Showing papers in "Journal of Ultrasound in Medicine in 2003"
TL;DR: There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid, and half of the lesions in this series had at least 1 uncommon sonographic feature.
Abstract: Objective. To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid. Methods. We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (≥35% of cases) or uncommon (<10% of cases). Combinations of features were also analyzed. Results. Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular. Conclusions. There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature. Key words: head and neck neoplasms, sonography; sonography, Doppler studies; sonography, power Doppler studies; thyroid, biopsy; thyroid, neoplasms; thyroid, sonography.
318 citations
TL;DR: The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant, and solid hypervascular thyroid nodules have a high likelihood of malignancies.
Abstract: Objective. To determine whether color Doppler interrogation of a thyroid nodule can aid in the prediction of malignancy. Methods. We obtained color Doppler images of thyroid nodules undergoing sonographically guided fine-needle aspiration. The color Doppler appearance of each nodule was graded from 0 for no visible flow through 4 for extensive internal flow. The size, sonographic appearance, results of fine-needle aspiration, and surgical pathologic findings, if available, were recorded for each nodule. Results. There were 254 nodules sampled, of which 32 were malignant (all confirmed at surgery) and 177 were benign. Fourteen (43.8%) of the 32 malignant nodules were color type 4, compared with only 26 (14.7%) of the 177 benign nodules (P = .0004, Fisher exact test). Thirteen (40.1%) of the 32 malignant nodules were solid, as were 18 (10.2%) of the 177 benign nodules (P = .006, Fisher exact test). Among solid nodules, the prevalence of malignancy was greater when the nodule was hypervascular (13 [41.9%] of 31) than when the color type was less than 4 (11 [14.7%] of 77; P = .004, Fisher exact test). Condusions. Solid hypervascular thyroid nodules have a high likelihood of malignancy (nearly 42% in our series). The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant.
301 citations
TL;DR: Sixty-nine percent of benign nodules had at least 1 finding reported previously as associated with malignancy, and the interobserver reliability of the sonographic findings was good to very good for 3 of the 5 findings assessed.
Abstract: Objective. To prospectively determine the sonographic findings of nodular hyperplasia of the thyroid, to compare these with reported findings associated with malignancy, and to assess interobserver reliability. Methods. Seventy thyroid nodules were scanned, and then biopsies of the nodules were performed under sonographic guidance with fine-needle cytologic analysis; in all cases images were reviewed by 2 experienced radiologists without knowledge of clinical outcome. Findings reported associated with malignancy were specifically assessed. Interobserver agreement between the expert and secondary readers for each finding was calculated by the κ or weighted κ statistic and the Fisher exact test of independence. Results. There were 68 benign and 2 malignant nodules in a population of 63 female and 7 male patients. The mean benign nodule size was 2.9 cm; 60% were solid; 54% were hypoechoic; 59% were microlobulated or macrolobulated; 47% had central vascularity; 24% contained calcifications; and 82% were elliptical in shape. There was very good interobserver reliability for the presence of calcium (κ = 0.91) and good agreement for the presence and location of vascularity (κ = 0.75) and the amount of cystic components (κ = 0.62; all P < .01). Conclusions. Sixty-nine percent of benign nodules had at least 1 finding reported previously as associated with malignancy. The interobserver reliability of the sonographic findings was good to very good for 3 of the 5 findings assessed. Key words: interobserver reliability; thyroid nodules; thyroid sonography.
257 citations
TL;DR: Power Doppler sonography showed increased vascularity around the fracture sites in treated dogs with and without contrast agent administration, and enhancement after contrastAgent administration was consistently higher in treated legs than control legs.
Abstract: Objective To study the use of power Doppler sonography for assessing changes in vascularity during treatment of fracture sites with low-intensity ultrasound. Methods In 6 dogs (3 pairs), subcutaneous dissection of the midshaft of the ulna allowed symmetrical osteotomies to be made with a reciprocation saw. Three dogs were treated and 3 were used as controls. The fracture site was subjected to 1.5-MHz low-intensity ultrasound (30 mW/cm2) for 20 minutes daily from a therapeutic ultrasonic device. Gray scale sonography was performed to evaluate the fracture site. Power Doppler sonography was used to assess flow patterns at the fracture site and surrounding soft tissue. A sonographic contrast agent was administered intravenously. The dose was 0.2 mL/kg. Results Power Doppler sonography showed an increase in flow around the fracture site in the treated dogs compared with that in control dogs. Color pixel values on day 7 were 3-fold higher in treated legs than control legs and on day 11 were 33% higher in treated legs than control legs. Enhancement after contrast agent administration was consistently higher in treated legs than control legs. Conclusions Power Doppler sonography showed increased vascularity around the fracture sites in treated dogs with and without contrast agent administration.
