Jill E.Jacobs1 BernardA. Birnbaum1 MichaelA. Shapiro1'2 CurtisR Langlotz1 FrancoisSlosman1'3 StephenE.Rubesin1 StevenC.Horii1OBJECTIVE. The purposeof thestudywasto developquantitativeandqualitativecriteria for diagnosing fatty liver on contrast-enhancedhelical CT.SUBJECTS AND METHODS. Differential liverâ€"spleen attenuationwas evaluatedbe tween 80 and I 20 sec after injection in 76 patients who underwent contrast-enhancedhelical CT. UnenhancedCT images had earlier establishedfatty liver when the liver minus spleen at tenuation difference was less than or equal to â€"¿ 10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presenceof geographic areassparedfrom fatty infi tration, and the relative liverâ€"spleen attenuation. The diagnostic accuraciesof various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves.RESULTS. Sensitivity,specificity, andreceiveroperatingcharacteristic curveareasfor ob servers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differ ential liverâ€"spleen attenuation (80â€"100sec; â€"¿ 20.5 H discriminatory value), the values were

In a patient population undergoing sonography for palpable nodular disease without known thyroiditis, focal nodules of thyroiditis had a wide variety of appearances. They most commonly appeared as solid hyperechoic nodules with ill-defined margins. However, the echogenicity was variable, and calcification and cystic-appearing regions were also noted. The vascularity of these nodules as assessed with color Doppler and power Doppler sonography also varied widely. Biopsy of these lesions is still necessary because there are no sonographic features that can reliably diagnose these lesions as thyroiditis and differentiate them from other lesions.

The Digital Imaging and Communications in Medicine (DICOM) Standard specifies a non-proprietary data interchange protocol, digital image format, and file structure for biomedical images and image-related information. The fundamental concepts of the DICOM message protocol, services, and information objects are reviewed as background for a detailed discussion of the functionality of DICOM; the innovations and limitations of the Standard; and the impact of various DICOM features on information system users. DICOM addresses five general application areas: (1) network image management, (2) network image interpretation management, (3) network print management, (4) imaging procedure management, (5) off-line storage media management. DICOM is a complete specification of the elements required to achieve a practical level of automatic interoperability between biomedical imaging computer systems--from application layer to bit-stream encoding. The Standard is being extended and expanded in modular fashion to support new applications and incorporate new technology. An interface to other Information Systems provides for shared management of patient, procedure, and results information related to images. A Conformance Statement template enables a knowledgeable user to determine if interoperability between two implementations is possible. Knowledge of DICOM's benefits and realistic understanding of its limitations enable one to use the Standard effectively as the basis for a long term implementation strategy for image management and communications systems.

Materials and MethodsSix patients were reviewed who had small angiomyolipomas (1 .2-4.0 cm) that contained tiny amounts of fat. A GE 8800 scanner was used in two patients and a GE 9800 in five; in one patient, one scan was obtained with each machine. Standard 1 0-mm-thick sections were used in all cases; four patients also were studied with 5-mm sections.In all patients, scans were obtained with IV contrast material; three patients had unenhanced scans as well. In total, 45 g of iodine were administered by the rapid bolus-infusion technique. Fatty tissue was considered to be present within a tumor if a region-of-interest value of -10 H or lower was found within the tumor. Region-of-interest measurements were used that included at least a total of three adjacent pixels. In three cases, the region-of-interest measurement included nine pixels or more. CT scanners were calibrated daily with a phantom.

A b s t r a c t The Digital Imaging and Communications in Medicine (DICOM) Standardspecifies a non-proprietary data interchange protocol, digital image format, and file structure for biomedical images and image-related information. The fundamental concepts of the DICOM message protocol, services, and information objects are reviewed as background for a detailed discussion of the functionality of DICOM; the innovations and limitations of the Standard; and the impact of various DICOM features on information system users. DICOM addresses five general application areas: (1) network image management, (2) network image interpretation management, (3) network print management, (4) imaging procedure management, (5) off-line storage media management. DICOM is a complete specification of the elements required to achieve a practical level of automatic interoperability between biomedical imaging computer systems -from application layer to bit-stream encoding. The Standard is being extended and expanded in modular fashion to support new applications and incorporate new technology. An interface to other Information Systems provides for shared management of patient, procedure, and results information related to images. A Conformance Statement template enables a knowledgeable user to determine if interoperability between two implementations is possible. Knowledge of DICOM's benefits and realistic understanding of its limitations enable one to use the Standard effectively as the basis for a long term implementation strategy for image management and communications systems.

To improve the ability of ultrasound to distinguish benign from malignant breast lesions, we used quantitative analysis of ultrasound image texture. Eight cancers, 22 cysts, 28 fibroadenomata, and 22 fibrocystic nodules were studied. The true nature of each lesion was determined by aspiration (for some cysts) or by open biopsy. Analysis of image texture was performed on digitized video output from the ultrasound scanner using fractal analysis and statistical texture analysis methods. The most useful features were those derived from co-occurrence matrices of the images. Using two features together (contrast of a co-occurrence matrix taken in an oblique direction, and correlation of a co-occurrence matrix taken in the horizontal direction), it was possible to exclude 78% of fibroadenomata, 73% of cysts, and 91% of fibrocystic nodules while maintaining 100% sensitivity for cancer. These findings suggest that ultrasonic image texture analysis is a simple way to markedly reduce the number of benign lesion biopsies without missing additional cancers.

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Myelomeningocele (MMC) is one of the most devastating, nonlethal congenital anomalies worldwide. The live birth prevalence of MMC changed dramatically in the 1980s with the introduction of maternal serum screening and the widespread use of prenatal ultrasound imaging. The high-resolution ultrasound affordable today with state-of-the-art equipment allows us to make a very accurate diagnosis of MMC, including details related to the entire fetal central nervous system. Ultrasound can accurately localize the site of the osseous and soft tissue defects. Congenital spinal defects can be characterized definitively as open or closed, which are treated very differently with in utero repair, which is done in some cases, compared to only conservative follow-up with postnatal therapy for occult defects. Additional findings of kyphosis, scoliosis and anomalous vertebrate and associated conditions such as cervical syrinx can be identified. The state of the intracranial structures, including the presence or absence of ventriculomegaly and hindbrain herniation, as well as unexpected complications such as intracranial hemorrhage can be diagnosed. The severity of neurological compromise in some fetuses can be estimated by detailed examination of the lower extremities. As well as searching for talipes, we also now routinely characterize flexion and extension motions at the hip, knee and ankle joints. The information provided by ultrasound plays a crucial role, now more than ever, in patient counseling and pregnancy management. This article emphasizes how we utilize ultrasound in the evaluation of patients with suspected MMC at the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia.