Diagnostic Performance of Shear
Wave Elastography for Predicting Esophageal Varices in Patients With
Compensated Liver CirrhosisJournal
of Ultrasound in Medicine July 2016 35:1373-1381; Published
Online First May 20, 2016, doi:10.7863/ultra.15.07024
Utility of Shear Wave
Elastography for Differentiating Biliary Atresia From Infantile Hepatitis
SyndromeJournal of Ultrasound in
Medicine July 2016 35:1475-1479; Published Online First May
26, 2016, doi:10.7863/ultra.15.08031
A Survey of Ultrasound
Milestone Incorporation Into Emergency Medicine Training ProgramsJournal of Ultrasound in Medicine July
2016 35:1517-1521; Published Online First June 7,
Correlating the Sonographic
Finding of Echogenic Debris in the Bladder Lumen With UrinalysisJournal of Ultrasound in Medicine July
2016 35:1533-1540; Published Online First May 31,
Sonography of Gastrointestinal
Tract Diseases: Correlation With Computed Tomographic Findings and
EndoscopyJournal of Ultrasound in
Medicine July 2016 35:1543-1571; Published Online
First June 7, 2016, doi:10.7863/ultra.15.09038
Diagnostic Performance of Shear Wave
Elastography for Predicting Esophageal Varices in Patients With Compensated
Objectives—The purpose of this study was to investigate the diagnostic
performance of shear wave elastography (SWE) for predicting the presence of
esophageal varices and high-risk esophageal varices in patients with
compensated cirrhosis and to compare it with other nonspecific predictors and
according to the presence of splenomegaly.
Methods—Clinical data from 103 patients with compensated cirrhosis who underwent
sonography, SWE, and endoscopy were collected consecutively. Liver stiffness
was measured by SWE. Comparisons of the accuracy of prediction between groups
were made by areas under the receiver operating characteristic curves (AUROCs),
and regression analyses were performed for the multiple variables related to
the presence of esophageal varices and high-risk varices.
Results—The optimal cutoff values for predicting the presence of
esophageal varices and high-risk varices were 13.9 and 16.1 kPa, respectively.
The AUROC of liver stiffness for prediction of esophageal varices was
significantly higher than the AUROCs of platelet count, spleen diameter, and
platelet count/spleen diameter ratio (P = .025; P = .001; P = .027). For
predicting esophageal varices in patients without splenomegaly, the AUROC of
liver stiffness was higher than that of the platelet count/spleen diameter
ratio. In multivariate logistic regression analysis, liver stiffness and the
platelet count/spleen diameter ratio were independent predictors of esophageal
varices (P < .001; P = .038). For
the presence of high-risk varices, only liver stiffness was a statistically
significant independent predictor (P = .012).
Conclusions—In patients with compensated cirrhosis, liver stiffness measured
by SWE is a new effective noninvasive diagnostic tool for predicting the
presence of esophageal varices. It is more accurate than the platelet
count/spleen diameter ratio, especially in patients without splenomegaly. In
addition, the SWE value was the only effective independent factor for
predicting high-risk esophageal varices.
Role of Doppler Sonography in Early
Detection of Splenic Steal Syndrome
Objectives—To retrospectively investigate the role of Doppler sonography in
the early detection of splenic steal syndrome.
Methods—Fifty cases of splenic steal syndrome after orthotopic liver
transplantation were identified. A control group was matched to the splenic
steal syndrome group. Information was collected about the clinical
presentation, liver enzyme levels, Doppler sonographic results, and follow-up
after patients underwent splenic artery embolization.
Results—A persistent hepatic arterial diastolic reversal waveform was
observed in 25 patients with splenic steal syndrome versus 0 control patients.
The mean hepatic arterial resistive index (RI) values ± SD were 0.95 ± 0.09 in
patients with splenic steal syndrome and 0.80 ± 0.10 in control patients (P < .0001). One week after orthotopic liver
transplantation, the area under the receiver operating characteristic curve for
the RI was 0.884 (95% confidence interval, 0.793–0.975; P = .001) for splenic steal syndrome diagnosis.
After splenic artery embolization, there was normalization of the reversal
waveform, with an average RI of 0.77 ± 0.11 (P <
Conclusions—Dynamic changes in the hepatic arterial waveform and RI are keys
to detecting splenic steal syndrome with Doppler sonography.
Utility of Shear Wave Elastography for
Differentiating Biliary Atresia From Infantile Hepatitis Syndrome
Objectives—The purpose of this study was to investigate the potential
utility of shear wave elastography (SWE) for diagnosis of biliary atresia and
for differentiating biliary atresia from infantile hepatitis syndrome by
measuring liver stiffness.