190 citations
TL;DR: Diffuse parenchymal lung disease should be considered if multiple comet tail artifacts distributed over the whole surface of the lung together with a thickened and irregular, fragmented pleural line are visible and transthoracic sonography may reflect the distribution of pleural involvement and show subpleural alterations.
Abstract: OBJECTIVE The value of transthoracic sonography in diffuse parenchymal lung disease is not established. This prospective study was conducted to analyze pleural and parenchymal alterations in patients with diffuse parenchymal lung disease by transthoracic sonography and to compare the results with the findings of a control group. METHODS Fifty-three patients with diffuse parenchymal lung disease and 35 control subjects underwent transthoracic sonography for assessment of (1) basal pleural effusion, (2) the presence and number of comet tail artifacts, (3) thickening, (4) an irregular, fragmented pleural line, and (5) subpleural alterations. RESULTS Basal pleural effusion was revealed in 37.7% of the patients with diffuse parenchymal lung disease (0% of the control subjects; P 6 per scan) comet tail artifacts (14.3% of the control subjects; P < .001). Only a few artifacts (< or = 6 per scan; P < .001) were shown in 85.7% of the control subjects. All the control subjects had strongly localized comet tail artifacts and no thickened pleural line (84.9% of patients; P < .001). In 98.1 % of the patients, an irregular, fragmented pleural surface could be detected (82.8% of the control subjects; P < .05). Subpleural alterations were found in 37.7% of the patients and in 8.6% of the control subjects (P < .001). CONCLUSIONS Diffuse parenchymal lung disease should be considered if multiple comet tail artifacts distributed over the whole surface of the lung together with a thickened and irregular, fragmented pleural line are visible. Transthoracic sonography may reflect the distribution of pleural involvement and may show subpleural alterations.
186 citations
TL;DR: The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch.
Abstract: Objective We sought (1) to describe an anatomic defect of the uterine cavity in the anterior isthmus diagnosed by transvaginal sonography in a group of premenopausal women with previous cesarean deliveries, (2) to establish whether there is an association between the presence of the pouch and a bleeding disturbance, and (3) to compare the diagnostic efficacy of transvaginal sonography versus hysteroscopy for the detection of this defect. Methods We performed a retrospective study of 92 premenopausal women with histories of at least 1 cesarean delivery. Age, number of previous cesarean deliveries, time elapsed between last cesarean delivery and first consultation, and total area of the pouch were recorded in groups of women with and without abnormal bleeding. Hysteroscopy was also performed in 43.8% of the patients who had abnormal bleeding. Results In all women, transvaginal sonography revealed the presence of a pouch on the anterior uterine segment at the site of the expected previous cesarean delivery scar. Hysteroscopy showed 100% correlation with transvaginal sonography in detection of this pouch. Conclusions The high correlation between bleeding disturbances and the presence of a pouch, in the absence of other pathologic entities, suggests this anatomic defect as the possible cause, especially in view of the fact that women who had heavier and longer bleeding episodes tended to have a larger pouch. Transvaginal sonography is a very simple, noninvasive, low-cost examination that should be considered as the first choice for screening, because it highly correlates (100%) with hysteroscopy in the diagnosis of this defect and may help rule out other causes.
167 citations
TL;DR: Accurate antenatal diagnosis of skeletal dysplasias is problematic; in this series, only 20 of 31 cases were correctly diagnosed; however, the antenatal prediction of lethality was highly accurate.
Abstract: Objective To assess the accuracy of the prenatal diagnosis of skeletal dysplasias. Methods All antenatally detected anomalies are coded in our ultrasound database, which is linked with a genetics database that includes outcomes. A final diagnosis is sought on the basis of radiographic studies, molecular testing, or both. Our ultrasound and genetics databases were queried for "skeletal dysplasias." All cases were reviewed specifically for the degree of bone shortening and other distinguishing characteristics on antenatal sonography. Results Thirty-seven cases of skeletal dysplasia were antenatally diagnosed over an 8-year period. Complete follow-up was available in 31 cases. The mean gestational age at diagnosis was 22.7 weeks (range, 14-32.3 weeks). Twenty-one cases were diagnosed before 24 weeks. A final diagnosis was obtained in 80% of cases. The antenatal diagnosis was correct in 20 (65%) of 31 cases. There were 2 false-positive diagnoses. Specific final diagnoses included thanatophoric dysplasia (8), osteogenesis imperfecta (6), Roberts syndrome (2), achondroplasia (3), Ellis-van Creveld syndrome (1), metaphyseal dysplasia (1), spondyloepiphyseal dysplasia (1), distal arthrogryposis (1), caudal regression (1), and glycogen storage disorder (1). The condition was correctly thought to be lethal in 16 of the fetuses on the basis of early severe long bone shortening (13), femur length-abdominal circumference ratio of less than 0.16 (12), hypoplastic thorax (10), marked bowing or fractures (4), short ribs (4), caudal regression (1), and cloverleaf skull (1). The ability to predict lethality was 100%. There were no false-positive findings with respect to lethality. Conclusions Accurate antenatal diagnosis of skeletal dysplasias is problematic; in this series, only 20 of 31 cases were correctly diagnosed. However, the antenatal prediction of lethality was highly accurate. The most common predictors of lethal skeletal dysplasias included early and severe shortening of the long bones, femur length-abdominal circumference ratio of less than 0.16, hypoplastic thorax, and certain distinguishing characteristics.
