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Thứ Năm, 17 tháng 12, 2015

SWE and TENDINOPATHY

Shear-wave elastography aids monitoring of tendinopathy
By Erik L. Ridley, AuntMinnie staff writer
December 15, 2015 -- Shear-wave elastography performs better than B-mode and power Doppler ultrasound for evaluating tendinopathy and helping to assess treatment response, German researchers recently reported at the RSNA 2015 meeting in Chicago.


Not only was shear-wave elastography more sensitive for detecting tendinopathy in a prospective study, but the technique's quantitative data had much higher correlation with clinical examination scores, according to presenter Dr. Timm Dirrichs of University Hospital RWTH Aachen in Aachen, Germany

Thứ Ba, 24 tháng 11, 2015

LIVER ELASTOGRAPHY IN THE PREDICTION OF THE PRESENCE OF HCC




LIVER ELASTOGRAPHY IN THE PREDICTION OF THE PRESENCE OF HCC



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.


Thứ Bảy, 31 tháng 10, 2015

SMI on Toshiba Aplio 500

Superb Micro-Vascular Imaging (SMI) is an innovative ultrasound Doppler technique developed by Toshiba. SMI offers a unique algorithm that allows visualization of microvasculature with low velocity but without using any contrast agents.

 The advantages of SMI include 
 1) low velocity flow visualization, 
 2) high resolution 
 3) minimal motion artefact, and
 4) high frame rates. The exceptional vessel detection ability allows SMI to be of benefit in the evaluation and treatment of liver diseases. 

SMI has potential in:
 i. Display of minute intra-lesional vasculature
 ii. Evaluating RFA treatment
 iii. Support RFA planning and guiding.


Advanced Applications

Superb Micro-Vascular Imaging (SMI)*

Toshiba's innovative Superb Micro-Vascular Imaging (SMI) technology expands the range of visible blood flow and provides visualization of low velocity microvascular flow never before seen with ultrasound. SMI's level of vascular visualization, combined with high frame rates, advances diagnostic confidence when evaluating lesions, cysts and tumors, improving patient outcomes and experience. Improve Accuracy and Speed with SMI Getting accurate diagnostic information faster is just one reason why Toshiba’s Superb Micro-Vascular Imaging (SMI) is an integral part of operations for our partners at Rex Healthcare.

Watch the Video »

