Manual for Abdominal Ultrasoundin Cancer Screening and Health Checkups
Introduction
Abdominal ultrasonography is an essential diagnostic method for early diagnosis of refractory cancers in
the abdomen, such as cancer in the liver, biliary tract, and pancreas. Because it causes no radiation exposure
or distress and the device is simple, it is broadly used not only in general practices, but also in opportunistic
screening and reported to be useful in early detection of cancer.
However, because abdominal ultrasonography in health screening generally handles multiple organs andlesions other than cancer and descriptions of findings at detection of cancer have not been unified, it has
not been evaluated for its accuracy or efficacy as cancer screening. Furthermore, although diagnostic abilityof ultrasonography depends on the examination environment and the operator’s skill level, even theexamination method has not been definitely specified.
The Ultrasonic Screening Committee (former Ultrasonography Working Group) of the Japanese Societyof Gastrointestinal Cancer Screening took leadership in publishing the Examination Standard, aiming to
improve quality of abdominal ultrasonic screening and Abdominal Ultrasonic Cancer Screening
Standard1,2 consisting of criteria to enable accuracy evaluation as cancer screening in 2011. Thereafter,
they partially revised the standards and added some items in cooperation with the Subcommittee for
Abdominal Ultrasonic Cancer Screening Category, Terminology/Diagnostic Criteria Committee of theJapan Society of Ultrasonics in Medicine. Furthermore, they prepared a manual including assessment
criteria in cooperation with the Division of Abdominal Ultrasonography, Committee for Preparation of
Imaging Assessment Guideline, Japan Society of Ningen Dock. Therefore, the content of the present
manual is common to Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups of theJapanese Society of Gastrointestinal Cancer Screening and the Japan Society of Ultrasonics in Medicine.
By broadly popularizing these standards, we would like to aim to improve and homogenize quality of
abdominal ultrasonography procedures and unify assessment criteria for cancer to evaluate accuracy andefficacy of abdominal ultrasonic screening as cancer screening in the future.

Standard Procedure for Abdominal Ultrasound Cancer Screening
Standardization of ultrasonic screening
Target organs
Liver, biliary tract, pancreas, kidneys, spleen, and abdominal aorta● The abdominal aorta is included for detection of swelling of surrounding lymph nodes and aortic
aneurysm.
● Although the adrenal glands and lower abdomen (e.g., bladder, uterus, ovaries, and prostate) are notformally included in the target organs, findings in these organs may be recorded if detected.
● It is necessary to explain to subjects that some cases or sites may be difficult to observe in advanceand report the presence of cases or sites difficult to observe after the examination if applicable.
Diagnostic devices● Use a 3.5 to 5.5-MHz convex probe in screening.

● Use a device having as high-performance as possible.
● Devices capable of color Doppler and tissue harmonic image are desirable.
● Concurrent use of high frequency probe (e.g., 7.5 MHz linear type) or sector probe is also useful.
● Appropriate maintenance of the device should regularly be performed.
● Use of an expired device is undesirable.
● Probes and monitors are consumable.
Operators
It is desirable that the examination is conducted by a physician certified by the Japanese Society of
Gastrointestinal Cancer Screening (hepatobiliary system and pancreas), a board certified fellow of theJapan Society of Ultrasonics in Medicine, or a registered medical sonographer (gastroenterology or
medical check-up field) of the Japan Society of Ultrasonics in Medicine.
Diagnostic techniques
Pretreatment
It is desirable to take no solid food after dinner on the day before the examination.
Scanning (Fig. 1)
Define the sections to be recorded by each institution and scan according to certain criteria.
Record 16 images or more.
Exemplary sections to record are listed in Fig. 1.
No particular order of scanning is specified.
Utilize position changes (e.g., scanning in left lateral position) ad libitum.
A localized lesion must be recorded in images of 2 different directions.
Describe the maximum size and site of lesions of Category 3 or severer.
Measure foci by expanding the image sufficiently on the screen. Round off the measurements tointegers in millimeter.
Pay attention not only to localized lesions, but also to diffuse lesions.
Standard duration of scanning operation is about 6 to 7 minutes per subject.
Scanning for less than 5 minutes has no adequate accuracy.
One should be skilled to be capable of scanning within 10 minutes per examination on average.
Recording
Storing as video is desirable.
If storing as still images, it is desirable to store in electronic media in DICOM format.
Interpretation/ultrasonic diagnosis
It is desirable that reports prepared by technologists be interpreted and diagnosed by physicians
certified by the Japanese Society of Gastrointestinal Cancer Screening (hepatobiliary system andpancreas) or Ultrasonic Specialists of the Japanese Society of Ultrasonics in Medicine.