164 citations
TL;DR: The initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroilitis.
Abstract: Objective. To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra-articular sacroiliac joint injections in patients with sacroiliitis. Methods. Thirty-four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra-articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. Results. Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra-articular), and 14 (23.3%) were missed. The successful intra-articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. Conclusions. Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists,
136 citations
TL;DR: Sonographic and color Doppler findings, when properly combined with clinical data, may substantially contribute to the correct preoperative diagnosis of abdominal wall endometriomas.
Abstract: Purpose To describe the sonographic and color Doppler features of endometriomas of the abdominal wall arising near cesarean delivery scars. Methods Twelve women (mean age, 31 years; range, 22-42 years) underwent sonographic and color Doppler examination of the abdominal wall with high-frequency probes for the presence of painful nodules near cesarean delivery scars, cyclic or continuous lower abdominal pain, or both. Results All patients had undergone at least 1 cesarean delivery before admission (mean, 4.1 years; range, 2-12 years). A typical clinical presentation (ie, mass and cyclic pain and swelling during menses) was recorded in 6 cases. Sonography disclosed all subcutaneous nodules (mean size, 28.1 mm; range, 7-50 mm). Common sonographic features included (1) a hypoechoic inhomogeneous echo texture with internal scattered hyperechoic echoes; (2) irregular margins, often spiculated, infiltrating the adjacent tissues; and (3) a hyperechoic ring of variable width and continuity. At color Doppler examination, a single vascular pedicle entering the mass at the periphery was shown in 7 cases. Abundant intralesional vascularization was shown in 3 cases with diameters of greater than 3 cm, whereas no vascular sign could be detected in 2 lesions smaller than 15 mm. All patients underwent wide surgical excision, and pathologic examination disclosed endometrial tissue in all of them. No relapses were recorded at clinical and sonographic follow-up (4-23 months). Conclusions Sonographic and color Doppler findings, when properly combined with clinical data, may substantially contribute to the correct preoperative diagnosis of abdominal wall endometriomas.
134 citations
TL;DR: Although a mass could not be discernible by mammography because of increased radiodensity during pregnancy or lactation, calcification, asymmetric density, axillary lymphadenopathy, and skin and trabecular thickening were helpful for diagnosis of pregnancy‐associated breast cancer.
Abstract: Objective. To evaluate the mammographic and sonographic findings of pregnancy-associated breast cancer. Methods. A total of 22 consecutive patients with breast cancer pathologically diagnosed during pregnancy (n = 10) or lactation (n = 12) were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and sonography were performed on 12 patients; sonography only was performed on 7 patients; and mammography only was performed on 3 patients. Mammographic and sonographic findings were evaluated retrospectively. Results. Mammography revealed positive findings in 13 (86.7%) of 15 patients, even though all 15 patients had dense breasts.
132 citations
TL;DR: In a patient with a previous cesarean delivery, a sac lying in the lower uterine segment on a scan at 10 weeks or earlier suggests the possibility of placenta accreta.
Abstract: Objective. To determine whether any sonographic findings in the first trimester predict placenta accreta. Methods. Patients who had a diagnosis of placenta accreta, increta, or percreta by clinical course or pathologic examination of the uterus and who had had a sonographic examination at 10 weeks or earlier were included in this study. Results. Seven patients met the study criteria. In 6 of these, who had had at least 1 previous cesarean delivery, the gestational sac was located in the lower uterine segment at the time of the early scan. Two of these pregnancies failed shortly after the early scan, and the patients underwent dilation and curettage, at which time severe bleeding necessitated a hysterectomy. The other 4 continued to term but had sonographic findings typical of placenta accreta during subsequent scans. In the seventh patient (who had had no previous cesarean deliveries), the gestational sac was located in the uterine fundus. Conclusions. In a patient with a previous cesarean delivery, a sac lying in the lower uterine segment on a scan at 10 weeks or earlier suggests the possi
TL;DR: The sonographic measurement of liver size at the midclavicular line was shown to be an easy and practical method for routine use and the factors body mass index and body height are the most important factors associated with the diameter of the liver measured at the midway line.
