Ultrasonography RSS : Gourt

Angiomyofibroblastoma-like tumor of the inguinal canal.

Related Articles Angiomyofibroblastoma-like tumor of the inguinal canal. J Ultrasound Med. 2009 Sep;28(9):1269-72 Authors: de Souza LR, Filho EC, Braga WP, Martins PT, De Nicola H PMID: 19710228 [PubMed - indexed for MEDLINE]

Imaging features of chest wall gossypiboma.

Related Articles Imaging features of chest wall gossypiboma. J Ultrasound Med. 2009 Sep;28(9):1265-8 Authors: Le HB, Lee S, Malfair D, Munk PL PMID: 19710227 [PubMed - indexed for MEDLINE]

Diaphragmatic laceration after penetrating trauma: direct visualization and indirect findings on focused assessment with sonography for trauma in the emergency department.

Related Articles Diaphragmatic laceration after penetrating trauma: direct visualization and indirect findings on focused assessment with sonography for trauma in the emergency department. J Ultrasound Med. 2009 Sep;28(9):1259-63 Authors: Hoffmann B, Nguyen H, Hill HF PMID: 19710226 [PubMed - indexed for MEDLINE]

Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered.

Related Articles Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered. J Ultrasound Med. 2009 Sep;28(9):1251-8 Authors: Smith HM, Duncan CM, Hebl JR OBJECTIVE: The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). METHODS: Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local anesthetic toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB. The ultrasound technique involved the use a low local anesthetic volume, anatomic identification of the brachial plexus trunk, needle placement opposite the phrenic nerve position, and control over local anesthetic spread. RESULTS: In both patients in whom diaphragmatic paralysis was a concern, postoperative respiratory parameters indicated successful regional analgesia without evidence of phrenic nerve blockade. In the patient requiring an additional regional anesthetic procedure, ISB was performed with a local anesthetic volume low enough to avoid exceeding toxic safety thresholds. CONCLUSIONS: Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexus blockade while avoiding issues related to phrenic nerve blockade and systemic local anesthetic toxicity. PMID: 19710225 [PubMed - indexed for MEDLINE]

High-resolution sonography is effective in detection of soft tissue foreign bodies: experience from a rural Indian center.

Related Articles High-resolution sonography is effective in detection of soft tissue foreign bodies: experience from a rural Indian center. J Ultrasound Med. 2009 Sep;28(9):1245-9 Authors: Saboo SS, Saboo SH, Soni SS, Adhane V OBJECTIVE: Patients with penetrating trauma or field injuries are commonly encountered by emergency physicians. Clinical examination by inspection or palpation can detect superficial foreign bodies (FBs), and radiographs can detect radiopaque FBs. However, soft tissue FBs can be easily missed. The aim of our series was to evaluate the role of high-resolution sonography in detection of soft tissue FBs. METHODS: All patients referred to our center for sonographic evaluation of suspected soft tissue FBs from 1999 to 2008 were included in this analysis. Patients were scanned with an ultrasound machine using a 7.5-MHz transducer. The suspected area was scanned in both axial and sagittal planes. The nature of the FB, length, and depth from the surface were recorded and reported. The presence of an FB was confirmed by surgical excision. RESULTS: During the study period, 123 patients underwent sonography for a suspected FB, of which 12 were lost to follow-up and excluded from the analysis. The study group included 73.8% male patients; the mean age was 36.2 years. Wood fragments and wooden thorns were the most frequently observed FBs, at 46.2% and 36.2%, respectively. The surgeon was satisfied with the reported depth of the FB from the surface in most cases (89%). The overall sensitivity and specificity of sonography were 94.5% and 53.8%. CONCLUSIONS: High-resolution sonography is a very sensitive tool in diagnosis of soft tissue FBs. It also helps the surgeon with accurate localization, permitting easy removal. PMID: 19710224 [PubMed - indexed for MEDLINE]

Video analysis of accidental arterial cannulation with dynamic ultrasound guidance for central venous access.

Related Articles Video analysis of accidental arterial cannulation with dynamic ultrasound guidance for central venous access. J Ultrasound Med. 2009 Sep;28(9):1239-44 Authors: Blaivas M OBJECTIVE: Accidental arterial cannulation during ultrasound-guided central venous cannulation is rarely reported and should be much less likely with dynamic guidance. Although accidental arterial penetration with the needle may occur periodically without notice and with little harm, actual arterial dilation and line placement may result in serious complications. METHODS: This series reports 6 such cases of accidental arterial cannulation and central line insertion under dynamic ultrasound guidance. RESULTS: Two of the arterial cannulations resulted in airway loss, with 1 of these ending in death. The remaining 4 arterial lines led to serious local complications. Ultrasound video analysis of each line placement or postplacement analysis was reviewed, and common pitfalls were extracted. In 3 cases, a central line went directly through the internal jugular vein (IJ) and into the carotid artery. In 1 case, a cordis introducer sheath traveled through the posterior wall of the common femoral vein and into the deep femoral artery branch below. Each patient was hypotensive and hypoxic, making traditional safety checkpoints such as aspiration of bright red blood and pulsatile flow from the syringe hub less reliable in identifying accidental arterial cannulation. All ultrasound-guided cannulations were performed by a standard short-axis approach with high-resolution linear array ultrasound transducers on modern equipment. CONCLUSIONS: The short-axis approach, as seen in this series, can provide a false sense of security to the practitioner and allows for potentially dangerous accidental arterial cannulation. In the setting of critically ill patients, it may be prudent to not only visualize the entire path of the needle with the long-axis approach but also confirm correct cannulation by tracing the guide wire in the long axis before line placement. PMID: 19710223 [PubMed - indexed for MEDLINE]

Use of sonography in thoracic outlet syndrome due to a dystonic pectoralis minor.

Related Articles Use of sonography in thoracic outlet syndrome due to a dystonic pectoralis minor. J Ultrasound Med. 2009 Sep;28(9):1235-8 Authors: Odderson IR, Chun ES, Kolokythas O, Zierler RE OBJECTIVE: For patients with thoracic outlet syndrome (TOS), it is important to determine the location of the neurovascular compression to achieve effective intervention. METHODS: The diagnostic workup for a 39-year-old man with TOS included a selective anesthetic block of the pectoralis minor muscle and duplex sonography before and after the block. RESULTS: The subclavian artery peak systolic flow velocity decreased after the block from 208 to 63 cm/s when the arm was in the abduction and external rotation position, indicating a reduction in the severity of focal arterial compression. Also, the arterial diameter increased by 10% after the block (from 0.80 to 0.88 cm). His level of discomfort was reduced from 6 to 2 on a scale of 1 to 10 (66%). CONCLUSIONS: The pectoralis minor block resulted in an improvement in subclavian artery blood flow and symptoms and confirmed the diagnosis of pectoralis minor TOS. This suggests that selective anesthetic muscle blocks and duplex sonographic studies may be useful before chemodenervation and surgery. PMID: 19710222 [PubMed - indexed for MEDLINE]

Impairment of changes in the diameter of the pancreatic portion of the superior mesenteric vein: an ultrasonographic sign of chronic pancreatitis or fibrosis.

Related Articles Impairment of changes in the diameter of the pancreatic portion of the superior mesenteric vein: an ultrasonographic sign of chronic pancreatitis or fibrosis. J Ultrasound Med. 2009 Sep;28(9):1229-34 Authors: Kitamura H, Nomura K, Arai M, Kobayashi M, Miyabayashi H, Furuta K, Koike S, Nakagawa K OBJECTIVE: A new ultrasonographic technique for detecting parenchymal stiffness of the pancreas is proposed. This technique measures changes in the diameter of the origin of the superior mesenteric vein (SMV) induced by deep inspiration. The origin of the SMV has extensive attachments to the pancreatic parenchyma; therefore, both physiologic enlargement and shrinkage of the venous lumen cannot occur without changes in the shape of the surrounding parenchyma. Therefore, increased parenchymal stiffness due to chronic pancreatitis (CP) may result in impaired changes in the venous diameter. To confirm this hypothesis, patients with CP and those with a normal pancreas were examined in this study. METHODS: Twelve patients in each group were examined. Images of the origin of the SMV were obtained with a commercial ultrasound system. The smallest diameter of the SMV was measured during normal breathing. The patients were then asked to take a deep breath to increase the portal blood pressure followed immediately by the same measurements as performed during normal breathing, and the ratio of the change was calculated. RESULTS: In the normal group, the diameter of the SMV changed by 79.5% +/- 43.8% (mean +/- SD), whereas a change of 1.4% +/- 7.3% was observed in the CP group. The difference between the two groups was statistically significant (P < .0001). CONCLUSIONS: The physiologic change in the diameter of the origin of the SMV enhanced by deep inspiration may reflect the stiffness of the pancreatic parenchyma. Therefore, detection of an impaired diameter change may be useful for screening of CP. PMID: 19710221 [PubMed - indexed for MEDLINE]

Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis?

Related Articles Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis? J Ultrasound Med. 2009 Sep;28(9):1219-27 Authors: Vessal S, Naidoo S, Hodson J, Stella DL, Gibson RN OBJECTIVE: The purpose of this study was to evaluate the accuracy of a new sonographic marker for the diagnosis of cirrhosis using hepatic vein wall changes. METHODS: A prospective pilot study evaluating 88 patients, 38 with cirrhosis and 50 with no evidence of liver disease, was undertaken. Hard copy sonograms of the hepatic veins were obtained and reviewed in a blinded fashion by 2 radiologists. The hepatic vein morphology was assessed by 3 parameters: hepatic vein wall straightness, uniformity of hepatic vein wall echogenicity, and visualization of a complete 1-cm hepatic vein segment. The 3 parameters were compared to evaluate sensitivity and specificity for the diagnosis of cirrhosis. Interobserver and intraobserver errors for each parameter were also calculated with kappa statistics to assess reproducibility. RESULTS: There was a strong correlation between altered straightness and nonuniformity of hepatic vein wall echogenicity and cirrhosis. The straightness parameter had superior sensitivity of 97% (95% confidence interval [CI], 85%-100%) and specificity of 91% (95% CI, 78%-97%) for diagnosis of cirrhosis. Uniformity of hepatic vein wall echogenicity was the next most useful parameter, with sensitivity of 88% (95% CI, 73%-97%) and specificity of 86% (95% CI, 72%-95%). The continuous 1-cm segment of the hepatic vein had sensitivity of 68% (95% CI, 49%-83%) and specificity of 91% (95% CI, 78%-97%). Hepatic vein evaluation was found to show both good intraobserver and interobserver error. CONCLUSIONS: Hepatic vein morphology on sonography, in particular, changes in the straightness and uniformity of hepatic vein wall echogenicity, is a new sign of cirrhosis, which may increase the overall accuracy of sonographic diagnosis of cirrhosis and which appears to have a moderately high degree of reproducibility. PMID: 19710220 [PubMed - indexed for MEDLINE]

Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion.

Related Articles Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion. J Ultrasound Med. 2009 Sep;28(9):1211-8 Authors: Mariano ER, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Abrams RA, Meunier MJ, Maldonado RC, Ferguson EJ, Ilfeld BM OBJECTIVE: Electrical stimulation (ES)- and ultrasound-guided placement techniques have been described for infraclavicular brachial plexus perineural catheters but to our knowledge have never been previously compared in a randomized fashion, leaving the optimal method undetermined. We tested the hypothesis that infraclavicular catheters placed via ultrasound guidance alone require less time for placement and produce equivalent results compared with catheters placed solely via ES. METHODS: Preoperatively, patients receiving an infraclavicular perineural catheter for distal upper extremity surgery were randomly assigned to either ES with a stimulating catheter or ultrasound guidance with a nonstimulating catheter. The primary outcome was the catheter insertion duration (minutes) starting when the ultrasound transducer (ultrasound group) or catheter placement needle (stimulation group) first touched the patient and ending when the catheter placement needle was removed after catheter insertion. RESULTS: Perineural catheters placed with ultrasound guidance took a median (10th-90th percentile) of 9.0 (6.0-13.2) minutes compared with 15.0 (4.9-30.0) minutes for stimulation (P < .01). All ultrasound-guided catheters were successfully placed according to the protocol (n = 20) versus 70% in the stimulation group (n = 20; P < .01). All ultrasound-guided catheters resulted in a successful surgical block, whereas 2 catheters placed by stimulation failed to result in surgical anesthesia. Six catheters (30%) placed via stimulation resulted in vascular punctures compared with none in the ultrasound group (P < .01). Procedure-related pain scores were similar between groups (P = .34). CONCLUSIONS: Placement of infraclavicular perineural catheters takes less time, is more often successful, and results in fewer inadvertent vascular punctures when using ultrasound guidance compared with ES. PMID: 19710219 [PubMed - indexed for MEDLINE]

Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation.

Related Articles Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. J Ultrasound Med. 2009 Sep;28(9):1201-9 Authors: Elias J, Nogueira-Barbosa MH, Feltrin LT, Furini RB, Foss NT, Marques W, dos Santos AC OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. METHODS: Twenty-one consecutive patients with leprosy (12 men and 9 women; mean age +/- SD, 47.7 +/- 17.2 years) and 20 control participants (14 men and 6 women; mean age, 46.5 +/- 16.2 years) were evaluated with sonography. Leprosy diagnosis was established on the basis of clinical, bacteriologic, and histopathologic criteria. The reference standard for ulnar neuropathy in this study was clinical symptoms in patients with proven leprosy. The sonographic cross-sectional areas (CSAs) of the ulnar nerve in 3 different regions were obtained. Statistical analyses included Student t tests and receiver operating characteristic curve analysis. RESULTS: The CSAs of the ulnar nerve were significantly larger in the leprosy group than the control group for all regions (P < .01). Sonographic abnormalities in leprosy nerves included focal thickening (90.5%), hypoechoic areas (81%), loss of the fascicular pattern (33.3%), and focal hyperechoic areas (4.7%). Receiver operating characteristic curve analysis showed that a maximum CSA cutoff value of 9.8 mm(2) was the best discriminator (sensitivity, 0.91; specificity, 0.90). Three patients with normal electrophysiologic findings had abnormal sonographic findings. Two patients had normal sonographic findings, of which 1 had abnormal electrophysiologic findings, and the other refused electrophysiologic testing. CONCLUSIONS: Sonography and electrophysiology were complementary for identifying ulnar nerve neuropathy in patients with leprosy, with clinical symptoms as the reference standard. This reinforces the role of sonography in the investigation of leprosy ulnar neuropathy. PMID: 19710218 [PubMed - indexed for MEDLINE]

Association of ultrasonographic findings of synovitis with anti-cyclic citrullinated Peptide antibodies and rheumatoid factor in patients with palindromic rheumatism during active episodes.

Related Articles Association of ultrasonographic findings of synovitis with anti-cyclic citrullinated Peptide antibodies and rheumatoid factor in patients with palindromic rheumatism during active episodes. J Ultrasound Med. 2009 Sep;28(9):1193-9 Authors: Chen HH, Lan JL, Hung GD, Chen YM, Lan HH, Chen DY OBJECTIVE: The purpose of this study was to investigate whether the presence of ultrasonographic findings of synovitis is associated with the presence of anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) in patients with palindromic rheumatism (PR) during active episodes. METHODS: Clinically involved regions of 84 patients with PR during active episodes were examined with high-resolution ultrasonography. Serum levels of anti-CCP antibodies were determined by an enzyme-linked immunosorbent assay, and RF levels were measured by nephelometry. RESULTS: Thirty patients (36%) had ultrasonographic findings of synovitis during active episodes. Significantly higher positive rates of anti-CCP antibodies and RF were observed in patients with PR who had ultrasonographic findings of synovitis compared with those who had no ultrasonographic findings of synovitis (26.7% versus 5.6%; odds ratio, 6.18; P < .05; and 30.0% versus 5.6%; odds ratio, 7.29; P < .01, respectively). The intraobserver and interobserver agreement for the detection of synovitis and Doppler signals by ultrasonographic assessment was excellent. CONCLUSIONS: Ultrasonography is a reliable method for assessing the presence of synovitis in patients with PR during active episodes. The ultrasonographic findings of synovitis are associated with the presence of anti-CCP antibodies and RF in patients with PR. PMID: 19710217 [PubMed - indexed for MEDLINE]

Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis.

Related Articles Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009 Sep;28(9):1187-92 Authors: Housner JA, Jacobson JA, Misko R OBJECTIVE: Initial reports have shown percutaneous sonographically guided needle tenotomy without corticosteroid injection to be effective for the treatment of tennis elbow. The purpose of this study was to determine the effectiveness of this procedure with various tendons throughout the body. METHODS: Fourteen tendons in 13 patients were identified as having a greater than 6-month history of clinical presentation consistent with tendinopathy that had failed treatment with physical therapy. All patients were treated with sonographically guided percutaneous tenotomy using a 22-gauge needle and a local anesthetic. A visual analog scale (VAS) pain score measurement was obtained before the procedure and at 4- and 12-week follow-up appointments. All complications were recorded. RESULTS: The 14 tendons in this study included patellar (5), Achilles (4), proximal gluteus medius (1), proximal iliotibial tract (1), proximal hamstring (1), common extensor elbow (1), and proximal rectus femoris (1). The composite VAS score was significantly lower at both 4 weeks (mean +/- SEM, 2.4 +/- 0.7) and 12 weeks (2.2 +/- 0.7) compared with the baseline (5.8 +/- 0.6; P < .001). No complications or morbidity occurred. CONCLUSIONS: Sonographically guided percutaneous tenotomy of tendinosis was effective in improving patient symptoms without complications. Further investigation with additional patients and comparisons to alternative treatments is needed to validate these preliminary results. PMID: 19710216 [PubMed - indexed for MEDLINE]

Assessment of global and regional left ventricular function after surgical revascularization in patients with coronary artery disease by real-time triplane echocardiography.

