Use of ultrasonography versus magnetic resonance imaging for tendon abnormalities around the ankle.

A prospective study was performed on 28 patients who underwent surgery for tendon disorders around the ankle. Preoperatively, all patients had real-time, high resolution ultrasonography performed with a 7.5 or 10 mHz transducer. Twenty of these patients also had a preoperative magnetic resonance imaging (MRI) examination of the ankle. A total of 54 tendons were inspected intraoperatively, revealing a total of 24 intrasubstance or complete tendon tears. These surgical findings were compared with the ultrasound and MRI findings, from which the sensitivity, specificity, and accuracy were calculated for both modalities. Ultrasound produced results with a sensitivity measurement of 100%, specificity of 89.9%, and accuracy of 94.4%. MRI produced results with a sensitivity measurement of 23.4%, specificity of 100%, and accuracy of 65.75%. Ultrasound results were more sensitive and accurate than MRI in the detection of ankle tendon tears in our study.

Ultrasonographic-surgical correlation of ankle tendon tears.

This study evaluates the accuracy of ultrasonography in detecting ankle tendon tears of the peroneal, posterior tibial, and flexor digitorum longus tendons based on operative findings and clinical follow-up. A prospective study was performed in 33 patients with clinically suspected tendon injury. Sixty-eight tendons were evaluated sonographically. The diagnosis of an intrasubstance tear was made when disruption of uniform tendon architecture by hypoechoic linear or globular clefts was observed. Criteria used to diagnose complete tendon rupture included discontinuity or gap within the tendon or complete nonvisualization of the tendon. Treatment decisions were based on a combination of clinical parameters and imaging studies. Twenty-six patients had the presence or absence of tear confirmed at surgery. Five patients had a final diagnosis based on clinical findings, and two were lost to follow-up. Of the 68 tendons evaluated sonographically, 54 were directly inspected at surgery; 20 were found to be torn and 34 were intact. Ultrasonography was able to identify all tears correctly with an accuracy of 93%, a sensitivity of 100%, and a specificity of 88%. The positive and negative predictive values were 83% and 100%, respectively. The combined accuracy, sensitivity, and specificity of ultrasonography in detecting tendon tears in all patients evaluated both surgically and by clinical follow-up were 94%, 100%, and 90%, respectively.

Color Doppler imaging and transrectal sonography of the prostatic fossa after radical prostatectomy: early experience.

OBJECTIVE: Our objective was to determine if the addition of color Doppler imaging (CDI) during transrectal sonography can improve the detection of residual or recurrent prostatic cancer after radical prostatectomy. MATERIALS AND METHODS: Thirty patients who had undergone radical prostatectomy for prostatic cancer were evaluated with transrectal sonography and transrectal sonography with CDI. Twenty-three of these 30 patients were evaluated for suspicion of local tumor recurrence. The remaining seven patients were not suspected of harboring recurrent tumor and served as controls. Transrectal sonography and CDI-directed needle biopsies of the vesicourethral anastomosis (four-quadrant) and perianastomotic soft tissues were obtained in the 23 patients suspected of recurrent tumor. The ability of transrectal sonography to detect local tumor recurrence was compared with transrectal sonography with CDI. RESULTS: Fourteen of 23 patients (61%) had positive transrectal sonography or transrectal sonography and CDI-directed biopsies. Transrectal sonography alone detected grayscale abnormalities in 11 of 23 patients (48%), of whom 10 (43%) had positive transrectal sonography-directed biopsies. CDI during transrectal sonography showed hypervascularity in 12 of 23 patients (52%). Biopsies of these hypervascular regions were positive in all 12 patients (100%). Hypervascularity was detected in 10 of 11 (91%) gray-scale abnormalities initially detected with transrectal sonography alone. CDI during transrectal sonography detected two patients with hypervascular areas without associated gray-scale findings. Both patients had positive biopsies of their hypervascular sites. Transrectal sonography had a sensitivity and specificity of 71% and 89%, respectively, with positive and negative predictive values of 91% and 67%, respectively. CDI during transrectal sonography had a sensitivity and specificity of 86% and 100%, respectively, with positive and negative predictive values of 100% and 82%, respectively. CONCLUSION: CDI used during transrectal sonography improves the detection of early recurrent or residual prostatic cancer compared with transrectal sonography alone. Although most gray-scale abnormalities that are recurrent tumor show hypervascularity, CDI can detect additional tumor recurrences not identifiable with transrectal sonography alone.

Endorectal color Doppler imaging of primary and recurrent rectal wall tumors: preliminary experience.