Assessment/Post-examination management

Assessment
It is desirable that assessment categories be assigned by physicians certified by the Japanese Societyof Gastrointestinal Cancer Screening (hepatobiliary system and pancreas), board certified fellow of
the Japan Society of Ultrasonics in Medicine, or certified physicians/specialists of Japan Society of
Ningen Dock.
Assessment category
As described below, assessment categories are basically assigned in compliance with the manual.
However, assessing physicians may change assessment category based on test results other thanultrasonography or comparison with the previous findings.
Examination interval
It is advisable to have annual screening even if no abnormality is present.
Selection of institutions providing thorough examination
Instruct/refer to medical institutions suitable for thorough examination items.
It is important to establish cooperative relationships with institutions providing thorough examination
so that feedback of thorough examination results can be requested.
When referring a patient, it is desirable to attach images in addition to definite description of site, size,and property of the foci.

Accuracy management
Management of basic indices in screening● Compile and manage examination rate, through examination rate by assessment category, cancer
detection rate, and other indices.
Prognosis research● It is necessary to recognize and follow up those who have thorough examination and those who do
not.
Thorough examination report and treatment recommendation, etc.
● Seek to recognize false-negative cancer cases and to identify sensitivity and specificity of thescreening.
Use of national cancer registration, recognition of results from annual screening, information frompublic health nurse, and so forth● Efforts to evaluate efficacy as cancer screening will be necessary in the future.
Decrease in mortality risk in subjects (individuals) in opportunistic screening
Decrease in mortality rate in the target population in population-based screening
Education of technologist
Active efforts to improve skill of ultrasonographers qualified by the Japan Society of Ultrasonics in
Medicine is necessary, such as supports to obtain qualification as ultrasonographers and holding

seminars and training programs for ultrasonographers.
References
１)

Journal of Gastrointestinal Cancer Screening. 2011；49： 667-685.

２)

Tanaka S, Okaniwa S, Kumada T, Nakajima M, Hirai T. Outline of the guideline forabdominal ultrasound cancer screening. Jpn.Jpn. J Med Ultrasonics 2013; 40: 549565

Fig. 1. Exemplary sections recorded

1) Epigastric sagittal scan: Liver/aorta

9) Right intercostal scan: Liver

2) Epigastric horizontal scan to right subcostal10) Right intercostal scan: Liverscan: Hepatic vein
3) Right Epigastric oblique scan: Horizontal

11) Right intercostal scan: Right kidney

portal vein
4) Right Subcostal scan: Gallbladder12) Epigastric vertical scan: Extrahepatic bile
duct/pancreas5) Right hypochondrium vertical scan:13) Epigastric horizontal scan: Pancreas

Gallbladder
6) Right hypochondrium vertical to oblique

14) Epigastric oblique scan: Pancreas

scan: Extrahepatic bile duct
7) Right subcostal scan: Liver

15) Left intercostal scan: Pancreas8) Right intercostal scan: Liver

16) Left intercostal scan: Left kidney

Categorized Criteria for Abdominal Ultrasound Cancer Screening
Ultrasonic imaging findings
Operators should consider in detail to which ultrasonic imaging finding item in the Manual theabnormal findings noted in observations of the liver, biliary tract, pancreas, kidneys, spleen, and othertarget organs correspond and select applicable items. Although observation of organs other than thetarget organs is not essential, findings suspected to be malignant or considered to be needing treatment
in such organs may be described if present. If an organ cannot be imaged at all, it will be assessed as
No image obtained. If an organ cannot be imaged partially, adopt findings from the imageable sites anddescribe the sites that cannot be imaged.

