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Thứ Bảy, 28 tháng 4, 2012

Radiology May 2012

Real-time Sonoelastography for the Evaluation of Testicular Lesions
Friedrich Aigner, Tobias De Zordo, Leo Pallwein-PrettnerDaniel Junker, Georg Schäfer, Renate Pichler, Nicolai LeonhartsbergerGermar Pinggera, Vikram S. Dogra, and Ferdinand Frauscher
 Abstract
Purpose: To evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions.
Materials and Methods: Institutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Fifty patients (mean age, 42 years; age range, 18–81 years) with testicular lesions detected with gray-scale ultrasonography (US) and color and/or power Doppler US were evaluated with RTE between December 2004 and August 2010 to assess tissue elasticity of the testes. Stiff or “hard” lesions were suspected of being malignant. Testicular lesions with normal or decreased tissue stiffness (“soft” lesions) were considered benign. Findings from surgery and histopathologic examination were used as the reference standard in 34 cases, and findings from clinical and US follow-up were used as the reference standard in 16 cases. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated.
Results: Thirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors.
Conclusion: RTE demonstrated all testicular tumors as lesions with increased tissue stiffness. Because of its higher specificity, RTE can provide additional information in cases with indeterminate US findings.
© RSNA, 2012
Triangular Cord Sign in Biliary Atresia: Does It Have Prognostic and Medicolegal Significance?
Akshay K. SaxenaVinayak Mittal,  and Kushaljit S. Sodhi
Editor:
We read with interest the article by Lee and colleagues (1) in the December 2011 issue of Radiology regarding the efficacy of ultrasonography (US)–guided percutaneous cholecystocholangiography for the early diagnosis and characterization of biliary atresia. We believe that the case illustrated in figure 3 of their article has additional importance.
Although the triangular cord sign has been a highly specific US finding of extrahepatic biliary atresia (EHBA), its sensitivity has shown large variations in different studies (2). A recent study evaluated US findings in infants younger than 90 days old with conjugated hyperbilirubinemia (2). The authors reported a sensitivity of only 23.3% for the triangular cord sign in the diagnosis of biliary atresia. They suggested that one of the reasons for low sensitivity could be the young age of the patients “if the tissue interfaces responsible for producing the triangular cord sign evolve with the age of patients” and noted that “in the absence of data on serial sonographic findings in infants with EHBA, the exact impact of screening at a younger …

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