bluuebunny/crossref_metadata_2025 huggingface dataset:
Types of neurovascular symptoms and carotid plaque ultrasonic textural characteristics.
Authors: Tegos T J , Mavrophoros D , Sabetai M M , Elatrozy T S , Dhanjil S , Karapataki M , Witt N , Nicolaides A N
Published: January 2017

The aim of this study was to identify the echo morphology and stenosis of carotid plaques that corresponded to ipsilateral asymptomatic status, amaurosis fugax, hemispheric transient ischemic attack, and stroke. One hundred ninety‐two plaques (150 patients), producing stenosis in the range of 50% to 99% and associated with various neurovascular manifestations, were studied. These plaques were imaged on duplex scans, and a series of textural features was produced in a computer to distinguish quantitatively their various echo patterns. Amaurosis fugax corresponded to dark, severely stenosed atheromas (90%); hemispheric transient ischemic attack and stroke corresponded to plaques with intermediate echoic characteristics and intermediate stenosis (80%); and asymptomatic status corresponded to bright, moderately stenosed plaques (70%; P < .05). The significance of these findings is discussed.
Duplex criteria for determination of 50% or greater carotid stenosis.
Authors: Neschis D G , Lexa F J , Davis J T , Carpenter J P
Published: January 2017

Recently the North American Symptomatic Carotid Endarterectomy Trial investigators reported a benefit of carotid endarterectomy compared with medical therapy for symptomatic patients with 50% or greater carotid stenosis. This has necessitated the development of screening parameters for diagnosis of 50% or greater carotid stenosis on the basis of the reference standards used in the study by the North American Symptomatic Carotid Endarterectomy Trial. The duplex scans and arteriograms of 110 patients (210 carotid arteries) were reviewed by blinded readers. Duplex measurements of peak systolic velocity and end diastolic velocity were recorded, and the ratio of these velocities in the internal and common carotid arteries was calculated. The criteria determined for detection of 50% or greater stenosis were as follows: peak systolic velocity of the internal carotid artery greater than 170 cm/s (sensitivity, 92%; specificity, 90%; positive predictive value, 92%; negative predictive value, 90%; and accuracy, 91 %); end diastolic velocity of the internal carotid artery greater than 60 cm/s (sensitivity, 92%; specificity, 86%; positive predictive value, 95%; negative predictive value, 79%; and accuracy, 91 %); ratio of peak systolic velocity of the internal carotid artery to peak systolic velocity of the common carotid artery greater than 2 (sensitivity, 93%; specificity, 75%; positive predictive value, 83%; negative predictive value, 89%; and accuracy, 85%); and ratio of end diastolic velocity of the internal carotid artery to end diastolic velocity of the common carotid artery greater than 2.4 (sensitivity, 96%; specificity, 79%; positive predictive value, 88%; negative predictive value, 92%; and accuracy, 89%). It is concluded that 50% or greater carotid artery stenosis can be reliably determined by duplex criteria. The use of receiver operating characteristic curves allows the individualization of duplex criteria to the clinical situation.
Ultrasonographic appearance of colon taeniasis.
Authors: Fabijanić D , Giunio L , Ivaniš N , Fabijanić A , Mirić D , Kardum D
Published: January 2017

We present the case of a 50‐year‐old woman with abdominal pain, nausea, loss of appetite, and frequent stools in whom the routine ultrasonographic examination demonstrated a double‐reflective, ribbon‐like structure in the lumen of the initial segment of the ascending colon, which suggested colon taeniasis. Because the initial parasitologic analysis yielded negative results and application of albendazol did not have any therapeutic effect, the diagnosis was confirmed by barium enema and subsequently by parasitologic examination of proglottids passed in the stool after application of niclosamide. The double‐reflective, ribbon‐like structure in the lumen of the intestine seems to be specific to the ultrasonographic appearance of intestinal taeniasis. Transcutaneous ultrasonography of the gastrointestinal tract, performed as a screening method before conventional radiologic or endoscopic examination, can point to the ultimate diagnosis of colon taeniasis.
Patterns of fluid accumulation on screening ultrasonography for blunt abdominal trauma: comparison with site of injury.
Authors: Sirlin C B , Casola G , Brown M A , Patel N , Bendavid E J , Hoyt D B
Published: January 2017

