Ultrasound imaging versus conventional histopathology in diagnosis of periapical lesions of endodontic origin: A comparative evaluation.

Context: Accurate assessment of periapical status is critical in diagnosis, treatment planning, and evaluation of healing. Novel imaging modalities like sonography offer promising results with reduced radiation risks. Aims: To evaluate the potential of ultrasound imaging technique together with the application of color Doppler to differentiate between periapical lesions of endodontic origin. Materials and Methods: Twenty patients with periapical lesions of endodontic origin who were already scheduled for undergoing endodontic surgery were examined further using sonography. Color Doppler was performed to assess blood flow. Information on the size of the lesion, its content, and vascular supply was gained and recorded by means of ultrasound images. The sonographic images were analyzed and discussed with an expert sonologist, and a tentative diagnosis between a periapical cyst and periapical granuloma was made. Endodontic surgery and histopathological examination was done for each case and the results were compared. Results: The sonograms revealed the lesions within the bone in three dimensions and their contents, that is, fluids or tissues or blood vessels. Measurements of the periapical lesions in three dimensions were also obtained. Of the twenty cases studied, ultrasound could detect periapical granulomas in all 9 cases and radicular cysts in all 11 cases. Conclusion: Ultrasound imaging had the potential to be used for the evaluation of periapical lesions of endodontic origin. However, further studies are required to establish a definite correlation.

Influence of maternal anemia on placental volume with study of uterine artery doppler

To study the influence of maternal hematocrit [Ht] and hemoglobin [Hb] level on placental volume with study of uterine artery Doppler. In this prospective study 40 pregnant [singleton pregnancy] cases were selected from the outpatient clinic of Alzahra university Hospital. They were divided into two groups the study group [20 cases] were anemic[iron deficiency] and the control group[20cases] were healthy. For each case two scans for the placenta and fetal growth were performed, the first at recruitment and the second 5 weeks later. Placenta volume was measured at each visit using three dimensional ultrasound. The maternal Hb and [Ht] were measured in each visit. It revealed a non statistical significance between maternal hemoglobin, hematocrit and placental volume during the 1[st] visit and 2[nd] visit in anemic group compared to the control group. As regards Doppler study of the uterine artery in the present study it was noted that the pulsatility index and resistance index showed a non significant increase in the anemic group compared to the control group. Maternal iron deficiency anemia can affect placental growth and development. Placental volume increased with mild anemia during the first trimester but has no significant effect of fetal growth. The use of 3D ultrasound is more accurate and efficient safe technique of great value in evaluating placental growth and volume. Also, the study of uterine artery blood flow during the mid second trimester showed a non significant increase of RI and PI with maternal anemia. Further study are needed for the effect of anemia on fetal growth during preconceptional, first, second, third trimester and the outcome of pregnancy

Diagnostic accuracy of color doppler ultrasonography in evaluation of cervical lymph nodes in oral cancer patients.

Aims: To assess the diagnostic accuracy of color doppler ultrasonography (CDUS) in differentiating metastatic from reactive lymph nodes in oral cancer patients. Material And Methods: Study comprised 80 adult subjects with oral cancer, divided in two groups based on clinical criteria. Group I included 40 patients with clinically suspected metastatic cervical lymph nodes, Group II included 40 patients with clinically suspected reactive cervical lymph nodes. Study population was evaluated with CDUS for color flow signals and intranodal vascular resistance (Pulsatility Index and Resistivity Index), followed by Fine Needle Aspiration Cytology, used as a standard, to confirm the etiology of the lymph node enlargement. Statistical Analysis Used: Chi-Square Test (SPSS 15.0 version) was used to evaluate the significance of the parameters used between the two study groups. Results: Sensitivity of CDUS by vascular flow pattern was 94.1%, specificity of 100%, with accuracy of 95.4% and by vascular indices the sensitivity was 81.4%, specificity of 100%, and accuracy of 85.5%, with statistically significant correlation.(P < 0.05) Conclusion: CDUS plays a definitive role as an adjunct to clinical evaluation of differentiating metastatic from reactive cervical lymph involvement in patients with oral cancer as it aid in grading and staging of oral cancer and can determine the treatment plan prognosis and morbidity by diminishing the possibility nodal dissection.

