Uterine Leiomyomas: Safety and Efficacy of US-guided Suprapubic Transvaginal Radiofrequency Ablation at 1-year Follow-up.

Purpose To assess the safety and efficacy of ultrasonography (US)-guided suprapubic transvaginal (ST) radiofrequency ablation (RFA) in the treatment of symptomatic uterine leiomyomas at 1-year follow-up. Materials and Methods The institutional review board approved this prospective study, and all patients provided informed consent. ST RFA was performed as an outpatient procedure 3 days after menstruation in 51 women (age range, 32-52 years; mean age, 42.2 years) with 62 leiomyomas. The leiomyomas were assessed with conventional and contrast material-enhanced US before and after ST RFA for leiomyoma size, location, and blood flow. All patients were evaluated for postoperative complications, including abdominal pain, injury to surrounding tissues and organs, vaginal bleeding, increased vaginal discharge, fever, dyspnea, and menorrhagia, after ST RFA and at follow-up visits. The leiomyoma volumes, improvement in leiomyoma-related symptoms, effect on quality of life (QOL), and patient satisfaction were assessed and compared before and after ST RFA and at follow-up visits by using statistical analyses. Results Sixty-two leiomyomas were successfully treated with ST RFA until 90% of the leiomyoma was echogenic. At 1-month follow-up, 46 (74%) leiomyomas had no contrast enhancement, five (8%) had peripheral enhancement, eight (13%) had focal enhancement, and three (5%) had scattered enhancement at contrast-enhanced US. At 6-month follow-up, the number of leiomyomas that had no enhancement, peripheral enhancement, focal enhancement, or scattered enhancement was 43 (69%), seven (11%), nine (15%), and three (5%), respectively. The leiomyoma volumes were significantly (P < .05) reduced at 1-, 3-, 6-, and 12-month follow-up (from 33.0 cm(3) ± 25.1 [standard deviation] before treatment to 6.8 cm(3) ± 7.7 at 12-month follow-up). The mean percentage volume reduction at 1-, 3-, 6-, and 12-month follow-up was 28%, 57%, 63%, and 78%, respectively. The scores for symptoms and QOL were all significantly improved (P < .05) at follow-up, going from 45 ± 14 and 65 ± 41, respectively, before treatment to 0 and 100, respectively, at 12-month follow-up. No complications were reported during the periprocedural period or throughout follow-up. Most patients (41 of 45) were satisfied. Conclusion ST RFA may be an effective and safe alternative in the treatment of uterine leiomyomas. (©) RSNA, 2015 Online supplemental material is available for this article.

Sonographic measurement of renal size in patients undergoing chronic hemodialysis: Correlation with residual renal function.

Previous studies have reported that renal size may change when the function is compromised. However, it is not known whether sonographically measured renal size reflects the residual renal function (RRF) in patients undergoing chronic hemodialysis. A total of 140 patients undergoing chronic hemodialysis (≥3 months) were investigated in the present study. The patients were divided into two groups according to the daily urine volume: Individuals with RRF (RRF+ group; ≥200 ml; n=65) and without RRF (RRF- group; <200 ml; n=75). Renal sizes were measured using sonography and renal volumes were calculated with the ellipsoid formula. Univariable and multivariable stepwise forward logistic regression analyses were performed to examine the correlation between the presence of RRF and various variables. The results indicated that there were statistically significant differences (P<0.001) between the RRF+ and RRF- groups with regard to renal length, width, thickness and volume of the left (length, 7.9±1.2 vs. 6.8±1.2 cm; volume, 60.0±26.7 vs. 40.2±18.1 ml, respectively) and right (length, 7.6±1.2 vs. 6.7±1.2 cm; volume, 50.2±26.5 vs. 33.9±15.3 ml, respectively) sides of the kidney. Multivariable stepwise forward logistic regression analyses showed that the mean renal length or volume and hemodialysis duration were independent predictors of the presence of RRF. Therefore, renal size assessment by ultrasonography may be useful for RRF evaluation in patients undergoing chronic hemodialysis.

Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma.

OBJECTIVES: The purpose of this study was to describe the findings of juxtapleural pulmonary tuberculoma on contrast-enhanced sonography and investigate their correlation with histologic findings. METHODS: From April 2008 to April 2012, 21 patients with biopsy or clinically proven juxtapleural pulmonary tuberculomas underwent contrast-enhanced sonography with an intravenous bolus injection of 4.8 mL of a sulfur hexafluoride-filled microbubble contrast agent. Enhancement patterns and functional parameters (time to enhancement, time to peak enhancement, and peak signal intensity) derived from a time-intensity curve were evaluated. Enhancement patterns were correlated with their histologic findings. RESULTS: A rim enhancement pattern was presented in 12 (57.1%), a homogeneous enhancement pattern in 5 (23.8%), and a heterogeneous enhancement pattern in 4 (19.1%) of 21 tuberculomas. A pathologic study confirmed that the nonenhancing center of the rim enhancement pattern corresponded to caseous or liquefied necrosis, and homogeneously enhanced portions corresponded to granulomatous inflammation. The medians (25th-75th interquartile ranges) for the time to enhancement, time to peak enhancement, and peak signal intensity were 14 seconds (9-14 seconds), 22 seconds (21-26 seconds), and 83 dB (55-92 dB), respectively. CONCLUSIONS: Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma is feasible. Juxtapleural pulmonary tuberculomas usually show rim, homogeneous, or heterogeneous enhancement. Enhancement patterns of juxtapleural pulmonary tuberculomas are well correlated with their pathologic features.

