In this prospective study the performance of transrectal or transvaginal endoscopic ultrasonography (EUS) was compared with that of computed tomography (CT) in the diagnosis of perirectal fistulae, abscesses and diffuse inflammatory changes in the lower pelvis in 25 patients with Crohn's disease. Results were verified by surgery in eight patients and by correlation with findings on endoscopy, barium radiography and fistulography, and the clinical course in all other patients. EUS was superior to CT in diagnosing fistulae (14 vs 4 correct diagnoses) and inflammatory infiltration of the lower pelvic muscles (11 vs 2 correct diagnoses). The methods were equivalent in diagnosing perianorectal abscesses. CT was superior in the detection of inflammatory changes in the pararectal fasciae and fatty tissue which could not be detected by EUS. It is concluded that EUS should be used as the primary method for diagnosing perianorectal changes in patients with Crohn's disease especially in the case of fistulae and abscesses, having the added advantage of lack of radiation for the patient.

Nineteen deep cervical lipomas and five patients with cervical lipomatosis were examined with computed tomography (CT) and Sonography. By means of CT, which is the imaging method of choice for both diseases, it is possible to differentiate between circumscribed lipomas and infiltrating intramuscular lipomas. In addition, an exact localization in parenchymatous organs is possible. Cervical lipomatosis is also clearly delineated. Sonography is the first imaging method in cervical swelling or lesions; therefore, knowledge of the sonomorphology of fatty tumors is mandatory. Cervical lipomas have a fairly typical sonomorphology, but it is not as pathognomonic as the density values are by means of CT. In cervical lipomatosis, an adequate pretherapeutic assessment of the depth of infiltration is not possible sonographically. Only the cervical vessels can be clearly differentiated in this condition.

To define the appearance of degenerative changes of the triangular fibrocartilage (TFC) of the wrist on magnetic resonance (MR) images, the TFCs in one wrist of each of 30 healthy subjects in three age groups (20-35, 36-50, and greater than 50 years) and six TFCs from fresh cadavers were examined by means of coronal T1-weighted spin-echo sequences. Histologic findings were compared with findings on MR images in the cadaveric TFCs. It was proved that patches or lines of signal hyperintensity within the cadaveric TFCs were caused by degenerative changes and tears. Similar changes of the TFCs on MR images of the healthy subjects may have been caused by degeneration. In the healthy subjects, degenerative changes of the TFC, usually well defined on MR images, occurred at a very early age. The TFC appears to undergo stages of degeneration comparable to those of the menisci of the knee, but differentiation between traumatic and degenerative tears may be difficult.

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We conclude that--if sternal acupuncture is planned in the region of corpus--previous radiographs should be done to rule out this anomaly. Furthermore, we strongly recommend the acupuncture technique of the "Wiener Schule", which prescribes a safe superficial-oblique approach to the sternum.