Related Articles Assessment of global and regional left ventricular function after surgical revascularization in patients with coronary artery disease by real-time triplane echocardiography. J Ultrasound Med. 2009 Sep;28(9):1175-84 Authors: Ren M, Tian JW, Leng XP, Wang HM, Wang Y, Wang ZZ OBJECTIVE: The purpose of this study was to evaluate the capability of real-time triplane echocardiography (RT3PE) for monitoring global and regional systolic function of the left ventricle (LV) after surgical revascularization and for evaluating the effect of surgery and predicting restenosis. METHODS: Forty-nine patients underwent RT3PE before and at 10 days and 1, 3, and 6 months after coronary artery bypass grafting (CABG). The global systolic function of the LV was assessed with the parameters of end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and stroke volume (SV). The regional myocardial deformation was detected by triplane strain rate imaging. Recovery of myocardial function after surgery and the correlation between global and regional function were investigated. RESULTS: In 41 of the 49 patients, the EDV and ESV decreased, and the EF and SV increased gradually and showed statistical significance at 3 and 6 months after surgery (P < .05; P < .01). The systolic strain rate (SR(sys)) and systolic strain (S(sys)) increased, and the postsystolic strain index (PSI) decreased progressively after CABG, with significant changes in almost all studied segments at 6 months (P < .05; P < .01). In addition, recovery of the SR(sys), S(sys), and PSI at each follow-up stage after surgery correlated well with EF improvement, with a positive correlation between the SR(sys), S(sys), and EF and a negative correlation between the PSI and EF. Restenosis was suspected in the other 8 patients. The sensitivity, specificity, and accuracy of RT3PE to predict restenosis were 75.00%, 89.47%, and 85.19%, respectively. CONCLUSIONS: Real-time triplane echocardiography can be used to quantitatively assess global and regional myocardial function. It may represent a new, powerful method to monitor improvement of myocardial function after CABG and to predict restenosis. PMID: 19710215 [PubMed - indexed for MEDLINE]

Ejection fraction/velocity ratio identifies prosthesis-patient mismatches in patients with aortic bioprosthetic valves and left ventricular dysfunction.

Related Articles Ejection fraction/velocity ratio identifies prosthesis-patient mismatches in patients with aortic bioprosthetic valves and left ventricular dysfunction. J Ultrasound Med. 2009 Sep;28(9):1167-74 Authors: Cattaneo P, Baravelli M, Rossi A, Mariscalco G, Romano M, Imperiale D, Bregasi A, Anzà C OBJECTIVES: Recently, a new echocardiographic nonflow corrected index (ejection fraction/velocity ratio [EFVR] = percent left ventricular ejection fraction [EF]/maximum aortic gradient) has been introduced and has shown excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves and bio-prostheses. The objective of this study was to assess the utility of the EFVR to quantify the indexed EOA in patients with an aortic bioprosthesis and left ventricular dysfunction considering an indexed EOA value of 0.85 cm(2)/m(2) or less to be indicative of a prosthesis-patient mismatch (PPM), defined as an EOA of the inserted prosthetic valve of less than that of the normal human valve. METHODS: We studied 100 patients (62 men and 38 women; mean age +/- SD, 71 +/- 8.6 years) with an aortic bioprosthesis and left ventricular dysfunction (EF < or =49%), and we evaluated the indexed EOA by both the continuity equation (CE) and EFVR. RESULTS: We found a significant linear correlation between the CE and EFVR (r = 0.85; P < .0001) and good agreement between the two methods in identifying patients with an indexed EOA of 0.85 cm(2)/m(2) or less; the correlation began to become nonlinear for patients with an indexed EOA of greater than 1.2 cm(2)/m(2), which was not clinically relevant. Notably, all 11 patients with a discrepancy between the indexed EOA and EFVR (ie, EFVR < or =1.0 and indexed EOA >0.85 cm(2)/m(2)) also showed an indexed EOA of greater than 0.85 but less than or equal to 1.0 cm(2)/m(2) (meaning the presence of a mild PPM). CONCLUSIONS: The EFVR can be considered a reliable echocardiographic alternative to the CE, especially in conditions in which that is technically difficult, allowing identification of a PPM (indexed EOA < or =0.85 cm(2)/m(2)) with excellent sensitivity and specificity. PMID: 19710214 [PubMed - indexed for MEDLINE]

Maintenance of hemodialysis arteriovenous fistulas by an interventional strategy: clinical and duplex ultrasonographic surveillance followed by transluminal angioplasty.

Related Articles Maintenance of hemodialysis arteriovenous fistulas by an interventional strategy: clinical and duplex ultrasonographic surveillance followed by transluminal angioplasty. J Ultrasound Med. 2009 Sep;28(9):1159-65 Authors: Scaffaro LA, Bettio JA, Cavazzola SA, Campos BT, Burmeister JE, Pereira RM, Barcellos CS, Caramori P OBJECTIVE: A native arteriovenous fistula (NAF) is a widely used access location for hemodialysis (HD). Monitoring of the NAF followed by percutaneous transluminal angioplasty (PTA) as needed may reduce the incidence of NAF failure according to nonrandomized studies. The aim of this randomized study was to determine whether an interventional strategy consisting of clinical and duplex ultrasonographic (DUS) surveillance of NAFs followed by PTA reduces the rate of the need of central venous dialysis catheters (CVCs) and NAF thrombosis in patients undergoing HD. METHODS: A total of 108 patients with 111 functioning NAFs in an HD program were randomized to control and interventional strategy groups. The control group received standard care: clinical and hemodynamic NAF assessment followed by vascular surgeon consultation in cases of dysfunction. In the interventional group, the patients underwent clinical monitoring and systematic DUS surveillance every 3 months. Cases with access dysfunction underwent angiography followed by PTA for stenosis of 50% or greater. Primary outcomes were the need of temporary CVCs and fistula thrombosis. RESULTS: Fifty-eight NAFs were randomized to the control group, and 53 were randomized to the interventional group. Groups had similar baseline characteristics. The interventional strategy showed a significant reduction in the CVC need (25.9% versus 7.5% for control and interventional groups, respectively; P = .021). No significant difference was observed for thrombosis rates (24.1% versus 17.0%; P = .487). The composite end point of NAF thrombosis or CVC need was reduced by the interventional strategy (44.8% versus 20.8%; P = .033). CONCLUSIONS: This randomized study indicates the benefit of a surveillance program for maintenance of NAFs based on clinical and DUS surveillance followed by PTA of major stenosis. PMID: 19710213 [PubMed - indexed for MEDLINE]

Sonographic follow-up of the access site after arterial angiography: Impact on the detected complication rate.

Related Articles Sonographic follow-up of the access site after arterial angiography: Impact on the detected complication rate. J Ultrasound Med. 2009 Sep;28(9):1151-7 Authors: Meis A, Osada N, Schlegel PM, Fischbach R, Heindel W, Kloska SP OBJECTIVE: This study prospectively evaluated the impact of sonographic follow-up on the detection rate of access site complications in arterial angiography and determined parameters associated with major complications of the access site after arterial angiography. METHODS: Sonographic follow-up (mean +/- SD, 1.46 +/- 1.11 days after) of the access site (transfemoral, n = 896; and transbrachial, n = 44) was obtained prospectively in 940 arterial angiographies and included evaluations for hematoma, pseudoaneurysm, arteriovenous fistula, arterial dissection, and venous/arterial thrombosis. Clotting parameters, anticoagulation therapy, and several patient and procedure characteristics were recorded. Univariate and multivariate logistic regression analyses were performed. RESULTS: Sonography depicted major access site complications in 39 of 940 angiographies (4.2%). Major access site complications (major local hematoma, n = 13; retroperitoneal hematoma, n = 1; pseudoaneurysm, n = 18; arterial dissection, n = 1; arteriovenous fistula, n = 1; arterial thrombosis, n = 2; and venous thrombosis, n = 3) required conservative (n = 32 [3.4%]) or surgical (n = 7 [0.7%]) treatment. Independent factors significantly associated with major access site complications were age older than 60.33 years and sheath size greater than 5F (P < .05). CONCLUSIONS: Major access site complications were detected in 4.2% of cases and were significantly associated with age and sheath size. PMID: 19710212 [PubMed - indexed for MEDLINE]

Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin.