Assessment of abnormal bowel perfusion using contrast-enhanced ultrasonography after small bowel transplantation: a case report.

A 59-year-old man with short-bowel syndrome received a small bowel transplantation. Because the recipient complained of severe abdominal pain 40 hours after the surgery and was highly suspected of having mesenteric vascular thrombosis, contrast-enhanced sonography (CEUS) was performed at his bedside. CEUS demonstrated that the superior mesenteric artery was patent, but the bowel graft showed hypoenhancement, indicating severely inadequate perfusion of the graft. Due to this complication, the patient underwent an exploratory laporatomy, and the bowel graft was removed. The pathologic findings support the diagnosis of acute vascular rejection after intestinal transplantation. This case suggests that CEUS can be used to assess perfusion and vascular complications after intestinal transplantation, as it is noninvasive and easily performed at bedside.

Sonographically guided transthoracic biopsy of peripheral lung and mediastinal lesions: role of contrast-enhanced sonography.

OBJECTIVES: The purpose of this study was to assess the impact of contrast-enhanced sonography on sonographically guided transthoracic needle biopsy of lung lesions. METHODS: A total of 121 patients underwent sonographically guided transthoracic needle cutting biopsy. Of the 121 patients, 62 (contrast-enhanced sonography group) underwent contrast-enhanced sonography before biopsy, and the information from contrast-enhanced sonography was used to optimize the biopsy procedure. The remaining 59 patients constituted the non-contrast-enhanced sonography group. The enhancement patterns and echogenicity were evaluated by the consensus of 2 sonographers. The diagnostic efficacy was compared between the contrast-enhanced and non-contrast-enhanced sonography groups. RESULTS: The enhancement intensity and extent varied greatly among different thoracic lesions, and an anechoic area (necrosis) was revealed in 26 of 62 lesions (41.9%) lesions after administration of the contrast agent. The overall diagnostic accuracy of sonographically guided transthoracic biopsy in this study was 85.9% (104 of 121). In the contrast-enhanced sonography group, the initial biopsy led to correct diagnosis in 58 of 62 lesions (93.6%). In the non-contrast-enhanced sonography group, the initial biopsy led to correct diagnosis in 46 of 59 lesions (78.0%). The difference in the diagnostic accuracy between the contrast-enhanced and non-contrast-enhanced sonography groups was statistically significant (P < .05). CONCLUSIONS: Contrast-enhanced sonography enables differentiation of viable from necrotic portions of thoracic lesions and has a positive impact on the diagnostic efficacy of sonographically guided transthoracic needle biopsy.

The nodular form of hepatic tuberculosis: contrast-enhanced ultrasonographic findings with pathologic correlation.

OBJECTIVE: The purposes of this study were to describe the ultrasonographic findings in hepatic tuberculosis (TB) after administration of a second-generation sulfur hexafluoride-filled microbubble contrast agent and to correlate these findings with pathologic characteristics. METHODS: Twenty-four hepatic TB lesions in 15 patients were studied with conventional ultrasonography (CUS) and contrast-enhanced ultrasonography (CEUS). Pathologic characteristics of the lesions were evaluated and were then correlated with enhancement patterns. RESULTS: The appearance of hepatic TB on CUS was variable and nonspecific with respect to the shape, echogenicity, and boundary of the lesions. The diameters of the lesions obtained from CEUS were statistically larger than those from CUS, with largest diameters +/- SD of 4.2 +/- 1.8 and 3.1 +/- 1.9 cm, respectively. During the arterial phase, 13 of 24 lesions (54.2%) showed a rapidly and markedly enhanced rim with a hypoenhanced or nonenhanced center; 9 of 24 lesions (37.5%) showed transient enhancement of the whole lesion with inconsistent intensities. During the portal phase, most lesions showed distinct wash-out of the contrast agent and maintained a hypoechoic appearance. Pathologic studies confirmed that the different appearances of hepatic TB on CEUS were related to the different pathologic stages of the lesions. CONCLUSIONS: Findings of hepatic TB on CEUS may be helpful in differentiating the diagnosis from other hepatic focal lesions. Correlation with pathologic findings would enrich the understanding of CEUS findings in hepatic TB.