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Chủ Nhật, ngày 29 tháng 11 năm 2015

J U M 12-2015

1.       Abstract 1 of 6Review Article
Transcranial Doppler Sonography in Pediatric Neurocritical Care
A Review of Clinical Applications and Case Illustrations in the Pediatric Intensive Care Unit
Transcranial Doppler sonography is a noninvasive, real-time physiologic monitor that can detect altered cerebral hemodynamics during catastrophic brain injury. Recent data suggest that transcranial Doppler sonography may provide important information about cerebrovascular hemodynamics in children with traumatic brain injury, intracranial hypertension, vasospasm, stroke, cerebrovascular disorders, central nervous system infections, and brain death. Information derived from transcranial Doppler sonography in these disorders may elucidate underlying pathophysiologic characteristics, predict outcomes, monitor responses to treatment, and prompt a change in management. We review emerging applications for transcranial Doppler sonography in the pediatric intensive care unit with case illustrations from our own experience.
o    © 2015 by the American Institute of Ultrasound in Medicine
2.       Abstract 2 of 6Original Research
Novel Use of Ultrasound Elastography to Quantify Muscle Tissue Changes After Dry Needling of Myofascial Trigger Points in Patients With Chronic Myofascial Pain
Objectives—To compare a mechanical heterogeneity index derived from ultrasound vibration elastography with physical findings before and after dry-needling treatment of spontaneously painful active myofascial trigger points in the upper trapezius muscle.
Methods—Forty-eight patients with chronic myofascial pain enrolled in a prospective interventional trial of 3 weekly dry-needling treatments for active myofascial trigger points. Trigger points were evaluated at baseline and at treatment completion using palpation, the pressure-pain threshold, and the mechanical heterogeneity index. Thirty patients were reevaluated at 8 weeks. Trigger points that “responded” changed to tissue that was no longer spontaneously painful, with or without the presence of a palpable nodule. Trigger points that “resolved” changed to tissue without a palpable nodule. The mechanical heterogeneity index was defined as the proportion of the upper trapezius muscle that appeared mechanically stiffer on elastography. Statistical significance for comparisons was determined at P< .05.
Results—Following 3 dry needle treatments, the mechanical heterogeneity index decreased significantly for the 38 myofascial trigger points (79% of 48) that responded to treatment. Among these, the baseline mechanical heterogeneity index was significantly lower for the 13 trigger points (27% of 38) that resolved, but the decrease after 3 dry needle treatments did not reach significance. The pressure-pain threshold improved significantly for both groups. At 8 weeks, the mechanical heterogeneity index decreased significantly for the 22 trigger points (73% of 30) that responded and for the 10 (45% of 22) that resolved. The pressure-pain threshold improvement was significant for trigger points that responded but did not reach significance for resolved trigger points.
Conclusions—The mechanical heterogeneity index identifies changes in muscle tissue properties that correlate with changes in the myofascial trigger point status after dry needling.
o    © 2015 by the American Institute of Ultrasound in Medicine
3.       Abstract 3 of 6Original Research
Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer
Objectives—To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer.
Methods—Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule.
Results—A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 10.23="" 100="" 16="" 62="" 87="" 88="" a="" absent="" abutment="" an="" analysis="" and="" best="" bulging="" capsular="" capsule="" carcinoma="" consisted="" contour="" conversely="" detection="" echogenic="" excluding="" extension.="" extension="" extracapsular="" final="" for="" group="" had="" i="" lack="" loss="" mm="" negative="" npv.="" odds="" of="" papillary="" pathologically="" patients="" predictive="" predictor="" presence="" proven="" ratio="" sensitivity="" the="" thyroid="" value="" was="" when="" whom="" with="">P
 = .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%.
Conclusions—Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.
o    © 2015 by the American Institute of Ultrasound in Medicine
4.       Abstract 4 of 6Original Research
Sonographic Diagnosis of Complicated Cholecystitis
Objectives—Early detection of the complications of cholecystitis is important for clinical management, yet only a small percentage of patients have a correct diagnosis before surgery. The purpose of our study was to identify sonographic findings that are associated with complicated cholecystitis.
Methods—Sonographic, surgical, and pathologic reports were reviewed for 70 patients who underwent early cholecystectomies from January 2010 to August 2014. Sonograms were assessed for 16 independent variables. Statistical analyses were performed to evaluate associations between various sonographic features and complicated cholecystitis.
Results—Sonographic signs associated with complicated cholecystitis (P< .05) were a greater short-axis gallbladder diameter (mean, 4.4 versus 4.0 cm), a greater mean wall thickness (5.6 versus 4.2 mm), and the likelihood of wall striations, gallbladder echogenic content, pericholecystic free fluid, and local inflammatory fat changes. Specific sonographic signs, such as sloughed intraluminal membranes, were detected in a small percentage of cases (10%). None of the sonographic features evaluated in this study was found to be sensitive and specific enough to indicate complicated cholecystitis. In most cases, sonograms reflected severe inflammation, with multiple sonographic signs.
Conclusions—Although multiple sonographic signs are associated with complicated cholecystitis, none of them is sensitive and specific enough to definitively diagnose it. Sonograms usually reflect severe inflammation, with numerous sonographic signs. Thus, in the right clinical context, sonograms of severe cholecystitis should alert radiologists to the possibility of complications.
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o    © 2015 by the American Institute of Ultrasound in Medicine
5.       Abstract 5 of 6Original Research
Using Acoustic Structure Quantification During B-Mode Sonography for Evaluation of Hashimoto Thyroiditis
Objectives—This study aimed to evaluate the usefulness of Acoustic Structure Quantification (ASQ; Toshiba Medical Systems Corporation, Nasushiobara, Japan) values in the diagnosis of Hashimoto thyroiditis using B-mode sonography and to identify a cutoff ASQ level that differentiates Hashimoto thyroiditis from normal thyroid tissue.
Methods—A total of 186 thyroid lobes with Hashimoto thyroiditis and normal thyroid glands underwent sonography with ASQ imaging. The quantitative results were reported in an echo amplitude analysis (Cm2) histogram with average, mode, ratio, standard deviation, blue mode, and blue average values. Receiver operating characteristic curve analysis was performed to assess the diagnostic ability of the ASQ values in differentiating Hashimoto thyroiditis from normal thyroid tissue. Intraclass correlation coefficients of the ASQ values were obtained between 2 observers.
Results—Of the 186 thyroid lobes, 103 (55%) had Hashimoto thyroiditis, and 83 (45%) were normal. There was a significant difference between the ASQ values of Hashimoto thyroiditis glands and those of normal glands (P< .001). The ASQ values in patients with Hashimoto thyroiditis were significantly greater than those in patients with normal thyroid glands. The areas under the receiver operating characteristic curves for the ratio, blue average, average, blue mode, mode, and standard deviation were: 0.936, 0.902, 0.893, 0.855, 0.846, and 0.842, respectively. The ratio cutoff value of 0.27 offered the best diagnostic performance, with sensitivity of 87.38% and specificity of 95.18%. The intraclass correlation coefficients ranged from 0.86 to 0.94, which indicated substantial agreement between the observers.
Conclusions—Acoustic Structure Quantification is a useful and promising sonographic method for diagnosing Hashimoto thyroiditis. Not only could it be a helpful tool for quantifying thyroid echogenicity, but it also would be useful for diagnosis of Hashimoto thyroiditis.
© 2015 by the American Institute of Ultrasound in Medicine
6.       Abstract 6 of 6Original Research
Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System
Objectives—The purpose of this study was to determine key features and define a strategy for differentiation between schwannomas and neurofibromas using sonography.
Methods—This retrospective study was approved by the Institutional Review Board at our hospital, and informed consent was waived. We reviewed sonograms of pathologically proven schwannomas and neurofibromas of the extremities and body wall. On grayscale images, tumors were evaluated on the basis of their size, maximum-to-minimum diameter ratio, shape, contour, margin, location, encapsulation, echogenicity, echo texture, cystic changes, presence of intratumoral calcifications, presence of a target sign, and presence of an entering or exiting nerve. If an entering or exiting nerve was identified, the nerve-tumor position and nerve-tumor transition were characterized. On color Doppler images, the presence and amount of vascularity were evaluated. Student t tests were used for analysis of continuous variables (size, maximum-to-minimum diameter ratio, and age); χ2 and Fisher exact tests were used for analysis of categorical variables.
Results—A total of 146 pathologically proven tumors, including 115 schwannomas and 31 neurofibromas of the extremities and body wall, were included. The maximum diameter, maximum-to-minimum diameter ratio, contour, cystic portion, nerve-tumor position, nerve-tumor transition, and vascularity were significantly different in schwannomas versus neurofibromas (P < .05), and a lobulated contour, fusiform shape, and hypovascularity of neurofibromas could be helpful for differentiation when a prediction model is considered. The nerve-tumor position, nerve-tumor transition, and maximum-to-minimum diameter ratio were also significantly different between groups (P < .05) and thus could be useful for differentiation of neurogenic tumors.
Conclusions—Sonographic findings are helpful in differentiating between schwannomas and neurofibromas.
o    © 2015 by the American Institute of Ultrasound in Medicine
Citation Abstracts
Copyright © 2015 by the American Institute of Ultrasound in Medicine