Categories (Tables 1-1, 1-2)
Category for cancer, ultrasonography findings (described in Report Form), and assessment are
determined in accordance with ultrasonic imaging findings selected.
Categories are criteria of cancer assessment and also summaries of findings noted in ultrasonography.
For each organ, the highest category noted is described as the category for the organ.
For a lesion that can be compared with the previous image, describe comments on chronologicalchanges.
If a lesion has findings corresponding to Category 3 or higher in ultrasonic images but has been
considered to be benign as a result of thorough examination, the Category in question is indicated withdash mark [e.g., 3' or 4'] and Assessment C is selected.

Ultrasonography findings (described in Report Form)
It consists of simplified terms for notification of description of ultrasonic imaging findings to subjects.
Ultrasonography finding terms are described in the Report Form. Categories 4 and 5 are described as“Tumor” and Category 3 localized lesion as “Mass,” including suspected ones.

Assessments (Table 1-3) (Table 2)
Assessment is determined principally based on abnormal findings in ultrasonic images, and physiciansin charge of assessment finally select the assessment taking into consideration laboratory results otherthan ultrasonography, such as blood tests and comparison with previous findings.
(Examples)* A Category 3 lesion may be assessed as C if it has no chronological change compared with at least
the past 2 results.
* Assessment D may be selected as necessary if the size of the localized lesion or lumen diameter
definitely increases compared to the previous result.
* Assessment D may be selected for a localized lesion in the liver as necessary if chronic hepatic diseaseis suspected such as infection with HBV or HCV or presence of thrombocytopenia (<15 x 104/mm3).
* Assessment D2 may be selected if the biliary tract is poorly imaged with abnormal biliary tract
enzyme.
* Assessment C may be selected if the case has undergone thorough examination in other medical
institutions and been followed up by the institution.

Table 1-1 Category
Category 0

Unassessable

Assessment is impossible due to device malfunction or
subject or operator factors.

Category 1

NormalNo abnormal findings. Normal variation included.

Category 2

BenignDefinite benign lesion.

Category 3

Difficult to assess

Lesions difficult to assess for benign/malignant or

malignancy

indirect findings indicating possible malignant lesion.
Including high-risk group.

Category 4

Possibly malignant

Lesion likely to be malignant.

Category 5

MalignantDefinite malignant lesion

Table 1-2 Category Table
Organ

Category

Site with no image
obtainedLiver

0/1/2/3/4/5

Present□

Biliary tract

0/1/2/3/4/5

Present□

Pancreas

0/1/2/3/4/5

Present□

Kidneys

0/1/2/3/4/5

Present□

Spleen0/1/2/3/4/5

Present□

OthersShaded cells are filled only if applicable findings are present.

Table 1-3 Assessment
A

NormalB

Mild abnormality

C

Following-up/reexamination/lifestyle instruction needed

D (Medical care

D1

Treatment neededneeded)D2

Thorough examination needed

E

Under treatment

Table 2-1 Liver
Ultrasonic imaging findings
Solid lesion
Maximum diameter ≥15 mm
With category 3 diffuse lesion in the
background liver

Category

Ultrasonography findings(described in Report Form)

Assessment

3

Liver mass

C

4

Liver tumor

D2

4

Liver tumor

D2

4

Liver tumor

D2

Any one of peripheral hypoechoic
zone, posterior echo enhancement, or
multiple
Peripheral bile duct dilation

Fig. 2

4

Liver tumor

D2

Mosaic patternFig. 3

5

Liver tumor

D1

Cluster sign

Fig. 4

5

Liver tumor

D15

Liver tumor

D1

2

Liver hemangioma

C

2

Liver cyst

B

4

Cystic tumor of liver

D2

2Intrahepatic calcification

B

With blockade of either intrahepatic
bile duct or blood vessel

Fig. 5* Only if any one of marginal strong
echo, chameleon sign, or wax andwane sign is present

Figs. 6, 7

Cystic lesion
With solid portion (e.g., intracystic
nodules, wall thickening, or septal
thickening)

Figs. 8, 9

Calcification image (including air
image)

Note 1)

Fig. 10

With intrahepatic bile duct dilation

3

Intrahepatic bile duct stone oremphysema

D2

Diffuse lesion
Any one of bright liver, liver-kidney
contrast, vascular blurring, or deep

