Altered Echogenicity Research Articles

Approach to Nonmass Lesions on Breast Ultrasound

AbstractNonmass lesions in breast ultrasound (US) are areas of altered echogenicity without definite margins or mass effect. However, these lesions may show calcifications, associated architectural distortion, or shadowing just like masses. They vary in their echogenicity, distribution, ductal or nonductal appearance and the associated features that can be seen in variety of benign and malignant pathologies. With no uniform definition or classification system, there is no standardized approach in further risk categorization and management strategies of these lesions. Malignant nonmass lesions are not uncommon and few sonographic features can help in differentiating benign and malignant pathologies. US-guided tissue sampling or lesion localization can be preferred in the nonmass lesions identified on second look US after magnetic resonance imaging or mammography. This article aims to describe various imaging patterns and attempts to provide an algorithmic approach to nonmass findings on breast US.

Imaging findings of spontaneous thymic hemorrhage in infancy: Case report and literature review

The authors report imaging findings of spontaneous thymic hemorrhage, which is a rare entity in infancy, in a 4-month-old boy with congenital factor VII deficiency presented with acute respiratory distress and anemia. Widening of superior mediastinum and left pleural effusion were detected on the chest radiograph. Ultrasound and computed tomography of the chest revealed diffusely enlarged thymus with heterogeneous parenchyma from poorly-defined areas of altered echogenicity or attenuation. Vascular flow was depicted within the abnormal thymus in color-mode sonography. The spontaneous involution of thymic abnormality seen on serial ultrasonography confirmed the diagnosis of thymic hemorrhage, resulting in avoidance of further unnecessary imaging or invasive procedure.

Imaging findings of spontaneous thymic hemorrhage in infancy: Case report and literature review

The authors report imaging findings of spontaneous thymic hemorrhage, which is a rare entity in infancy, in a 4-month-old boy with congenital factor VII deficiency presented with acute respiratory distress and anemia. Widening of superior mediastinum and leftpleural effusion were detected on the chest radiograph. Ultrasound and computed tomography of the chest revealed diffusely enlarged thymus with heterogeneous parenchyma from poorly-defined areas of altered echogenicity or attenuation. Vascular flow was depicted within the abnormal thymus in color-mode sonography. Thespontaneous involution of thymic abnormality seen on serial ultrasonography confirmed the diagnosis of thymic hemorrhage, resulting in avoidance of further unnecessary imaging or invasive procedure.

A comparison of the imaging features of pleomorphic and classical invasive lobular carcinoma.

Pleomorphic invasive lobular carcinoma (pILC) is a distinct morphological variant of ILC with a poorer prognosis than classical ILC (cILC). The aim of this study was to ascertain whether the conventional imaging appearances of the two entities differ. A single-center retrospective review of conventional imaging was undertaken in 150 consecutive patients with histopathologically confirmed ILC (38 pILC; 112 cILC) between April 2010 and July 2015. Mammographic and sonographic findings were evaluated using the BI-RADS lexicon by a radiologist blinded to pathology, and the findings in the two groups were compared. The degree of discrepancy between imaging and pathological sizing in the two groups was evaluated. Lesions were mammographically occult in 11% of pILC and 14% of cILC (p = 0.56). On mammography, skin or trabecular thickening and microcalcification were commoner in pILC than cILC (13% vs. 1%, p < 0.01; 25% vs. 5%, p < 0.01). Architectural distortion was more frequent in cILC than pILC (26% vs. 9%, p = 0.01). On ultrasound, pILC more frequently exhibited mixed echogenicity (28% vs. 13%; p = 0.04), skin thickening, subcutaneous or parenchymal edema (8% vs. 0%; p = 0.02), echogenic surrounding fat (33% vs. 9%; p < 0.01), and posterior acoustic enhancement (10% vs. 1%; p = 0.02) than cILC. CILC was more frequently manifested as a focal area of altered echogenicity (24% vs. 8%; p = 0.04). Mean elastography stiffness was higher for pILC (174.8 vs. 124.6kPa; p = 0.02). Imaging-pathological size disparity was similar for both subtypes. There are differences in the imaging features between pILC and cILC which reflect the more aggressive nature of pILC.