Abstract: OBJECTIVE We sought to determine the size of the liver in a nonselected population sample to establish normal and reference values and to study potential factors influencing liver size. METHODS A total of 2080 subjects (983 male and 1097 female; age range, 18-88 years) underwent prospective ultrasound examination to determine the size of the liver. Subjects also underwent physical examination and completed a short standardized interview questionnaire covering potential factors influencing liver size. Data were evaluated descriptively. The influence of multiple variables on liver size was studied by means of a covariance analysis. RESULTS The average measured liver diameter (midclavicular line) +/- SD was 14.0 +/- 1.7 cm (median, 13.9 cm; range, 9.4-21.3 cm; average in male subjects, 14.5 +/- 1.6 cm; and average in female subjects, 13.5 +/- 1.7 cm). Results of the multivariate analysis showed that the factors body mass index, body height, sex, age, and (in male subjects) frequent alcohol consumption exert an influence over liver size measured at the midclavicular line. CONCLUSIONS The sonographic measurement of liver size at the midclavicular line was shown to be an easy and practical method for routine use. Only in 239 (11.5%) of 2080 subjects did the size of the liver measured at the midclavicular line exceed 16 cm. Body mass index and body height are the most important factors associated with the diameter of the liver measured at the midclavicular line.
TL;DR: In this paper, the size of the extrahepatic bile duct was measured at three locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points.
Abstract: Objective. To determine whether the size of the extrahepatic bile duct increases with age in adults. Methods. We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct. Results. There were 126 men and 125 women aged 20 to 94 years (mean ± SD, 52.5 ± 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 ± 1.14 mm; middle, 3.72 ± 1.28 mm; and distal, 4.28 ± 1.18 mm. The overall mean for all measures was 3.66 ± 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 ± 0.862 mm in the patients younger than 50 years and 4.19 ± 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y. Conclusions. This study revealed an age-dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in
TL;DR: Ultrasonography allows the depiction and assessment of the femoral nerve from about 10 cm superior to 5 cm inferior to the inguinal ligament and, therefore, in decisions about planning and even acceleration of further treatment in this region.
Abstract: Objective To assess the feasibility of ultrasonography of femoral nerves in a cadaveric specimen, healthy volunteers, and patients. Methods In 1 unembalmed cadaveric specimen (female, 90 years) and 20 healthy volunteers (9 male and 11 female, 18-50 years; n = 40 scans), the topographic features, cross-sectional shapes (oval or triangular), and cross-sectional areas of the femoral nerves were evaluated by ultrasonography (5- to 12-MHz broadband linear array). In a subsequent study, 7 consecutive patients with postoperative findings assigned to the femoral nerve were evaluated and assessed by a neurologist. Results The mean +/- SD anteroposterior and mediolateral diameters of the femoral nerves in the volunteers were 3.1 +/- 0.8 and 9.8 +/- 2.1 mm, respectively, at an average cross-sectional area of 21.7 +/- 5.2 mm2. The cross-sectional shape was oval in 67.5% superior to the inguinal ligament and in 95% inferior to the ligament. The infrainguinal femoral nerve showed variable distances to the femoral artery. In the subsequent patient study, 5 patients had swelling of the femoral nerve in the affected side. In 1 patient, the nerve had a blurred echo structure due to a hematoma. In 1 patient, major damage of the femoral nerve was ruled out clearly. Conclusions Ultrasonography allows the depiction and assessment of the femoral nerve from about 10 cm superior to 5 cm inferior to the inguinal ligament. In this region, ultrasonography is helpful in detection of impairments and, therefore, in decisions about planning and even acceleration of further treatment.
TL;DR: The use of standardized real‐time ultrasonography to determine the gastric emptying rate of semisolid meals in diabetic patients, with the use of the change in gastric antral cross‐sectional area in a single section of the stomach 15 and 90 minutes postprandially, offers a valid method for clinical practice.