Observer Agreement Using the ACR Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, First Edition (2003)

OBJECTIVE: This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). MATERIALS AND METHODS: Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics. RESULTS: The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). CONCLUSION: Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Contribución del ultrasonido Doppler color al diagnóstico de la enfermedad de Mondor / Contribution of the color Doppler ultrasound on the Mondor's disease

La enfermedad de Mondor consiste en una tromboflebitis de las venas subcutáneas de la región toracoabdominal anterolateral. Es una entidad poco frecuente, descrita por primera vez por Fagge en 1870 y caracterizada por Mondor en 1939 (1,2). La causa no ha sido establecida, pero su aparición se ha asociado a trauma local, cirugía, infección, embarazo, lactancia, exceso de ejercicio físico, mamas grandes y péndulas y a alteraciones inmunológicas (3,4). También está descrita su aparición en concomitancia con ganglios axilares metastásicos y cáncer de mama. Esta última coexistencia llega hasta un 12 por ciento de los casos en una serie publicada (5-8). Afecta mayoritariamente a mujeres en una proporción de 3 de por cada hombre. Se presenta en la edad media de la vida, puede ser ocacionalmente bilateral y también hay descritos casos de recurrencia (3,4,9)

Utilidad de la ultrasonografía y el Doppler color en el diagnóstico del escroto agudo en pediatría / Usefullness of ultrasound and doppler imagind in the diagnosis of pediatric acute scrotum

Con el objeto de evaluar la ultrasonografía (US)y Doppler color en el diagnóstivo del escroto agudo en pediatría,se realizó un estudio retrospectivo que incluyó 79 pacientes operados en el Hospital J.P Garrahan entre julio de 1994 y noviembre de 1998.En todos los casos se realizó US y ecodopler testicular previo a la cirugía.De ellos 40 presentaron torsión testicular(Grupo A)y 39 no tuvieron torsión(grupoB)24 tenían una torsión de hidátide de morgagno,14 un proceso inflamatorio agudo epídimo testicular y 1 apendicitis aguda.En el grupo A la sensibilidad en la correlación ecográficas-quirúrgica fue del 92,5 por ciento.En 5 pacientes que ingresaron con sospecha de torsión testicular,el ecodoppler mostró ausencia del flujo vascular,siendo entonces la especifidad del 88.09 por ciento.En el grupo A observamos cremasteriano ausente en 39 de 40 pacientes.En el grupo B,la sensibilidad del método diagnóstico fue de 86,1 por ciento.La especifidad fue del 91.66 por ciento ya que sólo tres pacientes en los que el ecodoppler mostró flujo vascular presente,presentaron una torsión testicular.El escroto agudo en pediatría continúa planteando un dilema diagnóstico.El ideal consiste en evitar exploraciones quirúrgicas innecesarias que tanto en la bibliografía como en nuestra serie llegan a un 50 por ciento sin subdiagnosticar una torsión testicular.La alta sensibilidad y especificidad del método diagnóstico evaluado nos inducen a considerarlo un elemento de valor para disminuir el número de intervenciones quirúrgicas diagnósticadas

Imagenología del riñón trasplantado / Imaging of the transplanted kidney

El desarrollo de la medicina con la mejoría de la expectativa de vida ha permitido la realización exitosa de los trasplantes de diferentes órganos. La mejor comprensión de las causas de rechazo, la preservación de los órganos, la inmunosupresión, el desarrollo de protocolos específicos de prevención y tratamiento de infecciones han contribuido a la sobrevida del injerto y de los pacientes después del trasplante renal. Los especialistas en imágenes tenemos un importante rol en el estudio del donante y del control de la evolución del trasplante para prevenir y tratar oportunamente las complicaciones. La sobrevida del injerto ha mejorado significativamente después de la introducción de la ciclosporina en 1983. En Chile existen 5.500 pacientes en diálisis y desde 1966 se han efectuado 2.539 trasplantes renales, los cuales en un 60 por ciento son de donante cadáver. Entre las causas de pérdida de receptor (fallecimiento) el 41 por ciento son de causa infecciosa, generalmente por gérmenes oportunistas, ya que se trata de pacientes inmunodeprimidos y generalmente ocurre en el primer año post-trasplante. El 17 por ciento son complicaciones cardiovasculares, al segundo año de trasplante y el 10 por ciento corresponde a causas neoplásicas