Skin Tissue Water Assessed via Tissue Dielectric Constant Measurements in Persons With and Without Diabetes Mellitus

Skin changes in diabetes mellitus (DM) include possible increases in foot skin water content as interpreted from altered echogenicity in high-frequency ultrasound images. The present goal was to investigate the possibility of undetected increased local skin water in persons with DM using a handheld portable rapid measuring device that measures the tissue dielectric constant (TDC) as an indicator of skin tissue water. TDC measurements were done bilaterally on 18 persons with DM and 18 persons without DM (NODM) at foot dorsum and anterior forearm to tissue depths of 0.5, 1.5, and 2.5 mm. DM duration was 11.1 ± 10.9 years. Age, body mass index, and blood pressures were not significantly different between groups. NODM and DM TDC values decreased with increasing depth at forearm but were depth independent at foot dorsum. All DM foot TDC values were significantly (P<0.05) greater than for NODM, with foot TDC values at 2.5 mm depth being 14.8% greater than in NODM. DM forearm TDC values were not significantly greater than NODM. A technology that characterizes local skin water in a rapid and noninvasive way has been used for the first time in persons with DM. The greater TDC value at the foot dorsum of the DM group is consistent with the presence of previously unrecognized increased fluid content. This suggests that there may be benefit utilizing this measurement method as a way to screen for early changes in foot skin features that may tend to cause DM-related edema.

2209 ULTRA HIGH-RESOLUTION TRANSRECTAL ULTRASOUND: A NOVEL TECHNIQUE FOR ENHANCED PROSTATE CANCER IMAGING

You have accessJournal of UrologyProstate Cancer: Detection and Screening V1 Apr 20122209 ULTRA HIGH-RESOLUTION TRANSRECTAL ULTRASOUND: A NOVEL TECHNIQUE FOR ENHANCED PROSTATE CANCER IMAGING Jeffrey Mullins, Toby Cornish, Adam Reese, Joel Fradin, Lynda Mettee, Frederic Askin, Rachael Luck, Angelo DeMarzo, Jonathan Epstein, and Christian Pavlovich Jeffrey MullinsJeffrey Mullins Baltimore, MD More articles by this author , Toby CornishToby Cornish Baltimore, MD More articles by this author , Adam ReeseAdam Reese Baltimore, MD More articles by this author , Joel FradinJoel Fradin Baltimore, MD More articles by this author , Lynda MetteeLynda Mettee Baltimore, MD More articles by this author , Frederic AskinFrederic Askin Baltimore, MD More articles by this author , Rachael LuckRachael Luck Baltimore, MD More articles by this author , Angelo DeMarzoAngelo DeMarzo Baltimore, MD More articles by this author , Jonathan EpsteinJonathan Epstein Baltimore, MD More articles by this author , and Christian PavlovichChristian Pavlovich Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer is the only solid malignancy for which no reliable imaging modality exists. Ultra high-resolution transrectal ultrasound (UHR-TRUS) provides enhanced image definition by utilizing a unique transducer with a center frequency of 21 MHz. We report the results of an initial utilizing UHR-TRUS for the detection of human prostate cancer. METHODS Men with prostate cancer and gland size <60cc by LR-TRUS who were scheduled for radical prostatectomy (RP) were prospectively recruited into a clinical trial comparing UHR-TRUS and standard low-resolution TRUS (LR-TRUS). Patients were preoperatively imaged transrectally using both modalities in an attempt to identify foci of altered echogenicity > 5mm in maximum diameter in each sextant area of the prostate. Actual areas of prostate cancer > 5mm in maximal diameter at sagittally-sectioned RP specimen were correlated to abnormal foci previously noted on sagittal LR- and UHR-TRUS cine-loops. Complications, adverse events, and pain scores using LR-TRUS or UHR-TRUS were recorded. Sensitivity and specificity analysis were performed for each imaging modality. UHR-TRUS equipment was provided by Imagistx Inc. and LR-TRUS was using a standard Aloka system. RESULTS 20 men were prospectively recruited into the trial. There were no complications or adverse events. Pain scores using LR- and UHR-probes were low and not significantly different. Among the 56 pathologically identified cancerous foci, LR-TRUS identified 23 and missed 33. HR-TRUS identified 36 and missed 20. Sensitivity was 41.1% for LR-TRUS and 64.3% for UHR-TRUS. Specificity was 59.4% for LR-TRUS and 71.9% for UHR-TRUS. Agreements between LR-TRUS vs. pathology and UHR-TRUS vs. pathology were compared using McNemar's test; UHR-TRUS was significantly superior to LR-TRUS (p =0.01045) for cancer detection. CONCLUSIONS UHR-TRUS appears to be a safe and promising imaging modality for prostate cancer detection. Our initial experience suggests superiority to LR-TRUS for the detection of cancerous foci. Based on these promising results, planning of a clinical trial of UHR-TRUS in the biopsy setting is underway. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e891 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Mullins Baltimore, MD More articles by this author Toby Cornish Baltimore, MD More articles by this author Adam Reese Baltimore, MD More articles by this author Joel Fradin Baltimore, MD More articles by this author Lynda Mettee Baltimore, MD More articles by this author Frederic Askin Baltimore, MD More articles by this author Rachael Luck Baltimore, MD More articles by this author Angelo DeMarzo Baltimore, MD More articles by this author Jonathan Epstein Baltimore, MD More articles by this author Christian Pavlovich Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Renal Pyramids: Focused Sonography of Normal and Pathologic Processes

