Treated needles: do they facilitate sonographically guided biopsies?

OBJECTIVE: We sought to compare needle visualization and diagnostic yield rates resulting from the use of several commercially available treated needles in sonographically guided biopsies. METHODS: We conducted a randomized prospective study in which 61 patients (42 women and 19 men; mean age, 57 years; range, 19-84 years) were assigned to undergo biopsies (37 thyroid and 24 liver, 2 passes per patient) with 1 of 4 different 22-gauge needles: Teflon coated, etched tip, echogenic polymer coated, and untreated. Two blinded radiologists independently scored needle shaft and tip visualization from 0 (no visualization) to 4 (excellent visualization). After blinded cytologic evaluation, the individual passes were rated as adequate or inadequate for establishing a tissue diagnosis. RESULTS: The echogenic polymer-coated needle had the highest mean score +/- SD for visualization of both the shaft (3.4 +/- 0.90) and tip (3.5 +/- 0.87) compared with the untreated (shaft, 2.2 +/- 0.77; P = 0.003; tip, 2.8 +/- 0.92; P = 0.01), Teflon-coated (shaft, 2.7 +/- 0.94; tip, 3.1 +/- 0.75), and etched tip (shaft, 3.0 +/- 0.82; tip, 3.0 +/- 0.56) needles. Diagnostic yield rates for the 4 different needle types were 75.0% for the echogenic polymer-coated, 64.7% for the Teflon-coated, 56.3% for the etched tip, and 75.0% for the untreated needles (no significant difference). CONCLUSIONS: The echogenic polymer-coated needle was the best visualized of all needles evaluated, both treated and untreated. No significant difference was found in diagnostic yield rates, but that may be reflective of the relatively small sample size.

Randomized prospective study comparing routine versus selective use of sonography of the complete calf in patients with suspected deep venous thrombosis.

OBJECTIVE: We compared patient outcomes using two protocols: one routinely and the other selectively evaluating the calves completely during sonographic assessment of the lower extremities in patients with suspected deep venous thrombosis. SUBJECTS AND METHODS: In this randomized prospective study, patients were assigned to two groups. In one group, the deep calf veins were routinely evaluated in their entirety, and in the other group the calf was not evaluated unless the patient had symptoms or physical signs in the calf, in which case only the areas of symptoms or physical signs were evaluated. Patients were followed up for 3 months by medical record review, physician surveys, and telephone calls. An adverse outcome was a propagated deep venous thrombosis into the thigh or a pulmonary embolus. Examination times were recorded when possible. RESULTS: Of the 235 patients in the group in which the deep calf veins were routinely evaluated, we saw no adverse outcomes (0.0%; 97.5% one-sided confidence interval [CI], 0.6-1.6%). Of the 261 patients in the group in which the calf was only evaluated if there were signs or symptoms, we saw two adverse outcomes (0.8%; 95% CI, 0.1-2.7%). CONCLUSION: We found no significant difference in adverse outcomes in patients undergoing a protocol in which the deep calf veins were routinely evaluated or a protocol in which the calf was evaluated only if physical signs or symptoms were present.

CT in detecting urinary tract calculi: influence on patient imaging and clinical outcomes.

PURPOSE: To determine changes in examination patterns and effectiveness of care since the introduction of unenhanced helical computed tomography (CT) for examination of patients presenting to the emergency department (ED) with symptoms of urinary tract calculi (UTC). MATERIALS AND METHODS: Hospital clinical and radiology information systems were used to retrospectively identify patients presenting with UTC symptoms from January to December 1997 (before introduction of unenhanced CT) and from January to December 1999 (after introduction of unenhanced CT). Chart abstraction was used to confirm the identification of patients with presenting symptoms suggestive of UTC and assess patient outcomes. Two hundred sixty-five patients presented before (1997) and 602 after (1999) unenhanced CT was introduced. Distributions of dichotomous variables were compared between the 1997 and 1999 groups by using logistic regression. Means were compared between the groups by using analysis of variance and mean total numbers of imaging studies by using Poisson regression. RESULTS: Total number of imaging studies increased by 26.7% per patient visit (P <.001). Rates of admission following the initial ED visit (13.7% in 1997 vs 13.4% in 1999), as well as percentage of patients who subsequently returned to the ED (12.0% in 1997 vs 13.7% in 1999) or subsequently were admitted to the hospital (4.5% in 1997 vs 5.3% in 1999) in the month following the initial ED visit, were similar between the two groups. Unsuspected unenhanced CT findings that could affect acute patient care were observed at 5.9% of examinations. CONCLUSION: Use of imaging for suspected UTC has increased markedly since the introduction of unenhanced CT, with little effect on acute care of patients in the ED.

Risk of significant coronary artery disease as determined by CT measurement of the distribution of abdominal adipose tissue.

PURPOSE: The purpose of this work was to determine if CT measurement of the distribution of abdominal adipose tissue is reproducible between observers and is associated with patient risk of significant coronary artery disease. METHOD: We compared 11 male patients having abdominal CT who had a history of significant coronary artery disease and 9 male patients having abdominal CT without a history of coronary artery disease. Two observers, at the level of the umbilicus, independently measured the ratio of visceral adipose tissue (VAT) to total abdominal adipose tissue (TAT). VAT is equal to the sum total of intraperitoneal and retroperitoneal adipose tissue. TAT equals the sum total of visceral and subcutaneous adipose tissue. Measurements were made using a standard software package. RESULTS: The mean ratio of VAT to TAT was significantly different (p < 0.05) between patients with a history of coronary artery disease (mean = 0.51, SD = 0.10, range = 0.38-0.69) and without a history of coronary artery disease (mean = 0.40, SD = 0.12, range = 0.23-0.51). Agreement in measurements between observers was excellent (mean difference = 0.01, range = 0.00-0.03, intraclass correlation = 0.99). CONCLUSION: The measurement of the VAT/TAT ratio is highly reproducible between observers, and a high ratio is associated with patient risk of significant coronary artery disease.

Detection and diagnosis of nonpalpable supraclavicular lymph nodes in lung cancer at CT and US.

PURPOSE: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes by using chest computed tomography (CT) and supraclavicular ultrasonography (US) in patients at initial diagnosis of lung cancer. MATERIALS AND METHODS: Fifty-five patients with no prior malignancy who presented with suspected and subsequently proven lung cancer of any stage or a proven but potentially resectable lung cancer were prospectively selected after chest CT. Chest CT and other radiologic findings were reviewed and tabulated. Standardized US technique was used to identify and guide needle biopsy of enlarged supraclavicular lymph nodes (> or =0.5 cm short axis). RESULTS: Twenty-two (40%) of 55 patients had supraclavicular abnormalities detected at CT and/or US. In 18 (82%) of the 22 patients, supraclavicular abnormalities were recognizable at CT. Seventeen of 22 patients had malignant nodes, and five patients had benign nodes (n = 3), a cyst (n = 1), or an indeterminate lesion (n = 1) at US-guided supraclavicular needle sampling. There were no complications. Supraclavicular metastases (31% of patients) were about as common as the combined number of patients with indeterminate (n = 13) and probably or proven malignant (n = 6) adrenal nodules (35% of patients). Supraclavicular metastases were often associated with mediastinal adenopathy or suspected extrapulmonary nonnodal metastases (P <.05). CONCLUSION: In many patients with lung cancer, chest CT that includes the neck base followed by US-guided sampling of enlarged supraclavicular lymph nodes is a simple and safe method for simultaneously establishing a tissue diagnosis and tumor nonresectability.