Related Articles Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin. J Ultrasound Med. 2009 Sep;28(9):1143-7 Authors: Barr RG, Kido T, Grajo JR OBJECTIVE: Both sonography and scintigraphy have been used to evaluate gallbladder function with the use of sincalide (cholecystokinin [CCK]). However, the reported ejection fractions (EFs) for the two modalities are not the same. The techniques measure slightly different parameters. This study directly compared both techniques performed simultaneously on the same participants. METHODS: Twenty healthy volunteers were evaluated with sonography and scintigraphy to estimate the gallbladder EF simultaneously. The gallbladder EF was calculated at 5-minute intervals for 1 hour. RESULTS: The mean EFs +/- SD were 66.3% +/- 20% and 49% +/- 29% for sonography and scintigraphy, respectively. The mean times to the peak EF were 38 +/- 12 and 33 +/- 9 minutes for sonography and scintigraphy. An average time of 34 minutes was noted after radiopharmaceutical injection before CCK administration for the scintigraphic studies. The earliest time to the peak EF for sonography was 15 minutes, and the latest time to the peak EF was 60 minutes (mode, 40 minutes); for scintigraphy, the earliest and latest times were 15 and 50 minutes (mode, 30 minutes), respectively. One participant could not be evaluated secondary to nonfilling of the gallbladder on scintigraphy. There was wider variability of the gall-bladder EF with scintigraphy than sonography. CONCLUSIONS: Scintigraphy estimated a lower EF than sonography, had wider EF variability than sonography, and required additional time (>30 minutes more) to complete the study. Scintigraphy could not be performed in 5% of the participants because of nonfilling of the gallbladder. The use of sonography to estimate the gallbladder EF is less time-consuming and less costly. With these techniques, the range of normal gallbladder EFs should be adjusted for the technique used. PMID: 19710211 [PubMed - indexed for MEDLINE]

Focal hypoechoic tumors of Fatty liver: characterization of conventional and contrast-enhanced ultrasonography.

Related Articles Focal hypoechoic tumors of Fatty liver: characterization of conventional and contrast-enhanced ultrasonography. J Ultrasound Med. 2009 Sep;28(9):1133-42 Authors: Liu LP, Dong BW, Yu XL, Liang P, Zhang DK, An LC OBJECTIVE: The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). METHODS: Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. CONCLUSIONS: With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved. PMID: 19710210 [PubMed - indexed for MEDLINE]

Diagnosis of gastric varices and evaluation of the effectiveness of treatment using transabdominal color Doppler ultrasonography.

Related Articles Diagnosis of gastric varices and evaluation of the effectiveness of treatment using transabdominal color Doppler ultrasonography. J Ultrasound Med. 2009 Sep;28(9):1125-31 Authors: Sato T, Yamazaki K, Akaike J OBJECTIVE: The aim of this study was to evaluate the hemodynamics of gastric varices using transabdominal color Doppler ultrasonography (CDUS). METHODS: Using CDUS, we evaluated 41 consecutive patients with gastric varices. We examined color flow images and measured the velocity of gastric variceal blood flow using fast Fourier transform analysis. In addition, we compared detection rates of gastric varices and their outflow vessels using CDUS and computed tomography (CT). RESULTS: Gastric varices were detected with CDUS in 41 of 41 patients (100%), and outflow vessels were detected in 34 (82.9%). Of these, 32 were gastrorenal shunts (GRSs), and 2 were GRSs and subphrenic veins. The velocity of the large and coil-shaped varices (mean +/- SD, 23.0 +/- 5.8 cm/s; n = 13) was significantly higher than that of the enlarged and tortuous varices (14.1 +/- 4.3 cm/s; n = 28; P < .001). With CT, gastric varices were detected in 41 of 41 patients (100%), and outflow vessels were detected in 38 (92.7%). Color Doppler ultrasonographic and CT findings were in complete agreement in 35 of 41 patients (85.4%). A total of 11 patients with a high risk of variceal rupture underwent balloon-occluded retrograde transvenous obliteration, and CDUS and CT findings after treatments were consistent. CONCLUSIONS: Transabdominal CDUS is a useful noninvasive modality for the diagnosis of gastric variceal hemodynamics and for evaluation of the therapeutic effects of gastric variceal treatment. PMID: 19710209 [PubMed - indexed for MEDLINE]

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages v-vii[No author name available]

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Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Page viii[No author name available]

Accreditation Page

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Page ix[No author name available]

Ultrasound of Thyroid Nodules

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 87-103Terry S., Desser , Aya, KamayaThyroid nodules can be detected in 4% to 8% of the adult population by palpation, but in 40% to 50% of the population by ultrasound. The overwhelming majority of these represent benign hyperplastic nodules or adenomas. Approximately 5% of nodules are malignant, with papillary carcinoma representing approximately 75% to 80% of primary thyroid malignancies. Although many sonographic features have been studied as a means of distinguishing benign from malignant nodules, ultrasound- guided fine-needle aspiration with cytologic evaluation remains a mainstay in the management of palpable and incidentally detected nodules. This article reviews the current techniques for sonographic evaluation of the...

Sonographic Imaging of Cervical Lymph Nodes in Patients with Thyroid Cancer

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 105-115Jill E., Langer , Susan J., MandelSonography plays an important role in the evaluation of patients who have thyroid carcinoma by identifying metastatic disease to the regional cervical lymph nodes. The sonographic appearance of lymph node metastases may vary from subtle alterations in echogenicity or vascular patterns to more obvious findings of calcifications and cystic changes within an affected node. Identification of metastatic disease to lateral cervical lymph nodes by sonography may affect the extent of surgical resection at the time of diagnosis. In patients who have had thyroidectomy for cancer, sonographic evaluation has proved to be the most sensitive imaging technique to detect thyroid cancer...

Diagnostic Breast Ultrasound: Current Status and Future Directions

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 117-133Wei, Yang , Peter J., DempseyThis summary of breast ultrasound reviews the current indications for its use, discusses the potential technical and human pitfalls in its performance, and briefly examines possible future applications that currently are works in progress. It also contains an indepth discussion of the use and interpretation of color Doppler and power Doppler imaging, techniques that do not seem to be understood or used fully in daily practice.

Beyond Standard Mammographic Screening: Mammography at Age Extremes, Ultrasound, and MR Imaging

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 135-147Wendie A., BergThis article describes the principles and performance of screening mammography and discusses indications for screening before the age of 40 years and after the age of 69 years. Specific definitions of high risk are provided, and the rationale and performance characteristics to dare of supplemental screening with ultrasound or MR imaging are reviewed.

The Role of Echocardiography in Hemodynamic Assessment in Heart Failure

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 149-166Jacob, Abraham , Theodore P., AbrahamEchocardiography now is recommended as the most useful diagnostic test for routine evaluation and management of heart failure. This article reviews the role of echocardiography (M-mode, two-dimensional, spectral, and tissue Doppler) for qualitative and quantitative hemodynamic assessment of the patient who has heart failure. It highlights the echocardiographic parameters that have the most diagnostic and/or prognostic relevance for patients who have advanced heart failure. The importance of right heart failure and heart failure with preserved ejection fraction is increasingly recognized, and therefore the echocardiographic evaluation of these conditions is emphasized also.

Assessment of Left Ventricular Systolic Function by Echocardiography

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 167-180Martin G., St. John Sutton , Ted, Plappert , Hind, RahmouniEchocardiography serves an extremely important role in the diagnosis and management of patients with heart failure. The various stages of structural and functional changes that constitute progressive left ventricle remodeling have all been characterized by two-dimensional echocardiography. In addition, echocardiography has defined the transition from compensated hypertrophy to left ventricle dilatation and progression to end-stage heart failure. Echocardiography has also played an important role in clinical heart failure trials of b-adrenergic blocking agents and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and demonstrated their efficacy in heart failure.

Upper Extremity Venous Doppler Ultrasound

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 181-192Therese M., Weber , Mark E., Lockhart , Michelle L., RobbinUltrasound is the initial imaging modality of choice when evaluating the upper extremity venous system. When sonographic findings are equivocal or nondiagnostic, particularly in evaluating the central deep veins, MR venography or catheter venography correlation may be helpful. Ultrasound provides an accurate, rapid, low-cost, portable, noninvasive method for screening, mapping, and surveillance of the upper extremity venous system.

Ultrasound Evaluation of the Lower Extremity Veins

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 193-216Ulrike M., Hamper , M. Robert, DeJong , Leslie M., ScouttOver the past 2 decades venous ultrasonography has become the standard primary imaging technique for the initial evaluation of patients for whom there is clinical suspicion of deep venous thrombosis (DVT) of the lower extremity veins. This article addresses the role of duplex ultrasonography and color Doppler ultrasonography in today's clinical practice for the evaluation of patients suspected of harboring a thrombus in their lower extremity veins. It reviews the clinical presentation and differential diagnoses, technique, and diagnostic criteria for acute and chronic DVT. In addition, it addresses the sonographic evaluation of venous insufficiency.