2

Fatty liverC

3

Chronic hepatic disorder

D2

Intrahepatic bile duct dilation

3

Intrahepatic bile duct dilation

D2

Abnormal blood vessel

2

Abnormal hepatic blood vessel

D2

No abnormal findings

1

No image obtained0

attenuation is present.
Note 2)

Figs. 11-13

Dull liver edge, rough parenchymal
echo pattern, and nodular rugged
surface are present
Figs. 14, 15Note 1)A
No image obtainedD2

● Calcification image refers to hyperechoic spot with acoustic shadow.
● Confirm that it is not a part of solid mass with calcification such as metastatic liver cancer.
● If the lesions are multiple, focus on their locations and liver parenchyma echo pattern, with lesions
derived from parasites such as Schistosoma japonicum and Echinococcus in mind.
Note 2) If it is irregular hypoechoic region in frequent site of focally spared area in fatty liver without
disturbed speckle pattern and color Doppler detects no deviation in blood flow, it is not considered as solid
lesion (Fig. Liver-1).

Fig. Liver-1
Frequent site of focally spared area in fatty liver① Around the gallbladder: Cystic vein reflux region② Dorsal S4 and S2: Ectopic reflux region by right gastric vein③

Frontal S4 immediately below the liver surface: Sappey’s venous reflux region

Fig. Liver-2 Solid lesion with peripheral bile duct

Fig. Liver-3 Mosaic pattern, marginal hypoechoic

dilation (Category 4)

zone, and enhanced posterior echo (Category 5)

Fig. Liver-4 Cluster sign (Category 5)

Fig. Liver-5 Solid lesion in the portal vein (Category 5)

Fig. Liver-6 Marginal strong echo (Category 2)

Fig. Liver-7 Wax and wane sign (Category 2)

Fig. Liver-8 Cyst with nodules (Category 4)

Fig. Liver-9 Cyst with septal thickening (Category 4)

Fig. Liver-10 Calcification picture (Category 2)

Fig. Liver-11 Bright liver, liver-kidney contrast(Category 2)

Fig. Liver-12 Mild fatty liver (mild bright liver with liver-kidney contrast, without attenuationor unclear vessels) (Category 2)

Fig. Liver-13 Severe fatty liver (Severe bright liver, with liver-kidney contrast, deep attenuationand vascular blurring) (Category 2)

Fig. Liver-14 Rough speckle pattern of liverFig. Liver-15 Irregularity on the surface of the liver

parenchyma(Category 3)(Images provided by Takashi Kumada for #2-10 #12-15 and by Yasuji Arase for #11)

Table 2-2 Gallbladder/extrahepatic bile duct
Ultrasonic imaging findings

Category

Ultrasonography findings(described in Report Form)

Assessment

Gallbladder
Protrusion or polypoid lesion
Pedunculated
<5 mm

2

Gallbladder polypB≥5 mm, <10 mm

3

Gallbladder mass

C

2

Gallbladder polypB≥10 mm4

Gallbladder tumor

D2

Sessile4

Gallbladder tumor

D2

2

Gallbladder adenomyoma

C

5

Gallbladder tumor

D1

If hyperechoic spot or mulberry-likeecho is present

Fig. 1

If small cystic structure or comet-likeecho is present

Fig. 2

With irregularity or tear of the layered
structure of the attached wall
Wall thickening

Fig. 3Note 1)

Diffuse thickening (wall thickness ≥4 mm,
in the liver bed side of gallbladder wall on

3

the body)

Diffuse gallbladder wall
thickening

D2

If any one of layered structure, small
cystic structure, or comet-like echo ispresent2

Gallbladder adenomyoma

C

4

Gallbladder tumor

D2

4

Gallbladder tumor

D2

2

Gallbladder adenomyoma

C

3

Gallbladder enlargement

D2

2

Gallbladder enlargement

C

Fig. 4

With irregularity or tear of the layered
structure of the wall
Localized thickening (inner hypo echoic
layer in a part of the wall)Fig. 5

If small cystic structure or comet likeecho is present.
Swelling (minor axis ≥36 mm)
Without abnormal findings in the distalbile duct up to the near-papillary region
Stone image (including calcification andemphysema)
Wall cannot be evaluated2
3

