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Thứ Hai, 9 tháng 1, 2017

J U M 01-2017

Original Research
Evaluation of Renal Parenchyma Elasticity With Acoustic Radiation Force Impulse Quantification in Nutcracker Syndrome and Comparisons With Grayscale Doppler Sonography and Laboratory Findings
Authors
·         Tumay Bekci MD, Meltem Ceyhan Bilgici, Gurkan Genc, Demet Tekcan MD, Ahmet Veysel Polat,Leman Tomak MD, PhD
·          
Abstract
Objectives
We sought to evaluate renal parenchymal elasticity with Virtual Touch quantification of acoustic radiation force impulse imaging in nutcracker syndrome and to compare shear-wave velocity (SWV) values with grayscale Doppler sonography and laboratory findings.
Methods
Thirty-eight healthy volunteers and forty-three nutcracker syndrome patients were enrolled in this prospective study. SWV values for both kidneys in nutcracker syndrome patients and healthy volunteers were evaluated. Grayscale Doppler ultrasound and laboratory findings were obtained and compared with SWV values in both nutcracker syndrome patients and healthy volunteers.
Results
In nutcracker syndrome patients, SWV values for the left kidney were significantly lower than those for the right kidney (n=43; 1.93±0.43 m/s vs 2.53±0.45 m/s [P<.001]). Healthy volunteers' SWV values for both kidneys had no statistically significant differences. There was a statistically significant difference between nutcracker syndrome patients and healthy volunteers for the SWV values and body mass index values. There was no statistically significant correlation between SWV values of nutcracker syndrome patients and age, gender, glomerular filtration rate, body mass index, vein diameter ratio, peak velocity ratio, or resistive indices.
Conclusions
Acoustic radiation force impulse imaging offers new, additional information on the affected left kidney parenchymal changes in nutcracker syndrome patients.

Original Research
Sonographic Evaluation of Intrathyroid Metastases
Authors
·         J. Matthew Debnam MD, Michael Kwon MD, Bruno D. Fornage MD, Savitri Krishnamurthy MD, Gary L. Clayman MD, DMD, Beth S. Edeiken-Monroe MD
Abstract
Objectives
Intrathyroid metastases from extrathyroid primary tumors are rare. Clinical findings may be subtle, but detection of intrathyroid metastases has improved with sonography. The objective of this study was to evaluate the sonographic appearance of intrathyroid metastases.
Methods
Patients with thyroid masses with cytopathologic features matching those of an extrathyroid primary tumor were retrospectively identified. The appearances of intrathyroid metastases on sonography were reviewed for the following features: size, margin regularity, echogenicity, echotexture, vascularity on power or color Doppler ultrasonography, and the presence or absence of any associated cervical adenopathy.
Results
The study included 52 patients. The most frequent primary tumor sites were lung, head and neck, and breast. Intrathyroid metastases presented as a discrete nodule in 34 patients and as diffuse infiltration of the gland in 18 patients. The discrete nodules ranged in size from 1.1 to 5.6 cm (mean±SD, 2.5±1.2 cm). Thirty-three lesions (63%) had irregular margins, and 19 (37%) had well-defined margins. Most of the lesions were heterogeneously hypoechoic (n=50, 96%). Vascularity was present in 32 of 50 measured lesions (64%) that were evaluated with Doppler sonography. Cervical adenopathy was present in 37 patients (71%).
Conclusions
Intrathyroid metastases have sonographic characteristics similar to those described for both benign and malignant thyroid diseases. In patients with a previous or current extrathyroid malignancy, thyroid nodules or diffuse infiltration of the thyroid gland on sonography should be viewed as a potential intrathyroid metastasis and evaluated via ultrasound-guided fine-needle aspiration regardless of the site of the primary tumor.