OBJECTIVE: The purpose of our study was to assess whether color Doppler imaging is a useful adjunct to endorectal sonography in evaluating rectal wall neoplasms and in distinguishing recurrent or residual tumor from postoperative changes. MATERIALS AND METHODS: Thirty-two patients underwent endorectal sonography with color Doppler imaging for one of two indications: evaluation and staging of a suspected primary rectal wall cancer, or distinguishing tumor recurrence from postoperative scarring in patients with previously resected lesions. Rectal wall lesions were evaluated for hypervascularity, and their corresponding flow patterns were graded from 0 to 4. Local tumor staging with endorectal sonography and color Doppler imaging was performed before the results of pathological staging were available. RESULTS: Ninety-five percent of patients with malignant rectal wall tumors demonstrated hypervascularity during color Doppler imaging. In 61% of patients with rectal cancers, prominent perirectal vessels were identified supplying the tumor and were never identified in patients with benign lesions. Endorectal sonography alone correctly identified perirectal fat invasion with a 100% sensitivity and an 83% specificity. Color Doppler imaging during endorectal sonography correctly identified perirectal fat invasion with a sensitivity of 91% and a specificity of 83%. Of the 8 patients with previously resected lesions (five adenomas and three cancers), two patients had recurrent tumor, and both of these demonstrated grade 3 abnormality. Six patients with biopsy-proven fibrosis only had grades of 0 or 1. CONCLUSIONS: Both benign and malignant rectal wall tumors demonstrate abnormal intratumoral hypervascularity when seen with color Doppler imaging. Advanced rectal cancers (T3 or greater) are also associated with abnormal perirectal vascularity. Color Doppler imaging during endorectal sonography does not appear to improve discrimination of benign from T2 (or less) rectal wall cancers, nor does it appear to improve the ability to locally stage rectal wall cancers during endorectal sonography. However, endorectal sonography with color Doppler imaging may add significant information in distinguishing recurrent tumor from postsurgical scarring.

Atypical myxoid smooth muscle tumor of the prostate: ERUS, CDI, and MR findings.

Atypical myxoid smooth muscle tumor (AMSMT) of the prostate is a rare neoplasm not previously described in the radiographic literature. This report describes the unusual appearance of this tumor during endorectal ultrasound (ERUS), color Doppler imaging (CDI), and magnetic resonance imaging (MRI) in a 26-year-old man.

The foramen magnum: the underutilized acoustic window to the posterior fossa.

Visualization of the posterior fossa during neonatal cranial sonography through the anterior fontanelle can at times be limited. To improve visualization of the posterior fossa, the foramen magnum was used as an acoustic window. Scans through the foramen magnum were obtained in addition to routine scans via the anterior fontanelle in 21 preterm infants. A subjective and retrospective evaluation was performed comparing clarity and definition of posterior fossa structures using the anterior fontanelle and foramen magnum. Images of the fourth ventricle, pons, vermis, cerebellar hemispheres, and cisterna magna were considered superior in clarity and definition when obtained via the foramen magnum. The tentorium was visualized equally well with both windows. Foramen magnum scanning demonstrated improved clarity of two Dandy-Walker variants in comparison to anterior fontanelle scanning. The use of the foramen magnum in addition to other acoustic windows can improve perceived clarity and definition of posterior fossa structures and aid in the detection of abnormalities and anomalies occurring in this location.

Prostate: techniques, results, and potential applications of color Doppler US scanning.

Color Doppler ultrasound (US) scanning and conventional endorectal gray-scale US of the prostate were performed in 619 patients. Pathologic correlation was available in all cases after US-guided transrectal biopsy. There were 132 cancers in 121 men, 13 foci of atypia in 10 men, 33 foci of inflammation in 31 men, and 469 benign lesions in 457 men. Two hundred seventy patients with abnormal areas of flow identified at color Doppler scanning also underwent spectral waveform analysis of the area of potential concern. No statistical difference in the mean resistive indexes was identified in any patient (P = .25; Scheffe F test, analysis of variance). All malignant lesions had abnormalities demonstrated at gray-scale US and/or focal or diffuse abnormal flow demonstrated at color Doppler scanning. Of the 132 cancers, 123 (93%) had corresponding gray-scale abnormalities and 114 (86%) demonstrated abnormal flow at color Doppler imaging. Nine of the 132 cancers (7%) had no obviously identifiable abnormality at gray-scale scanning but had distinctly abnormal flow at color Doppler scanning. Abnormal findings at color scanning without abnormal findings at gray-scale scanning occurred in eight of the 33 cases of inflammatory foci (24%) and in 24 of the 469 (5%) benign lesions.

Frontal periventricular cysts on the first day of life. A one-year clinical follow-up and its significance.

During a 6-year period, the prospective interpretations of routine screening cranial ultrasound on 1453 premature infants indicated frontal periventricular cysts in 7 infants without other intracranial abnormalities during the first 24 hours after birth. The medical records of these 7 infants and their mothers and a developmental assessment at age 1 year were also reviewed. The cysts were predominantly single and unilateral and ranged in size from 2 to 11 mm. One infant had bilateral subependymal cysts as well as frontal periventricular cysts. All 7 infants before 1 year of age demonstrated mild neurological deficiencies. However, 6 of 7 demonstrated partial or complete resolution of their neurological impairment by the end of 1 year. One infant was lost to clinical follow-up. The presence of these frontal periventricular cysts in the first 24 hours after birth suggests an in-utero event, such as antepartum hemorrhagic infarction, as their etiology.