Debris (describe separately from stone

Cholecystolithiasis or
gallbladder emphysema
Cholecystolithiasis with poor
evaluation of gallbladder wall

C
D2

3

Biliary sludge

D2

No abnormal finding

1

Normal gallbladderA

No image obtained0

Gallbladder cannot be imaged

D2

image)

Fig. 6

Post-cholecystectomy0

Post-cholecystectomy

B

4Bile duct tumor

D2

5

Bile duct tumor

D1

3

Bile duct wall thickening

D2

4

Bile duct tumor

D2

5

Bile duct tumor

D1

3

Bile duct dilation

D2

2

Bile duct dilation

C

Extrahepatic bile duct
Protrusion or polypoid lesion

Fig. 7

With irregularity or tear of the layered
structure

Fig. 8Wall thickening (wall thickness ≥3 mm or
localized internal hypoechoic layer)
Irregular mucosal surface

Fig. 9Fig. 10

Irregular layered structure
Bile duct dilation (≥8 mm, or ≥11 mm aftercholecystectomy)
Without abnormal findings in the distal bile
duct up to the near-papillary region
Stone image (including calcification oremphysema)If history of biliary system operation ispresent and it moves by position change
DebrisFig. 11No abnormal finding
No image obtained

Note 2)2

Bile duct stone or bile ductemphysema

D2

2

Bile duct emphysema

B

3

Biliary sludge

D2

1

NormalA

0

No image obtained

C

Note 1) Pay attention to coexisting protruded lesions in case with the wall thickening with small cystic structure
or comet-like echo.
Note 2) Select D2 in assessment if abnormal findings are present in the gallbladder or intrahepatic bile duct.

Gallbladder/extrahepatic bile duct images

Fig. Gallbladder-1 A pedunculated polyp sized 5 to 9

Fig. Gallbladder-2 A sessile polyp with small cystic

mm with hyperechoic spot (Category 2)

structure (Category 2)

Fig. Gallbladder-3 A sessile polyp with irregularFig. Gallbladder-4 Diffuse thickening with regularlayered structure of the attached wall (Category 5)

layered structure (Category 2)

Fig. Gallbladder-5 Localized wall thickening

Fig. Gallbladder-6 Debris in the gallbladder(Category 4)(Category 3)

Fig. Gallbladder-7 Polypoid lesions in theFig. Gallbladder-8 Mass image in the extrahepatic bile

extrahepatic bile duct (Category 4)

duct with irregular layered structure in the holdfast(Category 5)

Fig. Gallbladder-9 Diffuse wall thickening of theFig. Gallbladder-10 Localized wall thickening of theextrahepatic bile duct with smooth mucosal surface

extrahepatic bile duct with irregular mucosal surface(Category 3)(Category 4)

Fig. Gallbladder-11 Debris in the extrahepatic bile duct (Category 3)(Images provided by Shinji Okaniwa)

Table 2-3. Pancreas
Ultrasonic imaging findings
Solid lesion

Category

Ultrasonography findings(described in Report Form)

Assessment

Note 1)Hyperechoic mass image
Hypo (iso) image

Fig. 2
Fig. 32

Pancreatic massC

4

Pancreatic tumor

D25

Pancreatic tumor

D1

2

Pancreatic cyst

B3

Pancreatic cyst

D2

4

Pancreatic cystic tumor

D2

2

Pancreatic stoneC

3

Pancreatic duct dilatation

D2

With blocking in any of the main pancreaticduct, extrahepatic bile duct, or peripancreatic
blood vessels

Fig. 4

Cystic lesion
Diameter ≥5 mm

Figs. 5, 6

With solid portion (e.g., intracystic nodule,
wall thickening, or septal thickening) Figs. 7-9
Calcification

Fig. 10Main pancreatic duct dilation (≥3 mm in thepancreatic body)

Note 2)

Figs. 11, 12

Nodule in the main pancreatic duct

Fig. 134

Pancreatic tumor

D2

Downstream stenosis

Fig. 144

Pancreatic tumor

D2

Maximum minor axis ≥ 30 mm

2

Pancreatic enlargement

D2

Maximum minor axis <10 mm

2

Pancreatic atrophy

D2

2

DeformationB

4

Pancreatic tumor

D2

No abnormal finding

1

NormalA

No image obtained0

No image obtained

D2

Morphological abnormality (swelling or
atrophy)