 Patrick Washko

Thứ Sáu, 16 tháng 10, 2015

THYROID CANCER in JAPAN and ULTRASOUND

Ultrasound shows thyroid cancer spike after Fukushima
October 14, 2015 -- Just as many had feared, the disaster at the Fukushima Daiichi nuclear power plant in March 2011 has sparked a sharp increase in thyroid cancer among children and adolescents in the area, according to a study published online in Epidemiology. And more cases may be lurking.
One particularly hard-hit district in the Fukushima Prefecture saw thyroid cancer rates that were 50 times higher than the national average in Japan among those 18 and younger, reported researchers who participated in a thyroid ultrasound screening program in the three years after the earthquake. Cancer rates throughout the prefecture are 30 times higher than in Japan as a whole.
"The result was unlikely to be fully explained by the screening effect," wrote the research team led by Dr. Toshihide Tsuda, PhD, of Okayama University. "In Chernobyl, excesses of thyroid cancer became more remarkable four or five years after the accident in Belarus and Ukraine, so the observed excess alerts us to prepare for more potential cases within a few years."
Radiation exposure
Following the meltdown of three Fukushima nuclear reactors, approximately 900 petabecquerel of radiation was released into the atmosphere, the radiological equivalent of one-sixth of the 5,200 petabecquerel released by the Chernobyl disaster. Based on its preliminary dose estimation in 2012, the World Health Organization (WHO) predicted there would be an increase in thyroid cancers among children who had been exposed to the radiation.
WHO estimated that those in the most affected areas of the prefecture received thyroid-equivalent doses of 100-200 mSv, while those in the rest of the prefecture received 10-100 mSv via inhalation, ingestion, and external exposure from fallout deposits on the ground, according to the researchers (Epidemiology, October 5).
Nearly four years after the accident, the group sought to determine accurate and quantitative estimates from the Fukushima experience to plan for the population's future health needs.
Thyroid ultrasound screening
Under a screening program planned and conducted by the government of the Fukushima Prefecture, all residents 18 years or younger received thyroid ultrasound screening sometime during the 2011-2013 fiscal years. Screening was performed in three areas: in 2011 in the area nearest the disaster, mostly within 50 km of the Fukushima plant; in 2012 in a middle area of the prefecture; and in 2013 in the least-contaminated area.
A second round of screening, which will also include residents born in the prefecture between April 2, 2011, and April 1, 2012, began in April 2014 and is expected to be completed in March 2016.
Those with positive ultrasound findings on screening received a secondary exam, followed by fine needle aspiration (FNA) biopsy if necessary. Patients with detected cancer cells were followed and operated on at an appropriate time, according to the researchers.
Of the 367,687 residents 18 years or younger in the prefecture in 2011, 298,577 (81%) had received the first round of screening by the end of December 2014. There were 2,251 positive thyroid ultrasound cases by 2014 and 2,067 received a secondary exam.
From these, FNA indicated the presence of 110 thyroid cancers, 87 of which had been operated on by the end of 2014. On histological examination, 86 were confirmed to be malignant, a number that included 83 papillary carcinomas and three poorly differentiated carcinomas.
The researchers compared the prevalence of thyroid cancer for each area by calculating a prevalence odds ratio in comparison with the least-contaminated district of the least-contaminated area of the prefecture. For a comparison with subjects outside of the prefecture, the team calculated incidence rate ratios in comparison with annual incidence rates nationwide in Japan, taking into account the prevalence as well as the latent duration (four years) of the disease.
Thyroid cancer prevalence
Area
Prevalence of thyroid cancer per 1 million people
Prevalence odds ratio compared to least-contaminated district
Incidence odds ratio compared to Japan national rates
Nearest to Fukushima
359
1.5
30
Middle -- not evacuated
402
1.7
33
Least contaminated
332
N/A
28
The researchers noted that the highest incidence odds ratio (50; 95% confidence interval: 25-90) in comparison with the mean Japanese annual incidence of thyroid cancer was found in the middle area's central middle district -- 50 to 60 km west of the power plant -- where residents were not evacuated. That district had a prevalence rate of 605/1,000,000 (95% confidence interval: 302-1,082) and a prevalence odds ratio in comparison with the least-contaminated district of 2.6 (95% confidence interval: 0.99-7.0).
The finding that southernmost districts within the middle and the least-contaminated areas of the prefecture had higher incidence rates than the northernmost districts was consistent with the flow of indium-131 being primarily in a southern direction from the Fukushima release.
2nd round of screening
In the second screening round that began in 2014, 106,068 (49%) of 218,397 total subjects have been screened so far. Of the 71% of exams with a decision as to whether the secondary exam was necessary or not, there were 611 positive studies.
The secondary exam has been performed on 377 subjects (62% of the positive studies), and 262 received a final diagnosis on the secondary exam. FNA was performed on 22 subjects (8%) and detected eight new thyroid cancer cases by cytology as of December 31, 2014. All eight had negative ultrasound findings in their first round of screening.
New data released in May 2015 added two additional thyroid cancer cases from the first round of screening and seven more cases from the second round (for a total of 15). As a result, the incidence ratio so far from the second round of screening is 13.7 (95% confidence interval: 7.7-23).
The authors concluded that within as few as four years after the disaster, there has been an approximately 30-fold increase in thyroid cancer among children and adolescents in the Fukushima Prefecture. As the number of thyroid cancer cases has increased faster than predicted by the WHO, it's possible that the organization's previous exposure estimates for residents were too low, according to the group.
Related Reading

Low-risk cases fuel rising thyroid cancer rates
The rapid increase in the number of thyroid cancers diagnosed over the past decade is being driven by low-risk cases that would never pose a health threat...

