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Thứ Sáu, 22 tháng 2, 2013

Radiology 3-2013


   

Selected Abstracts

1.     Abstract 1

2.     Original Research - Thoracic Imaging:

o    Luca Maria Sconfienza,     Giovanni Mauri,     Francesco Grossi,    Mauro Truini,    Giovanni Serafini,     Francesco Sardanelli,    and Carmelina Murolo

Pleural and Peripheral Lung Lesions: Comparison of US- and CT-guided Biopsy Radiology March 2013 266:3 930-935; Published online November 30, 2012, doi:10.1148/radiol.12112077

      When dealing with pleural or peripheral lung lesions, US guidance is comparable to CT in terms of technical success rate, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.

3.     Abstract 2

4.     Original Research - Ultrasonography:

o    Jennifer M. Ní Mhuircheartaigh,    Maryellen R. M. Sun,    Mark P. Callery,    Bettina Siewert,    Charles M. Vollmer,    and Robert A. Kane

Pancreatic Surgery: A Multidisciplinary Assessment of the Value of Intraoperative US Radiology March 2013 266:3 945-955; Published online December 6, 2012, doi:10.1148/radiol.12120201

       Intraoperative or laparoscopic US can be a valuable procedure in multiple types of surgical procedures that involve the pancreas and shows clear patterns of value in the different types of surgery.

5.     Abstract 3

6.     Original Research - Ultrasonography:

o    Sang-Woo Lee,     Hui Joong Lee,   Hye Jung Kim,   Jongmin Lee,   Ji-Young Park,    Seong Hun Kim,     and Junghun Kim

Combined Categorical Reporting Systems of US and Cytology Findings for Thyroid Nodules: Guidance on Repeat Fine-Needle Aspiration Cytology Radiology March 2013 266:3 956-963; Published online December 6, 2012, doi:10.1148/radiol.12112710

       The combination of the categorical reporting systems for cytology and US findings could be useful to suggest indications of repeat US-guided fine-needle aspiration cytology.

7.     Abstract 4

8.     Original Research - Ultrasonography:

o    Shigao Chen,   William Sanchez,   Matthew R. Callstrom,    Brian Gorman,    Jason T. Lewis,    Schuyler O. Sanderson,   James F. Greenleaf,    Hua Xie,   Yan Shi,   Michael Pashley,    Vijay Shamdasani,   Michael Lachman,    and Stephen Metz

Assessment of Liver Viscoelasticity by Using Shear Waves Induced by Ultrasound Radiation Force Radiology March 2013 266:3 964-970; Published online December 6, 2012, doi:10.1148/radiol.12120837

      Our preliminary results suggest that Voigt elasticity and viscosity measured between 95 Hz and 380 Hz by using shear wave dispersion ultrasound vibrometry (SDUV) are correlated and that the use of Voigt elasticity measurements from SDUV may not substantially improve performance in liver fibrosis staging compared with the time-to-peak method.


1.     Abstract Original Research / Thoracic Imaging

Pleural and Peripheral Lung Lesions: Comparison of US- and CT-guided Biopsy

Purpose: To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions.

Materials and Methods: Institutional review board approval was obtained, and the informed consent requirement was waived. From January 2000 to August 2011, 711 thoracic biopsies were performed at two institutions. Among these, 273 lesions in 273 patients (115 men, 158 women; mean age, 65 years ± 11 [standard deviation]; 86 pleural lesions; 187 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (170 patients; mean age, 64 years ± 12; 55 pleural lesions, 115 peripheral pulmonary lesions) or US (103 patients; mean age, 67 years ± 10; 31 pleural lesions, 72 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.

Results: No significant difference was found for patient age (P = .741), sex (P = .900), lesion size (P = .206), or lesion origin (P = .788). Median time was 556 seconds for CT-guided biopsy (25th percentile, 408 seconds; 75th percentile, 704 seconds) and 321 seconds for US-guided biopsy (25th percentile, 157 seconds; 75th percentile, 485 seconds) (P < .001). Postprocedural pneumothorax was observed in 25 of 170 (14.7%) CT-guided procedures and in six of 103 (5.8%) US-guided procedures (P = .025); hemorrhage occurred in two of 170 (1.2%) CT-guided procedures and in one of 103 (1.0%) US-guided procedures (P = .875). Technical success was achieved in 100 of 103 US-guided procedures (97.1%) and in 164 of 170 CT-guided procedures (96.5%) (P = .999).

Conclusion: With pleural or peripheral lung lesions, US guidance is comparable to CT guidance in terms of sample accuracy, while allowing for a significant reduction in procedure time and postprocedural pneumothorax and being free from ionizing radiation.

© RSNA, 2012

2.     Abstract Original Research / Ultrasonography

Pancreatic Surgery: A Multidisciplinary Assessment of the Value of Intraoperative US

Purpose: To assess the value of intraoperative ultrasonography (US) for different types of pancreatic surgery.