Musculoskeletal Ultrasound Intervention: Principles and Advances

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 217-236Luck J., LouisUltrasound scan is an invaluable tool in the diagnosis and treatment of disorders of the musculoskeletal system. Core concepts that are common to most ultrasoundguided procedures are reviewed, including an in-depth discussion regarding the use of injectable corticosteroids. Various aspects of intra-articular, intratendinous, bursal, and ganglion cyst intervention are discussed and promising advances in the treatment of chronic tendon disorders are presented.

Ultrasound of the Hindfoot and Midfoot

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 237-253David P., Fessell , Jon A., JacobsonUltrasound has demonstrated great utility and accuracy for imaging the hindfoot and midfoot. Its advantages include its capacity to allow evaluation during dynamic maneuvers, imaging of patients who cannot undergo MR imaging, and real-time evaluation of the symptomatic site. It can also reveal abnormalities that are not apparent during static imaging. This article makes the case that radiologists should continue to be experts in all aspects of musculoskeletal imaging, including ultrasound or the business will be taken over by other specialties. If musculoskeletal ultrasound is lost, additional modalities such as MR imaging may be lost as well. Radiologists, with their...

Index

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 2, April 2009, Pages 255-260[No author name available]

Preface

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Page xiArun D., Singh , Brandy C., Hayden , Charles J., Pavlin

Ophthalmic Ultrasonography: Theoretic and Practical Considerations

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 179-183Brandy C., Hayden , Linda, Kelley , Arun D., SinghOphthalmic ultrasonography is the main diagnostic imaging modality of the eye. It is a safe, noninvasive diagnostic tool that provides instant feedback for the evaluation of various ophthalmic disorders. Diagnostic ophthalmic ultrasonography is most useful in the presence of opaque ocular media caused by corneal opacities, anterior chamber opacities, cataracts, vitreous hemorrhage, or inflammatory opacities. Ophthalmic ultrasonography is also valuable in the presence of clear media and for evaluation of the iris, lens, ciliary body, and orbital structures. This article provides a brief overview of the basic physics of ultrasound, instrumentation, and special examination techniques used in ophthalmic ultrasonography.

Ultrasound Biomicroscopy

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 185-194Charles J., Pavlin , E. Rand, Simpson , F. Stuart, FosterThe authors applied the term ultrasound biomicroscopy to the technique of using high frequency ultrasound to image living tissue at microscopic resolution. A broad clinical experience in normal patients and ocular disease has been gained over the years since its development. This article summarizes the theoretic basis for this technology and illustrates the clinical application of this tool in clinical ophthalmology and ophthalmic research.

Ophthalmic Biometry

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 195-200Karolinne Maia, Rocha , Ronald R., KruegerCataract surgery and intraocular lens (IOL) implantation are currently evolving into a refractive procedure. The precision of biometry is crucial for meeting expectations of patients undergoing cataract surgery. Moreover, the optimal results for new IOLs being developed, such as toric, multifocal, accommodative, and aspheric, all depend on the accuracy of biometry measurements.

Anterior Segment Disorders

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 201-206Martin, Heur , Bennie H., JengBecause of its high resolution, ultrasound biomicroscopy (UBM) is becoming the preferred modality for evaluating anterior segment structures when direct visualization is not possible. This article reviews UBM evaluation of the cornea, of intraocular lenses, and in the setting of anterior segment trauma.

Glaucoma

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 207-215Edward J., Rockwood , Sumit, Sharma , Brandy C., Hayden , Arun D., SinghUltrasonic A-scan, B-scan, and ultrasound biomicroscopic imaging can assist the clinician in the diagnosis and management of patients who have glaucoma. A-scan ultrasonography is used most frequently to determine ocular axial length for purposes of intraocular lens implant calculation. B-scan ultrasonography can be used to map the location and extent of staphyloma formation to avoid accidental trauma to the globe during retrobulbar anesthetic administration and is valuable in the management of the patient who has glaucoma when there is little or no visualization of the posterior segment. Ultrasound biomicroscopic imaging is ideal for assessing anterior chamber angle anatomy and anterior...

Vitreoretinal Disorders

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 217-228Sumit, Sharma , Alexandre A.C.M., Ventura , Nadia, WaheedVitreoretinal diseases are the most common indication for ultrasonographic imaging of the posterior segment. Using ultrasound, it is possible to identify, evaluate, and follow numerous posterior segment conditions such as retinal tears, vitreous and retinal detachments, retinoschisis, retinal pigment epithelium detachment, subretinal hemorrhage, and eccentric disciform lesions. It is imperative to conduct a thorough examination of all the quadrants to avoid missing any pathology, and to evaluate the vitreous body, posterior hyaloid, subvitreal space, retina, choroid, sclera, optic disc, and macular region.

Intraocular Tumors

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 229-244Evelyn X., Fu , Brandy C., Hayden , Arun D., SinghUltrasonography is a powerful noninvasive tool for the accurate diagnosis and effective management of intraocular tumors. Distinguishing ultrasonographic characteristics of intraocular tumors result from their different histopathologic compositions that can be evaluated with one-dimensional reflectivity analysis (A-scan) and two-dimensional acoustic section (B-scan). Information regarding location, shape, and acoustic characteristics is considered together to aid the diagnosis of intraocular tumors. Determination of size progression and extension is critical in selecting and monitoring management.

Ocular Inflammatory Diseases

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 245-255Alexandre A.C.M., Ventura , Brandy C., Hayden , Mehran, Taban , Careen Y., LowderBecause of its ability to evaluate eyes using either clear or opaque media, ultrasonography has been a critical adjunct in ophthalmology for more than 50 years. This article provides an overview of the ultrasound characteristics observed in a variety of ocular inflammatory diseases.

Optic Nerve Disorders

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 2, April 2008, Pages 257-266Lisa D., Lystad , Brandy C., Hayden , Arun D., SinghDiseases of the optic nerve are difficult to assess, as tissue diagnosis is usually unavailable. Therefore, various subjective functional tests are relied upon to achieve a differential diagnosis. This article reviews clinical scenarios wherein ultrasonographic imaging provides a readily accessible and inexpensive means for diagnosing and monitoring optic nerve disorders.

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages v-vi[No author name available]

Forthcoming Issues

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Page vii[No author name available]

Preface

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Page ixHisham, Tchelepi

Ultrasound Interventions in the Neck with Emphasis on Postthyroidectomy Papillary Carcinoma

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 1-16Alexander S., Jung , Edward G., Grant

Ultrasound-guided Biopsies of Peripleural Lung Lesions

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 17-24Shannon M., Gulla , Hisham, Tchelepi , Brent T., Steadman , Hollins P., Clark

Ultrasound and Abdominal Intervention: New Luster on an Old Gem

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 25-43David D., Childs , Hisham, Tchelepi

Ultrasound-Guided Kidney Biopsies

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 45-55Yueh Z., Lee , JulieAnne, McGregor , Wui K., Chong

Ultrasound-Guided Radiofrequency Ablation Within the Abdomen

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 57-71John P., McGahan , Wayne, Monsky

Pelvic Drainage: Image Guidance and Technique

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 73-81Carol L., Phillips , Petra L., Williams , Anthony F., Watkinson

Index

Publication year: 2009Source: Ultrasound Clinics, Volume 4, Issue 1, January 2009, Pages 83-85[No author name available]

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages v-vi[No author name available]

Forthcoming Issues

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Page vii[No author name available]

Preface

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages ix-xNoam, Lazebnik , Roee S., Lazebnik

The Utilization of 3D and 4D Technology in Fetal Neurosonology

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 489-516Eran, Bornstein , Ana, Monteagudo , Ilan E., Timor-TritschThis article discusses the clinical use of three-dimensional technology while performing a fetal neuroscan. This technique allows us to better define the spatial relationship of brain structures and possible malformations. The varieties of display modes and the infinite number of different planes that can be generated facilitate the diagnostic process. Additional values of this technology include an off-line analysis of the volume by the sonographer or sonologist to obtain the necessary planes, as well as an electronic transmittal for an off-site expert to provide a second opinion consultation. This modality requires a short acquisition time, allowing high patient through-put and...

3D and 4D Fetal Neuroscan: Sharing the Know-how and Tricks of the Trade

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 517-528Eran, Bornstein , Ana, Monteagudo , Ilan E., Timor-TritschVisual information from 2-D images may be limited in reflecting a 3-D structural reality. 3-D techniques have emerged enabling acquisition of an entire volume of spatial ultrasound information that can be analyzed and displayed in multiple planes and display modes that exceed the capacities of 2-D US and better reflect the 3-D nature of a structure or anomaly. In the future 3-D evaluation of the fetal body will be an inherent part of fetal study in cases of congenital anomaly' specifically fetal brain abnormality. This article focuses on the technique for obtaining and analyzing acquired volumes and displaying them.