Abstract: Objective. To compare scintigraphic measurements of total stomach emptying of a semisolid meal with ultrasonographic measurements of changes in antral area as estimates of antral emptying in type 1 diabetic patients. Methods. Eleven patients with insulin-dependent diabetes mellitus were studied with simultaneous measurements of gastric emptying by scintigraphy and ultrasonography. Patients were imaged immediately after ingestion (time 0) and every 15 minutes over 120 minutes. The gastric emptying rate was expressed as percent reduction in antral cross-sectional area from 15 to 90 minutes after meal ingestion. Results. Ultrasonographic measurements showed a postprandial maximal antral area at 15 minutes, continuously decreasing with time, and reaching a plateau 45 to 90 minutes after the end of meal ingestion, whereas the scintigraphic counts attained their maximum immediately after the meal and began to fall thereafter. Between 15 and 90 minutes, the residual radioactivity and antral ultrasonographically measured distension curves were concordant. The curves then showed a tendency toward deviation for the last 15 minutes (median, 51% versus 59% at 105 minutes and 40% versus 57% at 120 minutes, respectively). A strong significant correlation could be seen between the ultrasonographic gastric emptying rate and scintigraphic half-time values (r = ‐0.94; P < .001). Comparing scintigraphic and ultrasonographic half-time values showed a systematic measurement error of 9.9 minutes and a random measurement error of 18.6 minutes. Conclusions. The use of standardized real-time ultrasonography to determine the gastric emptying rate of semisolid meals in diabetic patients, with the use of the change in gastric antral cross-sectional area in a single section of
TL;DR: In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness and contrast‐enhanced sonography correlated appreciably better than unenhancing sonography in detecting injuries and in estimating their extent.
Abstract: Objective To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. Methods From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. Results Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography. A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. Conclusions Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.
TL;DR: In patients with clinically unreliable anatomic landmarks, high‐resolution real‐time sonography was used to identify those landmarks and to assist in correct needle placement and found this method particularly useful for guiding needle placement in patients with moderate obesity.
Abstract: Objective. Caudal epidural steroid injections are used for the symptomatic treatment of radicular lumbosacral pain syndromes, but incorrect injection placement has been recognized as a common problem with the routinely used unguided technique. We aimed to explore the use of sonography to facilitate this procedure. Methods. In patients with clinically unreliable anatomic landmarks, highresolution real-time sonography was used to identify those landmarks and to assist in correct needle placement. Results. Sonography enabled localization of the sacral hiatus landmarks. We found this method particularly useful for guiding needle placement in patients with moderate obesity.
TL;DR: This 8‐center study that included many fetuses with Down syndrome validates the concept that the genetic sonogram can be used to better adjust the Down syndrome risk for high‐risk patients.
Abstract: OBJECTIVE A multicenter study was undertaken to evaluate the diagnostic efficacy of a genetic sonogram. METHODS Eight centers provided data on 176 pregnancies complicated by fetal Down syndrome. One hundred thirty-four pregnancies were considered high risk because of advanced maternal age (> 35 years), and 42 were considered high risk for having "abnormal" triple-screen results (risk > 1:250). Each center provided fetal biometric data, information regarding the presence or absence of major structural abnormalities, and between 3 and 6 additional ultrasonographic markers for trisomy 21. The heterogeneity of our 8 independent "sensitivity estimates" was evaluated by Poisson regression, and a single combined estimate of the sensitivity was calculated. RESULTS Of the total 176 cases of trisomy 21, 125 fetuses (71.0%) had either an abnormal long bone length (femur length, humerus length, or both), a major structural abnormality, or a Down syndrome marker. The combined diagnostic sensitivity was 71.6%, with a range of 63.6% (7 of 11) to 80% (8 of 10). Five centers had sensitivity estimates falling between 64% and 76%. The sensitivity of individual markers varied between 3% (sandal gap) and 46.5% (nuchal skin fold thickness). A condensed regimen of nuchal skin fold thickness, femur length, and a standard anatomic survey would screen in 56.8% of fetuses with Down syndrome. CONCLUSIONS This 8-center study that included many fetuses with Down syndrome validates the concept that the genetic sonogram can be used to better adjust the Down syndrome risk for high-risk patients.
TL;DR: The ultrasonographic version of the Greulich‐Pyle atlas can be used to estimate bone age even in ultrasonography departments, and is highly correlated and a valid alternative to plain radiography for bone age estimation.
Abstract: Objectives. For the evaluation of skeletal age, the methods of Greulich-Pyle and Tanner-Whitehouse are generally used in clinical practice. Our investigation was undertaken to determine whether the ultrasonographic version of the Greulich-Pyle atlas is capable of assessing skeletal age. If so, we aimed to describe the standards for the ultrasonographic version of the Greulich-Pyle atlas for each year during the first 6 years of life. Methods. Ninety-seven subjects underwent left hand and wrist radiography and ultrasonographic examination for bone age assessment during a 1.5-year study. Estimated bone ages derived from the plain radiography and “hand and wrist ultrasonography charts” interpreted by use of the Greulich-Pyle atlas were compared statistically. Results. The estimated bone ages from plain radiography and hand and wrist ultrasonography charts interpreted by use of the GreulichPyle atlas were significantly correlated; 71.1% of male patients had the same age in both methods, and in 84.4% of patients, the difference was less than 6 months. In 65.5% of female patients, both methods revealed the same age, and in 88.5% of them, the difference was less then 6 months. Conclusions. The ultrasonographic version of the Greulich-Pyle atlas can be used to estimate bone age even in ultrasonography departments. This method is highly correlated and a valid alternative to plain radiography for bone age estimation. This enables estimation of skeletal age in ultrasonography
TL;DR: In experienced hands, the sensitivity of detecting fetal trisomy 18 on prenatal sonography is 100%, and all cases will have multiple anomalies visualized.