Fukushima nuclear disaster casts shadow on CR images
Radiologists at a Japanese hospital were baffled when dark spots began appearing on computed radiography (CR) images in March 2011. They discovered that...


Thứ Hai, 31 tháng 8, 2015

J MEDICAL ULTRASOUND Sept 2015



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Ultrasound and Retained Products of Conception
Accepted: March 2, 2015; Published Online: May 04, 2015
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Early pregnancy loss is a serious psychological emergency in obstetrics [1]. In this issue, Esmaeillou et al [2] offer a highly educative article entitled Accurate detection of retained products of conception after first- and second-trimester by color Doppler sonography. Making an accurate diagnosis of retained products of conception (RPOC) is a major clinical challenge. Because RPOC may cause prolonged bleeding, endometritis, and intrauterine adhesion—Asherman's syndrome—with subsequently impaired fertility in the future [3], therapeutic intervention is mandatory.
© 2015 Published by Elsevier Inc.
Renal Tumors
Received: February 12, 2015; Accepted: March 10, 2015; Published Online: June 18, 2015
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Renal tumors can be classified as benign or malignant. The former include angiomyolipoma, renal cell adenoma, and oncocytoma; the latter include renal cell carcinoma, urothelial cell carcinoma, and other less common primary or metastatic cancers [1,2]. This article addresses the renal tumors that are most commonly observed in a clinical setting: angiomyolipomas, renal cell carcinomas, and urothelial cell carcinomas.
© 2015 Published by Elsevier Inc.
Physician-performed Focused Ultrasound: An Update on Its Role and Performance
Received: February 13, 2015; Accepted: February 25, 2015; Published Online: March 26, 2015
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There is an increase in the use of focused ultrasound (US) by physicians because it offers the major benefit of reduction in time to diagnosis. Some of these physicians have received formal training on focused US, others have not received any such training. However, among the formal training given on focused US, there is inconsistency across the teaching protocols. This review presents performances of focused US commonly performed by physicians, compared with radiology US. The various teaching protocols are also discussed.
© 2015 Published by Elsevier Inc.
Ultrasound-guided Corticosteroid Injection for the Treatment of Athletic Pubalgia: A Series of 12 Cases
Received: August 5, 2014; Accepted: November 24, 2014; Published Online: February 24, 2015
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Surgical treatment for athletic pubalgia is the standard of care, however, it poses risks. This study investigated the use of ultrasound-guided corticosteroid injections as an alternative treatment. Twelve consecutive patients underwent injections into the area of degeneration in the rectus abdominis and/or adductor longus aponeurosis. The Western Ontario and McMaster Universities (WOMAC) scores were used to evaluate treatment effectiveness. The average WOMAC score was 90.9. With a mean follow up of 8.7 months (range, 6–19 months), eight of the 12 patients reported complete symptom resolution. In conclusion, corticosteroid injections alleviate pain in patients with athletic pubalgia and provide an alternative to surgery.
© 2014 Published by Elsevier Inc.
Evaluation of Therapeutic Effect of Contrast-enhanced Ultrasonography in Hepatic Carcinoma Radiofrequency Ablation and Comparison with Conventional Ultrasonography and Enhanced Computed Tomography
Received: November 4, 2014; Accepted: January 30, 2015; Published Online: March 24, 2015
| Description: http://crossmark.crossref.org/images/logos/cm_sbs_018_plain.png
Objective
This paper aims to discuss the evaluation of the therapeutic effect of contrast-enhanced ultrasonography (CEUS) in radiofrequency ablation (RFA) for liver cancer and its application value.
Methods