The objectives of this study were to define where fluid accumulation is shown on screening ultrasonography after blunt abdominal trauma and to determine how fluid accumulation patterns are associated with the site of injury. From 1994 to 1998, 2,693 screening examinations for blunt abdominal trauma were performed, in which 7 regions were examined for fluid. On the basis of a preliminary analysis of patients with solitary injuries, all 194 patients with sonographically detected fluid were grouped by fluid accumulation pattern. Fluid patterns were compared with sites of injury. The patterns differed between hepatic and splenic injuries. Fluid in the left upper quadrant, in both upper quadrants, or diffusely distributed suggested splenic injury, whereas fluid in the right upper quadrant or the right upper quadrant and lower recesses suggested hepatic injury (P < .0001). Fluid accumulation was random after enteric injury. Patients with extraperitoneal injury had no fluid or had fluid focally at the injury site. The ability to predict the injury site on the basis of fluid patterns should expedite treatment of hemodynamically unstable patients with blunt abdominal trauma.
Cardiac output measurements in congenital heart disease: validation of a simple, portable Doppler method.
Authors: Gentles T L , Neutze J M , Caulder A L , Greene E R
Published: January 2017

Noninvasive Doppler cardiac output measurements are clinical standards in adults and children. Presently, these standard Doppler methods generally require relatively expensive and large imaging equipment with complex signal‐processing techniques. Thus, universal access to these important measurements has been limited. Simple, portable Doppler methods have been validated previously and applied to infants and children without cardiac disease. Nevertheless, these specific, inexpensive techniques have not been validated in children with complex congenital heart disease. Accordingly, we compared a noninvasive, suprasternal, non‐image‐guided, pulsed Doppler cardiac output with standard invasive Fick cardiac outputs in 20 patients (age range, 1 month to 15 years) with congenital heart disease. Doppler cardiac output was displayed by multiplying the mean velocity with an operator‐selected angiographic or echographic estimate of the aortic diameter. The values from linear regression analysis were r = 0.96; Doppler cardiac output = 0.98 x Fick cardiac output ‐ 0.08 L/min (range, 0.55‐3.10 L/min). The 95% confidence limits were less than 35% of the mean of Doppler and Fick cardiac outputs across the range of measurements. We conclude that relatively linear and accurate measurements of cardiac output can be made by this simple, inexpensive, portable method in selected infants and children with various forms of congenital heart disease.
Ultrasonographic texture analysis of parenchymatous organs by the four‐neighborhood‐pixels algorithm: clinical experiment.
Authors: Yao W , Zhao B , Zhao Y , Wang W , Qian G
Published: January 2017

The parenchyma of organs such as liver, thyroid, and mammary gland during climacterium have common ultrasonographic textural features, which together form what we call small‐dot‐structure texture. To study this texture we designed the 4‐neighborhood‐pixels algorithm, an ultrasonographic texture analysis algorithm. The objective of this study was to confirm whether the 4‐neighborhood‐pixels algorithm can reflect the features of small‐dot‐structure texture.

A changed small‐dot‐structure texture and 3 other textures were compared with the normal small‐dot‐structure texture in 4 groups, and a histogram algorithm was used for contrast with the 4‐neighborhood‐pixels algorithm.

The 4‐neighborhood‐pixels algorithm could reflect all the textural differences, but the histogram algorithm could reflect only some of them.

The 4‐neighborhood‐pixels algorithm is a good algorithm for analyzing ultrasonographic small‐dot‐structure texture. Not only can it reflect changes in the small‐dot‐structure texture, but it can also differentiate between small‐dot‐structure and non‐small‐dot‐structure textures.
Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.
Authors: Brown M A , Casola G , Sirlin C B , Hoyt D B
Published: January 2017

To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma.

A total of 2693 patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis.

One hundred seventy‐two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty‐four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography.

The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.
Analysis of three‐dimensional Doppler ultrasonographic quantitative measures for the discrimination of prostate cancer.
Authors: Moskalik A P , Rubin M A , Wojno K J , Bree R , Rubin J M , Fowlkes J B , Montie J E , Manley S , Carson P L
Published: January 2017

The purpose of this study was to determine whether several quantitative ultrasonographic measures have potential to discriminate prostate cancer from normal prostate and to determine the best combination of these measures. The true spatial distributions of cancer within the prostates studied were obtained histologically after radical prostatectomy. The relationship between Doppler ultrasonography and microvessel count was also investigated.

Three‐dimensional Doppler ultrasonographic data were acquired from 39 patients before radical prostatectomy. The removed prostate was sectioned, and whole‐mount hematoxylineosin‐stained slides were used to identify all regions of cancer within each prostate. These histologic and ultrasonographic data were spatially registered. Doppler ultrasonographic measures were calculated within uniformly sized three‐dimensional regions that were either entirely cancerous or noncancerous, and receiver operating characteristic analysis was performed on the results. Microvessel counts were made within each contiguous cancerous region and correlated with ultrasonographic measures.

Color pixel density was the best simple measure for discriminating prostate cancer (accuracy, 80%). The mean power mode value (normalized mean power in color pixels) was inversely related to cancer with an accuracy of 1‐‐normalized mean power in color pixels = 65% (low mean power is more cancerous). When color pixel density was combined with the normalized mean power in color pixels, its accuracy improved slightly to 84%. The peak microvessel count had a negative correlation with color pixel density as well as with cancer stage.

