comparable and indicate that gouty arthritis or chronic tophaceous gout evolves as a public health problem with raising prevalence. Patients with chronic tophaceous gout have a high cardiovascular risk. Additionally cardiovascular medication, such as acetylsalycilic acid, antihypertensive or diuretics have an influence of renal urate handling which might cause gout attacks. Therefore it is necessary to identify these patients to prevent them from new attacks. Serum measurement of urate levels might not be sufficient for this purpose. Objectives The dual-energy-computertomography (DECT) is a new method to detect monosodiumurate (MSU) deposits. Using two different x-ray voltages (80 and 140 kV) in combination with Hounsfield-units allows to separate calcium vom sodium and separate MSU from other adjacent structures. Using DECT for tophus detection reveals much more MSU deposits compared to clinical examination. We tried to determine the extent of the involvement of anatomical structures in tophus deposition. Methods In this study we used DECT to determine bone and tendon involvement of 14 patients with chronic tophaceous gout. There is no established gold standard for DECT evaluation. Therefore DECT-scans were independently assessed by a radiologist and a rheumatologist to determine the extent of bone and tendon involvement of the feet. Tophi were allocated to the involved bone and tendon. Tophussize was rated semiquantitatively (0-5). Results Our patients do not differ in their demographic data from other published results. There were more men than women affected and the average age is over 60 years old which is in line with other publications. Both examiners revealed more tophi on DECT scans than clinically apparent. Tendon involvement is much more common than clinically suspected. In contrast to the known bone manifestations (typically “Podagra”) we found far more tendon involvement, mainly achilles tendon, than expected. Conclusions Radiologist and Rheumatologist differed in their results indicating that there might be a learning curve. Further validation is needed to compare the results with other groups to establish a gold standard for interpreting the results of this new technique. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5296