A total of 80 patients (120 hepatic malignant tumor lesions) were treated using RFA, and CEUS was conducted on the liver before and after the treatment. Sixty-five patients (85/120 tumor lesions) had primary hepatic carcinoma and 11 (30/120 tumor lesions) had metastatic hepatic carcinoma (6 cases of 15 lesions had colorectal carcinoma, 3 cases of 8 lesions had lung carcinoma, and 2 cases of 7 lesions had gastric carcinoma). Four patients (5 lesions) had recurrence. Prior to the treatment, CEUS accurately guided the RFA of lesions, and after the treatment, the accuracy of CEUS was compared with conventional ultrasonography and enhanced computed tomography (CT).
Results
After the RFA, there were two cases of bile leakage, two cases of bleeding, and three cases of hydrothorax, and 20 cases had fever. In the CEUS performed after the operation, 114 of the 120 lesions (94.6%) were not filled with contrast agent in the arterial phase, venous phase, and delayed phase, indicating that the tumor lesions were totally inactivated. In the remaining six lesions, the arterial phase was enhanced partially on the edge, indicating suspected partial residues of tumor lesions. The final diagnosis was based on the aforementioned two kinds of imaging examinations in combination with the level of tumor markers, needle biopsy, and follow-up visits of over 1 month. Based on the therapeutic effects on the tumor after the operation with the final diagnosis as the standards, the accuracy of CEUS was 94.6%, whereas that of contrast-enhanced CT (CECT) and conventional ultrasonography was 93.4% and 60.5%, respectively. A comparative analysis was performed, which indicated that the difference between CEUS and conventional ultrasonography was of statistical significance (χ2 = 5.42, p < 0.05). A comparison between conventional ultrasonography and CECT was also of statistical significance (χ2 = 5.14, p < 0.05); however, the comparison between CEUS and CECT indicated no statistical significance (χ2 = 7.54, p > 0.05).
Conclusion
CEUS has important value of clinical application both prior to and after RFA operations. Prior to the operation, CEUS can accurately guide the RFA treatment, whereas after the operation, CEUS is an important method to evaluate the inactivation after the treatment, and can be an important means for follow-up visits for partial treatment of hepatic carcinoma.
© 2015 Published by Elsevier Inc.
Accuracy of Sonographic Fetal Weight Estimation in Bangladesh
Received: November 27, 2014; Accepted: February 16, 2015; Published Online: March 26, 2015
| Description: http://crossmark.crossref.org/images/logos/cm_sbs_018_plain.png
Objective
This study was conducted to determine the accuracy of estimated fetal weight (EFW) by ultrasound, compared with birth weight (BW), in Bangladesh.
Methods
This is a prospective, cross-sectional study on well-dated singleton fetuses. The accuracy of weight-prediction formula is determined by assessing how well the formula works in a group of fetuses scanned close to delivery. Results of previous studies were compared with those of this study.
Results
A total of 73 infants were included in the analysis to determine the accuracy of EFW. The mean absolute difference between ultrasound EFW and BW was −64.5 (±218.5) g, and the mean relative difference or the mean percentage error of fetal weight estimation was −1.4% (±7.6%).
Conclusion
Ultrasound is a reliable modality for estimating fetal weight in a Bangladeshi population using the head circumference, femur length, and abdominal circumference formula of Hadlock.
© 2015 Published by Elsevier Inc.
Contrast-enhanced Ultrasound of Kidneys in Children with Renal Failure
Department of Diagnostic Imaging, National University Hospital, Singapore
Received: January 28, 2015; Accepted: April 15, 2015; Published Online: June 04, 2015
| Description: http://crossmark.crossref.org/images/logos/cm_sbs_018_plain.png
Ultrasound (US) has been an important tool for evaluating and imaging renal pathology in children. Development of US contrast agents and dedicated software for the detection of microbubbles has given this radiological investigation a new dimension, especially in children with renal impairment. Application of contrast-enhanced US (CEUS) brings US into the domain historically occupied by computed tomography and magnetic resonance imaging. We retrospectively studied nine children who had undergone CEUS (age range 3–16 years). This pictorial essay draws on our experience and illustrates the safety and accurate depiction of enhancement pattern of focal renal lesions.
