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Thứ Hai, 1 tháng 2, 2016

MEDIC CHUẨN BỊ THAM DỰ AFSUMB 2016

1/ ARFI of TESTIS at MEDIC CENTER, NGUYEN THIEN HUNG - LE VAN TAI - PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

PURPOSE:
Acoustic radiation force impulse imaging (ARFI) is a new technique for the sonographic quantification of tissue elasticity. We applied  ARFI elastography to investigate the stiffness of  the normal and pathologic testes.

METHOD and MATERIALS:
20 male volunteers underwent normal B-mode sonography with ARFI elastometry of both testes using a Siemens Acuson S2000™ (Siemens Healthcare, Germany) system. 12 cases of testicular tumor  and 03 cases of hematoma were encountered in our study.  Results were statistically evaluated.
RESULTS:
-          From 40 normal testes of 20 male individuals, mean elastic velocity VTQ= 0.87+/- 0.11m/s [range 0.72-1.12 m/s]
-          From 03 cases of hematoma, mean elastic velocity VTQ=1.39+/-0.02m/s.
-          From 12 cases of testicular tumor, mean elastic velocity VTQ= 1.51+/- 0.18 m/s (range 1.26-1.69m/s) with the meaning more stiffness than normal and hematoma testis. On VTI tumor are harder the parenchyma (black color or blue code)

CONCLUSION:
ARFI elastometry  provides the initial values of testicular stiffness in normal and pathologic status. Further studies with more subjects may be required to define the normal range of values for normal and pathologic groups.

2/ARFI for OBSTRUCTIVE and with UPJO HYDRONEPHROSIS in ALDULT
NGUYEN THIEN HUNG - TRAN NGAN CHAU- PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
ABSTRACT:
We applied ARFI technique from Siemens S2000 to evaluate whether fibrotic process existing in adult hydronephrosis.
Using 1-4 MHz convex probe we calculated in 3 positions of hydronephotic kidney due to  obstruction [stone, outside compression] (n=33 cases), due to ureteropelvic junction obstruction [UPJO] (n=30 cases]. We had a control group of normal kidney (n=36 cases). Mean value of ARFI velocity of obstruction hydronephrosis (due to stone) was 2.73+/-0.39m/s and of UPJO hydronephrosis was 1.66+/-0.16m/s while in control group was 1.6+/-0.2m/s. There were stastistic differences of 2 stone and UPJO hydronephrosis groups (p < 0.0001), with stone hydronephrosis and control (p < 0.0001). But no statistic difference exists in UPJO hydronephrosis and control group.

3/ CLINICAL APPLICATION of Acoustic Radiation Force  Impulse  in BREAST TUMOR at MEDIC CENTER, PHAN THANH HAI PHUONG, VO NGUYEN THUC QUYEN, PHAN THANH HAI

INTRODUCTION
Early detection of Breast Cancer plays a critical role in decision making. Besides mammography and MRI, ultrasound has been a useful modality in detecting breast tumors. Moreover, the combination with Color Mode significantly reinforces the B-mode diagnosis. Lately, new ultrasound technique, elastography is providing extra information to increase accuracy. However, each one uses different method including compressed and non-compressed technologies. Developing by Siemens, ARFI is a non-compressed elastography, evaluates tissue stiffness base on replacement caused by acoustic radiation force impulse (ARFI).
AIMS:
To evaluate ARFI qualitative and quantitative assessment to differentiate benign and malignant breast tumors.
METHODS and MATERIALS
From April to November 2015, we selected 85 breast lesions classified as category 3-5 according to ACR Breast Imaging Recording and Data System (BI-RADS). Two radiologists analyzed them in ARFI features : Elasticity Score (E.S) which on scales 1-5 (Score 1-3: low suspicion, Score 4-5: high suspect of malignancy), then measure Area Ratio (proportion between VTI lesion area and B-mode area) and set ROI in 5 different points of the lesion then measured Shear-wave Velocity (SWV). Biopsy were required for final diagnosis (FNAC, Core Biopsy, Excisional Biopsy). Exclusion criteria include: Non histopathology confirmation or Male breast lesion.  
RESULT
85 selected breast lesions includes 59 benign (69.4%) and 26 (30.6%) malignant. Lesions appear to dominantly locate in right breast 52/85 (61.2%), left 33/85 (38.8%). The mean size is 16.26 ±6.56 transversely and perpendicularly 9.64 ±5.01 mm. In ES assessment, 26/26 cancer cases were within suspicious range ( ES4-5). The AR cut-off point would best at 1.34 with sensitivity 88.5% and specificity 94.9% (area under ROC curve for malignancy is 0.933). After excluded 8 malignant cases has SWV as X.XX m/s, the best SWV cut-off point is at 2.24 with sensitivity 94.4% and specificity 72.9% (area under ROC curve for malignancy is 0.911).
CONCLUSION
Overall, ARFI is a useful tools for diagnosis and decision of biopsy breast tumors. The technique is simple since it is non-compressed and repeatable. It cannot replaced biopsy but reinforced the Conventional ultrasound  findings. This is a promising technique helps avoiding invasive diagnosis if we use it right and well-combined with other features. 


4/ Ultrasound findings of rib fractures in undetected cases by chest x-rays
Le Thanh Liem MD, Phan Thanh Hai MD
Medic Medical Center, Ho Chi Minh City, Vietnam
Abstract:

OBJECTIVE:

To accumulate experiences of detection of costal cartilage and rib fractures which are negative on X-ray films of  chest trauma patients.

METHODS:

A total of 112 patients at the Medic Medical Center from 2008 to 2015, suffering from chest trauma, detected costal cartilage or rib fractures on chest ultrasound with a 7.5 MHz linear transducer of ultrasound. All patients were examined later by chest X-ray. Statistical analysis was done to outline the ultrasound findings of these rib fractures.

RESULTS:

In 112 patients showed costal cartilage and anterior rib lesions, only 10 patients (9%) showed of rib fracture on chest X-ray film, whereas 102 other patients (91.0%) had no evidence of rib lesions on chest X-ray film. Fracture of the rib with a disruption of continuity of bony cortex, mostly located near the costo-chondral junction. Rib fracture cases that the displacement is minimal, usually detected by longitudinal plane based on accompanied by the soft tissue edema or hematoma around the fracture site. Costal cartilage fractures were in five patients (4,5%). Costal cartilage fracture appeared as disruption of cortex, small echogenic lines in cartilage, and bruised cartilage. In addition to detecting rib fractures, ultrasound helps evaluating the stage of disease based on the presence of hematoma, cartilage callus or bone callus. Some patients may not specify the position localized pain or may not remember history of trauma until there is evidence of ultrasound to confirm the diagnosis.

CONCLUSIONS:

Ultrasonography is a useful imaging modalities in disclosing the rib fractures which were negative on chest X-ray film in chest trauma.
Although no significant change in treatment, but the detection of rib fractures is very helpful in explaining the cause of pain, reducing the anxiety of patients and avoid other unnecessary diagnostic procedures.
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