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). 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.
o .
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
