Showing papers in "Ultrasound Quarterly in 2011"
TL;DR: The first and most common application of elastography is for the diagnosis of breast lesions where studies have shown an area under the receiver operating characteristic curve of 0.88 to 0.95 for distinguishing cancer from benign lesions.
Abstract: Elastography has emerged as a useful adjunct tool for ultrasound diagnosis. Elastograms are images of tissue stiffness and may be in color, grayscale, or a combination of the two. The first and most common application of elastography is for the diagnosis of breast lesions where studies have
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136 citations
TL;DR: Acoustic Radiation Force Impulse measurement may be helpful to differentiate benign masses from metastases, in particular, but otherwise, ARFI measurements alone do not differentiate benign and malignant masses because of variations in stiffness of all types of masses.
Abstract: ObjectiveThe objective of the study was to determine the performance of Acoustic Radiation Force Impulse (ARFI) imaging to differentiate benign from malignant liver masses, both of hepatocellular origin and metastases, by quantification of their stiffness.MethodsThis study has institutional review b
64 citations
54 citations
TL;DR: The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel to rate the appropriateness of imaging and treatment procedures by the panel.
Abstract: Acute pelvic pain in premenopausal women frequently poses a diagnostic dilemma. These patients may exhibit nonspecific signs and symptoms such as nausea, vomiting and leukocytosis. The cause of pelvic pain includes a myriad of diagnostic possibilities such as obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The choice of the imaging modality is usually determined by a suspected clinical differential diagnosis. Thus the patient should undergo careful evaluation and the suspected differential diagnosis should be narrowed before an optimal imaging modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice, to assess for pelvic pain, when an obstetric or gynecologic etiology is suspected and computed tomography is often more useful when gastrointestinal or genitourinary pathology is thought to be more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies owing to its lack of ionizing radiation.The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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48 citations
TL;DR: Diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.
Abstract: Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.
46 citations
TL;DR: There is no benefit, with regard to incidence of bleeding complications, to discontinuing AT/AC medications in patients undergoing USGFNAB of neck masses, and the incidence of hematoma formation is shown to be no statistically significant difference.
Abstract: We examined records of patients who underwent ultrasound-guided fine needle aspiration biopsy (USGFNAB) of neck lesions to determine whether there was a significantly increased incidence of bleeding complications in patients on antithrombotic and/or anticoagulant (AT/AC) medications compared to patients not receiving AT/AC therapy. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant retrospective examination of patients' medical data without requiring informed consent. The records of 593 patients (422 women and 171 men ranging from 18 to 91 years of age) who underwent USGFNAB of 788 total neck lesions over an 18-month period were reviewed to determine AT/AC medication used and evidence of USGFNAB-related bleeding complications. Of these, 144 patients (24.3%) were taking one or more AT/AC medications including aspirin, clopidogrel, heparin, and warfarin. The χ2 test was used to assess statistically significant differences in the incidence of USGFNAB-related bleeding complications between patients who were on daily AT/AC medications (test group) and patients who were not (control group). Six USGFNAB-related hematomas (1.0%) occurred. Two hematomas developed in patients on AT/AC medications, and 4 hematomas developed in patients who did not take AT/AC medications (χ = 0.27, df = 1, P = 0.603). This study shows no statistically significant difference in the incidence of hematoma formation after USGFNAB of neck lesions in patients taking AT/AC medications compared to patients not taking AT/AC medications. On the basis of these data, there is no benefit, with regard to incidence of bleeding complications, to discontinuing AT/AC medications in patients undergoing USGFNAB of neck masses.
46 citations
TL;DR: The bull's-eye artifact seen on EI on Siemens ultrasonography equipment is a promising tool in the evaluation and characterization of benign breast cysts and has the potential to significantly reduce the amount of unnecessary breast biopsy.
Abstract: Purpose:The objectives of the study were to evaluate the accuracy of the "bull's-eye" artifact of elasticity imaging (EI) in determining the benignity of cystic breast lesions and to determine the utility of such artifact in reducing the biopsy rate of the benign lesions.Methods:This study was perfo
46 citations
TL;DR: In this article, the authors discuss the different components of performing percutaneous biopsies in adult patients including review of the patients imaging studies, coagulation status, and medications.
Abstract: Ultrasound is the most useful imaging technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. It is a safe and accurate method to guide needles using real-time imaging into abdominal and pelvic organs and masses. Its advantages over computed tomography-guided biopsies are that it can be done portably, is less expensive, and does not use ionizing radiation. Even lesions as small as 1 cm can be biopsied assuming the procedure can be performed safely and the mass can be visualized sonographically.This review article discusses the different components of performing percutaneous biopsies in adult patients including review of the patients imaging studies, coagulation status, and medications. We explain when and how we do core biopsies versus fine-needle aspirations to obtain a diagnosis depending on the suspected diagnosis and organ/mass being biopsied. We also describe how we take care of the patient after biopsy.Ultrasound can be used safely and successfully to perform biopsies and fine-needle aspirations in solid organs of the abdomen and pelvis including the retroperitoneum and abdominal wall. This technique allows adequate tissue sampling with real-time monitoring during placement of the biopsy needle. Postprocedure complications are extremely rare with the vast majority of our patients requiring only a short recovery time of 2 hours following the biopsy.
