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Thứ Ba, ngày 29 tháng 7 năm 2014

MULTICOMPARTMENT PELVIC FLOOR ULTRASOUND



Abstract

Objective:

Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies.

Methods:

Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently.

Results:

158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition.

Conclusion:

Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS.

Advances in knowledge:

PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.

JUM 8-2014

Selected Abstracts

Abstract 1
Original Research:
Douglas Zippel, Anat Shalmon, Arie Rundstein, Ilya Novikov, Ady Yosepovich, Andrew Zbar, David Goitein, and Miri Sklair-Levy
Freehand Elastography for Determination of Breast Cancer Size: Comparison With B-Mode Sonography and Histopathologic Measurement
JUM August 2014 33:1441-1446; doi:10.7863/ultra.33.8.1441


Abstract 2
Original Research:
Cemil Göya, Cihad Hamidi, Salih Hattapoğlu, Mehmet Güli Çetinçakmak, Memik Teke, Mehmet Serdar Degirmenci, Muhsin Kaya, and Aslan Bilici
Use of Acoustic Radiation Force Impulse Elastography to Diagnose Acute Pancreatitis at Hospital Admission: Comparison With Sonography and Computed Tomography
JUM August 2014 33:1453-1460; doi:10.7863/ultra.33.8.1453


Abstract 3
Case Series:
Chang Ho Jeon, Sun Mi Kim, Mijung Jang, Bo La Yun, Hye Shin Ahn, Sung-Won Kim, Eunyoung Kang, and So Yeon Park
Clinical and Radiologic Features of Neuroendocrine Breast Carcinomas
JUM August 2014 33:1511-1518; doi:10.7863/ultra.33.8.1511


Abstract 4
Case Series:
Li Lou, Jianbo Teng, Hengtao Qi, and Yongguang Ban
Sonographic Appearances of Desmoid Tumors
JUM August 2014 33:1519-1525; doi:10.7863/ultra.33.8.1519


Abstract 1 of 4
Original Research
Freehand Elastography for Determination of Breast Cancer Size Comparison With B-Mode Sonography and Histopathologic Measurement
Objectives—Elastography assesses the strain of soft tissues and is used to enhance diagnostic accuracy in evaluating breast tumors, but minimal data exist on its ability to accurately assess tumor size. This study was performed to assess the preoperative accuracy of measuring the size of biopsyproven breast cancer lesions with elastography and conventional B-mode sonography compared with the reference standard size measured by histopathologic examination.

Methods—Elastography and conventional B-mode sonography were performed on 69 women with histologically proven breast cancer, and tumor sizes on both modalities were recorded. These measurements were compared with the final pathologic size, which was used as the reference standard. The sizes and differences between sonographic, elastographic, and pathologic measurements were statistically tested, and an analysis of equivalence to the reference standard was performed using Bland-Altman plots.

Results—There was a significant difference between sizes on elastography and pathologic examination, with elastography overestimating the tumor size (P = .0187). Sonography slightly underestimated the tumor size, but this finding was not significant (P = .36). Bland-Altman plots confirmed that sonography but not elastography was an acceptable standard compared with the pathologic size.

Conclusions—Breast elastography but not B-mode sonography overestimates the size of breast tumors compared with the final pathologic size.

© 2014 by the American Institute of Ultrasound in Medicine


Abstract 2 of 4
Original Research
Use of Acoustic Radiation Force Impulse Elastography to Diagnose Acute Pancreatitis at Hospital Admission Comparison With Sonography and Computed Tomography

Objectives—To compare the diagnostic success rate of acoustic radiation force impulse (ARFI) elastography with those of sonography and computed tomography (CT) for acute pancreatitis at hospital admission.

Methods—B-mode sonography and ARFI elastography were performed on 88 patients with symptoms of acute pancreatitis and 50 healthy control participants who were admitted to our hospital between February 2013 and July 2013. Acute pancreatitis was verified in the 88 patients based on clinical and laboratory findings. Computed tomography was performed on 41 patients, and the CT results from these patients were compared with those of ARFI elastography. The appearances of the pancreases of the patients were classified into 6 groups using visual color encodings obtained with ARFI elastography. The elasticity values of pancreatic head, body, and tail regions were evaluated with Virtual Touch imaging and Virtual Touch tissue quantification (Siemens Medical Solutions, Mountain View, CA). The success rates of sonography, CT, and ARFI elastography for diagnosing acute pancreatitis at hospital admission were compared.

Results—Forty-six of the 88 patients had a diagnosis of pancreatitis by B-mode sonography; pancreatitis was diagnosed in all patients by ARFI elastography; and 10 of 41 patients could not be diagnosed by CT. The sensitivity and specificity of Virtual Touch tissue quantification were 100% and 98%, respectively, when a cutoff value of 1.63 m/s was used. The control group had color scores of 1 or 2, whereas all patients with pancreatitis had color scores of 3 to 6 on color scale evaluation with Virtual Touch imaging.

Conclusions—Acoustic radiation force impulse elastography is a rapid, radiation-free, and noninvasive tool for diagnosis of acute pancreatitis at initial hospital admission, with a higher success rate for diagnosis of acute pancreatitis than the grayscale sonography and CT.


© 2014 by the American Institute of Ultrasound in Medicine


Abstract 3 of 4
Case Series
Clinical and Radiologic Features of Neuroendocrine Breast Carcinomas

Neuroendocrine breast carcinoma is a rare and distinct type of breast carcinoma, with morphologic features similar to those of pulmonary and gastrointestinal tract neuroendocrine tumors. More than 50% of cells express neuroendocrine markers. We documented the clinical and radiologic features of 11 patients with histologically confirmed neuroendocrine breast carcinomas. Clinical manifestations included nipple discharge (6 patients) and palpable masses (5 patients). Lesions were mainly oval or irregular on mammography (n = 8), sonography (n = 11), and magnetic resonance imaging (n = 9). Understanding the clinical and radiologic features of neuroendocrine breast carcinoma will facilitate the differential diagnosis.


© 2014 by the American Institute of Ultrasound in Medicine


Abstract 4 of 4
Case Series
Sonographic Appearances of Desmoid Tumors

The medical records of 16 patients (9 female and 7 male; age range, 5–66 years) with 24 lesions that had a histologic diagnosis of desmoid tumors were reviewed at our institution. Six cases were extra-abdominal, 4 intra-abdominal, and 6 in the abdominal wall. Lesions ranged from 1.5 to 18.0 cm in diameter (mean, 6.8 cm). All lesions were solid masses, which appeared hypoechoic, isoechoic, or hyperechoic with homogeneous or heterogeneous echogenicity. Posterior acoustic enhancement was seen in 18 lesions. No lesions showed central necrosis. Most lesions had substantial flow and high resistive index values (>0.70). Sonography can show a desmoid tumor’s site, size, contour, margin, echogenicity, homogeneity, vascularity, and resistive index value in detail.


© 2014 by the American Institute of Ultrasound in Medicine

Copyright © 2014 by the American Institute of Ultrasound in Medicine