Abstract: Objective To describe the prenatal detection of fetal trisomy 18 through abnormal sonographic features and to determine the sensitivity of sonographically detecting fetuses with trisomy 18. Methods All genetic and cytogenetic records of fetuses with trisomy 18 were reviewed retrospectively (1992-2002). From these, singleton fetuses who had prenatal sonography at our unit were identified. The maximal numbers of individual abnormalities from 1 sonographic examination (not limited to type of organ system) were recorded. Each abnormality was classified as major, minor, or "other," and each organ system was classified as abnormal only once, regardless of the number of individual abnormalities identified in that system. The sensitivity of sonography in detecting abnormalities of trisomy 18 was determined. Results Of 38 fetuses identified with trisomy 18, all had 4 or more prenatally detected sonographic abnormalities (sensitivity of sonographic detection of fetuses with trisomy 18, 100%). The median number of abnormalities per examination was 8 (range, 4-19). Sonographically detected major abnormalities were cardiac (84%; n = 32), central nervous system (87%; n = 33), gastrointestinal (26%; n = 10), and genitourinary (16%; n = 6). Sonographically detected minor abnormalities were short ear length below the 10th percentile for gestational age (96%; n = 26/27), upper extremities and hands (95%; n = 36), lower extremities and feet (63%; n = 24), and face (53%; n = 20). Fifty percent (19 of 38) had choroid plexus cysts identified, but this was never an isolated finding. Conclusions In experienced hands, the sensitivity of detecting fetal trisomy 18 on prenatal sonography is 100%, and all cases will have multiple anomalies visualized.
TL;DR: Vascularity was detected by contrast‐enhanced sonography in only about half of the ductal carcinomas, confirming the difficulty in distinguishing those tumors from other pancreatic tumors and there was a correlation between the patency of the vessels in the tumors and their vascularity.
Abstract: Objective. The purpose of the study was to assess patterns of primary pancreatic lesions by contrast-enhanced sonography for differentiating ductal carcinomas from other pancreatic tumors. Methods. One hundred six consecutive patients with pancreatic masses, consisting of 83 ductal carcinomas, 7 endocrine carcinomas, 5 intraductal papillary mucinous tumors, 3 cases of autoimmune-related pancreatitis, 3 solid pseudopapillary tumors, 2 cases of chronic pancreatitis, 1 serous cystadenoma, 1 osteoclastoid giant cell tumor, and 1 follicular lymphoma, were examined by contrast-enhanced sonography with coded harmonic imaging in a phase inversion harmonic technique. The contrast enhancement patterns were assessed, and specimens removed during pancreatectomy were subjected to pathologic examination Results. Internal tumoral vascularity was detected in 47 (56.6%) of the 83 ductal carcinomas. Vascular image spreading and homogeneous staining throughout the tumors were observed in all endocrine carcinomas. Two of the 5 intraductal papillary mucinous tumors were positive for enhancement effects Enhancement effects were observed in all 3 cases of autoimmune-related pancreatitis, but the degree varied. There was a significant correlation between the intensity of enhancement effects and the ratio of patent vessels in the tumors (P <.05). Conclusions. Vascularity was detected by contrast-enhanced sonography in only about half of the ductal carcinomas, confirming the difficulty in distinguishing those tumors from other pancreatic tumors. There was a correlation between the patency of the vessels in the tumors and their vascularity.
TL;DR: A prospective cohort evaluation of the lateral ventricular width with special regard to the upper limit of its size found the upper cutoff of fetal ventricular atrium width should be 10 mm, corresponding to a 99.74% confidence interval.
Abstract: Objective. The upper limit of the fetal atrial width in normal fetuses is debated. This was a prospective cohort evaluation of the lateral ventricular width with special regard to the upper limit of its size. Methods. Measurements of fetal atrial ventricular size were obtained by abdominal ultrasonography in 427 male and female fetuses between 20 and 40 weeks’ gestation of normal singleton pregnancies. In addition, reanalysis of previous data (8 studies) and the current data was performed to produce a pooled mean and SD. Results. The mean ventricular width ± SD was 6.2 ± 1.2 mm. The ventricular width did not show significant modification throughout gestation. Reanalysis of the current and previous studies (8216 cases) yielded a pooled mean of 6.4 ± 1.2. Conclusions. According to the current and previous studies, the upper cutoff of fetal ventricular atrium width should be 10 mm. This cutoff represents a range of approximately 3 SDs above the
TL;DR: Comparison‐enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.