TL;DR: The formation of the placenta and its expected sonographic appearance throughout gestation along with its normal variants are reviewed, including anomalies of appearance, location, and function.
Abstract: The placenta and umbilical cord play important roles in the development of the growing fetus. The placenta can be clearly identified by the 14th gestational week and should be evaluated during each obstetric ultrasound examination.This article reviews the formation of the placenta and its expected sonographic appearance throughout gestation along with its normal variants. Expected findings in a singleton pregnancy are primarily addressed. The next portion of the article covers placental abnormalities of clinical consequence, including anomalies of appearance, location, and function.The umbilical cord is also discussed, focusing on the relevance of the location of the umbilical cord's insertion into the placenta.
TL;DR: The indications and efficacy of mammography, ultrasound, and magnetic resonance imaging as both screening and diagnostic tools are reviewed.
Abstract: Although mammography is the mainstay of early breast cancer detection, it has known limitations, particularly in women with dense breasts. As a result, additional imaging modalities, including ultrasound and contrast-enhanced magnetic resonance imaging, are also being used to supplement mammography in the early detection of occult breast cancer. This article reviews the indications and efficacy of mammography, ultrasound, and magnetic resonance imaging as both screening and diagnostic tools.
University of Washington1, Veterans Health Administration2, Indiana University3, Georgetown University4, University of Utah5, University of Toronto6, Harvard University7, Long Beach Memorial Medical Center8, Washington University in St. Louis9, Yale University10, Northwestern University11, University of North Carolina at Chapel Hill12
TL;DR: Imaging in pretreatment evaluation may play an important role in an assessment of morphological prognostic factors including tumor size, depth of myometrial invasion, endocervical extent, and lymph node status.
Abstract: Endometrial cancer is one of the common malignancies in the female genital tract. Imaging in pretreatment evaluation may play an important role in an assessment of morphological prognostic factors including tumor size, depth of myometrial invasion, endocervical extent, and lymph node status. Imaging is also useful in posttreatment evaluation of patients with clinically suspected recurrence. Various modalities including MRI, CT ultrasound and FDG PET-CT-CT have been used for evaluation of the endometrial cancer in both before and after treatment settings. Literature on the indications and usefulness of these imaging studies for endometrial cancer is reviewed.
TL;DR: A comprehensive sonographic examination of the appendix should investigate the size, the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes.
Abstract: Appendicitis is one of the most common causes of the acute abdomen often requiring emergent surgery. Delayed diagnosis leads to the progression of uncomplicated appendicitis to complicated (gangrenous, perforated) appendicitis, often changing clinical management. Computed tomography and ultrasound are imaging modalities of choice to preoperatively diagnose appendicitis. Recent concerns of radiation exposure and cost have renewed interest in using ultrasound as an initial, diagnostic study. A sonographic pictorial and histopathologic review of the continuum of appendicitis is presented. A comprehensive sonographic examination of the appendix should investigate the size (maximal diameter), the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes. Features of an uncomplicated appendicitis include size greater than 6 to 7 mm, hyperemia on color Doppler, mural thickening, and an intact echogenic submucosal layer. Gangrenous appendicitis is characterized by loss of the echogenic submucosal layer with absent color Doppler flow. Loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer are suggestive of perforation. Sonographic staging can triage management of appendicitis by directing urgent laparoscopic appendectomy for uncomplicated appendicitis, open appendectomy for complicated appendicitis, and conservative management (antibiotics with percutaneous drainage) for perforated appendicitis with abscess formation.
TL;DR: This review will provide an overview of the history, current status, limitations and potential future of US utility for the battlefield.
Abstract: Combat medical care provides unique challenges and opportunities for military medical teams. The austerity of the environment severely limits access to many diagnostic and therapeutic tools. Because of their compact size, handheld ultrasound (US) machines are increasingly being used in these constrained environments. A growing body of literature documents the diagnostic utility of handheld US for trauma encountered in the battlefield. Furthermore, US guidance may assist in the performance of some procedures performed in battlefield medical care. This review will provide an overview of the history, current status, limitations and potential future of US utility for the battlefield.
TL;DR: An overview of sonoelastography, an ultrasound application in which the elasticity of tissues is assessed by calculating the degree of tissue displacement secondary to compression by the transducer, which is a relatively new technique first described in 1991 and still being developed.