The Utility of Volume Sonography for the Detection of Fetal Spine Abnormalities

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 529-539Noam, Lazebnik , Eran, Bornstein , Ilan E., Timor-TritschSonographic evaluation of the fetal vertebral column is essential for fetal central nervous system evaluation and valuable for ruling out genetic conditions. This article provides an overview for obtaining and manipulating fetal vertebrae three-dimensional data as to obtain the necessary diagnostic views. Additional technical information is provided elsewhere in this issue. This discussion is limited to include only the most common fetal vertebral abnormalities. The same technical principals, however, enable detection of many additional abnormalities.

Fetal Neuroimaging of Neural Migration Disorder

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 541-552Ritsuko K., PoohPrenatal diagnosis of migration disorder is among the most difficult challenges of an antenatal sonographic examination. Anterior coronal demonstration of the sylvian fissures is recommended as the screening of cortical development and maldevelopment. Once suspicion of a migration disorder develops, MR imaging is the preferred modality for demonstration of cortical development. Considering that migration disorders occur before fetal viability but detection of brain lesions is most commonly performed in the third trimester, this presents a diagnostic dilemma. Early detection of migration disorder with severe prognosis is among the central missions of fetal neuroimaging.

The Differential Diagnosis of Fetal Intracranial Cystic Lesions

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 553-558Gustavo, Malinger , Edgardo Corral, Sereño , Tally, Lerman-SagieFetal Intracranial cysts can be diagnosed during pregnancy by the use of ultrasound scan. The cysts can be found in different brain compartments and may be of diverse origins. Choroid plexus and arachnoid cysts are the most commonly diagnosed lesions and when isolated carry a good prognosis. Intraparenchymal cysts may have different etiologies, and the prognosis depends largely on the location and the extent of the lesion.

Magnetic Resonance Imaging Following Suspicion for Fetal Brain Anomalies

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 559-582Alice B., Smith , Orit A., GlennFetal MR imaging provides a useful adjunct in the evaluation of anomalies of the fetal brain noted on ultrasound. The higher resolution of fetal MR imaging allows for improved assessment of cortical malformations and other anomalies. The use of fetal MR imaging is relatively new, however, and understanding of the imaging findings continues to evolve. In addition, the improvement of newer techniques, such as diffusion weighted MR imaging, should lead to improved understanding of the developing fetal brain and the impact of ischemic, infectious, and developmental insults.

Ultrasound of the Fetal Cranium: Review of Current Literature

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 583-594Eyal, Sheiner , Jacques S., AbramowiczFetal cranial defects and abnormal skull shape are amenable to ultrasound study diagnosis. Correct identification of the nature of the abnormality is extremely important and helpful in establishing diagnosis and longterm prognosis. In addition it might direct the care provider to apply the correct genetic study, chromosome or DNA related, for final diagnosis confirmation. This article discusses normal and abnormal fetal skull anatomy as observed using ultrasound technology.

Diagnostic Approach to Prenatally Diagnosed Limb Abnormalities

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 595-608Arie, Koifman , Ori, Nevo , Ants, Toi , David, ChitayatLimb formation occurs at 4–12 weeks gestation and involves many genes and gene families. The prevalence of limb abnormalities is approximately 6/10,000 live births, with higher incidence in the upper limbs compared to the lower limbs (3.4/10,000 and 1.1/10,000 respectively). Limb abnormalities are morphologically and etiologically heterogenous group of abnormalities and most are amenable for prenatal diagnosis. The investigation and counselling of woman/couple with prenatally diagnosed fetal limb abnormality requires a multidisciplinary team including obstetrician, radiologist, clinical geneticist, neonatologist/pediatrician and a pediatric orthopedic surgeon. Other specialties may be needed if other abnormalities are detected.

Index

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 4, October 2008, Pages 609-612[No author name available]

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 3, July 2008, Pages v-viii[No author name available]

Forthcoming Issues

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 3, July 2008, Page ix[No author name available]

Preface

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 3, July 2008, Page xiiiVikram S., Dogra , Deniz, Akata

Palpable and Nonpalpable Breast Masses

Publication year: 2008Source: Ultrasound Clinics, Volume 3, Issue 3, July 2008, Pages 277-287Figen, Başaran DemirkazıkBreast ultrasonography (US) is not only useful in identifying the cystic content of breast masses but also in characterization of the solid masses. BI-RADS US lexicon, like the mammography lexicon, provides a standard terminology and assessment for breast US reports. In this article, the author examines the different types of cysts and solid lesions and examines how they should be treated. He focuses on categories 2 through 6 of the BI-RADS ultrasonography final assessment categories in American College of Radiology Imaging Network 6666 protocol, which indicate how and if cysts and lesions should be treated by biopsy or aspiration.

Rapidly involuting congenital hemangioma: A case of complete prenatal involution

We report a case of rapidly involuting congenital hemangioma of the flank, which was diagnosed in the 2nd trimester of gestation and showed complete involution before term. In our case sonography revealed a highly vascular soft tissue mass with smooth contours, which was isointense with the placenta on T2-weighted MR images. The fetus was born with scar tissue at the site of the lesion. To our knowledge this is the 1st reported case of rapidly involuting congenital hemangioma showing complete involution before term. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010

Treatment of an extracapsular post-renal biopsy pseudoaneurysm with ultrasound-guided thrombin injection

Percutaneous renal biopsy is a convenient method to obtain allograft tissue for histologic evaluation. Vascular complications, such as arteriovenous (AV) fistula and pseudoaneurysm, following renal biopsy are well known, and they usually resolve without further intervention. When symptomatic, they should be treated. We present a patient on chronic anticoagulation who developed a pseudoaneurysm after percutaneous renal biopsy. Applying techniques learned in the management of femoral artery pseudoaneurysm, we treated our patient with ultrasound-guided thrombin injection. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Conservative management of an extensive renal graft subcapsular hematoma arising during living donor nephrectomy. Role of Doppler sonographic posttransplant follow-up

We report a case of subcapsular hematoma (SH) of a kidney graft arising during minimal-incision living-donor nephrectomy. SH covered at least two-thirds of the cortical surface. Capsulotomy was not done because it was deemed too risky. In the immediate postoperative period, a rapid deterioration of graft function was observed associated with Doppler sonographic evidence of graft compression. However, in the following days, spontaneous resolution of SH and progressive improvement of Doppler findings was observed, which preceded full recovery of graft function. Conservative management seemed a valid approach of this complication in this case where Doppler sonography proved essential for the follow-up. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Echocardiographic identification of ventricular septal rupture caused by acute stent thrombosis

Coronary stenting is an increasingly common procedure. Complications are rare. However, when they do occur, they often require urgent invasive treatment. Investigations that are critical for establishing a diagnosis as well as such guide treatment as a detailed assessment of myocardial morphology and function using transthoracic echocardiography may be overlooked in the haste to treat the patient. We present a case report of subacute drug-eluting stent thrombosis in which a meticulous echocardiographic examination allowed the identification of a ventricular septal rupture, which ultimately modified treatment. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Fetal thickened nuchal soft tissues may first appear in the second trimester in Down syndrome

To describe a series of cases of late-onset fetal nuchal translucency in Down syndrome.In our practice area, most pregnant women usually undergo 3 different sonographic examinations: a fetal nuchal translucency examination in the 1st trimester and 2 detailed surveys of all fetal organs in the early 2nd trimester and in midpregnancy.During the study period (2003-2008), we detected 11 fetuses with new appearance of severe thickened nuchal soft tissues ([ge]6 mm) at 14-16 weeks' gestation after a normal nuchal screening in the 1st trimester. All of these fetuses had trisomy 21. Associated structural anomalies were observed in 10/11 of the cases. In addition, there were 12 fetuses with new appearance of thickened nuchal soft tissues (<4 mm); all these fetuses had a normal karyotype and were normal at delivery.Obstetricians should be aware that a nuchal abnormality may first appear only at 14-16 weeks' gestation. Fetal karyotyping is advocated in these cases because of the high probability of Down syndrome. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Congenital left atrial appendage aneurysm diagnosed by fetal echocardiography

A newborn infant was evaluated because of a large cystic mass adjacent to the left atrium on prenatal ultrasound. The diagnosis was an aneurysm of the left atrial appendage. Most cases of this rare lesion are recognized between the 2nd and 4th decades of life. The present case, however, was detected on fetal echocardiography. The patient showed significant mitral regurgitation caused by the compression of the left atrioventricular groove. Simple aneurysmectomy without mitral valvuloplasty was sufficient to relieve significant mitral regurgitation in this case. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Sonographic detection of an aneurysm of the gastroepiploic artery

Gastroepiploic artery aneurysm (GEAA) is very rare. Furthermore, most GEAA cases are diagnosed after their rupture. We report a case of asymptomatic GEAA. The patient was a 61-year-old man. Sonography (US) revealed a 2-cm anechoic mass in the epigastrium near the anterior abdominal wall. Color Doppler US and contrast-enhanced US showed arterial flow within the mass leading to the diagnosisof visceral artery aneurysm. CT and angiography confirmed the diagnosis of right GEAA, and the aneurysm was treated successfully with embolization. Follow-up US 6 months later confirmed the absence of blood flow within the lesion. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Subcutaneous lipoma compressing the common peroneal nerve and causing palsy: Sonographic diagnosis