Methods—Thirty-eight patients with biliary atresia and 17 patients with
infantile hepatitis syndrome were included, along with 31 healthy control
infants. The 3 groups underwent SWE. The hepatic tissue of each patient with
biliary atresia had been surgically biopsied. Statistical analyses for mean values
of the 3 groups were performed. Optimum cutoff values using SWE for
differentiation between the biliary atresia and control groups were calculated
by a receiver operating characteristic (ROC) analysis.
Results—The mean SWE values ± SD for the 3 groups were as follows:
biliary atresia group, 20.46 ± 10.19 kPa; infantile hepatitis syndrome group,
6.29 ± 0.99 kPa; and control group, 6.41 ± 1.08 kPa. The mean SWE value for the
biliary atresia group was higher than the values for the control and infantile hepatitis
syndrome groups (P < .01). The mean SWE
values between the control and infantile hepatitis syndrome groups were not
statistically different. The ROC analysis showed a cutoff value of 8.68 kPa for
differentiation between the biliary atresia and control groups. The area under
the ROC curve was 0.997, with sensitivity of 97.4%, specificity of 100%, a
positive predictive value of 100%, and a negative predictive value of 96.9%.
Correlation analysis suggested a positive correlation between SWE values and
age for patients with biliary atresia, with a Pearson correlation coefficient
of 0.463 (P < .05).
Conclusions—The significant increase in liver SWE values in neonates and
infants with biliary atresia supports their application for differentiating biliary
atresia from infantile hepatitis syndrome.
A Survey of Ultrasound Milestone
Incorporation Into Emergency Medicine Training Programs
Objectives—With the introduction of the Emergency Medicine Milestone
Project in 2013, residencies now assess emergency ultrasound (US) skills at
regular intervals. However, it is unclear how programs are implementing the
emergency US milestones and assessing competency. With the use of the milestone
tool, a survey was distributed to emergency US educators to determine when
programs are providing emergency US education, when residents are expected to
attain competency, and whether the milestones reflect their expectations of
Methods—We conducted a prospective cross-sectional survey study
distributed electronically to designated emergency US experts at 169 programs.
Participants were queried on education and competency evaluation within the
context of the milestones by designating a postgraduate year when the 5
milestone levels were taught and competency was expected. Survey findings were
reported as percentages of total respondents from descriptive statistics.
Results—Responses were received from 53% of programs, and 99% were
familiar with the milestones. Most programs provide level 1 (88%) and 2 (85%)
instruction during postgraduate year 1. Most programs expect level 1 competency
before residency (61%) and expect mastery of level 2 by the end of postgraduate
year 1 (60%). Sixty-two percent believe the milestones do not accurately
reflect their expectations, citing insufficient minimum scan numbers, lack of
specificity, and unattainable level 5 requirements.
Conclusions—There is substantial variability in the frequency and methods of
competency evaluation using the emergency US milestones. However, most responders
agree that residents should obtain level 2 competency by postgraduate year 1.
Variation exists regarding what year and what skills define level 3 or greater
Correlating the Sonographic Finding of
Echogenic Debris in the Bladder Lumen With Urinalysis
Objectives—The purpose of this study was to determine the significance of
urinary bladder debris detected by sonography.
Methods—We conducted a retrospective analysis of urinalysis results in
age-matched patients with and without bladder debris detected by transabdominal
sonography. Patients were recruited from a radiology database search for
bladder sonograms either with words suggesting echogenic debris or by a
clinical history suggesting an infectious course. The sonograms were randomized
and read by a single radiologist, who was blinded to case versus control. The
urinalysis and sonographic results were analyzed by the Fisher exact test.
Results—There was no statistically significant correlation between the
finding of debris on sonography and the frequency of abnormal urinalysis
results, regardless of the quality of debris (layering versus floating). The
only variable that was significantly associated with abnormal urinalysis
results was a clinical history suggesting infection.
Conclusions—A urinalysis should not be routinely recommended to work up the
finding of urinary bladder debris on sonography.
Correlation With Computed Tomographic
Findings and Endoscopy
Sonographic evaluation of the
gastrointestinal (GI) tract may be difficult because of overlying intraluminal
bowel gas and gas-related artifacts. However, in the absence of these factors
and with the development of high-resolution scanners and the technical
experience of radiologists, sonography can become a powerful tool for GI tract
assessment. This pictorial essay focuses on sonographic findings of GI tract
lesions compared with endoscopic, computed tomographic, and magnetic resonance
imaging findings. Neoplastic and non-neoplastic diseases and postoperative
complications are illustrated, and the distinctive sonographic characteristics
of these entities are highlighted.