© 2015 Published by Elsevier Inc.
Discrepancy Between Duplex Sonography and Digital Subtraction Angiography When Investigating Extra- and Intracranial Ulcerated Plaque
Received: November 21, 2014; Accepted: January 5, 2015; Published Online: March 24, 2015
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Noninvasive color-coded duplex sonography has become a good, convenient, and reproducible screening tool for the general population when studying cerebral hemodynamics and atherosclerotic disease. Digital subtraction angiography (DSA) is still the gold standard for the diagnosis of carotid stenosis, although other noninvasive imaging tools are also available. At present, ultrasound scanning, followed by confirmatory DSA, is a cost-effective way to survey patients suspected of suffering from cerebral arterial stenosis. We report two patients who had cerebral ischemic symptoms due to high-grade stenosis of either the cervical internal carotid artery (ICA) or the middle cerebral artery (MCA), combined with an ulcerated plaque. Ultrasonographic Doppler analysis identified high-grade stenotic lesions as marked elevations in the turbulent flow of the cervical ICA in one patient and of the middle cerebral artery in the other patient. Subsequently, huge plaque ulceration was found by color B-mode scanning of the patient with cervical ICA stenosis. However, DSA was able to demonstrate only a mild–moderate degree of stenosis associated with the lesions. High-grade stenotic lesions of the ICA and the middle cerebral artery were reconfirmed by computed tomography angiography and magnetic resonance angiography. An atheromatous plaque with ulceration is believed to be the cause of this discrepancy between ultrasonography and DSA.
© 2015 Published by Elsevier Inc.
Ultrasound-guided Perineural Vitamin B12 Injection for Peripheral Neuropathy
Received: May 14, 2014; Accepted: January 27, 2015; Published Online: March 26, 2015
| Description: http://crossmark.crossref.org/images/logos/cm_sbs_018_plain.png
The objective of this article is to present an innovative treatment for peripheral neuropathy using ultrasound-guided perineural vitamin B12 injection. A 37-year-old patient presented with a progressive dropped foot for 2 months. Preceding trauma was denied. On examination, severe weakness of ankle dorsiflexion was revealed. Ultrasound showed peroneal nerve swelling. Nerve conduction velocity and electromyography study showed results compatible with peroneal neuropathy. Under the diagnosis of peroneal neuropathy, the patient was given 500 μg of methylcobalamin around the peroneal nerve under ultrasound guidance two times, with an interval of 2 weeks. The patient showed improvement of muscle power within 2 weeks. Full muscle power was regained after 3 months. There was no adverse symptom after ultrasound-guided perineural vitamin B12 injection. Ultrasound-guided perineural vitamin B12 has the advantage of precise delivery of high-dose vitamin B12 directly around the defective nerve.
© 2015 Published by Elsevier Inc.
A Mass on the Right Fifth Middle Phalanx in a 48-year-old Man with Chronic Hyperuricemia
Published Online: January 07, 2015
A 48-year-old male with a history of hyperuricemia had a painful mass over his right fifth middle phalanx for 6 months, which made it difficult to flex his right little finger (Fig. 1A). Milk-like materials were occasionally released from a small pore on this mass. Ultrasound images of the mass in the short-axis view, in the long-axis view, and under the power Doppler mode are shown in Figs. 1B, 1C, and 1D, respectively.
Posterior Knee Pain and Swelling
Published Online: June 24, 2015
A 68-year-old woman presented with gradual onset of right knee pain for 2 weeks. She reported discomfort at the back of right knee and difficulty squatting. Initial physical examination showed swelling of the right posterior knee without redness (Figure 1). Knee flexion was limited at 130°. Sonographic images are shown in Figures 2A and 2B.What is the diagnosis?