Doppler ultrasonography does provide discriminatory information for prostate cancer, with color pixel density being the most promising measure.
Shape reconstruction of the left ventricle: accuracy of limited‐plane three‐dimensional echocardiography.
Authors: Jakrapanichakul D , Tanabe K , Belohlavek M , Seward J B
Published: January 2017

To assess the accuracy of left ventricular cavity shape reproduction from 8 spatially related, apical two‐dimensional ultrasonographic images.

We scanned 6 dog heart specimens. Left ventricular cavity casts were reconstructed from 48‐tomogram (high‐density), 8‐tomogram (octaplane), and 2‐tomogram (low‐density biplane) apical data sets. The 48‐plane left ventricular cast served as the reference. Spatial shape resolution of 3 mm in radial distance from the rotational axis to the interpolated endocardium was used as the criterion of shape accuracy.

The adjusted limits of agreement for the octaplane and biplane left ventricular casts were +/‐2.31 and +/‐6.84 mm, respectively.

The three‐dimensional left ventricular cavity shape can be accurately reproduced by using a low‐data density apical octaplane echocardiographic examination.
An approach to acoustic properties of biological tissues using acoustic micrographs of attenuation constant and sound speed.
Authors: Okawai H , Kobayashi K , Nitta S
Published: January 2017

To develop a method for two‐dimensional measurement of acoustic properties of biological tissue elements at the microscopic level for specimens with a thickness of approximately 10 microm.

The procedure was developed on the basis of mechanically scanned acoustic microscopic techniques in the frequency range of 100 to 200 MHz and the theory of interference phenomena. Various tissues and samples were prepared to evaluate the method and to interpret sound propagation properties.

Tissues with high protein content, low water content, or both had a high attenuation constant and sound speed. The exponent n of attenuation against frequency was almost unity at the microscopic level, whereas it was greater than unity when the specimen thickness was greater. Sound speed dispersion was not observed.

The method was shown to be reproducible, and the data were interpreted acoustically and pathologically with reference to tissue type and specimen thickness.
The use of renal Doppler ultrasonography to diagnose patent ductus arteriosus in preterm infants.
Authors: Armstrong D L , Teele R L , Kuschel C A , Harding J E
Published: January 2017

To prospectively study the diagnostic usefulness of altered renal waveforms in patent ductus arteriosus.

We studied preterm infants undergoing echocardiography for a suspected patent ductus arteriosus. A spectral Doppler display was acquired for both renal arteries, and a resistive index was obtained. Sensitivity, specificity, and likelihood ratios were calculated using a clinically significant patent ductus arteriosus (>1.5‐mm diameter on color Doppler ultrasonography) as the standard of reference.

Fifty infants had 78 scans. A significant patent ductus arteriosus was present on 39 scans. When the renal resistive index was greater than 1.0, the likelihood ratio for a significant patent ductus arteriosus was 24.8 (specificity, 97.2%; SD, 3.8%). When the renal resistive index was 1.0 or less, the likelihood ratio for a significant patent ductus arteriosus was 0.2 (sensitivity, 77.2%; SD, 9.4%).

Renal resistive index measurement is a simple investigation that can predict a significant patent ductus arteriosus in patients without congenital heart disease or other causes of diastolic runoff when echocardiography is unavailable.
Feasibility of performing a virtual patient examination using three‐dimensional ultrasonographic data acquired at remote locations.
Authors: Nelson T R , Pretorius D H , Lev-Toaff A , Bega G , Budorick N E , Hollenbach K A , Needleman L
Published: January 2017

To evaluate the feasibility of performing three‐dimensional ultrasonographic studies that meet American Institute of Ultrasound in Medicine and American College of Radiology ultrasonographic examination guidelines with review off‐line and at remote locations.

One hundred patients were studied at 2 institutions using high‐end two‐dimensional clinical ultrasonographic scanners and commercially available three‐dimensional ultrasonography for a variety of organ systems (first‐ and second‐trimester fetus, abdomen, and female pelvis). We evaluated several parameters, including measurements, completeness of organ visualization, abnormalities identified, image quality, number of volumes required, and discrepancies between interpretations.

Overall, three‐dimensional ultrasonography could produce diagnostic‐quality results comparable with those of two‐dimensional ultrasonography. Three‐dimensional ultrasonographic image quality was lower than that of two‐dimensional ultrasonography. Two‐ and three‐dimensional ultrasonographic measurements were comparable (<5% difference), as was the extent of organ visualization, although some structures were challenging for both two‐ and three‐dimensional ultrasonography. In general, organs completely imaged in the scanner field of view required 1 to 1.5 volumes, whereas larger organs required between 3 and 6 volumes. Differences among reviewers' interpretations highlighted the need for standardization of acquisition and reviewing protocols for sonographers and physicians.