Abstract: Objective To evaluate the utility of gray scale harmonic ultrasonography with a microbubble contrast agent in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma. Methods Seventy-five patients with 81 nodular hepatocellular carcinomas (1.3-4.8 cm) treated with percutaneous radio frequency ablation were evaluated with contrast-enhanced gray scale harmonic ultrasonography after intravenous bolus injection of a galactose-based microbubble contrast agent. The vascularity within the ablation zones was evaluated with a continuous scan for 3 to 5 seconds between 15 and 30 seconds after initiation of contrast agent injection. To evaluate the perfusion of the ablation zones, intermittent stimulated acoustic emission imaging was performed with a rapid sweeping technique from the end of the continuous scan. All patients underwent follow-up 3-phase helical computed tomography at 1 month after radio frequency ablation and were followed for at least 1 year. The results of contrast-enhanced ultrasonography were compared with those of follow-up computed tomography in terms of the presence or absence of residual unablated tumors. Results In 10 (12%) of the 81 treated hepatocellular carcinomas, contrast-enhanced ultrasonography showed either nodular or crescentic enhancing foci at the margins of ablation zones, suggesting residual unablated tumors. Contrast-enhanced computed tomography obtained 1 month after radio frequency ablation confirmed the residual unablated tumors in the same 10 lesions. Diagnostic agreement between 1-month follow-up computed tomography and contrast-enhanced ultrasonography was achieved in all 81 cases (100%). Conclusions Contrast-enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.
TL;DR: All abnormalities shown on clinical or sonographic scrotal examination call for orchidectomy in patients admitted with metastatic germ cell neoplasms: retroperitoneal in 3 and supraclavicular in the other.
Abstract: Objective Burned-out tumors of the testis are extremely rare. From 5 new cases, the clinical and radiologic findings are discussed in light of a review of the literature. Methods Over a 13-year period, 5 patients 17 to 50 years old were admitted with metastatic germ cell neoplasms. All were explored by thoracic and abdominal computed tomography and scrotal sonographic examination. Results The disease was revealed by the presence of lymphadenopathies in 4 of these patients: retroperitoneal in 3 and supraclavicular in the other. Scrotal sonography revealed abnormalities in all cases. Conclusions Burned-out tumors may cause some confusion in the diagnosis, because secondary tumors can often be mistaken for primary tumors. Careful evaluation of the testis is crucial for identifying the primary lesion site; all abnormalities shown on clinical or sonographic scrotal examination call for orchidectomy.
TL;DR: This article presents a review of various methods for prostate boundary detection from ultrasonographic images, aiming to find a good solution that could efficiently detect the prostate boundary on ultrasonography images.
Abstract: Objective. Prostate diseases are very common in adult and elderly men, and prostate boundary detection from ultrasonographic images plays a key role in prostate disease diagnosis and treatment. However, because of the poor quality of ultrasonographic images, prostate boundary detection still remains a challenging task. Currently, this task is performed manually, which is arduous and heavily user dependent. To improve the efficiency by automating the boundary detection process, numerous methods have been proposed. We present a review of these methods, aiming to find a good solution that could efficiently detect the prostate boundary on ultrasonographic images. Methods. A full description of various methods is beyond the scope of this article; instead, we focus on providing an
TL;DR: The addition of erect views allowed the correct diagnosis of median arcuate ligament syndrome to be made and was important to prevent misdiagnosis of celiac artery stenosis.
Abstract: Objective. To describe the importance of obtaining erect views when evaluating the celiac artery with sonography. Methods. Two patients had duplex and color flow Doppler sonographic evaluations of the celiac artery, including inspiration, expiration, and erect views. Results. Both patients had elevated celiac artery velocities with inspiration and expiration. These results alone would suggest celiac artery stenosis. With erect views, the celiac artery velocities returned to normal. The addition of erect views allowed the correct diagnosis of median arcuate ligament syndrome to be made. Conclusions. When evaluating the celiac artery, it is important to include erect views to prevent misdiagnosis of celiac artery stenosis.
TL;DR: Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both, except in the patients with a hypersensitive bladder.