In neonates and children, sonographic examinations of the renal pyramids may depict a spectrum of unique changes in echogenicity due to the effects of physiologic processes or a wide variety of pathologic processes that may affect the collecting ducts or interstitium of the pyramids. Focused sonographic evaluation of the pyramids with high-frequency transducers produces the most detailed images of the pyramids, revealing some appearances not previously reported, to the authors' knowledge. The authors highlight the clinical settings in which they have documented detailed changes in the echogenicity of the pyramids. The patterns of altered echogenicity alone may reflect a specific cause but in many instances are nonspecific, with clinical and biochemical correlation required to establish a more precise diagnosis. However, there is a lack of histologic data to completely explain the mechanism of many of these changes in echogenicity in all of the processes. As the authors have expanded their use of the focused sonographic technique, they have been able to depict altered echogenicity in the pyramids in greater numbers of children in whom an explanation for the changes is not always immediately apparent; for now, the cause must be considered idiopathic. More work is required to expand the use of this focused technique together with clinical, biochemical, and histologic correlation in an attempt to offer more complete explanations for the changes in echogenicity of the pyramids.

Brainstem raphe lesion in patients with major depressive disorder and in patients with suicidal ideation recorded on transcranial sonography

Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line, corresponding to basal limbic system and raphe nuclei (RN) within, might represent functional marker for the development of depression. Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with suicidal ideation. We initiated this study to assess the usefulness of TCS recording in a group of MDD patients and in MDD patients who also reported suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Altogether 71 subjects: 17 patients with MDD, 14 patients with MDD who also reported suicidal ideation and 40 healthy controls, were studied using TCS by two independent physicians. Reduced raphe echogenicity was found in 8 of 17 (47%) of the patients with MDD but only in 6 of 40 (15%) controls. In patients with suicidal ideations that finding was even more pronounced (12 of 14, 86%) with the highest frequency of completely not visible TCS RN finding (10 of 14, 72%). Data showed that altered echogenicity of the RN is frequent in patients with suicidal ideation. Normal RN echogenicity in MDD patients was associated with less severe depressive symptoms and rarely with the presence of suicidal ideations. As far as we know, these are the first ever obtained results which show that TCS might help differentiating MDD patients with suicidal risk or eventually predict good disease recovery based on the findings of RN hypo- or normoechogenicity.

Renal pyramid echogenicity in ureteropelvic junction obstruction: correlation between altered echogenicity and differential renal function

Improvement in resolution and use of high-frequency transducers in US has enabled visualization of previously unreported changes in medullary pyramid echogenicity in children with obstructive hydronephrosis. To determine whether these unreported changes in echogenicity and morphology of the renal pyramids in ureteropelvic junction (UPJ) obstruction correlate with differential renal function (DRF) of the kidney as determined by technetium-99m mercaptoacetyltriglycine ((99m)Tc-MAG3) scan. Renal sonograms in 60 children with UPJ obstruction were retrospectively reviewed. Children were divided into three groups based on the echogenicity of the pyramids: (1) normal echogenicity of the pyramids, (2) increased echogenicity of the pyramids with maintained corticomedullary differentiation (CMD), and (3) loss of CMD. DRF, as determined by (99m)Tc-MAG3 scan, of the obstructed kidney of > or =45% was considered normal and of < or =44% was considered abnormal based on a published study correlating histological changes with DRF. Fisher's exact test was performed for assessing the association between DRF and altered echogenicity of the pyramids. In group 1, which consisted of 13 patients with normal pyramids on US, DRF was normal in 11 and abnormal in two. In group 2, which consisted of 33 patients with echogenic pyramids and preserved CMD, DRF was normal in 15 and abnormal in 18. In group 3, which consisted of 14 patients with complete loss of CMD, DRF was normal in 2 and abnormal in 12. There was a strong correlation between abnormal pyramids and DRF (P=0.0009). The risk ratio (RR) of DRF becoming abnormal for those kidneys with abnormal echogenicity of the pyramids with preserved CMD (group 2) compared to normal pyramid echogenicity (group 1) was 1.56 (95% CI 1.088-2.236). The RR of DRF becoming abnormal for those kidneys with loss of CMD (group 3) compared to normal pyramid echogenicity (group 1) was 5.571 (95% CI 1.530-20.294). We observed that in obstructed kidneys the echogenicity of the pyramids may be abnormal. Increased echogenicity of the pyramids correlated weakly with abnormal DRF and does not necessarily indicate poor renal function. However, loss of CMD strongly correlated with poor renal function.