Our results show that it is clinically feasible to acquire three‐dimensional ultrasonographic data at one site and to obtain accurate interpretation by off‐line review at another within the context of providing high‐quality clinical diagnostic studies.
Intraoperative sonographic localization of breast masses: success with specimen sonography and surgical bed sonography to confirm excision.
Authors: Feld R I , Rosenberg A L , Nazarian L N , Needleman L , Lev-Toaff A S , Segal S R , Johnson P T , Parker L , O'Reilly T
Published: January 2017

To assess the use of intraoperative sonography for localization of breast masses at excisional biopsy, with specimen and surgical bed sonography to confirm excision.

A computer search of the 5‐year period from January 1993 through January 1998 revealed 138 consecutive women referred for sonographically guided excisional biopsy of 148 masses; 35 masses were excluded because they had no postoperative mammograms. One hundred thirteen masses constituted the study group. Specimen sonography (n = 60) or surgical bed sonography (n = 53) was performed as the initial evaluation to confirm excision, but ultimately, surgical bed sonography may have been necessary after specimen sonography, and specimen sonography may have been necessary after surgical bed sonography. The miss rates determined by postoperative imaging were calculated for each group and compared with those of mammographically guided needle localization series from the literature.

Follow‐up physical examination and mammography showed no residual mass in the region of surgery in any patient. However, follow‐up sonography had 1 miss in the initial specimen sonogram group (1 [1.7%] of 60) and 1 miss in the initial surgical bed group (1 [1.9%] of 53). As shown by the Fisher exact test, there was no significant difference between the miss rates of the 2 initial methods of confirming lesion excision or between the miss rates of these initial methods, both groups combined, and 6 mammographic localization series from the literature.

Intraoperative breast sonography, using specimen sonography and scanning the surgical bed, has miss rates comparable with those of mammographic needle localization. Follow‐up sonography must be performed if there is any doubt of complete excision.
Gray Scale and Power Doppler Sonography of Normal Cervical Lymph Nodes
Authors: Ying Michael , Ahuja Anil , Brook Fiona
Published: January 2017

Objective. To investigate the racial difference in gray scale and power Doppler sonography of cervical lymph nodes between white and Chinese subjects. Methods. Twenty healthy white subjects and 20 healthy Chinese subjects had sonographic examination of the neck. They were age and sex matched. Lymph nodes were evaluated for their number, size, site, echogenic hilus, vascular pattern, degree of vascularity, blood flow velocity, and vascular resistance. Results. A total of 184 lymph nodes were detected in the 20 white subjects, and 196 lymph nodes were found in the 20 Chinese subjects. There were no significant differences in the number, size, and distribution of the lymph nodes between the 2 populations. One hundred ninety‐six region‐ and size‐matched lymph nodes were selected from the 2 groups of subjects (98 nodes from each group) for evaluation of echogenic hilus, vascular pattern, degree of vascularity, blood flow velocity, and vascular resistance. There was no significant difference in the gray scale and vascular features of cervical nodes between white and Chinese subjects. Conclusions. There is no significant racial difference in the gray scale appearance of cervical lymph nodes. Unlike some other body regions, there is no significant vascular difference between white and Chinese populations. Results on power Doppler and gray scale sonographic assessment of cervical lymphadenopathy reported in previous studies may be applicable in both populations.
The Normal Offset of the Tricuspid Septal Leaflet in the Fetus
Authors: Vettraino Ivana M. , Huang Raywin , Comstock Christine H.
Published: January 2017

Objective. To quantify the normal distance between the insertion of the medial leaflets of the mitral valve and tricuspid valve in the fetal heart. This mitral valve–tricuspid valve distance was compared with the distance from known cases of Ebstein anomaly. Methods. An apical 4‐chamber view was obtained at end diastole in fetuses between 18 and 41 weeks' gestation. Calipers were placed parallel to the ventricular septum, with 1 caliper on the medial insertion of the mitral valve and a second caliper on the medial insertion of the tricuspid valve. The distance recorded was plotted against gestational age. Statistical analysis was performed by descriptive and linear regression techniques. Results. One hundred forty‐five fetuses were studied. The mean ± SD mitral valve–tricuspid valve distance in the second trimester was 2.8 ± 0.9 mm with a range of 1.2 to 5.0 mm; in the third trimester it was 4.6 ± 1.1 mm with a range of 2.2 to 6.9 mm. Regression analysis showed that with each 1‐week increase in gestational age, there was an increase of 0.15 mm in separation between the medial leaflets of the mitral valve and tricuspid valve (β = 0.15 ± 0.011). Conclusions. A positive correlation between mitral valve–tricuspid valve distance and advancing gestational age was found. The reference range described allows for the identification of a fetal heart with normal variation in the mitral valve–tricuspid valve distance. Further downward displacement of the medial tricuspid cusp suggests the possibility of Ebstein anomaly.
Color Doppler Sonography in the Evaluation of Superficial Lymphomatous Lymph Nodes
Authors: Giovagnorio Francesco , Galluzzo Michele , Andreoli Chiara , De Cicco Maria Luisa , David Vincenzo
Published: January 2017

Objectives

We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes.

