The aim of the study was to investigate if contrast enhanced ultrasound (US) imaging of muscular blood flow during and following exercise could detect alterations in vascularity in fibromyalgia (FM) patients. Ten FM patients and 10 matched controls were examined with US during standardised static and directly following static and dynamic muscular contractions of the infraspinatus muscle. Doppler ultrasound evaluation was performed before and after the administration of ultrasound contrast media. The FM patients had lower magnitude of muscle vascularity following dynamic (p<0.001) and during (p<0.002) static exercise compared to controls. The immediate flow response to muscular activity was not only of a lower magnitude, but also of a shorter duration in FM patients following dynamic exercise (p<0.001) and during static exercise (p<0.01). There were no statistically significant group differences in blood flow intensity or duration following static contraction. In conclusion, contrast enhanced US was found useful to study real-time muscle blood flow changes during and following standardised, low-intensity exercise in FM patients and healthy controls. Our results support the suggestion that muscle ischemia can contribute to pain in FM, possibly by maintaining the central nervous changes such as central sensitisation/disinhibition. US with contrast can be a new valuable approach to assess muscle perfusion in pain patients during standardised exercise.

FDG-PET imaging was performed because of suspected recurrence of lymphoma of the chest. There was an area of increased activity posterior to the left sternoclavicular joint, suspected of being a relapse. Workup showed a thrombus at the tip of a central venous line corresponding to the FDG uptake. This is explained by the inflammatory process involving and surrounding chronic thrombus. Focal activity in relation to the tip of a venous catheter is very likely to have a benign etiology. It is important to recognize this not to overdiagnose a malignancy. For a correct interpretation, it is necessary to know the patient's history and having access to current radiologic examinations.

The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

Dynamic (99m)Tc-HIDA SPECT, capable of assessing different aspects of liver function for the total liver, as well as for individual segments, has potential value in the management of patients with primary sclerosing cholangitis.

Our study indicates that the use of CEUS significantly improves diagnostic confidence. CEUS improves the detection of HCC in patients with HCV-induced liver cirrhosis. Also, CEUS makes it possible to rule out malignancy in many cases where baseline US shows indeterminate focal lesions. In low-endemic countries, the use of CEUS in screening for HCC may be considered.

Intra-operative ultrasound (IOUS) is considered to be the most sensitive imaging modality for detection of focal liver lesions. It has been shown to affect the clinical management of patients with hepatic colorectal metastases and primary liver tumours undergoing exploratory laparotomy and segmental resection. However, small, and especially iso-echoic lesions are still missed and characterization of subcentimetre lesions is difficult. The improvement of detection and characterization of focal liver lesions using second-generation gas-containing contrast agents with specific non-linear detection modes in transabdominal scanning can be expected to apply to IOUS. Initial experience of contrastenhanced IOUS based on use of conventional abdominal probes provided impressive results. The recent development of high-frequency linear array probes for small parts use with contrast-specific software enables the detection of lesions as small as 2-3 mm and allows characterization of small lesions. Though only preliminary experience is available, this appears to be an exciting and promising new application.Keywords Liver resection · Liver metastases · Hepatocellular carcinoma · Helical computed tomography (hCT) · Magnetic resonance imaging (MRI) · Contrast-enhanced ultrasound (CEUS) · Intra-operative ultrasound (IOUS) · Contrast-enhanced intra-operative ultrasound (CE-IOUS)