Application of intraoprerative ultrasound in malignant liver tumor / 中华肝胆外科杂志

Intraoperative ultrasonography (US) is the very important tool for liver surgery which not only provides the operating surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach,but also provides the guidance for hepatectomy,vessel patency and intraoperative tumor ablation procedures.The indications,equipment,techniques and the benefits and limitations as well as future expectations are discussed.

Diagnostic Performance of Gray-scale Sonographic Findings for the Detection of Acute Pyelonephritis

PURPOSE: To evaluate the diagnostic performance of gray-scale renal sonographic findings for the diagnosis of acute pyelonephritis (APN) by using computed tomography as a reference standard. MATERIALS AND METHODS: We retrospectively reviewed gray-scale renal sonographic findings of 48 patients for the detection of APN. All patients had clinical symptoms such as fever, flank pain, or dysuria and were confirmed as APN by contrast-enhanced CT. The presence of sonographic findings such as renal swelling, alteration of the parenchymal echogenicity, wall thickening of the renal pelvis, loss of the renal sinus fat echogenicity, and loss of the corticomedullary differentiation were evaluated. We also categorized all patients into mild APN or severe APN groups according to the volume of the morbid renal parenchyma on contrast-enhanced CT, and evaluated the aforementioned sonographic findings between the two groups. RESULTS: Overall diagnostic sensitivity, specificity, and accuracy of gray-scale renal ultrasonography (US) for the detection of APN were 32.5%, 72.0%, and 58.5%, respectively. The sensitivity and specificity of each sonographic finding were measured for each group. Renal swelling sensitivity and specificity were 33.8% and 70.8% for the mild APN group, but 45.8% and 66.7% for the severe APN group. Sensitivity and specificity for alteration of the parenchymal echogenicity were 41.7% and 79.2% for the mild APN group, but 58.3% and 66.7% for the severe APN group. The sensitivity and specificity for wall thickening of the renal pelvis was 37.5% and 95.8% for the mild APN group, but 50.0% and 95.8% for the severe APN group. The sensitivity and specificity of loss of the renal sinus fat echogenicity were 12.5% and 83.3% for the mild APN group, but 12.5% and 91.7% for the severe APN group. The sensitivity and specificity of the loss of the corticomedullary differentiation were 12.5% and 95.8% for the mild APN group, but 20.8% and 75.0% for the severe APN group. There was no significant difference of gray-scale renal US diagnostic accuracy for the detection of APN between the mild and severe APN groups (56.3%: 58.3%; p > 0.05). CONCLUSION: Although overall gray-scale renal US has poor sensitivity for the detection of APN, wall thickening of the renal pelvis is the most specific sonographic finding in the both mild and severe APN groups.

Round Ligament Varicosities During Pregnancy: Case Report

There are various causes of a painful palpable mass in the groin during pregnancy. The differential diagnoses of an inguinal mass include hernia, lymphadenopathy, mesothelial cyst, cystic lymphangioma, neoplasms (lipoma, leiomyoma and sarcoma), endometriosis, embryonic remnants and round ligament varicosities. Among them, round ligament varicosities can be easily misdiagnosed as an inguinal hernia in a pregnant woman. These lesions should be managed conservatively because they resolve spontaneously during the postpartum period. Ultrasonography can help make the diagnosis of round ligament varicosities and so prevent unnecessary surgical intervention and the associated morbidity. Herein we report on a case of round ligament varicosities that presented during pregnancy and this condition was readily diagnosed via Doppler sonography.

Imaging Findings of Localized Lymphoid Hyperplasia of the Pancreas: a Case Report

We report here on a case of localized lymphoid hyperplasia of the pancreas in a 70-year-old man which manifested as double lesions (uncinate process and tail) in the organ. The lesions were incidentally detected as hypoechoic lesions on ultrasonography and they appeared as delayed enhancing lesions on the contrast-enhanced dynamic CT and MRI. Total pancreatectomy was performed, because malignant tumor could not be excluded according to the preoperative imaging studies and the endoscopic ultrasound-guided biopsy failed. Pathology revealed localized lymphoid hyperplasia. The patient had an uneventful postoperative course. He has been alive for 18 months after surgery.