Ultrasonido y cáncer mamario / Ultrasound and breast cancer

El ultrasonido es considerado una técnica de examen muy útil en el diagnóstico y manejo del diagnóstico mamario. Está indicado como herramienta complementaria a la mamografía. Se revisan las indicaciones, técnica de examen, caracterización de las lesiones haciendo un algoritmo con los pasos a seguir frente a determinados diagnósticos ecográficos. Además es posible realizar procedimientos de estudio percutáneo mediante la obtención de distintos tipos de muestra bajo guía ecográfica y la marcación preoperatoria de lesiones no palpables. No está indicada como herramienta de "detección precoz" por su inaceptable tasa de falsos negativos y positivos

Doppler color y modo de energía como nuevo método diagnóstico en el tumor del cuerpo carotídeo ventajas y desventajas

Se revisaron los hallazgos en Doppler color y modo de energía en 12 pacientes con 14 tumores del cuerpo carotídeo. El diagnóstico se estableció con Doppler color en el que se encontraron masas sólidas en la bifurcación carotídea con flujo intratumoral radial y centrípeto con una curva espectral de baja velocidad, monofásica con perdida de la pulsatilidad y ventana llena. se identificó claramente la relación del tumor con las arterias carótidas lo que permitió su clasificación; 7 de tipo I, 6 de tipo II y 1 de tipo III. La velocidad intratumoral fue significativamente más baja que las velocidades en la porción cervical de las carótidas, hallazgos compatiblescon la neoformación vascular. No existe diferencia significativa en la velocidad de las arterias carótidas del lado del tumor con las contralaterales. Dado que en el 37.5 por ciento de los pacientes programados para cirugía la desición se tomó con base en los hallazgos del Doppler color como único método diagnóstico, se plantea que sea utilizado como primer estudio en pacientes con masa en ecuello a la altura de la bifurcación carotídea, complementandose con Doppler transcraneano o arteriografía en los tipos III

Valor predictivo del ecodoppler color peneano con inyección de droga vasoactiva en pacientes con disfunción eréctil / Penile color Doppler US predictive value after vasoactive drug injection in patients with erectile disfunction

A fin de demostrar la utilidad del eco Doppler con drogas vasoactivas para definir la terapéutica en pacientes con disfunción eréctil se estudiaron 54 pacientes con tumescencia nocturna insuficiente, a quienes se les realizó ecografía peneana y Doppler color de las materias cavernosas en condiciones basales y con inyección intracavernosa de 1 cm3 de Trimix, registrándose las velocidades sistólicas basales y postinyección temprana, tardía y postestímulo y evaluando las velocidades sistólicas, distólicas y los índices de resistencia. Los estudios permitieron clasificar a los pacientes en 5 grupos de acuerdo a la etiología de la disfunción y de ese modo brindarles la terapéutica adecuada

Doppler colorido na análise da circulaçäo retrobulbar de olhos glaucomatosos com hemorragia do disco óptico / Color doppler in the investigation of retrobulbar circulation in glaucomatous patients

O objetivo deste estudo é avaliar a circulaçäo retrobulbar de pacientes glaucomatosos que apresentaram hemorragia do disco óptico (HDO), utilizando o Doppler colorido. Foram estudados 28 olhos glaucomatosos (15 com HDO) e 10 olhos normais. Foram medidas as velocidades sistólica máxima e diastólica final, e calculado o índice de resistência das artérias oftálmica, central da retina e artéria ciliar posterior curta temporal. Näo se observou diferenças estatísticas significativas nos parâmetros medidos nos três, com exceçäo da velocidade sistólica máxima na artéria central da retina, que foi significativamente menor nos olhos glaucomatosos em comparaçäo aos olhos normais