Abstract: This article gives an overview of sonoelastography (SEL), an ultrasound application in which the elasticity of tissues is assessed by calculating the degree of tissue displacement secondary to compression by the transducer. This is a relatively new technique first described in 1991 and still being developed. Stiff tissue will demonstrate less displacement compared to ‘‘soft’’ tissue, and a colorcoded map of tissue elasticities can be displayed over the grayscale ultrasound image. Sonoelastography may be able to identify pathological changes such as edema, mucoid degeneration, and small tears that may be missed on conventional ultrasound. Applicability of SEL in assessing tendinopathy has been studied mainly using the Achilles tendon as a model. With tendinopathy, the normal hard architecture of the tendon becomes soft, and this can be demonstrated on SEL with good correlation with clinical examination and conventional ultrasound. Studies suggest that SEL may be able to identify tendinopathy at an earlier stage than conventional ultrasound. The article describes several limitations of SEL, including the need for the correct amount of pressure on the skin during the examination and the lack of studies comparing SEL to MRI and to histology. The authors predict that the application of SEL to musculoskeletal ultrasound will expand as we improve our understanding of different artifacts seen in SEL.
TL;DR: Examples of normal and abnormal carotid and vertebral artery spectral Doppler ultrasound waveforms are reviewed and illustrated in this pictorial review.
Abstract: Carotid and vertebral artery spectral Doppler ultrasound waveforms can be affected by many types of local lesions, proximal cardiovascular disease, and devices, as well as distal cerebrovascular disease. Recognizing abnormal spectral Doppler ultrasound waveforms and their significance is important for proper management. Examples of normal and abnormal carotid and vertebral artery spectral Doppler ultrasound waveforms are reviewed and illustrated in this pictorial review.
TL;DR: Grayscale median of US images documenting femoropopliteal DVT correlated with (a) the time between symptoms onset and US examination and (b) the sonographers' interpretation of acute versus subacute thrombi.
Abstract: Aim:This study aimed to determine whether grayscale median (GSM) ultrasound (US) analysis could differentiate acute from subacute femoropopliteal deep venous thrombosis (DVT) classified based on (a) the time of symptoms onset and (b) sonographers' evaluation of US images.Methods:Patients who had US
TL;DR: Absence of hepatic arterial flow Doppler signal in the first 10 days after liver transplantation is associated with higher incidence of thrombosis than previously demonstrated, whereas persistently high diastolic flow early on seems to be more significant and leads to further hepaticarterial complications than decreased diastolics flow.
Abstract: OBJECTIVES To determine the significance of spectral Doppler hepatic artery waveforms obtained in the first 10 days after primary liver transplantation and to determine the best early predictor of hepatic arterial thrombosis (HAT). SUBJECTS AND METHODS A total of 645 patients were retrospectively followed up to 1 year after liver transplantation. Doppler waveforms of the hepatic arteries were categorized as normal, abnormally elevated, not visualized, or with resistive index (RI) <0.5 on all examinations performed within the first 10 days. Waveforms were then correlated with patient outcomes within 1 year. RESULTS Of the 645 patients, 83 (12.8%) had nonvisualization of at least one hepatic artery on Doppler evaluation and 56 (8.7%) developed HAT or stenosis within the first year after transplantation. Odds ratios (ORs) demonstrate that a single nonvisualized hepatic artery (OR, 9.66; 95% confidence interval [CI], 4.51-20.70) has a much higher incidence of HAT in the first 10 days after transplantation compared to low RI (OR, 1.93; 95% CI, 0.77-4.79)] or high RI (OR, 1.06; 95% CI, 0.44-2.55]. The loss or reversal of diastolic flow on Doppler ultrasound performed in the first 10 days after transplantation does not seem to correlate with active or impending HAT. CONCLUSION Absence of hepatic arterial flow Doppler signal in the first 10 days after liver transplantation is associated with higher incidence of thrombosis than previously demonstrated, whereas persistently high diastolic flow early on seems to be more significant and leads to further hepatic arterial complications than decreased diastolic flow.
TL;DR: The authors offer a concise summary of dos and don'ts for the radiologist/sonologist wishing to expand his horizons and join those physicians donating ultrasound equipment and training medical personnel in low-resource countries.
Abstract: The authors offer a concise summary of dos and don'ts for the radiologist/sonologist wishing to expand his horizons and join those physicians donating ultrasound equipment and training medical personnel in low-resource countries. Topics include choosing a site, obtaining ultrasound equipment, preparing to travel, and starting a training program. The most important points to keep in mind are: (1) be prepared for any circumstance; (2) do your homework ahead of time; (3) make sure there is a local group "on the ground" that can ensure the machine's sustainability; and (4) allow for much more time to get things accomplished than in the developed world.