Localized swelling

Note 3)The swollen region has any of decreasing echo
level, irregular echo pattern, or unclear internal
structure such as main pancreatic duct.
Fig. 15

Note 1) Mixed pattern mass lesion may be classified into either solid or cystic lesion.
Note 2) Measuring between the upper edge of the anterior line and the posterior line of the main pancreatic ductin magnified image (Fig. Pancreas-1)
Note 3) “localized swelling” means locally increased thickness with smooth surface contour.

Fig. Pancreas-1
Measurement of lumen diameter (round off
the measurements to integers in mm)
Enlarge the image

Pancreas images

Fig. Pancreas-2 Hyperechoic mass image (Category

Fig. Pancreas-3 Hypoechoic mass image (Category 4)

Fig. Pancreas-4 Hypoechoic mass image with

Fig. Pancreas-5 Cystic lesion or diameter ≥5 mm

obstraction of the main pancreatic duct (Category 5)(Category 3)

Fig. Pancreas-6 Cystic lesion of diameter ≥5 mm

Fig. Pancreas-7 Cystic lesion with septal thickening

without septal thickening (Category 3)(Category 4)

Fig. Pancreas-8 Cystic lesion with intracystic nodules

Fig. Pancreas-9 Cystic lesion with solid portionand septal thickening (Category 4)(Category 4)

Fig. Pancreas-10 Calcification (Category 2)

Fig. Pancreas-11 Calcification with main pancreatic
duct dilation (Category 3)

Fig. Pancreas-12 Main pancreatic duct dilation

Fig. Pancreas-13 Main pancreatic duct dilation with

(Category 3)

nodules in the main pancreatic duct (Category 4)

Fig. Pancreas-14 Main pancreatic duct dilation with

Fig. Pancreas-15 Localized swelling with decreasing

downstream stenosis (Category 4)

echo level and unclear internal structure (Category 4)(Images provided by Sachiko Tanaka for #2-5, #9-15 and by Shinji Okaniwa for #6-8)

Table 2-4 Kidneys
findings(Images provided by Yukiko Tanaka forUltrasonography#2-5 and #9-15 andShinji Okaniwa for # 6-8)
Ultrasonic imaging findings
Category
Assessment(described in Report Form)
Solid lesion
Round shaped mass image with smooth
contourFig. 1

3

Renal mass

D2

4

Renal tumor

D2

4

Renal tumor

D2

4

Renal tumor

D2

5

Renal tumor

D1

5

Renal tumor

D1

2

Renal angiomyolipoma

C

2

Renal cyst

B

3

Polycystic kidney diseaseC

3

Renal cystic tumor

C

4

Renal cystic tumor

D2With any one of internal anechoic region,
peripheral hypoechoic zone, or lateralshadow.
With dissociation or deformation of central
echo complex
Fig. 2Round shaped mass image with smooth
contour and internal anechoic region
Fig. 3
Internal anechoic region is present witheither of peripheral hypoechoic zone orlateral shadow
If it has brightness equal to or higher thanthat of the central echo complex withirregular contour or comet picture.
Fig. 4
Cystic lesion
Multiple cysts are aggregated bilaterallywith unclear renal parenchyma
Septum without thickening or calcification
pictureWith solid portion (e.g., intracystic nodules,
wall thickening, or septal thickening) are
noted
Figs. 5, 6
Calcification

2

Diameter ≥10 mm

2Pelvic dilatation (unknown cause of
occlusion)
Mild dilatation (without caliectasis)
Dilated region or occluded region withcalcification

Fig. 73

Nephrocalcinosis or renal
stone
Nephrocalcinosis or renal
stone
Pelvic dilatation,hydronephrosis