Methods

We selected 130 individuals who underwent sonography, color Doppler imaging, fine‐needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, “hilar normal”; type II, “hilar activated”; and type III, “peripheral.”

Results

Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non‐Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non‐neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma.

Conclusions

The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high‐grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.
Observation on the Integrity of the Blood‐Brain Barrier After Microbubble Destruction by Diagnostic Transcranial Color‐Coded Sonography
Authors: Schlachetzki Felix , Hölscher Thilo , Koch Horst J. , Draganski Bogdan , May Arne , Schuierer Gerhard , Bogdahn Ulrich
Published: January 2017

Objectives

To investigate alteration of the blood‐brain barrier from ultrasonic contrast agent destruction by diagnostic transcranial color‐coded sonography using gadolinium‐enhanced magnetic resonance imaging.

Methods

Healthy male volunteers received 10 mL (400 mg/dL) of Levovist (SH U 508A; Schering AG, Berlin, Germany; n = 6) or 3 mL of Optison (FS069; Mallinckrodt Inc, St Louis, MO; n = 4) followed by 0.3 mmol/kg magnetic resonance imaging contrast agent (Magnevist; Schering) intravenously. Then transcranial color‐coded sonography was performed with a conventional color duplex sonographic system, which insonated the brain in a slightly angulated axial plane with temporal average intensity of less than 700 mW/cm2 or acoustic pressure amplitude of less than 2.69 MPa, attenuated by the temporal bone. Before, immediately after, and 2 hours after insonation, T1‐weighted axial magnetic resonance imaging was performed. All magnetic resonance images were individually assessed, and T1 signal intensities were measured in 2 regions of interest in both hemispheres at the 3 time points.

Results

No focal contrast enhancement or damage to the brain and no significant difference between T1 signal intensities in the right and left brain regions could be detected during early or late phases when either ultrasonic contrast agent was used.Conclusions. This bioeffects study gives further evidence of the safety of ultrasonic destruction of Levovist and Optison microbubbles by diagnostic transcranial color‐coded sonography. However, more subtle local effects may have been missed by gadolinium‐enhanced magnetic resonance imaging. Studies on diagnostic contrast‐enhanced transcranial color‐coded sonography as well as microbubble‐based drug delivery strategies should consider ultrasonic contrast agent microbubble characteristics and concentration as well as ultrasound transmission power levels.
Chorioangiomas of the Placenta
Authors: Zalel Yaron , Weisz Boaz , Gamzu Ronni , Schiff Eyal , Shalmon Bruria , Achiron Reuven
Published: January 2017

Objective. To evaluate our experience with sonography and color Doppler blood flow in the diagnosis and management of chorioangiomas of the placenta. Methods. All cases with placental chorioangiomas diagnosed in our sonography unit between 1992 and 2001 were included in the study. Sonographic and color Doppler flow characteristics were evaluated in all cases. Our cases were compared with all cases of placental chorioangiomas diagnosed antenatally by sonography published in the English literature between 1978 and 2001. Results. Six cases of placental chorioangioma were identified antenatally, with a mean size of 6.5 cm (range, 4–13 cm). With the use of color Doppler flow, all cases of chorioangioma were shown to have either abundant blood flow or a large feeding vessel within the tumor. During follow‐up, 2 cases had reduction of the intratumoral blood flow, and the outcomes were favorable. Three of our cases had delivery before 33 weeks' gestation (1 with intrauterine fetal death and 1 with termination of pregnancy). Review of the literature revealed 72 cases of antenatally diagnosed placental chorioangioma. Two thirds of the cases had dismal outcomes. Conclusions. The sonographic diagnosis of chorioangiomas of the placenta is feasible and necessitates close surveillance of these pregnancies because of the dismal prognosis in more than half. The addition of color Doppler flow is important in the diagnosis and antenatal follow‐up of these pregnancies.
Three‐dimensional Power Doppler Ultrasonography During Pregnancy
Authors: Lee Wesley , Kalache Karim D. , Chaiworapongsa Tinnakorn , Londono Jorge , Treadwell Marjorie C. , Johnson Anthony , Romero Roberto
Published: January 2017