Recurred Myofibroblastoma of Breast After Excision: A Case Report

Myofibroblastoma of the breast is a rare benign mesenchymal tumor that is known to occur in middle-aged and elderly men, yet there are some recent reports showing no certain difference for the gender distribution of this malady. Localized mass excision can usually provide a complete cure. To the best of our knowledge, there have been no reports of metastasis or recurrence of this tumor. Here we describe the sonographic findings of a case of recurrent myofibroblastoma after surgical excision for suspected fibroadenomas in both breasts of a 25-year-old woman.

Castleman's Disease in the Sigmoid Mesocolon: A Case Report

Castleman's disease is a rare disorder that's characterized by the proliferation of lymphoid tissue. It is very rare to find this disease arising from the sigmoid mesocolon. We report here on a case of localized Castleman's disease involving the sigmoid mesocolon, and we discuss the findings of the gray-scale ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging.

Segmental Cystic Disease of the Kidney: A Case Report

Segmental cystic disease of the kidney is a rare form of cystic disease of the kidney that manifests as variable sized, numerous cysts that are localized in a segment of one kidney. Morphologically and pathologically, it is indistinguishable from autosomal dominant polycystic kidney disease except for its unilateral localization, the lack of an autosomal dominant genetic background and the progressive deterioration of the renal function. We experienced a case of surgically confirmed segmental cystic disease of the kidney in a 49-year-old patient and we report on its ultrasonographic and CT findings, along with a brief review of the relevant literature.

Cholesterol Granuloma of the Breast: A Case Report

Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the breast are rare (1). In fact, only eight cases have been previously described, and of these, an ultrasonography was performed in only . Here, we report the ultrasonographic findings of a breast cholesterol granuloma accompanied with with a literature review.

The determination of thyroid gland volume and imaging diagnosis of basedow disease by ultrasound

Background/Introduction: While manual clinical and imaging diagnosis methods expose their shortcomings such as errors, ultrasound becomes an appropriate technique for the measurement of the thyroid volume. \r\n', u'Objectives: We determine the thyroid in patient with Basedow disease by ultrasonography before radioiodine, diameter, measurement of thyroid volume, and the lesion echogenicity.\r\n', u'Subjects and method: The study groups consist of 264 patients, in which there are 53 men (20.07%) and 211 women (79.92%), in Bach Mai Hospital. The youngest is 16 years old and the oldest is 73. With a medium age of (42.97 \uf0b1 12.06) years (range from 16 to 73). The most common group ranging from 40 to 50 years of age, equivalent to a number of 80 patients (30.30%). Surveyed participants include 1845 people with normal thyroid. All of them underwent ultrasound scans with a 7.5 MHZ transducer. This is a prospective study. \r\n', u'Results/Outcomes: The average volume of thyroid is (37.03 \uf0b1 19.77) ml compared to the group with approximate thyroid volumes (p > 0.05 based on the ANOVA). Basedow patients\u2019 thyroid volumes tends to be bigger at the adult age, and were bigger than those of normal people (p = 0.0001 t test). 138 (52.27%) surveyed patients had diffuse injuries. 126 patients (47.73%) have thyroid glands which contained multiple nodules. 197 (96.57%) of them had nodules that were \r\n', u'solid echodense and echomix, and 35 (16.36%) had calcifications.\r\n', u'Conclusion: Ultrasonography (US) has become an important asset in thedetermination of thyroid volume at referred for 131I treatment and the evaluation of thyroid nodules of patients with Basedows\u2019 disease associated with nodules. These data suggest the value of surgery in Basedows\u2019 disease associated with nodules, to eliminate the risk of malignancy.\r\n', u'

Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer / 핵의학분자영상

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

Utility of Radiologic Imaging for Patients who underwent Appendectomy

PURPOSE: The primary aim of this study was to evaluate the rate of advanced radiographic imaging for patients who underwent appendectomy. The secondary aim was to investigate the effect of ultrasonography (US) and computed tomography (CT) on the outcome of an appendectomy. METHODS: We retrospectively reviewed the data of 585 patients who underwent an appendectomy as an emergency procedure in our hospital within a 2-year period. Cases were categorized by the presence or absence of advanced radiographic imaging. We evaluated the negative appendectomy rate, the occurrence of perforation, and the preoperative emergency department length of stay (ED LOS). RESULTS: Five hundred eighty-five (585) patients underwent operative exploration for presumed appendicitis. Of those 165 patients had no advanced imaging, 347 had a US, 49 had a CT scan, 24 had both US and a CT scan. Acute appendicitis was pathologically proven in 567 patients, corresponding to negative appendectomy rate of 3.1%. Ninetythree appendices (15.9%) were perforated. The mean preoperative ED LOS was 15.8 hours. CONCLUSION: Advanced radiographic imaging prior to operative exploration did not lower the negative appendectomy rate. Diagnostic imaging significantly increased the perforation rate and the preoperative ED LOS.

The Ultrasonographic Findings of Trigger Points of Myofascial Pain Syndrome in a Rabbit Model

PURPOSE: Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain. Myofascial trigger points (MTrPs) have been repeatedly described by numerous authors. However, there have been few studies in which their existence and behavior was supported and their location confirmed. The purpose of this study was to determine whether diagnostic ultrasonography is an objective diagnostic tool which is able to significantly identify or detect the soft tissue changes in the region of clinically identified active MTrPs by using a rabbit experimental model. MATERIALS AND METHODS: Ten MPS model rabbits were used in this study. We made an MPS animal model by causing the rabbits to overuse one leg for 3 weeks by cutting the contralateral L4 spinal nerve root. We compared the ultrasonographic findings of the taut band at pre-OP with those at post-OP during the consecutive three week period. To find the taut bands of the muscle, after skin exposure, the muscles were gently rubbed or pinched with the thumb and index finger on the two opposing surfaces of the muscle across the direction of the fibers. Then, the muscle was held in the same way, but with a 5-8 MHz stick probe being used in place of the thumb. After the palpation of various muscles, we selected the hardest and largest myofascial trigger nodule, in order to observe the ultrasonographic and power Doppler findings of the MPS. The size, shape, echogenecity and vascularity of the MTrPs were observed. RESULTS: The analysis of the results of the ultrasonography revealed that all MTrPs have a hyperechoic area. The mean thickness of the hyperechoic lesion in the biceps was 0.96+/-0.14 cm in the MPS site (at pre-OP?), and 0.49+/-0.12 cm at post-OP 3weeks (p < 0.01). The hyperechoic lesions in all of the studied biceps femoris of the rabbits were observed by high resolution ultrasonography. No definitively decreased vascularity was observed within the hyperechoic area by power Doppler imaging. CONCLUSION: Until now, there has been no objective method for the diagnosis of MPS. However, this study suggests the possibility of using diagnostic ultrasonography as an objective diagnostic tool, by identifying the tissue changes in the region of clinically indicated active MTrPs.

Subcapsular Hematoma of the Liver in a Neonate: Case Report

Subcapsular hematoma of the liver in the neonate is an uncommon clinical presentation, although these tumors are frequently found upon perinatal autopsy. We describe the sonographic and MR findings of a subcapsular hematoma of the liver in a neonate having a clinical history of an inserted umbilical venous catheter, necrotizing enterocolitis and sepsis, and we also include a review of the relevant literature.

Ceftriaxone-Associated Biliary Pseuodolithiasis: Sonographic and CT Findings

Ceftriaxone is known to induce a precipitation in the gallbladder that mimics gallstones on sonography in the children and adults. "Biliary pseudolithiasis" is now used to describe this reversible, benign complication accompanying ceftriaxone therapy. It is important to be aware of this adverse effect because it does not need any specific treatment. To our knowledge, there have not been any reports of CT findings of ceftriaxone-associated biliary pseudolithiasis in literature. We herein report two cases of ceftriaxone-associated biliary pseudolithiasis with sonographic and CT findings, which were completely resolved after the cessation of ceftriaxone therapy.