Thứ Ba, ngày 24 tháng 11 năm 2015



Prognosis of patients with chronic liver disease is determined by the extent and progression of liver fibrosis, which may lead to the development of HCC. Liver stiffness is significantly higher in patients with HCC than in patients without HCC. However, most of the studies found that liver stiffness alone is insufficient to predict the presence or absence of HCC and that it should be associated in a score with other markers. A score developed by Wong et al based on liver stiffness, age, serum albumin and hepatitis B virus DNA level was found to have AUROC’s of 0.83 to 0.89 in the identification of the HCC patients and a very good negative (99.4%-100%) for the exclusion of HCC in patients. In the study conducted by Feier et al, LS was significantly higher (42 kPa vs 27 kPa, P < 0.0001) in the HCC group than in the non-HCC group, but other 3 parameters (alanine-aminotransferase, alphafetoprotein and interquartile range of the LSMs) were added to elastography in a score and the resulted model combining the four variables showed a good diagnostic performance in both training and validation groups, with AUROCs of 0.86 and 0.8, respectively. Jung et al has shown that liver stiffness is also useful as a part of a predictive model that identifies patients that are at risk for late recurrence after curative resection of HCC. On multivariate analysis, patients with older age, male sex, heavy alcohol consumption (> 80 g/d), lower serum albumin, HBe antigen positivity and LSM> 8 kPa were at a significantly greater risk of HCC development.