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To get to know our products, visit us at Medica Hall 9 / C6 Or visit our Website: www.samsung.de/hme MONDAY @ MEDICA4 EH @ MEDICA No 1 2015 Pain in the Achilles tendon can be caused by a whole range of indica- tions. Dr Horst Sattler, a rheumatolo- gist and specialist in sports medicine based at the Department of Internal Medicine at the Park Hospital in Bad Dürkheim, Germany, is an expert at differentiating between the various characteristics and indications using ultrasound. He is so renowned for this expertise that even orthopae- dic specialists refer patients suffer- ing Achilles tendon pain to him. Dr Sattler spoke with EH about the dif- ferent causes of Achilles tendon pain and what is import in an ultrasound examination. Undefined pain Too much strain caused, among other reasons, by the running culture currently very much in fashion, can lead to Achilles tendon problems. The patient suffers, but can’t spec- ify exactly where it hurts. ‘Patients experience pain around the Achilles tendon, the insertion point and the heel,’ says Sattler, ‘which can be In mid-2015 the second generation of the ultrasound system H60 and the Urostation Touch was launched. At the Urology Department of the Hospital Fürth in Fürth, Germany the H60 and Urostation Touch are already being successfully used with 4 to 5 patients a week for prostate diagnostics. Patients who present with increased PSA levels under- go an mpMRI scan of the pros- tate since MRI achieves higher sen- sitivity in the detection of cancer lesions than other imaging modali- ties. “I have been a radiologist for more precisely specified with the help of ultrasound.’ In 2007, an examination of 1,000 marathon runners showed that it was not, as had been expected, the knees that were the runners’ biggest weakness but in fact the Achilles tendon. ‘The most important patho- logical finding was the hypo-echoic distension of the Achilles tendon, a widening and sprouting of ves- sels, the so-called angioneogenesis. This was even more noticeable and occurred more frequently than pos- sible problems with the knees,’ Dr Sattler points out. Ultrasound loves the Achilles tendon ‘The Achilles tendon is a showcase for ultrasound with regards to the pathology of the tendons,’ reports Sattler. ‘It has a synovial tube just like the biceps tendon and therefore no fluid around the tendon which can swallows sound. In turn it can have hypo-echoic widening of the so-called Peritendineum externum.’ 35 years and have been watching the development of multiparamet- ric Magnetic Resonance Imaging – mpMRI – of the prostate from the very beginning,” says Professor Josef Gmeinwieser, Medical Director of the Radiology Department at Klinikum Fürth. “Today, mpMRI yields much more reliable results than prostate ultrasound. While sonography has a 50 percent sensitivity in the detection of suspicious areas, diffusion and perfusion imaging multimodality MRI has been achieving a sensitivity of 80 to 90 percent.” This can occur in isolation and can cause pain, as Sattler has already diagnosed in many patients. ‘We can specify the pain in the Achilles tendon very accurately with the help of ultrasound. We can see whether peritendinitis is present, whether the tendon is directly intratendinous, whether it is the insertion point of the Achilles tendon which causes the pain (insertional Achilles tendinopa- thy) or whether the diagnosis may be bursitis, which can also occur in isolation.’ Often a combination of the aforementioned problems may be present. ‘As a rheumatologist I’m very interested in seronegative spondy- loarthritis. Rheumatology patients frequently have problems with their Achilles tendons, such as those anky- losing spondylitis. But sometimes the patient may also have bursitis and changes to the Achilles tendons, which they are not aware of because they can’t feel them. There’s a very broad range of indications.’ What methods are used for specification? ‘The best device is a high frequency transducer from 9 MHz and above,’ says Sattler. ‘We can use transducers up to 18 MHz. It’s important that the Achilles tendon is examined length- and crosswise. The foot should be positioned over a roller and freely movable,’ he explains, adding: ‘The tendon must not be tense and the foot must be dynamic.’ The colour Doppler ultrasound makes it easier to detect the sprout- Hand in hand: radiology and urology “However, if a mpMRI finding indi- cates that a biopsy is necessary, it is rather difficult to perform it using MRI. It is much easier with ultra- sound if you know where to take the tissue samples,” explains Professor Gmeinwieser. Therefore these two modalities have been merged. After an mpMRI scan was made, both the radiologist and the urologist assess the suspicious findings and decide on the areas to be marked for biopsy. Then the mpMRI scans of the prostate including the markings are loaded in the Urostation. Using a 3D endocavity probe a 3D ultrasound image of the pros- tate is generated and sent to the Urostation where it is fused with the MR images. The 3D ultrasound image is used to guide the biopsy while the mpMRI data show the location of the tumours. As soon as the images are matched and fused, the physician performs a virtual biopsy using the ultrasound image to control whether he would really “hit” the suspicious areas. Once the target is confirmed the actual biop- sy is carried out. While the biopsy needle is still in the prostate the 3D images are transmitted to the Urostation where they are displayed to check if the target was hit. “With the Urostation we achieve high accu- racy in the detection of tumours, especially aggressive and dangerous ones,” says Professor Blana, who is Head of the Department of Urology at Klinikum Fürth. Elastic fusion improve detection rate The so-called Elastic Fusion technol- ogy matches the mpMR and 3D ultrasound images since the prostate shape changes despite its relative stiffness, firstly because the patient is in different positions during the ultrasound and the mpMRI scan and secondly because the 3D probe exerts pressure on the prostate. No more superfluous biopsies A biopsy is a stressful procedure An Achilles heel describes a human’s weak point, but this is an ultra-tough tendon Samsung and the French company Koelis jointly developed a urology workstation that combines the advantages of multiparametric magnetic resonance imaging (mpMRI) with the practical advantages of 3D ultrasound-guided biopsy in the diagnosis of prostate cancer. Linking these two imaging procedures improves diagnostic accuracy and supports planning for focal therapy Ultrasound proves for Achilles tendon Prostate diagnostics: increased ac Fresh rupture of the Achilles tendon in a 76-year-old male amateur wine maker Achilles enthesitis with calcifications and increased vascularisation in a 70-year- old male tennis player Angioneogenesis with chronic tendinopathy of the Achilles tendon in a 56-year- old housewife UROSTATION, A JOINT DEVELOPMENT BY SAMSUNG AND THE FRENCH FIRM KOELIS, IS PROVING A SUCCESS AT THE UROLOGY DEPARTMENT IN FÜRTH HOSP EH @ MEDICA No 12015

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