B
C
D2

2

Pelvic dilatation

B

2

Renal stonestoneD2

Occluded with solid mass

Fig. 84

Renal tumor

D2

2

Kidney deformity

B

3

Renal mass

D2

Bilateral maximum diameter ≥12 cm

3

Kidney enlargement

D2

Bilateral maximum diameter <8 cm

2

Renal atrophy

D2

1

NormalA

No image obtained0

No image obtained

D2

Post-nephrectomy0

Post-nephrectomy

B

Morphological defect (e.g., different size
between the bilateral kidneys andmalformation)
Nodular rugged surface or deformation ofcentral echo complex

No abnormal finding

Fig. 9Note 1)

Note 1) Nodular deformation of renal contour or localized bulge into the central echo complex with isoechoic leveland echo pattern similar to that of renal cortex is assessed as Category 1 (normal variant). It is desirable toconfirm vascular construction similar to that of normal renal parenchyma in color Doppler (Figs. Kidney10 and -11)

Renal Images

Fig. Kidney-1 Round shaped solid mass image with

Fig. Kidney-2 Solid lesion with central echo

clear and smooth contour (Category 4)

complex dissociation or deformation (Category 4)

Fig. Kidney-3 Clear and smooth contour solid mass

Fig. Kidney-4 Solid mass image with irregularimage with marginal hypoechoic zone and internal

contour brighter than the central echo complex

anechoic region (Category 5)(C2)

Fig. Kidney-5 Cyst with septal thickening(Category 4)

Fig. Kidney-6 Cyst with solid portion (Category 4)

Fig. Kidney-7 Pelvic dilatation with calcification
picture in the occluded region (Category 2)

Fig. Kidney-8 Pelvic dilatation with solid lesion in
the occluded region (Category 4)

Fig. Kidney-9 Deformation of central echo complex(Category 3)

Fig. Kidney-10 Localized bulge into central echo
complex with isoechoic level and echo patternsimilar to that of renal cortex (Category 1)

Fig. Kidney-11 Localized bulge with vascular construction similar to that of normal renal parenchyma withcolor Doppler image(Category 1)(Images provided by Toshiko Hirai)

Table 2-5 Spleen/abdominal aorta/others
Ultrasonic imaging findings

Category

Ultrasonography findings(described in Report Form)

Assessment

SpleenSolid lesion
Hyperechoic mass image
Fig. 2Hypoechoic mass image
Figs. 3, 4
Mass image with hyperechoic portion in thecentral area
Fig. 5Mass image with mixture of hyperechoic portionand hypoechoic portion Fig. 6
Cystic lesion
With solid portion (e.g., intracystic nodule, wall
thickening, or septal thickening) Fig. 7
Calcification
Abnormal vessel in the splenic hilum

2

Swelling
Note 1)
Maximum diameter ≥10 cm, < 15 cm
Maximum diameter ≥15 cm
Solid lesion in the splenic hilum
Round shape mass with homogeneous internal
echo at echo level equal to that of the spleen
No abnormal finding
No image obtained
Note 2)
Post-splenectomy
Abdominal aorta
Localized aortic dilation
Maximum diameter ≥3 cm, <5 cm
Maximum diameter ≥5 cm
Fig. 8OthersLymph node swelling (minor axis ≥7 mm) Fig. 9
Either minor axis ≥10 mm or minor/major axis
ratio ≥0.5
Fig. 10
AscitesWith solid mass image
Pleural effusion
With solid mass image
Fluid retention in the cardiac cavity
Mass image in the abdominal cavity,
retroperitoneum, or pelvic cavity

3
4

Splenic mass
Splenic tumor

D2
D2

5

Splenic tumor

D1

4

Splenic tumor

D2

2

Splenic cyst

B

4

Splenic cystic tumor

D2

2

Calcification
Abnormal vessel in the
splenic hilum

B

2
3
3

Splenomegaly
Splenomegaly
Mass in the splenic hilum

B
D2
D2

2

Accessory spleen

B

1
0
0

NormalNo image obtained
Post-splenectomy

A
B
B

2
2

Abdominal aortic aneurysm
Abdominal aortic aneurysm

C
D2

3

Lymph node swellingC

4

Lymph node swelling

D2

3
4
3
4
2

Ascites
Ascites
Pleural effusion
Pleural effusion
Pericardial fluid

D2
D2
D2
D2
D2

4

Abdominal tumor

D2

Note 1) Measurement of maximum diameter of spleen (Fig. Spleen/others-1)