Objectives. To present the appearance of fetal and placental vascular anatomic structures by three‐dimensional power Doppler ultrasonography. Methods. Three‐dimensional multiplanar imaging, surface rendering, and volume rendering were combined with power Doppler ultrasonography to show the methods, imaging artifacts, and diagnostic potential of this technology during pregnancy. Results. Fetuses with normal and abnormal vascular anatomic structures were evaluated by three‐dimensional power Doppler ultrasonography. The combination of several imaging modalities (e.g., threedimensional multiplanar imaging, surface rendering, and volume rendering) with power Doppler ultrasonography is shown. Conclusions. Three‐dimensional power Doppler ultrasonography is an important adjunctive method that can be used to characterize normal vascular development and circulatory anomalies of the fetus.
Sonographically Guided Caudal Epidural Steroid Injections
Authors: Klocke Rainer , Jenkinson Timothy , Glew David
Published: January 2017

Objective. Caudal epidural steroid injections are used for the symptomatic treatment of radicular lumbosacral pain syndromes, but incorrect injection placement has been recognized as a common problem with the routinely used unguided technique. We aimed to explore the use of sonography to facilitate this procedure. Methods. In patients with clinically unreliable anatomic landmarks, high‐resolution real‐time sonography was used to identify those landmarks and to assist in correct needle placement. Results. Sonography enabled localization of the sacral hiatus landmarks. We found this method particularly useful for guiding needle placement in patients with moderate obesity. Conclusions. Real‐time sonography can facilitate caudal epidural steroid injections.
Treated Needles
Authors: Jandzinski Dana I. , Carson Nancy , Davis Delphine , Rubens Deborah J. , Voci Susan L. , Gottlieb Ronald H.
Published: January 2017

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.
Three‐dimensional Ultrasonographic Appearance of the Fetal Akinesia Deformation Sequence
Authors: Ruano Rodrigo , Dumez Yves , Dommergues Marc
Published: January 2017

Objective. To present the appearance of the fetal akinesia deformation sequence by three‐dimensional ultrasonography after four‐dimensional ultrasonographic scanning. Methods. Three‐dimensional surface‐rendering images were used to show the fixed postural abnormalities of the fetal extremities and body. Four‐dimensional ultrasonography was used to show that the postural abnormalities were fixed and to confirm the absence of fetal movements. These images were compared with the postmortem examination findings. Results. Three‐dimensional ultrasonographic images of 3 cases of fetal akinesia deformation sequence are presented. Surface‐rendering imaging and imaging in the skeletal mode were performed to show the postural abnormalities and the arthrogryposis. Conclusions. Facilitated by polyhydramnios, three‐ and four‐dimensional ultrasonography provided clear images of the fixed postural abnormalities, which were confirmed by postmortem examination. Although prenatal diagnosis can be easily made by conventional ultrasonography, three‐dimensional ultrasonography might be used as a confirmatory approach. In addition, the quality of recent three‐dimensional imaging might help prenatal counseling by providing images more readily understandable to the parents than those obtained by two‐dimensional ultrasonography.
The Mammary Hamartoma
Authors: Georgian-Smith Dianne , Kricun Bret , McKee Grace , Yeh Eren , Rafferty Elizabeth A. , D'Alessandro Helen Anne , Kopans Daniel B.
Published: January 2017

Objective. To determine the mammographic and sonographic findings of hamartomas that were not classic on imaging, how pathologists distinguish the hamartoma from benign breast tissue on core samples, and reasons for discrepancies between core and surgical biopsy. Methods. A retrospective review of all image‐recommended core biopsies between 1993 and 2001 was performed. There were 41 cases of hamartomas found on either core or surgical biopsy. The mammographic, sonographic, and pathologic findings were reviewed. Results. Of 41 hamartomas in 38 patients, 18 went on to surgical biopsy. Of these 18 cases, 4 cases of hamartoma on core biopsy were fibroadenoma after excision; 2 cases of hamartoma on core biopsy were confirmed by surgery; and 12 cases of fibrocystic change after core biopsy were hamartoma after surgical biopsy. The 4 cases of fibroadenoma shown at final pathologic examination were excluded from imaging review, leaving 37 cases. In the 20 patients who underwent only core sampling, 23 hamartomas were diagnosed. Seventeen masses were visible on mammography, and 82% were homogeneously dense. Of 36 masses shown on sonography, 86% were uniformly hypoechoic. At histologic examination, only 16% contained fat within the mass. Conclusions. Hamartomas may appear as homogeneously dense, well‐circumscribed masses, varying in appearance from the classically described encapsulated mixed fatty‐fibroglandular mass. Pathologists can make the diagnosis of hamartoma without the presence of adipose tissue but may have difficulty in distinguishing the hamartoma from fibrocystic change. However, if there is radiologic‐pathologic concordance, further surgical excision is not warranted.
Nature of Doppler Perfusion Index Changes in Patients With Colorectal Cancer Liver Metastases
Authors: Kopljar Mario , Brkljacić Boris , Doko Marko , Horzić Matija
Published: January 2017