Original Research
Shear Wave Ultrasound Elastographic Evaluation of the Rotator Cuff Tendon
Authors
·         Stephanie W. Hou MD, Alexander N. Merkle MD, James S. Babb PhD, Robert McCabe PT, OCS, Soterios Gyftopoulos MD, Ronald S. Adler MD, PhD
Abstract
Objectives
(1) Assess the association between the B-mode morphologic appearance and elasticity in the rotator cuff tendon using shear wave elastography (SWE). (2) Assess the association between SWE and symptoms.
Methods
Institutional Review Board approval and informed consent were obtained. A retrospective review identified 21 studies in 19 eligible patients for whom SWE was performed during routine sonographic evaluations for shoulder pain. Evaluations were compared with 55 studies from 16 asymptomatic volunteers and 6 patients with asymptomatic contralateral shoulders. Repeated studies were accounted for by resampling. Proximal and distal tendon morphologic characteristics were graded from 1 to 4 (normal to full-thickness tear), and average shear wave velocity (SWV) measurements were obtained at both locations. In 68 examinations, deltoid muscle SWV measurements were available for post hoc analysis.
Results
The morphologic grade and SWV showed weak-to-moderate negative correlations in the proximal (P<.001) and distal (P=.002) rotator cuff tendon. A weakly significant SWV decrease was found in the proximal tendon in symptomatic patients (P=.049); no significant difference was seen in the distal tendon. The deltoid muscle SWV showed weak-to-moderate negative correlations with the morphologic grade in the proximal (P=.004) and distal (P=.007) tendon; the deltoid SWV was also significantly lower in symptomatic shoulders (P=.001).
Conclusions
Shear wave elastography shows tendon softening in rotator cuff disease. It captures information not obtained by a morphologic evaluation alone; however, a poor correlation with symptoms suggests that SWE will be less useful in workups for shoulder pain than for preoperative assessments of tendon quality. Deltoid muscle softening seen in morphologically abnormal and symptomatic patients requires further exploration.

Original Research
Limited Abdominal Sonography for Evaluation of Children With Right Lower Quadrant Pain
Authors
·         Martha M. Munden MD, Shannon Wai MD, Michael C. DiStefano MD, Wei Zhang PhD

Abstract
Objectives
To determine whether a complete abdominal sonographic examination is necessary in the evaluation of children with right lower quadrant pain that is suspicious for appendicitis in the emergency department and whether performing a limited, more-focused study would miss clinically important disease.
Methods
With Institutional Review Board approval, a retrospective study was performed of 704 patients, from ages 5–19 years, presenting to the emergency department with right lower quadrant pain that was suspicious for appendicitis who underwent a complete abdominal sonographic examination. Data were extracted from the complete abdominal sonographic examination to see whether abnormalities were noted in the pancreas, spleen, and left kidney. Patients' medical charts were reviewed to see whether any positive findings in these organs were clinically important.
Results
Of the 65 studies with a finding that would have been missed with a limited study, only 6 were found to be clinically important. Of those, 5 were managed medically and 1 surgically. The chance of missing a potentially important finding using a limited study with our group of patients was 65 of 704 patients (9.2%), with a 95% confidence interval of 7.2% to 11.7%. The chance of missing an abnormality that was clinically important was 6 of 704 patients (0.85%), with a 95% confidence interval of 0.35% to 1.94%.
Conclusions
In children older than 5 years with abdominal pain that is suspicious for appendicitis, performing only a limited abdominal sonographic examination that excludes the pancreas, left kidney, and spleen will yield a miss rate for clinically important disease that is acceptably low to justify the savings of examination time.

Original Research
Doppler Characteristics of Recurrent Hepatic Artery Stenosis
Authors
·         Tyler A. Sandow MD, Edward I. Bluth MD, Neil U. Lall MD, Qingyang Luo PhD, W. Charles Sternbergh III MD
Abstract
Objectives
We sought to assess midterm sonographic findings in patients after stenting for hepatic artery stenosis.
Methods
Thirty-nine hepatic artery stent procedures were performed for hepatic artery stenosis after liver transplantation between September 2009 and December 2013. Thirty cases were technically successful and met the minimum follow-up time (76 days, defined by earliest diagnosed stenosis). Routine ultrasound surveillance was obtained on all patients, and statistical analysis of the findings in the patency and restenosis groups was performed.
Results
Of the 30 cases, restenosis occurred 9 times in 6 patients. Mean follow-up was 677 days. Mean time to restenosis was 267 days. Five cases (56%) were identified within the first 6 months after stent placement. Four cases (44%) were recognized in the second year after stent placement. Prior to the sonographic diagnosis of restenosis, the mean resistive indices of the main (.64 versus .57, P<.0001), left (.63 versus .54, P<.0001), right anterior (.60 versus .52, P<.0001), and right posterior (.60 versus .53, P=.001) hepatic artery branches differed among patency and restenosis groups, respectively. The mean peak systolic velocity also differed significantly between the 2 groups: 254 cm/sec in patients with eventual restenosis versus 220 cm/sec in patients without restenosis (P=.02).
Conclusions
The sonographic evaluation of hepatic artery stenosis remains critical during the first 2 years after stent placement. While the vast majority of patients do not restenose, resistive index and peak systolic velocity differed significantly between the 2 groups and may be prognostic surveillance markers for the development of restenosis.