Note 2) Confirm presence of history of splenectomy

D2

Images of spleen, abdominal aorta, or others

Fig. Spleen/others-2 Hyperechoic mass image (Category 3)

Fig. Spleen/others-4 Hypoechoic mass image (Category 4)

Fig. Spleen/others-3 Hypoechoic mass image(Category 4)

Fig. Spleen/others-5 Hypoechoic mass image
with hyperechoic portion in the central area (Category 5)

Fig. Spleen/others -6 Mass image with mixture of hyperechoic

Fig. Spleen/others-7 Cystic lesion with solid portion

portion and hypoechoic portion(Category 4)(Category 4)

Fig. Spleen/others-8 Abdominal aortic aneurysm(Category 2)

Fig. Spleen/others-9 Lymph node swellingFig. Spleen/others-10 Lymph node swellingwith minor axis ≥7 to 9 mm (Category 3)

with minor axis ≥10 mm (Category 4)(Images provided by Michiko Nakajima for #2, 3 and 6, Toshiko Hirai for #4, 5, 7, and 8, and Yasujiji Arase for # 9
and 10)Japan Society of Ningen Dock
Medical checkup examination judgment guidelines making committee Abdominal ultrasound department
Chief Commissioner :Sachiko Tanaka (Osaka Center for Cancer and Cardiovascular Disease Prevention)
Members :Tomofumi Atarashi (Division of Gastroenterology, JA Hokkaido Obihiro Kosei Hospital)
Yasuji Arase (Toranomon Hospital Health Management Center and Diagnostic Imaging Center)
Shinji Okaniwa (Division of Gastroenterology, Iida Municipal Hospital)
Kiyoshi Okamura (Sapporo Tokushukai Hospital)
Yoshihiro Mizuma (Division of Gastroenterology, Kobe Adventist Hospital)
Shuichi Mihara (Mihara Life Care Clinic)
External Evaluation Committee:
Hiroaki Jinguji (Tokyo Health Service Association)

Japanese Society of Gastrointestinal Cancer Screening
Working group for the preparation of ultrasound screening committee abdominal ultrasound screening
guidelines
Chairman: Sachiko Tanaka (Osaka Center for Cancer and Cardiovascular Disease Prevention)
Members : Shinji Okaniwa (Division of Gastroenterology, Iida Municipal Hospital)
Suguru Kumada (Division of Gastroenterology, Ogaki Municipal Hospital)
Masahisa Kojima (Health Examination Center Urasoe General Hospital)
Michiko Nakajima (Department of General Intarenal Medicine, Saitama Medical University)
Toshiko Hirai (Department of endoscopy and ultrasound, Nara medical university)
Yoshihiro Mizuma (Division of Gastroenterology, Kobe Adventist Hospital)
Yoshioki Yoda (Yamanashi Koseiren Health Care Center)
Masahiro Ogawa (Division of Gastroenterology and Hepatology, Department of Medicine,
Nihon University School of Medicine)
Hiroyoshi Onodera (Department of Gastroenterology, Miyagi Cancer Center)
Shigehiko Nishimura (Department of Surgery, Sumitomo Hospital)

Japan Society of Ultrasonics in Medicine
Subcommittee on Category Judgment of Term Diagnosis Criteria Committee Abdominal UltrasoundCancer Screening
Chairman:Takashi Kumada (Department of Gastroenterology, Ogaki Municipal Hospital)

Members :Shinji Okaniwa (Division of Gastroenterology, Iida Municipal Hospital)
Masahiro Ogawa (Division of Gastroenterology and Hepatology, Department of Medicine,
Nihon University School of Medicine)
Masahisa Kojima (Health Examination Center Urasoe General Hospital)
Michiko Nakajima (Department of General Intarenal Medicine, Saitama Medical University)
Shigehiko Nishimura (Department of Surgery, Sumitomo Hospital)
Senju Hashimoto (Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health
University)
Toshiko Hirai (Department of endoscopy and ultrasound, Nara medical university)
Yoshihiro Mizuma (Division of Gastroenterology, Kobe Adventist Hospital)
Shuichi Mihara (Mihara Life Care Clinic)
Apiril, 2014