Objective. Occult hepatic metastases from colorectal cancer result in an increase of the ratio of arterial hepatic blood flow to total hepatic blood flow, described as the Doppler perfusion index. Whether this alteration is due to an increase in arterial blood flow or a decrease in portal venous inflow has not yet been unequivocally determined. The purpose of this study was to analyze changes in hepatic perfusion in patients with liver metastases from colorectal cancer by standardization of hemodynamic parameters to body surface area. Methods. Hemodynamic parameters (crosssectional area, blood flow, and congestive index) were measured for the common hepatic artery and portal vein with duplex color Doppler sonography in 20 patients with liver metastases and 20 healthy control subjects and evaluated relative to body surface area. Results. No statistically significant differences in age, body surface area, cross‐sectional area of the common hepatic artery, and congestion index of the common hepatic artery and portal vein were observed between control subjects and patients with liver metastases. Patients with liver metastases had significantly greater arterial hepatic blood flow and Doppler perfusion index and significantly smaller portal cross‐sectional area portal blood flow as well as total liver blood flow (P < .001). Conclusions. This study supports the theory that the primary mechanism of alteration in liver perfusion is the reduction of portal inflow with subsequently increased arterial hepatic blood flow.
Right‐to‐Left Shunt Assessed by Contrast Transcranial Doppler Sonography
Authors: Uzuner Nevzat , Horner Susanna , Pichler Gerald , Svetina Daniela , Niederkorn Kurt
Published: January 2017

Objective. Simple diagnostic techniques such as contrast transcranial Doppler sonography (cTCDS) are popular for assessing a right‐to‐left shunt (RLS) because of their high sensitivity. In this study, we applied cTCDS to a large patient group with a patent foramen ovale, proved by contrast transesophageal echocardiography (TEE). Methods. One hundred one patients with stroke, in whom a patent RLS had been shown on contrast TEE, were investigated by TCDS of both middle cerebral arteries. Injection of 10 mL of agitated saline was applied without and subsequently with the Valsalva maneuver (VM) at the beginning of the contrast agent injection, and then 10 mL of a galactose‐based contrast agent was applied in the same protocol. Results. In all patients, cTCDS with the galactose contrast agent showed an RLS when performed with VM, but it showed an RLS in only 59 patients without VM. In contrast, saline showed an RLS in 54 patients with VM and in 20 patients without VM. The differences in diagnostic sensitivity were statistically significant (P < .001). Eighteen patients had only 1 microembolic signal (MES) after galactose injection, whereas others had more. The mean (SD) arrival times of the MES were 9 (6) seconds (range, 1–51 seconds) after galactose injection with VM and 9 (3) seconds (range, 2–20 seconds) after agitated saline with VM. The differences were not significant. Conclusions. Contrast TCDS with VM shows a TEE‐proven RLS with 100% sensitivity, but this was not true with galactose application without VM or agitated saline with or without VM. Therefore, use of the galactose contrast agent with VM is strongly recommended for detecting an RLS on TCDS. However, the arrival time and number of MESs detected need to be tested further.
Color Doppler Analysis of Vertebral Arteries
Authors: Kizilkilic Osman , Hurcan Cem , Mihmanli Ismail , Oguzkurt Levent , Yildirim Tulin , Tercan Fahri
Published: January 2017

Objective. Color Doppler ultrasonography is the most widespread diagnostic procedure in obstructive disease of the arteries supplying the brain. To our knowledge, there are only a few correlative color Doppler ultrasonographic and angiographic studies of the vertebral arteries, especially in patients who have flow‐restrictive stenosis at the carotid bifurcation. The main purpose of this prospective study was to evaluate diameter, flow volume, and time‐averaged mean velocities of angiographically verified normal vertebral arteries without collateral flow. The second purpose was to try to establish a threshold value for the flow volume of the vertebral artery. Methods. One hundred twenty patients referred for carotid angiography with a normal vertebrobasilar system and with no patent posterior communicating arteries were investigated with color Doppler ultrasonography. Luminal diameter, time‐averaged mean velocity, peak systolic velocity, and flow volume values were calculated for each patient. The parameters were compared between sexes, in different age groups, in patients with carotid stenosis of 50% or less and greater than 50%, and in patients who had clinical signs of vertebrobasilar insufficiency versus those who had not. Results. We have found no significant difference in evaluated parameters with the degree of associated carotid stenosis or vertebrobasilar insufficiency. Diameter and flow volume values on the left side were higher than on the right side. Conclusions. We found similar flow volume values of vertebral arteries in both sexes and both groups of patients with carotid stenosis of 50% or less and greater than 50%. All parameters did not differ in patients with stenosis of 50% or less and greater than 50% and in patients with and without clinical signs of vertebrobasilar insufficiency.
Sonographic Patterns of Intraperitoneal Hemorrhage Associated With Blunt Splenic Injury
Authors: Richards John R. , McGahan Patrick J. , Jewell Meredith G. , Fukushima Leslie C. , McGahan John P.
Published: January 2017