An Analysis of Cost-Effective Screening Interval for HCC in Korean Hepatitis B Virus Carriers

BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of screening tests (AFP and US) for early detection of primary hepatocellular carcinoma (HCC) and its optimal screening interval in Korean hepatitis B virus carriers. METHODS: Data relating to tumor incidence, efficacy of screening tests, tumour growth times and various cost for detecting HCC were obtained from reviews of Korean literature. Decision analysis technique was used to calculate the efficacy of these screening tests and screening interval. RESULTS: When the doubling time of HCC was 6 months, the most cost-effective screening interval of each AFP and US was 6 months, respectively. The optimal screening intervals of AFP and US were 3 and 5 months for each, respectively, and 7 months for both when a detection rate of 80% was expected. These results were significantly altered when the different tumour growth times reported in other literatures were applied. CONCLUSION: If the doubling time of HCC was 6 months, the optimal screening interval was 7 months on using both tests. Because the tumour doubling time alters the optimal screening interval, further evaluation on the doubling time of Korean hepatoma is needed.

Comparison of Computerized Tomography(CT) and Ultrasonography(US) in the Diagnosis of Nasal Bone Fracture and Medial Orbital Wall Fracture

For the diagnosis of nasal bone fracture and medial orbital wall fracture, plain radiography and computerized tomography(CT) have been utilized. But plain radiography is less reliable due to its low specificity. So CT has been given a preference to plain radiography in examining both fractures. However, CT has some disadventages; high expense, heavy radiation hazard, and coexistent injuries may restricted a patient,s positioning and so thus preventing or delaying the diagnosis. By comparison, ultrasonography(US) represents a safe, inexpensive, noninvasive, portable, and wide availability. This paper compares the relative values of CT and US in the diagnosis of both fractures. In nasal bone fracture, US proved to be more accurate than CT. Thirty-seven nasal bone fractures were diagnosed by US; whereas only thirty-two of these were revealed on CT. Compared with US, CT demonstrated 87% sensitivity. In examining medial orbital wall fracture, eight cases were diagnosed by CT; whereas seven of these were revealed on US. Compared with CT, US demonstrated 88% sensitivity. In medial orbital wall fracture, US was almost as accurate as CT. In this research, it is concluded that in the investigation of nasal bone fracture and medial orbital wall fracture, US is an accurate diagnostic modality and correlates well with CT.

Color Doppler Energy(CDE): Initial Ten-Months Experience

PURPOSE: Color Doppler Imaging(CDI) has shortcomings, including random noise, aliasing, and angle dependence. To overcome these, a method using CD US, termed power doppler or Color Doppler Energy(CDE), has recently been introduced. The purpose of this study was to show the clinical usefulness of CDE. MATERIALS AND METHODS: We retrospectively analyzed the CDI and CDE of 61 cases(20 renal pseudotumors, 8 musculoskeletal inflammations, 17epididymitis or epididymo-orchitis, 3 vaicoceles, 1 normal testis, 1 hepatocellualar carcinoma, 7 renal cell carcinomas, 1 renal angiomyolipoma, and 3 splenic varices). CDI and CDE scans were obtained at the same region with constant scan plane. The color gain was increased until noise first became perceptible, and scans were always obtained in such a way that the maximum amount af vascularity was shown. There after, the vascularity, vascular displacement, and the vascular relationship between CDI and CDE were compared. RESULT: In 17 of 20 cases of pseudotumor in the kidney, normal vascularity was identified in CDI and CDE, but was more clearly visible in CDE. In three cases, there was no visible vascularity in CDI, but normal vascularity in CDE. In eight cases of musculoskeletal inflammation and 17 cases of epididymitis with or without or chitis, the vascularity was increased due to hyperemia, which was more prominently seen in CDE than in CDI. In three varicoceles, CDE appeared to bebetter in demonstration low velocity flow. In one patient who was suspected of having acute testicular torsion, CDE was helpful in excluding this suspicion. In one case of hepatocellular carcinoma, seven cases of renal cell carcinoma, one case of renal angiomyolipoma, and three cases of splenic varices, CDE was better than CDI in showing the vascularity, vascular relationship, and vascular displacement. CONCLUSION: CDE is a potential lyuseful adjunct to standard CDI.