Abstract: Objective. To explore factors affecting bladder wall thickness on ultrasonographic cystourethrography in female patients with lower urinary tract symptoms. Methods. The records of 492 female patients with lower urinary tract symptoms who had undergone a urodynamic study and ultrasonography of the lower urinary tract and who had normal urinalysis findings, negative urine culture results, or both were identified from our urogynecologic database. These included 248 patients with urodynamic stress incontinence, 38 with detrusor overactivity, 39 with mixed incontinence, 35 with a hypersensitive bladder, 42 with voiding difficulty, and 90 with normal urodynamic findings. Results. Age, resting bladder neck angle, urethral mobility, and maximum urethral closure pressure were significantly associated with bladder wall thickness at the trigone and dome. Bladder wall thickness at the trigone was correlated with that at the dome (P < .0001). Bladder wall thickness at the trigone was positively correlated with pressure transmission ratios in the first and second quarters of the urethra (P < .0001; P = .002, respectively), whereas that at the dome was positively correlated with intravesical pressure at maximum flow and with detrusor opening pressure (P = .027; P = .046, respectively). Age and intravesical pressure at maximum flow were independently associated with bladder wall thickness at the trigone and dome (P = .007; P = .028), respectively. A thickened bladder wall was a common finding in female lower urinary tract symptoms, except in the patients with a hypersensitive bladder.
TL;DR: In this preliminary work, the 2 thrombi appeared very different, and these results suggest that elasticity imaging may be able to age deep venous thrombosis.
Abstract: Objective Aging of deep venous thrombosis is an important and difficult clinical problem. Because it is known that thrombi harden as they mature, we have preliminarily tested sonographic elasticity imaging, a technique that estimates tissue hardness, to age venous thrombi. Methods Two adult patients with lower extremity thrombi were studied. One had a clinically chronic thrombus (at least 3 years old), whereas the other patient's thrombus was clinically subacute (25 days old). We performed freehand compression sonographic scans using a 5-MHz linear array transducer. Phase-sensitive B-scan frames were processed offline by a two-dimensional complex correlation-based adaptive speckle-tracking technique. The distribution of internal strains in the wall of the vein, thrombus, and surrounding tissue was analyzed. Clot hardness was normalized to the venous wall. Results The chronic clot was homogeneous, and the strain in the chronic clot was at least 10 times smaller than that in the vessel wall. The subacute clot was much more heterogeneous, and, on average, the strain magnitude in the clot was 3 to 4 times greater than that in the vessel wall. Conclusions In this preliminary work, the 2 thrombi appeared very different, and these results suggest that elasticity imaging may be able to age deep venous thrombosis.
TL;DR: Three‐dimensional ultrasonography has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity.
Abstract: Objective. The aim of this work was to review the technical aspects and clinical applications of three-dimensional ultrasonography in gynecologic imaging. Methods. With the use of a computerized database (MEDLINE), articles on three-dimensional ultrasonography were reviewed. Other pertinent references were obtained from the references cited in these articles. In addition, we reviewed our own clinical experience over the past 7 years. Results. Numerous applications of three-dimensional ultrasonography have been reported, including imaging of the uterus, the endometrial cavity, adnexa, and the pelvic floor and color and power Doppler applications. The accuracy of volume calculations and the networking opportunities with three-dimensional ultrasonography have also been reported. Technical problems and limitations of this technique are summarized. Conclusions. Three-dimensional ultrasonography has proved to be a useful imaging tool for clinical problem solving in gynecology, especially in imaging the uterus and uterine cavity.
TL;DR: The presence of the main renal artery with a diameter smaller than usual in a kidney with normal dimensions is indicative of the presence of an accessory renal artery and taking this into account can obtain higher rates of detection of accessory renal arteries in sonographic examinations.
Abstract: Objective. To evaluate whether the diameter of the main renal artery is an indicator of the presence of an accessory renal artery in sonographic examination. Methods. Of cases undergoing renal intraarterial digital subtraction angiography for any reason, those with no renal arterial disease detected on digital subtraction angiography were included in the investigation. Accessory renal arteries were disclosed by digital subtraction angiographic examinations. The dimensions of the kidney were measured sonographically. The lowest, highest, and mean values of diameters of main renal arteries were determined by sonography and angiography in both the group with accessory renal arteries and the group without accessory renal arteries. Results. Of kidneys with sonographically normal dimensions, angiographic evaluation was made in 107, and sonographic evaluation was made in 97, the renal arteries of which could be visualized optimally. Both radiologic methods showed that diameters of main renal arteries were significantly smaller in the presence of the accessory renal artery (P <.001, Student t test, Mann-Whitney U test, and receiver operating characteristic curve). Condusions. In sonographic examination, the presence of the main renal artery with a diameter smaller than usual in a kidney with normal dimensions is indicative of the presence of an accessory renal artery. Taking this into account, we can obtain higher rates of detection of accessory renal arteries in sonographic examinations.