The compression of peripheral nerves by benign fatty tumors has rarely been reported in the literature. We present the case of a patient who had a subcutaneous lipoma in the region of the knee that caused common peroneal nerve palsy and appeared to compress the nerve on sonography. The surgical removal of subcutaneous lipoma allowed complete recovery. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Scrotal sonography revisited

Sonography is the imaging modality of choice for the scrotum because it is simple, relatively inexpensive, and quick. Recent technological advances and transducer improvements have led to exquisite high-resolution detail in gray-scale as well as Doppler imaging. The purposes of this pictorial essay are to review the anatomy and embryology of the scrotal contents and to review the various scrotal and extrascrotal pathologic conditions, including acute scrotum, pediatric and adult testicular and extratesticular scrotal neoplasms, traumatic lesions, and miscellaneous other scrotal lesions. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Continuous-type splenogonadal fusion associated with an ipsilateral testicular atrophy: Sonographic findings

Splenogonadal fusion is a rare congenital anomaly in which the spleen is abnormally connected to the gonad. Two types of splenogonadal fusion have been described: continuous and discontinuous. Splenogonadal fusion is frequently associated with cryptorchidism and/or congenital orofacial/limb anomalies. We describe the ultrasound findings in a case of continuous-type splenogonadal fusion associated with ipsilateral testicular atrophy with correlation with MRI. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Prenatal sonographic diagnosis of short umbilical cord in a dichorionic twin with normal fetal anatomy

Short umbilical cords are associated with fetal anomalies, often including those with decreased or absent fetal movement, fetal akinesia/hypokinesia sequence, and restrictive dermopathies and aneuploidy. In normal fetuses, abnormally short umbilical cords have been associated with an increased risk of umbilical vessel hematomas, thrombosis, rupture, thrombocytopenia, cord compression, variable fetal heart rate decelerations, instrumental and operative deliveries, and fetal demise. We report a 24-year-old gravida 2, para 0 with a concordant dichorionic twin gestation, at 26 weeks' gestation, in whom sonography depicted fetuses with normal-appearing anatomy as well as short umbilical cord of the 1st twin. Increased fetal surveillance was conducted. Following delivery at 36 weeks' gestation, the presence of a short umbilical cord of the 1st twin measuring 19 cm was confirmed. Systematic review of the literature confirms that this is the first report of prenatal diagnosis of a short umbilical cord in an otherwise normal fetus. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Inflammatory pseudotumor (myoblastic tumor) of the breast: A case report and review of the literature

Inflammatory pseudotumor of the breast is a very rare cause of breast mass. To our knowledge, only a few cases have been described in the English literature. In this case, the lesion appeared on mammography as a round high-density mass with ill-defined margins and on sonography as an irregular mass of complex echogenicity with ill-defined margins and an echogenic rim. The lesion was resected with no evidence of local recurrence after 3 years. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Contrast-enhanced ultrasound with SonoVue: Differentiation between benign and malignant focal liver lesions in 317 patients

The aim of the study was to investigate the ability of contrast-enhanced sonography (CEUS) with the contrast agent SonoVue to differentiate between benign and malignant focal liver lesions.In a prospective study, we examined 317 patients (204 males, 113 females, aged 59 ± 12 years) with focal liver lesions detected by B-mode gray-scale sonography. After intravenous injection of 1.2 mL SonoVue, the liver was examined continuously for 3 minutes using low-MI sonography with contrast-specific software. Final diagnosis was established by histopathology, CT, MRI, or HIDA-scintigraphy.Two hundred nine patients had malignant focal lesions, including 107 hepatocellular carcinomas, 70 metastases, 26 cholangiocellular carcinomas, and 6 other types of malignancy. One hundred eight patients had benign focal lesions, including 30 regenerative nodules, 30 hemangiomas, 13 cases of focal nodular hyperplasia, 12 abscesses, 8 cases of necrosis, 7 cases of focal steatosis areas, and 8 other benign lesions. Hypoenhancement or no enhancement in the late phase was found in 91% of the malignant lesions but in only 37% of the benign lesions (p < 0.001, sensitivity = 64%, specificity = 93%). Hyperenhancement in the late phase was found in 20% of the benign lesions but in none of the malignant lesions (p < 0.001, sensitivity = 21%, specificity = 100%). Hyperenhancement in the early phase with diffuse complete enhancement was found in 30% of the patients with malignant lesions but in only 2% of the patients with benign lesions (p < 0.001, sensitivity = 30%, specificity = 98%). CEUS had a sensitivity of 90%, a specificity of 99%, and an accuracy of 89% in the diagnosis of malignant liver lesions.CEUS is helpful in the differentiation between benign and malignant focal liver lesions. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Sonographic appearance of focal fatty infiltration of the pancreas

We report the sonographic, CT, and MRI findings in a case of focal fatty infiltration of the pancreas. Sonography revealed an echogenic mass in pancreas head. On CT, the mass was hypodense. The mass showed same signal intensity to the surrounding normal pancreas on in-phase T1-weighted MR images and a loss of signal intensity on opposed-phase MR images. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Serial compression B-scan and Doppler sonography for the screening of deep venous thrombosis in patients with spinal cord injuries

To evaluate the usefulness of serial compression B-scan and Doppler sonography (US) in screening for deep venous thrombosis (DVT) of the lower extremities in patients with spinal cord injuries.Patients with paraplegia and tetraplegia due to spinal cord injuries were screened by a serial compression B-scan and Doppler US protocol for DVT of the bilateral lower extremities within the first 36 hours after admission, at day 7 and at day 21. In patients with DVT, a follow-up US examination was performed 3 weeks after diagnosis to assess thrombi distribution.Between January 2007 and March 2008, a total of 115 patients (75 males, 40 females), aged 19 to 85 years, were included. The first US examination documented a DVT in 44 cases (38.3%). After an initial negative scan, sonography after 7 days and 21 days showed DVT in 6 patients and 2 patients, respectively. Cumulative rate of DVT after the first 3 weeks was 45.2% (n=52). Follow-up US after 3 weeks in patients with DVT documented a complete recanalization in 19 patients (36.5%), no change in 12 patients (23.1%), and residual thrombi with partial recanalization in 21 patients (40.4%).Our study supports the use of serial compression B-scan and Doppler US as a screening tool for DVT of the lower extremities in patients with spinal cord injuries early after injury. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

The utility of thoracic ultrasound before local anesthetic video-assisted thoracoscopy in patients with suspected pleural malignancy

Video-assisted thoracoscopy under local anesthesia (VAT-LA) is a key investigation in the diagnosis and management of suspected malignant pleural effusion. Two problems encountered at VAT-LA are accessing the pleural space and fibrinous intrapleural septa. Thoracic sonography (TUS) is known to facilitate thoracocentesis after dry tap but has not been studied in detail before VAT-LA. We report a case of lateral decubitus pre-VAT TUS that helped locate the optimal access to the pleural space and demonstrated fibrinous intrapleural septation, thereby affecting the decision to avoid thoracoscopic pleurodesis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Trumpet maneuver in the sonographic diagnosis of an external laryngocele

Laryngocele is an uncommon disease defined as an abnormal dilatation or herniation of the laryngeal saccule, forming an air-filled cavity. Radiologic evaluation of a suspected laryngocele generally includes plain radiographs, CT, and MRI. There are very few reports in the literature on sonographic findings of laryngocele. Trumpet maneuver has been reported in CT examination for the diagnosis of laryngocele. However, to the best of our knowledge, the use of trumpet maneuver in the sonographic diagnosis of laryngocele has not been previously described. This report presents the sonographic findings of an external laryngocele while performing the trumpet maneuver. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Evaluation of the hepatic artery anastomosis by intraoperative sonography with high-frequency transducer in right-lobe graft living donor liver transplantation

To describe the usefulness of intraoperative ultrasonography (IOUS) with high-frequency transducer in living donor liver transplantation (LDLT) using right-lobe graft (RLG).This retrospective study was approved by our institutional review board. We performed IOUS in 22 patients (17 men and 5 women, aged 51 ± 9.0 years) during LDLT with RLG using a Sequoia 512 scanner with an 8-12-MHz linear transducer. Hepatic artery (HA) anastomosis was identified on gray-scale US, and the diameter and percentage of stenosis of the anastomosis were measured. The HA was evaluated to detect thrombus or dissection in the region of anastomosis. Doppler study of the graft HA was also performed. Patients were divided into those with and without abnormalities, including thrombosis, dissection, and abnormal Doppler parameters (peak systolic velocity 2 m/s, resistance index 80 msec).On gray-scale and Doppler IOUS study, abnormalities were found in 10 of 22 patients. Diagnoses were anastomotic stenosis (n = 2), celiac stenosis (n = 1), compromise of HA inflow due to systemic hypotension (n = 1), HA thrombosis (n = 2), and HA dissection (n = 4). Re-anastomoses were done in 3 case (2 stenoses and 1 thrombosis). Uneventful postoperative recovery occurred in the other 7 patients without re-anastomosis.IOUS with high-frequency transducer is a useful method to make an early diagnosis of HA complications of LDLT with RLG. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Variations of the origin of renal arteries in the fetus identified on power Doppler and 3D sonography