Ultrasound and MRI features of pyomyositis in children.

Pyomyositis (PM) is an infectious disease of the skeletal muscle with a wide range of symptoms such as pain, fever or swelling, and is predominantly found in the tropics. In recent years PM has increasingly been diagnosed in Europe and in the U.S. Our objective is to describe the ultrasound and MRI features of PM in children. A retrospective analysis of 12 children with PM (2 girls and 10 boys; age range 1-13 years) admitted to our hospital between 1998 and 2002 was carried out. All children had a US exam and 8 children underwent MRI. Children with osteomyelitis and accompanying myositis were excluded from this study. In all patients who had MRI ( n=8) the infected muscles were found to have the following features: hyperintensity on the T2-weighted images, diffuse borders and contrast enhancement. In the pelvis ( n=4), only one PM could be detected with US, in the other 3 cases only US of the hip joint was performed based on the clinical symptoms. In the extremities ( n=8) US always revealed an altered echogenicity of the affected muscles as well as fluid collection in 5 cases. Both US and MRI reveal characteristic changes of the PM. Ultrasound should be the first imaging modality in the extremities. In the pelvis MRI is the imaging modality of choice. The MRI is needed to differentiate pyomyositis from osteomyelitis.

Ultrasound-guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy.

Thirty-eight athletes with unilateral patellar tendinopathy (17 with a tendinopathy of the main body of the tendon, and 21 with an insertional tendinopathy) underwent ultrasound-guided multiple percutaneous longitudinal tenotomy under local anaesthetic infiltration after failure of conservative management. Thirty-four patients were reviewed at least 24 months after the operation. Sixteen patients were rated excellent, nine good, eight fair, and five poor. Nine of the 13 patients with a fair or poor result had an insertional tendinopathy, and eight of them underwent a formal exploration of the patellar tendon. Before the operation, there were some areas of altered echogenicity at and around the site of involvement. These were still visible 6 wk after surgery in 70% of the patients. At the latest follow-up, in the patients with an excellent or good result, the tendon was generally isoechogenic but slightly thicker (P = 0.06) than the normal contralateral. In the patients with a fair or poor result, the tendon was significantly thicker than the contralateral (P = 0.03), and showed some areas of mixed echogenicity. In the patients in whom the procedure was successful, the thicker operated tendon did not interfere with physical training. Bilateral isokinetic peak torque (Nm), average work (Joules), and average power (Watts) were tested at 90 degrees x s(-1). Immediately before the operation, there was no significant difference in peak torque, but total work and average power were significantly lower in the limb to be operated (0.01 < P < 0.05). By the end of the study, although peak torque was, on average, within 7% of the unoperated limb, total work and average power were still significantly lower than in the unoperated limb (0.01 < P < 0.04). Percutaneous longitudinal internal tenotomy is simple, can be performed on an outpatient basis, requires minimal follow-up care, does not hinder further surgery should it be unsuccessful, and, in our experience, has produced no significant complications. In our hands, it has become the first line operative intervention in the treatment of chronic patellar tendinopathy after failure of conservative management. However, patients should be advised that, if they suffer from an tendinopathy at the attachment of the patellar tendon at the lower pole of the patella, a formal surgical exploration with stripping of the paratenon is preferable.

Rare case of acute scrotal swelling: Multiple testicular rupture with intraparenchymal lesions and intact tunica albuginea

Bilateral testicular rupture is rare. Incidence is highest in the 16–20 age group. There are no specific signs or symptoms which make a differential diagnosis between testicular rupture and scrotal traumas possible. Examination at Doppler and ultrasonography and early surgical exploration provide early diagnosis, which is necessary to safeguard fertility. We report one case of bilateral orchialgia, following a diving episode. Ultrasound examination of the scrotum showed bilateral multiple areas of altered echogenicity of the testicular parenchyma and an intact tunica albuginea. During surgery bilateral multiple areas of haemorrhagic necrosis were drained. Outpatient examination one month after leaving the hospital was normal. At 3 and 6 months the results of seminal examination were within normal limits according to the parameters established by the WHO.