Objective. To determine the correlation between sonographic detection of free fluid in the left upper quadrant and blunt splenic injury. Methods. A retrospective review was conducted of all consecutive emergency blunt trauma sonograms obtained at a level I trauma center from January 1995 to January 2001. Data were collected on demographics, free fluid location, and patient outcome. Injuries were determined from computed tomography, diagnostic peritoneal lavage, laparotomy, or a combination thereof. Results. A total of 4320 blunt trauma sonograms were obtained, and 596 patients (14%) had intra‐abdominal injuries. The mean age was 33.7 ± 19.1 years (range, 1–95 years), with 294 (49%) male and 302 (51%) female. There was no statistical difference between age, sex, or mechanism for all subgroups. There were 409 true‐positive, 187 false‐negative, 88 false‐positive, and 3636 true‐negative findings. Sensitivity of sonography for detecting all intra‐abdominal injuries was 68%, and specificity was 97.6%; sensitivity for detecting isolated splenic injuries was 73.8%. Locations of free fluid in patients with nonsplenic injuries were compared with those in patients with splenic injuries. Isolated left upper quadrant free fluid was significantly associated with splenic injury (odds ratio = 3.0; P = .002), followed by diffuse free fluid (odds ratio = 2.1; P = .005). A subanalysis of isolated splenic injuries also revealed a significant association with left upper quadrant free fluid (odds ratio = 3.1; P = .007) and diffuse free fluid (odds ratio = 2.7; P = .0007). Conclusions. Free fluid in the left upper quadrant is significantly associated with splenic injury. This finding should triage patients more rapidly to computed tomography, angiography, embolization, and laparotomy.
The Preferred Timing of Second‐Trimester Obstetric Sonography Based on Maternal Body Mass Index
Authors: Lantz Michael E. , Chisholm Christian A.
Published: January 2017

Objective. To determine the preferred timing of sonographic screening of fetal anatomy based on the maternal body mass index (BMI). Methods. We abstracted the sonographic reports of 2303 gravidas undergoing routine fetal anatomic screening between 15 and 24 weeks' gestation to determine the completeness of the study. Height and weight information was available on 1444 patients. The maternal BMI (weight [kilograms]/height [square meters]) was categorized as underweight (<19.8), normal weight (19.8–26.0), overweight (26.1–29.0), and obese (>29.0). Completion rates were compared by χ2 analysis. Multiple logistic regression was used to evaluate for independent predictors of a completed study. Results. Except for underweight women, completion rates for all BMI categories were significantly higher when the sonographic examinations were performed between 18 weeks and 19 weeks 6 days compared with those performed between 15 weeks and 17 weeks 6 days. Body mass index, estimated gestational age, and black race were independent predictors of a completed study. Conclusions. Except in underweight women, the 18‐ to 20‐week interval appears to be superior to the 15‐ to 18‐week interval when performing sonographic screening of the fetal anatomy.
Detection of Muscle Atrophy on Routine Sonography of the Shoulder
Authors: Sofka Carolyn M. , Haddad Ziyad K. , Adler Ronald S.
Published: January 2017

Objective. To describe the utility of sonography in visualizing muscle atrophy during routine sonographic examination of the shoulder for evaluation of the rotator cuff tendons. Methods. A retrospective review of 199 shoulder sonographic examinations performed by 2 musculoskeletal radiologists trained in musculoskeletal sonography with knowledge of the typical sonographic findings of muscle atrophy was performed. Reports were reviewed for the presence of muscle atrophy. If atrophy was present, the reports from those examinations were rereviewed for concomitant rotator cuff abnormalities. Results. Forty‐five examinations (23%) showed atrophy in at least 1 muscle on the basis of the criteria of increased echogenicity and decreased bulk. There were a total of 81 individual muscles that showed atrophy, with the following distribution: 16% supraspinatus (n = 13), 31% infraspinatus (n = 25), 36% teres minor (n = 29), 2% subscapularis (n = 2), and 6% biceps brachii (n = 5). In 34 of the 45 examinations with muscle atrophy, there were 57 concomitant full‐thickness tendon tears: 64% supraspinatus (n = 29), 38% infraspinatus (n = 17), 7% subscapularis (n = 3), 0% teres minor (n = 0), 16% long head of biceps (n = 7), and 2% deltoid (n = 1). Conclusions. Although primary sonographic evaluation of the painful shoulder concentrates on the tendons of the rotator cuff, we suggest that examination of the muscles should become a standard component of the comprehensive shoulder sonographic examination, particularly given the potential clinical implications of muscle atrophy on the outcome of rotator cuff surgery.