Purpose.To investigate anatomic variations of renal arteries (RAs) using 2-dimensional (2D)/3D power Doppler sonography (PDUS) in normal fetuses and in fetuses with renal anomalies.Methods.The origin, direction, and distribution of RAs were studied in 120 fetuses without renal malformations using 2D/3D PDUS. Studies were performed between 14 and 17 weeks of gestation age on 64 male and 56 female fetuses. PDUS of the RAs was also performed in 12 fetuses with renal anomalies.Results.In 117/120 fetuses, a single RA was found to originate from each side of the abdominal aorta. The origin of the right RA from the abdominal aorta was superior to, at the same level as, and inferior to that of the left RA in 47% (55/117), 25.5% (30/117), and 27.5% (32/117) of the cases, respectively. An accessory right RA was found in 3 cases. Bifurcation of the right RA was found in 2 cases. There were no variations of the origin of renal vessels in 69% of the cases (83/120), whereas the remaining 31% (37/120) had 1 or several variation patterns. Variations in renal vessels were found in 8 of the 12 fetuses with renal malformations: accessory artery in 3 cases, origin of the right RA from the iliac artery in horseshoe kidney and in 2 cases with pelvic kidney, and bifurcation in 2 of the fetuses with double collecting system.Conclusions.Variations in origin and distribution of fetal RAs are frequently observed in normal pregnancies. The majority of renal malformations are associated with such vascular variations. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Usefulness of contrast-enhanced ultrasound in the diagnosis of biliary leakage following T-tube removal

Biliary leakage is a serious complication related to T-tube removal. Identifying the location of the leak is important for accurate diagnosis and prompt treatment. We report a case of biliary leakage in the common bile duct (CBD) following a T-tube removal that was successfully diagnosed with contrast-enhanced ultrasound (CEUS). The micro-bubble contrast medium was administrated into the bile ducts through the percutaneous transhepatic biliary drainage catheter. The real-time delineation of contrast agent leaking from the CBD was confirmed by percutaneous transhepatic cholangiography. CEUS can be used to detect biliary leakage after T-tube removal. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009

Ileocolocolic intussusception secondary to a submucosal lipoma: An unusual cause of intermittent abdominal pain in a 62-year-old woman

We present a case of subacute nonobstructing ileocolocolic intussusception secondary to a submucosal lipoma and a mobile cecum diagnosed sonographically in a 62-year-old woman. The patient was seen following a 2-month history of nonspecific intermittent pain in the right and middle abdomen and weight loss. Sonography revealed ongoing intussusception involving distal ascending and transverse colon. Analysis of the distal intussusception end demonstrated a 3.0 × 2.5 cm echogenic polypoid lesion consistent with a lipoma serving as a lead point. The sonographic diagnosis was confirmed at surgery. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.

Follicular thyroid adenoma with eggshell calcification presenting as an intensely hypermetabolic lesion on 18F-FDG PET/CT

We report herein a case of follicular thyroid adenoma with an eggshell calcification presenting as an intensely hypermetabolic lesion on combined 18F-fluorodeoxyglucose whole-body PET and CT (18F-FDG PET/CT) performed for staging work-up in a 68-year-old woman who had undergone distal gastrectomy with Billroth II anastomosis for early gastric carcinoma. The mass was intensely hypermetabolic (SUVmax = 21.3 g/mL) on combined 18F-FDG PET/CT, hypoechoic with an interrupted eggshell calcification on gray-scale ultrasonography (US), and showed intranodular vascularity on power Doppler US. Follicular adenoma should be considered in the differential diagnosis of a mass with an eggshell calcification on US and intense hypermetabolism on 18F-FDG PET/CT. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Ultrasonography RSS : Gourt

Angiomyofibroblastoma-like tumor of the inguinal canal.

Imaging features of chest wall gossypiboma.

Diaphragmatic laceration after penetrating trauma: direct visualization and indirect findings on focused assessment with sonography for trauma in the emergency department.

Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered.

High-resolution sonography is effective in detection of soft tissue foreign bodies: experience from a rural Indian center.

Video analysis of accidental arterial cannulation with dynamic ultrasound guidance for central venous access.

Use of sonography in thoracic outlet syndrome due to a dystonic pectoralis minor.

Impairment of changes in the diameter of the pancreatic portion of the superior mesenteric vein: an ultrasonographic sign of chronic pancreatitis or fibrosis.

Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis?

Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion.

Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation.

Association of ultrasonographic findings of synovitis with anti-cyclic citrullinated Peptide antibodies and rheumatoid factor in patients with palindromic rheumatism during active episodes.

Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis.

Assessment of global and regional left ventricular function after surgical revascularization in patients with coronary artery disease by real-time triplane echocardiography.

Ejection fraction/velocity ratio identifies prosthesis-patient mismatches in patients with aortic bioprosthetic valves and left ventricular dysfunction.

Maintenance of hemodialysis arteriovenous fistulas by an interventional strategy: clinical and duplex ultrasonographic surveillance followed by transluminal angioplasty.

Sonographic follow-up of the access site after arterial angiography: Impact on the detected complication rate.

Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin.

Focal hypoechoic tumors of Fatty liver: characterization of conventional and contrast-enhanced ultrasonography.

Diagnosis of gastric varices and evaluation of the effectiveness of treatment using transabdominal color Doppler ultrasonography.

Contents

Forthcoming Issues

Accreditation Page

Ultrasound of Thyroid Nodules

Sonographic Imaging of Cervical Lymph Nodes in Patients with Thyroid Cancer

Diagnostic Breast Ultrasound: Current Status and Future Directions

Beyond Standard Mammographic Screening: Mammography at Age Extremes, Ultrasound, and MR Imaging

The Role of Echocardiography in Hemodynamic Assessment in Heart Failure

Assessment of Left Ventricular Systolic Function by Echocardiography

Upper Extremity Venous Doppler Ultrasound

Ultrasound Evaluation of the Lower Extremity Veins

Musculoskeletal Ultrasound Intervention: Principles and Advances

Ultrasound of the Hindfoot and Midfoot

Index

Preface

Ophthalmic Ultrasonography: Theoretic and Practical Considerations

Ultrasound Biomicroscopy

Ophthalmic Biometry

Anterior Segment Disorders

Glaucoma

Vitreoretinal Disorders

Intraocular Tumors

Ocular Inflammatory Diseases

Optic Nerve Disorders

Contents

Forthcoming Issues

Preface

Ultrasound Interventions in the Neck with Emphasis on Postthyroidectomy Papillary Carcinoma

Ultrasound-guided Biopsies of Peripleural Lung Lesions

Ultrasound and Abdominal Intervention: New Luster on an Old Gem

Ultrasound-Guided Kidney Biopsies

Ultrasound-Guided Radiofrequency Ablation Within the Abdomen

Pelvic Drainage: Image Guidance and Technique

Index

Contents

Forthcoming Issues

Preface

The Utilization of 3D and 4D Technology in Fetal Neurosonology

3D and 4D Fetal Neuroscan: Sharing the Know-how and Tricks of the Trade

The Utility of Volume Sonography for the Detection of Fetal Spine Abnormalities

Fetal Neuroimaging of Neural Migration Disorder

The Differential Diagnosis of Fetal Intracranial Cystic Lesions

Magnetic Resonance Imaging Following Suspicion for Fetal Brain Anomalies

Ultrasound of the Fetal Cranium: Review of Current Literature

Diagnostic Approach to Prenatally Diagnosed Limb Abnormalities

Index

Contents

Forthcoming Issues

Preface

Palpable and Nonpalpable Breast Masses

Rapidly involuting congenital hemangioma: A case of complete prenatal involution

Treatment of an extracapsular post-renal biopsy pseudoaneurysm with ultrasound-guided thrombin injection

Conservative management of an extensive renal graft subcapsular hematoma arising during living donor nephrectomy. Role of Doppler sonographic posttransplant follow-up

Echocardiographic identification of ventricular septal rupture caused by acute stent thrombosis

Fetal thickened nuchal soft tissues may first appear in the second trimester in Down syndrome

Congenital left atrial appendage aneurysm diagnosed by fetal echocardiography

Sonographic detection of an aneurysm of the gastroepiploic artery

Subcutaneous lipoma compressing the common peroneal nerve and causing palsy: Sonographic diagnosis

Scrotal sonography revisited