Materials and Methods: An institutional review board–approved, HIPAA-compliant retrospective review with waiver of informed consent was performed to evaluate all cases of pancreatic surgery with intraoperative US or laparoscopic US that occurred at a single institution during a 10-year period. Surgical notes, radiologic images, and clinical data for each surgical procedure and subsequent clinical course were reviewed by pancreatic surgeons and radiologists. Presumptive diagnosis, type of surgical procedure performed, and final pathologic data were recorded. A relative value score was established by consensus and assigned to each case with a grade of 0–3, which indicated the value of the intraoperative or laparoscopic US. The type of operation and pathologic data were compared in each of the value score groups. Categoric variables were compared by using either χ2 or Fisher exact test.

Results: One hundred ninety-three intraoperative or laparoscopic US procedures were performed in 189 patients. Of the patients, there were 102 men and 87 women. The mean age was 57.8 years (range, 18–86 years). Intraoperative or laparoscopic US value scores were as follows: value score 0, 3.6%; value score 1, 11.9%; value score 2, 31.1%; and value score 3, 53.4%. The most common contribution that resulted in a high score (value score 3) was facilitation of technical performance of the surgery (n = 60). High value score was significantly associated with performance of pancreatitis-related surgery (P < .001). The surgical indication that most commonly resulted in a low value score of 0 or 1 was staging of pancreatic cancers. All cases that received a score of 0 occurred in the laparoscopic adenocarcinoma surgical setting (staging or pancreatic biopsy).

Conclusion: Intraoperative or laparoscopic US can be a valuable procedure in multiple types of surgical procedures that involve the pancreas and shows clear patterns of value in the different types of surgery.

© RSNA, 2012

3.     Abstract Original Research / Ultrasonography

Combined Categorical Reporting Systems of US and Cytology Findings for Thyroid Nodules: Guidance on Repeat Fine-Needle Aspiration Cytology

Purpose: To investigate the usefulness of the combined categorical reporting system of ultrasonography (US) and cytology results for thyroid nodules to suggest indications of repeat US-guided fine needle aspiration cytology (FNAC).

Materials and Methods: Institutional review board approval was obtained, and the requirement for informed consent was waived for this retrospective study. From June 2001 to December 2009, 1084 patients (978 women, 106 men) who underwent repeat US-guided FNAC of thyroid nodules were included. FNAC results were reported by using the Bethesda system for reporting thyroid cytopathologic findings and five thyroid US categories (category US 1, benign; US 2, probably benign; US 3, indeterminate; US 4, probably malignant; US 5, malignant). The relative risk ratios were evaluated in each separate FNAC and combined initial category by means of Cox proportional risk model.

Results: Eighty-one of 1084 (7.5%) patients had malignancy over a mean follow-up time of 20.8 months (range, 3–98 months). Initial FNAC category of atypia of undetermined significance (relative risk ratio, 9.677) and US categories of US 3 (28.76), US 4 (142.0), and US 5 (411.6) had high relative risk ratios for malignancy (P < .05). Combined categories of benign cytology findings with US 3–5, nondiagnostic cytology findings with US 3–5, and atypia of undermined significance with any US categorization had high relative risk ratios of 104.80 (95% confidence interval: 53.328, 205.966).

Conclusion: The combination of the categorical reporting systems between cytology and US results could be useful to suggest indications of repeat US-guided FNAC.

© RSNA, 2012


4.     Abstract Original Research / Ultrasonography

Assessment of Liver Viscoelasticity by Using Shear Waves Induced by Ultrasound Radiation Force

Purpose: To investigate the value of viscosity measured with ultrasonographic (US) elastography in liver fibrosis staging and to determine whether the use of a viscoelastic model to estimate liver elasticity can improve its accuracy in fibrosis staging.

Materials and Methods: The study, which was performed from February 2010 to March 2011, was compliant with HIPAA and approved by the institutional review board. Written informed consent was obtained from each subject. Ten healthy volunteers (eight women and two men aged 27–55 years) and 35 patients with liver disease (17 women and 18 men aged 19–74 years) were studied by using US elasticity measurements of the liver (within 6 months of liver biopsy). US data were analyzed with the shear wave dispersion ultrasound vibrometry (SDUV) method, in which elasticity and viscosity are measured by evaluating dispersion of shear wave propagation speed, as well as with the time-to-peak (TTP) method, where tissue viscosity was neglected and only elasticity was estimated from the effective shear wave speed. The hepatic fibrosis stage was assessed histologically by using the METAVIR scoring system. The correlation of elasticity and viscosity was assessed with the Pearson correlation coefficient. The performances of SDUV and TTP were evaluated with receiver operating characteristic (ROC) curve analysis.

Results: The authors found significant correlations between elasticity and viscosity measured with SDUV (r = 0.80) and elasticity measured with SDUV and TTP (r = 0.94). The area under the ROC curve for differentiating between grade F0–F1 fibrosis and grade F2–F4 fibrosis was 0.98 for elasticity measured with SDUV, 0.86 for viscosity measured with SDUV, and 0.95 for elasticity measured with TTP.

Conclusion: The results suggest that elasticity and viscosity measured between 95 Hz and 380 Hz by using SDUV are correlated and that elasticity measurements from SDUV and TTP showed substantially similar performance in liver fibrosis staging, although elasticity calculated from SDUV provided a better area under the ROC curve.

© RSNA, 2012


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